Eun Ae Choi

Prevalence of Dementia and Its Subtypes in an Elderly Urban Korean Population: Results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

Background/Aims: We estimated the prevalence of dementia and its major subtypes in an elderly urban Korean population. Methods: A study population of 1,118 Korean elders was randomly sampled from the residents aged 65 years or older living in Seongnam, Korea. Standardized face-to-face interviews, and neurological and physical examinations were conducted on 714 respondents. Dementia was diagnosed according to the DSM-IV diagnostic criteria, and its subtypes were determined according to the criteria of the NINCDS-ADRDA, the NINDS-AIREN, and the consensus guideline proposed by McKeith et al. [Neurology 1996;47:1113–1124]. Results: The estimated age- and gender-standardized prevalences were 6.3% for dementia (95% CI = 4.5–8.1), 4.8% for Alzheimer’s disease (AD; 95% CI = 3.3–6.4), 1.0% for vascular dementia (VD; 95% CI = 0.3–1.8), and 0.4% for dementia with Lewy bodies (DLB; 95% CI = 0.0–0.9). The prevalence of AD consistently increased with age, whereas that of VD peaked at age 75–79 years and decreased thereafter. Of the dementia patients, 72.0% were in the very mild or mild stages of the disease. Conclusions: The prevalence of dementia in a typical urban area of Korea was estimated to be 6.3%, and AD was the most prevalent subtype. DLB was less prevalent than VD among these community-dwelling Korean elders.

Depression in Vascular Dementia Is Quantitatively and Qualitatively Different from Depression in Alzheimer's Disease

Background/Aims: To compare the prevalence and characteristics of depression in vascular dementia (VaD) and Alzheimer’s disease (AD) after adjusting for dementia severity and gender. Methods: One hundred and eight pairs of VaD and AD patients matched for dementia severity and gender were assessed. Results: Major depressive disorder (MDD) was more prevalent in the VaD group than in the AD group (20.4% in VaD, 10.2% in AD, p = 0.04, Cochran-Mantel-Haenszel, CMH, test) regardless of the dementia severity and gender. The odds ratio for developing MDD in the VaD group versus the AD group was estimated to be 2.20 (95% confidence interval = 1.02–4.74). Neurovegetative symptoms such as ‘felt tired and weak all the time’ (30.6% in VaD, 13.9% in AD, p = 0.003, CMH test) and ‘changed weight without trying’ (16.7% in VaD, 6.5% in AD, p = 0.02, CMH test) were more prevalent in the VaD group than in the AD group. Conclusion: Depression in VaD was quantitatively and qualitatively different from that in AD regardless of the severity of dementia and gender; depression was more prevalent, severer and more retarded and vegetative in VaD than in AD.

Prevalence of major depressive disorder and minor depressive disorder in an elderly Korean population: Results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

OBJECTIVE We investigated the prevalence, risk factors and impact of major depressive disorder (MDD) and minor depressive disorder (MnDD) in a randomly selected community-dwelling Korean elderly population. METHOD This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A study population of 1118 Korean elders was randomly sampled from residents of Seongnam, Korea aged 65 years or older. Standardized face-to-face interviews and neurological and physical examinations were conducted on 714 respondents using the Korean version of Mini International Neuropsychiatric Interview. MDD was diagnosed according to the DSM-IV criteria, and MnDD according to research criteria proposed in Appendix B of the DSM-IV criteria. RESULTS Age-, gender- and education-standardized prevalence rates in Korean elders aged 65 years or older were estimated as 5.37% (95% CI=3.72-7.03) for MDD, 5.52% (95% CI=3.84-7.19) for MnDD, and 10.89% (95% CI=8.60-13.17) for overall late-life depression (LLD). A prior MDD episode (OR=3.07, 95% CI=1.38-6.82 in MDD, OR=3.44, 95% CI=1.49-7.94 in MnDD), female gender (OR=3.55, 95% CI=1.53-8.24 in MDD, OR=2.68, 95% CI=1.19-6.04 in MnDD) and history of stroke or TIA (OR=3.45, 95% CI=1.62-7.35 in MDD, OR=2.95, 95% CI=1.34-6.52 in MnDD) were associated with the risks of both MDD and MnDD. Lack of formal education (OR=2.75, 95% CI=1.30-5.85) and low income (OR=2.83, 95% CI=1.02-7.88) were associated with the risk of MDD only. Quality of life (QOL) of the MDD and MnDD patients was worse than that of non-depressed elders (P<0.001, ANOVA). CONCLUSION MnDD was as prevalent as MDD in Korean elders and impacted QOL as MDD did. MnDD patients may increase in the future with accelerated population aging and westernization of lifestyle in Korea.

Prevalence, comorbidities and risk factors of restless legs syndrome in the Korean elderly population - results from the Korean Longitudinal Study on Health and Aging

The aim of this study was to determine the prevalence, neuropsychiatric comorbidities, iron metabolism and potential risk factors of restless legs syndrome (RLS) in the elderly Korean population. As a community‐based epidemiological study, a simple random sample of 1118 was drawn from a roster of 61 730 adult individuals aged 65 years and older and 714 participated. The diagnosis of RLS was established in face‐to‐face interviews using the four minimal diagnostic criteria for RLS recommended by National Institute of Health. Depressive symptoms, nocturnal sleep disturbances, daytime sleepiness and quality of life were evaluated. Laboratory tests of iron metabolism, markers of inflammation, renal and endocrine function, hormones and vitamins were performed. A total of 59 patients (42 women and 17 men) were diagnosed as RLS with a prevalence of 8.3% (95% confidence interval: 6.2–10.3%), with an almost twofold higher prevalence in women (10.2%) than in men (5.7%). Depression was more prevalent among the subjects with RLS than without RLS and poor nocturnal sleep and quality of life were also observed in subjects with RLS. Daytime sleepiness was observed in 32.8% of subjects with RLS. No significant differences were found in iron metabolism or other risk factors between the subjects with and without RLS. The prevalence of RLS in the Korean elderly population was comparable with that in the Caucasian population. RLS had undesirable effects on mood, sleep quality and general wellbeing of elderly individuals.

A Normative Study of the Revised Hasegawa Dementia Scale: Comparison of Demographic Influences between the Revised Hasegawa Dementia Scale and the Mini-Mental Status Examination

Background/Aims: We investigated the demographic influence on the performance of the Revised Hasegawa Dementia Scale (HDS-R) and provided normative data of the HDS-R in the elderly. Methods: The HDS-R was administered to 803 community-dwelling cognitively normal elderly subjects aged 55 years or over. Cognitive disorders and psychiatric disorders were strictly excluded using the CERAD-K assessment packet and the Mini-International Neuropsychiatric Interview. The demographic influence on the performance of the HDS-R was examined using multiple linear regression analyses, and compared with that on the performance of the Mini-Mental Status Examination (MMSE) using the Chow test and t statistics. Overlapping strata were used in developing age-, education- and gender-specific normative data of the HDS-R. Results: Age, education, and gender influenced significantly the performance of the HDS-R, and explained 22.5% of the total score variance. Older age, lower education, and male gender were associated with lower performance of the HDS-R. However, the demographic influence on the HDS-R was much weaker than that on the MMSE (t = 5.578, d.f. = 800, p < 0.001). The normative data of the HDS-R stratified by age (60–69, 70–79, ≧80), education (0–6, 7–12, ≧13), and gender were presented. Conclusions: The HDS-R was more robust to demographic influences than the MMSE, and normative data may contribute to improving further its diagnostic accuracy for dementia.

Development of the Subjective Memory Complaints Questionnaire

Aim: We aimed toevaluatethe psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ). Methods: The reliability of the SMCQ was evaluated by testing its internal consistency and test-retest reliability. Pearson correlation analyses were performed to assess the concurrent validity. Confirmatory factor analysis was used to evaluate the construct validity. Diagnostic ability for dementia was tested with receiver operator characteristic curve analyses. Results: Cronbach’s α coefficient and intraclass correlation coefficients of the SMCQ were 0.864 and 0.828 (p < 0.001), respectively. The SMCQ scores were significantly correlated with the scores on Camdex Memory Complaint Questionnaire, Seoul Informant Report Questionnaire for Dementia and cognitive tests from the CERAD (Consortium to Establish a Registry for Alzheimer’s Disease) neuropsychological test battery (p < 0.01). The results of confirmatory factor analyses confirmed that the SMCQ consisted of subjective memory complaints (SMC) for general memory and for everyday memory. The SMCQ score discriminated well between nondemented elderly without dementia and those with dementia (p < 0.01). The area under the curve value of the SMCQ was 0.84, indicating that it had high diagnostic ability. Conclusion: The SMCQ was found to be a brief, reliable and valid questionnaire for evaluating SMC. It might be useful for evaluating the cognition of elderly subjects when reliable informants are not available.

Impacts of Poor Social Support on General Health Status in Community-Dwelling Korean Elderly: The Results from the Korean Longitudinal Study on Health and Aging

Objective We investigated the influence of social support on health, quality of life (QOL), and the risk of depression in elderly Korean people. Methods This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A total of 787 nondemented community-dwelling elderly aged 65 years or older were recruited and underwent clinical evaluations for dementia and psychiatric disorders conformed to Korean version of the Consortium to Establish a Registry for Alzheimers Disease Clinical Assessment Battery (CERAD-K) and the Korean version of the Mini-International Neuropsychiatric Interview (MINI), respectively. Social support was assessed using the Medical Outcome Study Social Support Survey (MOS-SSS). Poor social support (PSS) was defined as having a MOS-SSS score below the 25th percentile of the entire sample. General health status was comprehensively evaluated using the modified Cumulative Illness Rating Scale (CIRS), the Korean version of the Geriatric Depression Scale (GDS-K), Mini-Mental Status Examination (MMSE-KC), Korean Activities of Daily Living (KADL), and Korean Instrumental Activities of Daily Living (KIADL). Health-related QOL was evaluated using the Short Form 36 (SF-36). Results Low educational attainment and living alone were associated with PSS. Geriatric depression was more prevalent in the PSS group (OR=3.05, 95% CI=1.77-5.27) than in the normal social support (NSS) group. Among the various forms of social support, positive social interaction was significantly associated with risk of geriatric depression (OR=2.25, 95% CI=1.07-4.73). Although health-related QOL was lower in the PSS group than in the NSS group, the ADL and IADL scores of the subjects in the PSS group were better than those of the subjects in the NSS group. In the subjects with geriatric depression, PSS was associated with more severe depression, higher medical morbidity, and poor QOL. Conclusion PSS had a negative influence on the general health status and QOL among community-dwelling elderly and was an independent risk factor of geriatric depression.

Prevalence of mild cognitive impairment and its subtypes are influenced by the application of diagnostic criteria: results from the Korean Longitudinal Study on Health and Aging (KLoSHA).

Aims: We investigated the influence of varying applications of diagnostic criteria on the prevalence of mild cognitive impairment (MCI) in community-dwelling Korean elders. Methods: A study population of 1,118 Korean elders was randomly sampled from the residents aged 65 years or older living in Seongnam, Korea. Standardized face-to-face interviews, with neurological and physical examinations, were conducted with 714 respondents. Cognitive function was evaluated using the Korean version of the CERAD Neuropsychological Assessment Battery, digit span test, and lexical fluency test. Activities of daily living were evaluated using the Blessed Dementia Scale in the CERAD Clinical Assessment Battery (Korean version). Using variable sets of operational diagnostic criteria, the prevalence of MCI was estimated. Results: Age- and gender-standardized prevalence estimates according to the Petersen criteria were 28.6% (95% CI = 25.3–31.9) for overall MCI, 17.0% (95% CI = 14.3–19.8) for amnestic MCI, and 11.5% (95% CI = 9.2–13.9) for non-amnestic MCI. However, the estimated prevalence of MCI varied widely (8.3–27.6%) according to the applied operational diagnostic criteria. The proportion of MCI subtypes also varied considerably according to the number and types of applied neuropsychological tests. Conclusions: Variable implementation of MCI diagnostic criteria may significantly complicate the homogeneity of this condition.

Prevalence of Stroke and Transient Ischemic Attack in Korean Elders Findings From the Korean Longitudinal Study on Health and Aging (KLoSHA)

Background and Purpose— Studies on the epidemiology of stroke and transient ischemic attack (TIA) are very limited in Asian elderly populations. We investigate the prevalence, risk factors, and neuropsychiatric comorbidities of stroke and TIA in community-dwelling Korean elders. Methods— Standardized face-to-face interviews, neurological examinations, and physical examinations were conducted in 714 randomly sampled community-dwelling Korean elders aged ≥65 years. Diagnoses of stroke and TIA were made according to the World Health Organization criteria. Results— Age- and education-standardized prevalences of stroke, TIA, and cerebrovascular disorder (implying stroke or TIA) were estimated to be 10.1%, 8.9%, and 15.4%, respectively, in Korean elders. Hypertension and current smoking were associated with the risk of stroke, whereas atrial fibrillation, high diastolic blood pressure, high serum low-density lipoprotein cholesterol, and hypertension were associated with the risk of TIA. Cerebrovascular disorder was associated with the risk of major depressive disorder, vascular dementia, and nonamnestic mild cognitive impairment (P<0.05). Conclusion— Prevalences of stroke and TIA in Korean elders were higher than in white elders. Stroke and TIA were associated with increased risk of depression and cognitive disorders.

Prevalence and neuropsychiatric comorbidities of alcohol use disorders in an elderly Korean population

We investigated the prevalence and comorbidities of problem drinking in community‐dwelling elders living in Korea.