Jeanyung Chey

Decreased N-acetyl-aspartate levels in anterior cingulate and hippocampus in subjects with post-traumatic stress disorder: a proton magnetic resonance spectroscopy study

The purpose of this study was to investigate the concentration of N‐acetyl‐aspartate (NAA) in the brain and its relationship with clinical characteristics in patients with post‐traumatic stress disorder (PTSD). Proton magnetic resonance spectroscopy was performed in order to measure NAA concentrations in the anterior cingulate cortex (ACC) and bilateral hippocampus in 26 subjects with fire‐related PTSD, who were survivors of a subway fire in South Korea, and 25 age‐ and sex‐matched healthy comparison subjects. There were decreased NAA levels in the ACC (t = −3.88, d.f. = 49, P < 0.001) and bilateral hippocampus (right, t = −3.88, d.f. = 49, P < 0.001; left, t = −3.62, d.f. = 49, P < 0.001) in the PTSD group relative to the healthy comparison group. Also, NAA levels of the ACC (r = –0.43, n = 26, P = 0.027) and bilateral hippocampus (right, r = –0.48, n = 26, P = 0.013; left, r = −0.40, n = 26, P = 0.04) were negatively correlated with re‐experience symptom scores in subjects with PTSD. In conclusion, our findings suggest that subjects with PTSD had decreased neuronal viabilities in the ACC and bilateral hippocampus, and that these deficits may play an important role in the pathophysiology of PTSD, especially regarding the re‐experiencing of traumatic events.

Effects of education, literacy, and dementia on the Clock Drawing Test performance

The Clock Drawing Test (CDT) has been recognized as an effective tool for dementia detection. This study investigated the clock drawing performance of 240 non-demented elderly Korean people with a wide-range of educational levels and 28 patients with mild dementia of the Alzheimers type (DAT). We examined the effects of demographic factors, including education, and established norms for the elderly population. We found that the educational attainment and literacy status of older people influenced performance on the CDT significantly (p < .001). Furthermore, qualitative error analysis revealed that normal participants with low educational background committed errors similar to errors of the DAT patients. The DAT patients performed significantly worse than the non-demented participants in the CDT Total score (p < .001). However, the CDT has better criterion validity in participants with more than 6 years of education. In conclusion, the CDT performance in older people who are either illiterate or with 6 or less years of education should be interpreted with caution. Conceptual errors in the CDT can be the result of not only dementia but also lack of education.

Impaired strategic decision making in schizophrenia

Adaptive decision making in dynamic social settings requires frequent re-evaluation of choice outcomes and revision of strategies. This requires an array of multiple cognitive abilities, such as working memory and response inhibition. Thus, the disruption of such abilities in schizophrenia can have significant implications for social dysfunctions in affected patients. In the present study, 20 schizophrenia patients and 20 control subjects completed two computerized binary decision-making tasks. In the first task, the participants played a competitive zero-sum game against a computer in which the predictable choice behavior was penalized and the optimal strategy was to choose the two targets stochastically. In the second task, the expected payoffs of the two targets were fixed and unaffected by the subjects choices, so the optimal strategy was to choose the target with the higher expected payoff exclusively. The schizophrenia patients earned significantly less money during the first task, even though their overall choice probabilities were not significantly different from the control subjects. This was mostly because patients were impaired in integrating the outcomes of their previous choices appropriately in order to maintain the optimal strategy. During the second task, the choices of patients and control subjects displayed more similar patterns. This study elucidated the specific components in strategic decision making that are impaired in schizophrenia. The deficit, which can be characterized as strategic stiffness, may have implications for the poor social adjustment in schizophrenia patients.

Medial temporal lobe volume of nondemented elderly individuals with poor cognitive functions

Poor cognitive performance of elderly individuals with low educational attainment is often difficult to interpret in dementia evaluation. Lack of education, as well as dementia, is often associated with poor cognitive test performance. To elucidate the underlying structural change of low cognitive performance in elderly individuals with low educational attainment, this study examined the relationship between low cognitive performance (LCP) and brain volumes, especially regions vulnerable to Alzheimers disease, in nondemented elderly Koreans. Individuals with LCP (n=14) were matched on age and education with individuals with normal cognitive performance (n=14). The two groups were compared on the MR-based volumetric measures in the hippocampus, the entorhinal cortex, the amygdala, the temporal lobe, the frontal lobe, the cerebrum, and the intracranial cavity. Intracranial volume (p<.05) and absolute hippocampus (p<.05) and frontal lobe volumes (p<.05) were significantly reduced in individuals with LCP. Normalized volumes of the hippocampus and the frontal lobe did not differ in the two cognitive performance groups. ICV was associated with the K-DRS scores. General cognitive functioning of the LCP individuals, measured with the Korean version of the DRS, did not deteriorate in the 1- or 2-year follow-up cognitive tests. LCP in a nondemented elderly population with limited education appears to be associated with stable lower intelligence rather than increased risk for dementia of the Alzheimers type.

Differentiating illiteracy from Alzheimer's disease by using neuropsychological assessments.

BACKGROUND In Asia, where illiteracy rates are high, determining the degree to which neuropsychological measures can be used to identify cognitive impairment in illiterate elders is important. The aim of this study was to evaluate the effectiveness of using formal neuropsychological assessments to distinguish healthy illiterate elders from dementia patients. METHODS We compared the cognitive performance of healthy elders who were illiterate (illiterate NC, n = 25) with those who were literate (literate NC, n = 25), literate patients with mild Alzheimers disease (literate AD, n = 25), and illiterate patients with mild AD (illiterate AD, n = 25). Neuropsychological measures included the Mini-Mental State Examination (MMSE), the verbal fluency test, the Boston naming test, the Rosen drawing test, and the verbal learning test. RESULTS In the between-group analyses, the scores on all tests, except verbal fluency and recognition memory, were lower for illiterate NC compared to the literate NC. The scores on the MMSE, Boston naming test, Rosen drawing test, and immediate free recall could not distinguish the illiterate NC from literate AD. However, the scores on all tests, except the Rosen drawing test, could distinguish illiterate NC from illiterate AD. ROC analyses showed the same pattern of results. In addition, age-, sex-, and education-matched cut-off scores of all tests, except immediate recall and delayed recall trials of the verbal learning test, showed good specificities in participants who were illiterate compared to those in participants who were literate. CONCLUSION These findings suggest that the impact of literacy on neuropsychological test performance is an important aspect of cognitive evaluations for elders who are illiterate.

The validity and reliability of a Computerized Dementia Screening Test developed in Korea

OBJECTIVE This study was done to verify the validity and the reliability of the newly developed Computerized Dementia Screening Test (CDST) to be easily used in the primary care setting of Korea. DESIGN Comparison of the results of CDST between 103 healthy control subjects and 41 patients who were diagnosed as having mild cognitive impairment or early dementia, having a clinical dementia rate of 0.5-1 from one health examination center and two neurology clinics in university hospitals. MEASUREMENTS In order to estimate the criterion-related validity, logistic regression analysis for dementia was done using the four individual test results of CDST, age and educational level. The correlation between Korean Mini-Mental State Examination (K-MMSE) and the predicted probability of mild cognitive impairment and early dementia from the logistic regression was measured to verify its validity. The reliability of CDST was measured by test-retest reliability. RESULTS The sensitivity and specificity of CDST were 75.6% and 94.2%, respectively, if the cut-off point was set to be 0.5 in the logistic regression model. The Pearsons Correlation Coefficient between K-MMSE and the predicted probability of mild cognitive impairment and early dementia from the logistic regression analysis was 0.59 (P<0.001). The overall test-retest reliability using the predicted probability of dementia from the logistic regression analysis of CDST was 0.89 (P=0.01). CONCLUSION The validity and reliability of CDST is adequate for use as a screening tool to identify mild cognitive impairment and early dementia in Korean primary care.

The effect of education on regional brain metabolism and its functional connectivity in an aged population utilizing positron emission tomography

Education involves learning new information and acquiring cognitive skills. These require various cognitive processes including learning, memory, and language. Since cognitive processes activate associated brain areas, we proposed that the brains of elderly people with longer education periods would show traces of repeated activation as increased synaptic connectivity and capillary in brain areas involved in learning, memory, and language. Utilizing positron emission topography (PET), this study examined the effect of education in the human brain utilizing the regional cerebral glucose metabolism rates (rCMRglcs). 26 elderly women with high-level education (HEG) and 26 with low-level education (LEG) were compared with regard to their regional brain activation and association between the regions. Further, graphical theoretical analysis using rCMRglcs was applied to examine differences in the functional network properties of the brain. The results showed that the HEG had higher rCMRglc in the ventral cerebral regions that are mainly involved in memory, language, and neurogenesis, while the LEG had higher rCMRglc in apical areas of the cerebrum mainly involved in motor and somatosensory functions. Functional connectivity investigated with graph theoretical analysis illustrated that the brain of the HEG compared to those of the LEG were overall more efficient, more resilient, and characterized by small-worldness. This may be one of the brains mechanisms mediating the reserve effects found in people with higher education.

Estimation of K-WAIS-IV Premorbid Intelligence in South Korea: Development of the KPIE-IV

Objective: The accurate estimation of premorbid intellectual functioning in patients with known or suspected cognitive impairment is crucial for clinicians. However, there is no reliable method for estimating premorbid intelligence in South Korea. The purpose of this study was to develop the Korea Premorbid Intelligence Estimate (KPIE) as an estimate of the premorbid intellectual functioning. Method: Data from the Korean WAIS-IV standardization sample were used to generate several Full Scale Intelligence Quotient (FSIQ) estimation formulas using demographic variables and current WAIS-IV subtest performance. The standardization sample (N = 1216) was randomly divided into two groups: the first group was used to develop the formulas and the second group was used to validate the prediction equations. Age, education, gender, region of the country, and select subtest raw scores (Vocabulary, Information, Matrix Reasoning, and Visual Puzzle) were used as predictor variables. Results: Five KPIE-4 equations were generated. Estimated FSIQ derived from the KPIE-4 equation is highly correlated with K-WAIS-IV FSIQ. Conclusions: The resulting formulas for estimating premorbid FSIQ were highly significant and precise in predicting FSIQ scores of participants in the K-WAIS-IV normative sample. These equations provide a means for clinicians to estimate intellectual functioning in adults, and can be utilized as a method of estimating individuals premorbid functioning.

Stress enhances model-free reinforcement learning only after negative outcome

Previous studies found that stress shifts behavioral control by promoting habits while decreasing goal-directed behaviors during reward-based decision-making. It is, however, unclear how stress disrupts the relative contribution of the two systems controlling reward-seeking behavior, i.e. model-free (or habit) and model-based (or goal-directed). Here, we investigated whether stress biases the contribution of model-free and model-based reinforcement learning processes differently depending on the valence of outcome, and whether stress alters the learning rate, i.e., how quickly information from the new environment is incorporated into choices. Participants were randomly assigned to either a stress or a control condition, and performed a two-stage Markov decision-making task in which the reward probabilities underwent periodic reversals without notice. We found that stress increased the contribution of model-free reinforcement learning only after negative outcome. Furthermore, stress decreased the learning rate. The results suggest that stress diminishes one’s ability to make adaptive choices in multiple aspects of reinforcement learning. This finding has implications for understanding how stress facilitates maladaptive habits, such as addictive behavior, and other dysfunctional behaviors associated with stress in clinical and educational contexts.

Effects of multicomponent training of cognitive control on cognitive function and brain activation in older adults

The aim of this study was to investigate the changes in cognitive functions and brain activation after multicomponent training of cognitive control in non-demented older adults, utilizing neuropsychological tests and fMRI. We developed and implemented a computerized Multicomponent Training of Cognitive Control (MTCC), characterized by task variability and adaptive procedures, in order to maximize training effects in cognitive control and transfer to other cognitive domains. Twenty-seven community-dwelling adults, aged 64-77 years, without any history of neurological or psychiatric problems, participated in this study (14 in the training group and 13 in the control group). The MTCC was administered to the participants assigned to the training group for 8 weeks, while those in the control group received no training. Neuropsychological tests and fMRI were administered prior to and after the training. Trained participants showed improvements in cognitive control, recognition memory and general cognitive functioning. Furthermore, the MTCC led to an increased brain activation of the regions adjacent to the baseline cognitive control-related areas in the frontoparietal network. Future studies are necessary to confirm our hypothesis that MTCC improves cognitive functioning of healthy elderly individuals by expanding their frontoparietal network that is involved in cognitive control.