Jin Hyeong Jhoo

A normative study of the CERAD neuropsychological assessment battery in the Korean elderly

This study aimed to explore the effects of age, education and gender on the performance of eight tests in the Korean version of the CERAD neuropsychological assessment battery and to provide normative information on the tests in the Korean elderly. The battery was administered to 618 healthy volunteers aged from 60 to 90. People with serious neurological, medical and psychiatric disorders, including dementia, were excluded. Multiple linear regression analyses were performed to assess the relative contribution of the demographic factors on the score of each cognitive test. Age, education, and gender were found to have significant effects on the performance of many tests in the battery. Based on these results, 4 overlapping age normative tables (60 to 74, 65 to 79, 70 to 84, and 75 to 90 years of age) with 3 educational strata (0 to 3 years, 4 to 6 years, and 7 years and more) for both genders are presented. The normative information will be useful for a clinical interpretation of the CERAD neuropsychological battery in Korean elderly as well as for comparing the performance of the battery across countries.

Posterior cingulate cortex atrophy and regional cingulum disruption in mild cognitive impairment and Alzheimer's disease

This study aimed to investigate the atrophy of the posterior cingulate cortex (PCC) and medical temporal lobe (MTL) structures (i.e., the entorhinal cortex (ERC) and hippocampus) and the regional disruption of the cingulum bundle in mild cognitive impairment (MCI) and Alzheimers disease (AD) patients. The relationships between atrophy of these structures and regional cingulum disruption were also explored. Three-dimensional MRI and diffusion tensor imaging were applied to 19 MCI, 19 probable AD patients, and 18 normal controls (NC). Fractional anisotropy (FA) values were obtained from three different regions of the cingulum. Both MCI and AD patients showed decreased PCC volumes compared with NC. ERC atrophy was also significant in AD and MCI, while hippocampus atrophy was significant only in AD. MCI patients showed a significant FA decrease in the parahippocampal cingulum (PH-C), whereas AD patients had lower FA values in the posterior cingulate cingulum (PC-C) and PH-C, as compared with NC. However, the middle cingulate cingulum (MC-C) showed no significant FA differences between groups. Moreover, the volumes of MTL structures were significantly correlated with PH-C and PC-C FA values. In terms of PCC functional deficit in MCI or early AD, our results support both the direct effect of PCC atrophy itself and the indirect effect of cingulum fiber degeneration secondary to MTL atrophy.

A nationwide survey on the prevalence of dementia and mild cognitive impairment in South Korea.

We investigated the prevalence of dementia and mild cognitive impairment (MCI) and the factors associate with risk of dementia from a representative nationwide sample of Korean elders. 8,199 randomly-sampled Koreans aged 65 years or older were invited to participate in the Phase I screening assessment using Mini-Mental State Examination by door-to-door home visit, and 6,141 subjects (response rate = 74.9%) responded. Among them, 2,336 subjects were invited to participate in the Phase II diagnostic assessment for dementia and MCI, and 1,673 subjects responded (response rate = 71.6%). Diagnostic assessments were administered using the Korean version of the Consortium to Establish a Registry for Alzheimers Disease Assessment Packet (CERAD-K) Clinical Assessment Battery. The CERAD-K Neuropsychological Assessment Battery was used for diagnosing MCI. Age-, gender-, education-, and urbanicity-standardized prevalence of dementia was estimated to be 8.1% (95% CI = 6.9-9.2) for overall dementia and 24.1% (95% CI = 21.0-27.2) for MCI. Alzheimers disease (AD) was the most prevalent type (5.7%) followed by vascular dementia (2.0%). Amnestic subtype (20.1%) was much more prevalent than nonamnestic subtype in MCI (4.0%). Older age, being male, lower education level, illiteracy, smoking, and histories of head trauma or depression were associated with increased dementia risk, and alcohol use and moderately intense exercise were associated with decreased dementia risk. We expect numbers of dementia patients to double every 20 years until 2050 in Korea and expect AD to account for progressively more dementia cases in the future.

The Prevalence of Dementia in Older People in an Urban Population of Korea: The Seoul Study

OBJECTIVES: To estimate prevalence of dementia and its subtypes in older people in Seoul, a metropolitan area of Korea, and compare these findings with estimates reported for other populations.

Predictive validity and diagnostic stability of mild cognitive impairment subtypes

Mild cognitive impairment (MCI) is subclassified into four subtypes by the presence of impairment in the memory domain (amnestic vs nonamnestic) and the number of impaired cognitive domains (single vs multiple). However, predictive validity for outcomes of these criteria and the diagnostic stability of the subtypes are questionable.

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.

A telemedicine system as a care modality for dementia patients in Korea.

Because dementia is a chronic debilitating disease, there are the issues of the difficulty in continuous long-term care and limited accessibility to medical service. We developed the telemedicine system for dementia patients and aimed to examine the acceptance, reliability, and clinical outcome of our telemedicine service. We established the Dementia Telemedicine Center in connection with two recipient sites in 1996. The reliability of the center, which provides telemedicine, tele-education, and telecounseling services, was tested by comparing assessment via our system with in-person assessment, and the clinical outcome was assessed by rating the changes of behavioral symptoms. There have been 140 registered patients for 2 years. The general acceptance of our system by the patients and caregivers was good, and the consistency rates between the assessment via our telemedicine system and in-person assessment ranged from 76% to 89%. A considerable proportion of dementia patients in nursing homes (46%) showed relative clinical improvements through our service. Our telemedicine system seems to be reliable and effective for the assessment and care of dementia patients. Our future direction is to promote our system as a core model of the home-based care system for dementia patients.

A nationwide survey on the prevalence and risk factors of late life depression in South Korea

OBJECTIVE This study aimed to estimate prevalence rates and risk factors of LLD among a large nationwide sample of Korean elders in South Korea. METHOD Of 8199 randomly sampled Koreans aged 65 years or more, 6018 participated (response rate=73.4%). Using the Korean version of the short form Geriatric Depression Scale (SGDS-K), we classified individual scoring 8 or 9 as having possible depression and those scoring ≥ 10 as having probable depression. RESULTS The age-, gender-, education-, and urbanicity-standardized prevalences were 10.1% (95% CI=9.3-10.8) for possible depression, 17.8% (95% CI=16.8-8.7) for probable depression, and 27.8% (95% CI=26.7-29.0) for overall depression. Poverty, living alone, low education, illiteracy, smoking, history of head trauma, and low Mini Mental Status Examination score were associated with greater risk of depression, while mild alcohol use and moderate to heavy exercise were associated with lower risk of depression. However gender difference in the risk of depression was not found. CONCLUSION LLD is decidedly common in South Korea. It was associated with various sociodemographic and clinical factors, some of which are amendable through policy actions. This study was limited by use of the SGDS-K rather than a standardized clinical interview.

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.

Normative study of the Stroop Color and Word Test in an educationally diverse elderly population

The purpose of this study was to explore the effects of demographic variables on Stroop Color and Word Test (SCWT) performance in an educationally diverse elderly population and to provide normative information.