Jun-Young Lee

Brief Screening for Mild Cognitive Impairment in Elderly Outpatient Clinic : Validation of the Korean Version of the Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening tool with high sensitivity for screening patients with mild cognitive impairment (MCI). The authors examined the validity and reliability of the Korean version of the MoCA (MoCA-K) in elderly outpatients. The MoCA-K, a Korean version of the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR) scale, and neuropsychological batteries were administered to 196 elderly persons (mild Alzheimers disease [AD] = 44, MCI = 37, normal controls [NC] = 115). MoCA-K scores were highly correlated with those of MMSE and CDR. Using a cutoff score of 22/23, the MoCA-K had an excellent sensitivity of 89% and a good specificity of 84% for screening MCI. Internal consistency and test−retest reliability were good. The results obtained show that the MoCA-K is brief, reliable, and suitable for use as a screening tool to screen MCI patients in elderly outpatient clinic settings.

Impulsivity in Internet Addiction: A Comparison with Pathological Gambling

Internet addiction has been considered to be associated with poor impulse control. The aim of this study is to compare the trait impulsivity of those suffering from Internet addiction with that of individuals suffering from pathological gambling. Twenty-seven patients diagnosed with Internet addiction (age: 24.78±4.37 years), 27 patients diagnosed with pathological gambling (age: 25.67±3.97 years), and 27 healthy controls (age: 25.33±2.79 years) were enrolled in this study. All patients were men seeking treatment. Trait impulsivity and the severity of the Internet addiction and pathological gambling were measured by the Barratt Impulsiveness Scale-11, the Youngs Internet Addiction Test, and the South Oaks Gambling Screen, respectively. The Beck Depression Inventory and the Beck Anxiety Inventory were also administered to all subjects. Our results show that those suffering from Internet addiction showed increased levels of trait impulsivity which were comparable to those of patients diagnosed with pathological gambling. Additionally, the severity of Internet addiction was positively correlated with the level of trait impulsivity in patients with Internet addiction. These results state that Internet addiction can be conceptualized as an impulse control disorder and that trait impulsivity is a marker for vulnerability to Internet addiction.

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.

Lifetime Prevalence and Correlates of Suicidal Ideation, Plan, and Single and Multiple Attempts in a Korean Nationwide Study

This was the first Korean national study to evaluate prevalence and correlates of suicidal behavior, and to compare multiple and single attempts. A total of 6510 adults completed face-to-face interviews (response rate, 81.7%) through randomly chosen one-person-per-households. Lifetime prevalence and correlates were evaluated with the Korean version of Composite International Diagnostic Interview (K-CIDI), and a questionnaire to inquire about suicidal behaviors. The lifetime prevalence of suicidal ideation, plan, and attempt in South Korea was 15.2%, 3.3%, and 3.2% (single 2.1% and multiple 1.1%), respectively. Younger age was associated with attempts and more strongly associated with multiple attempts. Attempts were the most strongly associated with mood disorders, especially bipolar disorder, which was more strongly associated with multiple attempts. In conclusion, suicidal behaviors are highly prevalent in Korea, especially in young adults. Bipolar disorder was the most strongly associated disorder with suicide attempts, more with multiple attempts.

Unplanned versus planned suicide attempters, precipitants, methods, and an association with mental disorders in a Korea-based community sample

BACKGROUNDnStudies have consistently reported that a considerable proportion of suicidal attempts are unplanned. We have performed the first direct comparison between planned and unplanned attempts including associated methods and precipitants.nnnMETHODnA total of 6510 adults, who had been randomly selected through a one-person-per-household method, completed interviews (response rate 81.7%). All were interviewed using the K-CIDI and a questionnaire for suicide.nnnRESULTSnTwo hundred and eight subjects reported a suicide attempt in their lifetime, one-third of which had been unplanned. These individuals exhibited a lower level of education; however, no significant differences were found with regard to age, gender, marital and economic status. Further, 84.0% of unplanned attempters experienced previous suicidal ideation, experiencing their first attempt 1.9 years before ideation. Additionally, 94.4% of unplanned attempters had precipitants for attempts such as familial conflict and it was also found that methods such as the use of chemical agents or falling were three times more common in unplanned than planned attempters. With respect to unplanned attempters, they exhibited a significant association with alcohol use disorder, major depressive disorder, posttraumatic stress disorder, and bipolar disorder. In particular, bipolar disorder was found to be 3.5 times higher in these individuals.nnnCONCLUSIONSnResults have revealed that unplanned suicide attempters experience suicidal ideation and precipitants prior to their attempt. Further, attempts were associated with affective and alcohol use disorders. Therefore, in order to reduce the number of suicidal attempts, it may be useful to evaluate suicidal ideation concurrent to the treatment of existing mental disorders.

Altered Brain Activity during Reward Anticipation in Pathological Gambling and Obsessive-Compulsive Disorder

Background Pathological gambling (PG) and obsessive-compulsive disorder (OCD) are conceptualized as a behavioral addiction, with a dependency on repetitive gambling behavior and rewarding effects following compulsive behavior, respectively. However, no neuroimaging studies to date have examined reward circuitry during the anticipation phase of reward in PG compared with in OCD while considering repetitive gambling and compulsion as addictive behaviors. Methods/Principal Findings To elucidate the neural activities specific to the anticipation phase of reward, we performed event-related functional magnetic resonance imaging (fMRI) in young adults with PG and compared them with those in patients with OCD and healthy controls. Fifteen male patients with PG, 13 patients with OCD, and 15 healthy controls, group-matched for age, gender, and IQ, participated in a monetary incentive delay task during fMRI scanning. Neural activation in the ventromedial caudate nucleus during anticipation of both gain and loss decreased in patients with PG compared with that in patients with OCD and healthy controls. Additionally, reduced activation in the anterior insula during anticipation of loss was observed in patients with PG compared with that in patients with OCD which was intermediate between that in OCD and healthy controls (healthy controls < PG < OCD), and a significant positive correlation between activity in the anterior insula and South Oaks Gambling Screen score was found in patients with PG. Conclusions Decreased neural activity in the ventromedial caudate nucleus during anticipation may be a specific neurobiological feature for the pathophysiology of PG, distinguishing it from OCD and healthy controls. Correlation of anterior insular activity during loss anticipation with PG symptoms suggests that patients with PG fit the features of OCD associated with harm avoidance as PG symptoms deteriorate. Our findings have identified functional disparities and similarities between patients with PG and OCD related to the neural responses associated with reward anticipation.

Prevalence, clinical correlations, comorbidities, and suicidal tendencies in pathological Korean gamblers: results from the Korean Epidemiologic Catchment Area Study

ObjectiveBased on the National Epidemiological Survey of Psychiatric Disorders in South Korea conducted in 2006, we examined the prevalence, clinical correlations, comorbidities, and suicidal tendencies of pathological gamblers in the community.MethodOf the 6,510 participants who completed the Korean version of the Composite International Diagnostic Interview (K-CIDI) administered by trained lay interviewers, 5,333 subjects fully completed the Diagnostic Interview Schedule (DIS) exploring pathological gambling. The DIS has 13 items mapping to 10 criteria. Endorsement of five DSM-IV criteria was considered to reflect pathological gambling, and we considered endorsement of one to four criteria to indicate problem gambling. The frequencies of psychiatric disorders and suicidal tendency were analyzed among pathological/problem gamblers in comparison with controls; both odds ratios and significance levels were calculated.ResultsThe lifetime prevalence rates of pathological gambling and problem gambling were 0.8% and 3.0%, respectively. Of pathological gamblers, 79.1% had at least one psychiatric illness in comparison to the control level of 28.1%, and 62.0% of problem gamblers also had psychiatric conditions. Associations between pathological/problem gambling and alcohol use disorder, nicotine dependence, mood disorder, anxiety disorder, and suicidality were overwhelmingly positive and significant (pxa0<xa00.05), even after controlling for age and gender. Male gender, divorced/separated/widowed marital status, and urban living were all associated with increased risks of pathological and problem gambling (pxa0<xa00.05).ConclusionPathological/problem gambling is highly associated with substance abuse, mood and anxiety disorders, and suicidality, suggesting that clinicians should carefully evaluate and treat such psychiatric disorders in gamblers.

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

OBJECTIVEnThis study aimed to estimate prevalence rates and risk factors of LLD among a large nationwide sample of Korean elders in South Korea.nnnMETHODnOf 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.nnnRESULTSnThe 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.nnnCONCLUSIONnLLD 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.

Clinical Characteristics of a Nationwide Hospital-based Registry of Mild-to-Moderate Alzheimer's Disease Patients in Korea: A CREDOS (Clinical Research Center for Dementia of South Korea) Study

With rapid population aging, the socioeconomic burden caused by dementia care is snowballing. Although a few community-based studies of Alzheimers disease (AD) have been performed in Korea, there has never been a nationwide hospital-based study thereof. We aimed to identify the demographics and clinical characteristics of mild-to-moderate AD patients from the Clinical Research Center for Dementia of Korea (CREDOS) registry. A total of 1,786 patients were consecutively included from September 2005 to June 2010. Each patient underwent comprehensive neurological examination, interview for caregivers, laboratory investigations, neuropsychological tests, and brain MRI. The mean age was 74.0 yr and the female percentage 67.0%. The mean period of education was 7.1 yr and the frequency of early-onset AD (< 65 yr old) was 18.8%. Among the vascular risk factors, hypertension (48.9%) and diabetes mellitus (22.3%) were the most frequent. The mean score of the Korean version of Mini-Mental State Examination (K-MMSE) was 19.2 and the mean sum of box scores of Clinical Dementia Rating (CDR-SB) 5.1. Based on the well-structured, nationwide, and hospital-based registry, this study provides the unique clinical characteristics of AD and emphasizes the importance of vascular factors in AD in Korea.

Prevalence of DSM-IV major mental disorders among Korean adults: A 2006 National Epidemiologic Survey (KECA-R)

OBJECTIVESnThe aim of this study was to estimate the prevalence of the DSM-IV major mental disorders in the Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI).nnnMETHODSnThe Korean Epidemiologic Catchment Area study Replication (KECA-R) was conducted between August 2006 and April 2007. The sampling of the subjects was carried out across 12 catchment areas using a multistage, cluster sampling design. The target population included all eligible community dwelling residents aged 18-64 years. Face-to-face interviews were conducted using the K-CIDI based on the DSM-IV.nnnRESULTSnA total of 6510 participants completed the interview (response rate=81.7%). The lifetime and 12-month prevalence rates for DSM-IV major mental disorders were 29.0% and 16.9%, respectively. Those of specific disorders were as follows: (1) alcohol use disorder, 16.2% and 5.6%; (2) nicotine use disorder, 9.0% and 6.0%; (3) specific phobia, 3.8% and 3.4%; (4) major depressive disorder, 5.6% and 2.5%; and (5) generalized anxiety disorder, 1.6% and 0.8%. Additionally, data related to nicotine and alcohol use disorder revealed a very high male to female ratio. Further, mood and anxiety disorders were more prevalent in females than in males.nnnCONCLUSIONnThe prevalence of major mental disorders was high. In comparison with the studies performed in other countries, notable differences were observed with respect to the distribution of mental disorders in Korea.