Sang Joon Son

Participation in Physical, Social, and Religious Activity and Risk of Depression in the Elderly: A Community-Based Three-Year Longitudinal Study in Korea

Background We examined the longitudinal association between participation in individual or combinations of physical, social, and religious activity and risk of depression in the elderly. Methods Elderly subjects aged ≥60 years who completed the Living Profiles of Older People Survey in Korea (n = 6,647) were included. The baseline assessment, Wave 1, was conducted in 2008, and a follow-up assessment, Wave 2, was conducted in 2011. We defined participation in frequent physical activity as ≥3 times weekly (at least 30 minutes per activity). Frequent participation in social and religious activity was defined as ≥1 activity weekly. The primary outcome was depression at 3-year follow up. Results Multivariable logistic regression analysis showed that subjects who participated in frequent physical, social, and religious activity had an adjusted odds ratio of 0.81 (95% confidence interval [CI], 0.69–0.96), 0.87 (95% CI, 0.75–1.00), and 0.78 (95% CI, 0.67–0.90), respectively, compared with participants who did not participate in each activity. Participants who participated in only one type of activity frequently and participants who participated in two or three types of activities frequently had an adjusted odds ratio of 0.86 (95% CI, 0.75–0.98) and 0.64 (95% CI, 0.52–0.79), respectively, compared with participants who did not participate in any type of physical, social, and religious activity frequently. Conclusion Participation in physical, social, and religious activity was associated with decreased risk of depression in the elderly. In addition, risk of depression was much lower in the elderly people who participated in two or three of the above-mentioned types of activity than that in the elderly who did not.

Perceived sleep quality is associated with depression in a Korean elderly population

Our study aimed to examine the relationship between perceived sleep quality and depression using Pittsburgh Sleep Quality Index (PSQI) and Coles model to materialize the concept of perceived sleep quality in the non-cognitively impaired elderly. Older adults aged 60+ were recruited from the baseline study of Suwon Project (SP) between 2009 and 2011 (n=2040). Perceived sleep quality was measured using the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K), and depression was accessed using the Korean version of the Geriatric Depression Scale-Short Form (SGDS-K). We excluded the cognitively impaired elderly using the Korean version-Mini Mental Status Examination (K-MMSE) score less than or equal to 17. In multivariable adjusted logistic regression related to PSQI-K components, poor perceived sleep quality, including poor subjective sleep quality (Odds ratio (OR)=1.27, 95% confidence interval (CI)=1.01-1.61), longer sleep latency (OR=1.32, 95% CI=1.13-1.55) and the frequent use of sleeping medication (OR=1.30, 95% CI=1.10-1.53) were significantly associated with depression after adjusting for age, sex, education, living status, current smoking and current alcohol drinking, the number of comorbidity and Beck Anxiety Inventory (BAI). PSQI-K global score also had greater odds of reporting depression (OR=1.12, 95% CI=1.07-1.16). These results suggested that poor perceived sleep quality was associated with a greater level of depression in the elderly.

Psychological Distress in Young Adult Males with Atopic Dermatitis: A Cross-Sectional Study

Abstract The relationship between atopic dermatitis (AD) and psychological distress has been well established for children and adolescents. However, it is unclear whether this relationship exists in young adults. This study aimed to assess the relationship between AD and psychological distress in young male adults in South Korea. A cross-sectional study was conducted using regional conscription data from 2008 to 2012. A dermatologist diagnosed AD based on historical and clinical features, and determined severity using the eczema area and severity index. A psychiatrist used medical records, an interview, and a psychological test to examine psychological distress (depression, anxiety, and somatization). The relationship between psychological distress and AD was assessed by multivariate logistic regression analyses. Among the 120,508 conscripts, 1517 (1.2%) presented with AD. The odds of having each type of psychological distress were significantly greater for individuals with AD compared with those without AD. The adjusted odds ratios for depression, anxiety, and somatization were 1.79 (95% CI 1.40–2.29), 1.38 (95% CI 1.08–1.76), and 1.75 (95% CI 1.40–2.20), respectively. Moderate-to-severe AD was significantly related to depression and somatization to a greater extent compared with mild AD. Depression, anxiety, and somatization are strongly and independently associated with AD in young adult males. Early treatment of skin inflammation might modify the risk of psychiatric problems. Prospective cohort studies are needed to verify causal relationships.

Effect of hypertension on the resting-state functional connectivity in patients with Alzheimer's disease (AD)

BACKGROUND/OBJECTIVES Although hypertension is known to be a risk factor for AD, the effects of hypertension on brain function in AD patients are not well understood. We investigated alterations in resting-state functional connectivity according to the presence of hypertension in AD patients by using a method of correlation analysis based on a seed region in the posterior cingulate cortex (PCC). We also determined whether differences in resting-state connectivity were associated with gray matter atrophy. METHODS Thirty-seven AD patients (18 patients with hypertension and 19 patients without hypertension) underwent the resting-state functional magnetic resonance imaging. We obtained the PCC maps by a temporal correlation method, to identify alterations in the functional connectivity of the PCC in hypertensive group relative to non-hypertensive group. Voxel-based morphometry analysis was also applied to adjust the confounding effect of gray matter atrophy. RESULTS We detected a decreased connectivity to the PCC in the regions of subgenual anterior cingulated cortex (ACC) in hypertensive group relative to non-hypertensive group. However, we observed a pattern of increased connectivity between the PCC and the left inferior parietal cortex in hypertensive group. After correction for gray matter atrophy, all detected regions still remained significant. CONCLUSIONS Altered connectivity in AD patients with hypertension suggests the possibility that hypertension impairs resting-state functional connectivity of the AD brain, inducing a compensational process outside the impaired networks or disequilibrium in brain connectivity. This finding may account for an additional contribution of hypertension to the pathophysiology of AD.

Association of alcohol drinking with verbal and visuospatial memory impairment in older adults: Clinical Research Center for Dementia of South Korea (CREDOS) study

BACKGROUND The studys aim was to examine the association of alcohol consumption with verbal and visuospatial memory impairment in older people. METHODS Participants were 1,572, aged ≥60 years, in the hospital-based registry of the Clinical Research Center for Dementia of South Korea (CREDOS). Moderate drinking was defined as no more than seven drinks per week and three drinks per day. Memory impairment was defined as performance with more than 1 standard deviation below the mean value on the Seoul Verbal Learning Test and Rey Complex Figure Test. RESULTS Those who consumed alcohol moderately, compared with abstainers, had a lower odds of verbal memory impairment (Odds Ratio [OR] = 0.64; 95% Confidence Interval [CI]: 0.46-0.87), adjusting for covariates. Visuospatial memory, however, was not significantly associated with alcohol consumption. CONCLUSIONS Moderate alcohol drinking is associated with a reduced likelihood of verbal memory impairment among older people attending memory clinics.

Increased Plasma Levels of Heat Shock Protein 70 Associated with Subsequent Clinical Conversion to Mild Cognitive Impairment in Cognitively Healthy Elderly

Background and Aims Heat shock proteins (HSPs) have been regarded as cytoprotectants that protect brain cells during the progression of neurodegenerative diseases and from damage resulting from cerebral ischemia. In this study, we assessed the association between plasma HSP 70/27 levels and cognitive decline. Methods Among participants in the community-based cohort study of dementia called the Gwangju Dementia and Mild Cognitive Impairment Study, subjects without cognitive impairment at baseline, who then either remained without impairment (non-conversion group), or suffered mild cognitive impairment (MCI) (conversion group) (non-conversion group, N = 36; conversion group, N = 30) were analyzed. Results After a five to six year follow-up period, comparison of the plasma HSP 70 and HSP 27 levels of the two groups revealed that only the plasma HSP 70 level was associated with a conversion to MCI after adjustments for age, gender, years of education, follow-up duration, APOE e4, hypertension, and diabetes (repeated measure analysis of variance: F = 7.59, p = 0.008). Furthermore, an increase in plasma HSP 70 level was associated with cognitive decline in language and executive function (linear mixed model: Korean Boston Naming Test, -0.426 [-0.781, -0.071], p = 0.019; Controlled Oral Word Association Test, -0.176 [-0.328, -0.023], p = 0.024; Stroop Test, -0.304 [-0.458, -0.150], p<0.001). Conclusions These findings suggest that the plasma HSP 70 level may be related to cognitive decline in the elderly.

Frequency of contact with non-cohabitating adult children and risk of depression in elderly: A community-based three-year longitudinal study in Korea

PURPOSE Our study aimed to assess the longitudinal association of frequency of contact with non-cohabitating adult children and risk of depression in the elderly. METHODS Elderly aged ≥60 years were included from Living Profiles of Older People Survey (LPOPS) in Korea. The baseline assessment, Wave 1, was conducted in 2008, and follow-up assessment, Wave 2, was conducted in 2011. We included participants who completed both waves and excluded those who met the following criteria: no adult children, living with adult children, cognitive impairment at either waves, and depression at baseline (n=4398). We defined infrequent contact as <1 time per month face-to-face contact or <1 time per week phone contact and classified participants into four groups based on contact method and frequency. Depression was measured using the 15-item geriatric depression scales (SGDS-K). RESULTS In multivariable logistic regression analysis, infrequent face-to-face and phone contact group had adjusted odds ratio (OR) of 1.86 (95% CI, 1.44-2.42) when compared with frequent face-to-face and phone contact group. Frequent face-to-face contact with infrequent phone contact group and infrequent face-to-face contact with frequent phone contact group had adjusted OR of 1.49 (95% CI, 1.12-1.98) and 1.44 (95% CI, 1.15-1.80), respectively, when compared with frequent face-to-face and phone contact group. CONCLUSION These results propose that the risk of subsequent depression in elderly is associated with frequency of contact with non-cohabitating adult children. Moreover, the efficacy of face-to-face contact and that of phone contact were similar, while the group lacking both types of contact demonstrated the highest risk of depression.

MRI-defined versus clinically-defined vascular depression; comparison of prediction of functional disability in the elderly

BACKGROUND We compared the validity of models of subcortical ischemic depression (SID) and depression-executive dysfunction syndrome (DED) in predicting functional disability in the elderly. METHODS We obtained data from elderly Korean subjects (n=1356) aged 60 years or older at baseline from the CREDOS study from November 2005 to July 2014. A generalized estimating equation (GEE) model was constructed to measure functional disability using instrumental activity of daily living as a primary outcome. A risk factor of interest was SID and DED evaluated by a visual rating scale of deep white matter hyperintensity in MRI, Stroop test and Geriatric Depression Scale (GDS) score. Receiver-operating-characteristic plots and area under the curve (AUC) test were applied to examine the difference of the two definitions of vascular depression with predicted values of functional disability outcome. RESULTS The mean (SD) follow-up duration of the participants was 1.7 (0.9) years. The GEE model showed that presence of SID at baseline predicted functional disability compared to non-depressed subjects (GDS score: Odds ratio [OR] 1.76; 95% CI 1.23, 2.53; p=0.002). The association was also statistically significant among the DED group (OR 1.48; 95% CI 1.15, 1.92; p=0.003). There were no significant differences in predicting functional disability (95% CI: -0.003 to 0.009, p=0.366) according to AUC differences between SID and DED. CONCLUSIONS The results will be useful in evaluating the cardinal features of the vascular depression hypothesis in predicting functional disability.

Large intracranial volume accelerates conversion to dementia in males and APOE4 non-carriers with mild cognitive impairment.

BACKGROUND It is unclear how brain reserve interacts with gender and apolipoprotein E4 (APOE4) genotype, and how this influences the progression of Alzheimers disease (AD). The association between intracranial volume (ICV) and progression to AD in subjects with mild cognitive impairment (MCI), and differences according to gender and APOE4 genotype, was investigated. METHODS Data from subjects initially diagnosed with MCI and at least two visits were downloaded from the ADNI database. Those who progressed to AD were defined as converters. The longitudinal influence of ICV was determined by survival analysis. The time of conversion from MCI to AD was set as a fiducial point, as all converters would be at a similar disease stage then, and longitudinal trajectories of brain atrophy and cognitive decline around that point were compared using linear mixed models. RESULTS Large ICV increased the risk of conversion to AD in males (HR: 4.24, 95% confidence interval (CI): 1.17-15.40) and APOE4 non-carriers (HR: 10.00, 95% CI: 1.34-74.53), but not in females or APOE4 carriers. Cognitive decline and brain atrophy progressed at a faster rate in males with large ICV than in those with small ICV during the two years before and after the time of conversion. CONCLUSIONS Large ICV increased the risk of conversion to AD in males and APOE4 non-carriers with MCI. This may be due to its influence on disease trajectory, which shortens the duration of the MCI stage. A longitudinal model of progression trajectory is proposed.

Differential effects of white matter hyperintensity on geriatric depressive symptoms according to APOE-ε4 status

BACKGROUND We aimed to examine differential effects of WMH on progression of depressive symptoms according to APOE ε4 status in the elderly. METHODS We obtained data from elderly Korean subjects (n=707) aged 60 years or older at baseline from the CREDOS study from November 2005 to July 2014. A linear mixed model stratified according to APOE genotype (APOE ε4 carrier vs. non-carrier) was constructed using GDS score as a primary outcome and degree of overall, deep, periventricular WMH evaluated by a visual rating scale as a risk factor of interest. We also tested interaction between APOE ε4, WMH and time as predictors of clinical progression on GDS scores to examine the moderating effect of APOE ε4 allele on the relationship between degree of WMH and progression of geriatric depressive symptoms. RESULTS The mean (SD) follow-up duration of the participants was 2.0 (0.8) years. Among APOE ε4 carriers, a severe degree of overall and deep WMH, but not periventricular WMH, predicted progression of geriatric depressive symptoms (overall WMH: coefficient=0.96, p=0.010; deep WMH: 0.87, p=0.016). There were significant interaction between APOE ε4, degree of WMH and time in predicting GDS increase (5df, F=2.28, p=0.046). LIMITATIONS Only subjects seeking medical attention and with follow-up measurements were enrolled in this study. Specific location of WMH and use of antidepressant were uncontrolled. CONCLUSIONS Considering biological markers such as degree of WMH and APOE ε4 status may be clinically relevant to predicting progression of geriatric depressive symptoms.