Su-Jin Yang

Interactions Between Life Stressors and Susceptibility Genes (5-HTTLPR and BDNF) on Depression in Korean Elders

BACKGROUND It has been reported that the functional polymorphism in the serotonin transporter gene linked promoter region (5-HTTLPR) modifies the association between stressful life events (SLEs) and depression in child, adolescent, and adult populations. We sought to replicate this finding in elders and, additionally, to test modifying effects of the brain-derived neurotrophic factor (BDNF) val66met polymorphism. METHODS In 732 Korean community residents ages 65+, diagnosis of depression (Geriatric Mental State Schedule), information on SLEs, and genotypes for 5-HTTLPR and BDNF val66met were ascertained. Of those without depression at baseline, 521 (88%) were followed up 2.5 years later. Interactions between SLEs and the two genotypes were investigated for both prevalent depression at baseline and incident depression at follow-up. RESULTS Significant interactions of SLEs with both 5-HTTLPR and BDNF genotypes were observed on risk of depression after adjustment for age, gender, education, and disability. A significant three-way interaction between 5-HTTLPR, BDNF, and SLEs was also found. The same findings were observed for predictors of incident depression in the prospective analysis. CONCLUSIONS These findings suggest that environmental risk of depression is modified by at least two genes and that gene-environment interactions are found even into old age.

Predictive value of folate, vitamin B12 and homocysteine levels in late-life depression

BACKGROUND The role of folate, vitamin B(12) and homocysteine levels in depression is not clear. AIMS To investigate cross-sectional and prospective associations between folate, B(12) and homocysteine levels and late-life depression. METHOD A total of 732 Korean people aged 65 years or over were evaluated at baseline. Of the 631 persons who were not depressed, 521 (83%) were followed over a period of 2-3 years and incident depression was ascertained with the Geriatric Mental State schedule. Serum folate, serum vitamin B(12) and plasma homocysteine levels were assayed at both baseline and follow-up. RESULTS Lower levels of folate and vitamin B(12) and higher homocysteine levels at baseline were associated with a higher risk of incident depression at follow-up. Incident depression was associated with a decline in vitamin B(12) and an increase in homocysteine levels over the follow-up period. CONCLUSIONS Lower folate, lower vitamin B(12) and raised homocysteine levels may be risk factors for late-life depression.

Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression

Aims:  The purpose of the present paper was to evaluate the effectiveness of mirtazapine orally disintegrating tablets for nausea and sleep disturbance, which are common and distressing symptoms of cancer.

Risperidone versus olanzapine for the treatment of delirium

This study compared the effectiveness of risperidone and olanzapine in the treatment of delirium.

Differences in predictors of traditional and cyber-bullying: a 2-year longitudinal study in Korean school children

Traditional bullying has received considerable research but the emerging phenomenon of cyber-bullying much less so. Our study aims to investigate environmental and psychological factors associated with traditional and cyber-bullying. In a school-based 2-year prospective survey, information was collected on 1,344 children aged 10 including bullying behavior/experience, depression, anxiety, coping strategies, self-esteem, and psychopathology. Parents reported demographic data, general health, and attention-deficit hyperactivity disorder (ADHD) symptoms. These were investigated in relation to traditional and cyber-bullying perpetration and victimization at age 12. Male gender and depressive symptoms were associated with all types of bullying behavior and experience. Living with a single parent was associated with perpetration of traditional bullying while higher ADHD symptoms were associated with victimization from this. Lower academic achievement and lower self esteem were associated with cyber-bullying perpetration and victimization, and anxiety symptoms with cyber-bullying perpetration. After adjustment, previous bullying perpetration was associated with victimization from cyber-bullying but not other outcomes. Cyber-bullying has differences in predictors from traditional bullying and intervention programmes need to take these into consideration.

BDNF genotype potentially modifying the association between incident stroke and depression.

OBJECTIVE To investigate the role of the brain-derived neurotrophic factor (BDNF) gene val66met polymorphism in the association between stroke and depression. METHOD Five hundred community residents aged >65 years without stroke or depression at baseline were re-evaluated after 2 years. Disability (World Health Organization Disability Assessment Schedule, WHODAS II), cognitive function (Mini-Mental State Examination, MMSE), and BDNF genotype were also measured at baseline. RESULTS The association between incident stroke and depression was strengthened progressively with increasing numbers of met alleles, and was only significant in subjects with the met/met genotype after adjustment for disability and cognitive function. CONCLUSION The BDNF val66met polymorphism may modify the association between stroke and depression.

Role of BDNF val66met polymorphism on the association between physical activity and incident dementia

BACKGROUND Increased physical activity may have beneficial effects on cognitive outcomes; a role of brain-derived neurotrophic factor (BDNF) has been suggested in animal models but not yet tested in humans. This study investigated modification by BDNF val66met polymorphism of the association between physical activity, incident dementia and other cognitive outcomes. METHODS Of 732 community elders, 107 had dementia at baseline, and 518 (83%) of the remainder were followed over 2.4 years. Cognitive impairment and decline were defined from Mini-Mental State Examination scores. Self-reported level of physical activity was recorded on a 4-point scale. BDNF val66met and apolipoprotein E genotypes were ascertained. Covariates included age, sex, education, depression, vascular risk factors, and instrumental activities of daily living. RESULTS Baseline lower physical activity was significantly associated with incident dementia as well as with baseline dementia and cognitive impairment and incident cognitive decline. BDNF val66met polymorphism itself was not associated with any cognitive outcome. However, the strength of association between lower activity and all cognitive outcomes increased incrementally with the number of met alleles, and was strongest in those with the met/met genotype. BDNF×activity interaction terms were stronger for prospective outcomes (incident dementia, cognitive decline) compared to cross-sectional outcomes (prevalent dementia, cognitive impairment no dementia). CONCLUSIONS This study supports a previously suggested neurobiological basis for the effects of physical activity on dementia involving the BDNF system since the met allele is recognised to be associated with lower activity-dependent secretion of BDNF.

Effectiveness of switching to aripiprazole from atypical antipsychotics in patients with schizophrenia.

Objective:To examine changes in cognitive function and clinical features after a switch from atypical antipsychotics to aripiprazole in patients with schizophrenia. Method:Sixty-one patients with schizophrenia treated with atypical antipsychotics participated in this open-label, 26-week study. Antipsychotics were switched to aripiprazole, and neurocognitive functions were measured at 12 and 26 weeks using the computerized battery. The secondary outcome measures were the Positive and Negative Syndrome Scale, the Social and Occupational Functioning Assessment Scale, the Calgary Depression Scale for Schizophrenia, the Subjective Well-being Under Neuroleptics Scale, and the Drug Attitude Inventory (DAI). The safety measures included metabolic parameters, the Simpson-Angus Rating Scale, the Barnes Akathisia Scale, and the Abnormal Involuntary Movement Scale. Results:Significant improvements in cognitive function were observed in the Verbal Learning Test, the Wisconsin Card Sorting Test, and the Trail Making Test part A after a switch to aripiprazole. Scores on the Positive and Negative Syndrome Scale, the Social and Occupational Functioning Assessment Scale, the DAI, the Simpson-Angus Rating Scale, and the Abnormal Involuntary Movement Scale were significantly improved. The metabolic parameters, including serum cholesterol levels, were also improved. The changes in cognitive measures were not correlated with the changes in positive symptoms or movements scales. The improvement of the scores on the DAI and the delayed recall of the Verbal Learning Test were significantly greater in the patients treated with antipsychotics for less than 1 year than in those treated for more than 1 year, in whom the improvement in metabolic parameters was significantly greater. Conclusions:Patients with schizophrenia who switched from their previous antipsychotics to aripiprazole demonstrated improvements in cognitive function, psychotic symptoms, social function, attitude toward medication, and metabolic abnormalities.

Association between attitude toward medication and neurocognitive function in schizophrenia.

Objectives: A patients attitude toward medication is important for medication adherence, which is a key determinant of outcome in schizophrenia. This study examined the association between attitude toward antipsychotic medication and clinical status, particularly neurocognitive function, in patients with schizophrenia. Method: Ninety-two patients meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for schizophrenia participated in this study. The attitudes of the subjects toward medication were evaluated using the Drug Attitude Inventory (DAI). Clinical characteristics, including psychiatric symptoms and side effects of medication were evaluated. Neurocognitive function was measured using the Mini Mental State Examination and a computerized battery consisting of the Digit Span Test, Verbal Learning Test, Continuous Performance Test, Wisconsin Card Sorting Test, Finger Tapping Test, and Trail Making Test, parts A and B. The associations between attitude toward medication and neurocognitive function and clinical characteristics were analyzed. Results: The scores on the DAI were not significantly correlated with the clinical characteristics, such as psychopathology, subjective well-being, or neuroleptic-induced extrapyramidal side effects. Instead, the scores on the DAI were significantly correlated with the learning index and delayed free recall on the Verbal Learning Test, the number of categories completed on the Wisconsin Card Sorting Test, and omission and commission errors on the Continuous Performance Test; the scores were not significantly correlated with measures on the Mini Mental State Examination, Digit Span Test, Finger Tapping Test, or Trail Making Test. Conclusions: Our findings indicate that a patients attitude toward medication is associated with neurocognitive function. Specifically, verbal learning memory, executive functioning, and sustained attention were associated with attitude toward medication.

Folate, Vitamin B12, and Homocysteine as Risk Factors for Cognitive Decline in the Elderly

Objective Cross-sectional studies have shown that the dysregulation of one-carbon metabolism is associated with cognitive impairment. However, the findings of longitudinal studies investigating this association have been inconsistent. This study investigated the prospective associations between cognitive decline and the levels of folate, vitamin B12 and homocysteine both at baseline and over course of the study period. Methods A total of 607 (83%) elderly individuals were selected from a group of 732 elderly individuals without dementia at baseline and followed over a 2.4-year study period. The Mini-Mental State Examination (MMSE) was administered to the subjects, and the serum levels of folate, vitamin B12 and homocysteine were assayed both at baseline and at follow-up examinations. Covariates included demographic data, disability, depression, alcohol consumption, physical activity, vascular risk factors, serum creatinine level, vitamin intake, and apolipoprotein E genotype. Results Cognitive decline was associated with decreasing quintiles of folate at baseline, a relative decline in folate and an increase in homocysteine across the two examinations after adjustment for relevant covariates. Conclusion These results suggest that folate and homocysteine are involved in the etiology of cognitive decline in the elderly.