Yoonseok Huh

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.

Standardization of the Korean Version of the Geriatric Depression Scale: Reliability, Validity, and Factor Structure

Objective We developed a Revised Korean version of the Geriatric Depression Scale (GDS-KR) and examined its reliability, validity, and factor structures. We also estimated its optimal cutoff scores for major depressive disorder (MDD) and minor depressive disorder (MnDD) stratified by age and education. Methods The GDS-KR was administered to 888 subjects (61 MDD patients, 45 MnDD patients, and 782 normal elders). Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D-K) and Hamilton Depression Rating Scale (HAM-D). The mean GDS-KR scores of the MDD patients, MnDD patients and normal elders were compared to evaluate its discriminant validity. To evaluate its construct validity, a principal component analysis with varimax rotation was performed. Receiver operator characteristic (ROC) curve analyses were performed to evaluate its diagnostic ability. Results Chronbachs coefficient alpha for the GDS-KR was 0.90 and the test-retest reliability was 0.91 (p<0.01). The Pearson correlation coefficients of the GDS-KR scores with the CES-D-K and HAM-D scores were 0.63 (p<0.01) and 0.56 (p<0.01), respectively. The GDS-KR consisted of 5 factors. The optimal cut-off scores of the GDS-KR were 16/17 for MDD only and 15/16 for both MDD and MnDD. The optimal cutoff scores of the GDS-KR were higher in the less educated and younger subjects. The diagnostic accuracy for MDD of the GDS-KR was higher than that of the CES-D. Conclusion The GDS-KR was found to be a reliable and valid questionnaire for screening MDD and MnDD in late life.

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.

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.

Korean Version of Frontal Assessment Battery: Psychometric Properties and Normative Data

Background: We developed the Korean version of the Frontal Assessment Battery (FAB-K), evaluated its psychometric properties and constructed normative data for Korean elders. Methods: FAB-K was administered to 300 Alzheimer’s disease (AD) patients and 635 normal controls. Reliability of FAB-K was evaluated by testing its internal consistency, test-retest and inter-rater reliabilities. Validity of FAB-K was evaluated by testing discriminant validity for AD and concurrent validity with other frontal function tests. Age- and education-specific normative data of FAB-K were developed. Results: Cronbach’s α, inter-rater reliability and test-retest reliability of FAB-K were 0.802, 0.980 (p < 0.001) and 0.820 (p < 0.001), respectively. FAB-K exhibited significant correlations with the scores of MMSE and other frontal function tests (p < 0.01). Total and item scores of FAB-K were lower in AD patients than in controls and became worse as clinical dementia rating increased (F = 192.026, d.f. = 4, p < 0.001). The optimal cut-off score of FAB-K for AD was determined as 10/11, where sensitivity and specificity for AD were 0.717 and 0.827, respectively. Normative data were stratified by 3 age groups and 4 education groups. Conclusion: The FAB-K is a valid and reliable instrument for evaluating frontal dysfunction, and may be useful for screening AD.

Impacts of Poor Social Support on General Health Status in Community-Dwelling Korean Elderly: The Results from the Korean Longitudinal Study on Health and Aging

Objective We investigated the influence of social support on health, quality of life (QOL), and the risk of depression in elderly Korean people. Methods This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A total of 787 nondemented community-dwelling elderly aged 65 years or older were recruited and underwent clinical evaluations for dementia and psychiatric disorders conformed to Korean version of the Consortium to Establish a Registry for Alzheimers Disease Clinical Assessment Battery (CERAD-K) and the Korean version of the Mini-International Neuropsychiatric Interview (MINI), respectively. Social support was assessed using the Medical Outcome Study Social Support Survey (MOS-SSS). Poor social support (PSS) was defined as having a MOS-SSS score below the 25th percentile of the entire sample. General health status was comprehensively evaluated using the modified Cumulative Illness Rating Scale (CIRS), the Korean version of the Geriatric Depression Scale (GDS-K), Mini-Mental Status Examination (MMSE-KC), Korean Activities of Daily Living (KADL), and Korean Instrumental Activities of Daily Living (KIADL). Health-related QOL was evaluated using the Short Form 36 (SF-36). Results Low educational attainment and living alone were associated with PSS. Geriatric depression was more prevalent in the PSS group (OR=3.05, 95% CI=1.77-5.27) than in the normal social support (NSS) group. Among the various forms of social support, positive social interaction was significantly associated with risk of geriatric depression (OR=2.25, 95% CI=1.07-4.73). Although health-related QOL was lower in the PSS group than in the NSS group, the ADL and IADL scores of the subjects in the PSS group were better than those of the subjects in the NSS group. In the subjects with geriatric depression, PSS was associated with more severe depression, higher medical morbidity, and poor QOL. Conclusion PSS had a negative influence on the general health status and QOL among community-dwelling elderly and was an independent risk factor of geriatric depression.

Prevalence of Stroke and Transient Ischemic Attack in Korean Elders Findings From the Korean Longitudinal Study on Health and Aging (KLoSHA)

Background and Purpose— Studies on the epidemiology of stroke and transient ischemic attack (TIA) are very limited in Asian elderly populations. We investigate the prevalence, risk factors, and neuropsychiatric comorbidities of stroke and TIA in community-dwelling Korean elders. Methods— Standardized face-to-face interviews, neurological examinations, and physical examinations were conducted in 714 randomly sampled community-dwelling Korean elders aged ≥65 years. Diagnoses of stroke and TIA were made according to the World Health Organization criteria. Results— Age- and education-standardized prevalences of stroke, TIA, and cerebrovascular disorder (implying stroke or TIA) were estimated to be 10.1%, 8.9%, and 15.4%, respectively, in Korean elders. Hypertension and current smoking were associated with the risk of stroke, whereas atrial fibrillation, high diastolic blood pressure, high serum low-density lipoprotein cholesterol, and hypertension were associated with the risk of TIA. Cerebrovascular disorder was associated with the risk of major depressive disorder, vascular dementia, and nonamnestic mild cognitive impairment (P<0.05). Conclusion— Prevalences of stroke and TIA in Korean elders were higher than in white elders. Stroke and TIA were associated with increased risk of depression and cognitive disorders.

Prevalence and neuropsychiatric comorbidities of alcohol use disorders in an elderly Korean population

We investigated the prevalence and comorbidities of problem drinking in community‐dwelling elders living in Korea.

Impact of alcohol use on mortality in the elderly: Results from the Korean Longitudinal Study on Health and Aging

BACKGROUND To examine the effects of problematic drinking, amount of alcohol use and binge drinking on all-cause mortality in the elderly. METHODS We investigated 45-month all-cause mortality of 997 randomly sampled community-dwelling elderly Koreans aged 65 years or older who participated in the Korean Longitudinal Study on Health and Aging. Problematic drinking was defined as having alcohol use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria or having 8 or higher of the Alcohol Use Disorders Identification Test. Light drinking was defined as drinking 7 alcoholic drinks or less, and heavy drinking as having 14 alcoholic drinks more per week during past 12 months. Binge drinking was defined as having 6 or more drinks on a single occasion at least monthly. RESULTS One hundred and thirteen participants (11.3%) died during the 45-month follow-up period. Heavy drinking (>14 alcoholic drinks per week) increased the all-cause mortality risk when in association with problematic drinking (hazard ratio [HR]=2.604, 95% confidence interval [CI]=1.221-5.553, p=0.012) or binge drinking (HR=2.823, 95% CI=1.259-6.328, p=0.013). Light drinking (≤ 7 alcoholic drinks per week) was associated with decreased all-cause mortality (HR=0.114, 95% CI=0.015-0.833, p=0.032). CONCLUSIONS Problematic drinking is associated with increased all-cause mortality in elderly Koreas, particularly when it is heavy and/or combined with binge drinking.

Role of severity and gender in the association between late-life depression and all-cause mortality

BACKGROUND Mortality associated with depression may be influenced by severity of depression and gender. We investigated the differential impacts on all-cause mortality of late-life depression by the type of depression (major depressive disorder, MDD; minor depressive disorder, MnDD; subsyndromal depression, SSD) and gender after adjusting comorbid conditions in the randomly sampled elderly. METHODS One thousand community-dwelling elderly individuals were enrolled. Standardized face-to-face clinical interviews, neurological examination, and physical examination were conducted to diagnose depressive disorders and comorbid cognitive disorders. Depressive disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria and SSD to study-specific operational criteria. Five-year survivals were compared between groups using Cox proportional hazards models. RESULTS By the end of 2010, 174 subjects (17.4%) died. Depressive disorder (p = 0.001) and its interaction term with gender (p < 0.001) were significant in predicting five-year survival. MDD was an independent risk factor for mortality in men (hazard ratio = 3.65, 95% confidence interval = 1.67-7.96) whereas MnDD and SSD were not when other risk factors were adjusted. CONCLUSIONS MDD may directly confer the risk of mortality in elderly men whereas non-major depression may be just an indicator of increased mortality in both genders.