Yoonseop So

Prevalence Rates of Dementia and Mild Cognitive Impairment Are Affected by the Diagnostic Parameter Changes for Neurocognitive Disorders in the DSM-5 in a Korean Population

Aim: To examine the impact of the revised diagnostic criteria for neurocognitive disorders (NCDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) on the prevalence of dementia and mild cognitive impairment (MCI). Methods: A total of 755 participants aged 65 years or older in the Nationwide Survey on Dementia Epidemiology in Korea 2012 were rediagnosed according to the DSM-5 criteria. Results: The estimated age-, gender-, education-, and urbanicity-standardized prevalence rates of major and mild NCDs were 8.35 and 11.10%, respectively, and those of dementia and MCI were 8.74 and 31.85%, respectively. Cohens κ for dementia and major NCD was 0.988, and that for MCI and mild NCD was 0.273. Conclusion: Diagnostic discrepancies between major/mild NCDs and dementia/MCI might depend on the operationalization of neuropsychological performance criteria.

PHYSICAL ACTIVITY IN INDIVIDUALS WITH DEMENTIA OR MILD COGNITIVE IMPAIRMENT: A META-ANALYSIS STUDY

(non-surgery) or 6 months after surgery.Primary outcome measures are visual acuity and QoL (VF-14).43 participants have been enrolled with recruitment ongoing. The current analysis includes 28 protocol completers: 20 in the surgery group, 8 in the non-surgery group. Results: Analysis of these 28 subjects showed improvement in visual acuity (logMAR OD -0.329 and -0.072; logMar OS -0.238 and -0.026, respectively) and VF-14 (+5.5 vs. -4.9). Digit cancellation (mean changes -1.462; vs. -2.400) and MMSE (+0.625;vs. -2.125] were better in subjects with surgery. ADCS-ADL declined less (-1.2 vs. -3.5); total NPI scores and caregiver distress scores were reduced in the surgery group. Conclusions: Our preliminary results show that cataract surgery can improve visual acuity and visual QoL, while reducing decline in memory, and executive function and showing improvements in behavioral measures. Our findings suggest the need to aggressively address dementia co-morbidities such as cataract impairing vision while balancing safety and medical risks.

Cognitive stimulation as a therapeutic modality for dementia: A meta-analysis

Objective Although cognitive stimulation (CS) is one of the most popular non-pharmacological interventions for people with dementia, its efficacy is still debatable. We performed a meta-analysis of randomized controlled trials (RCTs) on the efficacy of CS in people with dementia. Methods Data sources were identified by searching PubMed, MEDLINE, Embase, psychINFO, and Cochrane Reviews Library. A total of 7,354 articles were identified, and of these, 30 RCTs were selected based on the selection criteria. Of these 30 RCTs, 14 were finally included in our meta-analysis [731 participants with dementia; 412 received CS (CS group) and 319 received usual care (control group)]. Results We found that the people with dementia had a moderate benefit from CS. The mean difference between the CS and control groups was 2.21 [95% CI (0.93, 3.49), Z=3.38, p=0.00007] in the Alzheimers Disease Assessment Scale-Cognition and 1.41 [95% CI (0.98, 1.84), Z=6.39, p<0.00001] in the Mini-Mental State Examination. CS also improved quality of life in people with dementia [95% CI (0.72, 3.38), Z=3.02, p=0.003]. Conclusion CS is effective for improving cognition and quality of life in people with dementia; however, its effects were small to moderate.

Anhedonia is associated with the risk of Alzheimer's disease in elders with mild cognitive impairment: Results from the Korean Longitudinal Study on Health and Aging (KLOSHA)

rodent basal forebrain cholinergic neurons with established gene expression levels. Reconstruction of neurons and network function were acquired using the Transcriptome-To-Physiome NeurobioSimulation. Gene expression values [NCBI GEO GSE 13379] were used to derive protein level and kinetic parameters for ligand and voltage gated ion channels in the TTP NeurobioSimulator Model using COPASI software. Global parameters for membrane potential used permeability and ion concentrations inside and outside of the membrane in the Goldman-Hodgkin-Katz equation. Three compartments of the model neuron are included: glutamate synapse, distal dendrite, and proximal dendrite. Results: The simulation of voltage-gated sodium channel activation and inactivated states of distal dendrites of cholinergic modeled neurons depends on the Excitatory Post Synaptic Potential (EPSP) event. This distally activated event yielded temporally relevant proximal dendritic activation and inactivation of voltage-gated sodium and potassium channels in the reconstructed neuron. Voltage-gated sodium channel open state duration, in the dendrites, could be modified by adjusting the kvalue for transition to the inactivation state of the channel; whereas the concentration determined the peak amplitude. Simulated electrophysiological signatures exhibited similar temporal summation dynamics as those observed in the literature. Conclusions: Our current work demonstrates that electrophysiological reconstruction of basal forebrain cholinergic rodent neurons is not only feasible and reliable but time sensitive and cost effective making this novelmethodology an effective approach towards developing therapeutics for neurodegenerative diseases. In future studies, we will reconstruct the electrophysiology of vulnerable neuronal populations in theADbrain and compare them to controls thus lending substantial insight into molecular and network function corollary to neuropathogenesis. Our novel approach will ascertain the roles of diverse genes in neuronal functions that are impaired in AD.

Overview of the Korean Longitudinal Study on Cognitive Aging and Dementia

Objective Due to an unprecedented rate of population aging, South Korea is facing a dementia epidemic. For this reason, the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) was launched in 2009 with support from the Korean Health Industry Development Institute to investigate the epidemiology, biopsychosocial risk factors, and outcomes of dementia and dementia-related conditions. Methods The KLOSCAD is the first nationwide multi-center population-based prospective cohort study. In October 2010, 12,694 individuals were randomly sampled from residents aged 60 years or older who lived in 13 districts across South Korea. In the baseline assessment, which was conducted from November 2010 through October 2012, 6,818 (53.7%) individuals participated. Follow-up assessments have been conducted every two years, with the first follow-up assessment conducted between November 2012 and October 2014, and the second between November 2014 and October 2016. The third is now in progress, and will span from November 2016 to October 2018. Diagnosis of cognitive disorders, neuropsychological battery, behavioral and psychological symptoms of dementia, activities of daily living, physical and neurologic examination and laboratory tests, life styles, quality of life, and identification of death were evaluated in each assessment. Results The cumulative drop-out rate at the second follow-up assessment was 38.7%. Dementia and mild cognitive impairment were 5.0% and 27.0%, respectively. Conclusion The KLOSCAD may provide strong scientific evidence for advancing the fight against dementia both in Korea and globally.

Gait Variability Can Predict the Risk of Cognitive Decline in Cognitively Normal Older People

Background: The aim of this study was to investigate the association of gait speed and gait variability, an index of how much gait parameters, such as step time, fluctuate step-to-step, with risk of cognitive decline in cognitively normal elderly individuals. While high gait variability is emerging as an early indicator of dementing illnesses, there is little research on whether high gait variability predicts cognitive decline in cognitively normal elderly who have no evidence of cognitive impairment. Methods: In this 4-year prospective cohort study on 91 community-dwelling cognitively normal elderly individuals without cerebral ischemic burden or Parkinsonism, we evaluated gait speed and step time variability using a tri-axial accelerometer placed on the center of body mass, and diagnosed mild cognitive impairment (MCI) according to the International Working Group on MCI. We performed Kaplan-Meier analysis with consecutive log-rank testing for MCI-free survival by cohort-specific tertiles of gait speed; hazard ratios (HR) of incident MCI were estimated using Cox proportional hazards regression analysis adjusted for age, sex, education level, Cumulative Illness Rating Scale score, GDS score, and presence of the apolipoprotein E ε4 allele. Results: Out of the 91 participants in the baseline assessment, 87 completed one or more 2-year follow-up assessments, and the median duration of follow-up was 47.1 months. Kaplan-Meier curves of incident MCI show evident differences in risk by gait variability group (χ2 = 9.64, p = 0.002, log-rank test). Mean MCI-free survival in the high variability group was 12% shorter than in the mid-to-low tertile group (47.4 ± 1.74 [SD] vs. 54.04 ± 0.52 months), while it was comparable between gait speed groups (51.59 ± 0.70 vs. 50.64 ± 1.77 months; χ2 = 1.16, p = 0.281). In multivariate analysis, subjects with high gait variability showed about 12-fold higher risk of MCI (HR = 11.97, 95% CI = 1.29–111.37) than those with mid-to-low variability. However, those with slow gait speed showed comparable MCI risk to those with mid-to-high speed (HR = 5.04, 95% CI = 0.53–48.18). Conclusions: Gait variability may be a better predictor of cognitive decline than gait speed in cognitively normal elderly individuals without cerebral ischemic burden or Parkinsonism.

High use of dietary supplements is associated with a decreased risk of cognitive impairment: A cohort study from KLOSCAD

literature, in contrast to the increasing prescription of these routes. Our aim was to evaluate mortality and survival of demented elderly with advanced dementia with dysphagia and to compare these outcomes between patients on oral or enteral routes of nutrition. Hospital admissions, incidence of pneumonia and caregiver overload were also compared.Methods:A prospective observational cohort wit 64 patients (32 with oral and 32 with enteral route) was estimated to evaluate mortality and survival by the method of KaplanMeier. Patients with advanced dementia define as FAST 7A or worse were included. Patients with dementia of other etiologies, ALS, tracheotomies and cancer were excluded. Follow upwas performed by telephone for a minimum of 6 months. The scale by Zarit et al was employed to evaluate caregiver overload.Results: 67 patients were recruited, 36 in the oral route arm, 55,2%with probable Alzheimer’s dementia, 85.1% classified as FAST 7C or above. Mean age was 84.79, the majority of patients were females (85.1%), widowers (56.7%) and with low level of education (2.9 years, average). Both groups were similar with respect to all sociodemographic and clinical variables, with the exception of place of recruitment (hospital or outpatient) and number of pressure ulcers. Mortality after 3 months was 11,1% among patients in the oral route group and 41,9% in the alternative route group (p1⁄40,004), increasing to 27,8% and 58,1%, respectively, at 6 months (p1⁄40.012). The Kaplan-Meier survival analysis showed increased survival in oral route patients (p1⁄40,004), which persisted after censoring of crossover (p1⁄4 0.01) and group migration after crossover (p<0.001). More aspiration pneumonia diagnosis were observed among patients in the alternative route group (p1⁄40.006), but there were no differences in hospital admissions between groups (p1⁄40.365). No differences between groups were observed in caregiver overload at recruitment and at follow up. Conclusions: The use of alternative feeding routes resulted in increased mortality in demented elderly and more hospital admissions were observed in this group. Frequency of pneumonia and caregiver overload were similar in both groups.

Dementia epidemiology in Korea: Comparison of the results from the Nationwide Survey on the Dementia Epidemiology (NaSDEK) 2008 and the NaSDEK 2012

3M/4F), were assessed at UCL. Based on Clinical Dementia Rating (CDR), 12 carriers were asymptomatic (aMut+; CDR 1⁄4 0; mean age 1⁄4 35; 4M/8F) and eight symptomatic (sMut+; CDR 1⁄4 0.5-1; mean age 1⁄4 47; 5M/3F). Frontal, striatal (caudate and pallidum) and thalamic ’nodes’ of the loops of interest were automatically parcellated from structural MRI. Thalamofrontal tractography was performed for the NC, both via striatal ’waypoints’ and directly. The tracts were normalized, registered to standard space, averaged and thresholded. Tract average fractional anisotropy (FA) and mean diffusivity (MD) were then computed from native images using these template tracts. Effective connectivity between nodes was sDCM-estimated from the fMRI data (Figure.). Linear regression was used to compare metrics between groups (NC, aMut+, sMut+), adjusted for age and gender. Results: Both tract FA and MD revealed group differences: significant sMut+ > NC differences were found for all three loops (aCC, dlPFC and latOFC) bilaterally. Compared to aMut+, sMut+ had higher MD in right dlPFC-thalamus tract and lower FA and higher MD in right latOFC-thalamus tract. The aMut+ had lower FA than NC in left thalamus-latOFC tract. sDCM suggested left-hemisphere aCC connectivity abnormalities for sMut+ relative to both NC and aMut+. No sDCM differences were observed between aMut+ and NC. The Table shows these results and group-average FA, MD and connectivity values. Conclusions: Fronto-striato-thalamic tract structure is altered in FAD. Abnormal effective connectivity was also suggested by sDCM, but requires confirmation in a larger cohort.