The Effects of Galantamine Treatment on Attention and Its Relationship with Cognition and Activities of Daily Living in Patients with Mild to Moderate Alzheimer's Disease

BACKGROUND AND PURPOSE: The positive effects of galantamine on cognition and activities of daily living (ADL) in Alzheimer's disease (AD) are thought to be mediated via improvements in attention. The purpose of this study was to determine the effect of galantamine on attention in AD patients using a computerized attention test and to elucidate the relationship between improvements in attention and change in cognition and ADL. METHODS: In this multicenter, open-label, prospective study, patients with mild to moderate AD received galantamine and then submitted to computerized attention tests, the Alzheimer's Disease Assessment Scale-cognitive subscale, and instrumental ADL (IADL) at baseline, 4 weeks, and 12 weeks. The differences in reaction time on computerized tests were explored relative to the changes in cognition and IADL. RESULTS: After 12 weeks of taking the trial medication there was a significant reduction from baseline levels in the choice reaction time (baseline, 5,216+/-3,650 sec; 12 weeks, 4,139+/-2,920 sec; p<0.01) and the simple reaction time (baseline, 1,089+/-782 sec; 12 weeks, 908+/-606 sec; p<0.01). Correlation analyses of changes in choice or simple reaction times relative to cognition and ADL measures yielded no significant associations. The improvement in attention observed at 4 weeks of galantamine treatment was not associated with any significant changes in outcome measures at the end of trial. CONCLUSIONS: This study found no significant association between the improvement in attention after treatment with galantamine and changes in cognition and ADL in patients with mild to moderate AD, despite the significant improvement in attention over the course of the treatment.

A Validation Study of the Korean-version of Symmetry, Ordering and Arranging Questionnaire / 신경정신의학

OBJECTIVES: The Symmetry, Ordering and Arranging Questionnaire (SOAQ) has been reported as a valid tool for the assessment of symmetry, ordering and arranging compulsive behaviors of patients with obsessive compulsive disorder. It was introduced by Radomsky and Rachman in 2004. The aim of this study was to assess the reliability, validity and psychometric properties of the Korean-version of the SOAQ (K-SOAQ). METHODS: Two hundreds twenty eight under-graduate college students were enrolled in this study. They were assessed with K-SOAQ, Obsessive-Compulsive Inventory-Revised (OCI-R), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Statistical analysis was done using calculation of Cronbach's alpha, Spearman Correlation Coefficient and Principal Components Analysis. RESULTS: There were no significant differences in sex, education, and total scores of BDI and BAI. The Cronbach's alpha coefficient of K-SOAQ was high, Cronbach's alpha=0.96. There was strong evidence for a one-factor solution, accounting for 60.3% of the variance. Convergent validity was examined through correlations between the SOAQ and the OCI-R (r=0.61). Divergent validity was examined through correlations between the SOAQ and two self report measures; BDI (r=0.12) and BAI (r=0.19). CONCLUSION: The K-SOAQ showed good reliability and validity for the assessment of severity of compulsive characteristics regarding symmetry, ordering and arranging. The K-SOAQ is a useful instrument for assessing compulsive symptoms related with symmetry, ordering and arranging in Korea.

Evidence-Based Psychiatry / 신경정신의학

Evidence-based medicine (EBM) has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. EBM could be a meme in medicine that is transferred from one clinical filed to another. The knowledge base that informs clinical decision has been growing with a very rapid pace making it a difficult challenge for the busy clinician to keep up with this growing and high volume of research findings. To keep up to date with the best research evidence, clinicians need a set of strategies. EBM may be the solution of this challenge. The term, Evidence-Based Psychiatry (EBP) was introduced by Elliot Goldner and Dan Bilsker in 1995. The purposes of this review are to introduce EBP and to find the best way to adopt the evidence-based approach to the practice of psychiatry in Korea. For these purposes, we reviewed the practice of EBM and discussed the application of EBP in Korean psychiatric field of medicine.

Assessment of Abdominal Fat and Mid-Thigh Low-Density Muscle Areas in Patients with Schizophrenia / 대한정신약물학회지

OBJECTIVE: Patients with schizophrenia are at a higher risk for developing insulin resistance and type 2 diabetes mellitus (T2DM). However, few studies have examined abdominal fat and mid-thigh low-density muscle areas, which are known risk factors for insulin resistance and T2DM, in patients with schizophrenia. Therefore, we measured the abdominal fat and mid-thigh low-density muscle areas of schizophrenics and compared them with normal controls. METHODS: Nineteen (four men and 15 women) drug-naive or -free subjects who met the DSM IV criteria for schizophrenia and 19 age- and sex-matched controls were recruited. We measured weight, height, waist circumference, and percent body fat, and calculated the body mass index (BMI). Abdominal fat and mid-thigh low-density muscle areas were evaluated using computed tomography. RESULTS: There was no significant difference in terms of age and BMI between the two groups. The areas of abdominal fat (262.4+/-101.8 vs. 257.1+/-93.8 cm2 ; p=0.919), subcutaneous fat (182.4+/-72.8 vs. 180.5+/-75.1 cm2 ; p=0.988), visceral fat (79.9+/-47.2 vs. 76.6+/-49.3 cm2 ; p=0.872), and mid-thigh low-density muscle (15.0+/-9.9 vs. 15.4+/-5.2 cm2, p=0.373) did not differ between schizophrenics and controls. CONCLUSION: Abdominal obesity is a well-recognized risk factor for developing certain medical conditions such as insulin resistance and T2DM. We demonstrated that drug-naive or- free patients with schizophrenia do not have increased visceral fat or mid-thigh low-density muscle areas, which might have explained the higher prevalence of insulin resistance and T2DM in these patients.

Virtual Reality in Current and Future Psychiatry

Virtual reality technology is now being used in neuropsychological assessment and real-world applications of many psychiatric disorders, including anxiety disorders, schizophrenia, child psychiatric disorders, dementia, and substance related disorders. These applications are growing rapidly due to recent evolution in both hardware and software of virtual reality. In this paper, we review these current applications and discuss the future work of clinical, ethical, and technological aspects needed to refine and expand these applications to psychiatry.

Effect of ApoE Genotype on the Relationship between Nutritional Risk and Cognition in the Elderly

BACKGROUND: The purpose of this study is to find out the effect of ApoE genotype on the relationship between nutritional risk and cognition of the elderly in a community. METHODS: A total of 996 subjects (343 men and 653 women) aged 60~91 years were analyzed from preliminary data of GDEMCIS (Gwangju Dementia and MCI Study). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history, K-SGDS (Korean version of Short Form Geriatric Depression Scale), K-MMSE (Korean version-Mini Mental State Examina- tion), and NSI (Nutritional Screening Initiative) checklist. We also examined blood pressure, fasting serum glucose, lipid profile, body mass index, and ApoE genotyping. RESULTS: 649 subjects (65.2%) were on good nutritional state (NSI score or = 3). On multiple logistic regression analysis, moderate or high nutritional risk was associated with an increa- sed risk for cognitive impairment (K-MMSE score < or = 17) after adjustment with age, sex, K-GDS and educational level in the absence of ApoE epsilon4 allele (OR 1.78, 95% CI 1.15-2.77). CONCLUSION: These results suggest that nutritional risk may be associated with cognitive function in the elderly only in the absence of ApoE epsilon4 allele.

Ethical Aspect of Industry-Sponsored Psychopharmacological Research / 신경정신의학

Psychiatrists and pharmaceutical industry have a shared interest in advancing medical knowledge. Nonetheless, they also create opportunities for conflict of interests. The primary interest of the psychiatrist is to promote the patient's best interests, while the primary interest of industry is to promote profitability. This paper explores the content of ethical documents most relevant to the biomedical researcher and guidelines related to the ethics of sponsored research. Subsequently, it discusses the ethical quandaries involved and offers solutions for ethical business relationships.

Correlation between Metabolic Syndrome and Cognition in the Elderly / 신경정신의학

OBJECTIVE: The purpose of this study is to find out the effect of ApoE genotype in correlation between metabolic syndrome and cognition of the elderly in the community. METHODS: A total of 1,305 subjects (440 men and 865 women) aged 60-98 years were analyzed from preliminary data of Gwangju Dementia and MCI Study (GDEMCIS). The metabolic syndrome was assessed as defined by the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history, family history of dementia and stroke, and Korean version-Mini Mental State Examination (K-MMSE). We also examined ApoE genotype and analyzed associated factors with metabolic syndrome. RESULTS: These Metabolic syndrome was present in 28.6% of the subjects (13.4% of men and 36.3% of women). On multiple logistic regression analysis, low serum HDL cholesterol was associated with an increased risk for cognitive impairment (K-MMSE score < or = 17) adjusted by age, sex, educational level, and smoking in the presence of ApoE epsilon4 allele (OR 0.95, 95% CI 0.92-0.99). CONCLUSION: These results suggest that serum HDL cholesterol may affect cognitive function in the elderly in the presence of ApoE epsilon4 allele.

Practice of a Web-Based Paper Submission and Review System of a "Journal of Korean Neuropsychiatric Association" / 신경정신의학

The procedure of the online paper submission to the Journal of Korean Neuropsychiatric Association is consisted of seven steps:entering type, author, title, keyword and abstracts of the paper, author's affiliation, uploading the paper file, and completion of submission. Six steps before the completion of submission could be reversed. But after this, no change will be possible. When editor decide that the paper is eligible, correspondence author will get the acceptance letter. The review of the paper will be done by selective reviewers. They will login to the system for the evaluation. The efficacy and the convenience of this system will be heightened by user's feedback (ex, systemic error, inconvenience, improvements, and ideas).

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.

A Case of Frontotemporal Lobe Dementia

Frontotemporal lobe dementia have been underevaluated because of various clinical features, changing diagnostic criteria, and indifference of clinicians. It is important that frontotemporal lobe dementia patient showing behavioral and lingual problems should be early diagnosed and treated. Because frontotemporal lobe dementia patients often confused with Alzheimer's disease, senile depression, schizophrenia, drug abuse. We have presented a case of frontotemporal lobe dementia. He had typical clinical history and symptoms which deserve to be considered frontotemporal lobe dementia. He showed appropriate findings of frontotemporal lobe dementia in the neuropsychological tests and brain magnetic resonance imaging and single photon emission computed tomography. This case is thought to be helpful for clinicians to give attention to early diagnosis and appropriate treatment of frontotemporal lobe dementia.