Effect of Group-Based Cognitive Training on Cognitive Performance, Depression, and Quality of Life in Community-Dwelling Elderly

Objective@#There are reports that cognitive training improves cognitive performance in patients with mild cognitive impairment and dementia. However, the research on the effects of cognitive training in the community-dwelling elderly is insufficient. This study aimed to verify the effectiveness of cognitive training in the community-dwelling elderly. @*Methods@#The participants were community-dwelling elderly aged 60 years or over. We collected demographic data and assessed Korean Version of Montreal Cognitive Assessment (MoCA-K), The Short form of the Geriatric Depression Scale-Korean (SGDS-K), and Geriatric Quality of Life-Dementia (GQOL-D). Cognitive training consisted of performing tasks for multi-cognitive domains. It was a paper- and group-based program, conducted 15 sessions each 60 minute. After the intervention, clinical characteristics were reassessed. Paired t-test, pearson correlation, analysis of covariance (ANCOVA) were performed using R version 3.6.1. @*Results@#There were 206 participants. 162 participants completed the intervention, and were eligible for analyses. After the cognitive intervention, MoCA-K was improved 2.10±0.61 which was statistically significant (p<0.001). SGDS-K was decreased 0.57± 0.46 (p=0.003). GQOL-D was increased 1.65±1.64 (p=0.048). ANCOVA showed that the score change in MoCA-K was not in-fluenced by baseline SGDS-K or baseline GQOL-D score. @*Conclusion@#Group-and paper-based cognitive training could improve MoCA-K, SGDS-K, and GQOL-D for the communitydwelling elderly. Baseline SGDS-K and GQOL-D scores were not associated with cognitive training effects in the community-dwelling elderly.

Effect of Group-Based Cognitive Training on Cognitive Performance, Depression, and Quality of Life in Community-Dwelling Elderly

Objective@#There are reports that cognitive training improves cognitive performance in patients with mild cognitive impairment and dementia. However, the research on the effects of cognitive training in the community-dwelling elderly is insufficient. This study aimed to verify the effectiveness of cognitive training in the community-dwelling elderly. @*Methods@#The participants were community-dwelling elderly aged 60 years or over. We collected demographic data and assessed Korean Version of Montreal Cognitive Assessment (MoCA-K), The Short form of the Geriatric Depression Scale-Korean (SGDS-K), and Geriatric Quality of Life-Dementia (GQOL-D). Cognitive training consisted of performing tasks for multi-cognitive domains. It was a paper- and group-based program, conducted 15 sessions each 60 minute. After the intervention, clinical characteristics were reassessed. Paired t-test, pearson correlation, analysis of covariance (ANCOVA) were performed using R version 3.6.1. @*Results@#There were 206 participants. 162 participants completed the intervention, and were eligible for analyses. After the cognitive intervention, MoCA-K was improved 2.10±0.61 which was statistically significant (p<0.001). SGDS-K was decreased 0.57± 0.46 (p=0.003). GQOL-D was increased 1.65±1.64 (p=0.048). ANCOVA showed that the score change in MoCA-K was not in-fluenced by baseline SGDS-K or baseline GQOL-D score. @*Conclusion@#Group-and paper-based cognitive training could improve MoCA-K, SGDS-K, and GQOL-D for the communitydwelling elderly. Baseline SGDS-K and GQOL-D scores were not associated with cognitive training effects in the community-dwelling elderly.

An Investigation of Factors Affecting Elderly Depression in Korea

Objective@#The purpose of this study was to investigate the related factors of elderly depression among Korean adults aged 60 years and above. @*Methods@#From the database of Korea National Health and Nutrition Examination Survey conducted in 2018, data of 2,288 adults over age 60 who responded to the questionnaires of health interview were included in this study. We analyzed the data using logistic regression analysis. @*Results@#According to our results, the number of chronic diseases seemed to be associated with depression in elderly people, es-pecially when they have more than 4 chronic diseases. Poorer self-rated health was identified as a significant factor and the odd ratio was the highest among all independent variables in our study. Walking over 10 minutes more than 4 times a week was considered as a protective factor for elderly depression. The association between education level and depression was inconsistent. Variables such as female gender, single status, smoking showed statistically insignificant results. Older age itself was not identified as a risk factor as odd ratios of all groups (over age 65) compared to reference group (age 60-64) were below 1. @*Conclusion@#This study confirms several related factors for elderly depression. Having more than 4 chronic diseases, poorer self-rated health were identified as a significant risk factor for depression. Regular walking was considered as a protective factor for elderly depression. The knowledge of these factors might help to manage risks of elderly depression and devise early intervention approaches.

A Short Review of Delirium in Patients With COVID-19

We reviewed the clinical features, prevalence, pathophysiology, and prevention and treatment of delirium in patients with coronavirus disease of 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has neurotropic properties, and can penetrate the central nervous system and affect brain neurons. These characteristics may explain the fact that COVID-19 patients may be particularly susceptible to delirium. COVID-19 delirium occurred more frequently in intensive care unit and emergency room settings. Patients with neurologic disorders and the elderly were more vulnerable to delirium. Clinical symptoms of COVID-19 delirium may manifest as a hyper/hypoactive type. Prevention and treatment appear to be similar to conventional treatment strategies. And the patient’s feeling of isolation due to social distancing and a highly intensive labor force of medical personnel must be overcome. Melatonin, alpha-2 agonist, antipsychotics, and valproic acid have been recommended for the treatment of delirium symptoms. However, this article did not go through a systematic literature review.

A Rural Dementia-Friendly Village Project and Dementia Awareness, Cognition, and Depressive Symptom : A Preliminary Study

OBJECTIVE: According to the 3rd Korean National Dementia Plan, the dementia-friendly community initiative was launched. The aim of this study was to evaluate the effects of a rural dementia-friendly village project on the participants. METHODS: Jeollabukdo Provincial Dementia Center designated Sosu-maeul, located in Buan-gun Jeollabuk-do, as a rural dementia-friendly village. We conducted dementia partnership education, youth-elder matching activity, and cognitive enhancing program. The efficacy of this project was evaluated by the changes in dementia awareness, cognitive function, and depressive symptoms. We used dementia awareness questionnaire, Mini-Mental Status Examination for Dementia Screening (MMSE-DS), and Korean version of Short form of Geriatric Depression Scale (SGDS-K). RESULTS: This study was carried out with 24 residents in this community. There was no significant change in dementia awareness score between pre- and post-intervention (p=0.25). MMSE-DS score was significantly increased from 24.5 to 25.5 (p < 0.001) and SGDS-K score was statistically improved from 3.5 to 2.5 (p=0.04) after interventions. CONCLUSION: We Jeollabukdo Provincial Dementia Center carried out a pilot study of a rural dementia-friendly village project. This project led to improvements on cognitive functions and depressive symptoms in the participants. But the improvement of dementia awareness was not achieved. More direct and experiencing interventions for people with dementia are necessary to improve dementia awareness.

Atypical Antipsychotics for Behavioral and Psychological Symptoms in Alzheimer's Dementia

In addition to cognitive and functional decline, various behavioral and psychological symptoms in dementia (BPSD) are manifested in the patients with Alzheimer's dementia (AD). Some of BPSD, especially psychosis, agitation, and aggression could be challenges to caregivers and clinicians. Atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, and aripiprazole) are widely prescribed to manage complicated neuropsychiatric symptoms associated with AD. It is known that atypical antipsychotics (AAP) have modest and significant beneficial effects in the short term treatment of BPSD. However their safety of AAP has been concerned with potentially increased adverse events. This article reviewed the treatment outcomes and adverse effects of AAP when managing BPSD in the patients with AD. The effects of risperidone and aripiprazole are obvious on psychosis and aggression, but with small effect size. AAP could exacerbate cognitive decline, and it could increase the rate of cerebrovascular accidents and mortality rate in the patients with AD.

Clinical Approach to Delirium in Elderly Patients

Delirium is not uncommon and is a devastating clinical syndrome. Elderly patients are vulnerable to delirium, especially demented or/and medically-surgically ill patients. Old age, comorbid psychiatric, medical and/or neurological diseases, medications, changed pharmacodynamics, sensory impairment and psychosocial stresses contribute to the development of delirium. Delirium in elderly patients is somewhat different from delirium in younger patients, sometimes under detected and/or poorly managed. This review discusses the diagnosis, classification, etiology and treatment, and presents 3 clinical cases of delirium in elderly patients. This review also focuses on a practical approach in assessing and managing delirium in elderly patients. The management of delirium consists of identifying and correcting the underlying problems, including prescribing suitable medication.

Influence of Glutamate on the Circling Movement In the Unilateral Substantia Nigra-lesioned Rats / 신경정신의학

The aim of this study was to examine the effects of various concentrations of glutamate(10(-8), 10(-6) and 10(-4) M) on the circling movement induced by apomorphine in the unilateral substantia nigra-lesioned rats. Subcutaneous apomorphine(0.1 mg/kg) elicited contralateral circling movement(641.7+/-163.9/hr), Glutamate(10(-6)-10(-4) M) significantly reduced the numbers of apomorphine-induced circling movement. This reducing effect of glutamate was antagonized and/or reversed by 10(-7) M GABA antagonist bicuculline. These results suggest that glutamate reduces circling movement induced by apomorphine and this reducing effect of glutamate may be mediated by increased GABA concentration in striatum and substantia nigra.