Relationship between White Matter Changes and Cognitive Dysfunction in the Elderly with Subjective Memory Complaint

OBJECTIVES: The purpose of this study is to evaluate the relationship between the severity of white matter changes (WMC), risk factors and cognitive domains, including executive function profiles. METHOD: Forty nine subjects over 55 years with subjective memory complaints were assessed with MRI and neuropsychological tests. The WMC were assessed by MRI T2-FLAIR images and divided into 3 groups of mild vs. moderate vs. severe and 2 groups of mild-moderate vs. severe by using Mantyla's criteria and Fazeka's criteria. The risk factors were examined in hypertension, heart disease history and chemistry Lab. Medical conditions which affect to cognitive dysfunction and definite dementia were also excluded. RESULTS: Comparing 3 groups, hypertension was identified as a risk factor of the WMC. Comparing 2 groups, total cholesterol and LDL were identified for as the risk factor of WMC. The severity of WMC was significantly associated with cognitive disturbances and their main effect on cognition was working memory and inhibition. CONCLUSION: The risk factors of the WMC in the elderly were hypertension, hyperlipidemia. The severity of WMC appears to be associated with executive dysfunction in the elderly.

Validity of the Korean Version of the Executive Interview (K-EXIT25)

OBJECTIVES: This study was conducted to prove the validity of the Korean version of the Executive Interview (K-EXIT) which was developed by Donald Royall as a bed-side test to measure the executive function. METHODS: The K-EXIT was developed and applied to 169elderly people with other executive functiontests.The internal consistency,reliability and the validity of the K-EXIT were analyzed. RESULTS: The K-EXIT showed high internal consistency (Crohnbachalpha= 0.766) and high inter-rater reliability (r=0.997, p<0.01).The K-EXIT total score was well correlated with verbal fluency test (r=-0.460, p<0.001), and the initiation-perseveration-change score (r=-0.598, p<0.005). CONCLUSION: The K-EXIT is a reliable and valid instrument for assessing executive function of the Korean elderly people. It may be also useful for the less well-educated people.

Restriction of Instrumental Activities of Daily Living in MCI / 신경정신의학

OBJECTIVES: Mild cognitive impairment (MCI) is distinguished from mild dementia by an absence of global intellectual deterioration and the preservation of activities of daily living (ADL). Recently, however, it became apparent that impairment of instrumental activities of daily living (IADL) is present before the threshold of dementia is reached. Thus, we want to examine whether IADL are impaired in patients with MCI, and which items of IADL are particularly involved. We divided the MCI group into amnestic (aMCI) and non-amnestic MCI (naMCI), and compared to the cognitively normal controls. In this study, we focused on the instrumental activities of daily living (IADL). METHODS: The sample consisted of 69 community-dwelling older adults from a welfare center for the aged in Korea. The subjects were divided into three diagnostic groups; aMCI [N=19, memory domains below -1.5 standard deviation (SD)], naMCI (N=19, other cognitive domains below -1.5 SD, except memory domains) and cognitive normal controls (N=31). Subjects were assessed both on IADL and the cognitive function. In order to assess the IADL, we used the Seoul -Instrumental Activities of Daily Living (S-IADL). Included measures of cognitive tests are as follows; Seoul Verbal Learning Test (SVLT), Rey Complex Figure Test (RCFT), Korean-Boston Naming Test (K-BNT), Stroop test, and Korean-Mini Mental Status Examination (K-MMSE). Groups were compared on the S-IADL and the cognitive tests. RESULTS: The three groups did not differ in the mean age, gender distribution and years of education. S-IADL were shown to be different between the groups in this study. Subjects with aMCI were significantly more impaired in S-IADL in comparison to the controls [F(2,50)= 4.251, p=0.020]. And on four items of S-IADL (shopping, transportation, medication and talking about recent events), subjects with aMCI showed higher impairment compared to the controls. However, the S-IADL did not differ between the subjects with naMCI and controls. CONCLUSION: In this study, impairment of S-IADL was shown in subjects with aMCI. And S-IADL of naMCI was not significantly differed from aMCI and controls. The results suggest that naMCI would be distinguished from aMCI in characteristics and prognosis.

Depression and Cognitive Impairment in the Elderly

A number of studies have looked at depression and associated cognitive impairment. The term depressive pseudodementia has proved to be a popular clinical concept. Despite the improvement following treatment of depression, the baseline level of cognitive impairment in older depressive patients remained impaired, mostly. These patients would be likely at high risk of developing progressive dementia. Depressive symptoms and cognitive decline would be different phenotypes result from neurodegeneration of pathophysiology for dementia. Depression in elderly patients, especially late-onset appears to be a strong predictor of dementia. No more concept of pseudodementia, older patients with depressive symptoms combined cognitive impairment should probably have full dementia screenings, comprehensive cognitive testing and ongoing monitoring of their cognitive function.

The Effect of Attention on Executive Function in Traumatic Brain Injury Patients: Testing for Stage Model

OBJECTIVES: The purpose of this study was to test stage model in Traumatic Brain Injury(TBI) patients. According to the stage model, attention deficits which is basic stage in information processing lead to memory disturbance and subsequently affect higher-order cognitive function such as memory, decision-making, abstract thinking, and judgement related to executive function. Therefore, it was hypothesized that attention affect recall(retrieval efficacy) related to executive function mostly relative to other cognitive function, in TBI patients with low executive function. METHODS: Participants were referred to a TBI clinic and then was rated on K-WAIS and Executive Intelligence Test(EXIT). Participants were divided into two groups according to Executive IQ(EIQ) score, which of high function group(N=67) was more than 80(above low average) and of low function group(N=52) was under 80 (under borderline). To test the stage model, using hierarchical regression analysis, recall(retrieval efficacy) was regressed on 3 subscales(attention, verbal, visuospatial scale) after controlling for IQ according to each group. Furthermore, the mediation effect of attention between retrieval efficacy and verbal, visuospatial score was analyzed. RESULTS: In the low function group, only attention area predicted significantly recall(retrieval efficacy), indicating that lower attention were related to lower EIQ after controlling for IQ. In the high function group, no area predicted significantly retrieval efficacy. In the low function group, verbal and visuospatial scale did not predicted significantly retrieval efficacy, indicating that there was no evidences supporting the mediation model. CONCLUSION: Only attention affect retrieval efficacy in TBI patients with low executive function. But, the mediation effect of attention between retrieval efficacy and verbal and visuospatial scale was not tested in the low function group. These results implied that stage model was tested partially. In treating cognitive deficit in TBI patients, it is necessary to develop cognitive rehabilitation program based on stage model. Furthermore, it is necessary to necessary to test mediation model in the future study.

Comorbid Anxiety in Elderly Patients with Depression

The frequent comorbidity of anxiety and depression, particularly among elderly, is widely recognized by clinicians, but the debate continues as to whether the combined diagnostic designation is merited. There remains a group of patients with depression and anxiety symptoms who are not well classifyed. This article reviews the debate over anxious depression, generalized anxiety disroder in patients with major depressive disorder, mixed anxiety-depressive disorder, and reviews anxiety symptoms in elderly patients with depression. Comorbid anxiety symptoms are associated with a more severe presentation of depressive illness, including greater suicidality. Most antidepressant treatment studies in the elderly have found poorer treatment outcomes in those with comorbid anxiety (including delayed or diminished response and increased likelihood of dropout from treatment). Since comorbid anxiety affect clincal course and prognosis, and may worsen long-term disability in late life depression, considerably more research in this field is needed.

Epidemiologic Characteristics and Clinical Features of the Elderly Patients with Bipolar Disorders Admitted to a University Hospital

OBJECTIVES: As the elderly population is continuing to increase, psychiatric diseases of the elderly are becoming an important social issue. This study looks into the demographical and clinical features of the elderly patients diagnosed with bipolar disorder in a University hospital. METHODS: The study subjects include patients admissioned in the closed wards of Soonchunhyang Seoul hospital and Cheonan hospital from March, 2000 to February, 2005 who met the DSM-IV-TR criteria for bipolar disorder at the time of discharge. A total of 146 patients (76 men, 70 women) medical records were studied retrospectively. Subjects older than the age of 50 at time of admission were grouped as the old age group, whereas those who were younger than 50 as the young age group. Also among the old age group, those who had the first onset of episode under the age of 50 were grouped as the early onset group, whereas those who had the first onset after the age 50 were grouped as the late onset group. RESULTS: The number of bipolar disorder patients in the young age group and old age group were 73 and 73 respectively. The number of early onset group and late onset group were 46 and 23 respectively. The old age group had a relatively higher incidence of bipolar II disorder than the young age group. Also in the old age group there was a higher incidence of hypomanic or depressive episode rather than manic episode compared to the young age group. And in the old age group psychotic symptoms were less common and the mean admission length shorter than the young age group. Additionally in the old age group treatment with Lithium monotherapy or with no mood stabilizers at all were relatively common. Among the old age group, late onset group had a higher rate of bipolar II disorder than the early onset group. CONCLUSION: This study shows differences in the demographical and clinical features among different age groups. But additional research would be required to determine whether the bipolar disorders in the elderly or late onset group are actually a different type of disorder from those of the young.

Bipolar Disorder in Old Age

Bipolar disorder in old age is a growing public health problem. We reviewed the epidemiology, clinical characteristics, course, cormobidity, and treatment of bipolar disorder in old age with special focus on comparing with younger patients. Most available date is gleaned from retrospective chart reviews and cohort studies. Many of these reviews have been targeted toward the clinician, and they have relied heavily on extrapolating data from other psychiatric disorders in late life or younger people with bipolar disorder. But, at present, there are more gaps in empirical knowledge than there answer, and greater research on bipolar disorder in older people will assist in enhancing services to this group as well as inform research on bipolar disorder across the life span.

Bipolar Disorder in Old Age

Bipolar disorder in old age is a growing public health problem. We reviewed the epidemiology, clinical characteristics, course, cormobidity, and treatment of bipolar disorder in old age with special focus on comparing with younger patients. Most available date is gleaned from retrospective chart reviews and cohort studies. Many of these reviews have been targeted toward the clinician, and they have relied heavily on extrapolating data from other psychiatric disorders in late life or younger people with bipolar disorder. But, at present, there are more gaps in empirical knowledge than there answer, and greater research on bipolar disorder in older people will assist in enhancing services to this group as well as inform research on bipolar disorder across the life span.

Wellbutrin SR in Depression / 대한정신약물학회지

This article discusses the mechanism of action of Wellbutrin (bupropion) and relates the drug's neuropharmacologic effects to its clinical efficacy and side effect profiles. The preclinical and clinical data show that bupropion acts via dual inhibition of norepinephrine and dopamine reuptake and is devoid of clinically significant serotonergic effects or direct effects on postsynaptic receptors. With respect to treatment of depression, these catecholaminergic effects of bupropion tended to produce more robust effects on anhedonia/positive affect. Augmenting or switching antidepressants with bupropion has become an increasingly common strategy in the treatment of resistant depression. Bupropion has been suggested for the treatment of bipolar depression , because of its efficacy and a lower risk of inducing switches to hypomania or mania. Clinically, SR formulation, side effects are infrequent and benign, would be used without a risk of seizure in dose up to 400 mg/day.

The Study of Characteristic Defense Mechanisms in Medical and Surgical Area for Specialist / 한국의학교육

The purpose of this study was to explore the differentiation of common personality profiles and defense mechanisms between medicine and surgery specialist groups. The authors evaluated the defense mechanisms of the specialist by using Ewha Defense Mechanisms Test. The authors compared the defense mechanisms between two groups(medicine and surgery specialist groups) who are employed Soonchunhyang university hospital at 2000. First, There were significant differences in mean scores of the defense mechanisms ratings. For the surgery groups, projection and show-off were significantly higher than in the medicine group, and for the medicine groups, altruism was significantly higher than surgery groups. Second, Compared of maturity level between two groups, the medicine group used mature defense significantly. Third, We compared of major defense mechanisms between two groups. Surgery groups used show-off as a major defense mechanisms in significantly higher frequency than the medicine groups. This results were reflect that surgery group have property of apprentice system and dramatical therapeutic approach. The results seem to be useful in understanding specialist's optimal character for specific specialities that were selected by evaluating the differences of the common characteristics and coping mechanisms of each specialty group.

Therapeutic Effect of Amantadine in Traumatic Brain Injury Patients: Two Cases and Review

We reported two cases of amantadine treatment in traumatic brain injury patients and reviewed the literature of amantadine treatment of those patients. Problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive dificit could occur following traumatic brain injury or other types of acquired brain injury. this report described results of amantadine using in two patients with this type of symptom profile. Patients received neuropsychiatric examination as well as BPRS and Barthel index. These patients were improved, respectively from 57 point to 82 point(case 1), from 85 to 94(case 2) in Barthel index, and from 66 point to 35 point(case 1), from 55 to 32 point(case 2) in BPRS. These two patients did not reveal any other adverse effect. The rationale for using amantadine were discussed.

Body Weight, Body Mass Index, Plasma Leptin, Insulin and Fasting Glucose Level in Schizophrenic Patients Receiving Olanzapine / 신경정신의학

OBJECTIVE: The aim this study was to investigate possible mechanisms behind olanzapine-associated weight gain. METHOD: Thirteen psychiatric inpatients (all meeting DSM-IV criteria for schizophrenia or schizophreniform disorder) receiving olanzapine in Soonchunhyang university Chun-an hospital were studied. Body weight, plasma leptin, insulin and fasting glucose levels were measured five-times over 6 weeks. Body mass index (BMI) was calculated. RESULT: At the end of sixth week, body weight, BMI, plasma leptin, insulin and fasting glucose levels were significantly increased from baseline. Both insulin and leptin plasma levels were significantly increased from baseline at the end of the sixth week of treatment. Both body weight and BMI were significantly increased from baseline at the end of the first week, the fourth week and sixth week, respectively. Fasting glucose was significantly increased from baseline at the end of the fourth week and sixth week, respectively. Between baseline and sixth week, the body weight, BMI, plasma leptin and fasting glucose levels were significantly correlated to insulin level. There was a tendency toward a correlation between BMI and leptin level, whereas no correlation was found between body weight and leptin. CONCLUSION: Olanzapine treatment was associated with weight gain and elevated level of leptin, insulin and fasting glucose. Elevated insulin levels and hyperleptinemia may be mechanisms behind olanzapine-induced weight gain.

The use of Amantadine in Traumatic Brain Injury Patients

Avariety of symptoms can occur following traumatic brain injury(TBI) or other types of acquired brain injury. These symptoms can include problems with short-term memory, attention, planning, problem solving, impulsivity, disinhibition, poor motivation, and other behavioral and cognitive deficit. These symptoms may respond to certain drugs, such as dopaminergic agents. Amantadine may protect patients from secondary neuronal damage after brain injury as a effects of NMDA receptor antagonists and may improve functioning of brain-injured patients as a dopaminergic agonist. Clinically, based on current evidence, amantadine may provide a potentially effective, safe, and inexpensive option for treating the cognitive, mood and behavioral disorders of individuals with brain injury. The rationales for using amantadine are discussed, and pertinent literatures are reviewed.