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Objective@#The aims of our study were to identify distinct trajectories of cognitive function using the group-based trajectory model. We also investigate which demographic factors act as risk factors for cognitive decline in each group. @*Methods@#The data from the Seoul National University Hospital Healthcare System Gangnam Center, from 2005 to 2019. The number of study subjects was 637. We used a group-based model to identify cognitive function trajectories. Multinomial logistic regression was employed to define risk factors for cognitive function decline. @*Results@#The cognitive function trajectories among adults over 40 years of age were heterogeneous. We identified four trajectories: high (27.3%), medium (41.0%), low (22.7%), and rapid decline (9.1%). Older age, male, low educational level, bad dietary habits, diabetes mellitus, technical worker, and lower income increased the likelihood of a cognitive function decline. @*Conclusion@#A younger age, a higher educational level, professional worker, good dietary habits, no diabetes mellitus, and no obesity improved cognitive function. A combination of these factors can improve “cognitive reserve” and delay cognitive decline. Interventions to prevent cognitive decline are needed after identification of high-risk groups for cognitive decline.
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Background@#Texture analysis may capture subtle changes in the gray matter more sensitively than volumetric analysis. We aimed to investigate the patterns of neurodegeneration in semantic variant primary progressive aphasia (svPPA) and Alzheimer’s disease (AD) by comparing the temporal gray matter texture and volume between cognitively normal controls and older adults with svPPA and AD. @*Methods@#We enrolled all participants from three university hospitals in Korea. We obtained T1-weighted magnetic resonance images and compared the gray matter texture and volume of regions of interest (ROIs) between the groups using analysis of variance with Bonferroni posthoc comparisons. We also developed models for classifying svPPA, AD and control groups using logistic regression analyses, and validated the models using receiver operator characteristics analysis. @*Results@#Compared to the AD group, the svPPA group showed lower volumes in five ROIs (bilateral temporal poles, and the left inferior, middle, and superior temporal cortices) and higher texture in these five ROIs and two additional ROIs (right inferior temporal and left entorhinal cortices). The performances of both texture- and volume-based models were good and comparable in classifying svPPA from normal cognition (mean area under the curve [AUC] = 0.914 for texture; mean AUC = 0.894 for volume). However, only the texture-based model achieved a good level of performance in classifying svPPA and AD (mean AUC = 0.775 for texture; mean AUC = 0.658 for volume). @*Conclusion@#Texture may be a useful neuroimaging marker for early detection of svPPA in older adults and its differentiation from AD.
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Background@#and Purpose: Verbal and nonverbal fluency tests are the conventional methods for examining executive function in the elderly population. However, differences in impairments result in fluency tests in patients with mild cognitive impairments (MCIs) and Alzheimer’s disease (AD) and in neural correlates underlying the tests still necessitate concrete evidence. @*Methods@#We compared the test performances in 27 normal controls, 28 patients with MCI, and 20 with AD, and investigated morphological changes in association with the test performances using structural magnetic imaging. @*Results@#Patients with AD performed poorly across all the fluency tests, and a receiver operating characteristics curve analysis revealed that only category fluency test discriminated all the 3 groups. Association, category, and design fluency tests involved temporal and frontal regions, while letter fluency involved the cerebellum and caudate. @*Conclusions@#Category fluency is a reliable measure for screening patients with AD and MCI, and this efficacy might be related to morphological correlates that underlie semantic and executive processing.
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Objective@#The purpose of this study was to investigate the efficacy of medication management as a method of early intervention in dementia. @*Methods@#This study used data of survey and Mini-Mental State Examination for Dementia Screening score of 46 dementia patients given medication management. Participants were separated into three groups based on the duration of medication management. Then we compared the change in cognitive ability and the frequency of community service usage. @*Results@#The decline of Mini-Mental State Examination score that each group reported was -0.93±2.69, -1.38±1.71, and -1.00± 3.52 and there was no significant difference. In terms of the community service, after being given the medication management, the usage of community service increased. @*Conclusion@#Continuous medication management might relieved the decrease of cognitive ability and encourage dementia patients to participate in community service.
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Objective@#Creatine, energy buffer in high energy demanding systems including muscle and brain, may play a beneficial role against neuroinflammation in Alzheimer’s disease (AD), and thus be a potential biomarker. This study aimed to compare the levels of plasma creatine between persons with and without AD and investigate associations of plasma creatine levels with cognitive function and blood-based inflammatory markers. @*Methods@#We classified elderly participants by cognitive statuses: normal cognition (NC, n=17), mild cognitive impairment (MCI,n=21), and AD (n=21). To assess cognitive function and inflammatory condition, we performed neuropsychological tests and mea-sured plasma C-reactive protein (CRP) levels, respectively. @*Results@#Plasma creatine levels were comparable among participants with AD, MCI, and NC. In overall participants, plasma cre-atine levels were not associated with neuropsychological test scores, but negatively associated with plasma CRP levels. In AD group, plasma creatine levels were negatively associated with neuropsychological test scores and, although not significant, CRP levels (p=0.086). In participants without AD (NC plus MCI), these associations disappeared. @*Conclusion@#Plasma creatine levels may not be useful as a biomarker indicating cognitive statuses. However, our results suggest that, in AD, plasma levels of creatine might reflect the extent of neuroinflammation as well as cognitive deterioration.
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Objective@#Adjustment disorder (AD) remains an ambiguous diagnosis that overlaps with major depressive disorder (MDD). This study compared autonomic reactivity to the stress between AD and MDD to test for biological differences. @*Methods@#Physically healthy Korean male soldiers admitted to a psychiatric ward were recruited for participation. Clinical diagnoses indicated that 62 patients with AD and 47 with MDD were selected. Procedures consisted of electrocardiogram measurements according to three consecutive phases lasting five minutes each [i.e., resting, stress (including a mental arithmetic task and Stroop color word test), and recovery]. @*Results@#The reactive trends of all heart rate variability (HRV) parameters related to the stress tasks in participants with AD did not differ from those with MDD. High-frequency HRV (a proxy of parasympathetic activity) increased during times of stress for participants with AD and MDD. Despite similar reactive trends, AD participants had higher HRV values than participants with MDD during whole phases, particularly for variables reflecting overall autonomic activity. @*Conclusion@#AD is associated with higher basal activity in the autonomous nervous system when compared to MDD. However, both are associated with pathophysiology indicating an altered autonomic reactivity to stress.
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Objective@#Adjustment disorder (AD) remains an ambiguous diagnosis that overlaps with major depressive disorder (MDD). This study compared autonomic reactivity to the stress between AD and MDD to test for biological differences. @*Methods@#Physically healthy Korean male soldiers admitted to a psychiatric ward were recruited for participation. Clinical diagnoses indicated that 62 patients with AD and 47 with MDD were selected. Procedures consisted of electrocardiogram measurements according to three consecutive phases lasting five minutes each [i.e., resting, stress (including a mental arithmetic task and Stroop color word test), and recovery]. @*Results@#The reactive trends of all heart rate variability (HRV) parameters related to the stress tasks in participants with AD did not differ from those with MDD. High-frequency HRV (a proxy of parasympathetic activity) increased during times of stress for participants with AD and MDD. Despite similar reactive trends, AD participants had higher HRV values than participants with MDD during whole phases, particularly for variables reflecting overall autonomic activity. @*Conclusion@#AD is associated with higher basal activity in the autonomous nervous system when compared to MDD. However, both are associated with pathophysiology indicating an altered autonomic reactivity to stress.
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Suicide is a major public health problem among Korean military personnel. As multiple factors and their interactions are related to suicide, multicomponent intervention might be useful for reducing suicide and suicide-related outcomes. The United States Air Force Suicide Prevention Program (AFSPP) launched in 1996 is a good example of an evidence-based multifaceted program focusing on leadership involvement and whole community-level efforts. For early identification and management of an at-risk population, AFSPP aims to encourage help-seeking and reduce stigma by changing the community's social norms regarding mental health and suicide. The present study reviewed the key elements of this successful intervention and made a proposal for improving the suicide prevention strategy in the Korean armed forces. This review might be useful for establishing a comprehensive intervention in local communities and organizations outside of the military.
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Humans , Arm , Leadership , Mental Health , Military Personnel , Military Psychiatry , Public Health , Social Norms , Suicide , United StatesABSTRACT
OBJECTIVE: The aim of this study is to determine the utilization rates and predictors of dementia care services. METHODS: We recruited 66 low-income elderly patients who were registered to one community based dementia care center. The care services were composed of hygiene care items supply, nurse visiting service, education programs for caregivers and patients, and global positioning system (GPS) or identification tags supply. Service use prediction was evaluated by multiple logistic regression analysis. RESULTS: Use rate of hygiene care items supply was higher than others [44 of 66 (66.67%)]. The patients who lived with family had used more care items than who lived alone [odds ratio (OR), 3.43 ; 95% confidence interval (CI), 1.73 to 5.54]. The patients who had comorbid conditions used more hygiene care items than who had not (OR 2.50 ; 95% CI, 1.35 to 3.78). In participants with the higher education level, the higher use rate of education program was predicted (OR 1.14 ; 95% CI, 1.01 to 1.28). CONCLUSION: These findings suggested that living-alone and low education should be overcome for providing more effective dementia care services to low-income patients.