Validation of the Short Form of the Mood Instability Questionnaire-Trait (MIQ-T-SF) in the Korean General Population

Objective@#Mood instability (MI) is a clinically significant trait associated with psychiatric disorders. However, there are no concise measurements to evaluate MI. The initial Mood Instability Questionnaire-Trait (MIQ-T) was developed to fill this gap. The current study aimed to create a short form of MIQ-T (MIQ-T-SF) that measures MI with high validity and reliability in the Korean general population. @*Methods@#Of the 59 items in the MIQ-T, 17 items were chosen for the MIQ-T-SF following the factor analysis process. In total, 540 participants completed the MIQ-T-SF. Cronbach’s alpha and McDonald’s omega were used to evaluate reliability. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to determine construct validity. Concurrent validity was confirmed via comparisons with Personality Assessment Inventory-Borderline Features Scale. Measurement invariance across gender and age groups was confirmed before analyzing differences in scores using Kruskal-Wallis test. @*Results@#The MIQ-T-SF displayed expected correlations and high internal consistency (α=0.71–0.90, Ωt=0.72–0.92). Using EFA and CFA, a five-factor structure was confirmed. Measurement invariance was supported, and gender differences were observed. @*Conclusion@#The MIQ-T-SF is an accurate and reliable method to detect MI in the Korean general population. The study’s results offer new perspectives for future studies on MI.

The Role of Event-Related Rumination and Perceived Social Support on Psychological Distress during the COVID-19 Pandemic: Results from Greater Daegu Region in South Korea

Objective@#Research on psychological distress from the coronavirus disease 2019 (COVID-19) crisis has increased significantly, but the factors that can exacerbate or mitigate such distress have remained underexplored. To address the research gap, this study examined whether two types of rumination and perceived social support predict psychological distress during the pandemic. @*Methods@#Participants were recruited from communities of the greater Daegu area (n=316) where the first massive outbreak in South Korea occurred and most residents underwent substantial disruption of daily life. They completed self-report questionnaires that included measures of psychological distress, event-related rumination, and social support. @*Results@#The hierarchical regression analysis showed that maladaptive intrusive rumination and perceived social support predicted increases and decreases in psychological distress, respectively, even when subjective severity of COVID-19-related experiences was controlled. Putatively adaptive type of rumination (i.e., deliberate rumination) was not a significant predictor concurrently. @*Conclusion@#This is among the early endeavors to comprehensively understand risk and protective factors associated with an effective coping strategy against the COVID-19 crisis. Our results indicate that intrusive rumination aggravates but social support mitigates psychological distress during the pandemic, indicating that we can better adapt by differently attending to recent experiences and maintaining perceived social support.

The Role of Event-Related Rumination and Perceived Social Support on Psychological Distress during the COVID-19 Pandemic: Results from Greater Daegu Region in South Korea

Objective@#Research on psychological distress from the coronavirus disease 2019 (COVID-19) crisis has increased significantly, but the factors that can exacerbate or mitigate such distress have remained underexplored. To address the research gap, this study examined whether two types of rumination and perceived social support predict psychological distress during the pandemic. @*Methods@#Participants were recruited from communities of the greater Daegu area (n=316) where the first massive outbreak in South Korea occurred and most residents underwent substantial disruption of daily life. They completed self-report questionnaires that included measures of psychological distress, event-related rumination, and social support. @*Results@#The hierarchical regression analysis showed that maladaptive intrusive rumination and perceived social support predicted increases and decreases in psychological distress, respectively, even when subjective severity of COVID-19-related experiences was controlled. Putatively adaptive type of rumination (i.e., deliberate rumination) was not a significant predictor concurrently. @*Conclusion@#This is among the early endeavors to comprehensively understand risk and protective factors associated with an effective coping strategy against the COVID-19 crisis. Our results indicate that intrusive rumination aggravates but social support mitigates psychological distress during the pandemic, indicating that we can better adapt by differently attending to recent experiences and maintaining perceived social support.

Extrapyramidal Signs and Risk of Progression from Mild Cognitive Impairment to Dementia: A Clinical Research Center for Dementia of South Korea Study

OBJECTIVE: Extrapyramidal signs (EPS) are common in patients with mild cognitive impairment (MCI). However, few studies have assessed the effect of EPS on the clinical course of MCI. We aimed to evaluate whether patients with EPS show more frequent progression from MCI to Alzheimer's disease (AD) and to other types of dementia. METHODS: Participants (n=882) with MCI were recruited, and were followed for up to 5 years. The EPS positive group was defined by the presence of at least one EPS based on a focused neurologic examination at baseline. RESULTS: A total of 234 converted to dementia during the follow-up period. The risk of progression to AD was lower in the patients with EPS after adjusting for potential confounders [hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.53–0.93, p=0.01]. In contrast, the patients with EPS had a six-fold elevated risk of progression to dementia other than AD (HR=6.33, 95%CI=2.30–17.39, p < 0.001). CONCLUSION: EPS in patients with MCI is a strong risk factor for progression of MCI to non-Alzheimer dementia. The careful neurologic examination for EPS in patients with MCI can yield important clinical information for prognosis.

Factor Structure of Burden in Dementia Caregivers : Exploratory Factor Analysis and Confirmatory Factor Analysis of Zarit Burden Interview

OBJECTIVE: Zarit Burden Interview (ZBI) was the most commonly used measure of caregiver burden for demented older adults. The aim of this study was to investigate dimensions of caregiver burden through factor analysis of ZBI. METHODS: The participants were 706 outpatients with dementia and their caregivers in Korea. We assessed the caregiver burden using the Korean version of ZBI. The participants were randomly divided into two groups, for the purpose of identifying the most optimal factor structure through exploratory factor analysis in group 1 (n=368) and confirmatory factor analysis in group 2 (n=338). RESULTS: The results of exploratory factor analysis in group 1 suggested 3-factor structure, which was labeled ‘personal strain,’‘patient dependency,’ and ‘self-criticism.’ The confirmatory factor analysis results indicated the 3-factor structure which was discovered through exploratory factor analysis was the best-fitting model for explaining the caregiver burden in group 2. CONCLUSION: The current study has significant implications for advancing our understanding of ZBI as multidimensional burden scale. Furthermore, differentiating the dimensions may allow researchers to assess the effects of interventions more precisely.

Gender-Specific Influence of Education in Cognitive Subdomains in Alzheimer's Disease : A Clinical Research Center for Dementia of South Korea Study

OBJECTIVE: We aimed to find the sex differences of the way how educational attainment influence on cognitive function in patients with Alzheimer's disease (AD). METHODS: We recruited 424 patients with AD from a large hospital-based multi-center cohort. We evaluated cognitive subdomains using the Seoul Neuropsychological Screening Battery-Dementia version. We employed multiple linear regression analysis to compare the score of cognitive subdomains between the groups with high versus low educational attainment based on the high school graduate. Interaction between educational attainment and sex was also included in the analysis. RESULTS: High and low educational attainment group had 33.0% and 67.0% of patients in the study population. In the multiple regression analysis, score of all cognitive subdomains were significantly higher in the high educational attainment group. The score of attention was also significantly affected by interaction between educational attainment and sex. This result may be helpful to develop cognitive intervention therapy. CONCLUSION: In the female patients with AD, educational attainment showed higher influence on the attention score.

Factors Associated with Caregiver Burden in Dementia: 1-Year Follow-Up Study

OBJECTIVE: Dementia symptoms (cognitive function, daily-living function, and neuropsychiatric symptoms) become more serious over time, which is likely to increase caregiver burden. The aim of this study is to investigate which dementia-related symptoms, and how the progression of these symptoms, have influenced caregiver burden during a 1-year follow-up assessment. METHODS: A total of 110 patients with dementia were assessed for their cognitive function, daily-living function, and neuropsychiatric symptoms. Caregivers were assessed for their caregiver burden. Bivariate analyses were conducted between caregiver burden and dementia patients' symptoms, in order to examine which particular symptoms were significantly associated with caregiver burden at the baseline. A multiple regression analysis was then conducted with each significantly associated variable with a view to identifying determinants, influencing caregiver burden. Additionally, bivariate analyses were conducted between the changes in caregiver burden and the changes in patients' symptoms, to investigate which patient variable could best describe caregiver burden from baseline to the 1-year follow-up. A multiple regression analysis was conducted with each significantly-associated change in symptom, in order to identify determinants that influence a change in caregiver burden. RESULTS: Neuropsychiatric symptoms, such as irritability, aberrant motor-behavior, delusions and disinhibition were found to be significant predictors of caregiver burden at baseline, according to multiple regression analysis. In addition, changes in neuropsychiatric symptoms, such as delusions, agitation and memory-related functioning in daily-living significantly predict a change in caregiver burden. CONCLUSION: Our results demonstrate that neuropsychiatric symptoms and memory impairment in daily-living functions are significant predictors of an increase in caregiver burden.

Gender-Specific Influence of Education in Cognitive Subdomains in Mild Cognitive Impairment : A Clinical Research Center for Dementia of South Korea Study

OBJECTIVE: This study aimed to find the sex differences of the way how educational attainment influence on cognitive function in the mild cognitive impairment patients. METHODS: A total of 1,704 patients were recruited from a large hospital-based multi-center cohort. Cognitive subdomains were evaluated using the Seoul Neuropsychological Screening Battery-Dementia version. We employed multiple linear regression analysis to compare the score of cognitive subdomains between the groups with high versus low educational attainment based on the high school graduate. Interaction between educational attainment and sex was also included in the analysis RESULTS: High and low educational attainment group had 41.2% and 58.8% of patients in the study population. In the multiple regression analysis, score of all cognitive subdomains were significantly higher in the high educational attainment group. The score of attention, language, and visuospatial function were also significantly affected by interaction between educational attainment and sex. CONCLUSION: In the female patients, educational attainment showed higher influence on the attention, language, and visuospatial function score.

Extrapyramidal Signs and Impairment of Cognitive Subdomains in Mild Cognitive Impairment : A Clinical Research Center for Dementia of South Korea (CREDOS) Study

OBJECTIVES: This study investigated the association between extrapyramidal signs (EPS) and five cognitive sub-domains in a large number of patients with mild cognitive impairment (MCI). METHODS: Our analyses considered 1,943 patients with MCI drawn from the nationwide Clinical Research of Dementia of South Korea study. EPS were defined as presence in patients with at least 1 of 11 operationally specified features. We assessed five cognitive sub-domains : attention, language, visuospatial function, memory, and frontal/executive function using the Seoul Neuropsychological Screening Battery-Dementia version. The associations of EPS with each cognitive sub-domain were analyzed with a multiple linear regression model after controlling for confounding factors : sex, age, education years, diabetes, hypertension, severity of global function, depressive symptoms, and white matter hyperintensities (WMH). RESULTS: 138 MCI patients (7.1%%) had EPS. This group had more global cognitive deterioration and severe WMH. MCI patients with EPS showed lower performance compared to those without EPS in 3 cognitive sub-domains: attention (p=0.05), visuospatial function (p=0.02), and frontal/executive function (p<0.0001). The language sub-domain and the memory sub-domain did not differ between the EPS positive and the EPS negative groups. CONCLUSION: EPS in MCI are associated with greater cognitive impairment in specific functional sub-domains rather than with global greater cognitive deterioration.

Factors Associated with Caregiver Burden in Patients with Alzheimer's Disease

OBJECTIVE: Caregivers for patients with Alzheimer's disease (AD) suffer from psychological and financial burdens. However, the results of the relationship between burden and cognitive function, performance of activities of daily living, and depressive symptoms have remained inconsistent. Therefore, the aim of this study was to examine which factors are more significant predictors of heightened burden, cognitive impairment or functional decline, besides neuropsychiatric symptoms. METHODS: A cross-sectional study was conducted in a sample comprised of 1,164 pairs of patients with AD and caregivers from the Clinical Research of Dementia of South Korea study cohorts. The cognitive function of each sub-domain, functional impairments, depressive symptoms, and caregiver burden were assessed using the dementia version of Seoul Neuropsychological Screening Battery (SNSB-D), Barthel Index for Daily Living Activities (ADL), Seoul-Instrumental Activities of Daily Living (S-IADL), the Clinical Dementia Rating Sum of Box (CDR-SB), the Global Deterioration Scale (GDS), the Korean version of the Neuropsychiatric Inventory (K-NPI), and the 15-item Geriatric Depression Scale. RESULTS: We found that higher severity (higher CDR-SB and GDS scores) and more functional impairment (lower ADL and higher S-IADL scores) were significantly associated with higher caregiver burden. In addition, depressive symptoms of patients (higher Geriatric Depression Scale scores) were associated with higher caregiver burden. CONCLUSION: Therefore, interventions to help maintain activities of daily living in patients with AD may alleviate caregiver burden and improve caregiver well-being.

Alcohol Consumption as Risk Factor for Progression from Mild Cognitive Impairment to Dementia : A Clinical Research Center for Dementia of South Korea Study

OBJECTIVE: Patients with mild cognitive impairment (MCI) are at high risk for dementia. Excessive alcohol consumption is known to adversely affect cognitive function. This study aimed to investigate the relationship between alcohol consumption and the risk for dementia in a cohort of MCI patients. METHODS: Participants (n=416) with (MCI) who met Petersen's criteria were recruited from a nationwide, prospective cohort study of dementia and were followed for a median of 17.52 months (range 5.4-63.48). Alcohol consumption was evaluated at baseline. RESULTS: One hundred twenty seven individuals (30.5%) developed incident dementia (115 Alzheimer disease) during follow-up. Patients with current alcohol consumption at baseline had a higher rate of progression to Alzheimer's dementia than those without current alcohol consumption (hazard ratio 1.61 ; 95% confidence interval 1.03 to 2.53). CONCLUSION: Alcohol consumption may increase the risk of progression to Alzheimer's dementia in patients with MCI.

Association between Cognitive Subdomains and Insight in Alzheimer Disease: A Clinical Research Center for Dementia of South Korea Study

OBJECTIVE: The aim of this study was to investigate the association between cognitive subdomains and insight into one's cognitive impairment in patients with Alzheimer disease (AD). METHODS: We recruited 1,722 patients with AD from the Clinical Research of Dementia of South Korea study and designed a cross-sectional study. Each patient's cognitive subdomain was assessed by using the Seoul Neuropsychological Screening Battery-Dementia version. Severity of dementia was evaluated by Korean version of Mini-Mental Status Examination (K-MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SB). Insight into one's cognitive impairment was categorized as 'with insight' and 'without insight' through interview with patient's caregivers. RESULTS: Among the 1,722 patients with AD, 1,475 patients were included in the 'with insight' group and the remaining 247 patients were included in the 'without insight' group. Subjects in the 'without insight' group had lower K-MMSE and CDR-SB scores than those in the 'with insight' group. After controlling for demographic data and dementia severity, higher scores on both attention function (odds ratio=1.12, 95% confidence interval : 1.03-1.21) and frontal-executive function (odds ratio=1.03, 95% confidence interval : 1.01-1.05) significantly predicted the membership to 'with insight' group. CONCLUSION: In patients with AD, attention and frontal-executive function were associated with insight into one's cognitive impairment.

Association between Cognitive Subdomains and Extrapyramidal Signs in Alzheimer Disease: A Clinical Research Center for Dementia of South Korea (CREDOS) Study

OBJECTIVES: We aimed to investigate the prevalence of Extrapyramidal signs (EPS) and the associations between EPS and cognitive subdomains in patients with Alzheimer disease (AD). METHODS: We recruited 1,324 patients with AD from the Clinical Research of Dementia of South Korea (CREDOS), a hospital based cohort study with fifty-six participating hospitals. We estimated cognitive subdomain using the Seoul Neuropsychological Screening Battery-Dementia version (SNSB-D). Dementia severity was measured by Clinical Dementia Rating Sum of Boxes (CDR-SB) and Korean version of Mini-Mental Status Examination (K-MMSE). The EPS group was defined by the presence of at least one EPS based on a focused neurologic examination. RESULTS: The prevalence of patients with EPS was 11%. These had higher CDR-SB scores than non-EPS group. After controlling for demographic, radiological, and dementia severity (CDR-SB) factors, EPS group showed lower cognitive ability in the subdomains for visuospatial and frontal-executive function than non-EPS group. The patients with EPS were showed significantly higher scores in the subdomain for memory function. CONCLUSION: The presence of EPSs in patients with AD was associated with lower visuospatial, frontal-executive function and higher memory function.

Association between Insight and Neuropsychiatric Symptoms in Alzheimer's Dementia : A Clinical Research Center for Dementia of South Korea Study (CREDOS) / 신경정신의학

OBJECTIVES: The aim of this study was to identify the association between insight and neuropsychiatric symptoms in patients with Alzheimer's dementia (AD). METHODS: We examined 2607 patients with AD in the Clinical Research Center for Dementia of South Korea study and designed a cross-sectional study. Each patient underwent psychiatric, neurological, and medical examination, interview for caregivers, laboratory tests, neuropsychological tests, and brain MRI. Cognitive function was measured using the Korean version of the Mini-Mental State Examination, Global Deterioration Scale, and Clinical Dementia Rating. Behavioral and psychological symptoms were measured using the Korean version of the Neuropsychiatric Inventory. Daily Living was measured using the Barthel Index for daily living activities and Seoul-Instrumental Activities of Daily Living. Insight was classified according to 'with insight', 'partial insight', and 'without insight' by interview with caregivers. RESULTS: Among the 2607 patients, 990 were included in the 'with insight' group, 1191 were included in the 'Partial insight' group, and the 'without insight' group included 426 patients. The 'without insight' group had a significantly higher aggression level than the 'with insight' group, but not the 'partial insight' group [odds ratio (OR)=1.46, 95% confidence interval (CI) : 1,14-1.88]. A significantly lower prevalence of depression was observed in the 'Partial insight' group and the 'without insight' group, compared to the 'with insight' group (OR=0.51, 95% CI : 0.43-0.61/OR=0.61, 95% CI : 0.48-0.78). The 'partial insight' group showed a lower anxiety level than the 'with insight' group (OR=0.63, 95% CI : 0.53-0.75). CONCLUSION: Findings of this study confirmed that insight level was associated with aggression, depression, and anxiety in patients with Alzheimer' dementia.

Effects of Galantamine Treatment on Attention, Activities of Daily Living, and Neuropsychiatric Symptoms between the Patients with Pure Alzheimer's Disease and Mixed Dementia

OBJECTIVES: The purpose of this study was to compare the efficacy of galantamine treatment, especially attention ability between patients with pure Alzheimer's disease (AD) and Mixed dementia (MD) during a 24-week trial. METHODS: A total of 40 patients were recruited for this 24-week study. The effect of galantamine on attention was measured using Seoul Computerized NeuroCognitive Function Test (SCNT) and frontal functions test of Seoul Neuropsychological Screening Battery (SNSB). Patients'activities of daily living using the Seoul-Activities of Daily Living (S-ADL) and the Seoul-Instrumental Activities of Daily Living (S-IADL) ; behavioral symptoms using the Korean version Neuropsychiatric Inventory (K-NPI) were measured at baseline and 24-week. RESULTS: 17 pure AD patients and 23 MD patients were analyzed in this study. Attention as measured by SCNT was not significantly different from baseline after 24 weeks of treatment in both groups. There was no significant difference between two groups in mean change from baseline in the SCNT, S-ADL, S-IADL and K-NPI scores at 24-week. CONCLUSION: Galantamine showed a therapeutic effect on cognition, activities of daily living, neuropsychiatric symptoms in pure AD and MD. Furthermore, Galantamine may specifically help to maintain attention and it may have positive effects on other cognitive and functional abilities.

Association between Depression and Education Level in Alzheimer's Dementia : A CREDOS (Clinical Research Center for Dementia of South Korea) Study

OBJECTIVES: We aimed to identify the association depression with education level in patients with Alzheimer's dementia (AD). METHODS: We examined 911 patients with AD in CREDOS (Clinical Research Center for Dementia of South Korea) study and designed cross-sectional study. Each patient underwent psychiatrical, neurological and medical examination, interview for caregivers, laboratory tests, neuropsychological tests, and brain MRI. Cognitive function was measured using Korean version of Mini-Mental State Examination, Global Deterioration Scale and Clinical Dementia Rating. Psycho-Behavioral symptom was measured using Caregiver-Administered Neuropsychiatric Inventory. Daily Living was measured using Barthel Index for daily living activities and Seoul-Instrumental Activities of Daily Living. Depressive symptoms using the Korean version of the Short form on Geriatric Depression Scale were measured. Education was classified into low, intermediate, and high levels. 621 patients were performed APOE genotyping among the 911 patients. RESULTS: Out of the 911 patients, 477 were low education, 287 were intermediate education, and 147 were high education. 341 patients had depression. In logistic regression model we confirmed low education was the risk factor of depression (OR 2.26, 95% CI 1.66-3.07). CONCLUSION: This study confirmed that low education was associated with depression in Alzheimer's dementia.

Comparative Assessment of Clinical Efficacy after 12-Month Clinical Trial of Donepezil between the Patients with Pure Alzheimer's Disease and Mixed Dementia

OBJECTIVES: The purpose of this study was to compare the efficacy of donepezil treatment between patients with pure Alzheimer's disease (AD) and Mixed dementia (MD) during a 12-month trial. METHODS: A total of 139 patients were recruited for this 52-week study. The effect of donepezil on cognitive function was measured using Alzheimer's Disease Assessment Scale-cognitive subscale-preliminary Korean version (ADAS-cog-K). Patients' activities of daily living using the Seoul-Instrumental Activities of Daily Living (S-IADL) and Seoul-Activities of Daily Living (S-ADL);behavioral symptoms using the Korean version Neuropsychiatric Inventory (K-NPI) were measured at baseline, 13-weeks, 26-weeks, 39-weeks and 52-weeks. We defined the responsive patients to donepezil at those who showed a cognitive improvement or no change during the first six-month clinical trial. RESULTS: 84 pure AD patients and 34 MD patients were available for intent-to-treat (ITT) last observation carried forward (LOCF) analysis. There was no significant difference between two groups in mean change from baseline in the total ADAS-cog-k, S-ADL, S-IADL and K-NPI scores at 52-week. Based on the operational criteria, 60.7% of pure AD patients and 58.8% of MD patients were responders to donepezil. CONCLUSION: MD patients had similar levels of efficacy with pure AD patients and donepezil was well tolerated in both groups. These results suggest that donepezil is an effective and well-tolerated treatment for MD patients as well as for pure AD patients.

Comparative Assessment of Clinical Efficacy after 12-Month Clinical Trial of Donepezil between the Patients with Pure Alzheimer's Disease and Mixed Dementia

OBJECTIVES: The purpose of this study was to compare the efficacy of donepezil treatment between patients with pure Alzheimer's disease (AD) and Mixed dementia (MD) during a 12-month trial. METHODS: A total of 139 patients were recruited for this 52-week study. The effect of donepezil on cognitive function was measured using Alzheimer's Disease Assessment Scale-cognitive subscale-preliminary Korean version (ADAS-cog-K). Patients' activities of daily living using the Seoul-Instrumental Activities of Daily Living (S-IADL) and Seoul-Activities of Daily Living (S-ADL);behavioral symptoms using the Korean version Neuropsychiatric Inventory (K-NPI) were measured at baseline, 13-weeks, 26-weeks, 39-weeks and 52-weeks. We defined the responsive patients to donepezil at those who showed a cognitive improvement or no change during the first six-month clinical trial. RESULTS: 84 pure AD patients and 34 MD patients were available for intent-to-treat (ITT) last observation carried forward (LOCF) analysis. There was no significant difference between two groups in mean change from baseline in the total ADAS-cog-k, S-ADL, S-IADL and K-NPI scores at 52-week. Based on the operational criteria, 60.7% of pure AD patients and 58.8% of MD patients were responders to donepezil. CONCLUSION: MD patients had similar levels of efficacy with pure AD patients and donepezil was well tolerated in both groups. These results suggest that donepezil is an effective and well-tolerated treatment for MD patients as well as for pure AD patients.

Comparative Assessment of Clinical Efficacy between the Naive and the Switching Group to Donepezil: 12 Months Prospective Study

OBJECTIVES: The purpose of this study was to compare the efficacy between switching patients with Alzheimer's disease (AD) from galantamine or rivastigmine to donepezil because they were not responding adequately, and naive patients with AD who initiated therapy with donepezil. METHODS: A total of 108 patients were recruited for this 52-week study. The effect of donepezil on cognitive function was measured using Alzheimer's Disease Assessment Scale-cognitive subscale-preliminary Korean version (ADAS-cog-K). Patients' activities of daily living using Seoul-Activities of Daily Living (S-ADL) and the Seoul-Instrumental Activities of Daily Living (S-IADL);behavioral symptoms using the Korean version Neuropsychiatric Inventory (K-NPI) were measured at baseline, 13-weeks, 26-weeks, 39-weeks and 52-weeks. We defined the responsive patients to donepezil at those who showed a cognitive improvement or no change during the first six-month clinical trial. RESULTS: 86 naive patients and 22 switching patients were enrolled in the study. 74 patients completed the study and 34 discontinued their treatment before week 52. There was no significant difference between two patient groups in demographic data, baseline characteristics and dementia severity except duration of illness. The total ADAS-cog-K scores were not significantly different from baseline after 52 weeks of treatment in both groups. Both groups demonstrated deterioration of S-ADL and S-IADL at 52 weeks. The NPI scores did not significantly change in both groups. Based on the operational criteria, 61.6% of the naive group and 54.5% of the switching group were responders to donepezil. CONCLUSION: The switching group had similar levels of efficacy with the naive group who initiated therapy with donepezil. These results suggest that patients not responding adequately to rivastigmine or galantamine may improve or stabilize after switching to donepezil and prior medication does not effect donepezil's efficacy.

Impairment of Instrumental Activities of Daily Living in Patients with Mild Cognitive Impairment

OBJECTIVE: This study was conducted to examine the following: whether patients with mild cognitive impairment (MCI) show impairments in instrumental activities of daily living (IADL) as compared to controls; to identify the functional sub-domains of instrumental activities of daily living (IADL) that are affected in MCI and, finally, to identify the Seoul-Instrumental Activities of Daily Living (S-IADL) scale cut-off score that best differentiated between MCI and controls. METHODS: This study was carried out at the geropsychiatry clinic, university hospital. The study participants included 66 patients with MCI and 61 normal elderly. The S-IADL and Seoul-Activities of Daily Living (S-ADL) scales were administered to the main caregivers of all participants in order to assess everyday functioning. RESULTS: The total S-IADL score was significantly higher in the patients with MCI [mean (SD) score=4.47 (2.06)] than in the controls [mean (SD) score=1.44 (1.65)] (p<0.001). The patients with MCI performed significantly worse on IADLs, such as the ability to use the telephone, prepare meals, take medication, manage belongings, keep appointments, talk about recent events, and perform leisure activities/hobbies (p<0.05). The S-IADL scale discriminated well between patients with MCI and controls (Area Under Curve=87%). CONCLUSION: The patients with MCI showed impairments in the ability to perform complex ADL in comparison to healthy controls. IADLs related to memory and frontal/executive functioning were particularly affected in MCI.