Frequency of Depressive Disorders According to Cognitive Continuum in the Elderly Living in the Community

Objective@#We investigated the frequency of depressive disorders in the elderly with normal cognition (NC), mild cognitive impairment (MCI) and dementia patients living in the community to find out the association between cognitive disorders and depressive disorders in the community dwelling elderly. @*Methods@#6,262 baseline study subjects from November 2010 through October 2012 were enrolled based on the Korean longitudinal study on cognitive aging and dementia which is the first nationwide multi-center population based prospective cohort study in Korea. Diagnosis of MCI, dementia, major depressive disorder (MDD), minor depressive disorder (mDD) and subsyndromal depression (SSD) was made by psychiatrists with expertise in dementia based on the appropriate diagnostic criteria. @*Results@#4,303 NC, 1,737 MCI, 222 dementia were enrolled. The frequency of MDD, mDD, SSD were highest in dementia and lowest in NC and showed significant difference among three groups. The odds ratio also increased significantly in MCI and dementia compared with NC showing highest odds ratio in dementia. @*Conclusion@#Our findings propose that MCI and dementia in the community dwelling elderly were significantly associated with various types of depressive disorders showing highest association tendency in dementia.

Low Diastolic Blood Pressure and Cognitive Decline in Korean Elderly People: The Korean Longitudinal Study on Cognitive Aging and Dementia

Objective@#Cardiovascular diseases are representative risk factors for the onset of cognitive decline. The purpose of this study was to confirm the relationship between diastolic blood pressure and cognitive function in elderly people in Korea. @*Methods@#Data from subjects who were enrolled in the prospective Korean Longitudinal Study on Cognitive Aging and Dementia were used in this study. Data from 701 subjects whose diastolic blood pressure range did not change (≤79 mm Hg or ≥80 mm Hg) over 2 years were analyzed. To analyze the differences in cognitive function between the groups at the 2-year follow-up, an analysis of covariance was performed with covariates, which were significantly different between the two groups, and the baseline cognitive function. @*Results@#Significant differences were observed between the two groups, and the mean scores on the constructional praxis (η2=0.010) and word list recall tests (η2=0.018) in the diastolic blood pressure ≥80 mm Hg group were higher than those in the diastolic blood pressure ≤79 mm Hg group at the 2-year follow-up. @*Conclusion@#These results indicate that maintaining a DBP below 79 mm Hg presents a greater risk of cognitive decline in Korean elderly people.

Driving-Related Adverse Events in the Elderly Men: A Population-Based Prospective Cohort Study

Objective@#This study estimated the incidence of driving-related adverse events and examined the association of cognitive function with the risk of future driving-related adverse events in the elderly Korean male population. @*Methods@#We analyzed 1,172 male drivers aged 60 years or older in the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD). Using the data from Korean National Police Agency, we classified the participants into three groups: safe driving (drove for 2 years after baseline without a traffic accident or repeated violations), driving cessation (stopped driving), and risky driving (one or more traffic accidents or repeated violations). We estimated the incidences of driving cessation and risky driving, and examined the effect of cognitive function on their risks. @*Results@#The incidence of driving cessation and risky driving in the Korean male drivers aged 60 years or older was 19.3 and 69.9 per 1,000 person-years respectively and increased in the late 80s. Drivers with better baseline Word List Memory Test scores showed less risky driving (OR=0.94, p=0.039). @*Conclusion@#Driving-related adverse events increased in late 80s, and better memory function was protective against these events.

Development of a Screening Algorithm for Alzheimer's Disease Using Categorical Fluency and Confrontational Naming Abilities

OBJECTIVE: Declines in naming ability and semantic memory are well-known features of early Alzheimer's disease (AD). We developed a new screening algorithm for AD using two brief language tests : the Categorical Fluency Test (CFT) and 15-item Boston Naming Test (BNT15). METHODS: We administered the CFT, BNT15, and Mini-Mental State Examination (MMSE) to 150 AD patients with a Clinical Dementia Rating of 0.5 or 1 and to their age- and gender-matched cognitively normal controls. We developed a composite score for screening AD (LANGuage Composite score, LANG-C) that comprised demographic characteristics, BNT15 subindices, and CFT subindices. We compared the diagnostic accuracies of the LANG-C and MMSE using receiver operating curve analysis. RESULTS: The LANG-C was calculated using the logit of test scores weighted by their coefficients from forward stepwise logistic regression models : logit (case)=12.608−0.107×age+1.111×gender+0.089×education−0.314×HS(1st)−0.362×HS(2nd)+0.455×perseveration+1.329×HFCR(2nd)−0.489×MFCR(1st)−0.565×LFCR(3rd). The area under the curve of the LANG-C for diagnosing AD was good (0.894, 95% confidence interval=0.853–0.926 ; sensitivity=0.787, specificity=0.840), although it was smaller than that of the MMSE. CONCLUSION: The LANG-C, which is easy to automate using PC or smart devices and to deliver widely via internet, can be a good alternative for screening AD to MMSE.

The Utility of Subset of Subjective Memory Complaint Questionnaire and Mini-Mental State Examination for Dementia Screening

OBJECTIVE: Purpose of this study was to assess the potential added values of Subjective Memory Complaint Questionnaire (SMCQ) combined with Mini-Mental State Examination (MMSE) in developing a brief screening battery to improve the early detection rate of dementia in community setting. METHODS: Non-depressed community-dwelling Korean elderly aged 65 years and older who 945 randomly selected and 734 voluntarily involved were recruited. Dementia was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Diagnostic ability of 10 point SMCQ subscale for everyday memory (SMCQ-E) for dementia was evaluated. Additive values of SMCQ-E combined with MMSE for dementia screening and the economic benefits of SMCQ-E and its combination with MMSE were also evaluated. RESULTS: Overall area under the curve values of SMCQ-E were 0.605 (0.565–0.646) for nonrandom sample and 0.836 (0.783–0.890) for random sample. When SMCQ-E was combined with MMSE using ‘AND’ rule, accuracy, specificity, positive predictive values and positive likelihood ratio were increased than those of MMSE. While SMCQ-E was combined the MMSE using ‘OR’ rule, sensitivity and negative predictive values were increased and negative likelihood ratio were decreased than those of SMCQ-E and MMSE. When SMCQ-E and MMSE combined with AND rule, total cost for dementia screening was reduced to about 80% compared to MMSE single use model. CONCLUSION: Results of this study showed that brief SMCQ-E and its combination with MMSE could be used to dementia screening with cost effective manner.

Anhedonia and Dysphoria Are Differentially Associated with the Risk of Dementia in the Cognitively Normal Elderly Individuals: A Prospective Cohort Study

OBJECTIVE: We investigated the impact of depressed mood (dysphoria) and loss of interest or pleasure (anhedonia)on the risk of dementia in cognitively-normal elderly individuals. METHODS: This study included 2,685 cognitively-normal elderly individuals who completed the baseline and 4-year follow-up assessments of the Korean Longitudinal Study on Cognitive Aging and Dementia. We ascertained the presence of dysphoria and anhedonia using the Mini International Neuropsychiatric Inventory. We defined subjective cognitive decline as the presence of subjective cognitive complaints without objective cognitive impairments. We analyzed the association of dysphoria and anhedonia with the risk of cognitive disorders using multinomial logistic regression analysis adjusted for age, sex, education, Cumulative Illness Rating Scale score, Apolipoprotein E genotype, and neuropsychological test performance. RESULTS: During the 4-year follow-up period, anhedonia was associated with an approximately twofold higher risk of mild cognitive impairment (OR=2.09, 95% CI=1.20–3.64, p=0.008) and fivefold higher risk of dementia (OR=5.07, 95% CI=1.44–17.92, p=0.012) but was not associated with the risk of subjective cognitive decline. In contrast, dysphoria was associated with an approximately twofold higher risk of subjective cognitive decline (OR=2.06, 95% CI=1.33–3.19, p=0.001) and 1.7-fold higher risk of mild cognitive impairment (OR=1.75, 95% CI=1.00–3.05, p=0.048) but was not associated with the risk of dementia. CONCLUSION: Anhedonia, but not dysphoria, is a risk factor of dementia in cognitively-normal elderly individuals.

Normal-But-Low Serum Folate Levels and the Risks for Cognitive Impairment

OBJECTIVE: This study aimed to examine the association between normal-but-low folate levels and cognitive function in the elderly population using a prospective cohort study. METHODS: We analyzed 3,910 participants whose serum folate levels were within the normal reference range (1.5–16.9 ng/mL) at baseline evaluation in the population-based prospective cohort study named the “Korean Longitudinal Study on Cognitive Aging and Dementia.” The association between baseline folate quartile categories and baseline cognitive disorders [mild cognitive impairment (MCI) or dementia] was examined using binary logistic regression analysis adjusting for confounding variables. The risks of incident MCI and dementia associated with the decline of serum folate level during a 4-year follow-up period were examined using multinomial logistic regression analysis. RESULTS: The lowest quartile group of serum folate (≥1.5, ≤5.9 ng/mL) showed a higher risk of cognitive disorders than did the highest quartile group at baseline evaluation (odds ratio 1.314, p=0.012). Over the 4 years of follow-up, the risk of incident dementia was 2.364 times higher among subjects whose serum folate levels declined from the 2nd–4th quartile group to the 1st quartile than among those for whom it did not (p=0.031). CONCLUSION: Normal-but-low serum folate levels were associated with the risk of cognitive disorders in the elderly population, and a decline to normal-but-low serum folate levels was associated with incident dementia. Maintaining serum folate concentration above 5.9 ng/mL may be beneficial for cognitive status.

Overview of the Korean Longitudinal Study on Cognitive Aging and Dementia

OBJECTIVE: Due to an unprecedented rate of population aging, South Korea is facing a dementia epidemic. For this reason, the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) was launched in 2009 with support from the Korean Health Industry Development Institute to investigate the epidemiology, biopsychosocial risk factors, and outcomes of dementia and dementia-related conditions. METHODS: The KLOSCAD is the first nationwide multi-center population-based prospective cohort study. In October 2010, 12,694 individuals were randomly sampled from residents aged 60 years or older who lived in 13 districts across South Korea. In the baseline assessment, which was conducted from November 2010 through October 2012, 6,818 (53.7%) individuals participated. Follow-up assessments have been conducted every two years, with the first follow-up assessment conducted between November 2012 and October 2014, and the second between November 2014 and October 2016. The third is now in progress, and will span from November 2016 to October 2018. Diagnosis of cognitive disorders, neuropsychological battery, behavioral and psychological symptoms of dementia, activities of daily living, physical and neurologic examination and laboratory tests, life styles, quality of life, and identification of death were evaluated in each assessment. RESULTS: The cumulative drop-out rate at the second follow-up assessment was 38.7%. Dementia and mild cognitive impairment were 5.0% and 27.0%, respectively. CONCLUSION: The KLOSCAD may provide strong scientific evidence for advancing the fight against dementia both in Korea and globally.

Prevalence and Risk Factors of Abusive Behaviors in the Caregivers of People with Dementia in Korea

OBJECTIVE: We investigated the prevalence and risk factors of physically abusive behaviors (PhAB) and psychologically abusive behaviors (PsAB) towards people with dementia (PWD) in family caregivers, and compared their prevalences between East Asian and Western countries. METHODS: We estimated the prevalence and risk factors of PhAB and PsAB in 467 Korean pairs of community-dwelling PWD and their primary family caregivers. We evaluated abusive behaviors using the Modified Conflict Tactics Scale. In addition, we compared the prevalence of abusive behaviors between Asian and Western countries through a meta-analysis on 12 studies including the current one. RESULTS: More than a half of the caregivers reported PsAB and about one out of seven caregivers admitted PhAB within past three months. PsAB and PhAB were slightly more prevalent in East Asian countries than in Western countries. Non-Alzheimer type and moderate to severe behavioral and psychological symptoms of dementia were associated with the risk of PhAB but not with the risk of PsAB. Severe care burden and low income were associated with the risk of PhAB and PsAB. CONCLUSION: PhAB and PsAB were as prevalent in the family caregivers of PWD in Asian countries including Korea as in Western countries. Prevention strategies should be implemented according to the type of abusive behaviors.

Food and nutrient intake status of Korean elderly by degree of cognitive function / 한국영양학회지

PURPOSE: This study was conducted to examine the relationship among cognitive function, nutrition screening initiative (NSI) score, and food intake status. METHODS: A total of 409 subjects aged over 60 years were recruited from the Yongin dementia prevention and control center. Mini Mental State Examination Dementia Screening (MMSE-DS) method was used to assess the cognitive function of the subjects. Information on health related behaviors and food intake was collected by face to face interview using a structured questionnaire. The questionnaires included the NSI DETERMINE checklist, food intake sheets by 24 hr recall method and by semi-quantified food frequency questionnaire. RESULTS: Subjects were divided into low cognitive or normal groups according to the MMSE-DS result. The prevalence of low cognitive function in the subjects was 25.7%. The low cognitive group exercised less and had higher nutritional health risk than the normal group. The low cognitive group had lower consumption of polyunsaturated fatty acid and higher tendency of thiamin, riboflavin, and iron deficiency. The low cognitive group had less frequency of eating mackerel, pepper, tangerine, and watermelon and higher frequency of eating white rice and cookies than the normal group. CONCLUSION: The results of this study imply that the cognitive function of elderly is related to exercise behavior, nutritional health risk, and food and nutrient intake status.

The Effect of Choline Acetyltransferase Genotype on Donepezil Treatment Response in Patients with Alzheimer's Disease

OBJECTIVE: We examined the difference in responses to donepezil between carriers and non-carriers of the A allele at the +4 position of the choline acetyltransferase (ChAT) gene in Koreans. METHODS: Patients who met the criteria for probable Alzheimer's disease (AD) (n=199) were recruited. Among these, 145 completed the 12-week follow-up evaluation and 135 completed the 26-week scheduled course. Differences and changes in the Korean version of the mini-mental state examination (MMSE-KC) score, Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-K[N]) wordlist subtest score (WSS), CERAD-K(N) total score (TS), and the Korean version of geriatric depression scale (GDS-K) score between baseline and 12 weeks or 26 weeks were assessed by the Student's t-test. RESULTS: At 12 weeks, the changes in the MMSE-KC score, CERAD-K(N) WSS, and CERAD-K(N) TS from baseline were not significant between ChAT A allele carriers and non-carriers; however, at 26 weeks, these changes were significantly larger in ChAT A allele carriers than in non-carriers (p=0.02 for MMSE-KC and p=0.03 for CERAD-K(N) WSS respectively). CONCLUSION: Our findings in this study suggested that presence of the A allele at the +4 position of ChAT might positively influence the treatment effect of donepezil in the early stages of AD in Koreans.

Factors Associated with the Attitudes toward Dementia in Community Caregivers: Results from the Nationwide Survey on Dementia Care in Korea

OBJECTIVE: We investigated caregivers' attitudes toward dementia, which may play a key role in the timely treatment and optimal care of people with dementia (PWD), and patient and caregiver factors potentially associated with these attitudes. METHODS: As a part of the Nationwide Survey on Dementia Care in Korea, we evaluated the attitudes of 731 community-dwelling caregivers of PWD with the Dementia Attitude Scale (DAS). Using stepwise multiple regression analysis, we investigated the sociodemographic factors of the caregivers, the clinicodemographic factors of the PWD, and the situational factors of caregiving that may influence caregivers' attitudes. RESULTS: The mean score on the DAS total was 80.65+/-16.0 (maximum : 140). The mean score on the DAS Knowledge subscale, which reflects awareness of dementia, was 42.86+/-9.6 (maximum : 70), and that on the DAS Comfort subscale, which reflects emotional and behavioral attitudes toward dementia, was 37.79+/-10.3 (maximum : 70). Non-spouse caregiver, living in a rural area, completion of a formal care education program (caregiver factors) and female patient, high educational level, high clinical dementia rating and mild behavioral symptoms (patient factors) were associated with a high DAS total score. CONCLUSION: We found much room for improvement in caregivers' attitudes towards PWD in Korea, indicating a need for strategies to improve these attitudes, targeting the at-risk group.

Improvement of Screening Accuracy of Mini-Mental State Examination for Mild Cognitive Impairment and Non-Alzheimer's Disease Dementia by Supplementation of Verbal Fluency Performance

OBJECTIVE: This study aimed to investigate whether the supplementation of Verbal Fluency: Animal category test (VF) performance can improve the screening ability of Mini-Mental State Examination (MMSE) for mild cognitive impairment (MCI), dementia and their major subtypes. METHODS: Six hundred fifty-five cognitively normal (CN), 366 MCI [282 amnestic MCI (aMCI); 84 non-amnestic MCI (naMCI)] and 494 dementia [346 Alzheimer's disease (AD); and 148 non-Alzheimer's disease dementia (NAD)] individuals living in the community were included (all aged 50 years and older) in the study. RESULTS: The VF-supplemented MMSE (MMSE+VF) score had a significantly better screening ability for MCI, dementia and overall cognitive impairment (MCI plus dementia) than the MMSE raw score alone. MMSE+VF showed a significantly better ability than MMSE for both MCI subtypes, i.e., aMCI and naMCI. In the case of dementia subtypes, MMSE+VF was better than the MMSE alone for NAD screening, but not for AD screening. CONCLUSION: The results support the usefulness of VF-supplementation to improve the screening performance of MMSE for MCI and NAD.

A Normative Study of the Disability Assessment for Dementia in Community-Dwelling Elderly Koreans

OBJECTIVE: We investigated demographic influences on Korean version of Disability Assessment for Dementia (DAD-K) performance and developed normative data for DAD-K. METHODS: The DAD-K was administered to 2362 normal controls (NCs), 296 patients with mild cognitive impairment (MCI) and 293 patients with Alzheimer's disease (AD). MANOVA and ROC curve analysis were used to compare DAD-K performance and the diagnostic accuracy of DAD-K, respectively. The demographic influence on DAD-K scores was analyzed by multiple linear regression and ANOVA. Normative DAD-K data were calculated using natural logarithmic transformation. RESULTS: All DAD-K scores were significantly different among groups (p<0.001). Post hoc analysis showed that instrumental activities of daily living (IADL), executive function and DAD-K total scores began to decline significantly in the very mild stage of AD, whereas the basic activities of daily living (BADL) scores began to decline in the mild stage of AD. The area under the ROC curve differentiating MCI or AD from NC was 0.737 and that differentiating AD from MCI or NC was 0.911. IADL and planning and organization scores were influenced by age and education and performance and DAD-K total scores were influenced by education. CONCLUSION: The demographic influences on DAD-K scores are not conspicuous and are mainly limited to the IADL and planning and organization scores. Unitary or minimally stratified norms for a specific population were developed for DAD-K application. Our results suggest that the DAD-K is useful for differentiating NC or MCI from AD but not as powerful for differentiating NC from MCI.

Improvement of Dementia Screening Accuracy of Mini-Mental State Examination by Education-Adjustment and Supplementation of Frontal Assessment Battery Performance

This study aimed to investigate whether the demographic variable-adjustment and supplementation of Frontal Assessment Battery (FAB) score can improve the screening ability of Mini-Mental State Examination (MMSE) for dementia and its subtypes. Five hundred forty-one non-demented comparison (NC) and 474 dementia (320 Alzheimer's disease [AD]; 139 non-Alzheimer's disease dementia [NAD]; and 15 mixed AD-NAD dementia) individuals living in the community were included. Education-adjusted MMSE (MMSE-edu) score showed significantly better screening accuracy for overall dementia, AD, and NAD than MMSE raw score. FAB-supplemented MMSE (MMSE-FAB) score had significantly better screening ability for NAD, but not for overall dementia and AD, than MMSE raw score alone. Additional supplementation of FAB to MMSE-edu further increased the ability for overall dementia or NAD screening, but not for AD screening. Further education adjustment of MMSE-FAB also improved its ability for overall dementia, AD, and NAD screening. These results strongly support the usefulness of education-adjustment and supplementation of frontal function assessment to improve screening performance of MMSE for dementia and its subtypes, NAD in particular.

Impaired Design Fluency Is a Marker of Pathological Cognitive Aging; Results from the Korean Longitudinal Study on Health and Aging

OBJECTIVE: We investigated neuropsychological markers that can be used to discriminate pathological cognitive aging from normal cognitive aging. METHODS: We administered frontal lobe function tests including the Wisconsin Card Sorting Test (WCST), digit span test, lexical fluency test, fixed condition design fluency test, and Trail Making Test B (TMT-B) to 92 individuals with pathological cognitive aging (PCA) and 222 individuals with normal cognitive aging (NCA). We examined the main effects of participants' diagnoses (PCA, NCA) and age (65-69 years old, 70-74 years old and 75 years old or over) on their test performance using multivariate analysis of variance. RESULTS: The main effects of both the diagnosis (F=2.860, p=0.002) and the age group (F=2.484, p<0.001) were significant. The PCA group showed lower performance on the backward digit span test (F=14.306, p<0.001), fixed condition design fluency test (F=8.347, p=0.004) and also exhibited perseverative errors in the WCST (F=4.19, p=0.042) compared with the NCA group. The main effect of the diagnosis on the backward digit span test and the fixed condition design fluency test remained significant after Bonferroni correction. The main effect of age remained significant in the TMT-B (F=8.737, p<0.001) after Bonferroni correction. Other test scores were not influenced by diagnosis or age. CONCLUSION: The design fluency task may be a good neuropsychological marker to assess pathological cognitive aging.

The Impact of Choline Acetyltransferase Polymorphism on the Expression of Mild Cognitive Impairment

OBJECTIVES: The potential association between choline acetyltransferase(CHAT) polymorphism and the risk of mild cognitive impairment(MCI) has not been investigated in Korea. We examined the main effect of CHAT polymorphism and its interaction with apolipoprotein E(APOE) polymorphism in the development of MCI in elderly Korean sample. METHODS: We analyzed CHAT 2384G > A polymorphism and APOE polymorphism among 149 MCI subjects with MCI and 298 normal controls. We tested the association between MCI and CHAT A allele status using a logistic regression model. In addition, we employed generalized multifactor dimensionality reduction(GMDR) to investigate the interaction between CHAT and APOE with regard to the risk of MCI. RESULTS: The CHAT A allele was associated with AD risk(OR = 1.59, 95% CI = 1.02-2.48, p = 0.042). No significant gene-gene interaction between CHAT and APOE was found in GMDR method(testing balanced accuracy = 0.540, p = 0.055). CONCLUSION: The CHAT A allele was associated with MCI risk in the Korean elderly. Its interaction with the APOE epsilon4 allele was not significant with regard to the development of MCI.

Reliability and Validity of the Korean Version of Severe Mini-Mental Status Examination (SMMSE-K) / 신경정신의학

OBJECTIVES: We developed the Korean version of Severe Mini-Mental Status Examination (SMMSE-K) which is a brief cognitive test for the severely demented patients. METHODS: The translation was carried out keeping the basic structure of the English version Severe Mini-Mental Status Examination (SMMSE). The SMMSE-K, Korean version of Mini Mental State Examination (MMSE-KC), and Clinical Dementia Rating (CDR) were administered to 84 Alzheimer's disease (AD) patients and 36 cognitively normal elderly subjects. For evaluating the reliability of the SMMSE-K, Cronbach alpha coefficient, inter-rater reliability, and test-retest reliability were examined. For confirming the validity of the SMMSE-K, the correlations of the SMMSE-K with MMSE-KC and CDR were examined, and factor analysis was performed using principal component analysis with Varimax rotation. RESULTS: SMMSE-K was found to have a high internal consistency (Cronbach alpha coefficient=0.906, p<0.01), inter-rater reliability (Pearson correlation coefficient=0.980, p<0.01) and test-retest reliability (Pearson correlation coefficient=0.940, p<0.01). Performances on the SMMSE-K and MMSE-KC were found to correlate significantly in the subjects with CDR of 2 (Pearson correlation coefficient=0.827, p<0.001) and 3 (Pearson correlation coefficient=0.929, p<0.001). In the subjects with CDR of 3, the MMSE-KC showed a floor effect (2.93+/-3.21), whereas the SMMSE-K did not (11.00+/-8.48). Exploratory factor analysis yielded two factors (automatic informational processing, controlled informational processing) accounting for 76.1% of the total variance. CONCLUSION: The SMMSE-K was found to be a reliable and valid test for assessing the cognition of severely demented patients.

Relationship of Sleep Factors with Neurocognitive Function in Normal Elderly Subjects and Mild Cognitive Impairment (MCI) Patients / 신경정신의학

OBJECTIVES: We aimed to compare sleep factors including daytime sleepiness, sleep apnea and insomnia between mild cognitive impairment (MCI) patients and normal control (NC) subjects and to illustrate their relationship with neuropsychological function in the preclinical stage of dementia. METHODS: Epworth Sleepiness Scale (ESS), sleep apnea subscale of Sleep Disorders Questionnaire (SA) and questionnaire on insomnia were administered to community-dwelling elderly subjects above the age of 60. Both clinical and neuropsychological batteries of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) assessment packet and Stroop Color and Word Test (SCWT) were done for each subject. Seventy seven NC subjects and 47 MCI patients were selected. RESULTS: In the NC group, ESS scores negatively correlated with Stroop interference (SI) scores. SA scores were negatively correlated with Stroop Color Word (SCW) and SI scores. In the MCI group, ESS scores negatively correlated with SCW scores, and SA scores had no correlation with each neurocognitive function test. CONCLUSION: Daytime sleepiness was associated with impaired executive function in community-dwelling normal elderly subjects and MCI patients. But the higher risk of SA was associated with decreased executive function only in normal elderly subjects.

Comparison of the Performance in Two Different Korean Versions of Mini-Mental State Examination: MMSE-KC and K-MMSE / 신경정신의학

OBJECTIVES: We compared the scores of the MMSE-KC (Korean version of MMSE in the Korean version of CERAD Assessment Packet) and K-MMSE (Korean MMSE), and analyzed the influences of age, gender, and educational level on the differences between the two. METHODS: We administered the MMSE-KC and K-MMSE simultaneously along with geriatric depression scale (GDS-K) to 733 community-dwelling elderly aged 50 or over in three districts of Suwon. The differences between the MMSE-KC scores and K-MMSE scores were examined by repeated measure ANOVA computing the MMSE for intra-individual factor, age, gender, and educational level as inter-individual factor, and GDS-K score as a covariate. RESULTS: The scores of MMSE-KC and K-MMSE were identical only in the 17.8% of the subjects and the difference between the MMSE-KC score and K-MMSE score were significantly influenced by the educational level of the subjects (F (3,173)=8.21, p0.1), it was highly significant in 'judgement and writing/reading' subscores (F (1,731)=16.35, p<0.001) and its influences were significantly varied by the educational level of the subjects (F (1,731)=20.82, p<0.001). CONCLUSION: The MMSE-KC and K-MMSE which were standardized differently are not identical in scores as well as in content, and the difference between the two is greatly influenced by the educational level of the subject. When interpreting or comparing the MMSE scores of the two different versions of Korean MMSE, the comparability of the scores among them observed in this study should be considered.