Effect of Personalized Blue-Enriched White Light Intervention on Rest–Activity and Light Exposure Rhythms in Mild and Moderate Alzheimer’s Disease

Objective@#We aimed to examine the effectiveness of personalized light intervention using a blue-enriched light-emitting-diodes device on rest–activity rhythm (RAR) and light exposure rhythm (LER) in patients with mild and moderate Alzheimer’s disease (AD). @*Methods@#AD patients with poor sleep quality and/or insomnia symptoms were assigned into either an experimental group (EG) or control group (CG) in a single-blind design. Personalized light intervention was given at 9–10 h after individual dim light melatonin onset, lasting for 1 h every day for two weeks in the EG (77.36±5.79 years, n=14) and CG (78.10±7.98 years, n=10). Each patient of CG wore blue-attenuating sunglasses during the intervention. Actigraphy recording at home for 5 days was done at baseline (T0), immediate postintervention (T1), and at four weeks after intervention (T2). The variables of RAR and LER were derived using nonparametric analysis. @*Results@#We found a significant time effect on the intradaily variability (IV) of RAR at T2 with respect to T0 (p=0.039), indicating reduced IV of RAR at four weeks after personalized light intervention regardless of blue-enriched light intervention. There was a time effect on the IV of LER at T1 with respect to T0 (p=0.052), indicating a reduced tendency in the IV of LER immediately after intervention. @*Conclusion@#Our personalized light intervention, regardless of blue-enriched light source, could be useful in alleviating fragmentation of RAR and LER in AD patients.

A Patient with the Disrupted Sleep-Wake Rhythm after Traumatic Brain Injury / 신경정신의학

Many patients with a traumatic brain injury (TBI) experience a range of sleep problems. Although some studies investigated the pathophysiology of sleep-wake cycle disturbances in TBI patients, it has not been clarified. This paper presents a middle aged female patient who showed sleep deprivation and sleep-wake cycle disturbances for approximately three months after TBI. The improvement in the subjective and objective sleep quality was shown by the sleep diary and actigraphy during this period. Moreover, the dim light melatonin onset (DLMO) had been delayed before returning to the normal range in 3 months. In addition, the patient showed an improvement in the neurocognitive function, including attention, memory and language function, along with a consolidation of the sleep-wake cycle. This case showed that the sleep disturbance following a TBI was probably caused by the disrupted melatonin rhythm based on the abnormality of the DLMO. In addition, the cognitive dysfunction after TBI could be associated with sleep-wake cycle disturbances because its gradual improvement occurred as the sleep disturbance diminished. Further studies on the change in circadian rhythm after a brain injury related to neurocognitive impairment are required.

The Effects of Stress- and Sleep-Related Variables on the Quality of Life in Insomnia Patients / 신경정신의학

OBJECTIVES: We examined the effects of sleep variables and emotional factors including stress, anxiety and depression on the quality of life in insomnia patients. METHODS: We recruited 153 insomnia patients and 96 normal control (NC) subjects who visited three Public Health Centers in Kangwon-do from 2013 until 2015. The Pittsburgh Sleep Quality Index (PSQI), Korean version of Morningness-Eveningness Questionnaire (MEQ-K), Korean version of Epworth Sleepiness Scale, Ford Insomnia Response to Stress Test (FIRST), Hyperarousal Scale (HAS), Perceived Stress Scale (PSS), Anxiety-Sensitivity Index (ASI), Beck Depression Inventory (BDI), and Short Form-12 Health Survey Questionnaire (SF-12) were administered for each subject. We compared the scores of the above scales between the insomnia and control groups, using analysis of covariance to control for age. Stepwise regression analysis assessed the association of these variables with SF-12 scores. RESULTS: The scores of PSQI, FIRST, HAS, ASI, BDI in insomnia patients were significantly higher than those of NC subjects, but the Mental Component Summary (MCS) scores of SF-12 were lower. Stepwise regression analysis showed the scores of PSS and MEQ-K significantly predicted the MCS scores in NC subjects, and the BDI score predicted scores in insomnia patients. CONCLUSION: In our study, greater subjective stress and evening preference could explain lower mental quality of life in NC subjects. In insomnia patients, greater depression is an additional factor.

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.

A Case of Bright Light Therapy in a Treatment Resistant Patient with Major Depressive Disorder / 신경정신의학

The light therapy has been known to be effective to non-seasonal affective disorder as well as seasonal affective disorder. Although the mechanism of action of light therapy for depressive disorder has not been verified yet, its clinical application revealed similar effects like antidepressants and relatively smaller side effects. However, it is not common to apply the light therapy for treatment resistant depressive disorder. This case report indicates a robust efficacy of light therapy and its clinical usefulness, illustrating the complete remission in a treatment resistant patient with major depressive disorder after bright light therapy.

Relationship of Limb Movements during Sleep with Nocturnal Sleep Parameters in the Community-Dwelling Elderly with Sleep Complaints / 신경정신의학

OBJECTIVES: The aim of this study was to examine the differences in subjective sleep quality and objective sleep parameters between groups with different severities of limb movements during sleep in elderly persons with sleep complaints. METHODS: We recruited adult subjects with sleep complaints from four areas in Gangwon-do. Nocturnal polysomnography studies were conducted for 159 subjects at Kangwon National University Hospital. A total of 72 subjects older than 60 years were finally selected, and we classified them into three groups according to the limb movement index (LMI) : 29 subjects with LMI below 15, 21 subjects with LMI between 15 and 44, and 22 subjects with LMI above 44. RESULTS: The proportion of existing restless legs syndrome (RLS) symptoms differed between the three groups, but was not statistically significant (p=0.051). No difference in nocturnal sleep parameters was observed between the three groups. In the total group, the limb movement arousal index showed positive correlation with respiratory arousal index (r=0.252, p<0.05). CONCLUSION: In elderly persons with sleep complaints, a greater LMI severity was associated with a tendency of higher comorbidity of RLS. Frequent arousals due to limb movements were not associated with a greater severity of limb movements during sleep severity, but with increased arousals due to respiratory events.

Sleep Wake Patterns and Nocturnal Sleep Parameters in the Morning and Evening Types / 신경정신의학

OBJECTIVES: The aim of our study was to compare sleep wake patterns and nocturnal sleep parameters between the morning type (MT) and evening type (ET). METHODS: The Morningness-Eveningness Questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Korean version of the Epworth Sleepiness Scale (KESS) were administered to subjects recruited among visitors to the Chuncheon National Museum from 2010 to 2011. Actigraphy data (Actiwatch-2, Philips-Respironics Co.) were collected from eight MT (Age 38.0+/-3.8, M : F=2 : 6), 12 neither type (NT) (Age 34.2+/-5.1, M : F=2 : 10), and nine ET (Age 30.3+/-6.8, M : F=2 : 7) subjects. RESULTS: Scores for PSQI and KESS did not differ significantly among the MT, NT, and ET groups. No differences in time in bed, total sleep time, sleep efficiency, wake after sleep onset, sleep latency, and fragmentation index were observed among the three groups. In the ET group, the mean wake time on free days was significantly later, and the mean sleep duration on free days was significantly longer, compared with those of the MT group (p<0.01). CONCLUSION: No differences in sleep quality, daytime sleepiness, and nocturnal sleep parameters were observed among the MT, NT, and ET groups. Compared to MT subjects, ET subjects showed later wake time and longer sleep duration on free days.

Nocturnal Sleep Related with Metabolic Markers in End-Stage Renal Disease Patients Receiving Hemodialysis

OBJECTIVE: It has been suggested that oxidative stress and inflammation are associated with the pathophysiology of sleep disorders in end-stage renal disease (ESRD) patients. We examined the relationship of the sleep variables reflecting sleep breathing disorder and limb movements during sleep with the clinical variables reflecting the metabolic abnormalities in ESRD patients receiving hemodialysis. METHODS: Nocturnal polysomnography was conducted in 30 ESRD patients (21 men, 9 women), who were receiving hemodialysis. Blood was sampled before hemodialysis for each patient in order to measure uric acid (UA), C-reactive protein (CRP), and interleukin-6 (IL-6). RESULTS: UA was correlated positively with the total sleep time (TST)(r=0.407) and negatively with the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI)(r=-0.377, -405). CONCLUSION: CRP was positively correlated with the limb movement index (LMI)(r=0.401). Our study showed that increased UA was related to decreased respiratory disturbance during sleep in ESRD patients receiving hemodialysis.

Relationship of Neurocognitive Function with the Sleep-Wake Rhythm in Mild Cognitive Impairment Patients / 신경정신의학

OBJECTIVES: We compared the parameters of the sleep-wake rhythm in mild cognitive impairment (MCI) patients to those of normal elderly subjects, to illustrate how the characteristics of circadian rhythm relate to a specific neurocognitive function. METHODS: We selected 12 MCI patients and 12 age- and sex-matched normal control (NC) subjects and administered the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Neuropsychological battery and Stroop Color-Word Test (SCWT) to each subject. We measured each subject's sleep-wake rhythm by applying actigraphy for 96 hours. The sleep-wake rhythm was examined by cosinor analysis. RESULTS: There was no significant difference in the amplitude or acrophase of the sleep-wake rhythms between the NC and MCI groups. In the combined group, amplitude was positively correlated with Constructional Praxis scores (r=0.434, p<0.05), and acrophases tended to be positively correlated with Word List Memory scores (r=0.370, p=0.07). CONCLUSION: There was no difference between MCI patients' sleep-wake rhythm's amplitude and acrophase and those of NC subjects. Furthermore, decreased amplitude was associated with impaired visuospatial function in the combined group. It will be necessary to confirm this result in an expanded MCI group in a future study.

Relationship of Nocturnal Sleep with Frontal Lobe Function in Mild Cognitive Impairment(MCI) Patients / 신경정신의학

OBJECTIVES: Nocturnal sleep disruption has been considered as a risk factor for cognitive impairment in the elderly. And the frontal lobe dysfunction was suggested to predict the progression to dementia. We aimed to illustrate the relationship of nocturnal sleep with frontal lobe function in mild cognitive impairment (MCI) patients. METHODS: Thirty MCI patients and 30 age- and sex-matched normal control (NC) subjects were selected. Frontal lobe function tests including Stroop Test, Similarity Test, Digit Span Test (DST), and Benton Visual Retention Test (BVRT) were administrated. Nocturnal polysomnography was done for each subject. RESULTS: There was no significant difference in the sleep parameters and diagnostic distributions of sleep disorders between the MCI and NC groups. In MCI patients, the mean hypopnea index (HI) of the ApoE4 positive group was higher than that of ApoE4 negative group. In the NC group, the wake time after sleep onset (WASO) was negatively correlated with the DST score (r=-0.545). In the MCI group, WASO tended to be negatively correlated with the Similarity Test score (r=-0.376, p=0.053), and slow wave sleep amount (SWS) was negatively correlated with the error score of BVRT (r=-0.489). CONCLUSION: Although there was no difference in the sleep quality and frequency of SAS between the MCI and NC groups, the severity of SDB was higher in MCI patients with ApoE4 compared to those without ApoE4. In the MCI group, the difficulty in maintaining sleep was associated with decreased executive function, and the decreased SWS was associated with impaired working memory. The relationship of nocturnal sleep with the frontal lobe function in MCI patients appears to be different from that of normal elderly subjects.

Cognitive Dysfunction in non-hypoxemic COPD Patients / 결핵및호흡기질환

BACKGROUND: The cognitive function is impaired in patients with hypoxemic chronic obstructive pulmonary disease (COPD). However, there are conflicting results regarding the cognitive function in patients with non-hypoxemic COPD. COPD patients also have sleep disorders. This study examined the cognitive function in non-hypoxemic COPD patients, and nocturnal sleep was assessed in COPD patients with a cognitive dysfunction. METHODS: Twenty-eight COPD patients (mean age, 70.7 years) with an oxygen saturation > 90%, and 33 healthy control subjects (mean age, 69.5 years) who had visited for a routine check-up were selected. The neurocognitive tests were performed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Neuropsychological Battery. RESULTS: The scores of the word list recall test (p=0.03) and the word list recognition test (p=0.006) in the COPD group were significantly lower than those in the control group. Nine patients showed a significantly impaired cognitive function. Seven of these underwent polysomnography, which revealed apnea-hypopnea indices > or = five per hour in five patients. The median oxygen desaturation index and median limb movement index were 3.6/h and 38.6/h, respectively. CONCLUSION: These results suggest that the verbal memory function is impaired in non-hypoxemic COPD patients. Six out of seven COPD patients with an impaired cognitive function had sleep disorders of sleep apnea and/or periodic limb movements during sleep.

Relationship of Sleep Parameters with Neurocognitive Function in the Elderly with Excessive Daytime Sleepiness (EDS) / 신경정신의학

OBJECTIVES: Excessive daytime sleepiness (EDS) in the elderly is related to cognitive dysfunction. We aimed to analyze the difference in the neurocognitive function between the elderly groups with and without EDS and examine the correlation between sleep parameters and the neurocognitive function in the elderly with EDS. METHODS: Thirty seven subjects who visited Kangwon National University Hospital were recruited. We excluded those who had abnormalities in laboratory examination or chronic systemic diseases. For each subject, a neuropsychological battery in the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Assessment Packet was applied. Nocturnal polysomnographies were conducted in 16 subjects with EDS. RESULTS: There were no significant differences in the neurocognitive function between EDS positive and EDS negative groups. In the EDS positive group, the amount of stage 1 sleep negatively correlated with scores on Boston naming test, word list memory and Stroop interference, respectively (r=-0.611, -0.583, -0.611). Also, REM sleep amount positively cor-related with scores of word list recognition (r=0.568), and limb movement index negatively correlated with scores of word list memory (r=-0.523). CONCLUSION: The poor sleep quality was associated with impaired language, memory and executive functions. Also, increased limb movements were associated with the memory decline.

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.

Neurocognitive Dysfunction Related with Sleep Factors in Patients with Obstructive Sleep Apnea / 신경정신의학

We aimed to review the neurocognitive dysfunction in obstructive sleep apnea (OSA) and to clarify its relationship with hypoxemia, sleep fragmentation and daytime sleepiness. The disordered breathing during rapid-eye movement sleep (REMS) was recognized as a correlate of the neurocognitive impairment in OSA. Among sleep characteristics of OSA, intermittent hypoxemia (IH) was discussed in terms of possible mechanisms such as the abnormality of ventilatory drive, vasculopathy and oxidative stress. Specific brain damages in the frontal lobe and the hippocampus was also addressed. The OSA patients often experience decline in multiple domains of neurocognitive function. Particularly, decline in attention, executive function, constructional ability, or psychomotor performance was reported to be highly associated with IH. There have been some debates on the effect of daytime sleepiness on neurocognitive function. Persistent impairment in executive function and psychomotor performance after the treatment of OSA suggests an irreversible brain damage. A standardized instrument needs to be developed to evaluate each domain of neurocognitive function, and to measure the severity of OSA and its treatment response. Further studies on the relationship of REMS with the neurocognitive function are necessary.

The Association of Nocturnal Sleep Pattern with the Quality of Life in Chronic Renal Failure Patients on Hemodialysis / 신경정신의학

OBJECTIVES: We aimed to compare the quality of life (QOL) between patients with chronic renal failure (CRF) and normal control subjects, and to examine the relationship of QOL with the sleep characteristics in CRF patients. METHODS: The Epworth Sleepiness Scale (ESS) and World Health Organization Quality of Life assessment instrument-Brief form (WHOQOL-BREF) were administered to 26 CRF patients (male: 20 Age: 53.5+/-8.7 years) and 26 age- and sex-matched control subjects (male: 20 Age: 51.9+/-9.7 years). Nocturnal polysomnography (Embla S7000 Medcare system, New York, USA) was conducted for 26 CRF patients to measure the sleep parameters. RESULTS: The total score and all the subscale scores of WHOQOL-BREF in the CRF patients were lower than those of the control subjects (p<0.01). The amount of rapid eye movement sleep (REMS) was positively correlated with the physical health domain score (r=0.457). In addition, there were significantly negative correlations of the respiratory disturbance index and hypopnea index with the physical health domain score (r=-0.415, -0.616). CONCLUSION: The QOL of CRF patients was lower than that of the normal controls. Particularly, lower QOL of the physical health domain in CRF patients was associated with greater severity of sleep breathing disorder and lower amount of REMS.

Characteristics of Sleep Disturbances Correlated with Clinical Parameters in Hemodialysis Patients with Chronic Renal Failure / 신경정신의학

OBJECTIVES: Sleep disturbances are very common in hemodialysis (HD) patients with chronic renal failure (CRF). This study aimed to examine the characteristics of sleep disturbances, and to illustrate the relationship of sleep parameters with clinical parameters reflecting metabolic dysfunction in HD patients with CRF. METHODS: The Epworth Sleepiness Scale (ESS) and Sleep Disorders Questionnaire (SDQ) were administered in 26 HD patients with CRF. For fifteen patients with the risk of sleep disorder, nocturnal polysomnographic study (NPSG) and blood sampling were done. RESULTS: Among 15 patients, 14 patients (93%) were diagnosed as sleep disorders, sleep breathing disorder or periodic limb movements in sleep. Uric acid (UA) was positively correlated with sleep efficiency (r=0.571), and negatively correlated with waking after sleep onset, the amount of stage 1 sleep, and respiratory disturbance index (r=-0.515, -0.564, -0.646). Interleukin-6 was positively correlated with obstructive apnea index (r=0.661). CONCLUSION: In our study, the difficulty in maintaining sleep was found in HD patients with CRF. It also showed that increased UA was associated with improved sleep maintenance and decreased breathing disturbance during sleep. This might be related with antioxidant effect of UA in CRF. Further studies on total CRF patients including those without the risk of sleep disorder are necessary.

Development of an Informant Report Questionnaire for Dementia Screening: Seoul Informant Report Questionnaire for Dementia(SIRQD) / 신경정신의학

OBJECTIVES: This study aimed to develop an informant report questionnaire for dementia screening and to verify its reliability and validity. METHODS: A preliminary questionnaire with 30 items was administered to a reliable informant for each of 81 dementia patients and 166 normal controls. Through item analyses, the 15-item Seoul Informant Report Questionnaire for Dementia (SIRQD) was clraum up. Internal consistency and inter-informant correlation were analyzed. Factor analysis and ROC curve analysis were also performed. RESULTS: SIRQD was found to have high internal consistency and inter-informant reliability. Optimal cut-off score of SIRQD was 9/10, and the sensitivity and specificity at that score were .850 and .873, respectively. SIRQD was composed of four major factors (remote memory, recent memory, language, and activity of daily living). SIRQD was closely equivalent to MMSE-KC in terms of overall dementia screening ability, and it appeared efficient in discriminating very mild dementia from normal. SIRQD showed low false positive and negative rates, irrespective of levels of education, age, and sex. CONCLUSION: SIRQD possess good psychometrical properties and is probably very useful to screen dementia, especially for the Korean elderly with a very wide range of educational background.

Sleep Disturbance and Myocardial Damage in Patients with End-Stage Renal Disease / 대한신장학회잡지

BACKGROUND: Recently, it was suggested that sleep disorders, like sleep apnea and periodic limb movements during sleep, are associated with the cardiovascular complications and outcomes seen in ESRD patients. This study investigated the association between sleep disturbances, including nocturnal hypoxemia, and myocardial damage in ESRD patients. METHODS: We conducted a cross-sectional study of 15 hemodialysis patients (age=50+-8 years, M: F= 11: 4, diabetes=6) who were classified as at high risk of sleep disturbance using the Epworth Sleepiness Scale and Sleep Disorders Questionnaire. Overnight polysomnographic studies were performed in these 15 patients to evaluate sleep parameters. The predialysis serum concentration of cardiac troponin T (cTnT) was measured as a marker of myocardial damage. RESULTS: Apnea+hypopnea index >5, which is a diagnostic criterion of sleep-related breathing disorder, was found in 12 (80%) patients. Several sleep parameters were associated with cTnT concentration. Sleep efficiency and lowest oxygen saturation decreased (p<0.05 and p=0.06, respectively), and average desaturation increased (p<0.05) with increasing cTnT concentration. Spearman's Rho, which was used to assess the relationships between the severity of sleep apnea and clinical parameters, showed that apnea+hypopnea index and oxygen desaturation index were negatively correlated (both p<0.01) with the serum concentration of uric acid. In multivariate analysis, the uric acid concentration was also independently associated with apnea+hypopnea index and oxygen desaturation index. CONCLUSION: Elevated concentration of cTnT was associated with poor sleep efficiency and severe oxygen desaturation during sleep, and the serum concentration of uric acid was lower in patients with severe sleep apnea.

A Normative Study of the Mini-Mental State Examination in the Korean Elderly / 신경정신의학

This study aimed to determine the variables significantly related to the MMSE in the Korean version of the CERAD assessment battery(MMSE-KC) and present the normative information of the test in the Korean elderly. The MMSE-KC was administered in a standardized manner to 618 healthy volunteers aged 60 to 90 who were recruited from 4 dementia clinics, 2 elderly welfare centers and 1 community population. The elderly with serious neurological, medical and psychiatric disorders including dementia and major depression were excluded through clinical evaluation using CERAD-K clinical assessment protocol. Univariate and multivariate analyses were performed to determine the variables significantly related to the MMSE-KC score. Age, educational level, and sex were found to have statistically significant effect on the test score. Based on this result, overlapping age normative table(60 to 74, 65 to 79, 70 to 84, and 75 to 90 years of age) with 3 educational strata(0 to 3 years, 4 to 6 years, and 7 years and more) separately for both male and female were developed. For resulting 24 normative units, 5 percentile, lower quartile, median, upper quartile, mean and standard deviation were calculated. The normative data from this study can be widely used as reference values to objectively interpret the MMSE-KC scores of the Korean elderly.

Reliability and Validity of the Korean Version of Short Blessed Test (SBT-K) as a Dementia Screening Instrument / 신경정신의학

We aimed to develop the Korean version of Short Blessed test (SBT-K) by analyzing its reliability and validity, showing its usefulness as a dementia screening instrument. The translation, including back translation procedure, was carried out, keeping the basic structure of SBT. SBT-K. The Korean Version of Blessed Dementia Scale-Activity of Daily Living (BDS-ADL-K) and Clinical Dementia Rating Scale (CDR) were administered to 224 dementia patients and 191 control subjects, and The Korean Version of Consortium to Establish a Registry of Alzheimer's Disease-Mini-Mental State Examination (CERAD-MMSE-K) was to 157 patients and 167 controls. The correlation of SBT-K scores between two raters, correlation between the test and retest after one month, and its internal consistency were analyzed. To verify the concurrent validity of SBT-K, its correlation with each test: CERAD-MMSE-K, BDS-ADL-K, and CDR was analyzed. The sensitivity and specificity for each cut-off point of SBT-K were calculated and the Receiver Operator Characteristic (ROC) curve analysis was done to get its optimal cut-off point. SBT-K was found to have significantly high internal consistency, inter-rater reliability, and test-retest reliability. The significant correlation of SBT-K with each test described above was also shown. Its optimal cut-off point was estimated as 10/11, and the sensitivity and specificity were 0.85 and 0.90, respectively. The ROC curve analysis indicated that the diagnostic efficiency of SBT-K was comparable with CERAD-MMSE-K. We conclude that SBT-K has not only high reliability and validity, but also usefulness as a screening instrument for dementia.