Psychiatric Inpatient Care During the COVID-19 Pandemic: A Review / 신경정신의학

There are multitudinous obstacles in psychiatric inpatient treatment in the face of the coronavirus disease (COVID-19) pandemic. In addition, there are few guidelines or recommendations for the operation of psychiatric wards in Korea. This study reviewed the impact and changed patterns of psychiatric hospitalization due to the COVID-19 pandemic and recommendations and cases for psychiatric hospitalization. From keyword search of electronic databases, a total of 72 studies was eligible to review. It was reported that the diagnostic distribution of the patient population requiring psychiatric hospitalization before and after COVID-19 might change, and the severity of hospitalized patients might become higher after COVID-19. Although a causal relationship could not be established at that time, a confirmed case of COVID-19 appeared to impact psychiatric symptoms. 1) Consistent screening tests and symptom monitoring, 2) proper wearing of masks and personal protective equipment by patients and treatment staff, 3) distancing and limiting the number of inpatients, 4) limiting unnecessary visits and visits by outsiders, 5) close cooperation and linkage between treatment staff, and 6) referral, were consistently recommended. In addition, several works recommended non-face-to-face visits during hospitalization for patient recovery, and some attempts were made to provide virtual psychotherapy or prescriptions. It is necessary to flexibly operate the details by accommodating the needs of the mental health system for psychiatric inpatient treatment in the pandemic period. Future attempts are necessary to search through systematic reviews by integrating the reported studies.

The Role of Mobility of Cognition and Emotion in Elderly : A Conceptual Review

Considering that the aged population increases and the mobility problem is pointed out as a factor that indisposes the quality of life, cognition, and mood, it is important to understand and evaluate the elderly’s mobility. Factors that deteriorate mobility in the elderly include physical senility, various health changes including chronic diseases, polypharmacy as well as anticholinergics. Common mobility problems in old age are reduced gait speed, increased gait variability in walking length, careless walking, and frequent falls. Several studies have reported that decreased mobility and deterioration of gait can predict cognitive decline and emotional problems. Aerobic exercise, resistance exercise, and balance exercise are suggested as therapeutic interventions for mobility problems. Active correction for factors that reduce mobility in the elderly and prescribing physical activity can conserve the elderly’s quality of life and help improve cognition and mood. There is a need for related research in the future.

The Role of Mobility of Cognition and Emotion in Elderly : A Conceptual Review

Considering that the aged population increases and the mobility problem is pointed out as a factor that indisposes the quality of life, cognition, and mood, it is important to understand and evaluate the elderly’s mobility. Factors that deteriorate mobility in the elderly include physical senility, various health changes including chronic diseases, polypharmacy as well as anticholinergics. Common mobility problems in old age are reduced gait speed, increased gait variability in walking length, careless walking, and frequent falls. Several studies have reported that decreased mobility and deterioration of gait can predict cognitive decline and emotional problems. Aerobic exercise, resistance exercise, and balance exercise are suggested as therapeutic interventions for mobility problems. Active correction for factors that reduce mobility in the elderly and prescribing physical activity can conserve the elderly’s quality of life and help improve cognition and mood. There is a need for related research in the future.

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.

Characteristics and Risk Factors of High Caries Risk Group in 12-year-old Children Using Data from the 2015 Children’s Oral Health Survey / 대한소아치과학회지

The purpose of this study was to examine the characteristics of the high caries risk group of 12-year-old children in Korea. Oral health status and interview data were collected from 23,089 children aged 12 years who participated in the 2015 Korean Children’s Oral Health Survey. Subjects were classified into high-risk and low-risk groups according to the Significant caries (SiC) index, and the influence of each variable was analyzed. As a result of the study, the SiC index of the high-risk group was 5.08, which was about 9.6 times higher than the lowrisk group. The risk factors associated with the high-risk group were in the order of the number of sealant teeth, dental treatment demand for the past year, perceived oral health status, gender, region, frequency of snack intake per day, and use of oral hygiene aids. In order to improve the oral health of children, appropriate preventive treatment and oral health education should be carried out with reference to the items indicated as risk factors in the high-risk group of dental caries.

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.

Cognitive Stimulation as a Therapeutic Modality for Dementia: A Meta-Analysis

OBJECTIVE: Although cognitive stimulation (CS) is one of the most popular non-pharmacological interventions for people with dementia, its efficacy is still debatable. We performed a meta-analysis of randomized controlled trials (RCTs) on the efficacy of CS in people with dementia. METHODS: Data sources were identified by searching PubMed, MEDLINE, Embase, psychINFO, and Cochrane Reviews Library. A total of 7,354 articles were identified, and of these, 30 RCTs were selected based on the selection criteria. Of these 30 RCTs, 14 were finally included in our meta-analysis [731 participants with dementia; 412 received CS (CS group) and 319 received usual care (control group)]. RESULTS: We found that the people with dementia had a moderate benefit from CS. The mean difference between the CS and control groups was 2.21 [95% CI (0.93, 3.49), Z=3.38, p=0.00007] in the Alzheimer's Disease Assessment Scale-Cognition and 1.41 [95% CI (0.98, 1.84), Z=6.39, p<0.00001] in the Mini-Mental State Examination. CS also improved quality of life in people with dementia [95% CI (0.72, 3.38), Z=3.02, p=0.003]. CONCLUSION: CS is effective for improving cognition and quality of life in people with dementia; however, its effects were small to moderate.