Network Structure of Depressive Symptoms in General Population / 정신신체의학

Objectives@#：Although subclinical depression symptoms are associated with suicidal idea, most research have focused on clinical depression such as major depressive disorder or dysthymia. The aim of this study is to investigate network structure of depressive symptom and to reveal which symptoms are associated with suicidal ideation. @*Methods@#：We used part of data from the seventh Korea National Health and Nutrition Examination Survey. Participants were between 19 and 65 years of age (N=8,741). Network analysis with Isingfit model is used to reveal network structure of depressive symptoms and most central symptom and edges assessed by patient health questionnaire (PHQ-9). @*Results@#：The most two central symptoms were psychomotor activity and suicidal ideation. The strongest edge was psychomotor activity-suicidal ideation. Suicidal ideation also has strong association with depressive mood and worthlessness. @*Conclusions@#：These results suggest that psychomotor activity and suicidal ideation can serve as treatment target for subclinical depression and psychomotor activity, worthlessness and depressed mood may be important factor for early intervention of suicidal ideation.

Factors Associated With Fear of Coronavirus Disease 2019 Stigmatization in the Elderly

Objective@#The purpose of this study was to investigate the factors associated with the fear of coronavirus disease of 2019 (COVID-19) stigmatization in the elderly in Chungcheongnam-do, Korea. @*Methods@#This study used data of a survey on depression, loneliness, social support, and fear of COVID-19 of the elderly in a province of Korea in July to November, 2020. The sample consisted of 1,485 (female 1,117); mean age 78.3 (6.5) years old. We administered Korean version of the Geriatric Depression Scale-Short Form, 6-item De Jong Gierveld Loneliness Scale, Medical Outcome Study Social Support Survey and experience about COVID-19 infection or fear of stigmatization. Binary logistic regression analyses were performed for evaluating the association between fear of COVID-19 stigmatization and the factors; gender, education level, living with spouse, socioeconomic status, depression, loneliness, and social support. @*Results@#Socioeconomic status and loneliness are associated with the fear of COVID-19 disease stigmatization, and gender and socioeconomic status are associated with the fear of COVID-19 territorial stigmatization. @*Conclusion@#Gender, socioeconomic status and loneliness are the factors for COVID-19 stigmatization in the elderly in Chungcheongnam-do, Korea.

Effects of Dementia Caregiver Program on Caregiver Burden / 정신신체의학

Objectives@#：Dementia is one of the most distressing mental health problems in the older population. Caregivers also experienced physical, psychological, and emotional stress from taking care of dementia patients. So, we developed program for supporting dementia caregiver and evaluated its efficacy on reducing caregiver bur-den. @*Methods@#：We provided 5 sessions of dementia caregiver supporting program to 30 caregivers who were taking care of dementia patient in their home. Program was held in Cheonan Center for Alzheimer’s disease and other dementia that was established by Cheonan city government for supporting dementia patients and their caregivers. We evaluated caregiver burden using short Zarit burden inventory consisted of 12 items scoring 0 (no burden) to 4 (everyday burden) before and after program. We evaluated satisfaction of caregiver about program using satisfaction survey consisted of 10 items scoring 0 (very dissatisfy) to 4 (very satisfy) after program. @*Results@#：Mean age of caregiver was 61.9. 40.0% (n=12) of caregivers were spouse. 53.3% (n=16) of caregiv-ers were son or daughter. Caregiver burden that was estimated by short Zarit burden inventory were significantly decreased after program (p<0.001). When each item was compared, 4 items (7, 10, 11 and 12) were significantly decreased after program (p=0.036, p=0.018, p=0.01, p=0.024). All mean scores of 10 items about satisfactionwere over 3 meaning that participants generally satisfied to program. @*Conclusions@#：Our study suggested that dementia caregiver supporting program could reduce caregiver burden and provide satisfaction. Therefore, programs for supporting dementia caregivers might be important as well as treating dementia patients. So, we should be interested in developing and providing efficiently this kind of pro-gram to reduce caregiver burden.

The Association Between Cancer and Network Structure of Depressive Symptoms / 정신신체의학

Objectives@#：The characteristics of depressive symptoms in patients with cancer is different from those in control group. However, few research has focused on the association between depressive symptoms in cancer patients. The aim of this study was to compare the network structure of depressive symptoms between patients with cancer and normal control. @*Methods@#：This study was based on cohort data from Korea National Health and Nutrition Examination Survey in 2016-2018. The Patient health Quetionnaire-9 (PHQ-9) was used to assess depressive symptoms in 599 patients with cancer and 599 age-sex matched controls. We estimated network structure of depressive symptom using Isingfit model. @*Results@#：There was no significant difference of each PHQ-9 item score. There were strong associations be-tween symptoms were concentration problem-psychomotor activity, anhedonia-depressed mood, and depressed mood-suicidal ideation in both groups. Strength centrality of worthlessness was significantly higher in patients with cancer. @*Conclusions@#：These results suggest that worthless is associated with other depressive symptoms more tightly in patients with cancer. Worthless can serve as important treatment targets for intervention of depression in patients with cancer.

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.

Association between Sleep and Loneliness in the Elderly Living Alone / 정신신체의학

Objectives@#：Loneliness and poor sleep quality are common phenomena in old age and are associated with negative physical and mental health. However, little is known regarding the relation between loneliness and sleep quality. The aim of this study was to examine the association of loneliness and sleep quality among the elderly living alone. @*Methods@#：This is a cross-sectional study that enrolled 1,090 subjects who are the community-residing elderly living alone. Sociodemographic status, medical condition, cognition, mood disorder, sleep quality and levels of loneliness were collected using a self-administered questionnaire and a specific semi-structured interview con-ducted by trained nurses. Descriptive statistics were used to analyze data regarding sociodemographic variable and loneliness. Univariate and Multivariate regression analyses were applied to examine the association between loneliness and sleep quality after adjustment for multiple confounding variables. @*Results@#：The Pittsburgh Sleep Quality Index (PSQI) mean score of “lonely group” (9.2±4.2) was signifi-cantly higher than that of “not lonely group” (7.3±3.7) (student-t test, p<0.001). Loneliness was significantly as-sociated with PSQI (standardized β= 0.065, p=0.025), sleep disturbance (standardized β=0.086, p=0.005), use of sleep medication (standardized β= 0.065, p=0.034) after adjustment for possible confounding variables including sex and mood disorder. @*Conclusions@#：Loneliness was associated with sleep disturbance and this finding implied negative impact of loneliness on sleep quality of older adults. Public health promotion efforts to reduce loneliness may improve sleep quality and mental health in the elderly living alone.

Association between Sleep and Loneliness in the Elderly Living Alone / 정신신체의학

Objectives@#：Loneliness and poor sleep quality are common phenomena in old age and are associated with negative physical and mental health. However, little is known regarding the relation between loneliness and sleep quality. The aim of this study was to examine the association of loneliness and sleep quality among the elderly living alone. @*Methods@#：This is a cross-sectional study that enrolled 1,090 subjects who are the community-residing elderly living alone. Sociodemographic status, medical condition, cognition, mood disorder, sleep quality and levels of loneliness were collected using a self-administered questionnaire and a specific semi-structured interview con-ducted by trained nurses. Descriptive statistics were used to analyze data regarding sociodemographic variable and loneliness. Univariate and Multivariate regression analyses were applied to examine the association between loneliness and sleep quality after adjustment for multiple confounding variables. @*Results@#：The Pittsburgh Sleep Quality Index (PSQI) mean score of “lonely group” (9.2±4.2) was signifi-cantly higher than that of “not lonely group” (7.3±3.7) (student-t test, p<0.001). Loneliness was significantly as-sociated with PSQI (standardized β= 0.065, p=0.025), sleep disturbance (standardized β=0.086, p=0.005), use of sleep medication (standardized β= 0.065, p=0.034) after adjustment for possible confounding variables including sex and mood disorder. @*Conclusions@#：Loneliness was associated with sleep disturbance and this finding implied negative impact of loneliness on sleep quality of older adults. Public health promotion efforts to reduce loneliness may improve sleep quality and mental health in the elderly living alone.

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.

Risk Factors Associated with Loneliness in the Elderly Living Alone / 정신신체의학

OBJECTIVES@#Loneliness is associated with negative mental and physical health. However, little is known about the risk factors of loneliness in the Korean elderly living alone. The aim of this study was to examine sociodemographic and social network related risks for loneliness among the elderly living alone.@*METHODS@#This is a cross-sectional study that enrolled 1,091 subjects who are the community-residing elderly living alone. Sociodemographic status, medical condition, cognition, mood disorder and levels of loneliness were collected using a self-administered questionnaire and a specific semi-structured interview conducted by a trained nurse. Descriptive statistics were used to analyze data regarding sociodemographic variable and loneliness. Univariate and Multivariate regression analyses were applied to examine factors associated with loneliness.@*RESULTS@#The mean score of loneliness was 3.8 (SD=1.7). No family contact (standardized β=0.115, p<0.001), no religious attendance (standardized β=0.057, p=0.028), no gathering with friends (standardized β=0.088, p=0.001) and high score of Short for of Geriatric Depression Scale (standardized β=0.502, p<0.001) were significantly associated with high loneliness in the elderly living alone.@*CONCLUSIONS@#Family function, social network and depressive mood could be significant risk factors for high loneliness in the elderly living alone. Public health promotion efforts to reduce loneliness should focus on improving family function, social network and decreasing depression.

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.

Factors Associated with the Use of Over-the-Counter Medications in the Elderly Living Alone / 정신신체의학

OBJECTIVES: This study aimed to describe the use of over-the-counter (OTC) drugs and to identify predictors for their use in the elderly living alone. METHODS: This is a cross-sectional study that enrolled 1,099 subjects. Data regarding socio-demographic status, medical condition, cognition, mood disorder and use of OTC drugs were collected using self-administered questionnaire and from a specific semi-structured interview by a trained nurse. Data regarding use of OTC drugs were analyzed using descriptive statistics. Logistic regression analysis was applied to examine factors associated with the use of OTC drugs. RESULTS: The use of OTC drugs were reported by 35.4% of the subjects. Analgesics (13.6%) was the most frequent drugs. Depression (OR=1.10, 95% CI=1.10–1.87) and comorbidities measured by cumulative illness rating scale (CIRS) (OR=1.08, 95% CI=1.03–1.12) were significantly associated with the use of OTC drugs in the elderly living alone. CONCLUSIONS: Depression and severity of underlying medical conditions could be a predictor of the use of OTC drugs in the elderly living alone. The clinicians should be vigilant regarding the potential use of nonprescription medications in the elderly.

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.

Recent Advances in Diagnosis and Treatment of Alzheimer's Disease

Alzheimer's disease (AD) is a neurodegenerative disorder in which neuronal loss causes cognitive decline and other neuropsychiatric problems. It can be diagnosed based on history, examination, and appropriate objective assessments, using standard criteria such as the Diagnostic and Statistical Manual of Mental Disorders or the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA). Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. The cholinesterase inhibitors, donepezil, rivastigmine and galantamine and N-methyl-D-aspartate receptors antagonist memantine are approved by the US Food and Drug Administration for AD. Recently some acetylcholinesterase inhibitors gained approval for the treatment of severe AD and became available in a higher dose formulation or a patch formulation. Optimal care in AD is multifactorial and it should include early diagnosis and multidisciplinary care with pharmacological and nonpharmacological interventions including exercise interventions, cognitive interventions and maintenance of social networks.

Influence of Depression on the Prediction Accuracy of Mini-Mental State Examination as Screening Test for Early Detection of Dementia

OBJECTIVE: Depression and cognitive impairment are closely associated in old age. In this study, we investigate the influence of depression on the prediction accuracy of Mini-Mental State Examination (MMSE) as screening test for early detection of dementia. METHODS: Three hundred and twenty one dementia patients and five hundred and thirty five normal control subjects were enrolled in this study. We administered both the Mini International Neuropsychiatric Inventory and the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet clinical and neuropsychological battery. We diagnosed depressive disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnostic criteria, and evaluated the severity of depressive symptoms using the revised Korean version of the Geriatric Depression Scale. Subjects were divided into two groups : 1) depressed group, 2) non-depressed group. We compared sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic curve, and areas of under the curve (AUC) of MMSE between two groups. RESULTS: AUC of total group was 0.803 [95% confidence interval (CI)=0.774-0.833]. AUC of non-depressed group was the higher (0.855 ; 95% CI=0.823-0.887) than that of depressed group (0.767 ; 95% CI=0.710-0.824, p<0.009). CONCLUSION: In non-depressed group, diagnostic accuracy and positive predictive value were higher than those of depressed group. Depression should be considered for effective and efficient national dementia screening and registry program.