Practicability of Six Weeks of Korean-Style Mediterranean Diet for Elderly Koreans with High Risk for Dementia

The purpose of this study was to verify whether Mediterranean diet, which proved to have a significant effect on preventing dementia for people aged 65 or older, could be well modified to be a Korean-style Mediterranean diet. This study was performed as a randomized-controlled trial for 6 weeks. Functional physical changes, cognitive scores, depression scores and dietary changes were all assessed. The walking speed (P<0.001) and the cognitive scores were statistically improved in only the experimental group (P<0.001), and the depression scores were also significantly improved in only the experimental group (P<0.01). The dietary intake showed a 30% improvement for consuming more than 7 cups per day of vegetables and fruits. When the participants were contacted four months after the end of the study, 90% of them said that the Korean-style Mediterranean diet was feasible and 100% said the nutrition interventions helped them maintain the diet during their daily lives. The results suggest that although the Mediterranean diet can be difficult to apply, any limitations of this healthy diet can be overcome.

One-Year Follow-up Pilot Study for Dementia Diagnosis in Elderly with Recall Score of 0 in Korean-version of Mini-Mental State Examination

BACKGROUND: The early stage of Alzheimer disease might show early memory impairment with normal general cognitive function. Our study aimed to investigate elderly with normal Korean version of mini-mental state examination (K-MMSE) score and recall score of 0 for 1 year. We predicted that the patients would show different characteristics and would progress more rapidly compared with normal controls. METHODS: This study was based on the data from complete enumeration survey of Mapo-gu Regional Center for Dementia in 2009. We divided all subjects into three groups: subjects with normal K-MMSE scores and recall score of 0 were group 1-1 (n=152), subjects with abnormal K-MMSE scores were group 1-2 (n=64) and subjects with normal K-MMSE scores and recall score of 1 to 3 were group 1-3 (n=941). We compared basic demographics and social characteristics among the three groups. After 1 year (2010), the subjects in group 1-1 (90 out of 152) underwent follow-up examinations for dementia diagnosis. They were also divided into three groups (2-1, 2-2, 2-3) according to K-MMSE and recall scores. RESULTS: Group 1-1 showed different baseline characteristics compared with normal controls. After 1 year, 25.5% (23 out of 90) of the group 2-1 were diagnosed as mild cognitive impairment (n=16) or dementia (n=7). CONCLUSION: Our study suggested that subjects with normal K-MMSE scores but recall score of 0 are not entirely "normal". Further detailed evaluation might be needed if memory impairment is suspicious although the K-MMSE scores are within normal range.

Factors Associated with a Decline in Activities of Daily Living in Patients with Dementia at Geriatric Hospitals: A 6 Month Prospective Study

BACKGROUND: Decreased activities of daily living (ADL) in elderly people are related to decreased quality of life and death and are a clinically important issue. However, few studies have investigated the various characteristics and risk factors for a decline in ADL among elderly in-patients in geriatric hospitals in Korea. METHODS: In total, 163 elderly in-patients with dementia in three geriatric hospitals located in Incheon, Gwangju and Yongin, Korea were surveyed prospectively for associated factors of a decline in ADL after 6 months. RESULTS: On average, the subjects were 79.4+/-7.6 years old, and 67.5% were female. Approximately 63% had Alzheimer type dementia, 36.8% only attended primary school, 73.0% were widowed, and 38.7% had been admitted to hospitals for less than 1 year. The Korean version of the Mini Mental State Examination (K-MMSE) score was 14.1+/-6.5, and the clinical dementia rating was 1.9+/-0.9. In total, 8.6% were bed-ridden and 59.5% and 64.6% had never experienced fecal and urinary incontinence, respectively. Total ADL scores declined after 6 months follow-up, and significantly associated factors were low K-MMSE score, fecal incontinence, and co-existence of fecal and urinary incontinence. CONCLUSION: Low K-MMSE scores, fecal incontinence, and the co-existence of fecal and urinary incontinence were associated with ADL declines in elderly in-patients with dementia in long-term care hospitals located in three cities in Korea.

A Preliminary Study for the Effect of Multidivisional Program for Social Skill Improvement on Senile Dementia / 가정의학회지

BACKGROUND: Aging population correspond with an increase in the numbers of dementia patients. Dementia decreases the quality of life of patients and care-givers. However, current pharmacological treatment is limited by modest efficacy and adverse effect. Nonpharmacological treatment for dementia has been considered to be a substitute treatment. Recently we developed a special planned program for dementia with depression. The aim of this study was to evaluate therapeutic effect of this program. METHODS: We included patients aged 65 and older who diagnosed dementia with depression in a geriatric institution from April to June, 2006. We surveyed their sex, age, education period, and histories of hypertension, smoking, and alcohol intake. Patients in experimental group carried out our program, including cooking, painting, recreation, and activity, 9 times for 60 minutes a session. All included patients were checked Korean Mini-Mental State Examination (K-MMSE) and Korean Form of Geriatric Depression Scale (KGDS) before starting program and after 3 months when programs finished. RESULTS: There was no difference in demographic factors between two groups. K-MMSE was significantly improved in experimental group compared with control group (P = 0.01). And, the KGDS was significantly improved in experimental group compared with control group (P = 0.00). CONCLUSION: Multidivisional program for social skill improvement was effective on treatment for patients of dementia with depression. Nonpharmacological treatment for dementia with depression would be developed and studied to enhance the qualities of life of patients and care of dementia.

Comparison of the Efficacy between Risperidone and Quetiapine in Elderly Patients with Delirium

OBJECTIVES: Many studies showed that risperidone and olanzapine in the treatment of delirium were similar to haloperidol, in side effects were superior to that. Quetiapine is frequently used in delirious patients. However, the studies of quetiapine in the treatment of delirium are very few. This study was designed to compare the efficacy of risperidone and quetiapine in elderly patients with delirium. METHODS: We divided 2 groups (risperidone and quetiapine) of elderly patients with delirium. We compared the two groups of elderly patients with delirium by Korean Version of Delirium Rating Scale (K-DRS) and Korean Mini-Mental State Examination (K-MMSE) at baseline and 1 week later. RESULTS: Our results showed that risperidone and quetiapine were efficacious in the treatment of elderly patients with delirium according to using K-DRS and K-MMSE. There were no significant differences in the degree of effects in both drugs. CONCLUSION: We compared the efficacy of risperidone and quetiapine in the treatment of delirium. Quetiapine was as efficacious as risperidone in the treatment of the elderly patients with delirium. In future, the sample size need to be increased in the studies of delirium. And the evaluation of long-term side effects related to quetiapine need to be performed.

Correlation between Head Circumference and Cognition in the Elderly by ApoE Genotype / 신경정신의학

OBJECTIVES: The aim of this study is to find out the effect of ApoE genotype on correlation between head circumference and cognition of the elderly in the community. METHODS: A total of 1,152 subjects (380 men and 772 women) aged 60-91 years were analyzed from preliminary data of GDEMCIS (Gwangju Dementia and MCI Study). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history and K-MMSE (Korean version-Mini Mental State Examination). We also measured the head circumference and examined ApoE genotype. RESULTS: On regression analysis, as head circumference becomes smaller, K-MMSE scores decreased adjusted by age, sex, educational level, ApoE epsilon4 allele, current smoking and alcohol drinking status (beta=0.15, p=0.04). Only in the lowest quartile group, presence of ApoE epsilon4 allele reduced K-MMSE scores adjusted by age, sex, educational level, height, current alcohol drinking and smoking status (beta=-1.39, p=0.008). CONCLUSION: These results suggest that head circumference may have an influence on K-MMSE scores, and presence of ApoE epsilon4 allele may be a medicating factor.

Population-Based Norms for the Korean Mini-Mental State Examination and Korean version of modified Mini-Mental State Examination

BACKGROUND: Cognitive functioning was known to be affected by socioeconomic conditions including ethnicity. The Korean Mini-Mental State Examination (K-MMSE) and the Korean version of the modified Mini-Mental State Examination (K-modified MMSE; K-mMMSE) scores by age, gender, and educational levels were evaluated. METHODS: Screening interviews were conducted with 2251 men and 3267 women aged 45 and over in 3 communities (Namwon-city of Chonbuk province, Younggwang-gun of Chonnam province). Descriptive performances (means, medians and percentile ranks) were calculated to summarize the range of normal performance. Scatterplots of the K-mMMSE scores according to age or educational attainments were performed. RESULTS: Lower age, higher education, and male gender were associated with higher scores of the K-MMSE and K-mMMSE. In women, more than half (50.6%) had no formal education and 546 women (16.7%) were illiterate. In men, the K-MMSE and K-mMMSE median scores ranged from 27 and 88 for individuals aged from 45 to 49 years old, to 25 and 76 for those aged 70 years and over. In women, the K-MMSE and the K-mMMSE median scores ranged from 17 and 53 for illiterate women, to 28 and 90 for women with more than 10 years of education. CONCLUSIONS: The use of the reference values will allow the clinician to interpret a patients performance on the K-MMSE and K-mMMSE, in light of the value expected from a group of normal subjects with the same sociodemographic profile.

Correlation between Metabolic Syndrome and Cognition in the Elderly / 신경정신의학

OBJECTIVE: The purpose of this study is to find out the effect of ApoE genotype in correlation between metabolic syndrome and cognition of the elderly in the community. METHODS: A total of 1,305 subjects (440 men and 865 women) aged 60-98 years were analyzed from preliminary data of Gwangju Dementia and MCI Study (GDEMCIS). The metabolic syndrome was assessed as defined by the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history, family history of dementia and stroke, and Korean version-Mini Mental State Examination (K-MMSE). We also examined ApoE genotype and analyzed associated factors with metabolic syndrome. RESULTS: These Metabolic syndrome was present in 28.6% of the subjects (13.4% of men and 36.3% of women). On multiple logistic regression analysis, low serum HDL cholesterol was associated with an increased risk for cognitive impairment (K-MMSE score < or = 17) adjusted by age, sex, educational level, and smoking in the presence of ApoE epsilon4 allele (OR 0.95, 95% CI 0.92-0.99). CONCLUSION: These results suggest that serum HDL cholesterol may affect cognitive function in the elderly in the presence of ApoE epsilon4 allele.

Effect of ApoE Genotype on the Relationship between Nutritional Risk and Cognition in the Elderly

BACKGROUND: The purpose of this study is to find out the effect of ApoE genotype on the relationship between nutritional risk and cognition of the elderly in a community. METHODS: A total of 996 subjects (343 men and 653 women) aged 60~91 years were analyzed from preliminary data of GDEMCIS (Gwangju Dementia and MCI Study). The study questionnaire consisted of demographic characteristics, current and past illness history, drug history, K-SGDS (Korean version of Short Form Geriatric Depression Scale), K-MMSE (Korean version-Mini Mental State Examina- tion), and NSI (Nutritional Screening Initiative) checklist. We also examined blood pressure, fasting serum glucose, lipid profile, body mass index, and ApoE genotyping. RESULTS: 649 subjects (65.2%) were on good nutritional state (NSI score or = 3). On multiple logistic regression analysis, moderate or high nutritional risk was associated with an increa- sed risk for cognitive impairment (K-MMSE score < or = 17) after adjustment with age, sex, K-GDS and educational level in the absence of ApoE epsilon4 allele (OR 1.78, 95% CI 1.15-2.77). CONCLUSION: These results suggest that nutritional risk may be associated with cognitive function in the elderly only in the absence of ApoE epsilon4 allele.

The Change of K-MMSE Following Donepezil Medication in Patients with Alzheimer's Disease and Small Vessel Dementia, and the Characteristics of Alzheimer's Disease with Meaningful K-MMSE Change

OBJECTIVES: Donepezil is a widely used drug for the treatment of patients with Alzheimer's disease(AD). The aim of the present study was to clarify the efficacy and the characteristics of responders to donepezil. METHODS: Patients with probable AD(n=80 ; 75.7 years) and small vessel dementia(SVD)(n=18 ; 77.8 years) who received donepezil were retrospectively analyzed using Alzheimer's registry, and three questions were asked: 1) Does donepezil therapy improves cognitive symptoms in patients with dementia? 2) If donepezil improves cognitive symptoms, which items of the K-MMSE are improved? 3) What are the characteristics of responder to donepezil medication? RESULTS: 1) After donepezil medication, cognitive function measured by the K-MMSE was significantly improved in both types of dementia(AD and SVD), However, statistical differences were not found between these groups. 2) In a clinical trial of donepezil, the patients performed better than before mediation on K-MMSE items assessing orientation, recall, construction, concentration, calculation. 3) In AD, the K-MMSE score before medication was closely related with response of donepezil. CONCLUSION: This study suggests that donepezil improves various cognitive functions in both types of dementia, and the responsive group had significantly lower K-MMSE scores than the non-responsive group before medication.

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.

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.

Reliability and Validity of the Korean Version of Revised form of Hasegawa Dementia Scale (K-HDS)

BACKGROUND: The revised version of the Hasegawa Dementia Scale (HDS-R) is a useful dementia screening tool with a test for frontal lobe function and is relatively less influenced by education level and linguistic ability. We developed a Korean version of HDS-R (K-HDS) by translating the HDS-R to screen dementia patients in the Korean elderly. METHODS: The basic structure of the HDS-R was preserved but some questions were modified for lingual and cultural difference. It was administrated along with the Korean version of the MMSE, Korean Dementia Screening Questionnaire, Short form Samsung Dementia Questionnaire and Clinical Dementia Rating (CDR) scales, to 151 patients (55 Alzheimer's disease, 73 vascular dementia, 23 others) with mild to moderate dementia and to 225 elderly control subjects. To screen dementia, the optimal cut-off score was estimated by receiver operating characteristic (ROC) curve analysis. By comparing the Area Under the Curve, the diagnostic efficiency of K-HDS was compared with that of K-MMSE. RESULTS: The K-HDS had good internal consistency (Crohnbach's alpha coefficient=0.66), inter-rater reliability (r=0.95), and test-retest reliability (r=0.92). K-HDS was well correlated with the K-MMSE (r=0.84) and CDR (r=-0.67), which confirms the validity of this test. The optimal cut-off score was different according to educational level. In patients with an educational level less than 10 years, the cut-off score was 20 with the sensitivity of 87.0% and the specificity of 83%. With an educational level of 10 years or more, the cut-off score was 22 with the sensitivity of 93.0% and the specificity of 89.6%. The overall diagnostic efficiency of K-HDS was superior to that of K-MMSE especially in patients with an educational level of less than 10 years. CONCLUSIONS: The K-HDS is a reliable, valid and useful tool to screen dementia in the Korean elderly.

Cognitive Functions of Korean Elders Over 100 Years of Age

BACKGROUND: Almost no study has been carried out to explore the cognitive characteristics of the oldest old population in Korea, even though Korean society is becoming very 'old'. The purpose of this study is to the examine basic cognitive functions of Korean elders over 100 years of age. METHODS: Data collection was completed with 87 elders, 12 males and 75 females. Their mean age was 103.2 for males and 102.3 for females. The average year of education for this population was less than 1 year(0.5 year). We evaluated cognitive functions by K-MMSE and the severity of dementia by CDR (Clinical Dementia Rating). RESULTS: Most of them were able to speak fluently(81.6%) and had reasonable vision(67.8%), but 55.2 % of subjects had full comprehension ability. There was no significant difference in results between elders from Seoul and from other country area. We have divided the sample population into 5 groups according to CDR score; 0(7.4%), 0.5(33.3%), 1(25.9%), 2(14.8%), 3(18.5%), to compare with K-MMSE score. There were significant differences in K-MMSE scores between CDR groups. DISCUSSION: About 7% of elders over 100 years of age are still maintaining normal cognitive function. Considering the physical handicaps of the subjects, probable dementia group(30%) can also be regarded as to possess near normal cognitive function. This study is the first study on Korean centenarians and will provide essential data for future studies on the oldest old.

Comparison of Diagnostic Validities between MMSE-K and K-MMSE for Screening of Dementia / 신경정신의학

OBJECTIVES: This study aimed to compare the diagnostic validities between the Korean version of Mini-Mental State Examination (MMSE-K) and the Korean MMSE (K-MMSE) for screening of dementia and to investigate the possible changes of optimal cutoff scores of each instrument according to age, gender, and educational level. METHODS: 746 community residents aged 65 or over in two areas of Kwangju, Republic of Korea were assessed with MMSE-K and K-MMSE and were also evaluated for the diagnoses of dementia (DSM-IV). RESULTS: The performances, measured by area under receiver operating characteristics curve, of MMSE-K and K-MMSE against DSM-IV dementia were 0.93 and 0.94 respectively. The optimal cutoff scores for screening of dementia were 21|22 in MMSE-K and 17|18 in K-MMSE. Changes of the optimal cutoff scores according to age, gender, and educational level of the sample were 0-2 in the MMSE-K and 2-5 in the K-MMSE. CONCLUSIONS: MMSE-K and K-MMSE could be used for screening of dementia with excellent validities. For primary health care staff, however, it was suggested that MMSE-K would be more feasible than K-MMSE because the former had less changes in the optimal cutoff scores and was easier to interpret its results than the latter.

Association between Cognitive Impairment and ADL of the Elderly in Rural Area / 예방의학회지

OBJECTIVES: The purpose of this investigation was to study the correlation between cognitive impairment and activities of daily living(ADL) in the elderly of rural area. METHODS: The study population consisted of 210 elderly people aged 65 years and older, living in a district of Kyongju City. The cognitive impairment was measured with the Korean version of mini-mental state examination(MMSE-K) and newly constructed the Korean version of mini-mental state examination (K-MMSE). Bristol activities of daily living scale developed specifically to be used with people with dementia was used to measure ADL. RESULTS: The mean scores of both MMSE-K and K-MMSE were significantly different by sex groups and by age groups, respectively(p<0.05). The mean scores of ADL were significantly different by age groups(p<0.01) not by sex groups. Among the 4 components of ADL(instrumental activities of daily living(IADL), self care, orientation, and mobility), the mean score of the orientation was significantly higher in men(p<0.01); and IADL, orientation and mobility components were significantly different by age groups(p<0.01). ADL correlated well with MMSE-K (r=0.54) and K-MMSE(r=0.52) and showed higher correlation in female (r=0.73, 0.71) than male(r=0.27, 0.29). IADL and orientation showed significant correlation with MMSE-K(r=0.52, 0.62) and K-MMSE(r=0.50, 0.63), respectively(p<0.01). CONCLUSIONS: In developing and establishing a care model for people with dementia in the community, both cognitive impairment and the activities of daily living(ADL) need to be considered.