Evaluation of relationship between cognitive function and occlusal status in elderly individuals using the T-scan III® system / 대한구강보건학회지

OBJECTIVES: The aim of this study was to investigate the relationship between cognitive function and occlusal status in elderly individuals. METHODS: A total of 162 individuals aged 65 years and older, who attended the senior citizen center in Daegu city, were included after consent for participation in the study was obtained. The Korean version of the Mini-Mental State Examination (MMSE-K) was used to evaluate the level of cognitive function. Occlusal status was determined using the T-scan III® system. All collected data were analyzed by χ² test, t-test, one way ANOVA, and linear regression analysis using SPSS version 23.0 for Windows. RESULTS: There was a significant relationship between the cognitive function and the use of dentures. Individuals with posterior occlusal status had higher MMSE-K scores than those with anterior occlusal status. There was a positive correlation between the cognitive function and posterior occlusal force. CONCLUSIONS: These results suggest that occlusal status was associated with cognitive function in the elderly individuals. Active national policies to improve occlusal condition in the elderly population are needed.

The Effect of Living with Spouse on Cognitive Decline and Depressive Symptom in Elderly People

OBJECTIVE: The aim of this study was to determine whether living with spouse contributes to cognitive decline and depressive symptom among elderly people. METHODS: 939 participants were recruited through Keum-Cheon center for dementia in Seoul. All subjects were assessed using the Korean version of Mini-Mental Status Examination (MMSE-K), Korean version of Consortium to Establish a Registry for Alzheimer's disease (CERAD-K) and Geriatric Depression Scale (GDS). Furthermore, epidemiological factors (age, sex, education year, and characteristics of family) assessed to find correlation with cognitive decline. RESULTS: Controlling for gender, age, and education year, living with spouse was significantly associated with cognitive decline (B=-0.486, S.E=0.203, Wald=0.331, Exp (B)=1.107, p=0.01). Living with spouse group has lower depressive symptom, compared to living without spouse group (F=14.6, p<0.01). CONCLUSION: Correctly, our results suggest that spouse absent state may accelerate cognitive decline and depression. Further, elderly people living alone should be closely monitored for both depression and cognitive impairment.

The Role of BF-7 on Enhancement of Memory and Cognitive Funtion / 대한해부학회지

Various factors such as senescence, stress, neurodegenerative diseases including Alzheimer's disease (AD) contribute to the impairments of organs, especially brain. Also, they should be negative factors on normal brain function, like as memory and cognition. In this study, the neuroprotective role of BF-7, extracted from Bombyx mori, was examined agaist scopolamine-induced neurotoxicity in SK-N-SH cells. In order to know if the BF-7 has positive role on the cognition and memory, we examined using SD rat model and human. Scopolamine-induced memory impairments were observed, as measured by the passive avoidance and water maze tests, but treatment with BF-7 significantly improved memory and cognitive function. Moreover, the memory index and memory preservation of clinical experiments using MMSE-K tests were significantly improved memory and cognitive function. This results strongly represent that the BF-7 play effectively positive role in the improvement of brain function including learning and memory. Taken together, our results suggested that the BF-7 should be useful for developing strategies protecting nervous system and improving brain function.

Factors Related to Cognitive Impairment of Elderly Patients in Kyongin District

BACKGROUND: With the rapid increase in elderly population arousing from development of medical technology and in standards of living, mental disorders as well as organic disorders according to aging constitute a serious social problem. This study aimed to find a factor related closely to cognitive impairment by analyzing the risk factors influencing cognitive impairment, which is one of the typical geriatric neuropsychiatric conditions. METHODS: This study was conducted using a questionnaire survey and history taking and physical examination was done in 200 elderly patients over sixty-five, who had visited either of the four universities hospitals in the Kyongin district from July 1997 to June 2002. A variety of factors being widely known to be related to cognitive impairment by was investigated using the existing comprehensive geriatric assessment. By using MMSE-K (Korea version of Mini- Mental State Examination), the relation between cognitive impairment and each variable was analyzed by using chi-square test and logistic regression analysis with SPSS 10.0k/PC statistical program. RESULTS: The number of males and females was 73 (36.5%) and 127 (63.5%), respectively, among the total number of 200 examinees. Males and females having symptoms of cognitive impairment was 25 (34.2%) and 49 (38.6%) among the total number of 74 (37%), respectively. Total mean point of MMSE-K was 24 5.4, 24 5.3 in males and 23.9 5.5 in females. According to the results of multi-variable quantities analysis, it was shown that the cognitive impairment had positive relation to age (P= 0.004), but negative relation to regular exercising (P= 0.016), instrumental activities of daily living (P=0.039) and social support (P=0.003). CONCLUSIONS: The factors having a close relation to cognitive impairment of elderly people were social support, age, regular exercising and instrumental activities of daily living.

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.

Cut-off Score on MMSE-K for Screening of Dementia in Community Dwelling Old People

OBJECTIVES: This study aimed to estimate the optimal cut-off score on Korean version of Mini-Mental State Examination (MMSE-K) for screening of dementia in community dwelling old people, and to investigate possible changes of the cut-off score according to age, gender, educational level, living area, and depression of the old people. METHODS: For the old people aged 65 or over dwelling in two areas of Kwangju, cognitive function (MMSE-K) and demographic characteristics (age, gender, educational level, living area) were investigated. For those scoring 24 or less on MMSE-K of them, clinical diagnosis of dementia (DSM-IV) and depression (Hamilton Rating Scale for Depression) were assessed. The optimal cut-off score on MMSE-K with a sensitivity and a specificity was examined by using receiver operating characteristics curve analysis served by diagnosis of dementia as a gold standard. Associations of the cut-off score on MMSE-K with demographic characteristics and depression were estimated by odds ratios. For those factors showing significant association with cut-off score on MMSE-K regardless of the diagnosis of dementia, the optimal cut-off scores on MMSE-K were measured again at each level. RESULTS: In the old people scoring 24 or less on MMSE-K (n=341), the optimal cut-off score on MMSE-K served by diagnosis of dementia was 21/22 with a sensitivity of 81% and a specificity of 64%. Only the age among the investigated characteristics was significantly associated with the cut-off score on MMSE-K, and the optimal cut-off score in those aged 75 or over was revealed to be 20/21. CONCLUSIONS: We suggest that the cut-off score on MMSE-K for screening of dementia investigated in this study could be used by community health care staff as a guideline for assessing old people with questionable cognitive dysfunction or for considering to consult them to an expert.

Comparison of the time and change test with the Mini Mental status examination as a cognitive screening tool for elderly patients

BACKGROUND: The prevalence of dementia is estimated to be as high as 5 10% over 65 years of age in Korea. It is important to evaluate of dementia for the elderly, because of the chronicity and progressiveness of the disease. However, cognitive impairment often goes unrecognized by physician because the many previous tools to evaluate cognitive function in the clinical setting are complex, time consuming and sometimes questionable correlation with real world functioning. The purpose of this study is to assess the usefulness of The Time and Change test as screening test for dementia ,on the basis of the correlation between this measure(T&C) and MMSE K. METHODS: The subject for this study consisted of 64 elderly who visited to the outpatient department of family medicine of the Ehwa Mok dong hospital or Elderly Welfare Center in Seoul. They received the T&C test and MMSE K examination. Sensitivity, specificity, negative predictive value, and Pearson' Correlation coefficient were calculated using standard formulas. RESULTS: The T&C had a sensitivity of 50%, a specificity of 88 %, a positive predictive value of 69%, a negative predictive value of 77 %, respectably. when timed cutpoints were added, The T&C test had a sensitivity of 95%, specificity of 83 %, a positive predictive value of 75%, a negative predictive value of 97 %. respectibaly. CONCLUSION: The Time and Change(T&C) tests can be an effective, simple and performance based tool to recognize dementia. Further validation with a representative elderly sample is needed to establish screening value in primary care or community populations.

Clinical efficacy of the 7-Minute Screen at primary care setting

BACKGROUND: Because dementia tends to be underdiagnosed, Solomon PR developed a brief neurocognitive screening battery to identify Alzheimer's dementia. The 7-Minute Screen consists of four individual tests(orientation, memory, clock drawing, verbal fluency). It can be rapidly administered and it may be appropriately used in the primary care setting. We attempted to develop a screening tool of dementia based on the 7-Minute Screen at primary care setting in Korea. METHODS: We adapted the 7 Minute Screen to the Korean version of 7 Minute Screen(7 MS-K). 7 MS-K and MMSE-K were administered to 61 elderly people who visited the Sungbuk Public Health Center. Inter-rater reliability and test-retest reliability were evaluated. RESULTS: The 7 MS-K has a sensitivity of 92% and a specificity of 90% for cutoff point of MMSE-K 23/24. Inter-rater reliability and test-retest reliability for the entire battery was very high(both r=1). Mean time of administration was 10 minutes. CONCLUSION: 7 MS-K has a reasonable validity, reliability and can be administered in a brief period, and requires no clinical judgement and minimal training. It may be a useful tool for screening dementias in primary care setting.

Differences in Cognitive Function and Activities of Daily Living between Alzheimer Patients with Depression and Those without Depression / 신경정신의학

OBJECTIVES: Coexistence of depression is one of the important behavioral symptoms in patients with dementia of Alzheimer type. The study on the relationship between depression and cognitive abilities and/or functional abilities emerges as very important one. The aim of this study was to investigate whether depression is related to the impairment of daily activities and to certain areas of cognitive function in mild to moderate dementia of Alzheimer type. METHODS: In this study, 48 patients with dementia of Alzheimer type among elderly community-residents in Kwangju, Kyunggi province, aged 65 and older, were finally included. We examined their demographics and administered Korean Version of the Mini-Mental State Examination(MMSE-K), Korean Version of the Neurobehavioral Cognitive Status Examination(Korean version of NCSE), Korean Form of Geriatric Depression Scale(KGDS), Activities of Daily Living(ADL), and Instrumental Activities of Daily Living(IADL) to the subjects. We classified the subjects into two groups, dementia with and without depression on the basis of KGDS scores. The two groups were compared using X2 test and independent ttest. RESULTS: The results show that the two groups did not differ in sex, age, education, and scores of MMSE-K. The depressed dementia group showed significantly poorer performance in bathing, one item of ADL, than the nondepressed dementia group. The depressed dementia group showed significantly more impairment in total scores of IADL and each score of three items(shopping, housework, handling finances) than the non-depressed dementia group. However, the two groups showed no significant differences in five major cognitive ability areas of Korean version of NCSE. CONCLUSION: These results suggest that depression in patients with dementia of Alzheimer type is highly related to the functional impairments, instrumental activities of daily living and part of activities of daily living, beyond the effects of cognitive impairments.

One year follow up Study of the MMSE-K in the Elderly

BACKGROUNDS: As the elderly population in-creases the health problem, especially dementia, becomes the clinically important problem. So in the part of primary care medicine it becomes so important that family physician make a focus on the detection, evaluation, and management of demented patient. Until nowadays there is few cohort study about the dementia and few nursing home in Korea. So author performed the MMSE-K in the elderly who are over 65 to get the cognitive function for early diagnosis, management and rehabilitation of psychosocial problem. METHODS: One hundred three persons who included in community society in Seoul and nursing home of Kyunggido were tested. The survey was done twice on september 1997 and September 1998. Author used the MMSE-K to the elderly by same doctors. The analysis was done by SAS 6.12 and t-test, one-way ANOVA and two-way ANOVA with linear trend test. RESULTS: The mean of first MMSE-K score in the community is 26.1 and in the nursing home is 24.4. And the mean of second MMSE-K score in the community is 25.5 and in the nursing home is 22.0. The MMSE-K score is elevated with male and longer duration of education and is decreased with the advanced age in two groups. According to the classification by MMSE-K score the number of people who have normal cognitive function is 45(43.7%), mild impaired cognitive function is 45(43.7%), moderately impaired cognitive function is 13(12.6%) and none has severely impaired cognitive function in both groups. The follow up MMSE-K score shows that the difference of two MMSE-K scores increases as the age increases. CONCLUSION: Until todays there is few study that designed in the form of cohort study about the elderly cognitive function in Korea. So family physicians must perform the prospective cohort study with the consistent concern and effort to get the research data about the dementia for earthy detection, management and rehabilitation for elderly.

Prevalence of Cognitive Impairment and Depressive Symptomatology of the Elderly in a Long-term Institution / 신경정신의학

OBJECTIVES: This study was to investigate the prevalence of cognitive impairment and depressive symptomatology among the long-term institutionalized elderly people. METHODS: Mini-Mental state Examination-Korean version(MMSE-K), short portable Mental State Questionnaire(SPMSQ), Short version of Geriatric Depression Scale(SGDS), and the Center for Epidemiologic Studies Depression(CES-D) were administered to 169 elderly residents in an institution, 'Got Dong Rae'. RESULTS: One hundred fifty-three(males=72, females=79, and missing=2) completed the entire examination. Age ranged from 60 to 102 years and the mean of age was 74.17+/-8.27(males 71.76+/-8.14,females 76.14+/-7.78)years. Duration of education ranged from 0 to 16 years and the mean of duration of education was 3.04+/-3.93(males 4.13+/-4.23,females 2.01+/-3.38)years. The prevalence of cognitive impairment was estimated as 56.2% by MMSE-K or = 10 and 23.5% by CES-D > or = 25. In the case of using SGDS > or = 8 as cutoff-point to screen mild as well as severe depressive symptomatology, the prevalence was 39.2%. It was identical to the result achieved by using CES-D > or = 20. Significant correlations were observed between MMSE-K and SPMSQ, between SGDS and CES-D, between MMSE-K and CES-D, between MMSE-K and SGDS, and between SPMSQ and SGDS. CONCLUSION: The prevalences of cognitive impairment and depressive symptomatology were high in institutionalized elderly people. This results suggests that more intensive mental health care in needed for long-term institutionalized elderly people.

An Investigation to the Diagnostic Validity of MMSE-K and the Psychopathology in a Group of Urban Patients with Dementia of Alzheimer Type / 신경정신의학

OBJECTIVES: The purpose of present study was to determine the validity of MMSE-K and its items in a group of urban patients with dementia of Alzheimer type and investigate the frequency of psychiatric symptoms and the correlation between the severity of cognitive impairment and that of psychopathology in them. METHODS: The subjects were 107 residents, aged over 55, of an urban community, who participated voluntarily in a free medical service for dementic patients. At first, MMSE-K were administered to all the participients to screen for the cognitive impairment. They were diagnosed mainly by the criteria of DSM-IV for dementia of Alzheimer type. Other diagnostic procedures were performed at that time and these included: a history taking for the past and present medical and psychiatric illnesses of the subject and its family members, physical and neurological examinations, clinical evaluations using several psychiatric symptom rating scales such as BPRS, HDRS, HARS and Overt Aggression Scale, Hachinski's Ishcemic Scale, evaluations for sleep disturbances and behavioral problems in daily living. The majority, of total 72 subjects who were evaluated as having cognitive dysfunctions, were the patients with dementia of Alzheimer type: 52 dementia of Alzheimer type, 12 vascular dementia, one mixed type of the two, and 7 others. We determined the validity of MMSE-K and its items in 52 subjects with dementia of Alzheimer type except the two, who could not respond well to the instructions of MMSE-K due to severe cognitive impairments, and 34 non-dementic subjects with only mild psychiatric symptoms. In 42 subjects with dementia of Alzheimer type who completed all the clinical rating scales with confidence, we investigated the frequency of psychiatric symptoms and the correlation between the severity of cognitive impairment and psychopathology. RESULTS: 1) The percent of false positive in diagnosing dementia of Alzheimer type using MMSE-K was 8.0%, and the sensitivity of MMSE-K was 82% in our 107 urban subjects. 2) There were statistically significant differences in the the mean scores of all items except the item, judgement, between the patients with dementia of Alzheimer type and non-dementic subjects(p<0.05). The two items, orientation for time and place, and the item, copy two pentagons, had the sensitivity and specificity over 70%. 3) The frequencies of behavioral and psychiatric symptoms in 42 patients with dementia of Alzheimer type were as follows: verbal aggression(50.0%), depression(46.2%), insomnia(30.8%), ...... , hallucination(21.2%) and delusion(15.4%). 4) The more cognitive dysfunctions had the patient with dementia of Alzheimer type, the more higher scores in the thinking disturbance subscale of BPRS they showed(p<0.01). CONCLUSION: MMSE-K was proved to be a valid instrument to evaluate the cognitive impairments in patients with dementia of Alzheimer type, but the item, judgement, newly admitted to MMSE-K instead of a language item in MMSE, was proved to be lack of power to discriminate the dementic patient from non-dementic subjects. Our subjects with dementia of Alzheimer type had revealed several behavioral and psychiatric symptoms other than cognitive dysfunctions, and those included depression, anxiety, insommnia, aggression, delusion and hallucination which needed intensive pharmacological interventions.

A Comparison Study on the Psychopathology between the Patients with Dementia of Alzheimer Type and Normal Controls in an Urban Community / 신경정신의학

OBJECT: There are lots of studies on the cognitive impairments in patients with dementia of Alzheimer type in our country, but those on the psychopathology in them are very scanty. We investigated the psychopathology such as psychotic symptoms, depression, and anxiety and their correlations with the severity of cognitive impairments in our urban subjects with dementia of Alzheimer type. METHODS: Our subjects(N=34) with dementia of Alzheimer type in an area of Pusan, aged over 65, are screened with MMSE-K(below 24) and Hachinski's Ischemic Scale(below 4) and enrolled in this study when they met with the criteria of dementia of DSM-IV. They were devided into the mild(N=16) and severe dementic group(N=18) according to their scores of MMSE-K(cut-off point 20/21). The severities of psychiatric symptoms in the two groups were evaluated by using sets of clinical symptom rating scales such as BPRS, HAM-D, and HAM-A and the frequencies of aggressive behaviors and sleep disturbances in them were also rated at that time by two psychiatrists. Data of the two dementic groups were compared with those of healthy control subjects(N=40). RESULTS: The mean total score of BPRS, scores of thinking disturbance and withdrawal retardation subscale were lowest in the healthy control group and highest in the severe dementic group(p<0.05). Mean score of anxious depression subscale of mild dementic group was higher than that of other two groups(p<0.05). There were no ststistical differences in the mean score of hostile suspiciousness subscale among the three groups. The mean total scores of HAM-D and HAM-A tended to be higher in mild dementic group than in other two groups, but the differences were not reached to the statistical significance. These findings were thought to be identical with those of following. The total frequency of insomnia only tended to be higher, but the frequency of initial insomnia and that of using hypnotics were highest in mild dementic group(p<0.05). The frequency of aggressive behaviors tended to be higher in mild dementic group than in other two groups, but the differences were not reached to the statistical significance. CONCLUSION: Patients with dementia of Alzheimer type suffered from several psychiatric problems such as psychotic symptoms, depression, anxiety, insomnia, and aggressive behaviors from the initial stage of the illness. Clinicians should be more aware of those symptoms which need proper pharmacological and social interventions, especially in patients with mild cognitive impairment.

Effects of demographic characteristics and sensory function on the scores of Korean version of Mini-Mental State Examination (MMSE-K) of elderly persons living in a home for the Aged

BACKGROUND: The MMSE-K has been used widely to screen cognitive impairment of the elderly in Korea. However, the MMSE-K was validated only for elderly in the 60th and 70th, and did not consider the effect of vision and hearing impairment. So, this study was conducted to investigate the effect of demographic characteristics and sensory function on the scores of MMSE-K of elderly persons living in a home for the aged, who had low educational attainment, and high proportion of old age. METHODS: The MMSE-K was tested for 163 elderly persons living in a home for the aged in Seoul, by the interviewer who had been taught about the test methods. Vision and hearing were measured by the near vision card (40 cm), and 'whisper test' respectively RESULTS: Of the 162 subjects, 21 (13%) were excluded due to aphasia, severe vision and hearing impairment, and poor communication. The 141 study subjects (68 male, 73 female) had a mean age of 78.7 years (+/-7.1 years), and a mean MMSE-K score of 19.1 (+/-6.1). The mean score of women, elderly greater than 80 years, elderly with no education, and elderly with vision impairment was less than that of men (p0.05). In the multiple linear regression analysis with MMSE-K scores as the dependent variable, age (p0.05). CONCLUSION: These findings represent the cross-sectional relationship between MMSE-K performance and education, age, and vision among the institutionalized elderly. So, in using MMSE-K in the institutionalized elderly, we should take these variables into account. And the development of new adjustment methods of the MMSE-K will be needed.

Epidemiologic Study of Cognitive Impairment and Depressive Symptoms of the Elderly in a Korean Rural Community

OBJECTIVE: Elderly Dementia and depression are major neuropsychiatric disorders. Epidemiologic study considered essential part to evaluate and treatment guideline for community mental health. METHOD: The cross-sectional study evaluates the dementia and depression of community- living elderly, over 65 older in a Korean rural community. Mini-Mental State Examination- Korean (MMSE-K) and Geriatric Depression Scale (GDS) was conducted. RESULTS: The prevalence of dementia is 14.0% below the 17 of MMSE-K score. Cognitive function decline is increasing with age. The prevalence of dementia in female elderly is higher than that in male with statistical significance (p<.001). The prevalence of depression is 10% among elderly population. Female elderly have higher frequency than male with statistical significance. CONCLUSION: Elderly dementia and depression is very important neuropsychiatric disorders. MMSE-K and GDS-K is useful instruments for evaluation of elderly dementia and depression. Age and sex are important factors for dementia and depression. More developed instruments for accurate detection and differentiation of dementia and depression are need for mental health program to manage effectively them.

Relation between Cognitive Impairment and Activity of Daily Living in the Elderly of Nursing Home and Community

BACKGROUND: Due to the increase in average life expectancy, the number of elderly people in the population has also increased and it is argued that this has led to a rise in chronic regression type diseases or dementia and related psychoneurological diseases, together with the growing occurrence of cognitive function disorders. However, it can be said that research in Korea towards systematic general function assessment or machinery for diagnosis is insufficient. Accordingly, the authors of this paper, investigated elderly people, both institutionalized and shill living in the community for their cognitive functions and their ability to carry out daily life skills. Afterwards, the early diagnosis of mental illness and rehabilitation management for elderly patients was put into operation for this research. METHODS: During October of 1997 a certain retirement home in Kyonggi-do and a public health centre in Seoul were visited and forty patients from the home, and forty-five patients from the health centre, all over 65 years of age, were the objects of tests for cognition functions using the mini-mental status examination -Korea(MMSE-K), Their ability to carry out activity of daily living was tested through the modified Ballhel index for measurement, comparison and analysis. RESULTS: The group from the institution had an average MMSE-K of 24.05 with no significant difference between gender, age and degree of education. The health centre group's MMSE-K of 26.16 was a higher ,score(p<0.05), by men and by at least elementary ,school education. If we look at different classifications, the institutionalized group included 13 people(32.5%) ar a normal level, 18 people (45.0%) with mildly impairments, 9 people(17.5%) had moderately impairments and no severly handicapped patients. Looking at the community elderly, 23 people(51.1%) were at a normal level, 19 people (42.2%) had middle impairments, 3 people(6.7%) had moderately impairments and there were no severly impairments. With the MBI, the institutionalized group had an average of 95.9 and the community group had an average of 98.62 so both ,scored highly(p<0.05). If the MBI of the two group's dependency is compared, 17 people(42.5%) of the institution's elderly were independent in activity of daily living, 17 people(42.5%) were minimal dependent and the remaining 6 people(15.%) were mild dependent. 30(66.7%) of the community elderly were independent in daily living activity, 14 people (31.1%) were mild dependent and 1 people(2.2%) war mild dependent. Even the elderly with normal cognitive functions had disorders with their daily living activity Therefore a sample of the patients have above average damaged cognitive functions and severe living activity disorders are being seen in both groups. CONCLUSION: Both the community and institutionalized elderly had resonable cognition and the institutionalized groups had especially high levels. It is now believed that there is a relation between this and the lack of suitable evaluation in Korea. Even if the daily living activity disorders were not severe, they were observed in both groups, so henceforth, if cognitive function tests were made with consideration given to age and gender, and activity of daily living tests were implemented efficiently, the overall health and well-being of the elderly, and therefore demands for medical treatment and social services, could be decided and put into operation.