Reliability and Validity of the Korean Version of Severe Mini-Mental Status Examination (SMMSE-K) / 신경정신의학

OBJECTIVES: We developed the Korean version of Severe Mini-Mental Status Examination (SMMSE-K) which is a brief cognitive test for the severely demented patients. METHODS: The translation was carried out keeping the basic structure of the English version Severe Mini-Mental Status Examination (SMMSE). The SMMSE-K, Korean version of Mini Mental State Examination (MMSE-KC), and Clinical Dementia Rating (CDR) were administered to 84 Alzheimer's disease (AD) patients and 36 cognitively normal elderly subjects. For evaluating the reliability of the SMMSE-K, Cronbach alpha coefficient, inter-rater reliability, and test-retest reliability were examined. For confirming the validity of the SMMSE-K, the correlations of the SMMSE-K with MMSE-KC and CDR were examined, and factor analysis was performed using principal component analysis with Varimax rotation. RESULTS: SMMSE-K was found to have a high internal consistency (Cronbach alpha coefficient=0.906, p<0.01), inter-rater reliability (Pearson correlation coefficient=0.980, p<0.01) and test-retest reliability (Pearson correlation coefficient=0.940, p<0.01). Performances on the SMMSE-K and MMSE-KC were found to correlate significantly in the subjects with CDR of 2 (Pearson correlation coefficient=0.827, p<0.001) and 3 (Pearson correlation coefficient=0.929, p<0.001). In the subjects with CDR of 3, the MMSE-KC showed a floor effect (2.93+/-3.21), whereas the SMMSE-K did not (11.00+/-8.48). Exploratory factor analysis yielded two factors (automatic informational processing, controlled informational processing) accounting for 76.1% of the total variance. CONCLUSION: The SMMSE-K was found to be a reliable and valid test for assessing the cognition of severely demented patients.

Impacts of Poor Social Support on General Health Status in Community-Dwelling Korean Elderly: The Results from the Korean Longitudinal Study on Health and Aging

OBJECTIVE: We investigated the influence of social support on health, quality of life (QOL), and the risk of depression in elderly Korean people. METHODS: This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A total of 787 nondemented community-dwelling elderly aged 65 years or older were recruited and underwent clinical evaluations for dementia and psychiatric disorders conformed to Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Clinical Assessment Battery (CERAD-K) and the Korean version of the Mini-International Neuropsychiatric Interview (MINI), respectively. Social support was assessed using the Medical Outcome Study Social Support Survey (MOS-SSS). Poor social support (PSS) was defined as having a MOS-SSS score below the 25th percentile of the entire sample. General health status was comprehensively evaluated using the modified Cumulative Illness Rating Scale (CIRS), the Korean version of the Geriatric Depression Scale (GDS-K), Mini-Mental Status Examination (MMSE-KC), Korean Activities of Daily Living (KADL), and Korean Instrumental Activities of Daily Living (KIADL). Health-related QOL was evaluated using the Short Form 36 (SF-36). RESULTS: Low educational attainment and living alone were associated with PSS. Geriatric depression was more prevalent in the PSS group (OR=3.05, 95% CI=1.77-5.27) than in the normal social support (NSS) group. Among the various forms of social support, positive social interaction was significantly associated with risk of geriatric depression (OR=2.25, 95% CI=1.07-4.73). Although health-related QOL was lower in the PSS group than in the NSS group, the ADL and IADL scores of the subjects in the PSS group were better than those of the subjects in the NSS group. In the subjects with geriatric depression, PSS was associated with more severe depression, higher medical morbidity, and poor QOL. CONCLUSION: PSS had a negative influence on the general health status and QOL among community-dwelling elderly and was an independent risk factor of geriatric depression.

Predictors for Subjective Memory Complaints in the Elderly: The Results from Korean Longitudinal Study on Health and Aging (KLoSHA) / 신경정신의학

OBJECTIVES: We investigated the predictors of subjective memory complaints in the community-dwelling normal elderly. METHODS: This study was conducted as a part of Korean Longitudinal Study on Health and Aging (KLoSHA). 747 nondemented community-dwelling elderly aged 65 years or older were recruited. All participants underwent clinical evaluation for dementia and psychiatric disorder conformed to the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Clinical Assessment Battery and Korean version of Mini-International Neuropsychiatric Interview, respectively. Word list recall test, frontal assessment battery, Mini Mental Status Examination (MMSE-KC) and Korean version of Geriatric depression scale (GDS-K) were administered to evaluate episodic memory, frontal function, global cognition and depression, respectively. Subjective memory complaint was defined in two different ways: worse than one's past (SMC-P) and worse than others of one's age (SMC-O). RESULTS: In highly educated elderly, minor depressive disorder (OR=7.23, 95% C.I.= 2.29-22.86) and frontal dysfunction (OR=2.48, 95% C.I.=1.29-4.77) significantly increased the risk of SMC-O. However, they did not influence the risk of SMC-P. In low educated elderly, both the minor depressive disorder and frontal dysfunction did not influence the risk of SMC-O as well as that of SMC-P. CONCLUSION: SMC-O can be a sensitive subjective recognition of mild depression and/or frontal dysfunction in highly educated normal elderly.

The Efficacy and Safety of Topiramate in the Treatment of Alcohol Withdrawal / 신경정신의학

OBJECTIVES: Benzodiazepines are most often used for the treatment of alcohol withdrawal, but they also may result in several adverse consequencies such as sedation, respiratory depression, cognitive impairment, disinhibition, and abuse. New anticonvulsants, topiramate may have a potential to treat alcohol withdrawal effectively. This study compared the therapeutic responses of a benzodiazepine, lorazepam, and an anticonvulsant, topiramate, for the treatment of alcohol withdrawal. METHODS: Fifty-two hospitalized patients with the diagnosis of DSM-IV Alcohol dependence, after obtaining written informed consent, were randomely divided into the either lorazepam (N=27) or the topiramate (N=25) groups. Subjects were assessed with CIWA-Ar scores at the time of baseline, 1, 3, 5 day after the last alcohol drinking. Lorazepam was given 4 mg divided by 4 on day 1, tapering to 2 mg divided by 2, and topiramate was given fixed single dose of 50 mg a day. RESULTS: There were no significant differences between two groups in demographic or clinical characteristics except marital status and s-ALT level. Two groups had similar ADS scores and baseline withdrawal severity. There were no significant differences by treatment group in CIWA-Ar scores over time (F=0.883, p>0.05). CONCLUSION: Efficacy and safety were not different between the two groups. Therefore our results suggest that topiramate is a promising alternative agent to benzodiazepine for treating alcohol withdrawal.