Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease: Methodology and Baseline Sample Characteristics

OBJECTIVE: The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's disease (KBASE) aimed to recruit 650 individuals, aged from 20 to 90 years, to search for new biomarkers of Alzheimer's disease (AD) and to investigate how multi-faceted lifetime experiences and bodily changes contribute to the brain changes or brain pathologies related to the AD process. METHODS: All participants received comprehensive clinical and neuropsychological evaluations, multi-modal brain imaging, including magnetic resonance imaging, magnetic resonance angiography, [11C]Pittsburgh compound B-positron emission tomography (PET), and [18F]fluorodeoxyglucose-PET, blood and genetic marker analyses at baseline, and a subset of participants underwent actigraph monitoring and completed a sleep diary. Participants are to be followed annually with clinical and neuropsychological assessments, and biannually with the full KBASE assessment, including neuroimaging and laboratory tests. RESULTS: As of March 2017, in total, 758 individuals had volunteered for this study. Among them, in total, 591 participants–291 cognitively normal (CN) old-aged individuals, 74 CN young- and middle-aged individuals, 139 individuals with mild cognitive impairment (MCI), and 87 individuals with AD dementia (ADD)–were enrolled at baseline, after excluding 162 individuals. A subset of participants (n=275) underwent actigraph monitoring. CONCLUSION: The KBASE cohort is a prospective, longitudinal cohort study that recruited participants with a wide age range and a wide distribution of cognitive status (CN, MCI, and ADD) and it has several strengths in its design and methodologies. Details of the recruitment, study methodology, and baseline sample characteristics are described in this paper.

Clinical Dementia Rating Orientation Score as an Excellent Predictor of the Progression to Alzheimer's Disease in Mild Cognitive Impairment

OBJECTIVE: This study aimed to examine the usefulness of each subscale score of the Clinical Dementia Rating (CDR) for predicting Alzheimer's disease (AD) dementia progression in amnestic mild cognitive impairment (MCI) elderly subjects. METHODS: Fifty-nine elderly MCI individuals were recruited from a university dementia and memory disorder clinic. Standardized clinical and neuropsychological tests were performed both at baseline and at the time of 2 years follow-up. Logistic regression analyses were conducted to examine the ability of various clinical measures or their combinations to predict progression to AD dementia in MCI individuals. RESULTS: MCIp individuals showed significantly higher CDR Orientation subscale and CDR sum-of-boxes (SOB) score than MCInp ones, while there were no significant differences in other CDR subscale scores between the two. MCIp individuals also showed marginally higher MMSE scores than MCInp ones. A series of logistic regression analyses demonstrated that the model including CDR Orientation subscale had better AD dementia prediction accuracy than either the model with either MMSE or CDR-SOB. CONCLUSION: Our findings suggest that CDR Orientation subscale score, a simple and easily available clinical measure, could provide very useful information to predict AD dementia progression in amnestic MCI individuals in real clinical settings.

The Effect of Choline Acetyltransferase Genotype on Donepezil Treatment Response in Patients with Alzheimer's Disease

OBJECTIVE: We examined the difference in responses to donepezil between carriers and non-carriers of the A allele at the +4 position of the choline acetyltransferase (ChAT) gene in Koreans. METHODS: Patients who met the criteria for probable Alzheimer's disease (AD) (n=199) were recruited. Among these, 145 completed the 12-week follow-up evaluation and 135 completed the 26-week scheduled course. Differences and changes in the Korean version of the mini-mental state examination (MMSE-KC) score, Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery (CERAD-K[N]) wordlist subtest score (WSS), CERAD-K(N) total score (TS), and the Korean version of geriatric depression scale (GDS-K) score between baseline and 12 weeks or 26 weeks were assessed by the Student's t-test. RESULTS: At 12 weeks, the changes in the MMSE-KC score, CERAD-K(N) WSS, and CERAD-K(N) TS from baseline were not significant between ChAT A allele carriers and non-carriers; however, at 26 weeks, these changes were significantly larger in ChAT A allele carriers than in non-carriers (p=0.02 for MMSE-KC and p=0.03 for CERAD-K(N) WSS respectively). CONCLUSION: Our findings in this study suggested that presence of the A allele at the +4 position of ChAT might positively influence the treatment effect of donepezil in the early stages of AD in Koreans.

Comparison of Regional Gray Matter Atrophy, White Matter Alteration, and Glucose Metabolism as a Predictor of the Conversion to Alzheimer's Disease in Mild Cognitive Impairment

We compared the predictive ability of the various neuroimaging tools and determined the most cost-effective, non-invasive Alzheimer's disease (AD) prediction model in mild cognitive impairment (MCI) individuals. Thirty-two MCI subjects were evaluated at baseline with [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET), MRI, diffusion tensor imaging (DTI), and neuropsychological tests, and then followed up for 2 yr. After a follow up period, 12 MCI subjects converted to AD (MCIc) and 20 did not (MCInc). Of the voxel-based statistical comparisons of baseline neuroimaging data, the MCIc showed reduced cerebral glucose metabolism (CMgl) in the temporo-parietal, posterior cingulate, precuneus, and frontal regions, and gray matter (GM) density in multiple cortical areas including the frontal, temporal and parietal regions compared to the MCInc, whereas regional fractional anisotropy derived from DTI were not significantly different between the two groups. The MCIc also had lower Mini-Mental State Examination (MMSE) score than the MCInc. Through a series of model selection steps, the MMSE combined with CMgl model was selected as a final model (classification accuracy 93.8%). In conclusion, the combination of MMSE with regional CMgl measurement based on FDG-PET is probably the most efficient, non-invasive method to predict AD in MCI individuals after a two-year follow-up period.

A Normative Study of the Digit Span in an Educationally Diverse Elderly Population

OBJECTIVE: The purpose of this study was to explore the effect of demographic variables on Digit Span test (DS) performance in an educationally diverse elderly population and to provide normative information. METHODS: The DS was administered to 784 community-dwelling volunteers aged 60-90 years with an educational history of from zero to 25 years of full-time education. People with serious neurological, medical and psychiatric disorders (including dementia) were excluded. RESULTS: Age, education and gender were found to be significantly associated with performance on the DS. Based on the results obtained, DS norms were stratified by age (2 strata), education (3 strata), and gender (2 strata). CONCLUSION: Our results on DS performance suggest that both attention and working memory are influenced by age, education and gender. The present study provides reasonably comprehensive normative information on the DS for an educationally diverse elderly population.

Improvement of Screening Accuracy of Mini-Mental State Examination for Mild Cognitive Impairment and Non-Alzheimer's Disease Dementia by Supplementation of Verbal Fluency Performance

OBJECTIVE: This study aimed to investigate whether the supplementation of Verbal Fluency: Animal category test (VF) performance can improve the screening ability of Mini-Mental State Examination (MMSE) for mild cognitive impairment (MCI), dementia and their major subtypes. METHODS: Six hundred fifty-five cognitively normal (CN), 366 MCI [282 amnestic MCI (aMCI); 84 non-amnestic MCI (naMCI)] and 494 dementia [346 Alzheimer's disease (AD); and 148 non-Alzheimer's disease dementia (NAD)] individuals living in the community were included (all aged 50 years and older) in the study. RESULTS: The VF-supplemented MMSE (MMSE+VF) score had a significantly better screening ability for MCI, dementia and overall cognitive impairment (MCI plus dementia) than the MMSE raw score alone. MMSE+VF showed a significantly better ability than MMSE for both MCI subtypes, i.e., aMCI and naMCI. In the case of dementia subtypes, MMSE+VF was better than the MMSE alone for NAD screening, but not for AD screening. CONCLUSION: The results support the usefulness of VF-supplementation to improve the screening performance of MMSE for MCI and NAD.

Improvement of Dementia Screening Accuracy of Mini-Mental State Examination by Education-Adjustment and Supplementation of Frontal Assessment Battery Performance

This study aimed to investigate whether the demographic variable-adjustment and supplementation of Frontal Assessment Battery (FAB) score can improve the screening ability of Mini-Mental State Examination (MMSE) for dementia and its subtypes. Five hundred forty-one non-demented comparison (NC) and 474 dementia (320 Alzheimer's disease [AD]; 139 non-Alzheimer's disease dementia [NAD]; and 15 mixed AD-NAD dementia) individuals living in the community were included. Education-adjusted MMSE (MMSE-edu) score showed significantly better screening accuracy for overall dementia, AD, and NAD than MMSE raw score. FAB-supplemented MMSE (MMSE-FAB) score had significantly better screening ability for NAD, but not for overall dementia and AD, than MMSE raw score alone. Additional supplementation of FAB to MMSE-edu further increased the ability for overall dementia or NAD screening, but not for AD screening. Further education adjustment of MMSE-FAB also improved its ability for overall dementia, AD, and NAD screening. These results strongly support the usefulness of education-adjustment and supplementation of frontal function assessment to improve screening performance of MMSE for dementia and its subtypes, NAD in particular.

Validation of the Dementia Care Assessment Packet-Instrumental Activities of Daily Living

OBJECTIVE: We aimed to evaluate the psychometric properties of the IADL measure included in the Dementia Care Assessment Packet (DCAP-IADL) in dementia patients. METHODS: The study involved 112 dementia patients and 546 controls. The DCAP-IADL was scored in two ways: observed score (OS) and predicted score (PS). The reliability of the DCAP-IADL was evaluated by testing its internal consistency, inter-rater reliability and test-retest reliability. Discriminant validity was evaluated by comparing the mean OS and PS between dementia patients and controls by ANCOVA. Pearson or Spearman correlation analysis was performed with other instruments to assess concurrent validity. Receiver operating characteristics curve analysis was performed to examine diagnostic accuracy. RESULTS: Chronbach's alpha coefficients of the DCAP-IADL were above 0.7. The values in dementia patients were much higher (OS=0.917, PS=0.927), indicating excellent degrees of internal consistency. Inter-rater reliabilities and test-retest reliabilities were statistically significant (p<0.05). PS exhibited higher reliabilities than OS. The mean OS and PS of dementia patients were significantly higher than those of the non-demented group after controlling for age, sex and education level. The DCAP-IADL was significantly correlated with other IADL instruments and MMSE-KC (p<0.001). Areas under the curves of the DCAP-IADL were above 0.9. CONCLUSION: The DCAP-IADL is a reliable and valid instrument for evaluating instrumental ability of daily living for the elderly, and may also be useful for screening dementia. Moreover, administering PS may enable the DCAP-IADL to overcome the differences in gender, culture and life style that hinders accurate evaluation of the elderly in previous IADL instruments.

Frontal Dysfunction Underlies Depression in Mild Cognitive Impairment: A FDG-PET Study

OBJECTIVE: Depression is a very common symptom in people with mild cognitive impairment (MCI), a preclinical stage of Alzheimer's disease (AD), and in those with clinically evident AD. Moreover, MCI individuals with depression show a higher conversion rate to clinical AD than those without depression. This study aimed to elucidate the functional neuroanatomical substrate of depression in MCI. METHODS: Thirty-six patients were recruited from a University Hospital-based cohort; 18 of these subjects had MCI with depression (MCI_D); the remaining 18 subjects were age- and gender-matched, and had MCI with no depression (MCI_ND). For comparison, 16 cognitively normal (CN) elderly individuals were also included. All subjects underwent Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) scanning and regional cerebral glucose metabolism was compared among the three groups by a voxel-based method. The relationship between severity of depression, as measured by Hamilton Rating Scale for Depression (HRSD) scores, and glucose metabolism was also investigated. RESULTS: MCI_D showed lower glucose metabolism in the right superior frontal gyrus than MCI_ND. There was a significant negative correlation between HRSD score and glucose metabolism at the same frontal region for overall MCI subjects. When compared with CN, both MCI_D and MCI_ND showed decreased glucose metabolism in the precuneus, while MCI_D had, in addition, reduced metabolism in other diffuse brain regions. CONCLUSION: Given previous observations on depression in AD, our results suggest that functional disruption of the frontal region, known to be associated with primary or other secondary depression, underlies depression in preclinical AD as well as clinically evident AD.

A Normative Study of an Executive Clock Drawing Task(CLOX) in Korean Elderly / 신경정신의학

OBJECTIVES: The CLOX (an executive clock drawing task) consists of an unprompted task that is sensitive to executive function (CLOX1) and a copied version that is more dependent on visuoconstructive function (CLOX2). This study aimed to explore the effects of age, education, and gender on the performance of the CLOX and to provide normative information on the test in the Korean elderly. METHODS: We administered the CLOX to 608 community-dwelling healthy volunteers aged 60-90, excluding people with serious neurological, medical, and psychiatric disorders, including dementia. Multiple linear regression analysis was performed to assess the relative contributions of the demographic factors to the CLOX scores. RESULTS: Education had a considerable influence on performance of both CLOX1 and CLOX2. Age and gender also had significant effect on both. There were significant interactions between education and gender for both CLOX1 and CLOX2. We also found interactions between education and age on CLOX2. Based on these results, we created normative data for the CLOX, stratified by age (60-74 and 75-90 years), education (0-3, 4-9, and 10+ years), and gender. CONCLUSION: Our normative data, based on a large, healthy elderly population, provides accurate reference information on CLOX performance and should be very useful for proper interpretation of CLOX scores in the Korean elderly.

Standardization of the Korean Version of the Geriatric Depression Scale: Reliability, Validity, and Factor Structure

OBJECTIVE: We developed a Revised Korean version of the Geriatric Depression Scale (GDS-KR) and examined its reliability, validity, and factor structures. We also estimated its optimal cutoff scores for major depressive disorder (MDD) and minor depressive disorder (MnDD) stratified by age and education. METHODS: The GDS-KR was administered to 888 subjects (61 MDD patients, 45 MnDD patients, and 782 normal elders). Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D-K) and Hamilton Depression Rating Scale (HAM-D). The mean GDS-KR scores of the MDD patients, MnDD patients and normal elders were compared to evaluate its discriminant validity. To evaluate its construct validity, a principal component analysis with varimax rotation was performed. Receiver operator characteristic (ROC) curve analyses were performed to evaluate its diagnostic ability. RESULTS: Chronbach's coefficient alpha for the GDS-KR was 0.90 and the test-retest reliability was 0.91 (p<0.01). The Pearson correlation coefficients of the GDS-KR scores with the CES-D-K and HAM-D scores were 0.63 (p<0.01) and 0.56 (p<0.01), respectively. The GDS-KR consisted of 5 factors. The optimal cut-off scores of the GDS-KR were 16/17 for MDD only and 15/16 for both MDD and MnDD. The optimal cutoff scores of the GDS-KR were higher in the less educated and younger subjects. The diagnostic accuracy for MDD of the GDS-KR was higher than that of the CES-D. CONCLUSION: The GDS-KR was found to be a reliable and valid questionnaire for screening MDD and MnDD in late life.

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.

Relationship of Sleep Factors with Neurocognitive Function in Normal Elderly Subjects and Mild Cognitive Impairment (MCI) Patients / 신경정신의학

OBJECTIVES: We aimed to compare sleep factors including daytime sleepiness, sleep apnea and insomnia between mild cognitive impairment (MCI) patients and normal control (NC) subjects and to illustrate their relationship with neuropsychological function in the preclinical stage of dementia. METHODS: Epworth Sleepiness Scale (ESS), sleep apnea subscale of Sleep Disorders Questionnaire (SA) and questionnaire on insomnia were administered to community-dwelling elderly subjects above the age of 60. Both clinical and neuropsychological batteries of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) assessment packet and Stroop Color and Word Test (SCWT) were done for each subject. Seventy seven NC subjects and 47 MCI patients were selected. RESULTS: In the NC group, ESS scores negatively correlated with Stroop interference (SI) scores. SA scores were negatively correlated with Stroop Color Word (SCW) and SI scores. In the MCI group, ESS scores negatively correlated with SCW scores, and SA scores had no correlation with each neurocognitive function test. CONCLUSION: Daytime sleepiness was associated with impaired executive function in community-dwelling normal elderly subjects and MCI patients. But the higher risk of SA was associated with decreased executive function only in normal elderly subjects.

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.

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.

No Evidence of Association of Interleukin 1A(-889) Genetic Polymorphism with Alzheimer's Disease in Koreans

To examine whether the IL-1A(-889) polymorphism associates with a risk for Alzheimer's disease(AD) and acts interactively with the apolipoprotein(APOE) epsilon 4 in the development of AD, we performed genotype analyses of the IL-1A and the APOE of the 102 Korean AD patients and 200 Korean non-demented controls. We failed to detect a significant difference in genotypic and allelic frequencies of IL-1A between the AD group and control group. No overexpression of the IL-1A C/T genotype and IL-1A T allele was found when we analyzed the late-onset and early-onset patients, separately. There was no significant genetic interaction between IL-1A polymorphism and the APOE polymorphism. In conclusion, the IL-1A polymorphism did not contribute to the development of AD independently or interactively with the APOE epsilon4 allele in Koreans.

Development of an Informant Report Questionnaire for Dementia Screening: Seoul Informant Report Questionnaire for Dementia(SIRQD) / 신경정신의학

OBJECTIVES: This study aimed to develop an informant report questionnaire for dementia screening and to verify its reliability and validity. METHODS: A preliminary questionnaire with 30 items was administered to a reliable informant for each of 81 dementia patients and 166 normal controls. Through item analyses, the 15-item Seoul Informant Report Questionnaire for Dementia (SIRQD) was clraum up. Internal consistency and inter-informant correlation were analyzed. Factor analysis and ROC curve analysis were also performed. RESULTS: SIRQD was found to have high internal consistency and inter-informant reliability. Optimal cut-off score of SIRQD was 9/10, and the sensitivity and specificity at that score were .850 and .873, respectively. SIRQD was composed of four major factors (remote memory, recent memory, language, and activity of daily living). SIRQD was closely equivalent to MMSE-KC in terms of overall dementia screening ability, and it appeared efficient in discriminating very mild dementia from normal. SIRQD showed low false positive and negative rates, irrespective of levels of education, age, and sex. CONCLUSION: SIRQD possess good psychometrical properties and is probably very useful to screen dementia, especially for the Korean elderly with a very wide range of educational background.

A Normative Study of the Mini-Mental State Examination in the Korean Elderly / 신경정신의학

This study aimed to determine the variables significantly related to the MMSE in the Korean version of the CERAD assessment battery(MMSE-KC) and present the normative information of the test in the Korean elderly. The MMSE-KC was administered in a standardized manner to 618 healthy volunteers aged 60 to 90 who were recruited from 4 dementia clinics, 2 elderly welfare centers and 1 community population. The elderly with serious neurological, medical and psychiatric disorders including dementia and major depression were excluded through clinical evaluation using CERAD-K clinical assessment protocol. Univariate and multivariate analyses were performed to determine the variables significantly related to the MMSE-KC score. Age, educational level, and sex were found to have statistically significant effect on the test score. Based on this result, overlapping age normative table(60 to 74, 65 to 79, 70 to 84, and 75 to 90 years of age) with 3 educational strata(0 to 3 years, 4 to 6 years, and 7 years and more) separately for both male and female were developed. For resulting 24 normative units, 5 percentile, lower quartile, median, upper quartile, mean and standard deviation were calculated. The normative data from this study can be widely used as reference values to objectively interpret the MMSE-KC scores of the Korean elderly.

Comorbid Axis-II Disorders in Patients with Obsessive-Compulsive Disorder / 신경정신의학

The purpose of this study was to assess the comorbid axis-II disorders of obsessive compulsive disorder(OCD) patients and to investigate the relationship between symptoms of OCD and the comorbid personality traits. The subjects were 59 patients who met DSM-IV criteria for obsessive-compulsive disorder and 32 normal controls. All subjects completed Personality Disorder Questionnaire-IV(PDQ-IV). The patients completed Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI), and were rated with Yale-Brown Obsessive Compulsive Scale(YBOCS). The results were as follows. 1) The OCD patients showed significantly higher prevalence of avoidant, depresssive and borderline personality disorder(p<0.01) compared to controls. 2) The BAI score had significant effect on the avoidant personality score(t=3.23, p<0.003). The BDI score had significant effect on the depressive personality score(t=3.08, p=0.004). The YBOCS(t=2.10, p=0.043) and BAI(t=2.60, p=0.014)scores had significant effects on the borderline personality score. We found that OCD patients had higher prevalence of avoidant, depressive, and borderline personality disorders. We also found that obsessive-compulsive symptoms have significant effect on the severity of borderline personalty traits. We suggest that it would be very helpful to consider Axis-II disorders for managing patients with obsessive-compulsive disorder.