The Characteristics of Cognitive Impairment and Their Effects on Functional Outcome After Inpatient Rehabilitation in Subacute Stroke Patients

OBJECTIVE: To determine the frequency and characteristics of vascular cognitive impairment (VCI) in patients with subacute stroke who underwent inpatient rehabilitation and to analyze whether cognitive function can predict functional assessments after rehabilitation. METHODS: We retrospectively reviewed the medical records of patients who were admitted to our rehabilitation center after experiencing a stroke between October 2014 and September 2015. We analyzed the data from 104 patients who completed neuropsychological assessments within 3 months after onset of a stroke. RESULTS: Cognitive impairment was present in 86 out of 104 patients (82.6%). The most common impairment was in visuospatial function (65, 62.5%) followed by executive function (63, 60.5%), memory (62, 59.6%), and language function (34, 32.6%). Patients with impairment in the visuospatial and executive domains had poor scores of functional assessments at both admission and discharge (p<0.05). A multivariate analysis revealed that age (β=−0.173) and the scores on the modified Rankin Scale (β=−0.178), Korean version of the Modified Barthel Index (K-MBI) (β=0.489) at admission, and Trail-Making Test A (TMT-A) (β=0.228) were related to the final K-MBI score at discharge (adjusted R²=0.646). CONCLUSION: In our study, VCI was highly prevalent in patients with stroke. TMT-A scores were highly predictive of their final K-MBI score. Collectively, our results suggest that post-stroke executive dysfunction is a significant and independent predictor of functional outcome.

Development of a Korean Version of the Perceived Deficits Questionnaire-Depression for Patients with Major Depressive Disorder

OBJECTIVE: Cognitive symptoms are an important component of depression and the Perceived Deficits Questionnaire-Depression is one of only a few instruments available for the subjective assessment of cognitive dysfunction in depression. Thus, the present study aimed to validate a Korean version of the PDQ-D (K-PDQ-D) using patients with major depressive disorder (MDD). METHODS: This study included 128 MDD patients who were assessed at study entry and 86 of these patients were then completed 12 weeks of antidepressant monotherapy. All subjects were assessed with the K-PDQ-D, the Montgomery-Asberg Depression Rating Scale (MADRS), the Sheehan Disability Scale (SDS), the EuroQol-5 dimensions questionnaire (EQ-5D), and the number of sick leave days taken in the previous week. The internal consistency, Guttman's split-half and test-retest reliabilities, factorial analyses, and concurrent and predictive validities of the K-PDQ-D were investigated. RESULTS: The K-PDQ-D exhibited excellent internal consistency and reliabilities, and was composed of four factors with high coefficients of determination. The concurrent validity analyses revealed that the K-PDQ-D scores were significantly correlated with the MADRS, SDS, and EQ-5D scores and the number of sick leave days taken. The K-PDQ-D scores at study entry significantly predicted changes in sick leave days and EQ-5D score from study entry to the 12-week endpoint. CONCLUSION: The newly developed K-PDQ-D is a reliable and valid instrument for the evaluation of subjective cognitive symptoms in MDD patients. The K-PDQ-D may assist in the gathering of unique information regarding subjective cognitive complaints, which is important for the comprehensive evaluation of patients with MDD.

Awareness, Attitude and Impact of Perceived Depression in the Workplace in Korea / 신경정신의학

OBJECTIVES: Depression is a common disabling psychiatric illness in the workplace and is associated with high burden to both employer and employee. Little is known about the awareness, attitude, and impact of depression in the Korean workplace. This study investigates how workers perceive the symptomatology, disability, and management of depression. METHODS: This study is a cross-sectional web-based survey of 1000 workers recruited from online sites. Selected panel members were invited to participate in the survey through Ipsos MORI (www.ipsos-mori.com/) between 10th and 19th February 2014. The participants were Korean workers, aged 16-64, who are either currently working or had worked within the past year. Subjects were encouraged to respond to a 13-item questionnaire on the awareness, attitude, and impact of depression. RESULTS: According to the results, 7.4% of the subjects responded that they had ever been diagnosed as having depression from medical professionals. One third of workers with depression who had taken time off from work did not provide the actual reason to their employers, and the mean number of days off work was 9.8 days. The most common symptoms were depressed mood (76.7%), loss of interests (71.5%), sleep problem (69.8%), and cognitive dysfunction (47.0%). Cognitive symptoms (72.2%) were prominent among the workers who continued to work under the influence of depression. CONCLUSION: Korean workers reported a low rate of depression. Those who have been diagnosed with depression reported shorter number of days taken off from work compared to other countries. These results suggest that depression is poorly recognized and disclosed to employers in the Korean workplace. Presenteeism rather than absenteeism may be a major loss of productivity in Korea. An employee assistance program for depressed workers and new therapeutic strategies for treatment of cognitive symptoms of depression should be provided in Korea.

Relationships between Cigarette Smoking and Socio-Demographic and Clinical Characteristics in Patients with Schizophrenia in South Korea / 신경정신의학

OBJECTIVES: In patients with schizophrenia, the prevalence of smoking is significantly higher than that of the general population. This study aimed to evaluate the relationships between cigarette smoking and socio-demographic and clinical characteristics in patients with schizophrenia in South Korea. METHODS: Post analysis of 2008-2009 three multi-center studies on the paliperidone extended-release switching was performed. A total of 509 patients with a diagnosis of schizophrenia were recruited and interviewed regarding socio-demographic variables, smoking characteristics. Krawiecka Scale, Clinical Global Impression-Schizophrenia-Severity, Clinical Global Impression-Schizophrenia-Improvement, and Personal and Social Performance Scale were used to evaluate psychological disturbance. Safety assessments included adverse events, evaluation of extrapyramidal symptoms using the Drug Induced Extra Pyramidal Symptoms Scale, and laboratory tests. RESULTS: The results revealed that the prevalence of smoking in Korean patients with schizophrenia is significantly higher than that of the general population. Male, patients with occupation, and paranoid type showed higher rate of smoking and smokers with schizophrenia had higher rates of overweight, thick waist, high blood pressure than non-smokers with schizophrenia. The results revealed that smokers with schizophrenia had higher rating scales of negative and cognitive symptoms. CONCLUSION: From this study, we reported significant relationships between cigarette smoking and socio-demographic and clinical characteristics in patients with schizophrenia in South Korea. More studies will be needed to evaluate the association between cigarette consumption and schizophrenia, effect of smoking according to the antipsychotics, mechanism of nicotine on schizophrenia.

The Influences of Physical Health, Cognitive Symptom and Nutritional Status on the Depression of the Elderly Dwelling in a Big City

PURPOSE: The purposes of this study were to investigate factors related to the depression of the elderly dwelling in a big city, and to explore the influence of physical health, cognitive symptom and nutritional status on the elders' depression. METHODS: After the approval of the Institutional Review Board (IRB) and obtaining the participants' consent form, a face-to-face and private interview was conducted with each participant from May, 2007 to Aug, 2007 by trained graduate level students. A total of 201 elders aged over 65 years participated in the study. The questionnaire consisted of K-GDS, PHQ-15 and Nutritional Screening Initiative (NSI). Collected data were analyzed with the SPSS 13.0 program, which was used for frequency, percentage, mean, standard deviation, Pearson correlation coefficients, and multiple regression. RESULTS: The major findings of this study were as follows. 1) 28.4% of the subjects belonged to the depression group, 78.1% had one or more diseases, 85.6% had experienced somatic symptoms, and 49.7% belonged to the nutritional risk group. 2) Older age, lower educational level, more pocket money, a larger number of diseases, more severe cognitive symptoms and poorer nutritional status were significantly related to a higher depression score. 3) Significant factors influencing depression were nutritional status, cognitive symptoms and the number of diseases, which explained 38.1% of the variance of elderly depression, and nutritional status was the most influencing factor. CONCLUSION: The finding of this study gives useful information for developing assessment tools and interventions for elders' depression.