Prevalence of major depressive disorder and minor depressive disorder in an elderly Korean population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA).

OBJECTIVE: We investigated the prevalence, risk factors and impact of major depressive disorder (MDD) and minor depressive disorder (MnDD) in a randomly selected community-dwelling Korean elderly population. METHOD: This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A study population of 1118 Korean elders was randomly sampled from residents of Seongnam, Korea aged 65 years or older. Standardized face-to-face interviews and neurological and physical examinations were conducted on 714 respondents using the Korean version of Mini International Neuropsychiatric Interview. MDD was diagnosed according to the DSM-IV criteria, and MnDD according to research criteria proposed in Appendix B of the DSM-IV criteria. RESULTS: Age-, gender- and education-standardized prevalence rates in Korean elders aged 65 years or older were estimated as 5.37% (95% CI=3.72-7.03) for MDD, 5.52% (95% CI=3.84-7.19) for MnDD, and 10.89% (95% CI=8.60-13.17) for overall late-life depression (LLD). A prior MDD episode (OR=3.07, 95% CI=1.38-6.82 in MDD, OR=3.44, 95% CI=1.49-7.94 in MnDD), female gender (OR=3.55, 95% CI=1.53-8.24 in MDD, OR=2.68, 95% CI=1.19-6.04 in MnDD) and history of stroke or TIA (OR=3.45, 95% CI=1.62-7.35 in MDD, OR=2.95, 95% CI=1.34-6.52 in MnDD) were associated with the risks of both MDD and MnDD. Lack of formal education (OR=2.75, 95% CI=1.30-5.85) and low income (OR=2.83, 95% CI=1.02-7.88) were associated with the risk of MDD only. Quality of life (QOL) of the MDD and MnDD patients was worse than that of non-depressed elders (P<0.001, ANOVA). CONCLUSION: MnDD was as prevalent as MDD in Korean elders and impacted QOL as MDD did. MnDD patients may increase in the future with accelerated population aging and westernization of lifestyle in Korea.

Posterior cingulate cortex atrophy and regional cingulum disruption in mild cognitive impairment and Alzheimer's disease.

This study aimed to investigate the atrophy of the posterior cingulate cortex (PCC) and medical temporal lobe (MTL) structures (i.e., the entorhinal cortex (ERC) and hippocampus) and the regional disruption of the cingulum bundle in mild cognitive impairment (MCI) and Alzheimer's disease (AD) patients. The relationships between atrophy of these structures and regional cingulum disruption were also explored. Three-dimensional MRI and diffusion tensor imaging were applied to 19 MCI, 19 probable AD patients, and 18 normal controls (NC). Fractional anisotropy (FA) values were obtained from three different regions of the cingulum. Both MCI and AD patients showed decreased PCC volumes compared with NC. ERC atrophy was also significant in AD and MCI, while hippocampus atrophy was significant only in AD. MCI patients showed a significant FA decrease in the parahippocampal cingulum (PH-C), whereas AD patients had lower FA values in the posterior cingulate cingulum (PC-C) and PH-C, as compared with NC. However, the middle cingulate cingulum (MC-C) showed no significant FA differences between groups. Moreover, the volumes of MTL structures were significantly correlated with PH-C and PC-C FA values. In terms of PCC functional deficit in MCI or early AD, our results support both the direct effect of PCC atrophy itself and the indirect effect of cingulum fiber degeneration secondary to MTL atrophy.

Prevalence of mild cognitive impairment and its subtypes are influenced by the application of diagnostic criteria: results from the Korean Longitudinal Study on Health and Aging (KLoSHA).

AIMS: We investigated the influence of varying applications of diagnostic criteria on the prevalence of mild cognitive impairment (MCI) in community-dwelling Korean elders. METHODS: A study population of 1,118 Korean elders was randomly sampled from the residents aged 65 years or older living in Seongnam, Korea. Standardized face-to-face interviews, with neurological and physical examinations, were conducted with 714 respondents. Cognitive function was evaluated using the Korean version of the CERAD Neuropsychological Assessment Battery, digit span test, and lexical fluency test. Activities of daily living were evaluated using the Blessed Dementia Scale in the CERAD Clinical Assessment Battery (Korean version). Using variable sets of operational diagnostic criteria, the prevalence of MCI was estimated. RESULTS: Age- and gender-standardized prevalence estimates according to the Petersen criteria were 28.6% (95% CI = 25.3-31.9) for overall MCI, 17.0% (95% CI = 14.3-19.8) for amnestic MCI, and 11.5% (95% CI = 9.2-13.9) for non-amnestic MCI. However, the estimated prevalence of MCI varied widely (8.3-27.6%) according to the applied operational diagnostic criteria. The proportion of MCI subtypes also varied considerably according to the number and types of applied neuropsychological tests. CONCLUSIONS: Variable implementation of MCI diagnostic criteria may significantly complicate the homogeneity of this condition.

Prevalence and neuropsychiatric comorbidities of alcohol use disorders in an elderly Korean population.

OBJECTIVES: We investigated the prevalence and comorbidities of problem drinking in community-dwelling elders living in Korea. METHODS: Structured face-to-face diagnostic interviews were administered to the 714 Korean elders randomly sampled from Seongnam, Korea. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and the Alcohol Use Disorders Identification Test (AUDIT) scores, the participants were categorized into one of six diagnostic groups: lifetime abstainer, ex-drinker, social drinking, at-risk drinking, alcohol abuse, and alcohol dependence. RESULTS: Prevalence rates of social drinking, at-risk drinking, alcohol abuse, and alcohol dependence were estimated to be 13.60%, 5.42%, 2.28%, and 2.92%, respectively. Problem drinking was associated with increased risks of smoking (OR = 3.52), whereas social drinking was associated with decreased risks of stroke (OR = 0.27) and depression (OR = 0.49). CONCLUSIONS: Problem drinking was common particularly in men and associated with smoking. Social drinking was associated with the lower risks of stroke and depression.

Neural correlates of the Clock Drawing Test performance in Alzheimer's disease: a FDG-PET study.

BACKGROUND/AIM: This study aimed to identify the functional neuroanatomical correlates of impaired clock drawing test (CDT) performance in patients with Alzheimer's disease (AD). METHOD: The CDT was administered to 71 patients with AD, and regional cerebral glucose metabolism (rCMglc) was measured by positron emission tomography (PET). Correlations between CDT scores and rCMglc were examined on a voxel-by-voxel basis. RESULTS: Significant positive correlations were found between CDT performance and rCMglc in the right inferior parietal lobule and right posterior cingulate cortex. CONCLUSION: These results provide the first PET evidence that poor CDT performance in patients with AD is closely related to the functional decline in the right hemisphere, especially the right parietal cortex.

Normative study of the Stroop Color and Word Test in an educationally diverse elderly population.

OBJECTIVE: The purpose of this study was to explore the effects of demographic variables on Stroop Color and Word Test (SCWT) performance in an educationally diverse elderly population and to provide normative information. METHODS: SCWT was administered to 564 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 all three pages of the SCWT. Based on the results obtained, SCWT norms were stratified by age (four overlapping tables), education (three strata), and gender. CONCLUSIONS: In the present study, normative information on SCWT was obtained from an educationally diverse elderly population. SCWT would appear to be more useful in poorly educated elderly, and could be used in future cross-cultural comparisons of geriatric populations.

Topographic patterns of brain functional impairment progression according to clinical severity staging in 116 Alzheimer disease patients: FDG-PET study.

The study aimed to explore topographic progression pattern of brain functional impairment according to clinical stage in Alzheimer disease (AD). One hundred and sixteen AD patients and 25 normal subjects underwent a [18F] fluorodeoxyglucose-positron emission tomography scan. Regional cerebral glucose metabolism was compared between severity groups based on the Clinical Dementia Rating through voxel-based analyses. As clinical severity progressed, hypometabolic areas gradually increased, involving initially posterior cingulate cortex, later temporoparietal, and finally frontal and some subcortical areas. The results indicate that progression patterns of hypometabolism in AD are close to that of typical neuropathology, but that they do not fully coincide with it.

Performance on the Benton Visual Retention Test in an educationally diverse elderly population.

In this study, we investigated the effects of demographic variables on the performances of Administrations A and C of the Benton Visual Retention Test (BVRT) in a geriatric population with a wide range of educational achievement. We administered the test to 554 nondemented elders aged 60-90 years with an educational history of from zero to 25 years. Age and education significantly influenced Administrations A and C, although gender had no main effect. We observed significant Education x Gender interactions for Administrations A and C, Age x Gender interactions for Administration A, and Age x Education interactions for Administration C. Our results suggest that both nonverbal memory and constructional ability are influenced by age and education. Although there is no overall gender effect, men seem to outperform women in a poorly educated (for Administrations A and C) or relatively older (for Administration A) elderly population.

A normative study of the Trail Making Test in Korean elders.

OBJECTIVE: The purpose of this study was to explore the effects of age, education and gender on the performance of the Trail Making Test (TMT) and provide normative information in Korean elders. METHODS: The TMT was administered to 997 community-dwelling volunteers aged 60-90. People with serious neurological, medical and psychiatric disorders, including dementia, were excluded. RESULTS: Education and age had significant effects on both parts of the TMT. Gender also had an effect on part A of the TMT (Trail A). Based on these results, the norms of Trail A stratified by age (four overlapping tables), education (four strata) and gender, and the norms of part B of TMT (Trail B) stratified by age (four overlapping tables) and education (three strata). CONCLUSIONS: Age and educational level had a considerable influence on both Trail A and B. Our normative information on the Trail A will be useful in the elders with poor educational attainment and can be utilized for cross-cultural comparison of the Trail A performance. The fact that a large number of elders fail to complete Trail B indicates a limited applicability of Trail B in elderly population, particularly with poor educational background.

Frontal dysfunction underlies depressive syndrome in Alzheimer disease: a FDG-PET study.

OBJECTIVE: This study aimed to investigate the regional cerebral dysfunction associated with depressive syndrome in patients with Alzheimer disease (AD). METHOD: Twelve patients with AD with depressive syndrome (ADD) and 12 age-, gender-, and severity-matched patients with AD without depressive syndrome (ADND) underwent FDG-PET scanning. The regional cerebral glucose metabolism in the two groups was compared using a voxel-based method. RESULTS: The ADD group showed lower glucose metabolism in the right superior frontal gyrus than the ADND group. CONCLUSIONS: These results indicate that frontal dysfunction, known to be associated with primary or other secondary depressive syndromes, underlies the depressive syndrome of patients with AD patients as well.

White matter changes associated with psychotic symptoms in Alzheimer's disease patients.

This study explored the relationship between white matter changes seen on magnetic resonance imaging (MRI) and neuropsychiatric symptoms of Alzheimer's disease patients. Fifty-five probable Alzheimer's disease patients were assessed with Behavioral Rating Scale for Dementia (BRSD) and MRI. White matter changes in the bilateral frontal or parieto-occipital region and left basal ganglia significantly corresponded with the score of the Psychotic Symptoms subscale of BRSD. Secondary analyses revealed that white matter changes were not associated with paranoid delusion and hallucination, but only with delusional misidentification. Our results suggest that white matter changes in Alzheimer's disease patients probably contribute to the development of specific psychotic symptoms, namely delusional misidentification.

Combination of clinical and neuropsychologic information as a better predictor of the progression to Alzheimer disease in questionable dementia individuals.

OBJECTIVES: This study aimed to examine the clinical outcomes of questionable dementia (QD) elderly subjects after three years of follow-up and to compare the ability of a standardized clinical assessment, neuropsychologic tests, the ApoE genotyping, and possible combinations of these methods to predict their progression to Alzheimer disease (AD). METHODS: One hundred six elderly subjects with QD were evaluated with a standardized clinical assessment, neuropsychologic tests, and ApoE genotyping and followed up annually. The Clinical Dementia Rating Sum of Boxes (CDR-SOB) score was used as a quantitative summary score of the standardized clinical assessment on the overall functioning of the subjects. RESULTS: Among the individuals remaining in the study after the 3-year follow-up period, 8.3% had improved to a state of normal cognition, 72.7% were still in the QD state. and 19.4% had progressed to clinically evident AD. Although each of CDR-SOB, Word List Recall (WLR), and ApoE epsilon4 genotype was predictive for AD, the combination of CDR-SOB and WLR was found to predict AD better than any single variable. However, the addition of the ApoE epsilon4 genotype information to CDR-SOB or WLR did not improve their predictive ability. CONCLUSION: The combination of clinical assessment on function and episodic memory test can improve the predictive ability of each measure for progression to AD in QD individuals. However, ApoE genotyping dose not make an additional contribution to AD prediction in QD individuals when used in combination with clinical assessment or memory test.