Epidemiology of Dementia

JongChul Youn,DongYoung Lee,KiWoong Kim,JongInn Woo 대한신경정신의학회 2005 PSYCHIATRY INVESTIGATION Vol.2 No.1

Dementia is one of the most important public health problems. Because of rapid increasing of old age in the world, need for prevention strategies and caring of dementia should be solved. Epidemiological studies can provide the basic data for making health policy, developing the prevention strategies. Epidemiological studies can be classified into the descriptive studies for studying the prevalence and incidence of a disease and the analytic studies for identifying risk factors of a disease. This review summarized the recent achievements in the epidemiology of dementia performed in the world and our country. The prevalence and incidence of dementia increased double by every 5 years of age over the age of 65 years in general. However, whether the prevalence rate of dementia exponentially increases in the oldest old age is uncertain. The prevalence rates of dementia were generally lower in developing countries, but the exact mechanisms of these findings were not well understood. Although Alzheimer’s disease is the most common etiology of dementia in most countries, some studies, especially from Japan, reported that vascular dementia is more common. However, recent studies suggested that the prevalence of vascular dementia decrease and Alzheimer’s disease is more prevalent. Age and some genetic factors were consistently reported as the risk factors of dementia. In contrast, the association between most non-genetic risk factors and dementia were still controversial. The epidemiological studies for dementia should overcome some methodological difficulties such as diagnostic threshold for dementia and the diagnostic criteria of vascular dementia.

The Gender- and Age-dependency of the Risk for Alzheimer s Disease Conferred by Apolipoprotein E Polymorphism in Koreans

JinHyeong Jhoo,KiWoong Kim,YoungJu Suh,DongYoung Lee,JongChul Youn,JungHie Lee,JongInn Woo 대한신경정신의학회 2004 PSYCHIATRY INVESTIGATION Vol.1 No.1

Objectives-The aim of this study is to examine the impact of the apolipoprotein E (APOE) polymorphism on the risk of Alzheimer s disease (AD) in Koreans. Materials and Methods-We determined the APOE genotype of 303 probable AD patients and 1,052 non-demented normal controls, and compared their genotypic and allelic frequencies. Then, we determined the odds ratios for AD of the APOE polymorphism in the subjects, stratified by age and gender. Results-The APOE 4 allele was more prevalent in the AD patients than in the controls (P<0.0001). The APOE 4 allele increased the risk of AD in a dose-dependent manner; the odds ratios for AD of the APOE 4-heterozygous and the APOE 4-homozygous subjects were 3.9 (95% CI=2.8-5.3) and 15.6 (95% CI=6.6-36.7), respectively. The APOE 4-conferred AD risk was also dependent on the age and gender of the subjects; the odds ratios for AD were highest in the subjects aged 75-79 years and higher in the women than in the men. Conclusions-The APOE 4 allele is a significant genetic risk factor for AD and confers the AD risk in a dose-, age- and genderdependent manner in Koreans.

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

JaeKyung Shin,KiWoong Kim,JoonHyuk Park,JungJae Lee,Yoonseok Huh,SeokBum Lee,EunAe Choi,DongYoung Lee,JongInn Woo 대한신경정신의학회 2008 PSYCHIATRY INVESTIGATION Vol.5 No.3

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). Healthrelated 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.

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

HyeSook Lee,IlHan Choo,DongYoung Lee,JeeWook Kim,EunHyun Seo,ShinGyeom Kim,ShinYoung Park,JiHye Shin,KiWoong Kim,JongInn Woo 대한신경정신의학회 2010 PSYCHIATRY INVESTIGATION Vol.7 No.3

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.

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

JeeWook Kim,MinSoo Byun,BoKyung Sohn,Dahyun Yi,EunHyun Seo,YoungMin Choe,ShinGyeom Kim,HyoJung Choi,JunHo Lee,IkSeung Chee,JongInn Woo,DongYoung Lee 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.4

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.