Gait Variability Can Predict the Risk of Cognitive Decline in Cognitively Normal Older People

Byun, Seonjeong,Han, Ji Won,Kim, Tae Hui,Kim, Kayoung,Kim, Tae Hyun,Park, Jae Young,Suh, Seung Wan,Seo, Ji Young,So, Yoonseop,Lee, Kyoung Hwan,Lee, Ju Ri,Jeong, Hyeon,Jeong, Hyun-Ghang,Han, Kyuhee,Hon S. Karger AG 2018 DEMENTIA AND GERIATRIC COGNITIVE DISORDERS Vol.45 No.5

<P><B><I>Background:</I></B> The aim of this study was to investigate the association of gait speed and gait variability, an index of how much gait parameters, such as step time, fluctuate step-to-step, with risk of cognitive decline in cognitively normal elderly individuals. While high gait variability is emerging as an early indicator of dementing illnesses, there is little research on whether high gait variability predicts cognitive decline in cognitively normal elderly who have no evidence of cognitive impairment. <B><I>Methods:</I></B> In this 4-year prospective cohort study on 91 community-dwelling cognitively normal elderly individuals without cerebral ischemic burden or Parkinsonism, we evaluated gait speed and step time variability using a tri-axial accelerometer placed on the center of body mass, and diagnosed mild cognitive impairment (MCI) according to the International Working Group on MCI. We performed Kaplan-Meier analysis with consecutive log-rank testing for MCI-free survival by cohort-specific tertiles of gait speed; hazard ratios (HR) of incident MCI were estimated using Cox proportional hazards regression analysis adjusted for age, sex, education level, Cumulative Illness Rating Scale score, GDS score, and presence of the apolipoprotein E ε4 allele. <B><I>Results:</I></B> Out of the 91 participants in the baseline assessment, 87 completed one or more 2-year follow-up assessments, and the median duration of follow-up was 47.1 months. Kaplan-Meier curves of incident MCI show evident differences in risk by gait variability group (χ<SUP>2</SUP> = 9.64, <I>p</I> = 0.002, log-rank test). Mean MCI-free survival in the high variability group was 12% shorter than in the mid-to-low tertile group (47.4 ± 1.74 [SD] vs. 54.04 ± 0.52 months), while it was comparable between gait speed groups (51.59 ± 0.70 vs. 50.64 ± 1.77 months; χ<SUP>2</SUP> = 1.16, <I>p</I> = 0.281). In multivariate analysis, subjects with high gait variability showed about 12-fold higher risk of MCI (HR = 11.97, 95% CI = 1.29–111.37) than those with mid-to-low variability. However, those with slow gait speed showed comparable MCI risk to those with mid-to-high speed (HR = 5.04, 95% CI = 0.53–48.18). <B><I>Conclusions:</I></B> Gait variability may be a better predictor of cognitive decline than gait speed in cognitively normal elderly individuals without cerebral ischemic burden or Parkinsonism.</P>

정신건강의학과 개방병동 입원 환자의 진단군별 약물 처방 경향 변화 : 경기도 소재 일 대학병원에서의 11년 비교 연구

변선정,김의태,유희정,하태현,윤인영,김기웅,Byun, Seonjeong,Kim, Euitae,Yoo, Hee Jeong,Ha, Tae Hyon,Yoon, In-Young,Kim, Ki Woong 대한생물정신의학회 2015 생물정신의학 Vol.22 No.4

Objectives This study investigated the patterns of psychotropic medications prescribed to patients admitted to an open psychiatric ward. Methods We reviewed 4282 medical records of patients who were discharged from an open psychiatric ward from May 2003 through April 2014. Data were collected on each patient's age, sex, length of hospital stay, number of past admissions, discharge diagnosis, and kinds and dosages of psychotropic medications at discharge. Results Among the 1384 male and 2898 female patients, 3.56 psychotropic medications were prescribed on average, with the number increasing across years, from 3.30 in 2003-2008 to 3.76 in 2009-2014. Prescription rates of antipsychotics, anxiolytics, and hypnotics significantly increased in patients with depressive disorders, bipolar disorders, anxiety disorders, delirium, dementia, and amnestic and other cognitive disorders. Only lithium prescription rates decreased significantly. Prescriptions for two or more anxiolytics and antipsychotics increased during the survey years, while antidepressant polypharmacy rates decreased. Conclusions Recently, there has been a significant increase in the number of psychotropic medications prescribed, including antipsychotics, anxiolytics, and hypnotics. Caution should be exercised when prescribing medications to avoid cost increases and the risk of side effects, with uncertain gains in the quality of care.

How COVID-19 Affected Healthcare Workers in the Hospital Locked Down due to Early COVID-19 Cases in Korea

Lee Hyeon-Ah,Ahn Myung Hee,Byun Seonjeong,Lee Hae-Kook,Kweon Yong-Sil,Chung Seockhoon,Shin Yong-Wook,Lee Kyoung-Uk 대한의학회 2021 Journal of Korean medical science Vol.36 No.47

Background: The healthcare workers (HCWs) were exposed to never-experienced psychological distress during the early stage of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate how the COVID-19 pandemic affected the mental health of HCWs during the hospital lockdown period due to mass healthcareassociated infection during the early spread of COVID-19. Methods: A real-time online survey was conducted between April 14–18, 2020 among HCWs who worked at the university hospital where COVID-19 was confirmed in a patient, and the hospital was shut down for 3 weeks. Along with demographic variables and work-related information, psychological distress was measured using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Maslach Burnout InventoryGeneral Survey scale, and the Stress and Anxiety to Viral Epidemics-9. Results: The HCWs working in the cohort ward and those who have experienced social discrimination had significantly higher level of depression (PHQ-9 score; 5.24 ± 4.48 vs. 4.15 ± 4.38; P < 0.01 and 5.89 ± 4.78 vs. 3.25 ± 3.77; P < 0.001, respectively) and anxiety (GAD-7 score; 3.69 ± 3.68 vs. 2.87 ± 3.73; P < 0.05 and 4.20 ± 4.22 vs. 2.17 ± 3.06; P < 0.001, respectively) compared to other HCWs. Worries regarding the peer relationship and the skepticism about job were associated with depression (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.07–1.79; P < 0.05 and OR, 1.69; 95% CI, 1.31–2.17; P < 0.001, respectively) and anxiety (OR, 1.73; 95% CI, 1.21–2.49; P < 0.01 and OR, 1.54; 95% CI, 1.09–2.17; P < 0.05, respectively), while fear of infection or worsening of health was not. Path analysis showed that work-related stress associated with the viral epidemic rather than anxiety about the viral epidemic mainly contributed to depression. Conclusion: The present observational study indicates that mental health problems of HCWs exposed to COVID-19 are associated with distress in work and social relationship. Early intervention programs focusing on these factors are necessary.

Anhedonia and Dysphoria Are Differentially Associated with the Risk of Dementia in the Cognitively Normal Elderly Individuals: A Prospective Cohort Study

Ju Ri Lee,Seung Wan Suh,Ji Won Han,Seonjeong Byun,Soon Jai Kwon,Kyoung Hwan Lee,Kyung Phil Kwak,Bong Jo Kim,김신겸,김정란,Tae Hui Kim,Seung-Ho Ryu,Seok Woo Moon,Joon Hyuk Park,Dong Woo Lee,Jong Chul Youn,D 대한신경정신의학회 2019 PSYCHIATRY INVESTIGATION Vol.16 No.8

Objective We investigated the impact of depressed mood (dysphoria) and loss of interest or pleasure (anhedonia)on the risk of dementia in cognitively-normal elderly individuals. Methods This study included 2,685 cognitively-normal elderly individuals who completed the baseline and 4-year follow-up assessments of the Korean Longitudinal Study on Cognitive Aging and Dementia. We ascertained the presence of dysphoria and anhedonia using the Mini International Neuropsychiatric Inventory. We defined subjective cognitive decline as the presence of subjective cognitive complaints without objective cognitive impairments. We analyzed the association of dysphoria and anhedonia with the risk of cognitive disorders using multinomial logistic regression analysis adjusted for age, sex, education, Cumulative Illness Rating Scale score, Apolipoprotein E genotype, and neuropsychological test performance. Results During the 4-year follow-up period, anhedonia was associated with an approximately twofold higher risk of mild cognitive impairment (OR=2.09, 95% CI=1.20–3.64, p=0.008) and fivefold higher risk of dementia (OR=5.07, 95% CI=1.44–17.92, p=0.012) but was not associated with the risk of subjective cognitive decline. In contrast, dysphoria was associated with an approximately twofold higher risk of subjective cognitive decline (OR=2.06, 95% CI=1.33–3.19, p=0.001) and 1.7-fold higher risk of mild cognitive impairment (OR=1.75, 95% CI=1.00–3.05, p=0.048) but was not associated with the risk of dementia. Conclusion Anhedonia, but not dysphoria, is a risk factor of dementia in cognitively-normal elderly individuals.

A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia

Riyoung Na,Ji-hye Yang,Yusung Yeom,You Joung Kim,Seonjeong Byun,Kiwon Kim,Ki Woong Kim 대한신경정신의학회 2019 PSYCHIATRY INVESTIGATION Vol.16 No.5

Objective: Due to limited efficacy of medications, non-pharmacological interventions (NPI) are frequently co-administered to people with moderate to severe dementia (PWMSD). This systematic review and meta-analysis investigated the effects of NPI on activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD), and cognition and quality of life (QoL) of PWMSD. Methods: A literature search was conducted in the following databases: Cochrane CENTRAL, EMBASE, Medline, CIHNAL, PsycINFO, KoreaMED, KMbase, and KISS. We conducted a meta-analysis on randomized controlled trials and used the generic inverse variance method with a fixed-effects model to calculate the standardized mean difference (SMD). The protocol had been registered (CRD42017058020). Results: Ten randomized controlled trials met the inclusion criteria of the current meta-analysis. NPI were effective in improving ADL [SMD=0.28, 95% confidence interval (CI)=0.11–0.45] and reducing depression (SMD=-0.44, 95% CI=-0.70– -0.19). However, NPI were not effective in reducing agitation, anxiety, or overall, or improving cognitive function. In a subgroup analysis, music therapy was effective in reducing overall BPSD (SMD=-0.52, 95% CI=-0.90– -0.13). Conclusion: Albeit the number of studies was limited, NPI improved ADL and depression in PWMSD.

SLEEP PARAMETERS MAY PREDICT FUTURE COGNITIVE DECLINE: A PROSPECTIVE NON-DEMENTED ELDERLY COHORT STUDY

Suh, Seung Wan,Han, Ji Won,Lee, Ju Ri,Byun, Seonjeong,Lee, Kyoung Hwan,Hong, Jong Woo,Kwak, Kyung Phil,Kim, Bong-Jo,Kim, Shin Gyeom,Kim, Jeong Lan,Kim, Tae Hui,Ryu, Seung-ho,Moon, Seok Woo,Park, Joon Elsevier 2018 Alzheimer's & dementia Vol.14 No.7

Association of Low Blood Pressure with White Matter Hyperintensities in Elderly Individuals with Controlled Hypertension

Jun Sung Kim,LEESUBIN,Seung Wan Suh,Jong Bin Bae,Ji Hyun Han,Seonjeong Byun,Ji Won Han,Jae Hyoung Kim,Ki Woong Kim 대한뇌졸중학회 2020 Journal of stroke Vol.22 No.1

Background and Purpose Both hypertension and hypotension increase cerebral white matter hyperintensities. However, the effects of hypotension in individuals with treated hypertension are unknown. We analyzed the association of low blood pressure with the location and amount of white matter hyperintensities between elderly individuals with controlled hypertension and those without hypertension. Methods We enrolled 505 community-dwelling, cognitively normal elderly individuals from the participants of the Korean Longitudinal Study on Cognitive Aging and Dementia. We measured blood pressure three times in a sitting position using a mercury sphygmomanometer and defined low systolic and diastolic blood pressure as ≤110 and ≤60 mm Hg, respectively. We segmented and quantified the periventricular and deep white matter hyperintensities from 3.0 Tesla fluidattenuated inversion recovery magnetic resonance images. Results Low systolic blood pressure was independently associated with larger volume of periventricular white matter hyperintensity (P=0.049). The interaction between low systolic blood pressure and hypertension was observed on the volume of periventricular white matter hyperintensity (P=0.005). Low systolic blood pressure was associated with the volume of periventricular white matter hyperintensity in individuals with controlled hypertension (F1,248=6.750, P=0.010), but not in those without hypertension (P=0.380). Low diastolic blood pressure was not associated with the volumes of white matter hyperintensities regardless of presence of controlled hypertension. Conclusions Low systolic blood pressure seems to be associated with larger volume of periventricular white matter hyperintensity in the individuals with a history of hypertension but not in those without hypertension.

Overview of the Korean Longitudinal Study on Cognitive Aging and Dementia

Ji Won Han,Tae Hui Kim,Kyung Phil Kwak,Kayoung Kim,Bong Jo Kim,Shin Gyeom Kim,Jeong Lan Kim,Tae Hyun Kim,Seok Woo Moon,Jae Young Park,Joon Hyuk Park,Seonjeong Byun,Seung Wan Suh,Ji Young Seo,Yoonseop 대한신경정신의학회 2018 PSYCHIATRY INVESTIGATION Vol.15 No.8

Objective_Due to an unprecedented rate of population aging, South Korea is facing a dementia epidemic. For this reason, the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) was launched in 2009 with support from the Korean Health Industry Development Institute to investigate the epidemiology, biopsychosocial risk factors, and outcomes of dementia and dementia-related conditions. Methods_The KLOSCAD is the first nationwide multi-center population-based prospective cohort study. In October 2010, 12,694 individuals were randomly sampled from residents aged 60 years or older who lived in 13 districts across South Korea. In the baseline assessment, which was conducted from November 2010 through October 2012, 6,818 (53.7%) individuals participated. Follow-up assessments have been conducted every two years, with the first follow-up assessment conducted between November 2012 and October 2014, and the second between November 2014 and October 2016. The third is now in progress, and will span from November 2016 to October 2018. Diagnosis of cognitive disorders, neuropsychological battery, behavioral and psychological symptoms of dementia, activities of daily living, physical and neurologic examination and laboratory tests, life styles, quality of life, and identification of death were evaluated in each assessment. Results_The cumulative drop-out rate at the second follow-up assessment was 38.7%. Dementia and mild cognitive impairment were 5.0% and 27.0%, respectively. Conclusion_The KLOSCAD may provide strong scientific evidence for advancing the fight against dementia both in Korea and globally.

Low Diastolic Blood Pressure and Cognitive Decline in Korean Elderly People: The Korean Longitudinal Study on Cognitive Aging and Dementia

Dongyun Lee,Bong-Jo Kim,Ji Won Han,Tae Hui Kim,Kyung Phil Kwak,Kayoung Kim,Shin Gyeom Kim,Jeong Lan Kim,Tae Hyun Kim,Seok Woo Moon,Jae Young Park,Joon Hyuk Park,Seonjeong Byun,Seung Wan Suh,Ji Young S 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.1

Objective: Cardiovascular diseases are representative risk factors for the onset of cognitive decline. The purpose of this study was to confirm the relationship between diastolic blood pressure and cognitive function in elderly people in Korea. Methods: Data from subjects who were enrolled in the prospective Korean Longitudinal Study on Cognitive Aging and Dementia were used in this study. Data from 701 subjects whose diastolic blood pressure range did not change (≤79 mm Hg or ≥80 mm Hg) over 2 years were analyzed. To analyze the differences in cognitive function between the groups at the 2-year follow-up, an analysis of covariance was performed with covariates, which were significantly different between the two groups, and the baseline cognitive function. Results: Significant differences were observed between the two groups, and the mean scores on the constructional praxis (η2=0.010) and word list recall tests (η2=0.018) in the diastolic blood pressure ≥80 mm Hg group were higher than those in the diastolic blood pressure ≤79 mm Hg group at the 2-year follow-up. Conclusion: These results indicate that maintaining a DBP below 79 mm Hg presents a greater risk of cognitive decline in Korean elderly people.

Normal-But-Low Serum Folate Levels and the Risks for Cognitive Impairment

Soomin Jang,Ji Won Han,Jiyoon Shin,Tae Hui Kim,Kyung Phil Kwak,Kayoung Kim,Bong Jo Kim,김신겸,Jeong Lan Kim,Taehyun Kim,Seok Woo Moon,Jae Young Park,Joon Hyuk Park,Seonjeong Byun,Seung Wan Suh,Ji-Yeong S 대한신경정신의학회 2019 PSYCHIATRY INVESTIGATION Vol.16 No.7

Objective This study aimed to examine the association between normal-but-low folate levels and cognitive function in the elderly population using a prospective cohort study. Methods We analyzed 3,910 participants whose serum folate levels were within the normal reference range (1.5–16.9 ng/mL) at baseline evaluation in the population-based prospective cohort study named the “Korean Longitudinal Study on Cognitive Aging and Dementia.” The association between baseline folate quartile categories and baseline cognitive disorders [mild cognitive impairment (MCI) or dementia] was examined using binary logistic regression analysis adjusting for confounding variables. The risks of incident MCI and dementia associated with the decline of serum folate level during a 4-year follow-up period were examined using multinomial logistic regression analysis. Results The lowest quartile group of serum folate (≥1.5, ≤5.9 ng/mL) showed a higher risk of cognitive disorders than did the highest quartile group at baseline evaluation (odds ratio 1.314, p=0.012). Over the 4 years of follow-up, the risk of incident dementia was 2.364 times higher among subjects whose serum folate levels declined from the 2nd–4th quartile group to the 1st quartile than among those for whom it did not (p=0.031). Conclusion Normal-but-low serum folate levels were associated with the risk of cognitive disorders in the elderly population, and a decline to normal-but-low serum folate levels was associated with incident dementia. Maintaining serum folate concentration above 5.9 ng/mL may be beneficial for cognitive status.