Short-term air pollution exposure and emergency department visits for amyotrophic lateral sclerosis: A time-stratified case-crossover analysis

Myung, Woojae,Lee, Hyewon,Kim, Ho Elsevier 2019 Environment international Vol.123 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Amyotrophic lateral sclerosis (ALS) is a progressive and devastating neurodegenerative disease, eventually leading to respiratory failure. Although the only currently available therapeutic interventions merely slow the disease progression, few studies have examined risk factors associated with ALS exacerbation and progression.</P> <P><B>Objective</B></P> <P>To investigate the association between exposure to short-term air pollution and acute exacerbation of ALS requiring emergency department (ED) visit.</P> <P><B>Methods</B></P> <P>We identified from the national emergency database of Korea 617 patients who visited EDs in Seoul with ALS as a primary cause during the period 2008–2014. We estimated short-term exposure to particles <2.5 μm (PM<SUB>2.5</SUB>), particles <10 μm (PM<SUB>10</SUB>), nitrogen dioxide (NO<SUB>2</SUB>), sulfur dioxide (SO<SUB>2</SUB>), ozone (O<SUB>3</SUB>), and carbon monoxide (CO). We conducted a conditional logistic regression with a time-stratified case-crossover design to examine the association between ED visits for ALS and short-term exposure to interquartile range (IQR) increase and upper quartile levels of air pollutants on the day of the ED visit, compared to the control days matched to day of the week, month, and year.</P> <P><B>Results</B></P> <P>The risk of ED visits for ALS was significantly associated with an IQR increase of PM<SUB>2.5</SUB> [Odds ratio (OR) = 1.21; 95% confidence interval (CI): 1.08, 1.35], PM<SUB>10</SUB> [OR = 1.13; 95% CI: 1.02, 1.25], SO<SUB>2</SUB> [OR = 1.19; 95% CI: 1.01, 1.41], and CO [OR = 1.19; 95% CI: 1.03, 1.36]. Exposure to the highest quartiles of PM<SUB>2.5</SUB> and PM<SUB>10</SUB> showed higher associations with ED visits for ALS [OR = 1.40; 95% CI: 1.06, 1.85 and OR = 1.33; 95% CI: 1.00, 1.77].</P> <P><B>Discussion</B></P> <P>We provide new evidence that exposure to short-term air pollution may increase the risk of acute exacerbation of ALS. Further studies are warranted to understand the underlying mechanisms.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Short-term association between ambient air pollution and ALS was assessed. </LI> <LI> ED visit for primarily diagnosed ALS was evaluated as a main outcome. </LI> <LI> PM<SUB>2.5</SUB>, PM<SUB>10</SUB>, SO<SUB>2</SUB> and CO significantly increased the risk of ALS. </LI> <LI> The highest quartile exposure to PM<SUB>2.5</SUB> and PM<SUB>10</SUB> showed higher associations. </LI> </UL> </P>

Extrapyramidal Signs and Risk of Progression from Mild Cognitive Impairment to Dementia: A Clinical Research Center for Dementia of South Korea Study

Woojae Myung,JinHong Park,SookYoung Woo,Seonwoo Kim,SangHa Kim,JaeWon Chung,HyoShin Kang,ShinnWon Lim,Junbae Choi,Duk L. Na,SeongYoon Kim,JaeHong Lee,SeolHeui Han,SeongHye Choi,SangYun Kim,Bernard J. 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.6

Objective-Extrapyramidal signs (EPS) are common in patients with mild cognitive impairment (MCI). However, few studies have assessed the effect of EPS on the clinical course of MCI. We aimed to evaluate whether patients with EPS show more frequent progression from MCI to Alzheimer’s disease (AD) and to other types of dementia. Methods-Participants (n=882) with MCI were recruited, and were followed for up to 5 years. The EPS positive group was defined by the presence of at least one EPS based on a focused neurologic examination at baseline. Results-A total of 234 converted to dementia during the follow-up period. The risk of progression to AD was lower in the patients with EPS after adjusting for potential confounders [hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.53-0.93, p=0.01]. In contrast, the patients with EPS had a six-fold elevated risk of progression to dementia other than AD (HR=6.33, 95%CI=2.30–17.39, p<0.001). Conclusion-EPS in patients with MCI is a strong risk factor for progression of MCI to non-Alzheimer dementia. The careful neurologic examination for EPS in patients with MCI can yield important clinical information for prognosis.

Serotonin transporter genotype and function in relation to antidepressant response in Koreans.

Myung, Woojae,Lim, Shinn-Won,Kim, Seonwoo,Kim, Hyeran,Chung, Jae Won,Seo, Min Young,Kim, Jong-Won,Carroll, Bernard J,Kim, Doh Kwan Springer-Verlag 2013 Psychophamacology Vol.225 No.2

<P>Serotonin transporter (5-HTT) gene polymorphisms are linked with antidepressant response to selective serotonin reuptake inhibitor drugs (SSRIs), though the favorable allelic variant differs by ethnic group (Caucasian versus Korean or Japanese). In Caucasian patients, response also is linked to measures of platelet 5-HTT function. Here, we study both 5-HTT gene polymorphisms and 5-HTT function as determinants of antidepressant response to SSRIs in Korean patients. We enrolled 99 patients with major depression and 48 control subjects. For statistical power, both samples were enriched with the l/l 5-HTTLPR polymorphism, which is uncommon in Koreans. Patients were treated with fluoxetine or sertraline. Response was assessed at 6 weeks. Subjects were genotyped for s/l polymorphism in the 5-HTT promoter region (5-HTTLPR). Platelet 5-HTT activity was determined as maximal uptake rate (Vmax) and affinity constant (Km). Response was differentially associated with the s allele of 5-HTTLPR, which also was significantly associated with Vmax. These associations are opposite to those reported in Caucasian populations. Responders had significantly higher Vmax and Km than nonresponders. In Koreans as well as Caucasians, high Vmax is related to antidepressant response to SSRIs, though the 5-HTTLPR polymorphism associations with both response and function differ by ethnicity. Both ethnicity and function must be considered in evaluating candidate gene biomarkers of response to SSRIs in depression.</P>

Celebrity Suicides and Their Differential Influence on Suicides in the General Population: A National Population-Based Study in Korea

Woojae Myung,HongHee Won,Maurizio Fava,David Mischoulon,Albert Yeung,Dongsoo Lee,DohKwan Kim,HongJin Jeon 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.2

Objective-Although evidence suggests that there is an increase in suicide rates in the general population following celebrity suicide, the rates are heterogeneous across celebrities and countries. It is unclear which is the more vulnerable population according to the effect sizes of celebrity suicides to general population. Methods-All suicide victims in the general population verified by the Korea National Statistical Office and suicides of celebrity in South Korea were included for 7 years from 2005 to 2011. Effect sizes were estimated by comparing rates of suicide in the population one month before and after each celebrity suicide. The associations between suicide victims and celebrities were examined. Results-Among 94,845 suicide victims, 17,209 completed suicide within one month after 13 celebrity suicides. Multivariate logistic regression analyses revealed that suicide victims who died after celebrity suicide were significantly likely to be of age 20–39, female, and to die by hanging. These qualities were more strongly associated among those who followed celebrity suicide with intermediate and high effect sizes than lower. Younger suicide victims were significantly associated with higher effect size, female gender, white collar employment, unmarried status, higher education, death by hanging, and night-time death. Characteristics of celebrities were significantly associated with those of general population in hanging method and gender. Conclusion-Individuals who commit suicide after a celebrity suicide are likely to be younger, female, and prefer hanging as method of suicide, which are more strongly associated in higher effect sizes of celebrity suicide.

Serotonin Transporter Gene Polymorphisms and Chronic Illness of Depression

Myung, Woojae,Lim, Shinn-Won,Kim, Jinwoo,Lee, Yujin,Song, Jihye,Chang, Ki-won,Kim, Doh Kwan The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.12

<P>Clinical course of depression is variable. The serotonin transporter gene is one of the most studied genes for depression. We examined the association of serotonin transporter gene polymorphisms with chronicity and recurrent tendency of depression in Korean subjects. This cross-sectional study involved 252 patients with major depression. Patients were genotyped for s/l polymorphisms in <I>5-HTT</I> promoter region (<I>5-HTTLPR</I>), s/l variation in second intron of the <I>5-HTT</I> gene (<I>5-HTT VNTR</I> intron2). Chronicity was associated with <I>5-HTTLPR</I>. Patients with l/l had higher rate of chronicity than the other patients (l/l vs s/l or s/s; odds ratio, 4.45; 95% confidence interval, 1.59-12.46; <I>P</I>=0.005; logistic regression analysis). Recurrent tendency was not associated with <I>5-HTTLPR</I>. Chronicity and recurrent tendency were not associated with <I>5-HTT VNTR</I> intron2. These results suggest that chronic depression is associated with <I>5-HTTLPR</I>.</P>

Effect of Home-based Self-administered Transcranial Direct Stimulation in Patients with Mild to Moderate Major Depressive Disorder: A Single-arm, Multicentral Trial

Jihoon Oh(Jihoon Oh),Sekye Jeon(Sekye Jeon),Tae Hyon Ha(Tae Hyon Ha),Woojae Myung(Woojae Myung),Seung-Hwan Lee(Seung-Hwan Lee),Young-Hoon Ko(Young-Hoon Ko),Do Hoon Kim(Do Hoon Kim),Hwa-Young Lee(Hwa-Y 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.2

Objective: Although the effects and safety of transcranial direct current stimulation (tDCS) treatment in depressive patients are largely investigated, whether the self-administration of tDCS treatment at patient’s home is comparable to clinic-based treatment is still unknown. Methods: In this single-arm, multi-center clinical trial, 61 patients with mild to moderate major depressive disorder were enrolled. tDCS treatment was delivered at the patient’s home once a day, 5 to 7 times a week for 6 weeks, and each session lasted for 30 minutes. The primary outcome was a total Beck-Depression Inventory-II score, and no concurrent antidepressants were used. Results: The remission rates in both Full-Analysis (FA) (n = 61) and Per-Protocol (PP) (n = 43) groups were statistically significant (FA: 57.4% [0.44−0.70], PP: 62.8% [0.47−0.77]; percent [95% confidence interval]). The degree of depression- related symptoms was also significantly improved in 2, 4, and 6 weeks after the treatment when compared with baseline. There was no significant association between treatment compliance and remission rate in both FA and PP groups. Conclusion: These results suggest that acute treatment of patient-administered tDCS might be effective in improving the subjective feeling of depressive symptoms in mild to moderate major depressive disorder patients.

Factors Associated with Caregiver Burden in Patients with Alzheimer’s Disease

강효신,김도관,Woojae Myung,Duk L. Na,Seong Yoon Kim,Jae Hong Lee,Seol-Heui Han,최성혜,김상윤,김선우 대한신경정신의학회 2014 PSYCHIATRY INVESTIGATION Vol.11 No.2

Objective Caregivers for patients with Alzheimer’s disease (AD) suffer from psychological and financial burdens. However, the results of the relationship between burden and cognitive function, performance of activities of daily living, and depressive symptoms have remained inconsistent. Therefore, the aim of this study was to examine which factors are more significant predictors of heightened burden, cognitive impairment or functional decline, besides neuropsychiatric symptoms. Methods A cross-sectional study was conducted in a sample comprised of 1,164 pairs of patients with AD and caregivers from the Clinical Research of Dementia of South Korea study cohorts. The cognitive function of each sub-domain, functional impairments, depressive symptoms, and caregiver burden were assessed using the dementia version of Seoul Neuropsychological Screening Battery (SNSB-D), Barthel Index for Daily Living Activities (ADL), Seoul-Instrumental Activities of Daily Living (S-IADL), the Clinical Dementia Rating Sum of Box (CDR-SB), the Global Deterioration Scale (GDS), the Korean version of the Neuropsychiatric Inventory (K-NPI), and the 15-item Geriatric Depression Scale. Results We found that higher severity (higher CDR-SB and GDS scores) and more functional impairment (lower ADL and higher SIADL scores) were significantly associated with higher caregiver burden. In addition, depressive symptoms of patients (higher Geriatric Depression Scale scores) were associated with higher caregiver burden. Conclusion Therefore, interventions to help maintain activities of daily living in patients with AD may alleviate caregiver burden and improve caregiver well-being.

Association Between Functional Impairment, Depression, and Extrapyramidal Signs in Neuroleptic-Free Patients With Alzheimer Disease

Choi, Junbae,Myung, Woojae,Chung, Jae Won,Kang, Hyo Shin,Na, Duk L.,Kim, Seong Yoon,Lee, Jae-Hong,Han, Seol-Heui,Choi, Seong Hye,Kim, SangYun,Kim, Seonwoo,Carroll, Bernard J.,Kim, Doh Kwan SAGE Publications 2013 Journal of geriatric psychiatry and neurology Vol.26 No.3

<P><B>Background:</B></P><P>Extrapyramidal signs (EPSs) are commonly observed in patients with Alzheimer disease (AD). We report here the base rate of EPS in a large cohort of patients with AD who were not receiving neuroleptic drugs, and the associations of EPS with functional outcomes and depressive symptoms.</P><P><B>Methods:</B></P><P>In a consortium involving 56 clinics, we recruited 2614 patients with AD. We estimated basic activities of daily living (ADL) and instrumental ADL by the Barthel index and the Seoul-Instrumental Activities of Daily Living (S-IADL) scales, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The EPS group was defined by the presence of at least 1 EPS based on a focused neurologic examination.</P><P><B>Results:</B></P><P>The prevalence of EPS-positive patients was 12%. These had lower Korean version of the Mini-Mental State Examination (K-MMSE) scores than the EPS-negative cases (<I>P</I> < .001). After controlling for demographic, medical, radiological, genetic, and cognitive (K-MMSE) factors, the proportion of patients with impaired ADL was significantly higher in the EPS group than in the non-EPS group (<I>P</I> < .001, odds ratio = 1.90, 95% confidence interval, 1.45–2.48, and logistic regression). The S-IADL scores were significantly higher in the EPS group than this in the non-EPS group (<I>P</I> < .001, regression coefficient = 3.19, and median regression). The GDS-15 scores were higher in the EPS group (<I>P</I> = .04, regression coefficient = 0.89, and median regression).</P><P><B>Conclusion:</B></P><P>The presence of EPS in patients with AD who were not receiving neuroleptic drugs was associated with more impaired basic and instrumental ADL functioning and with greater depression symptoms.</P>

Factors Associated with Caregiver Burden in Patients with Alzheimer’s Disease

HyoShin Kang,Woojae Myung,Duk L. Na,Seong Yoon Kim,JaeHong Lee,SeolHeui Han,SeongHye Choi,SangYun Kim,Seonwoo Kim,DohKwan Kim 대한신경정신의학회 2004 PSYCHIATRY INVESTIGATION Vol.1 No.2

Objective-Caregivers for patients with Alzheimer’s disease (AD) suffer from psychological and financial burdens. However, the results of the relationship between burden and cognitive function, performance of activities of daily living, and depressive symptoms have remained inconsistent. Therefore, the aim of this study was to examine which factors are more significant predictors of heightened burden, cognitive impairment or functional decline, besides neuropsychiatric symptoms. Methods-A cross-sectional study was conducted in a sample comprised of 1,164 pairs of patients with AD and caregivers from the Clinical Research of Dementia of South Korea study cohorts. The cognitive function of each sub-domain, functional impairments, depressive symptoms, and caregiver burden were assessed using the dementia version of Seoul Neuropsychological Screening Battery (SNSB-D), Barthel Index for Daily Living Activities (ADL), Seoul-Instrumental Activities of Daily Living (S-IADL), the Clinical Dementia Rating Sum of Box (CDR-SB), the Global Deterioration Scale (GDS), the Korean version of the Neuropsychiatric Inventory (K-NPI), and the 15-item Geriatric Depression Scale. Results-We found that higher severity (higher CDR-SB and GDS scores) and more functional impairment (lower ADL and higher SIADL scores) were significantly associated with higher caregiver burden. In addition, depressive symptoms of patients (higher Geriatric Depression Scale scores) were associated with higher caregiver burden. Conclusion-Therefore, interventions to help maintain activities of daily living in patients with AD may alleviate caregiver burden and improve caregiver well-being.

Clinical epidemiology of long-term suicide risk in a nationwide population-based cohort study in South Korea

Lee, Hyewon,Myung, Woojae,Lee, Chunsoo,Choi, Junbae,Kim, Ho,Carroll, Bernard J.,Kim, Doh Kwan Pergamon Press 2018 Journal of psychiatric research Vol.100 No.-

<P>We investigated the effects of a large range of clinical factors on the long-term risk of suicide in the general population of South Korea. We analyzed the National Health Insurance Service-National Sample Cohort (NHISNSC) database in South Korea. A total of 300,232 individuals were followed for up to 12 years. We obtained information on demographic variables (age and sex), lifestyle variables (cigarette smoking, alcohol drinking and exercise), psychiatric and physical disorders, laboratory examination results and physical examination findings. We conducted a competing risk survival analysis to estimate the risk of completed suicide. 725 individuals (241/100,000) died by suicide in the follow-up period. After Bonferroni correction, we found a significant suicide risk associated with 6 variables: Parkinson's disease, depressive disorder, obsessive-compulsive disorder (inverted association), elevated serum aspartate aminotransferase levels, male gender and age. Before Bonferroni correction, variables such as cigarette smoking, heavy alcohol drinking, psychotic disorder, other psychiatric disorder, benzodiazepine use and higher fasting glucose showed some significant association. In addition, body mass index and height were inversely related to completed suicide before Bonferroni correction. However, only the 6 variables listed above were robust predictors of suicide in the fully adjusted analyses with multiple test correction. Common medical conditions had no clear influence on suicide. Diverse clinical factors influenced the long-term risk of completed suicide in this general population sample. Comprehensive assessment of these risk factors will facilitate more focused suicide surveillance measures.</P>