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.

루이체 치매

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.2

Here the author reviews the clinical and pathologic characteristics of dementia with Lewy bodies (DLB). DLB took many years to crystallize into a recognizable clinico-pathologic entity. Based on sensitive immunostaining technique, DLB is now considered the second most commonest cause of neurodegenerative dementia in the elderly. It is part of the range of clinical presentations that share a neuritic pathology based on abnormal aggregation of the synaptic protein α-synuclein. Lewy body pathology is found from the brainstem to the cortex and, in many cases, associated with concurrent Alzheimer' disease pathology. A recent international consortium on DLB has resulted in revised criteria for the clinical and pathological diagnosis of DLB incorporating new information about the clinical features and improved methods for their assessment. Neuropathologic diagnosis now assigns a weight to both α-synuclein and Alzheimer tangle pathology. Accurate identification of patients is important because they have specific symptoms, impairments, and functional disabilities that differ from those of other dementing illness including Alzheimer's disease.

치매 개념의 역사적 변천

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.1

Most histories of senile dementia begin with Alois Alzheimer's description in 1906 of the first case of Alzheimer's disease. However, the history of senile dementia is quite rich, dating back to the ancient Greek and Roman philosophers and physicians, so the history of dementia is probably as old as mankind itself. Although senile dementia has been recognized as a condition of aged individuals since at least the time of Pythagoras in the 7th century B.C., because it was dismissed as an inevitable feature of aging, it remained largely an uninvestigated disorder until the 19th century. An introduction of a scientific approach to clinical observation and the systematized classification of mental disorders in the mid-19th century that senile dementia began to be differentiated from other dementias, and was established as its own defined class of mental disorder. The identification of Alzheimer's disease at the onset of the 20th century was a turning point for the understanding of senile dementia, and the concepts and histological findings presented by the early researchers of Alzheimer's disease remain relevant still today. Here the author traces the history of the evolution of our current conceptualization of Alzheimer's disease from the Greek-Roman concept of age-associated dementia.

알쯔하이머병 환자에서 백질 변화와 혈중 호모시스테인 및 엽산 농도의 상관관계

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung),이소영(So Young Lee),신은영(Eun Young Shin),정우열(Woo Yeol Jung),박준호(Jun Ho Park) 대한노인정신의학회 2009 노인정신의학 Vol.13 No.2

Objectives : To explore the relationship of white matter changes (WMC) on magnetic resornance imaging (MRI) with plasma homocysteine and folate levels in Alzheimer's disease (AD) patients. Methods : Forty-one patients with probable AD were evaluated on WMC on brain MRI, plasma homocysteine and folate levels, and cerebrovascular risk factors. Subjects were divided into two groups according to WMC scores (lower group with <5 and higher group with ≥5). WMC were assessed by a scale of the European Task Force on Age-Related WMC. Results : Plasma homocysteine levels were correlated with right frontal WMC and have a tendency of correlation with left frontal WMC. When subjects were divided into two groups: higher plasma homocysteine group (≥14 μmol/L) and lower plasma homocysteine group (<14 μmol/L), the former was significantly higher than the latter in both frontal WMC. In a logistic regression analysis, higher plasma homocysteine were not a significant risk factor for higher WMC. Increasing age was a only significant risk factor for higher WMC and correlated with both frontal WMC. There was no relationship folate with any WMC. Conclusion : It is possible that plasma homocysteine levels have a region-specific correlation with frontal WMC in AD. However, it is important that effect of age on the relationship should be considered.

노인에서의 약물 유도성 섬망

김신겸(Shin Gyeom Kim),정한용(Han Yong Jung) 대한노인정신의학회 2008 노인정신의학 Vol.12 No.2

The elderly is accompanied by an increased likelihood of illness, and old people take a disproportionate amount of self-administered and prescribed medications. They are more likely to develop delirium as a result of taking medications than younger patients. Psychoactive drugs such as narcotics, long acting benzodiazepines, and tricyclic antidepressants are important causes of delirium. Drug induced confusion with nonpsychoactive drugs is often idiosyncratic in nature, and the diagnosis is easily missed. Anticholinergic medications are the most common causes of drug induced delirium in the elderly. Successful treatment of delirium depends on identifying the contributing factors, and drugs are the most common reversible cause of delirium. This article provides an clinical approach to prevent, recognize, and manage drug induced delirium.

노인학대

김신겸(Shinkyum Kim),박인수(In Soo Park) 대한노인정신의학회 2010 노인정신의학 Vol.14 No.1

Just these days elder abuse receives increasing social attention even though Korea already entered the ageing society with the steep increase of elderly population and this causes many social problems including elderly suicides. We need to develop methods to deal with these severe social problems, but, owing to lack of reliable data and studies, it is even difficult to document actual conditions of elder maltreatment. In a Korean nationwide epidemiological study conducted in 2007, the prevalence rate of elder abuse for last one year was 6.0%. Emotional abuse showed the highest prevalence (5.2%), and followed by neglect (2.3%), physical abuse (0.2%). The purpose of this study is to investigate the current prevalence and condition of elder maltreatment and provide the information about concept, types, risk factors and intervention of elder maltreatment.

남성 만성 조현병 환자에서 혈중 테스토스테론 농도와 인지 기능의 상관관계

김우림(Woo Rim Kim),서재원(Jae Won Suh),이경한(Kyung Han Lee),김신겸(Shin Kyum Kim) 대한생물치료정신의학회 2014 생물치료정신의학 Vol.20 No.3

Objectives:The purpose of this study was to investigate the relationships between sexual hormone level and cognition in male patients with schizophrenia. Methods:Total 80 male patients with schizophrenia were involved in this study. Among them, 61 patients were classified into normal cognition group(NCG) and 19 patients for lower cognition group(LCG), according to the Korean version of Consortium to Establish a Registry for Alzheimer’s Disease(CERAD-K) and Korean-Color Word Stroop Test. LCG was identified who were included at the below 5 percentile in at least one domain of the cognitive test. All the participants completed Positive and Negative Syndrome Scale(PANSS), Simpson Angus rating Scales(SAS) and Hamilton rating scale for Depression(HAM-D). Sexual hormone levels of prolactin, total testosterone, free-testosterone and estradiol were also checked by blood hormonal assays. Results:The patients with higher total testosterone level on construction domain were more likely to be included in LCG than NCG. Statistically significant correlations were still observed after adjustment of the several covariants. Total testosterone, free testosterone and estradiol levels have statistically significant positive correlations between each other, but there were negative correlations between prolactin and other hormone levels in 80 male patients with schizophrenia. Conclusion:These results suggest that sexual hormone may modulate the cognitive deficits in patients with chronic schizophrenia. Sexual hormone levels would be considered as predictive factors about cognitive function of patients with chronic schizophrenia. Furthermore, longitudinal and large-scale control studies would be needed to confirm these results.

만성 조현병 환자에서 대사증후군과 인지기능과의 연관성

김경윤,김신겸,변원탄,이덕기,정봉주,박영민,서재원,Kim, Kyung-Yoon,Kim, Shin-Kyum,Byun, Won-Tan,Lee, Duk-Ki,Jung, Bong-Joo,Park, Young-Min,Seo, Jae-Won 한국정신신체의학회 2014 정신신체의학 Vol.22 No.2

연구목적 이 연구는 만성 조현병 조현병 환자에서 대사증후군과 인지기능과의 연관성을 알아보기 위해 시행하였다. 방 법 일 병원에서 입원중인 만성 조현병 환자 105명(대사증후군 40명, 비대사증후군 65명)을 대상으로 A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet(CERAD-K)의 인지기능 검사 항목들을 시행하였다. 결 과 대사증후군에 이환된 만성 조현병 환자들에서 구성실행 검사 항목에서 대사증후군에 이환되지 않은 군에 비해 유의하게 낮은 점수를 나타냈으며, 그 외 다른 검사항목에서는 차이점이 나타나지 않았다. 결 론 만성 조현병 환자에서 대사증후군이 구성실행 검사 항목에서의 인지기능 저하를 나타내었다. 조현병 환자에서 대사증후군의 적절한 치료가 필요할 것이며 향후 장기추적연구가 필요할 것으로 보인다. Objectives : The aim of this study was to investigate the relationship between metabolic syndrome and cognitive functions among chronic schizophrenia patients. Methods : The survey participants were 105(40 metabolic syndrome and 65 non-metabolic syndrome) chronic schizophrenia patients at Yang-san Hospital. Each score of cognitive test(A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet, stroop test), Positive and Negative Syndrome Scale, Hamilton rating scale for Depression were assessed. Statistical analysis of the relationship between various tests of A Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet and metabolic syndrome were performed using ANCOVA and logistic regression. Results : Schizophrenia patients with lower score on construction praxia were likely to be included in Metabolic syndrome group. However, there were no significant relationships in other tests between the two groups. Conclusions : This study found metabolic syndrome caused cognitive decline in chronic schizophrenia patients, especially Construction praxia. This study could be a basis to show metabolic syndrome has to be treated appropriately in schizophrenia patients and suggests the necessity of following longitudinal designed study.

뇌졸중에서 우울증과 실행기능부전에 대한 고찰

나경세,김신겸,이소영,정한용,Na, Kyoung-Sae,Kim, Shin-Gyeom,Lee, Soyoung Irene,Jung, Han-Yong 대한생물정신의학회 2012 생물정신의학 Vol.19 No.4

Depression and executive dysfunction are common neuropsychiatric sequelae of stroke. Patients with stroke are more predisposed to depression and executive dysfunction compared to patients with similar degree of physical disability. Both depression and executive dysfunction are also associated with poor prognosis such as high mortality and delayed recovery after stroke. Complex neurobiological and anatomical mechanisms are associated with the development of depression and executive dysfunction after stroke. Activation of pro-inflammatory cytokines is thought to be associated with onset of depression, whereas injuries in frontal-subcortical circuit are thought to be a link between depression and executive dysfunction. Early detection of depressive symptoms and both pharmacological and non-pharmacological treatment would be helpful. In this review paper, the authors investigated 1) biological and neuroanatomical substrate for poststroke depression and executive dysfunction, 2) the relationship and common etiopathology for poststroke depression and executive dysfunction, and 3) pharmacological and non-pharmacological treatment for poststroke depression. The contents of the paper are as follows : the prevalence, clinical manifestation, and biological etiology for poststroke depression, neuroanatomical abnormalities as a common etiological factor for depression and executive dysfunction, pharmacotherapy and non-pharmacological approach.

Venlafaxine에 의한 급성 독성 간염 1예

나경세,황희성,김신겸,이소영,정한용,Na, Kyeong-Sae,Hwang, Hee-Sung,Kim, Shin-Gyeom,Lee, So-Young-Irene,Jung, Han-Yong 대한생물정신의학회 2011 생물정신의학 Vol.18 No.3

Venlafaxine is among the most widely prescribed antidepressants. It is extensively metabolized to O-desmethylvenlafaxine via cytochrome P450 (CYP) 2D6. We report a case of acute toxic hepatitis resulting from venlafaxine in a 54-year-old woman with pain disorder. During venlafaxine treatment, laboratory tests revealed elevated liver enzymes with a maximum of 169 IU/L for aspartate transaminase (AST) and 166 IU/L for alanine transaminase (ALT). AST and ALT levels returned to normal after 6 days of discontinuation of venlafaxine. The patient was finally diagnosed with acute toxic hepatitis through liver biopsy. This case indicates the importance that clinicians should be aware of the hepatotoxicity of venlafaxine in practice.