Executive Summary of 2023 International Conference of the Korean Dementia Association (IC-KDA 2023): A Report From the Academic Committee of the Korean Dementia Association

Geon Ha Kim,Jaeho Kim,Won-Seok Choi,Yun Kyung Kim,Kun Ho Lee,Jae-Won Jang,Jae Gwan Kim,Hui Jin Ryu,Soh-Jeong Yang,Hyemin Jang,Na-Yeon Jung,Ko Woon Kim,Yong Jeong,So Young Moon,Academic Committee of th Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.2

The Korean Dementia Association (KDA) has been organizing biennial international academic conferences since 2019, with the International Conference of the KDA (IC-KDA) 2023 held in Busan under the theme 'Beyond Boundaries: Advancing Global Dementia Solutions.' The conference comprised 6 scientific sessions, 3 plenary lectures, and 4 luncheon symposiums, drawing 804 participants from 35 countries. Notably, a Korea-Taiwan Joint Symposium addressed insights into Alzheimer's disease (AD). Plenary lectures by renowned scholars explored topics such as microbiome-related AD pathogenesis, social cognition in neurodegenerative diseases, and genetic frontotemporal dementia (FTD). On the first day, specific presentations covered subjects like the gut-brain axis and neuroinflammation in dementia, blood-based biomarkers in AD, and updates in AD therapeutics. The second day's presentations addressed recent issues in clinical neuropsychology, FTD cohort studies, and the pathogenesis of non-AD dementia. The Academic Committee of the KDA compiles lecture summaries to provide comprehensive understanding of the advanced dementia knowledge presented at IC-KDA 2023.

A Comparison of Item Characteristics and Test Information Between the K-MMSE~2:SV and K-MMSE

Jihyang Kim,Seungmin Jahng,SangYun Kim,Yeonwook Kang Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.3

Background and Purpose: The Korean-Mini Mental State Examination, 2nd edition (K-MMSE~2) was recently released. This study aimed to determine whether the K-MMSE~2: Standard Version (K-MMSE~2:SV) had the same test characteristics as the K-MMSE. Methods: A total of 1,514 healthy community-based participants aged 19 to 90 years were administered the K-MMSE~2:SV Blue Form along with the language items from the K-MMSE. The item and test characteristics and test information for the K-MMSE~2:SV and K-MMSE were compared using Item Response Theory analysis. Results: Item discriminations for the K-MMSE~2:SV and K-MMSE were above the moderate range for all items except Recall. Most of the items on the K-MMSE~2:SV and K-MMSE had item category difficulty in the very easy or easy range. The test information curve (TIC) showed that the K-MMSE~2:SV and K-MMSE provide almost the same amount of information (27.86 vs. 28.44), with both tests providing the most information at an ability level of -1.57. The generalizability (G) coefficient for the K-MMSE~2:SV and K-MMSE was 0.99. Conclusions: These results indicate that the K-MMSE~2:SV and K-MMSE are equally optimal tests for screening for mild cognitive impairment and early dementia. Given that the amount of test information provided by the two tests was almost identical, the shapes of the TICs were very similar, and the G coefficient was close to 1, we can conclude that the K-MMSE and K-MMSE~2:SV are equivalent tests.

Recent Updates of Therapeutic Intervention Programs for Caregivers of Patient with Dementia: Proposal of Hospital-Based Individual Therapy

Yeom, Jiyoung,Yoo, Rayoung,Bae, Seonghoon,Kang, Yeonwook,Kim, Geon Ha,Na, Hae Ri,Choi, Seong Hye,Jeong, Jee Hyang Korean Dementia Association 2016 Dementia and Neurocognitive Disorders Vol.15 No.2

<P>Caring for people with dementia is associated with multiple devastating social, financial, physical, and psychological challenges. There is strong evidence that multicomponent tailored caregiver intervention is effective in improving caregiver well-being and delaying institutionalization. In US, the government is actively funding for developing caregiver program and to prove its efficacy through randomized controlled trials (RCTs) to translate into practice. Even with the introduction of Korean Long-term Care Plan, still, the most of the patients with dementia are being cared by the family members. The distress of caregiving is enormous, but structured therapeutic intervention program which efficacy is proven through RCT is very insufficient in Korea. The purpose of this article is to review the caregiver intervention programs of ongoing clinical trials comparing US and Korea, and to propose a tailored, therapeutic intervention program (I-CARE; A multicenter, randomized trial to assess efficacy of therapeutic intervention programs for decreasing caregiver burden in dementia caregiver) for hospital-care in Korea.</P>

Speech Emotion Recognition in People at High Risk of Dementia

Dongseon Kim,Bongwon Yi,Yugwon Won Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.3

Background and Purpose: The emotions of people at various stages of dementia need to be effectively utilized for prevention, early intervention, and care planning. With technology available for understanding and addressing the emotional needs of people, this study aims to develop speech emotion recognition (SER) technology to classify emotions for people at high risk of dementia. Methods: Speech samples from people at high risk of dementia were categorized into distinct emotions via human auditory assessment, the outcomes of which were annotated for guided deep-learning method. The architecture incorporated convolutional neural network, long short-term memory, attention layers, and Wav2Vec2, a novel feature extractor to develop automated speech-emotion recognition. Results: Twenty-seven kinds of Emotions were found in the speech of the participants. These emotions were grouped into 6 detailed emotions: happiness, interest, sadness, frustration, anger, and neutrality, and further into 3 basic emotions: positive, negative, and neutral. To improve algorithmic performance, multiple learning approaches were applied using different data sources-voice and text-and varying the number of emotions. Ultimately, a 2-stage algorithm-initial text-based classification followed by voice-based analysis-achieved the highest accuracy, reaching 70%. Conclusions: The diverse emotions identified in this study were attributed to the characteristics of the participants and the method of data collection. The speech of people at high risk of dementia to companion robots also explains the relatively low performance of the SER algorithm. Accordingly, this study suggests the systematic and comprehensive construction of a dataset from people with dementia.

Discriminative Power of Seoul Cognitive Status Test in Differentiating Subjective Cognitive Decline, Amnestic Mild Cognitive Impairment, and Dementia Based on CERAD-K Standards

Hasom Moon,Eek-Sung Lee,Seunghee Na,Dayeong An,Joon Soo Shin,Duk L. Na,Hyemin Jang Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.3

Background and Purpose: We developed a new digital cognitive assessment called Seoul Cognitive Status Test (SCST), formerly called Inbrain Cognitive Screening Test. The purpose of this study was to validate the clinical utility of the SCST by comparing its scores of those with subjective cognitive decline (SCD), amnestic mild cognitive impairment (aMCI), and dementia diagnosed by the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K). Methods: All participants (n=296) who completed the CERAD-K, SCST, and Instrumental Activities of Daily Living tests were included in this study. Total score, cognitive domain scores, and subtest scores of the SCST were compared among the 3 groups (SCD, aMCI, and dementia). Additionally, correlations between SCST and CERAD-K subtests were examined. Results: Cognitive domain scores and total score of the SCST showed significant differences among the three groups, with scores being the highest in the order of SCD, aMCI, and dementia (p<0.001). Most subtests of the SCST also showed higher scores in the order of SCD, aMCI, and dementia (p<0.001). However, SCD and aMCI groups showed no significant differences in scores of the Phonemic Word Fluency Test (p=0.083) or Korean Trail Making Test-Elderly version Part A (p=0.434). Additionally, there was no significant difference in the score of Place Recognition (p=0.274) of the Word-Place Association Test between aMCI and dementia groups. Conclusions: In conclusion, differences in total score, cognitive domain scores, and subtest scores of the SCST among the 3 groups of participants diagnosed using CERAD-K confirm the clinical utility of the SCST for cognitive assessment.

Cerebral Perfusion Changes after Acetyl-L-Carnitine Treatment in Early Alzheimer's Disease Using Single Photon Emission Computed Tomography

Jeong, Hyeonseok S.,Park, Jong-Sik,Yang, YoungSoon,Na, Seung-Hee,Chung, Yong-An,Song, In-Uk Korean Dementia Association 2017 Dementia and Neurocognitive Disorders Vol.16 No.1

<P><B>Background and Purpose</B></P><P>Although acetyl-L-carnitine (ALC) treatment may have beneficial effects on Alzheimer's disease (AD), its underlying neural correlates remain unclear. The purpose of this study was to investigate cerebral perfusion changes after ALC treatment in AD patients using technetium-<SUP>99</SUP>m hexamethylpropylene amine oxime single photon emission computed tomography (SPECT).</P><P><B>Methods</B></P><P>A total of 18 patients with early AD were prospectively recruited and treated with ALC at 1.5 g/day for 1.4±0.3 years. At baseline and follow-up, brain SPECT, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), and Neuropsychiatric Inventory (NPI) were used to assess participants. After ALC administration, changes in brain perfusion, severity of dementia, cognitive performance, and neuropsychiatric disturbances were examined.</P><P><B>Results</B></P><P>After ALC administration, changes in scores of MMSE, CDR, GDS, and NPI were not statistically significant (<I>p</I>>0.05). Voxel-wise whole-brain image analysis revealed that perfusion was significantly (<I>p</I><0.001) increased in the right precuneus whereas perfusion was reduced in the left inferior temporal gyrus (<I>p</I><0.001), the right middle frontal gyrus (<I>p</I><0.001), and the right insular cortex (<I>p</I>=0.001) at follow-up.</P><P><B>Conclusions</B></P><P>Although previous studies have suggested that AD patients generally demonstrate progressive deterioration in brain perfusion and clinical symptoms, this study reveals that the perfusion of the precuneus is increased in AD patients after ALC administration and their cognitive and neuropsychiatric symptoms are not aggravated. Further studies are warranted to determine the potential association between perfusion increase in the precuneus and clinical symptoms after ALC treatment in AD patients.</P>

Gender Differences in Items of the Instrumental Activities of Daily Living in Mild Cognitive Impairment and Alzheimer's Disease Dementia

Hui Jin Ryu,Yeonsil Moon Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.2

Background and Purpose: Each item in the instrumental activities of daily living (IADL) questionnaire has differential importance to an individual's life functioning based on gender. However, IADL has mostly been utilized for its total score alone, without gender specificity. We identify the impact of each item on the transition from amnestic mild cognitive impairment (aMCI) to Alzheimer's disease dementia (ADD), and determine if the impact of each item differs by gender. Methods: Subjects were aMCI or ADD with a global clinical dementia rating of 0.5 or 1. The sample size was 146 men and 154 women. We used logistic regression analysis to determine the effect of each item of IADL on the transition from aMCI to ADD. Results: The odds ratio (OR) for "remembering recent events" had similar values: 27.2 for men, and 27.7 for women. Gender difference was identified in the item with the highest OR value. For women, the "using transportation" item was 63.3, and for men, "conducting financial affairs" was overwhelmingly high at 89.1. Conclusions: Functional decline on items with relatively higher ORs may indicate higher probability of a transition from aMCI to ADD. The OR of "conducting financial affairs" was relatively higher for both genders. In terms of gender differences, "conducting home repair" for men, and "using transportation" for women, have relatively higher impact. This study demonstrates that during the transition from aMCI to ADD, each item of IADL shows a staggered decline in functioning, and that this decline is gender-specific.

Impact of the Ventricle Size on Alzheimer's Disease Progression: A Retrospective Longitudinal Study

Ji-seon Lee,Do-yun Heo,Kyung-Hae Choi,Hee-Jin Kim Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.2

Background and Purpose: Ventricle enlargement has been implicated in the pathophysiology of Alzheimer's disease (AD). We studied the relationship between ventricular size and cognitive function in patients with AD. We focused on the effect of the initial ventricle size on the rate of cognitive decline in patients with AD. Methods: A retrospective analysis of probable clinical AD participants with more than 2 magnetic resonance imaging images was performed. To measure ventricle size, we used visual rating scales of (1) Cardiovascular Health Study (CHS) score and (2) conventional linear measurement method. Results: Increased clinical dementia rating (CDR) was correlated with a decreased Mini-Mental Status Examination (MMSE) score, and increased medial temporal lobe atrophy (MTLA) and global ventricle size (p<0.001, p<0.001, p=0.021, respectively). There was a significant correlation between the change in cognitive function in the group (70%-100%ile) with a large initial ventricle size (p=0.021 for ∆CDR, p=0.01 for ∆MMSE), while the median ventricle size (30%-70%ile) showed correlation with other brain structural changes (MTLA, frontal atrophy [FA], and white matter) (p=0.036 for initial MTLA, p=0.034 for FA). Conclusions: In this study, the initial ventricle size may be a potential new imaging biomarker for initial cognitive function and clinical progression in AD. We found a relationship between the initial ventricle size and initial AD-related brain structural biomarkers.

Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus Patient With Parkinson's Disease-Compatible Findings on Dopamine Transporter Scans

Chaejin Lee,Sang-Youl Yoon,Sang-Woo Lee,Shin Young Jeong,Eunhee Park,Jeong-Hyun Hwang,Ki-Su Park,Kyunghun Kang Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.3

Ventral Anterior Cingulate Atrophy as a Predisposing Factor for Transient Global Amnesia

Jeewon Suh,Young Ho Park,Hang-Rai Kim,Jae-Won Jang,SangHak Yi,Min Ju Kang,Yun Jung Bae,Byung Se Choi,Jae Hyoung Kim,SangYun Kim Korean Dementia Association 2024 Dementia and Neurocognitive Disorders Vol.23 No.2

Background and Purpose: This study aimed to evaluate the brain magnetic resonance imaging (MRI) of patients with acute transient global amnesia (TGA) using volumetric analysis to verify whether the brains of TGA patients have pre-existing structural abnormalities. Methods: We evaluated the brain MRI data from 87 TGA patients and 20 age- and sex- matched control subjects. We included brain MRIs obtained from TGA patients within 72 hours of symptom onset to verify the pre-existence of structural change. For voxel-based morphometric analyses, statistical parametric mapping was employed to analyze the structural differences between patients with TGA and control subjects. Results: TGA patients exhibited significant volume reductions in the bilateral ventral anterior cingulate cortices (corrected p<0.05). Conclusions: TGA patients might have pre-existing structural changes in bilateral ventral anterior cingulate cortices prior to TGA attacks.