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Background@#and Purpose: The SoUth Korea study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention (SUPERBRAIN) proved the feasibility of multidomain intervention for elderly people. One-quarter of the Korean population over 65 years of age has mild cognitive impairment (MCI). Digital health interventions may be costeffective and have fewer spatial constraints. We aim to examine the efficacy of a multidomain intervention through both face-to-face interactions and video communication platforms using a tablet personal computer (PC) application in MCI. @*Methods@#Three hundred participants aged 60–85 years, with MCI and at least one modifiable dementia risk factor, will be recruited from 17 centers and randomly assigned in a 1:1 ratio to the multidomain intervention and the waiting-list control groups. Participants will receive the 24-week intervention through the tablet PC SUPERBRAIN application, which encompasses the following five elements: managing metabolic and vascular risk factors, cognitive training,physical exercise, nutritional guidance, and boosting motivation. Participants will attend the interventions at a facility every 1–2 weeks. They will also engage in one or two self-administered cognitive training sessions utilizing the tablet PC application at home each week. They will participate in twice or thrice weekly online exercise sessions at home via the ZOOM platform. The primary outcome will be the change in the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status from baseline to study end. @*Conclusions@#This study will inform the effectiveness of a comprehensive multidomain intervention utilizing digital technologies in MCI.
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Background@#and Purpose: The efficacy and safety of GV1001 have been demonstrated in patients with moderate-to-severe Alzheimer’s disease (AD). In this study, we aimed to further demonstrate the effectiveness of GV1001 using subscales of the Severe Impairment Battery (SIB), which is a validated measure to assess cognitive function in patients with moderate-tosevere AD. @*Methods@#We performed a post hoc analysis of data from a 6 month, multicenter, phase 2, randomized, double-blind, placebo-controlled trial with GV1001 (ClinicalTrials.gov, NCT03184467). Patients were randomized to receive either GV1001 or a placebo for 24 weeks. In the current study, nine subscales of SIB—social interaction, memory, orientation, language, attention, praxis, visuospatial ability, construction, and orientation to name— were compared between the treatment (GV1001 1.12 mg) and placebo groups at weeks 12 and 24. The safety endpoints for these patients were also determined based on adverse events. @*Results@#In addition to the considerable beneficial effect of GV1001 on the SIB total score, GV1001 1.12 mg showed the most significant effect on language function at 24 weeks compared to placebo in both the full analysis set (FAS) and per-protocol set (PPS) (p=0.017 and p=0.011, respectively). The rate of adverse events did not differ significantly between the 2 groups. @*Conclusions@#Patients with moderate-to-severe AD receiving GV1001 had greater language benefits than those receiving placebo, as measured using the SIB language subscale.
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Globally, the population aged 65 years and over is growing faster than all other age groups. South Korea, in particular, is one of the most rapidly aging societies worldwide. With the increase in the older population, the incidence of urologic diseases has increased significantly along with that of chronic diseases. Urologic diseases are an important component of the health problems faced by an aging society. Among those, urinary incontinence and voiding dysfunction cause significant health and quality of life problems in older adults. To properly manage these diseases, especially in the field of urology, it is necessary to propose appropriate policies for the health care of older people. Accordingly, the significance of geriatrics, particularly geriatric urology, has increased. Although geriatric urology in South Korea began relatively recently, the founding of the Korean Society of Geriatric Urological Care represents a significant step in the development of geriatric urology as a subspecialty. The goal of this review is to elaborate on the concept of geriatrics and to provide an overview of geriatric urology with a focus on its current status in South Korea. Furthermore, future challenges in the face of rapid demographic changes are reviewed.
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This study examined the effect of the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet of the Korean multi-domain dementia prevention program on the cognitive functions of the elderly with dementia risk factors. We developed the program including nutrition, exercise, cognitive training, vascular disease prevention, and motivation. One- hundred and fifty-three participants aged 60∼79 years with at least 1 dementia risk factor were randomly assigned in a 1:1:1 ratio to the facility-based intervention (FMI), home-based intervention (HMI), and the control group. The nutrition education program consisted of 10 classes over 24 weeks: the FMI received 7 group sessions and three 1:1 sessions, the HMI received 4 group sessions and three 1:1 sessions with 3 homework sessions. The Nutrition Quotient for Elderly (NQ-E) and the Mini Nutritional Assessment (MNA) were used to evaluate nutritional status. The Repeatable Battery for the Assessment Neuropsychological Status (RBANS), Korean Mini-Mental State Examination (K-MMSE), and the Cognitive Complaint Interview (CCI) were used to evaluate cognitive functions. A total of 136 people completed the program with an 11.1% dropout rate. The NQ-E (P=0.009) and RBANS (P=0.001) scores significantly increased in the FMI (N=45) and HMI (N=49) groups compared to the control group (N=42) after the study. The changes in the score of MNA and CCI did not differ significantly between groups. In conclusion, the nutritional intervention which focused on the MIND diet as a part of a multi-domain intervention program had a positive effect on the improvement of healthy eating habits and cognitive function scores in the high-risk dementia group.
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At the request of the authors, the NRF-support number in ‘Acknowledgements’ is modified.
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BACKGROUND@#AND PURPOSE: The aim of this study was to determine the diagnostic performance and safety of a new ¹â¸F-labeled amyloid tracer, ¹â¸F-FC119S.@*METHODS@#This study prospectively recruited 105 participants, comprising 53 with Alzheimer's disease (AD) patients, 16 patients with dementia other than AD (non-AD), and 36 healthy controls (HCs). In the first screening visit, the Seoul Neuropsychological Screening Battery cognitive function test was given to the dementia group, while HC subjects completed the Korean version of the Mini Mental State Examination. Individuals underwent ¹â¸F-FC119S PET, ¹â¸F-fluorodeoxyglucose (FDG) PET, and brain MRI. The diagnostic performance of ¹â¸F-FC119S PET for AD was compared to a historical control (comprising previously reported and currently used amyloid-beta PET agents), ¹â¸F-FDG PET, and MRI. The standardized uptake value (SUV) ratio (ratio of the cerebral cortical SUV to the cerebellar SUV) was measured for each PET data set to provide semiquantitative analysis. All adverse effects during the clinical trial periods were monitored.@*RESULTS@#Visual assessments of the ¹â¸F-FC119S PET data revealed a sensitivity of 92% and a specificity of 84% in detecting AD. ¹â¸F-FC119S PET demonstrated equivalent or better diagnostic performance for AD detection than the historical control, ¹â¸F-FDG PET (sensitivity of 80.0% and specificity of 76.0%), and MRI (sensitivity of 98.0% and specificity of 50.0%). The SUV ratios differed significantly between AD patients and the other groups, at 1.44±0.17 (mean±SD) for AD, 1.24±0.09 for non-AD, and 1.21±0.08 for HC. No clinically significant adverse effects occurred during the trial periods.@*CONCLUSIONS@#¹â¸F-FC119S PET provides high sensitivity and specificity in detecting AD and therefore may be considered a useful diagnostic tool for AD.
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Lower urinary tract dysfunction (LUTD) is a common health challenge in dementia patients with significant morbidity and socioeconomic burden. It often causes lower urinary tract (LUT) symptoms, restricts activities of daily life, and impairs quality of life. Among several LUT symptoms, urinary incontinence (UI) is the most prominent storage symptom in the later stages of dementia. UI in patients with dementia results not only from cognitive impairment, but also from urological defects such as detrusor overactivity. Management of LUTD in patients with dementia is based on multiple factors, including cognitive state, functional impairment, concurrent comorbidities, polypharmacy and urologic condition.Behavioral therapy under caregiver support represents appropriate treatment strategy for UI in these patients. Pharmacological treatment can be considered in patients refractory to behavioral therapy, but it is more effective when combined with behavioral therapy.Antimuscarinics and mirabegron, a beta-3 receptor agonist, are effective for managing storage symptoms involving the LUT. However, anticholinergic side effects in elderly subjects are a concern, particularly when there is a risk of exacerbating cognitive impairment with prolonged use of antimuscarinics. Proper recognition and treatment of LUTD in dementia can improve quality of life in these patients.
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Background@#and PurposeThe prevalence of dementia is increasing in South Korea. Multidomain interventions may be useful for preventing dementia. Such programs need to be disseminated to elderly Koreans throughout the country. We have developed programs of the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN), which consists of a facility-based multidomain intervention (FMI) program and a home-based multidomain intervention (HMI) program suitable for elderly Koreans. We aim to determine the feasibility of the SUPERBRAIN programs before a large-scale randomized controlled trial. @*Methods@#We will recruit 150 participants among those without dementia aged 60–79 years with at least 1 modifiable dementia risk factor. They will be randomly assigned in a 1:1:1 ratio to the FMI, HMI, and the waiting-list control arm. The 6-month multidomain intervention consists of management of metabolic and vascular risk factors, cognitive training and social activity, physical exercise, nutritional guidance, and motivational enhancement programs. The primary outcomes are adherence and retention rates and changes in the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status from baseline to the study end. The main secondary outcomes are disability, depressive symptoms, quality of life, vascular risk factors, physical performance, nutritional assessment, and motivation questionnaire. There will be an exploratory evaluation of neurotrophic, neurodegeneration, and neuroinflammation factors, microbiome, telomere length, electroencephalography, and neuroimaging measures. @*Conclusions@#The results obtained will provide information on the applicability of these multidomain intervention programs to at-risk elderly people.
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Background@#and Purpose: The aim of this study was to investigate the effects of multicomponent exercise on cognitive function, depression, and quality of life in elderly individuals. @*Methods@#This study prospectively recruited 605 participants, and constructed an exercise pyramid comprising even distributions of daily physical activities, aerobic exercise, musclestrengthening exercise, flexibility exercise, balance exercise, and activities that subjects could perform while sitting down. The exercise program was divided into six stages according to the participant’s level of frailty. The 12-week exercise program intervention was conducted once yearly. @*Results@#The exercise regimen was followed by 402 of the 605 enrolled participants, giving a dropout rate of 33.6%. The 27-month exercise program was completed by 60 participants.The scores for the Mini Mental State Examination for dementia screening (MMSE-DS), short form of the Geriatric Depression Scale, World Health Organization Quality of Life Assessment (WHOQOL-BREF), International Physical Activity Questionnaire (IPAQ), fear of falling, handgrip strength, and walking speed were improved after the exercise intervention. The analysis of frailty revealed that participants in the frail group showed greater improvements for the MMSE-DS, WHOQOL-BREF, IPAQ, fear of falling, handgrip strength, and walking speed. @*Conclusions@#Individually customized, multicomponent exercise programs lead to improved levels of cognitive function, depression, and quality of life, especially among those who are more frail.
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The purpose of this study was to verify whether Mediterranean diet, which proved to have a significant effect on preventing dementia for people aged 65 or older, could be well modified to be a Korean-style Mediterranean diet. This study was performed as a randomized-controlled trial for 6 weeks. Functional physical changes, cognitive scores, depression scores and dietary changes were all assessed. The walking speed (P<0.001) and the cognitive scores were statistically improved in only the experimental group (P<0.001), and the depression scores were also significantly improved in only the experimental group (P<0.01). The dietary intake showed a 30% improvement for consuming more than 7 cups per day of vegetables and fruits. When the participants were contacted four months after the end of the study, 90% of them said that the Korean-style Mediterranean diet was feasible and 100% said the nutrition interventions helped them maintain the diet during their daily lives. The results suggest that although the Mediterranean diet can be difficult to apply, any limitations of this healthy diet can be overcome.
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Idoso , Humanos , Demência , Depressão , Dieta , Dieta Mediterrânea , Frutas , Verduras , CaminhadaRESUMO
Unfortunately, the original version of this article had errors in the data displayed in flow diagram.
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BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.
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Idoso , Humanos , Doença de Alzheimer , Atrofia , Transtornos Cognitivos , Demência , Diagnóstico , Coreia (Geográfico) , Pemetrexede , Curva ROCRESUMO
BACKGROUND AND PURPOSE: Several studies have validated the clinical efficacy of computerized cognitive training applications. However, few studies have investigated the neural substrates of these training applications using simultaneous multimodal neuroimaging modalities. We aimed to determine the effectiveness of computerized cognitive training and corresponding neural substrates through a multimodal approach. METHODS: Ten patients with mild cognitive impairment (MCI), six patients with subjective memory impairment (SMI), and 10 normal controls received custom-developed computerized cognitive training in the memory clinic of a university hospital. All of the participants completed 24 sessions of computerized cognitive training, each lasting 40 minutes and performed twice weekly. They were assessed using neuropsychological tests (both computerized and conventional), electroencephalography, fluorodeoxyglucose positron-emission tomography (FDG-PET), volumetric magnetic resonance imaging (MRI), and diffusion-tensor imaging (DTI) at pre- and posttraining. RESULTS: The patients with MCI exhibited significant improvements in the trail-making test–black & white-B, and memory domain of the computerized cognitive assessment. Subjects with normal cognition exhibited significant improvements in scores in the language and attention-/psychomotor-speed domains. There were no significant changes in subjects with SMI. In the pre- and posttraining evaluations of the MCI group, FDG-PET showed focal activation in the left anterior insula and anterior cingulate after training. Volumetric MRI showed a focal increase in the cortical thickness in the rostral anterior cingulate. DTI revealed increased fractional anisotropy in several regions, including the anterior cingulate. CONCLUSIONS: The anterior cingulate and anterior insula, which are parts of the salience network, may be substrates for the improvements in cognitive function induced by computerized cognitive training.
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Humanos , Anisotropia , Cognição , Eletroencefalografia , Giro do Cíngulo , Imageamento por Ressonância Magnética , Memória , Disfunção Cognitiva , Neuroimagem , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons , Resultado do TratamentoRESUMO
Population analyses and demographic data have clearly documented the rapid growth of the aging population in recent years. Although the population over 65 currently accounts for approximately 13.2% of the total population in Korea, it is estimated that this number will reach at least 40% by 2060. Aging is associated with a general decline in almost every physiological function of biological systems, including the lower urinary tract. Aging is also known to put individuals at a high risk for urinary tract infections. Geriatric hospitals in Korea have undergone a large expansion in terms of the number of beds and institutions. Many elderly patients in geriatric hospitals suffer from various genitourinary disorders. In particular, voiding dysfunction and urinary tract infections are prevalent comorbidities of other chronic geriatric diseases in patients in geriatric hospitals. Careful monitoring and management can help to reduce those genitourinary problems in elderly patients in geriatric hospitals.
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Idoso , Humanos , Envelhecimento , Comorbidade , Doenças Urogenitais Femininas , Coreia (Geográfico) , Doenças Urogenitais Masculinas , Sistema Urinário , Infecções UrináriasRESUMO
PURPOSE: Pelvic floor muscle exercise (PFME) is a therapeutic option for urinary incontinence (UI). However, studies of the efficacy of PFME on UI in patients with cognitive impairment (CI) are lacking. Therefore, we evaluated the effect of PFME on UI in elderly women with mild CI. METHODS: A total of 150 women with mild CI or Alzheimer disease and UI were screened using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Cognitive function and behavioral symptoms were evaluated by the Mini-Mental State Examination and Barthel's Activities of Daily Living. The patients were randomly divided into a control group (n=46) and a PFME group (n=52, 6 sessions of PFME for 12 weeks). The primary outcome was the change in UI episodes measured with a frequency volume chart (FVC). The secondary outcomes were other FVC parameters and the ICIQ-SF scores. RESULTS: A total of 82 women (control group: 40 and PFME group: 42) completed the study. After 12 weeks of PFME, the mean number of UI episodes per 24 hours decreased by 1.6 (from 3.3 to 1.7) in the PFME group and by 0.5 (from 3.4 to 2.9) in the control group (P < 0.001 between groups). The mean number of micturition episodes and total ICIQ-SF scores improved in the PFME group to a significantly greater extent than in the control group (P<0.001). CONCLUSIONS: Supervised PFME can be a good therapeutic option for improving UI in elderly women with CI.
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Idoso , Feminino , Humanos , Atividades Cotidianas , Doença de Alzheimer , Sintomas Comportamentais , Cognição , Transtornos Cognitivos , Diafragma da Pelve , Incontinência Urinária , MicçãoRESUMO
OBJECTIVE: Mitochondrial dysfunction is a prominent and early feature of Alzheimer's disease (AD). The morphologic changes observed in the AD brain could be caused by a failure of mitochondrial fusion mechanisms. The aim of this study was to investigate whether genetic polymorphisms of two genes involved in mitochondrial fusion mechanisms, optic atrophy 1 (OPA1) and mitofusin 2 (MFN2), were associated with AD in the Korean population by analyzing genotypes and allele frequencies. METHODS: One coding single nucleotide polymorphism (SNP) in the MFN2, rs1042837, and two coding SNPs in the OPA1, rs7624750 and rs9851685, were compared between 165 patients with AD (83 men and 82 women, mean age 72.3±4.41) and 186 healthy control subjects (82 men and 104 women, mean age 76.5±5.98). RESULTS: Among these three SNPs, rs1042837 showed statistically significant differences in allele frequency, and genotype frequency in the co-dominant 1 model and in the dominant model. CONCLUSION: These results suggest that the rs1042837 polymorphism in MFN2 may be involved in the pathogenesis of AD.
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Feminino , Humanos , Masculino , Doença de Alzheimer , Encéfalo , Codificação Clínica , Frequência do Gene , Genótipo , Dinâmica Mitocondrial , Atrofia Óptica Autossômica Dominante , Polimorfismo Genético , Polimorfismo de Nucleotídeo ÚnicoRESUMO
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.
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Humanos , Cuidadores , Demência , Administração Financeira , Institucionalização , Coreia (Geográfico) , Assistência de Longa DuraçãoRESUMO
We would like to correct the grant information.
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BACKGROUND: The verbal fluency test consists of two separate tests of semantic fluency and phonemic fluency. The performance patterns of these tests differ with the type of dementia. We studied the patterns of verbal fluency between Alzheimer's disease (AD) and subcortical vascular dementia (SVaD), and assessed the clinical utility of these tests. METHODS: The 1,475 selected participants comprised 73 normal control subjects, 673 patients with amnestic mild cognitive impairment (aMCI), 535 AD patients, 42 patients with subcortical vascular mild cognitive impairment (svMCI), and 152 SVaD patients. We analyzed the z-score for the total number of animal items as a semantic fluency index and the z-score of the phonemic total score as a phonemic fluency index. RESULTS: The performance of semantic fluency was lower than that of phonemic fluency in all groups. The SVaD group showed the worst scores and abnormal performances on both tests, while the AD group presented abnormal performance only for semantic fluency. Dividing the patients with dementia according to severity revealed a different pattern between AD and SVaD for the clinical dementia rating (CDR) stage of 0.5. The performance of the AD group declined gradually with CDR. However, the SVaD group performed very poorly in both tests even for very mild dementia (CDR stage of 0.5). The aMCI and svMCI groups exhibited similar performance patterns. CONCLUSIONS: The pattern of semantic and phonemic fluency was not clinically useful at the MCI stage, but it could be helpful in differentiating AD and SVaD in the early stage of dementia.
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Animais , Humanos , Doença de Alzheimer , Demência , Demência Vascular , Disfunção Cognitiva , Semântica , Análise e Desempenho de TarefasRESUMO
BACKGROUND AND PURPOSE: The one-day rivastigmine patch is reportedly well tolerated and has minimal side effects. However, Asian patients show more side effects than those in Western countries. We evaluated tolerability of the rivastigmine patch in South Korean patients with Alzheimer's disease (AD) and the specific factors affecting adverse events of the skin. METHODS: A 6-month, open labeled, multi-centered, observational study was carried out in 440 patients with probable AD from July 2009 to September 2010 (NCT01312363). RESULTS: A total of 25.9% of the patients experienced adverse skin events at the rivastigmine patch application site and 17.0% discontinued treatment due to adverse events at the skin application site. The most common adverse events were itching and erythema. Patients with an allergic history and users of electric heating appliances reported skin discomfort. Older age was associated with discontinuing treatment. CONCLUSION: These results suggest that the rivastigmine patch induced some adverse skin events and may contribute to understanding and improving skin tolerability to the rivastigmine patch.