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A longitudinal study of Alzheimer's disease: rates of cognitive and functional decline
- Authors:
- SUH Guk-Hee, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(9), September 2004, pp.817-824.
- Publisher:
- Wiley
The aim was to measure rates of decline in cognition and function in patients with Alzheimer's disease (AD) and to investigate their accelerating risk factors in Korea. This study presents longitudinal data on a community-based sample of 107 patients with AD, followed at 6 months and 12 months. The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini Mental State Examination (MMSE) and the Disability Assessment for Dementia Scale (DAD) were given. Mixed model analyses were conducted using the following independent variables: times of repeated assessment (0, 6 or 12 months), severity of dementia assessed by the Functional Assessment Staging (FAST) and individual indicators as covariates. Average annual rates of decline in the MMSE, the ADAS-cog and the DAD were 2.3, 11.4 and 15.1 points, respectively. Neither gender, duration of formal education, nor duration of AD since onset was significant predictors of cognitive and functional decline. Patterns of functional decline in total DAD, instrumental ADLs, planning and organization and performance subscale are linear as MMSE score declines, while those of the basic ADLs and the initiation are curvilinear. This naturalistic observational study measured rates of cognitive and functional decline in AD, and can provide reference data for further longitudinal studies or clinical trials. Further study will be necessary to determine whether linear or curvilinear pattern in functional decline is due to progression of AD itself or statistical artifact.
The prevalence of dementia in a metropolitan city of South Korea
- Authors:
- KIM Jungsoon, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(7), July 2003, pp.617-622.
- Publisher:
- Wiley
There are few studies on the prevalence of dementia in South Korea. This study was designed to estimate the prevalence rate of dementia in a metropolitan city of South Korea, Busan. This was a cross-sectional epidemiological study of 1101 residents aged 65 or over in a metropolitan city (Busan) as of 31 December 2001 who were selected with the stratified three-stage cluster sampling. Dementia was assessed by two-stage examination with Mini-Mental State Examination - Korean version (MMSE-K), psychometric measures and the Barthel index. Crude and sex-age adjusted prevalence rate were obtained. The crude rate was 7.4% (men 2.4%, women 10.5%). The sex-age adjusted rate was 7.0% (men 2.5%, women 9.0%) and 8.0% (men 2.7%, women 10.0%) when adjusted with Busan and whole Korean population, respectively. These results were lower than those of other domestic studies. This is the first well-designed total-population based epidemiologic study on the prevalence rate of dementia of the aged residing in Busan city. Further studies for evaluating the relationships with type and severity of dementia are needed.
Diagnosing dementia in a developing nation: an evaluation of the GMS-AGECAT algorithm in an older Korean population
- Authors:
- KIM Jae-Min, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(4), April 2003, pp.331-336.
- Publisher:
- Wiley
Numbers of older people are increasing rapidly in many developing nations and there is a pressing need for epidemiological studies of psychiatric morbidity, particularly dementia. Valid methods for case identification are an important first step. The Geriatric Mental State (GMS) is a widely used diagnostic instrument but has received little formal evaluation in developing nations. The objective of this study was to investigate the screening properties of GMS organic disorder with respect to clinically diagnosed dementia in an older Korean population, about half of whom have received no formal education. 746 people aged 65+ in Kwangju, South Korea who were participants in a community survey of psychiatic morbidity, completed a GMS interview (with diagnoses assigned through the AGECAT computerised algorithm) and, independently, received a clinical assessment for dementia. GMS organic disorder was diagnosed in 262 participants (35%) and DSM-IV dementia in 110 (15%). Increased age, female gender and lower education independently predicted disagreement between the two diagnoses. In these groups, GMS sensitivity to a clinical diagnosis of dementia remained high but specificity was markedly reduced. Dementia may be overestimated in developing nations if the GMS-AGECAT diagnosis of organic disorder is used alone. The validity of other diagnoses, such as affective disorder, may also be affected if the hierarchical diagnostic algorithm is used (i.e. where the diagnosis of organic disorder affects the likelihood of other diagnoses).
Agitated behaviours among the institutionalized elderly with dementia: validation of the Korean version of the Cohen-Mansfield Agitation Inventory
- Author:
- SUH Guk-Hee
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.378-385.
- Publisher:
- Wiley
The aim was to analyze the factor structure, the criterion validity, the internal consistency, inter-rater reliability and test-retest reliability of the Korean version of Cohen-Mansfield Agitation Inventory, to provide data on the frequency and distribution of agitated behaviours, and to compare patterns of agitated behaviours among the institutionalized elderly with Alzheimer's disease (AD) or Vascular dementia (VaD). The Korean version of the Cohen-Mansfield Agitation Inventory (CMAI-K) was administered to a total of 257 elderly with AD or VaD in a nursing home in Seoul, Korea. Three kinds of reliability and criterion validity were tested. Factor analysis using principal component analysis with the varimax rotation was performed. To identify different patterns of agitated behaviours, multiple logistic regression analysis was used. This study demonstrated satisfactory reliability and validity for the CMAI-K as an instrument measuring agitation in Korean dementia sufferers in nursing homes. Eighty-three percent of the subjects manifested one or more agitated behaviours at least once a week. Factor analysis yielded four subtypes of agitation: physically aggressive behaviours, physically nonaggressive behaviours, verbally agitated behaviours, and hiding/hoarding behaviours. These results indicate that the CMAI-K is a reliable and valid instrument to measure agitated behaviours in Korean elderly with AD or VaD. These results validate and expand previous research on the agitation in dementia, and guide in the development of interventions.