OBJECTIVES: The purpose of this study was to compare the efficacy between switching patients with Alzheimer's disease (AD) from galantamine or rivastigmine to donepezil because they were not responding adequately, and naive patients with AD who initiated therapy with donepezil. METHODS: A total of 108 patients were recruited for this 52-week study. The effect of donepezil on cognitive function was measured using Alzheimer's Disease Assessment Scale-cognitive subscale-preliminary Korean version (ADAS-cog-K). Patients' activities of daily living using Seoul-Activities of Daily Living (S-ADL) and the Seoul-Instrumental Activities of Daily Living (S-IADL);behavioral symptoms using the Korean version Neuropsychiatric Inventory (K-NPI) were measured at baseline, 13-weeks, 26-weeks, 39-weeks and 52-weeks. We defined the responsive patients to donepezil at those who showed a cognitive improvement or no change during the first six-month clinical trial. RESULTS: 86 naive patients and 22 switching patients were enrolled in the study. 74 patients completed the study and 34 discontinued their treatment before week 52. There was no significant difference between two patient groups in demographic data, baseline characteristics and dementia severity except duration of illness. The total ADAS-cog-K scores were not significantly different from baseline after 52 weeks of treatment in both groups. Both groups demonstrated deterioration of S-ADL and S-IADL at 52 weeks. The NPI scores did not significantly change in both groups. Based on the operational criteria, 61.6% of the naive group and 54.5% of the switching group were responders to donepezil. CONCLUSION: The switching group had similar levels of efficacy with the naive group who initiated therapy with donepezil. These results suggest that patients not responding adequately to rivastigmine or galantamine may improve or stabilize after switching to donepezil and prior medication does not effect donepezil's efficacy.

OBJECTIVES: The suicide rate has been increasing among the aged Koreans since 1990. However, there is few study on the epidemiology, causes, and strategies to help them. METHODS: The data were collected by the internet search for the journals and documents of studies on the suicide among aged Koreans from 1995 thru 2006. RESULTS: 1) The suicide rate (36.1 per 100,000) in the Korean elderly with age over 65 has been increasing over 50% since 1998, which estimated as 19.9 times of that in the general population. 2) The biopsychosocial factors possibly related to the elderly suicide in Korea are age, depression, bereavement, physical illness, elder abuse, poor economy and social support system. The poor economy, elder abuse and depression seemed to be the most influential. 3) The rate of the elderly suicide in Korea can be reduced with the active prevention by early detection and intervention of risk factors. CONCLUSION: The strategy including reduction of risk factors, regional welfare services and policy seems to be needed for the prevention of elderly suicide in Korea.
Aged* ; Bereavement ; Depression ; Elder Abuse ; Epidemiology ; Humans ; Internet ; Korea ; Risk Factors ; Suicide*

No abstract available.
Dementia*

No abstract available.
Silver*

The authers reported one case of manic episode that occured after retirement in a 63 year old male patient. There was no psychiatric past history and family history. Also there was no abnormal finding on laboratory examination. This patient had received small doses of antidepressants anxiolytic and hypnotic (amitriptyline 10 mg, lorazepam 0.5 mg, triazolam 0.25 mg) to control insomnia since 3 months ago before admission. This patient showed manic symptoms such as grandious idea, expansive and irritable mood, increased psychomotor activity and insomnia after retirement. Pharmacotherapy (lithium and chloropromazine) supportive psychotherapy and family therapy were administered. Excessive motivation for work after retirement and small dose of antidepressant were suspected to trigger a manic episode in this elderly patient. We also reviewed literatures about pathophysiology of elderly manic disorder.
Aged* ; Antidepressive Agents ; Bipolar Disorder ; Drug Therapy ; Family Therapy ; Humans ; Irritable Mood ; Lorazepam ; Male ; Middle Aged ; Motivation ; Psychotherapy ; Retirement* ; Sleep Initiation and Maintenance Disorders ; Triazolam

OBJECTIVES: This study aimed to evaluate the effects of severity of functional disability, caused by physical illness, on the depressive symptoms and depressive disorders of the elderly patients (above 65 year-old) with physical illness. METHOD: Complete medical and psychiatric evaluations were achieved on 138 patients, except the 12 patients, who were severely cognitively impaired (MMSE-K score;below 19), of the 150 elderly patients (above 65 year-old) with physical illness. Sociodemographic data and health characteristic data were systematically collected, and the severity of functional disability caused by physical illness was evaluated. Depression scales (KGDS, GDS, MADRS) on 138 elderly patients were executed. In addition, based on the 61 patients of the 65 elderly patients (above 65 years old) with physical illness, except 4 patients who were severely cognitively impaired (MMSE-K score;below 19), sociodemographic data and health characteristic data were collected. The clinical diagnosis by DSM-IV diagnostic criteria and KGDS on 61 elderly patients were performed, and their functional disability caused by physical illness was evaluated. RESULTS: The frequency of depressive symptoms showed 50.0%, 36.2%, and 35.5%, respectively in KGDS, GDS, and MADRS. The patients with severe functional disability caused by physical illness-compared with those with mild functional disability-had significantly higher score on the depression scales (KGDS, GDS, MADRS). The correlation between severity of functional disability caused by physical illness and depression scales was highly positive. Severity of functional disability caused by physical illness was the strongest contributor to the depression scales. In the additional study, 19.7% of patients were diagnosed as major depressive disorder, 18% of them as dysthymic disorder, and depressive disorder (major depressive disorder & dysthymic disorder) group-compared with nondepressive disorder group-showed significantly higher score on the FDRPT and KGDS. CONCLUSION: The frequency of depressive symptoms and depressive disorder in elderly patients with physical illness was higher, compared with those in general elderly people. Functional disability caused by physical illness most highly influenced on depressive symptoms. Thus, it is important to discriminate whether the elderly patients with physical illness have depressive symptoms or not. In addition, we assumed that KGDS was not only highly correlated with other depression scales (GDS, MADRS), but also had the high diagnostic power of dis-crimination for depressive symptoms and depressive disorder. This study suggested that KGDS was available in screening depression in the elderly patients with physical illness. It was necessary to study systematically the availability of KGDS in the future.
Aged* ; Depression* ; Depressive Disorder ; Depressive Disorder, Major ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dysthymic Disorder ; Humans ; Mass Screening ; Weights and Measures

The authers investigated risk factors between vascular dementia and Alzheimer's dementia patients admitted in Chung-Ang University Hospital and Inchen Eun Hea Hospital from October 1996 to Feburary 1997. Chart review was done and complete those were selected and final disgnoses of dementia for subjects (74) were made by DSM-IV and NINCDS-ADRDA criteria. Risk facters were studied between vascular dementia and Alzheimer's dementia. The results were as follows. 1) Alzheimer's dementia patients were 48 (male 16, female 32), mean age of those was 76.65 (+/-7.47) years and duration of education of those was 3.58 (+/-4.79) years. Vascular dementia patients were 26 (male 7, female 19), mean age and duration of education of those were 73.92 (+/-6.69) years and 5.04 (+/-5.27) years respectively. 2) With respect to risk factors , vascular dementia patients were more likely have a history of hypertension and general anesthesia. 3) We found no difference in history of COPD, diabetes mellitus, alcohol abuse, family history of dementia, closed head trauma and cigarette smoking.
Alcoholism ; Anesthesia, General ; Dementia* ; Dementia, Vascular* ; Diabetes Mellitus ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Female ; Head Injuries, Closed ; Humans ; Hypertension ; Pulmonary Disease, Chronic Obstructive ; Risk Factors* ; Smoking

Chronic and excessive alcohol consumption produces a subtle brain damage, which induces such organic mental disorders as delayed mental processes, abstract thinking impairment, and disturbances in learning and recent memory loss. These phenomena had been known to be caused by malnutrition. However, recent researches showed that it could be caused by mild brain lesions by direct neurotoxic effect of alcohol on the prefrontal cortex, or its related subcortical structures. This study was tried to evaluate the effect of alcohol on the short-term memory function, to compare with the histological changes, and to find out responses to the agonists and antagonists of possibly related neurotransmitters. For experiment 1, 10 aged male Sprague-Dawley rats weighed about 400-500 gm were used. 45 younger adult male Sprague-Dawley rats weighed about 200-300 gm were used for experiment 2 and 3. Therefore, 55 rats were totally used. In experiment 1, T-maze test with 10 nomal aged rats were done first, and then it was divided into 5 atropine-administered group and 5 control group. For the atropine-administered group, T-maze test was repeated on every 30, 60, 120 minute after the atropine injection. After the completion, of behavioral tests, the rats were sacrificed by the intracardiac perfusion with phosphate buffered 10% formaldehyde solution, and the brain specimen was stained with hematoxylin-eosin to count cells in the prefrontal cortex and the hippocampus. In experiment 2, T-maze test with 10 normal younger adult rats were done first, and then it was dividied into five 14% (v/v) ethanol administered group and 5 control group raised with tap water. T-maze test was repeated on every week for a month. After the completion of behavioral tests on the 4th week, histology was done by the same procedure. In experiment 3, T-maze test with 35 normal younger adult rats were done first, and then it was divided into seven groups with five rats each other. 14% (v/v) ethanol was administered ad libitum. In addition, normal saline, fluoxetine, bromocriptine, bethacholine, nimodipine, clonidine, and ketamine were intramuscularly injected on every other day. T-maze test was repeated on every week for a month. After the completion of behavioral tests on the 4th week, histology was done by the same procedure. 1) The reaction time of T-maze test was more delayed on 120 minutes after atropine injection in atropine-administered rats than those in normal aged rats without statistical significance. 2) The reaction time of T-maze test was more delayed in ethanol-treated rats, especially most prominent on the 3rd week, than those in normal younger adult rats without statistical significance. However, cell numbers in the CA1, CA3, dentate gyrus and the prefrontal cortex were significantly reduced in ethanol-treated rats on histology (p<0.05). 3) The reaction time of T-maze test was more shortened in fluoxetine and ketamine-treated rats on the 1st week without statistical significance. It was rather shortened in fluoxetine, ketamine, bromocriptine and nimodipine-treated rats without statistical significance on the 2nd week. On the 3rd week, the reaction time of T-maze test was shortened in every drug-treated rats. It returned to be delayed in all but fluoxetine, clonidine and bethacholine-treated rats on the 4th week without statistical significance. However, cell numbers in the CA1 were significantly increased in bromocriptine-treated rats (p<0.05) and in bethacholine-treated rats (p<0.01). In the CA3 and the dentate gyrus, cell numbers in bethacholine and clonidine-treated rats were significantly increased (p<0.05 respectively). In the prefrontal cortex, cell numbers in bethacholine-treated rats were significantly increased (p<0.005) on histology. 4) While there were no significant difference on the reaction time of T-maze test between ethanol-treated group, normal aged group and atropine-treated group, cell numbers in the prefrontal cortex were significantly different between those of normal aged group and atropine-treated group (p<0.05). Cell numbers in the prefrontal cortex of ethanol-treated group were signifncantly correlated with those of atropine-treated group (r=0.977, p<0.001), and of normal aged group (r=0.448, p<0.05). In conclusion, we should not neglect the risk of memory loss even in the subclinical cases, because neuronal cells in the prefrontal cortex and the hippocampus were significantly reduced on histology, while ethanol-induced short-term memory loss was not functionally significant. The drug responses in this experiments showed that the mechanism of alcohol-induced short-term memory loss might be mainly related with cholinergic system. Otherwise, adrenergic or dopaminergic mechanisms could be involved. Furthermore, we could not exclude the possiblity that pathological aging process might be exerted as an important mechanism underlying alcoholic dementia.
Adult ; Aging ; Alcohol Drinking ; Alcoholics* ; Animals ; Atropine ; Brain ; Bromocriptine ; Cell Count ; Clonidine ; Neurocognitive Disorders ; Dementia* ; Dentate Gyrus ; Ethanol* ; Fluoxetine ; Formaldehyde ; Hippocampus ; Humans ; Ketamine ; Learning ; Male ; Malnutrition ; Memory Disorders ; Memory, Short-Term* ; Mental Processes ; Neurons ; Neurotransmitter Agents ; Nimodipine ; Perfusion ; Prefrontal Cortex ; Rats ; Rats, Sprague-Dawley ; Reaction Time ; Thinking ; Water

The purpose of this study is to compare the difference of the tendency for depression and leisure functioning between two elderly groups in differnt socio-cultural environment. Also, this study investigated whether the difference of lesiure functioning affected the tendency for depression. The participants are 55 elderly residing in the nursing home in Seoul and 35 Sahalin returning Koreans in KangWon-Do. Leisure Diagnostic Battery (LDB) developed by Witt and Eliss (1987) was used to measure leisure functioning of the elderly and Yesavage (1983)'s Geriatric Depression Scale (GDS measured the tendency of depression. The LDB and GDS were gathered through interviewing. The result of this study reports that the tendency of depreesion in Sahalin returning Koreans was higher than the elderly in Seoul. And the result supports the hypothesis that the elderly in Seoul who have maintained higher leisure functioning showed lower depression level than the Sahalin elderly who had poor leisure functioning. In other words, there were significance between these two groups. This study suggests that education and the leisure program shoud developed and applied for the higher leisure functioning and satisfaction of the elderly (especially elderly in nursing home).
Aged* ; Depression* ; Education ; Gangwon-do ; Humans ; Leisure Activities* ; Nursing ; Nursing Homes ; Seoul

This study was aimed to standardize the Korean Geriatric Depression Scale (KGDS). In order to slove the unsatisfied discriminating power of Geriatric Depression Scale (GDS:Yesavage et al. 1983) presented in Korean studies, the authors made KGDs. The preliminary KGDS was costructed of 40 items selected from GDS, BDI, SDS, MMPI-D, CES-S and had satisfied reliability and validity, but had some problems in item contents, number of times, and sampling. Thus by correcting these problems, the authors made new KGDS of 30 item, and tested the reliability and validity of the final version of KGDS. The values of Cronbach's alpha and Split-half reliability were .88 and .79 respectively, and correlational coefficent with GDS was .87. The differences of means was signified at alpha=.001 level (patients group mean=17.82 (10.52), control group mean=10.52 (5.12), t=12.07). On factor anlaysis, 5 factors in KGDS were extracted. They were labeled Emotional discomfort (factor 1), Negative thinking and Unhappinesss feeling (factor 2), Physical weakening and decreased vitality (factor 3), Cognitive dysfunction (factor 4), Decreased social interest and activity (factor 5), which represent depressive features of the elderly in thought, emotional, cognitive, physical, social aspects. The total percentage of variance of 5 factors was 53.72%. The result of discriminatin anlaysis showed that hit ratio of KGDS was 75%, and the score of 14 was suggested as the optimal cut-off score. Additionally, by use percentile score distribution of control group (normal) subjects, each of the score of 14-18, 19-21, over 22 suggested borderline or mild depression, moderate depression, severe depression, respectively. Conclusively, the final version of KGDS not only improved diagnostic discriminatory power approxtimately 10% than GDS, but also showed satisfiable reliability and validity. So the KGDS could be a useful tool for evaluaion of elderly depression.
Aged ; Depression* ; Humans ; Reproducibility of Results ; Thinking