Alzheimer's disease (AD) is associated with cognitive and functional impairment as well as neuropsychiatric complications, including psychotic symptoms such as delusions and hallucinations. Recent studies strongly suggest that delusions should be separated from hallucinations. While AD with delusions is a phenotypically distinct from AD without delusions, subtypes of delusions may also define further distinct clinical entities. There has been also considerable debate as to whether delusions in patients with AD differ etiologically, phenomenologically, and therapeutically from delusions in other primary psychiatric illnesses. In other words, whether they are caused by changes to key areas of the brain that have been linked to the presence of delusions. This has led to speculation that these symptoms may respond better to certain drugs such as cholinesterase inhibitors. Integrating the epidemiology, clinical phenomenology, neuropathological and genetic literature for delusions in AD allows us to speculate on pathophysiology and is essential to making progress in the area of delusions in AD.
Alzheimer Disease* ; Brain ; Cholinesterase Inhibitors ; Delusions* ; Epidemiology ; Hallucinations ; Humans

With a rapidly aging society, geriatric mental health is emerging as important public health concern. Despite the short history of psychiatric epidemiology in Korea, recently, epidemiologic data regarding geriatric psychiatric problems has started to accumulate. In the current study, we reviewed epidemiological findings regarding geriatric mental health in Korea. It was found that up to 10% of the elderly suffer from dementia, and 10% to 20% from depressive disorder. Further, prevalence estimates of Alzheimer's disease ranged from 4.2% to 9.0%, and vascular dementia from 1.0% to 4.8%. Annual incidence rates for Alzheimer's were 2.7% to 3.4% whereas that for vascular dementia was found to be as low as 0.3%. The prevalence of major depressive disorder was 4.2% to 9.1%, while that of clinically significant depressive symptom was between 9.1% and 33.0%. Finally, those with alcohol use disorders were found to comprise up to 13.6% of elderly population and additionally, 22% to 58% of the elderly were found to have sleep difficulties. Thus major mental disorders are already prevalent among the Korean elderly and are likely to increase rapidly.
Aged ; Aged, 80 and over ; Alzheimer Disease/epidemiology ; Dementia/epidemiology ; Dementia, Vascular/epidemiology ; Depressive Disorder/epidemiology ; Humans ; Mental Disorders/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors

With a rapidly aging society, geriatric mental health is emerging as important public health concern. Despite the short history of psychiatric epidemiology in Korea, recently, epidemiologic data regarding geriatric psychiatric problems has started to accumulate. In the current study, we reviewed epidemiological findings regarding geriatric mental health in Korea. It was found that up to 10% of the elderly suffer from dementia, and 10% to 20% from depressive disorder. Further, prevalence estimates of Alzheimer's disease ranged from 4.2% to 9.0%, and vascular dementia from 1.0% to 4.8%. Annual incidence rates for Alzheimer's were 2.7% to 3.4% whereas that for vascular dementia was found to be as low as 0.3%. The prevalence of major depressive disorder was 4.2% to 9.1%, while that of clinically significant depressive symptom was between 9.1% and 33.0%. Finally, those with alcohol use disorders were found to comprise up to 13.6% of elderly population and additionally, 22% to 58% of the elderly were found to have sleep difficulties. Thus major mental disorders are already prevalent among the Korean elderly and are likely to increase rapidly.
Aged ; Aged, 80 and over ; Alzheimer Disease/epidemiology ; Dementia/epidemiology ; Dementia, Vascular/epidemiology ; Depressive Disorder/epidemiology ; Humans ; Mental Disorders/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors

Traumatic Brain Injury (TBI) is as common in elderly people as it is in young adults. Compared to TBI among young adults, TBI among the elderly differs in mechanism of injury, clinical presentation, comorbidities, and prognosis. This article begins with an overview of the literature on epidemiology, unique characteristics and pathophysiology of geriatric head injuries. Neurological sequelae and indices of general outcome following TBI will be disussed. We will discuss the proposed relationship between TBI and Alzheimer's disease, which lead to a greater understanding of the pathogenesis of both TBI and Alzheimer's disease. The literature about the assessment and management of TBI will be reviewed.
Aged* ; Alzheimer Disease ; Brain Injuries* ; Comorbidity ; Craniocerebral Trauma ; Epidemiology ; Humans ; Prognosis ; Young Adult

Cognitive function and its related issues were studied for 10 years in 766 elderly people aged 65 or more as of December, 1990 in Jookjang Myun, Pohang, Kyungpook Province. The major findings on prevalence of dementia, nature of questionable dementia, early cognitive symptoms of Alzheimer's disease, the meaning of a screening test for cognitive impairment, reliability of dementia diagnosis, variables affecting cognitive functions, relation of cognitive dysfunction to survival, and natural course of cognitive functions were summarized in this review.
Aged* ; Alzheimer Disease ; Cognition ; Dementia* ; Diagnosis ; Epidemiology* ; Gyeongsangbuk-do* ; Humans ; Mass Screening ; Neurobehavioral Manifestations ; Prevalence

Aging ; Alzheimer Disease ; diagnosis ; epidemiology ; prevention & control ; Humans ; Incidence ; Leisure Activities ; Psychological Tests

Objective: To construct and compare the dynamic prediction models of the risk of mild cognitive impairment (MCI) in the elderly based on six different cognitive function scales. Methods: Based on longitudinal data from the Alzheimer's Disease Neuroimaging Initiative from 2005 to 2020, Mini-mental state examination (MMSE), functional activities questionnaire (FAQ), Alzheimer's disease assessment scale-cognitive (ADAS-Cog) 11, ADAS-Cog13, ADAS delayed word recall (ADASQ4), and Rey auditory verbal learning test (RAVLT)_immediate were used as longitudinal cognitive function evaluation indicators to assess the longitudinal changes in cognitive function. The joint model was used to analyze association between indicators variation trajectory and survival outcome MCI, and construct the risk prediction model of MCI in the elderly, the linear mixed model was constructed the longitudinal sub-model which described the evolution of a repeated measure over time, a proportional hazards model was constructed the survival sub-model, and the two sub-models were connected through the correlation parameter (α). The areas under the receiver operator characteristic curve (AUC) were used to evaluate the predictive efficacy of the model in the follow-up period of (t, t+Δt). The starting point t was selected at the 30^th, 42^nd, and 54^th month, and the Δt was selected as 15 and 21 months. Based on the prediction model, an example of the research object was selected for dynamic individual predictions of the risk of MCI. Results: Finally, 544 older adults (aged 60 years and above) with normal baseline cognitive status were included, of which 119 cases (21.9%) had MCI during the follow-up process were regarded as the case group, and 425 cases remained normal as the control group. The joint model suggests that the longitudinal trajectories of the six evaluation indicators are all related to the risk of MCI (P<0.001). The risk of MCI decreased by 32.3% (HR=0.677, 95%CI: 0.541-0.846) and 10.8% (HR=0.892, 95%CI: 0.865-0.919) for each one-point increase of MMSE and RAVLT_immediate longitudinal scores. The risk of MCI increased by 53.2% (HR=1.532, 95%CI: 1.393-1.686), 36.2% (HR=1.362, 95%CI: 1.268-1.462), 23.2% (HR=1.232, 95%CI: 1.181-1.285), and 85.1% (HR=1.851, 95%CI:1.629-2.104) for each one-point increase of FAQ, ADAS-Cog11, ADAS-Cog13, and ADASQ4 longitudinal scores. AUC results show that RAVLT_immediate (0.760 2) and ADASQ4 (0.755 8) have higher average prediction efficiency, followed by ADAS-Cog13 (0.743 7), ADAS-Cog11 (0.715 3), FAQ (0.700 8) and MMSE (0.629 5). ADASQ4 joint model was used to provide a dynamic individual prediction of the risk of MCI. The average probability of MCI after five years of follow-up and ten years of follow-up in the example individuals were 8% and 40%, respectively. Conclusions: The RAVLT_immediate and ADASQ4 scales, which are only for memory tests, have high accuracy in predicting the risk of MCI. Using the RAVLT_immediate and ADASQ4 scales as longitudinal cognitive function evaluation indicators to construct a joint model, the results can provide a basis for realizing MCI risk prediction for the elderly.
Aged ; Alzheimer Disease/psychology* ; Cognition ; Cognitive Dysfunction/epidemiology* ; Humans ; Middle Aged ; Neuropsychological Tests ; Risk Factors

Through a systematic review and meta-analysis of epidemiological studies on dementia, we assessed the prevalence of dementia and its subtypes-Alzheimer' disease (AD) and vascular dementia (VaD)-in Korea. We searched for epidemiological studies on dementia published in 1990-2013 using PubMed, Scopus, EMBASE, KoreaMed, KISS, and RiCH. Dementia prevalence in elderly patients (aged> or =65 yr) was 9.2% (95% confidence interval [CI], 8.2%-10.4%) from 11 studies, which was higher than those from Western and other Asian countries. AD was the most prevalent dementia type, with a prevalence of 5.7% (95% CI, 5.0%-6.4%) from 10 studies compared with 2.1% (95% CI, 1.6%-2.7%) for VaD from 9 studies. The age-specific prevalence of dementia approximately doubled with each 5.8-yr increase of age. Although a significant increasing trend of dementia prevalence was not observed, it increased slightly from 7.3% to 8.7% after 2005; AD prevalence increased after 1995 and VaD prevalence decreased after the early 2000s. The AD/VaD ratio increased from 1.96 in the early 1990s to 4.13 in the 2010s, similar to the worldwide ratio. Owing to this high prevalence in the aging population, dementia will impose significant economic burdens to Korean society.
Age Factors ; Alzheimer Disease/epidemiology ; Asian Continental Ancestry Group ; Databases, Factual ; Dementia/*epidemiology ; Dementia, Vascular/epidemiology ; Humans ; Prevalence ; Quality Assurance, Health Care ; Republic of Korea

The polymorphism at codon 129 (M129V) of the human prion protein gene (PRNP) is a known risk factor for Creutzfeldt-Jakob disease (CJD) in Caucasians. There are few reports of this polymorphism's effect on memory and on the risk of Alzheimer's disease (AD). The M129V genotype distributions among Asians are very different from Caucasians. Another polymorphism, codon 219 (E219K) is not found in Caucasians. We investigated two polymorphisms of PRNP, M129V (rs1799990) and E219K (rs1800014) in 297 Korean AD patients and 217 healthy subjects. The analysis of the genotype and allele distributions showed no significant difference between the AD patients and the controls in both polymorphisms (P=0.19 genotype, P=0.51 allele for M129V; P=0.64 genotype, P=0.50 allele for E219K). Also, the PRNP polymorphisms were not significantly associated with AD when the populations were stratified for the presence or absence of apolipoprotein E-e4 (ApoE-epsilon4) allele. These results suggest that the PRNP genetic variants are not associated with the risk for AD in Korean population.
Prions/*genetics ; Polymorphism, Genetic/*genetics ; Male ; Korea/epidemiology ; Humans ; Genotype ; Genetic Predisposition to Disease/genetics ; Female ; Codon/genetics ; Apolipoproteins E/genetics ; Alzheimer Disease/*epidemiology/*genetics ; Alleles ; Aged

OBJECTIVETo study the predictive factors on mortality and survival of elderly dementia in Shanghai.

METHODSSubjects were from people who had been screened in a prevalence survey study from the selected 5 urban and 4 rural communities from 1997 to 1998. Phase I screening was carried out by a brief memory testing with mini-mental state examination. In phase II, those who scored below the cutoff points and 4% of those whose score was in the normal range were interviewed to identify dementia through a set of diagnostic examinations according to the DSM IV criteria. In phase III which was six months later, a follow-up program was conducted for all persons who were involved in phase II to identify those with Alzheimer's dementia (AD) and vascular dementia (VaD) according to NINCDS-ADRDA and NINDA-AIREN criteria and other types of dementia.

RESULTSThe mortality of elderly dementia was 6.06/1000 person-years. Compared to nondementia group, the survival rate of dementia group had a decrease of 57% after 40 months of follow-up (P < 0.05). There was no statistical difference between AD and VaD groups. The relative risk of death caused by dementia, AD and VaD were 1.63 (95% CI: 1.42-1.86), 1.71 (95% CI: 1.44-2.03) and 1.45 (95% CI: 1.16-1.82), respectively. Some factors such as age (RR = 1.0685), severalty (RR = 1.5733), and high ADL (RR = 1.0368) might have increased the risk of death among those patients.

CONCLUSIONThe mortality of elderly dementia in Shanghai was lower than that seen in other areas in the world. There was no obvious difference between the survival rates of AD and VaD patients. Age, severalty and high ADL seemed to be the risk factors to the death outcome.

Aged ; Alzheimer Disease ; mortality ; China ; epidemiology ; Dementia, Vascular ; mortality ; Female ; Humans ; Male ; Middle Aged ; Neuropsychological Tests ; Risk Factors