No abstract available.
Nootropic Agents*

OBJECTIVES: To develop the Korean version of Disability Assessment for Dementia Scale(DAD-K), an instrument for functional disability for use with proxy-respondents of community-dwelling persons who have Alzheimer`s disease METHOD: Community-dwelling elderly and their caregivers with memory impairment(N=341) participated in this study to evaluate reliabilities and validities of DAD-K. RESULTS: The DAD-K demonstrated a high degree of internal consistency(Cronbach`s alpha=0.88) and excellent interrater(ICC=0.96) and test-retest(ICC=0.96) reliability and good concurrent validity. In addi- tion, it was found not to have age, education and gender bias. CONCLUSION: The DAD-K is valid and reliable instrument in Korean elderly with Alzheimer`s disease, that may help clinicians and caregivers of the population with Alzheimer`s disease make decisions regar- ding the choice of suitable interventions.
Aged ; Caregivers ; Dementia* ; Education ; Humans ; Memory ; Sexism

BACKGROUND: The present study aims to examine the reliability and validity of a Korean version of the CAMCOG-R(CAMCOG-RK) in a clinical setting and an institution, that have been widely used to detect early dementia. METHODS: Study participants included 243 dementia sufferers, 68 mild cognitive impairment(MCI) suffers and 354 non-demented subjects. DSM-IV clinical criteria for dementia and Petersen's criteria for MCI were used as the 'gold' standards. The CAMCOG-R was translated into Korean and then back to English. Six items needed modifications for local usage. RESULTS: Interrater and test-retest scores calculated as intraclass correlation coefficients showed excel- lent for total score and all subscale scores of CAMCOG-RK. A strong concurrent validity was found with the MMSE-K score(r=0.82, p<0.01). Examination of the association between CAMCOG-R scores and socio- demographic variables(age, sex, and education) shows that age and education exerts a significant, and independent, effect upon performance. The eight age and education-specific cutoff point for dementia and MCI provided excellent sensitivity and specificity mostly more than 90%. CONCLUSION: The CAMCOG-RK was found to be an appropriate instrument to discriminate between demented and non-demented individuals and between individuals with MCI and without MCI in a clinical setting. Further studies should examine the psychometric characteristics of the CAMCOG-RK in a more varied sample.
Dementia* ; Diagnosis* ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Korea ; Psychometrics ; Reproducibility of Results ; Sensitivity and Specificity

OBJECTIVES: To develop the Korean version of Alzheimer`s Disease Assessment Scale(ADAS-K), an instrument for assessment of cognitive decline and behavioral symptoms seen in persons with Alzheimer`s disease METHOD: Community-dwelling elderly with Alzheimer`s disease(n=198) and mild cognitive impairment (n=30) participated in this study to evaluate reliabilities and validities of ADAS-K. RESULTS: The ADAS-K demonstrated a high degree of internal consistency and excellent interrater and test-retest reliability and high concurrent validity. Optimal cutoff points for the ADAS-K and ADAS-K-cog were 20/21(sensitivity 91%, specificity 83%) and 17/18(sensitivity 91%, specificity 93%). CONCLUSION: The ADAS-K is valid and reliable instrument in Korean elderly with Alzheimer`s disease, that may have potential to improve research outcomes and reduce the time and costs of research.
Aged ; Behavioral Symptoms ; Cognition* ; Dementia* ; Humans ; Mild Cognitive Impairment ; Sensitivity and Specificity

OBJECTIVES: Alcohol-induced oxidative stress has been known to injure various tissues or organs. This stress is related with free radicals which are produced as the result of long-term alcohol consumption. Malonyldialdehyde(MDA) is produced by the interaction of free radicals and cell membrane lipids, and indicates the degree of lipid peroxidation indirectly. The purpose of this study was to investigate the relationship between red blood cell(RBC) membrane lipid peroxidation by free radicals, and associated hepatic injuries and hematologic changes. METHODS: Thirty-three subjects diagnosed as alcohol dependence according to DSM-IV diagnostic criteria were evaluated within 72 hours after discontinuing alcohol drinking. Clinical characteristics were evaluated by CAGE questionnaire and Korean Michigan Alcoholism Screening Test(MAST). RBC membrane MDA level was measured as the marker of RBC membrane lipid peroxidation. Aspartate aminotransferase(AST), alanine aminotransferase(ALT) and gamma-glutamyltransferase(GGT) were used as the biochemical markers of liver damage due to alcohol ingestion. The alcohol-induced hematologic change was assessed by mean corpuscular volume(MCV). RESULTS: The results were as follows. Clinical characteristics were not different between two groups having normal and abnormal levels of AST, ALT, GGT or MCV. The levels of MDA were not correlated with the clinical characteristics and serum levels of AST, ALT and GGT. However, there was a significant correlation between the levels of MDA and the value of MCV(p=0.017). CONCLUSIONS: These findings suggest that oxidative stress in alcohol dependence may not be reflected in liver enzyme markers such as AST, ALT and GGT, but may be reflected in MCV.
Alanine ; Alcohol Drinking ; Alcoholism* ; Aspartate Aminotransferases ; Aspartic Acid ; Biological Markers ; Diagnostic and Statistical Manual of Mental Disorders ; Eating ; Erythrocyte Indices* ; Erythrocytes* ; Free Radicals ; Humans ; Lipid Peroxidation* ; Liver* ; Mass Screening ; Membrane Lipids ; Membranes* ; Michigan ; Oxidative Stress ; Surveys and Questionnaires

Alzheimer's disease (AD) is the most common cause of dementia in the elderly. AD afflicts 0.3 to 0.5 million people in Korea, and the number is projected to increase to 2 million by the year of 2050. This article provides a brief overview of the most popular drug therapies in the treatment of AD including cholinesterase inhibitors (AchEIs) (donepezil, galantamine, rivastigmine), NMDA receptor antagonist (memantine), acetyl-l-carnitine, antioxidant vitamins, and Ginko biloba. Based on a review of relevant papers in the literature, this article presents pharmacological and clinical safety profiles of these agents and prescribing tips as well as a final summary on the effectiveness, safety, and alerts for clinicians. AchEIs as well as memantine will continue to play an important role in the treatment armamentarium for AD, even though newer strategies are being explored. There is not enough evidence supporting the continuous use of other drugs such as acetyl-l-carnitine, antioxidant vitamins, and Ginko biloba for the treatment of AD.
Acetylcarnitine ; Aged ; Alzheimer Disease* ; Cholinesterase Inhibitors ; Dementia ; Drug Therapy* ; Galantamine ; Ginkgo biloba ; Humans ; Korea ; Memantine ; N-Methylaspartate ; Vitamins

Hachinski coined the term 'multi-infarct dementia', which now changed to 'vascular demntia', and used the Hachiski Ischemia Score (HIS) to differentiate multi-infarct dementia from Alzheimer's disease since 1974. The past two decades has seen a renewed interest in vascular dementia. New classification systems like DSM-IV, ICD-10, NINDS-AIREN and ADDTC have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke. Various aspects of clinical manefestation of vascular dementia were discussed and presented as tables.
Alzheimer Disease ; Classification ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular ; Diagnosis* ; Diagnostic and Statistical Manual of Mental Disorders ; International Classification of Diseases ; Ischemia ; Neuroimaging ; Numismatics ; Stroke

OBJECTIVES: The aim of this study was to investigate mortality rates and risk factors in dementia patients in a rural cohort. METHODS: A total of 114 subjects with clinically diagnosed dementia were followed up for eight years from 1997 to 2005. Their mortality was compared with sociodemographic and clinical variables using the Cox proportional hazards models after adjusting age, sex, and education. RESULTS: During follow-up, the mortality rate of subjects was 80.2% and the mean (SD) duration of survival from at diagnosis to death was 4 years. Mortality in subjects with dementia depended on old age (relative risk [RR] : 1.05 ; 95% confidence interval [CI] : 1.01-1.08), male (RR : 1.61 ; CI : 1.00-2.59), low Clinical Dementia Rating scale (RR : 1.54 ; CI : 1.14-2.10), low Activities of Daily Living (RR : 0.72 ; CI : 0.59-0.89), low Instrumental Activities of Daily Living (RR : 0.83 ; CI : 0.75-0.92), no physical activity (RR : 0.44 ; CI : 0.28-0.70), smoking (RR : 1.74 ; CI : 1.05-2.89). CONCLUSION: Mortality in dementia depended on age, sex, CDR, ADL, IADL, physical activity, smoking. These findings have important implications that contribute to make the disease management of dementia patients.
Activities of Daily Living ; Cohort Studies ; Dementia* ; Diagnosis ; Disease Management ; Education ; Follow-Up Studies ; Humans ; Male ; Mortality* ; Motor Activity ; Proportional Hazards Models ; Risk Factors* ; Smoke ; Smoking

OBJECTIVE: This study estimated the expected cost-effectiveness ratio expressed as the incremental cost per seizure-free day (SFD) gained and the incremental cost per quality adjusted life year (QALY) gained when using levetiracetam (LEV) as add-on therapy from a third-party payer perspective. METHODS: A 1-year dose-escalation decision-tree model comparing LEV plus standard therapy (ST) with ST alone was designed to combine transition probabilities, costs and outcomes. The short-term outcomes and probabilities were derived from a prospective, open-label clinical trial with 100 Korean adults with refractory partial epilepsy. All data for the direct medical costs were derived from Korean cost data extracted from reports published by the National Health Insurance Corporation. RESULTS: The average gain in SFDs attributed to LEV add-on was 18.3 days per patient per year and the incremental cost-effectiveness ratios (ICERs) for LEV add-on were US$ 44 per SFD per patient and US$ 11,084 per QALY gained. All sensitivity analyses showed that the model was robust to the assumptions made. CONCLUSION: The economic evaluation indicates that, given a wide range of assumptions, the increased cost of treating patients having refractory partial epilepsy with LEV may be partially offset by a reduction in other direct medical costs. This reduction is a consequence of an increase in the number of SFDs and improved quality of life.
Adult ; Epilepsies, Partial ; Epilepsy ; Humans ; Insurance, Health, Reimbursement ; Korea ; National Health Programs ; Piracetam ; Prospective Studies ; Quality of Life ; Quality-Adjusted Life Years

OBJECTIVE: The study aims to compare daily treatment costs of risperidone and olanzapine in the Korean RODOS data. METHODS: Retrospective inpatient chart review yielded pharmacoeconomic data of 1096 patients with schizophrenia and schizoaffective disorder. RESULTS: The mean+/-SD daily effective dose of olanzapine treatment was 14.9+/-5.3 mg compared to 5.1+/-1.8 mg for risperidone. Use of concomittant neuroleptics was higher in olanzapine group (risperidone 29%;olanzapine 35%;p=0.034), while use of other concomitant drugs was higher in risperidone group (risperidone 97%;olanzapine 90%;p<0.001). The mean+/-SD total costs of all inpatient drugs was significantly higher (p<0.001) for olanzapine (338, 431 Korean Won+/-289, 884) than risperidone (114, 775 Korean Won+/-97, 835). Although this difference in the average total costs in part reflects the longer treatment duration for olanzapine compared to risperidone (52 day versus 43 day), the cost difference remained when looking at costs on a daily basis and when correcting the baseline differences. The mean+/-SD daily costs of all inpatient drugs was significantly higher (p<0.001) for olanzapine (9, 407 Korean Won+/-10, 767) than risperidone (4, 475 Korean Won+/-4, 312). CONCLUSION: When both olanzapine and risperidone are considered appropriate, it is desirable to choose risperidone first in terms of the pharmacoeconomic consideration of the cost of these drugs.
Antipsychotic Agents ; Economics, Pharmaceutical ; Health Care Costs ; Humans ; Inpatients ; Psychotic Disorders ; Retrospective Studies* ; Risperidone* ; Schizophrenia