OBJECTIVES: This study aimed at investigating the diagnostic predictability of Cognitive Impairment Diagnosing Instrument(CIDI) in diagnosing dementia of elderly people aged 60 years or more. METHODS: The subjects were 129 patients with other mental diseases than dementia whose ages were more than 60 years and 86 patients with dementia. Psychiatric diagnoses were made by according to the DSM-IV criteria. Converted age(chronological age minus 59) was employed for the statistical reason. The length of education was classified into 4 intervals:1 for less than one year schooling, 2 for grade schooling, 3 for junior or senior high schooling and 4 for college or more schooling and each number expresses ordinal scale. The converted age, length of education expressed by one of 4 interval scores, and total CIDI score were independent variables while the diagnosis(dementia vs nondementia) was dependent variable in the logistic regression analysis. RESULTS: -2 log likelihood was 102.773 when the length of education, converted age and total CIDI score were included while it was 289.395 when only the constant was included(K 2=186.622, df=3, p=0.000). The goodness-of-fit statistic was 156.798(K 2=6.5843, df=8, p=0.5821), and the overall concordance of diagnostic classification was 90.2%. The logistic regression equation for the diagnosis of dementia was generated as follows:y=7.5752+0.0940*X 1+0.9820*X 2-0.1811*X 3(y=ln{pai/(1-pai)}, X 1:converted age, X 2:education intervals, X 3:total CIDI score, pai:possibility of dementia, > OR =0.50 indicating dementia and <0.50 indicating nondementia). The e bs(95% C.I.) for the converted age, education interval and total CIDI score were 1.0985(1.0107-1.1940), 2.6699(1.4134-5.0436), 0.8344(0.7898-0.8815), respectively. CONCLUSIONS: The CIDI could be considered as a useful diagnostic tool for dementia using the logistic regression analysis.
Aged ; Classification ; Cognition ; Dementia* ; Diagnosis* ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Humans ; Logistic Models

OBJECTIVES: This study was conducted to delineate the long-term natural change of cognitive functions in aged community residents, using the Korean version of the mini-mental state examination (MMSEK) METHODS: The first MMSEK was administered to as the screening test for identification of dementia between January and December, 1990 in a total of 702 persons. They were residents of a Myun area, Pohang, Kyungpook Province and 65 or more as of December 31. 1990. The MMSEK was repeated from November, 1995 to June, 1996, using the Cognitive Impairment Diagnosing Instrument and was successful in 440. RESULTS: The 6-year mean(+/-SD) decline of the total MMSEK score was 1.52+/-3.45 and 6.42%. Of the subtests, memory registration showed no significant decline while comprehension/judgement improved significantly. The decline was most prominent in attention/calculation and memory recall, and then language, orientation in time and orientation in place in order. Change of the total score was not related to sex, education and the first total score. Decline of language function was more severe in the educated than in the noneducated-illiterate. Performances of all subtests declined significantly with aging and improvement of the comprehension/judgement was less prominent in the group aged 75 or more. Relations of the change with the first total score were inconsistent among the subtests. The stepwise multiple regression analysis revealed that age, the first total score and education were the variables significantly affecting the decline of MMSEK score. However, they could account for only 16.4% of the variance of decline of the total MMSEK score. CONCLUSIONS:Decline of the cognitive function was small during the 6-year period, and the change pattern was not homogenous among the subtests. Age, the first total MMSEK score and education were idenrified as significant, but not so important, factors accounting for the variance of the cognitive decline.
Aged* ; Aging ; Cognition ; Dementia ; Education ; Follow-Up Studies* ; Gyeongsangbuk-do ; Humans ; Mass Screening ; Memory

OBJECTIVES: To study of the effects of gender, age and education on the MMSEK performances in the elderly. METHOD: The MMSEK was administered to a total of 702 persons aged 65 or more in a rural area. The effects on the total and subtest MMSEK scores of the 3 independent variables were analyzed by Student t-test, Pearson's correlation, oneway analysis of variance, analysis of covariance, and stepwise multiple regression. RESULTS: The total and all subtest scores of MMSEK were found to be affected by age. All subtest, except memory registration and memory recall, scores were affected by education and sex. 39.6% of the variance of total MMSEK score could be accounted for by the 3 variables. CONCLUSIONS: 40% of the variance of the total MMSEK score could be accounted for by age, gender and education while the remaing 60% is assumed to be affected by other variables than age, sex, and education. Memory registration and memory recall seems to be resistant to sex and education effect, but sensitive to aging.
Aged* ; Aging ; Cognition ; Education* ; Humans ; Memory ; Rural Population*

OBJECTIVES: This study was conducted in order to evaluate reliability and diagnostic validity of the CIDI. METHODS: 64 patients with DSM-IV dementia and 90 elderly patients with other mental disorders entered this study. Inter-subtest Pearson's correlations, corrected subtest-total correlations and Cronbach's alpha were computed for reliability while correlations of the total scores on CIDI with the performances on other scales relating to dementia, sensitivity and specificity, area under curve using the receiver operating characteristic curve, and group comparison were used for the assessment of validity. RESULTS: The CIDI's inter-subtest correlations ranged from 0.596 to 0.813, with a mean of 0.707. The corrected subtest-total correlations were between 0.759 and 0.890. Cronbach's alpha of the subtests was 0.941 and the Cronbach's alpha were between 0.928 and 0.948 when any subtest was deleted. In the demented subjects, the correlation coefficients of the total CIDI score with the performances on S-SDQ, IADL, BADL, BDRS, and MMSEK were around 0.5. Area under the receiver operating curve of CIDI was 0.933 with the standard error of 0.021(95% CI, 0.891-0.975). At the CIDI cutoff point of 65/66, sensitivity and specificity were 95.3% and 85.6%, respectively. The corresponding values of MMSEK were 0.930, 0.020 (95% CI, 0.891-0.969), 22/23, and 89.1% and 85.6%. The demented scored much poorer in all CIDI subtests than the nondemented mental patients, and the differences were highly significant. CONCLUSIONS: The CIDI was satisfactory regarding to reliabilities and diagnostic validities. The CIDI and MMSEK are thought to be reciprocal in assessment of cognitive functions: CIDI is preferable for clinical assessment of cognitive dysfunction and MMSEK for as a screening test.
Aged ; Area Under Curve ; Cognition ; Dementia ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening ; Mental Disorders ; Mentally Ill Persons ; ROC Curve ; Sensitivity and Specificity ; Weights and Measures

PURPOSE: Benign prostatic hyperplasia (BPH) frequently combines other geriatric diseases, which affect voiding in complicated manner. However, differential diagnosis of BPH attributable to voiding dysfunction in such complicated cases has been difficult. Videourodynamic study, allowing the better correlation of structure and function, have had an important position in the diagnosis of various kind of voiding dysfunction. We compared diagnostic values between traditional pressure-flow study and videourodynamic study in the evaluation of the BPH. MATERIAL AND METHODS: Forty-seven men were subjected to this study, who showed lower urinary tract symptoms (LUTS) secondary to BPH combined with other underlying diseases (cerebrovascular disease, spinal cord injury, diabetes mellitus, Parkinson's disease) which could affect the voiding pattern. Included was patients older than 50 years, with a total International Prostate Symptom Score (IPSS) of 8 points or more. All patients were evaluated with detailed history, physical examination including digital rectal examination, prostate specific antigen (PSA), transrectal ultrasonography (TRUS), and videourodynamic study. Pressure-flow study was additionally performed in 27 patients who had been diagnosed as equivocal or obstructed or unobstructed on videourodynamic findings. RESULTS: The sensitivity of videourodynamic study and pressure-flow procedures was 87% and 55%, respectively, as complete pressure-flow data are not available in 12 patients due to difficult urination by catheterization. The specificity of videourodynamic study and pressure-flow study was 76% and 100%, respectively. Videourodynamic study additionally showed uninhibited bladder contraction and/or detrusor sphincter dyssynergia (internal or external) in 65.1% of the patients, which are not available from pressure-flow study. CONCLUSIONS: To diagnose voiding dysfunction from BPH in complicated case, videourodynamic study showed advantages over pressure-flow study in terms of diagnostic sensitivity, both functional and anatomical informations on lower urinary tract. It is likely that the videourodynamic study is the method of choice for the assessment of voiding dysfunction in BPH combined with other diseases.
Ataxia ; Catheterization ; Catheters ; Diabetes Mellitus ; Diagnosis* ; Diagnosis, Differential ; Digital Rectal Examination ; Humans ; Lower Urinary Tract Symptoms ; Male ; Physical Examination ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Sensitivity and Specificity ; Spinal Diseases ; Ultrasonography ; Urinary Bladder ; Urinary Tract ; Urination

OBJECTIVE: The positive and negative predictive values are more important as the diagnostic validity than the sensitivity and specificity in the general population with a low prevalence rate of a disease. The present study is about the diagnostic predictive values of the Korean version of mini-mental state examination and Cognitive Impairment Diagnosing Instrument in an unselected community elderly group. METHOD: The positive and negative diagnostic values were calculated based on the Bayes theorem, using the sensitivity and specificity of the Korean version of mini-mental state examination and Cognitive Impairment Diagnosing Instrument and a previously reported prevalence rate. RESULTS: When the prevalence of dementia is 10.8% among elderly people living in a community, the positive predictive value, negative predictive value and combined error were estimated as being 56.7%, 99.0%, and 8.4%, respectively, at cutoff score of 23 of the Korean version of mini-mental state examination for diagnosing dementia. In the case of the Cognitive Impairment Diagnosing Instrument, they were 64.2%, 99.1% and 6.3%, respectively, at the point of 57 or less in an unselected community sample with the same prevalence. If the sensitivity and specificity are constant, the positive predictive values of the Korean version of mini-mental state examination and Cognitive Impairment Diagnosing Instrument incresed markedly with the rising prevalence while the negative predictive values and combined errors changed little. CONCLUSION: If a variety of diagnostic tests available are similar in the diagnostic sensitivity and specificity, a test with higher positive predictive value should be prefered because the negative predictive value and combined error are not significantly influenced by the prevalence. In this regard, the Cognitive Impairment Diagnosing Instrument may be superior to the Korean version of mini-mental state examination.
Aged ; Bayes Theorem ; Dementia ; Diagnostic Tests, Routine ; Humans ; Predictive Value of Tests ; Prevalence ; Sensitivity and Specificity

OBJECTIVE: The positive and negative predictive values are more important as the diagnostic validity than the sensitivity and specificity in the general population with a low prevalence rate of a disease. The present study is about the diagnostic predictive values of the Korean version of mini-mental state examination and Cognitive Impairment Diagnosing Instrument in an unselected community elderly group. METHOD: The positive and negative diagnostic values were calculated based on the Bayes theorem, using the sensitivity and specificity of the Korean version of mini-mental state examination and Cognitive Impairment Diagnosing Instrument and a previously reported prevalence rate. RESULTS: When the prevalence of dementia is 10.8% among elderly people living in a community, the positive predictive value, negative predictive value and combined error were estimated as being 56.7%, 99.0%, and 8.4%, respectively, at cutoff score of 23 of the Korean version of mini-mental state examination for diagnosing dementia. In the case of the Cognitive Impairment Diagnosing Instrument, they were 64.2%, 99.1% and 6.3%, respectively, at the point of 57 or less in an unselected community sample with the same prevalence. If the sensitivity and specificity are constant, the positive predictive values of the Korean version of mini-mental state examination and Cognitive Impairment Diagnosing Instrument incresed markedly with the rising prevalence while the negative predictive values and combined errors changed little. CONCLUSION: If a variety of diagnostic tests available are similar in the diagnostic sensitivity and specificity, a test with higher positive predictive value should be prefered because the negative predictive value and combined error are not significantly influenced by the prevalence. In this regard, the Cognitive Impairment Diagnosing Instrument may be superior to the Korean version of mini-mental state examination.
Aged ; Bayes Theorem ; Dementia ; Diagnostic Tests, Routine ; Humans ; Predictive Value of Tests ; Prevalence ; Sensitivity and Specificity

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) and some gram-negative bacilli are very prevalent nosocomial pathogens, commonly causing mixed infections, and are often resistant to multiple drugs. Arbekacin is an aminoglycoside used for the treatment of MRSA infections, but is also active against some gram-negative bacilli. The aim of this study was to determine in vitro activity of arbekacin against recent clinical isolates of staphylococci and gram-negative bacilli. Materials and METHODS: The strains were isolated from clinical specimens of patients at Severance Hospital in 2003. Antimicrobial susceptibility was tested by the Clinical and Laboratory Standards Institute agar dilution method. The following arbekacin breakpoints were used: susceptible, < or =4 microgram/mL; and resistant, > or =16 microgram/mL . RESULTS: All isolates of staphylococci tested were inhibited by < or =4 microgram/mL of arbekacin, regardless of their methicillin susceptibility. The MIC90s of arbekacin, 1-4 microgram/mL, were 8->32-fold and >32-128-fold lower than those of amikacin and gentamicin, respectively. The resistance rates of MRSA, methicillin-susceptible S. aureus, methicillin-resistant coagulase-negative staphylococci (CNS) and methicillin-susceptible CNS were 0% to arbekacin, 0-54% to amikacin, and 24-79% to gentamicin. The MIC90s of arbekacin for Escherichia coli and Citrobacter freundii, 1 microgram/mL and 16 microgram/mL, were 2-4-fold and 8-16-fold lower than those of amikacin and gentamicin, respectively. However, The MIC90s of arbekacin for other species of gram-negative bacilli, 64->128 microgram/mL, were similar to those of other aminoglycosides. CONCLUSIONS: Arbekacin may be a useful alternative to glycopeptides for the treatment of monomicrobial methicillin-resistant staphylococcal infections, as well as mixed infections with gram-negative bacilli, as most isolates of E. coli, C. freundii and some other gram-negative bacilli were also susceptible to arbekacin.
Anti-Bacterial Agents/*pharmacology ; Dibekacin/*analogs & derivatives/pharmacology ; Gram-Negative Bacteria/*drug effects/isolation & purification ; Gram-Negative Bacterial Infections/microbiology ; Humans ; Methicillin Resistance ; Microbial Sensitivity Tests ; Staphylococcal Infections/microbiology ; Staphylococcus aureus/*drug effects/isolation & purification

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) and some gram-negative bacilli are very prevalent nosocomial pathogens, commonly causing mixed infections, and are often resistant to multiple drugs. Arbekacin is an aminoglycoside used for the treatment of MRSA infections, but is also active against some gram-negative bacilli. The aim of this study was to determine in vitro activity of arbekacin against recent clinical isolates of staphylococci and gram-negative bacilli. Materials and METHODS: The strains were isolated from clinical specimens of patients at Severance Hospital in 2003. Antimicrobial susceptibility was tested by the Clinical and Laboratory Standards Institute agar dilution method. The following arbekacin breakpoints were used: susceptible, < or =4 microgram/mL; and resistant, > or =16 microgram/mL . RESULTS: All isolates of staphylococci tested were inhibited by < or =4 microgram/mL of arbekacin, regardless of their methicillin susceptibility. The MIC90s of arbekacin, 1-4 microgram/mL, were 8->32-fold and >32-128-fold lower than those of amikacin and gentamicin, respectively. The resistance rates of MRSA, methicillin-susceptible S. aureus, methicillin-resistant coagulase-negative staphylococci (CNS) and methicillin-susceptible CNS were 0% to arbekacin, 0-54% to amikacin, and 24-79% to gentamicin. The MIC90s of arbekacin for Escherichia coli and Citrobacter freundii, 1 microgram/mL and 16 microgram/mL, were 2-4-fold and 8-16-fold lower than those of amikacin and gentamicin, respectively. However, The MIC90s of arbekacin for other species of gram-negative bacilli, 64->128 microgram/mL, were similar to those of other aminoglycosides. CONCLUSIONS: Arbekacin may be a useful alternative to glycopeptides for the treatment of monomicrobial methicillin-resistant staphylococcal infections, as well as mixed infections with gram-negative bacilli, as most isolates of E. coli, C. freundii and some other gram-negative bacilli were also susceptible to arbekacin.
Anti-Bacterial Agents/*pharmacology ; Dibekacin/*analogs & derivatives/pharmacology ; Gram-Negative Bacteria/*drug effects/isolation & purification ; Gram-Negative Bacterial Infections/microbiology ; Humans ; Methicillin Resistance ; Microbial Sensitivity Tests ; Staphylococcal Infections/microbiology ; Staphylococcus aureus/*drug effects/isolation & purification

PURPOSE: We evaluated the concordance between core needle biopsy (CNB) and surgical specimens on examining intrinsic biological subtypes and receptor status, and determined the accuracy of CNB as a basic diagnostic method. METHODS: We analyzed breast cancer patients with paired CNB and surgical specimen samples during 2014. We used monoclonal antibodies for nuclear staining, and estrogen receptor (ER) and progesterone receptor (PR) status evaluation. A positive test was defined as staining greater than or equal to 1% of tumor cells. Human epidermal growth factor receptor 2 (HER2) was graded by immunohistochemistry and scored as 0 to 3+ according to the recommendations of the American Society of Clinical Oncology/College of American Pathologists. Ki-67 immunostaining was performed using the monoclonal antibody Ki-67, and the results were divided at 10% intervals. The cutoff value for high Ki-67 was defined as 20%. Concordance analysis of ER, PR, HER2, Ki-67, and five intrinsic biological subtypes was performed on CNB and surgical specimens. Statistical analysis for concordance was calculated using κ-tests. RESULTS: We found very good agreement for ER and PR with a concordance of 96.7% for ER (κ=0.903), and 94.3% for PR (κ=0.870). HER2 and Ki-67 showed concordance rates of 84.8% (κ=0.684) and 83.5% (κ=0.647), respectively, which were interpreted as good agreement. Five subgroups analysis showed 85.8% agreement and κ-value of 0.786, also indicating good agreement. CONCLUSION: CNB showed high diagnostic accuracy compared with surgical specimens, and good agreement for ER, PR, HER2, and Ki-67. Our findings reaffirmed the recommendation of CNB as an initial procedure for breast cancer diagnosis, and the assessment of receptor status and intrinsic biological subtypes to determine further treatment plans.
Antibodies, Monoclonal ; Biopsy, Large-Core Needle* ; Breast Neoplasms* ; Breast* ; Diagnosis ; Estrogens ; Humans ; Immunohistochemistry* ; Methods ; Receptor, Epidermal Growth Factor ; Receptors, Estrogen ; Receptors, Progesterone