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*

Depression is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of depressed patients with Alzheimer's disease (AD). The consecutive patients with AD who have significant depression were assigned to an 8-week open-label, prospective study. Patients received mirtazapine 15-45 mg/day. The changes in Hamilton Depression Rating Scale (HAM-D) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirty-two out of 38 (84.2%) patients completed the study. There was a significant reduction in HAM-D and CGI-S between the pre- and post-treatment with mirtazapine (p<0.01). There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of depressed patients with AD.
Alzheimer Disease ; Behavioral Symptoms ; Dementia ; Depression ; Humans ; Mianserin ; Pilot Projects ; Prospective Studies

OBJECTIVE:Optimized voxel based morphometry (VBM) has been increasingly applied to investigate differences in brain morphology between a group of Alzheimer's Disease (AD) patients and control subjects. Optimized VBM permits comparison of gray matter (GM) volume at voxel-level from the entire brain. The purpose of this study was to assess the regional GM volume loss measured by optimized VBM in AD compared to controls METHODS:Twenty-three AD patients and 20 cognitively normal elderly control subjects included in this study. To improve the VBM performance, the study specific template and the probability maps were generated from the control subjects. RESULTS:Optimized VBM analysis revealed GM loss, including hippocampus, amygdala, anterior cingulate, posterior cingulate, insula, frontal lobe and middle temporal complex in the AD group as compared to normal control group CONCLUSION:The VBM results confirmed previous findings of temporal lobe and limbic lobe atrophic changes in AD, and suggest that these abnormalities may be confined to specific sites within that lobe, rather than showing a widespread distribution.
Aged ; Alzheimer Disease ; Amygdala ; Brain ; Frontal Lobe ; Hippocampus ; Humans ; Temporal Lobe

OBJECTIVES:The purpose of this study is to evaluate the diagnostic validity of the three published short Geriatric Depression Scales and to identify a valid and reliable alternative to the Korean version of the Geriatric Depression Scale (GDS-K) and short form Geriatric Depression Scales (SGDS-K). METHODS:All subjects were registered elderly psychiatric patients who first visited the Geriatric Psychiatry Clinic of Seoul National University Hospital in Seoul between April 1996 and May 1999. The GDS-K, SGDS-K, Hoyl GDS-5, D'Ath GDS-4, van Marwijk GDS-4 were administered. Receiver operating characteristics (ROC) curve analysis performed to investigate the diagnostic validity of the Hoyl GDS-5, D'Ath GDS-4, and van Marwijk GDS-4. RESULTS:The best trade-off between sensitivity and specificity was achieved with a Hoyl GDS-5 score of 3 (sensitivity:0.7258, specificity:0.7717), a D'Ath GDS-4 score of 3 (sensitivity:0.5968, specificity:0.7391), and a van Marwijk GDS-4 score of 3 (sensitivity:0.6613, specificity:0.7391). The area under the ROC curves of each diagnostic tool were calculated into the Hoyl GDS-5 of 0.8198, the D'Ath GDS-4 of 0.7525, and the van Marwijk GDS-4 of 0.7528. CONCLUSION:The Hoyl GDS-5 may be utilized in screening for major depression among the elderly psychiatric patients in Korea.
Aged ; Depression ; Geriatric Psychiatry ; Humans ; Korea ; Mass Screening ; ROC Curve ; Sensitivity and Specificity ; Weights and Measures

OBJECTIVES:To investigate mortality rates and predictors of mortality in dementia patients (prevalence cohort) resident at institution. METHODS:We followed up a dementia cohort for 5 years. A total of 273 subjects with dementia were longitudinally assessed at baseline, 6 months and 12 months and then checked whether alive or dead every 1 year for 5 years. Their mortality was compared with sociodemographic and clinical variables using Cochran-Mantel-Haenszel test and independent sample t-test. Survival time quartiles were used to describe the time until when 25%, 50%, and 75% of patients died. Kaplan Meier log-rank tests were used for testing the equality of survival among groups when identifying some disruptive agitated behaviors as mortality predictors. Relative risk (RR) with 95% confidence intervals were calculated by the Cox regression analysis. RESULTS:In this study, overall 5-year mortality rate was 63.0% (12.6% per year). Median survival after baseline evaluation was 2.85 years, whereas median survival after institutionalization was 6.42 years. Log-rank tests revealed that some disruptive behaviors (i.e., Cagras syndrome, screaming, trying to get to a different place, intentional falling) were significantly higher in the deceased group. Mortality in subjects with dementia depended on old age {over 85, relative risk (RR):1.04;95% confidence interval (CI):1.02-1.06}, male gender (RR:2.04;CI:1.28-3.25), lower MMSE-K score (RR:1.03;CI:1.00-1.06). CONCLUSION:We expect that this study may provide basic health information for health policy making in institutional care approaches in Korea
Aged ; Cohort Studies ; Dementia ; Dihydroergotamine ; Follow-Up Studies ; Health Policy ; Humans ; Hypogonadism ; Institutionalization ; Korea ; Male ; Mitochondrial Diseases ; Nursing Homes ; Ophthalmoplegia

This article has reviewed general characters of schizophrenia in late life. Specifically, it has reviewed epidemiology, course, and several results of biological researches and so on of schizophrenia in old age. Then, it has studied effect and safety of antipsychotics for schizophrenia in old age. Conclusively, considering understanding on the concept of schizophrenia and importance of the increasing olds in mental health, the magnitude of schizophrenia in old age will grow serious.
Antipsychotic Agents ; Mental Health ; Schizophrenia

Growing body of evidence has suggested that bipolar disorder in the elderly is important issue of mental health care. While older bipolar patients show different clinical features and response to treatment compared to younger patients, there are few studies focused on the older bipolar patients. Authors reviewed clinical features and treatment issues for bipolar disorder in the elderly.
Aged ; Bipolar Disorder ; Humans ; Mental Health ; Mood Disorders