Dementia is one of the most common psychiatric problem in the elderly. According to the increase of the older people with dementia, management of dementia need to be systemized at the community level. The local center for dementia will be established for the community-based systematic and comprehensive management of dementia. It will be extended to all provinces of Seoul Metropolitan City. Activities of the local center for dementia includes 1) education, prevention, and public relations for dementia, 2) early detection and intervention for dementia, 3) establishment of effective, continuous, and personalized management system for the patient with dementia, 4) the development and promotion of community-based resources, 5) the construction of information and data related to dementia care system. This activity will increase the quality of life in the elderly with dementia and their caregivers. Finally, this management system for dementia may contribute to enhancement of the quality and the cost-effectiveness of community health promotion system for the older people.
Aged ; Caregivers ; Dementia* ; Education ; Health Promotion ; Humans ; Public Relations ; Quality of Life ; Seoul*

The author briefly describes background, aims and organizational scheme of the Seoul Dementia Management Project (SDMP) and introduces the Seoul Metropolitan Center for Dementia (SMCD), which is responsible for planning and managing the overall process of the SDMP. The SDMP emphasize a community-based "integrative management for dementia", which encompasses education, preventive programs, early detection and early therapeutic interventions, as well as providing proper care services, closely linked to online case-registration & management system. It also take a serious consideration not only for integrating medical and welfare services, but also for utilizing pre-existing community resources for dementia care. Besides the SMCD, the Supporting Center for Dementia (SCD), which functions as a local executive unit for the SDMP, will be established at each of twenty-five districts in Seoul. The SDMP is expected to be a leading model for a community-based dementia management system that can be referred to by other domestic or international cities.
Dementia* ; Education ; Seoul*

The rapid increase of the elderly and dementia patients has motivated psychiatrists and government officials in Korea to participate in dementia research, programs and projects more actively since the nineties. Korean association for geriatric psychiatry and Korean association for dementia were founded in 1994 and the ministry of health and welfare pronounced the 10 year project for dementia in 1995 and the dementia service program at the public health center was established by law in 1997. Several leading groups of psychiatrists have started the dementia registry and service programs with the public health centers based on local communities and their endeavor made the foundation for nationwide projects for early detection of dementia. The pilot project of registry and service for dementia has been performed with the participation of 16 hospitals and 21 public health centers in 2006. And in 2007 nationwide project for early detection of dementia has started with 60 hospitals and 85 public health centers throughout the country. This project might contribute to delay the development and progression of dementia and help to promote the quality of life in dementia patients and their families in Korea.
Aged ; Dementia* ; Geriatric Psychiatry ; Humans ; Jurisprudence ; Korea ; Occupational Groups ; Pilot Projects ; Psychiatry ; Public Health ; Quality of Life

OBJECTIVES: We investigated the relationship between apolipoprotein epsilon4 and clinical features of dementia. METHODS: Samples were obtained from 33 dementia patients in Korea, Buyeo Geriatric Hospital and apolipoprotein E polymorphisms were analysed using polymerase chain reaction and restriction fragment length polymorphism. The multidimensional evaluating methods (MMSE-K, B-ADL, BEHAVE-AD, GDS, GMHR) for dementia were performed to analyze relationship with Apolipoprotein E genotypes. RESULTS: The distributions of the apolipoprotein E genotypes of the dementia patients were presented by epsilon3/epsilon3 (58%), epsilon3/epsilon4 (22%), epsilon2/epsilon3 (15%), and epsilon4/epsilon4 (0%). There is no significant relationship between apolipoprotein epsilon4 and the findings of multidimensional evaluating measures. CONCLUSION: We could not find the association between apolipoprotein epsilon4 and the scores of the multidimensional evaluating measures of dementia patients. The results suggested that apolipoprotein epsilon4 might not play a main role in cognitive function, daily living ability and behavioral symptoms of dementia.
Apolipoproteins* ; Behavioral Symptoms* ; Dementia* ; Genotype ; Humans ; Korea ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

OBJECTIVE: This study aimed to investigate the association between cognitive decline and advancing age, and the potential effects of vascular risk factors on the associations. METHOD: 1134 old persons aged 65 or over was assessed by the Korean version of Mini-Mental State Examination (MMSE-K) in 1999, and after two years 686 (61%) of the total subjects were reassessed with MMSE-K. Data on age and vascular risk factors (hypertension and diabetes) was obtained. RESULTS: Cognitive decline was significantly associated with advancing age. The stratified analyses showed that the association of cognitive decline with advancing age was significant for those with vascular risk factors, but not significant for the subjects without vascular risk factors. CONCLUSION: We suggest that the cognitive decline with advancing age might be delayed by appropriate management for the vascular risk factors.
Humans ; Longitudinal Studies* ; Risk Factors*

OBJECTIVE: Level of education has been reported to modify the associations between vascular risk factors and cognitive impairment. This study aimed to test this hypothesis in a community dwelling Korean elders with relative cognitive impairment. METHOD: The study group consisted of 341 participants with the Korean version of Mini-Mental State Examination (MMSE-K) scores of 24 or below. The cognitive impairment was categorized into mild (MMSE-K 21-24) or moderate to severe (MMSE-K <21). For each participant, diagnoses for vascular risk factors were ascertained, and resting blood pressure and non-fasting blood glucose and serum cholesterol levels were examined. RESULTS: In the total sample, after adjustment for age, past occupation, physical activities of daily living and cholesterol levels, the worse cognitive function (MMSE-K <21) was associated with raised systolic blood pressure and the diagnosis of diabetes. However, the stratified analyses according to education level revealed that these associations were only significant in those with no formal education. In addition, the higher level of non-fasting blood glucose was significantly associated with the worse cognitive function only for those with no formal education CONCLUSION: Older Koreans with low levels of education may be particularly vulnerable to cognitive impairment associated with risk factors for cerebrovascular disease. This has an important implication for public health strategies regarding the prevention of dementia.
Blood Glucose ; Blood Pressure ; Cholesterol ; Dementia ; Diagnosis ; Education* ; Motor Activity ; Occupations ; Public Health ; Risk Factors*

BACKGROUND: The brain imaging techniques have developed to detect silent brain lesion in healthy elderly, including white matter changes. These silent brain lesions implicate the possibility of brain cerebrovasculopathy, which are also suggestive of having risk factors for geriatric depression, decrease in cognitive function, cerebral infarction and vascular dementia. This study investigated prevalence and clinical characteristics of patients with hyperintesities on MRI (Magnetic Resonance Imaging) T2 image in normal healthy adults. METHOD: Eighty-nine adults above age of 20 were studies who took health examinations including brain MRI. Hyperintensities on brain MRI were categorized by a neuroradiologist according to Fazekas classification. All subjects filled out Zung's depression scale (SDS) and Brief Encounter Psychosocial Instrument (BEPSI). Past histories of hypertension and diabetes mellitus, antihypertensive drug medication history, smoking, alcohol drinking, and height, body weight, BMI (body mass index), systolic and diastolic blood pressure, fasting blood sugar, serum lipids (cholesterol, triglyceride, HDL-C, LDL-C) were evaluated in all subjects. The subjects were divided into three group according to the evaluation scores of hyperintensities on MRI (control group with 0 score, hyperintensity 1 group with evaluation score of 1, hyperintesity 2 group with evaluation score of 2 or 3). ANOVA (Post Hoc test;Scheffe) or chi2 tests were carried out in three groups with the significance level of 0.05. RESULTS: Hyperintensities on MRI T2 image were found in relatively old age groups, and systolic blood pressures were higher in these groups. Serum cholesterol and triglycerides were higher in hyperintensity 1 and 2 group than normal control group, but there was no statistical significance. The amount of alcohol drinking and smoking were not significantly different in three groups. CONCLUSION: Normal healthy subjects with hyperintensities on MRI T2 image in normal healthy people would need to be treated if they have concurrent risk factors of cerebrovascular disease such as hypertension. Normal healthy adults with hyperintensities on MRI should be followed up for long-term to investigate incidence of clinical infarct and depressive symptoms, change in cognitive function.
Adult ; Aged ; Alcohol Drinking ; Blood Glucose ; Blood Pressure ; Body Height ; Brain ; Cerebral Infarction ; Cholesterol ; Classification ; Dementia, Vascular ; Depression ; Diabetes Mellitus ; Fasting ; Humans ; Hypertension ; Incidence ; Magnetic Resonance Imaging* ; Neuroimaging ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Triglycerides

This article reviews the recent literature of 'vascular depression' hypothesis. The 'vascular depression' hypothesis is supported by the evidence for associations between vascular disease and late-onset depression and between ischemic brain lesions and distinctive depressive symptoms. Patients with vascular depression is characterized by late-onset, absence of family history of mood disorders, evidence of vascular disease or vascular risk factors, cognitive impairment, psychomotor retardation, limited depressive ideation, poor insight, and disability. Vascular depression may be the entity suitable for studies of mechanism of depression. Depression in later life is often under-diagnosed and under-treated. Drugs used in the prevention and treatment of cerebrovascular disease may be shown to be beneficial influences for the prevention of vascular depression. Combined treatment with antidepressant and cognitive-behavioral rehabilitation will be more helpful. In the future, developments in structural and functional imaging, electrophysiology, chronobiology, and genetics will permit the knowledge of the association between mood disorders and brain lesions.
Brain ; Depression* ; Electrophysiology ; Genetics ; Humans ; Mood Disorders ; Psychomotor Disorders ; Rehabilitation ; Risk Factors ; Vascular Diseases

No abstract available.
Psychotic Disorders*

This paper reviews the frequency, clinical and neurobiological correlates, and treatments of apathy and anxiety following stroke. Apathy is defined as diminished motivation not attributable to decreased level of consciousness, cognitive impairment, or emotional distress. Apathy is a common neuropsychiatric manifestation following stroke, affecting up to 22.5-50% of patients. Post-stroke apathy frequently coexists with depression and is positively correlated with advancing aging. It was reported that poor ADL and cognitive function was related with apathy, while even greater impairment was associated with the presence of both apathy and depression. It has been suggested that apathy in stroke patients may be mediated by posterior limb of internal capsule, frontal subcortical pathway, or corticolimbic-reticular subsystem. Recently the possibility of pharmacological treatment of apathy following apathy has been raised, although there was no controlled trials addressing the issue. Generalized anxiety disorder (GAD), the most common form of anxiety after stroke, occurs in up to 26.9-28% of stroke patients. Many patients with GAD also have depression. It was reported that GAD following stroke had usually chronic course and negative impact to the physical and social recovery of patient. Post-stroke anxiety cannot be explained only by the psychological reaction to stroke and its possible physical complication, but is likely to be significantly associated with the pathophysiological mechanism caused by brain injury. Lorazepam, buspirone and some antidepressants, such as SSRI, SNRI, and nonsedating TCA, can be tried, although there was no controlled trials addressing the treatment of anxiety following stroke. In conclusion, apathy and anxiety are very common neuropsychiatric manifestation following stroke and seem to have negative influences to the functional recovery of patients. Therefore, it is needed to apply active treatments, especially including pharmacological approaches, to them.
Activities of Daily Living ; Aging ; Antidepressive Agents ; Anxiety Disorders ; Anxiety* ; Apathy* ; Brain Injuries ; Buspirone ; Consciousness ; Depression ; Extremities ; Humans ; Internal Capsule ; Lorazepam ; Motivation ; Stroke