Delirium is not uncommon and is a devastating clinical syndrome. Elderly patients are vulnerable to delirium, especially demented or/and medically-surgically ill patients. Old age, comorbid psychiatric, medical and/or neurological diseases, medications, changed pharmacodynamics, sensory impairment and psychosocial stresses contribute to the development of delirium. Delirium in elderly patients is somewhat different from delirium in younger patients, sometimes under detected and/or poorly managed. This review discusses the diagnosis, classification, etiology and treatment, and presents 3 clinical cases of delirium in elderly patients. This review also focuses on a practical approach in assessing and managing delirium in elderly patients. The management of delirium consists of identifying and correcting the underlying problems, including prescribing suitable medication.
Aged* ; Classification ; Delirium* ; Diagnosis ; Geriatric Psychiatry ; Humans

OBJECTIVE: The purpose of this study was to determine the difference of temperature effects on the nerve conduction variables and to obtain correction factors for temperature in demyelinated and normal peripheral nerves. METHOD: The compound muscle action potentials (CMAPs) were recorded with wrist stimulation during cooling and warming in 10 control subjects and 13 subjects with demyelinating neuropathies. The temperature of cooling and warming were 18degrees C and 40degrees C, respectively. The time of cooling and warming were 60 minutes and composed of successive 4 sessions of 15 minutes. The skin temperature of thenar area, latency, amplitude, duration, and area of CMAPs were measured before and after each session of 15 minutes of cooling or warming. RESULTS: The time constants of parameters of CMAPs were of higher tendency in cooling than in warming. The time constants of latency of CMAP were higher in subjects with demyelinating neuropathy than in controls (p<0.05): 33.3+/-4.0 minutes versus 27.2+/-2.2 minutes in cooling; 30.0+/-7.8 minutes versus 19.6+/-3.3 minutes in warming. The temperature correction factor of latency of CMAPs was 0.23+/-0.03 msec/degrees C in control and 0.33+/-0.06 msec/degrees C in subjects with demyelinating neuropathies (p<0.05). CONCLUSION: When studying a subject with demyelinating neuropathies, we should warm the extremity for more sufficient time than in normal subject, or may applicate a differenct temperature correction factors.
Action Potentials ; Extremities ; Neural Conduction ; Peripheral Nerves ; Peripheral Nervous System Diseases* ; Skin Temperature ; Wrist

Objective: The purpose of this study was to investigate the related factors of elderly depression among Korean adults aged 60 years and above. Methods: From the database of Korea National Health and Nutrition Examination Survey conducted in 2018, data of 2,288 adults over age 60 who responded to the questionnaires of health interview were included in this study. We analyzed the data using logistic regression analysis. Results: According to our results, the number of chronic diseases seemed to be associated with depression in elderly people, es-pecially when they have more than 4 chronic diseases. Poorer self-rated health was identified as a significant factor and the odd ratio was the highest among all independent variables in our study. Walking over 10 minutes more than 4 times a week was considered as a protective factor for elderly depression. The association between education level and depression was inconsistent. Variables such as female gender, single status, smoking showed statistically insignificant results. Older age itself was not identified as a risk factor as odd ratios of all groups (over age 65) compared to reference group (age 60-64) were below 1. Conclusion This study confirms several related factors for elderly depression. Having more than 4 chronic diseases, poorer self-rated health were identified as a significant risk factor for depression. Regular walking was considered as a protective factor for elderly depression. The knowledge of these factors might help to manage risks of elderly depression and devise early intervention approaches.

Objective: There are reports that cognitive training improves cognitive performance in patients with mild cognitive impairment and dementia. However, the research on the effects of cognitive training in the community-dwelling elderly is insufficient. This study aimed to verify the effectiveness of cognitive training in the community-dwelling elderly. Methods: The participants were community-dwelling elderly aged 60 years or over. We collected demographic data and assessed Korean Version of Montreal Cognitive Assessment (MoCA-K), The Short form of the Geriatric Depression Scale-Korean (SGDS-K), and Geriatric Quality of Life-Dementia (GQOL-D). Cognitive training consisted of performing tasks for multi-cognitive domains. It was a paper- and group-based program, conducted 15 sessions each 60 minute. After the intervention, clinical characteristics were reassessed. Paired t-test, pearson correlation, analysis of covariance (ANCOVA) were performed using R version 3.6.1. Results: There were 206 participants. 162 participants completed the intervention, and were eligible for analyses. After the cognitive intervention, MoCA-K was improved 2.10±0.61 which was statistically significant (p<0.001). SGDS-K was decreased 0.57± 0.46 (p=0.003). GQOL-D was increased 1.65±1.64 (p=0.048). ANCOVA showed that the score change in MoCA-K was not in-fluenced by baseline SGDS-K or baseline GQOL-D score. Conclusion Group-and paper-based cognitive training could improve MoCA-K, SGDS-K, and GQOL-D for the communitydwelling elderly. Baseline SGDS-K and GQOL-D scores were not associated with cognitive training effects in the community-dwelling elderly.

Objective: There are reports that cognitive training improves cognitive performance in patients with mild cognitive impairment and dementia. However, the research on the effects of cognitive training in the community-dwelling elderly is insufficient. This study aimed to verify the effectiveness of cognitive training in the community-dwelling elderly. Methods: The participants were community-dwelling elderly aged 60 years or over. We collected demographic data and assessed Korean Version of Montreal Cognitive Assessment (MoCA-K), The Short form of the Geriatric Depression Scale-Korean (SGDS-K), and Geriatric Quality of Life-Dementia (GQOL-D). Cognitive training consisted of performing tasks for multi-cognitive domains. It was a paper- and group-based program, conducted 15 sessions each 60 minute. After the intervention, clinical characteristics were reassessed. Paired t-test, pearson correlation, analysis of covariance (ANCOVA) were performed using R version 3.6.1. Results: There were 206 participants. 162 participants completed the intervention, and were eligible for analyses. After the cognitive intervention, MoCA-K was improved 2.10±0.61 which was statistically significant (p<0.001). SGDS-K was decreased 0.57± 0.46 (p=0.003). GQOL-D was increased 1.65±1.64 (p=0.048). ANCOVA showed that the score change in MoCA-K was not in-fluenced by baseline SGDS-K or baseline GQOL-D score. Conclusion Group-and paper-based cognitive training could improve MoCA-K, SGDS-K, and GQOL-D for the communitydwelling elderly. Baseline SGDS-K and GQOL-D scores were not associated with cognitive training effects in the community-dwelling elderly.

In addition to cognitive and functional decline, various behavioral and psychological symptoms in dementia (BPSD) are manifested in the patients with Alzheimer's dementia (AD). Some of BPSD, especially psychosis, agitation, and aggression could be challenges to caregivers and clinicians. Atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, and aripiprazole) are widely prescribed to manage complicated neuropsychiatric symptoms associated with AD. It is known that atypical antipsychotics (AAP) have modest and significant beneficial effects in the short term treatment of BPSD. However their safety of AAP has been concerned with potentially increased adverse events. This article reviewed the treatment outcomes and adverse effects of AAP when managing BPSD in the patients with AD. The effects of risperidone and aripiprazole are obvious on psychosis and aggression, but with small effect size. AAP could exacerbate cognitive decline, and it could increase the rate of cerebrovascular accidents and mortality rate in the patients with AD.
Aggression ; Alzheimer Disease ; Antipsychotic Agents* ; Behavioral Symptoms ; Caregivers ; Dementia* ; Dihydroergotamine ; Humans ; Mortality ; Psychotic Disorders ; Risperidone ; Stroke ; Aripiprazole ; Quetiapine Fumarate

The aim of this study was to examine the effects of various concentrations of glutamate(10(-8), 10(-6) and 10(-4) M) on the circling movement induced by apomorphine in the unilateral substantia nigra-lesioned rats. Subcutaneous apomorphine(0.1 mg/kg) elicited contralateral circling movement(641.7+/-163.9/hr), Glutamate(10(-6)-10(-4) M) significantly reduced the numbers of apomorphine-induced circling movement. This reducing effect of glutamate was antagonized and/or reversed by 10(-7) M GABA antagonist bicuculline. These results suggest that glutamate reduces circling movement induced by apomorphine and this reducing effect of glutamate may be mediated by increased GABA concentration in striatum and substantia nigra.
Animals ; Apomorphine ; Bicuculline ; Dopamine ; GABA Antagonists ; gamma-Aminobutyric Acid ; Glutamic Acid* ; Rats* ; Substantia Nigra

Objectives: This study examined the level of depression and anxiety and the related factors, especially the knowledge and attitudes towards dementia, of people caring for a family member with dementia. Methods: Data on the demographics, care burdens, and clinical characteristics of dementia patients and their family caregivers were collected. The Center for Epidemiologic Studies Depression Scale (CES-D) and Korean Screening Tool for Anxiety disorders (K-ANX), Dementia Knowledge Scale (DKS), and Dementia Attitudes Scale (DAS) were performed. This study investigated whether depression and anxiety of caregivers differed according to the caregivers, patients, and the burden of caregivers. Multiple regression analysis was performed to investigate the potential factors that may influence the psychological symptoms in family caregivers. Results: There were 135 respondents. The scores of CES-D and K-ANX were 19.18±12.05 (probable depression) and 11.48±8.88 (mild anxiety), respectively. There was a significant difference in the degree of depression according to the level of education (F=4.14, p<0.05), the severity of dementia (F=3.63, p<0.05), and cohabitation with patients with dementia (t=2.07, p<0.05). On the other hand, the difference in the degree of anxiety was not significant depending on the stratified potential factors. The degree of depression in caregivers was positively associated with severe dementia (β=0.252, p<0.01) and negatively associated with the DAS score (β= -0.392, p<0.001). Anxiety was only inversely affected by the DAS score (β=-0.369, p<0.001). Conclusion This study shows that family caregivers of people with dementia experience high levels of depression and anxiety, which are influenced by the patient’s severity of dementia and the caregiver’s attitude toward dementia.

We reviewed the clinical features, prevalence, pathophysiology, and prevention and treatment of delirium in patients with coronavirus disease of 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has neurotropic properties, and can penetrate the central nervous system and affect brain neurons. These characteristics may explain the fact that COVID-19 patients may be particularly susceptible to delirium. COVID-19 delirium occurred more frequently in intensive care unit and emergency room settings. Patients with neurologic disorders and the elderly were more vulnerable to delirium. Clinical symptoms of COVID-19 delirium may manifest as a hyper/hypoactive type. Prevention and treatment appear to be similar to conventional treatment strategies. And the patient’s feeling of isolation due to social distancing and a highly intensive labor force of medical personnel must be overcome. Melatonin, alpha-2 agonist, antipsychotics, and valproic acid have been recommended for the treatment of delirium symptoms. However, this article did not go through a systematic literature review.

BACKGROUND: In survivors of acute myocardial infarction(ANI), reduced heart rate variability(HRV) has been demonstrated to be an independent predictor of sudden cardiac death and mortality. The heart rate variability can be examined and analyzed non-invasively and quantitated with 24-hour ambulatory ECG monitoring. In general, the patency of infarct-related artery appears to be one of the most important prognostic factor after AMI. Therefor, the correlation between infarct artery patency and HRV was examined in survivors of AMI. METHODS: The 24-Hour ambulatory electrocardiogram was performed in 23 patients with AMI and 20 normal controls, and analyzed for frequency & time domain HRV. HRV was recorded dwithin 7 days after AMI, and coronary angiogram was performed at 7th day after AMI. The AMI patients were divided into two groups, depending upon patency of infarct-related artery and correlated to clinical manifestations. Thirteen patients had patent vessel(Group 1) and ten patients had non-patent vessel(Group 2). Parameters of frequency domain HRV include LF, HF & LF/HF ratio and time domain HRV include SDNN, SDANN, SD, rMSSD and pNN50. RESULTS: All parameters of HRV was depressed in patients of AMI than in normal control(p<0.05). The mean left ventricular ejection fraction(LVEF) was 54.1+/-10.6% in group 1 and 42.6+/-12.2% in group 2(p<0.05). The mean values of LF, SDNN, SDANN, and SD in group 1 and group 2 were 5.09+/-0.83msec2/Hz & 4.09+/-0.53msec2/Hz, 84.5+/-24.2msec & 59.0+/-11.8msec, 73.2+/-22.8msec & 50.5+/-12.6msec, and 37.8+/-13.1msec & 27.2+/-4.4msec(p<0.05), respectively. There was no difference between two groups in HF,rMSSD and pNN50. The location of infarction and thrombolytic therapy itself did not influence of HRV. The mean values of HF, SDANN, rMSSD and pNN50 in patients with LVEF<40% were reduced significantly than in patients with LVEF> or =40%. There was a significant correlation between LVEF and LF, between LVEF and HF and between LVEF and LF/HF ratio(r:0.55, p<0.05;r:0.67, p<0.05;r:-0.56, p<0.05). CONCLUSION: HRV was depressed due to reduced vagal activity in patients with AMI. The values of LF, SDNN, SDANN, and SD in group of patent infarct-related artery were reduced significantly than in non-patent group.
Arteries* ; Death, Sudden, Cardiac ; Electrocardiography ; Heart Rate* ; Heart* ; Humans ; Infarction ; Mortality ; Myocardial Infarction* ; Survivors ; Thrombolytic Therapy