OBJECTIVES: The prevalence of metabolic syndrome has recently increased. Payments from the Korea Labor Welfare Corporation for compensation for mortality in workers caused by cardiovascular and cerebrovascular diseases have also increased in Korea in recent years. The association of metabolic syndrome and cardiocere brovascular disease has been investigated by several researchers in recent studies. This study was conducted in an attempt to characterize the relationship between metabolic syndrome and Korean cardiocerebrovascular disease risk assessment, and to provide basic data to group health practices for the prevention of cardiocere brovascular disease. METHODS: Health examinations were previously conducted for 1526 male researchers at a private laboratory. The prevalence by age and the odds ratio of metabolic syndrome scores into the "cardiocerebrovascular risk group" (sum of low, intermediate, and high risk groups) of the Korean cardiocerebrovascular disease risk assessment were assessed, in an effort to elucidate the associations between metabolic syndrome and cardiocere brovascular disease risk assessment. RESULTS: The prevalence of metabolic syndrome and inclusion in the cardiocerebrovascular risk group was 11.7% and 22.1% respectively. The severity of metabolic syndrome and cardiocerebrovascular risk assessment showed that individuals in their 40's and 50's were at higher risk than those in their 30's (p<0.001). The age-adjusted odds ratio of metabolic syndrome to cardiocere brovascular risk group inclusion was 5.6. CONCLUSIONS: An active prevention program for cardiocerebrovascular disease needs to begin in the 40's, as the prevalence of metabolic syndrome and the risk group of cardiocerebrovascular risk assessment peak in the 40's age group. The odds ratio between metabolic syndrome and the cardiocerebrovascular risk group was high, which indicates that metabolic syndrome scores should be utilized as guidelines during the consultation and behavioral modification program for the workplace prevention of cardiocerebrovascular diseases in group health practices.
Age Distribution ; Cardiovascular Diseases/economics/*epidemiology ; Cerebrovascular Disorders/complications/*epidemiology ; Humans ; Korea/epidemiology ; Male ; Metabolic Syndrome X/complications/*epidemiology ; Prevalence

BACKGROUND: There are few studies about driving and dementia in Korea. The purpose of this study is to investigate the real condition of automobile driving in patients with dementia and the characteristics of those who continue to drive after diagnosis of dementia. METHODS: A total of 4,377 patients including 3,792 with Alzheimer's disease and 585 with vascular dementia were recruited from multiple nationwide hospitals. Clinical evaluations and neuropsychological tests were done in them according to the protocol of the Clinical Research Center for Dementia of South Korea study. Caregivers replied which patients drove an automobile, gave up driving, or has never driven. The same evaluations of them were followed after one year. RESULTS: There were 272 (6.2%) drivers, 321 (7.3%) ex-drivers, and 3,784 (86.5%) non-drivers with dementia. Drivers with dementia were younger and had higher Korean Mini-Mental State Examination (K-MMSE) (21.5+/-4.3 vs 19.8+/-5.1 vs 17.4+/-5.2, p<0.001) and lower Clinical Dementia Rating scale-Sum of Boxes (CDR-SB) scores (4.08+/-2.15 vs 5.80+/-3.41 vs 5.83+/-3.39, p<0.001) compared with ex-drivers and non-drivers with dementia. The drivers and ex-drivers with dementia had higher educational level and a higher proportion of male compared with non-drivers with dementia (77.6% vs 80.1% vs 23.3%, p<0.001). About 54.6% of the drivers with dementia continued to drive at one year after diagnosis of dementia. They had higher K-MMSE (23.2+/-3.6 vs 20.8+/-4.5, p=0.003) and lower CDR-SB scores (3.30+/-1.47 vs 4.40+/-1.85, p=0.001) at baseline compared with those who quitted driving after baseline. CONCLUSIONS: Male patients who were relatively young and had high educational level and mild dementia had a tendency to drive an automobile at that time of diagnosis of dementia. About half of them continued to drive after diagnosis of dementia.
Alzheimer Disease ; Automobile Driving ; Automobiles ; Caregivers ; Dementia* ; Dementia, Vascular ; Diagnosis ; Humans ; Korea ; Male ; Neuropsychological Tests

PURPOSE: Stress during pregnancy is a risk factor for the development of anxiety-related disorders in offspring later in life. The effects of treadmill exercise on anxiety-like behaviors and hippocampal cell proliferation were investigated using rats exposed to prenatal stress. METHODS: Exposure of pregnant rats to a hunting dog in an enclosed room was used to induce stress. Anxiety-like behaviors of offspring were evaluated using the elevated plus maze test. Immunohistochemistry for the detection of 5-bromo-2'-deoxyuridine and doublecortin (DCX) in the hippocampal dentate gyrus and 5-hydroxytryptamine 1A receptors (5-HT(1A)) in the dorsal raphe was conducted. Brain-derived neurotrophic factor (BDNF) and tyrosine kinase B (TrkB) levels in the hippocampus were evaluated by western blot analysis. RESULTS: Offspring of maternal rats exposed to stress during pregnancy showed anxiety-like behaviors. Offspring also showed reduced expression of BDNF, TrkB, and DCX in the dentate gyrus, decreased cell proliferation in the hippocampus, and reduced 5-HT(1A) expression in the dorsal raphe. Postnatal treadmill exercise by offspring, but not maternal exercise during pregnancy, enhanced cell proliferation and expression of these proteins. CONCLUSIONS: Postnatal treadmill exercise ameliorated anxiety-like behaviors in offspring of stressed pregnant rats, and the alleviating effect of exercise on these behaviors is hypothesized to result from enhancement of cell proliferation through 5-HT(1A) activation in offspring rats.
Animals ; Anxiety* ; Blotting, Western ; Brain-Derived Neurotrophic Factor ; Bromodeoxyuridine ; Cell Proliferation* ; Dentate Gyrus ; Dogs ; Dorsal Raphe Nucleus ; Exercise Test ; Hippocampus ; Immunohistochemistry ; Pregnancy ; Prenatal Exposure Delayed Effects ; Protein-Tyrosine Kinases ; Rats* ; Receptor, Serotonin, 5-HT1A* ; Risk Factors ; Serotonin*

OBJECTIVE: Caregivers for patients with Alzheimer's disease (AD) suffer from psychological and financial burdens. However, the results of the relationship between burden and cognitive function, performance of activities of daily living, and depressive symptoms have remained inconsistent. Therefore, the aim of this study was to examine which factors are more significant predictors of heightened burden, cognitive impairment or functional decline, besides neuropsychiatric symptoms. METHODS: A cross-sectional study was conducted in a sample comprised of 1,164 pairs of patients with AD and caregivers from the Clinical Research of Dementia of South Korea study cohorts. The cognitive function of each sub-domain, functional impairments, depressive symptoms, and caregiver burden were assessed using the dementia version of Seoul Neuropsychological Screening Battery (SNSB-D), Barthel Index for Daily Living Activities (ADL), Seoul-Instrumental Activities of Daily Living (S-IADL), the Clinical Dementia Rating Sum of Box (CDR-SB), the Global Deterioration Scale (GDS), the Korean version of the Neuropsychiatric Inventory (K-NPI), and the 15-item Geriatric Depression Scale. RESULTS: We found that higher severity (higher CDR-SB and GDS scores) and more functional impairment (lower ADL and higher S-IADL scores) were significantly associated with higher caregiver burden. In addition, depressive symptoms of patients (higher Geriatric Depression Scale scores) were associated with higher caregiver burden. CONCLUSION: Therefore, interventions to help maintain activities of daily living in patients with AD may alleviate caregiver burden and improve caregiver well-being.
Activities of Daily Living ; Alzheimer Disease* ; Caregivers* ; Cognition ; Cohort Studies ; Cross-Sectional Studies ; Dementia ; Depression ; Humans ; Korea ; Mass Screening ; Seoul

OBJECTIVES: We aimed to investigate the prevalence of Extrapyramidal signs (EPS) and the associations between EPS and cognitive subdomains in patients with Alzheimer disease (AD). METHODS: We recruited 1,324 patients with AD from the Clinical Research of Dementia of South Korea (CREDOS), a hospital based cohort study with fifty-six participating hospitals. We estimated cognitive subdomain using the Seoul Neuropsychological Screening Battery-Dementia version (SNSB-D). Dementia severity was measured by Clinical Dementia Rating Sum of Boxes (CDR-SB) and Korean version of Mini-Mental Status Examination (K-MMSE). The EPS group was defined by the presence of at least one EPS based on a focused neurologic examination. RESULTS: The prevalence of patients with EPS was 11%. These had higher CDR-SB scores than non-EPS group. After controlling for demographic, radiological, and dementia severity (CDR-SB) factors, EPS group showed lower cognitive ability in the subdomains for visuospatial and frontal-executive function than non-EPS group. The patients with EPS were showed significantly higher scores in the subdomain for memory function. CONCLUSION: The presence of EPSs in patients with AD was associated with lower visuospatial, frontal-executive function and higher memory function.
Alzheimer Disease ; Cohort Studies ; Dementia ; Humans ; Mass Screening ; Memory ; Neurobehavioral Manifestations ; Prevalence ; Republic of Korea

BACKGROUND AND PURPOSE: The one-day rivastigmine patch is reportedly well tolerated and has minimal side effects. However, Asian patients show more side effects than those in Western countries. We evaluated tolerability of the rivastigmine patch in South Korean patients with Alzheimer's disease (AD) and the specific factors affecting adverse events of the skin. METHODS: A 6-month, open labeled, multi-centered, observational study was carried out in 440 patients with probable AD from July 2009 to September 2010 (NCT01312363). RESULTS: A total of 25.9% of the patients experienced adverse skin events at the rivastigmine patch application site and 17.0% discontinued treatment due to adverse events at the skin application site. The most common adverse events were itching and erythema. Patients with an allergic history and users of electric heating appliances reported skin discomfort. Older age was associated with discontinuing treatment. CONCLUSION: These results suggest that the rivastigmine patch induced some adverse skin events and may contribute to understanding and improving skin tolerability to the rivastigmine patch.
Alzheimer Disease* ; Asian Continental Ancestry Group ; Erythema ; Heating ; Hot Temperature ; Humans ; Observational Study ; Pruritus ; Skin* ; Rivastigmine

BACKGROUND AND PURPOSE: It was recently reported that the prevalence of poststroke memory dysfunction might be higher than previously thought. Stroke may exist concomitantly with underlying Alzheimer's disease (AD), and so we determined whether post-stroke memory dysfunction indicates manifestation of underlying subclinical AD. METHODS: Of 1201 patients in a prospective cognitive assessment database, we enrolled subjects with poststroke amnestic vascular cognitive impairment-no dementia (aVCIND; n=48), poststroke nonamnestic vascular cognitive impairment-no dementia (naVCIND; n=50), and nonstroke amnestic mild cognitive impairment (aMCI; n=65). All subjects had cognitive deficits, but did not meet the criteria for dementia. A standardized neuropsychological test battery and magnetic resonance imaging were performed at least 90 days after the index stroke (mean, 473 days). Visual assessment of medial temporal atrophy (MTA) was used as a measure of underlying AD pathology. RESULTS: The MTA score was significantly lower in the naVCIND group (0.64+/-0.85, mean+/-SD) than in the aVCIND (1.10+/-1.08) and aMCI (1.45+/-1.13; p<0.01) groups. Multivariable ordinal logistic regression analysis revealed that compared with naVCIND, aVCIND [odds ratio (OR)=2.69; 95% confidence interval (CI)=1.21-5.99] and aMCI (OR=5.20; 95% CI=2.41-11.23) were significantly associated with increasing severity of MTA. CONCLUSIONS: Our findings show that compared with poststroke naVCIND, the odds of having more-severe MTA were increased for poststroke aVCIND and nonstroke aMCI.
Alzheimer Disease ; Atrophy ; Dementia ; Glutamates ; Guanine ; Humans ; Logistic Models ; Magnetic Resonance Imaging ; Memory ; Mild Cognitive Impairment ; Neuropsychological Tests ; Prevalence ; Prospective Studies ; Pemetrexed ; Stroke

OBJECTIVES: This study investigated the association between extrapyramidal signs (EPS) and five cognitive sub-domains in a large number of patients with mild cognitive impairment (MCI). METHODS: Our analyses considered 1,943 patients with MCI drawn from the nationwide Clinical Research of Dementia of South Korea study. EPS were defined as presence in patients with at least 1 of 11 operationally specified features. We assessed five cognitive sub-domains : attention, language, visuospatial function, memory, and frontal/executive function using the Seoul Neuropsychological Screening Battery-Dementia version. The associations of EPS with each cognitive sub-domain were analyzed with a multiple linear regression model after controlling for confounding factors : sex, age, education years, diabetes, hypertension, severity of global function, depressive symptoms, and white matter hyperintensities (WMH). RESULTS: 138 MCI patients (7.1%%) had EPS. This group had more global cognitive deterioration and severe WMH. MCI patients with EPS showed lower performance compared to those without EPS in 3 cognitive sub-domains: attention (p=0.05), visuospatial function (p=0.02), and frontal/executive function (p<0.0001). The language sub-domain and the memory sub-domain did not differ between the EPS positive and the EPS negative groups. CONCLUSION: EPS in MCI are associated with greater cognitive impairment in specific functional sub-domains rather than with global greater cognitive deterioration.
Cognition ; Dementia* ; Depression ; Education ; Humans ; Hypertension ; Korea* ; Linear Models ; Mass Screening ; Memory ; Mild Cognitive Impairment* ; Seoul

Background: and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. Methods: This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. Results: The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. Conclusions Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.

Background: and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. Methods: This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. Results: The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. Conclusions Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.