BACKGROUND: Few studies have evaluated risk factors for behavioral and psychological symptoms of dementia at the initial assessment for Alzheimer disease in large patient samples. In this study, the factors influencing Alzheimer disease were examined using the Clinical Research of Dementia of South Korea data. METHODS: This cross-sectional study was conducted using data of 1,128 patients with Alzheimer disease. The behavioral and psychological symptoms of dementia were examined using the Korean version of the Neuropsychiatric Inventory. Demographic characteristics, health-related behavior, neuropsychological tests, comorbidities, blood test results, and caregiver characteristics were assessed. Median logistic regression analysis with adjustment for covariates was conducted. RESULTS: The behavioral and psychological symptoms of dementia were negatively associated with memory (P=0.022) and frontal/executive (P < 0.001) function in the Seoul Neuropsychological Screening Battery-dementia, Barthel Index for Activities of Daily Living (P < 0.001), Korean version of the Mini-Mental State Examination score (P=0.003), and caregiver age (P=0.005) after adjustment for confounding factors, and positively associated with the Seoul-Instrumental Activities of Daily Living score (P < 0.001), Clinical Dementia Rating Sum of Box (P < 0.001), Global Deterioration Scale score (P < 0.001), abnormality of free T4 level (P < 0.001), anemia (P < 0.001), and family history of stroke (P=0.001). Patients with female caregivers exhibited more severe behavioral and psychological symptoms of dementia than those with male caregivers. CONCLUSION: Behavioral and psychological symptoms of dementia in Alzheimer disease patients were associated with various risk factors including the inability to live independently and Alzheimer disease severity. These findings suggest that prevention and treatment strategies for the behavioral and psychological symptoms of dementia should be comprehensive.
Activities of Daily Living ; Alzheimer Disease* ; Anemia ; Behavioral Symptoms ; Caregivers ; Comorbidity ; Cross-Sectional Studies ; Dementia* ; Female ; Hematologic Tests ; Humans ; Korea* ; Logistic Models ; Male ; Mass Screening ; Memory ; Neuropsychological Tests ; Risk Factors* ; Seoul ; Stroke

Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to provide guidance on the implementation of a surgical treatment of oral cancer. MEDLINE databases were searched for articles on subjects related to “surgical management of oral cancer” published in English. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. The quality of evidence was rated with use RoBANS (Risk of Bias Assessment Tool for Nonrandomized Studies) and AMSTAR (A Measurement Tool to Assess the Methodological Quality of Systematic Reviews). Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. Additional directives are provided as expert opinions and Delphi questionnaire when insufficient evidence existed. The Committee developed 68 evidence-based recommendations in 34 categories intended to assist clinicians and patients and counselors, and health policy-makers. Proper surgical treatment selection for oral cancer, which is directed by patient- and subsite-specific factors, remains the greatest predictor of successful treatment outcomes. These guidelines are intended for use in conjunction with the individual patient's treatment goals.
Advisory Committees ; Bias (Epidemiology) ; Carcinoma, Squamous Cell ; Counseling ; Expert Testimony ; Humans ; Mouth Neoplasms ; Neck ; Republic of Korea

OBJECTIVE: Extrapyramidal signs (EPS) are common in patients with mild cognitive impairment (MCI). However, few studies have assessed the effect of EPS on the clinical course of MCI. We aimed to evaluate whether patients with EPS show more frequent progression from MCI to Alzheimer's disease (AD) and to other types of dementia. METHODS: Participants (n=882) with MCI were recruited, and were followed for up to 5 years. The EPS positive group was defined by the presence of at least one EPS based on a focused neurologic examination at baseline. RESULTS: A total of 234 converted to dementia during the follow-up period. The risk of progression to AD was lower in the patients with EPS after adjusting for potential confounders [hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.53–0.93, p=0.01]. In contrast, the patients with EPS had a six-fold elevated risk of progression to dementia other than AD (HR=6.33, 95%CI=2.30–17.39, p < 0.001). CONCLUSION: EPS in patients with MCI is a strong risk factor for progression of MCI to non-Alzheimer dementia. The careful neurologic examination for EPS in patients with MCI can yield important clinical information for prognosis.
Alzheimer Disease ; Dementia* ; Follow-Up Studies ; Humans ; Korea* ; Mild Cognitive Impairment* ; Neurologic Examination ; Prognosis ; Risk Factors

OBJECTIVE: We aimed to find the sex differences of the way how educational attainment influence on cognitive function in patients with Alzheimer's disease (AD). METHODS: We recruited 424 patients with AD from a large hospital-based multi-center cohort. We evaluated cognitive subdomains using the Seoul Neuropsychological Screening Battery-Dementia version. We employed multiple linear regression analysis to compare the score of cognitive subdomains between the groups with high versus low educational attainment based on the high school graduate. Interaction between educational attainment and sex was also included in the analysis. RESULTS: High and low educational attainment group had 33.0% and 67.0% of patients in the study population. In the multiple regression analysis, score of all cognitive subdomains were significantly higher in the high educational attainment group. The score of attention was also significantly affected by interaction between educational attainment and sex. This result may be helpful to develop cognitive intervention therapy. CONCLUSION: In the female patients with AD, educational attainment showed higher influence on the attention score.
Alzheimer Disease* ; Cognition ; Cohort Studies ; Dementia* ; Education* ; Female ; Humans ; Korea* ; Linear Models ; Mass Screening ; Seoul ; Sex Characteristics

OBJECTIVE: This study aimed to find the sex differences of the way how educational attainment influence on cognitive function in the mild cognitive impairment patients. METHODS: A total of 1,704 patients were recruited from a large hospital-based multi-center cohort. Cognitive subdomains were evaluated using the Seoul Neuropsychological Screening Battery-Dementia version. We employed multiple linear regression analysis to compare the score of cognitive subdomains between the groups with high versus low educational attainment based on the high school graduate. Interaction between educational attainment and sex was also included in the analysis RESULTS: High and low educational attainment group had 41.2% and 58.8% of patients in the study population. In the multiple regression analysis, score of all cognitive subdomains were significantly higher in the high educational attainment group. The score of attention, language, and visuospatial function were also significantly affected by interaction between educational attainment and sex. CONCLUSION: In the female patients, educational attainment showed higher influence on the attention, language, and visuospatial function score.
Cognition ; Cognitive Reserve ; Cohort Studies ; Dementia* ; Education* ; Female ; Humans ; Korea* ; Linear Models ; Mass Screening ; Mild Cognitive Impairment* ; Seoul ; Sex Characteristics

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

PURPOSE: The effect of different peritoneal dialysis (PD) modalities on the decline in residual renal function (RRF) is unclear due to inconsistencies among studies. In particular, the effect of automated peritoneal dialysis (APD) modalities [continuous cyclic peritoneal dialysis (CCPD) and nightly intermittent peritoneal dialysis (NIPD)] on RRF has not been examined in a large cohort. MATERIALS AND METHODS: We conducted a single-center retrospective study to investigate the association between PD modalities and decline in RRF in 142 incident PD patients [34 on CCPD, 36 on NIPD, and 72 on continuous ambulatory peritoneal dialysis (CAPD)]. RRF was measured within 2 months from PD start and at 1 year after PD initiation. RESULTS: The RRF at 1 year after PD initiation was 1.98+/-2.20 mL/min/1.73 m2 in CCPD patients and 3.63+/-3.67 mL/min/1.73 m2 in NIPD patients, which were moderately lower than 4.23+/-3.51 mL/min/1.73 m2 in CAPD patients (p=0.064). Moreover, there was no significant difference in the 1-year rate of decline of RRF between CCPD and NIPD patients, although APD patients had a faster 1-year RRF decline rate than CAPD patients (CCPD and NIPD vs. CAPD: -45.68 and -36.69 vs. 1.17%/year, p=0.045). APD was associated with a more rapid decline in RRF in patients with end-stage renal disease undergoing PD, although multivariate analysis attenuated the significance of this finding (beta=-31.50; 95% CI, -63.61 to 0.62; p=0.052). CONCLUSION: Our results suggest that CAPD might be more helpful than APD for preserving RRF during the first year of dialysis therapy, although there was no significant difference in the 1-year rate of decline of RRF between the two APD modalities.
Adult ; Female ; Glomerular Filtration Rate/physiology ; Humans ; Kidney/pathology/physiopathology ; Kidney Failure, Chronic/*therapy ; Male ; Middle Aged ; Peritoneal Dialysis/*adverse effects ; Retrospective Studies

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

OBJECTIVE: The aim of this study was to investigate the association between cognitive subdomains and insight into one's cognitive impairment in patients with Alzheimer disease (AD). METHODS: We recruited 1,722 patients with AD from the Clinical Research of Dementia of South Korea study and designed a cross-sectional study. Each patient's cognitive subdomain was assessed by using the Seoul Neuropsychological Screening Battery-Dementia version. Severity of dementia was evaluated by Korean version of Mini-Mental Status Examination (K-MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SB). Insight into one's cognitive impairment was categorized as 'with insight' and 'without insight' through interview with patient's caregivers. RESULTS: Among the 1,722 patients with AD, 1,475 patients were included in the 'with insight' group and the remaining 247 patients were included in the 'without insight' group. Subjects in the 'without insight' group had lower K-MMSE and CDR-SB scores than those in the 'with insight' group. After controlling for demographic data and dementia severity, higher scores on both attention function (odds ratio=1.12, 95% confidence interval : 1.03-1.21) and frontal-executive function (odds ratio=1.03, 95% confidence interval : 1.01-1.05) significantly predicted the membership to 'with insight' group. CONCLUSION: In patients with AD, attention and frontal-executive function were associated with insight into one's cognitive impairment.
Alzheimer Disease* ; Caregivers ; Cross-Sectional Studies ; Dementia* ; Humans ; Korea ; Mass Screening ; Seoul

OBJECTIVE: Patients with mild cognitive impairment (MCI) are at high risk for dementia. Excessive alcohol consumption is known to adversely affect cognitive function. This study aimed to investigate the relationship between alcohol consumption and the risk for dementia in a cohort of MCI patients. METHODS: Participants (n=416) with (MCI) who met Petersen's criteria were recruited from a nationwide, prospective cohort study of dementia and were followed for a median of 17.52 months (range 5.4-63.48). Alcohol consumption was evaluated at baseline. RESULTS: One hundred twenty seven individuals (30.5%) developed incident dementia (115 Alzheimer disease) during follow-up. Patients with current alcohol consumption at baseline had a higher rate of progression to Alzheimer's dementia than those without current alcohol consumption (hazard ratio 1.61 ; 95% confidence interval 1.03 to 2.53). CONCLUSION: Alcohol consumption may increase the risk of progression to Alzheimer's dementia in patients with MCI.
Alcohol Drinking* ; Alzheimer Disease ; Cohort Studies ; Dementia* ; Follow-Up Studies ; Humans ; Korea ; Mild Cognitive Impairment* ; Prospective Studies ; Risk Factors*