Psychiatric disturbances in the elderly are complicated. Dementia and depression are serious causes of global impairment in the elderly. Aging is characterized by a progressive functional impairment of multiple organs, a reduction of homeostatic mechanisms, and a changed sensitivity or capacity of neurotransmitter receptors. Understanding the influence of age-dependent changes in the composition and function of the body on the pharmacokinetics and pharmacodynamics of drugs is important before prescribing drugs to elderly patients. However, there is little clinical pharmacological information available to guide pharmacotherapy for late-life psychiatric disorders. Treatment of dementia is based on the cognitive decline and behavioral symptoms that accompany dementia. Currently prescribed antidepressants have similar efficacies but the side effect profiles vary. Comprehension of the normal aging process and understanding the characteristics of each of the psychotropics are essential in geriatric psychopharmacology. Up to the present, most studies are confirmations or reproductions of previous results on efficacy or safety. Future directions for psychopharmacological research should include discovering newer drugs, treatment of resistance or nonresponders, and combination or adjunctive therapies. This review focused on the geriatric pharmacokinetic/pharmacodynamic changes and clinical information regarding currently prescribed psychotropic medications.
Aged ; Aging ; Antidepressive Agents ; Behavioral Symptoms ; Comprehension ; Dementia ; Depression ; Geriatric Psychiatry ; Humans ; Psychopharmacology ; Receptors, Neurotransmitter

Recent advances in brain imaging research are remarkable. Among them, many results from a variety of neuroimaging modalities in Alzheimer's dementia accompanied by the development and growing of imaging techniques have been presented in the research field. In this review we are focused on the imaging biomarkers for the Alzheimer's dementia to investigate the pathophysiologic mechanism. Future research on biomarkers for Alzheimer's dementia will provide more diverse and complex mechanisms or hypotheses than have been proposed in the current hypothesis about the pathogenesis of Alzheimer's dementia.
Biomarkers ; Dementia ; Neuroimaging

OBJECTIVES: This study was done in Korean elderly people in order to examine the relationship of white matter hyperintensity with clinical neuropsychological function and depression symptom severity. METHODS: A total of 148 subjects diagnosed first major depressive episode after age of 60 years were included. Brain magnetic resonance imaging scan was rated with the modified Fazekas White Matter Rating Scale by researcher blinded to clinical information. Cognitive function was evaluated with a comprehensive neurological battery and depression severity was assessed by Hamilton Depression Scale. Subjects were divided into vascular depression group and non vascular group according to the degree of white matter hyperintensity. Independent t-test was used to compare clinical difference between two groups and correlation analysis was used to identify whether white matter hyperintensity severity is correlated with neuropsychological function and depressive symptom. RESULTS: Vascular depression group was significantly poorer performance in verbal fluency, Boston naming test, Mini-Mental State Examination, trail making test B and stroop test (p<0.05). Furthermore, trail making test B and stroop test performance was correlated with white matter hyperintensity severity. However, Hamilton Depression Scale score was not significantly different between two groups. CONCLUSION: Several findings from our study suggest that white matter hyperintensity is associated with neuropsychological performance, especially executive function. Moreover, executive dysfunction might contribute to poor treatment outcome of vascular depression group.
Aged ; Boston ; Brain ; Depression ; Executive Function ; Humans ; Magnetic Resonance Imaging ; Stroop Test ; Trail Making Test ; Treatment Outcome

OBJECTIVE: We compared the one-year rehospitalization rates of first-episode bipolar manic patients who were discharged while being treated with atypical antipsychotics in combination with mood stabilizers. METHODS: We monitored the rehospitalization status of the first-episode bipolar manic patients who were discharged between 1 January 2003 and 31 December 2008 while they were taking risperidone (n=34), olanzapine (n=26) or quetiapine (n=32) in combination with mood stabilizers. Rehospitalizations were tracked over a 1-year period using the Kaplan-Meier method and Cox regression model was used to analyze covariates thought to affect time to rehospitalization. RESULTS: The rehospitalization rates during the 1-year follow-up period for patients taking atypical antipsychotics plus mood stabilizers were 22.8% (n=21). There were no significant differences in rehospitalization estimated using the Kaplan-Meier formula among the patients treated with risperidone (29.4%), olanzapine (23.1%) or quetiapine (15.6%). The psychotic symptoms, previous depressive episodes, lower Global Assessment of Functioning (GAF) score at discharge and less length of first hospitalization contributed to the risk of rehospitalization. CONCLUSION: The 1-year rehospitalization rates of first-episode bipolar manic patients taking risperidone, olanzapine, or quetiapine do not differ and the psychotic symptoms and previous depressive episodes affect time to rehospitalization.
Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Dibenzothiazepines ; Follow-Up Studies ; Hospitalization ; Humans ; Inpatients ; Risperidone ; Track and Field ; Quetiapine Fumarate

OBJECTIVE: The aim of this study was to explore the reliability and validity of the Korean version of the Cornell Scale for Depression in Dementia (CSDD-K), a scale for assessment of depression in dementia. METHODS: The original CSDD was translated into Korean and the content was verified through back-translation procedures. This study included 59 depressive patients with Alzheimer's disease (AD), 62 non-depressive patients with AD and 36 healthy elderly controls. The subjects were assessed using CSDD-K, the 17-item Hamilton Depression Rating Scale (HAM-D17), the 15-item Korean version of Geriatric Depression Scale (GDS15) and the Korean version of Mini-mental Status Examination (MMSE-K). RESULTS: In the reliability test, Cronbach's alpha coefficient and test-retest reliabilities were 0.92 and 0.91, respectively, indicating that the CSDD-K has good internal consistency. There were significant differences in CSDD-K total scores between AD patients with depression and AD patients without depression (p<0.001). In the analysis of the concurrent validity of the CSDD-K, there were significant correlations between the CSDD-K and HAM-D17 (r=0.91, p<0.001) and between the CSDD-K and GDS15 (r=0.75, p<0.001). ROC curve analysis identified a cut-off score of 7 for the CSDD-K, where the sensitivity was 87.5% and the specificity was 100%. Factor analysis resulted in a four-factor solution accounting for 63.8% of the common variance. CONCLUSION: The CSDD-K showed good reliability and validity for the assessment of depressive symptom severity in AD patients. The CSDD-K is a useful instrument for assessing AD patients with depressive symptoms in Korean ethnic population.
Accounting ; Aged ; Alzheimer Disease ; Dementia ; Depression ; Humans ; Reproducibility of Results ; ROC Curve ; Sensitivity and Specificity

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

OBJECTIVE: In Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), a new specifier of major depressive disorder (MDD) "with anxious distress" allows characterization of additional symptoms. The aim of this study was to investigate difference in treatment outcome of MDD with versus without anxious distress specifier in DSM-5. METHODS: Retrospective chart review of patients admitted to a university hospital with a primary diagnosis of MDD in a period from March 2013 to September 2014 was conducted. We reviewed anxious distress symptoms, medications and detailed clinical information at index episode. We compared treatment outcomes of anxious distress group with those of non anxious distress group. RESULTS: There were differences in remission rate after 4 weeks later (18.5% vs. 44.4%, p=0.040) and at discharge (33.3% vs. 66.7%, p=0.014) between anxious distress and non anxious distress. However, no significant differences were observed in the sociodemographic characteristics, treatment regimens, and response rate. CONCLUSION: Anxious distress specifier might be worthwhile to be further evaluated as a diagnostic entity of its own requiring specific diagnosis and therapeutic attention.
Depression* ; Depressive Disorder, Major ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Retrospective Studies ; Treatment Outcome*

OBJECTIVES: It is well-known that tobacco smoking is related to various disease entities including chronic obstructive pulmonary disease, inflammation, cardiovascular disease, and neoplasms. The prohibition of smoking is important for the protection of these health problems. Regarding leptin, ghrelin, glucagon-like peptide 1 (GLP-1), and nerve growth factor (NGF) levels, correlations with the smoking are suggested but the reports on the effects after smoking cessation are not sufficient. METHOD: The changes of plasma levels of leptin, ghrelin, GLP-1, and NGF levels were analyzed after quitting smoking in Korean adults. Eleven participants succeeding in quitting smoking among 37 male smokers were included in the final analysis. The plasma levels of NGF, leptin, ghrelin, and GLP-1 were measured before and after 8-weeks period of smoking cessation. RESULTS: The plasma level of leptin increased after 4 weeks of smoking cessation. In addition, the plasma level of NGF increased after 8 weeks of smoking cessation (p < 0.05). CONCLUSION: Our results suggested that smoking cessation induces increases in leptin and the NGF level after smoking cessation. Many toxic materials including nicotine in the cigarette may be related to these changes of plasma level of leptin and NGF, playing a key role in neurogenesis and synaptic plasticity.
Adult ; Cardiovascular Diseases ; Ghrelin ; Glucagon-Like Peptide 1 ; Humans ; Inflammation ; Leptin ; Male ; Nerve Growth Factor ; Neurogenesis ; Nicotine ; Plasma ; Plastics ; Pulmonary Disease, Chronic Obstructive ; Smoke ; Smoking ; Smoking Cessation ; Tobacco ; Tobacco Products

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is an established curative therapeutic modality for unresectable hepatocellular carcinoma (HCC), and transarterial chemoembolization (TACE) has been used as a palliative treatment for inoperable HCC. It is still unknown whether RFA and TACE are equally effective for improving the survival of patients with unresectable HCC that is amenable to either treatment. The aim of this retrospective study was to compare the clinical impacts of two treatments, and analyze the prognostic factors for recurrence and survival. METHODS: Ninety-three patients with a single HCC smaller than 4 cm who showed complete responses (complete ablation or complete lipiodol tagging) after treatment with RFA (n=43) or TACE (n=50) between January 2002 and February 2009 were investigated. Univariate and multivariate analyses were performed for 13 potential prognostic factors using the Cox proportional-hazards model. RESULTS: The time-to-recurrence rates at 1, 2, and 3 years after treatment were 32.9%, 44.3%, and 55.4%, respectively, for the RFA group, and 42%, 68.3%, 71.7% for the TACE group. The probability of survival at 1, 2, and 3 years was 97.7%, 77.4%, and 63.1%, respectively, for the RFA group, and 95.9%, 76.1%, and 60.2% for the TACE group. The time-to-recurrence and overall survival rates did not differ significantly between the two treatment groups. A multivariate Cox proportional-hazards model revealed that a tumor size larger than 3 cm and lower serum albumin levels were independent risk factors for recurrence, and that being male, being seropositive for hepatitis B surface antigen, and having a higher serum albumin level were independent favorable prognostic factors for survival. CONCLUSIONS: TACE and RFA exhibited similar therapeutic effects in terms of recurrence and survival for patients with a single HCC smaller than 4 cm, if they could exhibited complete responses.
Adult ; Aged ; Carcinoma, Hepatocellular/mortality/surgery/*therapy ; *Catheter Ablation ; *Chemoembolization, Therapeutic ; Data Interpretation, Statistical ; Female ; Hepatitis B/complications ; Humans ; Liver Neoplasms/mortality/surgery/*therapy ; Male ; Middle Aged ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors ; Serum Albumin/analysis ; Severity of Illness Index ; Sex Factors ; Survival Rate

BACKGROUND: Advanced hepatocellular carcinoma (HCC) with portal vein thrombosis has a poor prognosis and has little hope for meaningful therapy. Transarterial chemoembolization has been performed as a treatment for advanced HCC, but some patients die from progressive liver failure after therapy. This study was undertaken to evaluate the therapeutic effects of intra-arterial infusion chemotherapy in advanced HCC with portal vein thrombosis, and to compare with those of systemic chemotherapy, and to identify prognostic factors that could affect survival. METHODS: Between January 1995 and January 2001, a total of 102 patients with advanced HCC having portal vein thrombosis (TNM stage IVa) were enrolled and divided into 3 groups; Group 1 (n=24) was managed with only conservative treatment, group 2 (n=25) received systemic combination chemotherapy consisting of 5-fluorouracil (FU) + Adriamycin + Mitomycin C, or 5-FU + Etoposide + Cisplatin, and group 3 (n=52) received intra-arterial infusion chemotherapy with 5-FU (250 mg for 5 days) + cisplatin (10 mg for 5 days) via implanted chemoport. RESULTS: One-year survival rates were 0%, 4%, 21%, and median survivals were 2-, 4-, 6 months in group 1, group 2, group 3, respectively (p=0.003). When we divide group 3 patients into long term survivors (more than 8 months) or short term survivors (less than 8 months), former had significantly lower level of serum AST (p=0.032) and alkaline phosphatase (p=0.033). Especially, all female patients (n=9) survived more than 8 months, and had a longer survival than male patients (p=0.000). Other favorable prognostic factors for survival were cirrhosis of Child-Pugh class A (p=0.003), only one major branch involvement of the portal vein by tumor (p=0.005), presence of enhancement of tumor portion in arterial phase of CT scan (p=0.044), presence of enhancement of non-tumor portion in portal phase of CT scan (p=0.029). CONCLUSION: Intra-arterial infusion chemotherapy achieved favorable results in advanced HCC with portal vein thrombosis and showed better survival in selected patients. This therapy can be tried as a treatment option for the management of advanced HCC.
Alkaline Phosphatase ; Carcinoma, Hepatocellular* ; Cisplatin ; Doxorubicin ; Drug Therapy* ; Drug Therapy, Combination ; Etoposide ; Female ; Fibrosis ; Fluorouracil ; Hope ; Humans ; Infusions, Intra-Arterial* ; Liver Failure ; Male ; Mitomycin ; Portal Vein* ; Prognosis ; Survival Rate ; Survivors ; Thrombosis ; Tomography, X-Ray Computed ; Venous Thrombosis*