To identify the effects of a mobile-app-based self-management program for elderly hemodialysis patients on their sick-role behavior, basic psychological needs, and self-efficacy.

Depression is a relatively common agonizing psychiatric disorder that affects the way we feel and think about ourselves and the world around us. Cognitive theories of depression have long posited that various cognitive biases are involved in the development and recurrence of depression. However, the current cognitive theory of depression has been reformulated and expanded from the previous cognitive model of depression based on the results from pharmacological, neuroimaging and neurocognitive studies. This review summarizes the evidence for cognitive dysfunctions in depression and the related pharmacological, neuroanatomical and genetic aspects which aim to integrate our knowledge about the cognitive aspects of depression and its treatment. The newly formulated cognitive theory of depression provides directions for future investigation to identify people at risk, to minimize recurrence, and to maximize long-term beneficial outcomes for those suffering from depression.
Bias (Epidemiology) ; Cognition* ; Depression* ; Felodipine ; Neuroimaging ; Recurrence

Until recently, there is considerable mess regarding the nature of anxiety in dementia. However, anxiety is common in this population affecting from 8% to 71% of prevalence, and resulted in poor outcome and quality of life, even after controlling for depression. Because a presentation of anxiety in the context of dementia can be different from typical early-onset anxiety disorder, it is not easy one to identify and quantify anxiety reliably. Moreover, differentiating anxiety from the depression and/or dementia itself also can be formidable task. Anxiety gradually decreases at the severe stages of dementia and this symptom may be more common in vascular dementia than in Alzheimer's disease. Due to the lack of large randomized clinical trials, optimal treatment and the true degree of efficacy of treatment is not clear yet in this population. However, these treatments can reduce adverse impact of anxiety on patients and caregivers. This article provides a brief review for the diagnosis, evaluation and treatment of anxiety in dementia.
Alzheimer Disease ; Anxiety Disorders ; Anxiety* ; Caregivers ; Dementia* ; Dementia, Vascular ; Depression ; Diagnosis ; Humans ; Prevalence ; Quality of Life

Wandering is acknowledged as one of the most complex, challenging, and potentially dangerous dementia-related behaviors, and can result in elopement, injury, and even death. For the healthy people, walking is a common and a pleasurable leisure activity. However, wandering in dementia may be an exhausting behavior for caregivers and raise safety concerns. The term 'wandering' covers different types of behavior, including aimless movement without a discernible purpose. Although with respect to the etiology of wandering, biological, psychosocial and person-environment interaction has been suggested, the etiology of wandering is poorly understood. Although it is possible that management of coexistent psychopathology would help to ameliorate this problematic behavior, evidence on the effectiveness of pharmacological and non-pharmacological interventions is limited.
Caregivers ; Dementia* ; Humans ; Leisure Activities ; Psychopathology ; Walking

Alzheimer's disease (AD) is associated with cognitive and functional impairment as well as neuropsychiatric complications, including psychotic symptoms such as delusions and hallucinations. Recent studies strongly suggest that delusions should be separated from hallucinations. While AD with delusions is a phenotypically distinct from AD without delusions, subtypes of delusions may also define further distinct clinical entities. There has been also considerable debate as to whether delusions in patients with AD differ etiologically, phenomenologically, and therapeutically from delusions in other primary psychiatric illnesses. In other words, whether they are caused by changes to key areas of the brain that have been linked to the presence of delusions. This has led to speculation that these symptoms may respond better to certain drugs such as cholinesterase inhibitors. Integrating the epidemiology, clinical phenomenology, neuropathological and genetic literature for delusions in AD allows us to speculate on pathophysiology and is essential to making progress in the area of delusions in AD.
Alzheimer Disease* ; Brain ; Cholinesterase Inhibitors ; Delusions* ; Epidemiology ; Hallucinations ; Humans

The nature of late-onset psychosis in the absence of a dementia or secondary to organic dysfunctions in the fifth decade of life and beyond is contentious and unresolved. Different terminologies, diagnostic criteria and age cut-offs have been applied to late-onset psychosis, which have stymied clinicians and researchers. No official diagnostic designation for patients with late-onset psychosis is included in the current psychiatric diagnostic system (Diagnostic and Statistical Manual of Mental Disorders-V, International Classification of Diseases-10). The validity of this diagnostic exclusion has been questioned. Despite these problems, a relatively consistent clinical picture has reported. However, many questions remain regarding the underlying etiology, pathophysiological mechanisms, treatment and prognosis. Whether late-onset psychosis is distinct from schizophrenia and whether it might be a harbinger of dementia are unclear. Recent studies have suggested an underlying biological pathophysiology of late-onset psychosis.
Classification ; Dementia ; Humans ; Prognosis ; Psychotic Disorders* ; Schizophrenia

Depression is one of the most common psychiatric complications of Alzheimer disease (AD), affecting from 30% to 50% of prevalence, with most estimates in the 20-30% range. Because of having a presentation in the context of AD that differs from typical early-onset depression, it is not easy one to detect and quantify reliably, and can be difficulty to differentiate depression from the other neuropsychiatric symptoms of AD. Due to the lack of large randomized trials, optimal treatment and the true degree of efficacy remains undetermined. However, these treatments can reduce adverse impact of depression on patients and caregivers. This article provides a practical discussion of the diagnosis, evaluation, differential diagnosis and treatment of depression in AD for the clinician.
Alzheimer Disease* ; Caregivers ; Depression* ; Diagnosis ; Diagnosis, Differential ; Humans ; Prevalence

BACKGROUND: Normal pressure hydrocephalus (NPH) is a poorly understood condition, which typically presents with the triad of gait disturbance, urinary incontinence and cognitive decline. Diagnosis of NPH is often challenging due to its varied presentation and overlap with other neurodegenerative diseases including multiple system atrophy (MSA). CASE REPORT: A 68-year-old male developed rapidly progressive gait difficulty, urinary incontinence and memory impairment. Neurologic examination showed parkinsonism affecting the right side and impaired postural reflexes. Brain MRI showed enlargement of the ventricles and narrowing of the high convexity cerebrospinal fluid (CSF) spaces with relative dilated Sylvian fissure, the supporting features of NPH. 18F-fluorinated-N-3-fluoropropyl-2-b-carboxymethoxy-3-b-(4-iodophenyl) nortropane (¹⁸F-FP-CIT) PET showed decreased FP-CIT binding in the left posterior putamen and ¹⁸F-fluorodeoxyglucose PET showed decreased metabolism in the left basal ganglia, consistent with findings of MSA. CSF removal was performed and the symptoms were improved. The patient underwent ventriculo-peritoneal shunt and his gait and cognition improved. CONCLUSIONS: NPH is a potentially treatable neurological disorder. Therefore, it is necessary to consider the possibility of accompanying NPH when hydrocephalus is present in other neurodegenerative diseases.
Aged ; Basal Ganglia ; Brain ; Cerebrospinal Fluid ; Cognition ; Diagnosis ; Gait ; Humans ; Hydrocephalus* ; Hydrocephalus, Normal Pressure ; Magnetic Resonance Imaging ; Male ; Memory ; Metabolism ; Multiple System Atrophy* ; Nervous System Diseases ; Neurodegenerative Diseases ; Neurologic Examination ; Parkinsonian Disorders ; Putamen ; Reflex ; Urinary Incontinence ; Ventriculoperitoneal Shunt

BACKGROUND AND PURPOSE: Cognitive and gait disturbance are common symptoms in Parkinson's disease (PD). Although the relationship between cognitive impairment and gait dysfunction in PD has been suggested, specific gait patterns according to cognition are not fully demonstrated yet. Therefore, the aim of this study was to investigate gait patterns in PD patients with or without cognitive impairment. METHODS: We studied 86 patients at an average of 4.8 years after diagnosis of PD. Cognitive impairment was defined as scoring 1.5 standard deviation below age- and education-specific means on the Korean version of the Mini-Mental State Examination (K-MMSE). Three-dimensional gait analysis was conducted for all patients and quantified gait parameters of temporal-spatial data were used. Relationships among cognition, demographic characteristics, clinical features, and gait pattern were evaluated. RESULTS: Cognitive impairment was observed in 41 (47.7%) patients. Compared to patients without cognitive impairment, patients with cognitive impairment displayed reduced gait speed, step length, and stride length. Among K-MMSE subcategories, “registration,”“attention/calculation,” and “visuospatial function” were significantly associated with speed, step length, and stride length. However, age, disease duration, Hoehn-Yahr (HY) stage, or Unified Parkinson's Disease Rating Scale (UPDRS) motor score was not significantly related to any gait analysis parameter. CONCLUSIONS: Our present study shows that cognitive impairment is associated with slow and short-stepped gait regardless of HY stage or UPDRS motor score, suggesting that cognitive impairment may serve as a surrogate marker of gait disturbance or fall in PD patients.
Biomarkers ; Cognition ; Cognition Disorders* ; Diagnosis ; Gait* ; Humans ; Parkinson Disease*

Kluver-Bucy syndrome is defined as a rare neurobehavioral disorder with hyperphagia, hyperorality, hypersexuality, and visual agnosia. This syndrome is usually resulting from bilateral lesions of the anterior temporal lobe including amygdala. Although it could occur after various diseases, stroke is uncommon etiology. We report a patient with Kluver-Bucy syndrome due to bilateral posterior cerebral artery territory infarction.
Agnosia ; Amygdala ; Cerebral Infarction ; Humans ; Hyperphagia ; Infarction ; Infarction, Posterior Cerebral Artery* ; Kluver-Bucy Syndrome* ; Posterior Cerebral Artery ; Stroke ; Temporal Lobe