1.Dementia Overdiagnosis in Younger, Higher Educated Individuals Based on MMSE Alone: Analysis Using Deep Learning Technology
Hye-Geum KIM ; Dai-Seg BAI ; Bon-Hoon KOO ; Eun-Jin CHEON ; Seokho YUN ; So Hye JO ; Byoungyoung GU
Journal of Korean Medical Science 2025;40(9):e20-
Background:
Dementia is a multifaceted disorder that affects cognitive function, necessitating accurate diagnosis for effective management and treatment. Although the Mini-Mental State Examination (MMSE) is widely used to assess cognitive impairment, its standalone efficacy is debated. This study examined the effectiveness of the MMSE alone versus in combination with other cognitive assessments in predicting dementia diagnosis, with the aim of refining the diagnostic accuracy for dementia.
Methods:
A total of 2,863 participants with subjective cognitive complaints who underwent comprehensive neuropsychological assessments were included. We developed two random forest models: one using only the MMSE and another incorporating additional cognitive tests.These models were evaluated based on their accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) on a 70:30 training-to-testing split.
Results:
The MMSE-alone model predicted dementia with an accuracy of 86% and AUC of 0.872. The expanded model demonstrated increased accuracy (88%) and an AUC of 0.934.Notably, 17.46% of the cases were reclassified from dementia to non-dementia category upon including additional tests. Higher educational level and younger age were associated with these shifts.
Conclusion
The findings suggest that although the MMSE is a valuable screening tool, it should not be used in isolation to determine dementia severity. The addition of diverse cognitive assessments can significantly enhance diagnostic precision, particularly in younger and more educated populations. Future diagnostic protocols should integrate multifaceted cognitive evaluations to reflect the complexity of dementia accurately.
2.Dementia Overdiagnosis in Younger, Higher Educated Individuals Based on MMSE Alone: Analysis Using Deep Learning Technology
Hye-Geum KIM ; Dai-Seg BAI ; Bon-Hoon KOO ; Eun-Jin CHEON ; Seokho YUN ; So Hye JO ; Byoungyoung GU
Journal of Korean Medical Science 2025;40(9):e20-
Background:
Dementia is a multifaceted disorder that affects cognitive function, necessitating accurate diagnosis for effective management and treatment. Although the Mini-Mental State Examination (MMSE) is widely used to assess cognitive impairment, its standalone efficacy is debated. This study examined the effectiveness of the MMSE alone versus in combination with other cognitive assessments in predicting dementia diagnosis, with the aim of refining the diagnostic accuracy for dementia.
Methods:
A total of 2,863 participants with subjective cognitive complaints who underwent comprehensive neuropsychological assessments were included. We developed two random forest models: one using only the MMSE and another incorporating additional cognitive tests.These models were evaluated based on their accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) on a 70:30 training-to-testing split.
Results:
The MMSE-alone model predicted dementia with an accuracy of 86% and AUC of 0.872. The expanded model demonstrated increased accuracy (88%) and an AUC of 0.934.Notably, 17.46% of the cases were reclassified from dementia to non-dementia category upon including additional tests. Higher educational level and younger age were associated with these shifts.
Conclusion
The findings suggest that although the MMSE is a valuable screening tool, it should not be used in isolation to determine dementia severity. The addition of diverse cognitive assessments can significantly enhance diagnostic precision, particularly in younger and more educated populations. Future diagnostic protocols should integrate multifaceted cognitive evaluations to reflect the complexity of dementia accurately.
3.Dementia Overdiagnosis in Younger, Higher Educated Individuals Based on MMSE Alone: Analysis Using Deep Learning Technology
Hye-Geum KIM ; Dai-Seg BAI ; Bon-Hoon KOO ; Eun-Jin CHEON ; Seokho YUN ; So Hye JO ; Byoungyoung GU
Journal of Korean Medical Science 2025;40(9):e20-
Background:
Dementia is a multifaceted disorder that affects cognitive function, necessitating accurate diagnosis for effective management and treatment. Although the Mini-Mental State Examination (MMSE) is widely used to assess cognitive impairment, its standalone efficacy is debated. This study examined the effectiveness of the MMSE alone versus in combination with other cognitive assessments in predicting dementia diagnosis, with the aim of refining the diagnostic accuracy for dementia.
Methods:
A total of 2,863 participants with subjective cognitive complaints who underwent comprehensive neuropsychological assessments were included. We developed two random forest models: one using only the MMSE and another incorporating additional cognitive tests.These models were evaluated based on their accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) on a 70:30 training-to-testing split.
Results:
The MMSE-alone model predicted dementia with an accuracy of 86% and AUC of 0.872. The expanded model demonstrated increased accuracy (88%) and an AUC of 0.934.Notably, 17.46% of the cases were reclassified from dementia to non-dementia category upon including additional tests. Higher educational level and younger age were associated with these shifts.
Conclusion
The findings suggest that although the MMSE is a valuable screening tool, it should not be used in isolation to determine dementia severity. The addition of diverse cognitive assessments can significantly enhance diagnostic precision, particularly in younger and more educated populations. Future diagnostic protocols should integrate multifaceted cognitive evaluations to reflect the complexity of dementia accurately.
4.Dementia Overdiagnosis in Younger, Higher Educated Individuals Based on MMSE Alone: Analysis Using Deep Learning Technology
Hye-Geum KIM ; Dai-Seg BAI ; Bon-Hoon KOO ; Eun-Jin CHEON ; Seokho YUN ; So Hye JO ; Byoungyoung GU
Journal of Korean Medical Science 2025;40(9):e20-
Background:
Dementia is a multifaceted disorder that affects cognitive function, necessitating accurate diagnosis for effective management and treatment. Although the Mini-Mental State Examination (MMSE) is widely used to assess cognitive impairment, its standalone efficacy is debated. This study examined the effectiveness of the MMSE alone versus in combination with other cognitive assessments in predicting dementia diagnosis, with the aim of refining the diagnostic accuracy for dementia.
Methods:
A total of 2,863 participants with subjective cognitive complaints who underwent comprehensive neuropsychological assessments were included. We developed two random forest models: one using only the MMSE and another incorporating additional cognitive tests.These models were evaluated based on their accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC) on a 70:30 training-to-testing split.
Results:
The MMSE-alone model predicted dementia with an accuracy of 86% and AUC of 0.872. The expanded model demonstrated increased accuracy (88%) and an AUC of 0.934.Notably, 17.46% of the cases were reclassified from dementia to non-dementia category upon including additional tests. Higher educational level and younger age were associated with these shifts.
Conclusion
The findings suggest that although the MMSE is a valuable screening tool, it should not be used in isolation to determine dementia severity. The addition of diverse cognitive assessments can significantly enhance diagnostic precision, particularly in younger and more educated populations. Future diagnostic protocols should integrate multifaceted cognitive evaluations to reflect the complexity of dementia accurately.
5.Meditation-Induced Psychosis: Recurrent Case Reports in the Same Patient
Journal of the Korean Society of Biological Therapies in Psychiatry 2024;30(3):103-105
Meditation has been practiced across various cultures for religious, self-cultivation, and mental health purposes and has recently been integrated into psychiatric care. While meditation has demonstrated efficacy in managing insomnia, depression, anxiety, and schizophrenia, its potential adverse effects are often overlooked. Among these, meditation-induced psychosis is particularly concerning due to the severe subjective distress and functional impairment it causes.This case report presents a rare instance of repeated meditation-induced psychosis in a single patient. The patient, a 52-year-old woman, experienced psychotic episodes twice, each following intense meditation under significant stress, with an interval of over 1 year between the recurrences. Her symptoms included delusions, auditory and visual hallucinations, and inappropriate behavior, leading to hospitalization. Treatment with paliperidone successfully alleviated her symptoms on both occasions. This case highlights the dual nature of meditation as both a therapeutic tool and a potential risk factor in stressful situations or in individuals with a history of psychosis. The lack of specific guidelines on the contraindications of meditation in clinical settings emphasizes the need for cautious application, especially in vulnerable populations. Further research is essential to establish evidence-based guidelines that consider both the benefits and risks of meditation therapy, ensuring its safe and effective use in psychiatric practice.
6.Meditation-Induced Psychosis: Recurrent Case Reports in the Same Patient
Journal of the Korean Society of Biological Therapies in Psychiatry 2024;30(3):103-105
Meditation has been practiced across various cultures for religious, self-cultivation, and mental health purposes and has recently been integrated into psychiatric care. While meditation has demonstrated efficacy in managing insomnia, depression, anxiety, and schizophrenia, its potential adverse effects are often overlooked. Among these, meditation-induced psychosis is particularly concerning due to the severe subjective distress and functional impairment it causes.This case report presents a rare instance of repeated meditation-induced psychosis in a single patient. The patient, a 52-year-old woman, experienced psychotic episodes twice, each following intense meditation under significant stress, with an interval of over 1 year between the recurrences. Her symptoms included delusions, auditory and visual hallucinations, and inappropriate behavior, leading to hospitalization. Treatment with paliperidone successfully alleviated her symptoms on both occasions. This case highlights the dual nature of meditation as both a therapeutic tool and a potential risk factor in stressful situations or in individuals with a history of psychosis. The lack of specific guidelines on the contraindications of meditation in clinical settings emphasizes the need for cautious application, especially in vulnerable populations. Further research is essential to establish evidence-based guidelines that consider both the benefits and risks of meditation therapy, ensuring its safe and effective use in psychiatric practice.
7.Meditation-Induced Psychosis: Recurrent Case Reports in the Same Patient
Journal of the Korean Society of Biological Therapies in Psychiatry 2024;30(3):103-105
Meditation has been practiced across various cultures for religious, self-cultivation, and mental health purposes and has recently been integrated into psychiatric care. While meditation has demonstrated efficacy in managing insomnia, depression, anxiety, and schizophrenia, its potential adverse effects are often overlooked. Among these, meditation-induced psychosis is particularly concerning due to the severe subjective distress and functional impairment it causes.This case report presents a rare instance of repeated meditation-induced psychosis in a single patient. The patient, a 52-year-old woman, experienced psychotic episodes twice, each following intense meditation under significant stress, with an interval of over 1 year between the recurrences. Her symptoms included delusions, auditory and visual hallucinations, and inappropriate behavior, leading to hospitalization. Treatment with paliperidone successfully alleviated her symptoms on both occasions. This case highlights the dual nature of meditation as both a therapeutic tool and a potential risk factor in stressful situations or in individuals with a history of psychosis. The lack of specific guidelines on the contraindications of meditation in clinical settings emphasizes the need for cautious application, especially in vulnerable populations. Further research is essential to establish evidence-based guidelines that consider both the benefits and risks of meditation therapy, ensuring its safe and effective use in psychiatric practice.
8.Advances, challenges, and prospects of electroencephalography-based biomarkers for psychiatric disorders: a narrative review
Journal of Yeungnam Medical Science 2024;41(4):261-268
Owing to a lack of appropriate biomarkers for accurate diagnosis and treatment, psychiatric disorders cause significant distress and functional impairment, leading to social and economic losses. Biomarkers are essential for diagnosing, predicting, treating, and monitoring various diseases. However, their absence in psychiatry is linked to the complex structure of the brain and the lack of direct monitoring modalities. This review examines the potential of electroencephalography (EEG) as a neurophysiological tool for identifying psychiatric biomarkers. EEG noninvasively measures brain electrophysiological activity and is used to diagnose neurological disorders, such as depression, bipolar disorder (BD), and schizophrenia, and identify psychiatric biomarkers. Despite extensive research, EEG-based biomarkers have not been clinically utilized owing to measurement and analysis constraints. EEG studies have revealed spectral and complexity measures for depression, brainwave abnormalities in BD, and power spectral abnormalities in schizophrenia. However, no EEG-based biomarkers are currently used clinically for the treatment of psychiatric disorders. The advantages of EEG include real-time data acquisition, noninvasiveness, cost-effectiveness, and high temporal resolution. Challenges such as low spatial resolution, susceptibility to interference, and complexity of data interpretation limit its clinical application. Integrating EEG with other neuroimaging techniques, advanced signal processing, and standardized protocols is essential to overcome these limitations. Artificial intelligence may enhance EEG analysis and biomarker discovery, potentially transforming psychiatric care by providing early diagnosis, personalized treatment, and improved disease progression monitoring.
9.Using Deep Learning Techniques as an Attempt to Create the Most Cost-Effective Screening Tool for Cognitive Decline
Hye-Geum KIM ; Wan-Seok SEO ; Bon-Hoon KOO ; Eun-Jin CHEON ; Seokho YUN ; Sohye JO ; Byoungyoung GU
Psychiatry Investigation 2024;21(8):912-917
Objective:
This study aimed to use deep learning (DL) to develop a cost-effective and accessible screening tool to improve the detection of cognitive decline, a precursor of Alzheimer’s disease (AD). This study integrating a comprehensive battery of neuropsychological tests adjusted for individual demographic variables such as age, sex, and education level.
Methods:
A total of 2,863 subjects with subjective cognitive complaints who underwent a comprehensive neuropsychological assessment were included. A random forest classifier was used to discern the most predictive test combinations to distinguish between dementia and nondementia cases. The model was trained and validated on this dataset, focusing on feature importance to determine the cognitive tests that were most indicative of decline.
Results:
Subjects had a mean age of 72.68 years and an average education level of 7.62 years. The DL model achieved an accuracy of 82.42% and an area under the curve of 0.816, effectively classifying dementia. Feature importance analysis identified significant tests across cognitive domains: attention was gauged by the Trail Making Test Part B, language by the Boston Naming Test, memory by the Rey Complex Figure Test delayed recall, visuospatial skills by the Rey Complex Figure Test copy score, and frontal function by the Stroop Test Word reading time.
Conclusion
This study showed the potential of DL to improve AD diagnostics, suggesting that a wide range of cognitive assessments could yield a more accurate diagnosis than traditional methods. This research establishes a foundation for future broader studies, which could substantiate the approach and further refine the screening tool.
10.The Complexity of Borderline Personality Disorder: Network Analysis of Personality Factors and Defense Styles in the Context of Borderline Personality Organization
Seokho YUN ; So-Hye JO ; Hye-Jin JEON ; Hye-Geum KIM ; Eun-Jin CHEON ; Bon-Hoon KOO
Psychiatry Investigation 2024;21(6):672-679
Objective:
Borderline personality disorder (BPD) is known to share characteristics with a variety of personality disorders (PDs) and exhibits diverse patterns of defense mechanisms. To enhance our understanding of BPD, it’s crucial to shift our focus from traditional categorical diagnostics to the dimensional traits shared with other PDs, as the borderline personality organization (BPO) model suggests. This approach illuminates the nuanced spectrum of BPD characteristics, offering deeper insights into its complexity. While studies have investigated the comorbidity of BPD with other PDs, research exploring the relationship between various personality factors and defense mechanisms within BPD itself has been scarce. The present study was undertaken to investigate the complex interrelationships between various personality factors and defense styles in individuals diagnosed with BPD.
Methods:
Using a network analysis approach, data from 227 patients diagnosed with BPD were examined using the Defense Style Questionnaire and Personality Disorder Questionnaire-4+ for assessment.
Results:
Intricate connections were observed between personality factors and defense styles. Significant associations were identified between various personality factors and defense styles, with immature defense styles, such as maladaptive and image-distorting being particularly prominent in BPD in the centrality analysis. The maladaptive defense style had the highest expected influence centrality. Furthermore, the schizotypal, dependent, and narcissistic personality factors demonstrated relatively high centrality within the network.
Conclusion
Network analysis can effectively delineate the complexity of various PDs and defense styles. These findings are expected to facilitate a deeper understanding of why BPD exhibits various levels of organization and presents with heterogeneous characteristics, consistent with the perspectives proposed by the BPO.

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