INTRODUCTION: Behavioural and psychological symptoms of dementia (BPSD) are considered integral parts of dementia. While pharmacotherapy is reserved for severe symptoms of BPSD, the associated adverse effects can be detrimental. Therefore, non-pharmacological intervention is recommended as the first line of treatment in the management of BPSD. This study aimed to explore the non-pharmacological approaches for the management of BPSD and the strategies and barriers to implementing them in secondary care facilities in Malaysia. METHODS: A qualitative study design was employed. Data were collected through observations and semi-structured interviews of 12 caregivers and 11 people with dementia (PWD) at seven secondary care facilities. Observations were written in the field notes, and interviews were audio-recorded and transcribed. All data were subjected to thematic analysis. RESULTS: Some personalised non-pharmacological interventions, such as physical exercise, music therapy, reminiscence therapy and pet therapy, were conducted in several nursing care centres. Collaborative care from the care providers and family members was found to be an important facilitating factor. The lack of family support led to care providers carrying additional workload beyond their job scope. Other barriers to non-pharmacological interventions were cultural and language differences between the care providers and PWD, inadequate staff numbers and training, and time constraints. CONCLUSION Although non-pharmacological approaches have been used to some extent in Malaysia, continuous education and training of healthcare providers and the family members of PWD is needed to overcome the challenges to their successful implementation.
Humans ; Dementia/diagnosis* ; Psychotherapy ; Qualitative Research ; Health Personnel ; Caregivers

Aged ; Aged, 80 and over ; Alzheimer Disease/diagnosis* ; Animals ; Biomarkers/blood* ; Cognitive Dysfunction ; Female ; Humans ; Male ; Membrane Glycoproteins/blood* ; Mental Status and Dementia Tests ; Mice ; Middle Aged ; Models, Animal ; Morris Water Maze Test ; Parkinson Disease/diagnosis* ; ROC Curve ; Receptors, Immunologic/blood* ; Sensitivity and Specificity

To analyze the domestic clinical application of vascular dementia scales, and provide the basis for the refinement of clinical scales. VIP, SinoMed, Wanfang and CNKI databases were searched by computer to analyze the clinical application of vascular dementia scales published in Chinese Core Periodicals in Library of Peking University, CSSCI and CSCD, with time limit from database establishment to August 31, 2020. According to the inclusion or exclusion criteria, the combination of Note Express software and manual search was used to complete the literature duplicate detection and screening. According to the research needs, the relevant data were extracted and a new database was established. In this study, a total of 4 246 related literatures were initially searched, 2 048 repetitive literatures were eliminated, 1 484 literatures were manually screened out, and finally 714 literatures and 44 scales were included. The total using frequency of scales was 2 660. The results of descriptive analysis showed that there were many kinds of clinical scales for vascular dementia. In order to avoid the repeated use of scales with similar functions, it is correct to include the possible influences such as the purpose of use, way, frequency and function of the scales into reference factors of scale selection according to the disease diagnostic criteria. It is necessary to develop the scales with traditional Chinese medicine characteristic for objective clinical evaluation of traditional Chinese medicine.
Dementia, Vascular/diagnosis* ; Drugs, Chinese Herbal ; Humans ; Medicine, Chinese Traditional

BACKGROUND AND PURPOSE: Disability associated with activities of daily living (ADL) is the basis of dementia diagnosis and is an important factor in the care of dementia patients. The status of awareness and burden of ADL disability in dementia patients was investigated six years ago and used as an important reference for “Il-sang-ye-chan” campaign. They were re-investigated in six years and compared with previous results. METHODS: The survey included caregivers of 100 dementia patients listed at the four regional dementia centers. Structured open and closed questions about ADL were asked. Assessments included age, sex, education level, economic status, severity of dementia, caregiving pattern, current statues and cognition of ADL, and caregiver needs. RESULTS: The cognition of ADL was still very low (43%). Increased stress among caregivers was the biggest burden, and they frequently suffered from outing disability (56%), recent memory loss (48%), and loss of bowel/bladder control (40%). The economic burden has been greatly reduced compared with the burden six years ago and the needs of caregivers were still highly about educational guide lines or programs. CONCLUSIONS: Continued interest and further investigation into ADL disability of dementia patients are needed. Korean Dementia Association will further expand the “Il-sang-ye-chan” program: via a multi-domain cognitive intervention program under the Care for ADL in dementia and Relieve symptoms in Dementia Project.
Activities of Daily Living ; Caregivers ; Cognition ; Dementia ; Diagnosis ; Education ; Humans ; Memory Disorders

BACKGROUND AND PURPOSE: Epidemiological studies have suggested the presence of strong correlations among diet, lifestyle, and dementia onset. However, these studies have unfortunately had major limitations due to their inability to fully control the various potential confounders affecting the nutritional status. The purpose of the current study was to determine the nutritional status of participants in the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease (KBASE) and to identify clinical risk factors for being at risk of malnutrition or being malnourished. METHODS: Baseline data from 212 participants [119 cognitively unimpaired (CU), 56 with mild cognitive impairment (MCI), and 37 with dementia] included in the KBASE database were analyzed. All participants underwent a comprehensive cognitive test and MRI at baseline. The presence of malnutrition at baseline was measured by the Mini Nutritional Assessment score. We examined the cross-sectional relationships of clinical findings with nutritional status using multiple logistic regression applied to variables for which p<0.2 in the univariate analysis. Differences in cortical thickness according to the nutritional status were also investigated. RESULTS: After adjustment for demographic, nutritional, and neuropsychological factors, participants with dementia had a significantly higher odds ratio (OR) for being at risk of malnutrition or being malnourished than CU participants [OR=5.98, 95% CI=1.20–32.97] whereas participants with MCI did not (OR=0.62, 95% CI=0.20–1.83). Cortical thinning in the at-risk/malnutrition group was observed in the left temporal area. CONCLUSIONS: Dementia was found to be an independent predictor for the risk of malnutrition compared with CU participants. Our findings further suggest that cortical thinning in left temporal regions is related to the nutritional status.
Aged ; Aging ; Alzheimer Disease ; Brain ; Cerebral Cortex ; Dementia ; Diet ; Early Diagnosis ; Epidemiologic Studies ; Humans ; Life Style ; Logistic Models ; Magnetic Resonance Imaging ; Malnutrition ; Mild Cognitive Impairment ; Nutrition Assessment ; Nutritional Status ; Odds Ratio ; Risk Factors ; Temporal Lobe

BACKGROUND AND PURPOSE: Associations between alterations in body mass index (BMI) and cognitive function have been reported in Parkinson's disease (PD). We investigated whether the BMI at a PD diagnosis is associated with cognitive decline and the future development of dementia. METHODS: We recruited 70 patients with de novo PD who underwent neuropsychological testing every 3 years and were followed up for more than 6 years. We classified patients into the following three groups based on their BMI at the diagnosis: under-/normal weight (n=21), overweight (n=22), and obese (n=27). We evaluated differences in the rate of cognitive decline over time among the groups using linear mixed models and the conversion rate to dementia using survival analysis. RESULTS: The obese patients with PD showed a slower deterioration of global cognitive function as well as language and memory functions than did the under-/normal-weight group during the 6-year follow-up. The three BMI groups showed different rates of conversion to dementia (log-rank test: p=0.026). The combined overweight and obese group showed a lower risk of developing dementia compared with the under-/normal-weight group (hazard ratio= 0.36, 95% CI=0.12–0.82, p=0.046). CONCLUSIONS: We have demonstrated that a higher-than-normal BMI at the time of a PD diagnosis has a protective effect against the deterioration of cognitive function and the conversion to dementia.
Body Mass Index ; Cognition ; Dementia ; Diagnosis ; Follow-Up Studies ; Humans ; Memory ; Neuropsychological Tests ; Overweight ; Parkinson Disease

BACKGROUND: There has been no study on the time trends of dementia incidence in Korea. We report the 5-year incidence and its correlates of all-cause and Alzheimer's disease (AD) dementia, and compared our results with those of a 12-year-prior cohort study conducted in the same area. METHODS: A total of 751 community-dwelling older adults were followed up for a mean duration of 5.4 years. The age-, gender-, and educational attainment-specific incidence of all-cause and AD dementia were reported as cases per 1,000 person-years. We performed univariate and multivariate cox proportional hazard regression analyses to determine whether baseline sociodemographic, lifestyle, and clinical variables were associated with the risk of all-cause and AD dementia. A 12-year-prior cohort study was used for descriptive comparison to indicate the time trends of dementia incidence. RESULTS: The incidence rates were 16.2 and 13.0 cases per 1,000 person-years for all-cause and AD dementia, respectively. The baseline diagnosis of mild cognitive impairment increased the 5-year incidence of all-cause dementia by more than 4-fold. Old age and low baseline global cognitive function were noted as risk factors for both all-cause and AD dementia. CONCLUSION: Upon comparing the results with those from the earlier cohort study in Yeoncheon, the incidence of all-cause and AD dementia decreased by approximately 40% over 12 years; it has been mainly driven by the increase in the educational level of older adults. The declining time trends of incidence should be taken into account for estimating the future prevalence of dementia in Korea.
Adult ; Alzheimer Disease ; Cognition ; Cohort Studies ; Dementia ; Diagnosis ; Humans ; Incidence ; Korea ; Life Style ; Mild Cognitive Impairment ; Prevalence ; Risk Factors

BACKGROUND: In the early diagnosis of dementia, an important factor is the evaluation of activities of daily living. The Everyday Cognition (ECog) scale was developed to measure functional changes that are the everyday correlates of specific neuropsychological impairments. This study aimed to examine the validity of the Korean version of Everyday Cognition (K-ECog). METHODS: The participants were 268 cognitively normal older adults (NA), 151 amnestic mild cognitive impairment (aMCI), and 77 dementia of the Alzheimer's type (DAT). The Korean-Mini Mental State Examination (K-MMSE), Korean-Montreal Cognitive Assessment (K-MoCA), and Short form of the Geriatric Depression Scale (SGDS) were administered to all the participants. The K-ECog and Korean-Instrumental Activities of Daily Living (K-IADL) were rated by their informants. RESULTS: Internal consistency (Cronbach's α) of K-ECog global function was 0.93, and its test-retest reliability (Pearson's r) was 0.73. K-ECog was significantly correlated with K-IADL (0.66), K-MMSE (−0.38), and K-MoCA (−0.26). Confirmatory factor analysis of K-ECog yielded seven factor model that the original ECog proposed. K-ECog global score and six domain scores were significantly different across the NA, aMCI, and DAT groups. Receiver operating characteristic curve analyses showed that K-ECog effectively differentiated aMCI and DAT patients from NA, suggesting that K-ECog is as sensitive for detecting functional impairments as K-IADL. The proposed optimal cut-off score to differentiate aMCI from NA was 1.41. CONCLUSION: K-ECog is proven reliable and valid for clinical use. K-ECog can be used to distinguish very early stages of impaired ADL and cognitive impairment in the community.
Activities of Daily Living ; Adult ; Cognition Disorders ; Cognition ; Dementia ; Depression ; Early Diagnosis ; Fibrinogen ; Humans ; Mild Cognitive Impairment ; Reproducibility of Results ; ROC Curve

BACKGROUND: The increasing number of dementia patients is increasing the importance of identifying them and also those at a high risk of dementia. The early diagnosis and management of dementia can slow the progression of the disease and reduce the socioeconomic burden. For these purposes, the Local Dementia Centers established in all regions of Korea are working on the early detection of dementia using neuropsychological batteries. This study investigated the utility of the Seoul Neuropsychological Screening Battery-Core (SNSB-C) in a dementia management project performed in the local community. METHODS: This study was conducted in two parts. The first part used data from the Local Dementia Centers to investigate the accuracy of detecting cognitive impairment in SNSB-C compared with the Seoul Neuropsychological Screening Battery-Second Edition (SNSB-II). The second part of this study which data from hospital examined the accuracy of diagnosing dementia using SNSB-C. RESULTS: Data were collected from 508 participants at the Local Dementia Centers in Daejeon and 50 participants at a hospital. SNSB-C had a high sensitivity and specificity for detecting cognitive impairment, and also a high sensitivity, high specificity, and positive predictive value for diagnosing dementia. CONCLUSIONS: The sensitivity in diagnosing dementia was as high for SNSB-C as for SNSB-II while taking less time. SNSB-C could therefore be a good diagnostic evaluation tool for use in local dementia centers.
Cognition Disorders ; Dementia ; Diagnosis ; Early Diagnosis ; Humans ; Korea ; Mass Screening ; Neuropsychological Tests ; Sensitivity and Specificity ; Seoul

Diagnosis of transient ischemic attack has been entirely dependent on the clinical history due to the absence of brain magnetic resonance imaging lesion. It is challenging to distinguish between transient ischemic attack and transient ischemic attack-mimics. Cerebral microbleeds would be found in 11.1–23.5% of incidental findings in elderly population. However, cerebral microbleeds have been known to lead to cognitive decline, dementia, seizure and even status epilepticus. We report a case of cerebral microbleeds induced epileptic seizure, visiting the emergency room with sudden onset unilateral motor weakness.
Aged ; Brain ; Dementia ; Diagnosis ; Emergency Service, Hospital ; Epilepsy ; Humans ; Incidental Findings ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Seizures ; Status Epilepticus