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Background: Postoperative delirium is a challenging complication due to its adverse outcome such as long hospital stay. The aims of this study were: 1) to identify preoperative risk factors of postoperative delirium following knee arthroplasty, and 2) to develop a machine-learning prediction model. Method: A total of 3,980 patients from two hospitals were included in this study. The model was developed and trained with 1,931 patients from one hospital and externally validated with 2,049 patients from another hospital. Twenty preoperative variables were collected using electronic hospital records. Feature selection was conducted using the sequential feature selection (SFS). Extreme Gradient Boosting algorithm (XGBoost) model as a machine-learning classifier was applied to predict delirium. A tenfold-stratified area under the curve (AUC) served as the metric for variable selection and internal validation. Results: The incidence rate of delirium was 4.9% (n = 196). The following seven key predictors of postoperative delirium were selected: age, serum albumin, number of hypnotics and sedatives drugs taken preoperatively, total number of drugs (any kinds of oral medication) taken preoperatively, neurologic disorders, depression, and fall-down risk (all p < 0.05). The predictive performance of our model was good for the developmental cohort (AUC: 0.80, 95% CI: 0.77–0.84). It was also good for the external validation cohort (AUC: 0.82, 95% CI: 0.80–0.83). Our model can be accessed at https://safetka.connecteve.com. Conclusions: A web-based predictive model for delirium after knee arthroplasty was developed using a machine-learning algorithm featuring seven preoperative variables. This model can be used only with information that can be obtained from pre-operative electronic hospital records. Thus, this model could be used to predict delirium before surgery and may assist physician's effort on delirium prevention. [ABSTRACT FROM AUTHOR]

Background: The psychiatric treatment gap is substantial in Korea, implying barriers in seeking help. Objectives: This study aims to explore barriers of seeing psychiatrists, expressed on the internet by age groups. Methods: A corpus of data was garnered extensively from internet communities, blogs and social network services from 1 January 2016 to 31 July 2019. Among the texts collected, texts containing words linked to psychiatry were selected. Then the corpus was dismantled into words by using natural language processing. Words linked to barriers to seeking help were identified and classified. Then the words from web communities that we were able to identify the age groups were additionally organized by age groups. Results: 97,730,360 articles were identified and 6,097,369 were included in the analysis. Words implying the barriers were selected and classified into four groups of structural discrimination, public prejudice, low accessibility, and adverse drug effects. Structural discrimination was the greatest barrier occupying 34%, followed by public prejudice (27.8%), adverse drug effects (18.6%), and cost/low accessibility (16.1%). In the analysis by age groups, structural discrimination caused teenagers (51%), job seekers (64%) and mothers with children (43%) the most concern. In contrast, the public prejudice (49%) was the greatest barriers in the senior group. Conclusions: Although structural discrimination may most contribute to barriers to visiting psychiatrists in Korea, variation by generations may exist. Along with the general attempt to tackle the discrimination, customized approach might be needed. [ABSTRACT FROM AUTHOR]

Background: Air pollution control is necessary to decrease the burden on older adults with cognitive impairment, especially in low- and middle-income countries (LMICs).Objective: This study retrospectively examined the effect of cumulative exposure to air pollution, including NO2, SO2, CO, fine particulate matter (PM)10, PM2.5, and O3, on cognitive function in older individuals.Methods: Community-dwelling older adults who underwent the Mini-Mental State Examination (MMSE) from 2007 to 2018 were included in the analyses. We excluded older individuals diagnosed with dementia at baseline, while those who had completed more than two MMSE tests were included in the longitudinal analyses. Baseline MMSE and changes in MMSE scores were analyzed according to 5-year average concentrations of the district-level air pollutants, after controlling for covariates associated with cognitive decline in older adults.Results: In total, 884,053 (74.3±7.1 years; 64.1% females) and 398,889 (72.3±6.4 years; 67.0% females) older individuals were included in the cross-sectional and longitudinal analyses, respectively. Older individuals exposed to higher levels of NO2, SO2, CO, and PM10 showed lower baseline MMSE scores. During follow-up, exposure to higher levels of NO2, SO2, CO, and PM10 was associated with greater decreases in MMSE scores in older individuals; for O3, the opposite pattern was observed.Conclusion: Our findings suggest that exposure to high levels of air pollutants can worsen the cognitive performance of older adults without dementia. Efforts to reduce air pollution in LMICs that have similar levels of pollutants to South Korea are necessary to reduce the burden on older adults with cognitive impairment. [ABSTRACT FROM AUTHOR]

Aims: The aim of the current study was to develop and validate a short-form of the internet overuse screening questionnaire (IOS-Qs). Methods: A total of 571 adults were recruited from a representative, stratified, and multistage cluster sample. Among participants, 188 and 383 were used in the development and validation of the IOS-Qs, respectively. Results: Experts' ratings and Rasch model analyses led to the selection of 8 items from the IOS-Qs; latent-class analysis using these 8 items revealed an estimated prevalence of 8.6% (33 out of 383) of problematic internet over-users. Problematic internet over-users were positively associated with a 1-year prevalence rate of any mental disorder (OR 3.08, p = 0.008), mood disorder (OR 7.11, p = 0.003), and depressive disorder (OR 5.22, p = 0.016). The receiver operating characteristic curves identified an optimal cutoff score of 9.5 for differentiating problematic internet over-users from unproblematic internet users with 94% sensitivity and 94% specificity. Conclusion: The results suggest that the IOS-Qs was valid, and items including social isolation were crucial to the brief distinction of at-risk internet users. Because of its brevity, the questionnaire can be effectively administered as a large-scale survey. [ABSTRACT FROM AUTHOR]

Background: The degree of alpha attenuation from eyes-closed (EC) to eyes-open (EO) has been suggested as a neural marker of cognitive health, and its disruption has been reported in patients with clinically defined Alzheimer's disease (AD) dementia.Objective: We tested if EC-to-EO alpha reactivity was related to cerebral amyloid-β (Aβ) deposition during the early stage of AD.Methods: Non-demented participants aged ≥55 years who visited the memory clinic between March 2018 and June 2019 (N = 143; 67.8% female; mean age±standard deviation, 74.0±7.6 years) were included in the analyses. Based on the [18F]florbetaben positron emission tomography assessment, the participants were divided into Aβ+ (N = 70) and Aβ- (N = 73) groups. EEG was recorded during the 7 min EC condition followed by a 3 min EO phase, and a Fourier transform spectral analysis was performed.Results: A significant three-way interaction was detected among Aβ positivity, eye condition, and the laterality factor on alpha-band power after adjusting for age, sex, educational years, global cognition, depression, medication use, and white matter hyperintensities on magnetic resonance imaging (F = 5.987, p = 0.016); EC-to-EO alpha reactivity in the left hemisphere was significantly reduced in Aβ+ subjects without dementia compared with the others (F = 3.984, p = 0.048).Conclusion: Among mild cognitive impairment subjects, alpha reactivity additively contributed to predict cerebral Aβ positivity beyond the clinical predictors, including vascular risks, impaired memory function, and apolipoprotein E ɛ4. These findings support that EC-to-EO alpha reactivity acts as an early biomarker of cerebral Aβ deposition and is a useful measurement for screening early-stage AD. [ABSTRACT FROM AUTHOR]

Purpose: To investigate age-related differences in the relationships among at-risk alcohol consumption, alcohol use disorder (AUD), and psychological distress with a special focus on older adults.Methods: We used a nationwide cross-sectional study of a representative sample of community-dwelling adults from the Korean Epidemiologic Catchment Area study for psychiatric disorders conducted by door-to-door interviews. The Korean version of the Composite International Diagnostic Interview was applied. Subjects were categorized into four age groups: young-to-middle-aged (20-54 years), near-old (55-64 years), early-old (65-74 years), and late-old (≥ 75 years). The associations among at-risk drinking, alcohol use disorder, and psychological distress were examined according to age groups.Results: Among a total of 5102 individuals, half of them drank alcohol in the previous year, of whom 20.5% were at-risk drinkers (≥ 100 g/week). Older people were less often diagnosed with AUD than young-to-middle-aged adults with a similar degree of at-risk drinking. They were less likely to meet the DSM-5 AUD criteria in terms of social and vocational role disruption or creation of a physically hazardous situation. However, at-risk drinking showed a stronger association with subjective psychological distress in older adults, particularly in the near-old group (adjusted odds ratio 1.82, 95% confidence interval 1.09-3.03; p = 0.023).Conclusions: These findings indicate the importance of screening for mental health problems in older adults, especially near-old adults, who drink more than 100 g of alcohol per week even when they do not satisfy the criteria for a diagnosis of AUD. [ABSTRACT FROM AUTHOR]

Background: Although a focus on late-life depression may help preventing suicide in older adults, many older people, especially those living in rural areas, have relatively low accessibility to treatment. This study examined the feasibility and effectiveness of a village-based intervention for depression targeting older adults living in rural areas.Methods: A community-based randomised pilot trial was performed in two small rural villages in South Korea. Two villages were randomly selected and assigned to the intervention or active control group; all older adults living in the two villages (n = 451) were included in the intervention program or received standard Community Mental Health Service (CMHS) care, and the effectiveness of the program was examined using representative samples from both groups (n = 160). The 12-week intervention included case management according to individual risk level and group-based activities. Healthy residents living in the intervention village who played major roles in monitoring at-risk older individuals were supervised by CMHS staff. The score on the Korean version of the Geriatric Depression Scale-Short Form (SGDS-K) was the primary outcome, while social network, functional status, and global cognitive function were secondary outcomes. Linear mixed models including the factors of intervention group, time, and their interaction were used to examine group differences in changes in primary and secondary outcomes from baseline to follow up.Results: Overall, there was no significant group × time interaction with respect to the SGDS-K score, but older individuals with more depressive symptoms at baseline (SGDS-K ≥ 6) tended to have a lower likelihood of progressing to severe depression at post-intervention. The social network was strengthened in the intervention group, and there was a significant group × time interaction (F[df1, df2], 5.29 [1, 153], p = 0.023).Conclusion: This study examined a 12-week village-based intervention for late-life depression in which the CMHS helped village-dwellers deal with late-life depression in their communities. Although the intervention improved social interactions among older adults, it did not reduce depressive symptoms. Further studies including more rural villages and long-term follow up are needed to confirm the effectiveness of this prevention program.Trial Registration: NCT04013165 (date: 9 July 2019, retrospectively registered). [ABSTRACT FROM AUTHOR]

We aimed to examine the feasibility and effectiveness of a multidomain intervention including intensive and maintenance programs for reducing the risk of dementia in at-risk older adults. Community-dwelling older adults (aged ≥60 years) without dementia but having several risk factors for dementia (N = 32; 89% female; mean age±standard deviation, 76.8±4.7 years) were assigned to three parallel programs: intensive plus maintenance (INT+MNT), intensive only (INT-only), and active control. Subjects in INT+MNT and INT-only groups participated in a 4-week intensive group-based lifestyle modification program that focused on physical activity, vascular risk factors, dietary habits, cognitive activities, and social engagement. INT+MNT participants underwent an additional 20-week maintenance program to consolidate modified habits. The modified Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI) score was used as the primary outcome measure for dementia risk. The changes in ANU-ADRI scores exhibited a significant group-by-time interaction: the INT+MNT group showed significant improvement at 24 weeks (β= -6.05; SE = 1.86; p = 0.002), while the INT-only group did not. Additional exploratory analyses showed that the reduction in ANU-ADRI scores was caused by changes in protective factors rather than in risk factors. The INT + MNT group also showed greater improvement in executive function at 4 and 24 weeks (both p = 0.044), whereas changes in global cognitive function did not reach significance (p = 0.055). A 24-week multidomain dementia prevention involving a maintenance strategy for sustaining modified lifestyle habits reduced the risk of dementia and improved executive function in at-risk older adults. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the impacts of earlier traumatic events on the mental health of older adults, in terms of mental disorders and mental well-being, according to sociodemographic variables, trauma-related characteristics, and personality traits in a nationally representative sample of older Koreans.Methods: A total of 1,621 subjects aged 60 to 74 years from a Korean national epidemiological survey of mental disorders responded face-to-face interviews. The Korean Composite International Diagnostic Interview was used to investigate lifetime trauma exposure (LTE) and psychiatric diagnoses. The EuroQol health classification system and life satisfaction scale were used to assess quality of life (QoL), and the Big Five Inventory-10 (BFI-10) to measure personality traits.Results: Five-hundred and seventy-seven subjects (35.6%) reported a history of LTE (mean age at trauma, 30.8 years old). Current mental disorders were more prevalent in elderly people with LTE, while better current QoL was more frequent in those without LTE. Among older people with LTE, lower extraversion and higher neuroticism increased the risk of current mood or anxiety disorders, whereas higher extraversion increased the probability of experiencing mental well-being after adjusting for sociodemographic and trauma-related variables.Conclusion: Personality traits, especially extraversion, and neuroticism, may be useful for predicting the mental health outcomes of LTE in older adults. Further longitudinal studies investigating the relationship between traumatic events and mental health outcomes are needed. [ABSTRACT FROM AUTHOR]

Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions. [ABSTRACT FROM AUTHOR]

Purpose: Network medicine considers networks among genes, diseases, and individuals. Networks of mental disorders remain poorly understood, despite their high comorbidity. In this study, a network of mental disorders in Korea was constructed to offer a complementary approach to treatment.Methods: Data on the prevalence and morbidity of mental disorders were obtained from the 2006 and 2011 Korean Epidemiologic Catchment Area Study, including 22 psychiatric disorders. Nodes in the network were disease phenotypes identified by Diagnostic and Statistical Manual of Mental Disorders-IV, and the links connected phenotypes showing significant comorbidity. Odds ratios were used to quantify the distance between disease pairs. Network centrality was analyzed with and without weighting of the links between disorders. Degree centrality was correlated with suicidal behaviors and use of mental health services.Results: In 2011 and 2006, degree centrality was highest for major depressive disorder, followed by nicotine dependence and generalized anxiety disorder (2011) or alcohol dependence (2006). Weighted degree centrality was highest in conversion disorder in both years.Conclusions: Therefore, major depressive disorder and nicotine dependence are highly connected to other mental disorders in Korea, indicating their comorbidity and possibility of shared biological mechanisms. The use of networks could enhance the understanding of mental disorders to provide effective mental health services. [ABSTRACT FROM AUTHOR]

Purpose: Near-elderly adults go through many changes in socioeconomic status, such as retirement, which may affect their mental health differently according to when they live. We aimed to compare the prevalence of major depressive disorder (MDD) and its changes according to sociodemographic factors using nationally representative surveys of Korean near-elderly adults conducted 10 years apart.Methods: Nationwide community samples of individuals aged 55-64 years living in 2001 (n = 1256) and 2011 (n = 1066) were compared. Face-to-face interviews were conducted using the Korean version of the Composite International Diagnostic Interview to diagnose MDD. Sociodemographic data were collected using self-reported questionnaires including questions on employment and economic status. We examined differences in MDD prevalence and its association with sociodemographic factors over time by calculating 2011-to-2001 odds ratios (ORs) using multivariable logistic regression models.Results: Among near-elderly people, MDD tended to be more prevalent in 2011 than in 2001. However, only near-elderly men in 2011 showed a higher risk of MDD compared with those in 2001 (2011-to-2001 OR 4.19), while women did not. The prevalence ratio by gender decreased from 7.04 in 2001 to 2.34 in 2011. Among vulnerable sociodemographic groups, a significant increase in MDD was observed in unemployed men (adjusted OR 8.35), but not in unemployed women or other vulnerable groups.Conclusion: This study provides evidence of a substantial increase in MDD in Korean near-elderly men and suggests that unemployment should be considered as an important correlate of MDD in this group. [ABSTRACT FROM AUTHOR]

Objective To investigate the natural course of depressive symptoms among community-dwelling elderly over 5 years. Rates and correlates of the incidence and the persistence of late-life depression were examined. Methods A total of 701 elderly people 65 years of age or older without dementia at baseline were included in this study. The association between categorically defined late-life depression (score of ≥8 on the Korean version of the Geriatric Depression Scale-Short Form) and possible lifestyle and clinical risk factors, including physical activity assessed with a modified Korean version of the International Physical Activity Questionnaire (IPAQ) and transformed into weekly Metabolic Equivalent Task (MET) values, was longitudinally investigated using multiple logistic regression analyses. Adjustment was done with sociodemographic variables, chronic medical illnesses, and cognitive dysfunction. Results During the 5-year follow-up, 74 (26.5%) of the non-depressed elderly developed depression, whereas 30 (49.2%) of the depressed elderly experienced persistent depression. Above-moderate baseline physical activity was independently associated with decreased incidence and persistence rates of late-life depression (adjusted odds ratio (AOR) = 0.44, 95% confidence interval (CI) = 0.22-0.85; AOR = 0.17, 95% CI = 0.03-0.92, respectively), whereas mild physical activity was not. Conversely, poorer executive function also predicted 5-year incident depression (AOR = 0.93, 95% CI = 0.89-0.98) but not persistent depression. Conclusion This study suggests that a minimum of moderate physical activity is related to both emergent and persistent depression in elderly individuals. Research with an extended follow-up period and a shorter inter-assessment interval is needed to confirm this result. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the prevalence of sexual problems and associated factors, focusing particularly on comorbid psychiatric disorders, among older Korean women. Methods: A nationally representative sample of women aged 50-74 years ( n=3828) responded to in-person interviews using the Korean version of the Composite International Diagnostic Interview to assess psychiatric disorders and four symptoms of sexual dysfunction: (1) lack of sexual interest/sexual aversion, (2) dyspareunia, (3) loss of pleasure, and (4) other organic dysfunction (e.g., inability of sexual arousal). We examined the likelihood of sexual dysfunction by sociodemographic and clinical variables, including specific psychiatric disorders, and compared the characteristics of sexual dysfunction among women with and without a comorbid psychiatric disorder. Results: A total of 334 (8.7%) women reported one or more symptoms of sexual dysfunction during the year preceding the interview: lack of sexual interest/sexual aversion was most prevalent (7.7%), followed by loss of pleasure (4.2%), dyspareunia (2.4%), and other organic dysfunction (0.4%). Having a psychiatric disorder was associated with a 2.7-fold increase in the probability of sexual dysfunction. Among women with sexual dysfunction, having comorbid mental disorder was associated with being unmarried status, a symptom of loss of pleasure, and a history of sexual dysfunction before 50 years of age. Conclusions: The present study suggests a relatively lower prevalence of sexual dysfunction than previously reported, but supports its strong association with psychiatric disorders among postmenopausal women. We should evaluate comorbid mental disorder with sexual dysfunction, especially among those having some characteristics. [ABSTRACT FROM AUTHOR]

Background:In many countries, illiteracy rates among aged people are quite high. However, only few studies have specifically investigated the impact of illiteracy on depression.Methods:Data for 1,890 elderly individuals (aged ≥65 years) were obtained from a nationwide dementia epidemiological study conducted in South Korea. Based on their reading ability, the participants were divided into three groups: totally illiterate, partially illiterate, and literate. The Korean version of the Geriatric Depression Scale – Short Form (SGDS-K) was used to detect depression (cut-off score = 8). Multivariate logistic regression analyses were used to assess the association between illiteracy and depression. To explore clinical features of depression in illiterate people, we performed logistic regression to calculate odds ratios of positive responses (or negative responses to reverse-coded items) for each SGDS-K item using literate individuals as the reference group.Results:Totally illiterate participants had 2.41 times the odds and partially illiterate individuals had 1.59 times the odds of being depressed compared with literate participants after controlling for other variables. Compared with literate individuals, illiterate elderly persons were at increased odds for responding negatively to the majority of SGDS-K items, including “having memory problems,” “others are better off than me,” and “feeling worthless” even after controlling for various demographic and clinical factors.Conclusions:Illiteracy in elderly individuals was associated with a higher rate and increased severity of depression. Illiteracy negatively affected depression symptomatology, especially factors associated with self-esteem. Therefore, clinicians should carefully monitor for the presence of depression in illiterate elderly adults. [ABSTRACT FROM AUTHOR]

Background:We assessed eight-year mortality rates and predictors in a rural cohort of elderly individuals with cognitive impairment.Methods:A total of 1,035 individuals, including 155 (15.0%) individuals with cognitive impairment, no dementia (CIND), and 69 (6.7%) individuals with clinically diagnosed dementia were followed for eight years from 1997. The initial assessment involved a two-step diagnostic procedure performed during a door-to-door survey, and mortality data were obtained from the Korean National Statistical Office (KNSO). The relationship between clinical diagnosis and risk of death was examined using the Cox proportional hazards model after adjusting for age, sex, and education.Results:During follow-up, 392 individuals died (37.9%). Compared to persons without cognitive impairment, mortality risk was nearly double among those with CIND (hazard ratio [95% confidence interval], 1.92 [1.46–2.54]), and this increased more than three-fold among those with dementia (3.20 [2.30–4.44]). Old age and high scores on the behavioral changes scale at diagnosis were two common predictors of mortality among those with CIND and dementia. Among the items on the behavioral changes scale, low sociability, less spontaneity, and poor hygiene were associated with increased mortality in individuals with CIND. Conversely, low sociability, excessive emotionality, and irritability were associated with increased mortality in patients with dementia.Conclusions:Both dementia and CIND increased mortality risk compared with normal cognition in this community cohort. It is important to identify and manage early behavioral changes to reduce mortality in individuals with CIND and dementia. [ABSTRACT FROM AUTHOR]

Abstract: Background: Mild cognitive impairment (MCI) is subclassified into four subtypes by the presence of impairment in the memory domain (amnestic vs nonamnestic) and the number of impaired cognitive domains (single vs multiple). However, predictive validity for outcomes of these criteria and the diagnostic stability of the subtypes are questionable. Methods: We investigated the outcomes of 140 patients with MCI who participated in the baseline study of the Korean Longitudinal Study on Health and Aging and completed the 18-month follow-up evaluation (mean duration of follow-up = 1.57 ± 0.24 years). We evaluated the predictive validity of the criteria using multinomial logistic regression analyses, and the diagnostic stability of MCI subtypes using annual conversion rates between subtypes. Results: Compared with the single-domain type (MCIs), the multiple-domain type (MCIm) had a lower chance of reversion to normal cognition (MCIm = 10.94%, MCIs = 43.42%) and higher risk of conversion to dementia (MCIm = 23.44%, MCIs = 5.26%). The difference in the reversion rate between the multiple- and single-domain type was statistically significant (odds ratio = 0.233, 95% confidence interval = 0.070–0.771, P = .017). However, neither the chance of reversion nor the risk of conversion was different between amnestic and nonamnestic subtypes. Among the 81 participants who neither converted to dementia nor reverted to normal cognition, 39 converted to different subtype (annual conversion rate = 17.74%). Conclusions: The number of impaired cognitive domains, but not the presence of memory impairment, predicted poor outcomes in people with MCI. However, MCI subtype was diagnostically unstable. [Copyright &y& Elsevier]