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inability to communicate and to speak Portuguese. Delirium was operationally defined according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria, assessed by a psychiatrist. All patients were also assessed by the Confusion Assessment Method (CAM). For analysis of differences between the two groups with and without delirium (according DSM IVTR criteria), the Mann–Whitney test for continuous variables was used, at a significance level of 0.05. This was performed using the SPSS 21.0 version. Results: The final sample included 208 elderly patients, with a mean age of 78.3 (sd = 7.8). The majority were female (53.8%), married (53.4%), with low education level (92.4% with 0−4 years), and living with a partner (41.3%) at home (94.7%). The main reasons for admission were cardiovascular (44.3%) and gastrointestinal (20.7%) problems. The average number of comorbidities was 7.3 (sd=3.5) and most of the patients (73%) presented poly-medication major ( 5 medications/day). The occurrence rate of delirium was 25% (n = 53), according to the DSM-IV-TR criteria. In the present study, a significant difference for the length of stay in the IMCU (p< 0.001) was found, with the delirium group presenting the highest duration of hospitalization (median 8 vs. 6 days), which is in line with other previous studies [3]. Conclusion: The present results suggest that the development of delirium in elderly medical patients is associated with an increase in length of hospital stay, which may contribute to an increase in daily hospital costs. In this way, the implementation of interventions to prevent and improve management of delirium should be a priority for clinical services. Further studies will be needed to corroborate these results, and additional outcomes in this clinical syndrome.

This study aimed to clarify whether homocysteine has independent association, not mediated by cerebral beta amyloid protein deposition and vascular burden, with whole brain or hippocampal volume in elderly individuals with normal cognition, mild cognitive impairment, and Alzheimer's disease. Nineteen mild cognitive impairment and 24 Alzheimer's disease patients were recruited from the Dementia Clinic of the Seoul National University Hospital. Fourteen cognitively normal elderly subjects were also selected from a pool of elderly volunteers. Multiple linear regression analyses showed that plasma total homocysteine level was significantly associated with hippocampal volume even after controlling the degree of global cerebral beta amyloid deposition and vascular burden as well as other potential confounders including age, gender, education, and apolipoprotein E e4 genotype. On the contrary, plasma total homocysteine level did not show any significant association with whole brain volume. Our finding of the independent negative association between homocysteine and hippocampal volume suggests that homocysteine has a direct adverse effect, not mediated by cerebral beta amyloid deposition and vascular burden, on the hippocampus.

Objective The purpose of this study was to explore the effect of demographic variables on Digit Span test (DS) performance in an educationally diverse elderly population and to provide normative information. Methods The DS was administered to 784 community-dwelling volunteers aged 60-90 years with an educational history of from zero to 25 years of full-time education. People with serious neurological, medical and psychiatric disorders (including dementia) were excluded. Results Age, education and gender were found to be significantly associated with performance on the DS. Based on the results obtained, DS norms were stratified by age (2 strata), education (3 strata), and gender (2 strata). Conclusion Our results on DS performance suggest that both attention and working memory are influenced by age, education and gender. The present study provides reasonably comprehensive normative information on the DS for an educationally diverse elderly population.

We assessed the changes of plasma haloperidol concentrations and clinical responses repeatedly up to 4 weeks after coadministration or discontinuation of rifampin in 12 schizophrenic patients taking haloperidol alone (group I) and 5 patients taking haloperidol and antituberculotic drugs (group II). After coadministration of rifampin in group I, daily trough haloperidol concentrations rapidly decreased and reached 63% of baseline level by day 3, 41.3% by day 7, and 30% by day 28. On the other hand, after discontinuation of rifampin in group II, plasma haloperidol concentration increased to 140.7% of baseline level by day 3, 228.7% by day 7, and 329% by day 28. In this study, a 30% or greater change in the clinical rating scale was considered a positive clinical response of the drug interaction. Using this criterion, 50% of the group I subjects responded according to the Brief Psychiatric Rating Scale (BPRS) total score, and 25% responded according to the BPRS subscale for psychiatric symptoms. No positive responses were observed in group II patients. These results strongly suggest that rifampin interacts with the clinical effects as well as the plasma concentrations of coadministered haloperidol, and careful monitoring should be considered when coadministration or discontinuation of rifampin is needed in a schizophrenic patient taking haloperidol.

carriers had lower volumes at bilateral presubiculum, left hippocampus & left subiculum. Among controls none of the hippocampal subfields were differing between ApoE4 carrier status. Conclusions: Study validates previous observations of hippocampal atrophy including the sub-regions in AD. There is a modest association between ApoE4 carrier status and alterations in white-matter microstructural integrity at medial temporal and hippocampus. ApoE4 associated changes are more pronounced in AD with atrophy of subicular complex, which is the main information router from hippocampus to subcortical structures.

Background: The influences of demographics, culture, language, and environmental changes on Mini-Mental State Examination (MMSE) scores are considerable.Methods: Using a sample of 7452 healthy, community-dwelling elderly Koreans, aged 55 to 94 years, who participated in the four ongoing geriatric cohorts in Korea, we investigated demographic influences on MMSE scores and derived normative data for this population. Geropsychiatrists strictly excluded subjects with cognitive disorders according to the protocol of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Clinical Assessment Battery (CERAD-K-C).Results: Education (standardized β = 0.463), age (standardized β = −0.303), and gender (standardized β = −0.057) had significant effects on MMSE scores (p < 0.001). The score of MMSE increase 0.379 point per 1-year education, decrease 0.188 per 1-year older, and decrease 0.491 in women compared to men. Education explained 30.4% of the scores’ total variance, which was much larger than the variances explained by age (8.4%) or gender (0.3%). Accordingly, we present normative data for the MMSE stratified by education (0, 1–3, 4–6, 7–9, 10–12, and ≥ 13 years), age (60–69, 70–79, and 80–89 years), and gender.Conclusions: We provide contemporary education-, age-, and gender-stratified norms for the MMSE, derived from a large, community-dwelling elderly Korean population sample, which could be useful in evaluating individual MMSE scores.

Objective This study aimed to estimate prevalence rates and risk factors of LLD among a large nationwide sample of Korean elders in South Korea. Method Of 8199 randomly sampled Koreans aged 65 years or more, 6018 participated (response rate = 73.4%). Using the Korean version of the short form Geriatric Depression Scale (SGDS-K), we classified individual scoring 8 or 9 as having possible depression and those scoring ≥ 10 as having probable depression. Results The age-, gender-, education-, and urbanicity-standardized prevalences were 10.1% (95% CI = 9.3–10.8) for possible depression, 17.8% (95% CI = 16.8–8.7) for probable depression, and 27.8% (95% CI = 26.7–29.0) for overall depression. Poverty, living alone, low education, illiteracy, smoking, history of head trauma, and low Mini Mental Status Examination score were associated with greater risk of depression, while mild alcohol use and moderate to heavy exercise were associated with lower risk of depression. However gender difference in the risk of depression was not found. Conclusion LLD is decidedly common in South Korea. It was associated with various sociodemographic and clinical factors, some of which are amendable through policy actions. This study was limited by use of the SGDS-K rather than a standardized clinical interview.

including d, were regressed onto VBM data, in order to identify the neural substrates associated with our latent dementia proxy. In a base model, we constructed two latent factors: “g” 1⁄4 Spearman’s g, i.e., the shared variance in cognition derived from the cognitive battery; and “f”, i.e., the shared variance in functional status, derived from Physical Performance Test (PPT) and Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) items. In the final model, we added a third latent variable “d”, representing the shared variance between cognitive test scores and PPT /ADC-ADL items. Results: In the base model, g correlated r 1⁄4 0.643 with CDR sum of boxes (CDRSOB). f correlated r 1⁄4 0.562. Together, g and f explained 72.9% of CDRSOB variance. In the final model, d correlated strongly with CDRSOB (r 1⁄4 0.816). g’s association was attenuated (r 1⁄4 0.300), as was f’s (r 1⁄4 0.245). Together, g, f and d explained 82.7% of CDRSOB variance. Lower gray matter volumes in the regions associated with d and g were associated with higher CDR scores. After adjusting for age and gender, d was significantly and positively associated with grey matter volume in bilateral cingulate (BA 31), left posterior cingulate, (BA 31), right inferior parietal lobe (BA 40), and right middle temporal gyrus (BA 21). Conclusions: This study confirms in a third cohort that a latent variable can be constructed from readily available cognitive and functional status measures that is strongly associated with dementia severity. As we hypothesized, d is specifically associated with elements of the DMN.

Objectives: To identify regional alterations of white matter integrity associated with apathy in Alzheimer disease (AD). Design: Cross-sectional study. Setting: University Dementia Clinic. Participants: Fifty-one very mild or mild probable AD subjects. Intervention: Volumetric magnetic resonance imaging with diffusion tensor imaging. Measurements: Volume of interest analyses were performed to compare regional fractional anisotropy (FA) between apathy and apathy-free group, and to test linear relationship between regional FA and apathy severity. Apathy was assessed by the Neuropsychiatric Inventory. Results: Apathy group showed significantly lower FA values than apathy-free group in the left anterior cingulum (A-C), regardless of concomitant depression and psychotropic medications. Left A-C FA values also had significant linear relationship with apathy-composite scores as a measure of apathy severity, even after controlling gray matter density of the ipsilateral anterior cingulate cortex. Conclusions: Our findings support that communication failure between the anterior cingulate cortex and other brain structures via the A-C contributes to the development and aggravation of apathy in AD, additionally supporting the general notion of disconnection syndrome for clinical manifestation of AD.

To investigate the relationship between in vivo brain amyloid-beta (Aβ) burden, measured by C-labeled Pittsburgh Compound B (C-PiB) retention, and age-at-onset in patients with Alzheimer disease (AD).Cross-sectional study.University Dementia Clinic.Twenty-two AD patients including 11 early-onset AD (EOAD: onset65 years) and 11 late-onset AD (LOAD: onset ≥65years) cases with matched dementia severity, duration of illness, and apolipoprotein E ε4 allele number.C-PiB positron emission tomography scans.Both region of interest and voxel-based analyses were performed to compare C-PiB retention between EOAD and LOAD groups, and to test linear relationship between age-at-onset and C-PiB retention.Both region of interest (ROI) and voxel-based analyses revealed that EOAD patients had significantly higher C-PIB retentions than LOAD patients in diffuse brain regions including frontal, lateral parietal, lateral temporal, and occipital cortex, and basal ganglia. Subgroup analyses showed that negative correlation between age-at-onset and C-PiB retention was significant in LOAD but not in EOAD.Our finding of a heavier Aβ burden in the brain of living EOAD patients than LOAD patients is in agreement with those from postmortem studies. The inverse relationship between age-at-onset and Aβ burden is possibly associated with aging-related decrease of brain or cognitive reserve and with aging-related increase of brain vulnerability.

Objectives Sleep apnea syndrome (SAS) is considered a risk factor for cognitive decline in the elderly. The specific neurocognitive decline has been suggested as a predictive factor for dementia in patients with mild cognitive impairment (MCI). The authors aim to illustrate the sleep characteristics related to the specific neurocognitive decline in the community-dwelling elderly including patients with MCI. Design Cross-sectional. Settings Center for sleep and chronobiology in Kangwon National University Hospital. Participants Thirty patients with MCI and 30 age- and sex-matched normal elderly subjects were selected. Measurements The authors administered seven tests in the Korean version of the Consortium to Establish A Registry of Alzheimer's Disease Neuropsychological battery and conducted nocturnal polysomnography. A p value below 0.05 was considered a statistical significance. Results There was no significant difference in sleep parameters between the MCI and normal comparison (NC) groups. Sleep efficiency was positively correlated with Constructional Recall (CR) scores in both NC and MCI groups (r = 0.393 and 0.391, respectively). The amount of slow wave sleep (SWS) was also positively correlated with Boston naming test (BNT) scores in both groups (r = 0.392, 0.470, respectively). Stepwise multiple regression models showed that SWS and the apnea index were significant independent variables associated with the BNT score (Δβ = 0.43 and −0.34, respectively; adjusted R 2 = 0.298) in the MCI group, and the amount of rapid eye movement sleep was a significant independent variable associated with the CR score (Δβ = 0.49; adjusted R 2 = 0.217) in the NC group. Conclusions Our results show that poor sleep quality and greater severity of SAS were associated with impaired language function reflecting frontal-subcortical pathology in patients with MCI. This suggests that vulnerability to a specific brain damage associated with SAS could increase the risk for dementia.

Objectives This study aimed to validate the two total scores (TS-I and TS-II) of the Consortium to Establish a Registry for Alzheimer Disease neuropsychological battery (CERAD-NP) for a large elderly population including mild cognitive impairment (MCI) and dementia patients with various etiologic backgrounds. The authors also investigated whether the addition of frontal-executive function score can improve the discrimination accuracy of the total scores for dementia and MCI. Design, Setting, and Participants One thousand three hundred thirty-six normal comparison (NC), 583 dementia (420 AD, 111 non-AD dementia, and 52 mixed AD with non-AD dementia), and 250 MCI (223 amnestic and 27 nonamnestic MCI) individuals living in the community were included (all aged 60 years and older). Results Both TS-I and TS-II were highly correlated with other global cognitive and functional scales. Both total scores showed, though modest, superior NC versus MCI discrimination ability to Mini-Mental State Examination (MMSE). Their discrimination ability for NC versus dementia was excellent and significantly better, especially in discriminating very mild dementia, than MMSE. The addition of frontal-executive test score to TS-I or TS-II did not make a significant improvement in dementia or MCI discrimination ability. Both of them also showed higher test-retest and interrater reliability than MMSE or any individual neuropsychological tests in the CERAD-NP. Conclusion These results strongly support the validity and usefulness of CERAD total scores for early detection and progression monitoring of MCI and dementia in clinical and research settings.

Objective We investigated the prevalence, risk factors and impact of major depressive disorder (MDD) and minor depressive disorder (MnDD) in a randomly selected community-dwelling Korean elderly population. Method This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A study population of 1118 Korean elders was randomly sampled from residents of Seongnam, Korea aged 65 years or older. Standardized face-to-face interviews and neurological and physical examinations were conducted on 714 respondents using the Korean version of Mini International Neuropsychiatric Interview. MDD was diagnosed according to the DSM-IV criteria, and MnDD according to research criteria proposed in Appendix B of the DSM-IV criteria. Results Age-, gender- and education-standardized prevalence rates in Korean elders aged 65 years or older were estimated as 5.37% (95% CI = 3.72–7.03) for MDD, 5.52% (95% CI = 3.84–7.19) for MnDD, and 10.89% (95% CI = 8.60–13.17) for overall late-life depression (LLD). A prior MDD episode (OR = 3.07, 95% CI = 1.38–6.82 in MDD, OR = 3.44, 95% CI = 1.49–7.94 in MnDD), female gender (OR = 3.55, 95% CI = 1.53–8.24 in MDD, OR = 2.68, 95% CI = 1.19–6.04 in MnDD) and history of stroke or TIA (OR = 3.45, 95% CI = 1.62–7.35 in MDD, OR = 2.95, 95% CI = 1.34–6.52 in MnDD) were associated with the risks of both MDD and MnDD. Lack of formal education (OR = 2.75, 95% CI = 1.30–5.85) and low income (OR = 2.83, 95% CI = 1.02–7.88) were associated with the risk of MDD only. Quality of life (QOL) of the MDD and MnDD patients was worse than that of non-depressed elders ( P Conclusion MnDD was as prevalent as MDD in Korean elders and impacted QOL as MDD did. MnDD patients may increase in the future with accelerated population aging and westernization of lifestyle in Korea.

This study aimed to compare the discrimination accuracy of hippocampal volume (HC-Vol), parahippocampal cingulum fractional anisotropy (PHC-FA), hippocampal glucose metabolism (HC-Glu), and any combination of the three measurements among normal control (NC), mild cognitive impairment (MCI), and Alzheimer's disease (AD). Three-dimensional MRI, diffusion tensor imaging, and FDG-PET were applied to age- and gender-matched 17 NC, 17 MCI, and 17 mild AD patients. Subjects also underwent a neuropsychological test battery including three verbal episodic memory tests. Logistic regression analyses were systematically conducted to select the best model for between-group discrimination. PHC-FA plus HC-Vol model, HC-Glu only model, and the model combining all three modalities were finally chosen for NC vs. MCI (discrimination accuracy: 79.4%), MCI vs. AD (73.5%), and NC vs. AD discrimination (94.1%), respectively. All the three imaging measures also showed significant correlation with all three episodic memory tests. These findings support that each imaging measure, respectively, and their combination have a stage-specific potential as a useful neuroimaging marker for detection and progression monitoring of early stage of AD.