Background
Aging population correspond with an increase in the numbers of dementia patients. Dementia decreases the quality of life of patients and care-givers. However, current pharmacological treatment is limited by modest efficacy and adverse effect. Nonpharmacological treatment for dementia has been considered to be a substitute treatment. Recently we developed a special planned program for dementia with depression. The aim of this study was to evaluate therapeutic effect of this program. Methods: We included patients aged 65 and older who diagnosed dementia with depression in a geriatric institution from April to June, 2006. We surveyed their sex, age, education period, and histories of hypertension, smoking, and alcohol intake. Patients in experimental group carried out our program, including cooking, painting, recreation, and activity, 9 times for 60 minutes a session. All included patients were checked Korean Mini-Mental State Examination (K-MMSE) and Korean Form of Geriatric Depression Scale (KGDS) before starting program and after 3 months when programs finished. Results: There was no difference in demographic factors between two groups. K-MMSE was significantly improved in experimental group compared with control group (P = 0.01). And, the KGDS was significantly improved in experimental group compared with control group (P = 0.00). Conclusion: Multidivisional program for social skill improvement was effective on treatment for patients of dementia with depression. Nonpharmacological treatment for dementia with depression would be developed and studied to enhance the qualities of life of patients and care of dementia.

Citations

• Evaluating the Efficacy of Therapeutic Programs on Improving Cognitive Function and Depression among Older Adults Living with Dementia in Korea
  Jaeeon Yoo, Sunhee Lee
  International Journal of Environmental Research and Public Health.2020; 17(9): 3218.     CrossRef

Background
: A 15-item GDS form is now widely used to screen for depressive symptoms in elderly patients, but even the 15-item version seems fairly long for routine use in busy outpatient settings. This study was conducted to determine which of the three short-form GDS tools with four or five questions extracted from the 15-item GDS tool could be a valid alternative to the 15-item GDS.

Methods : This study was performed using a questionnaire survey of 102 elderly patients over sixty-five, who had either visited or had been admitted in either one of the two universities hospitals in Seoul or ChungCheong district from October 1999 to June 2004. Questionnaire contained demographic and statistical characteristics, items related to health behavior, 15-item GDS, Mini-Mental State Examination Korean (MMSE-K) and activities of daily living. Three scales, namely, D'Ath GDS-4, Van Marwijk GDS-4, and Hoyl GDS-5 were compared to the 15-item GDS. Sensitivity, specificity, positive predictive value and the area under the ROC curves were calculated for each short-form GDS scales.

Results : The mean 15-item GDS score was 7.4±3.3 and 69.6% of the subjects were to have suggested depression. Hoyl GDS-5 instrument had the highest sensitivity of 87.3%, specificity of 80.6%, and positive predictive value of 91.1% among the three short-form alternatives. The 5-item Hoyl GDS version had the highest area under the curve (0.84), compared to 0.76 for the 4-item Van Marwijk and 0.66 for the 4-item D'Ath GDS version.

Conclusion : The 5-item Hoyl GDS had superior validity over the D'Ath GDS-4 and Van Marwijk GDS-4. The GDS5/15 may be an effective alternative screening tool.

Background
: The cognitive subscale of the Alzheimer's Disease Assessment Scale(ADAS-Cog) has been extensively validated in assessing cognitive function in patients with Alzheimer's Disease (AD) and used as an efficacy measure in clinical trials of AD. There is a need for additional data on the relationship between cognitive performance and other measures of dementia to fully assess the value of the ADAS-Cog as a measure of treatment efficacy.

Methods : We used data from 53 AD participants in 8 multicenter clinical drug trials to examine the distribution of baseline ADAS-Cog scores in relation to Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDES), Katz Index of Activity of Daily Living(ADL), Lawton Instrumental Activity of Daily Living(IADL), Geriatric Depression Scale(GDS) and Mini-Nutritional Assessment(MNA).

Results : The ADAS-Cog score was statistically significantly correlated with MMSE (T=-0.755, P<0.001), GDES(R=0.403, P<0.003), ADL(R=-0.532, P<0.001), IADL(R=-0.626, P<0.001) and MNA(R=-0.427, P=0.004) scores. But GDS scores were not associated with ADAS-Cog scores.(R= -0.123, P=0.396)

Conclusion : This study characterizes the relationship between ADAS-Cog scores and other commonly used measures of dementia in AD patients. As expected, baseline scores on ADAS-Cog and MMSE demonstrated significantly high correlation. The relatively weaker correlation between ADAS-Cog and GDES scores may be related to the fact that GDES does not evaluate cognitive function only. There are also significant correlations between ADAS-Cog and ADL, IADL, and MNA which indicate the severity and progression of dementia in AD patients. Further studies with larger samples including cognitive function of broader spectrum need to confirm the findings in this study.

Background
: Although family physicians are performing an increasing number of esophagogastoduodenoscopies(EGDs), there is little research conducted in Korea. Thus, the purpose of this research is to assess the ability of family physicians in performing EGD.

Methods : All EGDs performed by family physicians in the department of family medicine of one general hospital from January 1995 to December 1996 were reviewed retrospectively through medical records. The including physicians a family physician and nine family residents, performed EGDs five times per week.

Results : 4,468 EGDs were performed on 4,313 persons during the two years. No major complications were noted and all of the procedures were completely investigated to the second portion of the duodenum. Normal findings were 1,268 cases(28.4%) and abnormal findings were 3,200 cases(71.6%). Among the abnormal findings, gastritis was the most common finding(73.7%). The most common pathologic diagnosis was peptic ulcer 37.7%(177/470cases). Positive rate of CLO test was 89.4%. Family physicians, endoscopic diagnosis agreed with pathologic reports in 86.6%. The number of EGDs performed by each family physician ranged from 2 to 1,503 cases. Data of six physicians who performed more than 200 EGDs for their diagnostic were comparatively analyzed ability. Diagnosis of normal, gastritis or gastric ulcer was significantly different(P<0.05) according to each physicians but the diagnosis of duodenal ulcer was not statistically different(P<0.05). There was little difference among physicians in the biopsy rate. The agreement ratio between endoscopic diagnoses and pathologic reports among those physicians who performed more than 200 procedures were 79.7-93.3% and were not statistically different(P<0.05).

Conclusion : This study is the first report of EGDs performed by family physician in Korea. Some family physicians performed more than 4,000 EGDs without major complications in primary care. These data confirm the ability of some family physicians to perform EGD. Biopsy analysis indicates the diagnostic accuracy is high. Further study on performance of EGD by family physicians and its standardization concerning description of endoscopic are needed.( J Korean Acad Fam Med 1999;20:1027-1039)