Korean Dementia Screening Questionnaire Research Articles

Risk of dementia in the elderly with non-alcoholic fatty liver disease: A nested case-control study in the Republic of Korea.

Non-alcoholic fatty liver disease (NAFLD) is known to be associated with metabolic syndrome of which diabetes is an important component. Although diabetes is a known risk factor for dementia, studies on the association between NAFLD and dementia still produce conflicting results. This study aimed to determine whether NAFLD would be a risk factor for the development of dementia in an elderly population. This study included 107,369 subjects aged ≥60 years in the Korean National Health Insurance Service-Senior cohort, entered in 2009 and followed up until 2015. NAFLD was diagnosed by calculating fatty liver index (FLI). Subjects were screened for dementia at baseline using a Korean Dementia Screening Questionnaire, and dementia was diagnosed using ICD-10 codes. Controls were randomly selected at a ratio of 1:5 from individuals who were at risk of becoming the case subjects at the time of selection. From 107,369 subjects, 65,690 stroke- and dementia-free subjects without chronic hepatitis B or C or excessive alcohol drinking were selected for evaluation. Having NAFLD, determined by FLI, was associated with increased risk of dementia development (adjusted odds ratio [AOR] 1.493; 95% confidence interval [CI] 1.214-1.836). The increased risk of dementia in NAFLD subjects was independent of type 2 diabetes (AOR 1.421; 95% CI 1.013-1.994, in subjects with diabetes: AOR 1.540; 95% CI 1.179- 2.010, in subjects without diabetes). In this population-based nested case-control study, having NAFLD increased the risk of dementia in elderly individuals, independent of accompanying diabetes.

Cognitive frailty increases the risk of long-term care dependency in community-dwelling older adults: A nationwide cohort study in South Korea.

To investigate whether cognitive frailty, compared with physical frailty or cognitive impairment alone, substantially increased the risk of long-term care (LTC) initiation in community-dwelling older adults. Subjects comprised a total of 39 148 participants aged 66 years from the Korean National Health Insurance-Senior cohort database. Cognitive frailty was defined as the coexistence of physical frailty and cognitive impairment, which was measured by the Timed Up and Go test and the Korean Dementia Screening Questionnaire-Prescreening, respectively. A stratified Cox model was estimated to explore the association of frailty status with LTC initiation. The baseline prevalence of cognitive frailty was 8.7%. During a mean follow-up of 5.3 years, 646 older adults started receiving LTC services. Compared with the robust group, older adults with cognitive frailty showed the highest risk of LTC initiation (hazard ratio [HR], 2.65; 95% confidence interval [CI], 2.08-3.35), followed by those with cognitive impairment (HR, 1.62; 95% CI, 1.26-2.07) and physical frailty (HR, 1.50; 95% CI, 1.25-1.81). Furthermore, cognitive frailty in depressed older adults (HR, 3.16; 95% CI, 2.31-4.33) showed a higher risk of LTC initiation than in nondepressed older adults (HR, 2.10; 95% CI, 1.46-3.04). Cognitive frailty was a significant predictor of LTC initiation among community-dwelling older adults, particularly if they are depressed. Early detection and timely intervention may help to delay LTC initiation in older adults with concurrent cognitive frailty and depression. Geriatr Gerontol Int 2023; 23: 117-123.

Association between Hearing Loss and Cognitive Disorder: A Nationwide Population-Based Study.

PurposeTo investigate the relationship between hearing loss and cognitive disorder with memory dysfunction in South Korea using data from the Korean Health Insurance claims database for 2009–2015.Materials and MethodsWe analyzed cross-sectional data of 66-year-old individuals who completed the Korea National Health and Nutrition Examination Surveys. Auditory function was evaluated using pure-tone audiometric testing. Cognitive disorder with memory dysfunction was assessed using standardized scores of the Prescreening Korean Dementia Screening Questionnaire.ResultsAmong 1815835 participants at the age of 66 years, the prevalence of unilateral hearing loss was 5.84%, and that of bilateral hearing loss was 3.40%. The normal cognitive group comprised 86.35% of the participants, and the high-risk group for cognitive disorder with memory dysfunction totaled 13.65% of the participants. The bilateral hearing loss group had the highest percentage of subjects who responded “sometimes or frequently” to all five questions about cognitive disorder with memory dysfunction, compared to the normal hearing group or the unilateral hearing loss group. After adjusting for sex, smoking status, alcohol intake, exercise, income, diabetes, hypertension, dyslipidemia, and depression, the odds ratios for cognitive disorder with memory dysfunction was 1.183 [95% confidence interval (CI): 1.163–1.203] for bilateral hearing loss and 1.141 (95% CI: 1.126–1.156) for unilateral hearing loss, compared to the normal cognitive group.ConclusionHearing loss has a significant effect on cognitive function in the Korean population. In our study, individuals with bilateral hearing loss showed poorer cognitive function than those with unilateral hearing loss.

주관적 인지장애를 호소하는 지역사회 노인에 대한 다요인 인지능력 향상프로그램(‘씽씽두뇌 발전소’)의 효과성 검증을 위한 비교 연구

Objectives: This study explored the effects of nonpharmacological multifactorial memory improvement program (‘Ssing-Ssing Doonoi baljeonso (SSD)’) developed by the National Center of Mental Health in 2015 in community-dwelling elderly complaining of subjective memory impairment (SMI). Methods: A randomized, controlled, 8-weeks trial of SSD with double-blind assessments at baseline and end-point of treatment. A total of 117 elderlies with SMI were recruited from 10 community-based welfare centers in Seoul, Korea. Participants were randomly assigned to two groups: SSD and art therapy group. 8 sessions of treatment were administrated to the groups. Results: SSD significantly improved immediate recall, delayed recall of word memory test, all items of the logical memory test, and immediate recall, delayed recall, and recognition of the visuospatial function test (all p<0.05). Korean short version of Geriatric Depression Scale(S-GDS-K) was also significantly improved, and Memory Efficacy Questionnaire(MEQ), Prospective-Retrospective Memory Questionnaire(PRMQ), and Korean Dementia Screening Questionnaire(K-DSQ) were all significantly improved. In particular, compared to the art therapy group, the K-DSQ showed better results(time * group, F(1, 114)=6.585, p=0.012, η²=0.055), and S-GDS-K was a tendency to improve in SSD group (time * group, F(1, 114)=3.596, p=0.060, η²=0.031). Conclusion: Our multifactorial memory training program significantly enhanced memory, visuospatial function, mood and subjective memory efficacy. Compared with art therapy, SSD had more advantages in memory function of daily life and showed a tendency to improve depression. It is likely to be applied as a nonpharmacological treatment for the prevention of cognitive decline in the elderly with SMI/MCI.

Physical Activity Amount and Cognitive Impairment in Korean Elderly Population.

The relationship between physical activity amount and cognitive function in elderly Koreans has received little attention. This study therefore aimed to understand the independent and common link between cognitive function and physical activity levels among elderly Korean adults. This study recruited a total of 2746 elderly adults (1348 males and 1398 females). All participants were assessed for cognitive functioning using the Korean Dementia Screening Questionnaire Cognition (KDSQ-C). The computerized Korean version short form of the International Physical Activity Questionnaire (IPAQ) used in this study was entirely based on the long, self-administered, usual week-long IPAQ found in the IPAQ manual of operation. In the unadjusted model, elderly adults who met the recommended level of moderate-to-vigorous physical activity were more likely to have a sufficient level of cognitive function. Hemoglobin, creatinine, cholesterol (TC), triglycerides (TG), LDL-C, and HDL-C differed significantly between groups. A negative correlation was found between KDSQ-C score and the moderate-to-vigorous physical activity (MVPA) amount per week. Physical activity amount is associated with cognition function in Korean elderly adults. Increasing physical activity may improve hemoglobin and creatinine and be involved in improving serum lipid profiles in elderly adults. Thus, physical activity has been suggesting as a useful tool to reduce the risk of cognitive function associated with aging.

Mild cognitive impairment, dementia, and cognitive dysfunction screening using machine learning.

ObjectiveTo develop a machine learning algorithm to identify cognitive dysfunction based on neuropsychological screening test results.MethodsThis retrospective study included 955 participants: 341 participants with dementia (dementia), 333 participants with mild cognitive impairment (MCI), and 341 participants who were cognitively healthy. All participants underwent evaluations including the Mini-Mental State Examination and the Montreal Cognitive Assessment. Each participant’s caregiver or informant was surveyed using the Korean Dementia Screening Questionnaire at the same visit. Different machine learning algorithms were applied, and their overall accuracies, Cohen’s kappa, receiver operating characteristic curves, and areas under the curve (AUCs) were calculated.ResultsThe overall screening accuracies for MCI, dementia, and cognitive dysfunction (MCI or dementia) using a machine learning algorithm were approximately 67.8% to 93.5%, 96.8% to 99.9%, and 75.8% to 99.9%, respectively. Their kappa statistics ranged from 0.351 to 1.000. The AUCs of the machine learning models were statistically superior to those of the competing screening model.ConclusionThis study suggests that a machine learning algorithm can be used as a supportive tool in the screening of MCI, dementia, and cognitive dysfunction.

Subjective cognitive decline and subsequent dementia: a nationwide cohort study of 579,710 people aged 66 years in South Korea

BackgroundSubjective cognitive decline (SCD) is a potential risk factor for dementia. We aimed to investigate the association between SCD and subsequent dementia in a nationwide population-based cohort in South Korea.MethodsThis cohort included 579,710 66-year-old adults who were followed for a total of 3,870,293 person-years (average 6.68 ± 1.33 years per person). All subjects completed a questionnaire about subjective memory impairment, the Pre-screening Korean Dementia Screening Questionnaire (KDSQ-P), which included a validated 5-item derivative, and were determined to have SCD based on a single question assessing memory decline. Depressive symptoms were assessed in all subjects using a 3-item modified geriatric depression scale. Hazard ratios were estimated using the Cox proportional hazards model and compared between subjects with and without SCD.ResultsCompared to subjects without SCD, those with SCD were more likely to develop dementia (incidence per 1000 person-years: non-SCD, 5.66; SCD, 8.59). After adjusting for potential confounding factors, the risk of subsequent dementia significantly increased in subjects with SCD, with an adjusted hazard ratio (aHR) of 1.38 (95% confidence interval [CI] 1.34 to 1.41). The risk of subsequent dementia was greatly increased in subjects with higher KDSQ-P scores (aHR = 2.77, 95% CI 2.35 to 3.27). A significant association between SCD and dementia was observed in both depressive and non-depressive symptom groups (aHR = 1.50, 95% CI 1.42 to 1.57 in subjects with depressive symptoms; aHR = 1.33, 95% CI 1.29 to 1.37 in subjects without depressive symptoms; P = 0.001).ConclusionsIn this population of 66-year-old individuals, SCD was significantly associated with an increased risk of subsequent dementia. This association was found in both depressive and non-depressive groups, with an increased risk of dementia in the presence of depressive symptoms. Our findings suggest that SCD indicates a risk for dementia. Further studies are needed to delineate potential approaches to preventing the development of dementia in individuals with SCD.

Conversion From The Korean Dementia Screening Questionnaire To The Informant Questionnaire On Cognitive Decline In The Elderly.

PurposeThe ability to convert scores between cognitive measurements would facilitate the longitudinal assessment of cognition in clinical practice and the comparison and synthesis of cognitive data from international, multicenter, or longitudinal studies. The primary aim of this study was to apply a simple and reliable method for converting scores from the Korean Dementia Screening Questionnaire (KDSQ) to those of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).Patients and methodsA total of 627 participants, with and without cognitive dysfunction, received both the KDSQ and the IQCODE at the same visit. The scores of both tools were calculated, and equipercentile equating was used to create a method for converting scores from the KDSQ to the IQCODE.ResultsKDSQ scores were highly correlated with IQCODE scores (Pearson r = 0.905, P < 0.01). We developed scores for converting the KDSQ to the IQCODE using equipercentile equating and log-linear smoothing. We provide an easy-to-use table that enables the conversion of KDSQ scores to IQCODE scores.ConclusionWe delivered a simple and reliable method for converting scores from the KDSQ to the IQCODE. The conversion score table reported here enables direct and easy comparison of these cognitive measurements in older adults.

Detection of cognitive impairment using a machine-learning algorithm

PurposeThe Mini-Mental State Examination (MMSE) is one of the most frequently used bedside screening measures of cognition. However, the Korean Dementia Screening Questionnaire (KDSQ) is an easier and more reliable screening method. Instead, other clinical variables and raw data were used for this study without the consideration of a cutoff value. The objective of this study was to develop a machine-learning algorithm for the detection of cognitive impairment (CI) based on the KDSQ and the MMSE.Patients and methodsThe original dataset from the Clinical Research Center for Dementia of South Korea study was obtained. In total, 9,885 and 300 patients were randomly allocated to the training and test datasets, respectively. We selected up to 24 variables including sex, age, education duration, diabetes mellitus, and hypertension. We trained a machine-learning algorithm using TensorFlow based on the training dataset and then calculated its accuracy using the test dataset. The cost was calculated by conducting a logistic regression.ResultsThe accuracy of the model in predicting CI based on the KDSQ only, the MMSE only, and the combination of the KDSQ and MMSE was 84.3%, 88.3%, and 86.3%, respectively. For the KDSQ, the sensitivity for detecting CI was 91.50% and the specificity for detecting normal cognition (NL) was 59.60%. The sensitivity of the MMSE was 94.35%, and the specificity was 59.62%. When combining the KDSQ and the MMSE, the sensitivity for detecting CI was 91.5% and the specificity for detecting NL was 61.5%.ConclusionThe algorithm predicting CI based on the MMSE is superior. However, the KDSQ can be administered more easily in clinical practice and the algorithm using KDSQ is a comparable screening tool.

Screening for Normal Cognition, Mild Cognitive Impairment, and Dementia with the Korean Dementia Screening Questionnaire.

Objective The Korean Dementia Screening Questionnaire (KDSQ) is an informant-based instrument used to screen for cognitive dysfunction. However, its ability to only dichotomously discriminate between dementia and normal cognition has been previously investigated. This study investigated the ability of the KDSQ to classify not only dichotomous but also multiple stages of cognitive dysfunction. Methods We examined 582 participants. Receiver operating characteristic (ROC) curves were used to determine dichotomous classification parameters. Multi-category ROC surfaces were evaluated to classify the three stages of cognitive dysfunction. Results Dichotomous classification using the ROC curve analyses showed that the area under the curve was 0.92 for dementia for subjects without dementia and 0.96 for dementia in controls. Simultaneous multi-category classification analyses showed that the volume under the ROC surface (VUS) was 0.57 and that the derived optimal cut-off points were 2 and 8 for controls, MCI, and dementia. The estimated Youden index for the KDSQ was 0.48, and the derived optimal cut-off points were 5 and 10. The overall classification accuracy of the VUS and Youden index was 61.2% and 58.6%, respectively. Conclusion The KDSQ is useful for classifying dichotomous and multi-category stages of cognitive dysfunction.

Cognitive function and activities of daily living in people affected by leprosy: A cross-sectional, population-based, case-control study.

There has been controversy regarding whether or not people affected by leprosy have more cognitive dysfunction than healthy individuals. The purpose of this study was to assess cognitive functions and activities of daily living (ADL) in people affected by leprosy relative to a control population living in rural areas. We assessed cognitive functions and ADL using the Korean Mini-Mental State Examination (K-MMSE), Korean Dementia Screening Questionnaire (KDSQ), and Seoul-Instrumental ADL (S-IADL). Higher scores of K-MMSE and lower scores of both KDSQ and S-IADL are indicative of better functioning. We assessed 224 persons living in Sorokdo who were affected by leprosy and 448 age- and gender-matched control subjects living in Namwon of the Chonbuk province. After adjusting for age, gender, and educational status, the K-MMSE score was found to be significantly higher in people affected by leprosy than in control subjects (23.14 ± 4.89 vs. 22.25 ± 4.62, respectively, P = 0.022). Items related to memory in the KDSQ showed no differences between the groups, but people affected by leprosy had a better score in division for other cognitive functions than controls. On items related to ADL in the KDSQ and S-IADL, people affected by leprosy performed significantly worse compared with controls. Our results suggest that although people affected by leprosy have a lower capacity of ADL, they may have better cognitive functions than normal controls.

Cognitive assessment tools in Asia: a systematic review.

The prevalence of dementia is increasing in Asia than in any other continent. However, the applicability of the existing cognitive assessment tools is limited by differences in educational and cultural factors in this setting. We conducted a systematic review of published studies on cognitive assessments tools in Asia. We aimed to rationalize the results of available studies which evaluated the validity of cognitive tools for the detection of cognitive impairment and to identify the issues surrounding the available cognitive impairment screening tools in Asia. Five electronic databases (CINAHL, MEDLINE, Embase, Cochrane Library, and Science Direct) were searched using the keywords dementia Or Alzheimer Or cognitive impairment And screen Or measure Or test Or tool Or instrument Or assessment, and 2,381 articles were obtained. Thirty-eight articles, evaluating 28 tools in seven Asian languages, were included. Twenty-nine (76%) of the studies had been conducted in East Asia with only four studies conducted in South Asia and no study from northern, western, or central Asia or Indochina. Local language translations of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were assessed in 15 and six studies respectively. Only three tools (the Korean Dementia Screening Questionnaire, the Picture-based Memory Intelligence Scale, and the revised Hasegawa Dementia Screen) were derived de novo from Asian populations. These tools were assessed in five studies. Highly variable cut-offs were reported for the MMSE (17-29/30) and MoCA (21-26/30), with 13/19 (68%) of studies reporting educational bias. Few cognitive assessment tools have been validated in Asia, with no published validation studies for many Asian nations and languages. In addition, many available tools display educational bias. Future research should include concerted efforts to develop culturally appropriate tools with minimal educational bias.

일부 치매 및 치매의심환자들의 인지기능에 따른 구강보건인식 조사

Objectives: The purpose of this study is to investigate cognitive function, performance of activities of daily living, and recognition on oral health with the cognitive function testto dementia or dementia-suspected patients in the outpatients. Methods: The subjects were 94 dementia or dementia-suspected patients visiting C University hospital for the dementia test. Study instruments included Korea Mini–Mental State Examination KMMS, The Bayer-Activities of Daily Living Scale; B-ADL, Seoul-Instrumental Activities of Daily Living; S-IADL, Global Deterioration Scale; GDS, Korean Dementia Screening Questionnaire; KDSQ, and underlying diseases. Results: Dementia or dementia-suspected patients were 42 by KMMSE test, 25 patients had impaired functioning of daily living by B-ADL test, 27 patients showed the presence of depression by GDS test, and 45 patients showed impaired functioning of daily living. There was a statistically significant difference in the subjective recognition on oral health conditions. There was a statistically significant difference in the subjective recognition on oral health conditions by ADL. There was a positive correlation between the cognitive function and ADL performance. Higher cognitive function is proportional to ADL performance. Conclusions: The cognitive function was closely associated with ADL and subjective oral health conditions.

Three screening methods for cognitive dysfunction using the Mini-Mental State Examination and Korean Dementia Screening Questionnaire.

To screen for and determine cognitive dysfunction, cognitive tests and/or informant reports are commonly used. However, these cognitive tests and informant reports are not always available. The present study investigated three screening methods using the Mini-Mental State Examination (MMSE) as the cognitive test, and the Korean dementia screening questionnaire (KDSQ) as the informant report. Participants were recruited from the Korea Clinical Research Center for Dementia of South Korea, and included 2861 patients with Alzheimer's disease (dementia), 3519 patients with mild cognitive impairment and 1375 controls with no cognitive dysfunction. Three screening methods were tested: (i) MMSE alone (MMSE(cut-off) ); (ii) a conventional combination of MMSE and KDSQ (MMSE+KDSQ(cut-off) ); and (iii) a decision tree with MMSE and KDSQ (MMSE+KDSQ(decision tree) ). For discriminating any cognitive dysfunction from controls, MMSE+KDSQ(cut-off) had the highest area under the receiver operating characteristic curve (0.784). For discriminating dementia from controls, MMSE+KDSQ(cut-off) had the highest area under the receiver operating characteristic curve (0.899). For discriminating mild cognitive impairment from controls, MMSE(cut-off) had the highest area under the receiver operating characteristic curve (0.683). MMSE+KDSQ(decision tree) showed the highest sensitivity for all discriminations. For overall classification accuracy, MMSE+KDSQ(decision tree) had the highest value (70.0%). These three methods had different advantageous properties for screening and staging cognitive dysfunction. As there might be different availability across clinical settings, these three methods can be selected and used according to situational needs.

P2‐312: The Korean dementia screening questionnaire in patients with mild cognitive impairment or Alzheimer's disease

P2‐312: The Korean dementia screening questionnaire in patients with mild cognitive impairment or Alzheimer's disease

Which symptoms can distinguish between subjective cognitive impairment (SCI) and mild cognitive impairment (MCI)?

The SCI, the MCI, and the Alzheimer's disease (AD) are on a spectrum of disease progression; therefore, identification of the earliest signs of cognitive deterioration is becoming a crucial issue. The goal of this study was to examine symptom characteristics and distinguish predictive symptoms in patients with MCI compared with SCI, using caregiver questionnaires. We assessed the Korean Dementia Screening Questionnaire (KDSQ) and Seoul Instrumental activities of Daily Living (S-IADL) of 344 subjects with SCI and 697 with MCI. Multivariate logistic regression analyses were conducted after adjusting for age, sex, and educational status. Common and rare symptoms were similar between the SCI and MCI groups. The most distinguishing features of KDSQ were ‘Finds it hard to go somewhere on his/her own using public transportation’ (odds ratio=OR=4.56, p<0.0001), ‘Has difficulty in operating appliances’ (OR=2.47, p=0.001), and ‘Keeps repeating the same question’ (OR=2.03, p<0.0001). In S-IADL, the most outstanding features were ‘using household appliances’ (OR=3.99, p<0.0001), ‘taking medication’ (OR=2.38, p=0.01), and ‘using public transportation’ (OR=1.94, p=0.04). The dysfunction in ‘using household appliance’ and ‘using public transportation’ reflect the possibility of MCI rather than SCI. Therefore, it is suggested that these symptoms also have a discriminative and predictive power in identifying SCI.

A Combination of the Korean Version of the Mini-Mental State Examination and Korean Dementia Screening Questionnaire Is a Good Screening Tool for Dementia in the Elderly

ObjectiveThe aim of this study is to investigate whether a combination of the Korean version of the mini-mental state examination (K-MMSE) and the Korean dementia screening questionnaire (KDSQ) is better than the use of test alone when differentiating patients with dementia from those without dementia in Korea.MethodsThe subjects (patients without dementia, 1120; patients with dementia, 908) were recruited from the Clinical Research Center for Dementia of South Korea. K-MMSE and KDSQ were used. Diagnosis of dementia was made according to the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. The weighted sum rule derived from logistic regression analysis was used for the combination of K-MMSE and KDSQ.ResultsOn comparing the Area Under the Curve for each test using the method of Hanley and McNeil, the weighted sum was significantly greater than KDSQ or K-MMSE, and K-MMSE was significantly greater than KDSQ.ConclusionThis study shows that when differentiating patients with dementia from those without dementia in Korea, a combination of K-MMSE and KDSQ achieved using the weighted sum method is better than either test performed alone. Further epidemiological studies in community-based settings are required before our results can be generalized to nonclinical samples.

The usefulness of the Korean dementia screening questionnaire in patients with mild cognitive impairment and Alzheimer's disease

The usefulness of the Korean dementia screening questionnaire in patients with mild cognitive impairment and Alzheimer's disease