Korean Version Of Mini-Mental State Examination Research Articles

Safety and feasibility of optimized transcranial direct current stimulation in patients with mild cognitive impairment due to Alzheimer's disease: a multicenter study protocol for a randomized controlled trial.

Transcranial direct current stimulation (tDCS) may effectively preserve and improve cognitive function in patients with mild cognitive impairment (MCI). Research has shown that Individual brain characteristics can influence the effects of tDCS. Computer three-dimensional brain modeling based on magnetic resonance imaging (MRI) has been suggested as an alternative for determining the most accurate tDCS electrode position based on the patients' individual brain characteristics to enhance tDCS effects. Therefore, this study aims to determine the feasibility and safety of applying tDCS treatment using optimized and personalized tDCS electrode positions in patients with Alzheimer's disease (AD)-induced MCI using computer modeling and compare the results with those of a sham group to improve cognitive function. A prospective active-sham group feasibility study was set to recruit 40 participants, who will be randomized into Optimized-tDCS and Sham-tDCS groups. The parameters for tDCS will be 2 mA (disk electrodes R = 1.5 cm) for 30 min during two sets of 15 sessions (2 weeks of resting period in between), using two electrodes in pairs. Using computer modeling, the tDCS electrode positions of each participant will be personalized. Outcome measurements are going to be obtained at three points: baseline, first post-test, and second post-test. The AD assessment scale-cognitive subscale (ADAS-Cog) and the Korean version of Mini-Mental State Examination (K-MMSE), together with other secondary outcomes and safety tests will be used. For the present study, we hypothesize that compared to a sham group, the optimized personalized tDCS application would be effective in improving the cognitive function of patients with AD-induced MCI and the participants would tolerate the tDCS intervention without any significant adverse effects.Clinical trial registration: https://cris.nih.go.kr, identifier [KCT0008918].

Effect of intensity of persistent social isolation on mental health in the late middle-aged and older population: results of the Korea Longitudinal Study of Ageing (2006-2020).

Social isolation (SI) was recently identified as a significant public health issue in the United States. Consequently, several studies on the association between SI and mental health were conducted. However, few studies have considered the duration and intensity of SI. In the present study, a longitudinal analysis was conducted to determine the effect of the intensity of persistent SI on the mental health status of late middle-aged and older Koreans. After excluding missing values, data on 6200 participants were analyzed using the group-based trajectory model (GBTM) from the first to fifth Korean Longitudinal Study of Ageing (KLoSA) to categorise the SI trajectory (SIT). The Chi-square test, t-test, analysis of variance, and time-lagged generalised estimation equations were utilised from the fifth to eighth KLoSA to determine the association between SIT and the incidence of cognitive decline (the group with a Korean version Mini-Mental State Examination score of 23 or lower), cognitive function score, and depression score. Four SIT groups were identified in the GBTM analysis. These were the non-SIT (21.7%), mild (46.8%), moderate (21.1%), and severe SIT (10.4%) groups. Compared to the non-SIT group, the severe SIT group experienced a greater incidence of cognitive decline (odds ratio = 1.57, P < 0.0001) as well as poorer cognitive function scores (B = -0.63, P < 0.0001) and depression scores (B = 0.90, P < 0.0001). Furthermore, stratified analysis by sex and age showed that mental health status was inversely proportionate to the intensity of SIT, particularly in males and patients, aged 65 years and above. A close association was observed between SIT and mental health. This finding highlighted the need for policies and institutional measures to reduce the incidence of mental health deterioration among vulnerable groups due to the intensity of SI.

A Study of Factors Influencing Quality of Life among Community Dwelling Elderly in Korean Urban Community

AbstractBackgroundWe examined the factors influencing quality of life among community dwelling elderly in Busan city.MethodThe subjects of this research were 160 community‐dwelling elderly people without dementia and major depressive disorder. Korean version of World Health Organization Quality of Life assessment instrument‐Abbreviated form (WHOQOL‐BREF), Korean version of Short Geriatric Depression Scale (SGDS‐K) and Korean version of MiniMental State Examination (K‐MMSE) were administered for each subject. Low quality of life was defined as below 60 points of WHOQOL‐BREF.ResultThe high quality of life group showed higher score of MMSE, lower score of GDS‐K, higher educational level and married status. About a third of the subjects complained about low quality of life. In the low quality of life group, there were significant associations between quality of life and SGDS‐K (p&lt;0.001), but there was no association with education (p = 0.708), marital status (p = 0.410), and K‐MMSE (p = 0.683).ConclusionDepressive disorders including minor depressive disorder and subsyndromal depression, might play a role in the quality of life rather than cognitive impairments in community‐dwelling elderly people. Therefore, the treatments for the depressive mood should be considered in dealing with low quality of life.

Segmental bioimpedance variables in association with mild cognitive impairment due to Alzheimer disease

AbstractBackgroundRecognizing and monitoring changes in body composition can reveal early signs of body vital status, thereby applying appropriate therapies or lifestyle changes which may help to reverse the risk of MCI. This study aims to examine the association between body composition and bioimpedance variables with mild cognitive impairment (MCI) due to Alzheimer’s disease (AD).MethodWe obtained four water‐related and six impedance‐related variables for upper and lower extremities as well as several whole body composition variables such as fat (%), body cell mass (%), water volume (TBW_FFM), and metabolic rate (BMR) from segmental multi‐frequency bioelectrical impedance analysis (MF‐BIA) for 938 elderly participants, including 672 cognitively normal individuals (CN) and 266 MCI subjects. Participants’ characteristics, anthropometric information, and the selected BIA variables were described and statistically compared between CN and MCI subjects. The correlations between the selected BIA and neuropsychological tests such as the Korean version of Mini‐Mental State Examination (K‐MMSE) and Seoul Neuropsychological Screening Battery – second edition (SNSB‐II) before and after controlling for age and sex were also examined. Univariate and multivariate logistic regression analyses with the estimated odds ratios were conducted to investigate the associations between these BIA variables and MCI prevalence and for different gender groups.ResultOur MCI samples were shown to be slightly older, more depressive, and have significantly poorer cognitive abilities compared to CN subjects. The partial correlations upon controlling for age and sex between the selected BIA variables and neuropsychological tests were not magnificent. However, after accounting for age, sex, GDS score, and the significant comorbidities, resistance and reactance in lower extremities survived to be associated with MCI with ORs (95%CI) of 0.81 (0.68‐0.96) and 0.79 (0.67‐0.94), respectively. After stratify by gender, these variables remained significant in only female group.ConclusionThe reductions in segmental body resistance and reactance increase the incidence of MCI, these patterns are more pronounced in the lower extremities and especially in female subjects. These two variables can be considered as early bioimpedance changes in MCI due to AD.

Association of Mental Health and Physical Activity with All-cause Mortality in Persons with Disability: Based on 14-year Follow-up Data from the Korean Longitudinal Study of Aging

PURPOSE This study investigated the associations between mental health and physical activity with all-cause mortality in persons with disability. METHODS A total of 595 participants (39.3% women) aged 45≥ years, who participated in the Korean longitudinal study of aging (KLoSA) were included in this study. The Korean version of mini-mental state examination (K-MMSE) and the center for epidemiologic studies depression scale (CES-D) were used to assess cognitive impairment and depressive symptoms, respectively. The participants were classified into active and inactive groups based on physical activity of 150 min/week. Cox’s proportional regression analyses were used to determine the hazard ratio (HR) and 95% confidence interval (CI) of mental health and physical activity relating to all-cause mortality. RESULTS During the follow-up period (11.8±4.1 years), a total of 218 (36.6%) deaths occurred from all-causes. Participants in the inactive group had significantly higher cognitive impairment (&lt;i&gt;p&lt;/i&gt; =0.046), depressive symptoms (&lt;i&gt;p&lt;/i&gt; =0.001), and all-cause mortality (&lt;i&gt;p&lt;/i&gt;=0.037) than those in the active group. Compared to participants in the normal (HR=1), cognitive impairment (HR=2.229, 95% CI=1.645-3.020, &lt;i&gt;p&lt;/i&gt;&lt;0.001), and depressive symptoms groups (HR=1.542, 95% CI=1.136-2.091, &lt;i&gt;p&lt;/i&gt;&lt;0.001), those in the inactive group had significantly higher HR related to all-cause mortality. However, in the active group, cognitive function and depressive symptoms were not associated with all-cause mortality. CONCLUSIONS The current finding suggests that the promotion of physical activity may play an important role in preventing premature death from all-causes in persons with disability, especially among those with mental health problems.

Association Between Social Network and Cognitive Function: A Cross-Sectional Assessment From the Cardiovascular and Metabolic Diseases Etiology Research Center Cohort (2013-2018).

BackgroundThis study aimed to investigate how social networks are associated with cognitive function in the middle-aged and elderly Korean population.MethodsA total of 7,704 individuals over the age of 50 were included from the baseline recruitment of the Cardiovascular and Metabolic Diseases Etiology Research Center cohort from the years 2013 to 2018. Egocentric social network characteristics including network size, intimacy, and frequency of face-to-face meetings were measured as exposures, and the Korean version of Mini-Mental State Examination (K-MMSE) score was measured to reflect general cognitive function as an outcome. We also stratified the analysis by income level into tertiles, with income caps of 42,000 thousand won and 72,000 thousand won. A general linear regression model was used, adjusting for age, gender, socioeconomic factors, lifestyle factors, depressive symptoms, and study settings.ResultsSocial network properties were positively associated with cognitive function in both men and women. However, the specific estimates varied according to gender and income level. In men, frequency was most significantly associated with cognitive function (standardized β = 0.093, p-value <0 .0001). In women, the strength of the association with cognitive function was found in size (standardized β = 0.055, p-value = 0.001). The effect modification of income level could be seen in the association between frequency and cognitive function. The strongest association between frequency and cognitive function was found in the middle income group in men (standardized β = 0.114, p-value = 0.0063), and the low income group in women (standardized β = 0.076, p-value = 0.0039).ConclusionThere were positive associations between social network properties (i.e., size, intimacy, and frequency of face-to-face meetings) and cognitive function. The degree of association varied according to social network properties, gender, and income level. Overall, among social network properties, social network size was an important factor in the cognition of women, whereas frequency was important in the cognition of men.

Changes in Function and Muscle Strength of Encephalitis Survivors After Inpatient Rehabilitation

ObjectiveTo investigate the clinical demographics and rehabilitative assessments of encephalitis survivors admitted to a rehabilitation center, and to confirm the effects of inpatient rehabilitation manifested by changes in muscle strength and function after hospitalization.MethodsData of encephalitis survivors who received rehabilitation at our institution from August 2009 to August 2019 were reviewed. Medical charts were retrospectively reviewed, and motor, functional, and cognitive assessments were collected. Manual muscle testing (MMT), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), Korean version of Modified Barthel Index (K-MBI), grip strength, Box and Block Test (BBT), and Korean version of Mini-Mental State Examination (K-MMSE) were performed, and the results upon admission and discharge were compared and analyzed.ResultsMost of the patients with encephalitis admitted to our institution had viral or autoimmune etiologies. The assessment results of 18 encephalitis patients upon admission and discharge were compared. The total K-MBI score, FAC, grip strength, and BBT significantly improved, but not the MMT and FMA. Subgroup analysis was performed for viral and autoimmune encephalitis, which are the main causes of the disease, but there was no difference in items with significant changes before and after hospitalization.ConclusionEncephalitis survivors showed a significant improvement in functional assessment scale during their hospital stay through rehabilitation, without significant changes in motor strength. Hence, we can conclude that encephalitis survivors benefit from inpatient rehabilitation, targeting functional gains in activities of daily living training more than motor strength.

Association of Different Muscle Mass Indices, Strength, and Physical Performance with Falling in Elderly: Results from the Korean Frailty and Aging Cohort Study

<h3>Research Objectives</h3> To evaluate the relationship between several measures of sarcopenia and incidence of falls in elderly. <h3>Design</h3> A 2-year prospective cohort study. <h3>Setting</h3> Community. <h3>Participants</h3> A total of 2252 subjects (1065 males; 1187 females; 70-84 years) were recruited. <h3>Interventions</h3> Demographic information, comorbidities and history of falls within 1 year were assessed. Cognitive performance was assessed using the Korean version of Mini Mental State Examination (K-MMSE) and muscle mass was measured via dual-energy X-ray absorptiometry. Grip strength and gait speed also measured at baseline and 2-year follow-up. <h3>Main Outcome Measures</h3> History of falls within 1 year at 2-year follow-up. <h3>Results</h3> History of previous falls and poor cognitive performance at baseline were significantly associated with incidence of falls during follow-up period. Subjects who had fallen during follow-up period showed poor hand grip strength and poor gait speed compared with those who had not. In females, the muscle mass index of body mass index (BMI) adjustment were significantly associated with incidence of falls. Multiple logistic regression analysis revealed that poor gait speed was a significant risk factor of falling in females. <h3>Conclusions</h3> The predictive value of individual measures of sarcopenia vary by genders. Poor physical performance was significantly associated with incidence of falls in females, but there was no significant associations between muscle mass indices, strength, and physical performance and falling in males. <h3>Author(s) Disclosures</h3> No conflict of interest.

Effect of a group music intervention on cognitive function and mental health outcomes among nursing home residents: A randomized controlled pilot study

The purpose of this study was to determine the effect of a group music intervention with rhythmic exercises program on cognitive function and mental health outcomes among Korean nursing home residents . A randomized controlled study design was employed, in which the experimental group (n=20) received a biweekly group music intervention with rhythmic exercises program and a regular activities program for 12 weeks, and the control group (n=20) received only a regular activities program provided by the nursing home. We measured cognitive function and mental health outcomes using the Mini-Mental State Examination-Korean Version (MMSE-K), Geriatric Depression Scale Short Form-Korean Version (GDSSF-K), Geriatric Anxiety Inventory-Korean Version (GAI-K), and Life Satisfaction Scale. ANCOVA was performed to examine the effect of the group music intervention on the study variables. The results suggested that the group music intervention with rhythmic exercises program improved cognitive function, depression, anxiety, and life satisfaction.

Association of Estimated Cardiorespiratory Fitness with the Incidence of Cognitive Impairment in Middle-Aged and Older Adults: Based on 12 Years Follow-Up Data from the Korean Longitudinal Study of Aging

PURPOSE:This study investigated association of estimated cardiorespiratory fitness (eCRF) with the incidence of cognitive impairment in Korean middle-aged and older adults.METHODS:Total of 4,239 subjects (53% women) aged ≥45 years, who participated in the Korean longitudinal study of aging (KLoSA) were included. Participants were classified into 4 categories from the lowest quartile to the highest quartile based on eCRF distribu¬tions. Korean version of mini-mental status examination (K-MMSE) was used to assessed mild cognitive impairment (MCI) and severe cognitive impairment (SCI). Cox’s proportional regression analyses were used to determine the hazard ratio (HR) and 95% confidence interval (CI) of eCRF categories for having MCI and SCI.RESULTS: During 12-years of follow-up, there were 736 (17.4%) and 272 (6.4%) cases of incidence from MCI and SCI, respectively. In women, compared to the quartile 1 group (reference, HR=1), the quartile 4 group had significantly lower HRs of having incidence of MCI/SCI (HR=0.72, 95% CI=0.55-0.94, p=.015) and MCI (HR=0.73, 95% CI=0.54-0.99, p=.045). However, in men, eCRF was not associated with incidence of cognitive impairment.CONCLUSIONS:The current findings suggest that eCRF may be an independent predictor of cognitive impairment in middle-aged and older women.

Clinical Factors Associated With Successful Gastrostomy Tube Weaning in Patients With Prolonged Dysphagia After Stroke.

ObjectiveTo investigate the clinical factors associated with successful gastrostomy tube weaning in patients with prolonged dysphagia after stroke.MethodsThis study involved a retrospective medical chart review of patients diagnosed with prolonged dysphagia after stroke who underwent gastrostomy tube insertion between May 2013 and January 2020. Forty-seven patients were enrolled and consequently divided into gastrostomy tube sustaining and weaning groups. The numbers of patients in the sustaining and weaning groups were 31 and 16, respectively. The patients’ demographic data, Korean version of Mini-Mental State Examination (K-MMSE) score, Korean version of the Modified Barthel Index (K-MBI), Functional Dysphagia Scale (FDS) score, and Penetration-Aspiration Scale (PAS) score were compared between the two groups. A videofluoroscopic swallowing study was performed before making the decision of gastrostomy tube weaning. The clinical factors associated with gastrostomy tube weaning were then investigated.ResultsThere were significant differences in age; history of aspiration pneumonia; K-MMSE, FDS, and PAS scores; and K-MBI between the groups. In the multiple logistic regression analysis, the FDS (odds ratio [OR]=0.791; 95% confidence interval [CI], 0.634–0.987) and PAS scores (OR=0.205; 95% CI, 0.059–0.718) were associated with successful gastrostomy tube weaning. In the receiver operating characteristic curve analysis, the FDS and PAS were useful screening tools for successful weaning, with areas under the curve of 0.911 and 0.918, respectively.ConclusionIn patients with prolonged dysphagia, the FDS and PAS scores are the only factors associated with successful gastrostomy tube weaning. An evaluation of the swallowing function is necessary before deciding to initiate gastrostomy tube weaning.

Renal dysfunction is associated with decline of cognitive function in community-dwelling older adults: Korean frailty and aging cohort study

BackgroundCognitive decline is common in older adults. Similarly, the prevalence of renal dysfunction is also increased in the elderly population. We conducted this study to clarify the relationship between renal dysfunction and decline of cognitive function in community-dwelling elderly population.MethodsA cross-sectional analysis was performed using data from the Korean Frailty and Aging Cohort Study, a nationwide cohort study. Total 2847 (1333 men, 1514 women) eligible participants were enrolled for this study. The estimated glomerular filtration rate (eGFR, mL/min/1.73m2) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Global cognitive function was assessed with the Mini-mental State Examination-Korean version. Other domains of cognitive function were tested with the Consortium to Establish a Registry for Alzheimer’s disease and the Frontal Assessment Battery.ResultsThe mean age of all participants was 76.0 ± 3.9 years and eGFR (all in mL/min/1.73 m2) was 77.5 ± 14.3. And the mean eGFR was 91.7 ± 3.2 in quartile 1, 84.9 ± 1.8 in quartile 2, 76.1 ± 3.7 in quartile 3, and 57.2 ± 10.8 in quartile 4. In baseline characteristics, participants with lower eGFR tend to have lower cognitive function scores than participant with higher eGFR. In linear regression analysis, eGFR was correlated with the word list memory (β = 0.53, P = 0.005), word list recall (β = 0.86, P < 0.001), and word list recognition (β = 0.43, P = 0.030) after adjustment of confounding variables. Moreover, after multivariate adjustment the association with cognitive impairment in quartile 2 was stronger (adjusted OR: 1.535, 95% CI: 1.111–2.120, P = 0.009), and the ORs of cognitive impairment were 1.501 (95% CI: 1.084–2.079, P = 0.014) in quartile 3 and 1.423 (95% CI: 1.022–1.983, P = 0.037) in quartile 4.ConclusionIn older adults, the immediate, recent memory, and recognition domains were significantly related to renal function. Also, the mild renal dysfunction was independently associated with impairment of global cognitive function. These results suggest that the early stages of renal dysfunction could be an effective target to prevent worsening of cognitive impairment. Therefore, regular monitoring and early detection of mild renal dysfunction in elderly population might be needed.

Post-stroke Aphasia as a Prognostic Factor for Cognitive and Functional Changes in Patients With Stroke: Ischemic Versus Hemorrhagic.

ObjectiveTo investigate the comprehensive outcomes in aphasic patients, including their cognitive and functional status after ischemic or hemorrhagic stroke. It also aimed to clarify whether aphasia is a prognostic factor for cognitive and functional improvements in stroke patients.MethodsSixty-seven ischemic or hemorrhagic stroke patients in the subacute stage who had been diagnosed with aphasia using the Korean version of Frenchay Aphasia Screening Test (K-FAST) were included in the study. Forty-six stroke patients without aphasia were used as controls. All patients were examined with the Korean version of the Western Aphasia Battery (K-WAB). Cognitive and functional assessments of the patients including the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of Modified Barthel Index (K-MBI) were performed during admission and 4 weeks after the initial assessments.ResultsThe initial and follow-up total K-MMSE and K-MBI scores were significantly lower in aphasic patients than in non-aphasic controls. The K-WAB scores highly correlated with the total K-MMSE scores at the follow-up stage in all aphasic stroke patients. The K-WAB scores moderately correlated with the follow-up scores of the K-MBI in ischemic stroke patients but not in hemorrhagic stroke patients.ConclusionAphasia influences the cognitive and functional status of stroke patients and has a greater impact on cognitive improvement. Aphasia severity can be one of the prognostic factors for cognitive status in aphasic patients with stroke.

An analysis of fall incidence rate and risk factors in an inpatient rehabilitation unit: A retrospective study

ABSTRACT Background Accurate prediction of fall likelihood is advantageous for instituting fall prevention program in rehabilitation facilities. Objective This study was designed to determine the clinical measures, which can predict the risk of fall events in a rehabilitation hospital. Methods Medical records of 166 patients (114 males and 52 females) who were hospitalized in an adult inpatient unit of a rehabilitation hospital were retrospectively analyzed for this study. As predictor variables for assessing fall risk, demographic data and the following measurements were selectively collected from patient’s medical records: Tinetti Performance-Oriented Mobility Assessment-Ambulation (POMA-G), Timed Up and Go test (TUG), 10 m walk test, 2 min walk test, Korean version Mini-Mental State Examination (K-MMSE), Korean version of the Modified Barthel Index (KMBI), Berg Balance Scale (BBS), Global Deterioration Scale (GDS), and Morse Fall Scale (Morse FS). Results The Morse FS, TUG, and age were found to be risk factors for the classification of faller and non-faller groups. Conclusion This study suggests Morse FS, TUG, and age in the routine initial assessment upon admission in a rehabilitation setting, as key variables for screening the risk of fall. Additionally, the cutoff scores of Morse FS and TUG were observed to be more rigid than other clinical settings.

Vulnerable Strata to Non-Adherence and Overuse in Treatment for Patients with Cognitive Impairment.

Background and purposeAppropriate medication treatment could enable both cognitively impaired patients and caregivers to hold on their cognitive functioning and quality of life. Thus, medication management and the factors influencing how management for this condition is carried out must be identified. In this study we aimed to evaluate the frequency of medication nonadherence (MNA) or drug overuse for cognitive impairment (DOC) and to extract significant variables, including the demographic and social characteristics, vascular risk factors, and cognitive status, for the diagnosis of MNA and DOC in Korean patients.MethodsWe investigated patients aged over 50 years between March 2019 and June 2019 via the cognitive enHancement of patIents with acQuired cognitive impairment (HIQ) campaign. MNA was defined as a participant who was classified as having cognitive impairment but did not take any cognition-related drugs, whereas DOC was defined as a participant who had normal cognition but was taking cognition-related drugs.ResultsWe included 10,767 patients. The MNA group consisted of 337 participants, whereas the DOC group comprised 1,107 participants. The factors that could differentiate the MNA group from the normal-behavior group were age, education, sex, and the total Korean version of Mini-Mental State Examination (K-MMSE) score. The factors that could differentiate the DOC group from the normal medication-behavior group were age, sex, residential distinction, experience of a dementia screening test, and the total K-MMSE score.ConclusionsThe underlying factors contributing to inadequate dementia-medication management must be understood, and intervention or support is needed to enable safe medication management.

Driving scene-based driving errors in brain injury patients and their relevance to cognitive-perceptual function and functional activity level: A cross-sectional study.

Driving is an essential activity for community engagement in patients with brain injury. However, brain injury patients have cognitive-perceptual deficits and low independence in daily activities. The aims of this study were to identify the driving errors of brain injury patients and determine their relevance to cognitive-perception function and daily activity level. This study was conducted at a single rehabilitation hospital. Thirty-one brain injury patients were included in the study. The patients underwent a driving-scene-based simulator evaluation in the rehabilitation clinic. Driving errors were checked using automatic software. Perceptual ability was measured using Motor-free Visual Perceptual Test (MVPT) and Cognitive-perceptual Assessment for Driving (CPAD). A linear relationship was found between the driving aptitude score, steering wheel and judgment, simultaneous operation items, total score of road course test, and cognitive-perceptual functions and daily activity levels of the participants (P <.05). The general factors that affected driving errors included driving experience, age, part of the hemispheric affected, and presence of vascular injury (P <.05). In addition, the Korean version of Mini-Mental State Examination (K-MMSE) score and the CPAD score correlated with driving errors (P <.05). The total error score of the participants correlated with the Korean version of the Modified Barthel Index (K-MBI) score (P <.05).These findings suggest that driving experience and age have more influence on driving error than perceptual level due to brain damage. In addition, it was found that the basic level of daily living influences overall operating errors.

The Effect of a Working Memory Training Program on the Traumatic Brain Injury: A Single Subject Study

The purpose of this research is to see the effect of applying working memory training program along with traditional occupational therapy to patients with mild cognitive impairments caused by traumatic brain injury The study chose two people with mild cognitive impairment due to injury from a traumatic brain injury of study. This study, as a single case study design, was conducted by applying ABA design; In baseline condition (A phase), the subjects were treated with traditional occupational therapy and the subjects were treated with working memory training program in the B phase. And then the subjects went back to a baseline condition - the A phase - traditional occupational therapy session. The study performed Mini Mental State Examination-Korean version (MMSE-K) and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) as assessments for the standardized cognitive function before and after every session of evaluation on working memory. A visual analysis of changes in each session and changes before and after arbitration was conducted. In comparison to the A phase in which all subjects were treated with traditional occupational therapy, it was shown that the working memory ability measured in each session was increased in phase B, in which all subjects were treated with a working memory training program. The study results confirmed the possibility of improvement of memory and cognitive function with a working memory training program even in patients with mild cognitive impairment due to traumatic brain injury.

Effect of Task-Specific Lower Extremity Training on Cognitive and Gait Function in Stroke Patients: A Prospective Randomized Controlled Trial.

ObjectiveTo elucidate the effect of task-specific lower extremity training (TSLET) on cognitive and gait function in stroke patients.MethodsThirty-eight patients were assigned to either the TSLET group or the control group. The individuals of TSLET group went through a TSLET plus conventional physical therapy. The control group received two sessions of conventional physical therapy. The primary outcome involved the assessment with visual and auditory digit span test. The secondary outcome was evaluated by the Korean version of Mini-Mental State Examination (K-MMSE) and Global Deterioration Scale (GDS) for cognitive function, Berg Balance Scale (BBS), Time Up and Go Test (TUG), 10 meters Walking Test (10mWT), 6 minutes Walking Test (6MWT), and Korean version of Modified Barthel Index (K-MBI) for gait, balance, and functional ability.ResultsAfter intervention (3 weeks) and 2 weeks of follow-up, the TSLET group showed statistically significant improvement in the visual digit span test backwards compared with the control group. In secondary outcome, a significant improvement was observed in GDS, BBS, TUG, and 10mWT in the TSLET group. There was no significant difference between the two groups concerning visual digit span test forward, auditory forward and backward digit span tests, K-MMSE, 6MWT, and K-MBI.ConclusionTSLET could be a useful alternative strategy for improving cognitive and gait function in stroke patients.

Association of head circumference with cognitive decline and symptoms of depression in elderly: a 3-year prospective study.

BackgroundBrain volume is associated with dementia and depression in the elderly. An easy way to predict relative brain volume is to measure head circumference. In this study, we investigated the relationship between head circumference and cognition as well as depression in a non-demented elderly community.MethodsBaseline and follow-up surveys were conducted in 2007 and 2010. At baseline, community residents aged 65 years or over (n=382) within a rural area of South Korea were screened for dementia and symptoms of depression and were followed using the same screening battery after 3 years (n=279). Data from anthropometric measurements (head circumference, height, and body weight), demographics, and blood tests were gathered. Neuropsychological tests, including the Korean version of mini-mental state examination (K-MMSE), clinical dementia rating (CDR) including the CDR-sum of boxes, the Korean version of instrumental activities of daily living, and geriatric depression scale (GDS), were performed. None of the 279 subjects followed were demented.ResultsBaseline performance on the K-MMSE and GDS was poorer for participants with smaller head circumferences. Follow-up performance on the MMSE was also poorer for participants with smaller head circumferences. Interestingly, participants with smaller head circumference showed worse GDS scores at baseline but on follow-up examination, participants with larger head circumference showed rapid worsening than those with smaller head circumference with marginal significance by ANOVA test. In regression coefficient analysis, GDS decline showed significant difference.ConclusionHead circumference was not associated with cognitive change but was associated with symptoms of depression in non-demented community residents.

Menopausal hormone therapy and mild cognitive impairment: a randomized, placebo-controlled trial.

The aim of the study was to explore the therapeutic potential of menopausal hormone therapy (MHT) in women with mild cognitive impairment (MCI). Thirty-seven postmenopausal women (age range: 57-82 y) with multiple-domain, amnestic subtype MCI were randomly assigned to either placebo (n = 18) or MHT (n = 19) for 24 months (percutaneous estradiol [E2] gel [0.1%, 2 mg/d] and oral micronized progesterone [MP4] [100 mg/d]). All participants received donepezil, and apolipoprotein E genotype was determined. The primary endpoint was general cognitive function: Alzheimer's disease Assessment Scale, cognitive subscale, the Korean version of Mini-Mental State Examination (K-MMSE), and the Korean version of the Montreal Cognitive Assessment (MoCA_K) were performed in-person every 6 months. Twenty-one participants (placebo 13, MHT 8) completed the trial (56.8%). Progression rates to dementia were 52.9% (9/17) in the placebo group and 44.4% (8/18) in the MHT group. Within-group analysis showed that all three tests significantly worsened during the trial in the placebo, but not the MHT groups. Analysis adjusted for ε4 allele demonstrated that MHT significantly reduced deterioration of MoCA_K score, a sensitive tool for assessing global cognition in MCI (P = 0.0261). Compared with the control group, both MoCA_K (P = 0.043; mean difference, 3.85; 95% CI, -0.46 to 8.16) and K-MMSE (P = 0.0319; mean difference, 3.26; 95% CI, 0.04-6.48) scores were significantly better at 24 months in the MHT group. Long-term MHT using percutaneous E2 gel and oral MP4 might attenuate cognitive decline in postmenopausal women with MCI.