This study aimed to identify the functional neuroanatomical correlates of figure copy and recall task performances as measured by the tests in the Consortium to Establish a Registry of Alzheimer's Disease (CERAD) neuropsychological battery and the Benton's Visual Retention Test (BVRT) in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Both the CERAD neuropsychological battery and BVRT were administered to 44 patients with amnestic MCI and 26 patients with AD. Regional cerebral glucose metabolism (rCMglc) was measured by 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET). Using statistical parametric mapping 8 (SPM 8), correlations between the test scores and rCMglc were analyzed on a voxel-by-voxel basis. CERAD constructional praxis (geometrical figure copy) scores showed significant positive correlation with rCMglc of the bilateral inferior parietal lobe, left middle and inferior temporal gyrus, left middle frontal gyrus, left insula, right superior parietal lobe, and right precuneus. In contrast, the scores of the BVRT figure copy task (irregular random figure copy) had significant positive correlation predominantly with rCMglc of the right side cortical regions including inferior parietal lobe, superior temporal gyrus, middle and inferior frontal gyrus, and middle and inferior occipital cortices. In terms of recall task performances, while CERAD constructional recall (delayed recall) scores were associated mainly with the metabolism of the right cortical regions such as inferior temporal, middle frontal, and angular gyrus, BVRT recall (immediate recall) scores were correlated predominantly with the metabolism of left side cortical regions including inferior and superior parietal lobe, middle, inferior and superior frontal gyrus, and middle and inferior temporal gyrus. The results suggested that, although classified as similar figure copy and recall task, each test in the CERAD neuropsychological battery has quite different functional neuroanatomical substrates compared to the corresponding test in the BVRT in MCI and AD individuals.
Background/Objectives: We aimed to elucidate the functional neuroanatomical correlates of Frontal Assessment Battery (FAB) performances by applying [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) to a large population of patients with Alzheimer disease (AD). Methods: The FAB was administered to 177 patients with AD, and regional cerebral glucose metabolism (rCMglc) was measured by FDG-PET scan. Correlations between FAB scores and rCMglc were explored using both region-of-interest-based (ROI-based) and voxel-based approaches. Results: The ROI-based analysis showed that FAB scores correlated with the rCMglc of the dorsolateral prefrontal cortices. Voxel-based approach revealed significant positive correlations between FAB scores and rCMglc which were in various cortical regions including the temporal and parietal cortices as well as frontal regions, independent of age, gender, and education. After controlling the effect of global disease severity with Mini-Mental State Examination score, significant positive correlation was found only in the bilateral prefrontal regions. Conclusions: Although FAB scores are influenced by temporoparietal dysfunction due to the overall progression of AD, it likely reflects prefrontal dysfunction specifically regardless of global cognitive state or disease severity in patients with AD.
To establish a proper care plan for people with dementia (PwD) and their families, comprehensive assessments for multiple domains including cognitive status, behavioral problems, basic ADL, and IADL, physical status, family status and burden are needed. We aimed to develop and validate a brief but relatively comprehensive dementia care assessment packet, the Seoul Dementia Assessment Packet (SDAP), for professional care planners or caregivers for dementia in the community. SDAP was initially developed for the Seoul Dementia Management Project, a metropolitan city level, community-based integrated dementia management program established by Seoul Metropolitan and Seoul National University Hospital (https://www.seouldementia.or.kr/eng). SDAP consists of two major parts: SDAP-I covers the status of a person with dementia (A. cognitive status; B. Behavioral problems; C. ADL; D. IADL; E. Physical status) and SDAP-II deals with family status and care burden. We tried to develop a comprehensive, but easily applicable assessment packet which can be used even by nurses or social workers without special training for clinical dementia assessment. It takes about 15 minitues to conduct SDAP. We validated the four quantitative instruments in the SDAP-I (A, B, C, and D) as follows. SDAP-I was applied to 63 dyads of PwD and their primary family caregivers who live in the community. They also received comprehensive clinical dementia assessment including CDR, MMSE, NPI, and BDS-ADL by neuropsychiatrists or neuropsychologist with special training for dementia. In addition, family caregivers also responded to questionnaires for caregiver burden, self-efficacy and family supports. To evaluate the interrater reliability of the SDAP-I, two raters simultaneously assessed 20 cases. SDAP-I total score showed significant positive correlation with CDR and CDR-SOB score. To verify the concurrent validity of the SDAP-I, correlational analysis results between the SDAP-I and the MMSE, NPI, BDS-ADL and CDR were statistically significant. In terms of predictive validity, SDAP-I total score had independent influence on caregiver burden even after controlling self-efficacy and family support. The SDAP's Cronbach's α coefficient was .91 ant its ICC were considered high. The results support that SDAP is probably a very useful dementia care assessment packet for care planning by persons without specialized training in the community.
본 연구는 지방 종합병원 간호사의 전문직 자아개념, 자기효능감 및 직무만족도를 확인하고 이들 간의 관계를 파악하며 직무만족도에 미치는 영향 요인들을 분석함으로써 궁극적으로 간호조직의 생산성을 높이기 위한 서술적 조사연구이다. B시 종합병원간호사 156명을 대상으로 설문지로 측정하였다. 간호사의 전문직 자아개념은 $3.02{\pm}0.23$, 자기효능감은 $2.92{\pm}0.21$, 그리고 직무만족도는 $2.76{\pm}0.26$이었다. 전문직 자아개념, 자기효능감 및 직무만족도 모두 유의한 순상관관계가 있는 것으로 나타났으며, 그 중 전문직 자아개념과 직무만족이 가장 높은 상관관계가 있는 것으로 나타났다 (r=.325, p <.001). 직무만족도에 영향을 주는 예측요인은 전문직 자아개념 (${\beta}=.403$, t=5.327, p <.001), 자기효능감 (${\beta}=.238$, t=3.309, p=.001) 그리고 임상경력 (${\beta}=-.224$, t=-3.014, p=.003) 이었으며, 24.2%의 설명력을 나타냈다. 따라서 지방 종합병원에 근무하는 간호사의 직무만족도를 높이기 위한 관리전략으로 간호사의 전문직 자아개념과 자기효능감을 높일 수 있는 업무체계와 프로그램 개발 및 적용이 필요하다. The purpose of this study was to explore the correlation among professional self-concept, self-efficacy and job satisfaction and to identify the effect of professional self-concept and self-efficacy on job satisfaction in general hospital nurses. Questionnaires were completed by 156 nurses who were working for one general hospital in Busan. The mean score of professional self-concept and self-efficacy were $3.02{\pm}0.23$ and $2.92{\pm}0.21$ respectively. The mean score of job satisfaction was $2.76{\pm}0.26$. With respect to job satisfaction, the correlations were .325 (p<.001) for professional self-concept and .212 (p=.008) for self-efficacy. As integrate of the study result showed job satisfaction had correlation to professional self- concept and self-efficacy. The regression model explained 12.6% of job satisfaction. Professional self-concept was factor influencing job satisfaction. So professional self-concept enhancement strategies and self-efficacy improvement programs should be developed to improve job satisfaction.
We tried to investigate the dementia prediction ability of subjective memory complaints (SMC) and compare the dementia prediction models including SMC in mild cognitive impairment (MCI) individuals. Eighty seven MCI subjects who visited the memory clinic in the Seoul National University Hospital were included. At baseline, participants' subjective memory complaints were measured by the Subjective Memory Complaints Questionnaire (SMCQ). All subjects also underwent standardized clinical evaluation and comprehensive neuropsychological assessment according to the CERAD protocol. They were followed up for 2 years. After a 2-year follow up period, 26 MCI subjects converted to dementia (MCIc) and 61 did not (MCInc). There was no significant difference of SMCQ score between the two groups at baseline, while clinical dementia rating of sum of boxes (CDR_SOB), 15-item Boston naming test (BNT), mini mental status examination (MMSE), word list recall (WLR), and constructional recall (CR) scores showed significant differences between the two groups. When dementia prediction models based on logistic regression analyses were compared, SMCQ score did not improve the prediction ability of CDR_SOB or neuropsychological test-based models. When we conducted the same analyses only for amnestic MCI to Alzheimer's disease dementia, the results were very similar. Our findings suggest that the degree of subjective memory complaints is not useful to predict the progression to dementia after 2 years in MCI.
It is important to know whether a mild cognitive impairment (MCI) patient has significant amyloid deposition to characterize the brain condition and predict the prognosis. We tried to compare the ability of various clinical, neuropsychological, structural imaging information, and their combinations for the discrimination of amyloid deposition positivity in the brain of MCI individuals. Thirty amnestic MCI subjects were included. All the subjects underwent standardized clinical evaluation and neuropsychological tests including the Subjective Memory Complaints Questionnaire(SMCQ), Seoul Informant Report Questionnaire for Dementia(SIRQD), Clinical Dementia Rating(CDR), CERAD neuropsychological battery, stroop test as well as Apolipoprotein E(APOE) allele typing, MRI, and Pittsburgh compound B PET(Pib PET). PiB PET Images were classified as amyloid deposition positive if the mean 11C-PiB retention value was over 1.4 in one of the following regions: the frontal, lateral temporal, lateral parietal, precuneus/posterior cingulate cortices. In MRI, we measured mean gray matter(GM) thickness using freesurfer. Among 30 subjects, 18 subjects classified as amyloid deposition positive group(MCI+). Compared to amyloid deposition negative(MCI-) group, MCI+ group showed significantly higher APOE e4 allele frequency, lower word list recall, higher stroop color-word test scores and lower mean cortical thickness in MRI. When amyloid deposition positivity prediction models based on logistic regression analyses were compared, the combined model of CERAD word list recall, stroop color word test, and MRI mean cortical thickness was the best discrimination model after adjusting age, education, and APOE e4 allele frequency (the prediction accuracy 90%). Our results suggest that the combination of verbal delayed recall, stroop color-word test, and cortical thickness on MRI may be useful for the discrimination of amyloid deposition status.
This study aimed to investigate the influences of age, education, and gender and provide the n ormative data for total score (TS) I and II of the CERAD neuropsychological battery (CERAD-NB) (Seo et al., 2010) in an elderly population with diverse educational background. One thousand nine hundred and eighty-seven healthy subjects (620 male and 1367 female; 50–90 years of age; and zero to 25 years of education) were recruited from among elderly individuals who participated in a community service program for the early detection and management of dementia at 9 centers located in a variety of regions Korea from January 1997 to February 2010. We used multiple linear regression analysis to assess the relative contribution of demographic factors on the TS I and II, and analyses of variance was applied to determine any main effects and interactions of age, education and gender on those scores. The CERAD-NB TSs were significantly influenced by age, education and gender. The order of the explanatory power of the demographic variables was education, that is, the strongest variable, and age, then gender for both TSs. The influence of gender was relatively weak on the TS I and was not found on the TS II in multiple linear regression analysis. In factorial ANOVA, the main effects of age and education, and the interactions of age and gender were found on both TSs. Post-hoc analyses revealed that there were the significant graded differences of both TSs between the 0–3, 4–9, 10–12 and above 13 year education groups. They also showed the significant differences between 50–59, 60–69, 70–79 and 80–90 year groups. Both TSs were higher in younger and high-education groups compared to older and low-education ones. In terms of age x gender interaction, male outperformed female with increased age for both TSs. Based on the results obtained, the norms for both TSs were stratified by age (six overlapping tables), education (four strata), and gender. In the present study, normative information on TSs of CERAD NB was obtained from an educationally diverse elderly population. The information presented in this report should contribute to improve clinical utility of CERAD NB.
Previous research focus primarily on comparisons between cognitively normal (CN), MCI and AD resulted in oversight of an important group of non-demented elderly people who cannot be included neither MCI nor CN. This group of people, tentatively called pre-MCI, is excluded form CN due to clinical dementia rating (CDR) 0.5 and from MCI due to absence of clear abnormality in neuropsychological tests. Inclusion of pre-MCI in the investigations of preclinical AD is needed to further elucidate the earlier manifestations of AD including subjective memory complaints (SMC). The current study aimed to examine the relationships between regional cerebral glucose metabolism (rCMglc) and SMC in CN and pre-MCI elderly. 74 healthy elderly without MCI or dementia (i.e., CN and pre-MCI) included in the study completed comprehensive clinical examination, the Subjective Memory Complaints Questionnaire (SMCQ), the Geriatric Depression Scale (GDS) and a range of neuropsychological tests, and also underwent APOE genotyping as well as FDG-PET. FDG-PET data were preprocessed and analyzed using SPM8, controlling for the effects of age, gender, education, the GDS score, and APOE4 status. SMCQ total score was associated with hypermetabolism primarily in the bilateral precuneus, cuneus, and fusiform gyri. It was also associated with hypometabolism in the inferior frontal gyrus, middle temporal gyrus, and supramarginal gyrus. In addition, participants were grouped based on whether or not they endorsed select items of the SMCQ on various aspect of SMC, which were: (a) "do you have problems in memory?" and, (b) "do you feel that your memory function is worse than your age-peers?" Compared to those who denied, those who endorsed the item "a" exhibited hypermetabolism in the fusiform gyrus and hypometabolism in the inferior frontal gyrus; and, those who endorsed the item "b" exhibited hypermetabolism in the precuneus/cuneus and hypometabolism in the fronto-temporal regions, parahippocampal gyrus and insula. The current findings indicate that severity of SMC is related to underlying alterations in specific regional cerebral glucose metabolism. The patterns of hyper- and hypometabolism associated with increased SMC may reflect increased compensatory mechanisms of the posterior brain regions and decreased fronto-temporal functions in very early degenerative changes.
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