The status of understanding Dementia and Living Environment of Korean elderly population Eun-Ah Lee, MD., Eun Hyang Song, MD., Joon Young Lee *, MD Department of Neurology, Geriatrics & Dementia Center *, Seoul Metropolitan Seodaemun Hospital.

Introduction

A critical issue in the clinical practice of dementia 1. diagnose as early as possible 2. by slowing the rate of cognitive decline 3. delaying institutionalization 4. reducing caregiver hours (Patrick D et al, 1998, Frank A et al.2002) improving quality of life & economic benefits

Effect of early diagnosis & Treatment Effect of early diagnosis & Treatment 인지기능인지기능인지기능인지기능 시간 치매 치료 치료하지 않은 경우 조기진단후 치료 사망 병리학적 변화 시작 증상의 시작 생활의 장애 간호 필요 중환자 간호 필요

The important things are 1. Information obtained from informants or proxies: about 20~40% of cases, inaccurate information, fail to recognize cognitive problem (Rosset al, 1997, Kemp et al.2002) 2. Elderly person ’ s proper understanding of dementia

Objectives

Our aims to 1. assess the status of understanding dementia in elderly population 2. investigated the correspondence between their knowledge and real status of cognition through screening test 3. education effect about dementia 4. know population needs and give the proper service planning

Materials and Methods

1. Subjects: 176 elderly persons at several welfare facilities in Seoul had not been diagnosed of dementia 2. Questionnaire including 35 items such as symptom, cause, and possibility of treatment of dementia, care place and caregivers to hope, status of formal schooling and finance, family form, kinds of associated diseases, etc through direct interview

3. Screening test: including 1 ) Short form of Samsung Dementia Questionnaire (S-SDQ) 2) Version of Mini-Mental State Exam (K-MMSE) 3) Hasegawa scale of Dementia Rating (HSD-R) 4) Korean Instrumental Activities of Daily Living (K-IADL) 5) Korean Version of Hopkins Verbal Learning Test (K-HVLT) 6) Abstract thinking and judgment 7) Clock Drawing Test (CDT)

S-SDQ K-IADL suspicious dementia: > 8/30 suspicious dementia: > 0.43

K-HVLT K-MMSE & HSD-R 12 items free & 20 min delayed recall < 24, education dependent

Statistical analysis 1. SPSS (version 10) for window Descriptive and exploratory data analysis 3. x 2 -test and Fisher ’ s exact test was used to evaluate parameters and the correlation of education effect 4. Spearman ’ s correlation and Pearson ’ s correlation 5. P value of <0.05 was defined as significant

Results

General characteristics Number of subjects 176 Age (years)  6.27 Sex (M:F)(%) 27:148 Duration of education(years) 4.17  2.16 Spouse(Y:N) 67(39.2):104(60.8) Mean income(won) 200,000~300,000 Income source(PM:FO:AN:AL:SE) 93(55):22:20:15:16 Family live in together(Sp or alone:son:daut) 108(62):45(25.9):13 Smoking(Y:N) 12(6.8):164(93.2) Alcohol(Y:N) 17(9.7):159(90.3) Associated Disease(Y:N) 146(83.4):29(16.6) Drug taking(Y:N) 137(79.2):36(20.8) Data represent mean  SD.PM;pocket money, FO;fortune, AN;annuity, AL;allowance SE;social security, Sp;spouse, daut;daughter.

Distribution of Income

Associated Disease

Drug taking is mainly resulted from associated disease

Hobby Religious activity 38(38.4%) Reading book 05(5.1%) Oriental Chess 06(6.1%) Korean card game 03(3.0%) Exercise 21(21.2%) Others 12(12.1%) None 14(14.1%)

Recognition of Dementia Memory impairment (%) 85(60.3%) No discrimination of person 18(12.8%) Difficulty of urination & defecation 11(7.8%) Lost way 06(4.3%) Stroke 06(4.3%) Cannot take a message 06(4.3%) Change of mind 04(2.8%) Hearing & visual Difficulty 02(1.4%) Mistrust 01(0.7%) Dizziness 01(0.7%) What’s dementia ?

Aging (%) 100(60.2) Stroke 011(6.6) Smoking & Alcohol 006(3.6) Hypertension 006(3.6) Disease 007(4.2) Genetic problem 011(6.6) Cause of dementia ? Most fearful disease ? Cancer (%) 37(22.2) Stroke 45(26.9) Hypertension 05(3.0) Dementia 63(37.7) Diabetes 09(5.4) Heart Disease 08(4.8)

Damage to family 104(71.2) Disturbance of ADL 018(12.3) Poor appearance 017(11.6) Betray from the family 006(4.1) Expensive cost 001(0.7) Why dementia is most fearful ? Hospital(%) Offspring House Doctor&nurse Sanatorium Caregiver Asylum for aged Spouse Others Others Expectation to manage dementia ? Care place Caregiver 56(33.7) 66(40.0) 52(31.3) 23(13.9) 43(25.9) 33(20.0) 12(7.2) 19(11.5) 03(1.8) 27(14.5)

Family Hospital Medical Hospital Social and national National institute Others Issue of Filial duty 39(34.5) Medical disease 23(21.3) National problem 45(41.7) The reason should be managed by those managed by 62(55.9) 39(34.5%) 33(29.2%) 09(8.1) 33(29.2%) 15(13.5) 38(33.6%) 24(21.6)

Cognitive function test MMSE  5.27 HSD  8.77 CDR  0.47 IADL  1.1 CDT  3.01 HVLT  6.17 HVLT  2.97 Abstract thinking  1.22 Judgment  0.58 HVLT20: Hopkins verbal learning test 20 min delayed recall CDT: Clock drawing test

Dementia, yourself ? Forget the locate where put the thing: (68.8%) Forget the promise: (12.5%) Cannot find the road: (18.8%) Still fair memory: 27(20.9%) No ADL Disturbance: 42(32.6%) Natural course of aging: 50(38.8%) Still good remote memory: 10(7.8%) Yes: 36(21.1%) No: 139(80.3%) IADL<0.43 MMSE:20.0± %

Education effect Before(n=92) After (n=84) dementia is curable? Yes: 38(42.7%) NO: 50(56.2%) Yes: 47(60.3%) NO: 31(39.7%) P=0.058

Conclusion

Many proportion of Korean elderly: 1. living alone or with spouse regardless of existence of offspring : hard to interview proper informant 2. Financially dependent on offspring: economic limit to work-up 3. Misunderstanding of dementia & restricted ADL Obstacles to early diagnosis of dementia

Education about dementia 4. Change the recognition of dementia 5. Promote the early diagnosis of dementia Our study may be useful guideline how to establish appropriate dementia management of Korean elderly

감사합니다