Objective: The purpose of this study is to select a cognitive training game that can evaluate five cognitive domains and to study their validity with existing cognitive evaluation tools. Design: Methods: Delphi survey was conducted through the 2nd questionnaire for 30 experts to select games suitable for training 5 cognitive domains. Five cognitive training games and Mini Mental State Examination - Korea(MMSE-K), and cognitive impairment screening test(CIST) were conducted for 82 elderly in the community. Pearson correlation analysis was performed to find out the correlation of the three tests. The ROC curve was used to calculate the selection criteria for the game results for the screening evaluation of the presence or absence of mild cognitive impairment. Results: The coefficient of variation to evaluate the stability of the Delphi survey was less than 0.50 in most game items. The 'correct answers' and 'level' of the five final selected game items showed a statistically significant positive correlation with the CIST and MMSE-K scores. CIST score and 'time' of all game items except 'number making_time' showed a statistically significant negative correlation. Conclusions: The validity of the cognitive training program using smart devices was evaluated, and the criteria for classifying the cognitive domain and distinguishing the presence or absence of cognitive impairment were confirmed.
Objective: Older adults with mild cognitive impairment (MCI) are more likely to progress to dementia. Motor-cognitive training is applied as a dual-task to improve the cognitive and physical functions of older adults with MCI. The purpose of the study was to know the recent trends in motor training types and outcome measures used for motor-cognitive training in older adults with MCI. Design: Aliterature review Methods: This literature review was conducted in Pubmed, MEDLINE® and Google Scholar with the following key words: older adults, mild cognitive impairment, motor-cognitive training, cognition, and dual-task. The 7 studies were found with the search tool and all studies were randomized controlled trials. Results: In motor-cognitive training in older adults with MCI, 6 studies applied aerobic exercise. And 3 out of 6 studies also applied strengthening exercises. One study applied dual tasks without aerobic exercise. In the 6 studies, overall cognitive and executive function were used as outcome measures, and physical function was evaluated as gait performance. Memory and physical frailty were also used as measurement tools. As a result of all studies, when motor-cognitive training was applied, cognition and physical performance showed significant results. Conclusions: A recent five-year study applied mainly aerobic exercise and strength training to older adults with MCI and found it to improve cognitive and physical performance.
PURPOSE: This study examined the differences in the trunk impairment scores according to the levels of the gross motor classification system by evaluating trunk control in children with spastic cerebral palsy using the index of trunk impairment. In addition, the characteristics of trunk control disabilities were investigated according to the cerebral palsy type. METHODS: The subjects were 49 children (mean age 8.57±1.83 years, 11 with hemiplegia, 26 with diplegia, and 12 with quadriplegia) with spastic cerebral palsy levels I to IV under the gross motor function classification system (GMFCS). The coordination and balance of the children with cerebral palsy were evaluated using the index for trunk impairment. Statistical analyses were performed using a Kruskal-Wallis test, and Bonferroni analyses were used as a post-hoc comparison for any significant results. RESULTS: The median of the total scores of trunk impairment was 13 (range, 9-17), which was 56% of the maximum score. The total score of trunk impairment and subscales differed significantly according to the disease severity and type of motor disability. The scores for children with quadriplegia were the lowest compared to children with hemiplegia and diplegia. CONCLUSION: Trunk control function in children with spastic cerebral palsy was reduced, and varied according to the disease severity and types of motor disabilities. The degree of trunk impairment differed from the trunk control ability according to the degree of motor disability of children with cerebral palsy.
Objective: Mild cognitive impairment (MCI) is a condition in which cognitive and executive functions are reduced, and older adults with MCI are ten times more likely to develop dementia than healthy older adults. Expression of brain-derived neurotrophic factor (BDNF) through aerobic exercise is associated with increased cognitive and executive functions. in this review, randomized controlled trials (RCTs) on the effects of aerobic exercise on BDNF in individuals with mild cognitive impairment are summarized and qualitatively and quantitatively analyzed to suggest the necessity of aerobic exercise. Design: a systematic review and meta-analysis. Methods: RCTs were searched for changes in BDNF through aerobic exercise using four international databases. Quality assessment and quantitative analysis were performed using RevMan 5.4. Quantitative analysis was quantified with a standardized mean difference (SMD) and presented as a random effect model. Results: Three RCTs evaluated BDNF in 123 patients with MCI. There was a significant improvement in the experimental group that performed aerobic exercise compared to the control group. The results analyzed using the random effects model were SMD = 0.48. Conclusions: In this review, we reported the effects and mechanisms of aerobic exercise in individuals with MCI. As a result of synthesizing RCTs that performed aerobic exercise, a significant increase in BDNF was confirmed.
For the purpose of promotion of mental health in the rural elderly, the author surveyed 558 elderlies aged 60 years or more, and assessed the prevalence rates of depression and cognitive impairment by using self-rating depression scale of Zung (SDS) and the Korean version of mini-mental state examination (MMSEK). Also the association between depression or cognitive function and socio-environmental factors were investigated. The major findings were as follows ; 1. The prevalence rates of severe depression and cognitive impairment were 20.9% and 14.9% in all the elderly of both sexes, respectively. 2. The rates of depression and cognitive impairment increased with increasing age in both sex groups. The mean scores of SDS increased and the mean scores of MMSEK decreased significantly among them (p<0.01). 3. Those being female, widows or widowers, and those having low levels of physical activity, showed significantly high the mean scores of depression and had significantly low the mean scores of cognitive impairment (p<0.01). 4. The depression scores relating to decreased libido, confusion, psychomotor retardation, hopelessness and indecisiveness were relatively high in both sexes. 5. All the items of mini-mental state examination were significantly correlated with depression. 6. In stepwise multiple regression analysis on depression, MMSEK, level of physical activity, chronic disease, marital status and family income were selected as highly correlated variables, and the $R^2$-value for these variables was 33.7%. 7. In stepwise multiple regression analysis on cognitive function, level of physical activity, age, depression, sex and marital status were selected as highly correlated variables, and the $R^2$-value for these variables was 62.6%. The depression and cognitive impairment of the elderly were positively correlated with nearly all sociodemographic variables.
The primary purpose of this study is to examine the buffering effect of social welfare services on the relationship between the level of older persons' impairment and burden experienced by the family caregivers. It also assessed the level of caregiving burden as well as the effect of both older person's impairment and the characteristics of the caregivers on burden. The survey data collected from 150 community residing family caregivers was used for analyses. Findings are as follows. First, the caregivers are more burdened in the deterioration of mental health, scarce time for oneself, and the suffering of social life than in other areas of burden. Second, the more severe the physical and the mental impairment of the elder, the more burden the caregivers experience. The caregivers' characteristics such as the worse mental health, the lower level of attachment to the elder, the longer caregiving hours are also related to the higher level of caregiving burden. Third, the caregivers' use of adult day care and respite care services buffer the relationship between the level of impairment of older persons and the caregiving burden. However, social work counselling, visiting nurse, homemaker services do not have such buffering effects. Among informal support, instrumental support buffers the relationship between the elder's physical impairment and burden, while emotional support buffers the relationship between the elder's mental impairment and burden. According to the results, implication for social welfare services and practice methods for the family caregivers was discussed.
Purpose: This study aimed to identify depression and its predictors among Korean community-dwelling elderly with mild cognitive impairment. Methods: Secondary data analyses of the data collected by the "Study on tailored integration program for reinforcing cognitive and physical function of the frail elderly. The study used data from one-to-one interviews using structured questionnaires. The subjects were 346 community-dwelling elderly who visited a healthcare center in Seoul, Korea. A descriptive correlational study design was utilized to explore depression and its predictors including physical factors and psychosocial factors among the elderly with mild cognitive impairment. Data were analyzed using t-test, Pearson's correlation, and hierarchical regression. Results: Mean score of depression was within normal limit $11.61{\pm}6.69$. Somatic symptoms, negative life events (severity), social support were shown as significant predictors of depression. The most influential predictor for depression was somatic symptoms (${\beta}$=.340, $p$ <.001). Conclusion: To prevent and relieve depression in the elderly with mild cognitive impairment, nursing intervention strategies which consider well-balanced physical and psychosocial aspects are needed. In particular, a specific nursing intervention strategy is required to improve physical health of the elderly with mild cognitive impairment.
This meta-analysis investigated the effects on arm motor impairment, arm motor function and disability, and psychological aspects of constraint-induced movement therapy (CIMT) for upper extremity hemiparesis following stroke, based on Korean studies. A comprehensive search of the complete Korean studies information service system (KISS), Research Information Sharing Service (RISS), Korea National Library, and the Korean Medical Database to September 2011 was conducted. Eleven eligible controlled clinical trials compared CIMT to a control group or an alternative treatment. All outcome measures of arm motor impairment, arm motor function and disability, and psychological aspects were pooled for calculating effect size. The overall effect size of CIMT was .700 (95% confidence interval=.482~.918). The CIMT programs showed large effect on the aspect of arm motor function and disability (the effect size is .920) and the psychological aspect (the effect size is .946). The effect of CIMT on arm motor impairment was moderate (the effect size is .588). These results show that CIMT may improve upper extremity motor impairment, function and disability, and psychological aspects following stroke. However, these results were based on a small number of studies, and not all of them were randomized control trials. Additional research is needed to include larger well-designed trials to resolve these uncertainties.
The purpose of this study was to find out the effects of electroencephalograph (EEG) power and coherence on cognitive function in normal elderly, non-demented elderly with mild cognitive impairment, and demented elderly during working cognition tasks. Forty elderly women (19 demented elderly, 10 non-demented elderly with mild cognitive impairment, 11 norma1 elderly) participated in this study, All subjects performed working cognition tasks with Raven's CPM while EEG signal was recorded, EEGs were measured continuously at rest and during the working cognition task. EEG power and coherence was computed over 21 channels: right and left frontal, central, parietal, temporal and occipital region. We found that there were more correct answers among normal elderly women than in other groups Owing the working cognition task, ${\Theta}$ wave at Fp1, Fp2 and F8, a wave at Fp2, ${\beta}$ wave at Fp1, Fp2. F4 and F8 of the frontal region was increased significantly in the demented elderly group. On the other hand. ${\Theta}$ wave at Fp1, Fp2 and F7, ${\beta}$ wave at Fp1, Fp2, F3 and F7 of the frontal region was increased significantly in the group of non-demented elderly with mild cognitive impairment. In contrast. in the normal elderly group, all of the ${\Theta}$ wave and ${\beta}$ wave at Fp1, Fp2, F3, F4, F7 and F8 of the frontal region (except ${\beta}$ wave at F3) was increased significantly, These results suggest that the nerves in prefrontal and right hemisphere regions were most active in the demented elderly group during problem solving, and the nerves in the prefrontal and left hemisphere lobe were most active in the group of non-demented elderly with mild cognitive impairment. In contrast, me majority of nerves in the frontal region were active in the normal elderly group.
Purpose: The purpose of this study was to identify correlates influencing cognitive impairment in breast cancer patients receiving chemotherapy. Methods: Study subjects consisted of 102 breast cancer patients who received chemotherapy. Subjects were the members of a breast cancer self-help group. Data were collected using structured self-reporting questionnaires including scales of cognitive impairment, physical status, fatigue, quality of life, emotional status, sleeping, family support, and menopausal symptoms. Statistical Package for Social Sciences was used for statistical analyses. Results: Breast cancer patients receiving chemotherapy appeared to show a high level of cognitive impairment. Among demographic characteristics, the effects of economic status and family type on cognitive impairment were found to be statistically significant. Among disease related characteristics, the effect of duration of chemotherapy on cognitive impairment was statistically significant. Menopausal symptoms were positively associated with cognitive impairment. The model including postmenopausal symptoms and caregiver type explained about 66% of variability in cognitive impairment. Conclusion: These findings highlight the importance of contextual factors in understanding cognitive impairment in breast cancer patients receiving chemotherapy and can be used to develop appropriate, effective nursing interventions.
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