Association between Insight and Neuropsychiatric Symptoms in Alzheimer's Dementia : A Clinical Research Center for Dementia of South Korea Study (CREDOS)

Hyeyeon Yoon; Woojae Myung; Jihye Song; Jun Bae Choi; Hyo Shin Kang; Duk L. Na; Seong Yoon Kim; Jae-Hong Lee; Seol-Heui Han; Seong Hye Choi; Sang Yun Kim; Doh Kwan Kim

doi:10.4306/jknpa.2013.52.1.42

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Yoon, Myung, Song, Choi, Kang, Na, Kim, Lee, Han, Choi, Kim, and Kim: Association between Insight and Neuropsychiatric Symptoms in Alzheimer's Dementia : A Clinical Research Center for Dementia of South Korea Study (CREDOS)

Original Article

Journal of Korean Neuropsychiatric Association

Journal of Korean Neuropsychiatric Association 2013; 52(1): 42-49.

Published online: 31 January 2013

DOI: https://doi.org/10.4306/jknpa.2013.52.1.42

Association between Insight and Neuropsychiatric Symptoms in Alzheimer's Dementia : A Clinical Research Center for Dementia of South Korea Study (CREDOS)

Hyeyeon Yoon, MD¹, Woojae Myung, MD¹, Jihye Song, MD¹, Jun Bae Choi, MD¹, Hyo Shin Kang, MA², Duk L. Na, MD, PhD³, Seong Yoon Kim, MD, PhD⁴, Jae-Hong Lee, MD, PhD⁵, Seol-Heui Han, MD, PhD⁶, Seong Hye Choi, MD, PhD⁷, Sang Yun Kim, MD, PhD⁸, Doh Kwan Kim, MD, PhD^1,²

¹Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

²Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Korea.

³Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

⁴Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁵Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

⁶Department of Neurology, Konkuk University School of Medicine, Seoul, Korea.

⁷Department of Neurology, Inha University School of Medicine, Incheon, Korea.

⁸Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.

Address for correspondence: Doh Kwan Kim, MD, PhD. Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel +82-2-3410-3582, Fax +82-2-3410-0941, paulkim@skku.edu

Received 20 September 2012 Revised 12 November 2012 Accepted 4 December 2012

Abstract

Objectives

The aim of this study was to identify the association between insight and neuropsychiatric symptoms in patients with Alzheimer's dementia (AD).

Methods

We examined 2607 patients with AD in the Clinical Research Center for Dementia of South Korea study and designed a cross-sectional study. Each patient underwent psychiatric, neurological, and medical examination, interview for caregivers, laboratory tests, neuropsychological tests, and brain MRI. Cognitive function was measured using the Korean version of the Mini-Mental State Examination, Global Deterioration Scale, and Clinical Dementia Rating. Behavioral and psychological symptoms were measured using the Korean version of the Neuropsychiatric Inventory. Daily Living was measured using the Barthel Index for daily living activities and Seoul-Instrumental Activities of Daily Living. Insight was classified according to 'with insight', 'partial insight', and 'without insight' by interview with caregivers.

Results

Among the 2607 patients, 990 were included in the 'with insight' group, 1191 were included in the 'Partial insight' group, and the 'without insight' group included 426 patients. The 'without insight' group had a significantly higher aggression level than the 'with insight' group, but not the 'partial insight' group [odds ratio (OR)=1.46, 95% confidence interval (CI) : 1,14-1.88]. A significantly lower prevalence of depression was observed in the 'Partial insight' group and the 'without insight' group, compared to the 'with insight' group (OR=0.51, 95% CI : 0.43-0.61/OR=0.61, 95% CI : 0.48-0.78). The 'partial insight' group showed a lower anxiety level than the 'with insight' group (OR=0.63, 95% CI : 0.53-0.75).

Conclusion

Findings of this study confirmed that insight level was associated with aggression, depression, and anxiety in patients with Alzheimer' dementia.

Keywords: Alzheimer's dementia, Insight, Aggression, Depression, Anxiety

Figures and Tables

Table 1

Clinical and demographic characteristics (n=2607)

^*: Chi-square test was used, ^†: Kruskal-Wallis test was used. K-MMSE score : Korean Mini Mental State Examination score, CDR-SB : Clinical Dementia Rating Sum of Box, GDS : Global Deterioration Scale, ADL : Barthel Index daily living actives, S-IADL : Seoul-Instrumental Activities of Daily Living, NPI : Neuropsychiatric Inventory

Table 2

Association between prevalence of each NPI item and insight

^*: Fisher's exact test was used ; p-value was corrected using False Discovery Rate method for testing 12 individual NPI items, ^†: Logistic regression was used for controlling for age, sex, education and Clinical Dementia Rating Sum of Box, ^‡: p-value was corrected using False Discovery Rate (FDR) method for testing 12 individual NPI items. NPI : Neuropsychiatric Inventory, OR : Odds ratio, CI : Confidence Interval

Acknowledgments

This study was supported by grants of the Korea Healthcare technology R&D Project, the Ministry of Health and Welfare, Republic of Korea (A102065) and Eisai Korea Inc.

Notes

The authors have no financial conflicts of interest.

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