• Korean Journal of Psychosomatic Medicine
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• v.21 no.2
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• pp.140-146
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• 2013

Objectives: We compared the characteristics of the pain threshold and pain experience between demented group and non-demented group. Methods: This study was part of Gangwon projects for early detection of dementia in 2010. We recruited 8302 local resident ages over 65 years old. Of theses, 1259 people who scored low MMSE were selected and 365 of them completed CERAD-K(Consortium to Establish a Registry for Alzheimer's disease). Finally, 90 in non-demented group and 57 in demented group(mild to moderate Alzheimer's disease) were analyzed. Pain threshold was experimentally measured by pressure algometer and we investigated the pain experience, by Brief pain inventory (BPI), a self-report test. Results: In the demographic characteristics, there are more female, higher ages, lower education in the demented group. There was no significant difference between the two groups in the pain threshold. On the BPI results, 'shoulder pain', 'the number of pain' and 'interference of working' were significantly more prevalent in non-demented group. However, there are no significant differences between the groups in the 'pain severity', 'prevalence of pain' and 'pain treatment'. Conclusions: Demented group report less pain experience but, still perceived pain. It support previous studies that patient with dementia have increased pain tolerance but preserved pain threshold. Thus, active pain assessment and treatment for patients with dementia is needed.

• Korean Journal of Biological Psychiatry
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• v.18 no.3
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• pp.141-147
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• 2011

Objectives The purpose of this study is to evaluate the relationship between the severity of white matter changes (WMC), risk factors and cognitive domains, including executive function profiles. Method Forty nine subjects over 55 years with subjective memory complaints were assessed with MRI and neuropsychological tests. The WMC were assessed by MRI T2-FLAIR images and divided into 3 groups of mild vs. moderate vs. severe and 2 groups of mild-moderate vs. severe by using Mantyla's criteria and Fazeka's criteria. The risk factors were examined in hypertension, heart disease history and chemistry Lab. Medical conditions which affect to cognitive dysfunction and definite dementia were also excluded. Results Comparing 3 groups, hypertension was identified as a risk factor of the WMC. Comparing 2 groups, total cholesterol and LDL were identified for as the risk factor of WMC. The severity of WMC was significantly associated with cognitive disturbances and their main effect on cognition was working memory and inhibition. Conclusion The risk factors of the WMC in the elderly were hypertension, hyperlipidemia. The severity of WMC appears to be associated with executive dysfunction in the elderly.

• IEMEK Journal of Embedded Systems and Applications
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• v.8 no.1
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• pp.31-42
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• 2013

Considerations of how to facilitate aging-in-place(AIP) are becoming increasingly pertinent as care-givers are overwhelmed by an aging population. Aging friendly home-care services combined with IT can satisfy the needs of the elderly suffer from chronic diseases such as depression and dementia. Therefore, we propose future smart phone services and application technologies which can estimate emotional states of the aged and respond to the desire to be happy with mental health, connectedness and consolation from peoples. Firstly, we introduce depression measurement techniques to estimate the severity of depression using multiple sensors. At second, the emotional responding services are categorized to four parts and the details are described. Lastly, we propose the process to implement emotional communication and the application techniques(services) to fulfill the emotional satisfaction and mental healthcare for AIP using smart phone as a mediator.

• Journal of Sensor Science and Technology
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• v.32 no.6
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• pp.378-385
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• 2023

Human biosignals provide essential information for diagnosing diseases such as dementia and Parkinson's disease. Owing to the shortcomings of current clinical assessments, noninvasive solutions are required. Machine learning (ML) on wearable sensor data is a promising method for the real-time monitoring and early detection of abnormalities. ML facilitates disease identification, severity measurement, and remote rehabilitation by providing continuous feedback. In the context of wearable sensor technology, ML involves training on observed data for tasks such as classification and regression with applications in clinical metrics. Although supervised ML presents challenges in clinical settings, unsupervised learning, which focuses on tasks such as cluster identification and anomaly detection, has emerged as a useful alternative. This review examines and discusses a variety of ML algorithms such as Support Vector Machines (SVM), Random Forests (RF), Decision Trees (DT), Neural Networks (NN), and Deep Learning for the analysis of complex clinical data.

• Journal of Korean Neurosurgical Society
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• v.43 no.3
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• pp.143-148
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• 2008

Objective: Postoperative delirium (POD) is characterized by an acute change in cognitive function and can result in longer hospital stays, higher morbidity rates, and more frequent discharges to long-term care facilities. In this study, we investigated the incidence and risk factors of POD in 224 patients older than 70 years of age, who had undergone a neurosurgical operation in the last two years. Methods: Data related to preoperative factors (male gender, >70 years, previous dementia or delirium, alcohol abuse, serum levels of sodium, potassium and glucose, and co-morbidities), perioperative factors (type of surgery and anesthesia, and duration of surgery) and postoperative data (length of stay in recovery room, severity of pain and use of opioid analgesics) were retrospectively collected and statistically analyzed. Results: POD appeared in 48 patients (21.4%) by postoperative day 3. When we excluded 26 patients with previous dementia or delirium, 17 spontaneously recovered by postoperative day 14, while 5 patients recovered by postoperative 2 months with medication, among 22 patients with newly developed POD. The univariate risk factors for POD included previously dementic or delirious patients, abnormal preoperative serum glucose level, pre-existent diabetes, the use of local anesthesia for the operation, longer operation time (>3.2 hr) or recovery room stay (>90 mini, and severe pain (VAS>6.8) requiring opioid treatment (p<0.05). Backward regression analysis revealed that previously dementic patients with diabetes, the operation being performed under local anesthesia, and severe postoperative pain treated with opioids were independent risk factors for POD. Conclusion: Our study shows that control of blood glucose levels and management of pain during local anesthesia and in the immediate postoperative period can reduce unexpected POD and help preventing unexpected medicolegal problems and economic burdens.

• Journal of Arbitration Studies
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• v.31 no.1
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• pp.83-105
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• 2021

If aggrieving consumers or employees cannot prove both substantive and procedural unconscionability, many U.S. state courts will enforce arbitration agreements. Additionally, U.S. courts weigh a variety of factors to determine whether an arbitration agreement is substantively unconscionable. For example, U.S. courts have considered one or a combination of the following factors: (1) the fairness of contractual terms; (2) the severity of contractual terms' deviation from prevailing standards, customs, or practices within a particular industry; (3) the reasonableness of goods-and-services contract prices; (4) the commercial reasonableness of the contract terms; (5) the purpose and effect of the terms and (6) "the allocation of risks between the parties." Further, procedural unconscionability characterized by surprise or lack of knowledge focuses on terms that are deceptively hidden in a mass of contract language, the object of another concealment, or imposed in the circumstances involving haste or high-pressure tactics so that they are not likely to be read or understood. This unconscionability doctrine can be applied to a situation where an alcoholic dementia-afflicted older adult is admitted to a nursing home. At that time, because she had alcoholic dementia, which precluded her reading, comprehending, writing, negotiating, or signing of any legal document, her son, who did not understand the adhesion contract, signed the standardized residential contract and the arbitration agreement.

• The Korean Journal of Nuclear Medicine
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• v.30 no.3
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• pp.299-314
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• 1996

The purpose of the present study was to validate the use of tissue radioactivity ratios instead of regional metabolic rates for the assessment of regional metabolic changes in Alzheimer's disease(AD) with [$^{18}F$]FDG PET and to examine the correlation of ratio indices with the severity of cognitive impairment in AD. Thirty-seven AD Patients(age $68{\pm}9 yrs$, $mean{\pm}s.d.$; 36 probable and 1 definite AD), 28 patients with dementia of non-Alzheimer type(age $66{\pm}7 yrs$), and 17 healthy controls(age $66{\pm}4 yrs$) underwent [$^{18}F$]FDG PET imaging. Two simplified radioactivity ratio indices were calculated from 37-66 min image: region-to-cerebellar radioactivity ratio(RCR) and a composite radioactivity ratio(a ratio of radioactivity in the most typically affected regions over the least typically affected regions: CRR). Local cerebral metabolic rate for glucose(LCMRglu) was also measured using a three-compartment, five-parameter tracer kinetic model. The ratio indices were significantly lower in AD patients than in controls(RCR in temporoparietal cortex, $0.949{\pm}0.136$ vs. $1.238{\pm}0.129$, p=0.0004; RCR in frontal cortex, $1.027{\pm}0.128$ vs. $1.361{\pm}0.151$, p<0.0001; CRR, $0.886{\pm}0.096$ vs. $1.032{\pm}0.042$. p=0.0024). On the RCR analysis, 86% of AD patients showed a pattern of bilateral temporoparietal hypometabolism with or without frontal involvement; hypometabolism was unilateral in 11% of the patients. When bilateral temporoparietal hypometabolism was considered to be suggestive of AD, the sensitivity and specificity of the RCR analysis for the differential diagnosis of AD were 86% and 73%, respectively. The RCR was correlated significantly with the macroparameter K [$K_1k_3/(k_2+k_3)$] (r=0.775, p<0.0001) and LCMRglu(r=0.633, p=0.0002) measured using the kinetic model. In patients with AD, both average RCR of cortical association areas and CRR were correlated with Mini-Mental Status Examination(r=0.565, p=0.0145; r=0.642, p=0.0031, respectively), Clinical Dementia Rating(r=-0.576, p=0.0124; r=-0.591, p=0.0077), and total score of Mattis Dementia Rating Scale (r=0.574, p=0.0648; r=0.737, p=0.0096). There were also significant correlations between memory and language impairments and corresponding regional RCRs. The results suggest that the [$^{18}F$]FDG PET ratio indices, RCR and CRR, reflect global and regional metabolic rates and correlate with the severity of cognitive impairment in AD. The simplified ratio analysis may be clinically useful for the differential diagnosis and serial monitoring of the disease.

• Journal of dental hygiene science
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• v.16 no.6
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• pp.481-487
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• 2016

The elderly population with dementia is rapidly growing in South Korea. The aim of this study was to investigate the relationship between dementia and oral health in 197 subjects aged ${\geq}65$ years. The questionnaire included questions on subjective health status, subjective health concern, subjective oral health status and behavior, mastication ability, Oral Health Impact Profile-14 (OHIP-14), and Korean Dementia Screening Questionnaires (KDSQ). Oral examination was conducted by a single dentist to evaluate upper or lower denture use, and determine the numbers of remaining and functioning teeth, including implant and fixed prosthesis. The subjects who required a dementia test (KDSQ-C [cognition] of ${\geq}6$) had significant differences in systemic disease prevalence rate, subjective health status, subjective health concern, KDSQ-V (vascular disease) score, KDSQ-D (depression) score, subjective oral treatment need, key food mastication ability and OHIP-14 score compared to the healthy subjects. The proportion of denture wearers, total remaining teeth, total functioning teeth, toothbrushing frequency, oral pain severity, symptoms of periodontal disease, subjective oral health status, and subjective oral health concern showed no significant differences between the two groups. KDSQ-C and OHIP-14 scores showed a strong positive relationship, while KDSQ-C score and total remaining teeth or key food mastication ability showed a weak negative relationship. In the multiple regression analysis, the KDSQ-D, KDSQ-V, and OHIP-14 scores influenced the KDSQ-C scores. We suggest a relationship between oral health and cognitive impairment.

• Health Policy and Management
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• v.10 no.4
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• pp.99-115
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• 2000

This study was conducted to get a resonable set of budget allocation to public health programs. Matrix Delphi technique was used to obtain the logic of study results and eventually to form a human model which could predict opinion of professionals on budget allocation. Thirty-two professionals in academic and governmental area responded to Delphi survey. Questionnaire was developed using matrix formation, and the matrix was formed by 6 decision criteria on budget allocation and 26 public health programs. The decision criteria are as following: size of problem(morbidity), severity of problem, social equity, importance of prevention, technical feasibility and efficiency of programs. Severity of problem dropped out of the model because it had significant correlation with the size of problem. A total score of each program was obtained by weighting the relative importance of each criteria which also were given by survey respondents. These total scores indicate that the most important public health program is vaccination for infants and children in terms of budget allocation. Monitoring communicable diseases, mental health program, and anti-smoking program are the next. In addition, respondents were asked of the desirable budget size of each program. The result was rearranged by multiple regression model using the scores of each decision criteria. In this process, the current budget size of central government was provided to the respondents, and included in the model. h set of desirable budgets modified using tile model was obtained. Considering the current size of budget, tile results of the model is very different from that of the total score. Managing dementia is ranked the first. Health promotion program for the elderly, rehabilitation of the disabled and monitoring communicable diseases are the next. The need to increase the budget of vaccination for the infants and children was not found as so high. The matrix structure in Delphi survey gave us the precise basis to make optimal decision, and made it possible to develop an opinion predicting model. However the plentifulness and diversity of professional opinions were not fully obtained due to the limited number of decision criteria.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.271-280
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• 2017

Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. Methods: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012-2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. Results: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ${\geq}6$. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. Conclusion: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.