Background and Purpose The prevalence of dementia is increasing in South Korea. Multidomain interventions may be useful for preventing dementia. Such programs need to be disseminated to elderly Koreans throughout the country. We have developed programs of the SoUth Korean study to PrEvent cognitive impaiRment and protect BRAIN health through lifestyle intervention in at-risk elderly people (SUPERBRAIN), which consists of a facility-based multidomain intervention (FMI) program and a home-based multidomain intervention (HMI) program suitable for elderly Koreans. We aim to determine the feasibility of the SUPERBRAIN programs before a large-scale randomized controlled trial. Methods We will recruit 150 participants among those without dementia aged 60-79 years with at least 1 modifiable dementia risk factor. They will be randomly assigned in a 1:1:1 ratio to the FMI, HMI, and the waiting-list control arm. The 6-month multidomain intervention consists of management of metabolic and vascular risk factors, cognitive training and social activity, physical exercise, nutritional guidance, and motivational enhancement programs. The primary outcomes are adherence and retention rates and changes in the total scale index score of the Repeatable Battery for the Assessment of Neuropsychological Status from baseline to the study end. The main secondary outcomes are disability, depressive symptoms, quality of life, vascular risk factors, physical performance, nutritional assessment, and motivation questionnaire. There will be an exploratory evaluation of neurotrophic, neurodegeneration, and neuroinflammation factors, microbiome, telomere length, electroencephalography, and neuroimaging measures. Conclusions The results obtained will provide information on the applicability of these multidomain intervention programs to at-risk elderly people.

Alzheimer’s disease (AD) is the most-common cause of neurodegenerative dementia, and it is characterized by abnormal amyloid and tau accumulation, which indicates neurodegeneration. AD has mostly been diagnosed clinically. However, ligand-specific positron emission tomography (PET) imaging, such as amyloid PET, and cerebrospinal fluid (CSF) biomarkers are needed to accurately diagnose AD, since they supplement the shortcomings of clinical diagnoses. Using biomarkers that represent the pathology of AD is essential (particularly when disease-modifying treatment is available) to identify the corresponding pathology of targeted therapy and for monitoring the treatment response. Although imaging and CSF biomarkers are useful, their widespread use is restricted by their high cost and the discomfort during the lumbar puncture, respectively. Recent advances in AD blood biomarkers shed light on their future use for clinical purposes. The amyloid β (Aβ)42/Aβ40 ratio and the concentrations of phosphorylated tau at threonine 181 and at threonine 217, and of neurofilament light in the blood were found to represent the pathology of Aβ, tau, and neurodegeneration in the brain when using automatic electrochemiluminescence technologies, single-molecule arrays, immunoprecipitation coupled with mass spectrometry, etc. These blood biomarkers are imminently expected to be incorporated into clinical practice to predict, diagnose, and determine the stage of AD. In this review we focus on advancements in the measurement technologies for blood biomarkers and the promising biomarkers that are approaching clinical application. We also discuss the current limitations, the needed further investigations, and the perspectives on their use.

There is a need for measures that can prevent the onset of dementia in the rapidly aging population. Reportedly, sustained physical exercise can prevent cognitive decline and disability. This study aimed to assess the feasibility of a 12-week physical exercise intervention (PEI) for delay of cognitive decline and disability in the at-risk elderly population in Korea. Twenty-six participants (aged 67.9 ± 3.6 years, 84.6% female) at risk of dementia were assigned to facility-based PEI (n = 15) or home-based PEI (n = 11). The PEI program consisted of muscle strength training, aerobic exercise, balance, and stretching using portable aids. Feasibility was assessed by retention and adherence rates. Physical fitness/cognitive function were compared before and after the PEI. Retention and adherence rates were 86.7% and 88.3%, respectively, for facility-based PEI and 81.8% and 62.3% for home-based PEI. No intervention-related adverse events were reported. Leg strength/endurance and cardiopulmonary endurance were improved in both groups: 30 s sit-to-stand test (facility-based, p = 0.002; home-based, p = 0.002) and 2 -min stationary march (facility-based, p = 0.001; home-based, p = 0.022). Cognitive function was improved only after facility-based PEI (Alzheimer’s Disease Assessment Scale-cognitive total score, p = 0.009; story memory test on Literacy Independent Cognitive Assessment, p = 0.026). We found that, whereas our PEI is feasible, the home-based program needs supplementation to improve adherence.

Background and Purpose The effects of high-intensity interval training (HIIT) interventions on functional brain changes in older adults remain unclear. This preliminary study aimed to explore the effect of physical exercise intervention (PEI), including HIIT, on cognitive function, physical performance, and electroencephalogram patterns in Korean elderly people. Methods We enrolled six non-dementia participants aged >65 years from a community health center. PEI was conducted at the community health center for 4 weeks, three times/week, and 50 min/day. PEI, including HIIT, involved aerobic exercise, resistance training (muscle strength), flexibility, and balance. Wilcoxon signed rank test was used for data analysis. Results After the PEI, there was improvement in the 30-second sit-to-stand test result (16.2±7.0 times vs. 24.8±5.5 times, p =0.027), 2-minute stationary march result (98.3±27.2 times vs. 143.7±36.9 times, p =0.027), T-wall response time (104.2±55.8 seconds vs.71.0±19.4 seconds, p =0.028), memory score (89.6±21.6 vs. 111.0±19.1, p =0.028), executive function score (33.3±5.3 vs. 37.0±5.1, p =0.046), and total Literacy Independent Cognitive Assessment score (214.6±30.6 vs. 241.6±22.8, p =0.028). Electroencephalography demonstrated that the beta power in the frontal region was increased, while the theta power in the temporal region was decreased (all p <0.05). Conclusions Our HIIT PEI program effectively improved cognitive function, physical fitness, and electroencephalographic markers in elderly individuals; thus, it could be beneficial for improving functional brain activity in this population.

Content-specific delusions (CSDs) are delusions that have a specific theme; for example, Othello syndrome (OS) 1 is another name for delusion of infidelity. CSDs are often caused by identifiable neurological diseases. We report a patient who had experienced OS over 5 years, which seemed to have developed from multidomain amnestic mild cognitive impairment (MCI) due to Alzheimer's disease (AD) accompanied by an old orbitofrontal hemorrhage.A 62-year-old right-handed female was brought to the dementia clinic presenting with a persistently mistaken belief about her husband. She was illiterate, but could perform her activities of daily living (ADL) as a housewife without problems. Five years prior to this visit she had begun to have morbid suspicions about his infidelity. This delusion increased to the level of physical violence. She did not report any hallucination. Her motor, sensory functions, and reflexes were normal. She scored 19 out of 30 on the Mini Mental State Examination (MMSE). A battery of neuropsychological tests was performed, although this was restricted by her illiteracy. The tests showed marked decrements in memory and naming, with the patient being at the 4.85th percentile for delayed recall in the verbal learning test and at the 14.30th percentile in the Boston Naming Test. Normal findings were obtained in frontal/executive function tests including the contrasting program, go/no-go test, fist-edgepalm test, digit symbol coding, and Controlled Oral Word Association Test. Her global Clinical Dementia Rating (CDR) was 0.5 and CDR-Sum of Boxes was 2.Brain magnetic resonance imaging revealed an encephalomalacic change in the left orbitofrontal cortex, which suggested an old hemorrhagic stroke (Fig. 1A-D). Mild cortical atrophy was evident in the frontal and parietal lobes, whereas the gross findings for hippocampal atrophy were unremarkable (Fig. 1E and F). There were no cerebral microbleeds. 18 Fflutemetamol amyloid positron-emission tomography (PET) was performed. Early dynamic brain images acquired 10 min after injecting 18 F-flutemetamol showed decreased uptake in the bilateral parietal and left dorsolateral prefrontal/orbitofrontal areas (Fig. 1G). 2,3 Delayed images obtained 90 min after the injection revealed amyloid deposition in the right frontal lobe (Fig. 1H).The cognitive defects of this patient had gone unnoticed by her family, but she had multidomain amnestic MCI due to AD. She denied any attack of severe headache, but an old orbitofrontal hemorrhage was found incidentally in the absence of cerebral microbleeds, and this did not seem to be associated with amyloid pathology. Therefore, the final diagnosis was made of multidomain amnestic MCI due to AD accompanied by orbitofrontal hemorrhage, both of which seemed to contribute to the development of her OS. The patient was prescribed olanzapine (15 mg), escitalopram (10 mg), and donepezil (5 mg), but her delusion persisted. Over the following year her ability to perform ADL deteriorated. She scored 18 on MMSE, 1 on global CDR, and 5 on CDR...