Preliminary Study to Develop the Korean Medical Pathologic Aging Scale and Korean Medical Pattern Identification for Dementia

Article information

J Korean Med. 2017;38(3):111-123

Publication date (electronic) : 2017 September 30

doi : https://doi.org/10.13048/jkm.17030

Go eun Lee ¹, Kwang Su Moon ¹, Nam Kwen Kim ², Chung sun yong ³, In Chul Jung ⁴^,

, Hyung Won Kang ⁵

Department of Korean Rehabilitation Medicine, National Rehabilitation Center.

¹Department of Psychology, Chung-Ang University

²Ophthalmology & Otolaryngology & Dermatology, School of Korean Medicine, Pusan National University

³Department of Korean Neuropsychiatry, Gangdong Kyung Hee University Hospital

⁴Department of Korean Neuropsychiatry, Dunsan Korean Medicine Hospital of Daejeon University

⁵Department of Korean Neuropsychiatry Medicine, Wonkwang University Sanbon Hospital

Correspondence to：강형원(Hyung Won Kang) 원광대산본병원 한방신경정신과 Tel：+82-31-390-2762, E-mail : dskhw@wku.ac.kr

Correspondence to：정인철(In Chul Jung) 대전대학교 둔산한방병원 신경정신과 Tel：+82-42-470-9129, E-mail : npjeong@dju.kr

Received 2017 August 24; Revised 2017 September 14; Accepted 2017 September 14.

Abstract

Objectives

To develop and investigate the reliability of the pathologic aging scale based on korean medical theory and korean medical pattern identification for dementia.

Methods

We searched the textbook of korean neurophychiatry and Donguibogam and selected items through professional consensus. We compared between dementia(n=40) and normal elderly(n=38) and tested the reliability of two scales.

Results

After professional consensus, we drafted the Korean Medical Pathologic Aging Scale(12 items, Likert 3 scale) and Korean Medical Pattern Identification for Dementia(4 patterns, 28 items, Likert 5 scale). On Korean Medical Pathologic Aging Scale, There is no significant difference between two groups. We had good internal consistency(Cronbach’s alpha = 0.6) and test-retest reliability(r=0.631) but low inter-rater reliability(r=0.430). On Korean Medical Pattern Identification for Dementia, dementia patients diagnosed with Qi deficiency are significantly more than those in normal group. We had fairly good internal consistency(Cronbach’s alpha = 0.574) and excellent test-retest(kappa= .800) and inter-rater reliability(kappa = .733).

Conclusions

Korean Medical Pattern Identification for Dementia is appropriate for diagnosing korean medical pattern. But Korean Medical Pathologic Aging Scale isn’t appropriate to discriminate dementia from normal elderly because of many subjective items. Therefore objective measurement of sensory dysfunction would be needed to measure pathologic aging based on korean medical theory.

Keywords: Dementia; Pathologic aging; Korean medicine; Oriental medicine

Table 1

The Characteristics of Participants

Table 2

Type of dementia on Participants

Table 3

Comparison of Pathological Aging Scale Based on Korean Medicine between Dementia Group and Normal Group

Table 4

Internal Consistency of Pathological Aging Scale Based on Korean Medicine.

Table 5

Test-Retest reliability of Pathological Aging Scale Based on Korean Medicine

Table 6

Inter rater reliability of Pathological Aging Scale Based on Korean Medicine

Table 7

The Result of Pattern Identification Diagnosis of Dementia on Participants

Table 8

Internal Consistency of Pattern Identification Diagnosis of Dementia

Table 9

Test-Retest Reliability of Pattern Identification Diagnosis of Dementia

Table 10

Inter-rater Reliability of Pattern Identification Diagnosis of Dementia

Acknowledgments

This study was supported by a grant of Ministry of Health & Welfare and the Traditional Korean Medicine R&D Project, Ministry of Health & Welfare, Republic of Korea. (HB16C0044)

References

1. Ku BD, Kim SG, Lee JY, Park KH, Shin JH, Kim KK, et al. Clinical practice guideline for dementia by Clinical Research Center for Dementia of South Korea. Journal of Korean Medical Association 2011;54(8):861–75.

2. The Textbook Compilation Committee of Neuropsychiatry of Korean Medical Schools in Nation. Third editionth ed. The Neuropsychiatry of Oriental medicine Seoul: Jipmoon-Dong; 2016. p. 319–27.

3. Jung IC. The Literature Review of Dementia. Journal of oriental neuropsychiatry 1996;7(1):77–94.

4. Hur J. Donguibogam Seoul: Namsandang; 2007.

5. Ryu CH, Jung IC, Cho SH, Hwang WW, Kang WC, Lee SR. Preliminary Study to Develop the Instrument of Oriental Medical Evaluation for dementia. Journal of oriental neuropsychiatry 2010;21(4):123–35.

6. Heo EJ, Kang HW, Jeon WK. Preliminary Research for Development of Instrument for Cold-Heat &Deficiency-Excess Pattern Identification of Dementia. Journal of oriental neuropsychiatry 2013;27(5):553–62.

7. Der G, Allerhand M, Starr JM, Hofer SM, Deary IJ. Age-related changes in memory and fluid reasoning in a sample of healthy old people. Aging, Neuropsychology, and Cognition 2009;17(1):55–70.

8. Reid LM, MacLullich AM. Subjective memory complaints and cognitive impairment in older people. Dementia and geriatric cognitive disorders 2006;22(5–6):471–85.

9. Hirschman KB, Paik HH, Pines JM, McCusker CM, Naylor MD, Hollander JE. Cognitive impairment among older adults in the emergency department. Western Journal of Emergency Medicine 2011;12(1):56.

10. Ravdin LD, Katzen HL. Handbook on the Neuropsychology of Aging and Dementia Springer; 2013. p. 4–5.

11. Bakker R. Sensory loss, dementia, and environments. Generations 2003;27(1):46–51.

12. Doty RL, Bayoda EA, Leon-Ariza DS, Cuadros J, Chung I, Vazquez B, et al. The lateralized smell test for detecting Alzheimer’s disease: Failure to replicate. Journal of the neurological sciences 2014;340(1):170–3.

13. Park JW, Lim CK, Kim KJ. Study on Connection between Physiology of Old People and Pathological Symptom in Dongeuibogam. Journal of Physiology & Pathology in Korean Medicine 2012;26(1):108.

14. Gros A, Manera V, De March CA, Guevara N, Konig A, Friedman L, et al. Olfactory disturbances in ageing with and without dementia: towards new diagnostic tools. The Journal of Laryngology & Otology 2017;:1–8.

15. Survey and Statistical Analysis for Psychology and Social Science Yang BH. Seoul: HakJisa; 2013.

16. AMOS 18.0 Structure Equation Model Analysis Kim GS. Seoul: Hannarae; 2013.

17. McGraw-Hill. Nunnally JC, Hillsdale NJ. Psychometric Theory 2ndth ed. 1978.

18. Pedhazur EJ, Schmelkin LP. Measurement, design, and analysis: An integrated approach Psychology Press; 2013.

19. Cortina JM. What is coefficient alpha? An examination of theory and applications. Journal of applied psychology 1993;78(1):98.

20. Standardization of the Pattern Identification for Stroke in Oriental Medicine. Team of Fundamental Study for Standarization and Objectification of Differentiation and Pattern Identification of Symptoms of Oriental Medicine for Stroke Seoul: Elsevier; 2014. p. 24.

Article information Continued

Table 1

The Characteristics of Participants

		Dementia group(n=40)	Normal group (n=38)	p-value
gender	Male	8(20.0)	17(44.7)	0.019*
gender	Female	32(80.0)	21(55.3)

Age		77.78(7.90)	76.97(5.64)	0.609

MMSE-DS		13.23(6.82)	27.61(2.16)	0.000**

K-MMSE		13.45(6.86)	27.58(2.14)	0.000**

Education	None	10(25.0)	2(5.3)	0.200
	Elementary school	11(27.5)	11(28.9)
	Middle school	7(17.5)	9(23.7)
	High school	5(12.5)	7(18.4)
	University	2(5.0)	1(2.6)
	Non-formal education	3(7.5)	7(18.4)
	No answer	2(5.0)	1(2.6)

Data presented as number(%) or mean(standard deviation)

p<0.05

^**

p<0.01

Table 2

Type of dementia on Participants

Type of dementia	n	%
Alzheimer’s disease	28	70.0
Vascular dementia	8	20.0
Others	4	10.0

Table 3

Comparison of Pathological Aging Scale Based on Korean Medicine between Dementia Group and Normal Group

Number of item	First assessment			Second assessment

	Dementia group (n=40)	Normal group (n=38)	p-value	Dementia group (n=35)	Normal group (n=29)	p-value
1	0.85(1.23)	1.26(1.46)	0.183	1.00(1.21)	1.03(1.35)	0.915
2	0.78(1.14)	0.97(1.13)	0.442	0.74(1.04)	1.17(1.35)	0.125
3	0.78(1.14)	1.00(1.36)	0.430	0.91(1.22)	0.79(1.26)	0.699
4	0.33(0.97)	1.00(1.43)	0.017*	0.51(0.89)	1.31(1.47)	0.014*
5	1.10(1.20)	1.89(1.41)	0.009**	1.14(1.22)	1.79(1.48)	0.072
6	0.98(1.10)	0.79(1.21)	0.480	1.17(1.15)	0.55(0.95)	0.024*
7	0.78(1.21)	0.61(1.03)	0.507	0.80(1.11)	0.93(1.10)	0.638
8	0.65(.1.14)	0.63(1.08)	0.942	0.66(1.00)	0.59(0.95)	0.772
9	1.98(1.80)	1.79(1.60)	0.633	1.54(1.6)	1.48(1.24)	0.869
10	1.85(.53)	1.66(1.38)	0.563	1.57(1.42)	148(1.38)	0.801
11	1.88(1.59)	1.79(1.30)	0.793	2.03(1.40)	1.52(1.09)	0.114
12	1.10(1.37)	1.53(1.33)	0.168	1.06(1.41)	1.21(1.11)	0.645
Total score	13.03(6.48)	14.92(6.78)	0.211	13.14(6.61)	13.83(7.43)	0.698

Data presented as mean(standard deviation)

p<0.05

^**

p<0.01

Table 4

Internal Consistency of Pathological Aging Scale Based on Korean Medicine.

	First assessment	Second assessment
Total	.578	.679
Dementia group	.560	.639
Normal group	.597	.735

Table 5

Test-Retest reliability of Pathological Aging Scale Based on Korean Medicine

Number of item	Pearson Correlation coefficient
1	0.547**
2	0.663**
3	0.637**
4	0.791**
5	0.714**
6	0.424**
7	0.265*
8	0.396**
9	0.347**
10	0.566**
11	0.504**
12	0.670**
Total score	0.631**

p<0.05

^**

p<0.01

Table 6

Inter rater reliability of Pathological Aging Scale Based on Korean Medicine

Number of item	Pearson Correlation coefficient
1	.486**
2	.662**
3	.590**
4	.834**
5	.720**
6	.332
7	−.008
8	.393*
9	.053
10	.636**
11	.436**
12	.557**
Total score	0.430*

p<0.05

^**

p<0.01

Table 7

The Result of Pattern Identification Diagnosis of Dementia on Participants

	First assessment				Second assessment

	Dementia group(n=38)	Normal group(n=40)	Total (n=78)	p-value	Dementia group(n=35)	Normal group(n=29)	Total (n=64)	p-value
Qi Deficiency	29(72.5%)	14(37%)	43(55%)	0.005	25(71%)	9(31%)	34(53%)	0.000

Yin Deficiency	3(7.5%)	8(21%)	11(14%)		3(9%)	3(10%)	6(9%)

Damum	4(10%)	5(13%)	9(12%)		4(11%)	4(14%)	8(13%)

Fire/Heat	4(10%)	11(29%)	15(19%)		3(9%)	13(45%)	16(25%)

Table 8

Internal Consistency of Pattern Identification Diagnosis of Dementia

	Cronbach’s Alpha	Number of item	Modified item-total correlation
		1	0.662
		2	0.552
Qi Deficiency	0.743	5	0.514
		6	0.63
		17	0.22

		7	−0.004
		8	0.038
Yin Deficiency	−0.173	11	−0.202
		14	−0.166
		20	0.041

		10	0.294
		13	0.33
Damum	0.578	16	0.461
		18	0.27
		19	0.328

		3	0.193
		4	−0.006
Fire/Heat	0.131	9	0.166
		12	−0.01
		15	−0.044

Table 9

Test-Retest Reliability of Pattern Identification Diagnosis of Dementia

	Qi Deficiency	Yin Deficiency	Damum	Fire/Heat	Diagnosis
Qi Deficiency	.700**	.281^*	.140	−.230	−.495**
Yin Deficiency	.048	.336**	.104	.039	.213
Damum	.221	.313^*	.665**	.078	.031
Fire/Heat	−.170	−.038	.025	.516**	.443**
Diagnosis	−.510**	−.159	−.001	.193	.800**

^**

p<0.01

Table 10

Inter-rater Reliability of Pattern Identification Diagnosis of Dementia

	Qi Deficiency	Yin Deficiency	Damum	Fire/Heat	Diagnosis
Qi Deficiency	.711**	.228	.248	−.187	−.474**
Yin Deficiency	−.111	−.092	−.060	−.121	.326
Damum	.014	.263	.690**	.033	.357*
Fire/Heat	−.075	.007	−.119	.350*	.478**
Diagnosis	−.393*	−.250	−.041	.125	.733**

p<0.05

^**

p<0.01