Synaptic calcium dysregulation appears to play an important role in synaptic loss in Alzheimer's disease (AD). Previous studies implicated that the pathological cascade of Alzheimer's disease may be modified by interactions in the amyloid-calcium axis. The calcium voltage-gated channel subunit alpha1 C (CACNA1C) gene encodes the alpha 1C subunit of the L-type voltage-gated calcium channel, which has been suggested to have an important role with the increased amyloid-β load in the plaques. We therefore, examined whether genetic polymorphisms of CACNA1C gene is associated with AD in Korean population by analyzing the genotype and allele frequencies. Additionally, we analyzed the relationship between the genetic polymorphisms of these genes and severity of behavioral and psychological symptoms of dementia (BPSD) based on clinical assessment. The diagnosis of the subjects was based on the ‘National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association’ criteria. AD patients were assessed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease – Neuropsychological Assessment Battery, The Neuropsychiatric Inventory. Five SNPs, rs216008, rs215976, rs1544514, rs10466907, and rs7957163 in the CACNA1C gene were compared between 278 patients with AD and 195 healthy control subjects using direct sequencing. Multiple logistic regression models were employed to calculate odds ratios (ORs), their 95% confidence intervals (CI) and corresponding p values, controlling for age and gender as covariates. In the logistic regression analysis for each SNP, we compared three different models of gene expression (co-dominant model, dominant model and recessive model). SNP rs10466907 showed significant difference in the allele frequencies between AD and controls (p=0.010). The genotype frequencies of rs10466907 showed significant association between AD and control groups [p=0.003 in the co-dominant model; p=0.01 in the dominant model]. No association was observed between genotype and BPSD severity as measured by the NPI. These results suggest that CACNA1C gene is a promising candidate gene in AD pathogenesis, and may represent a potential predisposing genetic factor for AD.

We assessed the cumulative conversion rates (CCR) from minor cognitive impairment (MCI) to dementia among individuals who failed to participate in annual screening for dementia. Additionally, we analyzed the reasons for failing to receive follow-up screening in order to develop better strategies for improving follow-up screening rates. We contacted MCI patients who had not visited the Dongdaemun-gu Center for Dementia, a center established by Seoul city for early detection of dementia patients, for annual screening during the year following their registration. We compared the CCR from MCI to dementia in the following two groups: subjects registered as having MCI in the Dongdaemun-gu Center for Dementia database and subjects who failed to revisit the center, but who participated in a screening test for dementia after being contacted. The latter participants completed a questionnaire asking reasons for not previously visiting for follow-up screening. The final diagnoses of the 188 subjects who revisited the center only after contact were 19.1% normal, 64.9% MCI and 16.0% dementia. The final diagnoses of the 449 subjects in the Dongdaemun-gu Center for Dementia database were 25.6% normal, 46.1% MCI and 28.3% dementia. The CCR of the revisit-after-contact group was much lower than anticipated. Among the reasons for not revisiting the center, “ no need for checkup” was the leading reason by 28.2%, followed by “other by 23.9% and “forgot the date” by 19.7%. The 45 subjects who answered “other” further reported the following reasons: 9 responded “there was no call from the center,” 3 responded “I was too busy,” 2 responded “I didn’t know I had to take a test,” 1 responded “personal reasons,” and 29 left the reason blank. Considering the low dementia detection rate of the group who revisited only after contact and the reasons they gave for noncompliance, there appears to be a need for ongoing outreach and education regarding the course and prognosis of MCI. Active publicity and detailed education for the public, along with secure personnel and budget may be crucial for detection improvement.

Remote mental health interventions are practical and effective tools for bridging mental health care gaps during disasters. To ensure sustainability, these interventions should be integrated into national disaster mental health frameworks, accompanied by adequate funding, clinician training, legal safeguards, and cultural adaptation.

Synaptic calcium dysregulation appears to play an important role in synaptic loss in Alzheimer's disease (AD). Previous studies implicated that the pathological cascade of Alzheimer's disease may be modified by interactions in the amyloid-calcium axis. The calcium voltage-gated channel subunit alpha1 C (CACNA1C) gene encodes the alpha 1C subunit of the L-type voltage-gated calcium channel, which has been suggested to have an important role with the increased amyloid-β load in the plaques. We therefore, examined whether genetic polymorphisms of CACNA1C gene is associated with AD in Korean population by analyzing the genotype and allele frequencies. Additionally, we analyzed the relationship between the genetic polymorphisms of these genes and severity of behavioral and psychological symptoms of dementia (BPSD) based on clinical assessment. The diagnosis of the subjects was based on the ‘National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association’ criteria. AD patients were assessed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease – Neuropsychological Assessment Battery, The Neuropsychiatric Inventory. Five SNPs, rs216008, rs215976, rs1544514, rs10466907, and rs7957163 in the CACNA1C gene were compared between 278 patients with AD and 195 healthy control subjects using direct sequencing. Multiple logistic regression models were employed to calculate odds ratios (ORs), their 95% confidence intervals (CI) and corresponding p values, controlling for age and gender as covariates. In the logistic regression analysis for each SNP, we compared three different models of gene expression (co-dominant model, dominant model and recessive model). SNP rs10466907 showed significant difference in the allele frequencies between AD and controls (p=0.010). The genotype frequencies of rs10466907 showed significant association between AD and control groups [p=0.003 in the co-dominant model; p=0.01 in the dominant model]. No association was observed between genotype and BPSD severity as measured by the NPI. These results suggest that CACNA1C gene is a promising candidate gene in AD pathogenesis, and may represent a potential predisposing genetic factor for AD.

We assessed the cumulative conversion rates (CCR) from minor cognitive impairment (MCI) to dementia among individuals who failed to participate in annual screening for dementia. Additionally, we analyzed the reasons for failing to receive follow-up screening in order to develop better strategies for improving follow-up screening rates. We contacted MCI patients who had not visited the Dongdaemun-gu Center for Dementia, a center established by Seoul city for early detection of dementia patients, for annual screening during the year following their registration. We compared the CCR from MCI to dementia in the following two groups: subjects registered as having MCI in the Dongdaemun-gu Center for Dementia database and subjects who failed to revisit the center, but who participated in a screening test for dementia after being contacted. The latter participants completed a questionnaire asking reasons for not previously visiting for follow-up screening. The final diagnoses of the 188 subjects who revisited the center only after contact were 19.1% normal, 64.9% MCI and 16.0% dementia. The final diagnoses of the 449 subjects in the Dongdaemun-gu Center for Dementia database were 25.6% normal, 46.1% MCI and 28.3% dementia. The CCR of the revisit-after-contact group was much lower than anticipated. Among the reasons for not revisiting the center, “ no need for checkup” was the leading reason by 28.2%, followed by “other by 23.9% and “forgot the date” by 19.7%. The 45 subjects who answered “other” further reported the following reasons: 9 responded “there was no call from the center,” 3 responded “I was too busy,” 2 responded “I didn’t know I had to take a test,” 1 responded “personal reasons,” and 29 left the reason blank. Considering the low dementia detection rate of the group who revisited only after contact and the reasons they gave for noncompliance, there appears to be a need for ongoing outreach and education regarding the course and prognosis of MCI. Active publicity and detailed education for the public, along with secure personnel and budget may be crucial for detection improvement.