Lee, Moon, Kim, yong, Jung, and Kang: Preliminary Study to Develop the Korean Medical Pathologic Aging Scale and Korean Medical Pattern Identification for Dementia

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.

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)

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*
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

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