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Background@#and Purpose Alzheimer’s disease (AD) does not always mean amyloid positivity. [ 18 F]THK-5351 has been shown to be able to detect reactive astrogliosis as well as tau accompanied by neurodegenerative changes. We evaluated the [ 18 F]THK-5351 retention patterns in positron-emission tomography (PET) and the clinical characteristics of patients clinically diagnosed with AD dementia who had negative amyloid PET findings. @*Methods@#We performed 3.0-T magnetic resonance imaging, [ 18 F]THK-5351 PET, and amyloid PET in 164 patients with AD dementia. Amyloid PET was visually scored as positive or negative. [ 18 F]THK-5351 PET were visually classified as having an intratemporal or extratemporal spread pattern. @*Results@#The 164 patients included 23 (14.0%) who were amyloid-negative (age 74.9±8.3 years, mean±standard deviation; 9 males, 14 females). Amyloid-negative patients were older, had a higher prevalence of diabetes mellitus, and had better visuospatial and memory functions. The frequency of the apolipoprotein E ε4 allele was higher and the hippocampal volume was smaller in amyloid-positive patients. [ 18 F]THK-5351 uptake patterns of the amyloid-negative patients were classified into intratemporal spread (n=10) and extratemporal spread (n=13).Neuropsychological test results did not differ significantly between these two groups. The standardized uptake value ratio of [ 18 F]THK-5351 was higher in the extratemporal spread group (2.01±0.26 vs. 1.61±0.15, p=0.001). After 1 year, Mini Mental State Examination (MMSE) scores decreased significantly in the extratemporal spread group (-3.5±3.2, p=0.006) but not in the intratemporal spread group (-0.5±2.8, p=0.916). The diagnosis remained as AD (n=5, 50%) or changed to other diagnoses (n=5, 50%) in the intratemporal group, whereas it remained as AD (n=8, 61.5%) or changed to frontotemporal dementia (n=4, 30.8%) and other diagnoses (n=1, 7.7%) in the extratemporal spread group. @*Conclusions@#Approximately 70% of the patients with amyloid-negative AD showed abnormal [ 18 F]THK-5351 retention. MMSE scores deteriorated rapidly in the patients with an extratemporal spread pattern.
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Objective@#Patients with breathing-related sleep disorder (BRSD) often complain of psychiatric symptoms such as depression in addition to snoring, excessive sleepiness, and disturbed sleep. However, the relationship between psychiatric symptoms and severity of sleep apnea in BRSD is controversial. We conducted this study to investigate the relationship between psychiatric symptoms and sleep electroencephalography (EEG) findings in BRSD patients using spectral analysis. @*Methods@#All participants underwent polysomnography and evaluation using Symptom Checklist-90-Revised (SCL-90-R) scale. We analyzed the absolute spectral power density values of standard EEG frequency bands in the participants (n = 169) with BRSD during the non-rapid eye movement (NREM) sleep period. We performed correlation analysis between the domain scores of SCL-90-R scale and the absolute values of the EEG frequency bands. @*Results@#Significant positive correlation was observed between the absolute spectral power density values in the slow oscillation band and the degree of paranoid ideation (r = 0.226, p = 0.028) and depression (r = 0.216, p = 0.044) in SCL-90-R. The multiple linear regression model showed that higher paranoid ideation domain score (B = 0.007, p = 0.020), younger age (B = −0.011, p ＜ 0.001), and female sex (B = 0.213, p = 0.004) were associated with higher slow oscillation power during NREM sleep. @*Conclusion@#The results of the present study suggested a relationship between sleep EEG and psychiatric symptoms in patients with BRSD. This relationship needs to be validated with further studies.
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Objective@#This study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. @*Methods@#A total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. @*Results@#After the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. @*Conclusion@#We conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.
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Objective@#Patients with breathing-related sleep disorder (BRSD) often complain of psychiatric symptoms such as depression in addition to snoring, excessive sleepiness, and disturbed sleep. However, the relationship between psychiatric symptoms and severity of sleep apnea in BRSD is controversial. We conducted this study to investigate the relationship between psychiatric symptoms and sleep electroencephalography (EEG) findings in BRSD patients using spectral analysis. @*Methods@#All participants underwent polysomnography and evaluation using Symptom Checklist-90-Revised (SCL-90-R) scale. We analyzed the absolute spectral power density values of standard EEG frequency bands in the participants (n = 169) with BRSD during the non-rapid eye movement (NREM) sleep period. We performed correlation analysis between the domain scores of SCL-90-R scale and the absolute values of the EEG frequency bands. @*Results@#Significant positive correlation was observed between the absolute spectral power density values in the slow oscillation band and the degree of paranoid ideation (r = 0.226, p = 0.028) and depression (r = 0.216, p = 0.044) in SCL-90-R. The multiple linear regression model showed that higher paranoid ideation domain score (B = 0.007, p = 0.020), younger age (B = −0.011, p ＜ 0.001), and female sex (B = 0.213, p = 0.004) were associated with higher slow oscillation power during NREM sleep. @*Conclusion@#The results of the present study suggested a relationship between sleep EEG and psychiatric symptoms in patients with BRSD. This relationship needs to be validated with further studies.
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Objective@#Cognitive reserve (CR) protects against cognitive decline by utilizing functional connectivity (FC) in the brain, such as the default mode network (DMN). We studied whether CR in individuals with predementia would correlate with better cognition and increased DMN FC in the resting brain. @*Methods@#Fifty-four participants with subjective cognitive decline or mild cognitive impairment completed the Cognitive Reserve Index (CRI) questionnaire, and underwent a comprehensive neuropsychological test battery and resting state functional magnetic resonance imaging. Correlation and regression analyses for clinical variables and seed-to-voxel analyses of CR-related FC in the DMN were conducted. @*Results@#CRI total (β=0.42, p=0.001), education (β=0.39, p=0.001), and leisure time (β=0.33, p=0.009) predicted the MiniMental State Examination. The CRI education predicted verbal memory recall (β=0.32, p=0.017), confrontational naming (β=0.57, p<0.001), and phonemic fluency (β=0.43, p=0.004). In the DMN in the resting brain, the CRI total correlated with increased FC, based on the posterior cingulate to both lateral parietal cortices. @*Conclusion@#In individuals with predementia, comprehensive CR correlated with an enhanced network in the DMN in the resting state. These results may support the neural correlate of CR during the initial stage of cognitive decline.
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Objective@#This study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. @*Methods@#A total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. @*Results@#After the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. @*Conclusion@#We conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.
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Background@#and PurposeMild cognitive impairment (MCI) is a condition with diverse clinical outcomes and subgroups. Here we investigated the topographic distribution of tau in vivo using the positron emission tomography (PET) tracer [18F]THK5351 in MCI subgroups. @*Methods@#This study included 96 participants comprising 38 with amnestic MCI (aMCI), 21 with nonamnestic MCI (naMCI), and 37 with normal cognition (NC) who underwent 3.0-T MRI, [18F]THK5351 PET, and detailed neuropsychological tests. [18F]flutemetamol PET was also performed in 62 participants. The aMCI patients were further divided into three groups: 1) verbal-aMCI, only verbal memory impairment; 2) visual-aMCI, only visual memory impairment; and 3) both-aMCI, both visual and verbal memory impairment. Voxel-wise statistical analysis and region-of-interest -based analyses were performed to evaluate the retention of [18F]THK5351 in the MCI subgroups. Subgroup analysis of amyloid-positive and -negative MCI patients was also performed. Correlations between [18F]THK5351 retention and different neuropsychological tests were evaluated using statistical parametric mapping analyses. @*Results@#[18F]THK5351 retention in the lateral temporal, mesial temporal, parietal, frontal, posterior cingulate cortices and precuneus was significantly greater in aMCI patients than in NC subjects, whereas it did not differ significantly between naMCI and NC participants. [18F] THK5351 retention was greater in the both-aMCI group than in the verbal-aMCI and visualaMCI groups, and greater in amyloid-positive than amyloid-negative MCI patients. The cognitive function scores were significantly correlated with cortical [18F]THK5351 retention. @*Conclusions@#[18F]THK5351 PET might be useful for identifying distinct topographic patterns of [18F]THK5351 retention in subgroups of MCI patients who are at greater risk of the progression to Alzheimer's dementia.
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OBJECTIVE: The aim of this study is to assess the efficacy of cognitive health promotion workbook for community-dwelling elderlies with mild cognitive impairment and dementia performed by trained dementia partners. METHODS: The trained dementia partners performed cognitive training program with the workbook developed by Incheon Metropolitan Dementia Center to 36 participants with mild cognitive impairment or dementia at their home. The cognitive training program consisted of 60-minute sessions held twice weekly for 10 weeks. We evaluated their cognitive performances at baseline and after intervention. Pre- and post-intervention measures included Korean version of Mini-Mental Status Examination for Dementia Screening (MMSE-DS), Global Deterioration Scale, Korea Activities of Daily Living Scale, Korea Instrumental Activities of Daily Living Scale, Korean Version of Short Form Geriatric Depression Scale (SGDS-K) and Korean Quality of Life-Alzheimer's Disease (KQoL-AD). RESULTS: Participants showed significant improvements compared with their baseline in MMSE-DS (p=0.002), SGDS-K (p=0.001) and KQoL-AD (p<0.001). There were no significant differences of improvement between high cognitive function group (MMSE ≤20, n=16) and low cognitive function group (MMSE ≤20, n=20). CONCLUSION: These findings suggest that the cognitive training program with cognitive health promotion workbook can improve cognitive function, quality of life and depression for community-dwelling elderlies with mild cognitive impairment and dementia and it would be efficient that trained dementia partners perform the cognitive training program regularly at their home.
Subject(s)
Activities of Daily Living , Cognition , Dementia , Depression , Education , Health Promotion , Korea , Mass Screening , Cognitive Dysfunction , Quality of LifeABSTRACT
BACKGROUND AND PURPOSE: Behavioral variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia, which has clinical symptoms of progressive personality and behavioral changes with deterioration of social cognition and executive functions. The pathology of bvFTD is known to be tauopathy or TDP-43 equally. We analyzed the 18F-THK5351 positron emission tomography (PET) scans, which were recently developed tau PET, in patients with clinically-diagnosed bvFTD. METHODS: Forty-eight participants, including participants with behavioral variant frontotemporal dementia (bvFTD, n=3), Alzheimer's disease (AD, n=21) and normal cognition (NC, n=24) who completed 3T magnetic resonance images, 18F-THK5351 PET scans, and detailed neuropsychological tests were included in the study. Voxel-wise statistical analysis and region of interest (ROI)-based analyses were performed to evaluate the retention of THK in bvFTD patients. RESULTS: In the voxel-based and ROI-based analyses, patients with bvFTD showed greater THK retention in the prefrontal, medial frontal, orbitofrontal, anterior cingulate, insula, anterior inferior temporal and striatum regions compared to NC participants. Left-right asymmetry was noted in the bvFTD patients. A patient with extrapyramidal symptoms showed much greater THK retention in the brainstem. CONCLUSIONS: The distribution of THK retention in the bvFTD patients was mainly in the frontal, insula, anterior temporal, and striatum regions which are known to be the brain regions corresponding to the clinical symptoms of bvFTD. Our study suggests that 18F-THK5351 PET imaging could be a supportive tool for diagnosis of bvFTD.
Subject(s)
Humans , Alzheimer Disease , Brain , Brain Stem , Cognition , Diagnosis , Executive Function , Frontotemporal Dementia , Gyrus Cinguli , Neuropsychological Tests , Pathology , Positron-Emission Tomography , TauopathiesABSTRACT
OBJECTIVES: Chronic insomnia disorder is a common and one of the most distressing sleep disorders. This pilot study was conducted to compare the spatial function between insomnia disorder patients and good sleeping control. METHODS: We enrolled the 22 patients with chronic insomnia during over one year who met the DSM-5 diagnostic criteria of insomnia disorder and 27 normal sleeping controls. The Cambridge Neuropsychological Test Automated Battery (CANTAB) has been performed to compare the spatial cognitive function between insomnia disorder patients and good sleeping controls. RESULTS: The CANTAB results showed significant differences in the problems solved in minimum moves of Stockings of Cambridge test (t = −2.499, p = 0.017). The significant difference between two groups remained after controlling age, sex, and Beck Depression Index non-sleep scores (F = 5.631, p = 0.022). CONCLUSION: This study suggests that the patients with insomnia disorder have poor spatial planning function.
Subject(s)
Humans , Cognition , Depression , Neuropsychological Tests , Pilot Projects , Sleep Initiation and Maintenance Disorders , Sleep Wake DisordersABSTRACT
OBJECTIVE: The provision of care for elderly people with dementia by healthy elderly caregivers is one of the new health-care paradigms in South Korea. The aim of this study was to determine whether this type of care, which includes cognitive stimulation, would improve the cognitive function of dementia patients and the quality of life of the healthy elderly caregiver. METHODS: Totals of 132 dementia patients and 197 healthy elderly caregivers participated in this study. We evaluated the cognitive function of the dementia patients at baseline and after providing the program for 6 months using the Korean version of the Consortium to Establish a Registry for Alzheimer's disease, 1st Edition (CERAD-K). We also evaluated the quality of life of the healthy elderly caregivers using the World Health Organization Quality of Life-Short Version (WHOQOL-BREF) at baseline and after 6 months. RESULTS: The word-list memory results of CERAD-K for the included dementia patients improved after 6 months (Z=-2.855, p=0.004). The WHOQOL-BREF score among the elderly caregiver also improved significantly (Z=-2.354, p=0.019). CONCLUSION: These data suggest that dementia care is associated with improvements in both the cognitive function of dementia patients and the quality of life of the healthy elderly caregivers.
Subject(s)
Aged , Humans , Alzheimer Disease , Caregivers , Cognition , Dementia , Korea , Memory , Quality of Life , World Health OrganizationABSTRACT
OBJECTIVE: We studied the effect of Hyu-Sig-Gong-Gan and Hye-Ah-Rim on several evaluations and compared the two programs. We then investigated factors associated with the difference between pre- and post-ratings. METHODS: Thirty-six patients were randomized to Hyu-Sig-Gong-Gan (n=23) or Hye-Ah-Rim (n=13). We tested for the effect of each program on several evaluations and compared the two programs through Zarit Burden Interview (ZBI), Center for Epidemiologic Studies-Depression Scale, Dementia Attitude Scale (DAS)-intelligence, DAS-comfort and DAS-total. We then investigated whether the difference between pre- and post-rating depends on other factors. RESULTS: We observed significant positive effect of Hyu-Sig-Gong-Gan on DAS-comfort (t=1.843, p=0.039) and significant positive effect of Hye-Ah-Rim on ZBI (t=-2.327, p=0.019), DAS-comfort (t=2.241, p=0.022), and EuroQol-5 Dimensions-Visual Analogue Scale (t=2.537, p=0.013). For comparing the two programs, we found a lack of evidence for the difference in any of the five commonly observed evaluations. In the secondary analysis, we observed a strong trend that the two programs were particularly effective for caregivers with negative pre-ratings. CONCLUSION: The two programs showed positive effects on the various evaluations, but some evaluations could not reach statistical significance. The programs appear to be particularly helpful for those who are in need before the program participation.
Subject(s)
Aged , Humans , Caregivers , Dementia , Program EvaluationABSTRACT
BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is often undiagnosed but is an important risk factor affecting the health of an individual. The level of awareness of the illness among patients with OSA is low and is not correlated with severity of the illness. This study was conducted to compare awareness of OSA symptoms and illness between patients with OSA and simple snorers. MATERIALS AND METHODS: Two hundred eighty-two patients who were suspected of having OSA participated in this study. All subjects underwent overnight polysomnography. Those with an apnea-hypopnea index (AHI) ≥ 5 were classified as the OSA group, while those with an AHI < 5 were classified as the simple snoring group. A sleep questionnaire, which included items on awareness of the illness, OSA, and sleep symptoms, was administered to all subjects and their bed-partners. RESULTS: Simple snorers were much more aware of their symptoms such as snoring, irregular breathing, and apnea than were patients with OSA. Bed-partners of simple snorers were also more aware of the participants' sleep symptoms than were partners of patients with OSA. However, the duration of OSA symptoms was longer in the OSA group. In the correlation analysis, the level of awareness of OSA symptoms was negatively correlated with AHI, age, body mass index, and Epworth Sleepiness Scale score. Among the sleep questionnaire and polysomnography results, only Pittsburgh Sleep Quality Index was positively correlated with level of awareness of OSA symptoms. The minority of the respondents had heard about the treatment methods of continuous positive airway pressure and oral appliance and preferred them as treatment options. CONCLUSION: This study suggests that simple snorers are more aware of their symptoms than are patients with OSA. A higher severity of OSA, represented by a higher AHI, is correlated with lower awareness of one's OSA symptoms.
Subject(s)
Humans , Apnea , Body Mass Index , Continuous Positive Airway Pressure , Polysomnography , Respiration , Risk Factors , Sleep Apnea, Obstructive , Snoring , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Few studies have evaluated the personality characteristics of patients with obstructive sleep apnea (OSA) and simple snoring. We investigated the personality characteristics of OSA and simple snoring patients and compared differences in personality between the two groups using the Eysenck Personality Questionnaire (EPQ). MATERIALS AND METHODS: Two hundred and thirty-seven patients who were suspected to have OSA or simple snoring participated in this study. A self-questionnaire which included the EPQ was administered to all participants. All subjects underwent polysomnography in a sleep laboratory and those with an apnea-hypopnea index (AHI) > or =5 were included in the OSA group, while those with an AHI <5 were included in the simple snoring group. RESULTS: OSA patients had significantly lower scores for Psychoticism (F=4.563, p=0.034) than simple snorers. There were no significant differences in Extraversion (F=3.029, p=0.083), Lie (F=0.398, p=0.529), or Neuroticism (F=3.367, p=0.068) scores between the two groups. In the correlation analysis of the OSA group, AHI was positively correlated with Extraversion score (r=0.16, p=0.029) and negatively correlated with Lie score (B=-0.31, p<0.001). Using multiple stepwise linear regression analysis with the four EPQ parameter scores as dependent variables, Lie score was associated with older age (B=0.14, p<0.001) and lower AHI (B=-0.05, p<0.001), Psychoticism score was associated with higher Pittsburgh Sleep Quality Index (PSQI ; B=0.14, p<0.001), Neuroticism score was associated with higher PSQI (B=0.34, p=0.001) and female sex (B=3.15, p=0.003), and Extraversion score was associated with younger age (B=-0.08, p=0.020) and higher body mass index (B=0.26, p=0.023). CONCLUSION: This study suggests that patients with OSA are significantly less prone to psychotic personality characteristics than those with simple snoring. Among OSA patients, higher AHI was correlated with low falsehood and high extraversion tendencies.