ABSTRACT
Background@#and Purpose Stereopsis refers to the perception of depth and awareness of the distance of an object from the observer that results from the brain receiving visual stimuli from both eyes in combination. Patients with idiopathic Parkinson’s disease (PD patients) typically experience problems with vision, eyeball movements, and visual perception due to degeneration of the cells that generate dopamine in the brain. We therefore hypothesized that stereopsis is affected more by visual cortical dysfunction in idiopathic PD than by retina and subcortical structural dysfunction. @*Methods@#We analyzed stereopsis in 12 PD patients and 7 healthy controls using a three-dimensional (3D) television (TV). Before allowing patients to watch TV, we examined their visual acuity and strabismus using the Titmus Stereo Fly Test, and evaluated their cognitive function using cognitive tests. The patients watched 3D and two-dimensional (2D) versions of a movie with an approximate duration of 17 minutes, and then completed a questionnaire about stereopsis. All subjects underwent brain F-18 fluorodeoxyglucose (FDG) positronemission tomography after watching the 3D version of the movie. One week later, subjects watched the 2D version of the same movie under the same conditions. Each scan was analyzed using statistical parametric mapping (version 8) software. @*Results@#The visual cortex was activated less in the PD patients than in the healthy controls when watching the 2D or 3D movie. However, there was no significant difference between watching 2D and 3D movies in the PD patients or healthy controls. @*Conclusions@#The lower activation of the primary visual cortex in PD patients suggests the presence of dysfunction of the visual cortex. In addition, there was less activation of the visual association cortex in PD patients when watching a 3D movie than in controls under the same conditions. This might be one reason why PD patients do not recognize real and dynamic stereopsis. These findings have clinical significance since they suggest that safety needs to be considered when making devices or programs using 3D or virtual reality for use by patients with various cerebral degenerative diseases.
ABSTRACT
Background@#and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. @*Methods@#This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. @*Results@#The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. @*Conclusions@#Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.
ABSTRACT
Background@#and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. @*Methods@#This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). @*Results@#Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. @*Conclusions@#In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.
ABSTRACT
Background@#and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. @*Methods@#This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. @*Results@#The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. @*Conclusions@#Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.
ABSTRACT
Background@#and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. @*Methods@#This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). @*Results@#Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. @*Conclusions@#In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.
ABSTRACT
Background@#and Purpose Screening tests for dementia such as the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment are widely used, but there are drawbacks to their efficient use. There remains a need for a brief and easy method of assessing the activities of daily living (ADL) that can be administered to elderly individuals by healthcare workers. We have therefore developed a new scale named the Simple Observation Checklist for Activities of Daily Living (SOC-ADL). @*Methods@#We developed the SOC-ADL scale as a team of experts engaged in caring for individuals with dementia. This scale comprises eight items and was designed based on the Korean instrumental activities of daily living (K-IADL) scale and the Barthel activities of daily living scale (Barthel Index). The new scale was validated by enrolling 176 patients with cognitive dysfunction across 6 centers. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were performed. We assessed its concurrent validity by performing comparisons with the Korean-MMSE, Clinical Dementia Rating, Clinical Dementia Rating-Sum of Boxes, K-IADL, and Barthel Index, and its criterion validity by performing comparisons between mild cognitive impairment (MCI) and dementia. We also used Cronbach’s alpha to assess the interitem reliability. The appropriate cutoff values were determined by analyzing receiver operating characteristic curves, including the areas underneath them. @*Results@#EFA extracted one factor and CFA revealed that all of the model fits exceeded the minimum acceptable criteria. The SOC-ADL scores were strongly correlated with those of the other tools for dementia and could be used to differentiate MCI from dementia. Cronbach’s alpha values indicated that the results were reliable. The optimal cutoff value of the SOC-ADL for discriminating dementia from MCI was 3 points, which provided a sensitivity and specificity of 74.5% and 75.7%, respectively. @*Conclusions@#Our results demonstrate that the SOC-ADL is a valid and reliable tool for differentiating dementia from MCI based on an assessment of ADL. This new tool can be used for screening ADL in elderly subjects who have difficulty communicating, and to increase the efficiency of dementia screening at the population level.
ABSTRACT
Background@#and Purpose: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that mainly affects the pyramidal motor system. However, recent studies have suggested that degeneration of the extramotor system plays a role in the disability experienced by patients with ALS. We investigated the local shape changes and mean volumes of the subcortical nuclei in sporadic ALS patients with preserved cognition. @*Methods@#The participants comprised 32 patients with ALS and 43 age- and sex-matched healthy controls. Three-dimensional T1-weighted structural images were acquired. Surfacebased vertex analysis was performed with fully automated segmentation of both amygdalae, hippocampi, caudate nuclei, nuclei accumbens, putamina, pallida, and thalami, and the brainstem. The scalar distances from the mean surfaces of the individual subcortical nuclei were compared between groups, and correlations of the local shape distances with initial Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALS-FRS-R) scores and the delta FRS-R and with the disease duration were analyzed. @*Results@#ALS patients showed regional shape contractions on the lateral surfaces of both pallida, the lateroposterior surface of the right putamen, and the anterior basal surface of the right accumbens. Delta FRS-R scores were negatively correlated with local shape distances in the right hippocampus and the putamina. However, the initial ALS-FRS-R score and disease duration were not correlated with local shape distances. @*Conclusions@#Subcortical gray-matter structures are involved in the neurodegenerative process of ALS before cognitive impairment becomes evident.
ABSTRACT
Background@#and purpose: Appropriate medication treatment could enable both cognitively impaired patients and caregivers to hold on their cognitive functioning and quality of life. Thus, medication management and the factors influencing how management for this condition is carried out must be identified. In this study we aimed to evaluate the frequency of medication nonadherence (MNA) or drug overuse for cognitive impairment (DOC) and to extract significant variables, including the demographic and social characteristics, vascular risk factors, and cognitive status, for the diagnosis of MNA and DOC in Korean patients. @*Methods@#We investigated patients aged over 50 years between March 2019 and June 2019 via the cognitive enHancement of patIents with acQuired cognitive impairment (HIQ) campaign.MNA was defined as a participant who was classified as having cognitive impairment but did not take any cognition-related drugs, whereas DOC was defined as a participant who had normal cognition but was taking cognition-related drugs. @*Results@#We included 10,767 patients. The MNA group consisted of 337 participants, whereas the DOC group comprised 1,107 participants. The factors that could differentiate the MNA group from the normal-behavior group were age, education, sex, and the total Korean version of Mini-Mental State Examination (K-MMSE) score. The factors that could differentiate the DOC group from the normal medication-behavior group were age, sex, residential distinction, experience of a dementia screening test, and the total K-MMSE score. @*Conclusions@#The underlying factors contributing to inadequate dementia-medication management must be understood, and intervention or support is needed to enable safe medication management.
ABSTRACT
Background@#and purpose: Appropriate medication treatment could enable both cognitively impaired patients and caregivers to hold on their cognitive functioning and quality of life. Thus, medication management and the factors influencing how management for this condition is carried out must be identified. In this study we aimed to evaluate the frequency of medication nonadherence (MNA) or drug overuse for cognitive impairment (DOC) and to extract significant variables, including the demographic and social characteristics, vascular risk factors, and cognitive status, for the diagnosis of MNA and DOC in Korean patients. @*Methods@#We investigated patients aged over 50 years between March 2019 and June 2019 via the cognitive enHancement of patIents with acQuired cognitive impairment (HIQ) campaign.MNA was defined as a participant who was classified as having cognitive impairment but did not take any cognition-related drugs, whereas DOC was defined as a participant who had normal cognition but was taking cognition-related drugs. @*Results@#We included 10,767 patients. The MNA group consisted of 337 participants, whereas the DOC group comprised 1,107 participants. The factors that could differentiate the MNA group from the normal-behavior group were age, education, sex, and the total Korean version of Mini-Mental State Examination (K-MMSE) score. The factors that could differentiate the DOC group from the normal medication-behavior group were age, sex, residential distinction, experience of a dementia screening test, and the total K-MMSE score. @*Conclusions@#The underlying factors contributing to inadequate dementia-medication management must be understood, and intervention or support is needed to enable safe medication management.
ABSTRACT
BACKGROUND AND PURPOSE: Disability associated with activities of daily living (ADL) is the basis of dementia diagnosis and is an important factor in the care of dementia patients. The status of awareness and burden of ADL disability in dementia patients was investigated six years ago and used as an important reference for “Il-sang-ye-chan” campaign. They were re-investigated in six years and compared with previous results. METHODS: The survey included caregivers of 100 dementia patients listed at the four regional dementia centers. Structured open and closed questions about ADL were asked. Assessments included age, sex, education level, economic status, severity of dementia, caregiving pattern, current statues and cognition of ADL, and caregiver needs. RESULTS: The cognition of ADL was still very low (43%). Increased stress among caregivers was the biggest burden, and they frequently suffered from outing disability (56%), recent memory loss (48%), and loss of bowel/bladder control (40%). The economic burden has been greatly reduced compared with the burden six years ago and the needs of caregivers were still highly about educational guide lines or programs. CONCLUSIONS: Continued interest and further investigation into ADL disability of dementia patients are needed. Korean Dementia Association will further expand the “Il-sang-ye-chan” program: via a multi-domain cognitive intervention program under the Care for ADL in dementia and Relieve symptoms in Dementia Project.
Subject(s)
Humans , Activities of Daily Living , Caregivers , Cognition , Dementia , Diagnosis , Education , Memory DisordersABSTRACT
BACKGROUND AND PURPOSE: Acetyl-L-carnitine (ALC) is a widely used drug for various neurodegenerative diseases including dementia. The aim of the present study was to elucidate the efficacy of ALC in dementia patients with cerebrovascular disease (vascular cognitive impairment; VCI). METHODS: Fifty-six patients were randomized to treatment with 500 mg ter in die ALC, or placebo in this 28-week, double-blind, placebo-controlled trial. The primary outcome measure was the Korean version of Montreal Cognitive Assessment (MoCA-K). RESULTS: Following treatment with ALC, the cognitive function measured by the MoCA-K was significantly improved in the ALC-treated groups. However, other secondary outcomes were not statistically significant between ALC- and placebo-treated groups. In MoCA-K analysis, attention and language sub-items significantly favored the ALC-treated group. CONCLUSIONS: Compared with placebo, treatment with ALC 1,500 mg/day produced significant changes in MoCA-K in dementia patients with VCI. ALC was well tolerated in this population. Despite the study limitations, the findings suggested the potential benefits associated with the use of ALC in dementia patients with VCI.
Subject(s)
Humans , Acetylcarnitine , Cerebrovascular Disorders , Cognition , Cognition Disorders , Dementia , Neurodegenerative Diseases , Outcome Assessment, Health CareABSTRACT
BACKGROUND: Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis was discovered less than 10 years ago. Its symptoms and characteristics are not well-defined yet. We experienced a case of anti-NMDA receptor encephalitis with phonemic paraphasia and acalculia that were not classical characteristics. CASE REPORT: A 44-year-old woman started to show dyslexia, phonemic paraphasia, and dyscalculia. These symptoms were gradually worsening for over 30 days. Various brain images were not helpful for primary diagnosis. Anti-NMDA receptor encephalitis was confirmed in two different laboratories. The patient started to recover with various immunosuppressive therapies. CONCLUSIONS: Anti-NMDA receptor encephalitis can have various symptoms, including phonemic paraphasia and acalculia.
Subject(s)
Adult , Female , Humans , Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Brain , Diagnosis , Dyscalculia , Dyslexia , EncephalitisABSTRACT
BACKGROUND: Activities daily living (ADL) disability has a direct influence on the patients' quality of life and on the amount of care needed. It is major factor of care in dementia patients. So Korean Dementia Association suggested guideline about activities of daily living in dementia patients in 2013. The purpose of this article is to investigate the effect of this. METHODS: A total of 110 subjects were enrolled. Assessments included age, sex, education level of patients and caregiver, the duration of disease, pattern of family, economic status. We divided "active practice" group and "passive practice" group by recognition of guideline contents after study. We compared two groups before and after by Korean Mini-Mental State Examination (K-MMSE), Short form of Geriatric Depression Scale-Korean version (S-GDS), Korean version of Zarit's Burden Interview (ZBI-K), Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL). Finally, we investigate the level of satisfaction about our guideline. RESULTS: Age of patients, the duration of disease was lower and education level of caregiver and economic status was higher in "active practice group". The pattern of family also differed from two groups. It was observed distinct difference between the variations of two groups in S-GDS, ZBI-K, and ADCS-ADL. The level of satisfaction about our guideline was very high. CONCLUSION: Considering these results, our guideline about activities of daily living is effective to manage dementia patient. Active application of it is needed in clinic or center for dementia.
Subject(s)
Humans , Activities of Daily Living , Alzheimer Disease , Caregivers , Dementia , Depression , Education , Quality of LifeABSTRACT
Dementia is a syndrome of global cognitive disability and is not a single disease. There are many risk factors of dementia, and some factors are adjustable. Therefore it is important to have knowledge about dementia risk factors, and modulate the risk factors for prevention of dementia. Through this paper, we review the risk factors for dementia with unadjustable factors (age, sex, genetic factors) and adjustable factors (diabetes melitus, hypertention, hypercholesterolemia, hypothyroidism, alcohol intake, depression, etc) in the aspects of the impact of them on the incidence of dementia.
Subject(s)
Alzheimer Disease , Dementia , Dementia, Vascular , Depression , Hypercholesterolemia , Hypothyroidism , Incidence , Risk FactorsABSTRACT
Transient memory impairment can be occurred by many causes. One of them is acute focal brain lesion in strategic site. Caudate nucleus and medial basal ganglia (globus pallidus) are lesion of strategic site. They play its role in cognitive processing. But lateral basal ganglia (putamen) is known as a structure involving movement, not cognitive function. We report a interesting case of transient memory dysfunction with acute focal putamen ICH with old caudate nucleus infarction.
Subject(s)
Basal Ganglia , Brain , Caudate Nucleus , Infarction , Intracranial Hemorrhages , Memory , PutamenABSTRACT
BACKGROUND: Foot Scan System (RS scan international cooperation) measuring the plantar pressure distribution is simple and inexpensive tool for gait analysis. The analysis of plantar pressure distribution of the feet during gait maybe helps the assessment of motor symptoms or gait stability of Idiopathic Parkinson's disease (IPD). METHODS: We compared the parameters of foot scan system between 34 normal controls and 23 IPD patients before and after levodopa administration. Data of plantar force distribution and time of stance phase were collected using pressure-sensitive insoles as parts of the Foot Scan System. RESULTS:There were significant difference between normal controls and IPD patients in fore foot peak pressure/rear foot peak pressure ratio, time percentage of heel strike phase, mid stance phase, propulsion phase in stance phase. But in these parameters there were no significant difference between IPD patients before dopamine with after dopamine medication. CONCLUSIONS: Using the Foot Scan System (RS scan international cooperation) measuring the plantar pressure distribution, we showed that F/R ratio and time percentage of propulsion phase are reduced significantly in patients with IPD, which enables us to understand the features of gait in IPD patients more easily.
Subject(s)
Humans , Dopamine , Foot , Gait , Heel , Levodopa , Parkinson Disease , Strikes, EmployeeABSTRACT
Preliminary studies have evaluated the effects of interferon beta formulations in the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) because of pathogenic similarities between CIDP and multiple sclerosis (MS). However, the efficacy of Interferon, which has been widely used for relapsing-remitting MS, is controversial in CIDP. We report here a 31year old woman with relapsing-remitting type MS treated with IFN beta-1b over 2 years who developed overt CIDP. She responded favorably to steroids. This case suggests that IFN beta-1b treatment may not prevent development of CIDP.
Subject(s)
Female , Humans , Interferon-beta , Interferons , Multiple Sclerosis , Polyneuropathies , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating , SteroidsABSTRACT
BACKGROUND: Cerebral infarction as a complication of tuberculous meningitis (TBM) is not uncommon, but has been rarely reported. The purposes of this study were to evaluate the clinical characteristics of cerebral infarction secondary to TBM and investigate the predictive values for cerebral infarction in patients with TBM. METHODS: We prospectively collected patients with TBM for 24 months. Patients were divided into two groups, either patients with stroke or without stroke. We compared the demographic features, clinical, laboratory, and neuroradiologic findings between the two groups. We classified the stroke subtype with neuroimaging findings. RESULTS: The 26 patients were diagnosed as TBM, and 6 patients had complications with cerebral infarction. The neutrophil percentage in the cerebrospinal fluid (CSF) leukocyte were significantly higher in patients with stroke than in patients without stroke (p=0.0098). On initial CT scan, meningeal enhancement was found in 9 patients, and 4 of them complicated with stroke. However, there were no significant differences in the other clinical and laboratory features such as demographic features, interval between meningitis onset time and treatment initiation time, peripheral white blood cell count, and CSF findings. In six patients with stroke, lacunar infarctions and non-lacunar territorial infarctions were found in 3 patients, respectively. In territorial non-lacunar infarction patients, one patient died due to herniation. CONCLUSIONS: We suggest that the possibility of cerebral infarction under the treatment of TBM should be considered, when the patient shows focal neurologic signs, meningeal enhancement on the CT scan and sustained polymorphic CSF pleocytosis.