Validation of the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale

Background@#and PurposeImpulse-control disorder is an important nonmotor symptom of Parkinson's disease (PD) that can lead to financial and social problems, and be related to a poor quality of life. A nationwide multicenter prospective study was performed with the aim of validating the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (K-QUIP-RS). @*Methods@#The K-QUIP-RS was constructed using forward and backward translation, and pretesting of the prefinal version. PD patients on stable medical condition were recruited from 27 movement-disorder clinics. Participants were assessed using the K-QUIP-RS and evaluated for parkinsonian motor and nonmotor statuses and for PD-related quality of life using a predefined evaluation battery. The test–retest reliability of the K-QUIP-RS was assessed over an interval of 10–14 days, and correlations between the KQUIP-RS and other clinical scales were analyzed. @*Results@#This study enrolled 136 patients. The internal consistency of the K-QUIP-RS was indicated by a Cronbach's α coefficient of 0.846, as was the test–retest reliability by a Guttman split-half coefficient of 0.808. The total K-QUIP-RS score was positively correlated with the scores for depression and motivation items on the Unified PD Rating Scale (UPDRS), Montgomery-Asberg Depression Scale, and Rapid-Eye-Movement Sleep-Behavior-Disorders Questionnaire. The total K-QUIP-RS score was also correlated with the scores on part II of the UPDRS and the PD Quality of Life-39 questionnaire, and the dopaminergic medication dose. @*Conclusions@#The K-QUIP-RS appears to be a reliable assessment tool for impulse-control and related behavioral disturbances in the Korean PD population.

Subtypes of Sleep Disturbance in Parkinson's Disease Based on the Cross-Culturally Validated Korean Version of Parkinson's Disease Sleep Scale-2

Differences in Therapeutic Responses and Factors Affecting Post-Stroke Depression at a Later Stage According to Baseline Depression / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: The pathophysiology of post-stroke depression (PSD) is complex and may differ according to an individual’s mood immediately after stroke. Here, we compared the therapeutic response and clinical characteristics of PSD at a later stage between patients with and without depression immediately after stroke. METHODS: This study involved a post hoc analysis of data from EMOTION (ClinicalTrials.gov NCT01278498), a placebo-controlled, double-blind trial that examined the efficacy of escitalopram (10 mg/day) on PSD and other emotional disturbances among 478 patients with acute stroke. Participants were classified into the Baseline-Blue (patients with baseline depression at the time of randomization, defined per the Montgomery-Asberg Depression Rating Scale [MADRS] ≥8) or the Baseline-Pink groups (patients without baseline depression). We compared the efficacy of escitalopram and predictors of 3-month PSD (MADRS ≥8) between these groups. RESULTS: There were 203 Baseline-Pink and 275 Baseline-Blue patients. The efficacy of escitalopram in reducing PSD risk was more pronounced in the Baseline-Pink than in the Baseline-Blue group (p for interaction=0.058). Several risk factors differentially affected PSD development based on the presence of baseline depression (p for interaction < 0.10). Cognitive dysfunction was an independent predictor of PSD in the Baseline-Blue, but not in the Baseline-Pink group, whereas the non-use of escitalopram and being female were more strongly associated with PSD in the Baseline-Pink group. CONCLUSIONS: Responses to escitalopram and predictors of PSD 3 months following stroke differed based on the presence of baseline depression. Our data suggest that PSD pathophysiology is heterogeneous; therefore, different therapeutic strategies may be needed to prevent PSD emergence following stroke.

Validity and Reliability Study of the Korean Tinetti Mobility Test for Parkinson's Disease

OBJECTIVE: Postural instability and gait disturbance are the cardinal symptoms associated with falling among patients with Parkinson’s disease (PD). The Tinetti mobility test (TMT) is a well-established measurement tool used to predict falls among elderly people. However, the TMT has not been established or widely used among PD patients in Korea. The purpose of this study was to evaluate the reliability and validity of the Korean version of the TMT for PD patients. METHODS: Twenty-four patients diagnosed with PD were enrolled in this study. For the interrater reliability test, thirteen clinicians scored the TMT after watching a video clip. We also used the test-retest method to determine intrarater reliability. For concurrent validation, the unified Parkinson’s disease rating scale, Hoehn and Yahr staging, Berg Balance Scale, Timed-Up and Go test, 10-m walk test, and gait analysis by three-dimensional motion capture were also used. We analyzed receiver operating characteristic curve to predict falling. RESULTS: The interrater reliability and intrarater reliability of the Korean Tinetti balance scale were 0.97 and 0.98, respectively. The interrater reliability and intra-rater reliability of the Korean Tinetti gait scale were 0.94 and 0.96, respectively. The Korean TMT scores were significantly correlated with the other clinical scales and three-dimensional motion capture. The cutoff values for predicting falling were 14 points (balance subscale) and 10 points (gait subscale). CONCLUSION: We found that the Korean version of the TMT showed excellent validity and reliability for gait and balance and had high sensitivity and specificity for predicting falls among patients with PD.

Validation of the Korean Version of the Scales for Outcomes in Parkinson's Disease-Sleep

BACKGROUND: Sleep problems commonly occur in patients with Parkinson's disease (PD), and are associated with a lower quality of life. The aim of the current study was to translate the English version of the Scales for Outcomes in Parkinson's Disease-Sleep (SCOPA-S) into the Korean version of SCOPA-S (K-SCOPA-S), and to evaluate its reliability and validity for use by Korean-speaking patients with PD. METHODS: In total, 136 patients with PD from 27 movement disorder centres of university-affiliated hospitals in Korea were enrolled in this study. They were assessed using SCOPA, Hoehn and Yahr Scale (HYS), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Sleep Scale 2nd version (PDSS-2), Non-motor Symptoms Scale (NMSS), Montgomery Asberg Depression Scale (MADS), 39-item Parkinson's Disease Questionnaire (PDQ39), Neurogenic Orthostatic Hypotension Questionnaire (NOHQ), and Rapid Eye Movement Sleep Behaviour Disorder Questionnaire (RBDQ). The test-retest reliability was assessed over a time interval of 10–14 days. RESULTS: The internal consistency (Cronbach's α-coefficients) of K-SCOPA-S was 0.88 for nighttime sleep (NS) and 0.75 for daytime sleepiness (DS). Test-retest reliability was 0.88 and 0.85 for the NS and DS, respectively. There was a moderate correlation between the NS sub-score and PDSS-2 total score. The NS and DS sub-scores of K-SCOPA-S were correlated with motor scale such as HYS, and non-motor scales such as UPDRS I, UPDRS II, MADS, NMSS, PDQ39, and NOHQ while the DS sub-score was with RBDQ. CONCLUSION: The K-SCOPA-S exhibited good reliability and validity for the assessment of sleep problems in the Korean patients with PD.

Vestibular Paroxysmia and Hemifacial Spasm by Vascular Compression / 대한평형의학회지

Vestibular Paroxysmia and facial spasm may be caused by vascular compression of the vestibular and facial root entry zone. We report a case of paroxysmal nystagmus accompanied by facial spasm and which is well visualized by three-dimensional reconstruction images. The 3-dimensional reconstruction image supports the view that vestibular paroxysmia may occur with hemifacial spasm simultaneously due to vascular compression.

Validation of the Korean Version of the Scale for Outcomes in Parkinson's Disease-Autonomic

OBJECTIVE: Autonomic symptoms are commonly observed in patients with Parkinson's disease (PD) and often limit the activities of daily living. The Scale for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) was developed to evaluate and quantify autonomic symptoms in PD. The goal of this study was to translate the original SCOPA-AUT, which was written in English, into Korean and to evaluate its reliability and validity for Korean PD patients. METHODS: For the translation, the following processes were performed: forward translation, backward translation, expert review, pretest of the pre-final version and development of the final Korean version of SCOPA-AUT (K-SCOPA-AUT). In total, 127 patients with PD from 31 movement disorder clinics of university-affiliated hospitals in Korea were enrolled in this study. All patients were assessed using the K-SCOPA-AUT and other motor, non-motor, and quality of life scores. Test-retest reliability for the K-SCOPA-AUT was assessed over a time interval of 10−14 days. RESULTS: The internal consistency and reliability of the K-SCOPA-AUT was 0.727 as measured by the mean Cronbach's α-coefficient. The test-retest correlation reliability was 0.859 by the Guttman split-half coefficient. The total K-SCOPA-AUT score showed a positive correlation with other non-motor symptoms [the Korean version of non-motor symptom scale (K-NMSS)], activities of daily living (Unified Parkinson's Disease Rating Scale part II) and quality of life [the Korean version of Parkinson's Disease Quality of Life 39 (K-PDQ39)]. CONCLUSION: The K-SCOPA-AUT had good reliability and validity for the assessment of autonomic dysfunction in Korean PD patients. Autonomic symptom severities were associated with many other motor and non-motor impairments and influenced quality of life.

Ictal Eletroencephalographic Findings of Nonconvulsive Status Epilepticus Associated With Glufosinate Ammonium Poisoning

No abstract available.

Loneliness in Elderly Patients with Mild Cognitive Impairment: A Pilot Study

BACKGROUND AND PURPOSE: Loneliness is a significant concern among the elderly, particularly in societies with rapidly growing aging populations. While loneliness may influence neuropsychological function, the exact nature of the association between loneliness and neuropsychological function is poorly understood. METHODS: We evaluated 50 elderly patients with mild cognitive impairment (MCI) and 33 without cognitive dysfunction with respect to demographics, clinical characteristics, cognitive and functional performance, depression scale, and loneliness scale. The associations between loneliness and neuropsychological assessments were evaluated. RESULTS: Although loneliness was not associated with cognitive or functional performance, it was correlated with depression in elderly patients. For elderly patients with MCI, depressive symptoms were reported more frequently in individuals with a high degree of loneliness (p < 0.05). CONCLUSIONS: Neither cognitive performance nor functional performance is associated with loneliness; however, loneliness is associated with depressive symptoms in elderly patients with MCI.

Reversible Cause of Rapidly Progressive Dementia as Presenting Symptom of Primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) is imbalance of calcium, phosphate, and bone metabolism attributed to an increased secretion of parathyroid hormone (PTH). Although PHPT is mainly associated with musculoskeletal and kidney dysfunction, variable symptoms can be presented in the elderly patients. A 75-year-old man presented with rapidly progressive dementia (RPD). Through etiological work-up of hypercalcemia and increased PTH, parathyroid adenoma was found. Subtotal parathyroidectomy resulted in recovery of cognitive impairment. Primary hyperparathyroidism should be considered in a differential diagnosis of RPD.

Erratum to: The KMDS-NATION Study: Korean Movement Disorders Society Multicenter Assessment of Non-Motor Symptoms and Quality of Life in Parkinson's Disease NATION Study Group

The original version of this article contained wrong informations of some authors which should be changed.

The KMDS-NATION Study: Korean Movement Disorders Society Multicenter Assessment of Non-Motor Symptoms and Quality of Life in Parkinson's Disease NATION Study Group

BACKGROUND AND PURPOSE: Nonmotor symptoms (NMS) in Parkinson's disease (PD) have multisystem origins with heterogeneous manifestations that develop throughout the course of PD. NMS are increasingly recognized as having a significant impact on the health-related quality of life (HrQoL). We aimed to determine the NMS presentation according to PD status, and the associations of NMS with other clinical variables and the HrQoL of Korean PD patients. METHODS: We surveyed patients in 37 movement-disorders clinics throughout Korea. In total, 323 PD patients were recruited for assessment of disease severity and duration, NMS, HrQoL, and other clinical variables including demographics, cognition, sleep scale, fatigability, and symptoms. RESULTS: In total, 98.1% of enrolled PD subjects suffered from various kinds of NMS. The prevalence of NMS and scores in each NMS domain were significantly higher in the PD group, and the NMS worsened as the disease progressed. Among clinical variables, disease duration and depressive mood showed significant correlations with all NMS domains (p<0.001). NMS status impacted HrQoL in PD (rS=0.329, p<0.01), and the association patterns differed with the disease stage. CONCLUSIONS: The results of our survey suggest that NMS in PD are not simply isolated symptoms of degenerative disease, but rather exert significant influences throughout the disease course. A novel clinical approach focused on NMS to develop tailored management strategies is warranted to improve the HrQoL in PD patients.

Frontoparietal Cortical Thinning in Respiratory-Type Panic Disorder: A Preliminary Report

OBJECTIVE: Many evidences raise the possibility that the panic disorder (PD) patients with respiratory subtype (RS) may have characteristic structural abnormalities. We aimed to explore the structural differences between PD patients with and without the respiratory symptoms. METHODS: Patients with PD were recruited from the Department of Psychiatry at Korea University Anam Hospital. Respiratory subtype (RS) was diagnosed when at least 4 out of 5 of the following respiratory symptoms were present during the panic attack: fear of dying, chest pain/discomfort, shortness of breath, paresthesias, and a choking sensation. We acquired high-resolution MRI scans and used FreeSurfer to obtain a measure of cortical thickness for each patient. RESULTS: Cluster based analysis revealed significantly decreased cortical thickness in the left hemisphere in the caudal-middle-frontal, superior frontal, and posterior parietal areas in the RS group. No significant difference was observed in any of the limbic areas. CONCLUSION: Respiratory symptoms of panic disorder were associated with a reduction in cortical thickness in the left frontal and parietal areas. This finding leads to the assumption that the frontoparietal network is the crucial component in a larger cortical network underlying the perception of dyspnea in RS.

Movement Disorders Following Cerebrovascular Lesions: Etiology, Treatment Options and Prognosis

Post-stroke movement disorders are uncommon, but comprise an important part of secondary movement disorders. These exert variable and heterogeneous clinical courses according to the stroke lesion and its temporal relationships. Moreover, the predominant stroke symptoms hinder a proper diagnosis in clinical practice. This article describes the etiology, treatment options and prognosis of post-stroke movement disorders.

Electromyographicanalysis of prevalence and characteristics of radiculopathy in Parkinson’s disease

Background & Objectives: To determine the prevalence and characteristics of radiculopathy in Parkinson’s disease (PD) patients through electrodiagnostic tests, to assess associated radicular pain characteristics,and to investigate the relationship between pain and other clinical manifestations of PD. Methods: Electrodiagnostic testing including nerve conduction studies and needle electromyographywas performed to investigate comorbid peripheral neuropathy or radiculopathy. All patients were asked to complete aquality of life (QOL) measurement related to pain. Results: Thirty-two (39%) of 82 PD patients had radiculopathy based on electrodiagnostic testing. 46.9% with radiculopathy patients had involvement of multiple roots level. The most commonly involved root was L5 (83.3%). Patients with radiculopathy had longer PD durations (p=0.011) and higher posture-related axial scores on the UPDRS scale (p=0.017).There was a trend for pain in the leg and low back to occur more frequently in PD patients with radiculopathy. QOL is not significantly different according to the presence of radiculopathy in PD. Conclusions: This study demonstrates a high prevalence of radiculopathy, particularly multiple root involvement, and is correlated with pain complaints and with axial motor scores on UPDRS. These findings might be related to increased shear force at the intervertebral disc by axial rigidity and flexed posture in PD along with the duration and severity of PD disease course.

Atypical Presentation of Cerebral Superficial Siderosis Mimicking Recurrent Sciatic Neuralgia

No abstract available.

Abnormal Head Impulse Test in a Unilateral Cerebellar Lesion

BACKGROUND: The findings of head impulse tests (HIT) are usually normal in cerebellar lesions. CASE REPORT: A 46-year-old male presented with progressive dizziness and imbalance of 3 weeks duration. The patient exhibited catch-up saccades during bedside horizontal HIT to either side, which was more evident during the rightward HIT. However, results of bithermal caloric tests and rotatory chair test were normal. MRI revealed a lesion in the inferior cerebellum near the flocculus. CONCLUSIONS: This case provides additional evidence that damage to the flocculus or its connections may impair the vestibulo-ocular reflex only during high-speed stimuli, especially when the stimuli are applied to the contralesional side. By observing accompanying cerebellar signs, the abnormal HIT findings caused by a cerebellar disorder can be distinguished from those produced by peripheral vestibular disorders.

Acute Ischemic Vestibulopathy without Hearing Loss

Acute isolated vestibulopathy could be caused by either viral inflammation or ischemia. However, diagnosing ischemic vestibulopathy is difficult due to the ambiguity of the causal relationship between ischemia and peripheral vestibulopathy. We present here a patient with acute ischemic vestibulopathy without hearing loss caused by internal auditory artery occlusion, indirectly proven by the finding of a simultaneously developed silent cerebellar infarction. The details of this case suggest that patients with acute isolated peripheral vestibulopathy should be carefully evaluated for underlying causes, including vascular risk factors.

Bilateral Mirror Movement in Hemiparkinsonism-hemiatrophy Syndrome

No abstract available.

Safety of intravenous thrombolysis in embolic stroke by infective endocarditis

Ischemic stroke is a serious neurological complication of infective endocarditis. Intravenous tissue plasminogen activator (t-PA), which has only been approved for treatment of hyperacute stroke, has been excluded as an ischemic stroke treatment due to infective endocarditis according to current expert consensus guidelines. Here, we describe a case of a hyperacute stroke patient treated with intravenous t-PA, who was later diagnosed with infective endocarditis.