Relationship between Blood Pressure and Cognitive Function according to Age in Elderly Adults

BACKGROUND: It has been reported that the association between blood pressure and cognitive impairment could be modified by factors such as gender, education, and Apo E genotypes. This study was aimed to investigate whether `age' could also be a modifier of the association. METHODS: The study group consisted of 489 participants aged 65 years or over who lived in Namwon, Korea. The presence of hypertension was ascertained by the measurement of their resting blood pressure. A cognitive impairment was considered to be present when a Korean Mini-Mental State Examination score was less than 19 (30th percentile). RESULTS: A higher systolic blood pressure was significantly associated with cognitive impairment, after an adjustment for age, gender, education, and occupation. However, the significance was lost in subjects aged 71 or over. CONCLUSIONS: High systolic blood pressure is a factor strongly associated with cognitive impairment in an aged population. However, in the subjects with far advanced age, the association is not significant. Further studies are required to elucidate whether blood pressure lowering strategies should be differentiated according to age in order to reduce cognitive impairment.

Relationships of Apolipoprotein E Genotypes with Vascular Risk Factors in Patients with Alzheimer's Disease

BACKGROUND: Apolipoprotein E-epsilon4 (APOE-epsilon4) is a known genetic risk factor for Alzheimer's disease (AD), but its relationship with vascular risk factors is still controversial. METHODS: We retrospectively studied 56 probable AD patients diagnosed by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorder's Association (NINCDS-ADRDA) criteria. RESULTS: The frequencies of APOE-epsilon2, 3, and 4 were 6.3%, 69.6%, and 24.1% in patients with AD. Compared to the no APOE-epsilon4 group (n=35), the APOE-epsilon4 group (n=21) revealed a higher frequency of male gender with no difference in age, educational level, dementia onset age, severity of dementia (CDR and K-MMSE), the frequencies of vascular risk factors (hypertension, diabetes, hypercholesterolemia), and total cholesterol level. High density lipoprotein (HDL)-cholesterol level was 36+/- 8 in the APOE-epsilon4 group and 43+/-11 in the no APOE-epsilon4 group with statistical significance (Student's t-test, p=0.02). In adjusting for sex, the APOE-epsilon4 group still had a significantly lower HDL-cholesterol level than the no APOE-epsilon4 group (p=0.047). CONCLUSIONS: These results suggest that there may be the genetic influence of APOE-epsilon4 on serum HDLcholesterol metabolism in AD patients.

Apolipoprotein E, Cholesterol, and Cognitive Decline in Patients with Alzheimer's disease

BACKGROUND: The associations of apolipoprotein E (ApoE) genotypes and cholesterol levels with cognitive decline in Alzheimer's disease (AD) are controversial. The aim of this study is to investigate the individual and combined effects of ApoE epsilon 4 allele (Epsilon4) and cholesterol levels on the progression of AD. METHODS: ApoE genotypes and fasting serum total cholesterol levels were measured in 79 patients with AD. The associations were investigated between Epsilon4, cholesterol level and decline in cognitive function (Korean version of Mini-Mental State Examination) over one year. RESULTS: No prospective individual and combined associations were found between Epsilon4, cholesterol level and decline of cognitive function. Adjustment for age, gender, education, and functional activities of daily living made little difference to the associations. CONCLUSIONS: The cognitive decline of AD might be determined by other factors rather than the impact of Epsilon4 or cholesterol levels.

Clinical Usefulness of Perfusion CT in Acute Ischemic Stroke

BACKGROUND: In recent years, thrombolytic therapy has been used with success to reduce the infarction area in patients with acute cerebral infarction, It is very important to identify ischemic penumbra in the treatment of stroke. The aim of this study is detect ischemic penumbra and border between ischemic penumbra and infarction area using perfusion CT and diffusion-weighted MR images (DW-MRI) in patient 's with acute ischemic stroke. METHODS: Thirteen inpatients with acute ischemic stroke at the Department of Neurology at Chonnam University Hospital were selected for this study. They had the discrepancy of lesion between perfusion CT and DW-MRI. Perfusion CT was done on admission and DW-MRI within 24 hours after stroke in all patients. Ischemic penumbra was assessed by comparing the defect on perfusion CT with the infarction area on DW-MRI. Clinical outcome was measured with the NIHSS on day 1, 3, and 7. RESULTS: The subjects (perfusion defect on the perfusion CT> infarction area on DW-MRI) achieved significant improvement at NIHSS. There was a significant difference between infarct and non-infarct tissue for both rCBF and rCBV but not for MTT. It could be possible not to define the tissue outcome but to estimate it by this study. CONCLUSIONS: Perfusion CT with DW-MRI is a useful tool for the detection of ischemic penumbra which may be the main target of active treatment.

Validation of Simple Screening test for Dementia in the Elderly: The Time and Change Test

BACKGROUND: Dementia has emerged as a leading public health problem with elderly persons and its early detection is important for treatment in curable cases. Although dementia screening tests are available, they are still complex and time consuming in practice and therefore difficult to use. Our goal was to validate the time and change(T&C) test, a simple, standardized method for detecting dementia in the elderly populations. METHODS: Participants were 59 patients aged 65 years or older at an urban hospital from November 1 to December 31, 2001. The time test evaluated the understanding of clock hands indicating 11:10, and the change test the ability making 1,000 Won from a group of coins consisting one 500 Won, seven 100 Won, seven 50 Won. T&C ratings were validated against a reference standard based on physician`s diagnosis. Test-retest reliability and inter-observer reliability were assessed. RESULTS: The T&C test had a sensitivity of 73.0%, specificity of 90.9%, positive predictive value of 93.1%, and negative predictive value of 66.7%. Test-retest and inter-observer agreement rates were 95% and 95%, respectively. The T&C test was not influenced by education. The time and change tests took a mean of 7.5 seconds and 19.6 seconds to complete respectively, and was acceptable to participants. When timed cut points were added, the T&C test had a sensitivity of 86.5%, specificity of 40.9% and test-retest and inter-observer agreement rates were 77.3% and 81.8%, respectively. CONCLUSION: The T&C test is a simple, accurate reliable, performance-based tool for detection of dementia in the elderly.

A Case of Metastatic Lung Cancer Presenting with Isolated Hypoglossal Nerve Palsy

The peripheral hypoglossal nerve palsy is caused by carotid aneurysm, vascular entrapment, local infection, trauma, neck radiation, and tumors in the neck, retropharyngeal spaces, and basilar area of skull. A basilar skull lesion may rarely involve the hypoglossal nerve alone. We report a 58-year-old man with isolated hypoglossal nerve palsy due to metastasis of lung cancer at the skull base.

Trends in Public Attitudes toward Epilepsy among Chonnam Rural Areas

BACKGROUND: Two successive surveys were conducted in the same rural areas. The first survey was intended to obtain an initial estimate of public familiarity with, understanding of, and attitudes toward epilepsy. The second survey was performed to assess trends in public attitudes toward epilepsy and the putative effect of campaigns on such a trend. METHODS: Cross-sectional studies were conducted by means of a door-to-door interview using the same questionnaire, in which all residents over 19 years of age, living in the survey area, were targeted. Vehicles for the educational campaign took the form of lectures and small group discussions. RESULTS: Of 820 respondents in the first survey, 93% of respondents were familiar with epilepsy. Nevertheless, only 8.5% answered they had an epileptic person among their family or relatives. The understanding of epilepsy among respondents appeared to be not only based more on supernatural or superstitious thinking, but was also less comparable to that of other studies. The attitudes toward epilepsy also were far more negative in Korean rural areas than in other countries. The false belief that epilepsy cannot be treated was the factor that contributed most to negative attitudes in Korean rural areas. Even though it was not remarkable, and was not attributed to the campaigns entirely, a positive trend was obvious not only in understanding the cause of epilepsy but also in attitudes toward epilepsy. CONCLUSIONS: It is important to recognize the fact that the majority of respondents still remain unchanged in their misunderstanding of and negative attitudes toward epilepsy, regardless of the new positive trend. In order to ameliorate prejudices against epilepsy and allow epileptic persons to interact with and adapt to their surroundings properly, not only continuous and repetitive educational efforts but also the sympathy of professional and lay societies regarding epilepsy would be needed.

A Case of Cerebral Venous Thromobosis Associated with Postsplenectomy Thrombocytosis

Cerebral venous thrombosis is come from thromboplebitis of infectious origin and bland occlusion of cerebral vein by various causes. Although the main cause of cerebral venous thrombosis is thrombophlebitis, the bland occlusion causes it infrequently as a form of an infarct state. We report a case of cerebral venous infarction caused by splenectomy induced thrombocytosis.