Blood Markers of Oxidative Stress in Dementia

OBJECTIVES: To identify changes in blood markers of oxidative stress among dementic and healthy aged persons, and to compare levels of peripheral markers of oxidative stress between dementia of the Alzheimer's type (DAT) and vascular dementia (VD), and finally to analyze factors affecting those. DESIGN: Some antioxidants had been known to reduce the risk of dementia, while increase of 4-hydroxy-nonenal and decrease of heme oxygenase in DAT had been reported. Recently increased free radical activities were also found in VD. Therefore, this study was tried to search for a blood markers to discriminate DAT and VD. MATERIALS AND METHOD: The blood levels of total antioxidant capacity (TAC) and catalase activity of 50 patients with DAT and 50 patients with VD were compared with those of 56 healthy aged controls. In addition, variables including risk factors of dementia, degree of dementia measured by MMSE, Hasegawa Dementia Scale, GDS and CDR, and activities of daily living were also assessed. RESULTS: 1) The levels of TAC were significantly (p<0.01) lower in dementia than normal aged controls (1.47+/-0.08 mmol/L), while the catalase activities were significantly (p<0.01) higher in dementia than normal aged controls (45.61+/-11.67 kU/L). 2) The TAC levels were significantly (p<0.01) lower while the catalase significantly (p<0.01) higher in DAT (1.24+/-0.09 mmol/L, 133.42+/-58.45 kU/L respectively) than VD (1.31+/-0.08 mmol/L, 81.33+/-24.65 kU/L respectively). 3) The TAC and catalase activities were significantly (p<0.01) correlated with duration of dementia, behavior symptoms, activities of daily living, and the severity of dementia. CONCLUSIONS: Peripheral blood markers of oxidative stress were significantly different in dementia from normal aged controls. Furthermore, the difference was more severe in DAT than VD, which means the effect of oxidative stress is more in DAT than in VD. Therefore, they might be clinically useful to assess and discriminate dementia.

The Changes of Bone Mineral Density, Biochemical Bone Markers, and Lipid Profiles according to Duration of Menopause and HRT

OBJECTIVE: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles according to the duration of menopause in postmenopausal osteoporosis patient receiving continuous hormonal replacement therapy (c-HRT). METHOD: Sixty seven patients with postmenopausal osteoporosis who have been under c-HRT for more than two years were used as subjects and divided into two groups according to the time past menopause: group I (0~10 years), group II (over 10 years). The changes of BMD, biochemical bone markers, lipid profiles on one year and two years of c-HRT were comparatively analyzed in each group. RESULTS: 1) BMD of lumbar vertebra was increased and biochemical bone markers were decreased after c-HRT in both groups, but BMD of femur from both groups showed no statistical significant changes. 2) The changes in lumbar vertebra, deoxypyridinoline and osteocalcin were significantly higher after first one year than next one year of c-HRT in both groups, with no statistical differences between two groups. 3) Total cholesterol and LDL-cholesterol were decreased, but HDL-cholesterol and triglyceride showed no significant changes after c-HRT in both groups. CONCLUSION: The effects of c-HRT on BMD, biochemical bone markers, lipid profiles were not influenced by postmenopausal period. And the effects of c-HRT during first one year were more prominent than those of c-HRT during next one year.

Transient Pancytopenia and SIADH associated with Administration of Carbamazepine

Carbamazepine is widely used to manage of seizures and symptomatic treatment of trigeminal neuralgia and central pain. We experienced two cases of exceedingly rare but potentially fatal side effects following carbamazepine administration. One traumatic brain injured patient developed pancytopenia 3 weeks after beginning to take carbamazepine for prophylactic management of seizure and the other C6 incomplete spinal cord injured patient receiving carbamazepine for the management of central pain sequentially developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 1 week after administration. Because of more frequent indications of carbamazepine, these side effects must be borne in mind and cautious administration will be desirable.

Clinical Usefulness of Cognitive Evoked Potentials in Cerebrovascular Diseases

OBJECTIVES: The purpose of this study is to evaluate the clinical applicability of cognitive evoked potentials (CEPs) to identify the cognitive disorder in cerebrovascular diseases (CVD). METHODS: The P3 latencies, amplitudes and latency to amplitude ratios (LARs) of CEPs were measured in 25 healthy controls and 35 patients with CVD. The association of CEPs with variables including age, sex, Mini-Mental State Examination (MMSE), CVD types, loci of hemiplegic limbs, duration, education, Brief Psychiatric Rating Scale (BPRS), and Instrumental Activities of Daily Living (IADL) were also analyzed. RESULTS: 1) The P3 latencies (447.87+/-113.06 msec) and LARs (65.83+/-43.25) were prolonged in CVD (p or =24 (363.39+/-19.67 msec, 38.40+/-8.37 and 9.81+/-1.76 microV, respectively). 3) The BPRS and IADL in CVD with MMSE or =24. 4) On analyzing the association of CEPs with variables in CVD, the P3 latencies were correlated positively with age, BPRS and IADL, while negatively with MMSE and DLFA. The amplitudes were correlated positively with MMSE, while negatively with age, BPRS and IADL. The LARs were correlated positively with age, BPRS and IADL, while negatively with MMSE. 5) On analyzing the association of CEPs with variables in CVD with MMSE> or =24, the P3 latencies were correlated positively with age, while negatively with MMSE. The amplitudes and LARs were not correlated with variables. 6) On analyzing the association of CEPs with variables in CVD with MMSE<24, the P3 latencies were correlated positively with BPRS, while negatively with MMSE. The amplitudes were positively correlated with age. The LARs were positively correlated with IADL. CONCLUSIONS: The P3 latencies and LARs of cognitive evoked potentials seemed to a useful clinical measures to assess cognitive disorders in CVD.

Acute Ischemic Polyneuropathy after Acute Abdominal Aortic Occlusion: A case report

A 45-year-old man with a long history of nephrotic syndrome presented with low back pain and progressive weakness of both legs for one day. Physical examination showed an acutely ill-appearing patient with a loss of both femoral artery pulses. Immediate digital subtraction angiography of abdominal aorta revealed total occlusion of the distal abdominal aorta. Transvascular embolectomy using urokinase was undertaken 6 hours later. Digital subtraction angiography after embolectomy revealed both common ilicac arteries to be patent with good distal flow. Electrodiagnostic examinations (post embolectomy 5th and 45th day) revealed peripheral polyneuropathy of both lower extremity. Anticoagulation therapy was continued and the patient was discharged several months later. During this period, there was improvement in both lower limbs from power of grade 1 to 4 except for both ankle dorsiflexors which had not recovered. We report a rare case of peripheral ischemic polyneuropathy of both lower extremities as the result of acute abdominal aortic occlusion.

Relationship among Estradiol, Lipid Profile, Biochemical Markers, and Bone Mineral Density according to Postmenopausal Period

OBJECTIVE: To determine whether estradiol (E2), lipid profile, biochemical markers, and bone mineral density (BMD) are related according to postmenopausal period. METHOD: One hundred fifty four women were divided into four groups according to the time past menopause: group I (0~5 years), group II (6~10 years), group III (11~15 years), group IV (more than 16 years). Group I, II, III were subdivided into osteoporosis group (t-score or = 2.5). E2, lipid profile, osteocalcin, alkaline phosphatase, deoxypyridinoline, and BMD by DEXA were measured in all groups. RESULTS: There were significant inverse correlation between BMD and postmenopausal period (p<0.05). Deoxypyridinoline and osteocalcin were correlated with postmenopausal period but there was no statistical significance. Deoxypyridinoline and osteocalcin were increased in osteoporosis group compared to non-osteoporosis group but there was no statistical significance. E2 had significant inverse correlations with postmenopausal period (p<0.05). E2 had no correlation with factors such as biochemical markers and lipid profile in group I, II, III but had adverse correlation with deoxypyridinoline in group IV. CONCLUSION: No specific biochemical markers regarding the duration of menopause were found. Regardless of the duration of menopause, checking both osteocalcin and deoxypyridinoline was statistically significant for the evaluation of postmenopausal osteoporosis.