Prevalence and Risk Factors of Dementia and MCI in Community-dwelling Elderly Koreans

BACKGROUND: We investigated the prevalence of dementia and mild cognitive impairment (MCI) and their risk factors in an urban community-dwelling elderly people over 65 years old. METHODS: A two-phase investigation was performed from January 2010 to December 2011. In Phase I, all subjects (n=9,485) responded to the Korean version of the Mini-Mental State Examination (K-MMSE). Based on the K-MMSE score the subjects were classified into two groups ('Normal' and 'Cognitive decline'). In Phase II, cognitive decline subjects were diagnosed as dementia or MCI according to the neuropsychological tests and doctor's interview. We also surveyed the socioeconomic and medical factors in Normal, Dementia and MCI groups. And we compared and analyzed the socioeconomic and medical risk factors by multiple logistic regressions in Dementia and MCI group. RESULTS: The prevalence of dementia and MCI was obtained 5.4% and 4.3%, respectively. Old age, alcohol intake, living together, low economic status, jobless in the past, diabetes mellitus, previous stroke, lower BMI and family history of dementia were associated with the increased dementia risk. Higher education, hypertension and physical activity were associated with the decreased dementia risk. And old age, alcohol intake, higher education, previous stroke, lower BMI and physical activity were common risk factors in MCI group. CONCLUSIONS: The prevalence of dementia and MCI was obtained much lower than previous reports. Dementia and MCI patients had common socioeconomic and medical risk factors. It is also important to control the risk factors earlier to prevent the increase of patients in dementia. And in order to prove the hypothesis that early control of the risk factors can decrease the occurrence of dementia, the further prospective studies are needed.

Multiple Territory Ischemic Stroke Aggravated by Severe Anemia

While acute anemia is regarded as a precipitating factor of ischemic stroke, there have been few reports on the evolution of infarction in the acute period of ischemic stroke by anemia. We describe a 71-year-old man with acute multiple territory infarction who had progressive neurologic deficits of paraparesis and dysarthria. This case suggests that sustained severe anemia due to intractable intestinal bleeding is an important cause of aggravation of ischemic stroke.

Fahr's Disease Presenting With Orofacial Dyskinesia

No abstract available.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Hyperfamiliarity for Unknown Faces Syndrome Following Encephalitis

Hyperfamiliarity for unknown faces (HFUF) is a rare disorder in which unfamiliar faces seem familiar. We report one case of HFUF syndrome. A 34-year-old woman was admitted as encephalitis with seizure. She repeatedly reported to her husband that all faces around her looked familiar. Our case supports the studies that show a differential contribution of two hemispheres in face recognition. Here we report this case for the first time in Korea.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy / 대한간질학회지

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Hypertensive Brainstem Encephalopathy with Atypical Supratentorial Involvement / 대한뇌졸중학회지

Hypertensive brainstem encephalopathy (HBE) is a variant of hypertensive encephalopathy characterized by brainstem and cerebellar involvement. Simultaneous supratentorial involvement in HBE is rarely reported as a vasogenic edema in subcortex and/or periventricular white matter. A 36-year-old woman visited hospital due to headache lasting 7 days before admission. Initial blood pressure was 270/170mmHg. T2-weighted and fluid-attenuated inversion recovery magnetic resonance imaging revealed multifocal high signal intensity lesions in upper medulla, pons, midbrain and cerebellar hemisphere. Especially, atypical periventricular lesions were shown as perpendicular fingers to the lateral ventricle like multiple sclerosis. Her clinical symptoms and radiological lesions were subsided with lowering blood pressure. We herein report a HBE with unusual supratentorial involvement mimicking multiple sclerosis.

The Characteristics of Capgras Syndrome in Patients Diagnosed as Probable Alzheimer Disease

OBJECTIVE: We assessed the characteristics of Capgras syndrome in patients diagnosed as probable Alzheimer disease, and compared the clinical and imaging findings with other previous reports. METHODS: We obtained medical records of patients with Capgras syndrome diagnosed as probable Alzheimer disease in three hospitals from March 2009 to March 2010. The basic characteristics, neuropsychologic tests, brain imaging data were investigated. RESULTS: The mean age of the patients was 74.7 years old and all of the patients experienced this syndrome in relation to a spouse. Brain magnetic resonance imaging showed mild-to-moderate global atrophy, variable hippocampal atrophy in this study. The Mini-Mental State Examination mean scores were 18.78 and clinical dementia rating scores were from 1 to 2. All of the patients took medicine of acetycholine esterase inhibitors and two patients recovered with antipsychotic medication. Five patients had showed continuous Capgras syndrome, at the last follow-up day, for a year. CONCLUSION: Capgras syndrome patients in this study who were diagnosed as probable Alzheimer disease showed similar results to the individuals from other reports. More study is needed to estimate the numbers and characteristics of patients with this syndrome.

A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram

BACKGROUND: Under certain conditions, exertional headaches may reflect coronary ischemia. CASE REPORT: A 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine provocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic effect of continuous electrocardiography changes. The patient's headache disappeared following intra-arterial nitroglycerine injection. CONCLUSIONS: A coronary angiogram with provocation study revealed variant angina and cardiac cephalalgia, as per the International Classification of Headache Disorders (code 10.6). We report herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm following an acetylcholine provocation test.

Influence of Chronic Kidney Disease on Mortality After Acute Ischemic Stroke

BACKGROUND: Chronic kidney disease (CKD) is known to be associated with atherosclerosis and silent small-vessel occlusion, but there is scant information regarding the association between CKD and acute stroke. The aim of this study was to establish whether CKD influences the outcome and mortality rate after acute ischemic stroke. METHODS: From January 2005 to June 2008, patients with CKD and with normal kidney function were identified from the entire population of patients presenting with acute ischemic strokes at Soonchunhyang university hospital. We analyzed the baseline demographics, risk factors, stroke severity, functional outcome, mortality rate, and the prognostic factors affecting mortality in the two groups, and investigated the causes of death. RESULTS: Totals of 541 patients with normal kidney function (age 67.0/12.6 years; mean/SD) and 66 patients with CKD (age 70.8/11.9 years) were recruited. Hypertension and diabetes were more prevalent in the CKD group. National Institutes of Health Stroke Survey scores at admission (8.3/8.5 vs 5.5/6.0, p=0.001) and Modified Rankin Scale (mRS) scores at discharge (2.32/1.5 vs 1.92/1.5, p=0.067) were higher in the CKD group than in that with normal kidney function. Patients with CKD had a higher case-fatality rate (median survival time 13.9/13.6 months) than those without CKD (median survival time 19.2/13.2 months) and CKD was an independent prognostic factor for mortality after acute ischemic stroke. Cox proportional hazard analysis leukocytosis (hazard ratio, HR=4.46; 95% confidence interval, CI=1.28-15.52), high cardioembolic risk (HR=7.68; 95% CI=1.59-37.08), and poor (mRS> or =3) functional outcome at discharge (HR=8.67, 95% CI=2.19-34.33) were significant influencing factors on mortality in the CKD group. CONCLUSIONS: Compared with the normal kidney function condition, CKD is associated with a higher mortality after acute ischemic stroke. Leukocytosis, high cardioembolic risk, and poor functional outcome may be important prognostic factors of mortality from acute ischemic stroke with CKD.