Dementia Epidemiology Fact Sheet 2022

This dementia epidemiology fact sheet 2022 is aimed at providing an overview of the epidemiology of dementia in Korea using representative government-led data. This review summarizes the prevalence and incidence of this condition using various types of data. The prevalence and incidence of dementia have increased and are predicted to continue to do so. This information will be utilized by public health officials, healthcare professionals, and policymakers to develop strategies for dementia rehabilitation and prevention.

The Korean Version of the Fugl-Meyer Assessment: Reliability and Validity Evaluation

Objective@#To systematically translate the Fugl-Meyer Assessment (FMA) into a Korean version of the FMA (K-FMA). @*Methods@#We translated the original FMA into the Korean version with three translators and a translation committee, which included physiatrists, physical therapists, and occupational therapists. Based on a test-retest method, each of 31 patients with stroke was assessed by two evaluators twice, once on recruitment, and again after a week. Analysis of intra- and inter-rater reliabilities was performed using the intra-class correlation coefficient, whereas validity was analysed using Pearson correlation test along with the Motricity Index (MI), Motor Assessment Scale (MAS), and Berg Balance Scale (BBS). @*Results@#The intra- and inter-rater reliabilities were significant for the total score, and good to excellent reliability was noted in all domains except for the joint range of motion of the lower extremity domain of the K-FMA. The MI and MAS scores were significantly correlated with all domains, all with p<0.01. The results for the MI ranged from r=0.639 to r=0.891 and those for the MAS from r=0.339 to r=0.555. However, the BBS was not significantly correlated with any domain, as the K-FMA lacks balance evaluation items. @*Conclusion@#The K-FMA was found to have high reliability and validity. Additionally, the newly developed manual for the K-FMA may help minimise errors that can occur during evaluation and improve the reliability of motor function evaluation.

The Korean Version of the Fugl-Meyer Assessment: Reliability and Validity Evaluation

Objective@#To systematically translate the Fugl-Meyer Assessment (FMA) into a Korean version of the FMA (K-FMA). @*Methods@#We translated the original FMA into the Korean version with three translators and a translation committee, which included physiatrists, physical therapists, and occupational therapists. Based on a test-retest method, each of 31 patients with stroke was assessed by two evaluators twice, once on recruitment, and again after a week. Analysis of intra- and inter-rater reliabilities was performed using the intra-class correlation coefficient, whereas validity was analysed using Pearson correlation test along with the Motricity Index (MI), Motor Assessment Scale (MAS), and Berg Balance Scale (BBS). @*Results@#The intra- and inter-rater reliabilities were significant for the total score, and good to excellent reliability was noted in all domains except for the joint range of motion of the lower extremity domain of the K-FMA. The MI and MAS scores were significantly correlated with all domains, all with p<0.01. The results for the MI ranged from r=0.639 to r=0.891 and those for the MAS from r=0.339 to r=0.555. However, the BBS was not significantly correlated with any domain, as the K-FMA lacks balance evaluation items. @*Conclusion@#The K-FMA was found to have high reliability and validity. Additionally, the newly developed manual for the K-FMA may help minimise errors that can occur during evaluation and improve the reliability of motor function evaluation.

Korean Version of the Stroke Rehabilitation Motivation Scale: Reliability and Validity Evaluation

Objective@#To translate the Stroke Rehabilitation Motivation Scale (SRMS), developed to evaluate the motivation level of stroke patients during rehabilitation, into the Korean language and to verify the reliability and validity of the Korean version of SRMS (K-SRMS). @*Methods@#The K-SRMS was developed following a structured process that included translation, verification, compromise assessment, reverse translation, feedback, and final correction. K-SRMS reliability was evaluated by performing internal consistency and test–retest analyses. The reliability test was conducted in 50 stroke patients. Its validity was assessed by comparing the K-SRMS with the scale and performing exploratory factor analysis. The validity test was conducted in 102 stroke patients. @*Results@#The test–retest analysis showed good reliability, and the internal consistency of the K-SRMS was similar to that of the original version for all, except 4, items. Thus, these 4 items were excluded, and then the validity test was conducted. Pearson correlation analysis demonstrated that the K-SRMS score was significantly correlated with the BAS total score (Pearson r=0.207, p<0.05). In the exploratory factor analysis, K-SRMS items were categorized into 7 groups (factors), and factors 1 and 4 showed mutual concordance with K-SRMS subscales, including intrinsic motivation factors and amotivation, respectively. @*Conclusion@#The newly developed K-SRMS showed good reliability and validity. It could also be used as a tool to objectify the degree of motivation for rehabilitation among stroke patients in clinical care and research.

Ultrasound-Guided Botulinum Toxin Injection with Factor VIII Administration for Post Stroke Spasticity in a Hemophilia A Patient

Chemodenervation with botulinum toxin (BTX) has been recommended for focal spasticity. BTX injection should be performed with caution in patients with bleeding disorders and/or receiving anticoagulation therapy. We present a case of BTX injection for post-stroke spasticity in a patient with hemophilia A who could not take oral spasmolytics due to chronic hepatitis C. To minimize the bleeding risk, we replaced factor VIII intravenously in accordance with the World Federation of Hemophilia guidelines for minor surgery. FVIII (3,000 IU) was administered 15 minutes before BTX injection. One day later, 2,000 IU was administered, and 2 days later, another 2,000 IU was administered. We performed the real-time Ultrasound-guided BTX injection three times, then spasticity and upper extremity function improved without adverse events. BTX injection can be considered as a treatment option for spasticity among patients with hemophilia.

Anatomical Correlates of Neuropsychological Deficits Among Patients With the Cerebellar Stroke

OBJECTIVE: To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. METHODS: We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. RESULTS: Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of 54.8±16.6 years were assessed 8.8±9.2 months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score < 0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <−1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. CONCLUSION: The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

Anatomical Correlates of Neuropsychological Deficits Among Patients With the Cerebellar Stroke

OBJECTIVE: To investigate the anatomical correlates of the neuropsychological deficits in patients with the cerebellar stroke. METHODS: We screened patients who were admitted to the National Rehabilitation Center with the cerebellar stroke between October 2012 and November 2016. The patients with the cerebellar stroke who underwent neuropsychological testing for which the Seoul Neuropsychological Screening Battery (SNSB) or the SNSB-II were enrolled. The neuropsychological function capacities were compared in accordance with the stroke type (hemorrhagic vs. ischemic) and the location (right/left anterior, right/left posterior intermediate, right/left posterior lateral lobe, and vermis). Mean z-scores were computed to compare the patient performances with the population averages. RESULTS: Twenty-six patients (15 with ischemic stroke and 11 with hemorrhagic stroke) with a mean age of 54.8±16.6 years were assessed 8.8±9.2 months after the stroke. Differences in the neuropsychological functioning according to the stroke type were not observed. All of the numerical subtests of the stroke patients showed significantly poorer performances compared with the population averages (mean z-score < 0), and some of the subtests revealed abnormal performances in attention-, visuospatial function-, memory-, and frontal/executive function-related tasks (mean z-score <−1). The patients with the presence of a lesion in the right posterior intermediate lobe of the cerebellum showed a poorer performance in the subtests evaluating the executive function including the Korean-version Stroop Test (p=0.04), the Digit Symbol Coding Test (p=0.01), and the Korean-version Trail Making Test (p=0.02) compared with the patients without that lesion. CONCLUSION: The present study confirms that the cerebellar stroke affects the neuropsychological functioning which is associated with the anatomical site of stroke.

Stroke Impact Scale 3.0: Reliability and Validity Evaluation of the Korean Version

OBJECTIVE: To establish the reliability and validity the Korean version of the Stroke Impact Scale (K-SIS) 3.0. METHODS: A total of 70 post-stroke patients were enrolled. All subjects were evaluated for general characteristics, Mini-Mental State Examination (MMSE), the National Institutes of Health Stroke Scale (NIHSS), Modified Barthel Index, Hospital Anxiety and Depression Scale (HADS). The SF-36 and K-SIS 3.0 assessed their health-related quality of life. Statistical analysis after evaluation, determined the reliability and validity of the K-SIS 3.0. RESULTS: A total of 70 patients (mean age, 54.97 years) participated in this study. Internal consistency of the SIS 3.0 (Cronbach's alpha) was obtained, and all domains had good co-efficiency, with threshold above 0.70. Test-retest reliability of SIS 3.0 required correlation (Spearman's rho) of the same domain scores obtained on the first and second assessments. Results were above 0.5, with the exception of social participation and mobility. Concurrent validity of K-SIS 3.0 was assessed using the SF-36, and other scales with the same or similar domains. Each domain of K-SIS 3.0 had a positive correlation with corresponding similar domain of SF-36 and other scales (HADS, MMSE, and NIHSS). CONCLUSION: The newly developed K-SIS 3.0 showed high inter-intra reliability and test-retest reliabilities, together with high concurrent validity with the original and various other scales, for patients with stroke. K-SIS 3.0 can therefore be used for stroke patients, to assess their health-related quality of life and treatment efficacy.

Complex Regional Pain Syndrome Type I after Stroke

Complex regional pain syndrome (CRPS) is a chronic painful, limb-confined condition with autonomic and inflammatory characteristics. Although the exact cause is still poorly understood, facilitated neurogenic inflammation, pathologic sympathetic-afferent coupling, and maladaptive neuroplasticity of CNS are suggested as major pathophysiology of CRPS. While acute CRPS may resolve with good prognosis, chronic CRPS is likely to continue painful condition, thus it is recommended to start early management with comprehensive, multidisciplinary intervention including physical and occupational therapy. It still lacks of studies regarding CRPS after stroke which applied new diagnostic criteria, although it was established in the year of 2004. Therefore, further researches are needed regarding the CRPS after stroke using new diagnostic criteria.

Factors Affecting Radiation Exposure during Lumbar Epidural Steroid Injection: A Prospective Study in 759 Patients

OBJECTIVE: To estimate and compare radiation exposure and intervention time during lumbar epidural steroid injection (ESI) 1) under different practitioners and methods with continuous fluoroscopic monitoring, and 2) under one practitioner with different methods and monitoring. MATERIALS AND METHODS: We consecutively recruited 804 patients who underwent lumbar ESI and 759 patients who underwent 922 interventions were included for analysis in this investigation. Three different practitioners (a senior faculty member, junior faculty member, trainee) performed lumbar ESI using different methods (caudal, interlaminar, transforaminal). The senior faculty member performed lumbar ESI under two different methods of fluoroscopic monitoring (continuous [CM] and intermittent monitoring [IM]). The dose area product (DAP) fluoroscopy time, and intervention time during lumbar ESI were compared for 1) ESI methods and practitioners under CM, and 2) ESI methods and monitoring. RESULTS: With CM, interaction between the effects of the practitioner and the intervention on DAP was significant (p < 0.001), but not fluoroscopy time (p = 0.672) or intervention time (p = 0.852). The significant main effects included the practitioner and intervention on DAP, fluoroscopy time, and intervention time with CM (p < 0.001). DAPs and fluoroscopy time for caudal, interlaminar, and transforaminal ESI were higher with CM than with IM (p < 0.001). Intervention time did not differ between CM and IM. CONCLUSION: Radiation exposure is dependent on the practitioners and methods and within the established safety limits during lumbar ESIs under CM. With an experienced practitioner, IM leads to less radiation exposure than CM.

Botulinum Toxin A Injection into the Subscapularis Muscle to Treat Intractable Hemiplegic Shoulder Pain

OBJECTIVE: To evaluate the beneficial effect of botulinum toxin A (Botox) injection into the subscapularis muscle on intractable hemiplegic shoulder pain. METHODS: Six stroke patients with intractable hemiplegic shoulder pain were included. Botulinum toxin A was injected into the subscapularis muscle. Intractable hemiplegic shoulder pain was evaluated using an 11-point numerical rating scale. Pain-free range of motion was assessed for shoulder abduction and external rotation. The spasticity of the shoulder internal rotator was measured using the modified Ashworth scale. Assessments were carried out at baseline and at 1, 2, 4, and, if possible, 8 weeks. RESULTS: Intractable hemiplegic shoulder pain was improved (p=0.004) after botulinum toxin injection into the subscapularis muscle. Restricted shoulder abduction (p=0.003), external rotation (p=0.005), and spasticity of the shoulder internal rotator (p=0.005) were also improved. Improved hemiplegic shoulder pain was correlated with improved shoulder abduction (r=–1.0, p<0.001), external rotation (r=–1.0, p<0.001), and spasticity of the internal rotator (r=1.0, p<0.001). CONCLUSION: Botulinum toxin A injection into the subscapularis muscle appears to be valuable in the management of intractable hemiplegic shoulder pain.

Paroxysmal Autonomic Instability With Dystonia Managed Using Chemodenervation Including Alcohol Neurolysis and Botulinum Toxin Type A Injection: A Case Report

Paroxysmal autonomic instability with dystonia (PAID) is a rare complication of brain injury. Symptoms of PAID include diaphoresis, hyperthermia, hypertension, tachycardia, and tachypnea accompanied by hypertonic movement. Herein, we present the case of a 44-year-old female patient, who was diagnosed with paraneoplastic limbic encephalopathy caused by thyroid papillary cancer. The patient exhibited all the symptoms of PAID. On the basis that the symptoms were unresponsive to antispastic medication and her liver function test was elevated, we performed alcohol neurolysis of the musculocutaneous nerve followed by botulinum toxin type A (BNT-A) injection into the biceps brachii and brachialis. Unstable vital signs and hypertonia were relieved after chemodenervation. Accordingly, alcohol neurolysis and BNT-A injection are proposed as a treatment option for intractable PAID.

Effect of Ultrasonography-Guided Botulinum Toxin Type A Injection in Holmes' Tremor Secondary to Pontine Hemorrhage: Case Report

Holmes' tremor is a low-frequency rest and intentional tremor secondary to various insults, including cerebral ischemia, hemorrhage, trauma, or neoplasm. Pharmacologic treatment is usually unsuccessful, and some cases require surgical intervention. We report a rare case of Holmes' tremor secondary to left pontine hemorrhage in a 29-year-old Asian male patient who developed 1.6-Hz postural and rest tremor of the right hand. He responded markedly to ultrasonography-guided botulinum toxin type A injection. To our knowledge, this is the first report of Homes' tremor treated with ultrasonography-guided botulinum toxin type A injection with favorable results.

Prosody Processing of Korean Language in Stroke Patients: A Preliminary Study

OBJECTIVE: To investigate the hemispheric contributions to prosody recognitions and interference effects of semantic processing on prosody for stroke patients by using the Korean language. METHODS: Ten right hemisphere damaged patients (RHD), nine left hemisphere damaged patients (LHD), and eleven healthy controls (HC) participated. In pure prosody recognition task, four semantically neutral sentences were selected and presented in both sad and happy prosodies. In interference task, participants listened to emotionally intoned sentences in which the semantic contents were congruent or incongruent with prosody. Participants were asked to rate the valence of prosody while ignoring the semantic contents, and thus, reaction time and accuracy were estimated. RESULTS: In pure prosody recognition task, RHD showed low accuracy as compared to HC (p=0.013), and the tendency of group response showed that RHD performed worse than HC and LHD with regards to accuracy and reaction time. In interference task, analysis of accuracy revealed a significant main effect of groups (p=0.04), and the tendency implied that RHD is less accurate as compared to LHD and HC. The RHD took longer reaction times than HC in congruent and incongruent items (p<0.001). CONCLUSION: Right hemispheric laterality to prosody processing of Korean language in stroke patients was observed. Interference effects of semantic contents to prosody processing were not observed, which suggested unique characteristics of prosody for Korean language. These results could be referred as preliminary data for future researches on Korean languages.

Effect of the Presence of Brain-Derived Neurotrophic Factor Val66Met Polymorphism on the Recovery in Patients With Acute Subcortical Stroke

OBJECTIVE: To investigate the effect of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on the recovery after subcortical stroke, using the modified Rankin Scale (mRS). METHODS: Subcortical stroke patients with copies of BDNF Val66Met polymorphism (n=7) were compared to their controls (n=7) without a copy of BDNF Val66Met polymorphism after matching for initial severity, location and type of stroke. The mRS scores at 1 and 3 months after discharge from the neurorehabilitation unit were compared between the groups. RESULTS: A repeated measures ANOVA for mRS revealed significant interaction between time and group (F(2, 24) =37.2, p<0.001) and a significant effect of time (F(2, 24)=10.8, p<0.001), thereby reflecting significant differences between the Met allele (+) group and the Met allele (-) group. There was a significant difference in mRS scores at 3 months post-discharge between the two groups (p=0.01) although no difference was evident in mRS scores at 1 month post-discharge between the two groups. There were significant improvements between mRS scores on admission and mRS scores at 1 month post-discharge (p=0.02), and between mRS scores at 1 month post-discharge and mRS scores at 3 months post-discharge (p=0.004) in the Met allele (-) group. CONCLUSION: BDNF Val66Met polymorphism may be associated with worse functional outcome in Korean patients with subcortical stroke. Therefore, BDNF Val66Met polymorphism should be considered as an important prognostic factor for recovery and responses to rehabilitation therapies after stroke in Korean patients. There is a need for developing different rehabilitation strategies for the population with BDNF Val66Met polymorphism. Further studies assessing different outcomes for various functional domains of stroke recovery are needed to clarify the role of BDNF Val66Met polymorphism.

Motor Learning: Basic Concept and Theories

Motor learning is defined as a relatively permanent change in the capability for skilled motor performance as a result of practice or experience. Neurorehabilitation is fundamentally a process of motor learning or re-learning with a disrupted neural network. There are many theory models to explain learning and performance. Recent studies demonstrate motor learning is associated with neuronal plasticity. In a viewpoint of motor learning, neurorehabilitation should be geared towards an active and task-specific treatment.

Clinical Outcomes after Peripheral Balloon Angioplasty or Stent Insertion in Patients with Peripheral Arterial Obstructive or Stenotic Disease

PURPOSE: Percutaneous peripheral balloon angioplasty and stent insertion are used for the treatment of peripheral arterial obstructions and stenosis. In this study, we assessed the efficacy of peripheral balloon angioplasty and stent insertion in patients with peripheral arterial disease. METHOD: We performed a retrospective review of patients who underwent peripheral balloon angioplasty or stent insertion in obstructive or stenotic peripheral arterial lesions between July 2003 and November 2006. Follow-up study was performed using lower extremity multi-directional computed tomography (MDCT) or lower extremity angiography. Mean follow-up was 22.8 months. RESULT: A total of 30 patients (47 lesions) were treated. The mean age was 66.8 years, and the ratio of male to female patients was 29 to 1. Calf claudication was the most common chief complaint, and 19 patients had hypertension. Obstructive lesions were found in the common iliac artery (CIA) (18), external iliac artery (EIA) (11), superficial femoral artery (SFA) (15), and anterior tibial artery (ATA) (3). Peripheral balloon angioplasty was performed for 8 lesions, and stent insertion was performed for 39 lesions. Re-stenosis occurred in 9 lesions (3 in the CIA, 5 in the SFA, 1 in the ATA) during follow-up. CONCLUSION: Peripheral balloon angioplasty and stent insertion are useful modalities for the treatment of obstruction or stenosis in lower extremity peripheral arteries. Close follow-up is necessary to improve long-term outcomes.

Analysis of Korean Internet Sites for 'Degenerative Osteoarthritis'

OBJECTIVE: To analyze and evaluate the quality of the Korean web sites of medical information about degenerative osteoarthritis. METHOD: The search term 'degenerative osteoarthritis' was entered into five popular Korean web search engines. The web sites for the first 20 matches generated by each search engine were grouped by author and evaluated by DISCERN instrument, certification standard of internet health information by Korean Academy of Medical Sciences (KAMS instrument), and guidelines and items for evaluation of internet health information by Chung and Park (Chung & Park Instrument). RESULTS: Of the 100 sites identified, only 44 were unique and included in the analysis. Eight sites were commercial and each 21, 5, 3, 7 sites were authored by physician, public institute, oriental medical doctor and others, respectively. By DISCERN instrument, there was a significant difference in total score, reliability of publication and overall quality rating. By KAMS instrument, there was a significant difference in total score, reliability, and content. By Chung & Park instrument, there was a significant difference in total score, objectivity, accuracy, credibility and authority. CONCLUSION: The quality of degenerative osteorarthritis information on the internet varied greatly. Web sites authored by public institutes and physicians were ranked higher than others.

The Comparison of the Peak Plantar Pressure according to Wedge Type in Osteoarthritis Patients

OBJECTIVE: This study was designed to investigate the effect of lateral wedged insole on foot of osteoarthritis patients. METHOD: 11 osteoarthritis patients participated in this study. Plantar peak pressures in shoes were measured by pedar(R) during a comfortable gait in three conditions (no wedge, with 5 degree wedged insole and with 10 degree wedged insole). Plantar pressure was analyzed by pedar C-expert program at TO (whole foot), M1 (medial heel), M2 (lateral heel), M3 (medial midfoot), M4 (lateral midfoot), M5 (1st, 2nd metatarsal area), M6 (3rd, 4th, 5th metatarsal area), M7 (great toe), M8 (2nd, 3rd toe area), M9 (4th, 5th toe area) zones respectively. RESULTS: There were significant differences in peak plantar pressures of whole foot, heel zone, and lateral midfoot zone according to wedge type. But there was no significant difference in peak plantar pressures at medial midfoot zone and forefoot zone according to wedge type. CONCLUSION: There were difference in peak plantar pressures of osteoarthritis patients according to wedge type.

Postural Sway and Limb Load Asymmetry in the Rural Inhabitants in Korea

OBJECTIVE: To evaluate the effects of age, height, weight, body mass index (BMI), diabetes mellitus, osteoporosis, smoking and alcohol on postural sway (PS) and limb load asymmetry (LLA) in the rural inhabitants in Korea METHOD: Nine hundred and sixty inhabitants were included in this study. PS and LLA were recorded while the subjects were standing on two adjacent force platforms (Mediance(R); Human-Tech Inc, Korea) in a comfortable stance for 30 seconds. Bone mineral density was measured in the right calcaneus by ultrasonography (Sahara(R); Hologic Inc, USA). History of diabetes and smoking were taken through interview. RESULTS: PS and LLA were correlated with age (p<0.01). There were significant decreases in PS and LLA in the young age-group (p<0.01). There was no significant difference in PS and LLA in terms of sex, osteoporosis, height, weight, BMI and smoking. There was a significant difference in LLA (p<0.05) but no difference in PS between diabetic and normal groups. CONCLUSION: PS and LLA may be related with ageing. Diabetic group may have higher LLA than normal group. However, sex, osteoporosis, height, weight, BMI, and smoking may not affect on PS and LLA.