Cognitive and Language Function in Aphasic Patients Assessed With the Korean Version of Mini-Mental Status Examination

OBJECTIVE: To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients. METHODS: Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters. RESULTS: All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group. CONCLUSION: Among subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function.

Correlates of Bone Mineral Density and Sagittal Spinal Balance in the Aged

OBJECTIVE: To investigate the relationship between bone mineral density (BMD) and sagittal spinal balance in the Korean elderly population. METHODS: The retrospective study included subjects aged 60 years and above, who had whole-spine lateral radiography and dual-energy X-ray absorptiometry (DEXA) within a year's gap between each other. Sagittal vertical axis (SVA) for evaluation of sagittal spinal balance and five spinopelvic parameters were measured through radiography. The presence of compression fracture was identified. Correlations of BMD T-scores with SVA and with the spinopelvic parameters were assessed using Pearson correlation coefficient (PCC). Linear regression analyses were performed between SVA and the clinical and radiologic variables. RESULTS: One hundred twenty-two subjects (42 males and 80 females; mean age, 69.93+/-5.5 years) were included in the study. BMD, femur or spine, was not correlated with SVA or any spinopelvic parameters in both genders (PCC<+/-0.2), except that spine BMD in men was associated with sacral slope. Univariate regression analysis revealed association between SVA and lumbar lordosis, pelvic tilt, and compression fractures in both genders; it was also associated with age and pelvic incidence in females and with sacral slope in males. Multivariate linear regression model showed lumbar lordosis and compression fracture as variables affecting SVA in both sexes; pelvic incidence was another factor affecting SVA in women only. CONCLUSION: BMD was not associated with sagittal spinal balance in the aged. Sagittal spinal balance was explained partly by lumbar lordosis and compression fracture. Further study is warranted to understand progression of sagittal imbalance with age.

Rotator Cuff Tear in Patients with Adhesive Capsulitis of Shoulders / 대한스포츠의학회지

To examine the association between adhesive capsulitis of shoulders and rotator cuff tears determined by ultrasonographic findings. Total 49 consecutive patients were diagnosed as adhesive capsulitis by physical examination and simple radiologic evaluation. Shoulder ultrasonographies were done for them. For 20 subjects, the sensitivity and the specificity of the empty can test for supraspinatus tear were measured. Among 49 subjects, 49.0% (n=24) had rotator cuff tears. The empty can test exhibited the sensitivity of 55.6% and the specificity of 81.8% for the supraspinatus tear. The physical examination of empty can test was not sufficient for the screening of supraspinatus tear. So the radiologic evaluation, for example ultrasonography, may be needed in the diagnosis of rotator cuff tear in adhesive capsulitis patients.

Comparison of the Hyoid Movement during the Pharyngolaryngeal Swallowing at the Healthy Young and Old Person

OBJECTIVE: To compare the movement pattern of the hyoid during the pharyngeal swallowing between healthy young and old person through the motion analysis using the videofluoroscopic study. METHOD: Eight young and eight old volunteers without dysphagia were included in this study. Movement patterns of the hyoid (degree of anterior and superior displacement, the speed, trajectory and temporal speed curve of the hyoid) were analyzed through the videofluoroscopy and the motion analysis system. RESULTS: The maximal anterior displacement and the maximal speed of the hyoid were decreased in the old group compared with the young. The trajectories of the young and old group showed asymmetrical pathway (returning pathway was different from the departing one). All groups showed two speed peaks at the temporal curve but the peaks at the old group were blunted. CONCLUSION: Decrease of the maximal anterior movement and the peak speed of the hyoid during the pharyngeal swallowing was found in the old group. It may be due to decrease in the contraction speed of the muscles related to the hyoid movement and elasticity of the laryngeal wall according to the aging.

Nicotinamide Reduces the Infarct Volume in a Rat Model of Transient Middle Cerebral Artery Occlusion

BACKGROUND: Cerebral ischemia depletes ATP and causes irreversible tissue injury. Nicotinamide is a precursor of NAD+ and it is also a poly (ADP-ribose) polymerase (PARP) inhibitor that increases the neuronal ATP concentration and so protects against stroke. Therefore we examined whether nicotinamide could protect against cerebral ischemia by using a model of transient middle cerebral artery occlusion (MCAO) (reperfusion 2 h post ischemia) in Sprague-Dawley rats. METHODS: Nicotinamide (500 mg/kg) or normal saline was administered intraperitoneally 24 and 0 h before and after MCAO, respectively. The infarction volumes were determined with triphenyltetrazolium chloride staining 24 h after reperfusion. The nitrotyrosine, PAR polymer and PARP-1 expressions were examined by immunohistochemistry with using brain slices obtained from the rats that were sacrificed at 0, 15, 30, 60 and 120 min after reperfusion. RESULTS: The infarction volumes were significantly attenuated (21.8%, p<0.05). The nitrotyrosine expressions were increased at 0, 15 and 30 min, and those expressions for PARP polymer and PARP-1 were increased at 60 and 120 min, respectively. Nicotinamide partly reduced the expressions for nitrotyrosine and PAR polymer except for PARP-1. CONCLUSIONS: These results suggest that nicotinamide may attenuate ischemic brain injury through its antioxidant activity and the inhibition of PARP-1.

Investigation of the Swallowing Parameters Related to the Aspiration Risk in the Elderly over 65 Years Old

BACKGROUND: To investigate the swallowing parameters which are related to the subglottic aspiration or supraglottic penetration when 2 cc or 5cc fluid swallowing through the fluoroscopic study METHODS: Fluoroscopic studies (2 cc or 5 cc barium-diluted fluid study) were done in 107 patients clinically suspicious of aspiration. Six oral/pharyngeal parameters (drooling, oral hesitancy, premature bolus loss, delayed epiglottic closure, vallecular residue and pyriform sinus residue) were analyzed whether correlated with the aspiration or penetration. They were also analyzed whether to have the correlation between each other. RESULTS: Degree of pyriform sinus residue and delayed epiglottic closure were correlated with the aspiration (p<0.05). No swallowing parameters had correlation with each other except the relation between the premature bolus loss and the pyriform sinus residue. CONCLUSION: Pyriform sinus residue and delayed epiglottic closure were important parameters to correlate with the aspiration risk in the elderly suspicious of aspiration. They can also be used to judge the aspiration risk when an elderly person swallow the food material.

Effect of Treatment after Stimulation of Suprahyoid Muscle in Geriatric Patients with Pharyngeal Dysphagia

Electrical stimulation is recently rising as a treatment protocol of dysphagia. The mechanism is known to induce the pharyngeal reflex to stimulate the sensory nerve around the neck. However, elevation of the hyoid and pharynx to stimulate the suprahyoid muscles (esp. mylohyoid muscle) is thought to be more beneficial. We presented 3 cases to improve the dysphagia after stimulation of the suprahyoid muscles to elevate the hyoid and pharynx similar to the normal swallowing during 4 weeks.

Validation of Clinical Dysphagia Scale: Based on Videofluoroscopic Swallowing Study

OBJECTIVE: Dysphagia is one of the important determinants of the prognosis for various diseases. Clinical dysphagia scale (CDS) was developed to screen dysphagia after stroke. We aimed to reevaluate this scale with comparison to the videofluoroscopic swallowing study (VFSS) findings. METHOD: Retrospective chart reviews were completed on 677 dysphagic patients undergoing the VFSS from July 2000 to January 2004. CDS was evaluated by a physiatrist before the VFSS. Functional dysphagia scale, new VFSS scale, and American Speech-Language-Hearing Association National Outcome Measurement System swallowing scale (ASHA NOMS scale) were evaluated based on the VFSS. The correlations between CDS and these VFSS scales were studied. In 118 patients, followed up for more than 6 months, the initial CDS were analysed with the follow-up VFSS findings. RESULTS: CDS was correlated with the VFSS findings and also correlated in disease groups other than stroke (p<0.05). CDS was different significantly between the aspiration, penetration, and normal group classified on the simultaneous VFSS but not on the VFSS after more than 6 months (p= 0.102). CONCLUSION: We confirmed that CDS was a quantitative clinical tool responding the VFSS findings well and was adoptable to any dysphagic patients irrespective of the causal disorders.

Central Cord Syndrome Developed in Patients with Ossification of the Posterior Longitudinal Ligament: Clinical Features and Functional Outcomes

OBJECTIVE: Ossification of the posterior longitudinal ligament (OPLL) is a degenerative disorder of the spine which is related to cervical compressive myelopathy. We studied patients with central cord syndrome (CCS) to explore the implication of OPLL on clinical features and functional outcomes of CCS. METHOD: A retrospective study was conducted on 26 patients with CCS between 1998 and 2003. Demographic characteristics, mechanisms of injury, neurological impairments, main functional outcomes, and complications were identified. Clinical features and outcomes were compared between OPLL and non-OPLL group. RESULTS: Twenty patients with CCS had OPLL (12/17 with traumatic and 8/9 with non-traumatic CCS). The initial ASIA motor score of OPLL and non-OPLL patients was 67.8 and 65.3 and, at discharge, 82.8 and 78.5. There were no significant differences in gait, bladder management, length of stay, discharge disposition, and major complications between OPLL and non-OPLL group. Among OPLL patients, non- traumatic CCS patients showed higher ASIA motor score at discharge and had a tendency of better functional outcome than traumatic CCS patients. CONCLUSION: OPLL was commonly observed in CCS patients. Mechanism of injury rather than the presence of OPLL was a significant determinant of clinical features or functional outcomes of CCS.

A Case of Recurrent Transverse Myelitis in an Eighty Year Old Woman

An eighty year old woman was admitted at our hospital diagnosed as a cervical transverse myelitis at a previous hospital. She had a sudden weakness of right upper extremity and left lower extremity 2 months after admission. She received magnetic resonance imaging of brain and spinal cord and cerebrospinal fluid examination and was diagnosed as a recurrent transverse myelitis and midbrain infarction. After a steroid treatment, the weakness of extremities was improved.

A Case of Recurrent Transverse Myelitis in an Eighty Year Old Woman

An eighty year old woman was admitted at our hospital diagnosed as a cervical transverse myelitis at a previous hospital. She had a sudden weakness of right upper extremity and left lower extremity 2 months after admission. She received magnetic resonance imaging of brain and spinal cord and cerebrospinal fluid examination and was diagnosed as a recurrent transverse myelitis and midbrain infarction. After a steroid treatment, the weakness of extremities was improved.