Clinical Practice Guideline for Dementia (Diagnosis and Evaluation):2021 Revised Edition

no abstract available.

Added Value of Chemical Exchange-Dependent Saturation Transfer MRI for the Diagnosis of Dementia

Objective@#Chemical exchange-dependent saturation transfer (CEST) MRI is sensitive for detecting solid-like proteins and may detect changes in the levels of mobile proteins and peptides in tissues. The objective of this study was to evaluate the characteristics of chemical exchange proton pools using the CEST MRI technique in patients with dementia. @*Materials and Methods@#Our institutional review board approved this cross-sectional prospective study and informed consent was obtained from all participants. This study included 41 subjects (19 with dementia and 22 without dementia). Complete CEST data of the brain were obtained using a three-dimensional gradient and spin-echo sequence to map CEST indices, such as amide, amine, hydroxyl, and magnetization transfer ratio asymmetry (MTR asym) values, using six-pool Lorentzian fitting. Statistical analyses of CEST indices were performed to evaluate group comparisons, their correlations with gray matter volume (GMV) and Mini-Mental State Examination (MMSE) scores, and receiver operating characteristic (ROC) curves. @*Results@#Amine signals (0.029 for non-dementia, 0.046 for dementia, p = 0.011 at hippocampus) and MTR asym values at 3 ppm (0.748 for non-dementia, 1.138 for dementia, p = 0.022 at hippocampus), and 3.5 ppm (0.463 for non-dementia, 0.875 for dementia, p = 0.029 at hippocampus) were significantly higher in the dementia group than in the non-dementia group. Most CEST indices were not significantly correlated with GMV; however, except amide, most indices were significantly correlated with the MMSE scores. The classification power of most CEST indices was lower than that of GMV but adding one of the CEST indices in GMV improved the classification between the subject groups. The largest improvement was seen in the MTR asym values at 2 ppm in the anterior cingulate (area under the ROC curve = 0.981), with a sensitivity of 100 and a specificity of 90.91. @*Conclusion@#CEST MRI potentially allows noninvasive image alterations in the Alzheimer’s disease brain without injecting isotopes for monitoring different disease states and may provide a new imaging biomarker in the future.

Effect of abdominal binder after laparoscopic cholecystectomy on enhanced recovery: a randomized controlled trial

Purpose@#The purpose of this randomized controlled trial was to compare the effects of abdominal binder after laparoscopic cholecystectomy. @*Methods@#From August to December 2020, 66 patients who were set to undergo cholecystectomy were selected for a prospective trial at Kangbuk Samsung Hospital, Seoul, Republic of Korea, and their clinical characteristics and postoperative surgical outcomes were evaluated. Among 66 patients, 33 patients belong to the abdominal binder group and the other 33 patients belong to the control group. @*Results@#The average hospital stay was 2.46 ± 1.29 days, and was not significantly different between the two groups. The average postoperative pain score (visual analogue scale, 0–10) 12, 24, and 48 hours after surgery were not significantly different. However, the degree of comfort score was significantly higher for the control group patients (2.56 vs. 3.33, p < 0.001). Time to the first ambulation, walking ability, return of bowel function, time to full diet resumption, and the numbers of analgesics and antiemetics administered were not significantly different between the two groups. @*Conclusion@#No postoperative recovery benefit and no reduction in hospital stay was found in patients who used an abdominal binder while undergoing laparoscopic cholecystectomy. Statistically, between the group that used the binder and the one that did not, no significant differences in surgical outcome nor postoperative outcome were observed. The only exception was that the degree of comfort score was significantly higher in the control group. Therefore, in terms of patient benefit and convenience, wearing an abdominal binder after laparoscopic cholecystectomy is not recommended.

Effect of abdominal binder after laparoscopic cholecystectomy on enhanced recovery: a randomized controlled trial

Purpose@#The purpose of this randomized controlled trial was to compare the effects of abdominal binder after laparoscopic cholecystectomy. @*Methods@#From August to December 2020, 66 patients who were set to undergo cholecystectomy were selected for a prospective trial at Kangbuk Samsung Hospital, Seoul, Republic of Korea, and their clinical characteristics and postoperative surgical outcomes were evaluated. Among 66 patients, 33 patients belong to the abdominal binder group and the other 33 patients belong to the control group. @*Results@#The average hospital stay was 2.46 ± 1.29 days, and was not significantly different between the two groups. The average postoperative pain score (visual analogue scale, 0–10) 12, 24, and 48 hours after surgery were not significantly different. However, the degree of comfort score was significantly higher for the control group patients (2.56 vs. 3.33, p < 0.001). Time to the first ambulation, walking ability, return of bowel function, time to full diet resumption, and the numbers of analgesics and antiemetics administered were not significantly different between the two groups. @*Conclusion@#No postoperative recovery benefit and no reduction in hospital stay was found in patients who used an abdominal binder while undergoing laparoscopic cholecystectomy. Statistically, between the group that used the binder and the one that did not, no significant differences in surgical outcome nor postoperative outcome were observed. The only exception was that the degree of comfort score was significantly higher in the control group. Therefore, in terms of patient benefit and convenience, wearing an abdominal binder after laparoscopic cholecystectomy is not recommended.

Added Value of Chemical Exchange-Dependent Saturation Transfer MRI for the Diagnosis of Dementia

Objective@#Chemical exchange-dependent saturation transfer (CEST) MRI is sensitive for detecting solid-like proteins and may detect changes in the levels of mobile proteins and peptides in tissues. The objective of this study was to evaluate the characteristics of chemical exchange proton pools using the CEST MRI technique in patients with dementia. @*Materials and Methods@#Our institutional review board approved this cross-sectional prospective study and informed consent was obtained from all participants. This study included 41 subjects (19 with dementia and 22 without dementia). Complete CEST data of the brain were obtained using a three-dimensional gradient and spin-echo sequence to map CEST indices, such as amide, amine, hydroxyl, and magnetization transfer ratio asymmetry (MTR asym) values, using six-pool Lorentzian fitting. Statistical analyses of CEST indices were performed to evaluate group comparisons, their correlations with gray matter volume (GMV) and Mini-Mental State Examination (MMSE) scores, and receiver operating characteristic (ROC) curves. @*Results@#Amine signals (0.029 for non-dementia, 0.046 for dementia, p = 0.011 at hippocampus) and MTR asym values at 3 ppm (0.748 for non-dementia, 1.138 for dementia, p = 0.022 at hippocampus), and 3.5 ppm (0.463 for non-dementia, 0.875 for dementia, p = 0.029 at hippocampus) were significantly higher in the dementia group than in the non-dementia group. Most CEST indices were not significantly correlated with GMV; however, except amide, most indices were significantly correlated with the MMSE scores. The classification power of most CEST indices was lower than that of GMV but adding one of the CEST indices in GMV improved the classification between the subject groups. The largest improvement was seen in the MTR asym values at 2 ppm in the anterior cingulate (area under the ROC curve = 0.981), with a sensitivity of 100 and a specificity of 90.91. @*Conclusion@#CEST MRI potentially allows noninvasive image alterations in the Alzheimer’s disease brain without injecting isotopes for monitoring different disease states and may provide a new imaging biomarker in the future.

Central Neurocytoma Presenting as Symptomatic Cataplexy

Central neurocytomas are well-differentiated tumors and are typically found in intraventriculat lesion in adult. We report a rare case of central neurocytoma presenting as symptomatic cataplexy. A 50-year-old man visited our hospital due to repetitive drop down triggered by emotional changes and was diagnosed of central neurocytoma at right lateral ventricles and head of caudate nucleus. Alterations of striatal dopaminergic system in narcolepsy with cataplexy have been reported, but there are no reports associated with single lesion. This case suggests the striatal lesion plays a role in cataplexy.

Two Cases of Oculopharyngeal Muscular Dystrophy in Brothers with Ptosis and Eye Movement Disorder

Purpose@#To report two cases of early onset oculopharyngeal muscular dystrophy, which were suspected to be chronic progressive external ophthalmoplegia.Case summary: Case 1, a 15-year-old male and Case 2, a 13-year-old male brother, visited the clinic with persistent diplopia 6 years prior. The older brother’s best-corrected visual acuity was 0.6 in both eyes and showed an exodeviation of 25 prism diopters. Bilateral ptosis was observed with ocular muscle movement limitations in all directions, and bilateral macular edema was found on fundus examinations. The younger brother had a best-corrected visual acuity of 1.0 in both eyes and showed exodeviation of 45 prism diopters. Bilateral ptosis and ocular muscle movement limitations were also observed. Both patients were suspected to have chronic progressive external ophthalmoplegia and were referred to a neurologist for a neurological examination and muscle biopsy. The muscle biopsies showed that both patients were diagnosed with oculopharyngeal muscular dystrophy. @*Conclusions@#It is important, initially, to report a case of early onset oculopharyngeal muscular dystrophy that has eyelid and eye movement symptoms, but no other typical symptoms.

Clinical Characteristics of Non-Amnestic Mild Cognitive Impairment: A Single-Center Experience

BACKGROUND: To evaluate the clinical characteristics of patients with non-amnestic mild cognitive impairment (naMCI) in a memory disorder clinic at a single center. METHODS: A retrospective study was conducted involving 312 patients with naMCI from May 2011 to July 2018. Brain magnetic resonance imaging and detailed neuropsychological tests were performed in all patients. We used the proposed criteria for naMCI to classify the patients into single- and multiple-domain groups. We compared the baseline clinical characteristics, neuroimaging findings, and the rate of progression to dementia between these two groups. RESULTS: The 312 patients comprised 210 in the single-domain group (67.3%) and 102 in the multiple-domain group (32.7%). The mean age was significantly higher in the multiple-domain group than in the single-domain group. The years of education, mean Mini Mental State Examination score, and mean Clinical Dementia Rating Scale Sum of Boxes score were significantly lower in the multiple-domain group than in the single-domain group. The Z-scores of neuropsychological tests in most cognitive domains were significantly lower in the multiple-domain group than in the single-domain group. Compared to the single-domain group, the multiple-domain group showed more-severe medial temporal atrophy and contained a higher proportion of patients with moderate white-matter hyperintensities. Thirteen (8.4%) patients with naMCI progressed to dementia, most of who were diagnosed with Alzheimer's disease. CONCLUSIONS: We present a single-center experience of clinical characteristics in patients with naMCI. Close observation of the clinical profiles of patients with naMCI may help identify individuals at the greatest risk of dementia.

Factors Related to Sleep Time Underestimation in Obstructive Sleep Apnea: Retrospective Study Based on Polysomnographic Data

BACKGROUND: The perception of sleep time in obstructive sleep apnea (OSA) is not well understood, some studies have reported that subjects with OSA have abnormal sleep perception. We hypothesized that the severity of OSA would affect the sleep perception of patients with OSA and investigated the associated factors that affect the sleep perception in OSA. METHODS: Four hundred and sixty eight subjects with OSA were included in present study. Subjects with OSA were divided, depending upon their sleep perception. The first group included individuals who underestimated their time spent sleeping, the second group included those who did not underestimate their sleep time. The underestimation of sleep time is defined as the perceived total sleep time being less than 80% of that measured in polysomnography (PSG). All participants were analyzed their demographics, PSG parameter and questionnaires such as Beck Depression Inventory, Epworth Sleepiness Scale. RESULTS: Of 468 participants, 179 (38.2%) subjects were included in the group that underestimating sleep. Gender (female, odds ratio [OR]=2.01, 95% confidence interval [CI]=1.25–3.22), depression (OR=1.75, 95% CI=1.03–2.97) and proportion of slow wave sleep (OR=0.98, 95% CI=0.96–0.99) were related to the underestimation of sleep. CONCLUSIONS: The underestimation of sleep in OSA is not directly related to OSA severity. Gender, psychiatric disorder, and sleep architecture are associated with the underestimating sleep in OSA.

The Effect of Psychological Factors on Postoperative Pain in Gastric Tumor Patients after Endoscopic Submucosal Dissection / 정신신체의학

OBJECTIVES: Since pain in cancer patients is an important factor that greatly affects the quality of life and prognosis, many attempts have been actively made to reduce the pain. Despite continuous effort on reducing pain after Endoscopic submucosal dissection (ESD), research has not been done on psychological factors as much as on biological factors affecting pain. The objective of this study is to investigate the psychological factors affecting postoperative pain in gastric tumor patients who underwent gastric ESD. METHODS: 91 gastric tumor patients who visited National Health Service Ilsan Hospital in Korean between May 2015 and June 2016, and received ESD were evaluated. Baseline characteristics including sociodemographic factors, anxiety, depression, and resilience were evaluated before the procedure. Multivariate logistic regression was done to analyze factors affecting postoperative pain. RESULTS: The group with high postoperative pain showed lower alcohol consumption and higher depressive symptom scores than the group with low postoperative pain. Also, the group with high postoperative pain showed lower total resilience score with lower subtotal scores in self-control and positive item. Multivariate logistic regression analysis of the postoperative pain showed that patients with lower score in self-control of resilience [odd ratio (OR), 0.911 ; 95% CI, 0.854–0.971, p=0.004) reported more pain after ESD. CONCLUSIONS: This study showed that patients with lower self-control ability of resilience felt more pain after ESD. Among the psychological factors evaluated in this study, resilience of an individual seems to have effect on pain.

Effects of Banxia Xiexin Decoction () on Cisplatin-Induced Apoptosis of Human A549 Lung Cancer Cells / 中国结合医学杂志

<p><b>OBJECTIVE</b>To examinie the synergistic effects of Banxia Xiexin Decoction (, Known as Banhasasim-tang in Korean) extract (BXDE) on cisplatin-induced cytotoxicity in the A549 human lung cancer cell lines.</p><p><b>METHODS</b>A549 cells were treated with varying concentrations (50-200 μg/mL) of cisplatin and BXDE alone or in combination for 96 h. We used 1-(4,5-dimethylthiazol-2-yl)-3,5-diphenylformazan assay and flow cytometry to analyze cell viability and apoptosis, respectively.</p><p><b>RESULTS</b>The exposure of cells to cisplatin and BXDE alone or in combination decreased cell viability dose- and time-dependently (P<0.05), which was found to be mediated by the apoptotic pathway as confirmed by the increase in the annexin V/propidium iodide- stained cell population and a ladder pattern of discontinuous DNA fragments. Furthermore, the apoptosis was inhibited by the pan-caspase inhibitor, benzyloxycarbonyl-Val-Ala-Asp (OMe) fluoromethylketone (z-VAD-FMK).</p><p><b>CONCLUSIONS</b>BXDE significantly potentiated apoptotic effects of cisplatin in A549 cells. Moreover, apoptosis induced by BXDE might be the pivotal mechanism mediating its chemopreventative action against cancer.</p>

A Case of Restless Legs Syndrome in Patient with Neurogenic Sciatic Nerve Tumor

Restless legs syndrome (RLS) is chronic neurological disorder, in which the primary symptoms is unpleasant and disturbing sensation accompanied by urge to move in multiple body parts especially in legs. RLS may present in distinct phenotypes often described as “primary” vs. “secondary.” Secondary RLS can arise from etiologies such as iron deficiency, pregnancy, peripheral neuropathy, and end-stage renal disease. We report a rare case of RLS associated with neurogenic tumor of the sciatic nerve. A 72-year-old man complained of recurrent and worsening RLS symptoms in his right lower extremity, despite medical treatment. Interestingly, we found a neurogenic tumor at the right greater sciatic notch region on magnetic resonance imaging of the hip.

Reflection of Pain in Cancer Patients Using a New Screening Tool for Psychological Distress / 정신신체의학

OBJECTIVES: The objective of this study was to investigate the relationship between psychological distress and pain in cancer patients. METHODS: 249 patients with cancer who visited National Health Insurance Service Ilsan Hospital between April 2013 and March 2014 were evaluated with National Cancer Center Psychological Symptom Inventory(NCC-PSI) which consisted of Modified Distress Thermometer(MDT) and Modified Impact Thermometer(MIT). Each scale was divided into 3 subscales targeting separate symptoms: insomnia, anxiety, and depression. Psychological distress was defined as positive for those who scored above the cutoff values in at least one of all six subscales. The Numeric Rating Scale for Pain(NRS-Pain) was used to assess the subjective severity of pain. Logistic regression was performed to investigate the association between psychological distress and pain. RESULTS: Univariate logistic regression analysis showed that pain, gender, compliance, and two subscale scores of Hospital Anxiety and Depression Scale(HADS) were significantly associated with psychological distress. Multivariate logistic regression analysis showed that pain and HADS anxiety subscale score maintained a statistically significant association with psychological distress adjusted for variables including age, gender, years of education, Eastern Cooperative Oncology Group performance status, cancer stage, Charlson Comorbidity Index, compliance, and HADS depression subscale score. One point increase in pain was 1.31 times more likely to cause psychological distress. In secondary analysis, pain was significantly associated with all subscales of NCC-PSI, except MIT-anxiety subscale. CONCLUSIONS: This study suggests that NCC-PSI, a screening tool for psychological distress, reflects pain. We recommend that physicians who treat cancer patients consider the examination of psychological distress which provides comprehensive evaluation of various factors regarding quality of life.

Prognosis of Patients with Behavioral Variant Frontotemporal Dementia Who have Focal Versus Diffuse Frontal Atrophy

BACKGROUND AND PURPOSE: Only a few studies have investigated the relationship between different subtypes and disease progression or prognosis in patients with behavioral variant frontotemporal dementia (bvFTD). Since a localized injury often produces more focal signs than a diffuse injury, we hypothesized that the clinical characteristics differ between patients with bvFTD who show diffuse frontal lobe atrophy (D-type) on axial magnetic resonance imaging (MRI) scans versus those with focal or circumscribed frontal lobe atrophy (F-type). METHODS: In total, 94 MRI scans (74 scans from bvFTD and 20 scans from age-matched normal controls) were classified into 35 D- and 39 F-type bvFTD cases based on an axial MRI visual rating scale. We compared baseline clinical characteristics, progression in motor and cognitive symptoms, and survival times between D- and F-types. Survival analyses were performed for 62 of the 74 patients. RESULTS: While D-type performed better on neuropsychological tests than F-type at baseline, D-type had higher baseline scores on the Unified Parkinson's Disease Rating Scale (UPDRS) Part III. Evaluations of motor progression showed that the disease duration with motor symptoms was shorter in D-type than F-type. Moreover, the survival time was shorter in D-type (6.9 years) than F-type (9.4 years). Cox regression analyses revealed that a high UPDRS Part III score at baseline contributed to an increased risk of mortality, regardless of the pattern of atrophy. CONCLUSIONS: The prognosis is worse for D-type than for those with F-type. Shorter survival in D-type may be associated with the earlier appearance of motor symptoms.

Crotonis Fructus Extract Inhibits 12-O-Tetradecanoylphorbol-13-Acetate-Induced Expression of Matrix Metalloproteinase-9 via the Activator Protein-1 Pathway in MCF-7 Cells / 한국유방암학회지

PURPOSE: Metastatic cancers spread from the primary site of origin to other parts of the body. Matrix metalloproteinase-9 (MMP-9) is essential in metastatic cancers owing to its major role in cancer cell invasion. Crotonis fructus (CF), the mature fruits of Croton tiglium L., have been used for the treatment of gastrointestinal disturbance in Asia. In this study, the effect of the ethanol extract of CF (CFE) on MMP-9 activity and the invasion of 12-O-tetradecanoylphorbol-13-acetate (TPA)-treated MCF-7 cells was examined. METHODS: The cell viability was evaluated using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. The expression of MMP-9 was examined by Western blotting, zymography, and real-time polymerase chain reaction. An electrophoretic mobility gel shift assay was performed to detect activator protein-1 (AP-1) DNA binding activity and cell invasiveness was measured by an in vitro Matrigel invasion assay. RESULTS: CFE significantly suppressed MMP-9 expression and activation in a dose-dependent manner. Furthermore, CFE attenuated the TPA-induced activation of AP-1. CONCLUSION: The results indicated that the inhibitory effects of CFE against TPA-induced MMP-9 expression and MCF-7 cell invasion were dependent on the protein kinase C δ/p38/c-Jun N-terminal kinase/AP-1 pathway. Therefore, CFE could restrict breast cancer invasiveness owing to its ability to inhibit MMP-9 activity.

Erratum to: Prognosis of Patients with Behavioral Variant Frontotemporal Dementia Who have Focal Versus Diffuse Frontal Atrophy

The original version of this article contained wrong information of an author which should be changed.

Correction: Prerequisites for Effective Implementation of Telemedicine: Focusing on Current Situation in Korea / 대한의료정보학회지

The authors and their affiliation are incorrectly listed in the article. Also, the Acknowledgments section of the above article incorrectly omitted.

Validation of the Korean version of Center for Epidemiologic Studies Depression Scale-Revised(K-CESD-R) / 정신신체의학

OBJECTIVES: The Center for Epidemiologic Studies Depression scale-Revised is a recently revised scale which has been reported as a valid tool for the assessment of depressive symptoms. It encompasses cardinal symptoms of depression described in the Diagnostic and Statistical Manual of Mental disorders, fourth edition. In this study, we assessed the reliability, validity and psychometric properties of the Korean version of the CESD-R(K-CESD-R). METHODS: Forty-eight patients diagnosed as major depressive disorder, dysthymia, depressive disorder NOS according to the DSM-IV criteria using Mini International Neuropsychiatric Interview and 48 healthy controls were enrolled in this study. They were assessed with K-CESD-R, K-MADRS, PHQ-9, KQIDS-SR, STAI to check cross-validation. Statistical analyses were performed using calculation of Cronbach's alpha, Pearson correlation coefficient, Principal Component Analysis, ROC curve and optimal cut-off value. RESULTS: The Cronbach's alpha of K-CESD-R was 0.98. The total score of K-CESD-R revealed significantly high correlations with those of K-MADRS, PHQ-9, KQIDS-SR(r=0.910, 0.966 and 0.920, p<0.001, respectively). Factor analysis showed two factors account for 76.29% of total variance. We suggested the optimal cut-off value of K-CESD-R as 13 according to analysis of the ROC curve which value sensitivity and specificity both equally. CONCLUSIONS: These Results showed that the K-CESD-R could be a reliable and valid scale to assess depressive symptoms. The K-CESD-R is expected as a useful and effective tool for screening and measuring depressive symptoms not only in outpatient clinic but also epidemiologic studies.

Impairments of Inhibitory Motor Control in Cerebral Cortical Infarction

No abstract available.

Prerequisites for Effective Implementation of Telemedicine: Focusing on Current Situations in Korea / 대한의료정보학회지

OBJECTIVES: The practice of telemedicine requires social interventions and systems for efficient implementation. Further, it requires sufficient discussions among related parties because the purpose of telemedicine is diagnosis and treatment, and the participation of medical specialists is essential. Based on the characteristics of the healthcare structure of Korea, which has a low proportion of public healthcare and most patients are taken care of by a few large tertiary care hospitals, the fundamental issues need to be discussed. METHODS: A comparison was conducted with overseas cases to discuss the prerequisites for the effective implementation of telemedicine in South Korea under the current situation. We also examined the structural characteristics of the Korean medical community. RESULTS: The current paper recommends that an in-depth analysis and studies are conducted on the following aspects: a search for telemedicine services focused on public healthcare, a search of services for illnesses that impose high levels of burden on households, and the development and implementation of a telemedicine system for follow-up management at primary and secondary care hospitals after the patient undergoes surgery or treatment at tertiary care hospitals. CONCLUSIONS: As the technology develops, the focus should also be on factors such as safety, usefulness, availability, and how the functions will be realized in order to enable user communication. A clear system should be established to regulate and manage the lack of sufficient discussions. In addition, seeking projects and systems that reflect the characteristics of each country will facilitate the efficient implementation of telemedicine.