Homocysteine and risk of cerebrovascular lesions: The PRESENT project

@#Objective: Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiological findings in neurologically asymptomatic elderly people. Their presence is associated with an increased risk of stroke or dementia. Homocysteine (Hcy) can cause atherosclerosis and may thus act as a useful marker of stroke prior to symptom onset. This study aimed to evaluate the utility of Hcy as a surrogate marker for early intervention for stroke in community-dwelling healthy elderly persons with cerebrovascular lesions such as WMCs and SBIs. Methods: We assessed the relationship between the Hcy level and presence of WMCs/SBIs on brain computed tomography (CT) in 554 elderly individuals aged ≥65 years with no history of stroke or dementia. Results: The mean age of the participants was 74.43±7.32 years. Of the 554 patients, 106 (19.1%) had WMCs and/or SBI findings on brain CT. The mean Hcy level was higher in participants with WMCs/SBIs (P=0.001). The WMCs/SBIs group had a significantly greater number of participants with high Hcy levels than the non-WMCs/SBIs group (P<0.001). High Hcy levels (≥12.3 μmol/L) was significantly associated with WMCs and SBIs even after adjusting for age, Korean Mini Mental Status Examination score, education level, and vascular risk factors such as hypertension, diabetes, hyperlipidemia and smoking status. Conclusion: The result of our study suggests that regular monitoring of homocysteine level as a modifiable risk factor may be helpful for predicting the association of cerebrovascular lesions such as WMCs and SBIs for the prevention of future ischemic stroke and cognitive impairment.

The clinical significance of aortic calcification in chest radiography in community-dwelling, healthy adults: The PRESENT project

@#Background: Aortic calcification (AC), a predictor of generalized atherosclerosis, may precedes cerebral white matter lesions. Cerebral white matter changes (WMCs) are associated with cognitive decline and future dementia. The aim of study was to evaluate the usefulness of aortic calcification (AC) detection by chest radiograph for cueing early intervention in possible WMCs to prevent stroke and dementia in community-dwelling healthy people. Methods: We assessed the relationship between AC in chest radiography and vascular risk factors and severity of WMCs in 543 middle-aged and elderly individuals with no history of stroke or dementia. Results: The mean age of the subjects was 61.6 ± 7.4 years. Of these, AC was observed in 39 (7.2%) subjects. AC combined with grade 1 WMC (mild), 2 (moderate), and 3 (severe) were seen in 8 (25.8%), 7 (23.3%) subjects, and 3 (30.0%) subjects, respectively. After adjustment for age and vascular risk factors, diabetes (odds ratio [OR], 1.92, 95% confidence interval (CI) 1.01–3.65, p<0.05) and hypertension (OR, 1.86, 95% CI, 1.03-3.35, p<0.05), aortic knob width (OR, 1.07, 95% CI, 1.01–1.13, p<0.05) and aortic calcification (OR, 2.93, 95% CI, 1.36-6.33, p<0.05) were significantly associated with the severity of WMCs. Conclusion: There is an association between the presence of AC in chest radiography and WMC. It may be useful in providing important information about development of WMCs for prevention of future vascular-related cognitive impairments or ischemic stroke

Vascular risk factors for stroke among urban community dwelling adults in Ansan city, Korea

Background & Objective: The number of ischemic stroke is increasing steadily. The recent stroke prevention strategies have targeted risk factors for preventing ischemic stroke. Community-based data that quantify the prevalence of these risk factors are needed to develop effective stroke prevention strategies. This study was performed aiming to establish customized prevention strategies by investigating vascular risk factors of ischemic stroke among the healthy adults in an urban population in Korea. Methods: The Prevention of Stroke and Dementia (PRESENT) survey collected data associated with stroke risk factors between 2007 and 2009 in Ansan city, Korea. Of 46,537 people, 2,843 were selected by random sampling, and final population included 358 men and 422 women over 50 years old. We checked modifiable risk factors, such as hypertension, diabetes mellitus, smoking, hyperlipidemia, atrial fibrillation, cardiovascular disease, obesity, and physical inactivity. Results: The mean age of study subjects was 60.1±8.2 years; 55.5% had hypertension, 18.6% had diabetes mellitus, 17.7% were current smoker, 44.9% had hyperlipidemia, 1.7% had atrial fibrillation, and 4.5% had cardiovascular disease. Men had more risk factors for stroke, and higher rates of diabetes mellitus and current smoking. However, women had higher cholesterol and obesity rates and lower physical activity. The proportion of individuals with >1 risk factor for stroke increased with age. Hypertension, diabetes mellitus, and cardiovascular diseases also increased with age, but low-density lipoprotein levels and current smoking decreased. Conclusions: This study provides valuable information to develop customized strategic policies for primary and secondary stroke prevention.

Prevalence and risk factors of cerebral white matter changes and silent infarcts on brain computed tomography scans among community-dwelling healthy adults: The PRESENT project

Cerebral white matter changes (WMCs) and silent brain infarcts (SBIs) are common radiologic findings in neurologically asymptomatic elderly people, but are associated with an increased risk of subsequent stroke. We investigated the prevalence and risk factors for these cerebral changes on brain computed tomography (CT) in 480 community-dwelling healthy Korean adults without stroke or dementia, who were recruited for an early health program. Cerebral WMCs were defined as the presence of approximately 5 mm wide ill-defined and moderately hypodense lesions, and SBIs were defined as the presence of >2 mm wide well-defined hypodense lesions. Of the 480 patients, 49 (10.2%) had cerebral WMCs and SBIs findings on brain CT. The prevalence of WMCs and SBIs increased with age: the prevalence was 2.4%, 9%, and 32% for subjects in their 50, 60s, and 70s, respectively. In addition, hypertension, abdominal obesity, increased levels of homocysteine and high sensitivity C-reactive protein were significantly associated with cerebral WMCs and SBIs. Our study suggests that regular monitoring of risk factors is required to prevent cerebral WMCs and SBIs and decrease the incidence of stroke and dementia in healthy individuals.

Improvements during the second cycle healthcare accreditation program in Korea: Toward the global standard for patient safety and quality of healthcare

The healthcare accreditation program established in November 2010 has provided a great opportunity to increase awareness of the importance of patient safety and healthcare quality in every clinical process in Korea. However, there have been several problems with the program, regarding the level of accreditation standards, and the objectivity of the accreditation survey and its assessment function during the first cycle of the healthcare accreditation program. Therefore, the process of improvement during the second cycle of the accreditation program has aimed to address the issues raised during the first cycle of the program. These issues include a relatively lower level of accreditation standards when compared with global standards, an incomplete scoring system for survey results, and the reliability of follow-up monitoring of accredited healthcare organizations. Over the past ten years, patient safety has been increasingly recognized as a global issue in the medical field. The upcoming second cycle accreditation program will result in an improved level of patient safety and an enhancement of the patient-centered culture in all healthcare organizations of Korea, in order to align with global standards.

Improvements during the second cycle healthcare accreditation program in Korea: Toward the global standard for patient safety and quality of healthcare

The healthcare accreditation program established in November 2010 has provided a great opportunity to increase awareness of the importance of patient safety and healthcare quality in every clinical process in Korea. However, there have been several problems with the program, regarding the level of accreditation standards, and the objectivity of the accreditation survey and its assessment function during the first cycle of the healthcare accreditation program. Therefore, the process of improvement during the second cycle of the accreditation program has aimed to address the issues raised during the first cycle of the program. These issues include a relatively lower level of accreditation standards when compared with global standards, an incomplete scoring system for survey results, and the reliability of follow-up monitoring of accredited healthcare organizations. Over the past ten years, patient safety has been increasingly recognized as a global issue in the medical field. The upcoming second cycle accreditation program will result in an improved level of patient safety and an enhancement of the patient-centered culture in all healthcare organizations of Korea, in order to align with global standards.

Tooth Loss Is Associated with Brain White Matter Change and Silent Infarction among Adults without Dementia and Stroke

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.

Tooth Loss May Predict Poor Cognitive Function in Community-Dwelling Adults without Dementia or Stroke: The PRESENT Project

Periodontal disease is a potential predictor of stroke and cognitive impairment. However, this association is unclear in adults aged 50 yr and above without a history of stroke or dementia. We evaluated the association between the number of teeth lost, indicating periodontal disease, and cognitive impairment in community-dwelling adults without any history of dementia or stroke. Dental examinations were performed on 438 adults older than 50 yr (315 females, mean age 63+/-7.8 yr; 123 males, mean age 61.5+/-8.5 yr) between January 2009 and December 2010. In the unadjusted analysis, odds ratios (OR) of cognitive impairment based on MMSE score were 2.46 (95% CI, 1.38-4.39) and 2.7 (95% CI, 1.57-4.64) for subjects who had lost 6-10 teeth and those who had lost more than 10 teeth, respectively, when compared with subjects who had lost 0-5 teeth. After adjusting for age, education level, hypertension, diabetes, hyperlipidemia, and smoking, the relationship remained significant (OR, 2.0; 95% CI, 1.08-3.69, P=0.027 for those with 6-10 teeth lost; OR, 2.26; 95% CI, 1.27-4.02, P=0.006 for those with more than 10 teeth lost). The number of teeth lost is correlated with cognitive impairment among community-dwelling adults aged 50 and above without any medical history of stroke or dementia.

A Standardization Study on the Korean Version of the Addenbrook's Cognitive Examination Revised (K-ACE) as a Cognitive Impairment Screening Instrument: Reliability, Validity and Normative Data

BACKGROUND: Addenbrooke's Cognitive Examination-Revised (ACE-R) is a brief but sensitive and specific test for screening cognitive impairment. The clinical need for brief, inexpensive, and sensitive cognitive screening tools is well acknowledged. The aims of this study were to develop a Korean version of the ACE-R (K-ACE) and to obtain normative data for community-dwelling, apparently healthy adults. METHODS: The ACE-R was translated and modified to produce the K-ACE. Some items that were considered less familiar to Koreans were replaced with "Korean-friendly" items. Back-translation was performed. The K-ACE was administered to 422 of 480 subjects who were recruited from stroke- and dementia-free adults living in Ansan-si, Gyeonggi-do, by systematic random sampling. The Korean version of the Short Blessed Test (SBT-K) was also completed by 85 of the subjects. We examined the internal consistency, reliability, and validity of the K-ACE. The influences of age, sex, and education level on K-ACE score were also evaluated. RESULTS: The internal consistency of the K-ACE was high (Cronbach's alpha=0.854), and the test.retest and interrater reliability were also very good (coefficient=0.929 and 0.984, respectively). The validity of the K-ACE was high through correlations between K-ACE and K-MMSE (r=0.939, p<0.01) and SBT-K (r=-0.871, p<0.01). Male, younger, and highly educated subjects had higher K-ACE scores on univariate analysis. Age and education level, but not sex, were significantly correlated with the score on stepwise multiple regression analysis. Therefore, normative data relative to age and education level were obtained. CONCLUSIONS: The K-ACE was found to be a brief, reliable, and valid screening test battery for cognitive dysfunction. We were able to determine the norms for the K-ACE for community-dwelling, middle-aged and elderly people.

Clinical Course of Small Vessel Dementia Patients According to Cholinesterase Inhibitor Treatment

BACKGROUND: Small vessel dementia (SVD) is the most frequent cause of vascular dementia and is regarded a distinct clinical entity. However, the data on the natural course of SVD and drug trials specifically aiming SVD have been sparse. The aim of this study was to answer the following three questions: 1) How does SVD progress? 2) Does cholinesterase inhibitor therapy improves cognitive symptoms and daily activity of life (ADL) in SVD? 3) Is there any clinical difference among the subtypes of SVD? METHODS: According to cholinesterase inhibitor medications, patients with SVD were retrospectively analyzed using Hyoja Dementia registry. In this study, effects of treatment were assessed by comparing the scores of Korea version Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), Functional Independence Measure (FIM) at the base line with those at endpoints. RESULTS: After 12 months, the mean MMSE, CDR, FIM scores improved significantly in the cholinesterase inhibitor treatment group, compared with that in no-treatment group. In no-treatment group, annual decline of MMSE was 2.7, compared with 0.3 increment in the treatment group. White matter type of SVD showed worst prognosis compared with other types. CONCLUSIONS: This study suggests that SVD has more benign clinical course than previously reported, and cholinesterase inhibitor improves cognitive and ADL functions in SVD. Among the subtypes of SVD, the white matter type may have poor prognosis.

Simultaneous Insonation of One MCA through Bilateral Temporal Bone Windows Using M-mode TCD

BACKGROUND: Transcranial Doppler ultrasonography (TCD) is limited by insufficient ultrasound penetration through the temporal bone. Recent studies have revealed poor temporal bone windows in 5~30% of patients. In about 38% of the patients with poor temporal bone windows, a temporal window was unilaterally absent. The aim of the present study was to compare the mean flow velocities (MFV) of the middle cerebral arteries (MCA) obtained through the ipsilateral temporal bone window with those obtained through the contralateral one using M-mode TCD. METHODS: Eighteen patients (mean age, 28 y; age range, 21~40 y) who had adequate bilateral temporal bone windows were enrolled and 36 MCAs were investigated. The investigators tried to detect the MCA through the ipsilateral and contralateral temporal windows with two 2-MHz probes simultaneously (ipsilateral insonation and contralateral one, respectively). RESULTS: The MCA MFV measured by ipsilateral insonation was 72.58 +/- 9.78 cm/sec and that demonstrated by contralateral insonation was 70.94 +/- 9.79 cm/sec. Even though the differences between MFVs by either side insonation was 2.25~3.94% (0~13.11%) and had significant difference statistically, those were within side-to-side limit of 30% generally considered as abnormal. The mean bitemporal diameter (BTD) was 130.72 +/- 3.75 cm (126~142 cm). We obtained similar waveforms in the reverse direction to those of ipsilateral insonation at 95.33 +/- 5.19 mm of depths (72.97 +/- 4.23% of BTD) during contralateral insonation. CONCLUSIONS: The demonstration of the MCA through the contralateral insonation provides an opportunity to obtain significant mean flow velocities in patients with absent or insufficient temporal bone window unilaterally.

Aseptic Meningitis in Kikuchi's Disease

The involvement of the nervous system in Kikuchi's disease (KD) is rare. Although some reports of meningeal involvement in KD were described in the literature from Japan, it has rarely been reported in Korea. A 23-year-old man presented with severe headache, fever, and vomiting. Cerebrospinal fluid (CSF) analysis revealed an opening pressure 300 mmH2O, WBC 283/mm3, glucose 44 mg/dl and protein 86 mg/dl. Multiple tender lymph nodes on the left anterior neck were found on the 9th day of his hospital stay. The lymph node biopsy disclosed histopathologic features typical of KD. We report a patient with KD accompanied by aseptic meningitis, emphasizing the importance of recognizing this disorder in diagnosing patients with meningitis.

A Case of Reversible Marchiafava-Bignami Disease Showing Severe Thalamic Hypometabolism in PET

No abstract available.

Differences of Spectral EEG Analysis and Prognosis Following Single Hemispheric Infarction and Hemorrhage in Striatocapsular Area

BACKGROUND: Vascular dementia is common cause of dementia, second to the dementia of Alzheimer desease. However in Asia and many developing countries, the incidence of vascular dementia exceeds that of Alzheimer's disease. Though many stroke-related factors related the nature of vascular injury, e.g. infarction and hemorrhage, have not assessed yet. Clarifying the difference of electroencephalograpy and clinical prognosis between infarction and hemorrhage, the aim of this study was to elucidate the role of nature of vascular injury. METHODS: to reduce confounding factors, the study population was restricted to the patients of single hemispheric striatocapsular infarction and hemorrhage saving cortex. On admission, we checked the KMMSE and FIM scores and using quantified EEG, we analyzed occipital peak frequency and the relative background alpha, theta and delta spectra power taken from 16 derivations by averaging twenty-2 -sec epoch in infarction, hemorrhage patients and elderly controls. After 6 months follow up, we compare the MMSE, FIM score between infarction and hemorrhage group. RESULTS: 1) Compared with infarction group, hemorrhage groups had a significantly bilateral lower occipital peak freqauency and background bilateral alpha spectra power. 2) In hemorrhage group, there is lower tendency in K-MMSE after 6 month follow up compared to infarction group. CONCLUSION: This study suggests that hemorrhage show more bilateral electrophysiological dysfunction than infarction group and possible grave prognosis for vascular dementia compared to infarction group.

Family Caregiver's Burden of Stroke Patients

BACKGROUND: The role of family caregivers is becoming more important for the recovery of patients with stroke, as the prevalence of stroke is increasing. Consequently, the burden of caregiving can affect both patients' and caregiver's functional health. The purpose of this study was to make a novel caregiving burden scale and evaluate factors that influence the burden of the family caregiver. METHODS: The caregiver burden scale consists of four aspects: psycho-emotional, financial, physical and isolation from social activities. The questionnaire was administrated to the family care-givers of 118 patients with stroke who consented to be interviewed. Among 118 caregivers, we analyzed 106 caregivers who answered the questionnaire completely. We evaluated the construct validity and internal reliability of the burden scale and applied multiple regression analysis for the factors that influence caregiver's burden. RESULTS:1) Construct validity by factor analysis and Internal reliability was high 2) Among 106 caregivers, 40 (37.7%) approached subjective depression on the Beck Depression Inventory (BDI). There was a statistically significant difference(p<0.01) in the strength of burden between the groups with and without depression. 3)Of the variables, including patient's age, caregiver's age, duration of caregiving, education level of caregiver, and socio-economic status of family, only the BDI scores of caregivers and the Barthel Index scores of patients were correlated to the degree of caregiving burden. CONCLUSIONS: This caregiving burden scale can be a useful tool for the evaluation of caregiver's burden with stroke. We believe that thoughtful consideration and realistic support for family caregivers can be very important in the long-term management of patients with stroke. (J Korean Neurol Assoc 19(3):213~218, 2001)

Formation of Nuclear Isopeptide in the Process of Neuronal Cell Death following Interstitial Hyperthermia in Normal Rat Brain

BACKGROUND: Radiofrequency (RF) interstitial hyperthermia has recently been shown to be a beneficial treatment modality for human malignant gliomas. It has also been shown that the thermal threshold dose for histopathological damage in the rat brain was heating at 41 degreesCfor 30 min. In the present study, we investigated apoptosis and necrosis of the neuronal cells in the brains of Fischer rats at different times after interstitial heating with lower than the thermal threshold dose. We also measured the isopeptide bond formation in neuronal cells showing apoptosis or necrosis. METHODS: The applicator needles of the RF interstitial heating device, connected to the Thermotron IV was applied to heat the brain at 39, 40, and 41 degreesCfor 30 minutes. Sham-heated control rats were treated the same as the heated rats. The sham-heated animals and those heated at 40 degreesCfor 30 min were sacrificed at 4, 72, 120, and 168 hours after heating, respectively, and the animals heated at 39 and 41 degreesCfor 30 minutes were sacrificed at 168 hours after heating. Coronally sectioned brain tissue, encompassing the heated lesions, were studied immunohistochemically for the expression of TGase1, TGase2, and TGase3, isopeptide. TUNEL assay was performed to examine apoptosis. RESULTS: Immunohistochemical studies showed that in the brains heated at 40 degreesCfor 30 minutes, necrosis with the maximal nuclear isopeptide-positive neuronal cells of the cerebral cortex were seen at 4 hours; The maximal number of isopep-tide- positive neuronal cells showing apoptosis was at 168 hours. CONCLUSIONS: Necrosis of neuronal cells following mild interstitial hyperthermia was maximal at 4 hours and apoptosis was maximal at 168 hours. Neuronal cells showing necrosis or apoptosis formed isopeptide bonds in their nuclei.

Usefulness of Occipital EEG Spectral Profile in the Differential Diagnosis of Alzheimer Type and Vascular Dementia

BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.

A Case of Midbrain Hemorrhage Presenting as Bilateral Ptosis with Diurnal Fluctuation

A 54 year-old woman presented with bilateral fatigable blepharoptosis with diurnal fluctuation and diplopia for 10 days. She had a 3 year history of hypertension and showed symptoms of bilateral ptosis, supranuclear upward gaze palsy, and vertical diplopia with the pupils promptly constricting to light. Bell's phenomenon and vertical oculocephalic responses were intact but an impaired convergence was noted in both eyes. A intramuscular neostigmine test was negative. T1 and T2-wighted MRI of the brain showed a small round high signal intensity lesion in the periaqueductal gray (PAG) region. Therefore, she was diagnosed with a midbrain ptosis due to midbrain hemorrhage. The PAG lesion was suggested as contributing to the fatigable blepharoptosis and supranuclear upward gaze palsy in the patient. We recommend that patients with clinical features of myasthenia limited to the ocular muscles and, having risk factors for cerebrovascular disease, be thoroughly evaluated for intracranial lesions if warranted.

Clinical Characteristics of Geriatric Patients Admitted to Yongin Hyoja Geriatric Hospital

BACKGROUND: As the size of the elderly population has increased compared to the hole, there has been growing concern over potential health problems and geriatric hospitals for elderly people. However, despite the emerging needs for geriatric hospitals, there is no data on the clinical characteristics of patients being admitted to geriatric hospitals. To analyze the characteristics of elderly patients admitted to a geriatric hospital, we studied the medical records of patients admitted to Yong-in Hyoja Geriatric Hospital during a recent 20 months period. By clarifying the clinical characteristics of elderly patients admitted to a geriatric hospital, the basic data for understanding and treating elderly patients could be made. METHODS: We analyzed the medical records of 345 patients who were admitted to Yong-in Hyoja Geriatric Hospital from November 1997 to July 1999. The diagnosis of patients was largely subgrouped according to the existence of dementia, and subsequent detailed diagnoses were made. RESULTS: (1) The average age of patients was 74.59 years and there were slightly more females than males admitted (ratio, 1.15:1). (2) Most of the patients suffered from dementia (62.1%), of which vascular dementia was the most common(31.6%), followed by Alzheimer dementia(19.15%). (3) Compared to vascular dementia, patients with Alzheimer dementia had more severe cognitive dysfunction, psychosis, and agitation, while patients with vascular dementia had more problems in activities of daily living (ADL) and were more depressed than Alzheimer dementia (4) The average hospitalization duration was 3.54 months and incidence of significant illness after admission was 29.8%. The mortality rate was 10.9%. (5) The most common cause of death was infection (45.2%), followed by cardiovascular problems(16.2%). CONCLUSIONS: In addition to significant illnesses and mortality after admission, most patients admitted to geriatric hospitals have severe cognitive and behavioral problems. Therefore, adequate medical and neurological assessment and treatment for the aged is necessary.

Huntington's Disease Confirmed by Genetic and Pathological Study

Huntington's disease is an autosomal dominantly inherited neurodegenerative disease, which is characterized by choreic movement and progressive dementia. A definite diagnosis of Huntington's disease cannot be made by clinical informations alone. Pathologic or genetic studies are necessary to exclude other neurodegenerative diseases which may present with familial dementia, dystonia, and chorea. We report a 40 year-old male patient with Huntington's disease confirmed by pathologic and genetic studies. His daughter who had rigidity, dystonia, involuntary movement, and progressive cognitive decline had abnormal CAG trinucleotide repeat on the short arm of chromosome 4. These findings confirmed that the korean patient with Huntington's disease has same genetic abnormalities with the western and other oriental patients with Huntington's disease.