Cardiovascular Biomarkers during Acute Periods of Ischemic Stroke due to Non-Valvular Atrial Fibrillation

BACKGROUND: A subanalysis study of the ENGAGE AF-TIMI 48 trial showed that cardiac troponin I, N-terminal proB-type natriuretic peptide, and D-dimer, were powerful predictors of cerebrovascular adverse events. We aimed to evaluate D-dimer and cardiac troponin I levels during the acute period of ischemic stroke in anticoagulation-naïve patients with non-valvular atrial fibrillation (NVAF) and also studied the association between these biomarkers and stroke severity. METHODS: Consecutive anticoagulation-naïve patients with acute ischemic stroke due to NVAF were enrolled within two days after each stroke event, and all patients were stratified into either moderate-to-severe or mild neurologic deficit groups using the National Institutes of Health Stroke Scale (NIHSS) at admission. RESULTS: A total of 98 patients were enrolled in this study. The median value for the D-dimer was above the upper limit of the normal reference range, but the troponin I value was within the normal range for all patients. After adjusting for CHA2DS2-VASc risk factors, the log-transformed values for D-dimer were positively correlated with an increasing NIHSS score (r=0.233; P=0.051). In the multivariate logistic analysis, the log-transformed D-dimer was positively associated with more severe strokes (odds ratio, 30.1; 95% confidence interval [CI], 1.9–486.2 and 29.7; 95% CI, 2.0–430.8 in the upper two quartiles respectively). The log-transformed values for troponin I did not correlate with the NIHSS score. CONCLUSION: D-dimer levels were higher and an independent risk factor for severe stroke in anticoagulation-naïve patients with NVAF related stroke. In contrast, troponin I levels were normal and were not associated with stroke severity.

Clinical Implication of High Sensitivity C-Reactive Protein for the Development of Dementia in Parkinson's Disease

BACKGROUND AND PURPOSE: High-sensitivity C-reactive protein (hs-CRP) is the most widely studied biomarker of systemic inflammation. Its level has been reported to be associated with cognitive impairment. While dementia and cognitive impairment are common non-motor symptoms in advanced idiopathic Parkinson's disease (PD), the clinical value of hs-CRP for predicting dementia in PD patients remains unclear. Therefore, the objective of this study was to clarify the relationship between hs-CRP levels and the development or progression of dementia in PD through evaluating hs-CRP levels in PD patients with or without dementia. METHODS: A total of 112 PD patients without dementia (PD-D), 103 PD patients with dementia (PD+D), and 94 healthy controls were used in this study. The levels of hs-CRP and cognitive function were analyzed among these three groups. RESULTS: The mean serum hs-CRP levels in PD-D and PD+D were 1.76+/-3.62 mg/dL and 1.44+/-2.78 mg/dL, respectively, which were significantly (p=0.02) higher than that (vs. 0.41+/-1.06 mg/dL) in healthy controls. However, the levels of hs-CRP were not significantly (p>0.05) different between PD-D and PD+D. CONCLUSIONS: Our results suggest that neuro-inflammation plays a role in the pathogenesis of PD. However, it does not significantly contribute to the development or the progression of dementia in PD patients.

Clinical Usefulness of 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography for Early Phase Multiple System Atrophy

BACKGROUND: Clinical diagnosis of multiple system atrophy (MSA) relays on signs and symptoms that are often difficult to identify particularly at early stage. Indeed neuropathological studies have demonstrated that Parkinson variant of MSA (MSA-P) is the first cause of misdiagnosis in a cohort of patients presenting with parkinsonian features. But accurate diagnosis of these disorders is important for deciding on treatment, appropriate advice and prognosis since atypical parkinsonian disorders are characterized by poor response to dopaminergic treatment and more rapid disease progression. Therefore, we conducted this study to investigate difference of perfusion Single Photon Emission Computed Tomography (SPECT) in patients with the early phase of MSA-P using SPM program. METHODS: We recruited consecutively 21 patients with MSA-P and 48 age-matched healthy controls. All subjects underwent Tc-99m HMPAO perfusion SPECT and this perfusion images were analyzed. RESULTS: For MSA-P, only hypoperfusion was seen in the middle frontal gyrus of left frontal lobe, superior frontal gyrus of right frontal lobe, precentral gyrus of left frontal lobe, middle frontal gyrus of right frontal lobe and precentral gyrus of right frontal lobe with respect to healthy subjects. CONCLUSIONS: We cautiously assume that perfusion SPECT may offer significant advantages compared to other imaging techniques in the assessment of neuronal degeneration in MSA-P and may help the clinician in the diagnostic characterization of patients presenting with atypical parkinsonism.

The Relationships between Homocysteine Levels and Memory in Early Alzheimer's Disease Patients

BACKGROUND: Alzheimer's disease (AD) is a representative neurodegenerative disorder associated with memory disturbance. Recent research has shown that risk factors for cerebrovascular disorders are also causes of dementia. Of these risk factors, hyperhomocysteinemia is well known to be positively correlated with all types of dementias including AD. But it is not clear if there is a difference in the concentration of homocysteine according to subtypes of memory impairment of AD. We performed this study to explore the relationship between homocysteine and memory. METHODS: A total of 54 patients (male: 15 patients) to the dementia clinic at our hospital were recruited for this study. All subjects underwent neuropsychological tests including detailed memory function tests and brain magnetic resonance images. The plasma homocysteine level was measured routinely in all patients. RESULTS: Verbal and visual memories in AD were significantly associated with the concentration of plasma homocysteine. The plasma homocysteine level was significantly correlated with delayed recalls of verbal and visual memories and recognition of visual memory. However, there was no relationship between plasma homocysteine and working memory. CONCLUSIONS: This study showed that plasma homocysteine level was related to the consolidation and retrieval stage of memory in AD. Therefore, we cautiously assumed that control of plasma homocysteine level could contribute to management for the prevention of cognitive impairment.

Can Silent Ischemic Cerebral Lesions Affect Cognition of Parkinson's Disease Dementia?

BACKGROUND: Several studies have shown that the presence of cerebrovascular lesions may play an important role for determining the severity of the clinical symptoms of dementia. But no study to date has explored the clinical effect of cerebrovascular disease in Parkinson's disease with dementia (PDD), although cerebrovascular disease is common causes of dementia in elderly population. Therefore we conducted this study to evaluate the relationship between silent cerebrovascular lesions and cognitive decline in PDD. METHODS: Only 27 patients with PDD were chosen; 17 patients had PDD with silent cerebral ischemic lesions (PDDI) and 10 patients had PDD without silent cerebral ischemic lesions (pure PDD). These subjects received the global cognitive function testing and were all evaluated with detailed neuropsychological tests including attention, memory, language, and also the visuospatial and frontal function. RESULTS: There were no significant differences between pure PDD and PDDI group on general cognitive functions tests. Regard to mean time duration of suffering from Parkinson motor symptoms and motor function scale, pure PDD group showed more long duration than PDDI group but there was no significant difference between two groups. Furthermore, there were not any significant differences between the two groups on detailed neuropsychological tests. CONCLUSIONS: We concluded that silent cerebrovascular lesions do not contribute to neuropsychological severity of PDD, although vascular disease is a common cause of cognitive impairment in the elderly. Thus the results of the present study suggest that factors other than cerebrovascular disease contribute to severity of PDD.

Clinical Significance of Hyperhomocysteinemia Between Alzheimer's Disease and Vascular Dementia

BACKGROUND: Recent research has shown that risk factors for cerebrovascular disorders are also causes of dementia. Of these risk factors, hyperhomocysteinemia is well known to be positively correlated with all types of dementias including Alzheimer's disease (AD) and vascular dementia (VaD). But it is not know if there is a difference in the concentration of homocysteine in AD and VaD. We analyzed the homocysteine concentrations in AD and VaD and investigated the relationship between homocysteine and the progression of these two dementias. METHODS: A total of 193 patients to the dementia clinic at our hospital were enrolled. Fifty-four patients had AD and 48 patients had VaD. The remaining patients were the healthy control. Data for analysis consisted of the results of neuropsychological tests and homocysteine levels. RESULTS: Homocysteine levels were higher in AD and VaD patients than in healthy subjects, and no statistical difference was seen between AD and VaD. With lower mini-mental state examination scores, the homocysteine concentration increased significantly in VaD, but not in AD. The homocysteine concentration and the sum of box of clinical dementia rating were positively correlated in both AD and VaD. Other neuropsychological tests had no correlation with the homocysteine level. CONCLUSION: This study suggests that hyperhomocysteinemia, resulting in inflammation of vessel walls and oxidative stress, is a risk factor for both AD and VaD. However, our results did not clarify if hyperhomocysteinemia is related to the progression of dementia symptoms.

A Clinical Significance of High-Sensitivity C-reactive Protein Level in Alzheimer's Disease and Vascular Dementia

BACKGROUND: There is increasing evidence about inflammatory processes in the development of dementia. Therefore, inflammation has been believed to play a pivot role in cognitive decline, Alzheimer's disease (AD), and vascular dementia. High-sensitivity C-reactive protein (hs-CRP) is a sensitive systemic marker of inflammation, and increased levels of hs-CRP are associated with inflammatory reactions. It is important to identify modifiable risk factors, which could be used in preventing or delaying the onset of dementia. Therefore, we studied to clarify a clinical role of hs-CRP in AD and VaD. METHODS: This study population consisted of a sample of 102 patients with dementia (54 patients of AD and 48 patients of VaD) and 91 controls. We have investigated hs-CRP levels and cognitive function of each group. Cognitive function was evaluated with Mini-Mental State Examination (MMSE), Global Deterioration Scale (GDS), Clinical Dementia Rating (CDR) with Sum of Box and Activities of Daily Living (ADL). RESULTS: All subjects with dementia showed higher hs-CRP levels than subjects without dementia. But, there was no significant difference of hs-CRP levels between patients with AD and those with VaD. The odds ratio of patients with AD and VaD by hs-CRP is 2.250 (95% Cl 1.670-3.032) for Alzheimer's disease and 4.0 (95% Cl 2.451-6.529) for vascular dementia. CONCLUSIONS: The result of our study suggests the presence of inflammatory activity is related with dementia, not only AD known to degenerative disease but also VaD associated with cerebrovascular disease. However, we could suggest that dementia with cerebrovascular lesions is more related with inflammatory activity than AD.

Is There the Preventive Effect of COMT-inhibitor on Parkinson's Disease Associated with Dementia?

BACKGROUND: Elevated homocysteine (hcy) levels are associated with dementia, which is a frequent non-motor symptom of Parkinson's disease (PD). High levels of hcy in PD patients treated with levodopa are thought to result from increased synthesis during the metabolism of levodopa by COMT, and that use of a COMT-inhibitor may reduce hcy levels. In this study, we sought to clarify the effects of COMT-inhibitors on dementia in PD patients. METHODS: Thirty-eight PD patients without dementia (PDwoD), 35 PD patients with dementia (PDD), and 48 controls were enrolled in this study. All subjects underwent neuropsychological testing and a neurological examination. The hcy levels were measured in all subjects, and the relationship between hcy levels and dementia was evaluated in two PD groups (those that underwent treatment with levodopa-alone versus treatment with levodopa plus a COMT-inhibitor). RESULTS: Patients in the PDD group showed higher hcy levels than patients in the PDwoD group, though there was no significant difference in the hcy level between PDwoD patients and healthy controls. Regarding the effects of a COMT-inhibitor, there was no correlation between hcy levels in the 2 PD subgroups, indicating that there were no significant effects of the COMT-inhibitor on PDD. In addition, the odds ratio for PDD with the use of a COMT-inhibitor was 0.864 (95% CI=0.342-2.180). CONCLUSIONS: These results are in agreement with previous studies in that levodopa treatment in PD patients leads to elevated hcy concentrations. COMT-inhibitors, on the other hand, had no preventive effect on cognitive impairment in PD patients.

Differences of Regional Cerebral Blood Flow between Early Alzheimer's Disease and Parkinson's Disease Associated with Dementia on 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography

BACKGROUND: Alzheimer's disease (AD) and Parkinson's disease associated with dementia (PDD) are considered to be frequent types of cortical and subcortical dementia. Definitive diagnosis of neurodegenerative diseases is impossible without biopsy. Single photon emission computed tomography (SPECT) of the brain has long been used for years with cognitive disorders. Nevertheless, differential brain perfusion of patients with PDD and AD who exhibit mild dementia has not been reported. Therefore, we investigated the differences in the cerebral perfusional pattern using perfusion SPECT between mild AD and mild PDD to help clarify the diagnosis in the early stage of these dementias, since accurate diagnosis is crucial in decision regarding treatment, appropriate advice, management and prognosis. METHODS: Thirty-one patients with mild PDD and 32 patients with mild probable AD were enrolled in this study. All subjects underwent 99mTc-hexamethyl propylene amine oxime perfusion SPECT and general neuropsychological tests, and these data including perfusion images were analyzed. RESULTS: Perfusion SPECT showed hypoperfusion in frontal, parietal and temporal regions in both PDD and AD patients with mild dementia. Hypoperfusion in the occipital and cerebellar regions was significantly apparent in only PDD patients. CONCLUSION: Comparison of mild PDD with mild AD showed a significantly decreased perfusion in the occipital and cerebellar region in patients with mild PDD. Cerebral perfusion in the occipital region and the cerebellum could be a crucial differential diagnostic method of these diseases in the early phase. Further studies are needed for a definitive conclusion.

Posterior Cerebral Artery Infarct Complicated by Bacterial Meningitis

No abstract available.

Cardiac 123I-Metaiodobenzylguanidine Scintigraphy in Patients with Parkinson's Disease and Parkinson's Disease with Dementia

BACKGROUND: Because patients with idiopathic Parkinson's disease (PD) may exhibit patterns of cognitive impairment, it is difficult to distinguish from patients with Parkinson's disease dementia (PDD). Recently, cardiac 123I-metaiodobenzylguanidine (MIBG) scinti-graphy has been used to help distinguish PD from atypical Parkinsonism. This study investigated the relations between cardiac 123I-MIBG scintigraphy and these diseases. METHODS: Cardiac 123I-MIBG scintigraphy was conducted on 18 patients with PD, 18 patients with PDD and 13 normal controls matched for age, disease duration and severity of symptoms. The heart to mediastinum (H/M) ratio was calculated. RESULTS: The mean values of H/M ratio were significantly lower for PDD and PD than for normal controls but there was no difference between the disease groups. CONCLUSION: Unfortunately, cardiac 123I-MIBG scintigraphy did not distinguish PDD from PD in our study. We suggest further research with larger study populations be done to clarify the use of cardiac 123I-MIBG scintigraphy in differentiating other Lewy body diseases from dementia with PD features.

Transient Global Amnesia Following Subarachnoid Hemorrhage

The etiology and pathogenesis of transient global amnesia (TGA) is still unclear. Several mechanisms have been proposed, including arterial thromboembolic ischemic attacks, epilepsy, and migraine. However, TGA following severe headache has not been reported, to our knowledge. We described a patient presenting with TGA associated with the sudden onset of headache provoked by a subarachnoid hemorrhage. MRI and CT with angiography of the brain showed no abnormal findings. CSF study revealed hemorrhage. Single photon emission computed tomography revealed mild low perfusion at both hippocampal regions.

Application of SPM for Comparison of Striatal Dopamine Transporter Density between the Early Stage of the Parkinsonian Variant of Multiple System Atrophy and Parkinson's Disease

OBJECTIVE: Nigrostriatal dopaminergic neuronal degeneration is common to idiopathic Parkinson's disease(PD) and multiple system atrophy(MSA); although the topography of the nigral cell loss and striatal dopamine deficiency may differ. Currently, several functional neuroimaging techniques have been developed to differentiate between these two diseases. However, since the basal ganglia are usually poorly delineated in parkinsonian disorders on most functional neuroimaging techniques, most studies have failed to show the different pathologic changes among the parkinsonian disorders. In this study, we investigated alternation in regional loss of dopamine transporter binding using statistical parametric mapping(SPM) in patients with PD and the parkinsonian variant of MSA(MSA-P). METHODS: Ten PD and five MSA-P patients within 3 years of duration were studied with dual isotope brain SPECT following simultaneous injection of 370 MBq [99mTc] HMPAO and 111 MBq [123I] IPT. RESULTS: The basal ganglia were clearly visible on the fusion image, which was possible for quantitative and sta- tistical analysis. MSA-P patients showed significant loss of dopamine transporter binding in the left globus pallidus, anterior putamen and caudate nucleus in comparison to PD patients. CONCLUSION: This result may provide a useful tool to differentiate the pattern of loss of dopamine transporter bin- ding between PD and MSA-P.

Clinical and Laboratory Characteristics of Recurrent Optic Neuritis; Comparison with Monophasic Optic Neuritis

BACKGROUND: Although relapses are known to be common in optic neuritis, there are only a few follow-up studies concerning recurrent optic neuritis. The aim of this study is to characterize the difference between monophasic and recurrent optic neuritis by analyzing clinical and laboratory spectrums of index event. METHODS: We performed a partially retrospective and prospective cohort study of patients with optic neuritis. The patients with optic neuritis were included by review of their medical records and neuroimaging studies and then followed up for the relapses of optic neuritis. Excluded were those who showed any evidence of multiple sclerosis, and those with prior demyelinating attacks. RESULTS: Thirteen of 43 enrolled patients had a recurrent optic neuritis during a mean (SD) follow up period of 58.0 (21.2) months, yielding a 5-year cumulative rate of recurrence of 39.5 percent. The patients who had CSF pleocytosis were more likely to develop a recurrent attacks (P<0.05), but neither clinical findings nor the other laboratory results appeared to influence recurrence. CONCLUSIONS: We suggest that this disorder have a distinctive feature in terms of relapse and CSF pleocytosis compared with monophasic optic neuritis.

Reliability and Validity of the Korean Version of Revised form of Hasegawa Dementia Scale (K-HDS)

BACKGROUND: The revised version of the Hasegawa Dementia Scale (HDS-R) is a useful dementia screening tool with a test for frontal lobe function and is relatively less influenced by education level and linguistic ability. We developed a Korean version of HDS-R (K-HDS) by translating the HDS-R to screen dementia patients in the Korean elderly. METHODS: The basic structure of the HDS-R was preserved but some questions were modified for lingual and cultural difference. It was administrated along with the Korean version of the MMSE, Korean Dementia Screening Questionnaire, Short form Samsung Dementia Questionnaire and Clinical Dementia Rating (CDR) scales, to 151 patients (55 Alzheimer's disease, 73 vascular dementia, 23 others) with mild to moderate dementia and to 225 elderly control subjects. To screen dementia, the optimal cut-off score was estimated by receiver operating characteristic (ROC) curve analysis. By comparing the Area Under the Curve, the diagnostic efficiency of K-HDS was compared with that of K-MMSE. RESULTS: The K-HDS had good internal consistency (Crohnbach's alpha coefficient=0.66), inter-rater reliability (r=0.95), and test-retest reliability (r=0.92). K-HDS was well correlated with the K-MMSE (r=0.84) and CDR (r=-0.67), which confirms the validity of this test. The optimal cut-off score was different according to educational level. In patients with an educational level less than 10 years, the cut-off score was 20 with the sensitivity of 87.0% and the specificity of 83%. With an educational level of 10 years or more, the cut-off score was 22 with the sensitivity of 93.0% and the specificity of 89.6%. The overall diagnostic efficiency of K-HDS was superior to that of K-MMSE especially in patients with an educational level of less than 10 years. CONCLUSIONS: The K-HDS is a reliable, valid and useful tool to screen dementia in the Korean elderly.

Correlation between Multifocal Hypointense Cerebral Lesions on Gradient-echo MRI and White Matter Changes in Patients with Stroke

BACKGROUND: The multifocal hypointense cerebral lesions (MHCLs) on gradient echo (GE)-MRI and white matter changes on T2WI have been thought to be indicative of microangiopathy. The purpose of this study is to elucidate the relationship between MHCLs and white matter (WM) changes and the clinical significance of WM changes in stroke patients. METHODS: We retrospectively reviewed MRI and clinical data of 115 patients with stroke (56 female and 59 male). Periventricular and deep white matter hyperintensity (PVHI and DWMHI) were measured by semiquantative rating scale proposed by Mantyla. The round, hypointense signal, less than 7 mm in diameter on GE-MRI were counted as MHCLs. The association between risk factors of stroke and MHCLs on GE-MRI and sum of the white matter change scores and total number of MHCLs were analyzed, respectively. RESULTS: MHCLs on GE-MRI were significantly associated with old age (p<0.05) and hypertension (p<0.001) among risk factors of stroke. The distribution of MHCLs in subcortical area is associated with hypertension (p<0.05) and total number of MHCLs was significantly associated with sum of the white matter change scores (p<0.05). CONCLUSIONS: MHCLs on GE-MRI were significantly associated with severity of WM changes. Severe WM change may be an indicator of advanced small artery disease of the brain with an increased risk factor for bleeding. This should be taken into consideration when treating patients with stroke.

Predictive Value of C-Reactive Protein in the Differential Diagnosis of Acute Meningitis in Adults

BACKGROUND: The aim of this study was to clarify to what extent bacterial meningitis could be distinguished from aseptic or tuberculous meningitis through C-reactive protein (CRP) in adults. METHODS: We retrospectively analyzed the medical records of 91 patients aged 15~81 years who had been hospitalized for acute meningitis and underwent lumbar puncture due to suspected central nervous system infection. RESULTS: We included 50 patients with aseptic meningitis, 23 patients with acute bacterial meningitis, and 18 patients with tuberculous meningitis. Blood CRP was higher in bacterial meningitis. None of the patients with bacterial meningitis had a CRP value of under 20 mg/dl. The CRP values were under 20 mg/dl in 92% of the patients with aseptic meningitis and in 73% of those with tuberculous meningitis. Taking a CRP level of above 20 mg/dl as a positive discriminatory factor for bacterial meningitis, the sensitivity and specificity were 1.0, 0.88. To better predict whether a patient has bacterial or nonbacterial meningitis, we developed a canonical discriminant function equation using CRP and CSF parameter, and finally concluded that blood CRP was a good predictive indicator that differentiated bacterial meningitis from aseptic or tuberculous meningitis at admission. CONCLUSIONS: The CRP measurement, is easily performed and inexpensive. We believe it is worth analyzing CRP whenever meningitis is suspected, it can also limit the unnecessary use of antibiotics.

The Selective Cyclooxygenase-2 Inhibitor Rofecoxib Reduces Chronic Cerebral Hypoperfusion-induced Apoptosis in the Rat Hippocampus

BACKGROUND: Chronic cerebral hypoperfusion induced by permanent occlusion of bilateral common carotid arteries (2VO) in rats caused cognitive deficits and neuronal damage. Cyclooxygenase-2 (COX-2) inhibitor was reported to attenuate both post-ischemic prostaglandin accumulation and neuronal damage. We studied the expression of mRNA of COX-2 in the hippocampus during hypoperfusion and the effectiveness of selective cyclooxygenase-2 inhibitor, rofecoxib, in preventing the neuronal damage of this model. METHODS: Bilateral common carotid arteries of the rat were ligated with silk sutures. The expression of mRNA for COX-1 and COX-2 were detected by the RT-PCR. The first group of animals (n=6) was treated with rofecoxib (10 mg/kg, i.p.) 7 days after operation and the following 7 days. The second group of animals (n=6) was treated with diclofenac sodium (9mg/kg, i.p.) and the third group of animals (n=5) was treated with vehicle (DMSO). TdT-mediated dUTP nick end labeling (TUNEL) technique was performed to estimate delayed cell death. RESULTS: Bilateral carotid artery occlusion (2VO) was shown to induce apoptotic morphology and DNA strand break in hippocampal neurons from 7 days with a peak at 14, 28 days. mRNA of COX-2 appeared in the frontal cortex (14, 28 days) and hippocampus (14, 28, 63 days). Treatment with rofecoxib significantly (p<0.05) attenuated the number of TUNEL-labeled cells in the hippocampus, whereas the cells of the diclofenac treated group were not protected. CONCLUSIONS: We concluded that COX-2 might contribute to cell death of pyramidal cells of the hippocampus of hypoperfusion and selective COX-2 inhibitor, rofecoxib, could prevent the neuronal damage.

The Different Patterns of Behavioral Derangements in Subcortical Vascular Dementia and Alzheimer's Disease: Evaluated by the Korean Version of the Neuropsychiatric Inventory

BACKGROUND: The neuropsychiatric derangements in dementing patients are common and troublesome in their managements. The purpose of this study is to compare the behavioral changes in patients with subcortical vascular dementia (SVaD) and to those in patients with Alzheimer's disease (AD) by using the Korean version of the neuropsychiatric inventory (K-NPI). METHODS: The K-NPI was administrated to the close caregivers of 19 patients with AD (who met the criteria of the NINCDS-ADRDA for probable AD) and 14 patients with SvaD (who met the criteria of the NINDS-AIREN criteria for probable or possible VaD). Groups were matched for age, education and dementia severity. We evaluated the prevalence, the composite score (frequency X severity) of each behavioral domain in K-NPI between two groups. RESULTS: The most common behavioral disturbances were anxiety (63%) in AD and apathy/indifference (93%) in SVaD. Patients with SVaD had significantly greater total K-NPI scores than patients with AD and exhibited apathy/indifference, agitation/aggression and anxiety more frequently. Composite score of apathy/indifference over 4.7 point discriminates between AD and SVaD with accuracy of 75.8%. CONCLUSIONS: The K-NPI provides behavioral profiles that differentiate patients with SVaD from patients with AD. Patients with SVaD are more behaviorally disturbed. Clinicians need to pay more attention to the behavioral disturbances when managing the patients with SVaD.

Apolipoprotein E4 Genotype in Patient with IschemicCerebrovascular Disease in Korea: A Preliminary Study

BACKGROUND: The apolipoprotein E (APOE) epsilon4 allele is over-represented in Alzheimer's disease, atherosclerosis, and ischemic heart disease. We investigated whether specific APOE polymorphism is a risk factor for ischemic cerebrovas-cular disease in the Korean population. METHODS: We compared 98 patients with ischemic cerebrovascular disease with 209 controls similar in age and dwelling areas. APOE genotypes were determined by restriction fragment-length poly-morphism analysis. The association of the APOE with: stroke subtypes, white matter hyperintensities, lipid profiles, and potential vascular risk factors, including: age, sex, hypertension, diabetes mellitus, lipid disorders, smoking habit, cardiac diseases, presence of past history and family history of ischemic cerebrovascular diseases, was examined. RESULTS: Overall, patients with ischemic cerebrovascular disease had no difference in APOE allele frequency with controls (p>0.05). Also, neither stroke subtypes nor white matter high signal intensities were associated with APOE polymorphism (p>0.05). APOE epsilon4 carriers exhibited more frequent personal stroke histories compared with non-epsilon4 subjects (p<0.01). CONCLUSIONS: Our data suggests that the APOE epsilon4 is not associated with ischemic cerebrovascular disease in the Korean population. However, an association between APOE epsilon4 and personal history supports the possibility that the APOE is a susceptibility locus for the risk of ischemic cerebrovascular diseases. (J Korean Neurol Assoc 19(1):19~23, 2001