A Validation Study of the Inbrain CST: a Tablet Computer-based Cognitive Screening Test for Elderly People with Cognitive Impairment

Background@#Computerized versions of cognitive screening test could have advantages over pencil-and-paper versions by eliminating rater-dependent factors and saving the time required to score the tests and report the results. We developed a computerized cognitive screening test (Inbrain Cognitive Screening Test [Inbrain CST]) that takes about 30 minutes to administer on a touchscreen computer and is composed of neuropsychological tests already shown to be sensitive in detecting early cognitive decline in Alzheimer's disease (AD). The aims of this study were to 1) introduce normative data for Inbrain CST, 2) verify its reliability and validity, 3) assess clinical usefulness, and 4) identify neuroanatomical correlates of Inbrain CST. @*Methods@#The Inbrain CST runs on the Microsoft Windows 10 operating system and comprises 7 subtests that encompass 5 cognitive domains: attention, language, visuospatial, memory, and executive functions. First, we recruited 480 cognitively normal elderly people (age 50–90) from communities nationwide to establish normative data for Inbrain CST.Second, we enrolled 97 patients from our dementia clinic (26 with subjective cognitive decline [SCD], 42 with amnestic mild cognitive impairment [aMCI], and 29 with dementia due to AD) and investigated sensitivity and specificity of Inbrain CST for discriminating cognitively impaired patients from those with SCD using receiver operating characteristic (ROC) curve analyses. Third, we compared the Inbrain CST scores with those from another neuropsychological test battery to obtain concurrent validity and assessed test–retest reliability. Finally, magnetic resonance imaging (MRI)-based cortical thickness analyses were performed to provide anatomical substrates for performances on the Inbrain CST. @*Results@#First, in the normative sample, the total score on the Inbrain CST was significantly affected by age, years of education, and gender. Second, Inbrain CST scores among the three patient groups decreased in the order of SCD, aMCI, and AD dementia, and the ROC curve analysis revealed that Inbrain CST had good discriminative power for differentiating cognitively impaired patients from those with SCD. Third, the Inbrain CST subtests had high concurrent validity and test–retest reliability. Finally, in the cortical thickness analysis, each cognitive domain score and the total score of Inbrain CST showed distinct patterns of anatomical correlates that fit into the previously known brain–behavior relationship. @*Conclusion@#Inbrain CST had good validity, reliability, and clinical usefulness in detecting cognitive impairment in the elderly. Furthermore, it showed neuroanatomical validity through MRI cortical thinning patterns. These results suggest that Inbrain CST is a useful cognitive screening tool with efficiency and validity to detect mild impairments in cognition in clinical settings.

Re-standardization of the Korean- Instrumental Activities of Daily Living (K-IADL): Clinical Usefulness for Various Neurodegenerative Diseases

BACKGROUND AND PURPOSE: Evaluating instrumental activities of daily living (IADL) is an important part of procedure to diagnose dementia. The Korean-Instrumental Activities of Daily Living (K-IADL) has been used extensively in Korea. However, its cut-off score has not been reformulated since 2002. The purpose of this study was to yield a new optimal cut-off score for the K-IADL and confirm the validity of this new cut-off score with various dementia groups. METHODS: We retrospectively collected a total of 2,347 patients' K-IADL data from 6 general hospitals in Korea. These patients had mild cognitive impairment (MCI) or dementia with various etiologies for cognitive impairment. We also recruited a normal control group (n=254) from the community. Korean-Mini Mental State Examination, Short version of the Geriatric Depression Scale, Clinical Dementia Rating, and Global Deterioration Scale were administered to all participants. Caregivers completed K-IADL and Barthel Index. RESULTS: K-IADL scores were significantly different among dementia subgroups, but not significantly different among MCI subgroups. Based on internal consistency, correlations with other scales, and factor analysis, K-IADL showed excellent reliability and validity. The new optimal cut-off score to diagnose dementia was 0.40, which gave a sensitivity of 0.901 and a specificity of 0.916. Positive predictive value for dementia using the new cut-off score was 94.2% for Alzheimer's disease, 100% for vascular dementia, and 84% for Parkinson's disease. CONCLUSIONS: Our results illustrate that the new K-IADL cut-off score of 0.40 is reliable and valid for screening impairments of daily functioning resulting from various etiologies.

Seoul Neuropsychological Screening Battery-Dementia Version (SNSB-D): A Useful Tool for Assessing and Monitoring Cognitive Impairments in Dementia Patients

The Seoul Neuropsychological Screening Battery (SNSB) is one of the standardized neuropsychological test batteries widely used in Korea. However, it may be a bit too lengthy for patients with decreased attention span; and it does not provide the score of global cognitive function (GCF), which is useful for monitoring patients longitudinally. We sought to validate a dementia version of SNSB (SNSB-D) that was shorter than the original SNSB and contained only scorable tests with a GCF score of 300. We administered SNSB-D to patients with mild cognitive impairment (MCI) (n=43) and Alzheimer's disease (AD) (n=93), and normal controls (NC) (n=77). MCI and AD groups had GCF scores significantly different from NC group, and GCF scores were able to distinguish patients with Clinical Dementia Rating of 0.5 and 1. Test-retest reliability was high, with a correlation coefficient of 0.918 for AD, 0.999 for MCI, and 0.960 for NC. The GCF score significantly correlated with the Mini-Mental State Examination (MMSE). Through ROC-curve analysis, GCF scores were found to yield more accurate diagnoses than the MMSE. The SNSB-D is a valid, reliable tool for assessing the overall cognitive function, and can be used to monitor cognitive changes in patients with dementia.

The Effect of Continuous Nutritional Education and Oral Mucositis Management on Nutritional Status of Patients Undergoing Hematopoietic Stem Cell Transplantation / 종양간호학회지

PURPOSE: This study aimed to evaluate the effectiveness of continuous nutritional education and oral mucositis management on the nutritive status of patients who received hematopoietic stem cell transplantation (HSCT). METHODS: After randomly allotting 72 patients who received HSCT to either an experimental group or a control group, intensive and continuous care for preventing malnutrition was conducted in the experimental group while usual routine care was conducted in the control group. The changes of the body scale, blood chemistry profile, oral intake calories, nausea and vomitus, and oral stomatitis scores were measured at three points during their hospitalization using a oral assessment guide and nutrition analysis program: admission, HSCT, and discharge day. The differences between the scores of two groups were analyzed by repeated measures analysis of covariance. RESULTS: The number of total lymphocytes was significantly improved in the experimental group after transplantation (p<.001). Nausea and vomiting score was significantly decreased in the experimental group during the conditioning regimen (p<.001). CONCLUSION: It was found that continuous nutritional education and oral mucositis control is an effective intervention by improving immune condition. Further investigations concerning direct examination of oral intake with controlling the effect of the chemotherapy are needed to ultimately discern the impact of varying oral nutrition patterns during HSCT.

Evaluation of CDSS for Drug Prescriptions Based on Success Measures / 대한의료정보학회지

OBJECTIVE: The Clinical Decision Support System (CDSS) for drug prescriptions was developed by integrating the computerized physician order entry (CPOE) system to support doctors and pharmacists in making correct decisions on prescribing drugs in line with the prescription guidelines by the Health Insurance Review Agency (HIRA). The objective of this study was to evaluate the performance of the CDSS with respect to system quality, information quality, and user satisfaction in reducing prescription errors. METHODS: The study was based on survey data from 38 hospitals that were using the CDSS for drug prescriptions. To identify factors influencing the performance of CDSS, multiple linear regression and chi-square analyses were performed. RESULTS: Regression analysis showed that the variables for system quality and information quality significantly influenced the overall system performance. Specifically, ease of understanding the results and terminology assystem quality measures significantly influenced user satisfaction. Furthermore, based on chi-square analysis, two independent variables (ease of understanding results and decision support functions) were statistically significant with respect to all four dependent variables (information satisfaction, system satisfaction, willingness to recommend to other hospitals, and drug safety). CONCLUSION: Based on this study, users should be educated to improve their understanding of the system,and system and information quality should be continuously monitored to improve user satisfaction.

The Closing-in Phenomenon in Alzheimer's Disease and Vascular Dementia

BACKGROUND AND PURPOSE: The closing-in phenomenon is the tendency to draw near or on the target when copying figures, which has been found mostly in patients with Alzheimer's disease (AD). We attempted to quantify the degree of closing-in and to compare it between patients with AD and vascular dementia (VaD). METHODS: The subjects (55 AD, 39 VaD and 38 normal controls) were asked to copy the figure of alternating square and triangle, starting at the designated point and continuing from left to right. The patients with AD and VaD did not differ in age, education, severity of dementia or Rey Complex Figure Test copy score. The proximity (Y-axis) of the subject's drawing to the target was plotted at intervals of 2 mm along the X-axis and the degree of closing-in was computed from the slope of the regression line. RESULTS: The AD and VaD patients showed a steeper slope than the controls. There was no significant difference, however, in the magnitude of closing-in of the AD and VaD patients. When closing-in was defined as a slope that was greater than the mean+2SD of the slope observed for the controls, 32.7% of the AD and 25.6% of the VaD patients showed closing-in. CONCLUSIONS: Our study, using a new method of measuring the degree of closing-in, suggests that this phenomenon is not specific to AD.

Erosion of an Inflatable Penile Prosthesis Reservoir into the Bladder, Presenting Bladder Calculi / 대한비뇨기과학회지

Complications of penile prosthesis include malfunction, infection and patient dissatisfaction. Herein, a rare complication of a retained reservoir having eroded into the bladder after the removal of the penile components of a three-piece penile prosthesis, is reported. A 39-year-old man complained of irritative voiding symptoms. The symptoms had developed 4 years after the removal of the penile components of the prosthesis. The erosion of the reservoir into the bladder was discovered incidentally during the treatment of bladder calculi. The reservoir was removed by an open vesicolithotomy.

The Validity of the Korean Version of Global Deterioration Scale

BACKGROUND: Clinicians broadly accept the Global Deterioration Scale (GDS) as a staging measure for dementia. The aim of this study is to test the inter-rater reliability and concurrent validity of the Korean version of GDS. METHODS: Participants included 34 subjects without dementia and 41 patients with Alzheimer's disease, in addition to 37 patients with vascular dementia. A rater, using a semi-structured clinical interview, interviewed the participants and their informed collateral sources. To obtain the concurrent validity, all participants received the Korean Mini-Mental State Examination (K-MMSE), the Korean version of Syndrome Kurz Test (K-SKT) and a 15-items abbreviated Korean-Boston Naming Test (K-BNT) on the same day. We also tested the inter-rater reliability among the four raters using a videotape design. RESULTS: The agreements of the overall GDS ratings by the four raters were high (kappa, 0.93-1.0). GDS correlated significantly with K-MMSE, K-SKT, and the abbreviated K-BNT and Clinical Dementia Rating scale. CONCLUSION: The Korean version of GDS may be a reliable and valid tool to be used as a staging measure for Korean patients with Alzheimer's disease as well as vascular dementia.

Estimating the Validity of the Korean Version of Expanded Clinical Dementia Rating (CDR) Scale

BACKGROUND: The Clinical Dementia Rating (CDR) scale is broadly accepted by clinicians as a staging measure for dementia. The aim of this study was to test inter-rater reliability and concurrent validity of the Korean version of the CDR. METHODS: Participants included 34 persons without dementia and 41 patients with Alzheimer's disease, and 37 patients with vascular dementia. The participants and their informed collateral sources were interviewed by a rater using a semistructured clinical interview. To obtain concurrent validity, all the participants received K-MMSE, K-SKT (Syndrom Kurz Test), and a 15-items abbreviated K-BNT on the same day. We also tested inter-rater reliability among four raters using a videotape design. RESULTS: Agreements of the overall CDR ratings (kappa, 0.86-1.0) and Sum of Boxes of CDR (CDR-SB) (gamma, 0.89-1.0) by the four raters were high. Both global CDR and CDR-SB correlated significantly with K-MMSE, K-SKT and the abbreviated K-BNT. The Orientation and Memory box score correlated significantly with orientation and memory scores of K-MMSE. CONCLUSIONS: The Korean version of CDR appears to be a reliable and valid tool as a staging measure for Korean dementia patients.

Squamous Cell Carcinoma Occurred Concomitantly in the Female Urethra and Vulva / 대한비뇨기과학회지

Urethral carcinomas represent a rare and challenging subset of genitourinary malignancies. Treatments are variable from a radical operation to only radiotherapy, depending upon the size, extent and location of the lesion. Despite of the various treatments, the prognosis for urethral carcinoma is poor. We report a case of a 41-year-old woman with squamous cell carcinoma which occurred concomitantly in the urethra and vulva.

Ocular Search Pattern during Line Bisection Task in Normal Subjects

BACKGROUND: The study of ocular search pattern in normal subjects and patients with hemispatial neglect may help understand spatial cognition. However, only a few studies are available that investigated ocular search pattern even in normal controls. The present study was to investigate ocular search pattern of normal subjects during line bisection task. METHODS: Nine normal subjects (6 men and 3 women with mean age of 21.8+/-4.2 years) were requested to fix their eyes on the midpoint of the line that was presented on the monitor. Lines for bisection were varied according to the location (center, right-sided or left-sided) and length (short or long) and each subject performed 6 trials (one trial/condition). Horizontal eye movements were recorded using an infrared video-oculography and were analyzed in terms of the range and the direction of eye movements. RESULTS: Average range of fixation during line bisection was 20.1% of entire length that corresponded middle portion of the line. There was no directional preference in searching the line during line bisection task. CONCLUSIONS: We expected that normal subjects overtly look at both ends of the line before they bisect the line. On the contrary, they seem to use a strategy such that they directly go to the middle part of the line and then make fine adjustment while looking at both ends of line covertly. (J Korean Neurol Assoc 19(2):96~101, 2001)

Ocular Search Pattern during Line Bisection Task in Normal Subjects

BACKGROUND: The study of ocular search pattern in normal subjects and patients with hemispatial neglect may help understand spatial cognition. However, only a few studies are available that investigated ocular search pattern even in normal controls. The present study was to investigate ocular search pattern of normal subjects during line bisection task. METHODS: Nine normal subjects (6 men and 3 women with mean age of 21.8+/-4.2 years) were requested to fix their eyes on the midpoint of the line that was presented on the monitor. Lines for bisection were varied according to the location (center, right-sided or left-sided) and length (short or long) and each subject performed 6 trials (one trial/condition). Horizontal eye movements were recorded using an infrared video-oculography and were analyzed in terms of the range and the direction of eye movements. RESULTS: Average range of fixation during line bisection was 20.1% of entire length that corresponded middle portion of the line. There was no directional preference in searching the line during line bisection task. CONCLUSIONS: We expected that normal subjects overtly look at both ends of the line before they bisect the line. On the contrary, they seem to use a strategy such that they directly go to the middle part of the line and then make fine adjustment while looking at both ends of line covertly. (J Korean Neurol Assoc 19(2):96~101, 2001)

A Clinical Analysis of 2503 Emergent Explo-Laparotomic Cases

BACKGROUND AND METHODS: We have tried to analyze the clinical findings from a total of 2503 emergent explo-laparotomic cases which had been performed during ten years from March 1989 to February 1999 at the Deptartment of General Surgery of Inchon Medical Center, Public Corporation. RESULTS AND CONCLUSIONS: 1) The total 2503 emergent explo-laparotomic cases were composed of 1992 cases (79.6%, most common) of acute appendicitis, 235 cases (9.4%) of panperitonitis, 93 cases (3.7%) of intestinal obstruction, 62 cases (2.7%) of hemoperitoneum (more than 2000 cc, without panperitonitis), 40 cases (1.6%) of gall bladder empyema, 16 cases (0.6%) of upper gastrointestinal bleeding, 15 cases (0.6%) of wound evisceration, 10 cases (0.4%) of incarcerated inguinal hernia, 9 cases (0.4%) of intra- peritoneal abscess, 9 cases (0.4%) of pancreatic abscess, 7 cases (0.3%) of septic cholangitis, 6 cases (0.2%) of diverticulitis, 5 cases (0.2%) of intussusception, 2 cases (0.1%) of liver abscess and 2 cases (0.1%) of retroperitoneal abscess. 2) Of the 1992 emergent explo-laparotomic cases which had been performed due to acute appendicitis, there were 1826 cases (more than 90%) of simple appendicitis, 95 cases of perforated appendicitis, and 71 cases of periappendiceal abscess. 3) The 237 explo-laparotomic cases of panperitonitis contained 147 cases (62%) of non-traumatic (by disease) panperitonitis and 90 cases (38%) of traumatic panperitonitis. Of the 147 cases of non-traumatic panperitonitis, there were 91 cases (62%, most common) of duodenal ulcer perforation, 21 cases of stomach ulcer perforation, 6 cases of bile peritonitis, 5 cases of colon cancer perforation, etc. Of the 90 cases of traumatic panperitonitis, there were 42 cases of small bowel rupture, 12 cases of colon rupture, 9 cases of stomach rupture, 8 cases of duodenal rupture, etc. 4) The 97 explo-laparotomic cases of intestinal obstruction were composed of 34 cases (35%, most common) of adhesive ileus, 18 cases of duodenal obstruction (16 cases due to duodenal ulcer obstruction, 2 cases due to periampullary cancer invasion), 16 cases of colon cancer obstruction, 7 cases of cancer peritoneii, 6 cases of incarcerated inguinal hernia, 4 cases of small bowel ileus, 3 cases of intestinal tuberculosis, etc. 5) The 61 cases of hemoperitoneum contained 56 cases (92%) of traumatic hemoperitoneum and 5 cases (8%) of spontaneous hemoperitoneum. Of the 56 cases of traumatic hemoperitoneum, there were 20 cases of splenic rupture, 18 cases of mesenteric tearing, 11 cases of liver laceration, etc. 6) The 148 cases of emergent explo-laparotomy for trauma contained 114cases (77%) due to blunt trauma and 34 cases (23%) due to penetrating trauma. Of the 114 emergent explo-laparotomic cases due to blunt trauma, there were 37 cases (32%, most common) of small-bowel rupture, 19 cases (17%, 2nd common) of splenic rupture, 17 cases of mesenteric tearing, 12 cases of colon rupture, 8 cases of liver laceration, 8 cases of duodenal rupture, 3 cases of stomach rupture, 3 cases of pancreas rupture, etc. Of the explo-laparotomic cases due to penetrating trauma, there were abdominal wall only penetration (most common), stomach, small bowel, liver organ injury, etc, in decreasing order.

A Case of Intracavernous Needle Breakage during Intracavernous Self-injection of Prostaglandin E1 ( Caverject? ) / 대한비뇨기과학회지

Intracavernous self-injection of vasoactive agents for the treatment of erectile dysfunction has been used widespread in recent years. Complications of intracavernous self-injection include priapism, burning sensation, fibrosis, penile nodule and urethral injection. We report a case of intracavernous needle breakage associated with the Prostaglandin E1 self-injection therapy.

Clinical Characteristics of the Geriatric Surgical Patients

BACKGROUND: Due to rapid economic growth and the development of medical science, the human life span is increasing nowadays. Due to this, old-aged people are increasing in number. However, the physiologic reserve power of old-aged people is lower than that of younger people. Therefore, it is necessary to be very careful about peri-operative care when doing surgery on old-aged people under general or spinal anesthesia. METHODS: We analyzed the medical records of 460 patients over 65 years of age who had undergone operations from August 1990 to July 1996 at the Department of General Surgery, Inchon Medical Center. RESULTS: (1) The ratio of geriatric surgical patients to all surgical patients during the same period was 14.7% (460/3122). Especially, the proportion of geriatric surgical patients increased to 17.0% during the last 2 years of this study compared to 16.2% for the previous 2 years, and 10.6% for the first 2 years. (2) The age distribution was 148 patients from 65 to 69 years (32.2%), 158 patients from 70 to 74 years (34.3%), 90 patients from 75 to 79 years (19.6%), and 64 patients over 80 years (13.9%). There was no significant difference between the number of men and women, there being 232 men and 228 women. (3) Among the 464 cases, 99 cases (21.3%) were malignant diseases compared to 365 cases (78.7%) of benign disease. Stomach cancer was the most common, 36 cases, colon cancer accounted for 31 cases and hepatobiliary cancer for 12 cases. Of the benign diseases, 103 cases (28.2%) were acute appendicitis, 85 (23.4%) were hepatobiliary diseases, 73 (20.1%) were hernias, and 35 (9.6%) were anal diseases. (4) Two hundred twenty-two (222) preoperative-associated diseases were found in 460 patients (48.3%). Cardiovascular disease was the most common (17.4%), and pulmonary disease was the 2nd most common (15.9%). (5) Of the total 133 cases of postoperative complication occurrence, wound infection was the most common, 43 cases, followed by pneumonia, 30 cases, respiratory failure, 11 cases, and renal failure, 7 cases. (6) The postoperative mortality rate was 5.0% and the most common cause was respiratory failure, 8 cases, followed by sepsis, 8 cases. CONCLUSION: The field of geriatric surgery must be pioneered and developed more by surgeons because the number of geriatric surgical patients is increasing more rapidly at present than in the past.

Malakoplakia of Urinary Bladder Misdiagnosed as a Cancer / 대한비뇨기과학회지

This report deals with a case of malakoplakia of urinary bladder in a 68 year old female. The lesion of malakoplakia has been misdiagnosed as a neoplasm on several occasions in other institutes. This disease has been reported seldomly, and many urologists and pathologists alike have been unfamiliar to the lesion. An emphasis on the clinicopathologic features is made in order to prevent the serious misdiagnosis. The pertinent literatures are reviewed.