Impact of an Education Program for Caregivers of Patients with Alzheimer’s Disease on Treatment Discontinuation and Compliance in Korea

Background@#and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. @*Methods@#This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. @*Results@#The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. @*Conclusions@#Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.

Discontinuation Rate of Newly Prescribed Donepezil in Alzheimer’s Disease Patients in Asia

Background@#and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. @*Methods@#This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). @*Results@#Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. @*Conclusions@#In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Impact of an Education Program for Caregivers of Patients with Alzheimer’s Disease on Treatment Discontinuation and Compliance in Korea

Background@#and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. @*Methods@#This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. @*Results@#The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. @*Conclusions@#Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.

Discontinuation Rate of Newly Prescribed Donepezil in Alzheimer’s Disease Patients in Asia

Background@#and Purpose The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia. @*Methods@#This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS). @*Results@#Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS. @*Conclusions@#In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Four-and-a-half-year Follow-up of Idiopathic Normal Pressure Hydrocephalus Patient Treated with a Ventriculoperitoneal Shunt

A 68-year-old man presented with progressive impairment of gait, balance, and memory. He exhibited a slow and unstable gait. Formal neuropsychological evaluation showed a deficit in visuospatial function and memory with frontal dysfunctions. He was diagnosed as idiopathic normal pressure hydrocephalus with an Evans' ratio of 0.35. Four-and-a-half years after ventriculoperitoneal shunt placement, he showed a marked improvement in gait, as well as in visuospatial and frontal lobe functions. He benefited from shunt surgery for at least four-and-a-half years.

Fluctuating Pramipexole Induced Dropped Head Syndrome

No abstract available.

Asymmetric and Upper Body Parkinsonism in Patients with Idiopathic Normal-Pressure Hydrocephalus

BACKGROUND AND PURPOSE: Our aims were to analyze the characteristics of parkinsonian features and to characterize changes in parkinsonian motor symptoms before and after the cerebrospinal fluid tap test (CSFTT) in idiopathic normal-pressure hydrocephalus (INPH) patients. METHODS: INPH subjects were selected in consecutive order from a prospectively enrolled INPH registry. Fifty-five INPH patients (37 males) having a positive response to the CSFTT constituted the final sample for analysis. The mean age was 73.7±4.7 years. The pre-tap mean Unified Parkinson's Disease Rating Scale motor (UPDRS-III) score was 24.5±10.2. RESULTS: There was no significant difference between the upper and lower body UPDRS-III scores (p=0.174). The parkinsonian signs were asymmetrical in 32 of 55 patients (58.2%). At baseline, the Timed Up and Go Test and 10-meter walking test scores were positively correlated with the total motor score, global bradykinesia score, global rigidity score, upper body score, lower body score, and postural instability/gait difficulties score of UPDRS-III. After the CSFTT, the total motor score, global bradykinesia score, upper body score, and lower body score of UPDRS-III significantly improved (p<0.01). There was a significant decrease in the number of patients with asymmetric parkinsonism (p<0.05). CONCLUSIONS: In the differential diagnosis of elderly patients presenting with asymmetric and upper body parkinsonism, we need to consider a diagnosis of INPH. The association between gait function and parkinsonism severity suggests the involvement of similar circuits producing gait and parkinsonian symptoms in INPH.

Selective Fascicle Injection of Botulinum Toxin at the Flexor Digitorum Superficialis and Flexor Digitorum Profundus in Patient with Focal Dystonia Affecting Fingers

No abstract available.

Cerebrospinal Fluid Tap Test in Idiopathic Hydrocephalus Patient with an Evans' Index Less Than 0.3

A 73-year-old man presented with progressive gait impairment. He exhibited slow, shuffling, and unstable gait. A formal neuropsychological evaluation revealed memory deficits with frontal dysfunction. Brain MRI revealed communicating hydrocephalus with an Evans' index of 0.27. After cerebrospinal fluid (CSF) removal by lumbar puncture, the patient exhibited a marked improvement in gait. A CSF tap test after careful clinical examination may need to be considered in the diagnosis of idiopathic hydrocephalus with an Evans' index of <0.3.

Expiratory Stridor Improved With Positive Airway Pressure Therapy in Multiple System Atrophy-Cerebellar Type

No abstract available.

Prevalence and Related Factors for High-Risk of Obstructive Sleep Apnea in a Large Korean Population: Results of a Questionnaire-Based Study

BACKGROUND AND PURPOSE: A population-based door-to-door study of cross-sectional methods for assessing the prevalence and factors related to a high risk of obstructive sleep apnea (OSA) was conducted using the Korean version of the Berlin Questionnaire (K-BQ). METHODS: Pooled data collected from Community Health Surveys by the Korea Center for Disease Control and Prevention were analyzed. Of 8,140 respondents from the population, 7,955 were finally included in this study. RESULTS: Of the 7,955 included subjects, 15.7% of the men and 9.8% of the women were at high risk of OSA. Significant differences were found in the following factors between the subjects with a high risk of OSA: gender, age, marital status, educational level, occupation, and presence of smoking, harmful alcohol use, and chronic diseases. Male sex, harmful alcohol use, and the presence of chronic diseases were identified as factors independently associated with a high risk of OSA. CONCLUSIONS: This is the first study to confirm the usefulness of the K-BQ to study the prevalence of OSA in the Korean general population. The findings demonstrate that harmful alcohol use and chronic diseases are very common characteristics among those with a high risk of OSA.

Idiopathic Normal-Pressure Hydrocephalus Patient With an Ataxic Gait as the Predominant Presenting Manifestation

A 43-year-old man presented with progressive ataxic gait of 5 months duration. His gait speed was almost normal, and he did not exhibit shuffling, freezing, or festination. A formal neuropsychological evaluation revealed a deficit in visuospatial function and memory with mild frontal dysfunctions. Brain MRI revealed communicating hydrocephalus with an Evans' ratio of 0.32. After CSF removal by lumbar puncture the patient showed a marked improvement in gait as well as frontal lobe functions, and was finally diagnosed as having idiopathic normal-pressure hydrocephalus.

Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus Patient with Delayed Improvement after Tap Test

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.

Chorea Associated With Mercury Poisoning

The differential diagnosis of chorea can be challenging in patients without a family history of Huntington's disease or acute-onset hemichorea with stroke. A 50-year-old woman presented with generalized choreic movements and gait disturbance that first appeared 1 month previously. An extensive diagnostic workup including genetic testing, neuroimaging, and various laboratory investigations revealed that this patient had developed chorea as a result of mercury poisoning. She was treated successfully with chelation therapy.

Chorea Associated With Mercury Poisoning

The differential diagnosis of chorea can be challenging in patients without a family history of Huntington's disease or acute-onset hemichorea with stroke. A 50-year-old woman presented with generalized choreic movements and gait disturbance that first appeared 1 month previously. An extensive diagnostic workup including genetic testing, neuroimaging, and various laboratory investigations revealed that this patient had developed chorea as a result of mercury poisoning. She was treated successfully with chelation therapy.

Co-Occurrence of Syringomyelia and Hydrocephalus in a Patient Without Chiari Malformation in Her 50's

Syringomyelia rarely accompanies hydrocephalus in the aged person except for the cases with a typical Chiari malformation. A 59-year-old woman developed progressive generalized weakness and gait disturbance for 9 years. MRI demonstrated marked enlargement of the cerebral ventricles and the longitudinal dilatation of central canal involving the entire spinal cord, whereas a typical Chiari malformation was absent. She was successfully treated by ventriculoperitoneal shunting. We report a hydrocephalic patient in her 50's accompanied by syringomyelia without a typical Chiari malformation.