Population-Based Norms for the Korean Mini-Mental State Examination and Korean version of modified Mini-Mental State Examination

BACKGROUND: Cognitive functioning was known to be affected by socioeconomic conditions including ethnicity. The Korean Mini-Mental State Examination (K-MMSE) and the Korean version of the modified Mini-Mental State Examination (K-modified MMSE; K-mMMSE) scores by age, gender, and educational levels were evaluated. METHODS: Screening interviews were conducted with 2251 men and 3267 women aged 45 and over in 3 communities (Namwon-city of Chonbuk province, Younggwang-gun of Chonnam province). Descriptive performances (means, medians and percentile ranks) were calculated to summarize the range of normal performance. Scatterplots of the K-mMMSE scores according to age or educational attainments were performed. RESULTS: Lower age, higher education, and male gender were associated with higher scores of the K-MMSE and K-mMMSE. In women, more than half (50.6%) had no formal education and 546 women (16.7%) were illiterate. In men, the K-MMSE and K-mMMSE median scores ranged from 27 and 88 for individuals aged from 45 to 49 years old, to 25 and 76 for those aged 70 years and over. In women, the K-MMSE and the K-mMMSE median scores ranged from 17 and 53 for illiterate women, to 28 and 90 for women with more than 10 years of education. CONCLUSIONS: The use of the reference values will allow the clinician to interpret a patients performance on the K-MMSE and K-mMMSE, in light of the value expected from a group of normal subjects with the same sociodemographic profile.

Ergotism With Ischemia In All Four Extremities: A Case Report

Here we describe a case of ergotism that presented with ischemia in all four extremities. A 48-year-old man was admitted for pain and weakness in both upper extremities. He had a long history of migraine and had taken 3 mg of ergotamine daily for more than 21 years. Angiography demonstrated vasospasm involving all four extremities, which resolved partially following intra-arterial prostaglandin infusion. Intravenous nitroprusside was administered, and the patient stopped smoking and stopped taking ergotamine in an attempt to counteract the vasospasm. Follow-up computed tomography angiogram revealed that both brachial arteries had normalized. Thus, in this case of ergotism, severe vasospasm in all of the extremities was resolved with appropriate management.

Relationship Between Essential Tremor and Cerebellar Dysfunction According to Age

BACKGROUND: The cerebellum and its neural circuitry have been assumed to play a major role in the pathophysiology of essential tremor (ET). In this study, we sought to find associations between ET and cerebellar dysfunction. METHODS: We performed tandem gait test in 41 ET patients and 44 age-matched controls. Investigators assessed tandem gait by counting the number of missteps during ten-step tandem walk and each subject repeated the trial three times. RESULTS: ET patients had a higher average and total numbers of missteps during tandem gait tests than control subjects (p or =70 years) showed significantly higher prevalence of tandem gait abnormality than young ones. Interaction terms determined by a likelihood ratio test was also statistically significant (p<0.05). CONCLUSIONS: Dysfunction of cerebellar neural circuitry may be associated with the pathophysiological mechanism of ET. In addition, aging may be an important factor modifying the association.

A Case of Tardive Blepharospasm

Blepharospasm is a focal dystonia that consists of repetitive involuntary spasmodic contractions of the orbicularis oculi muscle. A 27-year-old man was admitted with ptosis and involuntary blinking in both eyes. He was diagnosed as having schizophrenia when he was 15 years old and medicated with chlorpromazine for 12 years. After excluding all the possible etiopathological causes of the blepharospam, the offending drug was discontinued and changed to an atypical antipsychotic, clozapine. Clozapine was increased up to 75 mg in the 7th day of admission, and the symptoms were slowly ameliorated.

Akinetic-Rigid Syndrome in a Case of Post-traumatic Encephalopathy: Brain SPECT Finding

Head trauma has been mentioned as an uncommon cause of secondary Parkinsonism. We report a 68-year-old woman who developed a rapidly evolving post-traumatic encephalopathy with predominant akinetic-rigid syndrome. The clinical manifestations were mainly bradykinesia, rigidity, cognitive dysfunction and emotional lability. Brain SPECT showed perfusion defect in the left basal ganglia and thalamus. The parkinsonian symptoms improved moderately with levodopa.