Multi-Parametric Quantitative MRI for Measuring Myelin Loss in Hyperglycemia-Induced Hemichorea

Hyperglycemia-induced hemichorea (HGHC) is a rare but characteristic hyperkinetic movement disorder involving limbs on one side of the body. In a 75-year-old woman with a left-sided HGHC, conventional brain MR imaging showed very subtle T1-hyperintensity and unique gadolinium enhancement in the basal ganglia contralateral to movements. Multi-parametric MRI was acquired using pulse sequence with quantification of relaxation times and proton density by multi-echo acquisition. Myelin map was reconstructed based on new tissue classification modeling. In this case report of multi-parametric MRI, quantitative measurement of myelin change related to HGHC in brain structures and its possible explanations are presented. This is the first study to demonstrate myelin loss related to hyperglycemic insult in multi-parametric quantitative MR imaging.

Association of head circumference with cognitive decline and symptoms of depression in elderly: a 3-year prospective study / 영남의대학술지

BACKGROUND: Brain volume is associated with dementia and depression in the elderly. An easy way to predict relative brain volume is to measure head circumference. In this study, we investigated the relationship between head circumference and cognition as well as depression in a non-demented elderly community.METHODS: Baseline and follow-up surveys were conducted in 2007 and 2010. At baseline, community residents aged 65 years or over (n=382) within a rural area of South Korea were screened for dementia and symptoms of depression and were followed using the same screening battery after 3 years (n=279). Data from anthropometric measurements (head circumference, height, and body weight), demographics, and blood tests were gathered. Neuropsychological tests, including the Korean version of mini-mental state examination (K-MMSE), clinical dementia rating (CDR) including the CDR-sum of boxes, the Korean version of instrumental activities of daily living, and geriatric depression scale (GDS), were performed. None of the 279 subjects followed were demented.RESULTS: Baseline performance on the K-MMSE and GDS was poorer for participants with smaller head circumferences. Follow-up performance on the MMSE was also poorer for participants with smaller head circumferences. Interestingly, participants with smaller head circumference showed worse GDS scores at baseline but on follow-up examination, participants with larger head circumference showed rapid worsening than those with smaller head circumference with marginal significance by ANOVA test. In regression coefficient analysis, GDS decline showed significant difference.CONCLUSION: Head circumference was not associated with cognitive change but was associated with symptoms of depression in non-demented community residents.

Association of head circumference with cognitive decline and symptoms of depression in elderly: a 3-year prospective study / 영남의대학술지

BACKGROUND@#Brain volume is associated with dementia and depression in the elderly. An easy way to predict relative brain volume is to measure head circumference. In this study, we investigated the relationship between head circumference and cognition as well as depression in a non-demented elderly community.@*METHODS@#Baseline and follow-up surveys were conducted in 2007 and 2010. At baseline, community residents aged 65 years or over (n=382) within a rural area of South Korea were screened for dementia and symptoms of depression and were followed using the same screening battery after 3 years (n=279). Data from anthropometric measurements (head circumference, height, and body weight), demographics, and blood tests were gathered. Neuropsychological tests, including the Korean version of mini-mental state examination (K-MMSE), clinical dementia rating (CDR) including the CDR-sum of boxes, the Korean version of instrumental activities of daily living, and geriatric depression scale (GDS), were performed. None of the 279 subjects followed were demented.@*RESULTS@#Baseline performance on the K-MMSE and GDS was poorer for participants with smaller head circumferences. Follow-up performance on the MMSE was also poorer for participants with smaller head circumferences. Interestingly, participants with smaller head circumference showed worse GDS scores at baseline but on follow-up examination, participants with larger head circumference showed rapid worsening than those with smaller head circumference with marginal significance by ANOVA test. In regression coefficient analysis, GDS decline showed significant difference.@*CONCLUSION@#Head circumference was not associated with cognitive change but was associated with symptoms of depression in non-demented community residents.

Effect of chongmyungtang, a traditional Korean polyherbal formula, on the Pharmacokinetic profiles of donepezil in rats

Chongmyungtang [CMT] is a famous Korean herbal medicine for improving learning and memory, which has been reported to have anti-cholinergic and neuroprotective effects. Therefore, drug-drug interactions were examined between CMT and donepezil as a first screening of combination therapy for cognitive deficits. Rats received oral coadministration of donepezil with distilled water as a control or donepezil with CMT as a combination. The distilled water or CMT was co-administered at intervals within 5min after donepezil or 1.5h intervals. The plasma samples were analyzed for donepezil concentration and its pharmacokinetic parameters of T[max], C[max], AUC, t[1/2] and MRT[inf]. In the single co-administration at intervals within 5min, donepezil was detected lower in the combination than control at 0.5h and 2h post-treatment [P<0.05]. In addition, the combination showed significant increases in MRT[inf] compared to the control [P<0.05]. This suggests drug-drug interactions between donepezil and CMT in the co-administration within 5 min. However, no meaningful differences were found in the pharmacokinetic profiles of donepezil by single dosing with CMT at 1.5h intervals and even by the repeated dosing for a week at 1.5h intervals potential combination therapy of donepezil with CMT

Apolipoprotein E4: A Risk Factor for Successful Cognitive Aging

Apolipoprotein E is a plasma protein that has an important role in transport and metabolism of lipids in serum as well as central nervous system. Among the 3 common alleles, the ε2 allele has the most stable structure followed by ε3 and ε4 in order. There is evidence for a deleterious role of ε4 allele by atherosclerosis and amyloid beta accumulation in brain and body. The presence and gene dose of ε4 allele are risk factors for late-onset Alzheimer's disease. Apolipoprotein E ε4 may have a role in the pathology of amyloid beta and tau and it has a strong relationship with the early onset of late-onset Alzheimer's disease. However, early-onset Alzheimer's disease has a weaker relationship with ε4 allele of apolipoprotein E.

Factors Affecting Care Worker's Burden of Patients with Dementia

BACKGROUND: The importance of care workers in providing care to patients with dementia is increasing. The burden that care workers experience impacts the health of the patients as well as that of the workers themselves. This study examined the burden experienced by care workers looking after patients with dementia, with the aim of determining the factors associated with the severity of the caregiver burden. METHODS: Care workers providing care to patients with dementia were recruited from nine medical care centers in the metropolitan city of Daegu and Gyeongsanbuk-do province. Two hundred and twenty participants were included. During face-to-face interviews with a psychologist, they completed the Burden Interview, Life Satisfaction Index, Beck Depression Inventory, and Beck Anxiety Inventory, and their health status and the severity of dementia in their patients were evaluated. The burden experienced by care workers and the factors affecting it were assessed using statistical analyses. RESULTS: The care workers had a mean score in the Burden Interview of 28. A multiple linear regression analysis revealed that scores for the Life Satisfaction Index and the Beck Anxiety Inventory, as well as the health status and education level of caregivers were associated with the severity of caregiver burden (p<0.05). CONCLUSIONS: This study found that the burden of the included Korean care workers ranged from mild to moderate. In addition, their health status, education level, and scores for the Life Satisfaction Index and the Beck Anxiety Inventory were closely related to the burden they experienced in caring for patients with dementia.

Factors Affecting Care Worker's Burden of Patients with Dementia

BACKGROUND: The importance of care workers in providing care to patients with dementia is increasing. The burden that care workers experience impacts the health of the patients as well as that of the workers themselves. This study examined the burden experienced by care workers looking after patients with dementia, with the aim of determining the factors associated with the severity of the caregiver burden. METHODS: Care workers providing care to patients with dementia were recruited from nine medical care centers in the metropolitan city of Daegu and Gyeongsanbuk-do province. Two hundred and twenty participants were included. During face-to-face interviews with a psychologist, they completed the Burden Interview, Life Satisfaction Index, Beck Depression Inventory, and Beck Anxiety Inventory, and their health status and the severity of dementia in their patients were evaluated. The burden experienced by care workers and the factors affecting it were assessed using statistical analyses. RESULTS: The care workers had a mean score in the Burden Interview of 28. A multiple linear regression analysis revealed that scores for the Life Satisfaction Index and the Beck Anxiety Inventory, as well as the health status and education level of caregivers were associated with the severity of caregiver burden (p<0.05). CONCLUSIONS: This study found that the burden of the included Korean care workers ranged from mild to moderate. In addition, their health status, education level, and scores for the Life Satisfaction Index and the Beck Anxiety Inventory were closely related to the burden they experienced in caring for patients with dementia.

A Comparison of Apolipoprotein E Polymorphism in Alzheimer's Disease and Subcortical Vascular Dementia in Koreans

BACKGROUND AND PURPOSE: The apolipoprotein E (Apo E) epsilon4 allele is known to be a risk factor for Alzheimer's disease (AD). However, there are debates about the relationship between Apo E epsilon4 frequency and subcortical vascular dementia (SVaD). We compared the frequency of the Apo E epsilon4 allele in AD and SVaD in Koreans. METHODS: The study was comprised of 400 subjects who visited the Dementia Clinic at Daegu Catholic University from July 2007 to December 2011. Neuropsychological tests, a brain MRI, and blood laboratory tests were performed on all subjects. Two hundred and ninety subjects were AD, 32 subjects were SVaD and 78 subjects were normal. The diagnosis for SVaD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and Erkinjuntti criteria, and the diagnosis for AD was based on the DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's disease and Related Disorders Association criteria. Apo E polymorphism was genotyped in all subjects. RESULTS: The Apo E epsilon4 allele frequency was 17.4% in AD, 10.9% in SVaD and 8.3% in the normal group (p=0.03). The odds ratio (OR) after age adjustment for AD conferred to the Apo E epsilon4 was 2.04 (p=0.04). But, the OR for SVaD conferred to the Apo E epsilon4 allele was 1.34 (p=0.62), indicating that the Apo E epsilon4 allele does not significantly confer the risk of SVaD. CONCLUSIONS: Apo E epsilon4 is a reliable predictor of AD but has modest efficacy for predicting SVaD in Koreans.

Effect of Illiteracy on Cognition and Cerebral Morphology in Later Life

BACKGROUND AND PURPOSE: A better developmental environment has positive effects on brain development. The acquisition of literacy during childhood may affect brain functional organization. The present study aimed to evaluate the effects of illiteracy on neuropsychological test results and cerebral morphology in later life. METHODS: We recruited 7 illiterate elderly farmers who had never attended school and had no reading or writing knowledge. These subjects were compared with 9 literate subjects in terms of neuropsychological performance and brain volume. All subjects were over 65-years-old and had the same regional and occupational background. RESULTS: Neuropsychological tests indicated that the performance of the illiterate subjects was worse than that of literate subjects in all cognitive domains except forward digit span, tool-use and tool-free gestures, verbal word recognition, and verbal generation of animals and grocery items. The illiterate group also showed significantly decreased cortical volume and surface area in both parietal lobes. However, the illiterate group showed increased cortical thickness in the left cuneus. CONCLUSIONS: Literacy acquired in childhood may increase the volume of the parietal lobe and improve neuropsychological performance through the process of brain plasticity. The effects can be lifelong.

Transient Global Amnesia Developed in a 14-Year Old Girl during Cellular Phone Texting

A 14-year-old-girl developed sudden amnesia upon study for semester examination. She was using cellular phone texting when he realized amnesia and texted to her friend about the amnesia. On the captured texting messages, she showed grammatical errors and spelling errors. Diffusion-weighted brain MRI showed tiny lesions in left hippocampus consistent with transient global amnesia. EEG and other laboratory tests were normal. The amnesia recovered within 24 hours and did not recur during one and half year of follow up period.

Analysis of dispersion of lumbar interlaminar epidural injectates / 대한마취과학회지

No abstract available.

Analysis of dispersion of lumbar interlaminar epidural injectates / 대한마취과학회지

No abstract available.

The adsorption of inspired desflurane due to incorrectly mounted air dryer filter of the heated humidifier: A case report

Heated humidifiers are used to prevent respiratory complications associated with mechanical ventilation with an endotracheal tube. One of the heated humidifiers uses an air dryer filter in order to remove humidity from air before it enters the anesthetic machine. We report a case in which the air dryer filter was unintentionally misconnected to the inspiratory limb of the circuit, which caused insufficient volatile anesthetic concentration during anesthesia induction.

Factors Affecting Caregiver Burden in Family Caregivers of Patients with Dementia

BACKGROUND: This study aimed to know the state of caregiver burden of family caregivers of patients with dementia and also to know factors associated with the severity of caregiver burden. METHODS: Family caregivers of dementia patients were enrolled from five general hospitals in Daegu Metropolitan city, Korea. The participants analyzed in the present study were 199 subjects who were 24 to 86 years old, living in Daegu or Kyungsang Bukdo province. Demographic features, general characteristics, characteristics of caring patients were collected and Burden Interview was done by a psychologist. Factors affecting caregiver burden were assessed using statistical analyses. RESULTS: The average severity of caregiver burden of family caregivers were between mild and moderate. Factors affecting the severity of caregiver burden were caregiving days per week among caregiver's characteristics and Neuropsychiatric Inventory and Geriatric Depression Scale among patient characteristics by multiple regression linear analysis. Caregiving cost shows marginal significance. Interestingly, cognitive scales like Mini-Mental State Examination, Clinical Dementia Rating, Physical and Instrumental Activities of Daily Living did not affect caregiver burden of family caregivers. CONCLUSIONS: This study showed that caregiving days per week of caregivers and neuropsychiatric symptoms including depressive mood of patients are closely related with caregiver burden of family caregivers of patients with dementia in Korea.

The efficacy of OptiScope PM201 video system: comparison to conventional Macintosh laryngoscopic endotracheal intubation method

BACKGROUND: Optiscope PM201 is a newly developed video stylet device. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Optiscope PM201 systems during endotracheal intubation. METHODS: This study included 66 patients with American Society of Anesthesiologists physical status class I or II requiring tracheal intubation for general anesthesia. All patients were randomly allocated into two groups: OptiScope PM201 (group O) and Macintosh (group M). Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to intubation (Tbase), 1 minute after intubation (T0), and over the following 10 minutes at 5 minute intervals 5, 10 minutes after intubation (T1, T2). Time for intubation and degree of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, incidence of sore throat and time for intubation between both groups. The incidence of oral bleeding was none in patient in the Group O versus 1 in group M (P = 0.306). CONCLUSIONS: OptiScope PM201 video system in endotracheal intubation did not increase hemodynamic changes and postoperative airway complications comparing to the use of Macintosh laryngoscope.

The efficacy of OptiScope PM201 video system: comparison to conventional Macintosh laryngoscopic endotracheal intubation method

BACKGROUND: Optiscope PM201 is a newly developed video stylet device. In comparison to the Macintosh laryngoscope, it offers a significantly improved laryngeal view and facilitates endotracheal intubation. The present study was performed to compare the general efficiency and the cardiovascular responses generated by Macintosh and Optiscope PM201 systems during endotracheal intubation. METHODS: This study included 66 patients with American Society of Anesthesiologists physical status class I or II requiring tracheal intubation for general anesthesia. All patients were randomly allocated into two groups: OptiScope PM201 (group O) and Macintosh (group M). Systolic, mean and diastolic blood pressure (SBP, MBP, DBP) and heart rate (HR) were recorded just prior to intubation (Tbase), 1 minute after intubation (T0), and over the following 10 minutes at 5 minute intervals 5, 10 minutes after intubation (T1, T2). Time for intubation and degree of sore throat were also recorded. RESULTS: There were no significant differences in SBP, MBP, DBP, HR, incidence of sore throat and time for intubation between both groups. The incidence of oral bleeding was none in patient in the Group O versus 1 in group M (P = 0.306). CONCLUSIONS: OptiScope PM201 video system in endotracheal intubation did not increase hemodynamic changes and postoperative airway complications comparing to the use of Macintosh laryngoscope.

Neuropsychological Characteristics of Mild Cognitive Impairment in Parkinson Disease and Subcortical Vascular Mild Cognitive Impairment

BACKGROUND: Patients with Parkinson's disease and mild cognitive impairment (PD-MCI) and patients with subcortical vascular mild cognitive impairment (svMCI) are known to have cognitive dysfunction. The aim of this study was to determine the cognitive characteristics that can be used to differentiate these two conditions. METHODS: Twenty-two PD-MCI and 22 svMCI patients seen in our neurodegenerative disease clinic, and 22 normal controls were recruited. These three groups were matched in terms of age, gender, and education level. Mild cognitive impairment was diagnosed according to the criteria of Petersen. svMCI should meet the criteria modified from those of Erkinjuntti. RESULTS: Analysis of covariance revealed that frontal executive dysfunction was prominent in both the PD-MCI and svMCI groups after adjusting for depression. The scores in word fluency and the Stroop test were lower in the svMCI group than in the PD-MCI group. Both groups exhibited decreased performance in verbal and visuospatial memory tests. The score in the verbal recognition test was lower in the PD-MCI group than in the svMCI group, which exhibited comparatively reduced visuospatial memory. The depression level was higher in the PD-MCI group than in the svMCI group, as assessed using the Geriatric Depression Scale. CONCLUSIONS: The impairment in frontal executive function was more severe in the svMCI group than in the PD-MCI group, which displayed severe impairment in verbal memory function. These differences in cognitive function may help to differentiate PD-MCI from svMCI, and to further the understanding of their pathophysiologies. PD-MCI patients also exhibited severe depressive mood, which raises the possibility of cognitive improvement through therapy.

No correlation between COMT genotype and entacapone benefi ts in Parkinson’s disease

Catechol-O-methyltransferase (COMT) inhibitors are used to increase the bioavailability of therapeutic L-dopa. We examined the effi cacy of entacapone in Parkinson’s disease patients who had daily “off” duration of ≤2 hours, and carried different COMT polymorphisms. A total of 168 PD patients were recruited from 19 centers. Subjects were administered with 100–200 mg of entacapone in combination with each dose of L-dopa for 2 months. The clinical effi cacy was evaluated based on the activities of daily living (ADL), score on the Unifi ed Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) stage, and Clinical Global Impression (CGI). COMT polymorphisms were genotyped. 3-O-methyldopa (3-OMD) levels were measured before and after the administration of entacapone. Entacapone administration produced signifi cant improvements in the total daily “on” duration, ADL, UPDRS score, and H&Y stage. Nineteen patients (11.3%) had the low-activity COMT genotype, 68 patients (40.5%) had the intermediate-activity COMT genotype, and 81patients (48.2%) had the high-activity COMT genotype. The effi cacy, and adverse effects of entacapone therapy did not differ between the three groups. There was a signifi cant reduction in 3-OMD, but this did not differ among the three genotypes. Entacapone provided an increased “on” duration and improved motor function in all COMT genotypes.

Lambert-Eaton Myasthenic Syndrome (LEMS) Presented With Ocular Symptoms

Lambert-Eaton myasthenic syndrome (LEMS) is characterized clinically by fluctuating muscular weakness; presentation with ocular symptoms is unusual. A 60-year-old man had developed diplopia and ptosis 2 years previously. The findings of a neurologic examination were normal except for bilateral ptosis and ophthalmoplegia. The amplitude of compound muscle action potentials recorded on the abductor digiti minimi increased (by more than 500%) during 50-Hz stimulation. This case demonstrates that LEMS should be included in the differential diagnosis of myasthenic symptom confined to the ocular muscles.

Association of Apolipoprotein E Gene Polymorphism With Cognitive Function of the Elderly Residents in a Rural Community

BACKGROUND: It is not clear whether polymorphism of the apolipoprotein E (ApoE) gene influences the cognition of community residents. The aim of this study was to establish the association between ApoE gene polymorphism and cognitive function in an elderly rural community in Korea. METHODS: A total of 388 subjects aged 65 and over were recruited. Demographic characteristics, past history of illness, and scores on the Korean version of the Mini Mental State Examination (K-MMSE), the Geriatric Depression Scale . Short Form (GDS-S), and the Korean version of Instrumental Activities of Daily Living (K-IADL) were evaluated. The lipid profile and ApoE genotype were sampled from 377 of the participants. RESULTS: Of the entire cohort, 75% had less than 6 years of education, and 30% were illiterate. The frequencies of the ApoE epsilon2, ApoE epsilon3, and ApoE epsilon4 alleles were 48 (6.6%), 372 (86.9%), and 49 (6.5%), respectively. The K-MMSE score was much lower in those with two ApoE epsilon3 alleles than in those with only one ( p=0.046). However, the numbers of ApoE epsilon2 alleles (p=0.976) and ApoE epsilon4 alleles (p=0.934) carried by the individual were not associated with K-MMSE score. Both K-IADL (p<0.001) and GDS-S (p<0.001) scores were significantly correlated with K-MMSE score. Grouping of the participants into three groups according to K-MMSE score (i.e., 0-17 , 18-24, and 25-30) also revealed that this score was correlated with K-IADL score (p<0001), GDS-S score (p<0.001), and the ApoE epsilon3 allele (p=0.035). CONCLUSIONS: These results suggest that the ApoE epsilon3 allele has a negative influence on cognitive function (K-MMSE) in this rural community. Surprisingly, we were unable to detect any relationship between the ApoE epsilon4 allele and cognitive function. There was a positive correlation between K-MMSE, K-IADL, and GDS-S scores.