A Comparison of Substantia Nigra T1 Hyperintensity in Parkinson's Disease Dementia, Alzheimer's Disease and Age-Matched Controls: Volumetric Analysis of Neuromelanin Imaging

OBJECTIVE: Neuromelanin loss of substantia nigra (SN) can be visualized as a T1 signal reduction on T1-weighted high-resolution imaging. We investigated whether volumetric analysis of T1 hyperintensity for SN could be used to differentiate between Parkinson's disease dementia (PDD), Alzheimer's disease (AD) and age-matched controls. MATERIALS AND METHODS: This retrospective study enrolled 10 patients with PDD, 18 patients with AD, and 13 age-matched healthy elderly controls. MR imaging was performed at 3 tesla. To measure the T1 hyperintense area of SN, we obtained an axial thin section high-resolution T1-weighted fast spin echo sequence. The volumes of interest for the T1 hyperintense SN were drawn onto heavily T1-weighted FSE sequences through midbrain level, using the MIPAV software. The measurement differences were tested using the Kruskal-Wallis test followed by a post hoc comparison. RESULTS: A comparison of the three groups showed significant differences in terms of volume of T1 hyperintensity (p < 0.001, Bonferroni corrected). The volume of T1 hyperintensity was significantly lower in PDD than in AD and normal controls (p < 0.005, Bonferroni corrected). However, the volume of T1 hyperintensity was not different between AD and normal controls (p = 0.136, Bonferroni corrected). CONCLUSION: The volumetric measurement of the T1 hyperintensity of SN can be an imaging marker for evaluating neuromelanin loss in neurodegenerative diseases and a differential in PDD and AD cases.

Intra-Rater and Inter-Rater Reliability of Brain Surface Intensity Model (BSIM)-Based Cortical Thickness Analysis Using 3T MRI

PURPOSE: Brain surface intensity model (BSIM)-based cortical thickness analysis does not require complicated 3D segmentation of brain gray/white matters. Instead, this technique uses the local intensity profile to compute cortical thickness. The aim of the present study was to evaluate intra-rater and inter-rater reliability of BSIM-based cortical thickness analysis using images from elderly participants. MATERIALS AND METHODS: Fifteen healthy elderly participants (ages, 55-84 years) were included in this study. High-resolution 3D T1-spoiled gradient recalled-echo (SPGR) images were obtained using 3T MRI. BSIM-based processing steps included an inhomogeneity correction, intensity normalization, skull stripping, atlas registration, extraction of intensity profiles, and calculation of cortical thickness. Processing steps were automatic, with the exception of semiautomatic skull stripping. Individual cortical thicknesses were compared to a database indicating mean cortical thickness of healthy adults, in order to produce Z-score thinning maps. Intra-class correlation coefficients (ICCs) were calculated in order to evaluate inter-rater and intra-rater reliabilities. RESULTS: ICCs for intra-rater reliability were excellent, ranging from 0.751-0.940 in brain regions except the right occipital, left anterior cingulate, and left and right cerebellum (ICCs = 0.65-0.741). Although ICCs for inter-rater reliability were fair to excellent in most regions, poor inter-rater correlations were observed for the cingulate and occipital regions. Processing time, including manual skull stripping, was 17.07 +/- 3.43 min. Z-score maps for all participants indicated that cortical thicknesses were not significantly different from those in the comparison databases of healthy adults. CONCLUSION: BSIM-based cortical thickness measurements provide acceptable intra-rater and inter-rater reliability. We therefore suggest BSIM-based cortical thickness analysis as an adjunct clinical tool to detect cortical atrophy.

The Survey for the Effect of Guideline about Activities of Daily Living in Dementia Patients "Il-sang-ye-chan" Campaign

BACKGROUND: Activities daily living (ADL) disability has a direct influence on the patients' quality of life and on the amount of care needed. It is major factor of care in dementia patients. So Korean Dementia Association suggested guideline about activities of daily living in dementia patients in 2013. The purpose of this article is to investigate the effect of this. METHODS: A total of 110 subjects were enrolled. Assessments included age, sex, education level of patients and caregiver, the duration of disease, pattern of family, economic status. We divided "active practice" group and "passive practice" group by recognition of guideline contents after study. We compared two groups before and after by Korean Mini-Mental State Examination (K-MMSE), Short form of Geriatric Depression Scale-Korean version (S-GDS), Korean version of Zarit's Burden Interview (ZBI-K), Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL). Finally, we investigate the level of satisfaction about our guideline. RESULTS: Age of patients, the duration of disease was lower and education level of caregiver and economic status was higher in "active practice group". The pattern of family also differed from two groups. It was observed distinct difference between the variations of two groups in S-GDS, ZBI-K, and ADCS-ADL. The level of satisfaction about our guideline was very high. CONCLUSION: Considering these results, our guideline about activities of daily living is effective to manage dementia patient. Active application of it is needed in clinic or center for dementia.

Takotsubo Cardiomyopathy Following Cerebral Infarction Involving the Insular Cortex

BACKGROUND: Takotsubo cardiomyopathy is characterized by clinical features similar to those of acute myocardial ischemia, but without angiographic evidence of obstructive coronary artery disease. We present a patient with takotsubo cardiomyopathy following acute infarction involving the left insular cortex. CASE REPORT: A 52-year-old man was admitted with acute infarction of the left middle cerebral artery territory and acute chest pain. Acute myocardial infarction was suspected because of elevated serum troponin levels and hypokinesia of the left ventricle on echocardiography. However, a subsequent coronary angiography revealed no stenosis within the coronary arteries or ballooning of the apical left ventricle. CONCLUSIONS: We postulated that catecholamine imbalance due to the insular lesion could be responsible for these interesting features.