Pharmacological Treatment of Dementia

Pharmacological interventions are critical in dementia treatment to prevent disease progression. In this review, we aim to summarize and discuss about the current developments and recommendations in the pharmacological treatment of dementia. Cholinesterase inhibitors have demonstrated efficacy for Alzheimer's disease, mixed pathology with vascular dementia and Parkinson's disease dementia. The comparison study revealed no difference between each cholinesterase inhibitors. A high incidence of side effects of cholinesterase inhibitors could lower compliance. In this case, changing to the other drug or trying a transdermal type could be the solution. Memantine, a N-methyl-D-aspartate receptor antagonist, has proven to improve function at moderate to severe dementia and for dementia with Lewy body. But there are still insufficient evidences for the combination of a cholinesterase inhibitors and memantine. Discontinuing medicine in moderate to severe dementia may lead to worsening of cognitive function. For this reason, improving patients' compliance is important and for drug selection we should consider the type of dementia, severity of cognitive impairment and side effects of each medicine. Noncognitive symptoms, behavioral and psychological symptoms of dementia (BPSD) are common and can dominate disease presentation. For depression, selective serotonin reuptake inhibitors could be effective. Atypical antipsychotics could be used for other neuropsychological symptoms such as agitation, aggression, delusions and hallucinations.

Application of Non-invasive Brain Stimulation for Neurorehabilitation: Cerebellar Stimulation

Cerebellum serves an important function in diverse domain of motor, cognition control. Cerebellar non-invasive brain stimulation (NIBS) can provide a better comprehension of cerebellar circuity connecting to primary motor cortex. Cerebellar transcranial magnetic stimulation (TMS) activates Purkinje cells, causing increased inhibition of dentato-thalamo-cortical pathway. Assessing cerebellar-brain inhibition is useful for evaluating normal cerebellar functions and for understanding specific pathophysiology. Transcranial direct current stimulation (tDCS) has the polarity specific effect on cerebellar activity. Both TMS and tDCS can modulate cerebellar functions: motor learning, visuomotor adaptation, motor coordination, working memory and other cognitive domains. Further studies are encouraged to accumulate clinical and molecular evidences of neural plasticity induced by cerebellar NIBS. In the near future, cerebellar NIBS would play a crucial role in the field of neurorehabiliation.

Reliability and Validity of the Korean World Health Organization Quality of Life (WHOQOL)-BREF in People With Physical Impairments

OBJECTIVE: To identify the validity and reliability of the Korean version World Health Organization Quality of Life Assessment (WHOQOL)-BREF among people with physical impairments living in a community. METHODS: Participants listed in the community-based rehabilitation project were recruited from 45 public health centers. People with brain lesions or physical disabilities were selected. Respondents (n=750) filled out the Korean WHOQOL-BREF questionnaire. Obtained data were analyzed statistically to assess the internal consistency as well as the construct and discriminant validity. An exploratory factor analysis was also performed. RESULTS: Cronbach's alpha for the total score was 0.839. The value for each domain ranged from 0.746 to 0.849. Pearson correlation coefficient between each domain ranged from 0.539 to 0.717. The highest correlation was between the psychological and physical domain. The item-domain correlation indicated a significant correlation with their original domains. A multiple regression analysis of each domain with two overall questions was performed. The psychological domain made the strongest contribution with the overall quality of life (unstandardized coefficient B=0.065, r2=0.437). When general health satisfaction was considered as a dependent variable, the physical domain most strongly contributed to the variable (unstandardized coefficient B=0.081, r2=0.462). Exploratory factor analysis yielded four factors in the WHOQOL-BREF, accounting for 55.29% of the variability. To assess the discriminant validity, a comparison of each domain with Modified Barthel Index (MBI) was conducted. There were highly significant changes across the MBI scores with the WHOQOL-BREF domains (p<0.001). CONCLUSION: Korean WHOQOL-BREF is a valid and reliable tool to measure the quality of life for people with physical impairments. It has good internal consistency, construct validity and discriminant validity for the population. Further study with a stratified sample is needed.

The Influence of Sour Taste on Dysphagia in Brain Injury: Blind Study

OBJECTIVE: To verify the influence of sour taste on swallowing and the presence of reflex cough when sour material was swallowed in patients with dysphagia secondary to brain injury. METHOD: Fifty dysphagic brain injury patients who underwent videofluoroscopic swallowing study (VFSS) were recruited. The patients who had shown severe aspiration at 2 ml of liquid were excluded. The dysphagic patients were given 5 ml each of a sour tasting liquid (SOUR) and a thin liquid barium (LIQUID) in random order. An expert analyzed the result of VFSS by reviewing recorded videotapes. Analysis components consisted of the Penetration-Aspiration-Scale (PAS) score, oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and the reflex cough presence. RESULTS: The PAS score for SOUR was significantly lower than the one for LIQUID (p=0.03). The mean OTT for SOUR was significantly shortened compared to that for LIQUID (p=0.03). The mean PTT and PDT were also shortened in SOUR, although the differences were not statistically significant (p=0.26 and p=0.32, respectively). There was no significant difference between SOUR and LIQUID regarding the presence of reflex cough (p=1.00). CONCLUSION: The sour taste could enhance sensorimotor feedback in the oropharynx, thus lowering the chances of penetration-aspiration caused by shortening of the oropharyngeal passage times. There was no significant difference in the presence of reflex cough produced between LIQUID and SOUR.