Improvement of Frontal Lobe Dysfunctions in Neuromyelitis Optica after Treatment: A Case Report

BACKGROUND: Neuromyelitis optica (NMO) is characterized by optic neuritis and longitudinally extensive transverse myelitis. Generally, the brain had been considered healthy in NMO patients, though recent studies have demonstrated that T2-weighted abnormalities may be observed in various brain regions. Logically, NMO brain lesions are localized at sites of high aquaporin-4 expression. CASE REPORT: A 68-year-old right-handed man with dysuria, weakness in the bilateral upper and lower limbs, and decreased sensation of the lower extremities, was diagnosed with neuromyelitis optica. The patient was gradually speaking less, was showing reduced interest in hobbies, and had undergone changes in character and behavior. An examination was performed using the Seoul Neuropsychological Screening Battery (SNSB), which revealed that the profile of frontal lobe dysfunctions was prominent as compared with other cognitive domains. The patient was treated with prednisolone and azathioprine for about 1 year without recurrence, and showed prognostic improvement according to further SNSB testing. CONCLUSIONS: Further studies are considered necessary in order to find the most effective medication regimen for improving cognitive functions in those accurately diagnosed with NMO, and to develop systematic treatment using even more diversified immune-related agents.

Predictors for Subjective Memory Complaints in the Elderly: The Results from Korean Longitudinal Study on Health and Aging (KLoSHA) / 신경정신의학

OBJECTIVES: We investigated the predictors of subjective memory complaints in the community-dwelling normal elderly. METHODS: This study was conducted as a part of Korean Longitudinal Study on Health and Aging (KLoSHA). 747 nondemented community-dwelling elderly aged 65 years or older were recruited. All participants underwent clinical evaluation for dementia and psychiatric disorder conformed to the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Clinical Assessment Battery and Korean version of Mini-International Neuropsychiatric Interview, respectively. Word list recall test, frontal assessment battery, Mini Mental Status Examination (MMSE-KC) and Korean version of Geriatric depression scale (GDS-K) were administered to evaluate episodic memory, frontal function, global cognition and depression, respectively. Subjective memory complaint was defined in two different ways: worse than one's past (SMC-P) and worse than others of one's age (SMC-O). RESULTS: In highly educated elderly, minor depressive disorder (OR=7.23, 95% C.I.= 2.29-22.86) and frontal dysfunction (OR=2.48, 95% C.I.=1.29-4.77) significantly increased the risk of SMC-O. However, they did not influence the risk of SMC-P. In low educated elderly, both the minor depressive disorder and frontal dysfunction did not influence the risk of SMC-O as well as that of SMC-P. CONCLUSION: SMC-O can be a sensitive subjective recognition of mild depression and/or frontal dysfunction in highly educated normal elderly.

A Case of Fahr's Disease Presenting with Frontal Lobe Dysfunction

Bilateral calcifications of the basal ganglia, the thalami, the dentate nuclei of the cerebellum, and the white matter of the cerebral hemisphere characterize Fahr's disease. The common clinical manifestations of the disease are movement disorders accompanied by cognitive impairment and mood disorder. Herein we report a case of Fahr's disease with atypical clinical manifestations. The patient was a 48 year-old man who presented with behavioral changes. His neurological examination showed no focal neurological deficits except for frontal dysfunctions. Abnormal involuntary movement was absent. Neuroimaging work-ups were compatible with Fahr's disease.