Region and frequency specific changes of spectral power in Alzheimer's disease and mild cognitive impairment.

OBJECTIVES: To find out whether healthy control (HC), amnestic mild cognitive impairment (aMCI), and Alzheimer's disease (AD) subjects exhibit region and frequency specific spectral power differences and whether the spectral power changes correlate with domain-specific cognitive function. METHODS: Forty-one AD, 38 aMCI, and 39 HC subjects underwent quantitative EEG and comprehensive neuropsychological tests. Repeated measures analysis of variance was performed to identify differences in EEG spectral power among the three groups by scalp region and EEG frequency. Correlations between region and frequency specific spectral powers and neuropsychological test scores were evaluated. RESULTS: Temporal and parieto-occipital theta band powers were highest in AD. Whereas, parieto-occipital alpha and frontal and temporal beta 2 band powers were highest in HC and lowest in AD (p<0.05). Temporal and parieto-occipital theta powers negatively correlated with verbal and visuospatial memory recall, while parieto-occipital alpha and temporal beta 2 powers positively correlated with verbal memory recall (p<0.01). CONCLUSIONS: Region and frequency specific oscillatory characteristics of EEG reflect domain-specific cognitive function in patients with aMCI and AD. SIGNIFICANCE: Region and frequency specific spectral powers have clinical implications as additional markers differentiating AD, aMCI, and HC.

Prevalence of sleep-disordered breathing in acute ischemic stroke as determined using a portable sleep apnea monitoring device in Korean subjects.

OBJECTIVES: It has been suggested that there is a strong association between sleep-disordered breathing (SDB) and stroke. However, this connection has not been studied in Korean subjects. METHODS: Sixty-one patients with acute cerebral infarction (ACI) and 13 patients with transient ischemic attack (TIA) were consecutively enrolled. SDB was evaluated within 48 h of stroke or TIA onset using a portable screening device, which allowed incidents of apnea, hypopnea, and snoring to be automatically analyzed. Clinical and sleep-related variables, including body mass indices (BMI), cardiovascular risk factors, stroke severity and disability, and Epworth sleepiness scale, Stanford sleepiness scale, and Berlin questionnaire scores were assessed. Sixty-four age-matched patient's spouses or family members with no history of physician-diagnosed stroke were enrolled as controls. RESULTS: Mean apnea-hypopnea index (AHI) was significantly higher in TIA (14.6 ± 10.4) and ACI (15.6 ± 14.7) patients than in the controls (7.8 ± 7.0; p = 0.001). The prevalences of SDB were 69.2% in TIA and 50.8% in ACI patients and 32.8% in controls. BMI and systolic blood pressure (SBP) were significantly higher in patients with SDB than in patients without SDB. Sleep-related stroke onset occurred in 17 patients (22.9%), and these patients had significantly higher AHIs. Multiple logistic regression analysis showed that BMI (odds ratio, 1.293; p = 0.027) and SBP (odds ratio, 1.030; p = 0.004) were found to independently predict SDB in patients with TIA or ACI. CONCLUSIONS: SDB is prevalent during the 48 h following ACI or TIA in Korean subjects. The authors recommend that SDB be evaluated after an ACI or TIA, especially in those with a high BMI and an elevated SBP.

Familiarity with, understanding of, and attitudes toward epilepsy among people with epilepsy and healthy controls in South Korea.

This study identifies differences between people with epilepsy (PWE) and healthy controls in South Korea with respect to their familiarity with, understanding of, and attitudes toward epilepsy. PWE and controls older than 18 years of age were recruited from outpatient clinics and health promotion centers, respectively, associated with five university hospitals located throughout the country. Structured questionnaires consisting of 18 items were administered in face-to-face interviews. The sample consisted of 1924 participants (PWE: 384, controls: 1540). The groups did not differ with respect to age, sex, and place of residence. However, the groups did differ significantly in educational, marital, and occupational status (P=0.000). Familiarity with seizures and epilepsy (two items) did not differ significantly between the groups. Questions pertaining to understanding seizures and epilepsy (seven items) showed that controls had significantly greater misunderstanding of the etiology and long-term prognosis of epilepsy compared with PWE. Attitudes expressed toward PWE were significantly different in response to six of seven questions. Control subjects expressed more negative attitudes toward PWE than did PWE themselves, particularly concerning potential relationships with their children (e.g., friendships, marriage). In conclusion, we found significant differences between PWE and controls, particularly with respect to understanding of and attitudes toward epilepsy. We recommend the development of different strategies for PWE and controls to improve understanding of and attitudes toward epilepsy and to reduce the knowledge gap between these groups. Nationwide educational programs conducted by associated organizations and the government may provide the solution to this problem.

Limitation of brachial-ankle pulse wave velocity in assessing the risk of stroke: importance of instantaneous blood pressure.

BACKGROUND AND OBJECTIVE: The carotid-femoral pulse wave velocity is a well-established index of aortic stiffness, and the brachial-ankle pulse wave velocity (baPWV) has recently been developed as a new method for evaluating arterial stiffness. However, whether the baPWV is also useful in evaluating the risk of stroke is currently controversial. Moreover, it is also unknown which types of stroke and neuroradiological findings are associated with increased arterial stiffness. We investigated the association between the baPWV and risk of stroke using a case-control design. METHODS: This study enrolled 223 stroke patients (aged 65.6 +/- 10.3 years, mean +/- SD) and the same number of age- and sex-matched controls. All of the subjects in this study underwent a structured interview and had their vascular risk factors assessed. We reviewed brain magnetic resonance imaging and magnetic resonance angiography data of stroke patients to assessthe severity of white-matter hyperintensity lesions, number of cerebral microbleeds, and the stenosis of both intracranial and extracranial arteries. The baPWV was measured noninvasively by an oscillometric method. RESULTS: The baPWV was most affected by the instantaneous systolic blood pressure, and was significantly higher in stroke patients than control subjects (1,721 +/- 395 cm/s vs. 1,657 +/- 366 cm/s, p = 0.03). However, the baPWV did not differ significantly with a specific type of stroke or subtype of ischemic stroke. Multiple regression analysis revealed that the baPWV was not independently associated with increased risk of stroke, or the severity of white-matter hyperintensity lesions or cerebral microbleeds. CONCLUSION: Although the baPWV was significantly higher in stroke patients than control subjects, it was not independently associated with increased risk of stroke or specific subtypes of ischemic stroke or neuroradiological findings.

Cerebral microbleeds are independently associated with arterial stiffness in stroke patients.

BACKGROUND: Cerebral microbleeds (CMB) are now receiving considerable attention for their association with stroke recurrence and white matter lesions (WML). Pulse wave velocity (PWV), which is a measure of arterial stiffness, was found to be one of the predictors of cardiovascular disease and stroke in a large population-based study. The current study set out to investigate the association between CMB and arterial stiffness. METHODS: Subjects included 255 patients with strokes, such as cerebral infarctions or transient ischemic attacks, who were enrolled at Korea University Stroke Registry, Ansan arm, between October 2005 and May 2007, and underwent MRI and PWV. CMB, stroke lesion, stroke subtype and WML were coded by researchers blind to clinical details. Arterial stiffness was assessed by measuring brachial-ankle PWV (baPWV). RESULTS: CMB were observed in 57 patients (22.4%), and were most frequently seen in the basal ganglia, followed by the cerebral cortex. The baPWV was significantly higher in patients with CMBs compared to those without (p < 0.01). After adjustment for demographics, vascular risk factors and hemodynamic parameters, baPWV proved to be significantly associated with CMB using a logistic regression test (odds ratio 1.119, 95% CI 1.013-1.237). CONCLUSIONS: PWV had an independent association with CMB in patients with stroke. These findings suggest that arterial stiffness may be pathophysiologically associated with CMB.

Endothelin 1 protects HN33 cells from serum deprivation-induced neuronal apoptosis through Ca(2+)-PKCalpha-ERK pathway.

Endothelins (ETs), which were originally found to be potent vasoactive transmitters, were known to be implicated in nervous system, but the mode of mechanism remains unclear. ETs (ET-1, ET-2, and ET-3) were added to HN33 (mouse hippocampal neuron chi neuroblastoma) cells. Among the three types of ET, only ET-1 increased the intracellular calcium levels in a PLC dependent manner with the induction of ERK 1/2 activation. As the result of ET-1 exposure, the survival rate of HN33 cells and the PKCalpha translocation into the plasma membrane were increased. We suggest that ET-1 participated in the neuroprotective effect involving the calcium-PKCalpha-ERK1/2 pathway.

Clinical and laboratory characteristics of cerebral infarction in tuberculous meningitis: a comparative study.

Cerebral infarction as a complication of tubercular (TB) meningitis is not uncommon, but an adequate comparison of patients with and without stroke has not been carried out. This study was performed to evaluate the clinical characteristics of cerebral infarction secondary to TB meningitis, and to investigate predictive factors for cerebral infarction in patients with TB meningitis. Patients with TB meningitis were recruited over a period of 56 months. They were divided into two groups, those with and those without stroke. Demographic features and clinical, laboratory, and neuroradiological findings were compared between the two groups. We classified strokes into subtypes using neuroimaging findings. Of the 38 patients who were diagnosed with TB meningitis, eight also experienced cerebral infarction. The percentage of cerebrospinal fluid leukocytes that were neutrophils was significantly higher in patients with stroke (68%) than in patients without stroke (31%; p=0.0001). Upon initial CT imaging, meningeal enhancement was found in 11 patients, and of these patients, six experienced stroke. There were no significant differences between the groups with respect to other clinical and laboratory features, including demographic features, time between meningitis onset and treatment initiation, peripheral white blood cell count, and cerebrospinal fluid findings. Five of the eight patients who developed stroke had lacunar infarcts. One of the three patients with territorial nonlacunar infarction died due to herniation. When treating patients with TB meningitis, the possibility of cerebral infarction should be considered when patients develop focal neurological signs, meningeal enhancement on a CT scan, and sustained polymorphic cerebrospinal fluid pleocytosis.

Prevalence of Parkinson's disease in Korea.

The prevalence of neurodegenerative disorders is not well documented in Korea. We assessed the prevalence of Parkinson's disease in an elderly population in a newly industrialized city in a rural region. Subjects for this study were randomly selected from a community-based cohort study. The sample in the cohort represented approximately 1.3% (4700) of 362 625 adults (age>18 years) listed in the city register in 1998. Among this group, 4218 subjects (1086 subjects aged>60 years) agreed to be interviewed and underwent a physical examination and neuropsychological tests administered by a neurologist and neuropsychologist. All participants were examined. Participants who had bradykinesia and at least one other possible cardinal sign of parkinsonism at the neurologic screening, and those who reported that they had Parkinson's disease, or were taking antiparkinsonian drugs were identified. In our study, 16 subjects showed evidence of Parkinson's disease. The prevalence in this population was 0.37%. Prevalence increased with age, and prevalence was 1.47% for those aged older than 60 years. Postural instability and gait disturbance were more common in the older age group. The results of neuropsychological tests were as follows: (1) only two subjects had low scores (<20) in the Korea-version mini-mental status examination; (2) seven subjects scored 0.5, one subject scored 2 and the other eight subjects scored 0 in the clinical dementia rating. The results of our prevalence study are similar to those of studies carried out in Western countries. Age is a risk factor for Parkinson's disease in Korea.

Cutaneous silent period in patients with restless leg syndrome.

OBJECTIVE: To investigate the pathophysiological relationship between RLS and small fiber neuropathy using the cutaneous silent period (CSP), which is a spinal reflex mediated by Adelta cutaneous afferents and is useful for the evaluation of small-diameter nerve function. METHODS: The CSP was measured from the extensor digitorum brevis in 157 patients with RLS and 60 healthy controls. The CSP measurement was repeated in the RLS patients after dopamine agonist treatment for one month. The RLS rating scale for clinical severity was used to evaluate each patient before and after treatment. The measured CSP variables were compared between the patient group and the control group. In addition, the possible correlation between the CSP variables and the RLS rating scale score related to treatment was analyzed. RESULTS: The mean CSP latencies did not differ between the RLS patients and the healthy controls; however, the mean CSP duration was significantly longer in the RLS patients than in the controls, and this prolonged CSP duration improved to the level of the control subjects after dopamine agonist treatment (p=0.003). The mean RLS rating scale score also significantly decreased after medication (p=0.000). However, the changes in the CSP variables did not correlate with the decrement in the RLS rating scale score. CONCLUSIONS: Although our results do not support the role of Adelta fiber dysfunction in RLS, the observed change in CSP duration may be useful as a clinical measure of the improvement with dopamine agonist treatment in patients with RLS. SIGNIFICANCE: Further study is needed to elucidate the exact mechanism involved in the prolonged CSP duration in response to treatment.

Ophthalmoplegic migraine with alternating unilateral and bilateral internal ophthalmoplegia.

We describe a patient with ophthalmoplegic migraine and internal ophthalmoplegia with alternating unilateral involvement and bilateral involvement in whom brain MRI scan showed alternating gadolinium enhancement on the cisternal portion of the oculomotor nerve.

Successful treatment of postcraniectomy orthostatic headache with lumbar epidural blood patches.

Postcraniectomy orthostatic headache is a rare, but disabling, condition which can often interfere with patient rehabilitation. Previously, postsurgical CSF leaks have generally been managed with surgical repair. We present the case of a 32-year-old man with postcraniectomy orthostatic headache which was successively managed with repeated lumbar epidural blood patches.

Subjective memory complaints and clinical characteristics in elderly Koreans: a questionnaire survey.

OBJECTIVES: The overall objectives of the Ajou-Bundang Study for the Elderly (AB study) were to describe the current geriatric diseases and health behaviors, and to improve the visiting health service in South Korea. The particular objectives of the current study were to describe the AB study and to investigate the associations between subjective memory complaints (SMCs) and objective cognitive function, to assess the clinical characteristics of SMCs, and to measure possible differences between elderly people with and without cognitive dysfunction. METHODS: A cross-sectional study of a sample of people from the AB study was constructed to study the association between SMCs and demographic variables. SMCs, cognitive function, and demographic characteristics were ascertained. A total of 9,477 subjects aged 65 years or over were recruited from the residents of Bundang, Korea. RESULTS: SMCs were reported by 57.3% of the study participants. SMCs were correlated with advanced age and with being female. Further analyses of cognitive functions revealed that associated factor profiles differed between the participants with and without cognitive dysfunction. CONCLUSIONS: These results show that age is associated with SMCs, irrespective of the level of cognitive function. Longitudinal SMC studies should be undertaken to investigate potentially associated clinical parameters.

Helicobacter pylori infection and the CD14 C(-260)T gene polymorphism in ischemic stroke.

INTRODUCTION: There is increasing evidence that infective pathogens such as Helicobacter pylori is linked to atherosclerosis of cerebral vessels. As an independent contributing factor, the CD14 receptor-lipopolysaccharide complex plays an important role in activating inflammatory reactions. In particular, the C(-260)T polymorphism in the CD14 receptor may be implicated in atherosclerotic disease. In this study, we investigated a possible association between H. pylori infection and the polymorphism of CD14, and ischemic stroke. MATERIALS AND METHODS: A total of 125 patients with ischemic stroke and 125 age- and sex-matched controls were included in the study. The stroke subtype of each of the patients was characterized based on the underlying etiology. H. pylori serologic status and the CD14 genotype were determined in both patients and controls. RESULTS: H. pylori seropositivity was more common in the stroke patients than in the controls (80.0% vs. 60.0%, P=0.001). Moreover, H. pylori seropositivity was more common in the stroke subtype of large artery disease (87.7%, P<0.001). The distribution of CD14 genotypes was as follows: patients, T/T 21.6%, C/T 63.2%, C/C 15.2%; controls, T/T 19.2%, C/T 57.6%, C/C 23.2%. There was no significant difference between these two CD14 genotype distributions. CONCLUSIONS: These results suggest that H. pylori infection is a risk factor for ischemic stroke and that CD14 polymorphism is not.

Intracranial hypotension induced by cervical spine chiropractic manipulation.

STUDY DESIGN: Case report. OBJECTIVES: We report a case of intracranial hypotension ensuing after a spinal chiropractic manipulation leading to cerebrospinal fluid (CSF) isodense effusion in the upper cervical and thoracic spine. SUMMARY OF BACKGROUND DATA: The etiology of intracranial hypotension is not fully understood, but CSF leakage from spinal meningeal diverticula or dural tears may be involved. METHODS: A 36-year-old woman presented with neck and both shoulder pain 4 days earlier. She undertook a spinal chiropractic manipulation. After this maneuver, she complained of a throbbing headache with nausea and vomiting. Her headache worsened, and lying down gave the only measure of limited relief. In CSF study, it showed dry tapping. Brain MRI showed pachymeningeal gadolinum enhancement. Thoracic spine MRI showed CSF leakage. After admission to the hospital, she was treated by hydration and pain control over several days. However, her headache did not improve. RESULTS: She was treated by epidural blood patch. Afterwards, her headache was improved. This is the first case of spontaneous intracranial hypotension in which spinal chiropractic manipulation coincided with the development of symptoms and in which a CSF collection in the upper cervical and thoracic spine was demonstrated radiographically in Korea. CONCLUSIONS: From this case, we can understand the etiology of intracranial hypotension and consider the complication of chiropractic manipulation.

The PHC-cog: a brief cognitive function screening test for the elderly.

BACKGROUND: Cognitive dysfunctions such as dementia have emerged as a leading public health problem among the elderly. Its early detection is important for the management of patients, and for the educational support of other family members. Although cognitive dysfunction screening tests are available, they have not been widely utilized in community or primary care settings. AIM: To validate the PHC-cog (Public Health Center Cognitive Dysfunction Test) and to assess it as a simple and brief method for massive screening of cognitive dysfunctions in the primary care setting. MATERIALS AND METHODS: The study comprised 137 community-dwelling patients with dementia and 134 age, sex, and education-matched controls. The PHC-cog was made combining patients' and informants' questionnaires to improve performance. The PHC-cog patient's section briefly assessed the patient's cognition. RESULTS: The PHC-cog Patient's Section had a sensitivity and specificity of 0.75 and 0.92, respectively. The PHC-cog Informants' Section had a sensitivity and specificity of 0.79 and 0.83, respectively. The total method of administering the PHC-cog had a sensitivity and specificity of 0.96 and 0.82, and the two-stage method had a sensitivity and specificity of 0.92 and 0.76, respectively. CONCLUSIONS: The PHC-cog test is a simple, accurate and reliable, performance-based tool in the screening for cognitive dysfunction. The PHC-cog test is quick, and easy-to-use, and will hopefully become widely used in the cognitive screening of the aging population in the primary public medical institutions of Korea.

Stroke induced by splenectomy in hemoglobin Madrid: autopsy clues to the underlying mechanism.

Thrombo-embolic events, which can be increased after splenectomy in hemoglobin disorders, can cause potentially lethal complications. Although venous thrombosis has been reported, arterial strokes are rarely reported. A case of stroke in a 52-year-old patient with a previously performed splenectomy for known hemoglobin Madrid, an extremely unstable hemoglobinopathy, led us to investigate the possible causal role of splenectomy. The patient had no history of hypertension, diabetes mellitus, smoking, or other vascular risk factors--but upon autopsy, thrombotic angiopathy was observed in multiple organs, including the lung, liver, kidney, coronary artery and brain. Bone marrow hyperplasia was also observed. A thrombotic middle cerebral artery territory infarction appears to have been caused by chronic recurrent thrombosis, which may have been a result of the splenectomy for unstable hemoglobinopathy. This case supports that splenectomy be strongly considered as an uncommon risk factor for stroke.

Auditory event-related potentials and psychological changes during sleep deprivation.

This study investigated the psychophysiological effects of sleep deprivation on auditory event-related potentials (AERPs) and their relationship with psychological parameters. Twenty-four subjects remained awake for 37 h under continuous surveillance. In the mornings and the evenings of 2 consecutive study days, AERPs were recorded and 4 self-rated scales (sleepiness, fatigue, anxiety, and mood) were quantified. The latencies of P300 and N200 were significantly prolonged (p < 0.001) and their amplitudes decreased (p < 0.05) as a consequence of sleep deprivation. However, the only significant change in N100 and P200 was an increase in the P200 amplitude (p < 0.05). The increase in the latencies of P300 and N200 were correlated with increased sleepiness (p < 0.05), and the increase in P200 amplitude was correlated with negative mood, anxiety, and fatigue (p < 0.05). Although the changes in P300 and N200 induced by sleep deprivation are due to sleepiness, which may slow cognitive processing and decrease the efficiency of mental processing, the increase in P200 may be related with increased anxiety, negative mood, and fatigue.