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ABSTRACT: Cardiovascular risk factors are considered to also be risk factors for dementia. Recent studies have shown that the prevalence of cognitive dysfunction is high in patients with cardiac diseases. However, few studies have investigated the influence of cardiac function on cognition and brain structural changes in dementia. The aims of this study were to determine the relationship between cardiac and cognitive function, and to characterize any structural changes in the brain that could be caused by cardiac function in patients with dementia.
Dementia patients (n=93) were recruited prospectively with checking for the presence of vascular risk factors such as hypertension. Cognitive function was measured by the Mini-Mental State Examination, modified Mini-Mental State test, and Korean version of the Dementia Rating Scale. Brain magnetic resonance imaging was conducted to evaluate the cerebral white-matter changes (WMC), ventricular dilation, and cortical and hippocampal atrophy. Cardiac function was evaluated using two-dimensional echocardiography. We divided the patients into two groups according to the presence (+) or absence (-) of WMC.
In the entire cohort, the size of the left atrium (LA) was positively correlated with the degree of WMC, irrespective of age (p<0.05). The LA was larger in the WMC (+) group (n=42) than in the WMC (-) group. General cognitive function was significantly lower in the WMC (+) group than in the WMC (-) group. Subjects with an enlarged LA tended to exhibit lower cognitive function and more-severe cerebral WMC.
Cardiac dysfunction represented by LA enlargement could be related to cognitive decline and WMC of the brain resulting from impairment of the cerebral hemodynamic process in dementia.
Journal of Clinical Neurology 06/2012; 8(2):123-9. · 1.69 Impact Factor
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Hyun Jung Kim,
Eung Seok Oh,
Ji Hee Lee,
Jung Soo Moon,
Ji Eun Oh,
Jong Wook Shin,
Kyung Jae Lee,
In Chul Baek,
Seong-Hae Jeong,
Hee-Jung Song, Eun Hee Sohn,
Ae Young Lee
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ABSTRACT: Decreased BMI has been reported that it may be associated with cognitive decline in the elderly. Weight loss is common in patients with PD. However, studies comparing cognitive changes according to BMI changes in PD have not been done yet. We performed this study to know a relationship between BMI changes and the rate of cognitive decline in PD. PD patients were recruited retrospectively. The patients (n=104) were divided into two groups according to BMI changes during initial 6 months of follow-up: decreased (n=52) vs. stable BMI groups (n=52). Cognitive functions were repeated until 36 months of follow-up using the Korean version of the Mini-Mental State Examination (K-MMSE) and the modified Mini-Mental State (3MS) test. We calculated the rate of cognitive decline (K-MMSE and 3MS score changes/month) and compared it between the two groups. The decreased BMI group showed lower level of cognitive function than that of stable BMI group, especially at the 36th month of follow-up (p<0.05). In addition, the rate of cognitive decline was also significantly faster in the decreased BMI group, particularly at the 36th month of follow-up (p<0.05). This study suggests that decreased BMI during initial 6 months of follow-up in PD might be a useful indicator for future risk of dementia and let clinicians predict faster rate of cognitive decline in patients with PD.
Archives of gerontology and geriatrics 07/2011; 55(1):70-2. · 1.36 Impact Factor
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Clinical neurology and neurosurgery 06/2011; 113(7):596-8. · 1.30 Impact Factor
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ABSTRACT: Pathophysiological aspects of dementia and its rate of cognitive deterioration could be dependent on disease subtype, Alzheimer's dementia (AD), vascular dementia (VaD), and Parkinson's disease with dementia (PDD). 150 patients diagnosed at the Chungnam National University Hospital (87 women and 63 men) memory clinic. The participants consisted of 68 patients with AD, 23 patients with VaD, and 59 patients with PDD, who were diagnosed by the individual criteria, respectively. Cognitive screening was evaluated using the Korean version of the mini-mental state examination (MMSE). Repeated evaluations were conducted at 6-month, 1 year, and 2 years after initial baseline assessment. Rates of cognitive decline were calculated by dividing MMSE score differences by the number of months lapsed. No difference was found between the three dementia subtypes with respect to baseline MMSE scores. Cognitive decline was not obvious up to 6-month of the follow-up, but by 12-month of follow-ups was significant regardless of the dementia subtype. Furthermore, the rate of cognitive decline in the AD group was significantly faster than in the PDD or VaD groups. This study suggests that rate of cognitive deterioration in dementia is not linear over time and that dementia subtypes have different rates of cognitive deterioration.
Archives of gerontology and geriatrics 01/2011; 53(3):320-2. · 1.36 Impact Factor
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ABSTRACT: The CDT requires a patient to draw the face of a clock, insert all the numbers and set the hands for a specified time. This task engages a number of cognitive abilities including verbal understanding, memory, spatially coded knowledge, planning, concentration and visuoconstructive skills. Although CDT has been regarded as a simple and useful screening tool in dementia, little is known about the longitudinal changes in CDT performance and error types, according to dementia subtypes and their severity. MATERIALS AND METHODS: Two hundred thirty-five consecutive patients with dementia (Alzheimer disease = AD, n=94, Parkinson's disease with dementia (PDD), n = 119, Vascular dementia = VaD, n = 22) were recruited from the memory clinic at Chungnam University hospital from January 2005 to July 2009. The Korean version of the mini-mental state examination (MMSE-K) and CDT were performed by all participants every 6 months. Scoring of the CDT performance was in accordance with the method of Mano and Wu. Error types of CDT were classified as follows: stimulus-bound response (SBR), conceptual deficit (CD), spatial and/or planning deficit (SPD) and perseveration error (PE). We divided patients into 3 groups by their initial MMSE-K score (severe, MMSE-K ≤ 17; moderate, 18 ≤ MMSE-K < 24; mild, 24 ≤ MMSE-K). Comparisons of CDT scores and error types in the three dementia subtypes and three cognitive groups were conducted. Results: Longitudinal changes on CDT and MMSE-K scores were not different between the three dementia subtypes. From the analysis of CDT error type, the most common error type was SPD in patients with mild to moderate dementia. In contrast, CD error was the most frequent in severe dementia group. The order of error frequency in all subjects from baseline to the last follow-up was as follows: SPD, CD, SBR and PE except CD was the most frequent error type in AD patients after 18 months from baseline. CONCLUSION: Longitudinal analysis of error on CDT may reflect different characteristics of cognitive deterioration according to dementia subtypes and dementia stages.
Archives of gerontology and geriatrics 10/2010; 53(2):e179-82. · 1.36 Impact Factor
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ABSTRACT: We performed this study to evaluate the relationship between the stages of PD and autonomic dysfunction, and to find an association between the autonomic dysfunction and cognitive impairment in PD. Sixty-three patients who met the criteria of the United Kingdom PD Society Brain Bank were enrolled prospectively. Clinical stages were using the Hoehn and Yahr (H&Y) staging and unified PD rating scale motor scores. Cognitive functions were evaluated using the mini-mental state examination (MMSE) and the modified MMSE (3MS) test. The scale for outcome in PD-autonomic (SCOPA-AUT) was used to evaluate autonomic symptoms. Severities of autonomic dysfunction were classified using the composite autonomic scoring scale (CASS). Fifty-four of the 63 patients (86%) had shown abnormalities on CASS. H&Y stages correlated with SCOPA-AUT (p<0.05) and 3MS and MMSE scores (p<0.05). H&Y stages were positively related with autonomic dysfunction, heart rate ratios during deep breathing and the quantitative sudomotor axon reflex test (QSART) scores. Autonomic dysfunction may be present from disease onset, whereas the rate of cognitive decline increases with disease progression. We recommend that both qualitative and quantitative autonomic evaluation from the early stage of disease and regular cognitive screening with disease progression might be useful to facilitate optimal management in PD.
Archives of gerontology and geriatrics 03/2010; 52(1):84-8. · 1.36 Impact Factor
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ABSTRACT: Most patients with idiopathic PD (IPD) show variable degrees of cognitive decline. The purpose of this study was to evaluate the relationship between the predominant motor symptom at the time of disease onset and the level of cognitive function in patients with IPD. A total of 159 patients with IPD were enrolled in this study. The patients' initial motor symptoms were classified into three types: tremor-dominant (TD), bradykinesia and rigidity-dominant (BRD), gait and postural instability-dominant (GPD). Disease severity was rated according to the Hoehn-Yahr classification (H&Y stage). Overall cognitive status was evaluated using the Korean versions of the Mini-Mental State Examination (K-MMSE) and the Modified Mini-Mental State (3MS) tests. The GPD group showed the lowest scores of the K-MMSE/3MS, and the patients with TD showed the best performance in the cognitive analysis (p<0.05). The patients who were older at disease onset showed worse cognitive performance than those the patients who were younger at disease onset (p<0.05). There was no difference in cognitive status according to H&Y stages. The accurate classification of initial motor symptoms and the detailed history, including the exact onset age of IPD, may allow us to predict cognitive decline in IPD.
Archives of gerontology and geriatrics 02/2009; 49(3):351-4. · 1.36 Impact Factor
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ABSTRACT: Arterial stiffness (AS) and metabolic syndrome (MS) may correlate with poor cognitive function in elderly people. However, few studies have evaluated this relationship in a healthy, community-dwelling elderly population. Our aim was to evaluate a relationship between the AS measured by pulse wave velocity (PWV) and cognitive function and to know whether the relationship is influenced by the presence of MS. Our study population was community-dwelling healthy people in Geumsan province, Republic of Korea. A total of 370 participants without a history of cerebrovascular disease were evaluated with the Korean version of the mini-mental state examination (K-MMSE) and have measured the brachial-ankle PWV (baPWV). Correlation between baPWV and cognitive status and effect of MS were measured. Negative correlation between PWV and cognitive function was found in the older subjects (> or = 60 years of age) with MS (r=-0.38; p<0.05). In the receiver operating characteristic (ROC) curve, the cut-off score was 1800.8 cm/s with 67% sensitivity and 78% specificity. Aging (older than 60 years) and the presence of MS may affect synergistically cognitive decline in the elderly population. The baPWV can be a useful predictor for cognitive decline in elderly healthy community-dwelling population with MS.
Archives of gerontology and geriatrics 10/2008; 49(1):176-9. · 1.36 Impact Factor
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ABSTRACT: We have identified a compound heterozygous mutation of PYGM in a Korean patient with McArdle disease, which is composed of a novel single codon deletion (p.779delE) and a common nonsense mutation (p.R50X). Our study also showed an evidence of nonsense-mediated mRNA decay (NMD) caused by p.R50X mutation, supporting the importance of RNA processing defects in the molecular pathology of McArdle disease.
Neuromuscular Disorders 08/2008; 18(11):886-9. · 2.80 Impact Factor
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ABSTRACT: The CDT is a useful screening instrument for assessing cognition. The aim of this study is to identify which structural change of the brain is related with the CDT performance. Eighty-four patients with memory impairment were enrolled. The Korean versions of the mini-mental state examination (K-MMSE) and the modified mini-mental state (3MS) test, and the Seoul Neuropsychological Screening Battery (SNSB) were given to every subject. Four CDT scoring methods were used. The cerebral white matter hyperintensity (WMH), cortical atrophy (CA), ventricular enlargement (VE), and medial temporal lobe atrophy (MTA) were rated by two neurologists who were kept "blind" to the clinical information. The cognitive and executive functions were significantly correlated with the CDT performance. The degree of WMH and MTA showed an inverse relation with the CDT performance. The periventricular WMH (PVH) contributed more to impairment of CDT, than that of the deep WMH (DWMH). This study suggests that a combination of executive dysfunction via the frontal-subcortical disruption due to the PVH and memory impairment due to the MTA might be responsible for further worsening on the CDT.
Archives of gerontology and geriatrics 03/2008; 48(2):218-21. · 1.36 Impact Factor
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ABSTRACT: We wanted to define the characteristics of errors on the clock drawing test (CDT) and we also wanted to determine their value for making the early diagnosis of dementia, so the performance of patients with three types of dementia on the four CDT was evaluated. The patients with subcortical vascular dementia (VaD) and patients with Parkinson's disease with dementia (PDD) had more stimulus bound responses. Patients with Alzheimer disease (AD) made significantly more conceptual deficit (CD) errors. The CD correlated with the severity of dementia and it could be detected in the early and mild stage of dementia. Qualitative and quantitative analyses of the errors on the CDT might be useful for making the early differential diagnosis of dementia types.
Archives of gerontology and geriatrics 12/2007; 48(1):58-60. · 1.36 Impact Factor
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ABSTRACT: Lymphomatoid granulomatosis (LG) is a potentially malignant lymphoproliferative disorder. The lung is the most common involved site, followed by the skin and nervous system. However, LG of the central nervous system presenting with Parkinsonism is very rare. We report a patient with LG who presented with parkinsonian features such as bilateral rigidity, bradykinesia, and agitation. Brain magnetic resonance imaging showed multifocal punctuate enhanced lesions in both supra- and infratentorial areas. Steroid pulse therapy resulted in a dramatical improvement in the symptoms and MRI abnormalities.
Journal of Clinical Neurology 07/2007; 3(2):108-11. · 1.69 Impact Factor
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ABSTRACT: Multiple sclerosis (MS) in Asians is characterized by frequent involvement of the spinal cord and optic nerve and low prevalence rates, but even the most fundamental epidemiologic findings and unique clinical features of MS patients in Korea have not been studied extensively. We performed this study to establish the clinical spectrum of MS patients in Korea.
Sixty-two MS patients (25 men and 37 women) who satisfied the diagnostic criteria for definite MS were reviewed retrospectively using medical records from two university hospitals and one general hospital. The MS patients were classified into the three clinical subtypes according to the involved site (opticospinal, spinal, and conventional MS).
The age at MS onset was 35.2+/-13.3 (mean+/-SD) years, and the predominant initial clinical manifestations were myelopathy (54.8%) and optic neuropathy (33.9%). The single most common involved lesion site was the spinal cord (35.5%). Spinal (35.5%) and opticospinal (25.8%) MS were the most common type, and they had a frequent relapsing-remitting course and long lesions extending over two vertebral segments (as assessed using spinal cord MRI). The interval between the first symptom and relapse was 35.6+/-71.1 months, and the number of relapses was 3.8+/-2.6. The spinal form of MS was associated with a higher age at onset and a higher male-to-female ratio than the other types. Positive rates of CSF oligoclonal bands and IgG index and the number of patients with characteristic brain MRI lesions were low. However, the abnormal rate of visual evoked potentials was relatively high (64.4%).
The clinical features of MS patients in Korea are different from those in Western patients, but similar to those in Far East Asian patients. The value of the various diagnostic tools used for MS should therefore be reevaluated, at least for Korean patients.
Journal of Clinical Neurology 12/2006; 2(4):231-7. · 1.69 Impact Factor
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ABSTRACT: The relation between pulse pressure (PP) and Alzheimer disease (AD) remains unclear. We performed this study to investigate the relation between PP and AD and the impact of PP to impair cognitive performance on this relationship. It is a cross-sectional study from the Neurology Memory Clinic of Chungnam National University Hospital and five senior welfare centers in the city of Taejon, Korea. A cohort of 75 patients with AD and 117 control subjects were enrolled for the study. PP was significantly higher whereas mean arterial pressure (MAP) was lower in patients with AD than those of control subjects. Elevated serum total cholesterol (TC) level was significantly associated with both PP and MAP in control subjects as well as patients with AD. We found a significant relationship between PP and cerebral white matter changes (WMCs) in AD. PP changes correlate with leukoaraiosis in AD.
Archives of Gerontology and Geriatrics 42(2):157-66. · 1.45 Impact Factor
