Purpose: Cardiovascular disease is one of the major causes of death not only in Korea but also worldwide. Atherogenic index of plasma (AIP) has been extensively investigated, but studies on nutritional intake and eating habits are scarce. The purpose of this study was to analyze the general characteristics, dietary habits, and nutritional status of Korean adults based on their AIP values using data from the 2013–2015 Korea National Health and Nutrition Examination Survey. Methods: A total number of 3,040 adults in their 20s and 30s were included as study subjects. They were divided into quintiles according to their AIP values. Comparisons were then made among the general information, eating habits, and nutritional intake statuses of the groups. Results: The averages of AIP were different by age, obese status, education, occupation, alcohol drinking frequency, smoking, and exercise in men. As for women, the averages of AIP were different by age, obese status, education, occupation, alcohol drinking frequency, and smoking status. Except for high-density lipoprotein (HDL)-cholesterol, higher AIP values in men were associated with significant increasing trends in health indicators, including systolic and diastolic blood pressure, fasting blood glucose, insulin, hemoglobin A1c, total cholesterol, triglyceride, and low-density lipoprotein (LDL)-cholesterol. As for women, as AIP increased, systolic and diastolic blood pressure, fasting blood glucose, insulin, total cholesterol, triglyceride, and LDL-cholesterol showed significant increasing trends except HDL-cholesterol. HDL-cholesterol showed a significant decreasing trend as AIP increased in men and women. In the high AIP group of women, the frequency of breakfast was lower, whereas the frequency of alcohol beverage consumption was higher. Conclusion Among young adults, the risk of arteriosclerosis was higher in obese, smoking, and non-exercise individuals. More frequent alcohol drink consumption in women is associated with a higher risk of arteriosclerosis. Therefore, weight and lifestyle management are necessary for the prevention of atherosclerosis among young adults.

Subjective memory impairment (SMI) is now increasingly recognized as a risk factor of progression to dementia. This study investigated gray and white matter changes in the brains of SMI patients compared with normal controls and mild cognitive impairment (MCI) patients. We recruited 28 normal controls, 28 subjects with SMI, and 29 patients with MCI aged 60 or older. We analyzed gray and white matter changes using a voxel-based morphometry (VBM), hippocampal volumetry and regions of interest in diffusion tensor imaging (DTI). DTI parameters of corpus callosum and cingulum in SMI showed more white matter changes compared with those in normal controls, they were similar to those in MCI except in the hippocampus, which showed more degenerations in MCI. In VBM, SMI showed atrophy in the frontal, temporal, and parietal lobes compared with normal controls although it was not as extensive as that in MCI. Patients with SMI showed gray and white matter degenerations, the changes were distinct in white matter structures. SMI might be the first presenting symptom within the Alzheimer's disease continuum when combined with additional risk factors and neurodegenerative changes.
Aged ; Brain/*pathology ; Diagnosis, Differential ; Diffusion Tensor Imaging/methods ; Female ; Gray Matter/*pathology ; Humans ; Male ; Memory Disorders/*diagnosis/etiology ; Mild Cognitive Impairment/complications/*diagnosis ; Neurodegenerative Diseases/complications/*pathology ; Reference Values ; Reproducibility of Results ; Sensitivity and Specificity ; White Matter/*pathology

BACKGROUND: White matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) have been considered as a reliable biomarker of small vessel damages. To evaluate the severity of WMHs, it is vital to develop reliable methods to measure the volume of WMHs. We applied open source software to measure WMH volume in the semi-automated way, and tested the reliability and validity by comparing with the commonly used qualitative rating scale. METHODS: Twenty five subjects with variable WMHs were recruited. ANALYZE 10.0 was used for the image processing and volumetric measurement of WMHs. The inhomogeneity and artifacts of signal were corrected with Insight Segmentation and Registration Toolkit in ANALYZE. For the gold standard of the WMH volumetric measurement, threshold method was applied with consensus of manual editing on each slice of the MRI images by two raters. Histogram of the all slices of the Fluid Attenuated Inversion Recovery (FLAIR) MRI was generated to calculate the optimal voxel intensity of threshold, and the lowest voxel threshold was decided as the mean+1.4 SD. The volumes of WMHs were generated by multiplying the area and the thickness of each slice. Inter- and intrarater reliability of the semi-automated volumetric and Scheltens'methods, and the association between the individual methods were analyzed. RESULTS: The semi-automated WMH volume at the threshold of 1.4 SD as well as the gold standard volume was well correlated with the Scheltens' visual scale (r=0.75, p<0.001). The semi-automated volumetry showed the excellent intra-rater (ICC=0.9929; 95% CI, 0.9840-0.9968) and inter-rater reliability (ICC=0.9830; 95% CI, 0.9620-0.9925), superior to the Scheltens' visual rating scale. CONCLUSIONS: The semi-automated volume measurement of the WMHs with Analyze was a valid and a reliable method to quantify subcortical white matter damages of various etiologies.
Artifacts ; Consensus ; Glycosaminoglycans ; Humans ; Magnetic Resonance Imaging ; Reproducibility of Results

BACKGROUND: The early stage of Alzheimer disease might show early memory impairment with normal general cognitive function. Our study aimed to investigate elderly with normal Korean version of mini-mental state examination (K-MMSE) score and recall score of 0 for 1 year. We predicted that the patients would show different characteristics and would progress more rapidly compared with normal controls. METHODS: This study was based on the data from complete enumeration survey of Mapo-gu Regional Center for Dementia in 2009. We divided all subjects into three groups: subjects with normal K-MMSE scores and recall score of 0 were group 1-1 (n=152), subjects with abnormal K-MMSE scores were group 1-2 (n=64) and subjects with normal K-MMSE scores and recall score of 1 to 3 were group 1-3 (n=941). We compared basic demographics and social characteristics among the three groups. After 1 year (2010), the subjects in group 1-1 (90 out of 152) underwent follow-up examinations for dementia diagnosis. They were also divided into three groups (2-1, 2-2, 2-3) according to K-MMSE and recall scores. RESULTS: Group 1-1 showed different baseline characteristics compared with normal controls. After 1 year, 25.5% (23 out of 90) of the group 2-1 were diagnosed as mild cognitive impairment (n=16) or dementia (n=7). CONCLUSION: Our study suggested that subjects with normal K-MMSE scores but recall score of 0 are not entirely "normal". Further detailed evaluation might be needed if memory impairment is suspicious although the K-MMSE scores are within normal range.
Aged* ; Alzheimer Disease ; Dementia* ; Demography ; Diagnosis* ; Follow-Up Studies* ; Humans ; Memory ; Mild Cognitive Impairment ; Pilot Projects* ; Reference Values ; Sociology

BACKGROUND AND PURPOSE: The "closing-in" phenomenon refers to the tendency to copy near or overlap a model while performing figure-copying tasks. The mechanisms underlying the closing-in phenomenon have not been fully elucidated, and previous studies only investigated the mechanisms through neuropsychological tests. We investigated the neuroanatomical correlates of the closing-in phenomenon using voxel-based morphometry (VBM). METHODS: Thirty-eight patients diagnosed with probable Alzheimer's disease (AD) and 21 normal controls were included. All subjects underwent neuropsychological testing to diagnose dementia and magnetization prepared rapid acquisition gradient echo brain magnetic resonance imaging for the voxel-based statistical analysis. The subjects were asked to copy the modified Luria's alternating squares and triangles to quantify the closing-in phenomenon. We applied SPM8 for the VBM analysis to detect gray matter loss associated with the closing-in phenomenon. RESULTS: The patients with probable AD showed a higher closing-in score than that of the normal control subjects (p<0.0001). The VBM analysis revealed more parietal and temporal atrophy in the patients with AD than that in the normal control group. Moreover, atrophy of the orbito-frontal area was associated with the closing-in phenomenon. CONCLUSIONS: The closing-in phenomenon is dysfunction while performing figure-copying tasks and is more common in patients with AD. The analysis of the orbito-frontal area, which is associated with inhibiting primitive reflexes, revealed that the closing-in phenomenon is an imitation behavior commonly observed in patients with frontal lobe damage.
Alzheimer Disease ; Atrophy ; Brain ; Dementia ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Neuropsychological Tests ; Rabeprazole ; Reflex

BACKGROUND: Cultural characteristics of taking care of patients with dementia in Korea are based on the influence of Confucianism on the lifestyle of Koreans. In addition, as the family size has been getting smaller, the number of old persons who live alone has been increasing. The purpose of this study is to examine the proportion of the elderly with dementia who live alone and demographics of caregivers when such patients live with their family. METHODS: From the multiple hospital-based cohort, 973 elderly patients with very mild dementia (Clinical Dementia Rating [CDR]=0.5), 1,056 patients with mild dementia (CDR=1) and 359 patients with moderate dementia (CDR=2) were recruited. We analyzed the proportion of the patients with dementia who live alone and the demographics of the caregivers if such patients live with and are taken care of by such caregivers depending upon the severity of dementia. RESULTS: The proportion of the patients with dementia who live alone accounts for about 40% of all elderly patients with dementia. Major age groups of caregivers are of 40s and 50s. Sons, daughters, and spouses were ranked in the said order in the proportion of caregivers according to their relationship to patients. CONCLUSIONS: Up to now, family members care for about 60% of elderly patients with dementia, which may suggest that from the objective viewpoint, direct burden borne by caregivers for old patients with dementia would be considerably high. On the other hand, about 40% of dementia patients live alone, implying that the social care system is needed for them.
Aged ; Caregivers ; Cohort Studies ; Confucianism ; Cultural Characteristics ; Dementia ; Demography ; Family Characteristics ; Hand ; Humans ; Korea ; Life Style ; Nuclear Family ; Spouses

BACKGROUND: Cultural characteristics of taking care of patients with dementia in Korea are based on the influence of Confucianism on the lifestyle of Koreans. In addition, as the family size has been getting smaller, the number of old persons who live alone has been increasing. The purpose of this study is to examine the proportion of the elderly with dementia who live alone and demographics of caregivers when such patients live with their family. METHODS: From the multiple hospital-based cohort, 973 elderly patients with very mild dementia (Clinical Dementia Rating [CDR]=0.5), 1,056 patients with mild dementia (CDR=1) and 359 patients with moderate dementia (CDR=2) were recruited. We analyzed the proportion of the patients with dementia who live alone and the demographics of the caregivers if such patients live with and are taken care of by such caregivers depending upon the severity of dementia. RESULTS: The proportion of the patients with dementia who live alone accounts for about 40% of all elderly patients with dementia. Major age groups of caregivers are of 40s and 50s. Sons, daughters, and spouses were ranked in the said order in the proportion of caregivers according to their relationship to patients. CONCLUSIONS: Up to now, family members care for about 60% of elderly patients with dementia, which may suggest that from the objective viewpoint, direct burden borne by caregivers for old patients with dementia would be considerably high. On the other hand, about 40% of dementia patients live alone, implying that the social care system is needed for them.
Aged ; Caregivers ; Cohort Studies ; Confucianism ; Cultural Characteristics ; Dementia ; Demography ; Family Characteristics ; Hand ; Humans ; Korea ; Life Style ; Nuclear Family ; Spouses

Objective: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that can have a significant impact on the quality of life. According to recent studies, some OSAS patients exhibit swallowing abnormalities, such as the premature entry of food into the hypopharynx, and laryngeal penetration. We aimed to evaluate the swallowing function of OSAS patients and compare swallowing-related parameters between OSAS severity groups through a video fluoroscopic swallowing study (VFSS). Methods: Ninety-two participants with a symptom of snoring were enrolled in this retrospective study. Eighty-four participants were diagnosed with OSAS by polysomnography. The subjects were evaluated using the apnea-hypopnea index (AHI) and divided into four groups, namely non-OSAS, mild, moderate, and severe OSAS. Since all patients reported choking symptoms, they underwent VFSS and were evaluated for penetration or aspiration. The temporal parameters evaluated were oral transit time, pharyngeal transit time, and pharyngeal delay time. The movement parameters assessed were the distance, duration, and velocity of laryngeal elevation (LE). Results: Penetration was detected in six OSAS patients, but aspiration was not observed in any patient. Seventy-four patients showed vallecular and pyriform sinus residue, although the amount was not significantly large. There was no significant difference in any of the temporal parameters between the groups except pharyngeal transit time with 10 ml of yogurt. In the Pearson’s correlation and multivariate linear regression analysis, LE distance and LE velocity, both correlated with AHI scores with 5 ml of liquid, 10 ml of liquid, and 10 ml of yogurt, respectively. Conclusion Severe OSAS patients showed longer and faster hyolaryngeal movement while swallowing, which may be a compensatory movement to prevent penetration or aspiration.

Mild cognitive impairment (MCI) has been defined as a transitional state between normal aging and Alzheimer disease. Diffusion tensor imaging (DTI) can estimate the microstructural integrity of white matter tracts in MCI. We evaluated the microstructural changes in the white matter of MCI patients with DTI. We recruited 11 patients with MCI who met the working criteria of MCI and 11 elderly normal controls. The mean diffusivity (MD) and fractional anisotropy (FA) were measured in 26 regions of the brain with the regions of interest (ROIs) method. In the MCI patients, FA values were significantly decreased in the hippocampus, the posterior limb of the internal capsule, the splenium of corpus callosum, and in the superior and inferior longitudinal fasciculus compared to the control group. MD values were significantly increased in the hippocampus, the anterior and posterior limbs of the internal capsules, the splenium of the corpus callosum, the right frontal lobe, and in the superior and the inferior longitudinal fasciculus. Microstructural changes of several corticocortical tracts associated with cognition were identified in patients with MCI. FA and MD values of DTI may be used as novel biomarkers for the evaluation of neurodegenerative disorders.
Aged ; Aged, 80 and over ; Aging/*pathology ; Anisotropy ; Biological Markers ; Cerebral Cortex/*pathology ; Cognition Disorders/*pathology ; Diffusion Magnetic Resonance Imaging/*methods ; Female ; Humans ; Male ; Middle Aged ; Neural Pathways/*pathology ; Severity of Illness Index

BACKGROUND AND PURPOSE: Patients with mild cognitive impairment (MCI) and their caregivers are concerned with the likelihood and time course of progression to dementia. This study was performed to identify the clinical predictors of the MCI progression in a Korean registry, and investigated the effects of medications without evidence, frequently prescribed in clinical practice. METHODS: Using a Korean cohort that included older adults with MCI who completed at least one follow-up visit, clinical characteristics and total medical expenses including prescribed medications were compared between two groups: progressed to dementia or not. Cox proportional hazards regression analysis was conducted. RESULTS: During the mean 1.42±0.72 years, 215 (27.63%) of 778 participants progressed to dementia. The best predictors were age [hazard ratio (HR), 1.036; 95% confidence interval (CI), 1.006–1.067; p=0.018], apolipoprotein ε4 allele (HR, 2.247; 95% CI, 1.512–3.337; p<0.001), Clinical Dementia Rating scale-sum of boxes scores (HR, 1.367; 95% CI, 1.143–1.636; p=0.001), Instrumental Activities of Daily Living scores (HR, 1.035; 95% CI, 1.003–1.067; p=0.029), and lower Mini-Mental State Examination scores (HR, 0.892; 95% CI, 0.839–0.949; p<0.001). Total medical expenses were not different. CONCLUSIONS: Our data are in accordance with previous reports about clinical predictors for the progression from MCI to dementia. Total medical expenses were not different between groups with and without progression.
Activities of Daily Living ; Adult ; Alleles ; Apolipoproteins ; Caregivers ; Cholinesterase Inhibitors ; Cohort Studies* ; Dementia ; Follow-Up Studies ; Humans ; Mild Cognitive Impairment*