The Seoul Neuropsychological Screening Battery (SNSB) is one of the standardized neuropsychological test batteries widely used in Korea. However, it may be a bit too lengthy for patients with decreased attention span; and it does not provide the score of global cognitive function (GCF), which is useful for monitoring patients longitudinally. We sought to validate a dementia version of SNSB (SNSB-D) that was shorter than the original SNSB and contained only scorable tests with a GCF score of 300. We administered SNSB-D to patients with mild cognitive impairment (MCI) (n=43) and Alzheimer's disease (AD) (n=93), and normal controls (NC) (n=77). MCI and AD groups had GCF scores significantly different from NC group, and GCF scores were able to distinguish patients with Clinical Dementia Rating of 0.5 and 1. Test-retest reliability was high, with a correlation coefficient of 0.918 for AD, 0.999 for MCI, and 0.960 for NC. The GCF score significantly correlated with the Mini-Mental State Examination (MMSE). Through ROC-curve analysis, GCF scores were found to yield more accurate diagnoses than the MMSE. The SNSB-D is a valid, reliable tool for assessing the overall cognitive function, and can be used to monitor cognitive changes in patients with dementia.
Alzheimer Disease/diagnosis/physiopathology ; Cognition Disorders/*diagnosis/etiology/physiopathology ; Dementia/complications/*diagnosis/physiopathology ; Humans ; Korea ; *Neuropsychological Tests/standards ; ROC Curve ; Reproducibility of Results ; Severity of Illness Index

Adult ; Female ; Frontal Lobe ; physiopathology ; Frontotemporal Dementia ; diagnosis ; etiology ; physiopathology ; Humans ; Magnetic Resonance Imaging ; Treatment Outcome ; Tuberculoma, Intracranial ; complications

OBJECTIVETo investigate the sleep structure in patients with vascular cognitive impairment-no dementia (VCI-ND) and its differences from that of normal individuals.

METHODSThe whole night sleep record of 20 patients with VCI-ND were monitored by 32-head video-taped polysomnographic system, and the results were compared with the data of 20 normal subjects.

RESULTSCompared with normal subjects, patients with VCI-ND showed significantly reduced total sleep duration, increased waking times, increased stage 1 sleep, decreased stage 2 sleep, decreased stage 3 sleep, decreased rapid eye movement stage (REM) and reduced sleep efficiency.

CONCLUSIONIncreased light sleep as well as decreased slow-wave stage 3-4 sleep and decreased REM stage may be a specific electroneurophysiologic marker for VCI-ND, but large-sampled multi-centered randomized controlled trial is necessary to test the validity of these features as specific markers for screening and early diagnostic purposes.

Aged ; Case-Control Studies ; Cognition Disorders ; diagnosis ; etiology ; physiopathology ; Dementia, Vascular ; diagnosis ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; Sleep ; physiology ; Sleep Stages ; Sleep Wake Disorders ; etiology ; Stroke ; complications

A 68-year-old man presented with a three-week history of rapidly progressive dementia, gait ataxia and myoclonus. Subsequent electroencephalography showed periodic sharp wave complexes, and cerebrospinal fluid assay revealed the presence of a 14-3-3 protein. A probable diagnosis of sporadic Creutzfeldt-Jakob disease was made, which was further supported by magnetic resonance (MR) imaging of the brain showing asymmetric signal abnormality in the cerebral cortices and basal ganglia. The aetiology, clinical features, diagnostic criteria, various MR imaging patterns and radiologic differential diagnosis of sporadic Creutzfeldt-Jakob disease are discussed in this article.
Aged ; Brain ; pathology ; Cerebral Cortex ; Cerebrospinal Fluid ; metabolism ; Creutzfeldt-Jakob Syndrome ; diagnostic imaging ; Dementia ; physiopathology ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Electroencephalography ; Humans ; Hypoxia-Ischemia, Brain ; diagnostic imaging ; Male ; Prion Diseases ; physiopathology

Singapore has an ageing population with a projected 53,000 people aged ≥ 60 years living with dementia by 2020. Primary care doctors have the opportunity to initiate early work-up for reversible causes of cognitive dysfunction, allowing identification of comorbidities and discussion of medical therapy options. Early diagnosis confers the sick role on the patient, which allays frustration and explains events and behaviour that may have strained relationships with family and friends. The patient can be encouraged to plan for future health and personal care options with a Lasting Power of Attorney and/or Advance Care Planning. Objective cognitive tests (e.g. abbreviated mental test and Mini-Mental State Examination) and brain imaging are adjuncts that help in formulating the diagnosis. Referral to a hospital memory clinic activates a multidisciplinary team approach to dementia, including clinical consultation, dementia counselling, physiotherapy sessions on gait/fall prevention, occupational therapy sessions on cognitive stimulation and caregiver training.
Advance Care Planning ; Aged ; Aged, 80 and over ; Brain ; physiopathology ; Caregivers ; Cognition ; Cognitive Dysfunction ; diagnosis ; epidemiology ; therapy ; Cognitive Therapy ; Dementia ; diagnosis ; epidemiology ; therapy ; Geriatrics ; methods ; Home Nursing ; Humans ; Interdisciplinary Communication ; Memory ; Middle Aged ; Neuropsychological Tests ; Referral and Consultation ; Singapore

OBJECTIVE: Brain perfusion can be assessed non-invasively by modern arterial spin labeling MRI. The FAIR (flow-sensitive alternating inversion recovery)-TrueFISP (true fast imaging in steady precession) technique was applied for regional assessment of cerebral blood flow in brain areas close to the skull base, since this approach provides low sensitivity to magnetic susceptibility effects. The investigation of the rhinal cortex and the amygdala is a potentially important feature for the diagnosis and research on dementia in its early stages. MATERIALS AND METHODS: Twenty-three subjects with no structural or psychological impairment were investigated. FAIR-True-FISP quantitative perfusion data were evaluated in the amygdala on both sides and in the pons. A preparation of the radiofrequency FOCI (frequency offset corrected inversion) pulse was used for slice selective inversion. After a time delay of 1.2 sec, data acquisition began. Imaging slice thickness was 5 mm and inversion slab thickness for slice selective inversion was 12.5 mm. Image matrix size for perfusion images was 64 x 64 with a field of view of 256 x 256 mm, resulting in a spatial resolution of 4 x 4 x 5 mm. Repetition time was 4.8 ms; echo time was 2.4 ms. Acquisition time for the 50 sets of FAIR images was 6:56 min. Data were compared with perfusion data from the literature. RESULTS: Perfusion values in the right amygdala, left amygdala and pons were 65.2 (+/- 18.2) mL/100 g/minute, 64.6 (+/- 21.0) mL/100 g/minute, and 74.4 (+/- 19.3) mL/100 g/minute, respectively. These values were higher than formerly published data using continuous arterial spin labeling but similar to 15O-PET (oxygen-15 positron emission tomography) data. CONCLUSION: The FAIR-TrueFISP approach is feasible for the quantitative assessment of perfusion in the amygdala. Data are comparable with formerly published data from the literature. The applied technique provided excellent image quality, even for brain regions located at the skull base in the vicinity of marked susceptibility steps.
Adult ; Aged ; Aged, 80 and over ; Amygdala/*blood supply ; *Cerebrovascular Circulation ; Dementia/diagnosis/physiopathology ; Entorhinal Cortex/*blood supply ; Female ; Humans ; Image Processing, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Pons/blood supply ; Reproducibility of Results ; Spin Labels