BACKGROUND AND PURPOSE: Torrance Tests of Creative Thinking (TTCT) is a well-known and commonly used measure of creativity. However, the TTCT-induced creative hemodynamic brain activity is rarely revealed. The purpose of this study is to elucidate the neural correlates of creative thinking in the setting of a modified version of the figural TTCT adapted for an functional magnetic resonance imaging (fMRI) experiment. METHODS: We designed a blocked fMRI experiment. Twenty-five participants (11 males, 14 females, mean age 19.9±1.8) were asked to complete the partially presented line drawing of the figural TTCT (creative drawing imagery; creative). As a control condition, subjects were asked to keep tracking the line on the screen (line tracking; control). RESULTS: Compared to the control condition, creative condition revealed greater activation in the distributed and bilateral brain regions including the left anterior cingulate, bilateral frontal, parietal, temporal and occipital regions as shown in the previous creativity studies. CONCLUSIONS: The present revealed the neural basis underlying the figural TTCT using fMRI, providing an evidence of brain areas encompassing the figural TTCT. Considering the significance of a creativity test for dementia patients, the neural correlates of TTCT elucidated by this study may be valuable to evaluate the brain function of patients in the clinical field.
Brain* ; Creativity ; Dementia ; Female ; Gyrus Cinguli ; Hemodynamics ; Humans ; Magnetic Resonance Imaging* ; Male ; Occipital Lobe ; Rabeprazole ; Thinking*

Subjective cognitive decline (SCD) represents subjective complaints about cognitive decline in the absence of objective impairment in neuropsychological tests. Recently, growing evidence has suggested that SCD might be the first symptomatic stage of Alzheimer's disease (AD) spectrum disorders. However, SCD is a heterogeneous condition mixed with AD and non-AD related conditions. Hence, refinement of evidence from previous reports and standardization of the concept about SCD are needed to define appropriate target population with AD pathology. In this article, we review previous studies involving subjects with SCD, the new proposed research criteria, and characteristics of SCD in the aspect of preclinical AD. Biomarker status of SCD is also addressed. Future researches on SCD require a longitudinal follow-up with sufficient biomarker studies and proper outcome measures.
Alzheimer Disease* ; Follow-Up Studies ; Health Services Needs and Demand ; Neuropsychological Tests ; Outcome Assessment (Health Care) ; Pathology

Until recently, there is considerable mess regarding the nature of anxiety in dementia. However, anxiety is common in this population affecting from 8% to 71% of prevalence, and resulted in poor outcome and quality of life, even after controlling for depression. Because a presentation of anxiety in the context of dementia can be different from typical early-onset anxiety disorder, it is not easy one to identify and quantify anxiety reliably. Moreover, differentiating anxiety from the depression and/or dementia itself also can be formidable task. Anxiety gradually decreases at the severe stages of dementia and this symptom may be more common in vascular dementia than in Alzheimer's disease. Due to the lack of large randomized clinical trials, optimal treatment and the true degree of efficacy of treatment is not clear yet in this population. However, these treatments can reduce adverse impact of anxiety on patients and caregivers. This article provides a brief review for the diagnosis, evaluation and treatment of anxiety in dementia.
Alzheimer Disease ; Anxiety Disorders ; Anxiety* ; Caregivers ; Dementia* ; Dementia, Vascular ; Depression ; Diagnosis ; Humans ; Prevalence ; Quality of Life

The aim of this study was to investigate behavioral and psychological symptoms of dementia (BPSD) measured by caregiver-administered neuropsychiatric inventory (CGA-NPI) as a function of dementia severity in early onset (EOAD) versus late onset Alzheimer's disease (LOAD). A total of 113 patients with AD consisting of 49 patients with EOAD and 64 patients with LOAD were enrolled consecutively. General cognitive function and severity of dementia were assessed by the Korean version of mini-mental status examination and clinical dementia rating (CDR), respectively. In the mild stage (CDR 0.5-1), LOAD patients had a significantly higher total CGA-NPI score than EOAD patients. Subgroup analysis demonstrated that disinhibition and night-time behavior were more common and severe in the LOAD group than the EOAD group. However, in the moderate to severe stage (CDR 2-3), EOAD patients had a significantly higher total CGA-NPI score with higher subscores in hallucination, agitation/aggression, irritability/lability, aberrant motor behavior, and appetite/eating change. This study suggested that the heterogeneity of BPSD in AD might be accounted for by dementia severity as well as age at symptoms onset.
Alzheimer Disease* ; Dementia* ; Hallucinations ; Humans ; Population Characteristics

BACKGROUND: There are few studies about driving and dementia in Korea. The purpose of this study is to investigate the real condition of automobile driving in patients with dementia and the characteristics of those who continue to drive after diagnosis of dementia. METHODS: A total of 4,377 patients including 3,792 with Alzheimer's disease and 585 with vascular dementia were recruited from multiple nationwide hospitals. Clinical evaluations and neuropsychological tests were done in them according to the protocol of the Clinical Research Center for Dementia of South Korea study. Caregivers replied which patients drove an automobile, gave up driving, or has never driven. The same evaluations of them were followed after one year. RESULTS: There were 272 (6.2%) drivers, 321 (7.3%) ex-drivers, and 3,784 (86.5%) non-drivers with dementia. Drivers with dementia were younger and had higher Korean Mini-Mental State Examination (K-MMSE) (21.5+/-4.3 vs 19.8+/-5.1 vs 17.4+/-5.2, p<0.001) and lower Clinical Dementia Rating scale-Sum of Boxes (CDR-SB) scores (4.08+/-2.15 vs 5.80+/-3.41 vs 5.83+/-3.39, p<0.001) compared with ex-drivers and non-drivers with dementia. The drivers and ex-drivers with dementia had higher educational level and a higher proportion of male compared with non-drivers with dementia (77.6% vs 80.1% vs 23.3%, p<0.001). About 54.6% of the drivers with dementia continued to drive at one year after diagnosis of dementia. They had higher K-MMSE (23.2+/-3.6 vs 20.8+/-4.5, p=0.003) and lower CDR-SB scores (3.30+/-1.47 vs 4.40+/-1.85, p=0.001) at baseline compared with those who quitted driving after baseline. CONCLUSIONS: Male patients who were relatively young and had high educational level and mild dementia had a tendency to drive an automobile at that time of diagnosis of dementia. About half of them continued to drive after diagnosis of dementia.
Alzheimer Disease ; Automobile Driving ; Automobiles ; Caregivers ; Dementia* ; Dementia, Vascular ; Diagnosis ; Humans ; Korea ; Male ; Neuropsychological Tests

BACKGROUND: Human Herpes Virus 6 (HHV6) is commonly associated with encephalitis following bone marrow transplantation. However, hippocampal atrophy and global hypometabolism are rare findings in HHV6 encephalitis. CASE REPORT: A 41-year-old right-handed woman with acute lymphoblastic leukemia presented with fever and mental changes 2 weeks after receiving a sibling bone marrow transplant. The patient's cerebrospinal fluid (CSF) was positive for HHV-6 deoxyribonucleic acid (DNA), but was negative for other viral DNA. Brain magnetic resonance imaging revealed atrophic changes in bilateral medial temporal lobes. Following 4 weeks of ganciclovir therapy, a CSF exam was negative for HHV-6 DNA and the patient's neurological symptoms partially improved. However, she was disoriented and had severe retrograde and anterograde amnesia. 18F-fluorodeoxyglucose-positron emission tomography indicated global hypometabolism in the medial temporal lobes and the fronto-parietal cortices. CONCLUSIONS: This is a rare and unusual case of hippocampal atrophy in the acute stage of HHV6 encephalitis. Our imaging findings may reflect the chronic indolent course of HHV6 encephalitis.
Adult ; Amnesia, Anterograde ; Amnesia, Retrograde ; Atrophy ; Bone Marrow Transplantation* ; Bone Marrow* ; Brain ; Cerebrospinal Fluid ; DNA ; DNA, Viral ; Encephalitis* ; Female ; Fever ; Ganciclovir ; Herpesvirus 6, Human ; Humans* ; Limbic Encephalitis ; Magnetic Resonance Imaging* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Siblings ; Temporal Lobe

Vertebral artery dissection is one of the most common causes of stroke in young adults. The course of the vertebral artery dissection is usually benign, and pure transient amnesia as an initial symptom has been rarely reported. We describe a patient with vertebral artery dissection who presented with acute transient amnesia, and review the medical literatures about the pathophysiological mechanism of transient global amenesia (TGA). This case could be a one of evidence which supports the cerebrovascular mechanism of TGA.
Amnesia ; Amnesia, Transient Global* ; Humans ; Stroke ; Vertebral Artery Dissection* ; Young Adult

BACKGROUND: Alzheimer's disease (AD) is a representative neurodegenerative disorder associated with memory disturbance. Recent research has shown that risk factors for cerebrovascular disorders are also causes of dementia. Of these risk factors, hyperhomocysteinemia is well known to be positively correlated with all types of dementias including AD. But it is not clear if there is a difference in the concentration of homocysteine according to subtypes of memory impairment of AD. We performed this study to explore the relationship between homocysteine and memory. METHODS: A total of 54 patients (male: 15 patients) to the dementia clinic at our hospital were recruited for this study. All subjects underwent neuropsychological tests including detailed memory function tests and brain magnetic resonance images. The plasma homocysteine level was measured routinely in all patients. RESULTS: Verbal and visual memories in AD were significantly associated with the concentration of plasma homocysteine. The plasma homocysteine level was significantly correlated with delayed recalls of verbal and visual memories and recognition of visual memory. However, there was no relationship between plasma homocysteine and working memory. CONCLUSIONS: This study showed that plasma homocysteine level was related to the consolidation and retrieval stage of memory in AD. Therefore, we cautiously assumed that control of plasma homocysteine level could contribute to management for the prevention of cognitive impairment.
Alzheimer Disease* ; Brain ; Cerebrovascular Disorders ; Dementia ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Memory* ; Memory, Short-Term ; Neurodegenerative Diseases ; Neuropsychological Tests ; Plasma ; Risk Factors

BACKGROUND: Clinical diagnosis of multiple system atrophy (MSA) relays on signs and symptoms that are often difficult to identify particularly at early stage. Indeed neuropathological studies have demonstrated that Parkinson variant of MSA (MSA-P) is the first cause of misdiagnosis in a cohort of patients presenting with parkinsonian features. But accurate diagnosis of these disorders is important for deciding on treatment, appropriate advice and prognosis since atypical parkinsonian disorders are characterized by poor response to dopaminergic treatment and more rapid disease progression. Therefore, we conducted this study to investigate difference of perfusion Single Photon Emission Computed Tomography (SPECT) in patients with the early phase of MSA-P using SPM program. METHODS: We recruited consecutively 21 patients with MSA-P and 48 age-matched healthy controls. All subjects underwent Tc-99m HMPAO perfusion SPECT and this perfusion images were analyzed. RESULTS: For MSA-P, only hypoperfusion was seen in the middle frontal gyrus of left frontal lobe, superior frontal gyrus of right frontal lobe, precentral gyrus of left frontal lobe, middle frontal gyrus of right frontal lobe and precentral gyrus of right frontal lobe with respect to healthy subjects. CONCLUSIONS: We cautiously assume that perfusion SPECT may offer significant advantages compared to other imaging techniques in the assessment of neuronal degeneration in MSA-P and may help the clinician in the diagnostic characterization of patients presenting with atypical parkinsonism.
Cohort Studies ; Diagnosis ; Diagnostic Errors ; Disease Progression ; Frontal Lobe ; Humans ; Multiple System Atrophy* ; Neurons ; Parkinsonian Disorders ; Perfusion* ; Prognosis ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*

Depression is one of the most common psychiatric complications of Alzheimer disease (AD), affecting from 30% to 50% of prevalence, with most estimates in the 20-30% range. Because of having a presentation in the context of AD that differs from typical early-onset depression, it is not easy one to detect and quantify reliably, and can be difficulty to differentiate depression from the other neuropsychiatric symptoms of AD. Due to the lack of large randomized trials, optimal treatment and the true degree of efficacy remains undetermined. However, these treatments can reduce adverse impact of depression on patients and caregivers. This article provides a practical discussion of the diagnosis, evaluation, differential diagnosis and treatment of depression in AD for the clinician.
Alzheimer Disease* ; Caregivers ; Depression* ; Diagnosis ; Diagnosis, Differential ; Humans ; Prevalence