This article provides clinical practice guidelines for primary care physicians in the assessment of dementia patients. Dementia is an acquired syndrome due to brain dysfunction, which is characterized by multiple cognitive deficits with consequent impairment in daily or occupational activities. Thus, the first and second steps in the clinical approach to dementia are the assessment of cognition and activities of daily living (ACL). The third step may be the evaluation of abnormal behaviors associated with dementia, since those symptoms are one of the main causes of caregivers' burden and can be controlled by drugs such as antipsychotics and antidepressants. Finally, as the fourth step of the evaluation, the underlying etiologies for dementia should be explored. This article describes the elemental methods of history taking and clinical examinations for dementia patients with emphasis on the assessment of 1) cognition, 2) ADL, 3) behaviors, and 4) differential diagnosis. The assessment will lead the clinician to accurate diagnosis and better management of dementia patients.
Activities of Daily Living ; Antidepressive Agents ; Antipsychotic Agents ; Brain ; Cognition ; Cognition Disorders ; Dementia* ; Diagnosis ; Diagnosis, Differential ; Humans ; Physicians, Primary Care

No abstract available.
Aphasia*

BACKGROUND: The Wada test is an essential part of the preoperative evaluations in candidates for epilepsy surgery. Impaired reactions (IR) to intracarotid sodium amytal infusions include: confusion, disorientation, and decreased respon-siveness, thereby confounding test results. We retrospectively analyzed the factors affecting the impaired reactions (IR) regarding both individual and methodologic factors. METHODS: Subjects included 202 patients (age;28.5+/-9.48, range:8 to 64 years, M:F=113:89) with intractable epilepsy. Patients with IR (IR group) and those without IR (Non-IR group) were compared with respect to individual factors such as: age, sex, epilepsy syndromes, injected hemispheres, dominan-cy as well as methodologic factors including amobarbital doses. With regards to the dose of amobarbital, the total accu-mulated dose as well as the initial injected dose, were used. RESULTS: IR was observed in 50 patients (24.7%). Compared to the non-IR group, the IR group had more prolonged, contralateral weakness and total test times, but the same duration of EEG changes. IR occurred more frequently with injections into the left hemisphere (p<0.001), the dominant hemi-sphere (p<0.0001), and contralateral hemisphere of epileptic focus (p<0.07). The IR group received significantly higher amounts of amobarbital than the non-IR group (p<0.05). Considering the oversedation as well as the undersedation of amobarbital together, 100mg of amobarbital was the most appropriate dose in the Wada test. CONCLUSIONS: These results suggest that dominant hemisphere injections and usage of higher doses of amobarbital can frequently produce IR in the Wada test. The ideal dose of amobarbital in the Wada test for Korean patients should be 100mg.
Amobarbital ; Electroencephalography ; Epilepsy ; Humans ; Retrospective Studies

The cognitive domain of number processing has been known to be separable from that of language. Further, the number processing consists of Arabic and verbal number systems which could be also separable from each other. We report a 49-year-old woman who showed a dissociation between Arabic and Korean verbal numbers. Her impairment in number processing was characterized by the defective comprehension and expression of Korean verbal umbers, without notable defects in those of Arabic numbers. A follow-up examination revealed a further dissociation within the processing of Korean numbers, showing persistent impairment of number comprehension with improvement of number expression. In dealing with numbers with more than two digits, she showed syntactic errors characterized by uttering a string of single digit numbers(I.e., 365) rather than stating them as a whole number(365). Furthermore, auditory comprehension was also more accurate when the numbers were presented as an array of single digit numbers than a whole number with units. However, these syntactic errors were not observed on an automatic counting task. The evidence of separable representation of Arabic and Korean number system could be drawn from these observations, and therefore we propose the possibility of dual number processing pathways, one for a simple numbering system without semantic mediation and the other for a complex, multidigit numbering with semantic mediation.
Arabs* ; Comprehension ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Negotiating ; Semantics

We report a case of 53-year-old woman with personification following right middle cerebral artery territory infarction. Although she knew that her paralyzed left limbs belonged to her, she behaved as if it is a separate person. Verbalization of hatred toward her left arm was frequently observed. She attributed her neurologic deficit to the left arm instead of herself, frequently complaining in a fashion that 'I(a person except for the left arm) am all right but he/she(left arm) is wrong'. This delusional beliefs were mainly confined to her paralysed left limb, and were accompanied by left spatial neglect, transient anosognosia for hemiplegia and right-left disorientation.
Agnosia ; Arm ; Delusions ; Extremities* ; Female ; Hemiplegia ; Humans ; Infarction ; Middle Aged ; Middle Cerebral Artery ; Neurologic Manifestations ; Stroke*

The Mini Mental State Examination (MMSE; Folstein et al., 1975) is a quick and easy measure of cognitive functioning that has been widely used in clinical evaluation and research involving patients with dementia. The present study was conducted to examine the validity of the newly constructed Korean version of the MMSE (K-MMSE) in dementia patients. The K-MMSE was administered to 84 patients with Alzheimer's a disease, 64 patients with vascular dementia, and 23 patients with a diagnosis of pseudo-dementia. The result showed that of the cognitive components of the K-MMSE, Orientation, Attention and Calculaton, Recall, and Visual Construction are impaired in dementia patients. The sensitivities of the K-MMSE in detecting dementia were .70-83. Factor analysis indicated that the multiple cognitive components of the K-MMSE can he explained by one or two factors. The K-MMSE was also highly correlated with another brief measure of cognitive functioning, the Blessed Orientation Memory-Information(r=.78). The result, however, further suggested that the K-MMSE is relatively insensitive to detect the early stage of dementia, causing an increase in false negatives.
Dementia* ; Dementia, Vascular ; Diagnosis ; Humans

Neurodegenerative disorders cause a variety of dementia including Alzheimer disease, frontotemporal dementia, dementia with Lewy bodies, corticobasal degeneration, progressive supranuclear palsy, and Huntington's disease. PET scan is useful for early detection and differential diagnosis of these dementing disorders. Also, it provides valuable information about clinico-anatomical correlation, allowing better understanding of function of brain. Here we discuss recent achievements PET studies regarding these dementing disorders. Future progress in PET technology, new tracers, and image analysis will play an important role in further clarifying the disease pathophysiology and brain functions.
Alzheimer Disease* ; Brain ; Dementia* ; Diagnosis, Differential ; Frontotemporal Dementia ; Huntington Disease ; Lewy Bodies ; Neurodegenerative Diseases ; Positron-Emission Tomography ; Supranuclear Palsy, Progressive

BACKGROUND: The Korean-Boston Naming Test (K-BNT) is a popular measure of the confrontational naming ability. It is particularly sensitive to the early cognitive changes in Alzheimer's disease (AD) and Vascular dementia (VaD). The current study was conducted to develop parallel short forms for the K-BNT used in repeated assessments as well as in situations where the administration of the complete K-BNT is not practical. METHODS: Four 15-item short forms were newly constructed based on the item difficulties of the K-BNT measured from 565 normal elderly aged over 55. The K-BNT was administered to 130 dementia patients (75 AD, 55 VaD) and 130 healthy community-dwelling elderly whose age, sex, and education level were matched with the dementia patients. Scores for the short forms were derived by dividing up the items of the K-BNT. RESULTS: On each short form, normal elderly performed better than dementia patients, and scores on each could be extrapolated to a complete 60-item K-BNT score. Significant correlations were found between short forms and the K-BNT. To compare the probabilities of correctly identifying dementia, the areas under Receiver Operating Characteristic (ROC) curves of each form and the K-BNT were compared. It was found that all the short forms were as efficient as the 60-item K-BNT in identifying dementia. CONCLUSIONS: These results confirm that the four 15-item short forms developed in the current study are parallel and valid as the short forms of the K-BNT.
Aged ; Alzheimer Disease ; Dementia ; Dementia, Vascular ; Education ; Humans ; ROC Curve

BACKGROUND AND PURPOSE: The brief version of the Seoul Neuropsychological Screening Battery (SNSB), the SNSB-Core (SNSB-C), has been developed. Although each subtest score of the SNSB-C provides information on different features of broad cognitive functioning or impairment, a composite score is needed to identify the severity of global cognitive impairment. We aimed to develop and validate a composite score of the SNSB-C that would provide a normative-based summary score of global cognitive functioning, especially for differentiating patients with cognitive impairment from normal elderly. METHODS: A normative sample of 1067 elderly was used to develop a composite score of SNSB-C. The composite score was corrected for the effects of age, years of education, and sex by the regression method. Patients with Alzheimer's disease (n=41), vascular dementia (n=40), amnestic mild cognitive impairment (MCI) (n=73), vascular MCI (n=41), and Parkinson's disease with MCI (n=41) were differentiated from a normal sample (n=70) by the uncorrected and corrected composite scores using receiver operating characteristic (ROC) curve analysis. RESULTS: Confirmatory factor analysis showed that the composite score equal weight to each standardized cognitive domain of SNSB-C is appropriate for indexing overall cognitive functioning. The corrected and uncorrected composite scores yielded a satisfactory size of the area under the ROC curve comparable to the Mini Mental State Examination (MMSE). CONCLUSIONS: The composite scores of SNSB-C, especially the corrected score, provide an index of overall cognitive functioning, and they can be used as an alternative to MMSE for screening patients with cognitive impairment.
Abstracting and Indexing as Topic ; Aged ; Alzheimer Disease ; Dementia, Vascular ; Education ; Humans ; Mass Screening* ; Mild Cognitive Impairment ; Parkinson Disease ; ROC Curve ; Seoul*

Apolipoprotein E-epsilon4(APOE4) is recently known as a susceptibility gene or risk factor associated with late-onset Alzheimer's disease (AD). Association between APOE4 and probable AD was determined in Korean population. Twenty patients met the NINCDS-ADRDA probable AD criteria (M:F=7:13, Mean age: 70.1 yr)were compared with 146 controls without dementia (M:F=83:63, Mean age:63.6 yr). APOE genotype was determined by polymerase chain reaction and allele specific hybridization technique. APOE4 allele frequency (0.33 vs. 0.11, p<.01) and proportion of carriers with APOE4(60% vs. 19%, p<.01) were significantly increased in patient group. APOE4 genotype is also associated with late-onset sporadic AD in Korean, and APOE genotyping may be useful for differential diagnosis of AD for patients with dementia.
Alleles ; Alzheimer Disease* ; Apolipoprotein E4 ; Apolipoproteins E ; Apolipoproteins* ; Dementia ; Diagnosis, Differential ; Gene Frequency ; Genotype* ; Humans ; Korea* ; Polymerase Chain Reaction ; Risk Factors