BACKGROUND: The concept of Mild Cognitive Impairment (MCI) refers to a transitional period between normal aging and clinically demented state such as Alzheimer's disease. Detection of individuals with MCI is critical for prognosis of the disease progression and treatment of patients at risk. The current study manipulated linguistic complexity in naming nouns and verbs to examine whether the linguistically different entities contribute to differentiating individuals with MCI from normal elderly adults. Specific aims of the study are 1) to investigate the noun-verb dissociation in naming between the MCI and normal control groups and 2) to examine the differential effects between the groups depending on the linguistic subtypes of nouns (animate vs. inanimate) and verbs (the argument structure). METHODS: Twenty normal elderly individuals and 19 individuals with MCI participated in this study. A confrontation naming task was employed. Nouns were divided into the two subtypes (animate vs. inanimate), and verbs were classified into the three subtypes depending on the number of argument (1-place, 2-place, and 3-place). RESULTS: Results revealed that there were significant differences between the groups, indicating that individuals with MCI showed worse performance on naming in general than the control group. Furthermore, the MCI group presented differentially impaired performance on verbs than nouns compared to the control group. CONCLUSIONS: The results from the current study suggested that performance on a verb confrontation naming task could serve as a sensitive index to differentiate the MCI group from normal aging group.
Adult ; Aged ; Aging ; Alzheimer Disease ; Disease Progression ; Dissociative Disorders ; Humans ; Linguistics ; Mild Cognitive Impairment ; Prognosis

BACKGROUND: The ligation of the unilateral common carotid artery (CCA) in the gerbil has been known as an ischemic animal model showing various changes including selective neuronal necrosis as well as infarction. This study was performed to analyze the short and long term morphological changes of transient unilateral forebrain ischemia with special attention to astroglial proliferation. METHODS: 67 mongolian gerbils were subjected to 2 hr, 3 hr, 4 hr, or 5 hr of forebrain ischemia by the unilateral CCA ligation method. Each of the ischemic groups were examined after a 1 day, 3 day, or 7 day period of reperfusion. Long term reperfusion groups consisted of 2, 3, and 4 weeks of reperfusion after 5hr of unilateral CCA ligation. Morphological changes were analyzed by H-E staining and an immunohistochemical reaction with GFAP antibody. RESULTS: The ligation of the unilateral CCA, induced unilateral hemispheric infarction in 14 gerbils, selective neuronal necrosis (SNN) involving caudate in 1 gerbil, and delayed neuronal necrosis (DND) of the hippocampal CA1 neurons in 2 gerbils. Infarction was most frequent in 1 day reperfusion groups and did not show any differences according to the duration of ischemia. The GFAP reaction was strongly positive in the center of infarction at a 1 day period and negative at a 3 & 7 day period. The surrounding brain parenchyme progressively revealed increased positive reactions. Gerbils with SNN and DND showed moderately or markedly increased GFAP positive reactions in the unilateral caudate, thalamus, and hippocampus, whereas no apparent changes were shown by a H-E stain. CONCLUSIONS: Reactive astrogliosis is a stereotyped reaction of ischemic brain injury and is a more sensitive parameter than neuronal changes.
Brain ; Brain Injuries ; Carotid Artery, Common* ; Gerbillinae* ; Hippocampus ; Infarction ; Ischemia ; Ligation* ; Models, Animal ; Necrosis ; Neurons ; Prosencephalon ; Reperfusion ; Thalamus

The co-occurrence of multiple sclerosis and peripheral demyelinating neuropathy is rare. It has been disputed whether these are pathologically related or coincidental findings. We report a 36-year-old woman who presented with diplopia, right facial palsy and left-sided weakness. Brain magnetic resonance imaging showed a lesion indicative of central demyelinating disease. Nerve conduction studies revealed peripheral multifocal demyelinating neuropathies. We suggest that the central and the peripheral lesions may be continua of a demyelinating process.
Adult ; Brain ; Demyelinating Diseases ; Diplopia ; Facial Paralysis ; Female ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Neural Conduction

BACKGROUND AND PURPOSE: Semantic verbal fluency test is a neuropsychological assessment that can sensitively detect neuropathological changes. Considering its multifactorial features tapping various cognitive domains such as semantic memory, executive function, and working memory, it is necessary to examine verbal fluency performance in association with underlying cognitive functions. The objective of the current study was to investigate semantic fluency patterns of people with mild cognitive impairment (MCI) based on clustering and switching and their relationship with working memory. METHODS: Twenty-six individuals with MCI and 23 normal elderly adults participated in this study. A semantic verbal fluency test (animal version) was administered and the performance was analyzed using the following measures: number of correct words, cluster size, and number of switches. Scores of digit forward (DF) and backward span tasks were employed as working memory measures. RESULTS: Analyses of variance revealed significant group differences in the numbers of correct words and switches. Multivariate logistic regression and receiver-operating characteristic analyses showed that the number of switches more sensitively distinguished MCI existence than the number of correct words. Stepwise linear regression analysis showed that DF task and age significantly predicted the number of correct words while only the DF task significantly predicted the number of switches. CONCLUSIONS: Decrement in semantic verbal fluency in MCI seems to be associated with impaired switching abilities. Working memory capacity might serve as the underlying cognitive factor related to decreased verbal fluency in MCI.
Adult ; Aged ; Cluster Analysis ; Cognition ; Executive Function ; Humans ; Linear Models ; Logistic Models ; Memory ; Memory, Short-Term ; Mild Cognitive Impairment ; Semantics

Acute mountain sickness (AMS) occurs commonly in hikers who are rapidly exposed to high altitude environments. Despite the numerous reports of AMS, few studies have reported pallidal lesions associated with altitude sickness. A previously healthy 49-yr-old Korean patient, after ascent to 4,700 m, suffered symptoms consistent with AMS. After returning home, the patient showed changes in personality characterized by abulia, indifference, and indecisiveness. T2 weighted brain magnetic resonance imaging showed high signal lesions involving bilateral globus pallidus. Our case suggests that globus pallidus injury should be included in the differential diagnosis of patients with personality or cognitive change after recovery from AMS.
Altitude ; Altitude Sickness/*complications ; Behavior ; Brain/pathology ; Brain Damage, Chronic/*etiology/pathology ; Environment ; Globus Pallidus/*pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mountaineering

BACKGROUND: Diffusion-weighted MR imaging (DWI) was designed to detect the random molecular otion of water in tissue. DWI has gained increasing interest recently because it can demonstrate yperacute stroke earlier than any other imaging methods so far. The purpose of our study was to etermine the clinical usefulness and significance of DWI compared with those of Fast Spin Echo T2-weighted image (SE T2WI) and Fluid Attenuated Inversion Recovery (FLAIR) image in acute and subacute ischemic stroke. METHOD: Twenty-five adult patients with clinical diagnoses of acute or subacute cerebral infarctions were imaged with fast SE T2WI, FLAIR and DWI using a 1.5-T image. RESULTS:All the patients had areas of high signal intensity indicating acute or subacute lesions on DWI and these lesions provide an excellent clinicoanatomic correlation. CONCLUSIONS: DWI is most useful in the diagnosis and localization of acute or subacute lacuna or subcortical infarction in patients with preexisting chronic infarctions or white matter hyperintensity showing high signal intensity similar to acute or subacute infarctions on T2WI or FLAIR image.
Adult ; Brain ; Cerebral Infarction ; Diagnosis ; Diffusion* ; Humans ; Infarction ; Magnetic Resonance Imaging ; Stroke*

BACKGROUND: It is not uncommon to misdiagnose frontotemporal dementia (FTD) because it presents with alterations in personality and behavior rather than cognitive decline. Since compulsive behavior is one of the common early manifestations of FTD, analysis of compulsive behaviors, together with presenting symptoms, would help diagnose FTD in its early stage. METHODS: Subjects consisted of 25 patients (5 men and 20 women with mean age of 56 +/-9 years) who met the FTD criteria proposed by the Lund and Manchester group. We analyzed their presenting symptoms and compulsive behaviors retrospectively. RESULTS: The presenting symptoms were variable, including inappropriate judgement, loss of spontaneity, memory disturbance, personality change, apathy, repetitive movements, hypersexuality, and parsimony. Twenty-two out of the 25 patients (88%) showed compulsive behaviors. They included reading signboards, stereotypy of speech, ordering, hoarding, washing, checking, counting, singing, and wandering a fixed route. CONCLUSIONS: Compulsive behaviors are commonly associated with FTD and thereby understanding of these symptoms together with presenting symptoms may help diagnose FTD early and minimize the misdiagnosis of FTD for Alzheimer's disease or other psychiatric illnesses.
Alzheimer Disease ; Apathy ; Compulsive Behavior* ; Diagnostic Errors ; Female ; Frontotemporal Dementia* ; Humans ; Male ; Memory ; Obsessive Hoarding ; Retrospective Studies ; Singing

BACKGROUND AND PURPOSE: The most important treatment for subcortical vascular dementia (SVaD) is controlling the blood pressure (BP). However, the few studies that have investigated the relationships between diurnal BP rhythm and subcortical ischemic vascular cognitive impairment have produced inconclusive results. In the study presented here, the 24-hour BP values of three groups of subjects-patients with subcortical vascular mild cognitive impairment (SvMCI), patients with SVaD, and normal controls-were compared using working criteria and 24-hour ambulatory BP (ABP) monitoring. METHODS: The subjects (42 patients with SVaD, 37 patients with SvMCI, and 30 controls) were selected according to the study's inclusion/exclusion criteria. All subjects underwent brain magnetic resonance (MR) imaging and MR angiography, detailed neuropsychological testing, and 24-hour ABP monitoring. RESULTS: The prevalence of nondippers differed markedly between the control group and both the SVaD and SvMCI groups. Loss of nocturnal dipping was significantly associated with SVaD [odds ratio (OR), 4.827; 95% confidence interval (CI), 1.07-12.05]. CONCLUSIONS: It was found that SVaD is associated with loss of nocturnal BP dipping combined with increased pulse pressure and systolic BP (SBP) variability. Correction of these factors could therefore be important in the prevention of SVaD, independent of measures used to reduce BP.
Angiography ; Blood Pressure ; Brain ; Dementia, Vascular ; Humans ; Magnetic Resonance Spectroscopy ; Mild Cognitive Impairment ; Neuropsychological Tests ; Prevalence

Vertebral artery dissection (VAD) is one of important causes of posterior circulation strokes in young age patients. Typical presentations of VAD are occipital headache or posterior neck pain, with various signs arising from brainstem or cerebellar infarctions. Muscular weakness or sensory change of an ipsilateral arm owing to cervical nerve root involvement in association with the VAD has been reported very rarely. Herein we describe two unusual manifestations of extracranial VAD, which presented with monoplegia of single upper limb.
Arm ; Brain Stem ; Headache ; Hemiplegia* ; Humans ; Infarction ; Muscle Weakness ; Neck Pain ; Radiculopathy* ; Stroke ; Upper Extremity ; Vertebral Artery Dissection* ; Vertebral Artery*

PURPOSE: The purpose of this study was to develop evidence-based nursing practice guidelines for the care of febrile children in the emergency room and to evaluate the guidelines by applying them to practice. METHODS: This study was conducted using a methodological design. referring to the Scottish intercollegiate guideline network, draft of guidelines were developed based on the recommendations found from the critical literature analysis. Then, the draft was modified by an expert group and a pilot application. The final draft was evaluated by the expert group using appraisal of guidelines for research and evaluation. Finally, the final guideline and algorithm were completed. RESULTS: The guideline includes 39 recommendations for the care of febrile children in the emergency room. CONCLUSION: The clinical guidelines developed through this research can be utilized as systematic and scientific guidelines for the care of febrile children in the emergency room. In addition, the research results will contribute to improving care services.
Child ; Emergencies ; Evidence-Based Nursing ; Fever ; Humans ; Child Health