Cognitive decline in dementia patients causes impairment in daily activities as well as occupational or social activities, which results in frustration and anxiety for the patients themselves. Furthermore, from the caregivers' perspective, patients' cognitive decline and abnormal behaviors cause physical, emotional, financial, and social burdens. Most caregivers who visit a medical center need to be counseled in order to reduce these caregiver burdens and to provide better care for the patients. No fixed rules exist for taking care of dementia patients. Rather, coping strategies most ofter should be individualized according to the severity and type of dementia as well as the socioeconomic situation of the patients and caregivers. Therefore, I herein describe a general guideline on caregiving for dementia patients, which was based on the literature review and personal experiences from counseling in a dementia clinic. This guideline may be of help to medical staff in providing counsel to caregivers as well as in preparing their own brochures for caregivers.
Anxiety ; Caregivers ; Counseling ; Dementia* ; Frustration ; Humans ; Medical Staff ; Pamphlets

Vascular dementia (VD) is a dementia syndrome associated with cerebrovascular disease. Among the several subtypes of VD, most common subtypes are multi-infarct dementia, single-infarct dementia, and subcortical vascular dementia. In patients with multi-infarct dementia, dementia occurs with a close temporal relationship to stroke episodes. Brain imaging usually shows multiple territory cortico-subcortical infarcts. Single-infarct dementia, in contrast, is caused by a single infarct in specific regions of the brain such as thalamus, caudate nucleus, capsular genu, angular gyrus, or hippocampus. In subcortical VD, primary lesion is lacunar infacts or ischemic white matter lesions that are located in subcortical regions, i.e., deep nuclei (basal ganglia and thalamus) or white matter (periventricular and deep white matter). The diagnosis of subcortical vascular dementia is challenging, since stroke episodes are often unrecognized, thus temporal relationship between onset of dementia and stroke is lacking. This article describes 1) subtypes of VD, 2) illustrative cases with vascular dementia, 3) research criteria for VD, 4) treatment of VD, and 5) a general guideline on caregiving for patients with VD, which will enable clinicians to provide better diagnosis and management of patients with VD.
Brain ; Caudate Nucleus ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Diagnosis ; Ganglia ; Hippocampus ; Humans ; Neuroimaging ; Stroke ; Thalamus

BACKGROUND: Semantic dementia (SD) is a temporal variant of frontotemporal lobar degeneration (FTLD), which is characterized by naming difficulty, decreased comprehension of words, prosopagnosia and object visual agnosia. We report clinical features, neuropsychological and neuroimaging findings of 4 patients with SD. METHODS: Of 55 patients diagnosed as having FTLD between Jan 1995 and May 2001 at Samsung Medical Center, four patients fulfilled the diagnostic criteria of SD proposed by consensus on FTLD diagnostic criteria. We investigated their clinical features such as presenting symptoms and abnormal behaviors, neuropsychological and neuroimaging findings. Neuropsychological tests included the Seoul Neuropsychological Screening Battery, the Korean-version of Western Aphasia Battery and Hanja reading and writing. All patients underwent brain MRI and FDG-PET. RESULTS: All of the patients showed naming difficulty as a presenting symptom. Language assessments showed severe naming and compre-hension difficulties with preserved fluency and repetition, which were compatible with transcortical sensory aphasia. Whereas Hangul reading aloud and writing were intact, three patients were impaired at Hanja reading and writing. Other neuropsychological tests were remarkable for prosopagnosia, object visual agnosia and memory loss. Brain MRI showed asymmetric temporal atrophies, mainly left antero-inferior temporal cortices. FDG-PET also showed hypome-tabolism in bilateral anterior temporal lobes, more severe on the left. CONCLUSIONS: Our SD patients had characteristic neuropsychological and neuroimaging findings, which can be differentiated from other neurodegenerative diseases. We also found Hanja alexia and agraphia in SD patients, which has not been reported yet.
Agnosia ; Agraphia ; Aphasia ; Aphasia, Wernicke ; Atrophy ; Brain ; Comprehension ; Consensus ; Dyslexia ; Frontotemporal Dementia* ; Frontotemporal Lobar Degeneration ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Memory Disorders ; Neurodegenerative Diseases ; Neuroimaging* ; Neuropsychological Tests ; Prosopagnosia ; Semantics* ; Seoul ; Temporal Lobe ; Writing

BACKGROUND: Isolated amnesia without dementia results from various etiologies. When caused by degenerative etiol-ogy, it is recognized as a subtype of Alzheimer's disease (AD) and was termed progressive isolated amnesia or primary progressive amnesia (PPAm). Patients with PPAm have rarely been reported. We describe neuropsychogical and neu-roimaging findings in 3 patients with PPAm. METHODS: Patient 1 (M/74) showed progressive amnesia for 8 years and then developed probable AD. Patient 2 (M/76) and 3 (F/69) showed severe progressive amnesia without dementia for 9 years. Neuropsycholgical evaluations were conducted 3 times in each patient at 1 to 4 year interval. Hippocampal vol-ume was measured by a manual tracing in 1.6 mm thick coronal MRI slices which was obtained perpendicular to the long axis of the hippocampus. RESULTS: Neuropsychological tests revealed verbal and nonverbal memory loss with preservation of attention, language, praxis, visuospatial and frontal-executive functions. Right and left hippocampal vol-umes for patient 1, 2 and 3 were 1580.46/1586.38, 682.96/609 and 1152.84/1272.50 mm3 respectively, a result indica-tive of severe hippocampal atrophy. CONCLUSIONS: Neuropsychological profiles and clinical course of our patients fur-ther support the view that PPAm results from degenerative etiology. Severe atrophy of the hippocampus with relative preservation of other association cortices suggest that PPAm may be another focal cortical atrophy syndrome involving medial temporal region.
Alzheimer Disease ; Amnesia* ; Atrophy ; Axis, Cervical Vertebra ; Dementia ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Memory Disorders ; Neuropsychological Tests

BACKGROUND: Neglect dyslexia is a type of neglect syndrome, in which patients with unilateral hemisphere injury omit or misread the contralateral side of a text or the initial letters of a word. Hangul can be arrayed vertically (vertical reading, VR) as well as horizontally (horizontal reading, HR). Thus, HR and VR can be differentially affected in neglect dyslexia. We conducted an experiment in a 66 year-old woman who suffered from neglect dyslexia after a right cerebral infarction. We compared HR with VR in terms of error frequencies and patterns. METHODS: Stimuli for neglect dyslexia consisted of 227 words. The 227 words were written horizontally or vertically (total 554 words) and were pre-sented in random order. The patient was asked to read the words and the examiner recorded the patient's responses and reaction times. RESULTS: The differences in HR and VR were as follows: 1) the error frequency in HR (59.0%) was higher than the error frequency in VR (20.3%), 2) the most frequent error in HR was syllabic deletion (79.1%) whereas phonemic substitution (89.1%) predominated in VR, 3) the error rate was highest at the first syllabic position in HR whereas no position effect was noted in VR. CONCLUSIONS: Patients with neglect dyslexia make less error in VR than in HR. The neural processing of HR may be different from that of VR. VR may be an alternative reading strategy that may be useful during the recovery stage of neglect dyslexia.
Aged ; Cerebral Infarction ; Dyslexia* ; Female ; Humans ; Reaction Time

BACKGROUND: The measurement of functional disabilities in patients with dementia is one of the essential parts of evaluation for dementia from the viewpoint of diagnosis and therapeutic intervention. Nevertheless, few standardized scales for the instrumental activities of daily living (IADL) are available in Korea. The purpose of this study was to test the reliability and validity of the Korean IADL (K-IADL). METHODS: K-IADL is comprised of 11 items that were selected by the Representative Committee of the Korean Dementia Research Group. These include: (1) shopping, (2) mode of transportation, (3) ability to handle finances, (4) house keeping, (5) preparing food, (6) ability to use a tele-phone, (7) responsibility for own medication, (8) recent memory, (9) hobbies, (10) watching television, and (11) fixing around the house. K-IADL was administered to informants of 114 dementia patients and age and sex matched 106 con-trols. The informants rated each item as follows: 0=normal, 1=with some assistance, 2=with much assistance, 3=unable to do, NA=not applicable. RESULTS: Internal consistency (Cronbach's alpha=0.96) and the test-retest reliability(r=0.94) of K-IADL were significant. A principle component factor analysis extracted a single factor that accounted for 70.3% of the total variance (Eigenvalue: 7.74), and K-IADL was correlated significantly with other general cognitive indices, demonstrating good validity. With a cut-off point of 0.43, the K-IADL had a sensitivity of 83% and a specificity of 82% in the diagnosis of dementia. CONCLUSIONS: Our results showed that K-IADL could be a reliable and valid tool for the quantification of functional disabilities of Korean dementia patients.
Activities of Daily Living* ; Dementia ; Diagnosis ; Factor Analysis, Statistical ; Hobbies ; Humans ; Korea ; Memory ; Reproducibility of Results* ; Sensitivity and Specificity ; Television ; Transportation ; Weights and Measures

BACKGROUND AND PURPOSE: The closing-in phenomenon is the tendency to draw near or on the target when copying figures, which has been found mostly in patients with Alzheimer's disease (AD). We attempted to quantify the degree of closing-in and to compare it between patients with AD and vascular dementia (VaD). METHODS: The subjects (55 AD, 39 VaD and 38 normal controls) were asked to copy the figure of alternating square and triangle, starting at the designated point and continuing from left to right. The patients with AD and VaD did not differ in age, education, severity of dementia or Rey Complex Figure Test copy score. The proximity (Y-axis) of the subject's drawing to the target was plotted at intervals of 2 mm along the X-axis and the degree of closing-in was computed from the slope of the regression line. RESULTS: The AD and VaD patients showed a steeper slope than the controls. There was no significant difference, however, in the magnitude of closing-in of the AD and VaD patients. When closing-in was defined as a slope that was greater than the mean+2SD of the slope observed for the controls, 32.7% of the AD and 25.6% of the VaD patients showed closing-in. CONCLUSIONS: Our study, using a new method of measuring the degree of closing-in, suggests that this phenomenon is not specific to AD.
Alzheimer Disease* ; Dementia ; Dementia, Vascular* ; Education ; Humans

BACKGROUND: Patients with Alzheimer's disease (AD) at an early stage present with memory decline and impairments of language and visuospatial functions. However, some AD patients occasionally show frontal lobe dysfunctions in the early stage those are known to emerge only at the advanced stage. This subtype of AD is called a frontal variant of AD (frontal AD). We report neuropsychological and FDG-PET findings of three cases of frontal AD. METHODS: Three patients met the diagnostic criteria of probable AD proposed by the NINCDS-ADRDA. However, they unusually showed clinical symptoms associated with frontal lobe dysfunctions even if they were relatively in the early stage of dementia. All the patients underwent neuropsychological tests and brain FDG-PET scans. Distribution of glucose hypometabolism was analyzed using statistical parametric mappings (SPM). RESULTS: Results of neuropsychological tests were consistent with findings of AD except that frontal lobe dysfunctions were prominent. FDG-PET scans and SPM analysis of these images showed hypometabolism in the frontal as well as temporo-parietal regions. Unlike the hypometabolism pattern found in frontotemporal dementia, frontal hypometabolism in our patients was not as severe as parietal hypometablism and hypometabolic regions within the temporal lobe were in the middle or posterior part of the middle and inferior temporal gyri rather than in the anterior part. CONCLUSIONS: Detailed neuropsycholgical tests and FDG-PET may help differentiate AD with frontal involvement in its early stage (frontal AD) from frontotemporal dementia. Future studies with FDG-PET in a larger series of frontal AD cases, especially with histologically proven cases, may be needed.
Alzheimer Disease* ; Brain ; Dementia ; Frontal Lobe ; Frontotemporal Dementia ; Glucose ; Humans ; Memory ; Neuroimaging* ; Neuropsychological Tests ; Rabeprazole ; Temporal Lobe