Vitamin D is not a true vitamin but a fat-soluble steroid prohormone that has long been known for its important and diverse role in the biological system. Many studies have revealed that vitamin D deficiency is linked with an increased risk of autoimmune diseases, cardiovascular diseases, cancers, type II diabetes and infectious diseases. Vitamin D3 is transformed to its active form, 1, 25-dihydroxyvitamin D3, through metabolisms in the liver and kidney. 1, 25-dihydroxyvitamin D3 interacts with its vitamin D receptor, and the brain is now known to have vitamin D receptors and 1alpha-hydroxylase. Several lines of evidences suggest vitamin D deficiency is associated with cognitive impairment and dementia, however, its position in cognitive function is still in its infancy. Vitamin D deficiency is a reversible condition and can be easily treated with supplements. Randomized controlled trials of vitamin D supplementation in patients with neurodegenerative conditions are needed.
Autoimmune Diseases ; Brain ; Cardiovascular Diseases ; Cholecalciferol ; Cognition ; Communicable Diseases ; Dementia ; Humans ; Kidney ; Liver ; Receptors, Calcitriol ; Vitamin D ; Vitamin D Deficiency ; Vitamins

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

Sarcopenia (Greek ‘sarx’ or flesh+‘penia’ or loss) originally is proposed as the term to describe age-related decrease of muscle mass. These days, sarcopenia is defined as a syndrome characterized by progressive loss of skeletal muscle mass and strength with a risk of adverse outcomes such as poor quality of life, physical disability, and death. In the recent decade, there are a few of consensus; European, international, and Asian consensus panels have published definitions. Additionally, measurement techniques that can be used for research and clinical practice settings according to their suitability are suggested. Many studies are reported about the association with sarcopenia and neurologic diseases, however, the results are heterogenous due to lack of sufficient studies. Some pharmacologic and non-pharmacologic methods are suggested as the intervention of sarcopenia, although there are not enough studies, yet. In this review, we summarize current understanding of the diagnostic sarcopenia and neurological point of view of sarcopenia.
Asian Continental Ancestry Group ; Consensus ; Diagnosis* ; Humans ; Muscle, Skeletal ; Quality of Life ; Sarcopenia*

Subacute combined degeneration (SCD) of the spinal cord, which is a result of vitamin B12 deficiency, may cause irreversible neurological deficits. The lesion in the spinal cord is typically localized to the posterior and lateral columns, as the name implies. In this paper, we report on two patients with SCD, whose lesions involved the bilateral anterior column as well as the posterior and lateral columns. This report illustrates the importance of awareness of clinical and radiologic variable characteristics of SCD.

Background: and Purpose: Each item in the instrumental activities of daily living (IADL) questionnaire has differential importance to an individual’s life functioning based on gender.However, IADL has mostly been utilized for its total score alone, without gender specificity.We identify the impact of each item on the transition from amnestic mild cognitive impairment (aMCI) to Alzheimer’s disease dementia (ADD), and determine if the impact of each item differs by gender. Methods: Subjects were aMCI or ADD with a global clinical dementia rating of 0.5 or 1. The sample size was 146 men and 154 women. We used logistic regression analysis to determine the effect of each item of IADL on the transition from aMCI to ADD. Results: The odds ratio (OR) for “remembering recent events” had similar values: 27.2 for men, and 27.7 for women. Gender difference was identified in the item with the highest OR value. For women, the “using transportation” item was 63.3, and for men, “conducting financial affairs” was overwhelmingly high at 89.1. Conclusions Functional decline on items with relatively higher ORs may indicate higher probability of a transition from aMCI to ADD. The OR of “conducting financial affairs” was relatively higher for both genders. In terms of gender differences, “conducting home repair” for men, and “using transportation” for women, have relatively higher impact. This study demonstrates that during the transition from aMCI to ADD, each item of IADL shows a staggered decline in functioning, and that this decline is gender-specific.

Background: Determination of inter-method differences between clinically available volumetry methods are essential for the clinical application of brain volumetry in a wider context.Purpose: The purpose of this study was to examine the inter-method reliability and differences between the Siemens morphometry (SM) software and the NeuroQuant (NQ) software. Materials and Methods: MR images of 86 subjects with subjective or objective cognitive impairment were included in this retrospective study. For this study, 3D T1 volume images were obtained in all subjects using a 3T MR scanner (Skyra 3T, Siemens). Volumetric analysis of the 3D T1 volume images was performed using SM and NQ. To analyze the inter-method difference, correlation, and reliability, we used the paired t-test, Bland-Altman plot, Pearson’s correlation coefficient, intraclass correlation coefficient (ICC), and effect size (ES) using the MedCalc and SPSS software. Results: SM and NQ showed excellent reliability for cortical gray matter, cerebral white matter, and cerebrospinal fluid; and good reliability for intracranial volume, whole brain volume, both thalami, and both hippocampi. In contrast, poor reliability was observed for both basal ganglia including the caudate nucleus, putamen, and pallidum. Paired comparison revealed that while the mean volume of the right hippocampus was not different between the two software, the mean difference in the left hippocampus volume between the two methods was 0.17 ml (P < 0.001). The other brain regions showed significant differences in terms of measured volumes between the two software. Conclusion SM and NQ provided good-to-excellent reliability in evaluating most brain structures, except for the basal ganglia in patients with cognitive impairment.Researchers and clinicians should be aware of the potential differences in the measured volumes when using these two different software interchangeably.

Pain is often associated with a more rapid progression of cognitive and functional decline, and behavioral disturbance in dementia. Therefore, it is essential to accurately assesses pain for proper intervention in patients with dementia. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is an excellent behaviour scale which includes most of the domains that are recommended by the American Geriatrics Society to evaluate when assessing pain in patients with dementia. The purpose of this study was to develop the Korean version of the FLACC (K-FLACC) and to verify its reliability and validity in assessing pain of elderly patients with dementia. We developed the K-FLACC to consist of the five domains (face, legs, activity, cry, and consolability) with scores of 0, 1, and 2 for each domain and a total score ranging from 0 to 10 as in the original FLACC. Eighty-eight patients with dementia who visited Konkuk University Medical Center were evaluated. The K-FLACC revealed good validity as compared to the Numeric Rating Scale (NRS; r = 0.617, P < 0.001) and the Face Pain Scale (FPS; r = 0.350, P = 0.001). All of the five domains of the K-FLACC were related to the NRS and FPS, in which the activity domain showed the highest correlation. Test-retest reliability was excellent, as the intra-class correlation coefficient comparing the retest to test was 0.73 (95% confidence interval, 0.59–0.82). Our results show that the K-FLACC is a suitable and valuable scale to assess pain in patients with dementia in Korea.
Academic Medical Centers ; Aged ; Dementia* ; Facial Pain ; Geriatrics ; Humans ; Korea ; Leg* ; Mass Screening ; Reproducibility of Results

Many factors associated with a patient's lifestyle may disrupt timely access to dementia diagnosis and management. The aim of this study was to compare characteristics of lifestyle factors at the time of initial evaluation for dementia across degrees of dementia, and to identify risk factors relating to late detection of dementia, in order to understand the various lifestyle barriers to timely recognition of the disease. We reviewed medical records of 1,409 subjects who were diagnosed as dementia among 35,723 inhabitants of Gwangjin-gu. Dementia severity was divided into three degrees. Age, sex, education, income, smoking, heavy drinking, physical activity, religion, and living conditions were evaluated. There was a significantly greater proportion of individuals who were old age, female, less educated, who had never smoked or drank heavily, without physical activity, with no religious activity and living with family other than spouse in the severe dementia group. The lifestyle risks of late detection were old age, lower education, less social interactions, less physical activity or living with family. We can define this group of patients as the vulnerable stratum to dementia evaluation. Health policy or community health services might find ways to better engage patients in this vulnerable stratum to dementia.
Aged* ; Community Health Services ; Dementia* ; Diagnosis ; Drinking ; Education ; Female ; Health Policy ; Health Services ; Humans ; Interpersonal Relations ; Life Style ; Mass Screening ; Medical Records ; Motor Activity ; Risk Factors ; Smoke ; Smoking ; Social Conditions ; Spouses

No abstract available.
Aged ; Female ; Humans ; Memory

Objective: This study aimed to determine whether there are regional differences in the blood-brain barrier (BBB) permeability of cognitively normal elderly participants and to identify factors influencing BBB permeability with a clinically feasible, 10-minute dynamic contrast-enhanced (DCE) MRI protocol. Materials and Methods: This IRB-approved prospective study recruited 35 cognitively normal adults (26 women; mean age, 64.5 ± 5.6 years) who underwent DCE T1-weighted imaging. Permeability maps (Ktrans) were coregistered with masks to calculate the mean regional values. The paired t test and Friedman test were used to compare Ktrans between different regions. The relationships between Ktrans and the factors of age, sex, education, cognition score, vascular risk burden, vascular factors on imaging, and medial temporal lobar atrophy were assessed using Pearson correlation and the Spearman rank test. Results: The mean permeability rates of the right and left hippocampi, as assessed with automatic segmentation, were 0.529 ± 0.472 and 0.585 ± 0.515 (Ktrans, x 10-3 min-1 ), respectively. Concerning the deep gray matter, the Ktrans of the thalamus was significantly greater than those of the putamen and hippocampus (p = 0.007, p = 0.041). Regarding the white matter, the Ktrans value of the occipital white matter was significantly greater than those of the frontal, cingulate, and temporal white matter (p < 0.0001, p = 0.0007, p = 0.0002). The variations in Ktrans across brain regions were not related to age, cognitive score, vascular risk burden, vascular risk factors on imaging, or medial temporal lobar atrophy in the study group. Conclusion Our study demonstrated regional differences in BBB permeability (Ktrans) in cognitively normal elderly adults using a clinically acceptable 10-minutes DCE imaging protocol. The regional differences suggest that the integrity of the BBB varies across the brains of cognitively normal elderly adults. We recommend considering regional differences in Ktrans values when evaluating BBB permeability in patients with neurodegenerative diseases.