BACKGROUND AND PURPOSE: Subjective cognitive decline has been proposed as a potential indicator of the preclinical state of Alzheimer's disease (AD). The results of the studies of cortical atrophy on brain MRIs in subjects with subjective cognitive decline are inconsistent across the literatures. We investigated whether subjects with subjective cognitive decline had less gray matter volume compared to controls without subjective cognitive decline as per brain MRI. METHODS: Thirty-six subjects with subjective cognitive decline and thirty-three controls without subjective cognitive decline were recruited retrospectively from among the patients who had visited the department of neurology at Inha University Hospital between January 2008 and December 2010. All subjects had undergone a brain MRI scan including 3D T1-weighted spoiled gradient recalled echo imaging. We used voxel-based morphometry (VBM) to examine gray matter volumes between the two groups, after controlling for age, sex, education, and total intracranial volumes (TIV). RESULTS: There were no significant differences in age, gender, education, and TIV between the two groups. In comparison to controls without subjective cognitive decline, subjects with subjective cognitive decline showed gray matter atrophy in the left superior and medial frontal gyri, left superior and inferior parietal lobules, and right precuneus and insular in the VBM analysis. CONCLUSIONS: Individuals with subjective cognitive decline encountered in clinical settings have greater similarity to an AD gray matter atrophy pattern compared with cognitively normal individuals without subjective cognitive decline.
Alzheimer Disease ; Atrophy ; Brain ; Education ; Humans ; Magnetic Resonance Imaging ; Neurology ; Rabeprazole ; Retrospective Studies

BACKGROUND: Atrial fibrillation (AF) and patent foramen ovale (PFO) are established sources of cardioembolism. We investigated differences in stroke outcome and patterns between PFO and AF. METHODS: We performed a retrospective review of the medical records and brain MR images of patients with AF or PFO from the prospective acute stroke and transient ischemic attack registry. Infarct pattern and volume on diffusion-weighted imaging, and the national institutes of health stroke scale (NIHSS) on admission were compared between patients with AF and PFO. RESULTS: From June 2005 to July 2008, a total of 289 subjects were enrolled (AF group, n=156; PFO group, n=133). Infarct pattern analyzed with MR images revealed that multiple vascular territorial infarction was more prevalent in AF group than in PFO group (26.9% vs. 8.3%, P<0.01). A probable cardiac embolism, radiologically defined as territorial infarction without symptomatic steno-occlusion of the corresponding artery, was more frequently documented in AF group than in PFO group (71.8% vs. 41.4%, P<0.01) The infarct volume of PFO was smaller than that of AF. Compared to AF, PFO was associated with the mild neurologic deficit (NIHSS< or =3) after adjusting age, sex and previous stroke history. CONCLUSION: These results suggested that AF and PFO had different characteristics such as infarct patterns and initial clinical severity although both are classified as cardioembolism.
Arteries ; Atrial Fibrillation ; Brain ; Embolism ; Foramen Ovale, Patent ; Humans ; Infarction ; Ischemic Attack, Transient ; Medical Records ; National Institutes of Health (U.S.) ; Neurologic Manifestations ; Prospective Studies ; Retrospective Studies ; Stroke

BACKGROUND: Physical disability may result in some impairment of the score for Instrumental Activities of Daily Living (IADL). The aim of this study was to evaluate the effect of physical disability on IADL in patients with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), subcortical vascular dementia (SVD), and vascular mild cognitive impairment of the subcortical type (svMCI). METHODS: Fifty-six patients with AD, 30 with SVD, 27 with aMCI, and 21 with svMCI were recruited consecutively from a memory clinic. Informants for the subjects completed a Korean version of the IADL (K-IADL). In addition, the informants were asked to choose the cause of each dependent activity of K-IADL from the following: cognitive impairment, physical disability, or both. The cause of the physical disability was defined as being focal neurologic symptoms, other physical disease, or both. RESULTS: Compared to AD patients, SVD patients had higher K-IADL scores [2.02+/-0.80 (mean+/-SD) vs. 1.45+/-0.90, p<0.01] and focal neurologic signs (FNS; 8.0+/-5.8 vs. 0.0+/-0.0, p<0.001), and lower Barthel Index scores (14.7+/-5.1 vs. 19.6+/-1.2, p<0.001). Patients with svMCI had higher FNS (3.8+/-4.5 vs. 0.0+/-0.0, p<0.001) compared to those with aMCI. The most common cause of dependency of activities in K-IADL was cognitive impairment in AD, aMCI, and svMCI patients, and the combined effect of cognitive impairment and physical disability in those with SVD. The cause of physical disability was FNS in 96% of SVD patients and in all patients with svMCI. CONCLUSIONS: The effects of FNS as well as cognitive impairment should be considered when measuring the IADL of the patients with SVD or svMCI.
Activities of Daily Living ; Alzheimer Disease ; Dementia, Vascular ; Dependency (Psychology) ; Humans ; Memory ; Mild Cognitive Impairment ; Neurologic Manifestations

Digital therapeutics based on software, such as artificial intelligence, virtual reality, games, and smartphone applications, are in the spotlight as new therapeutic alternatives in child and adolescent psychiatry. It draws attention to overcoming conventional therapeutics’ limitations, such as toxicity, cost, and accessibility, and encourages patients to participate in the treatment attractively. The growth potential of the digital therapeutics market for psychiatric disorders in children and adolescents in Korea and abroad has been highlighted. Clinical studies and Food and Drug Administration approvals for digital therapeutics have increased, and cases approved by the Ministry of Food and Drug Safety have emerged in Korea. As seen above, digital transformation in child and adolescent psychiatry will change treatment paradigms significantly. Therefore, as this new field has just begun to emerge, it is necessary to verify the effectiveness and scope of the application of digital therapeutics and consider preparing a compensation system and institutional arrangements. Accordingly, this study analyzed the development trends and application status of digital therapeutics in children and adolescents and presented limitations and development directions from the perspective of application in healthcare. Further, the study is expected to identify the utility and limitations of digital therapeutics for children and adolescents and establish effective application measures.