A 42-year-old man with left posterior inferior cerebellar artery (PICA) infarction presented with akinetic mutism and cognitive impairment. Initially he suffered from akinetic mutism and MRI-documented infarction in the distribution of the left PICA. Twelve days later he developed cognitive impairment. Neuropsychological tests were performed, with the results corrected for age and education being compared with published Korean norms. Impaired performances were evident on executive function testing, with difficulties in planning, abstract reasoning, set-shifting, and perseveration. Akinetic mutism and cognitive-affective syndrome may be a manifestation of unilateral PICA infarction.
Adult ; Akinetic Mutism* ; Arteries ; Education ; Executive Function ; Humans ; Infarction* ; Neuropsychological Tests ; Pica*

BACKGROUND: The size reduction of low density lipoproteins(LDL) particles has been found associated with coronary artery disease(CAD), but the analysis of LDL subfractions is time consuming(over 24 hours) and technically demanding such as density gradient ultracentrifugation or gradient polyacrylamide gel electrophoresis(PAGE). In this study, the association between LDL subfractions and CAD was investigated using the new method for the separation of LDL subfractions, commercially available continuous disc PAGE. METHODS: LDL subfraction profiles were investigated in two groups(97 patients with CAD proven angiographically and 109 healthy controls) using Lipoprint LDL System(Quantimetrix Co., Redondo Beach, CA, USA). Seven LDL subfractions(from LDL-0 to LDL-6) can be identified with a specific electrophoretic mobility(Rf) relative to the HDL fraction. The relative percentage of the area under the curve(AUC) of each LDL band was multiplied by its band number and the sum of the relative AUC of all LDL bands percent was calculated to produce a final LDL score. RESULTS: Mean LDL score was significantly higher in CAD patients than in controls(2.09+/-0.77 and 1.01+/-0.38, respectively, P<0.0001). There was a significant association between the polydispersity of LDL subfractions and the presence of CAD(P=0.01). LDL score was highly correlated with triglyceride(r=0.330, P=0.0001). LDL score was the significant discriminators between control and CAD groups(F=168.3, P=0.0001). There was no significant association between LDL score and the severity of CAD. CONCLUSIONS: Lipoprint LDL System is an easy and quick method for routine assessment of LDL subfractions. LDL score was the best individual discriminant risk factor for CAD.
Area Under Curve ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Lipoproteins* ; Risk Factors ; Triglycerides ; Ultracentrifugation

PURPOSE: This study was conducted to analyze the factors associated with intoxicated patient's disposition in the pediatric emergency department. METHODS: We retrospectively evaluated pediatric intoxicated patients visiting the pediatric emergency department of a hospital between January 1, 2011 and December 31, 2013. Specifically, we analyzed the association between hospitalization recommended rate and the following variables: patient age group, symptoms, intentional poisoning, decontamination and toxic level of substance. RESULTS: We collected data from 345 patients. A high incidence was noted in the 1-4 years of age group and 10-15 years of age group. Unintentional poisoning occurred in 306 patients (88.7%). A total of 115 patients (33.3%) had symptoms when visiting. Forty three patients (12.5%) ingested cleaning substances, which was the most common agent. Potentially-toxic level was the most common level of the substance. The hospitalization recommended rate associated with visits in 2011 was 2.5 times greater than in 2012 and 2013, decontamination was 2.0 times greater than no decontamination, and poisoning with potentially-toxic substances was 2.6 times greater than poisoning with other toxic substances. Additionally, the hospitalization recommended rate associated with symptomatic patients was 2.4 times greater than that of asymptomatic patients and intentional poisoning was 2.4 times greater than unintentional poisoning. CONCLUSION: Patients with decontamination, ingestion of potentially-toxic substances, symptoms and intentional poisoning had increased hospitalization rates. In addition, the hospitalization rate for patients who visited in 2011 was greater than that of patients who visited in 2012 or 2013.
Child ; Decontamination ; Eating ; Emergencies* ; Emergency Service, Hospital* ; Factor Analysis, Statistical* ; Hospitalization ; Humans ; Incidence ; Patient Admission ; Pediatrics ; Poisoning ; Retrospective Studies

Activities of daily living (ADL) refer to the ability to care for self and perform daily activities within an individual's place or in outdoor environments. ADL comprise two main categories: Basic or physical ADL and Instrumental ADL. The latter allows for the earlier detection of functional decline than the former. The cognitive changes in neurodegenerative dementias contribute to the impaired ability of the patients to take care of themselves. Activities of daily living is a major criterion for diagnosing dementia. Furthermore, it has recently been emphasized that some impairment of activities of daily living, particularly of complex instrumental functions, is already present even in mild cognitive impairment prodromal stage of dementia, although mild cognitive impairment is distinguished from dementia by the absence of significant deficit in activities of daily living. The impaired activities of daily living increase the rate of institutionalization of the patients with dementia to nursing home and inevitably bring about the changes in the qualities of life not only of the patients but their caregivers. One of the best ways to evaluate the degree of impairment in activities of daily living and the care burden is through standardized functional assessment tools according to the severity of dementia. These tools provide objective data, thereby allowing the clinicians to judge decline and improvement in the functional status and to plan individualized care. In this review, we will review the clinical significance of evaluating ADL, the assessment tools according to the severity of dementia, and therapeutic approaches to enhance the functional levels. We will also review the impact of the impaired ADL on the quality of life among the patients and their care providers.
Activities of Daily Living ; Caregivers ; Dementia ; Humans ; Hypogonadism ; Institutionalization ; Mild Cognitive Impairment ; Mitochondrial Diseases ; Nursing Homes ; Ophthalmoplegia ; Prodromal Symptoms ; Quality of Life

BACKGROUND: Direct measurements of ionized magnesium (iMg) in serum by ion-selective electrodes have recently become available in clinical practice, and its usefulness needs to be investigated in dialysis patients because chronic renal failure is associated with disturbances in magnesium metabolism. METHODS: We measured serum iMg in 29 hemodialysis (HD) patients and 24 peritoneal dialysis (CAPD) patients using an ion-selective electrode. The results were compared with those from 30 age- matched control patients who were admitted due to non-renal diseases and were confirmed to have normal serum total magnesium (tMg) levels. RESULTS: Serum tMg was significantly higher in both HD (0.95 [0.81-1.06] mmol/L) and CAPD (0.86 [0.74-0.99] mmol/L) patients compared with the controls (0.74 [0.70-0.78] mmol/L). Serum iMg was significantly higher in HD patients (0.65 [0.60-0.72] mmol/L) compared with the controls (0.55 [0.51-0.57] mmol/L), but was not higher in CAPD patients (0.54 [0.50-0.60] mmol/L). Thus, the ionized fraction of serum magnesium (iMg/tMg) was significantly lower in CAPD patients (65.3 [58.8-68.2]%), but not in HD patients (68.7 [63.6-77.0]%), compared with the controls (72.2 [67.2-78.3]%). In dialysis patients, iMg/ tMg was significantly lower in those with residual renal function than in anuric patients (67.5 [63.6-74.8]% vs. 61.4 [56.4-70.7]%). CONCLUSION: In current practice, true hypermagnesemia may exist frequently in HD patients (at predialysis), but not in CAPD patients. The ionized fraction of serum magnesium may be reduced in CAPD patients, but not in HD patients.
Dialysis* ; Humans ; Ion-Selective Electrodes ; Kidney Failure, Chronic ; Magnesium* ; Metabolism ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Renal Dialysis

PURPOSE: The aim of this study is to evaluate the effect of dexmedetomidine on corrected QT (QTc) and Tp-e intervals in patients undergoing spinal anesthesia. MATERIALS AND METHODS: We studied 50 patients who were scheduled to undergo spinal anesthesia before orthopedic surgeries. Patients were allocated to receive either an infusion of dexmedetomidine or normal saline after spinal anesthesia. RESULTS: QTc intervals were significantly prolonged after spinal anesthesia, and the prolonged QTc interval returned to baseline values 10 minutes after either normal saline or dexmedetomidine administration in both groups. The QTc interval values after dexmedetomidine administration were significantly shorter compared to the QTc interval values just before dexmedetomidine administration. CONCLUSION: Dexmedetomidine could promote the return of a prolonged QTc interval induced by spinal anesthesia and might be helpful in patients who have a prolonged QTc interval.
Anesthesia, Spinal* ; Dexmedetomidine* ; Electrocardiography ; Humans ; Methods ; Orthopedics

Creutzfeldt-Jakob disease (CJD) is a degenerative neurological disorder that is incurable and invariably fatal. It is characterized by rapidly progressive dementia presenting with memory loss, personality changes and hallucinations. The symptoms of CJD are caused by progressive death of neurons in the central nervous system, which is associated with build-up of the abnormal prion proteins forming amyloids. In human, CJD can be acquired genetically through a mutation of the gene encoding for the prion protein (PRNP). This occurs in only 5-10% of all CJD cases. We report a 64-year old woman with CJD carrying a V180I mutation that features late onset, rapid progression, no periodic sharp wave complexes on electroencephalography, and cortical signal change and edema in bilateral frontotemporoparietal lobes and basal ganglia on MRI.
Amyloid ; Basal Ganglia ; Central Nervous System ; Creutzfeldt-Jakob Syndrome ; Dementia ; Depression ; Edema ; Electroencephalography ; Female ; Hallucinations ; Humans ; Lifting ; Memory Disorders ; Nervous System Diseases ; Neurons ; Prions

BACKGROUND AND PURPOSE: The one-day rivastigmine patch is reportedly well tolerated and has minimal side effects. However, Asian patients show more side effects than those in Western countries. We evaluated tolerability of the rivastigmine patch in South Korean patients with Alzheimer's disease (AD) and the specific factors affecting adverse events of the skin. METHODS: A 6-month, open labeled, multi-centered, observational study was carried out in 440 patients with probable AD from July 2009 to September 2010 (NCT01312363). RESULTS: A total of 25.9% of the patients experienced adverse skin events at the rivastigmine patch application site and 17.0% discontinued treatment due to adverse events at the skin application site. The most common adverse events were itching and erythema. Patients with an allergic history and users of electric heating appliances reported skin discomfort. Older age was associated with discontinuing treatment. CONCLUSION: These results suggest that the rivastigmine patch induced some adverse skin events and may contribute to understanding and improving skin tolerability to the rivastigmine patch.
Alzheimer Disease* ; Asian Continental Ancestry Group ; Erythema ; Heating ; Hot Temperature ; Humans ; Observational Study ; Pruritus ; Skin* ; Rivastigmine

Background: and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. Methods: This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. Results: The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. Conclusions Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.

Background: and Purpose: Reportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer’s disease patients who had newly been prescribed donepezil. Methods: This multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer’s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests. Results: The donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study. Conclusions Caregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.