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Vertebral Artery Dissection Presenting as Transient Global Amnesia: A Case Report and Review of Literature.

Dementia and Neurocognitive Disorders.2014;13(2):46-49. doi:10.12779/dnd.2014.13.2.46

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

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The Relationships between Homocysteine Levels and Memory in Early Alzheimer's Disease Patients.

Jong Sik PARK ; In Uk SONG ; Sung Woo CHUNG ; Yeonwook KANG ; Youngsoon YANG

Dementia and Neurocognitive Disorders.2014;13(2):42-45. doi:10.12779/dnd.2014.13.2.42

BACKGROUND: Alzheimer's disease (AD) is a representative neurodegenerative disorder associated with memory disturbance. Recent research has shown that risk factors for cerebrovascular disorders are also causes of dementia. Of these risk factors, hyperhomocysteinemia is well known to be positively correlated with all types of dementias including AD. But it is not clear if there is a difference in the concentration of homocysteine according to subtypes of memory impairment of AD. We performed this study to explore the relationship between homocysteine and memory. METHODS: A total of 54 patients (male: 15 patients) to the dementia clinic at our hospital were recruited for this study. All subjects underwent neuropsychological tests including detailed memory function tests and brain magnetic resonance images. The plasma homocysteine level was measured routinely in all patients. RESULTS: Verbal and visual memories in AD were significantly associated with the concentration of plasma homocysteine. The plasma homocysteine level was significantly correlated with delayed recalls of verbal and visual memories and recognition of visual memory. However, there was no relationship between plasma homocysteine and working memory. CONCLUSIONS: This study showed that plasma homocysteine level was related to the consolidation and retrieval stage of memory in AD. Therefore, we cautiously assumed that control of plasma homocysteine level could contribute to management for the prevention of cognitive impairment.
Alzheimer Disease* ; Brain ; Cerebrovascular Disorders ; Dementia ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Memory* ; Memory, Short-Term ; Neurodegenerative Diseases ; Neuropsychological Tests ; Plasma ; Risk Factors

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Clinical Usefulness of 99mTc-Hexamethyl Propylene Amine Oxime Perfusion Single Photon Emission Computed Tomography for Early Phase Multiple System Atrophy.

Jong Yoon LEE ; In Uk SONG ; Sung Woo CHUNG ; Yong An CHUNG ; Youngsoon YANG

Dementia and Neurocognitive Disorders.2014;13(2):37-41. doi:10.12779/dnd.2014.13.2.37

BACKGROUND: Clinical diagnosis of multiple system atrophy (MSA) relays on signs and symptoms that are often difficult to identify particularly at early stage. Indeed neuropathological studies have demonstrated that Parkinson variant of MSA (MSA-P) is the first cause of misdiagnosis in a cohort of patients presenting with parkinsonian features. But accurate diagnosis of these disorders is important for deciding on treatment, appropriate advice and prognosis since atypical parkinsonian disorders are characterized by poor response to dopaminergic treatment and more rapid disease progression. Therefore, we conducted this study to investigate difference of perfusion Single Photon Emission Computed Tomography (SPECT) in patients with the early phase of MSA-P using SPM program. METHODS: We recruited consecutively 21 patients with MSA-P and 48 age-matched healthy controls. All subjects underwent Tc-99m HMPAO perfusion SPECT and this perfusion images were analyzed. RESULTS: For MSA-P, only hypoperfusion was seen in the middle frontal gyrus of left frontal lobe, superior frontal gyrus of right frontal lobe, precentral gyrus of left frontal lobe, middle frontal gyrus of right frontal lobe and precentral gyrus of right frontal lobe with respect to healthy subjects. CONCLUSIONS: We cautiously assume that perfusion SPECT may offer significant advantages compared to other imaging techniques in the assessment of neuronal degeneration in MSA-P and may help the clinician in the diagnostic characterization of patients presenting with atypical parkinsonism.
Cohort Studies ; Diagnosis ; Diagnostic Errors ; Disease Progression ; Frontal Lobe ; Humans ; Multiple System Atrophy* ; Neurons ; Parkinsonian Disorders ; Perfusion* ; Prognosis ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*

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Depression in Alzheimer's Disease.

Yong Tae KWAK ; Youngsoon YANG ; Min Seong KOO

Dementia and Neurocognitive Disorders.2014;13(2):27-36. doi:10.12779/dnd.2014.13.2.27

Depression is one of the most common psychiatric complications of Alzheimer disease (AD), affecting from 30% to 50% of prevalence, with most estimates in the 20-30% range. Because of having a presentation in the context of AD that differs from typical early-onset depression, it is not easy one to detect and quantify reliably, and can be difficulty to differentiate depression from the other neuropsychiatric symptoms of AD. Due to the lack of large randomized trials, optimal treatment and the true degree of efficacy remains undetermined. However, these treatments can reduce adverse impact of depression on patients and caregivers. This article provides a practical discussion of the diagnosis, evaluation, differential diagnosis and treatment of depression in AD for the clinician.
Alzheimer Disease* ; Caregivers ; Depression* ; Diagnosis ; Diagnosis, Differential ; Humans ; Prevalence

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Splenial Corpus Callosum Infarction Presenting with Unilateral Prosopometamorphopsia: A Case Report.

Chang Min LEE

Dementia and Neurocognitive Disorders.2015;14(2):94-97. doi:10.12779/dnd.2015.14.2.94

BACKGROUND: Prosopometamorphopsia is a disorder of face perception in which faces appear distorted to the perceiver. Cases with unilateral prosopometamorphopsia caused by splenial lesion have been very rarely reported. CASE REPORT: A 52-year-old right-handed woman complained that the left half of people's faces looked distorted. She stated that objects other than the face looked normal. Brain magnetic resonance imaging revealed an infarction of the left splenium of the corpus callosum. Electroencephalography and automated perimetry were normal. CONCLUSIONS: The mechanism of unilateral prosopometamorphopsia remains unclear. However, it could be a dominant hemisphere-specific disconnection sign.
Brain ; Corpus Callosum* ; Electroencephalography ; Female ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Middle Aged ; Visual Field Tests

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Longitudinal Clinical Changes of Non-Fluent/Agrammatic Primary Progressive Aphasia as Tau Spectrum Disorder: A Case Report.

Jin Soo KIM ; Jae Won JANG ; Seong Heon KIM ; Min Jeong WANG ; Young Ho PARK ; Sangyun KIM

Dementia and Neurocognitive Disorders.2015;14(2):87-93. doi:10.12779/dnd.2015.14.2.87

BACKGROUND: Tauopathies are a group of diseases caused by the accumulation of hyperphosphorylated tau protein in the central nervous system. Previous studies have revealed that there is considerable overlap in clinical, pathological, and genetic features among different taupathies. CASE REPORT: We report a patient with non-fluent/agrammatic primary progressive aphasia at the initial assessment. Over time, other symptoms belonging to corticobasal degeneration and progressive supranuclear palsy appeared in this patient. CONCLUSIONS: Clinical overlapping features in these disorders may represent different phenotypes of a single disease process.
Aphasia, Primary Progressive* ; Central Nervous System ; Humans ; Phenotype ; Supranuclear Palsy, Progressive ; tau Proteins ; Tauopathies

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Posterior Cortical Atrophy with Acute Onset and Rapid Progressive Visual Symptoms: A Case Report.

Jaejeong JOO ; Sul Ki LEE ; In Ha HWANG ; Kyum Il KWON ; Byoung June AHN ; Youngsoon YANG

Dementia and Neurocognitive Disorders.2015;14(2):83-86. doi:10.12779/dnd.2015.14.2.83

BACKGROUND: Posterior cortical atrophy (PCA) is characterized by slowly progressive early onset dementia with cortical visual dysfunction and disproportionate atrophy of the posterior cortex. CASE REPORT: A 55-year-old right-handed woman developed visuo-spatial impairments that progressed rapidly into cortical blindness over the following 3 months. Neuro-psychological evaluation revealed Gerstmann syndrome and severe constructional impairments with all components of Balint syndrome. However, her memory, insight, and judgment were preserved. Her brain MRI was normal. However, 18F fluorodeoxyglucose positron emission tomography revealed a marked hypometabolism in the bilateral parieto-occipital region. CONCLUSIONS: Although rapid progression of visuo-spatial dysfunction without memory impairment occurred, we considered PCA as well.
Atrophy* ; Blindness, Cortical ; Brain ; Dementia ; Female ; Fluorodeoxyglucose F18 ; Gerstmann Syndrome ; Humans ; Judgment ; Magnetic Resonance Imaging ; Memory ; Middle Aged ; Passive Cutaneous Anaphylaxis ; Positron-Emission Tomography

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Cognitive Therapy Combined with Drug Treatment in Patients with Alzheimer's Disease: A Neuropsychological and Positron Emission Tomography Investigation, a Pilot Study.

Haeri NA ; Sangyun KIM ; Yu Kyeong KIM ; Moon Ho PARK ; Sung Tae CHO ; Woo Jung KIM

Dementia and Neurocognitive Disorders.2015;14(2):76-82. doi:10.12779/dnd.2015.14.2.76

BACKGROUND: Cognitive therapy may have therapeutic benefit in patients with early Alzheimer's disease (AD). CASE REPORT: This was a 12-week, single-blind pilot study of 4 patients with AD. The cognitive therapy included exercises for orientation to time and place; memory training, including face-name association, object recall training, and spaced retrieval; visuo-motor organization using software; similarity and ruled based categorization; and behavior modification and sequencing (e.g., making change, paying bills). The regional cerebral metabolic abnormalities and the effects of treatment on cortical metabolic responses were evaluated using 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography (PET). After 12 weeks, the participants showed slight improvement in some neuropsychological measures, and three of them showed increased regional cortical metabolism on brain PET studies. CONCLUSIONS: Cognitive therapy may stabilize or improve cognitive and functional performance of patients with early AD and increase regional cortical metabolism of the patients' brain.
Alzheimer Disease* ; Behavior Therapy ; Brain ; Cognitive Therapy* ; Exercise ; Humans ; Learning ; Metabolism ; Pilot Projects* ; Positron-Emission Tomography*

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A Comparison of Apolipoprotein E Polymorphism in Alzheimer's Disease and Subcortical Vascular Dementia in Koreans.

Jun Woo KIM ; Oh Dae KWON

Dementia and Neurocognitive Disorders.2015;14(2):70-75. doi:10.12779/dnd.2015.14.2.70

BACKGROUND AND PURPOSE: The apolipoprotein E (Apo E) epsilon4 allele is known to be a risk factor for Alzheimer's disease (AD). However, there are debates about the relationship between Apo E epsilon4 frequency and subcortical vascular dementia (SVaD). We compared the frequency of the Apo E epsilon4 allele in AD and SVaD in Koreans. METHODS: The study was comprised of 400 subjects who visited the Dementia Clinic at Daegu Catholic University from July 2007 to December 2011. Neuropsychological tests, a brain MRI, and blood laboratory tests were performed on all subjects. Two hundred and ninety subjects were AD, 32 subjects were SVaD and 78 subjects were normal. The diagnosis for SVaD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and Erkinjuntti criteria, and the diagnosis for AD was based on the DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's disease and Related Disorders Association criteria. Apo E polymorphism was genotyped in all subjects. RESULTS: The Apo E epsilon4 allele frequency was 17.4% in AD, 10.9% in SVaD and 8.3% in the normal group (p=0.03). The odds ratio (OR) after age adjustment for AD conferred to the Apo E epsilon4 was 2.04 (p=0.04). But, the OR for SVaD conferred to the Apo E epsilon4 allele was 1.34 (p=0.62), indicating that the Apo E epsilon4 allele does not significantly confer the risk of SVaD. CONCLUSIONS: Apo E epsilon4 is a reliable predictor of AD but has modest efficacy for predicting SVaD in Koreans.
Alleles ; Alzheimer Disease* ; Apolipoproteins E ; Apolipoproteins* ; Brain ; Communication Disorders ; Daegu ; Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Gene Frequency ; Magnetic Resonance Imaging ; Neuropsychological Tests ; Odds Ratio ; Risk Factors ; Stroke

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Understanding of Antipsychotics in Elderly Patients with Dementia.

Yong Tae KWAK ; Youngsoon YANG ; Hye Ryeon JANG

Dementia and Neurocognitive Disorders.2015;14(2):53-69. doi:10.12779/dnd.2015.14.2.53

Elderly patients affected with dementia frequently accompany delusions, hallucinations and other psychotic symptoms. As such, these patients are commonly prescribed antipsychotic medications for the treatment of psychosis. However, in recent years, the use of antipsychotics has been widely debated for reasons concerning their efficacy and safety in these patients. Conventional antipsychotics have been widely used for behavioral psychological symptoms in dementia (BPSD) in the past. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, the Food and Drug Administration alert the possible increase in cerebrovascular adverse events after using antipsychotics and consequent studies reported various adverse (including fatalities) events. Notwithstanding controversial data, antipsychotics are probably the best option for short-term treatment of severe BPSD. However, due to possible serious adverse events, long-term therapy is not recommended and clinician should decrease the dosage and discontinue treatment wherever a sufficient control of behavioral symptoms has been obtained. Before prescribing an antipsychotic drug, the possible risk factor should be structurally reviewed and monitored. The aim of this review is to asses systematically the efficacy and safety concern of antipsychotics in treating elderly patients with BPSD. And we also review how and what we should prescribe and monitor, if once antipsychotic medication is decided.
Aged* ; Antipsychotic Agents* ; Behavioral Symptoms ; Delusions ; Dementia* ; Equidae ; Hallucinations ; Humans ; Psychotic Disorders ; Risk Factors ; United States Food and Drug Administration

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