신경조직을 따라 뇌교로 전파된 비뇌 털곰팡이증 2예

심용수,나정호,권지현,하충건 대한신경과학회 1999 대한신경과학회지 Vol.17 No.6

A Semi-Automated Method for Measuring White Matter Hyperintensity Volume

심용수,윤보라,홍윤정,조아현,양동원 대한치매학회 2013 Dementia and Neurocognitive Disorders Vol.12 No.1

Background: White matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) have been considered as a reliable biomarker of small vessel damages. To evaluate the severity of WMHs, it is vital to develop reliable methods to measure the volume of WMHs. We applied open source software to measure WMH volume in the semi-automated way, and tested the reliability and validity by comparing with the commonly used qualitative rating scale. Methods: Twenty five subjects with variable WMHs were recruited. ANALYZE 10.0 was used for the image processing and volumetric measurement of WMHs. The inhomogeneity and artifacts of signal were corrected with Insight Segmentation and Registration Toolkit in ANALYZE. For the gold standard of the WMH volumetric measurement, threshold method was applied with consensus of manual editing on each slice of the MRI images by two raters. Histogram of the all slices of the Fluid Attenuated Inversion Recovery (FLAIR) MRI was generated to calculate the optimal voxel intensity of threshold, and the lowest voxel threshold was decided as the mean+1.4 SD. The volumes of WMHs were generated by multiplying the area and the thickness of each slice. Inter- and intrarater reliability of the semi-automated volumetric and Scheltens’methods, and the association between the individual methods were analyzed. Results: The semi-automated WMH volume at the threshold of 1.4SD as well as the gold standard volume was well correlated with the Scheltens’ visual scale (r = 0.75,p< 0.001). The semi-automated volumetry showed the excellent intra-rater (ICC= 0.9929; 95% CI, 0.9840-0.9968) and inter-rater reliability (ICC= 0.9830; 95% CI, 0.9620-0.9925), superior to the Scheltens’ visual rating scale. Conclusions: The semi-automated volume measurement of the WMHs with Analyze was a valid and a reliable method to quantify subcortical white matter damages of various etiologies.

Biomarkers Predicting Alzheimer’s Disease in Cognitively Normal Aging

심용수,John C. Morris 대한신경과학회 2011 Journal of Clinical Neurology Vol.7 No.2

The pathophysiologic process of Alzheimer’s disease (AD) begins years before the diagnosis of clinical dementia. This concept of preclinical AD has arisen from the observation of AD pathologic findings such as senile plaques and neurofibrillary tangles in the brains of people who at the time of death had normal cognitive function. Recent advances in biomarker studies now provide the ability to detect the pathologic changes of AD, which are antecedent to symptoms of the illness, in cognitively normal individuals. Functional and structural brain alterations that begin with amyloid-βaccumulation already show the patterns of abnormality seen in individuals with dementia due to AD. The presence of preclinical AD provides a critical opportunity for potential interventions with disease-modifying therapy. This review focuses on the studies of antecedent biomarkers for preclinical AD.

급성 뇌경색 환자에서 확산텐서영상의 적용: 분할 비등방도의 유용성

심용수,양동원,윤보라,손영민,김범생,안국진,하충건,나정호 대한신경과학회 2006 대한신경과학회지 Vol.24 No.3

알츠하이머병 및 피질하허혈성혈관치매 환자들의 국소 뇌 부피 정량 비교

심용수,손영민,김범생,양동원 대한치매학회 2009 Dementia and Neurocognitive Disorders Vol.8 No.1

Background: The findings like the brain atrophy and ventricular dilatation can be also shown on magnetic resonance imaging (MRI) of the patients with subcortical ischemic vascular dementia (SIVD) as well as Alzheimer’s disease (AD), and some patients with SIVD have the pathology of AD. There have been also objected to that SIVD is not the true vascular dementia (VaD), but the mixed type with AD. We compared the regional volumes of the gray and white matters between AD and SIVD with the hypothesis that the brain atrophy of the patients with SIVD shown on MRI is a relative result from the atrophy of the white matter, not from the atrophy of the gray matter. Methods: Twelve AD patients and 13 SIVD patients were included in this study. Eleven controls without the cognitive impairment were also included. The volumes of the bilateral frontal, temporal, parietal areas, and the bilateral hippocampus and entorhinal cortex were obtained. After the correction with the ratio to the intracranial volume, the regional volumes were compared among AD, SIVD and the controls by analysis of variances with multiple comparisons. Results: Whole brain volume of the patients with AD was the smallest (p=0.042). The ventricular volumes of the patients with AD and SIVD were smaller than that of the controls (p=0.001). For the volumes of frontal, temporal and parietal regions were not different. The volumes of the bilateral hippocampus (p=0.009) and entorhinal cortex (p=0.002 in the right side and p=0.001 in the left side) were the lowest in the AD patients. The left entorhinal cortex of AD patients was smaller also compared to that of SIVD. Conclusions: The brain atrophy and the ventricular dilatation can be observed in SIVD as well as in AD. However, these findings of SIVD are not from the cortical atrophy such as the hippocampus and entorhinal cortex, which is responsible for AD, and might be from the lesions of the white matters. Background: The findings like the brain atrophy and ventricular dilatation can be also shown on magnetic resonance imaging (MRI) of the patients with subcortical ischemic vascular dementia (SIVD) as well as Alzheimer’s disease (AD), and some patients with SIVD have the pathology of AD. There have been also objected to that SIVD is not the true vascular dementia (VaD), but the mixed type with AD. We compared the regional volumes of the gray and white matters between AD and SIVD with the hypothesis that the brain atrophy of the patients with SIVD shown on MRI is a relative result from the atrophy of the white matter, not from the atrophy of the gray matter. Methods: Twelve AD patients and 13 SIVD patients were included in this study. Eleven controls without the cognitive impairment were also included. The volumes of the bilateral frontal, temporal, parietal areas, and the bilateral hippocampus and entorhinal cortex were obtained. After the correction with the ratio to the intracranial volume, the regional volumes were compared among AD, SIVD and the controls by analysis of variances with multiple comparisons. Results: Whole brain volume of the patients with AD was the smallest (p=0.042). The ventricular volumes of the patients with AD and SIVD were smaller than that of the controls (p=0.001). For the volumes of frontal, temporal and parietal regions were not different. The volumes of the bilateral hippocampus (p=0.009) and entorhinal cortex (p=0.002 in the right side and p=0.001 in the left side) were the lowest in the AD patients. The left entorhinal cortex of AD patients was smaller also compared to that of SIVD. Conclusions: The brain atrophy and the ventricular dilatation can be observed in SIVD as well as in AD. However, these findings of SIVD are not from the cortical atrophy such as the hippocampus and entorhinal cortex, which is responsible for AD, and might be from the lesions of the white matters.

Clinical Application of Plasma Neurofilament Light Chain in a Memory Clinic: A Pilot Study

심용수 대한치매학회 2022 Dementia and Neurocognitive Disorders Vol.21 No.2

Background and Purpose: Neurofilament light chain (NfL) has been considered as a biomarker for neurodegenerative diseases including Alzheimer’s disease (AD). We measured plasma NfL levels in older adults with cognitive complaints and evaluated their clinical usefulness in AD. Methods: Plasma levels of NfL, measured by using the single molecule array method, were acquired in a total of 113 subjects consisting of subjective cognitive decline (SCD; n=14), mild cognitive impairment (MCI; n=37), or dementia of Alzheimer type (DAT; n=62). Plasma NfL level was compared among three groups, and its association with cognitive and functional status was also analyzed. Results: After adjusting for age, plasma NfL level was higher in subjects with DAT (65.98±84.96 pg/mL), compared to in subjects with SCD (16.90±2.54 pg/mL) or MCI (25.53±10.42 pg/mL, p=0.004). NfL levels were correlated with scores of the mini-mental state examination (r=−0.242, p=0.021), clinical dementia rating (CDR) (r=0.291, p=0.005), or CDR-sum of boxes (r=0.276, p=0.008). Just for participants who performed amyloid positron emission tomography (PET), the levels were different between subjects with PET (−) (n=17, 25.95±13.25 pg/mL) and PET (+) (n=16, 63.65±81.90 pg/mL, p=0.010). Additionally, plasma NfL levels were different between vascular dementia and vascular MCI, and between Parkinson’s disease- dementia and no dementia. Conclusions: This pilot study shows that in subjects with DAT, plasma NfL levels increase. Plasma NfL level correlated with cognitive and functional status. Further longitudinal studies may help to apply the plasma NfL levels to AD, as a potential biomarker for the diagnosis and predicting progression.

호주 타워크레인기사노동자의 노동조건 견학기

심용수 한국비정규노동센터 2004 비정규 노동 Vol.33 No.-

Literacy Independent Cognitive Assessment: Assessing Mild Cognitive Impairment in Older Adults with Low Literacy Skills

심용수,류희진,이동우,이준영,정지향,최성혜,한설희,유승호 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.3

ObjectiveaaComprehensive neuropsychological tests are important in the diagnosis and follow-up of patients with MCI; however, most were developed without consideration of illiteracy. We developed the Literacy Independent Cognitive Assessment (LICA) as a comprehensive neuropsychological assessment battery applicable to older adults who are either literate or illiterate. This study aimed to assess the reliability and validity of the LICA for diagnosis of MCI. MethodsaaNormal controls (n=634) and patients with MCI (n=128) were recruited from 13 centers were included in this study. Participants were divided into illiterate or literate groups, based on their performance on a brief reading and writing test. The LICA, Korean Mini-Mental State Examination (K-MMSE), and Seoul Neuropsychological Screening Battery (SNSB) were administered. ResultsaaTotal LICA scores distinguished MCI patients from controls (p<0.001). They were closely and positively correlated to the KMMSE scores (r=0.632, p<0.001) but negatively correlated to clinical dementia rating (CDR) (r=-0.358, p<0.001) and CDR sum of boxes (r=-0.339, p<0.001). Area under the receiver operating characteristic curve for patients with MCI by total LICA score was 0.827 (0.783- 0.870), superior to that presented by the K-MMSE. For the classification of MCI subtypes, inter-method reliability of LICA with the SNSB was good (κ 0.773; 0.679–0.867, p<0.001). ConclusionaaThe results of this study show that the LICA may be reliably used to distinguish MCI patients from cognitively intact adults, to identify MCI subtypes and monitor progression toward dementia, regardless of illiteracy.

Clinical Predictors for Mild Cognitive Impairment Progression in a Korean Cohort

심용수,양동원,윤보라,이윤환,홍창형,서상원,윤수진,정지향,박문호,최성혜,김성윤 대한치매학회 2016 Dementia and Neurocognitive Disorders Vol.15 No.3

Background and Purpose Patients with mild cognitive impairment (MCI) and their caregivers are concerned with the likelihood andtime course of progression to dementia. This study was performed to identify the clinical predictors of the MCI progression in a Korean registry,and investigated the effects of medications without evidence, frequently prescribed in clinical practice. Methods Using a Korean cohort that included older adults with MCI who completed at least one follow-up visit, clinical characteristics andtotal medical expenses including prescribed medications were compared between two groups: progressed to dementia or not. Cox proportionalhazards regression analysis was conducted. Results During the mean 1.42±0.72 years, 215 (27.63%) of 778 participants progressed to dementia. The best predictors were age [hazardratio (HR), 1.036; 95% confidence interval (CI), 1.006–1.067; p=0.018], apolipoprotein ε4 allele (HR, 2.247; 95% CI, 1.512–3.337; p<0.001),Clinical Dementia Rating scale-sum of boxes scores (HR, 1.367; 95% CI, 1.143–1.636; p=0.001), Instrumental Activities of Daily Living scores(HR, 1.035; 95% CI, 1.003–1.067; p=0.029), and lower Mini-Mental State Examination scores (HR, 0.892; 95% CI, 0.839–0.949; p<0.001). Totalmedical expenses were not different. Conclusions Our data are in accordance with previous reports about clinical predictors for the progression from MCI to dementia. Totalmedical expenses were not different between groups with and without progression.

알츠하이머병 및 혈관성치매 환자에서 렘난트양지질단백콜레스테롤의 증가: 예비 연구

심용수,심동석,윤보라,신혜은,박상희,강지민,양동원 대한치매학회 2010 Dementia and Neurocognitive Disorders Vol.9 No.3

Background: Cerebrovascular disease has been suggested as one of the mechanisms to explain the pathogenesis of Alzheimer’s disease (AD) as well as vascular dementia (VaD). Although remnant lipoprotein (RLP) is strongly atherogenic and known as an independent risk factor of cardiovascular disease, there are few studies on the role in cerebrovascular disease. We conducted this study to evaluate the association between RLP and dementia, in terms of vascular etiology. Methods: Subjects were classified into 3 groups of control, AD and VaD. Plasma RLP cholesterol (RLP-C) concentrations were measured by the immunoseparation method. A total of 173 participants, who were 87 ADs, 28 VaDs, and 58 controls, were analyzed and age-matched. Results: RLP-C level was elevated in VaD (11.95±6.67 mg/dL) and AD (10.04±5.90 mg/dL)groups more than in control (6.31±5.18 mg/dL) (p<0.001, ANCOVA). In addition to the control for age, the findings were also independent of the levels of triglyceride (TG), total cholesterol,low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The elevation of RLP-C level in AD and VaD was further distinct in subjects with normotriglyceridemia (p=0.001,ANCOVA). Conclusions: Our results demonstrated that RLP-C is elevated in VaD and AD, and can overcome the limitation of TG with heterogenous atherogenic particles. RLP-C might be a useful marker to indicate the cerebrovascular disease with large vessel problem.