Tau PET in Alzheimer disease and mild cognitive impairment

Cho, Hanna,Choi, Jae Yong,Hwang, Mi Song,Lee, Jae Hoon,Kim, You Jin,Lee, Hye Mi,Lyoo, Chul Hyoung,Ryu, Young Hoon,Lee, Myung Sik Ovid Technologies (Wolters Kluwer) - American Acad 2016 Neurology Vol.87 No.4

<P>Objective:To investigate the topographical distribution of tau pathology and its effect on functional and structural changes in patients with Alzheimer disease (AD) and mild cognitive impairment (MCI) by using F-18-AV-1451 PET.Methods:We included 20 patients with AD, 15 patients with MCI, and 20 healthy controls, and performed neuropsychological function tests, MRI, as well as F-18-florbetaben (for amyloid) and F-18-AV-1451 (for tau) PET scans. By using the regional volume-of-interest masks extracted from MRIs, regional binding values of standardized uptake value ratios and volumes were measured. We compared regional binding values among 3 diagnostic groups and identified correlations among the regional binding values, performance in each cognitive function test, and regional atrophy.Results:F-18-AV-1451 binding was increased only in the entorhinal cortex in patients with MCI, while patients with AD exhibited greater binding in most cortical regions. In the 35 patients with MCI and AD, F-18-AV-1451 binding in most of the neocortex increased with a worsening of global cognitive function. The visual and verbal memory functions were associated with the extent of F-18-AV-1451 binding, especially in the medial temporal regions. The F-18-AV-1451 binding also correlated with the severity of regional atrophy of the cerebral cortex.Conclusions:Tau PET imaging with F-18-AV-1451 could serve as an in vivo biomarker for the evaluation of AD-related tau pathology and monitoring disease progression. The accumulation of pathologic tau is more closely related to functional and structural deterioration in the AD spectrum than -amyloid.</P>

Premature intracranial arterial calcification in a patient with hyperhomocysteinemia

Nah, H.-W.,Kim, J. S. Ovid Technologies (Wolters Kluwer) - American Acad 2010 Neurology Vol.75 No.24

Neuroanatomic basis of amnestic MCI differs in patients with and without Parkinson disease

Lee, J. E.,Park, H.- J.,Song, S. K.,Sohn, Y. H.,Lee, J. D.,Lee, P. H. Ovid Technologies (Wolters Kluwer) - American Acad 2010 Neurology Vol.75 No.22

<P>OBJECTIVE: To explore the neuroanatomic basis of amnestic mild cognitive impairment (aMCI) in patients with Parkinson disease (PD; aMCI-PD(+)) and without PD (aMCI-PD(-)). METHODS: A total of 119 patients with aMCI (aMCI-PD(-), n = 78, and aMCI-PD(+), n = 41) underwent T1-weighted MRI, and the image data were analyzed using voxel-based morphometry. RESULTS: No significant differences in demographic characteristics or general cognition were found between patients with aMCI-PD(-) and aMCI-PD(+). Comparisons of neuropsychological tests between groups revealed that patients with aMCI-PD(-) had lower scores in delayed verbal and visual recognition memory, whereas visuospatial dysfunction was more severe in patients with aMCI-PD(+). Gray matter (GM) density in the right temporal and posterior cingular cortices was significantly lower in the aMCI-PD(-) group compared with controls. In contrast, GM density in the aMCI-PD(+) group was significantly lower in the precuneus and left prefrontal and primary motor areas relative to controls. A direct comparison between groups showed that decreased GM density in aMCI-PD(-) relative to aMCI-PD(+) was localized in the right temporal and anterior prefrontal areas, whereas decreased GM density in aMCI-PD(+) relative to aMCI-PD(-) was involved in the bilateral precuneus, left primary motor, and right parietal areas. Memory decline was correlated with temporal area atrophy in aMCI-PD(-) and with posterior cingulate cortex atrophy in aMCI-PD(+). CONCLUSIONS: Our data suggest that different neuroanatomic systems underlie memory dysfunction in patients with aMCI-PD(-) and aMCI-PD(+).</P>

White matter lesions and poor outcome after intracerebral hemorrhage: A nationwide cohort study

Lee, S. H.,Kim, B. J.,Ryu, W. S.,Kim, C. K.,Kim, N.,Park, B. J.,Yoon, B. W. Ovid Technologies (Wolters Kluwer) - American Acad 2010 Neurology Vol.74 No.19

<P>BACKGROUND: The ability to predict poor outcome is important for patient care and treatment decision-making in cases of intracerebral hemorrhage (ICH). Previous studies have included relatively brief follow-up periods and small numbers of patients, and are limited in terms of considerations regarding individual brain vulnerabilities. METHODS: The authors prospectively enrolled 1,321 ICH patients nationwide from 33 hospitals. Clinical, laboratory, and imaging variables, including white matter lesions (WMLs), were collected at admission. Immediate outcome after ICH was measured using total Glasgow Coma Scale (GCS) score at admission, early outcome using 30-day mortality, and long-term outcome using relative risk for mortality. The vital status of included patients was ascertained on December 31, 2006, using Korean National Death Certificates (mean follow-up, 32.6 months). RESULTS: Of the 1,321 ICH patients included, 352 (27.8%) presented with a moderate GCS score (8.5-12.4) and 249 (19.7%) with a severe GCS score (</=8.4). The mortality rate was 9.1% at day 30 post-ICH and 381 patients (29.8%) had died up to the end of December 2006. Extensive WMLs were associated with severe GCS scores at admission (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.73-3.46), 30-day mortality (OR 2.52, 95% CI 1.33-4.75), and the relative risk for mortality (RR 2.61, 95% CI 1.79-3.82) after adjusting for relevant covariates. CONCLUSIONS: These findings suggest that white matter lesions, which may reflect the vulnerability of individual brains to pathologic insults, should be considered when assessing immediate, early, and long-term outcomes after intracerebral hemorrhage.</P>

Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke

Cho, A. -H.,Lee, S. B.,Han, S. J.,Shon, Y. -M.,Yang, D. -W.,Kim, B. S. Ovid Technologies (Wolters Kluwer) - American Acad 2009 Neurology Vol.73 No.20

<P>BACKGROUND: We investigated the association between the presence of cerebral microbleeds and poor kidney function in patients with acute ischemic stroke. METHODS: We retrospectively examined consecutive acute ischemic stroke patients who underwent gradient echo MRI. The presence of cerebral microbleeds on gradient echo MRI was independently interpreted. The number and location of microbleeds were assessed. Demographics including age, sex, risk factors, and stroke subtype were obtained. Kidney function was estimated by measuring glomerular filtration rate (GFR) with the modification of diet in renal disease method. RESULTS: Of the 152 patients included, 45 (29.6%) patients had cerebral microbleeds on gradient echo MRI. The cerebral microbleeds were most commonly located in deep or infratentorial location (27/45 [60%]). Hypertension, presence of leukoaraiosis, old age, and low GFR were associated with the presence of cerebral microbleeds (p = 0.064, <0.001, 0.014, and <0.001). The mean GFR levels were lower in patients with cerebral microbleeds (65.15 +/- 22.54 vs 78.82 +/- 19.11 mL/min/1.73 m(2)). After the adjustment of risk factors, age, and sex, low GFR levels were associated with the presence of cerebral microbleeds (odds ratio, 3.85; 95% confidence interval, 1.52 to 9.76, p = 0.004). CONCLUSION: Impaired kidney function is associated with the presence of cerebral microbleeds in acute ischemic stroke.</P>

Teaching Video NeuroImages: Positional exophthalmos in orbital varices

Choi, K. -D.,Lee, H. -S.,Bae, J. -W.,Choi, H. Y.,Kim, H. -J. Ovid Technologies (Wolters Kluwer) - American Acad 2009 Neurology Vol.73 No.1

Reduced circulating angiogenic cells in Alzheimer disease

Lee, S-T,Chu, K.,Jung, K-H,Park, H-K,Kim, D-H,Bahn, J-J,Kim, J-H,Oh, M-J,Lee, S. K.,Kim, M.,Roh, J-K Ovid Technologies (Wolters Kluwer) - American Acad 2009 Neurology Vol.72 No.21

<P>OBJECTIVE: Neurovascular dysfunction and senescent endothelium contribute to the progression of Alzheimer disease (AD). Circulating angiogenic cells (CACs), such as endothelial progenitor cells (EPCs), provide a cellular reservoir for the endothelial replacement. To study the involvement of CACs in AD pathogenesis, we investigated the levels of CACs in patients with AD. METHODS: Consecutive patients with newly diagnosed AD (n = 55), patients with non-AD neurodegenerative diseases (n = 37), and nondemented risk factor control subjects (RF control, n = 55 and 37) were enrolled after matching for age, sex, and Framingham risk score. Peripheral blood samples were taken, and EPC colony-forming units (CFU-EPC) were cultured and counted. RESULTS: The patients with AD had significantly lower CFU-EPC than the RF controls. In the patients with AD, a lower CFU-EPC was independently associated with either a lower Mini-Mental State Examination score or a higher Clinical Dementia Rating scale score, indicating a greater reduction in CFU-EPC in advanced AD. Patients with non-AD neurodegenerative diseases did not show a significant decrease in CFU-EPC levels. CONCLUSION: Our results indicate that patients with Alzheimer disease (AD) have reduced circulating angiogenic cells, suggesting that an abnormal capacity to regenerate endothelium is associated with AD.</P>

Polyarteritis nodosa presenting with bilateral cavernous internal carotid artery aneurysms

Oh, M. S.,Kim, M. H.,Chu, M. K.,Yu, K. H.,Kim, K. H.,Lee, B. C. Ovid Technologies (Wolters Kluwer) - American Acad 2008 Neurology Vol.70 No.5

Osteopenia and osteoporosis in idiopathic benign positional vertigo

Jeong, S. H.,Choi, S. H.,Kim, J. Y.,Koo, J. W.,Kim, H. J.,Kim, J. S. Ovid Technologies (Wolters Kluwer) - American Acad 2009 Neurology Vol.72 No.12

<P>OBJECTIVE: Causes of benign positional vertigo (BPV) are mostly unknown. The aim of this study was to elucidate an association of osteoporosis with idiopathic BPV. METHODS: Two hundred nine consecutive patients with a confirmed diagnosis of idiopathic BPV underwent bone mineral densitometry of anterior-posterior lumbar spine and femur. The T scores were compared with those of 202 controls without a history of dizziness. Recurrence was defined when the patients reported two or more previous episodes of positional vertigo similar to those experienced at the time of diagnosis. RESULTS: In both women and men, the lowest T scores were decreased in patients with BPV compared with those in controls. Furthermore, the prevalences of osteopenia (-2.5 < T score < -1.0) and osteoporosis (T score < or =-2.5) were higher in both women and men with BPV than in controls. Multiple logistic regression analyses adjusted for age, sex, alcohol, smoking, and hyperphosphatemia showed that only the existence of osteopenia/osteoporosis was associated with an increased risk of BPV (adjusted odds ratio of osteopenia = 2.0, 95% confidence interval 1.2-3.4, p = 0.011; adjusted odds ratio of osteoporosis = 3.1, 95% confidence interval 1.4-7.2, p = 0.007). In women aged > or =45 years, the lowest T scores were also decreased in the recurrent group, compared with those in the de novo group. CONCLUSION: Osteopenia/osteoporosis may be associated with idiopathic benign positional vertigo (BPV). The effectiveness of measuring bone mineral densitometry and restoring normal calcium metabolism for preventing recurrences of BPV requires further validation.</P>

Prevalence of multiple sclerosis in Korea

Kim, N.- H.,Kim, H. J.,Cheong, H.- K.,Kim, B. J.,Lee, K. H.,Kim, E.- H.,Kim, E. A.,Kim, S.,Park, M. S.,Yoon, W. T. Ovid Technologies (Wolters Kluwer) - American Acad 2010 Neurology Vol.75 No.16

<P>OBJECTIVE: The aim of this study was to estimate the prevalence of multiple sclerosis (MS) in Korea through a nationwide survey. METHODS: We estimated the prevalence of MS in Korea using several sources collected between 2000 and 2005: verified cases from 38 major referral hospitals across the nation, the National Health Insurance (NHI) payment request data from NHI Corporation of Korea, and the national mortality dataset from Statistics Korea. We established a network of neurologists from 38 major referral hospitals and performed a nationwide hospital survey for MS cases. The diagnoses of MS were validated according to the McDonald criteria. The diagnostic validity of each hospital was evaluated from hospital survey data to reduce the uncertainty of NHI data and was applied to estimate the prevalence using novel statistical methods. RESULTS: The estimated numbers of MS cases in Korea through 2 different statistical methods which adjust NHI data by the diagnostic validity of each hospital were very similar: 1,681 (95% confidence interval [CI] 1,490-1,902) by the stratification method and 1,640 (95% CI 1,402-1,789) by the linear regression method. The crude MS prevalence was 3.5-3.6 cases per 100,000 individuals. The estimated female-to-male ratio was 1.26. CONCLUSION: This study is the first nationwide survey for the prevalence of MS in Korea utilizing a national database in complementary way. We found an increase in the prevalence of MS that is consistent with reports from neighboring Asian countries.</P>