The Closing-in Phenomenon in Alzheimer's Disease and Vascular Dementia

Chin, Juhee,Lee, Byung Hwa,Seo, Sang Won,Kim, Eun-Joo,Suh, Mee K.,Kang, Sue J.,Na, Duk L. Korean Neurological Association 2005 Journal of Clinical Neurology Vol.1 No.2

<P><B>Background and Purpose</B></P><P>The closing-in phenomenon is the tendency to draw near or on the target when copying figures, which has been found mostly in patients with Alzheimer's disease (AD). We attempted to quantify the degree of closing-in and to compare it between patients with AD and vascular dementia (VaD).</P><P><B>Methods</B></P><P>The subjects (55 AD, 39 VaD and 38 normal controls) were asked to copy the figure of alternating square and triangle, starting at the designated point and continuing from left to right. The patients with AD and VaD did not differ in age, education, severity of dementia or Rey Complex Figure Test copy score. The proximity (Y-axis) of the subject's drawing to the target was plotted at intervals of 2 mm along the X-axis and the degree of closing-in was computed from the slope of the regression line.</P><P><B>Results</B></P><P>The AD and VaD patients showed a steeper slope than the controls. There was no significant difference, however, in the magnitude of closing-in of the AD and VaD patients. When closing-in was defined as a slope that was greater than the mean+2SD of the slope observed for the controls, 32.7% of the AD and 25.6% of the VaD patients showed closing-in.</P><P><B>Conclusions</B></P><P>Our study, using a new method of measuring the degree of closing-in, suggests that this phenomenon is not specific to AD.</P>

서동증과 의지감소증으로 발현한 간성 뇌병증 : 증례보고

문소영,정용,강수진,진주희,나덕렬 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.1

We report a 70-year-old woman who, without a prior history of liver disease, presented abulia and bradykinesia as the initial symptoms of hepatic encephalopathy (HE). Neurological examination showed bilateral extensor plantar responses in addition to mild parkinsonian features On neuropsychological tests, she was impaired at the attention, visuospatial function, memory, and frontal lobe function. Laboratory tests were remarkable for increased AST and ammonia, and positive igG HbcAb. The results of ultrasonography of the liver were consistent with chronic liver disease. Brain T1 weighted MRI revealed a high signal intensity in bilateral basal ganglia. Brain PET showed diffuse cerebral hypometabolism After treatment with oral lactulose, the above symptoms remained improved for the next 6-month of follow-up From this case, we learned that hepatic encephalopathy could be a reversible cause of dementia plus parkinsonism even in patients without a prior history of chronic liver disease.

운동신경원성 질환을 동반한 전두측두엽치매의 임상양상과 신경심리소견

박기정,정용,김은주,진주희,강수진,나덕렬 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.1

Backgrounds:Frontotemporal dementia (FTD) is rarely associated with motor neuron disease (MND). This comorbidity (FTD-MND), a subtype of FTD, results in progressive dementia and muscle weakness. Among the few available reports of series of patients, however, there have been controversies about the clinical course of FTD-MND. This study, the first report of a series of FTD-MND patients in Korea, investigated demographic and clinical features, clinical course, and neuropsychological findings of nine patients with FTD-MND. Methods:Nine FTD-MND patients (2 men and 7 women with mean age 55.6±7.2 years) were selected among 45 FTD patients who met the FTD criteria proposed by the Lund and Manchester Groups. Their clinical and neuropsychological findings were analyzed retrospectively. Results:Mean age of onset was 54.3±8.0 years. The time interval from onset to death was 27±11.3 months. Presenting symptoms were personality change, hyperphagia, nonfluent speech or motor weakness. In most cases (8/9), dementia preceded the muscle weakness;in only one patient the muscle weakness preceded the cognitive decline. Regarding the muscle weakness, bulbar symptoms occurred earlier than limb weakness in four patients;bulbar and limb weakness occurred simultaneously in another four patients;in the remaining one patient limb weakness preceded bulbar weakness. Neuropsychologic tests showed no specific patterns but diffuse dysfunction in all cognitive domains. Conclusions:Our study suggests that FTD-MND predominantly affects the bulbar muscles rather than the limb muscles in early stage and symptoms related to MND occurs later than those related to FTD. The time from diagnosis to death was 10.6±6.5 months, suggesting that FTD-MND is a rapidly progressive disease. This rapid clinical course may account for our neuropsychological findings that showed general cognitive deficits father than predominant frontal dysfunctions.

알쯔하이머병 환자에서 Capgras 증후군 3예

강수진,정용,진주희,윤수진,나덕렬 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.2

Capgras′ syndrome, one form of the selusional misidentification syndromes, is the delusional belief in the existence of 'doubles' or 'impostors' of significant people in a patient′s life Capgras′ syndrome has been considered to be associated with psychiatric disorders other than dementia however, many recent studies have reported that this syndrome emerges frequently during the course of organic diseases such as Alzheimer′s disease Despite numerous reports about Capgras′ syndrome. there have been only two case reports in Korea. in which Capgras′ syndrome was caused by non-Alzheimer′s disease. We described detailed history of three patients with capgras′ syndrome associated with Alzheimer′s disease These three patientswere in the early stage of Alzheimer′s disease (CDR 1 or CDR 0 5) When they showed Capgras′ syndrome. Target people for the delusional misbelief in all three patients were the spouses who were believed as 'a thief' or 'a stranger' in case 1, 'a stranger' in case 2, 'a mother or a father' in case 3. Two of the three patients also had negative emotion toward their husbands. Capgras′ syndrome in our cases was accompanied by other behavior disturbances that included delusion of 'one's house not being one's home', paranoid delusion, and aggressiveness in case 1, Capgras' syndrome disappeared spontaneously one year later. In contrast. in case 2 and 3, Capgras' syndrome persisted for three years and two years respectively, despite treatment with olanzapine Our detailed description of the patients' symtoms and their caregivers' response verbatim wound help Korean clinicians to manage the patients with Capgras' syndrome and to educate their caregivers.

마비된 왼쪽 팔을 아기 팔이라고 주장하는 여자 환자 : 증례보고 A Case Report

정용,강수진,진주희,나덕렬 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.1

We report a 61-year-old woman with left hemispatial neglect, anosognosia for hemiplegia, asomatognosia, and confabulation following a right posterior artery territory infarction. Interestingly, she believed that her plegic left arm belonged to her grandson or sometimes was her grandson himself (personification). We investigated possible underlying explanations for this personification, which included autotopagnosia, body schema delusion, visuoperceptual deficit, and asomatognosia theories. Among these, a combination of asomatognosia ("This arm is not mine") and confabulation ("This arm belongs to my grandson") may best account for the personification phenomenon in our patient.

Racial differences in COPD patients with smoking history: Analysis of 2 nationwide cohort studies from the KOCOSS and COPDGene studies

( Hye Yun Park ),( Hyun Lee ),( Danbee Kang ),( Chin Kook Rhee ),( Juhee Cho ),( Kwang Ha Yoo ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: COPD is characterized by persistent respiratory symptoms and airflow limitation but, the clinical presentations of COPD appear to be substantially different by ethnicity. This study aims to characterize profiles of COPD patients with smoking history in different ethnic group. Methods: COPD patients aged 45 or older with at least 10 pack-year smoking history from The Korean COPD Subtype Study (KOCOSS) (n=1,772) and The Genetic Epidemiology of COPD (COPDGene) Study (3,461 non-Hispanic whites (NHW) and 1,016 African Americans (AA)) were analyzed to compare the clinical characteristics by race. Results: Koreans were older (69.6 years) than NHW and AA (64.3 and 58.6 years, respectively) and had higher prevalence of males (97.2%) than NHW and AA (56.3% and 54.6%, p <0.01). The prevalence of current-smokers was highest among AA (65.6%), followed by NHW (36.9%), and Koreans (27.9%, p <0.01). The average body mass index (BMI) of NHW and AA was similar (27.9 kg/m2 for both), but Koreans had significantly lower BMI (22.4 kg/m2, p < 0.01). The proportion of subjects with cough and phlegm >3 months in the previous year were higher in NHW (42.9% and 39.4%, respectively) than AA (36.2% and 36%, respectively) and Koreans (21.4% and 30.8%, respectively, p <0.01 for both). The mean St. George’s Respiratory Questionnaire (SGRQ) total score was highest among AA (40.1±24.2), followed by NHW (35.9±22.4), and Koreans (35.3±21.0, p <0.01). Conclusions: Clinical profiles varied significantly by race among COPD patients with smoking history. Different strategies may be required for the optimal management of COPD in different race.

Survival of Alzheimer's Disease Patients in Korea

Go, Seok Min,Lee, Kang Soo,Seo, Sang Won,Chin, Juhee,Kang, Sue J.,Moon, So Young,Na, Duk L.,Cheong, Hae-Kwan S. Karger AG 2013 Dementia and geriatric cognitive disorders Vol.35 No.3

<P>Abstract</P><P><B><I>Background/Aims:</I></B> The natural history of Alzheimer's disease (AD) has rarely been studied in the Korean population. Our study on survival analyses in Korean AD patients potentially provides a basis for cross-cultural comparisons. <B><I>Methods:</I></B> We studied 724 consecutive patients from a memory disorder clinic in a tertiary hospital in Seoul, who were diagnosed as having AD between April 1995 and December 2005. Deaths were identified by the Statistics Korea database. The Kaplan-Meier method was used for survival analysis, and a Cox proportional hazard model was used to assess factors related to patient survival. <B><I>Results:</I></B> The overall median survival from the onset of first symptoms and from the time of diagnosis was 12.6 years (95% confidence interval 11.7-13.4) and 9.3 years (95% confidence interval 8.7-9.9), respectively. The age of onset, male gender, history of diabetes mellitus, lower Mini-Mental State Examination score, and higher Clinical Dementia Rating score were negatively associated with survival. There was a reversal of risk of AD between early-onset and later-onset AD, 9.1 years after onset. <B><I>Conclusions:</I></B> The results of our study show a different pattern of survival compared to those studies carried out with western AD populations. Mortality risk of early-onset AD varied depending on the duration of follow-up.</P><P>Copyright © 2013 S. Karger AG, Basel</P>

COPD and lung cancer incidence in never smokers: A cohort study

( Sun Hye Shin ),( Hye Yun Park ),( Danbee Kang ),( Kwang Ha Yoo ),( Chin Kook Rhee ),( Gee Young Suh ),( Hojoong Kim ),( Young Mog Shim ),( Juhee Cho ),( O Jung Kwon ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

There has been limited evidence for the association between COPD and incidence of lung cancer among never smokers. We aimed to estimate the risk of lung cancer incidence in never smokers with COPD, and to compare it with the risk associated with smoking. Cohort study of 338,548 subjects 40 to 84 years of age with no history of lung cancer at baseline enrolled in the National Health Insurance Service National Sample Cohort. During 2,355,005 personyears of follow-up (median follow-up 7.0 years), 1,834 participants developed lung cancer. Compared to never smokers without COPD, the fully-adjusted hazard ratios for lung cancer in never smokers with COPD, ever smokers without COPD, and ever smokers with COPD were 2.67, 1.97, and 6.19, respectively. In this large national cohort study, COPD was also a strong independent risk factor for lung cancer incidence in never smokers, implying that COPD patients are at high risk of lung cancer, irrespective smoking status.

Executive Summary of the 2021 International Conference of Korean Dementia Association: A Report From the Academic Committee of the Korean Dementia Association

박기형,장재원,Suh Jeewon,Yi SangHak,배재성,Lim Jae-Sung,Lee Hyon,Chin Juhee,Park Young Ho,Hong Yun Jeong,김건하 대한치매학회 2022 Dementia and Neurocognitive Disorders Vol.21 No.2

Recently, aducanumab, a beta amyloid targeted immunotherapy, has been approved by the US Food and Drug Administration for the treatment of Alzheimer’s dementia (AD). Although many questions need to be answered, this approval provides a promising hope for the development of AD drugs that could be supported by new biomarkers such as blood-based ones and composite neuropsychological tests that can confirm pathologic changes in early stages of AD. It is important to elucidate the complexity of AD which is known to be associated with other factors such as vascular etiologies and neuro-inflammation. Through the second international conference of the Korean Dementia Association (KDA), researchers from all over the world have participated in the exchange of opinions with KDA members on the most up-to-date topics. The Academic Committee of the KDA summarizes lectures to provide the depth of the conference as well as discussions. This will be an important milestone to widen the latest knowledge in the research of AD’s diagnosis, therapeutics, pathogenesis that can lead to the establishment of future directions.

간질성 가성치매 1예

조형인,정용,강수진,진주희,윤수진,서대원,나덕렬 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.2

Epileptic pseudodementia refers to a condition in which elderly patient with memory disturbance due to unrecognized complex partial seizures Memory disturbances in these patients can manifest in two ways discrete episodes of amnesia, or an insidious fluctuating course of memory dysfunction, simulating dementia Cases of epileptic pseudodementia have rarely been reported so far We herein report a patient who presented with progressive dementia and personality change associated with complex partial seizure A 68-year old previously healthy man with 16 years of school education visited our memory disorder clinic because of memory disturbance and changes in personality These symptoms developed insidiously and progressed quite rapidity over 6 months without fluctuation. Detailed history revealed that the occasionally mumbled or smacked his lips with facial flushing during watching TV or conversation Neurological examinations were within normal limits except for the decreased MMSE score (21/30) Neuropsychological tests were significant for profound memory loss accompaned by mild anomia and frontal executive dysfunction Brain MRI showed high signal intensities in bilateral (left worse than right) hippocampus and amygdala on T2W1 and FLAIR images Brain F18-FDG PET revealed focal hypermetabolism in the left mesial temporal area Intial surface EEG was normal but prolonged EEG monitoring showed intermittent epileptiform discharges originating from the left temporal lobe Despite seizure-free state after treatment with antiepileptic drug. his cognitive impairments persisted for about 13 months and then began to improve gradually Unlike the previous epileptic pseudodementia cases who had only memory disturbance. our case showed dementia associated with complex partial seizures We learn from this case that possibility of epileptic pseudodementia should be considered when elderly patient with memory disturbance or dementia of atypical course especially because complex partial seizure is often unrecognized without detailed history and epileptic pseudodementia is a reversible cause of memory dysfunction.