복합 부분간질 환자에서 Clobazam의 추가치료

곽용태,백종삼,이준홍,조태영,박수철,이병인 대한신경과학회 1995 대한신경과학회지 Vol.13 No.4

Late-Onset Psychosis; Is It Real?

곽용태,양영순,구민성 대한치매학회 2015 Dementia and Neurocognitive Disorders Vol.14 No.1

The nature of late-onset psychosis in the absence of a dementia or secondary to organic dysfunctions in the fifth decade of life and beyond is contentious and unresolved. Different terminologies, diagnostic criteria and age cut-offs have been applied to late-onset psychosis, which have stymied clinicians and researchers. No official diagnostic designation for patients with late-onset psychosis is included in the current psychiatric diagnostic system (Diagnostic and Statistical Manual of Mental Disorders-V, International Classification of Diseases-10). The validity of this diagnostic exclusion has been questioned. Despite these problems, a relatively consistent clinical picture has reported. However, many questions remain regarding the underlying etiology, pathophysiological mechanisms, treatment and prognosis. Whether late-onset psychosis is distinct from schizophrenia and whether it might be a harbinger of dementia are unclear. Recent studies have suggested an underlying biological pathophysiology of late-onset psychosis.

확산강조 뇌자기공명영상에서 대뇌 피질 고영상 병변을 보이는 임상적으로 진단된 크로이츠펠트-야콥병 4예

곽용태,방오영,김옥준,김원주 대한신경과학회 2006 대한신경과학회지 Vol.24 No.6

A high signal in the cerebral cortex and/or basal ganglia on a diffusion-weighted MRI (DWI) has been described as a good diagnostic marker for sporadic Creutzfeldt-Jakob disease (sCJD). We report four cases of sCJD with atypical clinical presentations and ribbon-like areas of high signals in the cerebral cortex on DWI. DWI patterns of asymmetric cortical high signals in the cerebral cortex may offer the means for diagnosis of sCJD early in the course of the illness even when the clinical presentations are atypical.

The Relationship between Geriatric Depression Scale Structure and Cognitive-Behavioral Aspects in Patients with Alzheimer’s Disease

곽용태,송숙형,양영순 대한치매학회 2015 Dementia and Neurocognitive Disorders Vol.14 No.1

Background and PurposeAlthough the 15-item Geriatric Depression Scale (GDS15) is a widely used depression screening questionnaire, the implications of the GDS15 in patients with Alzheimer’s disease (AD) are questionable. We designed this study to explore the GDS15 factor structure and the relationships between these factors and cognitive-behavioral aspects. MethodsThe GDS15, cognitive function tests, and the Korean-Neuropsychiatry Inventory were administered to 310 patients with probable AD, who were not medicated before visiting the hospital. Three factors were identified by principal components analysis. A bivariate correlation analysis was conducted to determine the relationships between factors and neurocognitive and behavior symptoms. ResultsFactor 2 was correlated with the Korean Boston Naming Test, calculating ability, the go-no-go test, the Controlled Oral Word Association Test (COWAT), the Color Word Stroop Test (CWST; words and color), aggression, depression, and apathy. Factor 3 was correlated with calculating ability, the Seoul Verbal Learning Test, immediate recall, copy, and delayed recall on the Rey-Osterieth Complex Figure Test, contrasting on the COWAT, and words and delusion on the CWST. We identified three factors and revealed that the GDS15 may be comprised of a heterogeneous scale. ConclusionsThese results suggest that the GDS15 may be comprised of a heterogeneous scale and suggest multi-dimensional properties of the GDS15 in patients with AD.

알쯔하이머병의 단일 광전자 방출 뇌전산화 촬영에서 전형적인 유형과 관계를 보이는 요인

곽용태,한일우,방오영,박찬희,구민성 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.3

연구목적 : 최근 기능적 영상진단의 발전은 치매 환자의 진단에 많은 도움을 주고 있으며 이중 단일광자방출전산화단층촬영(SPECT ; single photon emission computed tomography)은 알쯔하이머 병의 특징적인 양측 두정측두엽의 혈류 감소를 보이므로 알쯔하이머 병의 진단에 많이 사용되어지고 있다. 본 연구는 알쯔하이머병의 SPECT 소견을 분석함으로써 알쯔하이머병의 진단에 있어서 SPECT 검사의 유용성 및 알쯔하이머병에서 전형적인 유형에 영향을 미치는 요인이 무엇인지를 규명한다. 방 법 : NINCDS-ADRDA진단 기준에 의거한 probable AD환자 26명을 대상으로 SPECT 검사를 시행하였으며 이중 14명은 전형적인 SPECT 소견을 보였으며 나머지 12명은 비전형적인 SPECT소견을 보였다. 치매의 정도는 Mini-Mental State Examination(MMSE)에 의하여 결정하였고 SPECT소견은 2명의 핵의학과 전문의의 합의에 의하여 정성적으로 판독하여 분석하였다. SPECT의 전형적인 소견과 연관이 있는 요소들을 확인하기 위하여 판별함수분석을 시행하였다. 결 과 : 알쯔하이머 환자에서 SPECT의 민감도는 53.8%이며, 조기 발병군의 경우에는 민감도가 76.9%이었다. 알쯔하이머의 전형적인 형태인 양측성 두정측두엽에 혈류량이 감소한 경우는 조기 발병군에서 유의하게 관찰되었으며, 이외에 이환기간, 교육정도, 성,병의 진행정도, 아포지단백E등은 유의한 연관성이 없었다. 결 론 : SPECT검사의 민감도는 높지 않으나 이를 조기 발병군에서만 적용하였을 경우 그 임상적 유용성이 높을 것으로 생각되며 조기 발병군에서 SPECT검사의 민감도가 만기 발병군에 비하여 유의하게 높은 것으로 보아 알쯔하이머병이 단일하지 않고 이질적인 집단의 증후군일 가능성이 높을 것으로 생각된다. 즉 SPECT검사가 알쯔하이머병의 진단뿐 아니라 병태생리적 기전의 이해에 도움이 될 것으로 생각되며 앞으로 정량화와 많은 중례를 확보하여 이에 대하여 좀더 규명할 필요가 있을 것으로 생각된다. Objectives : During the past few years, the development of functional brain imaging techniques has allowed to describe brain impairment in cognitive disorders. Among them, based on the observation of bilateral parietotemporal hypoperfusion in Alzheimer's disease(AD), single photon emission computed tomography(SPECT) is advocated by some as powerful diagnostic tool in the evaluation of demented patients. The aim of this study is to investigate the usefulness of SPECT in the diagnosis of AD and to clarify the associated factors of parietotemporal hypoperfusion, the typical SPECT pattern of Alzheimer's disease(AD). Methods : We reviewed the SPECT scans of 26 patients fulfilling NINCDS-ADRDA criteria for probable AD, 14 with typical pattern of SPECT and 12 with atypical pattern of SPECT. Dementia severity was assessed by the Mini-Mental State Examination. Inage interpretation was done visually by the consensus opinion of 2 experienced nuclear medicine physicians who were blind to clinical information. To estimate the association of typical pattern of SPECT with other variables of interest, discriminant function analysis was done. Results : Though the overall diagnostic sensitivity of SPECT in AD was 53.8%, it was 76.9%, in early-onset AD patients. Typical pattern of SPECT was more frequent in the patients with early onset on the symptoms. Duration of symptoms, duration of education, se, severity of disease was not associated with this SPECT pattern. Conclusion : These findings may be useful in the clinical setting and point to heterogeneity of AD according to age at onset.

콜린분해효소억제제 사용 중지 후 발생한 불연속증후군 2예

곽용태 대한신경과학회 2004 대한신경과학회지 Vol.22 No.4

Discontinuation syndrome is a cluster of symptoms that appear when a patient terminates long-term medication. We report 2 patients with Alzheimer's disease who developed significant behavioral disturbances after the cessation of cholinesterase inhibitors. Although the clinical profile of discontinuation syndrome in cholinesterase inhibitors are yet poorly defined, it may be of importance to consider this syndrome when patients develop significant behavioral disturbances after these agents are stopped, and if more severe reactions are expected, retrial of these agents may be prudent.

알쯔하이머병 환자에서 donepezil 치료 후 정량적 뇌파검사의 변화

곽용태,한일우,방오영 대한신경과학회 2001 대한신경과학회지 Vol.19 No.3

Gerstmann 증후군 증상의 동질성 -알쯔하이머병을 이용한 연구-

곽용태 대한신경과학회 2004 대한신경과학회지 Vol.22 No.1

It remains unclear whether the four signs of Gerstmann syndrome are a cluster because the neuronal nets responsible for these symptoms are closer together, or because they shares a common networks. If the latter is correct, then with degenerative disorders such as Alzheimer's disease, each sign associated with Gerstmann syndrome should correlate with the other three signs more closely than they correlate with other cognitive dysfunctions. Methods: Cluster and correlation analyses for various cognitive deficits including signs of Gerstmann syndrome were done among sixty-nine patients with probable Alzheimer's disease. Results: The four signs of Gerstmann syndrome did not cluster together. With the exception of calculation and writing, other signs including right-left orientation and finger naming placed in other groups and did not significantly correlate each other. Conclusions: A detailed statistical analysis of the tetrad showed that Gerstmann syndrome was not attributable to a common neuronal network, and the phenomenological association of the four signs may be related to the anatomical proximity of the different networks mediating these functions.

Understanding of Antipsychotics in Elderly Patients with Dementia

곽용태,양영순,Hye-ryeon Jang 대한치매학회 2015 Dementia and Neurocognitive Disorders Vol.14 No.2

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.

Citalopram 사용 후 발생한 각성시 이갈이 2예

곽용태,함동석,한일우,김형섭 대한정신약물학회 2006 대한정신약물학회지 Vol.17 No.2

Bruxism has been defined as an oral parafunctional activity characterized by clenching, bracing, gnashing and grinding of teeth while asleep and or awake. While bruxism has been associated with a number of neurological diseases, it has been mostly highlighted following drug medication. We report 2 female patients of awake bruxism after citalopram medication. The bruxism in these patients was completely or significantly improved after cessation of citalopram. We discuss the pathophyisological mechanism of bruxsm associated with selective serotonin reuptake inhibitors(SSRIs). These cases highlight that bruxism can occur in response to citalopram, as do in other SSRIs.