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.

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.

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.

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.