치매환자들의 운전실태: 노인성치매임상연구센터 연구

최성혜,이지욱,김수정,최준용,권지원,윤병남,김종헌,윤보라,양영순,김상윤,정지향 대한치매학회 2014 Dementia and Neurocognitive Disorders Vol.13 No.4

Background: There are few studies about driving and dementia in Korea. The purpose of this study is to investigate the real condition of automobile driving in patients with dementia and the characteristics of those who continue to drive after diagnosis of dementia. Methods: A total of 4,377 patients including 3,792 with Alzheimer’s disease and 585 with vascular dementia were recruited from multiple nationwide hospitals. Clinical evaluations and neuropsychological tests were done in them according to the protocol of the Clinical Research Center for Dementia of South Korea study. Caregivers replied which patients drove an automobile, gave up driving, or has never driven. The same evaluations of them were followed after one year. Results: There were 272 (6.2%) drivers, 321 (7.3%) ex-drivers, and 3,784 (86.5%) non-drivers with dementia. Drivers with dementia were younger and had higher Korean Mini-Mental State Examination (K-MMSE) (21.5±4.3 vs 19.8±5.1 vs 17.4±5.2, p<0.001) and lower Clinical Dementia Rating scale-Sum of Boxes (CDR-SB) scores (4.08±2.15 vs 5.80±3.41 vs 5.83±3.39, p<0.001) compared with ex-drivers and non-drivers with dementia. The drivers and ex-drivers with dementia had higher educational level and a higher proportion of male compared with non-drivers with dementia (77.6% vs 80.1% vs 23.3%, p<0.001). About 54.6% of the drivers with dementia continued to drive at one year after diagnosis of dementia. They had higher K-MMSE (23.2±3.6 vs 20.8±4.5, p=0.003) and lower CDR-SB scores (3.30±1.47 vs 4.40±1.85, p=0.001) at baseline compared with those who quitted driving after baseline. Conclusions: Male patients who were relatively young and had high educational level and mild dementia had a tendency to drive an automobile at that time of diagnosis of dementia. About half of them continued to drive after diagnosis of dementia.

근간대와 간질발작을 동반한 조발형 가족성 알쯔하이머병 환자 1예

안성기,이재홍 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.1

Early-onset familial Alzheimer's disease (EOFAD) is rare and autosomal-dominantly inherited disease by mutations in one of the following three known causative genes:amyloid precursor protein (APP) gene, presenilin-1 (PS1) and presenilin-2(PS2) genes. EOFAD tends to present clinically at a younger age (40-60 years) and myoclonus is recognized as a prominent and early clinical feature, particularly in chromosome 14-linked pedigrees with mutations in the PS1 gene, when myoclonus may be accompanied by seizures. We present a 44-year old man who developed progressive dementia and accompanied by myoclonus and recurrent seizure. His father and uncle had early-onset dementia at the fifth decade. He was pathologically confirmed as Alzheimer's disease. He had apolipoprotein E (ApoE) epsilon 3 allele and PS-1 mutation was not found.

동물의 기억 검사

한정수 대한치매학회 2004 Dementia and Neurocognitive Disorders Vol.3 No.2

Good animal models for memory impairments by aging or the diseases are necessary for the understanding of the fundamental cognitive mechanisms, and studying the causes of neurological diseases related memory disorders and the development of new drugs. It is widely accepted that the hippocampus and the related brain areas mediate declarative memory in humans. The rats with hippocampal damages fail to learn so called the hippocampal-dependant task', such as water maze task, radial arm maze and context fear conditioning. It was also pointed out that animal's strains and characteristics of memory task should be considered before the start of experiments for accessing memory nature or effects of a drug on the memory with rats or mice.

기억과 기능 자기공명영상 연구

강은주 대한치매학회 2004 Dementia and Neurocognitive Disorders Vol.3 No.2

To investigate neural substrates of memory, functional magnetic resonance imaging (fMRI) has been a useful functional neuroimaging tool which can be applied to young, old or patients quite safely with no limitation of repetition. In this paper, typical study designs, findings and research issues are introduced in review of how human memory function can be studied with fMRI. Discussed are also methodological considerations in clinical applications and recent findings in patients with memory problems, such dementia.

시계 그리기 검사의 채점방법에 따른 치매 및 경도인지장애 선별에 대한 신뢰도 및 타당도

이강수,정해관,오병훈,홍창형,이동우 대한치매학회 2009 Dementia and Neurocognitive Disorders Vol.8 No.1

Background: In order to evaluate the suitability of the clock drawing test (CDT) for a detection of dementia and mild cognitive impairment (MCI), we assessed interrater reliabilities, correlations, and validity of four common scoring methods of the CDT. Methods: The study subjects consisted of 524 community elderly aged between 60 and 85 yr. Clock drawings were scored independently and blindly by three raters according to four different methods (Freedman, Rouleau, Todd, and CERAD-CDT). Subjects were assessed of their cognitive function and activity of daily life. Dementia was assessed by a psychiatrist using DSM-IV or NINCDS-ADRDA criteria. Sensitivity and specificity of the each scoring methods was estimated. By comparing area under the curve, the diagnostic efficiency of the CDT methods for dementia and MCI were evaluated. Results: Inter-rater and intra-rater reliabilities were high for all four scoring methods. The area under the curve was 82.0-89.7% for the dementia and 65.3-66.9% for the mild cognitive impairment. Sensitivity of clock drawing test was between 0.75 and 0.85 for dementia and 0.41 and 0.85 for mild cognitive impairment, and specificity was between 0.80 and 0.84 for dementia and 0.43 and 0.83 for mild cognitive impairment. Conclusions: The reliability and validity of CDT for dementia and MCI in the elderly living in the community was not high. Therefore, CDT is not recommended to be used alone to screen for possible prodromal stages of dementing illnesses and dementia.

원발성 정상압수두증 환자의 국소 뇌혈류 변화 : Statistical Parametric Mapping을 이용한 SPECT 분석

윤보라,양동원,심용수,김범생,손영민,정성우,정용안,손형선 대한치매학회 2007 Dementia and Neurocognitive Disorders Vol.6 No.1

Background and Objectives: Idiopathic normal pressure hydrocephalus (iNPH) is a reversible condition characterized by gait disturbance, urinary incontinence, and dementia. This study investigates the neuropsychological characteristics and changes of regional cerebral blood flow (CBF) in patients with iNPH. Methods: Ten patients with iNPH and thirteen normal control subjects were evaluated. The general cognitive function and detailed neuropsychological functions were measured by the Korean mini-mental status examination (K-MMSE) and a comprehensive neuropsychological battery. Patients who showed clinical improvement in at least one clinical domain after CSF drainage were included. 99mTc-ECD(ethyl cysteinate dimmer) SPECT was performed to measure the regional CBF and the statistical parametric mapping (SPM) 99 software was applied for the objective analysis of SPECT data. Results: On the neuropsychological examination, all patients showed abnormalities in memory, psychomotor speed, and frontal executive function. SPM analysis of SPECT images revealed significantly decreased CBF in the bilateral thalami, right prefrontal area, anterior and posterior cingulate gyri, right caudate nucleus, and left parahippocampal gyrus in patients with iNPH compared to those of normal controls (uncorrected p=0.005). Conclusions: Neuropsychological abnormalities and CBF changes suggest that the prefrontal and subcortical areas may be associated with cognitive dysfunctions in patients with iNPH. Background and Objectives: Idiopathic normal pressure hydrocephalus (iNPH) is a reversible condition characterized by gait disturbance, urinary incontinence, and dementia. This study investigates the neuropsychological characteristics and changes of regional cerebral blood flow (CBF) in patients with iNPH. Methods: Ten patients with iNPH and thirteen normal control subjects were evaluated. The general cognitive function and detailed neuropsychological functions were measured by the Korean mini-mental status examination (K-MMSE) and a comprehensive neuropsychological battery. Patients who showed clinical improvement in at least one clinical domain after CSF drainage were included. 99mTc-ECD(ethyl cysteinate dimmer) SPECT was performed to measure the regional CBF and the statistical parametric mapping (SPM) 99 software was applied for the objective analysis of SPECT data. Results: On the neuropsychological examination, all patients showed abnormalities in memory, psychomotor speed, and frontal executive function. SPM analysis of SPECT images revealed significantly decreased CBF in the bilateral thalami, right prefrontal area, anterior and posterior cingulate gyri, right caudate nucleus, and left parahippocampal gyrus in patients with iNPH compared to those of normal controls (uncorrected p=0.005). Conclusions: Neuropsychological abnormalities and CBF changes suggest that the prefrontal and subcortical areas may be associated with cognitive dysfunctions in patients with iNPH.

White Matter Lesions Predominantly Located in Deep White Matter Represent Embolic Etiology Rather Than Small Vessel Disease

Jung Young Hee,Park Seongbeom,Lee Na Kyung,Han Hyun Jeong,Jang Hyemin,Kim Hee Jin,Seo Sang Won,Na Duk Lyul 대한치매학회 2023 Dementia and Neurocognitive Disorders Vol.22 No.1

Background and Purpose: We investigated the correlation between the deep distribution of white matter hyperintensity (WMH) (dWMH: WMH in deep and corticomedullary areas, with minimal periventricular WMH) and a positive agitated saline contrast echocardiography result. Methods: We retrospectively recruited participants with comprehensive dementia evaluations, an agitated saline study, and brain imaging. The participants were classified into two groups according to WMH-distributions: dWMH and dpWMH (mainly periventricular WMH with or without deep WMH.) We hypothesized that dWMH is more likely associated with embolism, whereas dpWMH is associated with small-vessel diseases. We compared the clinical characteristics, WMH-distributions, and positive rate of agitated saline studies between the two groups. Results: Among 90 participants, 27 and 12 met the dWMH and dpWMH criteria, respectively. The dWMH-group was younger (62.2±7.5 vs. 78.9±7.3, p<0.001) and had a lower prevalence of hypertension (29.6% vs. 75%, p=0.008), diabetes mellitus (3.7% vs. 25%, p=0.043), and hyperlipidemia (33.3% vs. 83.3%, p=0.043) than the dpWMH-group. Regarding deep white matter lesions, the number of small lesions (<3 mm) was higher in the dWMH-group(10.9±9.7) than in the dpWMH-group (3.1±6.4) (p=0.008), and WMH was predominantly distributed in the border-zones and corticomedullary areas. Most importantly, the positive agitated saline study rate was higher in the dWMH-group than in the dpWMH-group (81.5% vs. 33.3%, p=0.003). Conclusions: The dWMH-group with younger participants had fewer cardiovascular risk factors, showed more border-zone-distributions, and had a higher agitated saline test positivity rate than the dpWMH-group, indicating that corticomedullary or deep WMH-distribution with minimal periventricular WMH suggests embolic etiologies.

APP 대사과정의 Alpha-secretase의 활성을 조절하는 Furin의 역할 규명

황은미,심혜진,묵인희 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.2

Background:The β-amyloid protein, Aβ, which accumulates in the brains of Alzheimer's disease patients, is derived by proteolysis of the amyloid precursor protein (APP). APP can undergo endoproteolytic processing at three sites, one at the amino terminus of the Aβ domain (by β-secretase), one within the Aβ domain (by α-secretase), and one at the carboxyl terminus of the Aβ domain (by γ-secretase) Constitutive and PKC-regulated α-secretase pathways have been reported to secrete sAPPα. In both pathways, we examined mechanisms of furin, which is known to regulate α-secretase activity Methods:Two methods were used to inhibit the activity of furin:overexpression of prodomain of furin and the infection of furin-specific inhibitor α-1-PDX adenovirus in a COS-7 cell. Real-Time PCR was used to determine the level of mRNA of furin in both the APP transgenic mice and age-matched control mice. Results:As a result of inhibiting the activity of furin, the level of sAPPα was significantly decreased regardless of the PKC activity, and the total level of APP did not change as well In a real-time PCR, there was a significant decrease in the mRNA of furin in APP transgenic mice compared to that of control Conclusion:Our results suggest that furin plays an important role in the processing of APP through α-secretase and that the decrease in the level of furin may be closely related to the mechanisms that lead to Alzheimer's disease.

파킨슨 증상을 동반한 치매 : 피질기저핵변성 Corticobasal Degeneration

권재철,정용,나덕렬 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.2

Corticobasal degeneration (CBD) is one of the disorders that manifests as dementia plus parkinsonism Symptoms or signs in CBD can be classified into cortical (cortical sensory loss apraxia alien limb, frontal release signs, dysphasia, and dementia) movement Symptoms (akinetic-rigid syndrome dysequlibnum postural-action tremor, limb dystonia myoclonus, other dyskinesias), and others (hyperreffexia. Babinski signs supranuclear gaze palsy levator inhibition and dysarthria) Of these essential signs for the diagnosis of CBD especially ir its early stage include unilateral limb rigidity. bradykinesia. ideomotor apraxia postural imbalance, unilateral limb dystonia and cortical dementia CT or MRI in patients with CBD usually shows asymmetric atrophy in the panetal and frontal area, which is rather nonspecific SPECT or PET in contrast shows more widespread unctional changes involving cortical regions (prefrontal. antenor cingulate medial premotor, sensonmotor postenor panetal and supenor temporal) as well as putamen or caudate nucleus. It has been reported that clinically diagnosed CDB patients may disclose histopathologic findings compatible with Alzheimer's disease frontotempral dementia, progressive supranuclear palsy or Creutzfeldt-Jacob disease Recent achievements in molecular genetic studies in CBD. however, are expected to compliment clinical and neuroimaging findings in enhancing the diagnostic accuracy of CBD.

알쯔하이머병 환자의 뇌혈류 장애 : Statistical Parametric Mapping을 이용한 Tc-99m ECD SPECT 분석 Statistical Parametric Mapping analysis of Tc-99m ECD SPECT

양동원,김범생,손영민,박정욱,정용안,손형선,김상윤 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.2

Background and Objectives . Alzheimer's disease (AD) is the most common cause of the dementia Pathologic and functional changes of AD are known to be unevenly distributed in the brain. This study investigates changes of cerebral blood flow (CBF) in patients with AD to determine brain regions with hypoperfusion that reflects progression of disease. Methods. Tc-99m-ECD single photon emission computed tomography (SPECT) was performed to measure regional CBF and statistical parametric mapping (SPM) 99 soft ware was used for the automated and objective approach to analyze SPECT image data. Twenty-five patients with mild to moderate dementia who met NINCDS-ADRDA critena for AD (male 11 female 14) and 17 age-matched normal control subjects were studied. The severity of AD was measured by clinical dementia rating (CDR) scale Results. SPM analysis of SPECT images revealed that CBF in the anterior cingulate gyrus left superior panetal cortex left medial frontal cortex left infenor temporal cortex. right thalamus and left hippocampus was significantly decreased in AD patients compared with normal controls (corrected p<0.05). The reduction of CBF according to CDR was localized in the left hippocampus and infenor temporal cortex right antenor and postenor ciagulate cortex and right superior panetal cortex (uncorrected p<0.01). Conclusions : Our data suggest that the cognitive dysfunction of AD is strongly related with functional abnormality in discrete brain areas 99m-Tc ECD SPECT with SPM analysis could be used as a useful functional imaging tool in AD study.