루이소체 치매로 추정되는 이차성 파킨슨증 환자의 Non-Motor Symptom Scale(NMSS)로 평가한 비운동성 증상을 한약과 침의 복합치료로 호전시킨 증례보고 1례

노민영,이지현,한양희,임정태,Roh, Min-yeong,Lee, Ji-hyun,Han, Yang-hee,Leem, Jung-tae 대한한방내과학회 2021 大韓韓方內科學會誌 Vol.42 No.5

Parkinson's syndrome is a degenerative brain disease that presents characteristic motor symptoms of tremor, rigidity, and gait disturbance. In addition to these motor symptoms, Parkinson's syndrome also presents non-motor symptoms (NMSs) such as sleep disturbance and cognitive decline. NMSs reduce patient's quality of life and psychosocial functioning and cause economic burden on the patient, so appropriate evaluation and treatment are required. Lewy body dementia is one of the several diseases belonging to Parkinson's syndrome. Its symptoms such as cognitive function, memory impairment, and hallucinations occur with Parkinsonism. Although drug therapy is being used with drug treatment to treat non-motor symptoms, it has limitations such as side effects, which stimulated interest in other complementary treatment methods such as oriental medicine treatment, dance, and yoga. The patient in this case complained of tremor in the right upper extremity, muscle hypertension and pain, and persistent vision, memory, and cognitive decline. The patient was diagnosed with probable Lewy body dementia. The patient was hospitalized for 4 months and received acupuncture and herbal medicines. After treatment, the patient's NMS scale scores decreased from 90 to 63, and the Unified Parkinson's Disease Rating Scale scores (summed I, II, and III) decreased from 17 points to 8 points. The Beck Depression Inventory score decreased from 22 points to 13 points. In addition, the patient's subjective evaluation revealed improvement. In this case, a patient diagnosed with probable Lewy body dementia who did not respond to the standard treatment and did not want to take medications showed improvement in not only motor symptoms but also NMSs after integrative Korean medicine treatment.

Olfactory dysfunction in Alzheimer's disease– and Lewy body–related cognitive impairment

Yoo, Han Soo,Jeon, Seun,Chung, Seok Jong,Yun, Mijin,Lee, Phil Hyu,Sohn, Young Ho,Evans, Alan C.,Ye, Byoung Seok Elsevier 2018 Alzheimer's & dementia Vol.14 No.10

<P><B>Abstract</B></P> <P><B>Introduction</B></P> <P>Olfactory dysfunction is common in Alzheimer's disease– and Lewy body–related disorders, but its neural correlates have not been clearly elucidated.</P> <P><B>Methods</B></P> <P>We retrospectively recruited 237 patients with Alzheimer's disease–related cognitive impairment (ADCI) and 217 with Lewy body–related cognitive impairment (LBCI). They were identically evaluated using the Cross-Cultural Smell Identification Test, neuropsychological tests, and brain magnetic resonance imaging.</P> <P><B>Results</B></P> <P>LBCI had more severe olfactory dysfunction than ADCI. Patients with more severe cognitive dysfunction had worse olfactory function in both groups. In ADCI, lower Cross-Cultural Smell Identification Test scores correlated with a lower cortical thickness in brain regions typically affected in Alzheimer's disease, most prominently in the right parahippocampal cortex, whereas in LBCI, the scores correlated with white matter abnormalities in regions vulnerable to Lewy body, including subcortical regions of the orbitofrontal and frontoparietal cortices.</P> <P><B>Discussion</B></P> <P>Our results suggest that cortical atrophy in ADCI and white matter abnormalities in LBCI play important roles in olfactory dysfunction.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Olfactory dysfunction in Alzheimer's disease–related cognitive impairment was associated with a lower cortical thickness. </LI> <LI> Olfactory dysfunction in Lewy body–related cognitive impairment correlated with white matter disintegration. </LI> <LI> Lewy body–related cognitive impairment group had more prominent olfactory deficit compared with Alzheimer's disease–related cognitive impairment group. </LI> <LI> Alzheimer's disease–related cognitive impairment and Lewy body-related cognitive impairment had different cognitive dysfunctions correlating with olfactory function. </LI> </UL> </P>

Dementia with Lewy Bodies versus Alzheimer’s Disease and Parkinson’s Disease Dementia: A Comparison of Cognitive Profiles

박경원,김현숙,천상명,차재관,김상호,김재우 대한신경과학회 2011 Journal of Clinical Neurology Vol.7 No.1

Background and Purpose:It is particularly difficult to differentiate dementia with Lewy bodies (DLB) from the related dementias of Alzheimer’s disease (AD) and Parkinson’s disease dementia (PDD). Few studies have been designed to comparatively analyze detailed neuropsychological assessments of DLB patients and patients with AD and PDD. Methods:Three groups of patients participated in this study: 10 with DLB, 76 with AD, and 17with PDD, who had been diagnosed as probable DLB, AD, and PDD, respectively, according to the clinical criteria of the consortium on DLB, National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer’s Disease and Related Disorder Association, and the clinical diagnostic criteria for PDD. All patients were evaluated by careful neurological examination with detailed neuropsychological testing. Results:Significant differences among the three groups were found for attention, memory, and executive function, which included tasks of backward digit span, three-word recall, verbal delayed recall, and the Stroop test. Post hoc analysis revealed that the deficiencies of attention on the digit span task were greater in the DLB group than in the AD and PDD groups. The scores for episodic verbal memory tasks were significantly lower in the DLB and AD groups than in the PDD group. The performance in frontal executive function, as indicated by the Stroop test, was significantly worse in the DLB and PDD groups than in the AD group. Conclusions:The results of the present study show that the pattern of cognitive dysfunction, in terms of attention, episodic memory, and executive functions, differ between patients with DLB and patients with AD and PDD.

The Usefulness of 18F-FDG PET to Differentiate Subtypes of Dementia: The Systematic Review and Meta-Analysis

Na Seunghee,Kang Dong Woo,Kim Geon Ha,Kim Ko Woon,Kim Yeshin,Kim Hee-Jin,Park Kee Hyung,Park Young Ho,Byeon Gihwan,Suh Jeewon,Shin Joon Hyun,Shim YongSoo,Yang YoungSoon,Um Yoo Hyun,Oh Seong-il,Wang Sh 대한치매학회 2024 Dementia and Neurocognitive Disorders Vol.23 No.1

Background and Purpose: Dementia subtypes, including Alzheimer’s dementia (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD), pose diagnostic challenges. This review examines the effectiveness of 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) in differentiating these subtypes for precise treatment and management. Methods: A systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted using databases like PubMed and Embase to identify studies on the diagnostic utility of 18F-FDG PET in dementia. The search included studies up to November 16, 2022, focusing on peer-reviewed journals and applying the gold-standard clinical diagnosis for dementia subtypes. Results: From 12,815 articles, 14 were selected for final analysis. For AD versus FTD, the sensitivity was 0.96 (95% confidence interval [CI], 0.88–0.98) and specificity was 0.84 (95% CI, 0.70–0.92). In the case of AD versus DLB, 18F-FDG PET showed a sensitivity of 0.93 (95% CI 0.88-0.98) and specificity of 0.92 (95% CI, 0.70–0.92). Lastly, when differentiating AD from non-AD dementias, the sensitivity was 0.86 (95% CI, 0.80–0.91) and the specificity was 0.88 (95% CI, 0.80–0.91). The studies mostly used case-control designs with visual and quantitative assessments. Conclusions: 18F-FDG PET exhibits high sensitivity and specificity in differentiating dementia subtypes, particularly AD, FTD, and DLB. This method, while not a standalone diagnostic tool, significantly enhances diagnostic accuracy in uncertain cases, complementing clinical assessments and structural imaging.

불면을 호소하는 Lewy's body dementia 환자 치험 1례

박민정,이미림,김경묵,조기호,문상관,권승원,정우상,Park, Min-jeong,Lee, Mi-rim,Kim, Gyeong-muk,Cho, Ki-ho,Moon, Sang-kwan,Kwon, Seung-won,Jung, Woo-sang 대한한방내과학회 2017 大韓韓方內科學會誌 Vol.38 No.2

The patient was a 69-year-old Korean male with Lewy's body dementia and insomnia. He was treated with acupuncture and a herbal medicine, Ukan-san. To evaluate insomnia, the patient's total sleeping time was recorded. The patient's sleeping time increased after the administration of the Korean medicine treatments. Treatment with Korean medicine may be effective in treating insomnia in cases of Lewy's body dementia.

Neurodegenerative Dementias: A Brief Review

Sin Mo-Kyung,Khemani Pravin 한국기초간호학회 2020 Journal of korean biological nursing science Vol.22 No.3

Purpose: The purpose of this paper is to provide nurses with a concise review on neurodegenrative dementias. This review includes pathophysiology, clinical course, and tips on management of dementias from Alzheimer’s disease (AD), Parkinson disease (PD) and lewy body dementia (LBD). Considering increasing numbers of dementia cases among older adults, nurses who are cognizant about dementia care are instrumental in maximizing daily activities and quality of life of patients with cognitive impairment and dementia.

치매에 병발된 정신증

김진영(Jin Yeong Kim),정성훈(Seong Hoon Jeong),정인원(In Won Chung) 대한노인정신의학회 2009 노인정신의학 Vol.13 No.1

Psychosis in patients with dementia contributes substantially to patient morbidity and caregiver distress. The concept of psychosis of Alzheimer's disease (AD) and other types of dementia is developed with respect to prevalence, incidence, clinical characteristics, clinical course, and potential response to treatment. This article provides an overview of concept of psychosis in dementia. Published prevalence estimates of psychosis in patients with AD range from 10 to 73% within clinical populations. There is a continuing persistence of psychotic symptomatology among people with AD;most patients with psychosis continue to fulfill criteria for psychosis of dementia over at least 3 months, and over a half may have psychotic symptoms persist over a year. Among people with AD who have no psychotic symptoms there appears to be an annualized incidence of psychosis of about 20% in outpatients, and a much higher rate in nursing home patients. Frontal hypometabolism and greater frontal neuropsycological deficits occur in AD patients with psychosis in comparison to those without. There is some evidence that psychotic symptoms improve modestly with antipsychotic medication treatment, although optimal treatment guidelines have been elusive. The characteristics of psychosis in Parkinson's disease, Lewy body dementia, frontotemporal dementia and vascular dementia were also reviewed. Conclusively, further research to support the validity of a syndrome of psychosis in various types of dementia, as well as AD is needed.

Optimized Statistical Parametric Mapping for Partial-Volume-Corrected Amyloid Positron Emission Tomography in Patients with Alzheimer’s Disease and Lewy Body Dementia

오종수,김재승,채선영,오민영,오승준,차승남,장호종,이종식,이재홍 한국물리학회 2017 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.70 No.5

We present an optimized voxelwise statistical parametric mapping (SPM) of partial-volume (PV)- corrected positron emission tomography (PET) of 11C Pittsburgh Compound B (PiB), incorporating the anatomical precision of magnetic resonance image (MRI) and amyloid (A) burden-specificity of PiB PET. First, we applied region-based partial-volume correction (PVC), termed the geometric transfer matrix (GTM) method, to PiB PET, creating MRI-based lobar parcels filled with mean PiB uptakes. Then, we conducted a voxelwise PVC by multiplying the original PET by the ratio of a GTM-based PV-corrected PET to a 6-mm-smoothed PV-corrected PET. Finally, we conducted spatial normalizations of the PV-corrected PETs onto the study-specific template. As such, we increased the accuracy of the SPM normalization and the tissue specificity of SPM results. Moreover, lobar smoothing (instead of whole-brain smoothing) was applied to increase the signal-to-noise ratio in the image without degrading the tissue specificity. Thereby, we could optimize a voxelwise group comparison between subjects with high and normal A burdens (from 10 patients with Alzheimer’s disease, 30 patients with Lewy body dementia, and 9 normal controls). Our SPM framework outperformed than the conventional one in terms of the accuracy of the spatial normalization (85% of maximum likelihood tissue classification volume) and the tissue specificity (larger gray matter, and smaller cerebrospinal fluid volume fraction from the SPM results). Our SPM framework optimized the SPM of a PV-corrected A PET in terms of anatomical precision, normalization accuracy, and tissue specificity, resulting in better detection and localization of A burdens in patients with Alzheimer’s disease and Lewy body dementia.

치매 환자를 위한 청각 검사의 체계적 문헌 고찰 및 메타 분석

박시훈,한우재,공태훈,서영준,한재현,김태희 대한이비인후과학회 2021 대한이비인후과학회지 두경부외과학 Vol.64 No.2

It is acknowledged that there is a negative relationship between dementia and auditory functionin older adults. This study conducted a systematic review and meta-analysis based on the dataof audiologic testings from patients with neurodegenerative diseases in terms of auditory eventrelatedpotentials and central auditory processing tests, while focusing on Alzheimer’s disease(AD), dementia with Lewy bodies (DLB), and Parkinson’s disease dementia (PDD). A total of34765 articles were retrieved from the seven electronic databases. After being screened by Participants,Index test, Control, Outcomes, Study design (PICOS) criteria, 129 articles for ADwere included and then 72 articles were applied to the meta-analysis. However, five and six articleswere systematically reviewed for the auditory functions of DLB and PDD, respectively,due to a small number of articles. The results of meta-analysis showed a significant differencebetween patients with AD and age-matched normal subjects, for N200 and P300 latency, P300amplitude, and the behavioral central auditory processing tests, although there was a high heterogeneity. On the other hand, the systematic review indicated that the results of mismatchnegativity test might distinguish auditory performance of DLB patients from that of PDD. Furthermore, for P300 amplitude, anterior to posterior distribution of brain resulted in meaningfuldifference of auditory function between AD and DLB patients. In sum, current reviewstudy suggests that lesion and degree of auditory (dys)function may be different depending onthe type of dementia, although future research should be followed.

파킨슨병 치매와 루이소체 치매 환자에서 인지기능과 보호자 부담의 차이점

이지홍(Jihong Lee),박경련(Kyung Ryun Park),신윤정(Yoon Jung Shin),김현숙(Hyun Sook Kim) 대한노인정신의학회 2020 노인정신의학 Vol.24 No.1

Objective: This study aimed to identify the clinical characteristics for differential diagnosis of Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) by analyzing the differences in cognitive function and caregiver burden between the patient groups. Methods: We conducted a retrospective cross-sectional study with idiopathic Parkinson’s disease patients and DLB patients. Differences in cognitive function were measured using the standardized neuropsychological test battery (Seoul Neuropsychological Screening Battery-II). Differences in the caregiver burden were measured by the Neuropsychiatric Inventory-Questionnaire (NPIQ) for behavioral psychological symptoms of dementia (BPSD) and Korean-Instrumental Activities of Daily living (K-IADL) for daily living activities. For statistical analysis, chi-square test and multivariate analysis of variance and binary logistic regression and correlation analysis were conducted using SPSS 22. Results: Nine Parkinson’s disease-Normal cognition (PD-NC), 25 Parkinson’s disease-mild cognitive impairment (PD-MCI), 20 PDD and 11 DLB patients were included. Compared with PDD and DLB, attentional deficit correlated more strongly with DLB, but language dysfunction showed more correlation with PDD. Caregiver burden correlated more strongly with DLB than PDD. Delusion and aberrant motor behaviors of NPI-Q and taking medicine of K-IADL were strongly related with the caregiver burden of both PDD and DLB. Conclusion: This study identified that neuropsychological profile and caregiver burden in comparison of BPSD and ADL can contribute to the differential diagnosis of PDD and DLB.