노인성 치매의 임상양상

김성윤(Seong-Yoon Kim) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.1

Symptoms of dementia vary widely according to the etiology, nature, progression of the causative disease. Not only various cognitive and non-cognitive features are present in any given point of evaluation, but also it is very common to note the ups and downs of such symptoms in an individual patient as the disease progress. Although cortical degenerative dementia such as Dementia of Alzheimer's Type typically show cognitive deficit in language, memory, praxis etc. in its early stage, it is unwise to confine such symptoms to be characteristic only in cortical dementias. Likewise, neurologic symptoms or changes in affect, personality and behavior, frequently seen in vascular dementia or other subcortical degenerative dementias should be understood as a part of whole cognitive and behavioral symptomatic gamut. As a logical conclusion, when evaluating the symptoms of a dementic patient, all the physical, neurologic, and neuropsychiatric evaluation must be applied as well as neuropsychological assessments. In addition, attention must be paid on the patients' functionality of daily living, reversibility, and appropriateness of services by family members or caregivers.

서서히 진행하는 치매와 뇌위축을 주소로 내원한 원발성 항인지질 항체 증후군 2예

이창선,김현각,이재홍 대한치매학회 2002 Dementia and Neurocognitive Disorders Vol.1 No.1

Primary antiphospholipid syndrome (PAPS) is a complication of autoimmune antiphospholipid antibodies with lack of serologic and clinical features of systemic lupus erythematosus or other collagen vascular disorders We have observed progressive dementia. One patient is 31-year-old female who presented with progressive cognitive impairment of 2 years′ duration and decreased hand dexterity. Her Mini-Mental State Exam(MMSE) score was 20. Livedo reticularis was noted on both forearms and knees. She was tested positive for VDRL, lupus anticoagulant and anti-cardiolipin antibody. FTA-ABS and all other antibodies for collagen vascular disease were negative. Brain MRI showed mild to moderatrate cortical atrophy with no definite parenchymal lesion Her dementia deteriorated despite corticosteroid therapy and follow-up MRI revealed marked brain atrophy with ventricular dilatation The other patient, a 36-year-old male, presented with a one-year history of memory impairment and mental slowing Laboratory tests were significant only for lgG anti-cardiolipin antibody His MMSE score was 26. Brain MRI showed mild brain atrophy with some small T2 signal intensities in the centrum serriovale Cerebral angiogram was unrevealing We suggest that PAPS may produce progressive dementia mainly by causing cortical atrophy PAPS should be suspected in the differential diagnosis of young adult dementia.

루이체 치매의 임상적 특징

전진숙(Jin-Sook Cheon),Edmond Chiu 대한노인정신의학회 2001 노인정신의학 Vol.5 No.1

The dementia with Lewy bodies which was common next to the Alzheimer's dementia had been oftenly misdiagnozed as vascular dementia. The pathologic diagnosis of dementia with Lewy bodies was increasing with the development of immunocytochemical techniques, and it also drew much interest recently. The clinical criteria included core symptoms such as fluctuation of cognitive function, wellformed visual hallucination and extrapyramidal symptoms. For the pathologic criteria, presence of brainstem or cortical Lewy bodies were essential, besides of other pathology. However, it was difficult to obtain satisfactory consensus between investigators about the clinical and pathologic criteria of the dementia with Lewy bodies. There were several reports which suggested good response to the cholinesterase inhibitors.

알쯔하이머형 치매에서 SPECT의 특징적 소견에 대한 연구

박청산(Chung San Park) 대한노인정신의학회 1999 노인정신의학 Vol.3 No.2

기능적 신경영상기법의 하나인 SPECT는 알쯔하이머형 치매의 진단 및 병태생리에 대한 연구를 위한 실질적인 도구로 사용될 수 있다. 본 연구는 정도가 심하지 않은 알쯔하이머형 치매 환자에서 반정량적인 SPECT 소견을 연구함으로써, SPECT가 실제로 알쯔하이머형 치매 환자를 조기에 감별하는 유용한 도구로 사용될 수 있는 지를 조사하고자 하였다. 본 연구에서 저자는 14명의 건강한 정상노인과 19명의 정도가 심하지 않은 알쯔하이머형 치매환자 그리고 14명의 혈관성 치매환자의 양측 전두엽, 전 측두엽, 후 측두두정엽 그리고 후두엽의 대뇌피질 영역 등 관심영역에서의 상대적인 혈류지표 소견을 비교하였다. 본 연구의 결과는 SPECT의 혈류지표 소견이 정도가 심하지 않은 알쯔하이머형 치매의 경우 정상 대조군보다 양측 후 측두 두정엽 부위에서 통계적으로 유의하게 저하된 소견을 보여주고 인지기능은 일부 관심영역에서의 혈류 저하와 유의한 상관관계를 보여주었다. 결론적으로 이러한 소견은 SPECT에서의 반정량적인 혈류지표 소견이 알쯔하이머형 치매에서 정도가 심하지 않은 치매 환자군을 정상 성인으로부터 구별할 수 있는 유용한 도구가 될 수 있다는 것을 제시한다. Objectives:Single photon emission computed tomography is a practical modality for the study of physiologic cerebral activity in vivo. So to improve the diagnostic utility of brain single photon emission computed tomography (SPECT) in Alzheimer's disease (AD). we evaluated an objective method of differentiating patients and healthy elderly controls using a semiquantitive image analysis protocol. Methods:Supratentorial transaxial perfusion measurements were obtained in frontal, anterior temoral, posterior temporoparietal and occipital cortical areas in both hemispheres, in a baseline population of 14 healthy elderly controls and 19 mild to moderately impaired AD patients as well as 9 cases of vascular dementia. Results:Statistically significant hypoperfusion was noted in both posterior temporoparietal regions of interest in the AD group compared with controls. And also hypoperfusion in left posterior temporoparietal area was found in the vascular dementia group compared with controls. Several correlations between perfusion ratio in some cortical area and MMSE score, BDS score and duration of disease in patients with Alzheimer's dementia. Conclusion:We found that all subjects with AD demostrated flow deficits in temporoparietal cortex bilaterally, and that the cortical-to-cerebellar ratio in bilateral temporoparietal region allowed the differentiation of all patients with AD from both controls and from the patients with vascular dementia. And ratio in specific region showed a correlation with cognitive function, disease severity and duration ing the AD group. Single photon emission computed tomography appears to be useful in the differential diagnosis of dementia and reflects clinical features of the disease.

A Voxel Based Morphometric Analysis of Longitudinal Cortical Gray Matter Changes in Progranulin Mutation Carriers At-Risk for Frontotemporal Dementia: Preliminary Study

윤영철,Ging-Yuek Robin Hsiung 대한치매학회 2015 Dementia and Neurocognitive Disorders Vol.14 No.4

Background and Purpose One of the most common genetic causes of frontotemporal dementia (FTD) is mutation in the progranulin(PGRN) gene. The aim of this study is to assess the early effects of the PGRN mutations on brain volumes by longitudinal voxel based morphometric(VBM) evaluation in asymptomatic mutation carriers. Methods We recruited 17 asymptomatic members of families with FTD caused by PGRN mutations; 7 mutation carriers (51.0±11.6 yr)and 10 non-carriers (55.2±6.0 yr, p=0.404). The MRI follow-up intervals of carriers and non-carriers were 788.6±103.8 and 922.0±225.1 days(p=0.124) respectively. We performed cross-sectional and longitudinal VBM analysis on both groups. Results At baseline, the carriers had lower white matter (WM) volumes in left frontal regions (p<0.001, uncorrected), but had no gray matter(GM) volume reduction. The carrier’s global GM (p=0.924) and WM volume (p=0.364) reduction rate were not different from the noncarrier’s. However, statistical parametric mapping T-maps showed differentially increased GM volume reductions in the bilateral parietal areasof carriers (p<0.001, uncorrected). Conclusions The findings from this study to examine WM and GM cross-sectional and longitudinal changes in PGRN mutation carrierssuggest that WM atrophic changes could precede both GM changes and symptom onset in FTD. Asymptomatic PGRN mutation carriershave measurably higher rates of regional GM atrophy than non-carriers even in the pre-dementia stages.

치매의 증상학

한일우(Il Woo Han) 대한노인정신의학회 1997 노인정신의학 Vol.1 No.1

Dementia can be defined as an acquired persistent impairment of intellectual func-tion with compromise in at least three of the mental activities such as language, memory, visuospatial skill, emotion or personality, and cognition. The purposes of diagnosing a dementia syndrome are to search systemically for various etiologies, to differentiate reversible or irreversible dementia, cortical or subcortical dementia, and degenerative or nondegenerative dementia, and to apply to patients neurocognitive rehabilitation or other specific trea-tment strategies. The evaluation of dementia includes neuropsychiatric history taking, neuropsychological assessment, neurologic examination, neuroimaging studies, and laboratory studies. It is impossible to evaluate dementic patients only with clinical signs, symptoms, and neuropsychiatric histories. But I will address specific neurologic or neuropsychiatric symptoms and signs of various dementias to und-erstand them as classification.

알츠하이머 치매에서 경두개 자기자극의 임상적 의의

강동우,주수현,이창욱 대한신경정신의학회 2016 신경정신의학 Vol.55 No.1

The objective is this study is to provide a comprehensive understanding of the clinical implication of transcranial magnetic stimulation (TMS) in Alzheimer’s dementia (AD). We collected studies using TMS in patients with AD and reviewed 41 identified articles. Thirty five articles were about measures of cortical reactivity, plasticity, connectivity, and six articles were about the enhancement of cognitive function in AD. Reduced short-latency afferent inhibition and resting motor threshold which reflect cholinergic dysfunction and enhanced cortical excitability respectively are consistent findings of altered cortical reactivity in AD. In addition, cortical plasticity and connectivity have shown impaired results in AD compared with healthy controls. Repetitively delivered TMS can improve several domains of cognitive function impaired in AD. Although the evidence is still preliminary, TMS has a clinical implication as a diagnostic and therapeutic method in AD. Thorough investigation of factors that can affect the results of TMS and further studies to clarify the results are needed.

후부 대뇌피질 위축 1례

백종삼,박재현 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Posterior cortical atrophy is a subgroup of focal cortical atrophy with progressive degenerative dementia that begins with higher visual dysfunction. A 51-year-old man presented with visual disturbance for several months. He was a taxi driver and when he came to hospital, he couldn't drive a taxi because of geographical disorientation, impairment of calculation and writing. So he experienced car accident frequently. On examination, he had a Balint syndrome, visuospatial dysfunction, prosopagnosia, apraxia and Gerstmann's syndrome. Brain MRI showed marked atrophy especially both occipito-parietal areas, more pronounced on the left. SPECT with HMPAO disclosed hypometabolism on bilateral occipito-parietal area, more marked on the left rather than right. We think that these findings consistent with posterior cortical atrophy which is variant of Alzheimer's disease.

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>