Du-Shin Jeong

Influence of white matter hyperintensities on the cognition of patients with Parkinson disease.

BackgroundWhite matter hyperintensities (WMH) have been associated with cognitive impairment in elderly persons and in patients with Alzheimer disease. However, the role of WMH in Parkinson disease (PD) dementia remains to be elucidated. MethodsThe cohort for this study comprised 71 consecutive patients with PD, all of whom completed a clinical assessment, neuropsychologic investigation, and magnetic resonance imaging of brain. WMH were rated using the semiquantitative visual rating system proposed by Scheltens et al. ResultsThe PD dementia group had significantly more WMH than the PD without dementia group in the evaluated brain regions except for the infratentorial area. The WMH showed a significant correlation with age, Unified Parkinsons Disease Rating Scale, Mini-Mental State Examination, sum of the box of Clinical Dementia Rating, and many of the cognitive domains. The linear regression model showed that the WMH was independently associated with cognitive impairment in patients with PD, regardless of age, sex, duration or severity of PD symptoms, and vascular risk factors. ConclusionsThese findings confirm that WMH might be associated with cognitive decline in patients with PD, regardless of age, sex, education status, duration or severity of PD symptoms, and vascular risk factors. This result suggests that other nonvascular factors contribute to the progression of dementia in patients with PD.

Relationship between High-Sensitivity C-Reactive Protein and Clinical Functional Outcome after Acute Ischemic Stroke in a Korean Population

Background: High-sensitivity C-reactive protein (hs-CRP) has been shown to be a powerful predictor of coronary ischemic events. However, the prognosis of functional disability in patients with cerebrovascular disease has not been well established. Therefore, we performed this study to determine the prognostic significance of hs-CRP levels in patients with functional disability after acute ischemic stroke. Methods: A total of 417 Korean patients with ischemic stroke were examined within 24 h after symptom onset. hs-CRP measurements were obtained on admission and on the seventhhospital day. The correlations between the concentration of hs-CRP and functional disability duration 12 months after stroke onset were analyzed. Results: The present study showed that hs-CRP levels on admission and on the seventh hospital day were significantly correlated with the modified Rankin Scale (mRS) score 12 months after stroke onset. These results also demonstrated that mRS scores are more closely associated with hs-CRP levels on the seventh hospital day than hs-CRP levels on admission. Conclusion: This study demonstrated that elevated hs-CRP levels on the seventh hospital day, rather than within 24 h after stroke onset, could strongly predict the prognosis of functional disability. These results supported that hs-CRP is a useful marker of ischemic stroke in the Korean population.

Higher Glycated Hemoglobin Level Is Associated with Increased Risk for Ischemic Stroke in Non-Diabetic Korean Male Adults

Background The role of glycated hemoglobin (HbA1c) in the prediction of ischemic stroke in non-diabetic subjects is not clear. We performed a study to analyze the role of HbA1c in the risk prediction of ischemic stroke in non-diabetic Korean males adult. Methods A total of 307 non-diabetic male patients with ischemic stroke were enrolled, and 253 age-matched control subjects without a history of diabetes, hypertension, or cardiovascular disease were selected from a Health Check-up database. Anthropometric measurement data, fasting glucose level, lipid profile, and HbA1c level were available for all subjects. Associations of the variables and the presence or absence of ischemic stroke were analyzed. Results The ischemic stroke patient group had significantly higher HbA1c levels (5.8±0.5% vs. 5.5±0.5%, P<0.01) and mean systolic and diastolic blood pressure compared with the control group. Among the variables, smoking, low high density lipoprotein cholesterol, systolic blood pressure, and HbA1c were the significant determinants for ischemic stroke. The highest quartile of HbA1c showed a 9.6-fold increased odds ratio for ischemic stroke compared with the lowest quartile of HbA1c (odds ratio, 9.596; 95% confidence interval, 3.859 to 23.863, P<0.01). The proportion of ischemic stroke patients showed a significant trend for increment as the deciles of HbA1c increased (P for trend <0.01). Conclusion Higher HbA1c indicated a significantly increased risk for ischemic stroke after adjusting for other confounding variables in non-diabetic Korean adult males. HbA1c might have significance in predicting the risk for ischemic stroke even in the non-diabetic range.

Early neuropsychological detection and the characteristics of Parkinson's disease associated with mild dementia

Parkinsons disease (PD) may exhibit patterns of cognitive deficits, yet physicians are currently lacking operational criteria to define the clinical boundaries between PD and PD dementia (PDD). Therefore, we investigated the characteristics of the cognitive impairments in mild PDD. We recruited 30 PDD, 20 PD-MCI (PD with mild cognitive impairment without dementia) and 33 controls. All subjects were evaluated with detailed neuropsychological tests. Our results showed that visual memory, visuospatial functions, naming and calculation displayed more marked impairment than that of the other domains. Thus we suggest that adding cognitive dysfunctions of cortical type to the early cognitive deficits of PD-MCI can help predict the development of dementia.

Are plasma homocysteine levels related to neurological severity and functional outcome after ischemic stroke in the Korean population

Hyperhomocysteinemia is known to be an independent risk factor for arteriosclerosis. However, the prognosis of functional disability in cerebrovascular disease has not been well established. Therefore, we conducted this study to determine the prognostic significance of plasma homocysteine (Hcy) levels in Asian patients with functional disabilities after acute ischemic stroke. A total of 267 patients were examined within 24 h after symptom onset. Hcy was measured at admission. The correlations between plasma Hcy concentration and functional disability at 1-month, 3-months, 6-months, and 12-months after stroke onset were analyzed. In addition, the associations between each risk factor for stroke or neurological severity and plasma Hcy level were evaluated. The results of the present study showed that there was no significant correlation between Hcy level on admission and modified Rankin Scale score obtained at 1-month, 3-months, 6-months, and 12-months after stroke onset. There was also no association between plasma Hcy level and neurological severity after stroke or stroke subtype. This study showed that there is no association between Hcy levels and functional outcome after stroke. Therefore, we cautiously assert that plasma Hcy levels have no value as predictors of functional disability in Asian patients with stroke.

The relationship between low bone mineral density and Parkinson’s disease in a Korean population

There have been few studies concerning osteoporosis in patients with Parkinsons disease (PD), even though patients with PD have a high incidence of falls. Using a Korean population, we investigated the association between bone mineral density (BMD) and PD. A total of 107 patients with PD were compared with age-matched and sex-matched normal controls. Using the Hoehn & Yahr staging system, we classified the patients with PD into three subgroups. Parts II and III of the Unified Parkinsons Disease Rating Scale were administered to evaluate the relationship between the severity of PD and BMD. In conclusion, in the PD population we found that decreased BMD was related to the severity of immobility of patients, and that BMD changes were greater at the femoral neck than the spine area. Therefore, we assert that clinicians should consider administering screening tests to elderly patients with PD and provide appropriate primary or secondary prophylactic treatment for osteoporosis.

Clinical effect of cerebrovascular atherosclerosis on cognition in Alzheimer's disease

BACKGROUND The association between cerebrovascular atherosclerosis and Alzheimers disease (AD) has been examined in many cross-sectional studies; however, there are few data regarding the role of cerebrovascular atherosclerosis on the longitudinal course of cognitive decline in AD. The aim of this study was to examine the progression of cognitive function in AD patients with cerebrovascular atherosclerosis compared to those without atherosclerosis over a two-year period. METHODS Forty-seven AD patients with cerebrovascular atherosclerosis and 81 AD patients without atherosclerosis were assessed for cognitive function at the time of diagnosis and again at follow-up after two years. The cognitive functions were evaluated by neuropsychological tests including mini-mental state examination (MMSE) and clinical dementia scale (CDR). RESULTS Repeated-measures multivariate analyses showed that there was a significant group-by-time interactions for the temporal changes of the MMSE and CDR between the two groups. The group-by-time interactions remained significant when the atherosclerotic patients were sub-classified into either an extracranial stenosis (EC) group or an intracranial stenosis(IC) group. Comparing either the EC or IC group with the non-atherosclerosis group, there were no main effects by time or group alone, but there were significant group-by-time interactions for the MMSE and CDR. CONCLUSIONS Cognitive function worsened more in terms of progressive impairment in AD patients with cerebrovascular atherosclerosis compared to AD patients without cerebrovascular atherosclerosis, regardless of whether the atherosclerosis was extracranial or intracranial.

Response: Higher Glycated Hemoglobin Level Is Associated with Increased Risk for Ischemic Stroke in Non-Diabetic Korean Male Adults (Diabetes Metab J 2011;35:551-7)

We appreciate the interest and comments on our study, “Higher glycated hemoglobin level is associated with increased risk for ischemic stroke in non-diabetic Korean male adults,” which was published in Diabetes & Metabolism Journal 2011;35:5517. We have responded to the questions below. In our study, we excluded patients with iron-deficiency ane mia, end-stage renal disease, a history of alcohol abuse, persons older than 80 years, pregnant women, children, cancer patients, subjects without fasting blood glucose and HbA1c level data, patients with a history of diabetes or fasting blood glucose level ≥126 mg/dL and patients with cardioembolic ischemic stroke, or recurrent stroke. We analyzed the risk of ischemic stroke only in adult males because our aim was to determine if there were any gender differences considering the fact that HbA1c failed to predict cardiovascular disease in nondiabetic women in a previous report [1]. We also failed to show the usefulness of HbA1c as a predictor of ischemic stroke in non-diabetic Korean women. This re sult might be due to a lack of consideration for hormonal changes or hormonal replacement therapy in postmenopausal women. Recent studies reported that sex hormone and sex hormone-binding globulin, in addition to HbA1c, are associated with a risk of type 2 diabetes [2,3]. Because the women in our study were in their sixties, on average, most female subjects were postmenopausal and likely undergoing drastic hormonal changes, making it difficult to identify HbA1c as a pre dictor of ischemic stroke. Although the smoking rate was significantly different between the control and the stroke patients, our results are reliable because we assessed the risk of ischemic stroke according to the HbA1c levels after adjusting for age, smoking, body mass index, high density lipoprotein cholesterol, low density lipoprotein cholesterol, systolic and diastolic blood pressure, and HbA1c quartile. This was a cross-sectional study such that a definite relationship between HbA1c and ischemic stroke cannot be assumed. Further research in a more ethnically diverse group must be conducted to clarify this relationship. In spite of these limitations, the results of this study are meaningful in that this study was the first to report the association of increasing HbA1c with risk of ischemic stroke in non-diabetic Korean male adults. Our findings warrant future large-scale, long-term prospective cohort studies to evaluate the association between HbA1c and stroke morbidity.

P3-143: A comparison study in the cognitive functions between the Alzheimer's disease and the Alzheimer's disease with cerebrovascular disease: Korean case study

Background: Recent advances in the epidemiology of Alzheimer disease suggest strong association between vascular factors predisposing to cerebrovascular disease and Alzheimer disease (AD). Furthermore, recent study reported that subjects with episodes of cerebrovascular disease had a greater risk of developing dementia than those without stroke. We achieve this study to compare cognitive decline between two groups of patients with Alzheimer disease without and with cerebrovascular disease on neuropsychological test. Methods: Of seventy patients with AD diagnosed by available clinical and radiological assessment, 66 patients had pure AD, and 64 patients had AD with cerebrovascular disease (ADV). These patients received neuropsychological test, including the Korea version of Mini-Mental State Examination, the expended version of Korean Clinical Dementia Scale (CDR), and Global Deterioration Scale (GDS). Results: The mean K-MMSE, CDR, sum of box of CDR, GDS of pure AD were 20.8 3.99, 0.85 0.57, 4.30 2.92, 3.80 0.71, respectively. Those of ADV were 17.1 5.06, 1.28 0.74, 7.17 5.10, 4.23 0.77. There were no differences in age, sex, education, and duration of AD between groups. All score of neuropsychological test in ADV showed more severe cognitive decline than those in pure AD. Conclusions: In this study, cognitive function of ADV patients is more severe decline than AD patients, indicating that cerebrovascular disease contribute to the severity of cognitive decline in AD patients. These results suggest that intensive prevention of cerebrovascular disease plays an important role in prevention of rapid cognitive decline in patients with AD.