HyangHee Kim

Dysphagia in patients with dementia: Alzheimer versus vascular.

Patients with dementia develop dysphagia some time during the clinical course of their disease. The aim of this study was to compare the swallowing functions of the 2 most common types of dementia: Alzheimer disease (AD) and vascular dementia (VaD). Videofluoroscopic swallowing studies of the 2 patient groups were analyzed according to various oral, pharyngeal, and laryngeal variables of swallowing. The results indicate that there are some different patterns of swallowing disorders. The AD patients were significantly more impaired in “oral transit delay over 5 seconds” with liquids (χ2=7.065, df=1, P=0.008), whereas the VaD patients showed more deficits in “bolus formation and mastication” of semisolid food (χ2=4.64, df=1, P=0.039), “hyolaryngeal excursion” (χ2=4.102, df=1, P=0.043), “epiglottic inversion” (χ2=4.612, df=1, P=0.032), and “silent aspiration” (χ2=6.258, df=1, P=0.011). These results could indicate that the swallowing disorders of the AD group may result from sensory impairment in relation to dysfunctions in the temporoparietal areas, whereas the swallowing disorders of VaD group may primarily be caused by motor impairments due to disruptions in the corticobulbar tract. This study is noteworthy because it is one of the first attempts to differentiate between the swallowing symptoms of AD and VaD patients. A further study that includes patients with more severe degree of dementia (eg, patients over clinical dementia rating 3) might delineate additional discriminating swallowing patterns between the 2 dementia groups. In addition, a follow-up study exploring various kinematic characteristics of dysphagia would address physiologic issues of swallowing disorders as related to one of the most important clinical variables, laryngeal aspiration in the 2 dementia groups.

Normative data on the Korean version of the Western Aphasia Battery.

ABSTRACT The study aimed to describe the properties of the Korean version of the Western Aphasia Battery (hereinafter K-WAB) and to present the normative data of normal individuals and patients. The K-WAB contains the same test contents and structure as the original WAB and the general test administration method was maintained. We administered the K-WAB to 224 normal adults in seven age groups (15–24, 25–34, 35–44, 45–54, 55–64, 65–74, and 75 years or older), in five educational levels (0, 1–6, 7–9, 10–12, and 13 years or more) and by gender. The age and educational levels were influential to the K-WAB performance. Accordingly, we formed six subgroups of the normal: two age groups (15–74, and 75 years or older groups) by three educational groups (0, 1–6, and 7 years or more). Two hundred thirty-eight patients were also evaluated using the K-WAB. The highest aphasia quotient (AQ), language quotient (LQ), and cortical quotient (CQ) were achieved by 15–74 age group with 7 or more years of education (M=97.11, M=95.51, M=95.57, respectively). Based on the receiver operating curve (ROC) analyses on AQ, LQ and CQ values, cut-off scores to optimally differentiate between the normal and the aphasic individuals were also provided.

Vagus nerve stimulation in pediatric intractable epilepsy: a Korean bicentric study.

OBJECTIVE To present our experience with vagus nerve stimulation (VNS) and to evaluate the long-term efficacy and safety of the procedure in pediatric intractable epilepsy. METHODS This study included sixteen patients, who were implanted with a vagus nerve stimulator and could be followed up for at least more than 12 months in two epilepsy centers. Data including seizure frequency, EEG, quality of life measures and adverse events were prospectively filed over a 5-year period. RESULTS VNS resulted in a > 50% reduction in seizure frequency in 50.0% (8/16) of children with 31.3% (5/16) of patients achieving a > 90% reduction. Additionally, enhancements in quality of life were as follows: memory in 50.0% (8/16), mood in 62.5% (10/16), behavior in 68.8% (11/16), alertness in 68.8% (11/16), achievement in 37.5% (6/16), and verbal skills in 43.8% (7/16) of the patients. Adverse events included hoarseness in two patients, dyspnea during sleep in two patients, and sialorrhea in one patient. However, these events were tolerable or could be controlled by the adjustment of output currents. In one patient, wound revision was required. CONCLUSION Our data supports the role of VNS as an alternative therapy for pediatric intractable epilepsy.

Differentiating between aphasic and nonaphasic stroke patients using semantic verbal fluency measures with administration time of 30 seconds.

Administration time of 1 min for semantic verbal fluency measures can be overly long and therefore bothersome for aphasic patients because they can often retrieve only a few items after a certain period of time. The purpose of this study was to determine whether an administration time of 30 s would be more efficient in differentiating among aphasics, nonaphasic stroke patients, and normal controls. The subjects were 53 stroke patients and 28 normal controls. They had to generate as many animal names as they could within a given time. The number of animal names is gradually diminished in three groups (p < 0.001) in each time frame, that is, during the entire 60 s, the initial 30 s, and the following 30 s. The reaction time (RT) measure indicated that the RT of the aphasic patients was significantly increased compared to those of the other two groups (p < 0.001). The most optimal cutoff scores that differentiated each group are presented. These results suggest that an administration time of 30 s has discriminative validity to differentiate between the two patient groups. This shorter administration time could make the test more efficient by reducing the burden on both examiners and aphasic patients.

A normative study of the Boston Naming Test in 3- to 14-year-old Korean children

We administered the 60-item Korean version of the Boston Naming Test (K-BNT) to 2560 normally developing Korean children aged between 3 and 14 years. The children were stratified into 24 groups between the ages of 3 years, 0 months (3;0) and 14 years, 11 months (14;11) with 6-month intervals between each group. Statistical analysis did not reveal gender differences, but there were significant age differences among the groups (F = 615.340, p = .000). The lowest score (M = 14.17, SD = 4.28) was observed in the 3;0 ∼ 3;5 age-group and the highest (M = 50.64, SD = 3.70) in the 14;6 ∼ 14;11. Simple linear regression analysis revealed an R2 value of .800, indicating that the age variable explains 80% of the score variance (F = 10228.343, p = .000). Some of the 24 age groups were clustered due to lack of difference of the test scores between the neighboring groups, reducing the number of age groups to 13. This large cross-sectional study provided clinically useful norms of the BNT on Korean children and confirmed an importance of the age parameter in a neuropsychological testing.

Effect of literacy level on cognitive and language tests in Korean illiterate older adults

Illiterate individuals represent a significant proportion of the worlds population. Acquisition of reading and writing skills influences the functional status of the brain, and consequently alters the performance on cognitive and language tests. Thus, it is important to identify the degree of the impact of levels of both illiteracy and education as potential confounders on test performance in people with neurological communication disorders.

Response time measurements in the iOS app‐based Token Test, the Brief Token Test in the elderly

A pen and paper Token Test utilizing binary scoring of accuracy–inaccuracy in responses evaluates linguistic functions including verbal comprehension. However, the test might not be sensitive enough to detect the aging effect on performance in normal older adults unless the test utilizes a multidimensional scoring system. We hypothesized that the measurement of response time (RT) instead of accuracy would be a feasible way to measure deterioration of verbal comprehension as a function of age in this linguistically vulnerable population.

Language-specific dysgraphia in Korean stroke patients.

ObjectivesWe investigated how changes in the writing of 14 Korean stroke patients reflect the unique features of the Korean writing system. BackgroundThe Korean writing system, Han-geul, has both linguistic and visuospatial/constructive characteristics. In the visuospatial construction of a syllable, the component consonant(s) and vowel(s) must be arranged from top-to-bottom and/or left-to-right within the form of a square. This syllabic organization, unique to Korean writing, may distinguish dysgraphia in Korean patients from the disorder in other languages, and reveal the effects of stroke on visuospatial/constructive abilities. MethodsWe compared 2 groups of patients affected by stroke, 1 group with left hemisphere (LH) lesions and the other with right hemisphere (RH) lesions. We instructed them to write from a dictation of 90 monosyllabic stimuli, each presented with a real word cue. Patients had to repeat a target syllable and a word cue, and then to write the target syllable only. ResultsPatients with LH and RH lesions produced qualitatively different error patterns. While the LH lesion group produced primarily linguistic errors, visuospatial/constructive errors predominated in the group with RH lesions. With regard to language-specific features, these Korean patients with RH lesions produced diverse visuospatial/constructive errors not commonly observed in dysgraphia of the English language. ConclusionsLanguage-specific writing errors by Korean stroke patients reflect the unique characteristics of Korean writing, which include the arrangement of strokes and graphemes within a square syllabic form by dimensional and spatial rules. These findings support the notion that the Korean writing system possesses a language-specific nature with both linguistic and visuospatial/constructive processes. Distinctive patterns of dysgraphia in the Korean language also suggest interactivity between linguistic and visuospatial/constructive levels of processing. This study is noteworthy for its systematic description of Korean dysgraphia in the largest group of patients studied to date.

Intransigent vowel-consonant position in Korean dysgraphia: evidence of spatial-constructive representation.

Dysgraphia due to a focal brain lesion can be characterized by substitution, transposition, deletion and/or addition errors of graphemes or strokes. However, those linguistic errors can be language-specific because the writing system of a given language may influence error patterns. We investigated a Korean stroke patient, a 57-year-old English teacher with dysgraphia both in Korean Han-geul (한글) and in English alphabet writings. The results of an experimental testing revealed transposition errors between a consonant and a vowel only in English but not in Korean writings. This austerity of vowel-consonant position may be attributed to a unique Korean writing system of a spatially well-formed syllabic configuration or block with consonant(s) and a vowel. In light of a neuropsychological model of writing, which depicts a multi-level spelling and writing process, we suggest a spatial-constructional component of internal orthographic representations in Korean writing. This Korean graphemic configuration feature may be resistant to a focal, left cerebral damage, and thus, we also discuss our results in terms of cerebral lateralization of the writing processes.

Association of alcohol drinking with verbal and visuospatial memory impairment in older adults: Clinical Research Center for Dementia of South Korea (CREDOS) study

BACKGROUND The studys aim was to examine the association of alcohol consumption with verbal and visuospatial memory impairment in older people. METHODS Participants were 1,572, aged ≥60 years, in the hospital-based registry of the Clinical Research Center for Dementia of South Korea (CREDOS). Moderate drinking was defined as no more than seven drinks per week and three drinks per day. Memory impairment was defined as performance with more than 1 standard deviation below the mean value on the Seoul Verbal Learning Test and Rey Complex Figure Test. RESULTS Those who consumed alcohol moderately, compared with abstainers, had a lower odds of verbal memory impairment (Odds Ratio [OR] = 0.64; 95% Confidence Interval [CI]: 0.46-0.87), adjusting for covariates. Visuospatial memory, however, was not significantly associated with alcohol consumption. CONCLUSIONS Moderate alcohol drinking is associated with a reduced likelihood of verbal memory impairment among older people attending memory clinics.