Effect of Tablet-based Cognitive Intervention on Cognition in Patients With Mild Cognitive Impairment: A Pilot Study

Background@#and Purpose: Growing evidence has shown that cognitive interventions can mitigate cognitive decline in patients with mild cognitive impairment (MCI). However, most previous cognitive interventions have been group-based programs. Due to their intrinsic limitations, group-based programs are not widely used in clinical practice. Therefore, we have developed a tablet-based cognitive intervention program. This preliminary study investigated the feasibility and effects of a 12-week structured tablet-based program on cognitive function in patients with MCI. @*Methods@#We performed a single-arm study on 24 patients with MCI. The participants underwent a tablet-based cognitive intervention program 5 times a week over a 12-week period. The primary outcome was changes in cognitive function, measured using the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet (CERAD-K). Outcomes were evaluated at baseline, within two weeks of the last program (post-intervention), and at the six-month follow-up session. @*Results@#The completion rate of the tablet-based program was 83.3% in patients with MCI.The program improved cognitive function based on the CERAD-K total score (p=0.026), which was maintained for at least three months (p=0.004). There was also an improvement in the depression scale score (p=0.002), which persisted for three months (p=0.027). @*Conclusions@#Our 12-week structured tablet-based program is feasible for patients with MCI.Furthermore, although further studies with a double-arm design are required, the program appears to be an effective strategy to prevent cognitive decline in patients with MCI.

Constipation is Associated With Mild Cognitive Impairment in Patients With de novo Parkinson’s Disease

Objective@#The association between gastrointestinal (GI) symptoms and cognitive profile in patients with Parkinson’s disease (PD) at diagnosis remains unclear, although GI symptoms and cognitive impairment are highly prevalent in patients with PD. We investigated the relationship between constipation and cognitive status. We also aimed to identify the correlation between constipation and each neuropsychological dysfunction. @*Methods@#A total of 427 patients with de novo Parkinson’s disease with normal cognition (PD-NC, n = 170) and Parkinson’s disease with mild cognitive impairment (PD-MCI, n = 257) at Korea University Guro Hospital in Seoul, Korea were included. All patients underwent comprehensive neuropsychological tests and completed the Non-Motor Symptoms Scale (NMSS). The frequency and severity of constipation were assessed using the NMSS GI symptoms scale, we used logistic regression analysis and partial correlation analysis to determine the associations between constipation score, MCI, and each neuropsychological dysfunction. @*Results@#Frequent and severe constipation was associated with MCI in patients with PD at diagnosis regardless of disease severity. Specifically, constipation was related to poor performance in frontal-executive and visuospatial functions after controlling for age and sex. @*Conclusion@#Our findings may provide an understanding of constipation as a marker associated with cognitive impairment in individuals with PD. Therefore, the evaluation of cognitive function is warranted in PD patients with constipation, while further studies are necessary to investigate the detailed mechanism of our results.

Dance Intervention Using the Feldenkrais Method Improves Motor, and Non-Motor Symptoms and Gait in Parkinson’s Disease: A 12-Month Study

Objective@#The aim of this study was to assess the effects of dancing (using the Feldenkrais method) on motor and non-motor symptoms, quality of life (QoL), and objective parameters of gait at the time of intervention and at the end of the 1-year study period. @*Methods@#This was a single-arm study in which 12 subjects with Parkinson’s disease (PD) received dance intervention during a 6-month period. Objective motor scales, gait analysis, and questionnaires on non-motor symptoms were evaluated at baseline and at 3, 6, and 12 months. @*Results@#Dance intervention decreased motor scale (Unified Parkinson’s Disease Rating Scale and Tinetti scale) scores and improved gait disturbance (gait velocity and step length) without increasing levodopa equivalent dose. Furthermore, dancing decreased non-motor scale (Non-Motor Symptoms Scale and Montgomery-Asberg Depression Rating Scale) scores and improved QoL. @*Conclusion@#Our findings suggest that dance intervention can be a complementary management method for PD patients.

Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report

Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report

Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

Validation of Four Methods for Converting Scores on the Montreal Cognitive Assessment to Scores on the Mini-Mental State Examination-2

Background@#and Purpose: There are many methods for converting scores from the Montreal Cognitive Assessment (MoCA) to those on the Mini-Mental State Examination (MMSE). In this study we aimed to validate 4 methods that convert the full score range (0–30 points) of the MoCA to an equivalent range for the MMSE. @*Methods@#We examined the medical records of 506 subjects who completed the MoCA and MMSE-second edition (MMSE-2) on the same day. For the validation index, we calculated mean, median, and root-mean-squared error (RMSE) of the difference between true and equivalent MMSE-2 scores. We also calculated intraclass correlation coefficients (ICCs), the Bland-Altman plot, and the generalizability coefficient between true and equivalent MMSE-2 scores for reliability. We compared the ICCs according to age, sex, education, MMSE, and cognitive-status subgroups. For accuracy, we evaluated a ±2 point difference between the true and equivalent MMSE-2 scores. @*Results@#The 4 conversion methods had a mean of −0.79 to −0.05, a median of −1 to 0, and an RMSE of 2.61–2.94 between true and equivalent MMSE-2 scores. All conversion methods had excellent reliability, with an ICC greater than 0.75 between true and equivalent MMSE-2 scores. These results were almost maintained in the subgroup analyses. These conversion methods provided more than 65% accuracy within ±2 points of the true MMSE-2 scores. @*Conclusions@#We suggest that these 4 conversion methods are applicable for converting MoCA scores to MMSE-2 scores. They will greatly enhance the usefulness of existing cognitive data in clinical and research settings.

Cerebrospinal Fluid Biomarkers for the Diagnosis and Classification of Alzheimer's Disease Spectrum

Background@#Cerebrospinal fluid (CSF) biomarkers are increasingly used in clinical practice for the diagnosis of Alzheimer's disease (AD). We aimed to 1) determine cutoff values of CSF biomarkers for AD, 2) investigate their clinical utility by estimating a concordance with amyloid positron emission tomography (PET), and 3) apply ATN (amyloid/taueurodegeneration) classification based on CSF results. @*Methods@#We performed CSF analysis in 51 normal controls (NC), 23 mild cognitive impairment (MCI) and 65 AD dementia (ADD) patients at the Samsung Medical Center in Korea. We attempted to develop cutoff of CSF biomarkers for differentiating ADD from NC using receiver operating characteristic analysis. We also investigated a concordance between CSF and amyloid PET results and applied ATN classification scheme based on CSF biomarker abnormalities to characterize our participants. @*Results@#CSF Aβ42, total tau (t-tau) and phosphorylated tau (p-tau) significantly differed across the three groups. The area under curve for the differentiation between NC and ADD was highest in t-tau/Aβ42 (0.994) followed by p-tau/Aβ42 (0.963), Aβ42 (0.960), t-tau (0.918), and p-tau (0.684). The concordance rate between CSF Aβ42 and amyloid PET results was 92%. Finally, ATN classification based on CSF biomarker abnormalities led to a majority of NC categorized into A-T-N-(73%), MCI as A+T-N-(30%)/A+T+N+(26%), and ADD as A+T+N+(57%). @*Conclusion@#CSF biomarkers had high sensitivity and specificity in differentiating ADD from NC and were as accurate as amyloid PET. The ATN subtypes based on CSF biomarkers may further serve to predict the prognosis.

The Cortical Neuroanatomy Related to Specific Neuropsychological Deficits in Alzheimer's Continuum

BACKGROUND AND PURPOSE: In Alzheimer's continuum (a comprehensive of preclinical Alzheimer's disease [AD], mild cognitive impairment [MCI] due to AD, and AD dementia), cognitive dysfunctions are often related to cortical atrophy in specific brain regions. The purpose of this study was to investigate the association between anatomical pattern of cortical atrophy and specific neuropsychological deficits. METHODS: A total of 249 participants with Alzheimer's continuum (125 AD dementia, 103 MCI due to AD, and 21 preclinical AD) who were confirmed to be positive for amyloid deposits were collected from the memory disorder clinic in the department of neurology at Samsung Medical Center in Korea between September 2013 and March 2018. To analyze neuropsychological test-specific neural correlates representing the relationship between cortical atrophy measured by cortical thickness and performance in specific neuropsychological tests, a linear regression analysis was performed. Two neural correlates acquired by 2 different standardized scores in neuropsychological tests were also compared. RESULTS: Cortical atrophy in several specific brain regions was associated with most neuropsychological deficits, including digit span backward, naming, drawing-copying, verbal and visual recall, semantic fluency, phonemic fluency, and response inhibition. There were a few differences between 2 neural correlates obtained by different z-scores. CONCLUSIONS: The poor performance of most neuropsychological tests is closely related to cortical thinning in specific brain areas in Alzheimer's continuum. Therefore, the brain atrophy pattern in patients with Alzheimer's continuum can be predict by an accurate analysis of neuropsychological tests in clinical practice.

A Case of Primary Ciliary Dyskinesia

Primary ciliary dyskinesia is a disease characterized by unexplained neonatal respiratory distress, otitis media, chronic sinusitis, and chronic bronchiectasis. In approximately half of cases, situs inversus totalis or other laterality defects are found. The incidence ranges from 1 in 4,000 to 1 in 40,000 live births. Early diagnosis is important and the disease is finally confirmed by electron microscopic biopsy. The treatment of primary ciliary dyskinesia is based on appropriate procedures. We present a rare case of a 20-year-old male with bronchiectasis, chronic otitis media and chronic sinusitis.

Cervical Bronchogenic Cyst Mimicking Thyroid Cyst

Bronchogenic cysts are rare congenital malformations that result from an abnormal development of the ventral foregut budding of the tracheobronchial tree at the time of organogenesis. They are usually located in the mediastinum and intrapulmonary regions. Localization in the cervical area is unusual, and specially, bronchogenic cysts presenting as thyroid and perithyroid cyst are quite rare. We report a case of bronchogenic cyst mimicking a thyroid colloid cyst. We tried percutaneous ethanol injection at 3 times for treatment of this thyroid cyst, but we failed, because of intractable cough. After cyst excision with thyroid lobectomy, we diagnosed the lesion to bronchogenic cyst. Bronchogenic cyst should be considered in the differential diagnosis of perithyroid cyst, which especially the lesion is intolerable cyst to enthanol injection.

Colonic MALT Lymphoma Diagnosed 6 Months after Complete Remission of Gastric MALT Lymphoma / 대한내과학회지

Most mucosa-associated lymphoid tissue (MALT) lymphomas are found in the gastrointestinal tract. The most common site is the stomach, whereas colon MALT lymphomas are rare. There are a few reports of simultaneously diagnosed stomach and colon MALT lymphomas. However, diagnosis of primary colonic MALT lymphoma after complete remission of gastric MALT lymphoma is extremely rare. Although the treatment protocol for gastric MALT lymphoma is well established, there is no consensus protocol for colonic MALT lymphoma owing to its rarity. Herein, we report a case of colonic MALT lymphoma incidentally diagnosed 6 months after completion of radiation therapy for gastric MALT lymphoma and treated via polypectomy, with no recurrence for 3 years.

A Case of Nonfunctioning Parathyroid Cyst in the Mediastinum / 대한이비인후과학회지

Parathyroid cysts, which are classified as either functioning or nonfunctioning, are rarely observed as neck masses, especially in the mediastinum. Herein, we present a 38-year-old woman with a nonfunctioning parathyroid cyst in the mediastinum. Physical and radiologic examinations of parathyroid cysts are not specific and preoperative diagnosis is usually difficult. Therefore, clinicians should consider the possibility that parathyroid cysts occuring in the mediastinum mimick other more frequently observed lesions.

A Case of Branch Duct Intraductal Papillary Mucinous Neoplasm Mimicking Pseudocysts Complicated by Recurrent Pancreatitis / 대한췌담도학회지

Branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) are characterized by cystic dilation of secondary ducts clearly communicating with a normal-sized main pancreatic duct and seem to have a less aggressive clinical course than those arising from the main duct. BD-IPMNs are related to pancreatitis but the causal relationship is unclear. We report a case of a 62-year-old woman initially thought to have pseudocysts complicated by idiopathic recurrent pancreatitis but was finally diagnosed with BD-IPMN leading to recurrent acute pancreatitis attacks. The patient had six episodes of acute pancreatitis over 5 years. An abdominal computed tomography scan revealed two cystic lesions of 2.0 and 1.5 cm in the pancreatic body, which appeared at the second episode of acute pancreatitis. Each pancreatitis episode improved with conservative treatment, but the cystic lesions increased in size to 2.5 and 3.5 cm during the late follow-up period. A distal pancreatectomy was performed under the diagnosis of recurrent pancreatitis caused by BD-IPMN. The pathological findings revealed BD-IPMN with moderate dysplasia. We herein present a case of BD-IPMN mimicking pancreatic pseudocysts with a review of the literature.

Risk Factors for Dieulafoy Lesions in the Upper Gastrointestinal Tract

BACKGROUND/AIMS: The purpose of this study is to verify the risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract. METHODS: A case-control study was performed by reviewing the electronic medical records of 42 patients who were admitted to a tertiary medical center in the Daejeon region for Dieulafoy lesions from September 2008 to October 2013, and the records of 132 patients who were admitted during the same period and who underwent endoscopic examination for reasons other than bleeding. We analyzed clinical and endoscopic findings retrospectively, and searched for risk factors associated with Dieulafoy lesion formation. RESULTS: All 42 patients diagnosed with Dieulafoy lesion had accompanying bleeding, and the location of the bleeding was proximal in 25 patients (59.5%), the middle portion in seven patients (16.7%), and distal in 10 patients (23.8%). Antiplatelet agents (p=0.022) and alcohol (p=0.001) use showed statistically significant differences between the two groups. The odds ratios (95% confidence intervals) of the two factors were 2.802 (1.263 to 6.217) and 3.938 (1.629 to 9.521), respectively. CONCLUSIONS: This study showed that antiplatelet agents and alcohol consumption were risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

Risk Factors for Dieulafoy Lesions in the Upper Gastrointestinal Tract

BACKGROUND/AIMS: The purpose of this study is to verify the risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract. METHODS: A case-control study was performed by reviewing the electronic medical records of 42 patients who were admitted to a tertiary medical center in the Daejeon region for Dieulafoy lesions from September 2008 to October 2013, and the records of 132 patients who were admitted during the same period and who underwent endoscopic examination for reasons other than bleeding. We analyzed clinical and endoscopic findings retrospectively, and searched for risk factors associated with Dieulafoy lesion formation. RESULTS: All 42 patients diagnosed with Dieulafoy lesion had accompanying bleeding, and the location of the bleeding was proximal in 25 patients (59.5%), the middle portion in seven patients (16.7%), and distal in 10 patients (23.8%). Antiplatelet agents (p=0.022) and alcohol (p=0.001) use showed statistically significant differences between the two groups. The odds ratios (95% confidence intervals) of the two factors were 2.802 (1.263 to 6.217) and 3.938 (1.629 to 9.521), respectively. CONCLUSIONS: This study showed that antiplatelet agents and alcohol consumption were risk factors associated with Dieulafoy lesion formation in the upper gastrointestinal tract.

Successful Treatment of Massive Hemorrhage due to Cytomegalovirus Colitis by Angiographic Embolization in an Elderly Patient

Cytomegaloviurs (CMV) usually causes severe infection only in immunocompromised patients. However, in rare cases, gastrointestinal infection can occur in patients with normal immunity. Though most such patients recover spontaneously, major complications such as massive hemorrhage have also been reported. We report a case of massive hemorrhage in an immunocompetent elderly patient which was successfully treated with angiographic embolization.

Inflammatory Fibroid Polyp in the Jejunum Causing Small Bowel Intussusception

Intussusceptions are defined as the telescoping of one segment of the gastrointestinal tract into an adjacent distal segment. In the small bowel, intussusceptions are typically caused by benign processes, but can occasionally be caused by inflammatory fibroid polyps, which often present as intussusception and bowel obstruction. These polyps are rare, benign, tumorous lesions in the gastrointestinal tract and are typically observed in the stomach, but can occur anywhere in the gastrointestinal tract. Any case of a jejunojejunal intussusception caused by inflammatory fibroid polyps is considered rare, and we report the case of a 51-year-old woman with an inflammatory fibroid polyp of the jejunum presenting as an intussusception who was successfully treated with a resection.

Paraneoplastic Necrotizing Myopathy Associated With Ovarian Adenocarcinoma

We describe here a case of female patient who presented with mild proximal weakness, myalgia, and markedly elevated CPK, which could be ascribed to paraneoplastic necrotizing myopathy in association with ovarian adenocarcinoma. A histologic examination of the vastus lateralis muscle showed necrosis of muscle fibers without inflammatory cell infiltration. Her neurologic symptoms improved following tumor resection and systemic chemotherapy. Paraneoplastic necrotizing myopathy may be a presenting manifestation of malignancy, and early recognition and prompt treatment are crucial for the clinical improvement.

Multiple Brain Tuberculoma without Meningitis

No abstract available.

Probable Creutzfeldt-Jakob Disease Presenting as Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) is a clinical syndrome comprising vertical supranuclear palsy, parkinsonism, postural instability, and mild dementia. Other disorders can present with similar clinical pictures. In this report we describe a case of Creutzfeldt-Jakob disease (CJD) presenting with the PSP and discuss which features may help to prevent misdiagnosis. To the best of our knowledge, this is the first report of CJD presenting with PSP syndrome in Korea.