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Kim SY, Lee SJ. The characteristics of cognitive and daily living functions of neurocognitive disorders with delusions in elderly Alzheimer's disease. PeerJ 2024; 12:e18026. [PMID: 39285920 PMCID: PMC11404475 DOI: 10.7717/peerj.18026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Background Delusions in neurocognitive disorder due to Alzheimer's disease (AD) worsen patients' cognitive functions and activities of daily living (ADL), increasing caregiver burden and the risk of mortality. AD patients with delusions tend to experience a more rapid decline in cognition and have demonstrated poorer performance on various cognitive function tests. Considering the prognosis of delusion in AD patients, it tends to be more favorable with appropriate treatment. However, there is a lack of neuropsychological research, specifically examining the impact of delusions in AD, characterized by progressive deterioration of cognitive function. This study investigates the impact of delusions on cognitive function and ADL under conditions controlling for disease severity. Methods We compared cognitive function and ADL in AD patients aged 65 years or older according to the presence of delusions. To assess longitudinal change, we analyzed data from patients monitored for an average of 15 to 16 months. We assessed cognitive function and ADL using the Seoul Neuropsychological Screening Battery-Second Edition (SNSB-II) and delusions using the Neuropsychiatric Inventory (NPI). We used IBM SPSS Statistics version 25.0 for all statistical analyses. The analysis was not adjusted for multiple comparisons. We investigated how delusions impact cognitive function and ADL, controlling for age, educational level, and disease severity. Results The delusions group exhibited poorer immediate recall of verbal memory than the non-delusions group. In the follow-up evaluation, patients who developed delusions had lower baseline cognitive function than those who did not, and their language fluency declined over time. In addition, we found the presence of delusions associated with worse functional impairment in ADL as the disease progressed. Conclusion While controlling for the severity of AD, we found no significant negative impacts of delusions on most cognitive functions. Nevertheless, it is noteworthy that the immediate recall of verbal memory and the Controlled Oral Word Association Test (COWAT)_animal sensitively detected the negative impact of delusions. Furthermore, since delusions are associated with worsening ADL, we understand that delusion treatment is important for improving the quality of life for patients and caregivers.
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Affiliation(s)
- Seo Yoo Kim
- Department of Psychology, Kyungpook National University, Daegu, Republic of South Korea
- Department of Neuropsychiatry, Good Samsun Hospital, Busan, Republic of South Korea
| | - Soo Jin Lee
- Department of Psychology, Kyungsung University, Busan, Republic of South Korea
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Simfukwe C, A An SS, Youn YC. Comparison of machine learning algorithms for predicting cognitive impairment using neuropsychological tests. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-12. [PMID: 39248700 DOI: 10.1080/23279095.2024.2392282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
OBJECTIVES Neuropsychological tests (NPTs) are standard tools for assessing cognitive function. These tools can evaluate the cognitive status of a subject, which can be time-consuming and expensive for interpretation. Therefore, this paper aimed to optimize the systematic NPTs by machine learning and develop new classification models for differentiating healthy controls (HC), mild cognitive impairment, and Alzheimer's disease dementia (ADD) among groups of subjects. PATIENTS AND METHODS A total dataset of 14,926 subjects was obtained from the formal 46 NPTs based on the Seoul Neuropsychological Screening Battery (SNSB). The statistical values of the dataset included an age of 70.18 ± 7.13 with an education level of 8.18 ± 5.50 and a diagnosis group of three; HC, MCI, and ADD. The dataset was preprocessed and classified in two- and three-way machine-learning classification from scikit-learn (www.scikit-learn.org) to differentiate between HC versus MCI, HC versus ADD, HC versus Cognitive Impairment (CI) (MCI + ADD), and HC versus MCI versus ADD. We compared the performance of seven machine learning algorithms, including Naïve Bayes (NB), random forest (RF), decision tree (DT), k-nearest neighbors (KNN), support vector machine (SVM), AdaBoost, and linear discriminant analysis (LDA). The accuracy, sensitivity, specificity, positive predicted value (PPV), negative predictive value (NPV), area under the curve (AUC), confusion matrixes, and receiver operating characteristic (ROC) were obtained from each model based on the test dataset. RESULTS The trained models based on 29 best-selected NPT features were evaluated, the model with the RF algorithm yielded the best accuracy, sensitivity, specificity, PPV, NPV, and AUC in all four models: HC versus MCI was 98%, 98%, 97%, 98%, 97%, and 99%; HC versus ADD was 98%, 99%, 96%, 97%, 98%, and 99%; HC versus CI was 97%, 99%, 92%, 97%, 97%, and 99% and HC versus MCI versus ADD was 97%, 96%, 98%, 97%, 98%, and 99%, respectively, in predicting of cognitive impairment among subjects. CONCLUSION According to the results, the RF algorithm was the best classification model for both two- and three-way classification among the seven algorithms trained on an imbalanced NPTs SNSB dataset. The trained models proved useful for diagnosing MCI and ADD in patients with normal NPTs. These models can optimize cognitive evaluation, enhance diagnostic accuracy, and reduce missed diagnoses.
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Affiliation(s)
- Chanda Simfukwe
- Department of Bionano Technology, Gachon University, Seongnam-si, South Korea
| | - Seong Soo A An
- Department of Bionano Technology, Gachon University, Seongnam-si, South Korea
| | - Young Chul Youn
- Department of Neurology, College of Medicine, Chung-Ang University Seoul, Seoul, South Korea
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Kim HE, Kim BR, Hong SH, Song SY, Jeong JH, Kim GH. Predicting superagers: a machine learning approach utilizing gut microbiome features. Front Aging Neurosci 2024; 16:1444998. [PMID: 39314993 PMCID: PMC11417495 DOI: 10.3389/fnagi.2024.1444998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/29/2024] [Indexed: 09/25/2024] Open
Abstract
Objective Cognitive decline is often considered an inevitable aspect of aging; however, recent research has identified a subset of older adults known as "superagers" who maintain cognitive abilities comparable to those of younger individuals. Investigating the neurobiological characteristics associated with superior cognitive function in superagers is essential for understanding "successful aging." Evidence suggests that the gut microbiome plays a key role in brain function, forming a bidirectional communication network known as the microbiome-gut-brain axis. Alterations in the gut microbiome have been linked to cognitive aging markers such as oxidative stress and inflammation. This study aims to investigate the unique patterns of the gut microbiome in superagers and to develop machine learning-based predictive models to differentiate superagers from typical agers. Methods We recruited 161 cognitively unimpaired, community-dwelling volunteers aged 60 years or from dementia prevention centers in Seoul, South Korea. After applying inclusion and exclusion criteria, 115 participants were included in the study. Following the removal of microbiome data outliers, 102 participants, comprising 57 superagers and 45 typical agers, were finally analyzed. Superagers were defined based on memory performance at or above average normative values of middle-aged adults. Gut microbiome data were collected from stool samples, and microbial DNA was extracted and sequenced. Relative abundances of bacterial genera were used as features for model development. We employed the LightGBM algorithm to build predictive models and utilized SHAP analysis for feature importance and interpretability. Results The predictive model achieved an AUC of 0.832 and accuracy of 0.764 in the training dataset, and an AUC of 0.861 and accuracy of 0.762 in the test dataset. Significant microbiome features for distinguishing superagers included Alistipes, PAC001137_g, PAC001138_g, Leuconostoc, and PAC001115_g. SHAP analysis revealed that higher abundances of certain genera, such as PAC001138_g and PAC001115_g, positively influenced the likelihood of being classified as superagers. Conclusion Our findings demonstrate the machine learning-based predictive models using gut-microbiome features can differentiate superagers from typical agers with a reasonable performance.
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Affiliation(s)
- Ha Eun Kim
- Department of Artificial Intelligence Convergence, Ewha Womans University, College of Artificial Intelligence, Seoul, Republic of Korea
| | - Bori R. Kim
- Ewha Medical Research Institute, Ewha Womans University, Seoul, Republic of Korea
| | - Sang Hi Hong
- GI&Neurology Part, R&D, CJ Bioscience, Seoul, Republic of Korea
| | | | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
| | - Geon Ha Kim
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University, College of Medicine, Seoul, Republic of Korea
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Kang JM, Kim N, Yun SK, Seo HE, Bae JN, Kim WH, Na KS, Cho SE, Ryu SH, Noh Y, Youn JH, Kang SG, Lee JY, Cho SJ. Exploring transfer effects on memory and its neural mechanisms through a computerized cognitive training in mild cognitive impairment: randomized controlled trial. Psychogeriatrics 2024; 24:1075-1086. [PMID: 39014538 DOI: 10.1111/psyg.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Computerized cognitive training (CCT) has been proposed as a potential therapy for cognitive decline. One of the benefits of CCT is a transfer effect, but its mechanism on the memory domain is unclear. This study aimed to investigate the transfer effect of non-memory multidomain CCT on the memory domain and its neural basis in patients with mild cognitive impairment (MCI) through a randomized controlled trial. METHODS Patients with MCI recruited from memory clinics were randomly assigned to either the CCT or the control group. The CCT group received multidomain CCT training excluding memory training, while the control group read educational books with learning-based quizzes twice a week for 8 weeks. Participants underwent memory tests yielding a composite score, other cognitive domain tests, non-cognitive scales, and resting-state functional magnetic resonance imaging (rsfMRI), at baseline and after intervention. Within- and between-group comparisons, group × time interactions, and seed-to-voxel analyses in memory-involving brain networks were performed. RESULTS The CCT group showed improvement over the control group in memory domain (Group × time, F = 5.87, P = 0.03, η2 = 0.31), which was related with the increased connectivity in the hippocampal-frontal and fusiform-occipital network. No other cognitive and non-cognitive symptoms differed between groups after adjusting for covariates. CONCLUSION Eight weeks of multidomain CCT without memory training improved memory function and restored functional network in the hippocampal and medial temporal region in MCI patients. These results can provide evidence for the transferring ability of CCT on memory functioning with its neural basis.
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Affiliation(s)
- Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Nambeom Kim
- Department of Big Data & AI Master Business Administration, Sejong University, Seoul, Republic of Korea
| | - Seon Kyung Yun
- Department of Nursing, Saekyung University, Yeongwol, Republic of Korea
| | - Ha-Eun Seo
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jung-Hae Youn
- Department of Counselling Psychology, Cha University, Seongnam, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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Yoo SW, Ryu DW, Oh Y, Ha S, Lyoo CH, Kim JS. Unraveling olfactory subtypes in Parkinson's disease and their effect on the natural history of the disease. J Neurol 2024; 271:6102-6113. [PMID: 39043904 DOI: 10.1007/s00415-024-12586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Hyposmia in Parkinson's disease (PD) had been studied before but had not been detailed by its temporal progression. This study observed how each olfactory subtype evolved in terms of motor symptoms, cardiac sympathetic innervation, and cognition. METHODS Two hundred and three early PD patients were classified as normosmia, hyposmia-converter (hypo-converter), and hyposmia. Their presynaptic monoamine availability at the time of diagnosis was assessed by positron emission tomography imaging using 18F-N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane and compared across the subtypes. Motor symptoms were evaluated in all patients, cardiac denervation was examined in 183 patients, and cognition in 195 patients were assessed using a neuropsychological battery. The domains were re-assessed 2-4 times, and the longitudinal data were analyzed to discern the natural course of each subtype. RESULTS Twenty-nine (14.3%) patients belonged to the normosmia group, 34 (16.7%) to the hypo-converter group, and the rest to the hyposmia (69.0%) group. 85.7% of the total population became hyposmic during an average 3 years of follow-up. The baseline motor symptoms, cardiac denervation, and cognition were comparable across the olfactory subtypes. Across the subtypes, a decline in the presynaptic monoamine densities of the caudate, especially the ventral-anterior subdivisions, correlated inversely with olfaction dysfunction. Over time, motor and cardiac denervation burdens worsened regardless of olfactory subtypes, but hypo-converters experienced faster cognitive deterioration than the other two groups. CONCLUSIONS The results suggest that the olfactory subtypes have differential significance along the disease course, which might reflect the involvement of different neuro-biochemical circuitries.
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Affiliation(s)
- Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoonsang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seunggyun Ha
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Kim Y, Bae JS, Kim YJ, Lee JH, Park SH, Lee M, Lee SH, Kim C. Distorted time perception in patients with neurocognitive impairment. Heliyon 2024; 10:e36002. [PMID: 39224255 PMCID: PMC11366858 DOI: 10.1016/j.heliyon.2024.e36002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Background Time perception is known to be distorted in patients with neuropsychiatric disorders. Therefore, this study aims to investigate the correlation between cognitive decline and time distortion by examining time perception in participants with neurocognitive impairment (Alzheimer's disease [AD], vascular dementia [VD], and Parkinson's disease dementia [PDD]) compared to those with subjective cognitive impairment (SCI). Methods Overall, 569 participants with cognitive decline complaints between 2013 and 2022 were investigated. Participants were subjected to a verbal estimation task, time production task, time comparison task, and neuropsychological assessments. Results Time perception abilities were distorted in patients with neurocognitive impairment compared to those with SCI. Despite similar educational backgrounds, the vascular cognitive impairment (VCI)/VD group demonstrated the lowest MMSE scores (22.4 ± 4.2, p-value <0.001) and larger time-estimation errors. Patients with VCI/VD significantly underestimated time in the 35-s (19.6 ± 12.6s) and 60-s (28.7 ± 19.9s) tasks. In the time production task, patients with VCI/VD produced shorter times in their 15-s (12.7 ± 4.3; p-value = 0.001), 30-s (23.6 ± 8.3; p value < 0.001), and 60-s (43.8 ± 18.9; p-value <0.001) trials. In the time comparison task, the VCI/VD group had significantly fewer correct answers than that in the SCI groups (6.0 ± 1.3 vs. 7.1 ± 0.9, p-value <0.001). Correlation analysis revealed that multiple cognitive functions are involved in the time perception tasks. Conclusions Patients with VCI/VD had the poorest time perception. These findings may provide a modest contribution to understanding the underlying pathophysiology and psychological connections related to temporal abilities in time perception.
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Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yeo Jin Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ju-Hun Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
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Kim YE, Lim JS, Suh CH, Heo H, Roh JH, Cheong EN, Lee Y, Kim JW, Lee JH. Effects of strategic white matter hyperintensities of cholinergic pathways on basal forebrain volume in patients with amyloid-negative neurocognitive disorders. Alzheimers Res Ther 2024; 16:185. [PMID: 39148136 PMCID: PMC11325579 DOI: 10.1186/s13195-024-01536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND The cholinergic neurotransmitter system is crucial to cognitive function, with the basal forebrain (BF) being particularly susceptible to Alzheimer's disease (AD) pathology. However, the interaction of white matter hyperintensities (WMH) in cholinergic pathways and BF atrophy without amyloid pathology remains poorly understood. METHODS We enrolled patients who underwent neuropsychological tests, magnetic resonance imaging, and 18F-florbetaben positron emission tomography due to cognitive impairment at the teaching university hospital from 2015 to 2022. Among these, we selected patients with negative amyloid scans and additionally excluded those with Parkinson's dementia that may be accompanied by BF atrophy. The WMH burden of cholinergic pathways was quantified by the Cholinergic Pathways Hyperintensities Scale (CHIPS) score, and categorized into tertile groups because the CHIPS score did not meet normal distribution. Segmentation of the BF on volumetric T1-weighted MRI was performed using FreeSurfer, then was normalized for total intracranial volume. Multivariable regression analysis was performed to investigate the association between BF volumes and CHIPS scores. RESULTS A total of 187 patients were enrolled. The median CHIPS score was 12 [IQR 5.0; 24.0]. The BF volume of the highest CHIPS tertile group (mean ± SD, 3.51 ± 0.49, CHIPSt3) was significantly decreased than those of the lower CHIPS tertile groups (3.75 ± 0.53, CHIPSt2; 3.83 ± 0.53, CHIPSt1; P = 0.02). In the univariable regression analysis, factors showing significant associations with the BF volume were the CHIPSt3 group, age, female, education, diabetes mellitus, smoking, previous stroke history, periventricular WMH, and cerebral microbleeds. In multivariable regression analysis, the CHIPSt3 group (standardized beta [βstd] = -0.25, P = 0.01), female (βstd = 0.20, P = 0.04), and diabetes mellitus (βstd = -0.22, P < 0.01) showed a significant association with the BF volume. Sensitivity analyses showed a negative correlation between CHIPS score and normalized BF volume, regardless of WMH severity. CONCLUSIONS We identified a significant correlation between strategic WMH burden in the cholinergic pathway and BF atrophy independently of amyloid positivity and WMH severity. These results suggest a mechanism of cholinergic neuronal loss through the dying-back phenomenon and provide a rationale that strategic WMH assessment may help identify target groups that may benefit from acetylcholinesterase inhibitor treatment.
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Affiliation(s)
- Ye Eun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwon Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Hoon Roh
- Department of Biomedical Sciences, Department of Physiology, Korea University College of Medicine, Seoul, Korea
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea
| | - E-Nae Cheong
- Department of Medical Science and Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoojin Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Kim GH, Kim BR, Yoon HJ, Jeong JH. Elevated cerebral blood flow proxy with increased beta-amyloid burden in Alzheimer's disease preclinical phase evaluated by dual-phase 18F-florbetaben positron emission tomography. Sci Rep 2024; 14:18480. [PMID: 39122860 PMCID: PMC11315901 DOI: 10.1038/s41598-024-68916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
This study investigated the earliest change of cerebral blood flow (CBF) and its relationship with β-amyloid (Aβ) burden in preclinical Alzheimer's disease (AD) employing dual-phase 18F-florbetaben (FBB) PET. Seventy-one cognitively normal (NC) individuals were classified as Aβ negative (Aβ-NC) or positive (Aβ+NC) based on two different cutoff values: an SUVR of > 1.08 and a Centiloid scale of > 20. The PET scans were acquired in two phases: an early phase (0-10 min, eFBB) and a delayed phase (90-110 min, dFBB), which were averaged to generate single-frame images for each phase. Furthermore, an R1 parametric map was generated from the early phase data using a simplified reference tissue model. We conducted regional and voxel-based analyses to compare the eFBB, dFBB, and R1 images between the Aβ positive and negative groups. In addition, the correlations between the CBF proxy R1 and the dFBB SUVR were analyzed. The Aβ+NC group showed significantly higher dFBB SUVR in both the global cerebral cortex and target regions compared to the Aβ-NC group, while no significant differences were observed in eFBB SUVR between the two groups. Furthermore, the Aβ+NC group exhibited significantly higher R1 values, a proxy for cerebral perfusion, in both the global cerebral cortex and target regions compared to the Aβ-NC group. Significant positive correlations were observed between R1 and dFBB SUVR in both the global cerebral cortex and target regions, which remained significant after controlling for demographics and cognitive profiles, except for the medial temporal and occipital cortices. The findings reveal increased CBF in preclinical AD and a positive correlation between CBF and amyloid pathology. The positive correlation between R1 and amyloid burden may indicate a compensatory mechanism in the preclinical stage of Alzheimer's disease, but to elucidate this hypothesis, further longitudinal observational studies are necessary.
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Affiliation(s)
- Geon Ha Kim
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Bori R Kim
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
- Ewha Medical Research Institute, Ewha Womans University, Seoul, Republic of Korea
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University, College of Medicine, Seoul, Republic of Korea.
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
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Park YJ, Choi JY, Lee KH, Seo SW, Moon SH. Risk Factors for Rapid Cognitive Decline in Amyloid-Negative Individuals Without Cognitive Impairment or With Early-Stage Cognitive Loss in Screening Tests. Clin Nucl Med 2024:00003072-990000000-01229. [PMID: 39086042 DOI: 10.1097/rlu.0000000000005384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE Although rapid cognitive decline (RCD) is an important unfavorable prognostic factor, not much is known about it, especially in amyloid-negative individuals. The purpose of this study was to investigate risk factors for RCD in amyloid-negative individuals. PATIENTS AND METHODS We retrospectively enrolled 741 individuals who were either cognitively unimpaired or had early-stage cognitive ability loss and who underwent 18F-florbetaben (FBB) (n = 402) or 18F-flutemetamol (FMM) (n = 339) PET/CT. Based on visual and semiquantitative (SUV ratio [SUVR]-based) analysis, the following amyloid-negative groups were established: visual-negative FBB (n = 232), visual-negative FMM (n = 161), SUVR-negative FBB (n = 104), and SUVR-negative FMM (n = 101). Univariable and multivariable logistic regression analyses were performed for RCD using 5 SUVRs, 5 cortical thicknesses, and 5 neuropsychological domains and clinico-demographic factors. RESULTS In the amyloid-negative groups, a decline in language function was commonly identified as a significant risk factor for RCD (P = 0.0044 in the visual-negative FBB group, P = 0.0487 in the visual-negative FMM group, P = 0.0031 in the SUVR-negative FBB group, and P = 0.0030 in the SUVR-negative FMM group). In addition, declines in frontal/executive function, frontal SUVR, and parietal SUVR; a longer duration of education; and mild cognitive decline in the amyloid-negative groups were also significant risk factors for RCD. CONCLUSIONS Even in amyloid-negative individuals without cognitive impairment or with early-stage cognitive ability loss, those with decreased language and frontal/executive functions on neuropsychological testing are at risk of progression to RCD.
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Affiliation(s)
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Oh Y, Kim JS, Lyoo CH, Park G, Kim H. Spatiotemporal Progression Patterns of Dopamine Availability and Deep Gray Matter Volume in Parkinson Disease-Related Cognitive Impairment. Neurology 2024; 103:e209498. [PMID: 38885485 DOI: 10.1212/wnl.0000000000209498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is a frequent nonmotor symptom in patients with Parkinson disease (PD), and early cognitive decline is often attributed to dopaminergic system dysfunction. We aimed to explore spatiotemporal progression patterns of striatal dopamine availability and regional brain volume based on cognitive status among patients with PD. METHODS This retrospective, cross-sectional study included patients with newly diagnosed PD who were not taking medication for this condition who visited a university-affiliated hospital in Seoul between January 2018 and December 2020. Patients were classified as having normal cognition (PD-NC), mild cognitive impairment (PD-MCI), or PD dementia (PDD) based on Seoul Neuropsychological Screening Battery-II, which includes 31 subsets covering activities of daily living and 5 cognitive domains. They all had brain imaging with MRI and PET with 18F-N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane at baseline. Subsequently, standardized uptake value ratios (SUVRs) for regional dopamine availability and regional gray matter volumes were obtained using automated segmentation. These metrics were compared across cognitive status groups, and spatiotemporal progression patterns were analyzed using the Subtype and Stage Inference machine learning technique. RESULTS Among 168 patients (mean age, 73.3 ± 6.1 years; 81 [48.2%] women), 65 had PD-NC, 65 had PD-MCI, and 38 had PDD. Patients with PD-MCI exhibited lower SUVRs (3.61 ± 1.31, p < 0.001) in the caudate than patients with PD-NC (4.43 ± 1.21) but higher SUVRs than patients with PDD (2.39 ± 1.06). Patients with PD-NC had higher thalamic SUVRs (1.55 ± 0.16, p < 0.001) than patients with both PD-MCI (1.45 ± 0.16) and PDD (1.38 ± 0.19). Regional deep gray matter volumes of the caudate (p = 0.015), putamen (p = 0.012), globus pallidus (p < 0.001), thalamus (p < 0.001), hippocampus (p < 0.001), and amygdala (p < 0.001) were more reduced in patients with PD-MCI or PDD than in patients with PD-NC, and the SUVR of the caudate correlated with caudate volume (r = 0.187, p = 0.015). Hippocampal atrophy was the initial change influencing cognitive impairment. The reduced dopamine availability of the thalamus preceded reductions in volume across most deep gray matter regions. DISCUSSION Our finding underscores the association between decreased dopamine availability and volume of the caudate and thalamus with cognitive dysfunction in PD. The dopamine availability of the caudate and thalamus was reduced before the volume of the caudate and thalamus was decreased, highlighting the spatiotemporal association between dopaminergic and structural pathology in cognitive impairment in PD.
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Affiliation(s)
- Yoonsang Oh
- From the Department of Neurology (Y.O., J.-S.K.), College of Medicine, The Catholic University of Korea; Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and USC Stevens Neuroimaging and Informatics Institute (G.P., H.K.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Joong-Seok Kim
- From the Department of Neurology (Y.O., J.-S.K.), College of Medicine, The Catholic University of Korea; Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and USC Stevens Neuroimaging and Informatics Institute (G.P., H.K.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Chul Hyoung Lyoo
- From the Department of Neurology (Y.O., J.-S.K.), College of Medicine, The Catholic University of Korea; Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and USC Stevens Neuroimaging and Informatics Institute (G.P., H.K.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Gilsoon Park
- From the Department of Neurology (Y.O., J.-S.K.), College of Medicine, The Catholic University of Korea; Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and USC Stevens Neuroimaging and Informatics Institute (G.P., H.K.), Keck School of Medicine, University of Southern California, Los Angeles
| | - Hosung Kim
- From the Department of Neurology (Y.O., J.-S.K.), College of Medicine, The Catholic University of Korea; Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; and USC Stevens Neuroimaging and Informatics Institute (G.P., H.K.), Keck School of Medicine, University of Southern California, Los Angeles
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Ju EY, Kim CY, Choi BY, Ryoo SW, Min JY, Min KB. Deficits of Facial Emotion Recognition in Elderly Individuals with Mild Cognitive Impairment. Dement Geriatr Cogn Disord 2024:1-8. [PMID: 39043155 DOI: 10.1159/000540364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION The study of facial emotion recognition is under-explored in subjects with mild cognitive impairment (MCI). We investigated whether deficits in facial emotion recognition are present in patients with MCI. We also analyzed the relationship between facial emotion recognition and different domains of cognitive function. METHODS This study included 300 participants aged 60 years or older with cognitive decline. We evaluated 181 MCI and 119 non-MCI subjects using the Seoul Neuropsychological Screening Battery-Core (SNSB-C) and facial emotion recognition task using six facial expressions (anger, disgust, fear, happiness, sadness and surprise). A Generalized Linear Model (GLM) was used to assess the association between cognitive performance and accuracy of facial emotion recognition and to compare facial emotion recognition in the MCI group based on the impairment of five different domains of cognitive function. The model was adjusted for age, sex, years of education, and depressive symptoms. RESULTS Patients with MCI had a lower score for accurately recognizing total facial emotion (0.48 vs. 0.53; ρ = 0.0003) and surprise (0.73 vs. 0.81; ρ = 0.0215) when compared to cognitively healthy subjects. We also discovered that frontal/executive function domain (Digit Symbol Coding [DSC, 0.38 vs. 0.49; p < 0.0001], Controlled Oral Word Association Test [COWAT, 0.42 vs. 0.49; p = 0.0001], Korean-Trail Making Test [K-TMT, 0.37 vs. 0.48; p = 0.0073], Korean-Color Word Stroop Test [K-CWST, 0.43 vs. 0.49; p = 0.0219]) and language domain (Korean-Boston Naming Test [S-K-BNT, 0.46 vs. 0.47; p = 0.003]) were statistically associated with the deficits of facial emotion recognition in patients with MCI. CONCLUSION We observed a significant association between deficits in facial emotion recognition and cognitive impairment in elderly individuals.
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Affiliation(s)
- Eun-Yoo Ju
- Graduate School of Psychological Service, Chung-Ang University, Seoul, Republic of Korea
| | - Chae Yoon Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Baek-Yong Choi
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seung-Woo Ryoo
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Republic of Korea
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Na S, Kim T, Song IU, Hong YJ, Kim SH. Cortex-to-caudate volume ratio as a predictor of cognitive decline in Alzheimer's disease and mild cognitive impairment. J Neurol Sci 2024; 462:123113. [PMID: 38941706 DOI: 10.1016/j.jns.2024.123113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Brain and cortical atrophy play crucial roles in supporting the clinical diagnosis of Alzheimer's disease (AD). This study hypothesized that the ratios of brain or cortical volume to subcortical gray matter structure volumes are potential imaging markers for cognitive alterations in AD dementia and amnestic mild cognitive impairment (aMCI). METHODS Seventy-seven subjects diagnosed with AD dementia or aMCI underwent baseline neuropsychological testing, 2-year follow-up cognitive assessments, and high-resolution T1-weighted MRI scans. Total brain/cortical volume and subcortical gray matter structure volumes were automatically segmented and measured. Univariate and multiple linear regression analyses were conducted to determine the associations between volumetric ratios and interval changes in cognitive scores. RESULTS The ratio of cortical volume to caudate volume showed the most significant association with changes in MoCA (B = 0.132, SE = 0.042, p = 0.002), MMSE (B = 0.140, SE = 0.040, p = 0.001), and CDR-SOB (B = -0.013, SE = 0.005, p = 0.007) scores over the 2-year follow-up period. These associations remained significant after adjusting for various covariates. Similar associations were observed for the ratios of cortical volume to putamen and globus pallidum volumes. CONCLUSIONS The cortex-to-caudate volume ratio is significantly associated with cognitive decline in AD dementia and aMCI. This ratio may serve as a useful biomarker for monitoring disease progression and predicting cognitive outcomes. Our findings highlight the importance of considering the relative atrophy of cortical and subcortical structures in understanding AD pathology.
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Affiliation(s)
- Seunghee Na
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Taewon Kim
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - In-Uk Song
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yun Jeong Hong
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong-Hoon Kim
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee S, Kim SE, Jang H, Kim JP, Sohn G, Park YH, Ham H, Gu Y, Park CJ, Kim HJ, Na DL, Kim K, Seo SW. Distinct effects of blood pressure parameters on Alzheimer's and vascular markers in 1,952 Asian individuals without dementia. Alzheimers Res Ther 2024; 16:125. [PMID: 38863019 PMCID: PMC11167921 DOI: 10.1186/s13195-024-01483-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/15/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Risk factors for cardiovascular disease, including elevated blood pressure, are known to increase risk of Alzheimer's disease. There has been increasing awareness of the relationship between long-term blood pressure (BP) patterns and their effects on the brain. We aimed to investigate the association of repeated BP measurements with Alzheimer's and vascular disease markers. METHODS We recruited 1,952 participants without dementia between August 2015 and February 2022. During serial clinic visits, we assessed both systolic BP (SBP) and diastolic BP (DBP), and visit-to-visit BP variability (BPV) was quantified from repeated measurements. In order to investigate the relationship of mean SBP (or DBP) with Alzheimer's and vascular markers and cognition, we performed multiple linear and logistic regression analyses after controlling for potential confounders (Model 1). Next, we investigated the relationship of with variation of SBP (or DBP) with the aforementioned variables by adding it into Model 1 (Model 2). In addition, mediation analyses were conducted to determine mediation effects of Alzheimer's and vascular makers on the relationship between BP parameters and cognitive impairment. RESULTS High Aβ uptake was associated with greater mean SBP (β = 1.049, 95% confidence interval 1.016-1.083). High vascular burden was positively associated with mean SBP (odds ratio = 1.293, 95% CI 1.015-1.647) and mean DBP (1.390, 1.098-1.757). High tau uptake was related to greater systolic BPV (0.094, 0.001-0.187) and diastolic BPV (0.096, 0.007-0.184). High Aβ uptake partially mediated the relationship between mean SBP and the Mini-Mental State Examination (MMSE) scores. Hippocampal atrophy mediated the relationship between diastolic BPV and MMSE scores. CONCLUSIONS Each BP parameter affects Alzheimer's and vascular disease markers differently, which in turn leads to cognitive impairment. Therefore, it is necessary to appropriately control specific BP parameters to prevent the development of dementia. Furthermore, a better understanding of pathways from specific BP parameters to cognitive impairments might enable us to select the managements targeting the specific BP parameters to prevent dementia effectively.
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Affiliation(s)
- Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Si Eun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, 48108, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Gyeongmo Sohn
- Department of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, 48108, Republic of Korea
| | - Yu Hyun Park
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Hongki Ham
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Yuna Gu
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Chae Jung Park
- Research Institute, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, 06351, Republic of Korea
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
- Neuroscience Center, Samsung Medical Center, Seoul, 06351, Republic of Korea.
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, 06351, Republic of Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, Republic of Korea.
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, 06351, Republic of Korea.
- Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, 06351, Republic of Korea.
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Chun MY, Lee T, Kim SH, Lee HS, Kim YJ, Lee PH, Sohn YH, Jeong Y, Chung SJ. Hypoperfusion in Alzheimer's Disease-Prone Regions and Dementia Conversion in Parkinson's Disease. Clin Nucl Med 2024; 49:521-528. [PMID: 38584352 DOI: 10.1097/rlu.0000000000005211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
PURPOSE OF THE REPORT Although early detection of individuals at risk of dementia conversion is important in patients with Parkinson's disease (PD), there is still no consensus on neuroimaging biomarkers for predicting future cognitive decline. We aimed to investigate whether cerebral perfusion patterns on early-phase 18 F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane ( 18 F-FP-CIT) PET have the potential to serve as a neuroimaging predictor for early dementia conversion in patients with PD. MATERIALS AND METHODS In this retrospective analysis, we enrolled 187 patients with newly diagnosed PD who underwent dual-phase 18 F-FP-CIT PET at initial assessment and serial cognitive assessments during the follow-up period (>5 years). Patients with PD were classified into 2 groups: the PD with dementia (PDD)-high-risk (PDD-H; n = 47) and the PDD-low-risk (PDD-L; n = 140) groups according to dementia conversion within 5 years of PD diagnosis. We explored between-group differences in the regional uptake in the early-phase 18 F-FP-CIT PET images. We additionally performed a linear discriminant analysis to develop a prediction model for early PDD conversion. RESULTS The PDD-H group exhibited hypoperfusion in Alzheimer's disease (AD)-prone regions (inferomedial temporal and posterior cingulate cortices, and insula) compared with the PDD-L group. A prediction model using regional uptake in the right entorhinal cortex, left amygdala, and left isthmus cingulate cortex could optimally distinguish the PDD-H group from the PDD-L group. CONCLUSIONS Regional hypoperfusion in the AD-prone regions on early-phase 18 F-FP-CIT PET can be a useful biomarker for predicting early dementia conversion in patients with PD.
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Affiliation(s)
| | | | | | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Phil Hyu Lee
- From the Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Jung W, Kim SE, Kim JP, Jang H, Park CJ, Kim HJ, Na DL, Seo SW, Suk HI. Deep learning model for individualized trajectory prediction of clinical outcomes in mild cognitive impairment. Front Aging Neurosci 2024; 16:1356745. [PMID: 38813529 PMCID: PMC11135285 DOI: 10.3389/fnagi.2024.1356745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/18/2024] [Indexed: 05/31/2024] Open
Abstract
Objectives Accurately predicting when patients with mild cognitive impairment (MCI) will progress to dementia is a formidable challenge. This work aims to develop a predictive deep learning model to accurately predict future cognitive decline and magnetic resonance imaging (MRI) marker changes over time at the individual level for patients with MCI. Methods We recruited 657 amnestic patients with MCI from the Samsung Medical Center who underwent cognitive tests, brain MRI scans, and amyloid-β (Aβ) positron emission tomography (PET) scans. We devised a novel deep learning architecture by leveraging an attention mechanism in a recurrent neural network. We trained a predictive model by inputting age, gender, education, apolipoprotein E genotype, neuropsychological test scores, and brain MRI and amyloid PET features. Cognitive outcomes and MRI features of an MCI subject were predicted using the proposed network. Results The proposed predictive model demonstrated good prediction performance (AUC = 0.814 ± 0.035) in five-fold cross-validation, along with reliable prediction in cognitive decline and MRI markers over time. Faster cognitive decline and brain atrophy in larger regions were forecasted in patients with Aβ (+) than with Aβ (-). Conclusion The proposed method provides effective and accurate means for predicting the progression of individuals within a specific period. This model could assist clinicians in identifying subjects at a higher risk of rapid cognitive decline by predicting future cognitive decline and MRI marker changes over time for patients with MCI. Future studies should validate and refine the proposed predictive model further to improve clinical decision-making.
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Affiliation(s)
- Wonsik Jung
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Republic of Korea
| | - Si Eun Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chae Jung Park
- National Cancer Center Research Institute, Goyang, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
- Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Heung-Il Suk
- Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea
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Lee H, Yong SY, Choi H, Yoon GY, Koh S. Association between loneliness and cognitive function, and brain volume in community-dwelling elderly. Front Aging Neurosci 2024; 16:1389476. [PMID: 38741916 PMCID: PMC11089178 DOI: 10.3389/fnagi.2024.1389476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction We investigated the relationship between loneliness, cognitive impairment, and regional brain volume among elderly individuals residing in the Korean community. Methods Data from the ARIRANG aging-cognition sub-cohort, collected between 2020 and 2022, were utilized for the present study. Loneliness was assessed using the UCLA-Loneliness Scale (UCLA-LS) questionnaire and the relevant item from Center for Epidemiologic Studies Depression Scale Korean version (CES-D-K). Cognitive impairment was measured through Mini-Mental State Examination (K-MMSE-2) and Seoul Neuropsychological Screening Battery (SNSB-C), with five sub-categories: attention, memory, visuospatial function, language, and executive function. Logistic regression was employed for prevalence ratios related to cognitive impairment, while linear regression was used for regional brain volume including white matter hyperintensity (WMH) and cortical thickness. Results Our analysis involved 785 participants (292 men and 493 women). We observed increased cognitive impairment assessed by K-MMSE-2 [UCLA-LS: odds ratio (OR) 3.133, 95% confidence interval (CI) 1.536-6.393; loneliness from CES-D: OR 2.823, 95% CI 1.426-5.590] and SNSB-C total score (UCLA-LS: OR 2.145, 95% CI 1.304-3.529) in the lonely group compared to the non-lonely group. Specifically, the lonely group identified by UCLA-LS showed an association with declined visuospatial (OR 1.591, 95% CI 1.029-2.460) and executive function (OR 1.971, 95% CI 1.036-3.750). The lonely group identified by CES-D-K was associated with impaired memory (OR 1.577, 95% CI 1.009-2.466) and executive function (OR 1.863, 95% CI 1.036-3.350). In the regional brain volume analysis, loneliness was linked to reduced brain volume in frontal white matter (left: -1.24, 95% CI -2.37 ∼-0.12; right: -1.16, 95% CI -2.31 ∼ -0.00), putamen (left: -0.07, 95% CI -0.12 ∼-0.02; right: -0.06, 95% CI -0.11 ∼-0.01), and globus pallidus (-15.53, 95% CI -30.13 ∼-0.93). There was no observed association in WMH and cortical thickness. Conclusion Loneliness is associated with cognitive decline and volumetric reduction in the frontal white matter, putamen, and globus pallidus.
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Affiliation(s)
- Hunju Lee
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
- Institute of Genomic Cohort, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Sang Yeol Yong
- Department of Rehabilitation Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
- International Olympic Committee Research Centre Korea, Yonsei Institute of Sports Science and Exercise Medicine, Wonju, Republic of Korea
| | - Hyowon Choi
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Ga Young Yoon
- Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Sangbaek Koh
- Department of Preventive Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
- Institute of Genomic Cohort, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
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Park B, Kim Y, Park J, Choi H, Kim SE, Ryu H, Seo K. Integrating Biomarkers From Virtual Reality and Magnetic Resonance Imaging for the Early Detection of Mild Cognitive Impairment Using a Multimodal Learning Approach: Validation Study. J Med Internet Res 2024; 26:e54538. [PMID: 38631021 PMCID: PMC11063880 DOI: 10.2196/54538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/29/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Early detection of mild cognitive impairment (MCI), a transitional stage between normal aging and Alzheimer disease, is crucial for preventing the progression of dementia. Virtual reality (VR) biomarkers have proven to be effective in capturing behaviors associated with subtle deficits in instrumental activities of daily living, such as challenges in using a food-ordering kiosk, for early detection of MCI. On the other hand, magnetic resonance imaging (MRI) biomarkers have demonstrated their efficacy in quantifying observable structural brain changes that can aid in early MCI detection. Nevertheless, the relationship between VR-derived and MRI biomarkers remains an open question. In this context, we explored the integration of VR-derived and MRI biomarkers to enhance early MCI detection through a multimodal learning approach. OBJECTIVE We aimed to evaluate and compare the efficacy of VR-derived and MRI biomarkers in the classification of MCI while also examining the strengths and weaknesses of each approach. Furthermore, we focused on improving early MCI detection by leveraging multimodal learning to integrate VR-derived and MRI biomarkers. METHODS The study encompassed a total of 54 participants, comprising 22 (41%) healthy controls and 32 (59%) patients with MCI. Participants completed a virtual kiosk test to collect 4 VR-derived biomarkers (hand movement speed, scanpath length, time to completion, and the number of errors), and T1-weighted MRI scans were performed to collect 22 MRI biomarkers from both hemispheres. Analyses of covariance were used to compare these biomarkers between healthy controls and patients with MCI, with age considered as a covariate. Subsequently, the biomarkers that exhibited significant differences between the 2 groups were used to train and validate a multimodal learning model aimed at early screening for patients with MCI among healthy controls. RESULTS The support vector machine (SVM) using only VR-derived biomarkers achieved a sensitivity of 87.5% and specificity of 90%, whereas the MRI biomarkers showed a sensitivity of 90.9% and specificity of 71.4%. Moreover, a correlation analysis revealed a significant association between MRI-observed brain atrophy and impaired performance in instrumental activities of daily living in the VR environment. Notably, the integration of both VR-derived and MRI biomarkers into a multimodal SVM model yielded superior results compared to unimodal SVM models, achieving higher accuracy (94.4%), sensitivity (100%), specificity (90.9%), precision (87.5%), and F1-score (93.3%). CONCLUSIONS The results indicate that VR-derived biomarkers, characterized by their high specificity, can be valuable as a robust, early screening tool for MCI in a broader older adult population. On the other hand, MRI biomarkers, known for their high sensitivity, excel at confirming the presence of MCI. Moreover, the multimodal learning approach introduced in our study provides valuable insights into the improvement of early MCI detection by integrating a diverse set of biomarkers.
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Affiliation(s)
- Bogyeom Park
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Yuwon Kim
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hojin Choi
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seong-Eun Kim
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul, Republic of Korea
| | - Hokyoung Ryu
- Graduate School of Technology and Innovation Management, Hanyang University, Seoul, Republic of Korea
| | - Kyoungwon Seo
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, Seoul, Republic of Korea
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Hartwigsen G, Lim JS, Bae HJ, Yu KH, Kuijf HJ, Weaver NA, Biesbroek JM, Kopal J, Bzdok D. Bayesian modelling disentangles language versus executive control disruption in stroke. Brain Commun 2024; 6:fcae129. [PMID: 38707712 PMCID: PMC11069117 DOI: 10.1093/braincomms/fcae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/06/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Stroke is the leading cause of long-term disability worldwide. Incurred brain damage can disrupt cognition, often with persisting deficits in language and executive capacities. Yet, despite their clinical relevance, the commonalities and differences between language versus executive control impairments remain under-specified. To fill this gap, we tailored a Bayesian hierarchical modelling solution in a largest-of-its-kind cohort (1080 patients with stroke) to deconvolve language and executive control with respect to the stroke topology. Cognitive function was assessed with a rich neuropsychological test battery including global cognitive function (tested with the Mini-Mental State Exam), language (assessed with a picture naming task), executive speech function (tested with verbal fluency tasks), executive control functions (Trail Making Test and Digit Symbol Coding Task), visuospatial functioning (Rey Complex Figure), as well as verbal learning and memory function (Soul Verbal Learning). Bayesian modelling predicted interindividual differences in eight cognitive outcome scores three months after stroke based on specific tissue lesion topologies. A multivariate factor analysis extracted four distinct cognitive factors that distinguish left- and right-hemispheric contributions to ischaemic tissue lesions. These factors were labelled according to the neuropsychological tests that had the strongest factor loadings: One factor delineated language and general cognitive performance and was mainly associated with damage to left-hemispheric brain regions in the frontal and temporal cortex. A factor for executive control summarized mental flexibility, task switching and visual-constructional abilities. This factor was strongly related to right-hemispheric brain damage of posterior regions in the occipital cortex. The interplay of language and executive control was reflected in two distinct factors that were labelled as executive speech functions and verbal memory. Impairments on both factors were mainly linked to left-hemispheric lesions. These findings shed light onto the causal implications of hemispheric specialization for cognition; and make steps towards subgroup-specific treatment protocols after stroke.
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Affiliation(s)
- Gesa Hartwigsen
- Wilhelm Wundt Institute for Psychology, Leipzig University, 04109 Leipzig, Germany
- Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, 13620, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 14068, Republic of Korea
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, 3582 KE Utrecht, The Netherlands
| | - Jakub Kopal
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2BA, Canada
- Mila—Quebec Artificial Intelligence Institute, Montreal, Quebec H2S 3H1, Canada
| | - Danilo Bzdok
- Department of Biomedical Engineering, Faculty of Medicine, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2BA, Canada
- Mila—Quebec Artificial Intelligence Institute, Montreal, Quebec H2S 3H1, Canada
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Baek K, Kim YM, Na HK, Lee J, Shin DH, Heo SJ, Chung SJ, Kim K, Lee PH, Sohn YH, Yoon J, Kim YJ. Comparing Montreal Cognitive Assessment Performance in Parkinson's Disease Patients: Age- and Education-Adjusted Cutoffs vs. Machine Learning. J Mov Disord 2024; 17:171-180. [PMID: 38346940 PMCID: PMC11082615 DOI: 10.14802/jmd.23271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE The Montreal Cognitive Assessment (MoCA) is recommended for general cognitive evaluation in Parkinson's disease (PD) patients. However, age- and education-adjusted cutoffs specifically for PD have not been developed or systematically validated across PD cohorts with diverse education levels. METHODS In this retrospective analysis, we utilized data from 1,293 Korean patients with PD whose cognitive diagnoses were determined through comprehensive neuropsychological assessments. Age- and education-adjusted cutoffs were formulated based on 1,202 patients with PD. To identify the optimal machine learning model, clinical parameters and MoCA domain scores from 416 patients with PD were used. Comparative analyses between machine learning. METHODS and different cutoff criteria were conducted on an additional 91 consecutive patients with PD. RESULTS The cutoffs for cognitive impairment decrease with increasing age within the same education level. Similarly, lower education levels within the same age group correspond to lower cutoffs. For individuals aged 60-80 years, cutoffs were set as follows: 25 or 24 years for those with more than 12 years of education, 23 or 22 years for 10-12 years, and 21 or 20 years for 7-9 years. Comparisons between age- and education-adjusted cutoffs and the machine learning method showed comparable accuracies. The cutoff method resulted in a higher sensitivity (0.8627), whereas machine learning yielded higher specificity (0.8250). CONCLUSION Both the age- and education-adjusted cutoff. METHODS and machine learning. METHODS demonstrated high effectiveness in detecting cognitive impairment in PD patients. This study highlights the necessity of tailored cutoffs and suggests the potential of machine learning to improve cognitive assessment in PD patients.
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Affiliation(s)
- Kyeongmin Baek
- Department of Computer Engineering, Hallym University, Chuncheon, Korea
| | - Young Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Han Kyu Na
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Junki Lee
- Department of Computer Engineering, Hallym University, Chuncheon, Korea
| | - Dong Ho Shin
- Massachusetts College of Pharmacy & Health Sciences, Boston, USA
| | - Seok-Jae Heo
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea
| | - Kiyong Kim
- Department of Electronic Engineering, Kyonggi University, Suwon, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Young H. Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Jeehee Yoon
- Department of Computer Engineering, Hallym University, Chuncheon, Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
- YONSEI BEYOND LAB, Yongin, Korea
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Chung SJ, Kim SH, Park CW, Lee HS, Yun M, Kim YJ, Sohn YH, Jeong Y, Lee PH. Patterns of regional cerebral hypoperfusion in early Parkinson's disease: Clinical implications. Parkinsonism Relat Disord 2024; 121:106024. [PMID: 38377658 DOI: 10.1016/j.parkreldis.2024.106024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/07/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION This study aimed to investigate whether regional cerebral perfusion patterns on early-phase 18F-FP-CIT PET scans, which is typically coupled to cerebral metabolism, predict the long-term prognosis of Parkinson's disease (PD). METHODS We enrolled 397 drug-naïve patients with early-stage PD who underwent dual-phase 18F-FP-CIT PET scans. After quantifying the early-phase 18F-FP-CIT PET images, cluster analysis was performed to delineate the PD subtypes according to the patterns of regional cerebral perfusion. We compared the risk of developing levodopa-induced dyskinesia (LID), wearing-off, freezing of gait (FOG), and dementia between the PD subtypes. RESULTS Cluster analysis classified patients into three subtypes: cluster 1 (relatively preserved cortical uptake; n = 175), cluster 2 (decreased uptake in the frontal, parietal, and temporal regions; n = 151), and cluster 3 (decreased uptake in more extensive regions, additionally involving the lateral occipital regions; n = 71). Cluster 1 was characterized by a younger age-of-onset, less severe motor deficits, less severely decreased 18F-FP-CIT binding in the caudate, and better cognitive performance. Cluster 3 was characterized by an older age-of-onset, more severe motor deficits, and poorer cognitive performance. Cluster 2 was intermediate between clusters 1 and 3. Cox regression analyses demonstrated that clusters 2 and 3 had a higher risk for dementia conversion than cluster 1, whereas the risk for developing LID, wearing-off, and FOG did not differ among the clusters. CONCLUSION The patterns of regional cerebral perfusion can provide information on long-term prognosis with regards to cognitive, but not motor aspects of patients with early-stage PD.
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Affiliation(s)
- Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; YONSEI BEYOND LAB, Yongin, South Korea
| | - Su Hong Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Department of Radiology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea; YONSEI BEYOND LAB, Yongin, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Department of Radiology, Yeungnam University College of Medicine, Daegu, South Korea; Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea; Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Choi KE, Ryu DW, Oh YS, Kim JS. Fasting Plasma Glucose Levels and Longitudinal Motor and Cognitive Outcomes in Parkinson's Disease Patients. J Mov Disord 2024; 17:198-207. [PMID: 38444294 PMCID: PMC11082616 DOI: 10.14802/jmd.23264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 03/06/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Hyperglycemia and diabetes mellitus have been identified as poor prognostic factors for motor and nonmotor outcomes in patients with Parkinson's disease (PD), although there is some controversy with this finding. In the present study, we investigated the effects of fasting plasma glucose (FPG) levels on longitudinal motor and cognitive outcomes in PD patients. METHODS We included a total of 201 patients who were diagnosed with PD between January 2015 and January 2020. The patients were categorized based on FPG level into euglycemia (70 mg/dL < FPG < 100 mg/dL), intermediate glycemia (100 mg/dL ≤ FPG < 126 mg/dL), and hyperglycemia (FPG ≥ 126 mg/dL), and longitudinal FPG trajectories were analyzed using group-based trajectory modeling. Survival analysis was conducted to determine the time until motor outcome (Hoehn and Yahr stage ≥ 2) and the conversion from normal cognition to mild cognitive impairment. RESULTS Among the patient cohort, 82 had euglycemia, 93 had intermediate glycemia, and 26 had hyperglycemia. Intermediate glycemia (hazard ratio 1.747, 95% confidence interval [CI] 1.083-2.816, p = 0.0221) and hyperglycemia (hazard ratio 3.864, 95% CI 1.996-7.481, p < 0.0001) were found to be significant predictors of worsening motor symptoms. However, neither intermediate glycemia (hazard ratio 1.183, 95% CI 0.697-2.009, p = 0.5339) nor hyperglycemia (hazard ratio 1.297, 95% CI 0.601-2.800, p = 0.5078) demonstrated associations with the longitudinal progression of cognitive impairment. Diabetes mellitus, defined by self-reported medical history, was not related to poor motor or cognitive impairment outcomes. CONCLUSION Our. RESULTS suggest that both impaired glucose tolerance and hyperglycemia could be associated with motor progression in PD patients.
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Affiliation(s)
- Ko-Eun Choi
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ahn SH, Jeong JH, Park KW, Kim EJ, Yoon SJ, Yoon B, Jang JW, Minn Y, Choi SH. Effect of Dietary Habits on Alzheimer's Disease Progression. Yonsei Med J 2024; 65:217-226. [PMID: 38515359 PMCID: PMC10973553 DOI: 10.3349/ymj.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Research on the relationship between diet and dementia among Koreans are lacking. This study investigated the association between dietary habits and dementia progression over 3 years in patients with Alzheimer's disease dementia (ADD). MATERIALS AND METHODS This study included 705 patients with mild-to-moderate ADD. Dietary habits were assessed using the Mini Dietary Assessment Index, comprising 10 questions. Outcome measures included the Clinical Dementia Rating scale-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living, Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), and neuropsychological test battery (NTB) z-scores, which were evaluated annually over 3 years. RESULTS In Q10 (eat all food evenly without being picky), the 3-year mean differences in CDR-SB (increases in scores represent worsening) compared to the "rarely" group were -1.86 [95% confidence interval (CI)=-3.64 - -0.09, p=0.039] for the "usually" group and -2.23 (95% CI=-4.40 - -0.06, p=0.044) for the "always" group. In Q7 (add salt or soy sauce to food when eating), the 3-year mean differences in CDR-SB compared to the "always" group were -2.47 (95% CI=-4.70 - -0.24, p=0.030) for the "usually" group and -3.16 (95% CI=-5.36 - -0.96, p=0.005) for the "rarely" group. The "rarely" and "usually" groups in Q7 showed significantly less decline in NTB z-score and CGA-NPI compared to the "always" group. CONCLUSION Eating a balanced diet and reducing salt intake were associated with a slower decline in dementia severity, cognition, and behavioral alterations in patients with ADD.
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Affiliation(s)
- So Hyun Ahn
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yangki Minn
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Seong Hye Choi
- Department of Neurology, Inha University College of Medicine, Incheon, Korea.
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Ryoo SW, Choi BY, Son SY, Oh KH, Min JY, Min KB. Association between Multiple Trace Elements, Executive Function, and Cognitive Impairment with No Dementia in Older Adults. Nutrients 2024; 16:1001. [PMID: 38613034 PMCID: PMC11013674 DOI: 10.3390/nu16071001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Many studies suggest a significant association between individual essential trace elements (ETEs) and cognitive impairment in older adults, but evidence of the synchronized effect of multiple ETEs on cognitive function is lacking. We investigated the association between multiple ETEs, cognitive impairment with no dementia (CIND), and executive function in older Korean adults, using the Bayesian kernel machine regression (BKMR) model. Three hundred and thirty-six older adults were included as the study population and classified as the CIND and control groups. Blood manganese (Mn), copper (Cu), zinc (Zn), selenium (Se), and molybdenum (Mo) were measured as relevant ETEs. The frontal/executive tests included digit symbol coding (DSC), the Korean color word Stroop test (K-CWST), a controlled oral word association test (COWAT), and a trial-making test (TMT). Overall, the BKMR showed a negative association between multiple ETEs and the odds of CIND. Mn was designated as the most dominant element associated with the CIND (PIP = 0.6184), with a U-shaped relationship. Cu and Se levels were positively associated with the K-CWST percentiles (β = 31.78; 95% CI: 13.51, 50.06) and DSC percentiles (β = 25.10; 95% CI: 7.66, 42.53), respectively. Our results suggest that exposure to multiple ETEs may be linked to a protective mechanism against cognitive impairment in older adults.
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Affiliation(s)
- Seung-Woo Ryoo
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; (S.-W.R.)
| | - Baek-Yong Choi
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; (S.-W.R.)
| | - Seok-Yoon Son
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; (S.-W.R.)
| | - Kun-Hee Oh
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; (S.-W.R.)
| | - Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul 03080, Republic of Korea; (S.-W.R.)
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul 03080, Republic of Korea
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24
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Kim HG, Kim Y, Edmonds EC, Bondi MW. Comparison of Cognitive Impairment Diagnosis Criteria in Clinical Settings: Conventional vs. Neuropsychological. ALPHA PSYCHIATRY 2024; 25:212-219. [PMID: 38798819 PMCID: PMC11117417 DOI: 10.5152/alphapsychiatry.2024.231448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 05/29/2024]
Abstract
Background Theories on Alzheimer disease pathogenesis propose a gap between pathological changes and the onset of clinical symptoms. The early detection of cognitive decline is crucial for the implementation of preventive strategies. Mild cognitive impairment is a transitional stage and an accurate diagnosis is vital. However, the diagnosis of mild cognitive impairment varies due to inconsistent diagnostic criteria. This study aims to explore the effectiveness of comprehensive neuropsychological criteria, including all cognitive domains, for diagnosing cognitive impairment in clinical settings. Methods The study included 509 subjects with subjective cognitive complaints between 2017 and 2021. They were diagnosed using the conventional and neuropsychological criteria, and the results were named the complex criteria (conventional criteria-neuropsychological criteria). Results Concordance between the conventional and neuropsychological diagnostic criteria diagnoses was 87.82%. Some participants diagnosed with mild cognitive impairment or dementia using the conventional criteria were classified as normal according to the neuropsychological criteria. Notably, the mild cognitive impairment - normal cognition (MCI-NC) and dementia (DEM)-NC (normal cognition) groups exhibited distinct characteristics. The MCI-NC group had higher depression scores (P = .008) and better memory performance (P = .026) and executive function (P = .020) than the MCI-MCI group. The DEM-NC group had better instrumental activities of daily living (P < .001) than the DEM-DEM group. Conclusion This study highlights the complexity of diagnosing cognitive impairment and the importance of comprehensive criteria. Relying solely on conventional criteria may lead to overdiagnosis. The neuropsychological criteria consider various cognitive domains and better discriminate between individuals with MCIs or other factors that contribute to cognitive difficulties.
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Affiliation(s)
- Hye-Geum Kim
- Department of Psychiatry, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Republic of Korea
- Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, CA, USA
| | - Younggyo Kim
- Department of Psychology, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Emily C. Edmonds
- Banner Alzheimer’s Institute, Tucson, AZ, USA
- Departments of Neurology and Psychology, University of Arizona, Tucson, AZ, USA
| | - Mark W. Bondi
- Department of Psychiatry, University of California San Diego, School of Medicine, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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25
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Ryu DW, Yoo SW, Choi KE, Oh YS, Kim JS. Correlation of olfactory function factors with cardiac sympathetic denervation in Parkinson's disease. J Neurol 2024; 271:1397-1407. [PMID: 37940708 DOI: 10.1007/s00415-023-12080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Hyposmia is a common nonmotor symptom of Parkinson's disease (PD) and reportedly associated with dysautonomia in PD. The smell identification test for measuring olfactory function consists of multiple items to discriminate specific scents. In the present study, factor analysis of the smell identification test was performed, and the correlation of extracted factors with cardiac sympathetic denervation (CSD) in patients with PD was investigated. METHODS The present study included 183 early PD patients who underwent the Cross-Cultural Smell Identification Test (CC-SIT) and 123I-meta-iodobenzylguanidine (123I-MIBG) myocardial scintigraphy. Factor analysis of 12 items on the CC-SIT was performed using the computed correlation matrix for the binary items, and five smell factors were extracted. Multiple linear regression was performed to determine the correlation of olfactory function with late heart-to-mediastinum (H/M) ratio of 123I-MIBG uptake. RESULTS The mean CC-SIT score was 6.1 ± 2.6, and 133 patients (72.7%) had CSD. The CC-SIT score and five smell factors were not associated with dopamine transporter uptake or cognitive functions. However, the CC-SIT score significantly correlated with age (P < 0.001) and late H/M ratio (P < 0.001). Factors 1 and 5 showed an increasing trend with larger H/M ratio, although it was not statistically significant (β = 0.203, P = 0.085 and β = 0.230, P = 0.085, respectively). Factor 5 significantly correlated with the H/M ratio in PD patients with CSD (β = 0.676, P = 0.036). DISCUSSION The results showed olfactory dysfunction to be selectively associated with cardiac sympathetic burden in PD. The correlation of certain factors with CSD indicates the possibility of selective hyposmia in PD patients.
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Affiliation(s)
- Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ko-Eun Choi
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Yoo SW, Oh YS, Ryu DW, Ha S, Lyoo CH, Kim Y, Yoo JY, Kim JS. Cardiac sympathetic "morbidity" might reflect the neurobiology of early Parkinson's disease. J Neurol 2024; 271:944-954. [PMID: 37864716 DOI: 10.1007/s00415-023-12049-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND An appropriate extracranial biomarker that delineates endophenotypes of Parkinson's disease (PD) at an early stage and reflects the neurodegenerative process is lacking. An evaluation of myocardial sympathetic nerve terminals could be a good candidate. This study aimed to explore subtypes of PD patients that showed cardiac catecholaminergic vesicular defect and their characteristics. METHODS This study included 122 early drug-naïve PD patients who were followed for approximately 4-5 years. All patients were examined with 18F-N-(3-fluoropropyl)-2beta-carbon ethoxy-3beta-(4-iodophenyl) nortropane positron-emission tomography and 123I-meta-iodobenzylguanidine myocardial scintigraphy. Cardiac scans were reexamined two or three times. Patients were subgrouped into the sympathetic denervated group at the initial scan, those without evidence of denervated myocardium in the first and subsequent scans, and the converters whose myocardium was initially normal but became impaired in the subsequent scans. Cognition in 99 patients was initially assessed with neuropsychological tests. Any associations between cardiac denervation subtypes and presynaptic dopamine transporter densities were investigated. Cognitive status relevant to cardiac sympathetic denervation status was evaluated. RESULTS This study found that cross-sectional comparisons of presynaptic monoamine transporter availability with a predefined order of cardiac denervation groups revealed parallel degeneration. A quadratic correlation between cardiac catecholamine capacity and cognition was observed. This association was interpreted to reflect the early neurobiology of PD. CONCLUSION An observed cardiac catecholaminergic gradient was to mirror the central neurobiology of early PD.
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Affiliation(s)
- Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong-Woo Ryu
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seunggyun Ha
- Division of Nuclear Medicine, Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Hyoung Lyoo
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuna Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji-Yeon Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Chun MY, Chung SJ, Kim SH, Park CW, Jeong SH, Lee HS, Lee PH, Sohn YH, Jeong Y, Kim YJ. Hippocampal Perfusion Affects Motor and Cognitive Functions in Parkinson Disease: An Early Phase 18 F-FP-CIT Positron Emission Tomography Study. Ann Neurol 2024; 95:388-399. [PMID: 37962393 DOI: 10.1002/ana.26827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE We investigated whether hippocampal perfusion changes are associated with cognitive decline, motor deficits, and the risk of dementia conversion in patients with Parkinson disease (PD). METHODS We recruited patients with newly diagnosed and nonmedicated PD and healthy participants who underwent dual phase 18 F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane positron emission tomography scans. Patients were classified into 3 groups according to hippocampal perfusion measured by standard uptake value ratios (SUVRs): (1) PD hippocampal hypoperfusion group (1 standard deviation [SD] below the mean hippocampal SUVR of healthy controls; PD-hippo-hypo), (2) PD hippocampal hyperperfusion group (1 SD above the mean; PD-hippo-hyper), and (3) the remaining patients (PD-hippo-normal). We compared the baseline cognitive performance, severity of motor deficits, hippocampal volume, striatal dopamine transporter (DAT) availability, and risk of dementia conversion among the groups. RESULTS We included 235 patients (PD-hippo-hypo, n = 21; PD-hippo-normal, n = 157; PD-hippo-hyper, n = 57) and 48 healthy participants. Patients in the PD-hippo-hypo group were older and had smaller hippocampal volumes than those in the other PD groups. The PD-hippo-hypo group showed less severely decreased DAT availability in the putamen than the other groups despite similar severities of motor deficit. The PD-hippo-hypo group had a higher risk of dementia conversion compared to the PD-hippo-normal (hazard ratio = 2.59, p = 0.013) and PD-hippo-hyper (hazard ratio = 3.73, p = 0.006) groups, despite similar cognitive performance at initial assessment between groups. INTERPRETATION Hippocampal hypoperfusion may indicate a reduced capacity to cope with neurodegenerative processes in terms of the development of motor deficits and cognitive decline in patients with PD. ANN NEUROL 2024;95:388-399.
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Affiliation(s)
- Min Young Chun
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Su Hong Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Radiology, Yeungnam University College of Medicine, Daegu, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
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Na S, Lee SK, Lee ES. The Multifocal Dural Arteriovenous Fistula Presumed to Present as a Progressive Cognitive Impairment. Dement Neurocogn Disord 2024; 23:67-70. [PMID: 38362058 PMCID: PMC10864701 DOI: 10.12779/dnd.2024.23.1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 02/17/2024] Open
Affiliation(s)
- Seunghee Na
- Department of Neurology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Korea
| | - Seung-Keun Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Ryoo N, Suh J, Son EJ, Park YH, Kim S. Neuropsychological Correlates of Clinical Progression in Subjective Cognitive Decline. J Alzheimers Dis 2024; 101:1121-1126. [PMID: 39302360 DOI: 10.3233/jad-231042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Background Subjective cognitive decline (SCD) refers to self-reported cognitive decline in individuals with normal performance on standardized cognitive tests. Understanding the factors predicting progression from SCD to mild cognitive impairment (MCI) is crucial, as approximately 14% of SCD cases progress to dementia and about 27% develop MCI over four years. Objective This study aims to identify neuropsychological predictors of progression from SCD to MCI, focusing on cognitive domains assessed through neuropsychological tests. Methods This retrospective study at Seoul National University Bundang Hospital analyzed a cohort of 107 patients diagnosed with SCD through comprehensive assessment. Patients underwent annual neuropsychological testing, including the Digit Span Test, Boston Naming Test, Rey Complex Figure Test, Seoul Verbal Learning Test, and Stroop Test. Results Annually, these patients underwent neuropsychological tests over a 5-year period; 24 progressed to MCI per NIA-AA criteria. Key predictors of MCI progression included age, ischemic heart disease, and scores from the forward digit span, delayed recall, and Boston naming tests. Lower scores in delayed recall and Boston naming tests significantly correlated with a higher risk of MCI (p < 0.001). Conclusions These findings suggest a need for targeted management of memory and language functions to monitor disease progression effectively.
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Affiliation(s)
- Nayoung Ryoo
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeewon Suh
- Department of Neurology, National Medical Center, Seoul, Republic of Korea
| | - Eun Ji Son
- Department of Rehabilitation Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Na S, Lee C, Ho S, Hong YJ, Jeong JH, Park KH, Kim S, Wang MJ, Choi SH, Han S, Kang SW, Kang S, Yang DW. A Longitudinal Study on Memory Enhancement in Subjective Cognitive Decline Patients: Clinical and Neuroimaging Perspectives. J Alzheimers Dis 2024; 97:193-204. [PMID: 38108349 DOI: 10.3233/jad-230667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Subjective cognitive decline (SCD) refers to the self-reported persistent cognitive decline despite normal objective testing, increasing the risk of dementia compared to cognitively normal individuals. OBJECTIVE This study aims to investigate the attributes of SCD patients who demonstrated memory function improvement. METHODS In this prospective study of SCD, a total of 120 subjects were enrolled as part of a multicenter cohort study aimed at identifying predictors for the clinical progression to mild cognitive impairment or dementia (CoSCo study). All subjects underwent 18F-florbetaben PET and brain MRI scans at baseline and annual neuropsychological tests. At the 24-month follow-up, we classified SCD patients based on changes in memory function, the z-score of the Seoul verbal learning test delayed recall. RESULTS Of the 120 enrolled patients, 107 successfully completed the 24-month follow-up assessment. Among these, 80 patients (74.8%) with SCD exhibited memory function improvements. SCD patients with improved memory function had a lower prevalence of coronary artery disease at baseline and performed better in the trail-making test part B compared to those without improvement. Anatomical and biomarker analysis showed a lower frequency of amyloid PET positivity and larger volumes in the left and right superior parietal lobes in subjects with improved memory function. CONCLUSIONS Our prospective study indicates that SCD patients experiencing memory improvement over a 24-month period had a lower amyloid burden, fewer cardiovascular risk factors, and superior executive cognitive function. Identifying these key factors associated with cognitive improvement may assist clinicians in predicting future memory function improvements in SCD patients.
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Affiliation(s)
- Seunghee Na
- Department of Neurology, College of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, South Korea
| | - Chonghwee Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
| | - SeongHee Ho
- Department of Neurology, Hanyang University Hanmaeum Changwon Hospital, Changwon, Korea
| | - Yun Jeong Hong
- Department of Neurology, College of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, South Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Kee Hyung Park
- Department of Neurology, Gachon University Gil Hospital, Incheon, South Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | | | - Seung Wan Kang
- Data Center for Korean EEG, College of Nursing, Seoul National University, Seoul, South Korea
- iMediSync Inc. Seoul, South Korea
| | - Sungmin Kang
- Research and Development, PeopleBio Inc., Seongnam-si, Gyeonggi-do, South Korea
| | - Dong Won Yang
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, South Korea
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Kim J, Yang Y. Alterations in cognitive function and blood biomarkers following transcranial direct current stimulation in patients with amyloid positron emission tomography-positive Alzheimer's disease: a preliminary study. Front Neurosci 2023; 17:1327886. [PMID: 38178837 PMCID: PMC10765986 DOI: 10.3389/fnins.2023.1327886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Alzheimer's disease (AD), the most common form of dementia, is characterized by progressive cognitive decline. To address this, we conducted a randomized, double-blinded, sham-controlled study to investigate the therapeutic potential of transcranial direct current stimulation (tDCS) on patients with amyloid positron emission tomography (PET)- positive AD. Methods Participants already undergoing pharmacological treatment and testing positive for amyloid PET were divided into Active-tDCS (n = 8) and Sham-tDCS (n = 8) groups. For 12 weeks, participants or their caregivers administered daily bi-frontal tDCS (YMS-201B+, Ybrain Inc., Seongnam, Korea) at home (2 mA, 30 min). Pre- and post-intervention assessments included neuropsychological tests and blood sample measurements for oligomerized beta-amyloid. Results The Active-tDCS group demonstrated significant improvements in cognitive domains such as language abilities, verbal memory, and attention span and in frontal lobe functions compared to the Sham-tDCS group. Furthermore, the Active-tDCS group showed a marked reduction in post-intervention plasma Aβ oligomerization tendency level, suggesting changes in pivotal AD-associated biomarkers. Discussion Our results emphasize the potential therapeutic benefits of tDCS for mild AD patients with amyloid PET positivity and stress the urgency for broader research, considering the global challenges of dementia and the need to pursue innovative therapeutic strategies.
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Affiliation(s)
- Jinuk Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, Republic of Korea
| | - YoungSoon Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
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Lee KH, Lee HG, Kwon S, Park SU, Jung WS, Moon SK, Park JM, Ko CN, Cho SY. Effect of Kami Guibi-tang (KGT) in elderly subjects with insomnia: a study protocol from a single center, randomized, double-blind, placebo-controlled trial. BMC Complement Med Ther 2023; 23:375. [PMID: 37872506 PMCID: PMC10594819 DOI: 10.1186/s12906-023-04199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The incidence of insomnia increases with age and is related to cognitive function in older adults; therefore, it is important to manage it actively. In this study, we report a protocol for the evaluation of the efficacy and safety of Kami Guibi-tang (KGT), a herbal prescription that has been widely used in East Asia for insomnia, forgetfulness, and depression, in older adults with insomnia. METHODS In this single-center, double-blind, randomized controlled trial, 60 older adults with insomnia and subjective cognitive decline will be recruited and randomly assigned to the KGT or placebo group. The KGT group will take KGT granules thrice a day for 12 weeks, whereas the control group will take placebo granules in the same manner. Participants will be assessed for sleep, cognitive function, quality of life, and depression using the Pittsburgh Sleep Quality Index-Korean (PSQI-K), Insomnia Severity Index-Korean (ISI-K), Seoul Neuropsychological Screening Battery-Dement (SNSB-D), 36-item MOS Short Form Survey (SF-36) and Short version of the Geriatric Depression Scale (S-GDS) before and at the end of administration of the investigational product. The PSQI-K, ISI-K, and SF-36 will be further assessed 12 weeks after the end of medication to determine whether the effects on sleep and quality of life are sustained. The PSQI-K total score difference between the two groups at 12 and 24 weeks will be the primary outcome; all other endpoints will be secondary. Safety will be assessed by performing blood tests and electrocardiograms before taking the investigational drug, 6 weeks after taking the drug, and 12 weeks after taking the drug; any adverse events will be observed throughout the study. DISCUSSION The protocol will provide a detailed process for a clinical trial to evaluate the efficacy and safety of KGT in elderly patients with insomnia. We will also investigate if changes in cognitive function correlated with improvements in insomnia. TRIAL REGISTRATION This trial was registered at CRIS (Clinical Research Information Service) on April 27, 2023 (KCT0008391, version 2.0). https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24811&search_page=L .
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Affiliation(s)
- Kyeong-Hwa Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Han-Gyul Lee
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seong-Uk Park
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Woo-Sang Jung
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Sang-Kwan Moon
- Department of Cardiology and Neurology, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Jung-Mi Park
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Chang-Nam Ko
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seung-Yeon Cho
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
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Eyamu J, Kim WS, Kim K, Lee KH, Kim JU. Prefrontal event-related potential markers in association with mild cognitive impairment. Front Aging Neurosci 2023; 15:1273008. [PMID: 37927335 PMCID: PMC10620700 DOI: 10.3389/fnagi.2023.1273008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Background Alzheimer's disease (AD) is among the leading contributors of dementia globally with approximately 60-70% of its cases. Current research is focused on the mild cognitive impairment (MCI), which is associated with cognitive decline but does not disrupt routine activities. Event-related potential (ERP) research is essential in screening patients with MCI. Low-density channel electroencephalography (EEG) is frequently used due to its convenience, portability, and affordability, making it suitable for resource-constrained environments. Despite extensive research on neural biomarkers for cognitive impairment, there is a considerable gap in understanding the effects on early stages of cognitive processes, particularly when combining physiological and cognitive markers using portable devices. The present study aimed to examine cognitive shortfalls and behavioral changes in patients with MCI using prefrontal selective attention ERP recorded from a prefrontal two-channel EEG device. Methods We assessed cognitive decline using the Mini-Mental State Examination (MMSE) and the Seoul Neuropsychological Screening Battery (SNSB). We administered auditory selective attention tasks to 598 elderly participants, including those with MCI (160) and cognitively normal (CN) individuals (407). We conducted statistical analyses such as independent t-tests, Pearson's correlations, and univariate and multiple logistic regression analyses to assess group differences and associations between neuropsychological tests, ERP measures, behavioral measures, and MCI prevalence. Results Our findings revealed that patients with MCI demonstrated slower information-processing abilities, and exhibited poorer task execution, characterized by reduced accuracy, increased errors, and higher variability in response time, compared to CN adults. Multiple logistic regression analyses confirmed the association between some ERP and behavioral measures with MCI prevalence, independent of demographic and neuropsychological factors. A relationship was observed between neuropsychological scores, ERP, and behavioral measures. Discussion The slower information processing abilities, and poor task execution in the MCI group compared to the CN individuals suggests flawed neurological changes and reduced attentional maintenance during cognitive processing, respectively. Hence, the utilization of portable EEG devices to capture prefrontal selective attention ERPs, in combination with behavioral assessments, holds promise for the identification of mild cognitive deficits and neural alterations in individuals with MCI. This approach could potentially augment the traditional neuropsychological tests during clinical screening for MCI.
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Affiliation(s)
- Joel Eyamu
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- KM Convergence Science, University of Science and Technology, Daejeon, Republic of Korea
| | - Wuon-Shik Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kahye Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Kun Ho Lee
- Gwangju Alzheimer’s Disease and Related Dementias (GARD) Cohort Research Center, Chosun University, Gwangju, Republic of Korea
- Department of Biomedical Science, Chosun University, Gwangju, Republic of Korea
- Dementia Research Group, Korea Brain Research Institute, Daegu, Republic of Korea
| | - Jaeuk U. Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
- KM Convergence Science, University of Science and Technology, Daejeon, Republic of Korea
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Kang S, Jeon S, Lee YG, Ye BS. Striatal dopamine transporter uptake, parkinsonism and cognition in Alzheimer's disease. Eur J Neurol 2023; 30:3105-3113. [PMID: 37493955 DOI: 10.1111/ene.15995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND AND PURPOSE The correlates of motor parkinsonism in Alzheimer's disease (AD) remain controversial. The effects of nigrostriatal dopaminergic degeneration on parkinsonism and cognition in biomarker-validated patients with AD were evaluated. METHODS This study recruited 116 patients with AD who underwent dual-phase 18 F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane positron emission tomography, 18 F-florbetaben positron emission tomography, 3 T brain magnetic resonance imaging, and Unified Parkinson's Disease Rating Scale (UPDRS) and neuropsychological tests. The mean cortical thickness in the frontal, temporal, parietal and occipital cortices, and the dopamine transporter (DAT) uptake in the caudate, anterior/posterior putamen and substantia nigra were quantified. The relationship between DAT uptake, mean lobar cortical thickness, UPDRS motor score and cognition was investigated using general linear models (GLMs) after controlling for age, sex, education, intracranial volume, and deep and periventricular white matter hyperintensities. A path analysis was performed for the UPDRS motor score with the same covariates. RESULTS Path analysis and multivariable GLMs for UPDRS motor score showed that lower caudate DAT uptake was directly associated with a higher UPDRS motor score, whereas caudate DAT uptake confounded the association between mean frontal/parietal thickness and UPDRS motor score. Multivariable GLMs for cognitive scores showed that lower caudate DAT uptake was associated with visuospatial/executive dysfunction independent of mean frontal or parietal thickness. CONCLUSIONS Nigrostriatal dopaminergic dysfunction is associated with parkinsonism and visuospatial/executive dysfunction in patients with AD.
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Affiliation(s)
- Sungwoo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seun Jeon
- Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Gun Lee
- Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Shim Y. Facial Emotion Recognition in Older Adults With Cognitive Complaints. Dement Neurocogn Disord 2023; 22:158-168. [PMID: 38025409 PMCID: PMC10654485 DOI: 10.12779/dnd.2023.22.4.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Purpose Facial emotion recognition deficits impact the daily life, particularly of Alzheimer's disease patients. We aimed to assess these deficits in the following three groups: subjective cognitive decline (SCD), mild cognitive impairment (MCI), and mild Alzheimer's dementia (AD). Additionally, we explored the associations between facial emotion recognition and cognitive performance. Methods We used the Korean version of the Florida Facial Affect Battery (K-FAB) in 72 SCD, 76 MCI, and 76 mild AD subjects. The comparison was conducted using the analysis of covariance (ANCOVA), with adjustments being made for age and sex. The Mini-Mental State Examination (MMSE) was utilized to gauge the overall cognitive status, while the Seoul Neuropsychological Screening Battery (SNSB) was employed to evaluate the performance in the following five cognitive domains: attention, language, visuospatial abilities, memory, and frontal executive functions. Results The ANCOVA results showed significant differences in K-FAB subtests 3, 4, and 5 (p=0.001, p=0.003, and p=0.004, respectively), especially for anger and fearful emotions. Recognition of 'anger' in the FAB subtest 5 declined from SCD to MCI to mild AD. Correlations were observed with age and education, and after controlling for these factors, MMSE and frontal executive function were associated with FAB tests, particularly in the FAB subtest 5 (r=0.507, p<0.001 and r=-0.288, p=0.026, respectively). Conclusions Emotion recognition deficits worsened from SCD to MCI to mild AD, especially for negative emotions. Complex tasks, such as matching, selection, and naming, showed greater deficits, with a connection to cognitive impairment, especially frontal executive dysfunction.
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Affiliation(s)
- YongSoo Shim
- Department of Neurology, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Seoul, Korea
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Jeong SH, Kim SH, Park CW, Lee HS, Lee PH, Kim YJ, Sohn YH, Jeong Y, Chung SJ. Differential Implications of Cerebral Hypoperfusion and Hyperperfusion in Parkinson's Disease. Mov Disord 2023; 38:1881-1890. [PMID: 37489576 DOI: 10.1002/mds.29565] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) exhibit widespread brain perfusion changes. OBJECTIVE This study investigated whether cerebral regions with hypoperfusion and hyperperfusion have differential effects on motor and cognitive symptoms in PD using early-phase 18 F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (18 F-FP-CIT) positron emission tomography (PET) scans. METHODS We enrolled 394 patients with newly diagnosed PD who underwent dual-phase 18 F-FP-CIT PET scans. Indices reflecting associated changes in regional cerebral hypoperfusion and hyperperfusion on early-phase 18 F-FP-CIT PET scans were calculated as PD[hypo] and PD[hyper] , respectively. The associations of PD[hypo] and PD[hyper] on motor and cognitive symptoms at baseline were assessed using multivariate linear regression. Also, Cox regression and linear mixed models were performed to investigate the effects of baseline PD[hypo] and PD[hyper] on longitudinal outcomes. RESULTS There was a weak correlation between PD[hypo] and PD[hyper] (γ = -0.19, P < 0.001). PD[hypo] was associated with baseline Unified Parkinson's Disease Rating Scale Part III scores (β = -1.02, P = 0.045), rapid increases in dopaminergic medications (β = -18.02, P < 0.001), and a higher risk for developing freezing of gait (hazard ratio [HR] = 0.67, P = 0.019), whereas PD[hyper] was not associated. Regarding cognitive function, PD[hypo] was more relevant to the baseline cognitive performance levels of visuospatial, memory, and frontal/executive function than PD[hyper] . However, greater PD[hyper] was associated with future dementia conversion (HR = 1.43, P = 0.004), whereas PD[hypo] was not associated. CONCLUSIONS These findings suggest that PD[hypo] and PD[hyper] may differentially affect motor and cognitive functions in patients with PD. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Su Hong Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Chan Wook Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Physiology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Joong Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- KAIST Institute for Health Science Technology, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Program of Brain and Cognitive Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- Yonsei Beyond Lab, Yongin, South Korea
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Kim SJ, Bae YJ, Park YH, Jang H, Kim JP, Seo SW, Seong JK, Kim GH. Sex differences in the structural rich-club connectivity in patients with Alzheimer's disease. Front Aging Neurosci 2023; 15:1209027. [PMID: 37771522 PMCID: PMC10525353 DOI: 10.3389/fnagi.2023.1209027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Background and objectives Alzheimer's disease (AD) is more prevalent in women than in men; however, there is a discrepancy in research on sex differences in AD. The human brain is a large-scale network with hub regions forming a central core, the rich-club, which is vital to cognitive functions. However, it is unknown whether alterations in the rich-clubs in AD differ between men and women. We aimed to investigate sex differences in the rich-club organization in the brains of patients with AD. Methods In total, 260 cognitively unimpaired individuals with negative amyloid positron emission tomography (PET) scans, 281 with prodromal AD (mild cognitive impairment due to AD) and 285 with AD dementia who confirmed with positive amyloid PET scans participated in the study. We obtained high-resolution T1-weighted and diffusion tensor images and performed network analysis. Results We observed sex differences in the rich-club and feeder connections in patients with AD, suggesting lower structural connectivity strength in women than in men. We observed a significant group-by-sex interaction in the feeder connections, particularly in the thalamus. In addition, the connectivity strength of the thalamus in the feeder connections was significantly correlated with general cognitive function in only men with prodromal AD and women with AD dementia. Conclusion Our findings provide important evidence for sex-specific alterations in the structural brain network related to AD.
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Affiliation(s)
- Soo-Jong Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Youn Jung Bae
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
| | - Yu Hyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Jun Pyo Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
- Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea
| | - Geon Ha Kim
- Department of Neurology, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Doan DNT, Kim K, Ku B, Lee KH, Kim JU. Reduced body cell mass and functions in lower extremities are associated with mild cognitive impairment and Alzheimer's dementia. Sci Rep 2023; 13:13389. [PMID: 37591966 PMCID: PMC10435546 DOI: 10.1038/s41598-023-39110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
This study examined the alterations of segmental body composition in individuals with Alzheimer's pathology (AD), including mild cognitive impairment (MCI) and dementia. A multifrequency bioimpedance analysis (BIA) was used to provide segmental water and impedance variables from 365 cognitively normal (CN), 123 MCI due to AD, and 30 AD dementia participants. We compared the BIA variables between the three groups, examined their correlations with neuropsychological screening test scores, and illustrate their 95% confidence RXc graphs. AD dementia participants were older, more depressive, and had worse cognitive abilities than MCI due to AD and CN participants. Although the BIA variables showed weak partial correlations with the cognitive test scores, we found patterns of an increasing water content in lean mass, increasing extra to intracellular water ratio, and decreasing reactance and phase angle in the lower extremities with effect sizes ranging from 0.26 to 0.51 in the groups of MCI and dementia due to AD compared with CN individuals. The RXc graphs upheld the findings with a significant displacement downward and toward the right, dominantly in the lower extremities. Individuals with AD pathology exhibit a reduced body cell mass or cell strength, an abnormal cellular water distribution, and an overhydration status in lean mass, especially in the lower extremities.
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Affiliation(s)
- Dieu Ni Thi Doan
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- School of Korean Convergence Medical Science, University of Science and Technology, Daejeon, South Korea
| | - Kahye Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Boncho Ku
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Kun Ho Lee
- Gwangju Alzheimer's Disease and Related Dementias (GARD) Cohort Research Center, Chosun University, Gwangju, South Korea
- Department of Biomedical Science, Chosun University, Gwangju, South Korea
- Dementia Research Group, Korea Brain Research Institute, Daegu, South Korea
| | - Jaeuk U Kim
- Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.
- School of Korean Convergence Medical Science, University of Science and Technology, Daejeon, South Korea.
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Jang WH, Jang JS. Standardization of apple cancellation test for neglect patients in Korea: An observational study. World J Clin Cases 2023; 11:5236-5243. [PMID: 37621587 PMCID: PMC10445065 DOI: 10.12998/wjcc.v11.i22.5236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/08/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Neglect can be divided into two types using apple cancellation test (apple test): Egocentric neglect (EN) and allocentric neglect (AN). However, in South Korea, apple test results and decision criteria are still largely dependent on tests by foreign countries. AIM To establish a new South Korea standard and improve the accuracy of neglect assessment, the apple experiment was standardized in this study. METHODS This study was conducted on 223 healthy subjects for a total of 7 mo from August 2021 to February 2022. Standardization was carried out using the original apple test developed by Bickerton in 2011. In scoring for the apple test, total omission error refers to the number of missed targets (full apple) in the entire test sheet (left, middle, and right area). The score for EN is the difference between the cor-rect number of right area and the correct number of left area (excluding the middle area). For AN, the score is difference between the number of left opening apples and number of right opening apples (including the middle area). Linear regression analysis was used for standardization using the general characteristics of subjects and the results of the apple test. RESULTS The cut-off score, which is the standard value indicating the pathological condition by combining the results of all subjects, is as follows: Total omission error (5), error for EN (2), and error for AN (2). Also, differences in cut-off score according to age were found. CONCLUSION This study will be helpful in facilitating a more accurate differential diagnosis of neglect.
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Affiliation(s)
- Woo-Hyuk Jang
- Department of Occupational Therapy, College of Health Science, Kangwon National University, Samcheok-si 25949, Gangwon-do, South Korea
| | - Jong-Sik Jang
- Department of Occupational Therapy, College of Health Science, Kangwon National University, Samcheok-si 25949, Gangwon-do, South Korea
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Jang WH, Jang JS. Standardization of apple cancellation test for neglect patients in Korea: An observational study. World J Clin Cases 2023; 11:5230-5237. [DOI: 10.12998/wjcc.v11.i22.5230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/08/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Neglect can be divided into two types using apple cancellation test (apple test): Egocentric neglect (EN) and allocentric neglect (AN). However, in South Korea, apple test results and decision criteria are still largely dependent on tests by foreign countries.
AIM To establish a new South Korea standard and improve the accuracy of neglect assessment, the apple experiment was standardized in this study.
METHODS This study was conducted on 223 healthy subjects for a total of 7 mo from August 2021 to February 2022. Standardization was carried out using the original apple test developed by Bickerton in 2011. In scoring for the apple test, total omission error refers to the number of missed targets (full apple) in the entire test sheet (left, middle, and right area). The score for EN is the difference between the cor-rect number of right area and the correct number of left area (excluding the middle area). For AN, the score is difference between the number of left opening apples and number of right opening apples (including the middle area). Linear regression analysis was used for standardization using the general characteristics of subjects and the results of the apple test.
RESULTS The cut-off score, which is the standard value indicating the pathological condition by combining the results of all subjects, is as follows: Total omission error (5), error for EN (2), and error for AN (2). Also, differences in cut-off score according to age were found.
CONCLUSION This study will be helpful in facilitating a more accurate differential diagnosis of neglect.
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Affiliation(s)
- Woo-Hyuk Jang
- Department of Occupational Therapy, College of Health Science, Kangwon National University, Samcheok-si 25949, Gangwon-do, South Korea
| | - Jong-Sik Jang
- Department of Occupational Therapy, College of Health Science, Kangwon National University, Samcheok-si 25949, Gangwon-do, South Korea
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Na S, Seo SW, Kim YJ, Yoo H, Lee ES. Correlation analysis between subtest scores of CERAD-K and a newly developed tablet computer-based digital cognitive test (Inbrain CST). Front Aging Neurosci 2023; 15:1178324. [PMID: 37455932 PMCID: PMC10338869 DOI: 10.3389/fnagi.2023.1178324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction The prevalence of Alzheimer's disease (AD) and other dementias is increasing; therefore, identifying individuals at risk for dementia is crucial. Traditional neuropsychological assessments are expensive and time-consuming; however, computerized cognitive testing is becoming popular in clinical and research settings, particularly during the COVID-19 pandemic. This study aimed to investigate the correlation between the computerized cognitive test, Inbrain cognitive screening test (CST), and the traditional neuropsychological battery, the consortium to establish a registry for Alzheimer's disease assessment packet (CERAD-K). Methods We enrolled 166 participants from five districts in Republic of Korea, including cognitively unimpaired individuals and those with mild cognitive impairment (MCI) diagnosed by experienced neurologists. We used the Inbrain CST and CERAD-K to evaluate the cognitive function of the participants, and the scores of each subtest of the Inbrain CST and CERAD-K were compared. Results A significant correlation was found between the Inbrain CST and CERAD-K subtests. Furthermore, multivariate analysis revealed a significant correlation between the Inbrain CST and the CERAD-K test pairs after adjusting for age, educational level, and sex. Discussion In conclusion, this study demonstrates that the Inbrain CST is a reliable tool for detecting cognitive impairment in cognitively unimpaired individuals and patients with MCI, because it has a high correlation and agreement with CERAD-K. Therefore, the Inbrain CST can be a useful, time-efficient, and cost-effective computer-based cognitive test for individuals at risk for cognitive impairment.
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Affiliation(s)
- Seunghee Na
- Department of Neurology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Ju Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heejin Yoo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eek-Sung Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Jeong SH, Cha J, Jung JH, Yun M, Sohn YH, Chung SJ, Lee PH. Occipital Amyloid Deposition Is Associated with Rapid Cognitive Decline in the Alzheimer's Disease Continuum. J Alzheimers Dis 2023:JAD230187. [PMID: 37355901 DOI: 10.3233/jad-230187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND Clinical significance of additional occipital amyloid-β (Aβ) plaques in Alzheimer's disease (AD) remains unclear. OBJECTIVE In this study, we investigated the effect of regional Aβ deposition on cognition in patients on the AD continuum, especially in the occipital region. METHODS We retrospectively reviewed the medical record of 208 patients with AD across the cognitive continuum (non-dementia and dementia). Multivariable linear regression analyses were performed to determine the effect of regional Aβ deposition on cognitive function. A linear mixed model was used to assess the effect of regional deposition on longitudinal changes in Mini-Mental State Examination (MMSE) scores. Additionally, the patients were dichotomized according to the occipital-to-global Aβ deposition ratio (ratio ≤1, Aβ-OCC- group; ratio >1, Aβ-OCC+ group), and the same statistical analyses were applied for between-group comparisons. RESULTS Regional Aβ burden itself was not associated with baseline cognitive function. In terms of Aβ-OCC group effect, the Aβ-OCC+ group exhibited a poorer cognitive performance on language function compared to the Aβ-OCC- group. High Aβ retention in each region was associated with a rapid decline in MMSE scores, only in the dementia subgroup. Additionally, Aβ-OCC+ individuals exhibited a faster annual decline in MMSE scores than Aβ-OCC- individuals in the non-dementia subgroup (β= -0.77, standard error [SE] = 0.31, p = 0.013). CONCLUSION The present study demonstrated that additional occipital Aβ deposition was associated with poor baseline language function and rapid cognitive deterioration in patients on the AD continuum.
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Affiliation(s)
- Seong Ho Jeong
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jin Ho Jung
- Department of Neurology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
- YONSEI BEYOND LAB, Yongin, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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Lee HJ, Choi JY, Hong D, Kim D, Min JY, Min KB. Sex differences in the association between sarcopenia and mild cognitive impairment in the older Korean population. BMC Geriatr 2023; 23:332. [PMID: 37248457 DOI: 10.1186/s12877-023-03911-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/20/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND A link between sarcopenia and cognitive function has been proposed and is supported by several investigations. Nevertheless, the sex-linked relationship between these two diseases has been scarcely investigated. This cross-sectional study investigated sex differences in the association between sarcopenia and mild cognitive impairment. METHODS We included all 286 participants aged 60 years or older with MCI who visited the Department of Neurology at Veterans Health Service Medical Center in South Korea from January to December 2021. The diagnosis of MCI was confirmed by two neurologists based on the participants' neuropsychological test scores. Diagnosis of sarcopenia was based on the algorithm of Asian Working Group for Sarcopenia (AWGS) 2019 including bioelectrical impedance analysis and handgrip strength, and cognitive function was assessed using Seoul Neuropsychological Screening Battery Core (SNSB-C) test. RESULTS Among the 286 participants, 171 and 112 were men and women. After adjustment for potential covariates including APOE genotype, in women participants, there were significant associations between diagnosis of sarcopenia and MCI (OR = 4.72, 95%CI [1.39-15.97]), while there was no significant relationship in men participants. In eight subdomains of SNSB-C, we also found that women participants with sarcopenia demonstrated a significant memory decline (OR = 3.21, 95%CI [1.01-10.19]) as compared with the reference women group without sarcopenia after adjusting all covariates mentioned above. No significant association between any SNSB-C subdomain and MCI was demonstrated in men participants. CONCLUSIONS We demonstrated that there was a different relationship between sarcopenia and MCI by sex and that sarcopenia may affect the cognitive subdomain differently by sex. These results imply that, with regard to cognitive function, maintaining muscle function and muscle mass might be more crucial for women than for men.
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Affiliation(s)
- Hyo-Jung Lee
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Ju-Young Choi
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Dongui Hong
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Donghoon Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea
| | - Jin-Young Min
- Veterans Medical Research Institute, Veterans Health Service Medical Center, 53, Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul, Republic of Korea.
| | - Kyoung-Bok Min
- Department of Preventive Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea.
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, Republic of Korea.
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Kang JM, Shin JH, Kim WR, Seo S, Seo H, Lee SY, Park KH, Na DL, Okamura N, Seong JK, Noh Y. Effects of the APOEɛ4 Allele on the Relationship Between Tau and Amyloid-β in Early- and Late-Onset Alzheimer's Disease. J Alzheimers Dis 2023; 94:1233-1246. [PMID: 37393505 DOI: 10.3233/jad-230339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
BACKGROUND Little is known regarding the differential effects of the apolipoprotein E (APOE) ɛ4 on the regional topography of amyloid and tau in patients with both early-onset (EOAD) and late-onset Alzheimer's disease (LOAD). OBJECTIVE To compare the distribution and association of tau, amyloid, and cortical thickness among groups classified by the presence of APOEɛ4 allele and onset age. METHODS A total of 165 participants including 54 EOAD patients (29 ɛ4-; 25 ɛ4+), 45 LOAD patients (21 ɛ4-; 24 ɛ4+), and 66 age-matched controls underwent 3T MRI, 18F-THK5351 (THK) and 18F-flutemetamol (FLUTE) PET scans, APOE genotyping, and neuropsychological tests. Data for voxel-wise and standardized uptake values from PET scans were analyzed in the context of APOE and age at onset. RESULTS EOAD ɛ4- patients showed greater THK retention in the association cortices, whereas their EOAD ɛ4+ counterparts had more retention in medial temporal areas. THK topography of LOAD ɛ4+ was similar to EOAD ɛ4 + . THK correlated positively with FLUTE and conversely with mean cortical thickness, being lowest in EOAD ɛ4-, highest in LOAD ɛ4-, and modest in ɛ4+ groups. Even in the APOEɛ4+ groups, THK tended to correlate with FLUTE and mean cortical thickness in the inferior parietal region in EOAD and in the medial temporal region in LOAD. LOAD ɛ4- manifested with prevalent small vessel disease markers and the lowest correlation between THK retention and cognition. CONCLUSION Our observations suggest the differential effects of the APOEɛ4 on the relationship between tau and amyloid in EOAD and LOAD.
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Affiliation(s)
- Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jeong-Hyeon Shin
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
- Bio Medical Research Center, Bio Medical & Health Division, Korea Testing Laboratory, Daegu, Republic of Korea
| | - Woo-Ram Kim
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Seongho Seo
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Haeun Seo
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Sang-Yoon Lee
- Department of Neuroscience, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Kee Hyung Park
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea; Happymind Clinic, Seoul, Republic of Korea
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Joon-Kyoung Seong
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
- Department of Artificial Intelligence, Korea University, Seoul, Republic of Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
- Department of Health Science and Technology, GAIHST, Gachon University, Incheon, Republic of Korea
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Shim Y. Follow-up Comparisons of Two Plasma Biomarkers of Alzheimer's Disease, Neurofilament Light Chain, and Oligomeric Aβ: A Pilot Study. Curr Alzheimer Res 2023; 20:715-724. [PMID: 38299421 DOI: 10.2174/0115672050284054240119101834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/06/2024] [Accepted: 01/16/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Recent evidence suggests that blood-based biomarkers might be useful for Alzheimer's disease (AD). Among them, we intend to investigate whether neurofilament light (NfL) and multimer detection system-oligomeric Aβ (MDS-OAβ) values can be useful in screening, predicting, and monitoring disease progression and how the relationship between NfL and MDS-OAβ values changes. METHODS Eighty participants with probable AD dementia, 50 with mild cognitive impairment (MCI), and 19 with subjective cognitive decline (SCD) underwent baseline and follow-up evaluations of the Mini-Mental Status Examination (MMSE) and both plasma biomarkers. RESULTS Baseline MDS-OAß (p = 0.016) and NfL (p = 0.002) plasma concentrations differed significantly among groups, but only NfL correlated with baseline MMSE scores (r = -0.278, p = 0.001). In follow-up, neither correlated with MMSE changes overall. However, in SCD and MCI participants (n = 32), baseline MDS-OAß correlated with follow-up MMSE scores (r = 0.532, p = 0.041). Linear regression revealed a relationship between baseline MDS-OAβ and follow-up MMSE scores. In SCD and MCI participants, plasma NfL changes correlated with MMSE changes (r = 0.564, p = 0.028). CONCLUSION This study shows that only in participants with SCD and MCI, not including AD dementia, can MDS-OAß predict the longitudinal cognitive decline measured by follow-up MMSE. Changes of NfL, not MDS-OAß, parallel the changes of MMSE. Further studies with larger samples and longer durations could strengthen these results..
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Affiliation(s)
- YongSoo Shim
- Department of Neurology, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
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