Authors: Kim, Hee-Jin | Moon, Won-Jin | Han, Seol-Heui
Article Type: Research Article
Abstract: Background: This study aimed to evaluate the relationship between loss of white matter cholinergic pathways, atrophy of the nucleus basalis of Meynert (NBM), and cognitive function in patients with subcortical ischemic vascular dementia (SIVD) or Alzheimer’s disease (AD). Methods: The participants included 26 SIVD, 17 probable AD with or without white-matter changes, and 20 age-matched healthy controls. Thin-section coronal T2-weighted images were acquired using 3.0 T MR. The extent of white matter hyperintensities within cholinergic pathways were assessed using the cholinergic pathways hyperintensities scale (CHIPS). NBM atrophy was assessed from the thickness of the substantia innominata (SI) at the level …of the crossing of the anterior commissure. Cognitive impairment was measured using the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). Correlations between CHIPSs, SI thickness, and cognitive impairment were evaluated using the Spearman ranked correlation test. Results: In AD, MMSE scores and CDR were correlated with SI thickness (ρ = 0.450, p = 0.006 and ρ = −0.520, p = 0.030, respectively) but not with CHIPS scores (ρ = −0.160, p = 0.530 and ρ = 0.270, p = 0.292, respectively). By contrast, aggravated MMSE score and CDR in SIVD had a tendency to correlate with elevated CHIPS scores (ρ = −0.344, p = 0.127 and ρ = 0.521, p = 0.021, respectively) but not with SI thickness (ρ = −0.210, p = 0.480 and ρ = 0.080, p = 0.736, respectively). Conclusions: Loss of cholinergic pathways correlates with cognitive dysfunction in both AD and SIVD. The mechanisms appear to differ: NBM atrophy is likely to be the predominant contributor to cognitive impairments in AD, whereas, the cognitive dysfunction of SIVD was associated with compromised subcortical cholinergic fibers not with nucleus itself. Show more
Keywords: Alzheimer's disease, cholinergic pathway, nucleus basalis of Meynert, subcortical ischemic vascular dementia
DOI: 10.3233/JAD-122320
Citation: Journal of Alzheimer's Disease, vol. 35, no. 1, pp. 129-136, 2013
Authors: Kim, Hee Jin | Jeon, Beomseok | Chung, Sun Ju
Article Type: Review Article
Abstract: The practice of complementary and alternative medicine (CAM) is not, at present, considered an integral part of conventional medicine. As the popularity of CAM grows and access to information about CAM increases through the media and internet where CAMs are often promoted, patients are at risk of exposure unvalidated information. Therefore, there is a need for physicians to examine objectively the efficacy and safety of CAM, compare it with current medications, and become actively involved in the CAM treatment with patients. In accordance with these needs, this manuscript reviews the utility, scientific evidence, safety and cost-effectiveness of CAM in the …treatment of Parkinson’s disease (PD). We also address the ethical issues of CAM practices. Show more
Keywords: Parkinson’s disease, complementary and alternative medicines, complementary medicines, traditional medicine, acupuncture, herbal medicine, review
DOI: 10.3233/JPD-160890
Citation: Journal of Parkinson's Disease, vol. 6, no. 4, pp. 675-683, 2016
Authors: Ryu, Hui Jin | Moon, Yeonsil | Kim, Minyoung | Kim, Hee-Jin | Galvin, James E. | Han, Seol-Heui
Article Type: Research Article
Abstract: Background: The Quick Dementia Rating System (QDRS) is a brief and rapid dementia staging tool that does not require a trained rater. Objective: The purpose of this study is to demonstrate the validity, reliability, and diagnostic usefulness of the Korean version of the QDRS (K-QDRS). Methods: We collected a total of 411 subject-informant dyads including cognitively unimpaired (CU, n = 22), mild cognitive impairment (MCI, n = 198), and dementia (n = 191). The Clinical Dementia Rating (CDR) scale, Korean version of the Mini-Mental State Examination (K-MMSE), Korean version of instrumental activity of daily living (K-IADL), Short Form of the Geriatric Depression Scale, …Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), and detailed neuropsychological tests were administered as gold standards of dementia staging, cognition, function, mood, and behavior. Results: Internal consistency of the K-QDRS was excellent with Cronbach’s alpha of 0.933. Concurrent validity was also satisfactory, with the K-QDRS correlating highly with the CDR Sum of Boxes (Pearson’s r = 0.791), K-MMSE (Pearson’s r = –0.518), K-IADL (Pearson’s r = 0.727), and CGA-NPI (Pearson’s r = 0.700). The K-QDRS was highly correlated with the global CDR, K-IADL, and CGA-NPI. We suggested two types of comparisons (for initial diagnosis and for follow-up evaluation). The cutoff scores for follow-up were 1.0 for MCI, 3.5 for very mild dementia, 6.5 for mild dementia, and 11.0 for moderate dementia. Conclusion: The K-QDRS is a valid and reliable dementia rating questionnaire and can be used, briefly and rapidly, in various settings like clinical practices, longitudinal cohort studies, and community primary care. Show more
Keywords: Activities of daily living, clinical dementia rating, cognition, dementia, neurocognitive disorders, screening
DOI: 10.3233/JAD-210584
Citation: Journal of Alzheimer's Disease, vol. 84, no. 4, pp. 1645-1656, 2021
Authors: Kim, Hee-Jin | Im, Hyung Kyun | Kim, Juhan | Han, Jee-young | de Leon, Mony | Deshpande, Anup | Moon, Won-Jin
Article Type: Research Article
Abstract: Background: Rapid eye movement sleep behavior disorder (RBD) may present as an early manifestation of an evolving neurodegenerative disorder with alpha-synucleinopathy. Objective: We investigated that dementia with RBD might show distinctive cortical atrophic patterns. Methods: A total of 31 patients with idiopathic Parkinson’s disease (IPD), 23 with clinically probable Alzheimer’s disease (AD), and 36 healthy controls participated in this study. Patients with AD and IPD were divided into two groups according to results of polysomnography and rated with a validated Korean version of the RBD screening questionnaire (RBDSQ-K), which covers the clinical features of RBD. Voxel-based morphometry was adapted for …detection of regional brain atrophy among groups of subjects. Results: Scores on RBDSQ-K were higher in the IPD group (3.54 ± 2.8) than in any other group (AD, 2.94 ± 2.4; healthy controls, 2.31 ± 1.9). Atrophic changes according to RBDSQ-K scores were characteristically in the posterior part of the brain and brain stem, including the hypothalamus and posterior temporal region including the hippocampus and bilateral occipital lobe. AD patients with RBD showed more specialized atrophic patterns distributed in the posterior and inferior parts of the brain including the bilateral temporal and occipital cortices compared to groups without RBD. The IPD group with RBD showed right temporal cortical atrophic changes. Conclusion: The group of patients with neurodegenerative diseases and RBD showed distinctive brain atrophy patterns, especially in the posterior and inferior cortices. These results suggest that patients diagnosed with clinically probable AD or IPD might have mixed pathologies including α -synucleinopathy. Show more
Keywords: Brain atrophy, dementia, RBD screening questionnaire, REM sleep disorder, voxel-based morphometry
DOI: 10.3233/JAD-151197
Citation: Journal of Alzheimer's Disease, vol. 52, no. 3, pp. 1101-1109, 2016
Authors: Kim, Jinhee | Jang, Hyemin | Park, Yu-hyun | Youn, Jinyoung | Seo, Sang Won | Kim, Hee Jin | Na, Duk L.
Article Type: Research Article
Abstract: Background: Age at onset was suggested as one possible risk factor for motor dysfunction in Alzheimer’s disease (AD). Objective: We investigated the association of motor symptoms with cognition or neurodegeneration in patients with AD, and whether this association differs by the age at onset. Methods: We included 113 amyloid positive AD patients and divided them into early-onset AD (EOAD) and late-onset AD (LOAD), who underwent the Unified Parkinson’s Disease Rating Scale (UPDRS)-Part III (=UPDRS) scoring, Mini-Mental State Examination (MMSE)/Clinical Deterioration Rating Sum-of-Boxes (CDR-SOB), and magnetic resonance image (MRI). Multiple linear regression was used to evaluate the association of UPDRS and …MMSE/CDR-SOB or MRI neurodegeneration measures, and whether the association differs according to the group. Results: The prevalence of motor symptoms and their severity did not differ between the groups. Lower MMSE (β= –1.1, p < 0.001) and higher CDR-SOB (β= 2.0, p < 0.001) were significantly associated with higher UPDRS. There was no interaction effect between MMSE/CDR-SOB and AD group on UPDRS. Global or all regional cortical thickness and putaminal volume were negatively associated with UPDRS score, but the interaction effect of neurodegeneration and AD group on UPDRS score was significant only in parietal lobe (p for interaction = 0.035), which showed EOAD to have a more pronounced association between parietal thinning and motor symptoms. Conclusion: Our study suggested that the severity of motor deterioration in AD is related to the severity of cognitive impairment itself rather than age at onset, and motor symptoms might occur through multiple mechanisms including cortical and subcortical atrophy. Show more
Keywords: Alzheimer’s disease, neuropsychological tests, parkinsonian disorders
DOI: 10.3233/JAD-220745
Citation: Journal of Alzheimer's Disease, vol. 91, no. 1, pp. 345-354, 2023
Authors: Moon, Hasom | Ham, Hongki | Yun, Jihwan | Shin, Daeun | Lee, Eun Hye | Kim, Hee Jin | Seo, Sang Won | Na, Duk L. | Jang, Hyemin
Article Type: Research Article
Abstract: Background: Amyloid-β (Aβ) commonly coexists and impacts prognosis in subcortical vascular cognitive impairment (SVCI). Objective: This study aimed to examine the differences in clinical and neuroimaging variables between Aβ-positive and Aβ-negative SVCI and to propose a prediction model for Aβ positivity in clinically diagnosed SVCI patients. Methods: A total of 130 patients with SVCI were included in model development, and a separate cohort of 70 SVCI patients was used in external validation. The variables for the prediction model were selected by comparing the characteristics of the Aβ-negative and Aβ-positive SVCI groups. The final model was determined using a stepwise method. …The model performance was evaluated using the receiver operating characteristic (ROC) curve and a calibration curve. A nomogram was used for visualization. Results: Among 130 SVCI patients, 70 (53.8%) were Aβ-positive. The Aβ-positive SVCI group was characterized by older age, tendency to be in the dementia stage, a higher prevalence of APOE ɛ 4, a lower prevalence of lacune, and more severe medial temporal atrophy (MTA). The final prediction model, which excluded MTA grade following the stepwise method for variable selection, demonstrated good accuracy in distinguishing between Aβ-positive and Aβ-negative SVCI, with an area under the curve (AUC) of 0.80. The external validation demonstrated an AUC of 0.71. Conclusions: The findings suggest that older age, dementia stage, APOE ɛ 4 carrier, and absence of lacunes may be predictive of Aβ positivity in clinically diagnosed SVCI patients. Show more
Keywords: Alzheimer’s disease, amyloid-β, dementia, mild cognitive impairment, subcortical vascular cognitive impairment
DOI: 10.3233/JAD-240196
Citation: Journal of Alzheimer's Disease, vol. 99, no. 3, pp. 1117-1127, 2024
Authors: Jang, Hyemin | Park, Yu-hyun | Choe, Young Sim | Kang, Sung Hoon | Kang, Eun-Sook | Lee, Seunghoon | Seo, Sang Won | Kim, Hee Jin | Na, Duk L.
Article Type: Research Article
Abstract: Background: Alzheimer’s disease (AD) and normal pressure hydrocephalus (NPH) commonly coexist. Objective: We aimed to characterize an overlapping syndrome of AD and NPH that presents with gait disturbance, ventriculomegaly on magnetic resonance imaging, and significant amyloid deposition on positron emission tomography (PET). Methods: Of 114 patients who underwent cerebrospinal fluid (CSF) drainage for a possible diagnosis of NPH between 2015 and 2020 in Samsung Medical Center, we identified 24 patients (21.1%) with the NPH patients with amyloid deposition on PET, which we referred to as hydrocephalic AD in this study. We compared their clinical and imaging findings with those of …123 typical AD without hydrocephalic signs/symptoms. We also investigated the frequency and potential predictors of the tap test response in hydrocephalic AD. Results: Evans’ index was 0.36±0.03, and a disproportionately enlarged subarachnoid space was present in 54.2% of the hydrocephalic AD patients. The mean age (75.2±7.3 years) and the APOE4 frequency (68.2%) did not differ from those of AD controls. However, the hydrocephalic AD patients showed better memory and language performance, and a thinner cingulate cortex. About 42% of the hydrocephalic AD patients responded to the tap test, of whom seven underwent shunt surgery. Cognition did not improve, whereas gait improved after shunt surgery in all. Conclusion: Hydrocephalic AD has different neuropsychological and imaging characteristics from typical AD. Future studies are warranted to further investigate the effect of CSF removal on their clinical course and to elucidate the pathophysiological interaction between amyloid and NPH. Show more
Keywords: Alzheimer’s disease, cerebrospinal fluid, hydrocephalus, MRI, PET
DOI: 10.3233/JAD-215110
Citation: Journal of Alzheimer's Disease, vol. 85, no. 4, pp. 1467-1479, 2022
Authors: Cho, Eun Bin | Seo, Sang Won | Kim, HoJeong | Lee, Jong-Min | Yoon, Uicheul | Im, Kiho | Kim, Geon Ha | Noh, Young | Cho, Hanna | Yoon, Cindy W. | Kim, Hee Jin | Na, Duk L.
Article Type: Research Article
Abstract: There are some studies identifying the association between kidney dysfunction and cognitive impairment through various mechanisms including small vessel disease. However, results concerning the relationship between kidney dysfunction and cortical atrophy have been inconsistent. Thus, we aimed to evaluate the relationship among kidney dysfunction, small vessel disease, and cortical thinning in probable Alzheimer's disease (AD) dementia patients. Patients consisted of 162 subjects with probable AD dementia who underwent high-resolution T1-weighted volumetric magnetic resonance imaging (MRI) scans using the same scanner. The estimated glomerular filtration rate (GFR) was calculated and divided into the quartiles of patients for comparison. Volume of white …matter hyperintensities (WMH) was automatically measured. Two neurologists counted the number of lacunes. Cortical thickness was measured using a surface-based method. GFR was not associated with WMH and the number of lacunes. However, the lowest quartile group of GFR (GFR 1) had cortical thinning in each lobe, compared to the highest quartile group of GFR (GFR 4). The topography of cortical thinning in the GFR 1 group was distributed predominantly in temporoparietal regions, compared to GFR 4. After further adjustment of small vessel disease MRI markers, the association between GFR and the cortical thinning remained. Our findings suggested that kidney dysfunction, represented by GFR, was related to temporoparietal thinning independent of small vessel disease in probable AD dementia patients. Show more
Keywords: Alzheimer's disease, cortical thinning, glomerular filtration rate, kidney function
DOI: 10.3233/JAD-2012-121180
Citation: Journal of Alzheimer's Disease, vol. 33, no. 4, pp. 961-968, 2013
Authors: Kim, Hee Jin | Im, Kiho | Kwon, Hunki | Lee, Jong Min | Ye, Byoung Seok | Kim, Yeo Jin | Cho, Hanna | Choe, Yearn Seong | Lee, Kyung Han | Kim, Sung Tae | Kim, Jae Seung | Lee, Jae Hong | Na, Duk L. | Seo, Sang Won
Article Type: Research Article
Abstract: There is growing evidence that the human brain is a large scale complex network. The structural network is reported to be disrupted in cognitively impaired patients. However, there have been few studies evaluating the effects of amyloid and small vessel disease (SVD) markers, the common causes of cognitive impairment, on structural networks. Thus, we evaluated the association between amyloid and SVD burdens and structural networks using diffusion tensor imaging (DTI). Furthermore, we determined if network parameters predict cognitive impairments. Graph theoretical analysis was applied to DTI data from 232 cognitively impaired patients with varying degrees of amyloid and SVD burdens. …All patients underwent Pittsburgh compound-B (PiB) PET to detect amyloid burden, MRI to detect markers of SVD, including the volume of white matter hyperintensities and the number of lacunes, and detailed neuropsychological testing. The whole-brain network was assessed by network parameters of integration (shortest path length, global efficiency) and segregation (clustering coefficient, transitivity, modularity). PiB retention ratio was not associated with any white matter network parameters. Greater white matter hyperintensity volumes or lacunae numbers were significantly associated with decreased network integration (increased shortest path length, decreased global efficiency) and increased network segregation (increased clustering coefficient, increased transitivity, increased modularity). Decreased network integration or increased network segregation were associated with poor performances in attention, language, visuospatial, memory, and frontal-executive functions. Our results suggest that SVD alters white matter network integration and segregation, which further predicts cognitive dysfunction. Show more
Keywords: Amyloid, diffusion tensor imaging, graph theory, small vessel disease, white matter network
DOI: 10.3233/JAD-141623
Citation: Journal of Alzheimer's Disease, vol. 44, no. 3, pp. 963-975, 2015
Authors: Jang, Hyemin | Ye, Byoung Seok | Woo, Sookyoung | Kim, Sun Woo | Chin, Juhee | Choi, Seong Hye | Jeong, Jee Hyang | Yoon, Soo Jin | Yoon, Bora | Park, Kyung Won | Hong, Yun Jeong | Kim, Hee Jin | Lockhart, Samuel N. | Na, Duk L. | Seo, Sang Won
Article Type: Correction
DOI: 10.3233/JAD-179010
Citation: Journal of Alzheimer's Disease, vol. 61, no. 2, pp. 825-825, 2018
