輕度阿茲海默氏症患者之認路功能：比 較指北地圖/路徑地圖與地標之輔助功 能
方楨文1 林松農2 歐陽昆2 柳永青2
1台大醫院雲林分院 神經內科
2雲林科技大學 管理學院
Comparison study of north-up and track-up electronic maps with and without landmarks on the wayfinding performance of mild Alzheimer's disease patients
Fang, Chen-wen1, Sung-Nung Lin2, Yang-Kun Ou2, Yung-Ching Liu2
1 Department of Neurology, National Taiwan University Hospital (Yunlin Branch), Yunlin, Taiwan
2 Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
Objective In this study, through four different exams on a virtual
three-dimensional simulated maze, we compared the ability of way finding in three different groups of elderly. (Normal aging/ Minimal cognitive impaired (MCI)/ Early Alzheimer's patient) with different navigation systems.
Methods We prospectively recruited 40 participants (10 AD. 10 MCI. 20 normal control) with similar demographic distribution of age and gender. They received a series of cognitive battery exams, including complex figure test-copy version, clock drawing test, visual form discrimination, trail making test, useful field of view task. They then tried to reach the destination in 4 different mazes with 2 different
facilitating system (North-up v.s.
Track-up) and landmarks (with landmarks v.s. without landmarks).
They then needed to point out the start point and were asked to pick out a correct route on the paper. .
Results These groups did not differ in age, gender, education, and VFD scores. MMSE, TMT-B and clock drawing test were the 3 tests mostly corrected to error times. (P<0.001) 3 participant groups all made fewer errors with track-up maps (0.18) than with north-up maps (1.83); better outcome was also performed in maps with landmarks (0.91) than in maps without landmarks (1.10). In 3 participant groups, track-up map had shorter performance (126.85 s) time than the north-up map (170.17 s). But, maps without landmarks had a shorter performance time (140.49 s) than the map with landmarks (156.53s).
Conclusion We found that track-up map system could effectively improve the way-finding ability of people with Alzheimer's disease and minimal cognitive impairment. We also noticed that several surrogate markers in cognitive tests were much correlated with the performance of way-finding.
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職能治療對輕中度失智症患者之療效 王瑾琦 劉景寬 周美鵑 李建勳 龔達瑋 許惠敏
高雄醫學大學醫學系神經學碩士班 高雄醫 學大學附設中和紀念醫院神經內科 高雄市
註解 [YHL4]: Mild cognition impaired?
註解 [YHL5]: Mild?
立大同醫院 高雄市立小港醫院 高雄市失智症 協會
Effect of Occupational Therapeutic Program for Patients with Early to Mild Dementia
Chin-Chi Wang1,2,5, Ching-Kuan Liu1,2, Mei-Chuan Chou1,2,3, Chien-Hsun Li1,2,4, Ta -Wei Kung5, Hui-Min Hsu1,2
1 Department of Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University;
2 Department of Neurology, Kaohsiung Medical University Hospital;
3 Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital;
4 Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital;
5 Kaohsiung Dementia Association
Objectives We examined the efficacy of occupational therapeutic program
modified from School of Wisdom of Taiwan Alzheimer’s Disease Association (TADA) in improving cognitive function and emotion and prompting quality of life of family caregivers.
Methods This is a single-blinded interventional trial. Subjects with early to mild dementia received occupational therapeutic program two hours once a week. It lasted for 10 weeks each group.
We also provided educational-support groups for the family caregivers. The primary parameters were Cognitive Abilities Screening Instrument (CASI) and Center for Epidemiologic
Studies-Depression Scale (CES-D). The family caregivers were also evaluated with CES-D and quality of life (WHO-QOL). Paired-samples T tests were used to examine the intervention effect.
Results In total, 50 subjects (21 male and 29 female) participated in the study with a mean age of 73.94 (SD 7.35) years old and a mean education of 9.08 (SD 5.56) years. With paired-samples T test, the CASI (t=-3.17, p=.003) and CES-D (t=2.42, p=.002) scores of subjects showed significant effect for intervention.
There was also a significant difference of the scores of quality of life of the family caregivers before and after intervention for the patients (t=-2.12, p=.040). However there was no significant difference of the CES-D of the family caregivers (t=1.94, p=.059).
Discussion Qualitatively, in the beginning, many of the patients may have lower activation and motivation for the program and have resistant passive behaviors. When it came to the middle or late stage of the group, they showed more spontaneity and less resistance. After the program, the intervention the participants showed increased social interaction in the group, enriched verbal expression, improved positive mood, and gained self-confidence and both the patients and family caregivers expected a continuous group for them. There were also individual effects for respective group observed. During the program, subjects shared their suffering and adjustment for dementia, which could help them cope with their illness;
family caregivers could gain
psychological support to help them relieve their stress.
Conclusion The results were consistent findings of TADA. It implied that intervention of occupational therapeutic program could improve cognitive function of early to mild dementia patients and quality of life of their family caregivers. Occupational therapy could benefit dementia patients and their family, which deserves further promotion in Taiwan.
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阿茲海默氏症病患經乙醯膽鹼酯脢抑 制劑治療後於認知功能篩檢量表之變 異
何柏陵 賴秋蓮 周美鵑 劉景寬 楊淵韓 高雄市立大同醫院 高雄醫學大學附設中和 紀念醫院 神經內科
The Change of CASI and Its Subscale after the Treatment of
Acetyl-Cholinesterase Inhibitor in Patients with Alzheimer's disease
Bo-Lin Ho, Chiou-Lian Lai, Mei-Chuan Chou, Ching-Kuan Liu, Yuan-Han Yang
Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University
Objective To evaluate the cognitive outcomes in Alzheimer's patients by Cognitive Abilities Screening Instrument (CASI) after annual medical treatment in Taiwan
Background Acetyl-cholinesterase inhibitors (AChEIs) are widely used for the treatment of Alzheimer's disease (AD). The CASI provides quantitative assessment on nine cognitive domains,
and has been widely used for dementia screening in several epidemiological studies. However, its usefulness in evaluating treatment outcome of AD has not been examined.
Methods Consecutive patients fulfilled the diagnostic criteria of AD from January 2007 to September 2010 were prospectively registered into our computerized database. For each recruited AD patient, a series of neuropsychological assessments, including Mini-Mental State Exam (MMSE), CASI, and Clinical Dementia Rating (CDR), were conducted annually to evaluate the therapeutic responses to AChEIs therapy.
Results A total of 385 AD patients were included in our study; 89 patients with global CDR 0.5, 237 with CDR 1.0, and 59 with CDR 2.0. The mean age was 76.96 ± 7.76 years and there were 113 men (29.35%). In CASI subscales analysis, statistically significant improvements were performed in fluency and short-term memory, but declines were
demonstrated in orientation and long-term memory. Intergroup differences showed statistical improvement in concentration and orientation in patients with CDR 2.0.
Conclusion Based on the
observational results of our study, the
treatment outcomes of AChEIs for AD patients were multidimensional and diverse in view of different cognitive domains. This may provide practical guidance for treatment options and prognostic evaluation in clinical settings.
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病例個案報告: 左側下顳葉腦迴出血 引起之辭彙提取障礙
凃敏謙 1 嚴寶勝2,3 林佩怡 1
1佛教慈濟綜合醫院台中院區神經內科
2影像醫學部
3慈濟大學
Word retrieval deficit after left inferior temporal gyrus hemorrhage:
A case report
Min-Chien Tu 1, Pao-Sheng Yen2,3, Pai-I, Lin 1
1 Department of Neurology,
2 Department of Radiology, Buddhist Tzu Chi General Hospital Taichung Branch, Taichung, Taiwan,
3 School of Medicine, Tzu Chi University, Hualien, Taiwan
Abstract
Background Albeit learning process and speech production stream varied across different languages, similarity of neuronal substrate activation and mental conceptualization during oral word production might exist. Previous studies had highlighted the role on anterior and posterior temporal structures, denoting semantic and lexical processing, respectively. It is often the case that speech disturbance happening among subjects with multi-domain cognitive impairment consequent to more extensive brain pathology. Herein we presented a case with word retrieval deficits resulting from focal hemorrhage
at left inferior temporal gyrus and made detail distinction of impaired word retrieval from other possible causes.
Case Report A 82-year-old right handed woman with hemorrhage of left inferior temporal gyrus demonstrated long-lasting word retrieval deficit, in the presence of fluent spontaneous speech, accurate writing, and a few paraphasic errors. Neuropsychological assessment suggested a mismatched phonological representation with preserved semantics and visuospatial function, typical for genuine word retrieval failure (pure anomia).
Confrontation naming tests suggested response favorable for category “tools”
than “plants”/”animals” and partial benefit from phonological cue. Brain magnetic resonance images had unveiled the Wallerian degeneration from previous old hemorrhagic nidus.
Conclusion A distinct role of inferior temporal gyrus in dominant
hemisphere was proposed, as the word being retrieved from the semantic system. Our study implied mechanism underlying phonological word production depends on different, but overlapping areas, in line with the deafferentation processs from neuroimages. On the basis of category-dependent response, it is possible the result of more perceptual attributes being allocated during
naming animals. Benefit from phonological but not semantic cue suggested a novel network, independent to semantic access, parallels major cascade representation process. Our study declared the Chinese phonological naming process was largely consistent with literatures from other languages.
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失用症在皮質基底核退化症:個案研究 徐榮隆
新光吳火獅紀念醫院神經科
Apraxia in corticobasal syndrome: a case study
Jung-Lung, Hsu
Department of Neurology, Shin Kong WHS Memorial Hospital
Background Apraxia is an uncommon neurobehavioral symptom. However, it is often a presenting feature making it as one of the hallmark signs of corticobasal syndrome, one of the rare parkinsonism.
Here we present a clinical case study of apraxia with image findings.
Case Report A74-year-old retired high school chemistry teacher, a
right-handedness, was admitted due to the delusion of infidelity and forgetful for 6 months. His wife first noted that he had the delusion of infidelity, irritable mood and poor sleep 6 months ago. He was visited a psychiatric clinic and
anti-psychotic medication was prescribed.
Two months later, his insomnia became more prominent and a sleep study was arranged in the other hospital. No REM behavior was documented. His gait
became more clumsy and his wife also noted that he became more dullness and forgetful. He was brought to our hospital for further evaluation. On examination, he was cooperative and orientated. He had good attention and his speech was fluent but slow. His comprehension on single command was preserved. On short-term memory, he only could memorize 5 words after 3 trials of 10 words list learning study.
The spontaneous recall and recognition test showed severe deficit. He also demonstrated severe impairment on constructional ability and frontal lobe test such as category verbal fluency and Luria 3-steps test. He had a mask face and his left arm showed slow of motion, increased muscle tone. He could perform voluntary movement in his right hand but he could not perform simple movement in his left hand. His left hand could not pantomime brush/smoking movement. The imitation test also failure in his left hand. He also could not perform simple gesture in his left hand.
However, he could understand the gesture meaning by visual inspection.
No tremor, myoclonus or alien hand sign noted. His stance was flexion posture and no wide base. His gait was slow, with mild propulsive gait. On image study, brain MRI showed right frontal and bilateral parietal atrophy.
HMPAO-SPECT study also
demonstrated right frontal and bilateral parietal decreased perfusion.
TRODAT-SPECT study showed decreased the bilateral putamen binding ratio with more severe in the right side.
Conclusion Apraxia in corticobasal syndrome is a frequent feature. This patient demonstrates the limb apraxia in corticobasal syndrome is due to
production system defect rather than the concept system or sensory/perceptual system lesion.
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老年人的次發性躁症: 個案研究與文 獻回顧
陳軾正
奇美醫療財團法人柳營奇美醫院 神經內科 Secondary Mania in the Elderly: Case Study and Literature Review
Shih-Cheng Chen
Division of neurology, department of internal medicine, Chi Mei medical center, Liouying
Background "primary mania" means a state in bipolar disorder, whereas
"secondary mania" results from pharmacological, metabolic, or neurologic causes. Mania has been estimated to represent the cause of 4.6%
to 18.5% of all geriatric psychiatric admissions. Mania in older patients used to manifest with more irritability,
confusion, psychosis, and mixed features.
This syndrome is clinically important because it is associated with relatively poor outcomes in terms of cognition, morbidity and mortality.
Case Study 5 cases regularly
followed-up in my clinic were reviewed,
who presented with mania during his/her disease courses. The age of the patients is between 79 to 89 years old.
The diagnoses of the patients include right hemisphere infarction (1 case), dementia and parkinsonism (5 cases).
The clinical dementia rating scores of the patients are 2–3. The symptoms of mania include decreased need of sleep, being hypertalkative and restless, singing, and psychotic features. Some patients show persisted mania and some have fluctuation of mood states.
All 5 patients have been treated with valproic acid and most of them show responses.
Discussion Dementia with Lewy bodies is suspected in my reviewed patients, which is proposed an
important etiology of secondary mania in the elderly. Even low-dose
dopaminergic therapy is at risk to trigger a mania episode in such patients. Lesions involving the right hemisphere and specifically the orbito-frontal, basal temporal and basal ganglia areas are associated with mania. Dopamine dysregulation with post-synaptic hypersensitivity has been implied in the pathogenesis of mania.
Valproic acid seems a reasonable choice to treat secondary mania, as long as the hepatic function is preserved. In conclusion, mood disorder is an important part of behavior and psychological symptoms of dementia, and mania should be
considered in dementic patients with insomnia, confusion or psychotic features, since the treatment responses differ.
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眼控電腦溝通輔具介入對改善運 動神經元疾病患者生活品質及照 護者生活壓力之探討
黃啟訓1 翁賀修1 王麗芬1張顥騰2
1台北市立聯合醫院忠孝院區 神經內科
2中國醫藥大學 分子系統生物醫學研究所 The application of eye-tracking assistive device for improving the life quality of ALS patients and the burden on caregivers
Chi-Shin Hwang1, Ho-Hsiu Weng 1, Li-Fen Wang 1, Hao-Teng Chang2
1 Department of Neurology, Taipei City Hospital - Zhong Xiao Branch
2 Graduate Institute of Molecular Systems Biomedicine, College of Medicine, China Medical University
Objective Amyotrophic lateral sclerosis (ALS) is a relentlessly devastating neurodegenerative disease characterized by selective loss of motor function. As such, ALS patients usually retain a normal conscious level, but disease progression eventually results into quadriplegia and severe handicap of oral communication. This communication barrier can generate a great deal of stress for ALS patients and their caregivers. We aimed, therefore, to know whether the use of a communication-assistive device could improve the life quality of ALS patients and relieve the burden on their primary caregivers.
Methods Twenty quadriplegic severe handicapped ALS patients with their primary caregivers were collected from
the ALS center of Taipei City Hospital.
Subjects were divided into two groups depending on whether they used (n = 10) or did not use (n = 10) an
eye-tracking communication-assistive device. We assessed patients’ quality of life and severity of depression using the ALS Specific Quality of Life Instrument-Revised and the Taiwanese Depression Questionnaire, respectively.
The Caregiver Burden Scale was used to assess the burden on caregivers. The data were analyzed using GraphPad Prism software. For comparisons between two groups, the two-tailed Student’s t-test was used.
Results The eye-tracking assistive device significantly improved patients’
quality of life, as compared with patients in the non-user group. The assistive device also reduced the burden on caregivers. This likely resulted from more-effective
communication between patients and caregivers.
Conclusions Our study shows that an eye-tracking communication
technology can reliably improve the life quality of ALS patients and relieve the burden on their caregivers.
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改善 β-澱粉樣蛋白(1～40)誘發學習
記憶障礙模式的替代療法
葉宗勳 1,2 , 謝明村 3 , 葛其梅 2,吳啟瑞 3, 廖俊旺4, 周寬基5
1秀傳紀念醫院神經內科
2國立中興大學生命科學系
3中國醫藥大學藥學院中國藥學暨中藥資源學 系
4國立中興大學獸醫病理學研究所
5國立中興大學生物醫學研究所
Alternative therapy on amyloid β 1-40 -induced Alzheimer's disease-like phenotype
Chung-Hsin Yeh 1, 2, Ming-Tsuen Hsieh3, Chi-Mei Hsueh2, Chi-Rei Wu3, Jiunn-Wang Liao4, Kuan-Chih Chow5
1Department of Neurology Show Chwan Memorial Hospital, Changhua, Taiwan, (ROC)
2Graduate Institute of Life Sciences, National Chung Hsing University, Taichung 40001, Taiwan, (ROC)
3School of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Pharmacy, China Medical University, Taichung 40001, Taiwan, (ROC)
4Department of Veterinary Medicine, National Chung-Hsing University, Taichung 40001, Taiwan, (ROC)
5Graduate Institute of Biomedical Sciences, National Chung Hsing University, Taichung 40001, Taiwan, (ROC)
Abstract Alzheimer's disease (AD) is an irreversible neurodegenerative disorder characterized by amyloid accumulation, neuronal death and cognitive impairments.
YCTMT is one of traditional Chinese
YCTMT is one of traditional Chinese