• Journal of Korean Neurosurgical Society
• /
• v.54 no.4
• /
• pp.329-335
• /
• 2013

Objective : Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. Methods : From March 2001 to May 2011, 124 women with metastatic brain lesions originating from a primary breast cancer underwent GKRS at a tertiary medical center in Seoul, Korea. All patients had radiosurgery as a primary treatment or salvage therapy. We retrospectively reviewed their clinical outcomes and radiological responses. The end point of this study was the date of patient's death or the last follow-up examination. Results : In total, 106 patients (268 lesions) were available for follow-up imaging. The median follow-up time was 7.5 months. The mean treated tumor volume at the time of GKRS was 6273 $mm^3$ (range, 4.5-27745 mm3) and the median dose delivered to the tumor margin was 22 Gy (range, 20-25 Gy). Local recurrence was assessed in 86 patients (216 lesions) and found to have occurred in 36 patients (83 lesions, 38.6%) with a median time of 6 months (range, 4-16 months). A treated tumor volume >5000 $mm^3$ was significantly correlated with poor local tumor control through a multivariate analysis (hazard risk=7.091, p=0.01). Overall survival was 79.9%, 48.3%, and 15.3% at 6, 12, and 24 months, respectively. The median overall survival was 11 months after GKRS (range, 6 days-113 months). Multivariate analysis showed that the pre-GKRS Karnofsky performance status, leptomeningeal seeding prior to initial GKRS, and multiple metastatic lesions were significant prognostic factors for reduced overall survival (hazard risk=1.94, p=0.001, hazard risk=7.13, p<0.001, and hazard risk=1.46, p=0.046, respectively). Conclusion : GKRS has shown to be an effective and safe treatment modality for treating brain metastases of primary breast cancer. Most metastatic brain lesions initially respond to GKRS, though, many patients have further CNS progression in subsequent periods. Patients with poor Karnofsky performance status and multiple metastatic lesions are at risk of CNS progression and poor survival, and a more frequent and strict surveillance protocol is suggested in such high-risk groups.

• Korean Journal of Clinical Laboratory Science
• /
• v.47 no.3
• /
• pp.97-104
• /
• 2015

Sleep is not only an essential physiological function, but also serves important roles in promoting growth, maturation, and overall health of humans. There is increasing interest regarding the impact of sleep and its disorders on the regulation of inflammatory processes and end-organ morbidities, particularly in the context of metabolic and cardiovascular diseases (CVD) and their complications. Obstructive sleep apnea syndrome (OSAS) is an increasingly common health problem in children. In the last decade, the emergence of increasing obesity rates has further led to remarkable increases in the prevalence of OSAS, along with more prominent neurocognitive, behavioral, cardiovascular and metabolic morbidities. Although the underlying mechanisms leading to OSAS-induced morbidities are likely multifactorial and remain to be fully elucidated, activation of inflammatory pathways by OSAS has emerged as an important pathophysiological component of the end-organ injury associated with this disorder. To this effect, it would appear that OSAS could be viewed as a chronic, low-grade inflammatory disorder. Furthermore, the concurrent presence of obesity and OSAS poses a theoretically increased risk of OSAS-related complications. In this study, we will critically review the current state of research regarding the impact of insufficient and disrupted sleep and OSAS on the immune processes and inflammatory pathways that underlie childhood OSAS as a distinctive systemic inflammatory condition in children, and will explore potential interactions between OSAS and obesity.

• Sleep Medicine and Psychophysiology
• /
• v.26 no.1
• /
• pp.16-22
• /
• 2019

Objectives: The objective of this study was to investigate the correlation between insufficient sleep and visuospatial memory in adolescents using a computerized neurocognitive function test. Methods: A total of 103 high school students (26 males and 77 females; mean age $17.11{\pm}8.50years$) without a serious psychiatric problem was recruited. All subjects were requested to complete a self-report questionnaire about weekday total sleep time and weekend total sleep time. The epworth sleepiness scale (ESS) and the beck depression inventory (BDI) were administered to measure daytime sleepiness and symptoms of depression. Seven subsets of the Cambridge Neuropsychological test automated battery were examined to assess visuospatial memory. Results: After controlling for age, sex, ESS, and BDI, longer weekend total sleep time was correlated with poor performance on delayed matching to sample (r = -0.312, p = 0.002) and immediate recall on pattern recognition memory (r = -0.225, p = 0.025). Increased weekend catch-up sleep time was correlated with poor performance of delayed matching to sample (r = -0.236, p = 0.018), immediate recall on pattern recognition memory (r = -0.220, p = 0.029), and delayed recall on pattern recognition memory (r = -0.211, p = 0.036) after controlling for age, sex, ESS, and BDI. Conclusion: This study showed that increased weekend catch-up sleep time reflecting insufficient weekday sleep were associated with poor performance in delayed recall tasks of visual memory. This finding suggests that insufficient sleep during adolescence might produce a decline of visuospatial memory.

• Journal of Korean Society of Neurocognitive Rehabilitation
• /
• v.10 no.2
• /
• pp.45-52
• /
• 2018

The purpose of the present study was to determine correlations between the Berg Balance Scale (BBS), Montreal Cognitive Assessment-Korean (MoCA-K) and Modified Barthel Index (MBI) targeting stroke patients, and it seeks to analyze the influence among each factor to establish the fundamental research in evaluating the functional performance capability of stroke patients. The study was conducted between December 2017 and March 2018 and the target of the study was 34 stroke patients who are hospitalized and treated in Y rehabilitation hospital located in Goyang city. Following in criteria of how participants were selected. First, a person without the onset of 6months or more. Second, a person who can communicate and score over 20 points on MMSE-K. Third, a person without unilateral neglect. Fourth, a person without lower motor neuron lesion and orthopedic disease on the bilateral lower extremity. Fifth, a person without audiovisual problem and history of using drug or surgery that influence athletic function. sixth, patients who agreed on participating in the study. The evaluation was processed by measuring BBS, MoCA-K, and MBI with the occupational therapist and physical therapist. Also, one assistant was participated in measuring balanced ability for the safety reason. It was found that significantly correlates (p<.01) with BBS and MoCA-K (r=.459), BBS and MBI (r=.550), MoCA-K and MBI (r=.565). This study is meaningful that it provided the basis for the active use of BBS, MoCA-K and MBI as a clinical evaluation tool and its usefulness.

• Sleep Medicine and Psychophysiology
• /
• v.8 no.2
• /
• pp.129-137
• /
• 2001

Objectives: The purpose of this study is to investigate the effects of 38-hour sleep deprivation on fine motor performance. The Motor Performance Series (MPS) in the Vienna Test System (computerized neurocognitive function tests) was used in this study. Methods: Twenty four subjects participated in this study. Subjects had no past history of psychiatric disorders and physical illness. Subjects had normal sleep-waking cycle without current sleep disturbances and were all right-handed (Annett's Hand Preference Questionnaire: above +9 points). To minimize the learning effects, familiarization with the Vienna Test System was performed one day before the study. Subjects were to get up at 6:00 in the morning after getting enough sleep according to his or her usual sleep-wake cycle. After awakening, subjects remained awake for 38 hours under continuous surveillance. During two consecutive study days, the subjects tested MPS at 7 AM and 7 PM each day, which means the MPS was done four times in total. During the experiment, anything that could affect the subjects' sleep such as coffee, tea, alcohol, a nap, tiring sports, and all medications were prohibited. Results: In MPS, the fine motor functions of both hands decreased after 38 hours of sleep deprivation. The decrement in motor performance was prominent in the dominant right hand. In the right hand, the total number of tapping was reduced (p<.005), and the number of misses (p<.05) and the length of misses (p<.05) of line tracking, the total length of inserting a short pin (p<.01), the total length of inserting a long pin (p<.05), and the number of misses in aiming (p<.05) increased. Such performance decrement was distinct in the morning sessions. Conclusions: These results suggest that fine motor performance decrement during sleep deprivation is predominant in the right hand, which exerts maximal motor function. The finding of decrement in motor function in tapping during sleep deprivation also suggested that the time required for exhaustion of muscles is shortened during sleep deprivation. More deterioration of motor performance was shown in the morning, which could be explained as circadian rhythm effects.

• Korean Journal of Psychosomatic Medicine
• /
• v.24 no.2
• /
• pp.184-190
• /
• 2016

Objectives : This study analyzed the differences of body mass index(BMI) in Korean patients with Alzheimer's diseases(AD), Mild Cognitive Impairment(MCI), and healthy controls to verify whether low BMI is associated with cognitive impairment. Furthermore, this study also sought to examine any association between BMI and Mini Mental State Examination-Korean version(MMSE-K), Clinical Dementia Rating(CDR), and Global Deterioration Scale(GDS). Methods : A total of 257 subjects were included in the study. History taking, mental status examination, physical examination and neurocognitive function test were carried out for the diagnosis of AD and MCI. The subjects' demographic data and presence of diseases were also surveyed. The overall cognitive function and severity of diseases were assessed using MMSE-K, GDS, and CDR. Results : The order of BMI was found to be healthy controls>MCI>AD, with statistically significant differences among the groups. The order of MMSE-K scores was similar, with healthy controls>MCI>AD in statistically significant differences. The healthy controls had the lowest CDR and GDS scores, and AD patients had the highest scores. There was a significant positive correlation between BMI and MMSE scores(r=0.238, p=0.000). BMI was negatively correlated with CDR(r=-0.174, p=0.008) as well as with GDS(r=-0.233, p= 0.000). Conclusions : Measuring BMI of patients with AD or MCI is expected to be meaningful in that BMI could be a clinical indicator of AD. We expect this to be beneficial for the diagnosis, prevention, and therapeutic approach of AD and also expect large-scale, long-term longitudinal studies to follow.

• Journal of Life Science
• /
• v.30 no.3
• /
• pp.250-259
• /
• 2020

Diabetes is a well-known risk factor for dementia and cognitive impairment. Diabetic polyneuropathy (DPN) is the most prevalent microvascular complication in type 2 diabetes mellitus (T2DM) patients. The purpose of this study was to evaluate the relation between diabetic peripheral polyneuropathy and cognitive factors in T2DM patients. Retrospective chart review of type 2 diabetic patients with results of a nerve conduction study (NCS) and a neurocognitive study. A total of 19 patients were included. DPN was defined using data from a nerve conduction study: a score of less than 24 in the Korean version of the Mini-Mental State Examination (K-MMSE) was considered as an indicator of cognitive impairment (CI). The mean age of the 19 patients was 71.6±5.0 years. The mean duration of diabetes was 8.4±9.1 years, and the mean HbA1c level was 8.1±1.8%. DPN was present in 7 of the 19 patients. Based on the K-MMSE score, CI was diagnosed in eight patients. The mean K-MMSE scores and the prevalence of CI was not different between the groups with and without DPN. There was no significant difference in DPN prevalence between the groups with and without CI. Education was significantly correlated with cognitive factors. Only the digit span-forward among the cognitive factors showed a significant negative correlation with nerve conduction velocity. In conclusion, the longer education period was associated with higher cognitive function and no significant correlation was observed between diabetic peripheral neuropathy and cognitive dysfunction in type 2 diabetic patients. Further prospective research is needed in the future.

• Journal of the Korean Society of Radiology
• /
• v.81 no.3
• /
• pp.676-687
• /
• 2020

Purpose To analyze the altered brain regions and intrinsic brain activity patterns in trauma-exposed firefighters without posttraumatic stress disorder (PTSD). Materials and Methods Resting-state functional MRI (rsfMRI) was performed for all subjects. Thirty-one firefighters over 40 years of age without PTSD (31 men; mean age, 49.8 ± 4.7 years) were included. Twenty-six non-traumatized healthy controls (HCs) (26 men; mean age, 65.3 ± 7.84 years) were also included. Voxel-based morphometry was performed to investigate focal differences in the brain anatomy. Seed-based functional connectivity analysis was performed to investigate differences in spontaneous brain characteristics. Results The mean z-scores of the Seoul Verbal Learning Test for immediate and delayed recall, Controlled Oral Word Association Test (COWAT) score for animals, and COWAT phonemic fluency were significantly lower in the firefighter group than in the HCs, indicating decreased neurocognitive function. Compared to HCs, firefighters showed reduced gray matter volume in the left superior parietal gyrus and left inferior temporal gyrus. Further, in contrast to HCs, firefighters showed alterations in rsfMRI values in multiple regions, including the fusiform gyrus and cerebellum. Conclusion Structural and resting-state functional abnormalities in the brain may be useful imaging biomarkers for identifying alterations in trauma-exposed firefighters without PTSD.