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Background Computerized versions of cognitive screening test could have advantages over pencil-and-paper versions by eliminating rater-dependent factors and saving the time required to score the tests and report the results. We developed a computerized cognitive screening test (Inbrain Cognitive Screening Test [Inbrain CST]) that takes about 30 minutes to administer on a touchscreen computer and is composed of neuropsychological tests already shown to be sensitive in detecting early cognitive decline in Alzheimer's disease (AD). The aims of this study were to 1) introduce normative data for Inbrain CST, 2) verify its reliability and validity, 3) assess clinical usefulness, and 4) identify neuroanatomical correlates of Inbrain CST. Methods The Inbrain CST runs on the Microsoft Windows 10 operating system and comprises 7 subtests that encompass 5 cognitive domains: attention, language, visuospatial, memory, and executive functions. First, we recruited 480 cognitively normal elderly people (age 50–90) from communities nationwide to establish normative data for Inbrain CST. Second, we enrolled 97 patients from our dementia clinic (26 with subjective cognitive decline [SCD], 42 with amnestic mild cognitive impairment [aMCI], and 29 with dementia due to AD) and investigated sensitivity and specificity of Inbrain CST for discriminating cognitively impaired patients from those with SCD using receiver operating characteristic (ROC) curve analyses. Third, we compared the Inbrain CST scores with those from another neuropsychological test battery to obtain concurrent validity and assessed test–retest reliability. Finally, magnetic resonance imaging (MRI)-based cortical thickness analyses were performed to provide anatomical substrates for performances on the Inbrain CST. Results First, in the normative sample, the total score on the Inbrain CST was significantly affected by age, years of education, and gender. Second, Inbrain CST scores among the three patient groups decreased in the order of SCD, aMCI, and AD dementia, and the ROC curve analysis revealed that Inbrain CST had good discriminative power for differentiating cognitively impaired patients from those with SCD. Third, the Inbrain CST subtests had high concurrent validity and test–retest reliability. Finally, in the cortical thickness analysis, each cognitive domain score and the total score of Inbrain CST showed distinct patterns of anatomical correlates that fit into the previously known brain–behavior relationship. Conclusion Inbrain CST had good validity, reliability, and clinical usefulness in detecting cognitive impairment in the elderly. Furthermore, it showed neuroanatomical validity through MRI cortical thinning patterns. These results suggest that Inbrain CST is a useful cognitive screening tool with efficiency and validity to detect mild impairments in cognition in clinical settings., Graphical Abstract

Background The Rey-Osterrieth Complex Figure Test (RCFT) is a neuropsychological test that is widely used to assess visual memory and visuoconstructional deficits in patients with cognitive impairment, including Alzheimer disease (AD). Patients with AD have an increased tendency for exhibiting extraordinary behaviors in the RCFT for selecting the drawing area, organizing the figure, and deciding the order of images, among other activities. However, the conventional scoring system based on pen and paper has a limited ability to reflect these detailed behaviors. Objective This study aims to establish a scoring system that addresses not only the spatial arrangement of the finished drawing but also the drawing process of patients with AD by using digital pen data. Methods A digital pen and tablet were used to copy complex figures. The stroke patterns and kinetics of normal controls (NCs) and patients with early-onset AD (EOAD) and late-onset AD (LOAD) were analyzed by comparing the pen tip trajectory, spatial arrangement, and similarity of the finished drawings. Results Patients with AD copied the figure in a more fragmented way with a longer pause than NCs (EOAD: P=.045; LOAD: P=.01). Patients with AD showed an increased tendency to draw the figures closer toward the target image in comparison with the NCs (EOAD: P=.005; LOAD: P=.01) Patients with AD showed the lower accuracy than NCs (EOAD: P=.004; LOAD: P=.002). Patients with EOAD and LOAD showed similar but slightly different drawing behaviors, especially in space use and in the initial stage of drawing. Conclusions The digitalized complex figure test evaluated copying performance quantitatively and further elucidated the patients’ ongoing process during copying. We believe that this novel approach can be used as a digital biomarker of AD. In addition, the repeatability of the test will delineate the process of executive functions and constructional organization abilities with disease progression.

Recent improvements in neuroimaging and molecular markers of Alzheimer’s disease (AD) have aided diagnosis in the early stage of the disease, which greatly increases the chance for successful prevention and treatment. However, the expanding resources for AD diagnosis are unlikely to benefit all elderly due to economic burden. Here, we aimed to develop an inexpensive and sensitive method to detect early-stage AD. A scenario for real-world social event memory test (SEMT) was created and filmed in 360° video. Participants watched the 7-min video through head-mounted display (HMD) and then answered questionnaire about the video. We categorized the SEMT score into recall, recognition, and place-matching scores and compared them to scores on the Mini-Mental State Examination and Seoul Verbal Learning Test. Using the SEMT scores, we built a logistic regression model that discriminated between amyloid positivity and negativity of the participants, with a cross-validation AUC. Furthermore, a classifier was created using support vector machine, which produced 93.8–95.1% sensitivity in classifying individuals into four groups of normal, mild cognitive impairment with or without amyloid, and AD elderly. The high correlation between the SEMT score and amyloid positivity in individuals who experienced virtual social gathering through an HMD opens a new possibility for early diagnosis of AD.

Purpose To evaluate whether hinge position affects the change in posterior tibial slope in medial open-wedge high tibial osteotomy (HTO). Methods We retrospectively evaluated 19 knees from 17 patients who underwent medial open-wedge HTO by 3-dimensional computed tomography scan before and after surgery. A 3-dimensional image model was constructed by applying reverse-engineering software to the computed tomography DICOM (Digital Imaging and Communications in Medicine) files. The hinge axis (i.e., the position of the hinge compared with the anteroposterior axis on an axial view), posterior tibial slope, medial-proximal tibial angle, and gap ratio (i.e., the ratio of anterior gap to posterior gap in the opened wedge) were measured. Results The mean hinge axis was 4.92° ± 3.86°. Posterior tibial slope increased from 7.29° ± 2.56° preoperatively to 10.48° ± 3.01° postoperatively ( P = .001). The mean medial-proximal tibial angle was 85.96° ± 1.97° preoperatively and 93.13° ± 3.17° postoperatively ( P = .001). The mean gap ratio was 62.48% ± 7.26%. Linear regression analysis determined that the hinge axis ( P = .0001) was a significant factor changing posterior tibial slope. Conclusions Hinge position affected the change in posterior tibial slope in medial open-wedge HTO; in particular, a posterolateral hinge position led to an increase in posterior tibial slope. Level of Evidence Level IV, therapeutic study.

Background/Aims: Although the Mini-Mental State Examination (MMSE), Clinical Dementia Rating-Sum of Boxes (CDR-SOB), and neuropsychological batteries are widely used for evaluating cognitive function, it remains elusive which instrument best reflects the longitudinal disease progression in amnestic mild cognitive impairment (aMCI) and probable Alzheimer disease (AD). We investigated whether changes in these three instruments over time correlate with loss of cortical gray matter volume (cGMV). Methods: We retrospectively investigated 204 patients (aMCI, n = 114; AD, n = 90) who had undergone MMSE, CDR-SOB, the dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D), and 3-dimensional T1-weighted magnetic resonance images at least twice. We investigated the partial correlation between annual decline in test scores and percent change of cGMV. Results: In aMCI patients, changes in the SNSB-D total score (r = 0.340, p < 0.001) and CDR-SOB (r = 0.222, p = 0.020), but not MMSE, showed a correlation with cGMV loss, with the SNSB-D total score showing the strongest correlation. In AD patients, decline in all three test scores correlated significantly with cGMV loss, with MMSE exhibiting the strongest correlation (r = 0.464, p < 0.001). Conclusion: In aMCI patients, neuropsychological battery, though time-consuming, was the most adequate tool in tracking disease progression. In AD patients, however, MMSE may be the most effective longitudinal monitoring tool when considering cost-effectiveness.

Objective: Motor intentional disorders (MIDs) are characterized by dysfunction in the preparation, initiation, maintenance, and termination of goal-oriented actions. In this study, we investigated (1) whether patients with right hemisphere strokes (RHS) and left hemisphere strokes (LHS) differ in the frequency of delayed action initiation (hypokinesia) and motor impersistence; (2) whether there is a directional or hemispatial component of hypokinesia or motor impersistence; (3) whether there is an association between the presence of hemispatial neglect and tests for MID; and (4) the location of injury associated with MID. Method: Thirty-two patients with acute unilateral stroke (21 with RHS and 11 with LHS) and 12 age-matched healthy controls participated in the study. To determine the presence and severity of directional and spatial hypokinesia and impersistence we used a new apparatus, the Directional Movement Tester (DMT). While being tested with the DMT, the participants held a static bar located either in the right or left hemispace using either their right or left hand and upon stimulus onset pushed the bar either leftward or rightward and maintained a given force for 10 sec. Results and Conclusion: The frequency of hypokinesia and impersistence was higher in the RHS group than in the LHS group, but there were no hypokinetic directional or spatial asymmetries. The RHS group did demonstrate left contralesional directional impersistence, but there were no spatial asymmetries of impersistence. Signs of hemispatial neglect were not associated with these measures of MID. Participants with frontal or subcortical lesions were significantly more likely to demonstrate hypokinesia and impersistence than those with posterior lesions.

Patients with probable Alzheimer's disease (AD) and the amnesic form of mild cognitive impairment (aMCI) often demonstrate several types of neuropsychological deficits. These deficits are often related to cortical atrophy, induced by neuronal degradation. The purpose of this study is to investigate whether different anatomic patterns of cortical atrophy are associated with specific neuropsychological deficits. The participants were 170 patients with AD and 99 patients with aMCI. All participants underwent the Seoul Neuropsychological Screening Battery (SNSB), which includes tests that assess attention, language, visuospatial functions, verbal and visual memory, and frontal/executive functions. Cortical atrophy (thinning) was quantified by measuring the thickness of the cortical mantle across the entire brain using automated, three-dimensional magnetic resonance imaging. The relationship between cortical thickness and neuropsychological performance was analysed using stepwise multiple linear regression analyses. These analyses (corrected P

Patients with left unilateral neglect misbisect lines toward the right. To discriminate between contralesional unawareness and ipsilesional hyperattention hypotheses for this ipsilesional bias, we performed the line quadrisection test on 18 patients with and 25 without neglect, and 24 normal controls. Overall the patients with neglect were unbiased when performing the left quadrisection task, but erred rightward on the right quadrisection task. These results suggest that the ipsilesional bisection errors produced by patients with neglect are primarily influenced by ipsilesional hyperattention rather than contralesional unawareness. However, further analyses showed heterogeneity of performance in left quadrisection, which can be explained by multiple factors that include the top down attention to left space associated with left quadrisection, the orienting to the salience of the line's left end, and distorted mental representation, in addition to ipsilesional hyperattention.

A recent study has shown that optokinetic stimulation (OKS) can induce attentional distractibility in Alzheimer disease (AD). In this study, we investigated whether OKS also perturbs balanced attentional deficit in patients with amnestic mild cognitive impairment (aMCI), a prodromal phase of AD, and explored whether the effects of OKS at baseline differ between aMCI patients who convert to AD at follow-up (converters) and those who do not (nonconverters). A total of 44 patients with aMCI, 14 patients with subcortical vascular mild cognitive impairment (svMCI), and 35 age-matched and education-matched normal controls were studied for their ability to bisect solid lines superimposed on a background of OKS. Background OKS movements were either leftward or rightward, or were stationary. A total of 33 of the 44 patients with aMCI were clinically followed for an average of 2.8 years, of which there were 15 converters and 18 nonconverters. Under both the leftward and rightward movement conditions, the magnitudes of line bisection errors (LBEs) in aMCI patients were greater than in normal controls. However, there were no differences in LBEs between svMCI patients and normal controls or between aMCI and svMCI patients. Baseline LBEs of aMCI converters were significantly greater than those of nonconverters in both leftward and rightward movement conditions. These results may indicate that OKS is useful for detecting AD at a very early stage and for predicting the conversion of aMCI to AD.

Objective Vascular cognitive impairment associated with small vessel disease (sVCI) may manifest as both cognitive and motor dysfunctions. However, few instruments exist for systematically assessing motor symptoms in sVCI, even though many neuropsychological tests exist to evaluate cognitive function. We developed a new scale for assessing motor impairments and evaluated the reliability and validity of the scale in patients with sVCI. Methods A new motor scale, called the PEPS (Pyramidal and Extra Pyramidal Scale for sVCI), consisted of 34 items (for 60 total points) with 5 subdomains: corticospinal, corticobulbar, extrapyramidal signs, gait abnormalities, and gait severity. The PEPS was compared between 75 patients with sVCI and 73 control patients who had dementia or mild cognitive impairment (MCI) without ischemia. Results The PEPS had good interrater and test–retest reliability, and it was moderately to highly correlated with the UPDRS, NIHSS, MMSE, CDR, and ADL scales. An optimal cut-off score of PEPS to discriminate dementia or MCI patients with ischemia from those without ischemia was 6.5 with a sensitivity of 88% and a specificity of 100%. Conclusion The PEPS is a reliable and valid scale that can be used to assess and monitor motor impairment in patients with vascular cognitive impairment due to small vessel disease.

Background: Despite many studies that investigated the neural correlates of hemispatial neglect (HN) with structural imaging, studies using voxel-wise analyses of functional imaging are not available. Furthermore, previous studies neither considered the neglect severity nor investigated whether there are differences in these neural correlates according to each neglect subtest. This study aimed to investigate the neural correlates of HN by correlating the total and the individual neglect score with hypoperfusion value on single photon emission computed tomography (SPECT) using voxel-wise analyses. Methods: Forty-two patients with acute right hemisphere strokes underwent a neglect test battery consisting of 3 bisection tasks, 2 cancellation tasks and 2 copying tasks. The SPECT images were acquired in these patients and 10 age- and education-matched normal controls. Results: Patients with HN, compared to those without HN, had hypoperfusion in the right middle temporal-occipital junction, inferior frontal gyrus and retrosplenial area. The total neglect score correlated with the hypoperfusion in the right middle temporal-occipital junction, fusiform gyrus, parahippocampal gyrus, inferior temporal gyrus, anterior part of the superior and middle temporal gyri, cuneus, lingual gyrus, angular gyrus, and the cerebellum. Across the neglect subtests similar correlation patterns were observed with minor variations. Conclusions: Unlike the results of previous studies showing that the critical neural correlates for HN are inferior parietal lobule or superior temporal gyrus, our study showed that the lesions that critically contribute to the neglect severity were located in the posterior parts of the middle temporal gyrus (temporal-occipital junction).

Background Patients with neglect often repeatedly cancel the same targets, a form of motor perseveration (MP). There seems to be 2 types of MP, making uninterrupted multiple strokes for each target, consecutive MP (CMP) or return MP (RMP) where patients return to previously canceled targets and remark them. Objective The purpose of this study is to learn whether these 2 forms of MP are dissociable. Methods We studied 3 patients, 1 with primarily CMP, another with primarily RMP and a third with mixed CMP and RMP by having them perform the cancellation task with and without background movement. Results In the patient with primarily RMPs (patient 1), leftward background movement decreased the severity of the neglect and the perseveration. Rightward background movement increased both. In contrast to patient 1, who showed the correspondence between the severity of neglect and perseveration, the patient with both CMP and RMP (patient 2) and the patient with primarily CMPs (patient 3) did not show such correspondence. Conclusions The different responses of CMP and RMP to the treatment of neglect suggest that different mechanisms account for these 2 forms of MP. Although RMP might be related to neglect induced aberrant approach behaviors, CMP seems to be related to a disengagement disorder.

Objectives: To evaluate the efficacy and tolerability of donepezil in patients with Binswanger type subcortical vascular dementia. Methods: Patients (n = 34, mean age = 71.8 + 7.12) with Binswanger type subcortical vascular dementia from 8 multicenter, according to clinical and neuroradiological working criteria, were selected to receive donepezil 5 mg/day (n = 2) or donepezil 10 mg/day (n = 32, after 5 mg/day) for 24 weeks. Our primary endpoints were change from baseline to weeks 12 and 24 in the Seoul Neuropsychological Screening Battery-Dementia version (SNSB-D) and the Korean version of neuropsychiatric inventory (K-NPI). Results: A total of 24 patients received donepezil completed the study (mean age = 72.0 + 7.5 K-Mini-Mental State Examination [MMSE] = 21.0 + 5.1). After 12 weeks and 24 weeks, patients showed improvements in cognitive function on the SNSB-D compared baseline of 16.29 points at 12 weeks (P < .05) and 12.44 points at 24 weeks (P < .05). Significant improvements were shown in only memory domain, immediate verbal recall and delayed recall tests. Subgroup with better cognitive function (SNSB-D > 100) were more effective in frontal and memory domains than the other subgroup (SNSB-D < 100). Withdrawal rates due to adverse events were very low (4.16%). Conclusions: Donepezil-treated patients with Binswanger type subcortical vascular dementia demonstrated significant improvement in cognition compared with baseline, and donepezil was well tolerated.

Patients with right hemisphere injury often omit or misread words on the left side of a page or the beginning letters of single words (neglect dyslexia). Our study involving a large sample of acute right hemisphere stroke investigated (1) the frequency of neglect dyslexia (ND), (2) the association between ND and other types of contralesional hemispatial neglect (CN), (3) the effect of visual field defect (VFD) on ND, and (4) the anatomical substrates for ND. Participants were 138 consecutive patients with right hemisphere stroke who underwent a neglect test battery including a test for ND. ND was considered present if the patient misread or omitted the left portion of the word in three or more of the 25 target words. CN was noted in 80/138 (58.0%) patients while ND was found in 31/138 (22.5%) patients. Of the 80 patients with CN, the frequency of neglect based on ND test was only 37.5% while the frequency of neglect based on other neglect tasks ranged from 51.3% to 86.3%. The severity of neglect was a significant predictor for ND. VFD was also a significant predictor for the occurrence of ND but this effect disappeared when the severity of neglect was controlled. Patients with CN had lesions in the superior and middle temporal gyri, inferior parietal lobule, and posterior insular cortex; patients with ND had additional lesions in the lingual and fusiform gyri. In summary, ND was dissociated from other types of neglect and was most often associated with severe neglect. VFD contributed to the occurrence of ND. ND resulted from lesions of temporoparietal junction areas (inferior parietal/superior temporal gyri) combined with those of lingual/fusiform gyri.

Little is known about cognitive differences between patients showing neglect and those without neglect in their acute stroke stage. The aim of this study was to investigate how the patients with neglect (N+) differ from those without neglect (N-) in general cognitive function assessed by the Mini-Mental State Examination (MMSE).Patients consisted of 98 consecutive patients with acute right hemisphere stroke. The patients underwent neglect test battery followed by MMSE in the same day.The frequency of cognitive deficits in N+ group was higher than that of N- group (74.1% vs. 35.0%). A regression analysis, after controlling for lesion volume, age, and education, showed that neglect was a significant predictor of low MMSE score. Among MMSE subdomains, the severity of neglect was related to poor performances on episodic memory (orientation and 3-word recall), working memory/calculation (serial 7s), and constructional praxis (interlocking pentagons).These results suggest that hemispatial neglect is associated with several forms of cognitive deficits in patients with acute right hemisphere stroke.

Choi KM, Lee BH, Lee SC, Ku BD, Kim E-J, Suh MK, Jeong Y, Heilman KM, Na DL: Influence of moving background on line bisection: performance in the normal elderly versus patients with hemispatial neglect. Am J Phys Med Rehabil 2007; 86:515‐526. Objective: Previous studies have shown that when healthy young participants bisect stationary lines on a moving background (MB) or optokinetic stimulation, they perceive the stationary line moving in the opposite direction of the MB (illusory motion [IM]), and they displace their bisection mark in the direction of the IM. This study attempted to learn whether IM also influences attentional biases of the healthy elderly and patients with hemispatial neglect. Design: In experiment 1, healthy elderly participants and patients with neglect bisected lines in conditions where IM was absent or present. To better understand the MB dichotomy between the healthy elderly and neglect patients, in experiment 2, participants’ eye movements were recorded using an infrared eye tracker. Results: In experiment 1, healthy elderly participants’ biases occurred in the opposite direction of MB when IM was present but in the same direction of MB when IM was absent. In contrast, neglect patients’ biases occurred in the same direction of MB regardless of conditions. Eye movements reflect the spatial direction of attention. In experiment 2, the healthy elderly participants were able to selectively attend to the line, whereas neglect patients were impaired in that they fixated on the line. Conclusions: These results suggest that the healthy elderly can selectively fixate on a line, and with MB, they perceive the stationary line moving, resulting in a bisection bias in the direction of the IM. In contrast, when there is an MB, the patients with neglect are impaired in that they fixate on the line. Thus, they do not perceive IM; instead, they are primarily influenced by the MB.

Background Patients with right hemisphere damage are often unaware of, inattentive to and fail to interact with stimuli on their left side. This disorder, called hemispatial neglect, is a major source of disability. Inducing leftward ocular pursuit by optokinetic stimulation (OKS) relieves some of the signs of unilateral neglect. However, it is difficult to provide patients with a continuously moving background that is required for OKS. We studied whether OKS projected onto a see-through head-mounted display (HMD) would help treat neglect. Methods 14 patients with neglect after cerebral infarction performed line bisections on a computer screen, both with and without OKS that was either delivered by the HMD or on the same screen that was displaying the lines that were to be bisected. Results The line bisection performances were significantly different in the four conditions (P

Damage to the left occipital lobe and the splenium or forceps major is often associated with pure alexia, thought to be an occipital-temporoparietal disconnection syndrome. A patient with the parallel lesion, a combined right occipital and splenial lesion, showed severe left-sided visual spatial neglect, but no significant neglect in other sensory modalities. This visual neglect might be related to a disconnection between the visual information processed by the left occipital lobe and the right posterior temporal-inferior parietal areas that mediate attention in the left hemispace.

Background Only a few studies have reported on the frequency of micrographia in idiopathic Parkinson's disease (IPD), and the definition of micrographia in these studies was based simply on the visual inspection of the patients' free writing. Objectives We investigated the frequency of consistent (CM) and progressive (PM) micrographia by quantifying the patients' copying of a target letter or figure. Methods Seventy-five IPD patients and 30 sex/age matched healthy controls were assigned the tasks of free writing and letter/figure copying. CM was defined by the average size of the letter or figure written or copied by the patients below the controls' mean−2SD. PM was defined by the slope of reduction in size as a function of the serial positioning of the letters/figures below the mean−2SD of the controls. Results In the free writing, of 75 patients, only one met the criteria for the definition of CM and two met the criteria for the definition of PM definition. In contrast, letter/figure copying tasks identified 33 (44%) patients with CM and 19 (25%) with PM. Conclusion Our study suggests that the prior definition of CM or PM by visual inspection in free writing task is less valid, and that the definition of CM and PM, based on the letter/figure copying tasks rather than free writing tests, could be more objective.

The"closing-in phenomenon"in figure copying tasks refers to a tendency to copy near the target, or to overlap the target to be copied. The mechanisms underlying the closing-in phenomenon have not been fully elucidated. We posit that closing-in may be related to the patients'compensatory strategies to overcome visuospatial dysfunction or visuospatial working memory deficit. Thus, it is expected that as the complexity of the target figure or the distance from the target to the copying space is increased, the magnitude of closing-in will be increased. Thirteen patients with Alzheimer's disease (AD) who demonstrated closing-in on a screening test and 15 healthy controls participated in this study. Each subject copied figures in conditions that varied in terms of figure complexity and distance from the target to the copying space. Neither figure complexity nor distance between the target and copying space affected the degree of closing-in in normal subjects. In contrast, in AD patients, the magnitude of closing-in increased as a function of figure complexity; however closing-in was unchanged by varying the distance from the target to the copying space. Our results suggest that copying near the target figure might be the patients'strategy to compensate for their visuospatial dysfunction or visuospatial working memory deficits.

The Syndrom Kurztest SKT is a brief neuropsychological test battery that consists of nine subtests and defines two independent factors of memory and attention deficit. The aim of this study was to validate the Korean version of the SKT. The reliability of each subtest among three parallel Forms (A, B and C) of the Korean version was high (r = 0.46–0.95). The SKT had good concurrent validity with the Mini-Mental State Examination (r = −0.83, p

Objective Normal subjects tend to bisect lines slightly to the left of the true midpoint, a phenomenon termed pseudoneglect. To test whether pseudoneglect relates to the right hemisphere's dominance for spatial attention or to the hemispheric difference in processing global-local stimulus properties, we administered conventional solid-line (SBT) and novel character-line (CBT) bisection tasks to normal subjects of different ages. Methods Normal subjects, consisting of 40 young and 40 older individuals, received 3 experimental tasks, a standard SBT and 2 types of CBT. Each subject completed 10 consecutive trials of each task presented in counterbalanced order between subjects. Results Across age groups, deviations on CBT were further to the right than those of SBT, and the leftward bias (pseudoneglect) was significant only in SBT. Conclusion These results indicate that the bisection errors in normal subjects depend on the characteristics demanded by the specific task. Thus, our findings argue against the attention dominance theory and support a "task specificity" theory for pseudoneglect.

A failure to report or respond to stimuli presented in a portion of space is termed hemispatial neglect. Line bisection and line cancellation are two of the tests used most commonly to assess for neglect. Perhaps, because neglect can be induced by a variety of deficits, neither of these tests used alone is as sensitive as both used together. Hence, the primary purpose of this study was to assess the sensitivity, reliability and validity of a new test called the Character-line Bisection Task (CLBT) that combines features of both the bisection and cancellation tests. Since local attention and language are primarily mediated by and activate the left hemisphere, our second goal was to learn if the CLBT and especially the letter version induce a greater rightward bias than the solid-line bisection task. Eighty patients with acute right hemisphere stroke and 81 controls performed the CLBT that consists of two subtests, the Letter-line and Star-line Bisection tasks. All subjects also completed four conventional tests for neglect (Standard solid-line bisection, line cancellation, Star Cancellation, and figure copying). In the bisection tasks both patients and controls bisected to the right with the CLBT than with the solid-line bisection task, suggesting the CLBT induces asymmetrical hemispheric activation. This enhanced rightward deviation with the CLBT was the same for the Letter-line and Star-line Bisection tasks. In regard to sensitivity, we defined the presence of neglect syndrome based on a total score derived from performance of controls on all six tests. This total score detected 55 (68.8%) patients with neglect. Within this group, the Letter-line and Star-line tasks diagnosed neglect in 50 and 48 patients, respectively, resulting in the highest sensitivities (90.9, 87.3%) of the six tests. Thus, the CLBTs demonstrated higher sensitivities than the other commonly used neglect tests and these new tests can be useful for the detection and quantification of unilateral neglect.

The Bayer-activities of daily living (B-ADL) is a brief and internationally applicable ADL instrument which has been validated in three European countries. The B-ADL has been developed to provide a tool for the assessment of functional deficits in performance of every day tasks as they are observed in mild to moderate stages of dementia. The B-ADL has been constructed for use in clinical trials as well as in clinical practice. From an international perspective the major application is the evaluation of treatment effects in clinical studies and the current study was to validate the Korean version of the B-ADL. The B-ADL was administered to a total of 129 subjects with varying degrees of cognitive decline. A substantial cross-sectional correlation between B-ADL and MMSE scores was found. The internal consistency of B-ADL was above 0.98. A factor analysis revealed that a one factor solution accounted for most of the total variance. The B-ADL global score significantly increased as the severity of dementia, assessed by global deterioration scale increased from stage 1 to 5. Test-retest reliabilities of B-ADL global score and each item were very high. All of these results were very similar to those from three European countries except for the proportion of 'non-applicability' in some ADL items. These findings provide evidence that the Korean version of B-ADL can be useful not only for clinical purposes but also for international multicentre studies.

The purpose of this study was to investigate if multi-domain cognitive training, especially robot-assisted training, alters cortical thickness in the brains of elderly participants. A controlled trial was conducted with 85 volunteers without cognitive impairment who were 60 years old or older. Participants were first randomized into two groups. One group consisted of 48 participants who would receive cognitive training and 37 who would not receive training. The cognitive training group was randomly divided into two groups, 24 who received traditional cognitive training and 24 who received robot-assisted cognitive training. The training for both groups consisted of daily 90-min-session, five days a week for a total of 12 weeks. The primary outcome was the changes in cortical thickness. When compared to the control group, both groups who underwent cognitive training demonstrated attenuation of age related cortical thinning in the frontotemporal association cortices. When the robot and the traditional interventions were directly compared, the robot group showed less cortical thinning in the anterior cingulate cortices. Our results suggest that cognitive training can mitigate age-associated structural brain changes in the elderly. Trial Registration ClnicalTrials.gov NCT01596205

Background and Purpose— Despite many studies investigating the association between the ischemic changes and cognitive impairment in subcortical vascular dementia (SVaD), few studies correlated cognitive impairment with microbleeds (MBs) frequently seen in SVaD. Methods— Participants consisted of 86 patients with SVaD who fulfilled the criteria proposed by Erkinjuntti et al. Results— MBs occurred in 73 of 86 (84.9%) patients with SVaD. MBs were most commonly distributed in the cortex, and the cortical MBs were most pronounced in the temporoparietal area. A multiple regression showed that the number of cerebral MB was an independent predictor of cognitive impairment in multiple domains and the severity of dementia even after controlling confounding factors such as age, education, ischemic severity, and number of lacunes. Conclusion— These results indicate that cerebral MB is one of the important factors that cause cognitive impairments in SVaD.

Subcortical vascular mild cognitive impairment (svMCI), a prodromal stage of subcortical vascular dementia (SVaD), is primarily associated with frontal injuries, whereas amnestic MCI (aMCI) is associated with temporoparietal injuries. Twenty-seven patients with svMCI, 20 with aMCI, 14 with SVaD, and 10 normal controls underwent motor intentional tasks (force initiation, development, maintenance, and termination) using a force dynamometer. Of the four motor intentional tasks, the maintenance task proved sensitive in differentiating svMCI from aMCI. In most motor intentional tasks, performances of svMCI patients were intermediate between those of controls and SVaD patients (initiation and termination: NC=aMCI=svMCI>SVaD; development: NC>aMCI=svMCI>SVaD; maintenance: NC=aMCI>svMCI=SVaD).

Amnestic mild cognitive impairment (MCI) is considered to be a prodromal stage of Alzheimer's disease. Likewise, subcortical vascular MCI (svMCI) is considered as a prodromal stage of subcortical vascular dementia (SVaD). The objective of this study was to investigate neuropsychiatric features in patients with svMCI compared to healthy controls and patients with SVaD. We evaluated 31 patients with svMCI, 42 with SVaD, and 28 healthy controls who underwent neuropsychiatric assessments using the Neuropsychiatric Inventory (NPI) and the Frontal Behavioral Inventory (FBI). On both the NPI and FBI, SVaD patients had the most severe neuropsychiatric symptoms, followed by svMCI patients and then healthy controls, suggesting that svMCI might be a prodromal stage of SVaD in terms of neuropsychiatric abnormalities. When we compared the differences of mean scores between negative and positive symptoms in FBI, negative symptoms tended to be more predominant than positive symptoms in both svMCI and SVaD patients, but the tendency was stronger in SVaD patients than in svMCI patients. These results suggest that vascular cognitive impairment with small vessel disease would start with both negative and positive neuropsychiatric symptoms and progress to present more severe negative symptoms. These behavioral ratings may be useful for early detection of vascular cognitive impairment associated with small vessel disease.

Patients with Alzheimer disease (AD) usually experience naming difficulty due to storage and access problems in phonological-lexical representation. Investigating naming response patterns followed by cueing may help us to understand the underlying mechanism of naming deficits in AD. A total of 221 patients with mild cognitive impairment and AD [Clinical Dementia Rating (CDR) 0.5, 1, 2] were included as subjects. Sixty items of the Korean version of the Boston Naming Test were given, and upon failure, semantic/syllabic cues were verbally presented. From the results, even in the CDR 2 group, which is considered to be a moderate stage of AD, syllabic cues significantly facilitated correct responses. Our findings are in contrast with previous studies conducted with English-speaking patients, which reported that phonological-lexical representation may have been disrupted in the moderate stage of AD, and that none of the cues facilitated correct word retrieval. The difference may be ascribed to the fact that direct access to the phonological-lexical representation via syllabic cues was possible in the confrontation naming task performed by the Korean patients. It can be concluded that phonological-lexical representation in moderate stage Korean AD might be partially preserved because syllabic cues in AD patients were effective in facilitating target words.

Aims: Our purpose was to investigate differences in neuropsychological characteristics and glucose metabolism between early-onset mild cognitive impairment (EOMCI) and late onset MCI (LOMCI) patients and to determine if the baseline differences are predictive of conversion to dementia. Methods: We enrolled 28 patients with MCI (12 EOMCI, 16 LOMCI) and 2 age-matched control groups. At the end of a 5-year follow-up, we compared the baseline neuropsychological and PET data between converters and nonconverters. Results: The EOMCI patients obtained significantly higher scores in verbal recall and word fluency tests than the LOMCI patients. The EOMCI group, compared to the young controls, demonstrated hypometabolism in brain regions vulnerable in mild Alzheimer’s disease. Converters were significantly more impaired in the delayed verbal recall test than nonconverters (p = 0.028) and tended to be more impaired in the semantic word fluency test (p = 0.084). The baseline PET scan of the converters demonstrated severer hypometabolism in frontal areas than that of the nonconverters both in the EOMCI and LOMCI groups. Conclusion: Our study suggests that EOMCI patients may differ from LOMCI in the patterns of cognitive deficits and glucose hypometabolism. In addition, baseline neuropsychological and FDG-PET findings suggest that MCI patients with poor memory or frontal dysfunction are at greater risk of conversion to dementia.

OBJECTIVE: Damage to premotor and prefrontal regions results in motor-intentional disorders (MIDs) that disrupt initiation, maintenance, and termination of volitional movements. MIDs more frequently occur in right hemisphere rather than in left hemisphere injury. The aim of this study was to evaluate the prevalence of MIDs in patients with right hemisphere stroke and the factors that have influence on MIDs. METHODS: Subjects consisted of 25 consecutive patients with right hemisphere stroke and 12 normal controls. They underwent a series of experiments using force dynamometer along with bedside examination. RESULTS: It was identified that the force control test screened for MIDs with a higher sensitivity than bedside examinations: motor akinesia (38% vs. 11%), motor impersistence (50% vs. 10%), and motor perseveration (47% vs. 25%). The patients were significantly inferior to the controls in terms of force control capabilities in the 4 force control phases (1.6 to 16.3 times). The location and area of lesion and space of force production were not related to the severity of MIDs whereas the presence of neglect was related to the severity of MIDs. CONCLUSIONS: Our results suggest force dynamometer is a sensitive method to detect MIDs and the presence of neglect may influence the frequency of MIDs. Language: en

Posterior fusiform gyrus (BA 37) is responsible for Hanja (ideogram) alexia in stroke patients. Patients with semantic dementia (SD) have lesions in the basal temporal area. The close proximity in these two lesions and the fact that reading ideograms requires holistic processing as is necessary in recognition of objects, suggests a possibility that ideogram alexia/agraphia may occur in patients with SD. We established and carried out Hanja and Hangul (phonogram) reading/writing tasks on six SD patients and nine Alzheimer's disease (AD) patients as control to see if these two patient groups show dissociation in the two sets of tests. SPM analysis was performed on the SD patients' PET images to look for any dysfunctions in the posterior fusiform gyrus. The SD patients manifested Hanja alexia/agraphia whereas Hangul reading/writing ability was relatively preserved. There were group differences between SD and AD in the Hanja tasks but not in the Hangul tasks. The SPM analysis revealed no hypometabolism in the posterior fusiform gyrus, but only in the middle and the anterior part of the temporal gyrus. Dysfunction in the middle temporal gyrus (BA 21) may have disrupted the temporal lobe connections preventing the function of the posterior fusiform gyrus.

Clinical Dementia Rating (CDR) scale and Global Deterioration Scale (GDS) are commonly used to measure the severity of dementia. However, no specific rules are available to convert the scores of CDR into those of GDS and vice versa. Using a semi-structured interview, two examiners independently rated CDR and GDS in 78 patients with dementia and 34 controls. Regression analysis showed a curvilinear relationship between CDR and GDS. This curve may provide a rule to interchange the scores of GDS and CDR (or Sum of Boxes of CDR).

Background Patients' tendency to draw near or into the target when copying figures, a phenomenon termed closing-in , has been previously described. That the closing-in could occur when copying hand gestures has also been noted. Objectives To study a patient with corticobasal degeneration to quantify his manual approach behavior and to test a possible working memory hypothesis. Methods The subject of this study is a patient with severe ideomotor apraxia from probable corticobasal degeneration. Fluorine 18–labeled deoxyglucose–positron emission tomographic findings revealed a hypometabolism involving the bilateral parietotemporal and the right frontal lobes. When asked to copy an examiner's (J.C.K.) hand gesture, the patient approached, touched, or grasped the examiner's hand, a behavior mostly consistent with the closing-in behavior previously proposed. To investigate the frequency and severity of closing-in, the patient was asked to copy 20 meaningless hand gestures (10 simple and 10 complex). Copying the 20 hand gestures was performed with either the left or the right hand while the patient was seated opposite the examiner (across condition) or on the same side of the examiner (lateral condition). Results Of the 80 trials, closing-in occurred in 43 (53.8%) (35 with approaching, 6 with touching, and 2 with grasping). The closing-in was more frequent and more severe when gesturing with the left than the right hand, but it did not differ between the lateral and across conditions and between simple and complex gestures. Conclusions Corticobasal degeneration might be associated with aberrant manual approach behavior. Although our results do not support the working memory hypothesis, frontal dysfunction might have led to a loss of voluntary control of ontologically primitive propensity to move the forelimb in the direction to which one attends.