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Introduction Idiopathic normal pressure hydrocephalus (INPH) is known to be a potentially treatable neurologic condition. The neurocognitive outcomes after surgery, however, have been variable. It is important to define preoperative characteristics of patients that predicts the shunting outcome. We aimed to compare baseline differences between shunt-responsive and unresponsive patients after 1 year from surgery in order to identify preoperative predictors showing favorable clinical outcomes. Methods Among 69 candidates, 31 patients with probable INPH completed the study. Patients were divided into two groups, responsive group (n = 17) and unresponsive group (n = 14), according to the clinical outcomes on INPH grading scale and modified Rankin score (MRS). Preoperative cerebrospinal (CSF) As, tau levels, MRI findings, and clinical characteristics were compared between the groups. Correlations between shunt responsiveness and preoperative characteristics were also assessed. Results After 1 year from shunt, gait problem was the most likely to improve. Shunt-responsive group showed lower CSF p-tau/As, fewer lacunes, and higher incidence of disproportionately enlarged subarachnoid space (DESH) signs on MRIs compared to those in unresponsive group. Favorable outcome was related with positive DESH sign and fewer lacunes. Conclusions Our results suggest that biomarkers representing non-INPH related pathology including Alzheimer's disease and small vessel disease might show less favorable clinical outcomes after 1 year from surgery.

Background: We investigated differences in the prevalence of anosognosia and neuropsychiatric symptoms (NPSs) characteristics according to disease severity in patients with early-onset Alzheimer disease (EOAD). Methods: We recruited 616 patients with EOAD. We subdivided participants into 2 groups based on the presence or absence of anosognosia and then again by Clinical Dementia Rating (CDR) scale. We compared the differences in the Neuropsychiatric Inventory (NPI) scores according to anosognosia and disease severity. Results: The percentage of patients with anosognosia in each CDR group steadily increased as the CDR rating increased (CDR 0.5 8.6% vs CDR 1 13.6% vs CDR 2 26.2%). The NPI total score was significantly higher in patients with anosognosia in the CDR 0.5 and 1 groups; by contrast, it had no association in the CDR 2 group. Frontal lobe functions were associated with anosognosia only in the CDR 0.5 and 1 groups. After stratification by CDR, in the CDR 0.5 group, the prevalence of agitation ( P = .040) and appetite ( P = .013) was significantly higher in patients with anosognosia. In the CDR 1 group, patients with anosognosia had a significantly higher prevalence of delusions ( P = .032), hallucinations ( P = .048), and sleep disturbances ( P = .047). In the CDR 2 group, we found no statistical difference in the frequency of symptoms between patients with and without anosognosia. Conclusion: These results confirm that the prevalence of anosognosia as well as the individual NPS and cognitive functions associated with it differ according to EOAD severity.

This study was to evaluate the influence on cognition and activities of daily living (ADL) by white matter hyperintensities (WMHs) based on the severity and location, as well as the interactions among WMHs, lacunes, and medial temporal atrophy (MTA). In 150 patients with amnestic mild cognitive impairment, WMHs were quantified with the use of a semiautomated volumetric method. Lacune counting and MTA assessment were performed by visual rating. The severer WMHs were, the more executive functions decreased. The influence on executive functions such as verbal fluency test and Stroop color reading test were greater in periventricular (PV) WMHs than deep WMHs, as well as bigger in anterior, middle, and posterior areas in order. The instrumental (I) ADL was strongly associated with the anterior ( P = .028) and middle area ( P = .014) of PVWMHs only. WMHs had synergistic interactions with lacunes in Controlled Oral Word Association Task-semantic (s = −1.12; R 2 = .24; P = .039), Stroop color (s = −2.07; R 2 = .15; P = .049), and IADL (s = .23; R 2 = .20; P = .009). Anterior PVWMHs demonstrated the most powerful impact on frontal executive dysfunction and poor performance of IADL. WMHs had synergistic effects with the number of lacunes on them. Therefore, it is desirable to consider WMHs and lacunes simultaneously as potential imaging biomarkers for predicting cognition and IADL in aMCI.

Background: The early stage of Alzheimer disease might show early memory impairment with normal general cognitive function. Our study aimed to investigate elderly with normal Korean version of mini-mental state examination (KMMSE) score and recall score of 0 for 1 year. We predicted that the patients would show different characteristics and would progress more rapidly compared with normal controls. Methods: This study was based on the data from complete enumeration survey of Mapo-gu Regional Center for Dementia in 2009. We divided all subjects into three groups: subjects with normal K-MMSE scores and recall score of 0 were group 1-1 (n=152), subjects with abnormal K-MMSE scores were group 1-2 (n=64) and subjects with normal K-MMSE scores and recall score of 1 to 3 were group 1-3 (n=941). We compared basic demographics and social characteristics among the three groups. After 1 year (2010), the subjects in group 1-1 (90 out of 152) underwent follow-up examinations for dementia diagnosis. They were also divided into three groups (2-1, 2-2, 2-3) according to K-MMSE and recall scores. Results: Group 1-1 showed different baseline characteristics compared with normal controls. After 1 year, 25.5% (23 out of 90) of the group 2-1 were diagnosed as mild cognitive impairment (n=16) or dementia (n=7). Conclusion: Our study suggested that subjects with normal K-MMSE scores but recall score of 0 are not entirely “normal”. Further detailed evaluation might be needed if memory impairment is suspicious although the K-MMSE scores are within normal range.

Flow of two immiscible stratified liquids in a pipe is observed in many industrial applications. Estimating the interfacial boundary between the immiscible liquids inside the pipeline can provide valuable information about volume fraction therefore can aid in monitoring the flow process. Several methods are proposed to represent the shape of an open boundary using linear combination of known functions. In this paper, the open boundary is characterized by discrete front points from the reference horizontal line at the center. The boundary parameterization with front points eliminates the fixed end problem that is caused while using Fourier series or a polynomial like a Bezier curve. Therefore, it can be more suitable to practical conditions and can be used to represent any complex shape with fewer unknowns. The forward problem is solved using boundary element method (BEM) with the integral equations solved analytically. The proposed BEM formulation is computationally efficient due to less number of system equations to solve. The unknown front points locations that describe the boundary surface are estimated using Levenberg–Marquardt method. Numerical and phantom experiments are performed to validate the performance of the proposed computational method.

Background/Aims: A limited number of studies addressed MRI-based neurodegenerative changes in subjective memory impairment (SMI). We investigated changes in white matter (WM) microstructures as well as gray matter (GM) macrostructures in subjects with SMI of high and low risk for progression. Methods: A modeling scale (score range, 0-6) developed for prediction of SMI progression was used to divide SMI subjects (n = 46) into two groups: a high risk of progression (score ≥3; n = 19) and a low risk of progression (score ≤2; n = 27). Cross-sectional comparisons were performed using a region-of-interest-based diffusion tensor imaging (DTI) analysis, cortical thickness analysis, and hippocampal volumetry. Results: The high-risk group had more microstructural disruption shown by lower fractional anisotropy in the hippocampus, parahippocampal gyrus, supramarginal gyrus, and parts of frontotemporal lobes. On the other hand, GM macrostructural changes did not differ between the groups and were not associated with modeling scale scores. Conclusion: SMI subjects with a high risk of progression had more WM microstructural disruption than those with a low risk, and the changes were not explained by GM atrophy. Our findings suggest that the degree of microstructural alterations in SMI may be distinctive according to the risk factors and may precede GM atrophy.

Although some studies have supported the association between white matter hyperintensities (WMH) and cognitive impairment, whether WMH are associated with the impairments in instrumental activities of daily living (IADLs) remains unknown. This cross-sectional study investigated differences in basic ADLs and IADLs among different severity of WMH in a large, well-defined registry of patients with amnestic mild cognitive impairment (aMCI). 1,514 patients with aMCI were divided into three groups according to the degree of WMH (1,026 mild, 393 moderate, and 95 severe). We compared the total IADL scores and analyzed the prevalence of the impairment for each IADL item for each group. The severity of WMH was associated with the impairments in IADLs. Among 15 Seoul IADL items, "using public transportation", "going out (short distance)", "grooming" and "participating in leisure activities/hobbies" showed greater positive association with the severity of WMH. WMH in patients with aMCI were associated with the impairments in IADLs but not in basic ADLs. These findings are likely to be more obvious with respect to using public transportation, going out (short distances), shopping, grooming and participating in leisure activities/hobbies.

Regional atrophy of gray matter (GM) in Alzheimer's disease (AD) is well known; however, the relationship between macroscopic and microscopic changes of cerebral white matter (WM) is uncertain. The aim of this study was to investigate the pattern of GM, WM atrophy, and microscopic WM changes in the same individuals with AD. All subjects (10 AD and 15 healthy controls [HC]) underwent a MRI scanning at 1.5 T, including a 3-dimensional volumetric scan and diffusion tensor imaging (DTI). We performed statistical parametric mapping (SPM) with DTI to evaluate the patterns of the microscopic WM changes, as well as voxel-based morphometry (VBM) for GM and WM volume changes between patients with AD and HC. GM atrophy was detected, mainly in posterior regions, and WM atrophy was similarly distributed, but less involved on VBM analysis. Unlike WM atrophy on VBM analysis, microscopic WM changes were shown in the medial frontal, orbitofrontal, splenium of the corpus callosum, and cingulum on DTI analysis with SPM. We demonstrated that the pattern of macroscopic WM atrophy was similar to GM atrophy, while microscopic WM changes had a different pattern and distribution. Our findings suggest that WM atrophy may preferentially reflect the secondary changes of GM atrophy, while microscopic WM changes start earlier in frontal areas before GM and WM atrophy can be detected macroscopically.

Background and Purpose Subjective cognitive decline (SCD) may be the first symptomatic stage of Alzheimer's disease (AD). Hence, a screening tool to characterize the patients' complaints and assess the risk of AD is required. We investigated the SCD neuroimaging biomarker distributions and the relevance between the self-report questionnaire and Alzheimer's pathologic changes. Methods Individuals aged 50 and above with consistent cognitive complaints without any objective cognitive impairments were eligible for the study. The newly developed questionnaire consisted of 2 parts; 10 questions translated from the ‘SCD-plus criteria’ and a Korean version of the cognitive failure questionnaire by Broadbent. All the subjects underwent physical examinations such as blood work, detailed neuropsychological tests, the self-report questionnaire, brain magnetic resonance imagings, and florbetaben positron emission tomography (PET) scans. Amyloid PET findings were interpreted using both visual rating and quantitative analysis. Group comparisons and association analysis were performed using SPSS (version 18.0). Results A total of 31 participants with SCD completed the study and 25.8% showed positive amyloid depositions. The degree of periventricular white matter hyperintensities (WMH) and hippocampal atrophy were more severe in amyloid-positive SCDs compared to the amyloid-negative group. In the self-reported questionnaire, the ‘informant's report a decline’ and ‘symptom's onset after 65 years of age’ were associated with more Alzheimer's pathologic changes. Conclusions Amyloid-positive SCDs differed from amyloid-negative SCDs on WMH, hippocampal atrophy, and a few self-reported clinical features, which gave clues on the prediction of AD pathology.

The gboma (Solanum macrocarpon L.) and scarlet eggplants (Solanum aethiopicum L.), which form part of the traditional sub-Saharan African culture, are two of the many neglected crops with potential for increased cultivation or as a genetic resource for improving agronomic traits of the common eggplant. This work is focused on the analysis of glycoalkaloid levels in S. macrocarpon and S. aethiopicum to assess their safety. Liquid chromatography-mass spectrometry was used to quantify glycoalkaloids in S. macrocarpon and S. aethiopicum compared to Solanum melongena L. Fruits of S. aethiopicum and S. melongena contained 0.58-4.56 mg/100 g of alpha-solamargine and 0.17-1 mg/100 g of alpha-solasonine, on a wet basis. S. macrocarpon fruits had much higher values of alpha-solamargine (124-197 mg/100 g) and alpha-solasonine (16-23 mg/100 g). However, the proportions of alpha-solamargine and alpha-solasonine of S. melongena and S. macrocarpon were similar (76-89% of alpha-solamargine), whereas in S. aethiopicum fruit composition was more variable (48-89% of alpha-solamargine). According to these results, the glycoalkaloid levels of S. macrocarpon fruits are 5-10 times higher than the value considered to be safe in foods and might not be considered suitable for human consumption; however, the glycoalkaloid levels of S. aethiopicum were similar to those of S. melongena (about 14% of values considered as toxic) and could be considered as safe for consumption. The incorporation of the cultivated African S. aethiopicum into eggplant breeding programs to develop improved varieties of the common eggplant may represent an alternative to crossing with wild species.

Understanding how environment, crop management, and other factors, particularly soil fertility, influence the composition and quality of food crops is necessary for the production of high-quality nutritious foods. The flavonoid aglycones quercetin and kaempferol were measured in dried tomato samples (Lycopersicon esculentum L. cv. Halley 3155) that had been archived over the period from 1994 to 2004 from the Long-Term Research on Agricultural Systems project (LTRAS) at the University of CaliforniasDavis, which began in 1993. Conventional and organic processing tomato production systems are part of the set of systems compared at LTRAS. Comparisons of analyses of archived samples from conventional and organic production systems demonstrated statistically higher levels (P < 0.05) of quercetin and kaempferol aglycones in organic tomatoes. Ten-year mean levels of quercetin and kaempferol in organic tomatoes [115.5 and 63.3 mg g -1 of dry matter (DM)] were 79 and 97% higher than those in conventional tomatoes (64.6 and 32.06 mg g -1 of DM), respectively. The levels of flavonoids increased over time in samples from organic treatments, whereas the levels of flavonoids did not vary significantly in conventional treatments. This increase corresponds not only with increasing amounts of soil organic matter accumulating in organic plots but also with reduced manure application rates once soils in the organic systems had reached equilibrium levels of organic matter. Well-quantified changes in tomato nutrients over years in organic farming systems have not been reported previously.

Data collection and sharing for this project was funded by the Alzheimer''s Disease Neuroimaging Initiative (ADNI) (National Institutes of Health grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012). ADNI is funded by the National Institute on Aging, the National Institute of Biomedical Imaging and Bioengineering, and through generous contributions from the following: Alzheimer''s Association; Alzheimer''s Drug Discovery Foundation; Araclon Biotech; BioClinica, Inc.; Biogen Idec; Bristol-Myers Squibb Company; Eisai; Elan Pharmaceuticals, Inc.; Eli Lilly and Company; EuroImmun; F. Hoffmann-La Roche Ltd. and its affiliated company Genentech, Inc.; Fujirebio; GE Healthcare; IXICOLtd.; Janssen Alzheimer Immunotherapy Research & Development, LLC.; Johnson & Johnson Pharmaceutical Research & Development LLC.; Medpace; Merck & Co., Inc.; Meso Scale Diagnostics, LLC.; NeuroRx Research; Neurotrack Technologies; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Piramal Imaging; Servier; Synarc; and Takeda Pharmaceutical Company. The Canadian Institutes of Health Research is providing funds to support ADNI clinical sites in Canada. Private sector contributions are facilitated by the Foundation for the National Institutes of Health (www.fnih.org). The grantee organization is the Northern California Institute for Research and Education, and the study is coordinated by the Alzheimer''s Disease Cooperative Study at the University of California, San Diego. ADNI data are disseminated by the Laboratory for Neuro Imaging at the University of Southern California. This work was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (2013R1A1A1012925), grants of the Korea Health Technology RD grant number: 10060305), a grant from the Korea Institute of Science and Technology Institutional Open Research Program (2E24242-13-110), and grants (2015-590; 2014-0783) from the Asan Institute for Life Sciences (J.H.R.).

The glutathionylation of quercetin was investigated in murine hepatic suspensions, in the absence of chemically or enzymatically induced oxidative stress, and in human urine after the consumption of 200 g of cooked onions ( approximately 74 mg of quercetin). In murine hepatic suspensions, 22 metabolites, including glucuronide, sulfate, and glutathione conjugates of quercetin, were identified by LC/ESI-MS/MS. In total, eight glutathione conjugates were identified in these suspension, including three isomeric forms of monoglutathionyl quercetin, two isomers of monoglutathionyl quercetin glucuronide, and three isomers of glutathionyl methyl quercetin. Quinone forms of glutathionyl quercetin and glutathionyl methyl quercetin were also apparent in mass spectra. In humans, several glutathione-related metabolites of quercetin were identified in urine as mercapturic acids of common hydroxyphenylacetic acids generated by the microbial degredation of quercetin in the gut. These include mercaptic acids of dihydroxytoluene, dihydroxybenzaldehyde, dihydroxyphenylacetic acid, dihydroxycinnamic acid, and dihydroxyphenylpropionic acid. Our results suggest that glutathionylation of quercetin occurs in both murine hepatic suspensions and humans and indicate that under certain conditions, quercetin intermediates require inactivation through conjugation with glutathione.

Non-galloylated and galloylated flavan-3-ol composition in seeds from Vitis vinifera L. var. Graciano, Tempranillo and Cabernet Sauvignon grapes harvested in 2000, 2001 and 2002 at the same geographical area were determined using normal-phase HPLC coupled with electrospray ionization mass spectrometry (LC/ESI-MS) detection. Non-galloylated and monogalloylated flavan-3-ols up to octamers, and di-, and trigalloylated flavan-3-ols up to heptamers were identified in all grape seeds. Comparisons of the flavan-3-ol composition in three grape varieties harvested in three different years indicate that levels of non-galloylated flavan-3-ols decrease as the degree of polymerization increased, whereas the monogalloylated dimers were present in the highest levels in all varieties and vintages. The levels of other monogalloylated flavan-3-ols varied in different vintages. Tempranillo contained the lowest levels of non-galloylated and monogalloylated flavan-3-ols, whereas Graciano contained the highest levels, with the exception of non-galloylated flavan-3-ols in vintage 2001, and non-galloylated monomers in vintages 2000 and 2002. Grape seeds from vintage 2000 contained the highest levels of both non-galloylated and galloylated structures. Statistical analyses indicate that the distribution of the flavan-3-ols is primarily determined by genetic factors and is also strongly influenced by climate conditions., The authors thank the Ministerio de Ciencia y Tecnología for an FPI predoctoral scholarship to VN, and the Spanish Comisión Interministerial de Ciencia y Tecnología (CICYT) (Project AGL2003-07394-C02-02).

Proanthocyanidins have been characterized and levels compared in an ale and a lager using normal-phase liquid chromatography-mass spectroscopy (LC/MS) after a pre-concentration step employing Sephadex LH-20 chromatography. Twenty proanthocyanidins were identified including both non-galloylated and galloylated forms of the monomers, dimers and trimers. Oligomers greater than trimer were not detected. A proportion of all classes of proanthocyanidin adsorbed non-specifically to a silica xerogel product, but polyvinylpolypyrrolidone (PVPP) and a product that comprises polyvinylpyrrolidone (PVP) on a surface of amorphous silica displayed greater capability (i.e. specificity) for binding these materials. Of the two specific adsorbents, it was the PVPP that had the greater binding capability compared to the PVP-silica co-product.

Twenty-one flavonol metabolites have been identified by LC/ESI-MS/MS in human urine, including isomers, after the consumption of cooked onions. Metabolites identified include quercetin monoglucuronides, methyl quercetin monoglucuronides, a quercetin monoglucuronide sulfate, quercetin diglucuronides, a methyl quercetin diglucuronide, quercetin glucoside sulfates, methyl quercetin, quercetin, and kaempferol monoglucuronides. The fragmentation patterns of flavonol metabolites obtained by MS/MS were distinctive for some isomers, indicating that fragmentation patterns may be useful predictors of conjugation position. Two isomers of sulfate quercetin glucosides were also found in urine, suggesting that many of the quercetin glucosides in onion are absorbed intact and undergo metabolism to the sulfate conjugate. Additionally, the interindividual variation in urinary quercetin metabolite profiles was determined by comparing the relative level of six different quercetin metabolites excreted in the urine of healthy volunteers. The ranges of quercetin metabolites excreted were similar among volunteers, yet notable differences in the levels of metabolites among individuals were observed. This study demonstrates the potential of monitoring the range of quercetin metabolites to reveal information on interindividual biotransformation capacity in response to dietary manipulations and as a biomarker for flavonol consumption.

Normal-phase liquid chromatography/mass spectrometry (LC/MS) was used to determine the levels and fate of procyanidins in frozen and canned Ross clingstone peaches as well as in the syrup used in the canning over a 3 month period. Procyanidin oligomers, monomers through undecamers, were identified in Ross clingstone peaches. Optimized methods allowed for the quantitation of oligomers through octamers. The profile of procyanidins in peaches is similar to profiles found in grapes, chocolate, and beverages linked to health benefits such as tea and wine. The monomer content in frozen peeled peaches was found to be 19.59 mg/kg. Dimers (39.59 mg/kg) and trimers (38.81 mg/ kg) constituted the largest percent composition of oligomers in the peaches. Tetramers through octamers were present in levels of 17.81, 12.43, 10.62, 3.94 and 1.75 mg/kg, respectively. Thermal processing resulted in an 11% reduction in monomers, a 9% reduction in dimers, a 12% reduction in trimers, a 6% reduction in tetramers, and a 5% reduction in pentamers. Hexamers and heptamers demonstrated an approximate 30% loss, and octamers were no longer detected. Analysis of the syrup after thermal processing indicates that there is a migration of procyanidin monomers through hexamers into the syrup that can account for the losses observed during the canning process. Storage of canned peaches for 3 months demonstrated a time-related loss in higher oligomers and that by 3 months oligomers larger than tetramers are not observed. At 3 months postcanning, levels of monomers had decreased by 10%, dimers by 16%, trimers by 45%, and tetramers by 80%. A similar trend was observed in the canning syrup.

Clingstone peaches contain a wide array of complex secondary plant metabolites and polyphenolics, and increasing evidence indicates that many of these components are important in human health. Oligomeric flavan-3-ol metabolites (procyanidins) are particularly interesting owing to their potent antioxidant activity and protective cardiovascular effects. To date, little information is available on how postharvest and processing conditions impact levels of phenolics and procyanidins in fruit. This research addresses the impact of lye peeling, freezing, storage temperature (4 and 30 °C) and three different time-temperature sterilisation combinations on levels of total phenolics (TPs) in Ross clingstone peaches. Additionally, we describe the profile of procyanidin oligomers (monomers through heptamers) in clingstone and freestone peaches and demonstrate a dramatic decrease in procyanidins in thermally processed peaches. TP levels ranged between 316 and 397mg kg � 1 in peeled peaches and between 376 and 609mg kg � 1 in unpeeled peaches. Cold storage at 4 °C for 14 days or freezing and storing at � 12 °C for 3 months produced no loss in TPs. Peaches stored at 30 °C for 24h resulted in a 1.7-fold increase in TPs. Studies of TPs in peaches processed at temperatures of 213 °F for 40min, 220 °F for 10min and 230 °F for 2.4min indicate that processing above 213 °F decreases levels of both TPs (up to 21%) and procyanidins (up to 100%). Processing at 213 °F for 40min produced no significant loss in TPs. Furthermore, studies reveal that a 30-43% loss in phenolic levels occurs during the first 3 months in storage after canning. It is clear that both storage and thermal processing conditions profoundly impact the levels of polyphenolics in peaches. More interestingly, these studies indicate that peaches are a rich source of procyanidins, having profiles similar to those found in cocoa, apples, wine and tea. # 2002 Society of Chemical Industry

Mild cognitive impairment (MCI) describes a transitional state in progression from normal aging to dementia, especially Alzheimer's disease (AD). Currently, there is no effective pharmacological treatment that offers a long-term beneficial effect to delay the progression to dementia. There is growing evidence that supports an important role of non-pharmacological cognitive interventions. Therefore, it is warranted to clarify the distinct forms of cognitive interventions and their effects based on previous clinical trials. We aimed to provide a review of clinical trials of non-pharmacological cognitive interventions for MCI and to address the characteristics of the study patients, cognitive intervention programs and short-term / long-term benefits of the interventions. A total of 32 articles were identified according to the inclusion criteria. The results showed positive effects for both objective and subjective outcome variables, and these effects persisted from 1 month up to 5 years. Although many of the positive effects were related to improvement in trained tasks, alterations in neuroimaging and the transfer effects shown by some studies are encouraging. Future research in this area requires a larger sample size with a wider spectrum of MCI, more instructive outcome measures and a longer follow up duration.

BACKGROUND Patients with amnestic mild cognitive impairment (aMCI) have an increased risk of dementia. However, conversion rate varies. Therefore, predicting the dementia conversion in these patients is important. OBJECTIVE We aimed to develop a nomogram to predict dementia conversion in aMCI subjects using neuropsychological profiles. METHODS A total of 338 aMCI patients from two hospital-based cohorts were used in analysis. All patients were classified into 1) verbal, visual, or both, 2) early or late, and 3) single or multiple-domain aMCI according to the modality, severity of memory dysfunction, and multiplicity of involved cognitive domains, respectively. Patients were followed up, and conversion to dementia within 3 years was defined as the primary outcome. Our patients were divided into a training data set and a validation data set. The associations of potential covariates with outcome were tested, and nomogram was constructed by logistic regression model. We also developed another model with APOE data, which included 242 patients. RESULTS In logistic regression models, both modalities compared with visual only (OR 4.44, 95% CI 1.83-10.75, p = 0.001), late compared to early (OR 2.59, 95% CI 1.17-5.72, p = 0.019), and multiple compared to single domain (OR 3.51, 95% CI 1.62-7.60, p = 0.002) aMCI were significantly associated with dementia conversion within 3 years. A nomogram incorporating these clinical variables was constructed on the training data set and validated on the validation data set. Both nomograms with and without APOE data showed good prediction performance (c-statistics ≥ 0.75). CONCLUSIONS This study showed that several neuropsychological profiles of aMCI are significantly associated with imminent dementia conversion, and a nomogram incorporating these clinical subtypes is simple and useful to help to predict disease progression.

METHOD OF BRAIN BASED ON FLAIR MRI Dong Won Yang, Ka Won Jung, Eun Ye Lim, Jung Hee Cho, Yong Soo Shim, Bora Yoon, Yun JeongHong, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, South Korea; 2 Bucheon St.Mary’s Hospital, Seoul, South Korea; Department of Neurology, Konyang University, Daejeon, South Korea; Hyoja Geriatric Hospital, Seoul, South Korea. Contact e-mail: neuroman@catholic.ac.kr

Vascular disease is associated with cognitive impairment. White matter hyperintensities (WMHs), as detected by brain magnetic resonance imaging (MRI), are associated with cognitive impairment and considered to be a marker of cerebral microvascular abnormality. Ankle-brachial pressure index (ABI) and pulse wave velocity (PWV) are noninvasive methods to assess blockage and stiffness in peripheral arteries, respectively. We investigated the associations of ABI and PWV with WMHs and cognition. We included 242 subjects representing 56 controls, 75 patients with mild cognitive impairment, and 111 patients with Alzheimer’s disease. We assessed brachial-ankle PWV (baPWV), ABI, general cognitive status with the Korean Mini-Mental State Examination (K-MMSE), and WMHs with brain MRI. The mean age of subjects correlated with values of baPWV (r=0.432, p

The clinical implications of WMHs in aMCI are inconclusive. Moreover, clinical interactions between APOE genotypes and WMHs remain unclear. This study was conducted to investigate the relationship between WMHs and cognitive functions and how this relationship interacted with APOE genotype in people with aMCI. This study included a total of 1472 patients with aMCI from the Clinical Research Center for Dementia of South Korea (CREDOS) and divided them into 3 groups according to the severity of WMHs as assessed by visual ratings of brain magnetic resonance images. The associations of WMHs with the various cognitive domains and with APOE epsilon 4 (ɛ4) status were evaluated. After multivariable adjustments, the severity of WMHs was independently associated with semantic/phonemic verbal fluency and Stroop test-color reading, while APOE ɛ4 status was associated with verbal and visual memory-immediate, delayed recall, and recognition. Moreover, there were interaction between WMHs and APOE ɛ4 status in semantic verbal fluency (animal, P=0.033; supermarket, P=0.047)/Stroop test-color reading (P=0.024). WMHs independently deleteriously affected frontal executive functions in aMCI patients, regardless of APOE ɛ4 presence. Furthermore, APOE ɛ4 possession caused a rapid decline in frontal executive functions with the increase in the WMHs severity (vs. absence), suggesting that WMHs and APOE ɛ4 genotypes synergistically contribute to frontal executive dysfunctions in aMCI.

Diffusion tensor imaging (DTI) is a sensitive MRI technique in the detection of white matter degeneration. We sought to demonstrate microstructural changes in normal controls, patients with amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) and to determine which DTI parameters could be a reliable tool for the early diagnosis of AD. In total, 90 participants (35 normal, 20 aMCI, 35 AD) were recruited. We included early AD patients with clinical dementia rating scores of 0.5 and 1. The fractional anisotropy and mean diffusivity values, DTI parameter, were measured with the regions of interest method in the bilateral hippocampal body and posterior cingulate. Clinical history, neurological examination, and neuropsychological assessments were conducted. The DTI parameters in the bilateral hippocampus and posterior cingulate in aMCI and AD were different from those in normal controls. No difference was found in DTI parameters of the posterior cingulate between aMCI and AD. However, hippocampal DTI parameters were different between aMCI and AD. Cognitive summary measures were significantly correlated with DTI parameters, especially FA values in the hippocampus. The DTI analysis technique demonstrated significant microstructural alterations in the hippocampus and posterior cingulate already in prodromal stage of AD. DTI parameters in the hippocampus may be a more sensitive method to determine microstructural changes in early AD states and more correlated with cognition than DTI parameters in the posterior cingulate.

In animal studies, hydroxypropyl methylcellulose (HPMC) intake results in increased fecal fat excretion; however, the effects on dietary saturated fatty acids (SATs) and trans-fatty acids (TRANS) remain unknown. This study investigated the effect of HPMC on digestion and absorption of lipids in male Golden Syrian hamsters fed either freeze-dried ground pizza (PZ), pound cake (PC), or hamburger and fries (BF) supplemented with dietary fiber from either HPMC or microcrystalline cellulose (MCC) for 3 weeks. We observed greater excretion of SATs and TRANS by both diets supplemented with HPMC or MCC as compared to the feed. SAT, TRANS, and unsaturated fatty acids (UNSAT) contents of feces of the PZ diet supplemented with HPMC were 5-8 times higher than diets supplemented with MCC and tended to be higher in the PC- and BF-HPMC supplemented diets as well. We also observed significant increases in fecal excretion of bile acids (2.6-3-fold; P0.05), sterols (1.1-1.5-fold; P0.05), and unsaturated fatty acids (UNSAT, 1.7-4.5-fold; P0.05). The animal body weight gain was inversely correlated with the excretion of fecal lipid concentrations of bile acids (r = -0.56; P0.005), sterols (r = -0.48; P0.005), SAT (r = -0.69; P0.005), UNSAT (r = -0.67; P0.005), and TRANS (r = -0.62; P0.005). Therefore, HPMC may be facilitating fat excretion in a biased manner with preferential fecal excretion of both TRANS and SAT in hamsters fed fast food diets.

Learning to read and to write influences not only verbal skills but also global cognitive performance. Our study aimed to compare the visuoconstructional abilities of elderly illiterates with those of elderly literates. A total of 125 healthy subjects over 65 years old were recruited. Korean version of Mini-Mental State Examination (K-MMSE) and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) constructional praxis examination were used. We divided subjects into three groups (educated literate n = 53, uneducated literate n = 36 and uneducated illiterate n = 36). Interlocking pentagons drawing, a part of the K-MMSE, was scored using the 6-point hierarchical scale. The uneducated-illiterate group obtained significantly lower scores than did the other two groups. Scores on the ADAS-cog constructional praxis test were highest in the educated-literate group and those in the uneducated-illiterate group obtained the lowest scores. We demonstrated that illiteracy influences not only language performance but also visuoconstructional functioning. (JINS, 2011, 17, 934–939)

Few studies have investigated the apolipoprotein E (APOE) e4 allele status of dementia patients with severe white matter hyperintensities (WMH). In this study, we aimed to characterize the APOE epsivlon genotypes and clinical features of dementia patients with severe WMH. Four hundred and thirty nine patients with dementia and 152 subjects with normal cognition (NC) were recruited from multiple centers in Korea, known as the Clinical Research Center for Dementia of South Korea (CREDOS), since November 2005. The WMH were rated using the scale that had been developed by the CREDOS study. Dementia patients with minimal WMH were considered to have Alzheimer's disease (AD) without WMH (AD-WMH: 325), and those with severe WMH were considered to have Subcortical Ischemic Vascular Dementia (SIVD: 50) or AD with severe WMH (AD+WMH: 64). Comparisons of APOE e4 allelic prevalence were performed using chi-square analysis. The APOE e4 allele was more prevalent in those with AD than in those with SIVD and NC (p < 0.001). It was not more prevalent in those with SIVD than in those with NC (p = 0.169). APOE e4 allele status in AD+WMH did not differ from that in AD-WMH (p = 0.625). The APOE e4 allele was more prevalent in those with AD than in those with SIVD. APOE e4 may not be associated with SIVD although it is one of the vascular risk factors.

The SCI, the MCI, and the Alzheimer's disease (AD) are on a spectrum of disease progression; therefore, identification of the earliest signs of cognitive deterioration is becoming a crucial issue. The goal of this study was to examine symptom characteristics and distinguish predictive symptoms in patients with MCI compared with SCI, using caregiver questionnaires. We assessed the Korean Dementia Screening Questionnaire (KDSQ) and Seoul Instrumental activities of Daily Living (S-IADL) of 344 subjects with SCI and 697 with MCI. Multivariate logistic regression analyses were conducted after adjusting for age, sex, and educational status. Common and rare symptoms were similar between the SCI and MCI groups. The most distinguishing features of KDSQ were 'Finds it hard to go somewhere on his/her own using public transportation' (odds ratio=OR=4.56, p

P2-111 ADAPTATED SPANISH-AMERICAN MIS VERSION. PRELIMINARY RESULTS OF ARGENTINIAN MULTICENTRIC STUDY Daniel B. Seinhart, Edith Labos, Alberto Mourino, Sofia Trojanoski, Jorge Etchepareborda, Daniel Cruz, Graciela Arguello, Diana Cristalli, Luis Camera, Hospital Italiano, Buenos Aires, Argentina; Hospital Central de San Isidro, Buenos Aires, Argentina; Centro Neurologico, Mar del Plata, Argentina; Hospital Municipal Arturo Onativia, Rafael Calzada, Argentina; Centro de Memoria, Rio Gallegos, Argentina; Hospital San Roque, Gonnet, Argentina. Contact e-mail: daniel.seinhart@ hospitalitaliano.org.ar

BACKGROUND AND PURPOSE: DTI can be used to assess the degradation of WM tracts by measuring the FA and MD. Decreased FA/increased MD values in the AD hippocampus have been reported by many studies. In contrast, only a few studies reported on hydrocephalus by using the DTI technique. In elderly patients with dementia and with dilated ventricles, it is often difficult to differentiate iNPH from AD with visual measurements on MR imaging. The aim of this study was to investigate the changes of microstructural integrity of the hippocampus in iNPH by using DTI and determining whether this method could be a new diagnostic tool to differentiate iNPH from AD. MATERIALS AND METHODS: We recruited 43 participants (15 healthy controls, 15 patients with AD, and 13 patients with iNPH). The FA and MD values were measured by using the region-of-interest method in the hippocampal head, body, and tail on both sides. Clinical history, neurologic examination, and neuropsychological assessment were included. RESULTS: The FA values were the lowest in the patients with AD, the patients with iNPH, and the healthy controls in this order. The MD values were the highest in the same order. These findings were consistent in the 3 subdivisions of the bilateral hippocampal regions. Hippocampal volume was not different between patients with iNPH and AD. CONCLUSIONS: The microstructural alterations of the hippocampus were more sensitive than the volumetric changes in AD and iNPH. DTI analysis might be a useful tool for discriminating AD from iNPH.