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Background and PurposezzThe National Institutes of Health Stroke Scale (NIHSS) is a clinical assessment tool that is widely used in clinical trials and practice to evaluate stroke-related neurological deficits. The aim of this study was to determine the validity and reliability of the Korean version of the NIHSS (K-NIHSS) for evaluating Korean stroke patients. MethodszzThe K-NIHSS was translated and adapted with regard to cultural and linguistic peculiarities. To examine its content validity, we quantified the Content Validity Index (CVI), which was rated by 11 stroke experts. The validity of the K-NIHSS was assessed by comparison with the Glasgow Coma Scale (GCS), the modified Rankin Scale (mRS), and the Barthel Index. The reliability of the K-NIHSS was evaluated using the unweighted kappa statistics for multiple raters and an intraclass correlation coefficient (ICC). ResultszzThe CVI of the K-NIHSS reached 0.91-1.00. The median K-NIHSS score at baseline was 3 (interquartile range, 2-7), and the mean±SD score was 6.0±6.6. The baseline K-NIHSS had a significantly negative correlation with the GCS at baseline and the Barthel Index after 90 days. The K-NIHSS also had a significantly positive correlation with the mRS after 90 days. Facial paresis and dysarthria had moderate interrater reliability (unweighted kappa, 0.41-0.60); kappa values were substantial to excellent (unweighted kappa, >0.60) for all the other items. The ICC for the overall K-NIHSS score was 0.998. The intrarater reliability was acceptable, with a median kappa range of 0.524-1.000. ConclusionszzThe K-NIHSS is a valid and reliable tool for assessing neurological deficits in Korean acute stroke patients. J Clin Neurol 2012;8:177-183 Key Wordszz NIH Stroke Scale, validity, reliability.

For the treatment of osteomyelitis and the prevention of infections after orthopedic surgery, topically implantable gentamicin sulfate (GS)-loaded poly(D,L-lactide- co-glycolide) microparticles (GSMP) containing glycolide monomer (GM), as a biodegradable and nontoxic material, were prepared by melt-extrusion method without organic solvent for controlled release. After preparation of polymer blend, the powders of different size (90-1200 mm) were obtained by means of freezer-mill. The influences of GM and particle size were investigated on the GS release pat- terns. GSMP containing GM (in case of 10% loaded) showed a near-zero order release from 2 to 7 days with the initial burst. GM affected to increase of GS release rate during the in vitro release test. The pH variations of the media were investigated to determine effect of GM on pH drop of media. The morphological evaluations, change of molecular weight, and thermal property of microparticles were characterized by scanning electron microscope, gel permeation chromatography, and differential scanning cal- orimeter, respectively. Bacterial inhibition zone test was established to identify antibiosis of GS. It showed anti- biotic areas except control sample. From these results, the authors expected that GSMP containing GM would be a good dosage form as a topically implantable device that can get rid of lag period of GSMP. 2007 Wiley Periodicals

We examined the neuroprotective efficacy of eugenol against N-methyl-D-aspartate (NMDA)-, oxygen-glucose deprivation-, and xanthine/xanthine oxidase-induced neurotoxicity in primary murine cortical cultures. Eugenol (100-300 microM) attenuated NMDA (300 microM)-induced acute neurotoxicity by 20-60%. At the same concentration range, eugenol also inhibited NMDA (300 microM)-induced elevation in neuronal 45Ca2+ uptake by 10-30%. In the oxygen-glucose deprivation (50 min) neurotoxicity, eugenol (100-300 microM) prevented acute neuronal swelling and reduced neuronal death by 45-60% in a concentration-dependent fashion. Oxidative neuronal injury induced by xanthine/xanthine oxidase was also significantly reduced (75-90%) by eugenol (100- 300 microM) addition. These results suggest that eugenol may play a protective role against ischemic injury by modulating both NMDA receptor and superoxide radical.

Background/Aims: The apolipoprotein E (APOE) genotype in response to pharmacological treatments in patients with Alzheimer’s disease (AD) remains a matter of controversy. This analysis investigated the effect of the APOE genotype on the clinical response to rivastigmine transdermal patch monotherapy or memantine plus rivastigmine patch in patients with mild to moderate AD. Methods: Two hundred and six (n = 206) patients with probable AD and Mini-Mental State Examination (MMSE) scores of 10–20 were randomized to rivastigmine patch monotherapy or memantine plus rivastigmine patch for 24 weeks. Of the 206 patients with probable AD, 146 patients who consented to genetic testing for APOE were included and assessed for this subgroup study. Results: There were no significant differences on MMSE, NPI, ADAS-cog, ADCS-ADL, CDR-SB, NPI and FAB between rivastigmine patch monotherapy and memantine plus rivastigmine patch according to the APOE genotype. However, patients with moderately severe AD (MMSE ≤15) who were APOE e4 carriers showed higher responder rates on ADCS-ADL with memantine plus rivastigmine patch compared to rivastigmine patch monotherapy. Conclusion: Moderately severe AD patients with the APOE e4 allele may respond more favorably to memantine plus rivastigmine patch than e4 noncarriers.

Background and Purpose: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). Methods: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns. Symptomatic HTr was defined as cerebral hemorrhage temporally related to neurological deterioration. Results: Of the 389 included patients (mean age 71 years), 260 (67%) were treated with anticoagulation within 1 week from the onset. Symptomatic HTr occurred in 4.6%. Large infarct (OR 6.38, 95% CI 1.16–35.14), previous hemorrhagic stroke (OR 10.67, 1.77–64.25), and low platelet count (OR per 104 increase 0.87, 0.79–0.97) were independent predictors of symptomatic HTr. hsCRP values tended to be higher in patients with symptomatic HTr (p = 0.055). Conclusions: Caution is needed in anticoagulation treatment of acute cardioembolic stroke patients with a large infarct, previous hemorrhagic stroke, low platelet count, or a high hsCRP level.

Clinical practice guideline for dementia by Clinical Research Center for Dementia of South Korea Bon D. Ku, MD·Shin Gyeom Kim, MD·Jun-Young Lee, MD·Kee Hyung Park, MD·Joon Hyun Shin, MD·Kwang Ki Kim, MD·Young Chul Youn, MD·Yung Min Lee, MD·Chang Hyung Hong, MD·Sang Won Seo, MD·Duk L. Na, MD·Sung Yoon Kim, MD·Hae-Kwan Cheong, MD·Doh Kwan Kim, MD·Jae-Hong Lee, MD·SangYun Kim, MD·Byeong Kil Yeon, MD·Soo Young Kim, MD·Seol-Heui Han, MD Department of Neurology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Department of Psychiatry, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Boramae Hospital, Seoul National University College of Medicine, Seoul, Department of Neurology, Gil Hospital, Gachon University of Medicine and Science, Incheon, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Ilsan Hospital, Dongguk University School of Medicine, Goyang, Chung-Ang University College of Medicine, Seoul, Department of Psychiatry, Busan National University School of Medicine, Busan, Ajou University School of Medicine, Suwon, Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Department of Social and Preventive Medicine, Sungkyunkwan University College of Medicine, Suwon, Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Department of Neurology, Konkuk University

Dementia is the syndrome declined the human cognitive function, especially the memory. It is important that each subdomain of cognition must be evaluated in the diagnosis of dementia. The neuropsychological test is needed for proper evaluation of the cognitive state of patients suspected dementia. Because many neuropsychological (NP) tests have been developed and validated in Korea, we have to understand the characteristics and the pros and cons of each test. Clinical Practical Guideline (CPG) for dementia has been developed by clinical research center for dementia since 2007 and NP tests that have been used and validated frequently in Korea was presented in this CPG. As elderly population increases, the more patients have been diagnosed as dementia. Therefore, the primary physician examining and diagnosing the dementia patients have to understand the NP test fundamentally.