Korean Mini-Mental State Examination Research Articles

A longitudinal study of cognitive trajectories and its factors for Koreans aged 60 and over: A latent growth mixture model.

The purpose of this study is twofold: first, to identify cognitive trajectories of older Koreans in a population-based longitudinal panel survey and, second, to investigate the main characteristics of the identified heterogeneous classes of cognitive trajectories. Data came from 2445 cognitively healthy persons aged 60 or older in the 2006 to 2012 Korean Longitudinal Study of Aging. Using Korean-mini mental status examination (K-MMSE) as a measure of global cognitive function, the latent growth mixture modeling approach examined potential heterogeneity of longitudinal changes over the 6years. This study found that older Koreans reported an average K-MMSE score of 27 at baseline and experienced a cognitive decline every 2years by -1.6 (2006-2008) and -1.2 (2008-2010), followed by a slight increase of 0.7 in 2012. Results from the latent growth mixture modeling analysis indicated that there were 2 heterogeneous classes of longitudinal changes in the K-MMSE over a period of 6years: class 1 with stable cognitive function and class 2 with sharp cognitive decline over time. The sharp decline was found among those older in age and with higher level of depression at baseline. On the contrary, being male, higher education, active social engagement, and regular exercise were main characteristics of stable cognitive function. As the first to examine cognitive trajectories among older Koreans, this study highlighted heterogeneity of cognitive trajectories in the population that should be considered for developing differential intervention strategies aimed at both promoting healthy brain and delaying/preventing cognitive decline.

Insulin Resistance is Associated with Cognitive Decline Among Older Koreans with Normal Baseline Cognitive Function: A Prospective Community-Based Cohort Study

We evaluated whether metabolic factors were associated with cognitive decline, compared to baseline cognitive function, among geriatric population. The present study evaluated data from an ongoing prospective community-based Korean cohort study. Among 1,387 participants who were >65 years old, 422 participants were evaluated using the Korean mini-mental status examination (K-MMSE) at the baseline and follow-up examinations. The mean age at the baseline was 69.3 ± 2.9 years, and 222 participants (52.6%) were men. The mean duration of education was 7.1 ± 3.6 years. During a mean follow-up of 5.9 ± 0.1 years, the K-MMSE score significantly decreased (−1.1 ± 2.7 scores), although no significant change was observed in the homeostasis model assessment of insulin resistance (HOMA-IR) value. Participants with more decreased percent changes in K-MMSE scores had a shorter duration of education (p = 0.001), older age (p = 0.022), higher baseline K-MMSE score (p < 0.001), and increased insulin resistance (∆HOMA-IR, p = 0.002). The correlation between the percent changes in K-MMSE and ∆HOMA-IR values remained significant after multivariable adjustment (B = −0.201, p = 0.002). During a 6-year follow-up of older Koreans with normal baseline cognitive function, increased insulin resistance was significantly correlated with decreased cognitive function.

Validation of the Conversion between the Mini-Mental State Examination and Montreal Cognitive assessment in Korean Patients with Parkinson's Disease.

Objective Two conversion tables between the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) have recently been established for Parkinson’s disease (PD). This study aimed to validate them in Korean patients with PD and to evaluate whether they could be influenced by educational level.Methods A total of 391 patients with PD who undertook both the Korean MMSE and the Korean MoCA during the same session were retrospectively assessed. The mean, median, and root mean squared error (RMSE) of the difference between the true and converted MMSE scores and the intraclass correlation coefficient (ICC) were calculated according to educational level (6 or fewer years, 7–12 years, or 13 or more years).Results Both conversions had a median value of 0, with a small mean and RMSE of differences, and a high correlation between the true and converted MMSE scores. In the classification according to educational level, all groups had roughly similar values of the median, mean, RMSE, and ICC both within and between the conversions.Conclusion Our findings suggest that both MMSE-MoCA conversion tables are useful instruments for transforming MoCA scores into converted MMSE scores in Korean patients with PD, regardless of educational level. These will greatly enhance the utility of the existing cognitive data from the Korean PD population in clinical and research settings.

Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems.

Background and PurposeAlthough the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia.MethodsPatients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems.ResultsOn all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE.ConclusionsThe results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.

Identifying Dietary Patterns Associated with Mild Cognitive Impairment in Older Korean Adults Using Reduced Rank Regression.

Diet plays a crucial role in cognitive function. Few studies have examined the relationship between dietary patterns and cognitive functions of older adults in the Korean population. This study aimed to identify the effect of dietary patterns on the risk of mild cognitive impairment. A total of 239 participants, including 88 men and 151 women, aged 65 years and older were selected from health centers in the district of Seoul, Gyeonggi province, and Incheon, in Korea. Dietary patterns were determined using Reduced Rank Regression (RRR) methods with responses regarding vitamin B6, vitamin C, and iron intakes, based on both a one-day 24-h recall and a food frequency questionnaire. Cognitive function was assessed using the Korean-Mini Mental State Examination (K-MMSE). Multivariable logistic regression models were used to estimate the association between dietary pattern score and the risk of mild cognitive impairment. A total of 20 (8%) out of the 239 participants had mild cognitive impairment. Three dietary patterns were identified: seafood and vegetables, high meat, and bread, ham, and alcohol. Among the three dietary patterns, the older adult population who adhered to the seafood and vegetables pattern, characterized by high intake of seafood, vegetables, fruits, bread, snacks, soy products, beans, chicken, pork, ham, egg, and milk had a decreased risk of mild cognitive impairment compared to those who did not (adjusted odds ratios 0.06, 95% confidence interval 0.01–0.72) after controlling for gender, supplementation, education, history of dementia, physical activity, body mass index (BMI), and duration of sleep. The other two dietary patterns were not significantly associated with the risk of mild cognitive impairment. In conclusion, high consumption of fruits, vegetables, seafood, and protein foods was significantly associated with reduced mild cognitive impairment in older Korean adults. These results can contribute to the establishment of dietary guidelines targeting older Korean adults to reduce mild cognitive impairments. Future prospective cohort studies are warranted to examine the effect of the seafood and vegetable dietary pattern on reducing mild cognitive impairment to prove the cause–effect relationship between dietary patterns and cognitive function.

Re-standardization of the Korean-Instrumental Activities of Daily Living (K-IADL): Clinical Usefulness for Various Neurodegenerative Diseases.

Background and PurposeEvaluating instrumental activities of daily living (IADL) is an important part of procedure to diagnose dementia. The Korean-Instrumental Activities of Daily Living (K-IADL) has been used extensively in Korea. However, its cut-off score has not been reformulated since 2002. The purpose of this study was to yield a new optimal cut-off score for the K-IADL and confirm the validity of this new cut-off score with various dementia groups.MethodsWe retrospectively collected a total of 2,347 patients' K-IADL data from 6 general hospitals in Korea. These patients had mild cognitive impairment (MCI) or dementia with various etiologies for cognitive impairment. We also recruited a normal control group (n=254) from the community. Korean-Mini Mental State Examination, Short version of the Geriatric Depression Scale, Clinical Dementia Rating, and Global Deterioration Scale were administered to all participants. Caregivers completed K-IADL and Barthel Index.ResultsK-IADL scores were significantly different among dementia subgroups, but not significantly different among MCI subgroups. Based on internal consistency, correlations with other scales, and factor analysis, K-IADL showed excellent reliability and validity. The new optimal cut-off score to diagnose dementia was 0.40, which gave a sensitivity of 0.901 and a specificity of 0.916. Positive predictive value for dementia using the new cut-off score was 94.2% for Alzheimer's disease, 100% for vascular dementia, and 84% for Parkinson's disease.ConclusionsOur results illustrate that the new K-IADL cut-off score of 0.40 is reliable and valid for screening impairments of daily functioning resulting from various etiologies.

The relationships between cognitive function and hearing loss among the elderly.

[Purpose] Research related to dementia has gained momentum in South Korea and studies have found that the auditory sense affects dementia. This study aims to examine the relationship between the decline in hearing function and the overall cognitive function among the elderly. [Subjects and Methods] Eighty-two older adults aged 65–90 years (mean age: 79.3, SD: 5.2) participated. The Korean Mini-Mental State Examination was used to assess cognitive function. Further, to assess the hearing function, pure-tone audiometry was performed prior to the cognitive function test. We used a paired t-test and Pearson’s correlation test for the analysis. [Results] Generally, the higher the frequency band, the more hearing loss was identified among the elderly. In addition, the difference in hearing between both ears was significant; particularly, hearing loss in the right ear was significantly higher than that in the left. Cognitive function was not related to age, however, the correlation between cognitive function and hearing loss in the right ear was statistically significant. [Conclusion] Hearing loss influences cognitive function among the elderly.

Comparison of the Effects of Middle Ear Implants and Conventional Hearing Aids on Cognitive Function

Background and Objectives The association between hearing impairment and cognitive function has been established in previous studies. The aim of this study was to compare the effects of conventional hearing aids and middle ear implants on cognitive function. Subjects and Method This study included 22 participants who underwent middle ear implantation between October 2013 and September 2016. Their mean age at surgery was 70 years. Using Pure tone audiometry (PTA), the Speech discrimination test (SDT), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, we compared audiologic benefits of three conditions [without hearing aids, with conventional hearing aids, or with Vibrant Sound bridge (VSB)]. Cognitive ability was evaluated using neuropsychological testings (Seoul Neuropsychological Screening Battery) at intervals of approximately eight weeks. Results The results of PTA showed a 7.96 dB HL gain with conventional hearing aids and a 10.00 dB HL gain with the use of VSB. SDT results showed a 4.10% gain with conventional hearing aids and a 10% gain with the use of VSB. Results of the APHAB questionnaire showed a significant increase with the use of VSB compared to conventional hearing aids. In the Korean Mini-Mental State Examination, a slight improvement was observed after middle ear implantation. In the Digit Span Test and Korean-Boston Naming Test, a significant improvement was seen with the use of VSB compared to conventional hearing aids. Conclusion The use of middle ear implants in rehabilitation of hearing communication in patients showed improvements in cognitive abilities, compared to the use of conventional hearing aids. Key words: Hearing loss ㆍ Cognition ㆍ Middle ear implant ㆍ Hearing aids

Relationships between cognitive function and body composition among community-dwelling older adults: a cross-sectional study

BackgroundPrevious studies reported mixed results regarding the association between cognition and body weight in late life. We evaluated the relationships between cognitive function and body composition among community-dwelling older adults.MethodsThree hundred twenty subjects (≥65 years, women 53%) with available data of cognitive function and body composition from 2010 Hallym Aging Study. Cognitive function was assessed using Korean Mini-Mental State Examination (K-MMSE). Dual-energy X-ray absorptiometry (DEXA) was used for measuring body composition including body fat and lean body mass. Anthropometric measurements and laboratory data were collected in clinical examination. Body composition variables were divided into sex-specific tertiles, and examined by multivariable logistic regression.ResultsAmong female, the highest tertile group of fat mass and second tertile group of total lean body mass were associated with lower risk for cognitive impairment compared to the respective first tertile groups (odds ratios, 0.23 and 0.09, respectively; 95% confidence intervals, 0.04–0.88 and 0.01–0.44, respectively) after adjusting for confounding factors. In male, higher arm bone mineral content was associated with lower risk for cognitive impairment, but significance was lost after adjusting for adiponectin, age, and education.ConclusionsHigher fat mass and lean body mass were associated with lower risk of cognitive impairment in older women. These observations suggest that body fat and lean mass later in life might be beneficial for cognition.

Combined Impact of Telomere Length and Mitochondrial DNA Copy Number on Cognitive Function in Community-Dwelling Very Old Adults

Background: This study was conducted to investigate the combined impact of telomere length and mitochondrial DNA (mtDNA) copy number on cognitive function in community-dwelling very old adults. Methods: In total, 186 subjects over 75 years participated in this study. Cognitive function was assessed using the Korean Mini-Mental State Examination, and leukocyte telomere length and mtDNA copy number were measured using real-time polymerase chain reaction methods. Results: Both the fourth quartile of telomere length and mtDNA copy number were associated with cognitive dysfunction with an adjusted odds ratio of 0.23 (95% confidence interval (CI), 0.10-0.75) and 0.18 (95% CI, 0.03-0.54), respectively. Participants in the high telomere length/high mtDNA copy number group were more likely to have cognitive dysfunction than participants in the low telomere/low mtDNA copy number group with an adjusted odds ratio of 0.19 (95% CI, 0.07-0.58). Conclusion: Our results collectively suggest that the combination of telomere length and mtDNA copy number may be useful for monitoring cognitive decline in older adults.

Effect of Daily Communication Behaviors on Cognitive and Language Abilities of the Elderly

Purpose: The International Classification of Functioning, Disability, and Health can be utilized to measure individual health. Although ‘activity’ is one of the components of health, no studies have investigated the frequency of participation of the elderly in daily communication activities, such as talking, reading, and writing. We examined the daily communication behaviors of normal elderly subjects and their effects on cognitive and language test performance. Methods: Normal elderly subjects (n = 456) over 60 years old completed a questionnaire on how often they thought that they talked/read/wrote in their daily lives. Also, they were administered the Korean Mini-Mental State Examination, Controlled Oral Word Association Test, Short Form of the Korean version-the Boston Naming Test, and Sentence Comprehension Test. Results: About 50% of the participants reported that they seldom talked, read, and/or wrote daily. The more frequently that the participants reported daily talking, reading and writing, the better they performed on cognitive and/or language tests. Daily writing influenced the test results the most, which suggested that writing behavior was closely related to all four cognitive/ language tests. Conclusion: These results suggested that daily active communication behaviors play major roles in the cognitive and language abilities of the elderly.

Subjective cognitive decline in patients with migraine and its relationship with depression, anxiety, and sleep quality

BackgroundCognitive decline is a major concern in patients with migraine. Depression, anxiety, and/or poor sleep quality are well-known comorbidities of migraine, but available evidence on the subjective cognitive decline (SCD) is limited. This study aimed to investigate the presence and frequency of SCD and its relationship with anxiety, depression and sleep quality in patients with migraine.MethodsWe enrolled patients with migraine who scored within the normal range of the Korean-Mini Mental State Examination and the Korean-Montreal Cognitive Assessment. Using the Subjective Cognitive Decline Questionnaire (SCD-Q), participants with ≥7 were assigned to the SCD group. The Headache Impact Test-6, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Pittsburgh Sleep Quality Index were used and analyzed between the two groups.ResultsA total of 188 patients with migraine, aged 38.1 ± 9.9 years, were enrolled. The mean SCD-Q score was 6.5 ± 5.5, and 44.7% of participants were identified as SCD. Migraineurs with SCD reported higher headache pain intensity and headache impact, as well as greater prevalence of anxiety, depression, reduced quality of sleep, and shorter sleep duration during weekdays compared to migraineurs without SCD. There were no significant differences in terms of age, sex, migraine type (chronic/episodic), medication, or sleep duration during weekends between the two groups. Upon multivariate logistic analysis adjusted for age, sex, headache characteristics, and psychological variables, depression was associated with increased risk of SCD (Odds ratio 1.31, 95% confidence interval 1.16–1.49) and sleep duration during weekdays was associated with decreased risk of SCD (Odds ratio 0.66, 95% confidence interval 0.44–0.97).ConclusionsA non-negligible number of patients with migraine complained of SCD. Depression and short sleep duration during weekdays were related to SCD among adult migraineurs.

Effects of Novel Guidance Tubing Gait on Electromyographic Neuromuscular Imbalance and Joint Angular Kinematics During Locomotion in Hemiparetic Stroke Patients

ObjectiveTo compare the immediate effects of conventional treadmill gait and guidance tubing gait (GTG) on electromyographic neuromuscular imbalance and knee joint kinematics in hemiparetic gait. DesignCase-control study. SettingUniversity medical center. ParticipantsParticipants (N=33; 19 men, 14 women) were patients with hemiparetic stroke (n=18 [experimental]; mean age ± SD, 39.2±16.8y) and healthy controls (n=15; mean age ± SD, 26.3±2.6y). InterventionsThe GTG was provided for approximately 30 minutes and involved application of an assistive guidance force using the tubing, specifically to improve knee joint stabilization during midstance and increase knee joint flexion during midswing phase. Main Outcome MeasuresClinical tests included the Korean Mini-Mental State Examination, Modified Ashworth Scale, Berg Balance Scale, manual muscle test, and knee joint range of motion and sensory tests. Knee joint muscle electromyographic and kinematic analyses were determined at pretest and posttest. ResultsAfter the intervention, the experimental group showed significantly greater improvements in balanced quadriceps and hamstring electromyographic coactivation and knee joint kinematics relative to the control group (P=.005). The GTG intervention decreased overactive hamstring activity (P=.018) and reciprocally increased quadriceps activity (P<.001). The knee joint kinematic analysis showed significant changes in the hemiparetic stroke group (P=.004). ConclusionsThis study demonstrates the effectiveness of the tubing gait condition to restore knee joint muscle imbalance and kinematics in individuals with hemiparetic stroke who present with an abnormal hyperextension knee gait.

Role of physical activity in mortality prediction in elderly hospice patients.

The prediction of life-expectancy in terminally ill patients is important both for medical and social reasons but it is widely recognized as being inaccurate. The aim of this study was to investigate the mortality predictors and indicators of life extension among elderly patients in a hospice service center. In order to determine the mortality predictors, we investigated the relationship between patients’ cognitive status using the Korean-Mini Mental State Examination & Global Deterioration Scale (K-MMSE & GDS), the patient’s physical function using the instrumental Activities of Daily Living (ADL) score, and the patient’s blood component values. The subjects included 43 men and 57 women with a mean age of 82.4±8.4 years, and a mean nursing period of 11.1±12.2 months. These terminally ill patients were enrolled in a cross-sectional study. All data were collected from paper and electronic charts, and patient interviews. A simple correlation analysis was performed to determine the relationship between the variables and to satisfy the normal distribution (P<0.01). The results revealed that the time of death negatively correlated with ADL score (r=−0.273, P=0.006). However, the K-MMSE & GDS, and the values of blood component such as albumin, gamma-glutamic transpeptidase, blood urea nitrogen, and creatinine were not correlated with the time of death. Consequently, the ADL score might be an important predictor of mortality and life extension in elderly patients. Therefore, in order to improve ADL score, physical exercise and overall fitness may be potential non-pharmacologic methods useful in preventing mortality in elderly people.

Factors associated with improvement or decline in cognitive function after an ischemic stroke in Korea: the Korean stroke cohort for functioning and rehabilitation (KOSCO) study

BackgroundWe conducted a prospective cohort study to investigate prevalence of poststroke cognitive impairment at 3 and 12 months after stroke onset and identify clinical and demographic factors associated with improvement or decline in cognitive function between 3 months and 12 months.MethodsWe analyzed the cognitive assessments of total patients and patients older than 65 years separately. All patients with an ischemic stroke were divided into normal cognitive group (NCG) and impaired cognition group (ICG) by using a cutoff score on the Korean Mini-Mental State Examination (K-MMSE). Patients were additionally classified into 3 subgroups according to the changes in their K-MMSE scores between 3 and 12 months: Stable group with K-MMSE scores changes ranging from −2 to +2 points (−2 ≤ △MMSE ≤ +2); converter group with increase more than 3 points (3 ≤ △MMSE); and reverter group with decrease more than 3 points (−3 ≤ △MMSE). We also analyzed factors affecting cognitive change from 3 months to 12 months among the 3 groups including baseline medical record, stroke and treatment characteristics, and various functional assessments after 3 months.ResultsThis study included 2,625 patients with the first time ischemic stroke. Among these patients, 1,735 (66.1%) were classified as NCG, while 890 patients (33.9%) were belonged to the ICG at 3 month. Within the NCG, 1,460 patients (82.4%) were stable group, 93 patients (5.4%) were converter group, and 212 patients (12.2%) were reverter group at 12 months onset. Within the ICG group, 472 patients (53.0%) were stable group, 321 patients (36.1%) were converter group, and 97 patients (10.9%) were reverter group. When different factors were investigated, the three subgroups in NCG and ICG showed significant different factors affecting cognitive function from 3 to 12 month.ConclusionsThe prevalence of cognitive impairment showed difference between 3,12 months. To analyze the cognitive change from 3 month to 12 month, the proportion stable group was dominant in NCG and converter group was higher in ICG. By investigating the influencing factors from each group, we were able to identify the predictors including the age factor.

Interaction of obstructive sleep apnoea and cognitive impairment with slow gait speed in middle-aged and older adults.

to investigate whether slow gait speed is associated with cognitive impairment and further whether the association is modified by obstructive sleep apnoea (OSA). in total, 2,222 adults aged 49-80 years, free from dementia, stroke and head injury were asked to walk a 4-m course at fast and usual gait speeds. The time taken to walk was measured. All participants completed the Korean Mini-Mental State Examination, which was validated in the Korean language, to assess cognitive function. Additionally, the participants completed a polysomnography test to ascertain OSA (defined as an apnoea-hypopnoea index ≥15). Multivariable linear regression models were utilised to test the associations. time taken to walk 4 m showed significant inverse associations with cognitive scores (P value = 0.001 at fast gait speed and P = 0.002 at usual gait speed). Furthermore, a significant interaction according to OSA on the association between time to walk and cognitive impairment was found (P value for interaction = 0.003 at fast gait speed and P value for interaction = 0.007 at usual gait speed). we found that the inverse association between the time taken to walk 4 m and a cognitive score became significantly stronger, if an individual had OSA.

Analyzing Factors Affecting Cognitive Function in the Elderly using Computerized Neurocognitive Tests

Purpose: The purpose of this study is to examine the cognitive function in the elderly and to identify the influencing factors. Methods: The design of this study was descriptive research design. A total of 139 elderly people (aged 65 years and over) visiting the electroencephalogram (EEG) center in Seoul, Korea were evaluated. Data were assessed by self-administered questionnaires and CNS Vital Signs (CNSVS). Data were analyzed using SPSS Statistics 23.0 for Windows. Results: There were significant differences in the Korean Mini-Mental State Examination (K-MMSE), executive functions and reasoning according to education level. K-MMSE, visual memory and executive functions were different depending on the jobs. Age was highly correlated with cognitive function. In addition, stepwise multiple regression analyses showed that the factor significantly associated with reaction time and visual memory was depression. Depression and Trait-Anxiety had significant impacts on executive functions and K-MMSE. Conclusion: CNSVS enabled the accurate and objective measurement of cognitive function. Therefore, this study provides useful data to improve cognitive function of the community-dwelling elderly. The results suggested that there is need for comprehensive interventional programs that manage cognitive impairment.

18F-FP-CIT Positron Emission Tomography for Correlating Motor and Cognitive Symptoms of Parkinson's Disease.

Background and PurposeThe aim of this paper was to investigate the utility of 18F-N-(3-fluoropropyl)-2β-carboxymethoxy-3β-(4-iodophenyl) nortropane (FP-CIT) positron emission tomography (PET) for evaluating the severity of Parkinson's disease (PD) according to various clinical stages, and to identify the relationship between the striatal substructure and the Unified Parkinson's Disease Rating Scale (UPDRS) motor score, cognitive symptoms through 18F-FP-CIT PET.MethodsWe retrospectively identified 542 patients with various clinical stages of PD who underwent an 18F-FP-CIT PET at our clinics. The difference between the 18F-FP-CIT PET according to the Hoehn-Yahr stage, correlation between 18F-FP-CIT PET and the UPDRS III grouped motor items, and the Korean Mini-Mental State Examination (K-MMSE) were investigated.ResultsAs disease progressed, the right caudate and both the anterior putamen and caudate/putamen ratios exhibited a significantly lower uptake. The uptake of all striatal substructures was significantly correlated with the UPDRS total motor score. The right caudate nucleus was significantly related to both the UPDRS tremor items and the right UPDRS akinesia-rigidity items. The left caudate nucleus was related to both the UPDRS tremor items and UPDRS akinesia-rigidity items. The right anterior putamen was related to the axial items, right tremor and akinesia-rigidity items; while the left anterior putamen was related to the right tremor and right akinesia-rigidity items. Both of the posterior putamens were related to the axil items, left tremor and left akinesia rigidity items. K-MMSE was not significantly related to any striatal substructures.ConclusionsThe UPDRS total motor score was significantly correlated with the uptake of all striatal substructures. However, the 18F-FPCIT uptake in specific striatal substructures was rather complexly correlated with the UPDRS motor grouped items and was not significantly related to K-MMSE. These results suggest the possibility of the complex pathophysiology of motor symptoms of PD and limitation of 18F-FPCIT PET for the evaluation of the severity of PD motor and cognitive symptoms.

Menopause Symptoms and Perceived Cognitive Decline in Menopausal Women: The Mediating Effect of Health Promotion Behavior

Purpose: The purpose of this study was to assess the relationship between menopausal symptoms and decline in cognitive functioning of menopausal women with mediating effects of health promoting behavior. Methods: Using a convenience sampling, 140 menopausal women were recruited for the cross-sectional survey. Data were collected by using the Menopause Rating Scale, Health Promoting Lifestyle Profile, Everyday Cognition, and Korean Mini-Mental State Examination. Results: The mean scores for menopausal symptoms, health promotion behavior, and subjective cognitive decline were 14.40, 153.79, and 67.40 respectively. Health promotion behavior was directly affected by menopausal symptom (R2=8%). Cognitive decline was directly affected by menopausal symptom (R2=11%). Menopausal symptom (β=.33, p<.001) and health promotion behavior (β=-.21, p=.014) were found to be predictive factors in subjective cognitive decline and explained 14%. Health promotion behavior had a partial mediating effect in the relationship between menopausal symptom and perceived cognitive decline (Sobel test: Z=2.05, p=.040). Conclusion: Based on the findings of this study, developing nursing intervention programs focusing on decreasing menopausal symptoms and encouraging health promotion behavior are recommended to improve cognitive decline in menopausal women.

Arterial Stiffness in Subacute Stroke: Changing Pattern and Relationship with Functional Recovery

To examine changing patterns in arterial stiffness and functional outcome in patients with subacute stroke, and to determine which parameter shows a strong correlation with the reversal of arterial stiffness, during a 3-month period of comprehensive rehabilitation therapy. This descriptive, observational cohort study enrolled 60 patients (43 male and 17 female; average age, 62.7 years), and all received conventional rehabilitation therapy, during a 3-month period. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness. Functional assessments included the 6-minute walk test (6MWT), Fugl-Meyer Assessment of hemiparetic upper and lower limbs, the functional ambulatory category, the Berg balance scale, the Korean Mini-Mental Status Examination, and the Korean-Modified Barthel Index. All measurements were conducted at baseline and 1 and 3 months after stroke onset. Rehabilitation therapy resulted in a statistically significant improvement in baPWV since 3 months post stroke. Another functional outcome measure showed statistically significant improvements since 1 month after rehabilitation. Multivariable linear regression analysis revealed that a change in baPWV was significantly correlated with changes in the 6MWT. Three months of comprehensive rehabilitation therapy led to statistically significant improvements in arterial stiffness and functional outcomes during the subacute phase of stroke. Thus, the comprehensive rehabilitation focused on improving gait endurance would be warranted in subacute stroke patients.