Impact of an Education Program for Caregivers of Patients with Alzheimer's Disease on Treatment Discontinuation and Compliance in Korea

Background and PurposeReportedly 30–50% of patients being treated for chronic illnesses do not adhere to their medication regimen. We assessed the impact of a nurse-led education program for caregivers of Korean de novo Alzheimer''s disease patients who had newly been prescribed donepezil.MethodsThis multicenter study analyzed 93 participants in a caregiver education group and 92 participants in a caregiver no-education group. At every visit up to the end of the study (1 year), caregivers in the education group were given educational brochures regarding Alzheimer''s disease and the efficacy and adverse events of donepezil treatment. The primary endpoint was the discontinuation rate of donepezil treatment during the 1-year observation period. The secondary endpoints included the effect of education on compliance with donepezil treatment assessed at each visit using a clinician rating scale (CRS) and visual analog scale (VAS), and changes from baseline in cognitive assessment tests.ResultsThe donepezil discontinuation rates at 1 year were 5.38% (5/93) and 6.52% (6/92) in the caregiver education and no-education groups, respectively (p=0.742). No significant between-group differences in donepezil compliance rates on the CRS and VAS were observed, but significant changes were observed in some cognitive tests from baseline to the end of the study.ConclusionsCaregiver education had no significant effect on treatment discontinuation, but this may have been due to the low severity of cognitive impairment among the included population at baseline. In addition, the low discontinuation rates meant that no significant difference in treatment compliance was observed.     

ANCA-Negative Wegener's Granulomatosis with Multiple Lower Cranial Nerve Palsies

Wegener''s granulomatosis (WG) is a systemic vasculitis affecting small and medium-sized vessels with granulomatous formation. Though it is known for respiratory tract and kidney involvement, neurologic manifestation has been also reported. Herein we report a patient who suffered pansinusitis with multiple lower cranial nerve palsies but reached remission by immunosuppressant after the diagnosis of WG. A 54-yr-old female visited with headache, hearing difficulty, and progressive bulbar symptoms. She experienced endoscopic sinus surgeries due to refractory sinusitis. Neurologic examination revealed multiple lower cranial nerve palsies. Vasculitic markers showed no abnormality. Nasal biopsy revealed granulomatous inflammation and vasculitis involving small vessels. Given cyclophosphamide and prednisolone, her symptoms were prominently improved. WG should be considered in the patient with multiple cranial nerve palsies, especially those with paranasal sinus disease. Because WG can be lethal if delayed in treatment, prompt immunosuppressant is warranted after the diagnostic tissue biopsy.     

A New MRI Grading System for Cervical Foraminal Stenosis Based on Axial T2-Weighted Images

ObjectiveThe purpose of this study was to evaluate the reliability of a new magnetic resonance imaging (MRI) grading system for cervical neural foraminal stenosis (NFS).ResultsFor the distinction among the three individual grades at all six neural foramina, the ICC ranged from 0.68 to 0.73, indicating fair to good reproducibility. The percentage agreement ranged from 60.2% to 70.6%, and the kappa values (κ = 0.50-0.58) indicated fair to moderate agreement. The percentages of intraobserver agreement ranged from 85.4% to 93.8% (κ = 0.80-0.92), indicating near perfect agreement.ConclusionThe new MRI grading system shows sufficient interobserver and intraobserver agreement to reliably assess cervical NFS.     

Cardiorespiratory endurance in children with and without cerebral palsy as measured by an ergometer: a case series study

[Purpose] This preliminary study aimed to determine the cardiorespiratory endurance of children with cerebral palsy (CP) using a case series study in order to provide the reference data required for interventions appropriate for South Korean CP sufferers, since aerobic ability evaluation and interventions for children with CP are not well recognized in South Korea. [Subjects and Methods] Four children and adolescents with CP GMFCS (Gross Motor Function Classification System) level I and II and two normally developing children (ND) (age: 7–15 years) were studied. Cycle ergometer testing was performed to determine their VO₂ peak and RER peak concentrations as well as VE peak and 6MWT distance. [Results] The VO₂ peak was lower in subject E (CP) at 44.5 than in subject B (ND), and it was lower in subject A (ND) at 22.9 than in subject C (CP). The 6MWT distance was longer in subjects A and B (ND) than in age-matched CP subjects. [Conclusion] This case report demonstrates that the cardiorespiratory parameters values of CP children were similar to those reported previously. Further research is required to evaluate the normative values of CP and the optimal cardiorespiratory parameters.Key words: Cardiorespiratory endurance, Ergometer test, Cerebral palsy