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Subjective memory impairment (SMI) is common among older adults. Increasing evidence suggests that SMI is a risk factor for future cognitive decline, as well as for mild cognitive impairment and dementia. Medial temporal lobe structures, including the hippocampus and entorhinal cortex, are affected in the early stages of Alzheimer's disease. The current study examined the gray matter (GM) volume and microstructural changes of hippocampal and entorhinal regions in individuals with SMI, compared with elderly control participants without memory complaints.
A total of 45 participants (mean age: 70.31 ± 6.07 years) took part in the study, including 18 participants with SMI and 27 elderly controls without memory complaints. We compared the GM volume and diffusion tensor imaging (DTI) measures in the hippocampal and entorhinal regions between SMI and control groups.
Individuals with SMI had lower entorhinal cortical volumes than control participants, but no differences in hippocampal volume were found between groups. In addition, SMI patients exhibited DTI changes (lower fractional anisotropy (FA) and higher mean diffusivity in SMI) in the hippocampal body and entorhinal white matter compared with controls. Combining entorhinal cortical volume and FA in the hippocampal body improved the accuracy of classification between SMI and control groups.
These findings suggest that the entorhinal region exhibits macrostructural as well as microstructural changes in individuals with SMI, whereas the hippocampus exhibits only microstructural alterations.
Previous studies suggest that there is a strong association between depression and cognitive decline, and that concurrent depressive symptoms in MCI patients could contribute to a difference in neurocognitive characteristics compared to MCI patients without depression. The authors tried to compare neurocognitive functions between MCI patients with and without depression by analyzing the results of neuropsychological tests.
Participants included 153 MCI patients. Based on the diagnosis of major depressive disorder, the participants were divided into two groups: depressed MCI (MCI/D+) versus non-depressed MCI (MCI/D−). The general cognitive and functional statuses of participants were evaluated. And a subset of various neuropsychological tests was presented to participants. Demographic and clinical data were analyzed using Student t-test or χ2 test.
A total of 153 participants were divided into two groups: 94 MCI/D+ patients and 59 MCI/D− patients. Age, sex, and years of education were not significantly different between the two groups. There were no significant differences in general cognitive status between MCI/D+ and MCI/D− patients, but MCI/D+ participants showed significantly reduced performance in the six subtests (Contrasting Program, Go-no-go task, Fist-edge-palm task, Constructional Praxis, Memory Recall, TMT-A) compared with MCI/D− patients.
There were significantly greater deficits in neurocognitive functions including verbal memory, executive function, attention/processing speed, and visual memory in MCI/D+ participants compared to MCI/D−. Once the biological mechanism is identified, distinct approaches in treatment or prevention will be determined.
Social support programs for dementia caregivers were widely used in order to reduce care burden. We investigated which types of social supports can reduce psychological and non-psychological burdens of dementia caregivers, and explored the mechanism of those social supports.
We evaluated 731 community-dwelling dementia patients and their caregivers from the National Survey of Dementia Care in South Korea. We investigated the five types of social supports (emotional support, informational support, tangible support, positive social interaction, affectionate support) using the Medical Outcomes Study Social Support Survey in each caregiver. The mechanisms of specific types of social support on psychological/non-psychological burden were examined using path analysis.
Positive social interaction and affectionate support reduced psychological burden via direct and indirect paths. Tangible support reduced the non-psychological burden via direct and indirect paths. Informational support and emotional support were not helpful for reducing psychological or non-psychological burden. A maximum of 20% of psychological burden could be relieved by positive social interaction and 10.3% of that could be reduced by affectionate support. Tangible support was associated with a 15.1% maximal improvement in non-psychological burden.
In order to reduce caregiver burden in dementia effectively, psychosocial interventions should be tailored to target type of caregiver burden.
It is controversial whether Borna disease virus (BDV) infects humans and causes psychiatric disorders.
The relationship between BDV infection and schizophrenia with deficit syndrome was investigated.
Using the Schedule for the Deficit Syndrome, 62 schizophrenic in-patients were selected from three psychiatric hospitals. RNA was extracted from peripheral blood mononuclear cells and analyzed using nested reverse transcriptase-polymerase chain reaction with primers to detect BDV p24 and p40.
Results and conclusions:
BDV transcripts were not detected in samples from any of the 62 schizophrenic patients. These data do not support an etiologic association between BDV infection and the deficit form of schizophrenia.
Background: The influences of demographics, culture, language, and environmental changes on Mini-Mental State Examination (MMSE) scores are considerable.
Methods: Using a sample of 7452 healthy, community-dwelling elderly Koreans, aged 55 to 94 years, who participated in the four ongoing geriatric cohorts in Korea, we investigated demographic influences on MMSE scores and derived normative data for this population. Geropsychiatrists strictly excluded subjects with cognitive disorders according to the protocol of the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) Clinical Assessment Battery (CERAD-K-C).
Results: Education (standardized β = 0.463), age (standardized β = −0.303), and gender (standardized β = −0.057) had significant effects on MMSE scores (p < 0.001). The score of MMSE increase 0.379 point per 1-year education, decrease 0.188 per 1-year older, and decrease 0.491 in women compared to men. Education explained 30.4% of the scores’ total variance, which was much larger than the variances explained by age (8.4%) or gender (0.3%). Accordingly, we present normative data for the MMSE stratified by education (0, 1–3, 4–6, 7–9, 10–12, and ≥ 13 years), age (60–69, 70–79, and 80–89 years), and gender.
Conclusions: We provide contemporary education-, age-, and gender-stratified norms for the MMSE, derived from a large, community-dwelling elderly Korean population sample, which could be useful in evaluating individual MMSE scores.
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)
Background: Agraphia in Korean patients may be different from agraphia in other patients who use alphabetical writing systems due to the “visuoconstructional script” characteristics of the Korean writing system, Hangul. Patients with early onset Alzheimer's disease (EOAD) have a severe degree of hypometabolism in the parietal area, which is known to be involved in processing visuospatial function. Thus, we explored the diverse error patterns manifested in writing single syllables in Korean patients with EOAD.
Methods: A study sample of 35 patients with EOAD and 18 healthy controls (HC) performed a Hangul writing task. We analyzed the erroneous responses of the subjects according to visuoconstructional and linguistic characteristics. In addition, we evaluated the relationship between Hangul writing and the neuropsychological variables as well as the severity of dementia.
Results: When comparing the total number of erroneous responses between EOAD and HC groups, the performances of EOAD patients were significantly worse than those of HC. EOAD patients demonstrated visuoconstructional errors even in the early stages of the disease. Severity of dementia and multiple cognitive domains such as attention, language, immediate memory, and frontal executive functions significantly correlated with the performance of Hangul writing.
Conclusion: Our findings suggest that patients with EOAD exhibit not only linguistic errors but also visuoconstructional manifestations of agraphia, which are associated with cognitive impairments in the multiple domains.
Analytical electron microscopy (AEM) was used to examine the initial interfacial reaction layers between a eutectic Sn–3.5Ag solder and an electroless nickel-immersion gold-plated (ENIG) Cu substrate during reflow at 255 °C for 1 s. AEM confirmed that a thick upper (Au,Ni)Sn2 layer and a thin Ni3Sn4 layer had formed through the reaction between the solder and ENIG. The amorphous electroless Ni(P) plated layer transformed into two P-rich Ni layers. One is a crystallized P-rich Ni layer, and the other is an intermediate state P-rich Ni layer before the crystallization. The crystallized P-rich layer consisted of Ni2P and Ni12P5. A thin Ni2P layer had formed underneath the Ni3Sn4 layer and is believed to be a predecessor of the Ni2SnP ternary phase. A Ni12P5 phase was observed beneath the Ni2P thin layer. In addition, nanocrystalline Ni was found to coexist with the amorphous Ni(P) phase in the intermediate state P-rich Ni layer.
The interfacial reactions and ball shear properties of an In–48wt%Sn solder joint with an electroplated Au/Ni ball grid array substrate were investigated with increasing numbers of reflows using scanning electron microscopy, transmission electron microscopy, energy dispersive x-ray spectrometry, inductively coupled plasma-atomic emission spectroscopy, x-ray diffractometry, and bonding testing. After one reflow, two different intermetallic compound (IMC) layers, AuIn and AuIn2, were formed at the solder–substrate interface. The AuIn was completely transformed into the AuIn2 after three reflows. The AuIn2 IMC layer broke off, and a thin continuous Ni3(SnxIn1–x)4 IMC layer was formed between the molten solder and the exposed Ni substrate after four reflows. After 10 reflows, the AuIn2 IMC layer completely spalled off the substrate and the Ni3(SnxIn1–x)4 IMC layer was dissolved into the molten solder. These interfacial reactions greatly affected the shear properties of the solder joint.
The microstructural evolution and interfacial reactions of fluxless-bonded, Au-20wt%Sn/Cu solder joint were investigated during reflow and aging. After reflowing at 310 °C, only one thick and irregularly shaped ζ(Cu) layer was formed at the interface. After the prolonged reflow reaction, the AuCu layer was formed between the ζ(Cu) layer and the Cu substrate. During reflowing, the Cu substrate reacted primarily with the ζ-phase in the solder matrix. The solid-state interfacial reaction was much faster at 250 °C than at 150 °C. After aging at 250 °C for 100 h, thick ζ(Cu), AuCu and AuCu3 IMC layers were formed at the interface. The formation of the AuCu3 intermetallic compound (IMC) was caused by Cu enrichment at the AuCu/Cu layer interface. After aging for 500 h, cracks were observed inside the interfacial AuCu layer. The study results clearly demonstrate the need for an alternative surface finish on Cu, to ensure the high temperature reliability of the Au-20Sn/Cu solder joint.
In this study, we fabricated eutectic Au–Sn (Au–20 wt% Sn) flip-chip solder bumps from a single electroplating bath. After reflowing, the average diameter of the solder bump was approximately 80 μm. The (Ni,Au)3Sn2 phase was initially formed when the liquid Au–Sn solder reacted with the Ni UBM (under bump metallization). After aging at 150 °C, the (Ni,Au)3Sn2 intermetallic compound (IMC), which formed at the interface during reflow, was fully transformed into the (Au,Ni)Sn IMC due to the restricted supply of Ni atoms from the UBM to the interface. On the other hand, after aging at 250 °C for 1000 h, two IMC layers, (Au,Ni)Sn and (Ni,Au)3Sn2, were formed at the interface. The lower (Ni,Au)3Sn2 phase was formed when the (Au,Ni)Sn phase reacted with the Ni UBM. The interfacial (Au,Ni)Sn IMC grew with the preferential consumption of the available δ-phase in the solder matrix. Eventually, the ζ-phase covered most of the interfacial layer. In the bump shear tests, the Au–Sn/Ni joint aged at 150 °C fractured through the bulk of the solder, confirming the mechanical reliability of the interface. In contrast, the Au–Sn/Ni joint aged at 250 °C fractured along the interface, thereby demonstrating brittle failure, possibly a result of the brittle IMC layer at the interface.
Joint reliability of immersion Ag with two different solders, Sn–37Pb and Sn–3.5Ag, were evaluated. We first compared the interfacial reactions of the two solder joints and also successfully revealed a connection between the interfacial reaction behavior and mechanical reliability. The Sn–Pb solder produced a Pb-rich phase along the interface between the solder and the Cu substrate during aging. In contrast, the Sn–Ag solder exhibits an off-eutectic reaction to produce the eutectic phase and Ag3Sn precipitate. The shear test results show that the Sn–Pb solder joint fractured along the interface showing brittle failure indications possibly due to the brittle Pb-rich layer. In contrast, the failure of Sn–Ag solder joint was only through the bulk solder, providing evidence that the interface is mechanically reliable. The results from this study confirm that the immersion Ag/Sn–Ag solder joint is mechanically robust, and thus the combination is a viable option for a Pb-free package system.
The interfacial reaction between eutectic Sn-9 wt% Zn solder and two different kinds of ball-grid-array substrates (Cu and Au/Ni electroplated Cu) during aging at 150 °C and the shear strength of the resulting joints were investigated. In the Sn-9Zn/Cu joints, only Cu5Zn8 intermetallic compound (IMC) was observed between the solder and Cu layer during the first 100 h of aging. After aging for 1000 h, the layer-type Cu5Zn8 IMC layer was disrupted at the interface, causing it to act as a channel for the diffusion of Sn. As a result, Cu6Sn5 and Cu3Sn IMCs were formed underneath the Cu5Zn8 IMC layer. This interfacial reaction significantly degraded the joint strength. In the case of the Au/Ni/Cu substrate, an AuZn3 IMC layer formed at the interface because of the fast reaction between Au and Zn. In addition, the AuZn3 IMC layer became detached from the interface during reflow. The detachment of the AuZn3 IMC layer is presumably from the mismatch in the coefficients of thermal expansion and weak adhesion between the AuZn3 IMC layer and Ni layer caused by the depletion of the Au layer. When the aging time was extended to 100 h, Ni5Zn21 IMC was observed on the Ni substrate. The shear strength of the aged Sn-9Zn/Au/Ni/Cu joint was significantly related to the detachment of the AuZn3 IMC layer. After aging at 150 °C, fracturing occurred on the detached AuZn3 IMC layer. To ensure the reliability of the Sn-Zn/Au/Ni/Cu joint, the detachment of the AuZn3 IMC needs to be prevented.
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