Journal of Movement Disorders

Sang-Myung Cheon

11 Articles

Trends in Physiotherapy Interventions and Medical Costs for Parkinson’s Disease in South Korea, 2011–2020: Dong-Woo Ryu, Jinse Park, Myung Jun Lee, Dallah Yoo, Sang-Myung Cheon; J Mov Disord. 2024;17(3):270-281. Published online March 19, 2024; DOI: https://doi.org/10.14802/jmd.23269

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Abstract PDF Supplementary Material: Objective
Physiotherapy (PT), which is an effective strategy for managing Parkinson’s disease (PD), can influence health care utilization. We analyzed trends in health care utilization, PT interventions, and medical costs among patients with PD.
Methods
Using data from the Korean National Health Insurance Service from 2011 to 2020, we analyzed the number of patients with PD and their health care utilization and assessed the odds ratio (OR) for receiving regular PTs.
Results
Over 10 years, 169,613 patients with PD were included in the analysis. The number of patients with PD increased annually from 49,417 in 2011 to 91,841 in 2020. The number of patients with PD receiving PT increased from 4,847 (9.81%) in 2011 to 13,163 (14.33%) in 2020, and the number of PT prescriptions increased from 81,220 in 2011 to 377,651 in 2019. Medical costs per patient with PD increased from 1,686 United States dollars (USD) in 2011 to 3,202 USD in 2020. The medical expenses for each patient with PD receiving PT increased from 6,582 USD in 2011 to 13,475 USD in 2020. Moreover, regular PTs were administered to 31,782 patients (18.74%) and were administered only through hospitalization. Those patients in their 50s with disabilities demonstrated a high OR for regular PTs, whereas those aged 80 years or older and residing outside of Seoul had a low OR.
Conclusion
The PD burden increased in South Korea between 2011 and 2020, as did health care utilization and medical costs. A significant increase in medical expenses can be associated with increased PD incidence and PT interventions. Regular PT applications remain restricted and have barriers to access.

Evaluating the Validity and Reliability of the Korean Version of the Scales for Outcomes in Parkinson’s Disease–Cognition: Jinse Park, Eungseok Oh, Seong-Beom Koh, In-Uk Song, Tae-Beom Ahn, Sang Jin Kim, Sang-Myung Cheon, Yoon-Joong Kim, Jin Whan Cho, Hyeo-Il Ma, Mee Young Park, Jong Sam Baik, Phil Hyu Lee, Sun Ju Chung, Jong-Min Kim, Han-Joon Kim, Young-Hee Sung, Do Young Kwon, Jae-Hyeok Lee, Jee-Young Lee, Ji Seon Kim, Ji Young Yun, Hee Jin Kim, Jin Yong Hong, Mi-Jung Kim, Jinyoung Youn, Hui-Jun Yang, Won Tae Yoon, Sooyeoun You, Kyum-Yil Kwon, Su-Yun Lee, Younsoo Kim, Hee-Tae Kim, Joong-Seok Kim, Ji-Young Kim; J Mov Disord. 2024;17(3):328-332. Published online April 3, 2024; DOI: https://doi.org/10.14802/jmd.24061

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Abstract PDF Supplementary Material: Objective
The Scales for Outcomes in Parkinson’s Disease–Cognition (SCOPA-Cog) was developed to assess cognition in patients with Parkinson’s disease (PD). In this study, we aimed to evaluate the validity and reliability of the Korean version of the SCOPACog (K-SCOPA-Cog).
Methods
We enrolled 129 PD patients with movement disorders from 31 clinics in South Korea. The original version of the SCOPA-Cog was translated into Korean using the translation-retranslation method. The test–retest method with an intraclass correlation coefficient (ICC) and Cronbach’s alpha coefficient were used to assess reliability. Spearman’s rank correlation analysis with the Montreal Cognitive Assessment-Korean version (MOCA-K) and the Korean Mini-Mental State Examination (K-MMSE) were used to assess concurrent validity.
Results
The Cronbach’s alpha coefficient was 0.797, and the ICC was 0.887. Spearman’s rank correlation analysis revealed a significant correlation with the K-MMSE and MOCA-K scores (r = 0.546 and r = 0.683, respectively).
Conclusion
Our results demonstrate that the K-SCOPA-Cog has good reliability and validity.

Validation of the Korean Version of the Scale for Outcomes in Parkinson’s Disease-Autonomic: Ji-Young Kim, In-Uk Song, Seong-Beom Koh, Tae-Beom Ahn, Sang Jin Kim, Sang-Myung Cheon, Jin Whan Cho, Yun Joong Kim, Hyeo-Il Ma, Mee-Young Park, Jong Sam Baik, Phil Hyu Lee, Sun Ju Chung, Jong-Min Kim, Han-Joon Kim, Young-Hee Sung, Do Young Kwon, Jae-Hyeok Lee, Jee-Young Lee, Ji Sun Kim, Ji Young Yun, Hee Jin Kim, Jin Young Hong, Mi-Jung Kim, Jinyoung Youn, Ji Seon Kim, Eung Seok Oh, Hui-Jun Yang, Won Tae Yoon, Sooyeoun You, Kyum-Yil Kwon, Hyung-Eun Park, Su-Yun Lee, Younsoo Kim, Hee-Tae Kim, Joong-Seok Kim; J Mov Disord. 2017;10(1):29-34. Published online January 18, 2017; DOI: https://doi.org/10.14802/jmd.16057

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Abstract PDF Supplementary Material

Objective
Autonomic symptoms are commonly observed in patients with Parkinson’s disease (PD) and often limit the activities of daily living. The Scale for Outcomes in Parkinson’s disease-Autonomic (SCOPA-AUT) was developed to evaluate and quantify autonomic symptoms in PD. The goal of this study was to translate the original SCOPA-AUT, which was written in English, into Korean and to evaluate its reliability and validity for Korean PD patients.
Methods
For the translation, the following processes were performed: forward translation, backward translation, expert review, pretest of the pre-final version and development of the final Korean version of SCOPA-AUT (K-SCOPA-AUT). In total, 127 patients with PD from 31 movement disorder clinics of university-affiliated hospitals in Korea were enrolled in this study. All patients were assessed using the K-SCOPA-AUT and other motor, non-motor, and quality of life scores. Test-retest reliability for the K-SCOPA-AUT was assessed over a time interval of 10−14 days.
Results
The internal consistency and reliability of the K-SCOPA-AUT was 0.727 as measured by the mean Cronbach’s α-coefficient. The test-retest correlation reliability was 0.859 by the Guttman split-half coefficient. The total K-SCOPA-AUT score showed a positive correlation with other non-motor symptoms [the Korean version of non-motor symptom scale (K-NMSS)], activities of daily living (Unified Parkinson’s Disease Rating Scale part II) and quality of life [the Korean version of Parkinson’s Disease Quality of Life 39 (K-PDQ39)].
Conclusion
The K-SCOPA-AUT had good reliability and validity for the assessment of autonomic dysfunction in Korean PD patients. Autonomic symptom severities were associated with many other motor and non-motor impairments and influenced quality of life.

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Comparison of disease progression between brain-predominant Parkinson's disease versus Parkinson's disease with body-involvement phenotypes
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Orthostatic Hypotension and Cognitive Impairment in De Novo Patients with Parkinson’s Disease: Hyo-Jin Bae, Jun-Ho Lim, Sang-Myung Cheon; J Mov Disord. 2014;7(2):102-104. Published online October 30, 2014; DOI: https://doi.org/10.14802/jmd.14016

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Genetics of Parkinson’s Disease - A Clinical Perspective: Sang-Myung Cheon, Lilian Chan, Daniel Kam Yin Chan, Jae Woo Kim; J Mov Disord. 2012;5(2):33-41.; DOI: https://doi.org/10.14802/jmd.12009

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Abstract PDF

Discovering genes following Medelian inheritance, such as autosomal dominant-synuclein and leucine-rich repeat kinase 2 gene, or autosomal recessive Parkin, P-TEN-induced putative kinase 1 gene and Daisuke-Junko 1 gene, has provided great insights into the pathogenesis of Parkinson’s disease (PD). Genes found to be associated with PD through investigating genetic polymorphisms or via the whole genome association studies suggest that such genes could also contribute to an increased risk of PD in the general population. Some environmental factors have been found to be associated with genetic factors in at-risk patients, further implicating the role of gene-environment interactions in sporadic PD. There may be confusion for clinicians facing rapid progresses of genetic understanding in PD. After a brief review of PD genetics, we will discuss the insight of new genetic discoveries to clinicians, the implications of ethnic differences in PD genetics and the role of genetic testing for general clinicians managing PD patients.

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Orthostatic Hypotension in Drug-Naïve Patients with Parkinson’s Disease: Hyo-Jin Bae, Sang-Myung Cheon, Jae Woo Kim; J Mov Disord. 2011;4(1):33-37.; DOI: https://doi.org/10.14802/jmd.11005

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Abstract PDF

Background and Purpose

Orthostatic hypotension (OH) is known to be present even in patients with early Parkinson’s disease (PD). To affirm the presence of OH and find correlation between OH and other dysautonomic symptoms in PD, this study has done in newly-diagnosed PD patients.

Methods

Forty-five non-demented patients with no prior history of treatment for PD were recruited (17 men, 63.8 ± 10.1 years of age). All the patients were evaluated for OH before starting medications. Autonomic symptoms were evaluated with structured questionnaires. Clinical characteristics of PD were evaluated (median Hoehn and Yahr stage 2.0 (1–3), 1.3 ± 1.1 years of disease duration), and comorbid medical conditions that could affect blood pressure were also recorded.

Results

OH was prevalent, and eighteen patients (40%) showed orthostatic hypotension, and twenty-seven (60%) did not (normotensive group). There was no significant difference in demographic and clinical characteristics between groups. The presence or severity of symptoms of autonomic dysfunction in the OH group also not differed from those of the normotensive group.

Conclusions

OH was prevalent even in the early stage of PD, and was not related to presence or severity of any other symptoms of autonomic dysfunction. Our findings suggest that clinicians should pay attention to OH from the early stage of disease.

Citations

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Orthostatic Hypotension and Cognitive Impairment in <i>De Novo</i> Patients with Parkinson’s Disease
Hyo-Jin Bae, Jun-Ho Lim, Sang-Myung Cheon
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Autonomic Dysfunctions in Parkinsonian Disorders: Hyo-Jin Bae, Sang-Myung Cheon, Jae Woo Kim; J Mov Disord. 2009;2(2):72-77.; DOI: https://doi.org/10.14802/jmd.09019

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Abstract PDF

Background and Purpose:

Symptoms of autonomic dysfunctions are common in the patients with parkinsonian disorders. Because clinical features of autonomic dysfunctions are diverse, the comprehensive evaluation is essential for the appropriate management. For the appreciation of autonomic dysfunctions and the identification of differences, patients with degenerative parkinsonisms are evaluated using structured questionnaire for autonomic dysfunction (ADQ).

Methods:

Total 259 patients, including 192 patients with [idiopathic Parkinson’s disease (IPD, age 64.6 ± 9.6 years)], 37 with [multiple system atrophy (MSA, 62.8 ± 9.1)], 9 with [dementia with Lewy body (DLB, 73.9 ± 4.3)], and 21 with [progressive supranuclear palsy (PSP, 69.4 ± 9.6)]. The ADQ was structured for evaluation of the presence of symptoms and its severity due to autonomic dysfunction, covering gastrointestinal, urinary, sexual, cardiovascular and thermoregulatory domains. Patients were also evaluated for the orthostatic hypotension.

Results:

Although dementia with Lewy body (DLB) patients were oldest and duration of disease was longest in IPD, total ADQ scores of MSA and PSP (23.9 ± 12.6 and 21.1 ± 7.8) were significantly increased than that of IPD (15.1 ± 10.6). Urinary and cardiovascular symptom scores of MSA and gastrointestinal symptom score of PSP were significantly worse than those of IPD. The ratio of patient with orthostatic hypotension in IPD was 31.2% and not differed between groups (35.1% in MSA, 33.3% in DLB and 33.3% in PSP). But the systolic blood pressure dropped drastically after standing in patients with MSA and DLB than in patients with IPD and PSP.

Conclusions:

Patients with degenerative parkinsonism showed widespread symptoms of autonomic dysfunctions. The severity of those symptoms in patients with PSP were comparing to that of MSA patients and worse than that of IPD.

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The Correlation of ON and OFF Status With Clinical Characteristics in Patients With Parkinson’s Disease: Jung-Hwa Seo, Sang-Myung Cheon, Jae Woo Kim; J Mov Disord. 2008;1(2):65-70.; DOI: https://doi.org/10.14802/jmd.08012

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Abstract PDF: Background:
Status of the disease is the one of main concerns of clinicians, especially in the course of primary degenerative disorders. In Parkinson’s disease (PD), Unified Parkinson’s Disease Rating Scale (UPDRS) is an useful clinical score that can express severity of parkinsonian symptoms, but L-DOPA treatment and motor fluctuations can change the UPDRS scores. Even in the best ‘on’ state, there can be residual motor deficits, and it is very difficult to estimate the worst ‘off’ state due to long duration effect of L-DOPA.
Objective:
To find relevant examination scores of ‘on’ or ‘off’ state of PD patients which correlates with clinical and demographic variables those can represents the status of Parkinson’s disease.
Methods:
Sixty-four patients with PD (24 male, age 63.0±8.6 years, Hoehn and Yahr stage (HY) 2.8±0.5) were examined UPDRS at ‘on’ and practically defined ‘off’ (12 hours after last medication) state. We evaluated the association between the ‘on’ and ‘off’ scores of UPDRS and duration of disease and treatment, and equivalent L-DOPA dose of the patients. Patients were grouped according to the presence of motor fluctuation to find the differences in those associations.
Results:
There were significantly strong correlations between UPDRS ‘off’ scores and clinical variables such as duration of disease and treatment. In ‘on’ state, only complication part of UPDRS was correlated with duration of disease and treatment, but activity of daily living (ADL) and motor part of UPDRS were correlated well with age of the patients. Age at disease onset showed significant negative association with the difference between ‘off’ and ‘on’ state UPDRS scores. Thirty-one patients who had motor fluctuation (9 male, age 62.7±9.3 years, HY 3.0±0.6) showed significantly increased duration of the disease, duration of L-DOPA treatment and equivalent DOPA dose compared to those of 33 patients without motor fluctuation (15 male, age 63.3±8.1 years, HY 2.6±0.3). In patients without motor fluctuation, both ‘off’ and ‘on’ UPDRS showed association with duration of disease and treatment, but ‘off’ and ‘off’ – ‘on’ difference of UPDRS were better correlated with duration of disease and treatment in patients with motor fluctuation.
Conclusion:
We found that the UPDRS scores of practically defined ‘off’ state significantly correlated with the duration of the disease and treatment. Patients with motor fluctuation revealed better responsiveness to medication than those without motor fluctuation. In patients without motor fluctuation, UPDRS scores of ‘on’ state can reflect the clinical presentation as much as those of ‘off’ state.

Mild Cognitive Impairment in Parkinson’s Disease: Jae Woo Kim, Hee Young Jo, Min Jeong Park, Sang-Myung Cheon; J Mov Disord. 2008;1(1):19-25.; DOI: https://doi.org/10.14802/jmd.08004

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Abstract PDF

Background

To determine the frequency of mild cognitive impairment (MCI) of Parkinson’s disease (PD, PDMCI) and its subtypes among non-demented PD patients, and to identify the influence of the age and presenting symptom on the development of PDMCI.

Methods:

A total 141 non-demented PD patients underwent a comprehensive neuropsychological assessment including attention, language, visuospatial, memory and frontal functions. PDMCI was defined by neuropsychological testing and was classified into five subtypes. Patients were divided into two groups (tremor vs. akinetic-rigid type) for presenting symptom and three groups according to the age. Neuropsychological performance of patients was compared with normative data.

Results:

Almost half (49.6%) of non-demented PD patients had impairment in at least one domain and can be considered as having PDMCI. Executive type of PDMCI was the most frequent and amnestic, visuospatial, linguistic and attention types followed in the order of frequency. The population of PDMCI was increasing as the age of disease onset was higher. Whereas the frequency of executive and amnestic types of PDMCI was comparable in younger group, executive type was the most frequent in older group. The patients with tremor dominant type performed worse on tests, particularly on attention test.

Conclusions:

MCI was common even in the early stage of PD and the subtype was diverse. Unlike MCI developing Alzheimer’s disease later, executive type of PDMCI was the most common. Age was an important risk factor for development of MCI in PD. The concept of MCI should be introduced in PD.

Citations

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Orthostatic Hypotension and Cognitive Impairment in <i>De Novo</i> Patients with Parkinson’s Disease
Hyo-Jin Bae, Jun-Ho Lim, Sang-Myung Cheon
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Correlated regions of cerebral blood flow with clinical parameters in Parkinson’s disease; comparison using ‘Anatomy’ and ‘Talairach Daemon’ software
Hyun Jin Yoon, Sang Myung Cheon, Young Jin Jeong, Do-Young Kang
Annals of Nuclear Medicine.2012; 26(2): 164. CrossRef
Correlation between neuropsychological tests and hypoperfusion in MCI patients: anatomical labeling using xjView and Talairach Daemon Software
Hyun Jin Yoon, Kyung Won Park, Young Jin Jeong, Do-Young Kang
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Significant correlation between cerebral hypoperfusion and neuropsychological assessment scores of patients with mild cognitive impairment
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Utility and Limitations of Addenbrooke’s Cognitive Examination-Revised for Detecting Mild Cognitive Impairment in Parkinson’s Disease
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Dementia and Geriatric Cognitive Disorders.2011; 31(5): 349. CrossRef
Characterizing mild cognitive impairment in Parkinson's disease
John C. Dalrymple‐Alford, Leslie Livingston, Michael R. MacAskill, Charlotte Graham, Tracy R. Melzer, Richard J. Porter, Richard Watts, Tim J. Anderson
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Comparison of Impact of Various Exercise Modalities on Parkinson’s Disease: Jinse Park, Sang-Myung Cheon, Myung Jun Lee, Dong-Woo Rhu, Dallah Yoo; Received February 13, 2025 Accepted April 15, 2025 Published online April 15, 2025; DOI: https://doi.org/10.14802/jmd.25038 [Accepted]

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Abstract PDF: Background and Purpose
Exercise is a critical non-pharmacological intervention for Parkinson’s disease (PD); however, comparative evidence on the efficacy of different exercise modalities is limited. This study aimed to compare the effects of tai chi, strength training, yoga, and home-based exercises on motor in patients with Parkinson’s disease (PD).
Subject and Methods
In this multicenter, open-label, randomized clinical trial, 99 patients with PD were allocated to one of four exercise interventions: tai chi, strength training, yoga, or home-based exercises. Each intervention consisted of 12 weeks of supervised sessions, followed by 12 weeks of independent practice. The primary outcomes included the MDS-UPDRS Part III and timed up-and-go (TUG) test parameters. The secondary outcomes assessed included physical activity (SPPB and 6 MWT), balance (Mini-BEST), and freezing of gait (NFOGQ).
Results
Home exercise and tai chi demonstrated significant improvements in the MDS-UPDRS Part III scores over 24 weeks. 6 minutes walking test was improved by home exercises, tai chi, and MiniBest was enhanced by strength exercises and yoga. The total duration and forward movement of TUG and turning duration measuring by wearable sensor were markedly improved in yoga group.
Conclusion
Our results support that various in adherence and outcomes of exercise have been observed in real-world setting even though effectiveness of exercise is well established. These findings highlighted the importance of tailoring exercise regimens considering individual patients in PD management

Factors associated with response to exercise in patients with Parkinson's disease: Myung Jun Lee, Jinse Park, Dong-Woo Ryu, Dallah Yoo, Sang-Myung Cheon; Received March 17, 2025 Accepted May 16, 2025 Published online May 16, 2025; DOI: https://doi.org/10.14802/jmd.25068 [Accepted]

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Abstract PDF: Introduction
Exercises have been proposed as adjuvants for the treatment of Parkinson's disease (PD); however, responses to exercise interventions have shown inconsistent results. We investigated clinical factors associated with improvements in motor deficits after exercise.
Methods
85 PD patients were enrolled from five tertiary hospitals and classified into four exercise groups: home exercises, strength training, Tai Chi, and yoga. Clinical measurements of the motor and non-motor features of PD were assessed at baseline and 12 weeks after the exercise intervention. We employed principal component analysis (PCA) to reduce variables into ten factors and then examined associations of baseline characteristics with percentage improvement in the Movement Disorder Society Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) using the Bayesian regression model.
Results
In the multivariate Bayesian regression model including ten PCA-driven factors, the percentage improvement of the MDS-UPDRS III was associated with factors including prominent motor deficits (posterior interval; mean ± SD, – 3.9 ± 1.7) and non-motor symptoms such as depression, anxiety, and subjective memory impairment (2.5 ± 1.5). Another factor related to functional impairments in gait and postural control was associated with less improvement after the exercise intervention (3.3 ± 1.7). In the subgroup analyses, motor features were associated with improvement in the home exercise and strength training groups, whereas mood disturbance, fatigue, and subjective cognitive impairment were related to changes in the home exercise and Tai Chi groups.
Conclusions
Our results suggest that individual phenotypes of PD patients may be associated with clinical improvement following exercise.

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