Hidetomo Murakami

Increase in hepatic mRNA expression of coagulant factors in type 2 diabetic model mice

AIM The purpose of the study is to investigate whether hypercoagulation in diabetes is observed not only in increased plasma levels of the coagulative factors but also in increased hepatic mRNA levels. MATERIALS AND METHODS The age-related changes of coagulation factors were determined using KK and KK-A(y) mice as a model for human type 2 diabetes mellitus. Expression of the alpha-, beta- and gamma-chains of fibrinogen-mRNA and prothrombin-mRNA from the mouse liver was examined by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS Hemoglobin A(1c) (HbA(1C)), plasma fibrinogen, triglyceride and insulin levels increased apparently, especially in KK-A(y) mouse at 4 months old. The mRNA levels of gamma-chain of fibrinogen significantly increased at 3 and 4 months of age in both mice. The mRNA levels of alpha- and beta-chains of fibrinogen and prothrombin were significantly increased in 4-month-old KK-A(y) mouse. CONCLUSIONS These results suggest that the increase in hepatic mRNA expression of coagulant factors contributes to the hypercoagulable state in type 2 diabetic mice.

Correlation between motor and cognitive functions in the progressive course of Parkinson's disease

Correlations between motor function and frontal‐executive function in Parkinsons disease (PD) have been examined previously, but correlations with other cognitive domains remain unknown. We examined the correlation between motor dysfunction and cognitive impairment with regard to their precise domains.

Writing Error May Be a Predictive Sign for Impending Brain Atrophy Progression in Amyotrophic Lateral Sclerosis: A Preliminary Study Using X-Ray Computed Tomography

Aim: To investigate whether writing errors are predictive of longitudinal brain atrophy progression in patients with amyotrophic lateral sclerosis (ALS). Methods: The frequency of writing errors in 6 ALS patients without dementia was compared with longitudinal changes in lateral ventricular areas of the bilateral anterior and inferior horns on X-ray computed tomography scans. The increase in area per month for the anterior and inferior horns was used as a measure of longitudinal brain atrophy progression, and was calculated as: (area on the initial scan – area on the follow-up scan)/scan interval (month). Results: The longitudinal rate of increase in the area of the anterior horns showed significant associations with the rates of total writing errors (r = 0.886, p = 0.0152), kana errors (r = 0.887, p = 0.0148) and kana omission (r = 0.856, p = 0.0268), whereas that for the inferior horns size showed no significant association with any writing errors. Conclusion: The increased area of the anterior horns indicates frontal-lobar atrophy, and writing errors may be a predictive sign for impending brain atrophy progression in the frontal lobes, which reflects the development of anterior-type dementia.

Cerebral Microbleeds and Dilative Remodeling of the Basilar Artery: A Magnetic Resonance Imaging Study

This study was conducted to examine the relationship between cerebral microbleeds (CMBs), one of the manifestations of small-vessel diseases (SVDs), and basilar artery (BA) dilatation on magnetic resonance imaging (MRI). Clinical information and MRI images were reviewed for 149 outpatients aged 46-90 years, excluding those who had a previous symptomatic cerebrovascular event. CMBs were evaluated on T2∗-weighted MRI, and BA diameters were measured as the maximal width of the flow void on axial T2-weighted MRI to assess dilatation. Patients were divided into 2 groups, with CMBs and without CMBs, and clinical information and BA diameters were compared between the groups. Regression analyses of the data also were performed. The 2 groups had significant differences in mean blood pressure (MBP), low-density lipoprotein (LDL) and uricemic acid levels, and BA diameter. Adjusted logistic regression analysis showed that MBP (odds ratio [OR], 1.059 per 1 mm Hg; 95% confidence interval [CI], 1.019-1.101; P = .0035), LDL (OR, 0.976 per 1 mg/dL; 95% CI, 0.960-0.994; P = .0072), and BA diameter (OR, 3.266 per 1 mm; 95% CI, 1.504-7.103; P = .0028) each had an independent association with the presence of CMB. Adjusted multiple regression analysis showed that only BA diameter (β coefficient, 0.240; 95% CI, 0.775-3.734; P = .0031) was independently associated with the number of CMBs. Our data indicate that CMB, a manifestation of SVD, shows a strong association with BA dilatation.

perceiving "ghost" images: a unique case of visual allesthesia with hemianopsia in mitochondrial disease

A 49-year-old man with mitochondrial disease presented with visual allesthesia, a rare and puzzling phenomenon. He was admitted for treatment because of convulsions. After the convulsions ceased, he exhibited left homonymous hemianopsia. Brain diffusion-weighted magnetic resonance imaging (MRI) showed a high-intensity area in the right occipital lobe. Both the hemianopsia and the MRI activation in this area disappeared by day 36 of hospitalization. On the morning of day 57, right homonymous hemianopsia emerged in a singular manner. The patient perceived an illusory object (a bottle placed by the bedside) in his left visual field, while the real object was in his blind right field. This case of visual allesthesia was accompanied by palinopsia, ie, perseveration of the image of the bottle. Diffusion-weighted MRI showed a new, high-intensity area in the left occipital lobe. We believe the visual allesthesia resulted from transfer of cortical information obtained by blindsight between hemispheres as a result of epileptic excitation.

The Montreal Cognitive Assessment and Neurobehavioral Cognitive Status Examination are useful for screening mild cognitive impairment in Japanese patients with Parkinson's disease

Diagnosis of mild cognitive impairment (MCI) in Parkinsons disease (PD; PD‐MCI) can be difficult. We examined whether the Japanese version of the Montreal Cognitive Assessment (MoCA‐J) and the Neurobehavioral Cognitive Status Examination (COGNISTAT‐J) were suitable to screen PD‐MCI.

Emotion recognition from stimuli in different sensory modalities in post-encephalitic patients.

Emotion recognition from facial and non-facial stimuli was investigated in two post-encephalitic patients a few months after the onset of the disease. One patient who had a lesion relatively restricted to the amygdala and hippocampus experienced difficulty in recognizing fear from facial expressions. In contrast, the other patient who had a lesion that extended beyond the amygdala experienced difficulty in recognizing fear from non-facial (prosodic and written verbal) stimuli. We showed that impairment of emotion recognition was evident within a short duration after encephalitis and that recognizing emotion from different sensory modalities relies partly on integration of different neural systems.

Modified Six Elements Test: Earlier diagnosis of the correlation between motor and executive dysfunction in Parkinson's disease without dementia

In patients with Parkinsons disease, executive deficits are known to correlate with motor dysfunctions, such as gait and postural instability. However executive deficits are sometimes difficult to detect using common frontal assessment batteries. Behavioral Assessment of Dysexecutive Syndrome includes six subtests to evaluate different aspects of executive function required in daily life. Among these the Modified Six Elements Test examines higher levels of executive function with regard to prospective memory and organization of behavior.

Self-Rated Anosognosia Score May Be a Sensitive and Predictive Indicator for Progressive Brain Atrophy in Amyotrophic Lateral Sclerosis: An X-Ray Computed Tomographic Study

We investigated whether a self-rated anosognosia score can be an indicator for progression of brain atrophy in patients with amyotrophic lateral sclerosis (ALS). Scores for 16 patients were compared with the ventricular areas of the bilateral anterior and inferior horns measured on x-ray computed tomography. Longitudinal enlargement was expressed as a monthly increase in size: (ventricular size at the initial scan – ventricular size at the follow-up scan)/scan interval (months). The anosognosia scores ranged from –4 to 3 and 3–18 in patients with and without frontotemporal lobar degeneration (FTLD), respectively (p = 0.0011). Anosognosia scores were significantly correlated with sizes of anterior (r = 0.704, p = 0.0016) and inferior (r = 0.898, p < 0.0001) horns. In non-demented patients for whom follow-up CT scans were available (n = 7), the scores were significantly correlated with the longitudinal increase in inferior horn size (r = 0.754, p = 0.0496), but not with that of anterior horn size (r = –0.166, p = 0.7111). In conclusion, anosognosia in ALS is associated with greater anterior and inferior horn sizes, reflecting frontotemporal lobar atrophy. Moreover, mild anosognosia in ALS patients without FTLD may predict impending inferior horn enlargement, reflecting medial temporal atrophy.

Accumulation of 123I-Ioflupane Is a Useful Marker of the Efficacy of Selegiline Monotherapy in Drug-Naïve Parkinson’s Disease

Background: Selegiline enhances the patient’s endogenous dopamine by inhibiting dopamine metabolism. The efficacy of selegiline monotherapy for drug-naïve Parkinson’s disease (PD) patients may depend on the degree of dopaminergic neuronal degeneration. 123I-Ioflupane single photon emission computed tomography (SPECT) and 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy are diagnostic methods to assess the pharmacological and pathological changes in PD. Objective: We examined the utility of these imaging methods to predict the efficacy of selegiline monotherapy for motor symptoms in drug-naïve PD patients. Methods: We observed the efficacy of selegiline monotherapy in 28 drug-naïve PD patients and compared the improvement in motor function and the imaging findings. These patients received selegiline monotherapy, and the amount was increased to the optimal dose in clinical practice. Motor function was assessed using the Unified Parkinson’s Rating Scale (UPDRS) at baseline and at the stable dose. Imaging was performed before treatment, and the striatal Specific Binding Ratio (SBR) of the 123I-Ioflupane SPECT and the Heart-to-Mediastinum (H/M) ratio of the 123I-MIBG myocardial scintigraphy were calculated. Both ratios were compared with improvements in scores for motor assessment using Pearson’s correlation coefficient. Results: The mean UPDRS part III score significantly improved with at least 5.0 mg/day of selegiline. Further dose escalation did not improve the mean motor score. The percent improvement in the motor score from baseline showed a significant negative correlation with the SBR of average of the right and left striatum, but not with the H/M ratio. Multiple regression analysis using patient’s background factors showed that percent improvement in the UPDRS part III score directly correlate with the SBR (p = 0.04), but not with the age (p = 0.72), disease duration (p = 0.31), baseline UPDRS part III (p = 0.77) and the drug dose (p = 0.26). Conclusion: PD patients with a lower accumulation of 123I-Ioflupane in the striatum can have greater improvement with selegiline monotherapy.