Hiroo Kasahara

Association between executive dysfunction and hippocampal volume in Alzheimer's disease

BACKGROUND Some previous research has hypothesized that executive dysfunction in patients with early Alzheimers disease (AD) occurs as a result of a disconnection between different cerebral areas. The aim of the present study was to evaluate how the hippocampal volume influences executive function as a non-memory cognitive function. METHODS From 157 consecutive patients with AD or amnestic mild cognitive impairment (A-MCI), we recruited 107 subjects who had a global Clinical Dementia Rating (CDR) of 0.5 or 1.0 and whose degree of hippocampal atrophy had been measured using magnetic resonance imaging (MRI); the severity of atrophy was assessed using the voxel-based specific regional analysis for Alzheimers disease (VSRAD) system. We divided the subjects into three groups: mild atrophy, 0 < Z-score < 1.0 (N = 21); moderate atrophy, 1.0 ≤ Z-score < 2.0 (N = 46); or severe atrophy, 2.0 ≤ Z-score < 4.0 (N = 40) according to the Z-score and compared the Frontal Assessment Battery (FAB) and its subtest scores between each atrophy group. RESULTS The results demonstrated that age, sex ratio, duration of illness, education years, MMSE score, Behave-AD score, and proportion of atrophy area in total brain (%) were not significantly different among the three groups. Only the go/no-go score among the six subtests was significantly lower for increasing atrophy severity (P < 0.05). Furthermore, hippocampal atrophy significantly influenced the go/no-go score independently of interactions from whether the diagnosis was early AD or A-MCI (P < 0.05). CONCLUSION These results support a significant association between hippocampal atrophy and executive dysfunction as a non-memory cognitive impairment in patients with early AD and A-MCI.

Correlation between a reduction in Frontal Assessment Battery scores and delusional thoughts in patients with Alzheimer's disease

Aims:  The purpose of the present study was to investigate the relationship between delusional thoughts (delusional ideation or misidentification) and frontal lobe function using the Japanese version of the Frontal Assessment Battery (FAB) bedside screening neuropsychological test in early stage Alzheimers disease (AD) patients.

Consideration of the relationship between depression and dementia

The literature was reviewed with regard to the relationship between Alzheimer’s dementia (AD) and depression. Then comparison was made of the case for depression as a precursor symptom of AD versus the case for depression as the initial symptom of AD. We also discussed such points as the coexistence of depression and AD, pseudodementia, etc. Finally, we postulated that the relationship between AD and depression shows a spectrum, and on that basis we attempted to define six clinical patterns.

Association between brain-derived neurotrophic factor (BDNF) gene polymorphisms and executive function in Japanese patients with Alzheimer's disease

Background:  To address the functional roles of genetic polymorphisms of brain‐derived neurotrophic factor (BDNF) in Alzheimers disease (AD) from a neuropsychological aspect, we used a cross‐sectional study design to investigate the association between novel single nucleotide polymorphisms (SNPs) of the BDNF gene (Val66Met (G196A) and C270T) and the Frontal Assessment Battery (FAB) score, which reflects executive function as a non‐memory cognitive impairment.

Differentiation between amnestic-mild cognitive impairment and early-stage Alzheimer's disease using the Frontal Assessment Battery test

Background:  Previous research has described the executive dysfunction that occurs in patients with amnestic‐mild cognitive impairments (A‐MCI) and early‐stage Alzheimers disease (EAD), which are comparatively similar stages of dementia. The aim of the present cross‐sectional study is to evaluate executive dysfunction using the Frontal Assessment Battery (FAB) screening test in two groups and to investigate the interaction with other cognitive impairments.

Alcohol dementia and alcohol delirium in aged alcoholics.

Abstract In the present study, 126 alcoholics aged 60 years or older were compared with 104 alcoholics aged 35–45 years. No dementia was found in the younger group, whereas 62.7% of the aged patients had dementia; the dementia being irreversible in 32.9% of such patients. Cases of so‐called alcohol dementia excluding organic brain diseases accounted for 42.1%. The percentage of aged alcoholics having dementia increased with age, being far beyond the frequency of senile dementia in the general aged. Among various physical complications, hepatic injury and myocardiopathy were more frequent in the aged alcoholics than in general aged people, suggesting that hypertension, myocardiopathy and hepatic injury underlie the manifestation of dementia. There was no case of dementia attributable to the direct effect of alcohol distinctly exceeding the effects of various physical factors. Problem behaviors characteristic of the aged group included ‘being soaked in drink’ and being inebriated, showing no correlation with the presence or absence of dementia. There was no significant difference in frequency of delirium between the aged group and the younger group. However, in aged alcoholics delirium tended to continue for a longer period during abstinence and was more likely to occur even during non‐abstinence. A similar trend was found in aged alcoholics with dementia compared with those without dementia.

Effectiveness of carbamazepine for benzodiazepine-resistant impulsive aggression in a patient with frontal infarctions.

Abstract  Anticonvulsants have been used for the treatment of impulsive aggression since the 1980s. A 50‐year‐old man suffered from irritability and agitation after developing a right ipsilateral frontal lobe infarction as a result of Moyamoya disease; these symptoms caused difficulties with his working and interpersonal relationships. The patient had been treated using multiple benzodiazepine agents for 2 years but his symptoms had not improved. However, after treatment with carbamazepine (CBZ; 200 mg) was begun, the patients irritability and agitation gradually decreased. The efficacy of CBZ treatment in this patient suggests a method for controlling benzodiazepine‐resistant impulsive aggression.

Hemodialysis for lithium intoxication: preliminary guidelines for emergency

Abstract: In Japan, 9 cases of severe lithium intoxication have been treated by hemodialysis so far, and the usefulness and indications of this procedure are not yet understood fully. We have recently experienced a case of lithium intoxication treated by hemodialysis. Considering this case together with those reported previously, we have prepared some preliminary guidelines for the application of hemodialysis to patients with lithium intoxication. The blood concentration of lithium, renal function, the severity of consciousness disturbance and clinical symptoms such as somatic complications are, of course, important indices for the application of this therapy. We think that the signs of intoxication and the time interval between the onset and the beginning of treatment also serve as useful indices for application of hemodialysis.

Perspectives on phantom boarder symptom

Phantom boarder symptom (PBS) is a hallucinatory and delusional syndrome that tends to occur in the elderly, in which the patient imagines that someone uninvited is living in their home. This article provides an overview of the historical background that has led to the current focus on PBS as a single symptom, from its classification as late paraphrenia to its being recognized as a type of misidentification, and discusses classification problems and PBS subclassifications. In addition, the results of our own investigation of PBS, which focused on PBS in senile dementia, support the findings of previous studies, such as the absence of a relationship between dementia severity and the occurrence of delusion. The discussion therefore focuses on the psychosocial factors that serve as the mechanism of PBS onset, and directions and possibilities for therapy are suggested.

Psychological distress of family members with cancer patients in Japan.

BACKGROUND: There were no previous studies in Japan on the psychological distress of members of families with cancer patients which focussed on the disclosure of the diagnosis of cancer. This study was designed to investigate factors that may have an effect on the psychological distress of family members. METHODS: The subjects were 95 members of families of cancer patients in the surgical ward; one member was recruited from each patients family. The psychiatrist investigated the demographic factors of both the patient and the family member: for the patient - gender, age, occupation, cancer site, disclosure (or not) of cancer diagnosis, cancer stage and performance status (PS); for the family member - gender, age, occupation, relationship to the patient, physical illness, frequency of visiting the ward, the period from when the family member was informed of the diagnosis, and any past experience of the loss of close relatives due to cancer. Furthermore, we conducted a survey on the family members anxiety and depression by using the Spielberger State - Trait Anxiety Inventory (STAI) and the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: A multiple regression analysis indicated that the factors which were associated with the STAI scores independently were the lack of disclosure of the diagnosis to the patient (P=0.01), and advanced or recurrent cancer (P=0.01). The factors which were associated with the CES-D scores independently were the lack of disclosure of the diagnosis to the patient (P=0.03), advanced or recurrent cancer (P=0.01), and the family members past history of psychiatric disorders (P=0.01). CONCLUSIONS: The results suggested that the psychological distress of a family member increases when the patient is not informed of the cancer diagnosis, when the cancer is advanced or recurrent, and when the family member has a past history of psychiatric disorders. (Int J Psych Clin Pract 2002; 6: 205-210 )