Katsuyuki Ukai

Effects of Mild Cognitive Impairment on Driving Performance in Older Drivers

older adult goes back to the concept of frailty. The greater the severity of the infection, the greater the risk of functional decline, but it can also be inferred that the greater the functional decline the greater the frailty (functional status can be evaluated as a risk factor for infectious disease or as an outcome of interest after specific interventions using well-validated instruments). When an acute disease such as infection produces a functional impairment, this condition becomes an index of outcome and should be detected to predict poor clinical course.

A case of dementia with Lewy bodies that temporarily showed symptoms similar to Creutzfeldt–Jakob disease

We discuss a case of a 67‐year‐old male with dementia with Lewy bodies (DLB) that was initially suspected as Creutzfeldt–Jakob disease (CJD) or another type of encephalopathy, because he showed rapidly progressive deterioration, myoclonus, gait disturbance and a decline in activities of daily living. The present study describes a clinically atypical case with probable DLB and reviews similar cases in the literature, and we propose a rapidly progressive clinical subtype of DLB.

Physical complications of dementia : 12 months research in a special ward for the elderly with senile dementia

Background:  The Imaise Branch of Ichinomiya City Hospital proactively accepts patients with behavioral and psychological symptoms of dementia (BPSD). In cases with serious physical complications, we treat them in cooperation with other medical departments. We investigated the physical complications in our Special Ward for Elderly with Senile Dementia (WED) to determine the need to treat them for dementia.

Diffuse neurofibrillary tangles with calcification (Kosaka–Shibayama disease) in Japan

Diffuse neurofibrillary tangles with calcification (DNTC) is a rare, pre‐senile type of dementia. The term ‘DNTC’ was initially proposed by Kosaka in 1994. Although 26 autopsies and 21 clinical patients with DNTC have been described in Japan to date, DNTC has rarely been reported in the European and North American published work. We speculate that DNTC has been overlooked in other countries. Herein, we review all known reports of DNTC in Japan and propose clinical diagnostic criteria for DNTC.

Long-term efficacy of donepezil for relapse of visual hallucinations in patients with dementia with Lewy bodies

The use of cholinesterase inhibitors is recommended for the treatment of dementia with Lewy bodies (DLB) in the guidelines of the DLB Consortium. However, no consensus regarding therapeutic approaches for DLB‐related visual hallucinations has been reached. To the best of our knowledge, an appropriate dose of donepezil for the treatment of DLB at each stage has not been discussed.

Physical complications for elderly inpatients with senile dementia in the Imaise Branch of Ichinomiya City Hospital

Background:  In the present study, we investigated the physical complications of elderly patients with senile dementia in the Department of Psychogeriatrics, Imaise Branch, Ichinomiya City Hospital.

Effectiveness of low‐dose pregabalin in three patients with Lewy body disease and central neuropathic pain

Many patients with Lewy body disease complain of pain, and their pain may be associated with this disease. Recently, pain has become a focus of attention in Parkinsons disease, but there is little information regarding pain in patients who have dementia with Lewy bodies. We used pregabalin to treat three Lewy body disease patients with chronic pain that may have been related to degeneration of central neurons. All three patients responded well to pregabalin at 25–50 mg/day. To our knowledge, there have been no previous reports of pregabalin showing efficacy for central neuropathic pain in Parkinsons disease or Lewy body disease.

Similarity of symptoms between transient epileptic amnesia and Lewy body disease

Epilepsy with the main symptom of amnesia is known as transient epileptic amnesia (TEA). Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia. The concept that Lewy body disease includes Parkinsons disease with dementia and dementia with Lewy bodies was proposed in the 2005 revision of the Clinical Diagnostic Criteria. Here, we describe a woman with cognitive impairment, olfactory dysfunction, and reduced 123I‐meta‐iodobenzylguanidine uptake on myocardial scintigraphy. The patient and her family and friends were unaware of parkinsonism, visual hallucinations, or epilepsy for a long period. After syncope occurred twice within a short interval, electroencephalography revealed sharp waves from the bilateral frontal to parietal lobes, indicating a diagnosis of TEA. The present case prompted us to compare the symptoms of TEA with the clinical diagnostic criteria for dementia with Lewy bodies, revealing their similarities. We also discuss whether Lewy body disease may cause TEA rather than having an incidental association with it.

Effectiveness of low-dose milnacipran for a patient suffering from pain disorder with delusional disorder (somatic type) in the orofacial region.

Glossodynia is chronic pain localized around the tongue, with no perceivable organic abnormalities. In the fields of oral and maxillofacial surgery, it is categorized as an oral psychosomatic disease. In contrast, psychiatric nosology classifies glossodynia as a pain disorder among somatoform disorders, per the DSM‐IV. The patient was a 71‐year‐old woman who developed symptoms of glossodynia, specifically a sore tongue. In the decade before she presented to us, she had had bizarre symptoms of oral cenesthopathy such as the sensation that her teeth had become ‘limp and floppy’ and that she needles in her mouth. Treatment was attempted using several psychotropic drugs, but no satisfactory response was noted. Because the patient was referred to our outpatient clinic, we tried psychotropic therapy again. Additionally, valproic acid, tandospirone and sertraline were administered (in this order), but the patient still showed no response. However, when sertraline was changed to milnacipran, all symptoms disappeared in a short period. We suggest that a small dose of milnacipran can be effective for controlling oral cenesthopathy as well as glossodynia.

Distribution of neurofibrillary tangles in diffuse neurofibrillary tangles with calcification

Aims:  In this study, the appearance and distribution of neurofibrillary tangles (NFT) in diffuse neurofibrillary tangles with calcification (DNTC) were investigated neuropathologically in order to elucidate the detailed distribution pattern in this disease.