Kazue Shigenobu

Increased prevalence of vascular dementia in Japan A community-based epidemiological study

Background and Objective: It has been suggested that there is a major difference in the ratio of AD to vascular dementia (VaD) between Japan and Western countries. To determine the type-specific prevalence of dementia in community-dwelling elderly from the Japanese community of Nakayama, all patients with dementing illness underwent a CT scan. Methods: A door-to-door three-phase population survey was carried out on all persons aged 65 years and older residing at home on the prevalence day (January 1, 1997). The ascertainment of cases was made between January 1997 and March 1998. The study included a psychiatric interview; physical, neurologic, and neuropsychologic examinations; comprehensive laboratory tests; and cranial CT. A public health nurse also interviewed a person close to each subject. Dementia was defined according to the Diagnostic and Statistical Manual of Mental Disorders, third edition–revised, criteria, AD according to the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association, and VaD according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, combined with information from the patient’s neurologic history and CT scanning. Results: Of 1438 inhabitants, 1162 (81.0%) completed the protocol. The prevalence of dementia was 4.8%. Of the 60 subjects with dementia, 35% had AD, 47% had VaD, and 17% had dementia resulting from other causes. Conclusions: The prevalence of dementia was similar to previous reports, but, contrary to results of virtually all studies conducted in developed countries and those recently conducted in Japan, almost half of the cases in the present study appeared to have VaD with neuroradiologic confirmation.

The Stereotypy Rating Inventory for frontotemporal lobar degeneration

A many behavioral disturbances, Stereotypic behaviors are among the best discriminators of Frontotemporal Lobar Degeneration (FTLD). A recent preliminary report suggests many of the behavioral symptoms, including stereotypic behaviors in FTLD patients, respond to medication with selective serotonin re-uptake inhibitors. However, there is no scale that evaluates stereotypic behaviors comprehensively. To assess the wide range of stereotypic behaviors encountered in FTLD, we developed a new instrument, the Stereotypy Rating Inventory (SRI). The SRI assesses five distinctive stereotypic behavioral disturbances often seen in patients with FTLD: eating and cooking behaviors, roaming, speaking, movements, and daily rhythm. The SRI uses the same technique as the Neuropsychiatric Inventory (NPI) in that both the frequency and the severity of each behavior are determined. The studies reported here demonstrate the content and concurrent validity, as well as inter-rater and test-retest reliability, of the instrument. Scores of FTLD patients (n=26) on the SRI were much higher than those of patients with Alzheimers disease (n=46), patients with vascular dementia (n=26), and normal control subjects (n=40). The SRI appears to be a useful instrument for detecting stereotypic behaviors and monitoring of therapies in FTLD patients.

Efficacy of fluvoxamine as a treatment for behavioral symptoms in frontotemporal lobar degeneration patients

Patients with frontotemporal lobar degeneration (FTLD) present a profound personality change, social misconduct, overeating, and stereotyped behavior. We examined the hypothesis that many of the behavioral symptoms of FTLD will respond to selective serotonin reuptake inhibitors (SSRIs). Sixteen FTLD patients were treated with an SSRI (fluvoxamine maleate) in an open 12-week trial. Treatment responses for stereotyped behavior and other neurobehavioral symptoms were evaluated by the Stereotypy Rating Inventory and the Neuropsychiatric Inventory. The behavioral symptoms, especially stereotyped behaviors of FTLD, significantly improved after treatment. Randomized, placebo- and other SSRI-controlled trials may improve available treatments.

Alteration of rCBF in Alzheimer's disease patients with delusions of theft

We investigated the neural substrate of the delusion of theft in patients with Alzheimers disease (AD). Nine AD patients with only one type of delusion (delusions of theft) and nine age, cognitive function-matched AD patients without any type of delusions were selected from 334 consecutive outpatients of Ehime University Hospital. All subjects underwent 99mTc-HMPAO SPECT scanning, and SPECT images were analyzed by Statistical Parametric Mapping (SPM). AD patients with delusions of theft showed significant hypoperfusion in the right medial posterior parietal region compared to patients without delusions. Our data suggest that attention impairment or lack of awareness of illness caused by right parietal dysfunction might play a role in producing the delusion of theft.

Frontotemporal Lobar Degeneration: A Study in Japan

Frontotemporal lobar degeneration is the most common form of cortical dementia occurring in the presenium after Alzheimer’s disease. We analyzed two types of frontotemporal dementia (FTD) and semantic dementia (SD) selected from a consecutive series of outpatients based on neuropsychological symptoms, psychiatric symptoms and abnormal behavior. In our series of 134 patients with primary degenerative dementia, there were 16 cases of FTD and 6 cases of SD. Patients with subgroups of FTD and patients with SD were distinguishable only by the presence of aphasia in the latter group. They were not distinguishable from one another by other neuropsychological examinations, behavioral abnormalities or psychiatric symptoms assessed with the Neuropsychiatric Inventory.

Characteristics of abnormal eating behaviours in frontotemporal lobar degeneration: A cross-cultural survey

Frontotemporal lobar degeneration (FTLD) is characterised by behavioural changes, including loss of insight, disinhibition, apathy, mood changes, stereotypic behaviour and abnormal eating behaviour.1 2 Although many studies have highlighted the high prevalence of alterations in food preference and eating habits in FTLD and described loss of appetite in dementia represented by Alzheimer disease (AD),3 there have been few systematic studies comparing FTLD subgroups, or contrasting AD and FTLD.1 2 4 Eating behaviours are modulated by many factors including personal habits, ethnic culture and climate, such that alteration in eating behaviour in dementias may be confounded by ethnic or cultural factors. Food culture, meal styles and customs differ substantially between Western countries and Japan. People in the UK consume considerably more sweets, and total daily calorific intakes are higher than they are for the Japanese. (Data derived from the Food and Agriculture Organization of the United Nations; http://faostat.fao.org/.) Therefore, it is unclear whether altered eating behaviours of FTLD in Western cohorts are an entirely disease-specific effect or whether they are modulated by ethnic–cultural factors. The aims of this study were to investigate changes in eating behaviours in Japanese FTLD and AD patients and to compare the profile of abnormal eating behaviours in Japanese and Western patients using the same …

Utility of 99mTc-HM-PAO SPECT hippocampal image to diagnose early stages of Alzheimer's disease using semiquantitative analysis

Objective: Examination of the utility of 99mTc-hexamethylpropylene amine oxide (99mTc-HM-PAO) SPECT hippocampal image to diagnose early stages of Alzheimer’s disease (AD) using semiquantitative analysis. Subjects: 10 early-stage AD patients and 8 normal sex-matched elderly controls. Setting: Outpatient division of the Ehime University Hospital. Method: We performed 99mTc-HM-PAO SPECT perfusion imaging in each subject. A semiquantitative method of assessing regional variation was used. The regions of interest for temporal regions were set at images parallel to the long axis of the hippocampal formation which were reconstructed at 30Results: The regional cerebral blood flow ratio of the bilateral medial temporal lobe at the hippocampal image was significantly lower in the AD subjects than in the normally aged controls without any other differences in ordinary transaxial images. Conclusion: This study suggests that 99mTc-HM-PAO SPECT hippocampal images might be a helpful tool for the diagnosis of very-early-stage AD.

Pacing and lapping movements among institutionalized patients with dementia.

Wandering is a complex behavior, and defining wandering has been challenging. The current study used the integrated circuit (IC) tag monitoring system to describe the distance moved per day and the spatial movements of patients with dementia. The study was conducted in a 60-bed semiacute dementia care unit in a general hospital in Japan over a 3-month period in 2006. The distance moved per day, the numbers of pacing and lapping movements, and the proportions of the distance moved that was paced or lapped were tabulated in 23 patients diagnosed with dementia. The distance moved per day and the numbers of pacing and lapping movements varied greatly within and among study participants. The median distance moved per day was inversely correlated with participants’ age and Mini-Mental State Examination (MMSE) scores (adjusted r2 = .34, P = .01). Consecutive lapping and pacing movements were rare patients with in Alzheimer’s disease (AD), while 2 patients with frontotemporal dementia paced or lapped repeatedly.

Relationship between Blood Flow Kinetics and Severity of Alzheimer’s Disease: Assessment of Severity Using a Questionnaire-Type Examination, Alzheimer’s Disease Assessment Scale, Cognitive Sub-Scale (ADAScog)

We assessed hemokinetics associated with changes in Alzheimer’s disease (AD) severity in 90 AD patients by researching the relationship between AD Assessment Scale, cognitive sub-scale (ADAScog) scores and regional cerebral blood flow (rCBF). In the present study, we employed the questionnaire-type ADAScog examination to accurately assess the severity of AD. Between five groups classified on the basis of ADAScog score, significant differences were observed in parietal, lateral temporal and superior frontal rCBF. In addition, in parietal and lateral temporal regions, significant correlations were also observed between ADAScog score and rCBF. In superior frontal rCBF, significant differences were noted only between group 5 (≥40 ADAScog points) and each of the other groups; there was no significant correlation between rCBF and ADAScog score. Thus, we propose the following mechanism for blood flow kinetics associated with changed severity: In an early stage of AD, blood flow in the medial temporal cortex is impaired, and gradually involves the temporoparietal regions. While the medial temporal impairment of blood flow reaches a plateau, temporoparietal blood flow continues to be impaired well into a severe stage, at which point blood flow impairment in the frontal region is initiated.

Validity of the Short-Memory Questionnaire in vascular dementia

Purpose. To determine whether the Short‐Memory Questionnaire (SMQ) being administered by caregivers to patients with Alzheimers disease (AD) is also valid when given to patients with vascular dementia (VaD).