Keiko Koyama

Estimation of premorbid IQ in individuals with Alzheimer’s disease using Japanese ideographic script (Kanji) compound words: Japanese version of National Adult Reading Test

Abstract  The National Adult Reading Test (NART) is widely used as a measure of premorbid IQ of the English‐speaking patients with dementia. The purpose of the present study was to develop a Japanese version of the NART (JART), using 50 Japanese irregular words, all of which are Kanji (ideographic script) compound words. Reading performance based on JART and IQ as measured by the Wechsler Adult Intelligence Scale–Revised (WAIS‐R) was examined in a sample of 100 normal elderly (NE) persons and in 70 age‐, sex‐, and education‐matched patients with Alzheimer’s disease (AD). The NE group was randomly divided into the NE calculation group (n = 50) and the NE validation group (n = 50). Using the NE calculation group, a linear regression equation was obtained in which the observed full‐scale IQ (FSIQ) was regressed on the reading errors of the JART. When the regressed equation computed from the NE calculation group was applied to the NE validation group, the predicted FSIQ adequately fit the observed FSIQ (R2 = 0.78). Further, independent t‐tests showed that the JART‐predicted IQs were not significantly different between the NE and AD groups, whereas the AD group performed worse in the observed IQs. The reading ability of Kanji compound words is well‐preserved in Japanese patients with AD. The JART is a valid scale for evaluating premorbid IQ in patients with AD.

Literature Review of Pain Prevalence Among Older Residents of Nursing Homes

Pain is a common symptom among older residents of nursing homes and can lead to adverse effects such as a decrease in the activities of daily living and quality of life. Existing literature on the prevalence of pain among older residents of nursing homes was reviewed. Of the studies that were reviewed here, 27 met the criteria of this study, and these were selected for further analysis. These studies were published from 1990 to 2009. There was a slight increase in the number of studies on this topic from 2004 onwards. It was clear that older residents commonly suffer from pain and other serious problems related to pain. The prevalence of pain in these studies appeared to be related to the research methods and data sources used as well as to the time frame of pain detection. Therefore, the results of such prevalence studies should be interpreted cautiously. It was also reported that higher pain intensity led to greater limitations in the activities of daily living. Insufficient use of analgesics for treating residents with pain was often reported, particularly in residents with a low cognitive status. Health professionals should be aware of the serious issues related to pain among nursing home residents and the fundamental right to have pain assessed and treated to the greatest extent possible.

Suicide and Aging in Japan: An Examination of Treated Elderly Suicide Attempters

Although individuals aged 65 and over accounted for 12% of the total population of Japan in 1990, suicides in this age group consisted of 29% of all suicides. The elderly population of Japan is expected to grow rapidly to 24% of the total population by the year 2020, and suicide prevention for the elderly is an urgent mental health problem. Among a total of 1,216 elderly patients who were admitted to the Department of Psychiatry at Tokyo Metropolitan Geriatric Hospital between April 1980 and March 1990, 50 were hospitalized immediately after suicide attempts in order to study their psychosociomedical problems. Because early diagnosis of depression and initiation of proper treatment are indispensable--even if patients do not show obvious depressive symptoms--those who develop persistent somatization and/or delirium should be considered highly suicidal and given special attention. With the cooperation of mental health professionals, it is necessary to educate general practitioners, the public, and the elderly themselves about characteristics of psychiatric disorders and various problems associated with aging. Further research on other elderly Japanese populations, as well as research that examines suicide completion, is needed to confirm the findings of the present study.

Quantitative EEG correlates of normal aging in the elderly

To clarify the effect of normal aging on the EEG in the elderly, relative EEG power and coherence were studied in 68 elderly subjects (age range 61-90 years) as well as in 20 young subjects (age range 23-38 years). Relative beta power was significantly higher in the elderly subjects, while no significant differences were seen among the elderly groups. Therefore it may be assumed that EEG power in the centrooccipital region among the normal elderly remains almost unchanged. Also, age had no effect on interhemispheric coherence. However, intrahemispheric coherence was found to decrease with age in all bands almost linearly. Thus, intrahemispheric coherence is a more sensitive indicator of normal aging than relative power.

Suicide in Japan: Present State and Future Directions for Prevention:

There were 23,104 suicides in Japan in 1996, making the suicide rate 18.4 per 100,000, which is not much higher than those of some European countries. This paper focuses on current trends of suicide in Japan. In addition, the problem of suicide among the elderly and some characteristic forms of suicide found in Japan, such as shinju (suicide pact) and inseki-jisatsu (suicide committed in order to take responsibility) are discussed. Future strategies are also proposed for suicide prevention in Japan.

Cerebral blood volume in the sleep measured by near‐infrared spectroscopy

Abstract We investigated the relationship between hemodynamic changes in the cortex measured by near‐infrared spectroscopy (NIRS) and the polysomnographic changes during sleep. Four healthy male volunteers participated in the study. Near‐infrared spectroscopy measuring and polysomnographic recordings were done simultaneously during sleep. In many case, oxy‐hemoglobin (oxy‐Hb) decreased and deoxy‐hemoglobin (deoxy‐Hb) increased during the transition from wakefulness to sleep, and oxy‐Hb increased toward deep sleep. Oxy‐Hb and deoxy‐Hb had larger fluctuations during REM sleep than those during non‐REM sleep. During REM sleep, oxy‐Hb often showed a lower level and deoxy‐Hb showed a higher level than those during the preceding and following non‐REM sleep.

Restriction of suicide methods: A Japanese perspective

Abstract Whether legal restriction of access to methods which can be used for suicide will actually reduce the suicide rate has been an issue of debate for years. Among the various methods of suicide, those at the center of debate have been firearms, prescription psychotropic drugs, herbicides, home gas, and automobile exhaust fumes. The opinions on this debate seem to be classified into three: 1) restriction is effective, 2) the effect of restriction is limited or only temporary, 3) restriction is ineffective. This paper reviews the debate briefly and gives some of our considerations on this issue.

Donepezil-induced sleep spindle in a patient with dementia with Lewy bodies: A case report

Here, we report a case of rapid eye movement sleep behavioural disorder in an elderly patient with dementia with Lewy bodies. Pretreatment polysomnography revealed atonia during rapid eye movement sleep, absence of sleep spindles and loss of slow‐wave sleep. Administration of donepezil, an acetylcholinesterase inhibitor, markedly improved delusional symptoms and cognitive function. Pretreatment polysomnography performed after donepezil administration revealed a considerable number of sleep spindles. The effects of cholinergic modulation induced by donepezil seemed to cause remarkable improvement in mental status, incorporating associated with sleep spindles generated by the thalamocortical circuit involved in this patient.

Simultaneous recording by NIRS and VEP revealed the dominant response in left primary visual cortex

Introduction Visual evoked potential (VEP) is the response of electrical activity of neurons recorded during 0 (ETH) 300 msec after the stimulation. Functional MRI, PET and NIRS that were recently used for functional brain mapping record the hemodynamic change of the brain which occur a few seconds after the stimulation and continue for several seconds. It is very important to compare these two methodologies for combining conventional EEG studies with new findings in the brain mapping. In the present study simultaneous recording of the response of primary visual field (Vl) was done using conventional VEP and 22-channel NIRS.

Validity of Clinical Diagnosis in Age-associated Dementia.

With neuropathological diagnosis as the point of reference, the validity of clinical diagnosis was studied in 50 patients who had met DSM-III-R criteria for dementia. Clinical diagnosis of ATD (dementia of Alzheimer type) was made in 14 cases, of VD (vascular dementia) in 14 cases, of others in 5 cases and of undefined in 16 cases. At necropsy, 16 cases fulfilled the histological criteria for ATD, while 15 cases were VD, 3 cases were mixed dementia and 14 cases were other CNS disorders. In 2 other cases, the neuropathological picture was considered to be nondiagnostic. The accuracy of clinical diagnosis of VD was higher than that of ATD. Clinical diagnostic sensitivity was 81.8% for ATD and 91.7% for VD; corresponding specificity was 78.3% and 86.4%. With our clinical criteria, slowly evolving VD with no clinical evidence of stroke would not be identified as VD. On the other hand, AD patients who happened to have a stroke would be diagnosed as VD. These results suggest that further investigations as to VD (its clinical course, findings of computed tomographic scan and magnetic resonance imaging) are needed for more appropriate clinical criteria.