Mitsunori Morimatsu

Senile Degenerative Brain Lesions and Dementia

In a study of senile degenerative lesions—including Alzheimers neurofibrillary changes, senile plaques and amyloid angiopathy—the hippocampal area of the brain was examined by thioflavine T fluorescence microscopy in 146 consecutive autopsy patients over the age of 49. The incidence and quantity of neurofibrillary changes and senile plaques rose with age, and an approximate positive correlation in quantity was noted among the three kinds of degenerative change. The quantity of neurofibrillary lesions and senile plaques was significantly different between the demented and non‐demented patients, but not between the severely and less severely demented patients. The cause of dementia was studied retrospectively, based on the extent of morphologic changes in the brain, thus classifying dementia into three types: degenerative, vascular, and mixed. Clinically, the mixed type resembled the vascular type with regard to major neurologic signs, and there was some similarity to the degenerative type with regard to mental features.

Intracytoplasmic Inclusions (Bunina Bodies) in Amyotrophic Lateral Sclerosis

In an autopsy case of sporadic amyotrophic lateral sclerosis, there were intracytoplasmic eosinophilic inclusions of the Bunina type in motor neurons. Electron microscopically, these bodies were observed as amorphous substances, irregularly deposited around the endoplasmic reticulum to form masses. Similar small masses were also visible in mitochondria. These substances did not stain for acid phosphatase. By analytical electron microscopy they contained silicon. Bunina bodies, therefore, seem to be due to deposition of some metabolite, but their nature is still obscure.

INVOLVEMENT OF THE CENTRAL NERVOUS SYSTEM IN HAND-SCHÜLLER-CHRISTIAN DISEASE REPORT OF A CASE AND DISCUSSION ON THE ENTITY OF THE DISEASE–

A case of Hand‐Schüller‐Christian disease with involvement of the central nervous system is reported. In addition to the visceral and bone lesions, the central nervous system were involved by granulomatous lesions with prominent astrocytic reaction and only few deposits of doubly retractile material in the form of foam cells.

Diseases in the Elderly; Up to Date. Dementia-Causes, Diagnosis, Treatment, and Care.

The prevalence of dementia in the elderly (65 years old and over) was estimated at 6.3% (men 5.8%, women 6.7%) in Japan in 1985. Epidemiological studies done in several prefectures in 1989 and later showed a tendency for patients with Alzheimers disease (AD) to outnumber those with vascular dementia (VD); the VD/AD ratio was less than 1.0 in over half of the surveys. A pathologic study (Kosaka 1996) of 79 patients with dementia revealed that AD was more common than VD, although clinical diagnoses were the reverse, which indicated that VD is still overdiagnosed in Japan. Diffuse Lewy body disease was observed in 15% of those patients without correct clinical diagnosis. Many biological markers for AD have been reported. We used 1H-magnetic resonance spectroscopy of the brain and found that the ratio of N-acetyl aspartate to creatine in AD patients was significantly smaller than that in age-matched controls without dementia. Based on genetic studies, AD is classified into five types. These are related to chromosomes 14 (presenilin-1), 21 (βAPP gene), 1 (presenilin-2), 19 (e4 alleles), and other. The causes of most sporadic cases remain unclear. Tacrine is the only drug authorized in the U.S.A. for treatment of AD, but it is not used in Japan because of its side effects. Many other drugs to treat dementia are now in nationwide clinical trials although only four are in phase III. Therefore, rehabilitation therapy is mandatory and details of that therapy should be individualized. A new system of public insurance for nursing care may be implemented by the government.

Lumbago in the Geriatric Medical Patients

1975年から1977年までの3年間の東大老人科初診者2,284例 (50歳以上) を対象として, 腰痛の臨床的分析を行なった.(1) 腰痛患者の頻度と原因: 腰痛は受診者の26.2% (男22.6%, 女29.3%) にみられた. また腰痛を主訴としたものは6.9% (男5.2%, 女8.3%) で, いずれも女性により高頻度であった. 腰痛の原因は多い方から, 男性では変形性腰椎症, 脊椎骨粗鬆症, 脊椎辷り症, 椎間板ヘルニア, 女性では骨粗鬆症, 変形性腰椎症, 脊椎辷り症, 腰痛症の順であった.(2) 変形性腰椎症および骨粗鬆症と腰痛との関係: 腰椎単純X線写真における変形性腰椎症 (骨棘形成, 椎間腔狭小) および脊椎骨粗鬆症の程度をそれぞれ0～IIIの4段階に分け, 腰痛群と非腰痛群の間で対応する例数分布を比較した. その結果, 骨粗鬆症に関してのみ有意差がみられ, 骨粗鬆症の進展が腰痛発生により密接な関連をもつことが示された.(3) 腰椎X線写真における計測値と臨床症状との関係: X線写真において椎管椎体比 (Jones ら), 脊椎管前後径, 外側陥凹前後径を測定した. 3種の数値 (5個の腰椎の平均値として) の間にはそれぞれ有意の相関がみられた. 腰痛群と非腰痛群の比較では, 脊椎管前後径 (平均値, 最小値) が腰痛群において有意に狭小であった. 腰椎部の最小値で椎管椎体比1:5以下, 脊椎管前後径15mm以下, または外側陥凹前後径5mm以下の患者はほぼすべて腰痛群に属していた. 坐骨神経痛の有無と有意に関連する測定値は発見されなかった. 馬尾性間歇性跛行の患者は17例であったが, うち7例は椎管椎体比最小値が1:5以下であった. さらに馬尾性間歇性跛行のある患者は, 間歇性跛行のない腰痛者および非腰痛患者に比べ, 椎管椎体比 (平均値, 最小値) が有意に小さく, 椎管椎体比の計測が脊椎管狭窄症の発見に有用であることが確認された.