Raita Fukasawa

Elevated inflammatory markers in diabetes‐related dementia

the questionnaire, of which 132 (63.5%) are aged less that 65 years and 76 (36.5%) where aged 65 years or older. No significant differences were found between age groups, level of education, family history of dementia and immigration status. Both sexes performed poorly on question 1 (females 24%; males 22%, χ = 0.95, P = 0.759). However, in question 2, both sexes recognized symptoms of dementia (females 64%; males 75%, χ = 2.27, P = 0.132). Albeit in question 3, men were more informed on dementia prognosis (females 32%; males 50%, χ = 5.62, P = 0.017). Our survey shows that males and females recognize symptoms of dementia, but continue to exhibit the misconception that dementia is a natural process of aging, which is consistent with those found in prior research. Also worrisome is that women seem to know less about the prognosis of dementia than men. This could be related to Asian–American females creating stronger social support; that they are more likely than men to serve as caregivers to those with dementia. Prior studies have shown, even without education as a confounding factor, these caregivers combine a folk and biomedical model to describing dementia. With consistently misinformed female caregivers continuing their role every generation, differences in sex impressions of dementia could develop due to how information is disseminated to the next generation of caregivers. As such, properly informed females are the bridge to early disease recognition and seeking treatment. If Asian–American females do not understand that dementia decreases lifespan, this could delay early medical intervention. The study’s limitations include the participant group consisting mainly of females and research only consisting of three questions. Despite these limitations, the present study alludes to the gaps in knowledge needing to be filled in the Asian–American community. With this community already underutilizing mental healthcare, dementia management in this population is grim without prompt intervention. To this end, clinical efforts should be made to further dementia knowledge among Asian– Americans, especially for women, as they are the forerunners to preventing delays in care. Building on this foundation might finally help improve dementia management within the fastest growing minority group.

Peripheral oxidative stress markers in diabetes‐related dementia

We previously found that there was a dementia subgroup with characteristics predominantly associated with diabetes mellitus (DM)‐related metabolic abnormalities, referred to as “diabetes‐related dementia (DrD).” We determined the possible role of oxidative stress in the pathophysiology of DrD.

Identification of diabetes-related dementia: Longitudinal perfusion SPECT and amyloid PET studies

AIMS We attempted to identify a dementia subgroup with characteristics associated with diabetes mellitus (DM)-related metabolic abnormalities, referred to as diabetes-related dementia, using longitudinal single photon emission computed tomography (SPECT) and Pittsburgh compound-B (PiB) positron emission tomography (PET). METHODS We classified 175 patients with clinically diagnosed Alzheimer disease (AD) and DM into 4 subgroups based on brain imaging in a 2013 study. Among them, we investigated follow-up SPECT studies in 29 patients of an AD group showing decreased regional cerebral blood flow (rCBF) of the parietotemporal lobe on initial SPECT and 18 patients of a diabetes-related dementia group showing neither decreased rCBF of the parietotemporal lobe nor cerebrovascular disease, which is strongly associated with DM-related factors. Eleven of them underwent PiB PET. RESULTS Follow-up SPECT showed more profound rCBF reduction in the parietotemporal lobe and other areas of the AD group, whereas follow-up SPECT showed an rCBF reduction in small areas of the frontotemporal and limbic lobes of the diabetes-related dementia group. Six of 9 patients with diabetes-related dementia were negative or equivocal for PiB binding. CONCLUSION A subset of a dementia subgroup with characteristics predominantly associated with DM-related factors may underlie a pathophysiology different from AD, although these patients were clinically diagnosed as having AD. The identification of diabetes-related dementia may be necessary for considering an appropriate therapy and prevention in clinical practice.

Guidelines for the Clinical Diagnosis of Diabetes Mellitus-Related Dementia.

ties in the context of poor glycemic control. Diabetic striatopathy is a well-recognized but rare cause of hemiballism-hemichorea, associated with contralateral basal ganglia hyperdensity on CT and hyperintensity on T1weighted MRI. The cause of clinical and imaging abnormalities is unclear. Several mechanisms attributed to hyperglycemia have been proposed: transient ischemic injury with microhemorrhage resulting in hyperviscosity caused by hyperosmotic state, calcium deposition, gemistocytosis, altered GABAergic and dopaminergic neurotransmission, paramagnetic mineral deposition including zinc-containing metallothionein expressed in swollen astrocytes, and autoimmunity-mediated inflammation. This was the first case, to the authors’ knowledge, of contemporary occurrence of hyperglycemia-related hemichorea and stroke. Two possible diagnostic hypothesis were taken into account: the first considered stroke to have played a central role in diabetes mellitus decompensation, which, in a context of cerebral frailty due to stroke, led to the development of hyperglycemia-related hemiballismhemichorea; the second considered hyperglycemia as the trigger of stroke through an ischemic injury due to hyperviscosity. The available anamnestic data did not help identify which of the two disorders first appeared. The proximity of the stroke lesion to the altered basal ganglia, both in the right middle cerebral artery area, is interesting; although this strengthens the hypothesis of the ischemic mechanism for imaging abnormalities associated to hyperglycemia, it seems in accord with the second hypothesis. It could also be related to the first hypothesis, if the abnormal basal ganglia is considered to enter the ischemic penumbra of the documented stroke. Moreover, a participating direct role of the documented ischemic stroke to the abnormal movements cannot be excluded given the existence also of vascular hemichorea-hemiballism typically associated with lesions of the basal ganglia and, as in this case, of the adjacent white matter. Difficulties in optimal glycemic control probably contributed to the persistence for several months of basal ganglia abnormalities accompanied by recurrence of hemichorea, both finally disappearing 24 months later when diabetes mellitus compensation was also evident. Hyperglycemia-related hemiballism-hemichorea and the occurrence of four ischemic strokes during a 24-month period are rare in clinical practice. This man’s case raises doubts also about the possible predictive role of hyperglycemiarelated hemiballism-hemichorea for recurrence of stroke.

Differences in peripheral oxidative stress markers in Alzheimer's disease, vascular dementia and mixed dementia patients

We determined whether the possible roles of oxidative stress differ in the pathophysiology and cognitive decline of Alzheimers disease (AD), vascular dementia (VaD) and mixed Alzheimers/vascular dementia (MD).

Diabetes-related dementia is associated with dynapenia, but not with sarcopenia

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Frailty in diabetes-related dementia

In older adults, delirium is a frequent cause for hospitalization and is a length misleading condition. Aseptic meningitis might be related to specific leukemia CNS involvement, usually in end-stage treated disease. We showed that aseptic meningitis might reveal AML with no blast cells in blood samples. Therefore, a bone marrow examination should be considered in unexplained aseptic meningitis.

Comprehensive geriatric assessment in elderly patients with dementia

We have recently developed and validated a screening test for comprehensive geriatric assessment (CGA) named “Dr. SUPERMAN”. We compared the results obtained by the CGA of patients with Alzheimers disease (AD), vascular dementia (VaD) and dementia with Lewy bodies (DLB), and determined the relationship between functional deficits and clinical characteristics in each type of dementia.

Frailty and sarcopenia in subjects with Alzheimer's disease with or without cerebrovascular disease

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Cerebrospinal fluid analysis in individuals with diabetes-related dementia

Highlights • CSF P-tau and Aβ42 show normal levels in diabetes-related dementia.• Diabetes-related dementia may have a different underlying pathology from AD.• CSF analysis is useful for the differentiation of diabetes-related dementia from AD.