Ryo Kumagai

Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia

Aim:  The aim of this study was to clinically evaluate percutaneous endoscopic gastrostomy (PEG) tube feeding of elderly Japanese patients with dementia.

Effect of Rikkunshi-to on appetite loss found in elderly dementia patients: a preliminary study.

Background:  Functional gastrointestinal symptoms are frequently found in elderly dementia patients. In such a case, we attempt treatment by the administration of antidepressants or second‐generation antipsychotics. However, these medications have a risk of side‐effects. In the present study, we carried out oral administration of Rikkunshi‐to to elderly dementia patients with appetite loss, and examined its effects on food intake.

Long-term effect of donepezil for Alzheimer's disease: Retrospective clinical evaluation of drug efficacy in Japanese patients

Background:  Alzheimers disease (AD) is common in the Japanese population. In 1999, donepezil was authorized in Japan for the treatment of AD. However, because the time since donepezil was authorized is relatively short, there are few reports regarding the long‐term effects of donepezil in Japanese AD patients.

Serum insulin-like growth factor-I and amyloid beta protein in Alzheimer's disease: relationship with cognitive function

Previous studies have suggested that insulin‐like growth factor‐I (IGF‐I) deficiency may lead to cognitive deficits in neurodegenerative diseases such as Alzheimers disease. The present study aimed to investigate the possible relationship between cognitive function and concentration of IGF‐I or amyloid beta protein (Aβ) in serum in Alzheimers patients.

Manic episode induced by steroid (fluorometholone) eye drops in an elderly patient

DYSAUTONOMIA AND DEPRESSION often antedate the onset of dementia with Lewy bodies (DLB) by years or even decades. Previous studies revealed that many DLB patients have an initial clinical diagnosis of depression before core features of DLB appear. It is challenging to clinically diagnose DLB in elderly depressed patients because of the differences in prognosis and management. With the development of I-metaiodobenzylguanidine (MIBG) scintigraphy, increasing clinical attention has been focused on cardiac sympathetic denervation in DLB patients. Although pathological studies revealed that cardiac sympathetic denervation begins early in the Lewy body disease (LBD) process, there is limited information regarding MIBG scintigraphy images of prodromal DLB. Thus, it is clinically important to determine if the cardiac MIBG scintigraphy is useful for the detection of the prodromal DLB state in elderly depressed patients. Yokoyama et al. reported that milnacipran, a serotoninnorepinephrine reuptake inhibitor, influences the cardiac MIBG scintigraphy indices in elderly depressed patients who were suspected to have underlying LBD. They demonstrated that cardiac MIBG reuptake is significantly lower in depressed patients and controls who are taking milnacipran compared to those who are not. This finding helps us to interpret the cardiac MIBG scintigraphy results in elderly depressed patients, but the effects of depressed conditions were not considered in their study. Although the depressed patients may have episodes of emotional or psychological stress at their initial examinations, subsequent MIBG scintigraphy was performed in the remission state. Takotsubo cardiomyopathy (TTC) is characterized by transient systolic dysfunction without obstructive coronary artery disease after an intensive emotional stressor. TTC is probably related to a high adrenergic state and shows transient reduced cardiac MIBG reuptake. Given that depression was associated with increased odds of developing TTC, the emotional and psychological stress in depressed patients may contribute to the onset of TTC. Even if there are no overt cardiac symptoms, stressful episodes, which can cause a high adrenergic state in depressed patients, may influence the cardiac MIBG scintigraphy index. Although the sample size was small (six depressed patients and two controls) in Yokoyama’s study, the washout rate was significantly lower in depressed patients than in controls when both groups were taking milnacipran (P = 0.02 by t-test). In contrast, there was no difference between the two groups when the patients were not taking the drug (P = 0.28 by Mann–Whitney rank sum test). These differences suggest that depressed conditions influence MIBG scintigraphy results because an increased washout rate indicates sympathetic hyperactivity. The influence of possible multiple factors on the index of MIBG scintigraphy should be considered in elderly depressed patients to determine whether underlying LBD is present. Noguchi and Yamaga reported a patient with major depression and TTC preceding the onset of DLB. In this case, dysautonomia at prodromal DLB state and depressed episode may contribute to concomitant TTC. Sympathetic abnormality detected by cardiac MIBG scintigraphy may be one of the key clinical features, forming the link between depression and subsequent onset of DLB. Further longitudinal follow-up studies are warranted to elucidate the time course of cardiac MIBG reuptake in elderly depressed patients who develop DLB.

A patient with schizophrenia presenting with post-lobotomy catatonia treated with olanzapine: a case report

A 79‐year‐old Japanese woman with schizophrenia was hospitalized because of idiopathic duodenal stenosis. Three days after discontinuing ingestion, including the administration of psychotropic drugs, the patient demonstrated incoherent behaviour and strong general muscle tension, and was unable to engage in conversation. Computed tomography indicated bilateral regions of low density in the frontal lobes, subsequent to which she was diagnosed with post‐lobotomy catatonia. Administration of olanzapine (10 mg/day) improved the patients condition within a short period. Previous studies have demonstrated an association between the dysfunction of frontal circuits and catatonia; therefore, the observed catatonic episode might relate to the disconnection of nerve fibres in the prefrontal lobes induced by her lobotomy. Olanzapine was likely effective in treating catatonia because of its reported efficacy in improving frontal lobe function.

Erythropoietin preparation drastically improved activities of daily living in a patient with severe dementia: Letters to the Editor

A 79-year-old woman with Alzheimers disease and chronic renal failure was hospitalized with a trochanteric fracture of the left femur. Surgery was performed, however, from approximately day 30 of hospitalization, the patients level of activity gradually decreased. Further, her food intake was also reduced to several mouthfuls per day, and the patient became bedridden. In accordance with the wishes of her family, a conservative approach was taken, with oral intake when possible and fluid replacement. Malnutrition, dehydration, and renal dysfunction gradually progressed; on day 89 of admission, the patients hemoglobin levels had dropped to 7.3 g/dL. Since there was no increase in erythropoietin (EPO), which was at 16.7 mIU/mL, the patient was diagnosed with concurrent renal anemia. The patients family desired treatment for anemia; thus, treatment was initiated using an EPO preparation. This article is protected by copyright. All rights reserved.