Shinji Ouma

Multicentre population-based dementia prevalence survey in Japan: a preliminary report

Community‐based surveys were performed in seven rural areas in Japan to investigate the prevalence of dementia and illnesses causing dementia. A total of 5431 elderly subjects were selected based on census data from 1 October 2009. In total, 3394 participants were examined (participation rate: 62.5%), and 768 dementia cases and 529 mild cognitive impairment cases were identified. Of the illnesses causing dementia, Alzheimers disease was the most frequent (67.4%), followed by vascular dementia (18.9%), dementia with Lewy body disease (4.6%), mixed dementia (4.2%) and other illnesses. The prevalence of dementia according to 5‐year age strata between 65 and 99 years was 5.8–77.7% among the participants. The prevalence of dementia in this study was higher than in previous reports in Japan and other countries. To verify the upward trend of dementia prevalence and its background factors, we have scheduled surveys for three other urban areas in 2011–2012.

Improvement in delusions and hallucinations in patients with dementia with Lewy bodies upon administration of yokukansan, a traditional Japanese medicine.

Background:  This multicentre open‐label trial examined the efficacy and safety of the traditional Japanese medicine, or Kampo medicine, yokukansan (YKS), for behavioural and psychological symptoms of dementia (BPSD) in patients with dementia with Lewy bodies.

OPEN LABEL TRIAL TO EVALUATE THE EFFICACY AND SAFETY OF YOKUKANSAN, A TRADITIONAL ASIAN MEDICINE, IN DEMENTIA WITH LEWY BODIES

cian’s choice to recommend surgery, taking into consideration the likelihood of perioperative mortality and postoperative complications, but advanced patient age alone should not prevent the surgeon from proceeding to surgery if clinically indicated. In particular, available data support pursuit of elective surgical procedures in nonagenarians and suggest that such procedures in this age group have an acceptable risk of morbidity and mortality. Laparoscopic approaches in nonemergent settings, in carefully selected nonagenarians, may reduce overall morbidity and shorten the recovery period.

Dysgeusia in a Patient with Guillain-Barré Syndrome Associated with Acute Hepatitis E: A Case Report and Literature Review

Guillain-Barré syndrome (GBS) is usually triggered by viral or bacterial infection. In addition, it was recently reported that infection with hepatitis E virus (HEV) also causes GBS. A 49-year-old man presented with acute-onset paralysis in all extremities and dysgeusia during an episode of acute hepatitis. Serological tests showed the presence of anti-HEV IgM antibodies and HEV-RNA in the serum. As an electrophysiological examination showed acute demyelinating polyradiculoneuropathy, the patient was diagnosed as HEV-associated GBS. Following the initiation of treatment with intravenous immunoglobulin, his paralysis and dysgeusia rapidly improved. This case suggests that HEV-associated GBS may rarely be complicated by dysgeusia.

Impact of initial symptom for accurate diagnosis of vertebral artery dissection

Background It has been recognized that spontaneous vertebral artery dissection without neurological symptoms is not rare and easily misdiagnosed. Clinical clue for diagnosis of vertebral artery dissection includes initial symptoms such as headache, neck pain, or dizziness. Aim To assess the role of initial symptoms for diagnosis of spontaneous vertebral artery dissection. Methods Between September 2007 and January 2014, we retrospectively reviewed clinical records of 83 patients with unilateral vertebral artery dissection without consciousness disturbance at admission. Based on the diagnostic criteria of the Spontaneous Cervicocephalic Arterial Dissections Study, the patients were divided into three groups: possible, probable, and definite cases of vertebral artery dissection. Initial symptoms were collected at the time of diagnosis from medical record for the presence or absence of headache, neck pain, tinnitus and vertigo, as well as the area of pain and its characteristics. Results The numbers of definite, probable, and possible vertebral artery dissection were 39, 26, and 18, respectively. Out of 83 cases, unilateral or bilateral headache was the most commonly seen (in 60 cases), followed by neck pain (in 41 cases) and vertigo (in 20 cases). Statistically, unilateral headache and/or neck pain was more common in cases with definite vertebral artery dissection group compared with other classification of the Spontaneous Cervicocephalic Arterial Dissections Study (P = 0.040). Vertigo was also associated with the stratification of Spontaneous Cervicocephalic Arterial Dissections Study criteria (P = 0.012). Conclusions In our study, headache and/or neck pain, especially unilateral presentation, and vertigo were symptoms associated with the stratification of Spontaneous Cervico-cephalic Arterial Dissections Study criteria. Physicians should carefully obtain clinical history for the presence of a unilateral headache and/or neck pain and vertigo when vertebral artery dissection is suspected in patients with or without objective neurological signs.

Serum vitamin D in patients with mild cognitive impairment and Alzheimer's disease

To determine the relevance of Mini‐Mental State Examination (MMSE), serum 25‐hydroxyvitamin D (25(OH)D3), and 1,25(OH)2D3 concentrations to mild cognitive impairment (MCI) and various stages of Alzheimers disease (AD).

Utility of the Japanese version of the 9-item Wearing-off Questionnaire

BACKGROUND AND PURPOSE The 9-item Wearing-off Questionnaire (WOQ-9) is a useful tool for screening of wearing-off. We performed a validation study of the Japanese version of the WOQ-9 (JWOQ-9) using a cross-sectional design in Japanese Parkinsons disease (PD) patients diagnosed with sporadic PD and treated with levodopa. METHODS Subjects with severe dementia, uncontrolled psychiatric comorbidities, and previous PD neurosurgery were excluded. The wearing-off phenomenon was detected according to the JWOQ-9, and the results were compared with independent evaluations of wearing-off conducted by PD specialists blinded to the JWOQ-9 results. To validate the JWOQ-9, a sample size of at least 70 patients with wearing-off and 70 patients without wearing-off was required. Therefore, a total of 180 patients (101 patients with wearing-off and 79 patients without wearing-off) were enrolled. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of the JWOQ-9 were 94.1%, 39.2%, 66.4%, and 83.8%, respectively. Motor symptom questions demonstrated both moderate sensitivity (58.1-87.3%) and specificity (60.4-87.5%). In contrast, non-motor symptom questions demonstrated fair to moderate sensitivity (51.5-64.6%), with high specificity (80.0-94.1%). Like the original WOQ-9, the JWOQ-9 exhibits significant value for detecting possible wearing-off. CONCLUSIONS The JWOQ-9 is a useful screening tool for detecting wearing-off of both motor and non-motor symptoms.

Different Effect of Vitamin D 2 and Vitamin D 3 on Amyloid-β40 Aggregation In Vitro

The seeding of amyloid-β 40 (Aβ40) oligomers from monomers is the initial step of Aβ aggregation, and many reports have suggested that cholesterol enhances this step. We studied the potential of secosteroid vitamin D derivatives for Aβ40 aggregation in vitro. The quartz-crystal microbalance technique demonstrated that vitamin D3 does not show any effect on Aβ40 aggregation while vitamin D2 promoted it and docking simulation but that vitamin D2 has high potential in this regard. Thus, stacking of the Phe19 benzene ring in Aβ40 and the C22-C23 double bond in vitamin D2 may alter the energy of these molecules. Electron microscopy revealed the potential of vitamin D2 to increase Aβ40 aggregation. Thioflavin-T assays indicated that Vitamin D2 induced increased fluorescence at 490 nm, as typically observed for amyloid fibrils but also for protofibrils; in both cases this reflects of the increase of β-sheet contents. Aβ40 aggregation was further confirmed in ELISA, SDS-PAGE and dot blot analysis which revealed changes in protease K resistance. These results suggest a possible mechanism, of how vitamin D2 could increase Aβ40 aggregation and the docking simulation explains, why the same is not observed with vitamin D3.

Idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome associated with bilateral pleural and pericardial effusions: a case report

BackgroundRemitting seronegative symmetrical synovitis with pitting edema syndrome is characterized by symmetrical synovitis with pitting edema in the dorsum of the hands or feet. Most cases of remitting seronegative symmetrical synovitis with pitting edema syndrome are idiopathic, but some are secondary to malignancy, autoimmune disease, or neurodegenerative disorders. Pleural and pericardial effusions are unusual complications in idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome.Case presentationA 74-year-old Japanese woman presented to our hospital with arthralgia and pitting edema in her feet. She had pain in multiple joints, peripheral edema, and a markedly elevated erythrocyte sedimentation rate. Enhanced computed tomography and laboratory data showed no evidence of malignancy. These findings suggested that she had idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome. She also developed respiratory distress because of bilateral pleural and pericardial effusions. Laboratory data showed that serum vascular endothelial growth factor and interleukin-6 were significantly elevated. After administration of steroids, her pleural and pericardial effusions decreased and finally disappeared. Furthermore, vascular endothelial growth factor and interleukin-6 decreased when the pleural and pericardial effusions disappeared.ConclusionsHere we report the case of a patient with idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome associated with life-threatening complications, including bilateral pleural and pericardial effusions during the course of the illness, which led to respiratory failure and atrial fibrillation. Elevated vascular endothelial growth factor and interleukin-6 may be associated with the cause of pleural and pericardial effusions in idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome.

Influence of Memantine on Continuous Treatment with Rivastigmine Patches-Retrospective Study Using the Logistic Regression Analysis.

Rivastigmine patches exhibit stable effects when attached once a day, and may reduce Alzheimers disease (AD) patients or caregivers burden. On the other hand, it was reported that adverse events, such as dermal disorder, frequently appeared after the start of rivastigmine administration. We retrospectively investigated medical records in 120 patients with moderate or mild AD in whom rivastigmine administration was started in the Department of Neurology, Fukuoka University Hospital between July 2011 and June 2014 (43 males, 77 females, mean age: 76.9±8.0 years). In 72 patients (60.0%), rivastigmine administration was discontinued within 52 weeks after its start. In 45 of these, it was discontinued before reaching a dose of 18 mg/d which was proven to be effective for AD patients. A primary reason for discontinuation was the appearance or deterioration of adverse events in 64 patients. Of these, 43 complained of dermal disorder, accounting for the highest percentage. To clarify factors influencing the continuous administration of rivastigmine, multivariate analysis was performed in 114 patients meeting criteria. Combination therapy with memantine was extracted as a factor (p=0.008). The results of this study suggest that adherence to combination therapy with rivastigmine and memantine is more favorable than that to monotherapy with rivastigmine.