Tomomi Ogihara

Behavioral and psychological symptoms of dementia and medical treatment

After 1994, when the International Psychogeriatric Association (IPA) proposed the concept of behavioral and psychological symptoms of dementia (BPSD; http://www.ipa-online.org/ipaonlinev3/ipaprograms/ taskforces/bpsd/Default.asp), BPSD began to be evaluated from a variety of standpoints. In the biological treatment of BPSD, the pathological conditions must be accurately understood by clarifying the mental symptoms of demented patients and evaluating their biological background.

Patterns of hippocampal atrophy differ among Alzheimer's disease, amnestic mild cognitive impairment, and late-life depression

This study investigated whether the characteristic changes in hippocampal atrophy seen in coronal scans are useful for differentiating Alzheimers disease (AD), amnestic mild cognitive impairment (aMCI), and major depressive disorder (MDD).

New visual rating system for medial temporal lobe atrophy: a simple diagnostic tool for routine examinations

Aim:  We estimated the usefulness of our new scale to rate medial temporal atrophy with short inversion time inversion recovery images.

Comparison of diagnostic names of mental illnesses in medical documents before and after the adoption of a new Japanese translation of ‘schizophrenia’

Aim:  The name of a disease entered in medical documents often differs from the true diagnosis in psychiatric practice. We examined the effects of different translations of ‘schizophrenia’ into Japanese on the usage of disease names in documents.

A case of severe parkinsonism in an elderly person induced by valproic acid

CASE HISTORY The case involved a 75-year-old woman who was diagnosed with bipolar disorder at the age of 36 years and was stabilized on lithium. At the age of 74, she started complaining of freezing of gait, which did not improve with L-DOPA administration. She became depressed and was admitted to a psychiatric ward 2 months later. While in the psychiatric ward, the patient complained of finger tremors, which improved after lithium was switched to 1000-mg/day VPA and 20-mg/day perospirone. The change in medication ameliorated both the tremors and the depressive symptoms. She was discharged from the hospital after 2 months and continued to have only a minor gait disturbance. However, her parkinsonism worsened 4 months after discharge. The patient complained of stiffness in her arms and legs, freezing of gait, and tremors of the fingers. A decline in cognitive function (Hasegawa’s Dementia Scale-Revised: 10/30) and increased mood swings were observed. The subsequent exacerbation of parkinsonism left her bedridden and unable to walk by herself. She was admitted to hospital 6 months after the previous discharge. On admission, the plasma concentration of VPA was 25.27 μg/mL, which suggested poor adherence to medication. Hyperammonaemic encephalopathy was unlikely based on her blood levels of ammonia (64 μg/mL). The dose of VPA was reduced to 800 mg/day, and treatment with 5-mg/day donepezil hydrochloride was started for cognitive decline. Her cognitive function improved, but the parkinsonism persisted. After 3 months of treatment, the patient was transferred to our hospital for further evaluation and treatment in our psychiatric ward. There was no apparent cognitive impairment at admission (Mini-Mental State Examination: 28/30). Her plasma levels of VPA and blood levels of ammonia were 67 μg/mL and 60 μg/ mL, respectively. Her mood was euthymic with no complaints of sleep problems or appetite loss. Marked symmetric intention tremor was present in the upper extremities, although resting tremor was not apparent. Spinal rigidity and bilateral rigidity of the upper and lower extremities were observed. Restricted range of motion of the joints associated with prolonged immobility was present, particularly in her lower extremities. Her Unified Parkinson’s Disease Rating Scale score was 98. Because drug-induced parkinsonism was suspected, the dose of VPA was reduced to 400 mg/day on the day of admission, and VPA and donepezil hydrochloride were gradually withdrawn thereafter. On day 3, the range of motion of her upper extremities improved, and she was able to move her legs by herself while lying on her back. VPA was discontinued on day 7. The rigidity and intention tremor improved, and after a few days, she was able to stand by herself. Donepezil hydrochloride was discontinued on day 14. By day 27, she was able to walk by herself with a walker. Brain magnetic resonance imaging revealed scattered small infarctions in the deep white matter and surrounding basal ganglia, and the cerebral blood flow scintigraphy showed blood flow reduction in the frontal lobe, suggesting multi-infarct lesions. There was no decrease in myocardial accumulation of Metaiodobenzylguanidine on myocardial scintigraphy. Electroencephalography was also normal. From these findings, we diagnosed this case as agerelated vascular parkinsonism exacerbated by medication. To further improve the patient’s parkinsonism, treatment with 100-mg/day amantadine hydrochloride was started. On day 45, she was able to walk by herself with a cane. The Unified Parkinson’s Disease