Toshiro Kawashima

Involvement of the Noradrenergic System in Performance on a Continuous Task Requiring Effortful Attention

To determine the effects of noradrenergic neuronal activity on performance in continuous tasks requiring effortful attention, the performance of 23 male students in the Uchida-Kraepelin test (UKT) was examined. The UKT requires continuous arithmetic addition of single-digit figures for 25 min. The relationship of performance with saliva levels of 3-methoxy-4-hydroxyphenylglycol (sMHPG) was analyzed. Saliva samples were taken before, during and after test performance, and sMHPG levels determined by gas chromatography-mass spectrometry. There was no significant change in mean sMHPG as a result of test performance. However, when initial effort was calculated, defined as number of items completed during the 1st min subtracted from the average completed per minute in the 1st and the 2nd halves (blocks) of the test, significant correlations with sMHPG (p = 0.0002 for the 1st block and p < 0.0001 for the 2nd block) were found. Thus the data indicate that noradrenergic neuronal activity affects the performance on continuous tasks requiring effortful attention.

Association of inflammatory biomarkers with depressive symptoms and cognitive decline in a community-dwelling healthy older sample: A 3-year follow-up study

BACKGROUND The relationship between the pathophysiology of dementia and neuroinflammation is well-known. The number of reports stating that depression is a risk factor for dementia has recently been increasing. These epidemiological findings suggest the possibility that both depression and dementia have common pathophysiological backgrounds of neuroinflammation. METHODS The sample consists of 64 non-demented community-dwelling older participants aged 65 years or over. Participants were assessed at baseline (2004-2006) and 3 years later (2007-2009). Plasma concentration of markers of inflammation (interleukins (IL)-1β, IL-2, IL-6, soluble interleukin-2 receptor (sIL-2R), soluble interleukin-6 receptor (sIL-6R), high sensitivity C-reactive protein (hsCRP) and tumor necrosis factor (TNF)-α) were measured at baseline. Depression symptoms were assessed with the Beck Depression Inventory (BDI) and cognitive decline was assessed with the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB) and Clock Drawing Test (CDT) at baseline and follow-up. All analyses were adjusted for age, gender and years of education. RESULTS In the cross-sectional analysis, the present study found soluble IL-2 receptor (sIL-2R) to be associated only with the MMSE score at baseline in men. In the longitudinal analysis, none of our inflammatory biomarkers were associated with either depressive symptoms or cognitive decline. LIMITATIONS The present study consists of small number of participants and body mass index (BMI) scores were not obtained. CONCLUSIONS Our findings suggest that sIL-2R is associated with current cognitive function in men. None of our inflammatory markers predicted future depressive state or cognitive decline in our community-dwelling healthy older sample.

Relationship between saliva level of 3-methoxy-4-hydroxyphenylglycol and mental health in the elderly general population

Aims:  A large number of studies on the monoamine systems in Alzheimers disease (AD) have found abnormalities of the noradrenergic system in the brain, but there has been no report concerning the relationship between noradrenergic activity and cognitive function in elderly living in a community. The aim of the present study was to explore the relationship between saliva level of 3‐methoxy‐4‐hydroxyphenylglycol (sMHPG) and mental health in this population.

A patient with Alzheimer's disease complicated by elderly-onset Cushing's syndrome who had undergone surgical treatment for adrenocorticotropic hormone-independent macronodular adrenal hyperplasia

Cushings syndrome (CS) is a rare disorder, especially in older people. Loss of brain volume and neurocognitive impairment of varying degrees has been demonstrated in patients with CS. However, there is a large difference between the median age of presentation of CS and that of Alzheimers disease. We herein report a case of a patient with Alzheimers disease complicated by elderly‐onset CS who had undergone surgical treatment for adrenal hyperplasia. Surgical correction of hypercortisolism seems to have slowed the progression of brain volume loss and cognitive dysfunction and improved psychiatric symptoms such as visual hallucination, restlessness, and psychomotor excitement. These improvements have remarkably reduced the burden on the patients caregivers. The present case suggests that subclinical CS may be present, particularly in rapidly progressive dementia, and that surgical treatment of CS for neuropsychiatric symptoms is useful.

Belief in life after death, salivary 3-methoxy-4-hydroxyphenylglycol, and well-being among older people without cognitive impairment dwelling in rural Japan

Research has found that spirituality/religiosity has a salutary association with mental/physical health. However, the association of belief in life after death with well‐being has rarely been studied, and the same is true of its association with biological indices, such as monoamine transmitters. Therefore, we examined the associations between well‐being and religiosity, salivary 3‐methoxy‐4‐hydroxyphenylglycol (sMHPG), and demographic characteristics.

Association of salivary cortisol levels and later depressive state in elderly people living in a rural community: a 3-year follow-up study.

BACKGROUND Late-life depressive disorder is becoming an important issue in health economics in the world, as it has been reported to be one of major risk factors for incidence of dementia. Identification of predictive markers associated with depression in later life is therefore of high priority in public health. The aim of the study was to examine the association of salivary cortisol levels with a later depressive state in elderly healthy people living in a rural Japan community. METHODS Salivary cortisol levels were measured in 68 elderly healthy people (24 men; 44 women) followed by completion of the BDI, MMSE, and FAB from 2004 to 2006. The same cohort underwent BDI again from 2007 to 2009. RESULTS In healthy elderly women subject, a significant positive correlation was found between salivary cortisol levels at baseline and BDI scores at follow-up, but not at baseline. Salivary cortisol levels at baseline were not correlated with the score of either MMSE or FAB. When the cut-off point of BDI scores were set at 20/21, logistic regression analyses revealed that salivary cortisol levels at baseline had a significant positive relationship with a later depressive state. Age and gender were also significantly related with a later depressive state. LIMITATIONS The present study involves small number of participants. CONCLUSIONS Higher salivary cortisol levels were associated with a later depressive state in elderly healthy women living in rural community. Salivary cortisol might be a predictive marker for a later depressive state in elderly women.

Neurocognitive Disorders in Chronic Kidney Disease: A Case Report and Literature Review

Chronic kidney disease (CKD) is a substantial public health problem. In the United States, almost 8% of the population has CKD and 571,000 patients receive treatment for endstage renal disease. Although the incidence of CKD is increasing in all age groups, this is particularly true in the elderly. There is a greater risk of developing neurocognitive disorders and dementia in older adults, and amajor determinant of quality of life in the elderly is the level of cognitive function. Recent data in this regard suggest that in individuals at all stages of CKD, theremay be a higher risk of developing dementia and cognitive impairment than in those without CKD. Given the increase in life expectancy and the aging of the population in industrialized countries, the neurocognitive disorder burden associated with CKD is expected to worsen. Up to 70% of patients undergoing hemodialysis who are 55 years and older have moderate to severe chronic cognitive impairment, yet it is largely undiagnosed. Dementia is associated with high risks of death, dialysis withdrawal, hospitalization, and disability among patients with endstage renal disease. We describe the case of Ms. A, who is undergoing hemodialysis, in whom various neuropsychiatric symptoms developed, and we review the relevant literature on neurocognitive disorders in CKD. University, Saga, Japan (HT, TH, JM, YH, YM, TK, AM); Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan (TN); Department of Neuropsychiatry, Graduate School of Medical Sciences, Fukuoka, Japan (TAK). Send correspondence and reprint requests to Hiroshi Tateishi, M.D., and Akira Monji, M.D., Address: 5-1-1 Nabeshima, Saga, Japan; e-mail: muutoyukainanakamatachi@gmail.com, amonji@hf.rim.or.jp & 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved. Case Report

An association between belief in life after death and serum oxytocin in older people in rural Japan

Previous research suggests that spirituality/religiosity has benefits for both mental and physical health, measured using biological indices such as cortisol and IL‐6. However, there have been few studies concerning the association of religious beliefs with oxytocin, a neuropeptide hormone secreted by the pituitary. Levels of peripheral oxytocin are thought to reflect the strength of bonding and stress regulation in social relationships. As such, the oxytocin system may underpin the biological mechanisms by which belief in life after death is associated with good mental and physical health. Here, we examine associations between oxytocin and belief in life after death.

Effect of excessive coffee consumption on the clinical course of a patient with bipolar disorder: A case report and literature review

Objective The aim of this study was to examine the impact of excessive caffeine consumption on therapeutic outcomes in bipolar disorder. Methods and Results We report on a case of a patient with bipolar disorder whose psychiatric symptoms were ameliorated with the elevation of lithium concentrations after the reduction of excessive daily coffee consumption, and we review the relevant literatures. Conclusions Excessive coffee consumption may exacerbate the therapeutic course of bipolar disorder through its effects on the mechanisms underlying bipolar disorder itself, as well as by affecting the blood concentration of lithium.

Mania occurring during systemic lupus erythematosus relapse and its amelioration on clinical and neuroimaging follow-up

Psychiatric manifestations of systemic lupus erythematosus (SLE) that are commonly preceded by organic syndromes include confusional states, anxiety disorder, cognitive dysfunction, mood disorder and psychosis. A 35-year-old woman was admitted to hospital with a relapse of SLE. Laboratory data were exacerbated, with some physical symptoms, and her primary psychiatric symptom was mania. The symptoms were reduced by treatment with prednisolone, methylprednisolone and aripiprazole. Magnetic resonance imaging and single-photon emission computed tomography (SPECT) using 123I-IMP was then performed and analyzed with three-dimensional stereotactic surface projection. This case emphasizes that SLE can commence with organic syndromes and relapse with predominantly psychiatric symptoms, and that the treatment efficacy may be confirmed using a follow-up of SPECT.