Yasuyoshi Ouchi

Development of a simple screening test for sarcopenia in older adults

To develop a simple screening test to identify older adults at high risk for sarcopenia.

Antimicrobial peptide defensin: identification of novel isoforms and the characterization of their physiological roles and their significance in the pathogenesis of diseases.

Defensins comprise a family of cationic antimicrobial peptides containing a specific six-cysteine motif. Their contribution to the host defense against microbial invasion and the control of normal flora have been previously described. Some of the β-defensin isoforms are predominantly expressed in the epididymis and showed a region-specific expression pattern in the epididymis, which thus suggested that these isoforms may possess epididymis-specific functions in addition to antimicrobial activities. A sequence variant of the β-defensin 126 gene has been shown to be associated with reductions in the human sperm function, thus supporting this hypothesis. Furthermore, defensins have the capacity to chemoattract immune cells and induce the secretion of inflammatory cytokines. Mice expressing human neutrophil α-defensin showed more severe lung injuries after the aspiration of acidic contents than did control mice. Recent investigations regarding copy number variations of human defensin genes also suggest the significance of defensin in the pathogenesis or the worsening of chronic obstructive pulmonary diseases, sepsis and psoriasis.

High risk of adverse drug reactions in elderly patients taking six or more drugs: Analysis of inpatient database

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trans-Resveratrol in Gnetum gnemon protects against oxidative-stress-induced endothelial senescence.

Gnetum gnemon is an arboreal dioecious plant that is cultivated in Indonesia. The seeds of this species mainly contain dimeric stilbenoid compounds [gnetin C (1), gnemonoside A (2), and gnemonoside D (3)] along with trans-resveratrol (4). trans-Resveratrol has been reported to have antiaging, anticancer, and antidiabetic effects, as well as being a calorie restriction mimetic. SIRT1 exerts a protective effect against vascular senescence. In this study, the effects of these four main stilbenoid derivatives of a G. gnemon seed endosperm ethanolic extract on endothelial senescence were investigated. In streptozotocin-induced diabetic mice, administration of the G. gnemon ethanolic extract increased SIRT1 and decreased endothelial senescence. The concentration of 1 in blood plasma was 6-fold higher than 4 in these mice. Next, the in vitro effects of the four main stilbenoid derivatives of G. gnemon seeds were investigated. Senescent human umbilical vein endothelial cells were induced by hydrogen peroxide. Endothelial senescence was inhibited by 4, which increased the expression of endothelial nitric oxide synthase and SIRT1, whereas 1-3 had no effect. These results indicated that the ethanolic extract of G. gnemon seeds inhibits endothelial senescence, suggesting that 4 plays a critical role in the prevention of endothelial senescence.

The high frequency of periodic limb movements in patients with Lewy body dementia

BACKGROUNDnAlthough dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimers disease (AD), the clinical diagnosis is frequently difficult. Because both REM sleep behavior disorders and Parkinsons disease also have alpha-synucleinopathy similar to DLB, and show an increase in periodic limb movements (PLM), we evaluated the association between DLB and PLM, which may serve as an additional information to differentiate AD and DLB.nnnMETHODSnOvernight polysomnographic recordings were performed for the inpatients in our hospital who were suspected to have dementia. The quality of sleep, oxygen-desaturation index and periodic limb movements were compared among the patients clinically diagnosed with DLB, AD or as having no dementia.nnnRESULTSnNine DLB patients, twelve AD patients and ten non-demented patients were enrolled in the study. The number of PLM during sleep per hour of total sleep time (PLMS index) was significantly higher in the DLB patients than the AD patients or the non-demented patients. No significant differences were found between the AD patients and the non-demented patients. To differentiate DLB from AD, a PLMS index of more than 15.0 had a sensitivity of 88.9% and a specificity of 83.3%.nnnCONCLUSIONSnThe DLB patients exhibited a higher PLMS index than the AD patients, and this index could be clinically useful for the diagnostic differentiation of DLB from AD.

Association of decreased sympathetic nervous activity with mortality of older adults in long-term care

To investigate the relationship between physical function, mortality and autonomic nervous activity measured by heart rate variability of elderly in long‐term care.

Acute exogenous lipoid pneumonia caused by accidental kerosene ingestion in an elderly patient with dementia: a case report.

Acute exogenous lipoid pneumonia is an uncommon condition caused by aspiration of oil‐based substances, occurring mainly in children. Here, we report the case of an 83‐year‐old patient with Alzheimers disease who presented with coughing and hypoxia. The diagnosis of acute exogenous lipoid pneumonia caused by accidental kerosene ingestion was made on the basis of the patients clinical history, and typical radiological and cytological findings. The patients cognitive impairment and an unsafe environment, in which the patients 91‐year‐old husband stored kerosene in an old shochu bottle, were responsible for the accidental ingestion. Acute exogenous lipoid pneumonia should be considered in the differential diagnosis for acute respiratory disorders in the rapidly aging population. Geriatr Gerontol Int 2013; 13: 222–225.

Factors Associated with Prolonged Hospital Stay in a Geriatric Ward of a University Hospital in Japan

1. Sikkes SAM, Visser PJ, Knol DL et al. Do instrumental activities of daily living predict dementia at 1and 2-year follow-up? Findings from the Development of Screening guidelines and diagnostic Criteria for Predementia Alzheimer’s disease study J Am Geriatr Soc 2011;59:2273–2278. 2. Folstein MF, Folstein SE, McHugh PE. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–189. 3. Nasreddine ZS, Phillips NA, Bédirian V et al. The Montreal Cognitive Assessment (MoCA): A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005;53:695–699. 4. Nouri FM, Lincoln NB. An extended activities of daily living scale for stroke patients. Clin Rehabil 1987;1:301–305. 5. Regal P. Antithyroid antibodies, cognition and IADL in the elderly. Int J Geriatr Psychiatry 2012;27, in press.

Marked improvement of elderly postprandial hypotension by dipeptidyl peptidase IV inhibitor

Postprandial hypotension (PPH) is an important and frequent problem, particularly in the elderly. Rapid drops of blood pressure after meals cause syncope, dizziness, falls and muscle weakness, and might result in angina pectoris and stroke. Accordingly, accurate diagnosis and effective treatment of PPH are Figure 1 Computed tomography (CT) images. (a,b) Delayed-phase images obtained by helical dynamic CT. (a) This CT image shows a giant liver cyst (GLC) measuring 18 cm in diameter. The cyst was occupying the right hepatic lobe and compressing the inferior vena cava (IVC; white arrow). (b) The caliber of the IVC on a 3-cm caudad slice from the furcation of the celiac artery was larger than that of the abdominal aorta. The shape of the IVC was round, which indicates a strained IVC (white short arrow). (c) Reconstructed CT image of GLC. This image shows that the caliber of the IVC narrowed on the same level as GLC (white arrow). (d,e) Plain CT images obtained 6 months after the drainage. CT images show no compression of the IVC. (d) This CT image shows that the caliber of the IVC on the 3-cm caudad slice from the furcation of the celiac artery was smaller than that of the abdominal aorta. The shape of the IVC changed to oval, which indicates a lax IVC (white short arrow). (e) The CT image on the same level as that in (b), indicated by paraspinal muscles, shows that the caliber of the IVC was smaller than that of the abdominal aorta (white short arrow). bs_bs_banner

Respiratory dysrhythmia in dementia with Lewy bodies: a cross-sectional study

Objectives Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimers disease (AD). DLB is characterised by intracytoplasmic inclusions called Lewy bodies that are often seen in the brainstem. Because modulation of the respiratory rhythm is one of the most important functions of the brainstem, patients with DLB may exhibit dysrhythmic breathing. This hypothesis has not yet been systematically studied. Therefore, we evaluated the association between DLB and dysrhythmic breathing. Design In this cross-sectional study consecutive inpatients who were admitted for the evaluation of progressive cognitive impairment were enrolled. We assessed breathing irregularity using polysomnographic recordings on bed rest with closed eyes, without reference to the clinical differentiation among DLB, AD and having no dementia. Setting Single centre in Japan. Participants 14 patients with DLB , 21 with AD and 12 without dementia were enrolled in this study. Primary outcome measures The coefficient of variation (CV) of the breath-to-breath time was calculated. We also examined the amplitude spectrum A(f) obtained using the fast Fourier transform and Shannon entropy S of A(f) in patients with DLB compared with patients with AD and patients without dementia. Results The values of CV and entropy S were significantly higher in patients with DLB than in patients with AD and patients without dementia. No significant differences were observed between patients with AD and patients without dementia. Conclusions Patients with DLB exhibit dysrhythmic breathing compared with patients with AD and patients without dementia. Dysrhythmic breathing is a new clinical feature of DLB and the spectral analysis of breathing patterns can be clinically useful for the diagnostic differentiation of DLB from AD.