2023 年 40 巻 4 号 p. 627-632
As the pandemic that has swept the globe has passed three years, the theme of the 40th Annual Meeting of the Japanese Society of Neurological Therapeutics was A New Beginning for Neurological therapeutics : Overcoming the Pandemic and Aiming for Further Development. As a medical practitioner who has faced this “pandemic disaster,” I cannot help but think of the difficulty of correctly grasping and dealing with the present, which encompasses the present and future, even though I can look down on the time that has passed. In Symposium 21, the theme of neuroradiological findings in degenerative diseases, we pursued the possibility of diagnosis in the preclinical stage of degenerative diseases by making full use of cutting edge neuroimaging techniques, and explored the genes, etiology, and pathophysiology of the diseases. The presentations were exciting. Among them, the author, from the standpoint of a physician at a city hospital that provides emergency care to the elderly, presented imaging diagnosis in daily practice and the complex pathologies that lie behind the diagnosis, including the correspondence with the background pathology. The course of many neurodegenerative diseases is long, and the imaging findings change with the passage of the disease course. In addition, in diagnosing neurodegenerative diseases in the world, which have entered the hyper–aging society, age–related modifications are added, and complex etiologies and pathologies exist in the background at a high rate. In routine diagnostic imaging, the scope of diagnosis must take into account the time axis from the preclinical stage to the transitional stage, early onset of clinical symptoms, and advanced stages, and the process of searching for the “true nature of the disease” while diagnosing the three– or four–dimensional spread of the disease is required. It takes a long time to “search for the transition of the pathology along with the patient's long clinical course” until the knowledge obtained through the clinical–imaging–pathological linkage is reapplied to clinical practice. More than a year after the conditional approval of disease–modifying drugs for Alzheimer disease (AD) by the U.S. FDA, the possibility of appropriate diagnosis, including the preclinical stage of AD, has been attracting attention, and a newly identified degenerative disease that should be clinically differentiated from early–stage A, has been described. The present study will discuss the imaging–pathological relationships of the newly clarified degenerative diseases that should be clinically differentiated from early AD, such as argyrophilic grain disease/dementia with grains (AGD/DG), primary age–related tauopathy (PART), limbic–predominant age–related TDP–43 encephalopathy (LATE), and hippocampal sclerosis in the elderly, and will serve as a link to the 2nd∼4th presentations that demonstrate the significance and potential of applying the latest neuroimaging technology development and application.
