In 1984, we conducted a follow-up study by questionnaire on 479 aphasic patients who had received initial speech therapy in 1981 at 85 hospitals throughout Japan.
    The purposes of this study were : 1) to clarify the rate of aphasic cases who reached occupational return, and 2) to analyze which factor had the main or chief effect on their occupational return among 17 factors by Hayashi quantification method type II (categorical discriminant analysis).
    The main results were as follows :
    1) Of the 479 aphasics, 61 (12.7%) worked 3 years after initial speech therapy. These cases were among to 344 aphasics who had held jobs before the stroke. The rate of occupational return was 17.7 %.
    2) Among the 61 aphasics who returned to work, 19 cases (31.1 %) were assigned to different jobs and 5 cases (8.2 %) changed their employment.
    3) Among the 17 factors examined, hand function showed the strongest effect on occupational return. Next strongest was the duration of treatment. Time lapse before the beginning of treatment ranked third. Speech output level also had a considerable effect.

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     Although many case reports of aphasia following left putaminal hemorrhages have been accumumulated, the mechanism of these language disorders has not yet been clarified. In this report, 41 patients with left putaminal hemorrhages were studied to compare the language disorders with the regional cerebral blood flow(rCBF) measured with single photon emission CT. The following conclusions were obtained :
    1) Examination of language revealed 10 nonaphasics and 31 aphasics. Almost all of the aphasics showed a tendency for language disorders in the expressive aspect (fluency) and the receptive aspect (comprehension) to be equal in degree.
    2) Low blood flow areas revealed by emission CT were larger than lesions by X-ray CT and they involved remote surface areas of perfusion territory of the left middle cerebral artery (MCA). Appearance of aphasia was more related to the blood flow change in this cortical area than to that in area of the basal ganglia. Fluency disorders correlated with the rCBF value in the anterior part of the perfusion territory of the left MCA (aMCA) which included Broca's area. Comprehension disorders correlated with the rCBF value in the posterior part of the perfusion territory of the left MCA (pMCA), including Wernicke's area. Such disorders were observed in 12 aphasic patients following left cerebral infarction. Moreover, the decreases of rCBF values in the aMCA and pMCA of hemorrhagic patients were equal in degree.
    3) As the possible causes for rCBF change in the surface of the hemisphere, several factors had to be considered such as mass effect, secondary irreversible brain damage from mass effect and transneural effect.

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     Dementias are classified as 1) vascular dementia, 2) Alzheimer's disease and senile dementia of Alzheimer type (SDAT), 3) dementias due to various neurodegenerative diseases and physical diseases like endocrine abnormalities, 4) pseudodementia.
In this article, clinicopathological features of Alzheimer's disease and SDAT are described in detail. Alzheimer's disease is characterized by memory disturbance (especially loss of recent memory), desorientation, especially of spatial one, various kind of bahaviour disturbance and insomnia, euphoria and lack of insight etc. Pathologically, loss of neurons mainly in the cerebral cortex, appearance of Alzheimer's neurofibrillary tangles in the Ammon's horn, cerebral cortex, and hypothalamus, brain stem nuclei such as basal nucleurs of Meynert, locus coeruleus (adrenergic neuron) and raphe nucleus (serotonergic neurons), deposition of senile plaques mainly in the cerebral cortex are the main features of Alzheimer brain.

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