[in Japanese]

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[in Japanese]

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Aim: We studied the influences of silent brain infarction (SBI) and hypertension on brain atrophy and its longitudinal progression in healthy adults.
Methods: MRI scans were performed on 109 neurologically normal adults (mean age, 58.6±5.8 years), with follow-up at an average of 4.9 years later. Patient histories of hypertension, smoking habits, and alcohol consumption were examined. We evaluated brain atrophy using the brain atrophy index (BAI; the ratio of the brain area to the intracranial area) and the ventricular atrophy index (VAI; the ratio of the ventricular area to the brain area) on MRI T1-weighted images at the levels of the basal ganglia and lateral ventricle in horizontal sections.
Results: There were no differences in age, sex, dyslipidemia, BMI, smoking habit, and alcohol consumption between the normal group and the SBI or hypertension group. The BAI was significantly lower at entry for the SBI (+) group than for the SBI (-) group at both the basal ganglia and lateral ventricle levels (basal ganglia level, p=0.02; and lateral ventricle level, p=0.05). Moreover, the VAI was significantly higher at entry for the SBI (+) group than for the SBI (-) group at the lateral ventricle level (p=0.03). Furthermore, the BAI was significantly lower at entry for the hypertensive group than for the non-hypertensive group at the basal ganglia level (p=0.007). There were no significant differences in the annual variations of the BAI and VAI between the normal group and the SBI (+) or hypertensive group.
Conclusion: The present results suggest that the SBI and hypertension are accelerating factors for brain atrophy and ventricular dilatation.

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Aim: The purpose of this study was to investigate the related to swallowing function among chronic stroke patients with dysphagia in nursing home.
Methods: Using a cross-sectional survey design, the subjects were 60 chronic stroke patients (22 men and 38 women, mean age of 82.6±8.3SD) who had given approval for participation in the study. Expert nurses and physical therapists examined swallowing function by Modified Water Swallow Test (MWST) and Repetitive Salvia Swallowing Test (RSST), oral function (oral sense, dry mouth, mouth opening), pulmonary function (respiration, blowing, ability to blow), motor and cognitive function (positioning, range of neck, dementia).
Results: There was significant relationship between MWST and RSST (0.64; p<0.01). Multiple linear regression analysis revealed that the independent factors related to MWST were oral sense, dry mouth, and position of chin. These three factors could explain 49% of MWST variance (adjusted R²=0.49). The independent factors related to RSST were revealed to be dementia and oral sense. These two factors could explain 44% of RSST variance (adjusted R²=0.44).
Conclusion: These findings indicate that the independent factors related to reflexive swallowing are different from these related to volitional swallowing. The result of the present study suggested that improvement of oral function is important for promoting reflexive swallowing, and that improvement of cognitive activity is important for promoting volitional swallowing from viewpoint of swallowing rehabilitation for chronic stroke patients.

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Aim: To study the influence of exercise on the QOL of local elderly individuals, we created an activity scale for the elderly (ASE) and investigated its reliability and validity.
Methods: We created 36-item ASE and performed factor analysis. The reliability of the ASE was tested by determining Cronbach's coefficient alpha and confirmatory factor analysis in a cohort of 5,280 people, living in the community. The validity of the ASE was assessed by analyzing the interrelationship between the subdomains, age, and exercise.
Results: By factor analysis, four subdomains and 20 items remained significant for measuring ASE. The average ASE in the 5,280 people was 27.18±5.28 points, with no sex difference. Confirmatory factor analysis showed the stability of the four subdomains. Cronbach's alpha demonstrated the internal consistency of the scale. Regarding the relationship between the four subdomains, age, and exercise, a significant difference was found between those who exercised and those who did not exercise, and between the 4 different age groups. By means of two-way ANOVA, significant interaction was found between exercise and age; ASE decreased from 26.3 points in the sixth decade of life to 23.9 in the seventh decade of life in those who did not exercise, while no decrease was found in those who exercised. Furthermore, ASE was significantly higher in those who exercised than those who did not non-exercise in each age decade group. These results suggest that exercise prevents age-associated decline in ASE.
Conclusion: ASE provides a reliable and valid measure for the QOL of elderly individuals living in the community, and exercise appears beneficial for preventing age-associated decline in ASE.

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Aim: The effectiveness of oral care in preventing pneumonia among the elderly has recently been elucidated. This study was designed to evaluate the efficacy of moisturizing gel (Oral Balance^® (T&K Co., Ltd., Tokyo)) at a special nursing home for the aged as an oral care product for preventing dry mouth.
Methods: The subjects were 9 patients (aged 83.8±2.4 years; 3 men and 6 women) with cerebrovascular disease accompanied by frequent onset of loss of appetite, cough, sputum, halitosis, and fever. An oral care assessment table and checklist were prepared in advance, and weekly observations and evaluations were conducted for 6 months following the use of the moisturizing gel regarding the activities of daily living (ADL), physical condition, dietary condition, oral findings. Patients were instructed to apply a suitable amount of the moisturizing gel on their oral mucosa after each meal. In addition, for 6 (aged 83.8±2.5 years; 2 men, 4 women) of the subjects, the number of days with fever and the number of administrations of antibiotics and replacement fluid were compared during a six-month period before and after use of the moisturizing gel.
Results: Improvements were observed for ADL and consciousness level (n=1 each), dehydration, cough, sputum (n=2 each), fever (n=5) , and dietary intake (n=6). In addition, 6 patients had decreased plaque and dental calculi. No exacerbations were observed for any of the above findings. Comparison of monthly changes in the number of days with fever and the same months of the previous year revealed that no patients developed fever as of March 2007 (6 months after the start of use) following the use of the moisturizing gel. Comparison of the number of days with fever over a 6-month period showed a significant decrease (p<0.05) from a mean of 6.5±2.5 days before use to 5.2±2.6 days after use. Antibiotics were not given to any patients using the moisturizing gel from February and March 2007 following use. The number of administrations of replacement fluid decreased from around January 2007 following use.
Conclusion: These findings suggest that oral care using a moisturizing gel might contribute to prevention of respiratory tract infections by oral contamination due to cerebrovascular disease.

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Aim: Mild Cognitive Impairment (MCI) is considered as a precursor state of Alzheimer disease (AD). SPECT brain blood flow imaging was investigated in MCI and it's relevance to the prognosis of MCI was evaluated in an attempt define the characteristics of brain blood flow imaging of MCI (amnestic MCI; aMCI) converting to AD.
Methods: Ninety-two patients over 60 years old with amnesia were studied. ^99mTc-ECD SPECT brain blood flow examinations of the subject under drug-free conditions were conducted and imaging was analyzed according to the first clinical diagnosis. Patients given a diagnosis of MCI on the first clinical diagnosis, were examined again after 2 years and the SPECT imaging before 2 years previously was classified and analyzed.
Results: Of them, there were 35 MCI patients, converting of 13 AD patients (37.1%; aMCI), 10 MCI patients (28.6%; non-converter), 4 depression patients (11.4%; Depression type MCI (dMCI)), 1 Geriatric psychosis patient, but 7 patients dropped out. In the aMCI group, relative hypoperfusion was recognized in the posterior cingulate and the precuneus. In the dMCI group, relative hypoperfusion was recognized in the dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate. In the non-converter group, relative hypoperfusion was recognized in the basal forebrain.
Conclusions: The hypoperfusion of the precuneus in aMCI, and the hypoperfusion of the right frontal lobe (DLPFC, dorsal-anterior cingulate) in dMCI were characteristic brain blood-flow abnormalities. We believe ^99mTc-ECD SPECT brain blood flow imaging to be useful in the diagnosis of aMCI and in the early detection of depression.

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Aim: The purpose of this study was to determine the best way to indicate muscle mass of community-dwelling elderly men and women.
Methods: We recruited 398 elderly men and women (age range, 61-96, years) who use a community center and live in a metropolitan suburb. We measured appendicular and whole body muscle mass by using bioelectrical impedance analysis and analyzed our results in relation to indicators of physical function. We assessed muscle mass with no adjustment, adjustment by body mass, and adjustment by body height.
Results: In men, appendicular muscle mass adjusted by body mass correlated significantly with 10-m obstacle walking time, and whole body muscle mass adjusted by body mass correlated significantly with all indicators physical function except five chair stands and maximum walking speed. In women, appendicular and whole body muscle mass adjusted by body mass correlated significantly with all indicators of physical function. However, appendicular and whole body muscle mass adjusted by body height were unrelated to indicators of physical function.
Conclusions: Only whole body muscle mass adjusted by body mass was related to physical function in both men and women. This finding suggests that whole body muscle mass adjusted by body mass is the best indicator of muscle mass in community-dwelling elderly persons.

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A 77-year-old right-handed woman was admitted to our hospital with memory disturbance. Neurological examination was normal except for amnesia. Neuropsychological tests showed severe impairments in verbal and visual memories. Brain MRI revealed a fresh lacunar infarction in the genu of the right internal capsule. Decreased perfusion in the right thalamus and frontal lobe on ^99mTc-ECD SPECT was attributable to disconnection of the thalamo-cortical tract by infarction. We consider that the patient's amnesia in this case was induced by infarction of the capsular genu, which includes some fibers from the anterior and inferior thalamic peduncles. Our findings demonstrated that lacunar infarction in the genu of the right internal capsule caused severe and persistent amnesia.

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A 73-year-old woman was admitted with dry mouth, polyposia, polyuria, hyperglycemia (611 mg/dl) and positive urine ketone bodies. Blood glucose levels decreased gradually after initiation of insulin injections. The patient was discharged, but developed involuntary movement of the right extremities on the following day. At that time, her blood glucose levels were 54 mg/dl. Four days later, she was admitted to our Neurology Ward because the movement worsened. On admission, choreic involuntary movements were severe in the right extremities and slight in the left extremities. Urine ketone bodies were negative, but HbA1c had elevated to 11.7%. Although a brain CT did not detect any abnormal density areas, we suspected that the patient had cerebral infarction of the basal ganglia or the parietal lobe on the left side, or of the subthalamic nucleus on the right side because choreic involuntary movements were more prominent on the right side. Anti-platelet therapy was performed, but the involuntary movements persisted. A T1-weighted image of brain MRI, performed on the 4th day after hospitalization, detected abnormal high intensity areas in the bilateral putamens. The abnormal area in the left putamen was more prominent. This MRI finding was consistent with that of diabetic chorea-ballism. Surface electromyography demonstrated the simultaneous appearance of grouping discharges in the biceps and triceps muscles of the right arm. We diagnosed the patient as having diabetic chorea based on the MRI findings, and discontinued anti-platelet therapy. MRI should be performed as soon as possible in diabetic patients with acute-onset chorea-ballism which occurs on one side or predominantly on one side in order to differentiate diabetic chorea-ballism from cerebral infarction.

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An 82-year old, elderly woman who had been found to have myelodysplastic syndrome (MDS)-refractory anemia three years previously, complained of fever and abdominal pain, and was hospitalized. Abdominal CT images resulted in a diagnosis of renal subcapsular hematoma thus conservative treatment, including blood transfusions of platelet, was initiated. However, the hematoma enlarged, and she also had a spiking fever. After the hematoma was punctured and we drained an abscess caused by Klebsiella Pneumoniae, the hematomal legion subsided, and the inflammatory symptoms improved. There has been no recurrence for more than one year. This case is thought to be the first in which a renal subcapsular hematoma developed with MDS. Although the cause of the renal subcapsular hematoma has not yet been identified, the vulnerability due to aging of the small vessels along with a decrease in the number of platelets have been considered as contributing factors in this elderly case.

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