[in Japanese]

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Aim: In elderly patients with dementia, it is known that a loss of independence in eating can cause malnutrition, dehydration, a decrease in food consumption and the immune function and further worsening of the cognitive function, with an increased risk of pneumonia and a shortened life expectancy. The purpose of this study was to investigate the occurrence of a disturbed eating behavior in elderly patients with Alzheimer's disease (AD) and vascular dementia (VaD), who together comprise the majority of elderly patients with dementia.
Methods: A total of 233 patients (150 AD patients and 83 VaD patients) who were residents of institutions or group homes were enrolled. The patients underwent an assessment of eating behavior, a cognitive assessment, a neurological examination and measurement of the vital signs. Additionally, statistical analyses were performed to compare eating behavior between the patients with AD and those with VaD at varying severity of dementia.
Results: A disturbed eating behavior was observed significantly more frequently as the severity of dementia increased. The prevalence of difficulty in rinsing/gargling and dysphagia increased with the severity of dementia. There were differences in the frequency of disturbed eating behavior between the AD and VaD patients. Among the patients with mild dementia, the VaD patients exhibited a higher incidence of a disturbed eating behavior than the AD patients. On the other hand, some behaviors prominent in the patients with severe dementia were related to various types of cognitive impairment in the AD patients, namely difficulty in beginning a meal, difficulty in maintaining attention while eating and difficulty in performing the specific motor skills necessary to open food packages. Marked individual differences were observed in the mild VaD patients, with a high frequency of disturbed eating behavior and dysphagia related to symptoms of neurological deficits. No correlations were found with the severity of dementia.
Conclusions: Both AD and VaD are types of dementia; however, the frequency of a disturbed eating behavior differs greatly between these populations. It is necessary to focus on differences in these parameters and also the causes of dementia in order to develop effective care techniques for patients with dementia.

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A 85-year-old female was admitted to our hospital because of a fever and unconsciousness. Three days prior to admission, she had been diagnosed to have influenza A, and oseltamivir was therefore prescribed. The symptoms due to the influenza infection, including the fever, thereafter rapidly resolved. She regularly took 10 mg zopiclone for insomnia before sleeping. On the day of admission, she was drowsy with fever. Chest radiography showed bilateral massive infiltration of the lungs. Chest CT images revealed multilobar and nodular infiltration on both lungs. She underwent the partial gastrectomy 10 years ago due to the gastrointestinal bleeding. After that, gastro-esophageal reflux syndrome was occurred in the patient. A bronchoscope was easily inserted into the trachea without anesthesia. Aspirated saliva was found in trachea. Based on her post-gastrectomy state, post-gastrectomy aspiration pneumonia was diagnosed. Sulbactam/ampicillin (SBT/ABPC) (6 g) was administered daily, which led to reduced inflammatory responses and lung infiltration. Although influenza itself is sometimes critical for the elderly, careful attention should be paid to subsequent bacterial infections in patients who are at risk for developing aspiration pneumonia.

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