Post-stroke apathy had been neglected for long time. However, 20 years ago in Japan, improving less of spontaneity（＝apathy）was main target in development of drugs for post stroke patients. Post-strokedepression related to left frontal lesion that Robinson reported in 1984 had been noted because of symptomatic depression. Definition of vascular depression（VD）also had been reported in 1997. However, after that, people had lost interest in VD because of insufficient effect of anti-depressant drugs. I think that this “vascular depression” is a just “post-stroke apathy”, when we reconsider now. Internationally, apathy is not recognized as independent syndrome also in new DSM-V. Post-stroke apathy is not only a symptom of vascular dementia, but it should be recognized as an important factor inducing vascular dementia itself through disuse syndrome.
Resting-state functional MRI(rs-fMRI) has been developed for analyzing large-scale connectivity in the brain network. The measurement of rs-fMRI could be performed in a short time(5-10 min) without any task load on subjects, thus this method is suitable for evaluating alterations of brain functions in many psychiatric or neurologic diseases. Specifically, dementia is now a main target for clinical application of this method. The most salient network active during resting state is the default-mode network(DMN) , which comprises a characteristic set of brain regions, including the precuneus/posterior cingulate cortex, medial prefrontal cortex, lateral temporal and parietal cortices, and hippocampus. Since a large number of recent studies have demonstrated decrease connectivity of the DMN in Alzheimerʼs disease before onset of symptoms, rs-fMRI seems a promising tool for early diagnosis of dementia. Some studies have also shown the pattern of alteration in functional connectivity can be used for differential diagnosis of dementia, such as fronto-temporal dementia. Graph theoretical analysis has been applied to rs-fMRI data and provided unique metrics for evaluating the changes of brain network in dementia. Resting state fMRI is expected to be available in clinical settings for diagnosis and treatment of dementia in near future.
We reported an aphasic patient who showed difficulty in repetition of word sequences or short sentences, although repetition of digits and non-words was intact. We examined his verbal short-term memory. Thecase was a 70-year-old, right-handed male. He had an operation for removal of the middle-temporal-gyrus owing to brain tumor. Afterwards he showed fluent aphasia. He had a digit span of 7 figures and succeeded in repetition of non-words of 8 mora. On the other hand, repetition of short sentences and word sequences was difficult. The results of pointing at word sequences varied according to presentation modalities. There were some deviations in repetition of non-words and repetition of word sequences. These findings suggest that processing of short-term memory for digits and words is different.
The patient was a 59-year-old right-handed female with a language comprehension problem of spatial relationships due to a unilateral cerebral hemorrhage in the left parietal lobe. She demonstrated normal language comprehension and oral expression ability regarding positional relationships（e.g., “big and small,” “front and back,” “left and right”）. Although the patient had good language comprehension regarding size（e.g., “big and small”）, she had difficulty comprehending spatial relationships describing multiple objects and family relationships. Further analysis revealed functional declines in her ability to shift and/or change point-of-view（POV）necessary for manipulating images in mental space. Furthermore, there was a dysfunction of the object-centered coordinate system. Fukuda（1990）indicated that POV-operating ability in mental apace is necessary to comprehend sentences that include the expression of POV. We hypothesized that a language comprehension problem of spatial relationships such as this case might be based on a functional decline of the nervous system relevant to mental image manipulation.