Proteoglycans (PGs) consist of a core protein and glycosaminoglycans (GAGs). They are components of the extracellular matrices of the central nervous system (CNS) and also are present in the peripheral nervous system. They have been reported to be axon regenerating inhibitors in the CNS. They may therefore affect the pathogenetic mechanisms of the neurological diseases, but their roles have rarely been studied so far. Recently we investigated experimental autoimmune encephalomyelitis (EAE) induced in the mice deficient in glycosyltransferases involved in the synthesis of GAGs and found that modification of the carbohydrate residue of PGs have major effects on the pathogenesis of EAE. About half of the patients with IgM paraproteinemic neuropathy (IgM–N), IgM M–proteins are known to recognize HNK–1 epitope of myelin–associated glycoprotein (MAG). Phosphacan is a proteoglycan, which also has HNK–1 epitope. We studied binding specificities of such IgM M–proteins and found that they were heterogeneous. The ratio of the binding activity to phosphacan divided by that to MAG (P/M ratio) was related with the clinical severity of IgM–N. Further investigation on the roles of PGs in the neurological diseases may lead to the understanding of the pathogenesis and the development of novel therapies of neurological diseases.

We investigated the role of a dementia care support team (DCST) for patients with dementia admitted for underlying physical illness. Subjects were 130 patients aged ≥ 65 (mean age 86±6) years, with stage III or higher dementia according to the degree of independence in activities of daily living for the demented elderly. Of physical illness, the most frequent cause of hospitalization was pneumonia or fracture, and behavioral and psychological symptoms of dementia (BPSD) were observed in 67% of subjects. Support by the DCST was started in an average of 9.1 days after admission, and the mean interval of support was 34.0 days. Fifty–seven subjects received several forms of nursing care (environmental adjustment, communication modification, lifestyle changes, and/or other changes) without medical treatment, and 40% of subjects received medical treatment in addition to nursing care. Of the subjects with BPSD, 64% showed improvement at the end point of the support by the DCST. Of subjects who lived at home before hospitalization, 40 (46%) returned home and 47 (54%) were admitted to another hospital or facility. The most frequent causative factors for admission to another hospital or facility were the need for medical care in subjects admitted to another hospital and physical disability in subjects admitted to another facility. Patients with dementia frequently develop several types of BPSD during hospitalization for physical illness. The dementia care support team through cooperation among various medical professionals might be an effective countermeasure against BPSD during admission.

We applied a trial approach for early phase after diagnosis in patients suffered from ALS from 2007. This approach was constituted with corraboration of inter–professional works. Benefit of accompanying ST from early phase after diagnosis was, to point out of worsening of dysphagia and dysarthria, and to predict and avoid aspiration. Difficulty of communication is also common symptom of ALS. Speech therapist could help and teach alternative way for disability of communication and which improved QOL in two ALS patients in the report.

We report the effectiveness of dysphagia rehabilitation to patients who have prolonged swallowing difficulty after myasthenia gravis crisis. Three patients with late onset myasthenia gravis developed crisis triggered by respiratory infection. They were treated with a combination of plasmapheresis, tacrolimus and intravenous gamma globulin therapy. However they needed to receive mechanical ventilator management for a long time, so they underwent tracheostomy. Even after tapering from the mechanical ventilator, they were suffered from dysphagia caused by myasthenia symptom and indwelling tracheal catheter. The dysphagia rehabilitation for swallowing difficulty and appropriate food form selection according to their swallowing function made them possible to oral intake again without development of aspiration pneumonia. Monotherapy with tacrolimus was effective to improve myasthenia symptoms after crisis.