Introduction of Induction Heating is too late for older residents with difficulty in handling fire.

Handling errors with household flammables, for example pan burning, may result in serious accidents, which may be caused by decreased attention or executive function. Objective: The manuals by several cities simply suggest the use of induction heating (IH) cookers. However, it requires complicated operation of buttons. Furthermore, no previous studies have examined the difficulty of IH operation in older adults. Methods: We examined 166 residents aged 75+ years in Wakuya, consisting 66 Clinical Dementia Rating (CDR) 0 (healthy), 79 CDR 0.5 (very mild dementia), and 21 CDR 1+ (dementia) participants. Based on fire accident, they were classified into "high-risk," "low-risk," and "safety" groups. They were asked to actually use an IH as an examination. The participants who passed all procedures were classified as "good users," and the remaining who failed were classified as "poor users." Their overall cognitive and executive functions were assessed using the Mini-Mental State Examination (MMSE) and Trail Making Test A and Digit Symbol (DS), respectively. Results: The proportions of "good users" in the CDR 0, CDR 0.5, and CDR 1+ groups were 7 (10.6%), 6 (7.3%), and 0 (0%), respectively. For the CDR 0 and CDR 0.5 group, the good users had higher scores on the MMSE and DS than do the poor users. Conclusions: The introduction of IH is too late for "high-risk group." Since the IH cooker requires complicated operation of buttons, they may be difficult for older residents to handle. Executive function may be examined for early detection of handling errors with household flammables.

Erros no manuseio de artigos domésticos muito aquecidos, por exemplo, panelas, podem resultar em acidentes graves, que podem ser causados por diminuição da atenção ou de funções executivas. Objetivo: Manuais de várias cidades sugerem simplesmente o uso de fogões de aquecimento por indução (FAI), mas esses aparelhos requerem uma operação complexa, com necessidade de uso de diversos botões. No entanto, nenhum estudo anterior examinou a dificuldade de operação de FAI em adultos mais velhos. Métodos: Foram examinados 166 residentes de Wakuya, Japão, com mais de 75 anos, entre os quais 66 participantes com classificação clínica de demência (CDR) 0 (saudável), 79 CDR 0,5 (demência muito leve) e 21 CDR 1+ (demência). Em função do risco de queimadura, eles foram classificados nos grupos "alto," "baixo risco" e "sem risco". Solicitou-se que realmente utilizassem o FAI como parte do exame. Os participantes que passaram em todos os procedimentos foram classificados como "bons usuários", enquanto os demais foram classificados como "usuários fracos". As funções cognitivas e executivas globais foram avaliadas por meio do Miniexame do Estado Mental (MEEM), do Teste de Trilha A e do Teste Dígito-Símbolo (DS), respectivamente. Resultados: As proporções de "bons usuários" nos grupos CDR 0, CDR 0,5 e CDR 1+ foram 7 (10,6%), 6 (7,3%) e 0 (0%), respectivamente. Para os grupos CDR 0 e CDR 0,5, os "bons usuários" tiveram pontuações mais altas no MEEM e no DS em comparação com os "usuários fracos". Conclusões: A introdução de FAI é muito tardia para o grupo de "alto risco". Uma vez que o FAI requer uma operação complicada com o uso de botões, o seu manuseio pode ser difícil para os residentes mais velhos. A função executiva pode ser examinada para a detecção precoce de erros de manuseio de aparelhos domésticos que podem causar acidentes.

Impaired attention function based on the Montréal Cognitive Assessment in vascular dementia patients with frontal hypoperfusion: The Osaki-Tajiri project.

We previously reported that the Montréal Cognitive Assessment (MoCA) was effective in the evaluation of cerebrovascular diseases. We also demonstrated that the test was effective for screening for very mild vascular dementia (VaD) in the community. Herein, we examined the effectiveness of MoCA in the assessment of patients with VaD in an outpatient clinic. Forty-four patients with VaD (National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences [NINDS-AIREN] criteria) and 58 patients with Alzheimer's disease (AD) (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association [NINCDS-ADRDA] criteria) were compared with 67 non-demented control subjects. All were outpatients at the Tajiri Memory Clinic, Osaki-Tajiri, northern Japan. All underwent 1.5 Tesla MRI and ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) examinations. The SPECT images were used to classify the VaD patients into two subgroups, those with frontal hypoperfusion (F-VaD) and those without frontal hypoperfusion. The frontal hypoperfusion pattern was defined as the "P2" pattern of the Sliverman classification, with or without focal hypometabolism in other areas, based on the agreement of three neurologists who were blinded to the results of the neuropsychological examinations. Total scores and attention subscores on the MoCA were lower in the F-VaD group compared with other groups. Our results suggest that the MoCA attention subscale can detect VaD participants, particularly those with frontal hypoperfusion.

Normal Hearing Ability but Impaired Auditory Selective Attention Associated with Prediction of Response to Donepezil in Patients with Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) patients have a poor response to the voices of caregivers. After administration of donepezil, caregivers often find that patients respond more frequently, whereas they had previously pretended to be "deaf." We investigated whether auditory selective attention is associated with response to donepezil. METHODS: The subjects were40 AD patients, 20 elderly healthy controls (HCs), and 15 young HCs. Pure tone audiometry was conducted and an original Auditory Selective Attention (ASA) test was performed with a MoCA vigilance test. Reassessment of the AD group was performed after donepezil treatment for 3 months. RESULTS: Hearing level of the AD group was the same as that of the elderly HC group. However, ASA test scores decreased in the AD group and were correlated with the vigilance test scores. Donepezil responders (MMSE 3+) also showed improvement on the ASA test. At baseline, the responders had higher vigilance and lower ASA test scores. CONCLUSION: Contrary to the common view, AD patients had a similar level of hearing ability to healthy elderly. Auditory attention was impaired in AD patients, which suggests that unnecessary sounds should be avoided in nursing homes. Auditory selective attention is associated with response to donepezil in AD.

Disorders of "taste cognition" are associated with insular involvement in patients with Alzheimer's disease and vascular dementia: "memory of food is impaired in dementia and responsible for poor diet".

BACKGROUND: In dementia patients, dietary intake problems may occur despite the absence of swallowing problems. We investigated cognitive functions on food and taste in Alzheimer's disease (AD) and vascular dementia (VaD) patients. METHODS: Participants included 15 healthy controls (HC), 30 AD and 20 VaD patients. Food Cognition Test: Replicas of three popular foods in Japan with no odors were presented visually to each participant, with the instruction to respond with the name of each food. Replicas of food materials were subsequently presented to ask whether they were included in these foods. Taste Cognition Test: Replicas of 12 kinds of foods were presented to describe their expected tastes. RESULTS: The AD/VaD groups exhibited significantly lower scores on Food/Taste Cognition Tests compared with the HC group. These scores correlated inversely with Mini-Mental State Examination (MMSE) scores in the AD group. Decreased dietary intake was observed in 12 of the 50 patients; 8 of the 12 exhibited decreased Taste Cognition Test scores, higher than that of the normal-intake patients. There was no difference in the filter paper taste disc test between HC/AD/VaD groups. To test the hypothesis that the insula is associated with taste cognition, two MMSE-matched AD subgroups (n = 10 vs. 10) underwent positron emission tomography. Glucose metabolism in the right insula was lower in the low taste cognition subgroup. The VaD patients with insular lesions exhibited impaired Taste Cognition Test findings. CONCLUSIONS: It is important to consider the cognitive aspect of dietary intake when we care for dementia patients.

[A case of obstruction in the left internal jugular vein which both ultrasound prescan and chest computed tomography could not detect before the insertion of a pulmonary artery catheter].

In a 54-year-old man, at the time of anesthesia administration during the Bentall re-operation, a preoperative ultrasound scan showed right internal jugular vein thrombosis before insertion of a pulmonary artery catheter into the right internal jugular vein. Therefore, we performed the insertion after confirming that the left internal jugular vein was safe via a preoperative ultrasound and chest computed tomography (CT). Although we could insert the catheter sheath, contrast imaging revealed that the pulmonary artery catheter had advanced no further than approximately 15 cm into the left internal jugular vein. Similar advancement was noted when inserting the pulmonary artery catheter under fluroscopic guidance. This indicated an obstruction in the confluence of the left internal jugular vein and the brachiocephalic vein. A postoperative chest contrast CT showed thrombosis in the confluence of the left internal jugular vein and the brachiocephalic vein. Considering that the chest CT scan was performed 2 months before the surgery, it is necessary to perform imaging again before surgery.

Apathy is more severe in vascular than amnestic mild cognitive impairment in a community: the Kurihara Project.

AIM: The aim of this study was to estimate the prevalence of apathy, and to compare vascular mild cognitive impairment (vMCI), amnestic MCI (amMCI), and other type using Clinical Assessment for Spontaneity (CAS). METHODS: Agreement to take part in the study was obtained from 590 community dwellers, aged ≥75 years living in Kurihara, Japan. Of the 590 subjects, 221 had a clinical dementia rating (CDR) of 0 (normal); 295 had CDR 0.5 (mild cognitive impairment; MCI); and 74 had CDR 1+ (dementia). The CDR 0.5 subjects were divided into three groups: 55 with vMCI (Erkinjuntti et al. criteria), 91 with amMCI and 149 with other type. To evaluate the various aspects of apathy, we used the three CAS subscales: clinical interview (CAS1), self-evaluation (CAS2), and caregiver assessment (CAS3). Three analyses were then performed to determine: (i) the validity of CAS; (ii) the prevalence rate of apathy in CDR 0 versus CDR 0.5 versus CDR 1+; and (iii) the prevalence rate of apathy in normal versus vMCI versus amMCI versus other type. RESULTS: CAS was validated with the Apathy Evaluation Scale. There were significant differences among the three CDR groups in CAS1, CAS2 and CAS3 (P < 0.001). The prevalence rate of apathy in each CAS in the CDR 1+ group was higher than the CDR 0.5 group, which was higher than the CDR 0 group. There was a significant difference in CAS3 score between the four groups (the normal and the three subgroups; P < 0.001). Apathy in vMCI was more severe than in the other three groups (P < 0.05) on CAS3 score. CONCLUSIONS: vMCI subjects have more severe apathy compared with amMCI subjects on caregiver assessment.

The protective effects of tetrahydrocurcumin on oxidative stress in cholesterol-fed rabbits.

Tetrahydrocurcumin (THC) is an antioxidative substance which is derived from curcumin by hydrogenation. Curcumin is the main component of turmeric and is responsible for the yellow color of curried foods.First, LDL derived from a normal human volunteer was incubated in the presence of an antioxidant with 10 microM CuSO(4) at 37 degrees C for 2 hours.All antioxidants tested (THC, curcumin, probucol, and alpha-tocopherol) dose-dependently (1-10 microM) inhibited the oxidative modification of LDL. Probucol was the strongest, followed by THC, alpha-tocopherol, and curcumin.Next, in order to evaluate the antioxidative activity of THC in vivo, we fed rabbits diets containing 1% cholesterol with or without 0.5% THC and examined their effects on oxidative stress and atherosclerosis. Animals were divided into two groups: the control group rabbits (n = 12) were fed a normal chow diet and the experimental group (n = 12) was fed a diet containing 0.5% THC for one week.Then, 1% cholesterol was added to the diets and the animals were allowed to feed further for either 6 (n = 4 for each group) or 12 weeks (n = 8 for each group). Although serum cholesterol levels rapidly increased after starting the high cholesterol diet, no difference was observed between the control and THC groups.TBARS formation in the absence of added copper ion was inhibited in the LDL separated from THC-treated animals compared with that from control animals.THC treatment tended to inhibit the area covered with atherosclerotic lesions compared with the control, although this was not significant (28.8 +/- 17.5% vs. 40.0 +/- 23.7%, p = 0.2). Formation of N(epsilon)-(hexanoyl) lysine, 4-hydroxynonenal and dityrosine in liver and kidney also had a tendency to be inhibited by THC treatment. Although free THC was not detected in serum and liver, THC was detected in samples treated with beta-glucuronidase and sulfatase, suggesting that THC is present as a conjugate with glucuronic acid or sulfate. In conclusion, the present results suggest that curcuminoids, particularly THC, which are contained in turmeric, may be useful as a functional food factor.