Characteristics of Early-Onset Dementia in Chiba Prefecture, Japan: A Multicenter Survey.

INTRODUCTION: Early-onset dementia (EOD), defined as dementia onset before the age of 65 years, is relatively rare, but its social impacts are significant. This study aimed to characterize the diagnosis and clinical and social status of EOD subjects in the 11 dementia centers in Chiba Prefecture, Japan. METHODS: A retrospective 1-year survey was conducted. Collected data included clinical diagnosis, age at onset, age at survey, neuropsychological test, family history, employment, and living status. RESULTS: We identified 208 EOD subjects, including 123 (59.4%), 24 (11.6%), 21 (10.1%), 17 (8.2%), and 10 (4.8%) with Alzheimer's disease (AD), vascular dementia, frontotemporal lobar degeneration (FTLD), dementia with Lewy bodies/Parkinson's disease dementia, and alcohol-related dementia, respectively. The Mini-Mental State Examination (MMSE) score <24 was observed in 50-75% of patients and was not correlated with disease duration. Twenty-four (16.4%) subjects had positive family history of EOD. EOD subjects were at risk of early retirement, and 133 subjects lived with their family, in whom 64 (30.8%) lived with their child. CONCLUSION: In dementia centers, AD, FTLD, and Lewy body dementia had relatively large proportion. Employment, economy, and social supports are urgently needed for EOD subjects and their family.

[Challenges faced by psychiatric services in Miyagi Prefecture after the Great East Japan Earthquake].

Following the Great East Japan Earthquake and Tsunami, the number of patients with onset, relapse, and exacerbation of mental disorders was expected to increase in Miyagi Prefecture, one of the worst affected areas. The functioning of almost all psychiatric hospitals sharply declined or even ceased. This situation worsened with traffic congestion and crippled public transportation, hindering many patients with psychiatric disorders from accessing mental health services. Among them, patients with schizophrenia and related disorders were affected the most; some could not reach the hospitals and clinics they had regularly visited and had to become new patients of another hospital or clinic. Moreover, an increasing number of patients with schizophrenia needed to be hospitalized because of acute exacerbations of their disorder, due to the experience of the disaster and the consequent drastic changes in their living environment Unfortunately, the support system for psychiatric institutions after disasters is not yet well structured; the system needs to be rebuilt and strengthened in anticipation of future disasters.

[Assessment of competence of predialysis chronic kidney disease stage 5 patients to make treatment decisions: preliminary report].

The competence to consent to treatment of 26 adults with stage 5 predialysis chronic kidney disease (CKD) (16 males, 10 females, age; 58 +/- 11 years, creatinine clearance; 10.1 +/- 3.9 mL/min)was assessed using two kinds of format: the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and mini-mental-state examination (MMSE). The MacCAT-T revealed poor ability for understanding(3.72 +/- 1.11 points; perfect score, 6 points), appreciating (2.88 +/- 0.88 points; perfect score, 4 points)and reasoning(4.30 +/- 2.11 points; perfect score, 8 points). The MMSE revealed poor performance on the attentional task. The level of attentional deficit was significantly related to both poor ability for understanding and reasoning (r = 0.432, p = 0.031 and r = 0.542, p = 0.014, respectively). These results suggest that the competence of predialysis CKD stage 5 patients to consent to treatment is impaired partly via an attentional deficit.

Epileptic seizures superimposed on catatonic stupor.

PURPOSE: Some patients with nonconvulsive status epilepticus are known to exhibit catatonic stupor. Thus it is necessary to rule out ictal catatonia by electroencephalography in patients with catatonic stupor. However, few reports are available on epileptic seizures superimposed on catatonic stupor. METHODS: We report three cases of epileptic seizures superimposed on psychiatric catatonic stupor without a prominent predisposing factor, including high fever or encephalitis. None of the patients had a personal or family history of neurologic disease, including epilepsy. RESULTS: In all three patients, catatonic stupor persisted after resolution of the epileptic seizures with administration of phenytoin. In two of the three patients, catatonic stupor resolved with electroconvulsive therapy, which caused no marked adverse effects. CONCLUSIONS: Because it is possible that catatonic stupor itself predisposes patients to the development of epileptic seizures, electroencephalographic examinations in patients with catatonic stupor are indispensable for early recognition not only of nonconvulsive status epilepticus but also of epileptic seizures superimposed on catatonic stupor. Electroconvulsive therapy deserves consideration when catatonic stupor persists after resolution of epileptic seizures.

Reduced word-repetition effect in the event-related potentials of thought-disordered patients with schizophrenia.

Repetition effect in event-related potentials (ERPs) was studied in 10 non-thought-disordered (non-TD) patients with schizophrenia, 8 thought-disordered (TD) patients with schizophrenia, and 10 normal control subjects while they performed a semantic categorization task with incidental word repetitions. All patients were in a stable or partially remitted stage. Although both healthy control and non-TD groups produced more positive ERPs to the repeated words than to the new words (ERP repetition effect) for 250-500 ms, the TD group did not show the ERP repetition effect. These findings suggest that the abnormal attenuation of the ERP repetition effect during semantic processing may be more prominent in schizophrenic patients with thought disorder than in those without the symptom.

[The Japanese version of RBANS (Repeatable Battery for the Assessment of Neuropsychological Status)].

In Japan, neuropsychological assessment of dementing illnesses has been done mainly using Mini-Mental State Examination (MMSE) and a revised version of Hasegawa Dementia Scale (HDS-R). However, because of a lack of appropriately designed test domains, early detection of senile dementia and/or cognitive impairment is hardly possible, even if using these batteries. This paper is to introduce a Japanese Version of RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) which was originally developed by Randolph and revised by us. The entire battery of Japanese Version RBANS took less than 30 minutes to administer, and yielded scaled scores for five cognitive domains such as immediate memory, visuospatial/constructional ability, language, attention, and delayed memory. On RBANS, abnormal cognitive decline in the older adult was much easily detected, being compared to MMSE and HDS-R: 52 normal volunteer subjects ranging from 24 to 80 years old showed a significant (p < 0.05 on t test) impairment of delayed and immediate memories due to ageing. The aged (60-79) subjects with average scores of MMSE and HDS-R being over 25, significantly showed impairment of both immediate memory (list and story learnings) and delayed memory (list, story and figure recalls). The present data suggest that the Japanese Version RBANS is useful for both detecting and characterizing early dementia, and should be widely utilized for a neuropsychological screening battery in the clinical practice throughout Japan.