The relationship among sleep, resilience, and stress response in Japanese female university students during the COVID-19 pandemic.

We examined the effect of sleep and resilience on stress responses in female Japanese university students during the COVID-19 pandemic. Sleep was measured using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J), stress response was evaluated using the Stress Response Scale-18 (SRS-18), and resilience using the Resilience Scale for Students (RS-S). Multiple regression analysis showed that approximately 40% of the SRS-18 score could be explained by PSQI-J score and RS-S score. Subjective sleep quality, daytime dysfunction, and global score of PSQI-J had direct influences on SRS-18.

A simple method to evaluate the pentagon copy test of the Mini-Mental State Examination for the differentiation of dementia with Lewy bodies.

There are many commonalities between the clinical symptoms of dementia with Lewy bodies (DLB) and those of Alzheimer's disease (AD). The accurate differentiation of these two diseases is an important neuropsychological issue. The Mini-Mental State Examination (MMSE) is often used as a screening test for dementing disorders. We created evaluation items for the pentagon copy test of MMSE and developed a simple, highly accurate evaluation method for differentiating DLB in combination with conventional evaluation items such as the Qualitative Scoring MMSE Pentagon Test (QSPT). Subjects were divided into three groups: DLB (n = 119), AD (n = 50), and Normal (n = 26). The severities of DLB and AD ranged from mild cognitive impairment (MCI) to mild dementia. We compared the results of the pentagon copy test. We found that the rates of patients with abnormalities in "motor incoordination" and "gestalt destruction" were higher in the DLB group than the AD group. Furthermore, receiver operating characteristic curve analysis suggested the differentiation of DLB with high accuracy (sensitivity: 0.70, specificity: 0.78) using the criterion of patients meeting one of the following three characteristics: "the number of angles on QSPT: scores other than 4," "major tremor (Parkinsonism-related tremor) is present," and "gestalt destruction (distortion in overall coherence) is present." This evaluation method may be clinically useful for evaluating MCI to mild DLB patients because the burden on patients is low.

The Bender Gestalt Test is useful for clinically diagnosing dementia with Lewy bodies: Analysis of its sensitivity, specificity, and clinical characteristics of the figure copy.

A previous study that evaluated the ability of the Bender Gestalt Test (BGT) to discriminate between dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) suggested that a total score of 98 is the optimal cutoff value for discriminating between these two diseases and that DLB tends to exhibit unique errors; i.e., "element deformation" and "gestalt destruction." The objectives of the present study were: (1) to examine the sensitivity and specificity of a total BGT score of 98 as a cutoff value in greater numbers of DLB patients than in the previous study, (2) to set a new cutoff value if a cutoff value of 98 is not optimal, and (3) to clarify the frequency of element deformation and gestalt destruction in DLB patients. The participants were 133 DLB patients, 65 AD patients, and 30 cognitively normal elderly people. All of the participants underwent the Mini-Mental State Examination, BGT, and brain magnetic resonance imaging. As a result, the total BGT score cutoff value of 98 showed low sensitivity (0.58), and a cutoff value of 84 was indicated to be the optimal cutoff value for discriminating between DLB and AD. In addition, 32 out of 133 DLB patients and one out of 65 AD patients exhibited element deformation or gestalt destruction. This study suggested that the BGT is a useful neuropsychological test for differentiating DLB from AD. In addition, the need to evaluate the spatial and perceptual difficulties of DLB patients with various types of visual stimulation is also discussed.

The Use of the Japanese Public Financial Support Has Positive Impact on Persistence with Outpatient Treatments for Schizophrenia: Single-center Retrospective Cohort Study in Japan.

PURPOSE: One of the challenges of treating schizophrenia is how to improve persistence with outpatient treatments. Lengthening community life by improving persistence and preventing relapse and rehospitalization can have positive influence on the patients' personal recovery and well-being. In Japan, there is "Medical Expenses for Services and Supports for Persons with Disabilities" ("Jiritsu-shien-iryo-hi" in Japanese) which is the public financial support system for psychiatric outpatient treatments. However, it is not clear how this financial support affects persistence with outpatient treatments for patients with schizophrenia. The purpose of the study is to investigate how the financial support affects persistence with outpatient treatments for schizophrenia. PATIENTS AND METHODS: Data of outpatients who visited the clinic between October 1, 2006 and September 30, 2016 was collected. The variables for the analysis were continuation and discontinuation of treatment of those who used the financial support (user) and those who did not (nonuser). The covariates were sex, age, time from onset of the disease to first visit to the clinic, number of hospitalizations in the past, use of psychiatric day care, and use of psychiatric home nursing care. Kaplan-Meier analysis was performed using propensity score matching. The observation period was five years from the first visit to the clinic. RESULTS: Among 1155 patients who were diagnosed with schizophrenia, 718 were excluded, based on the exclusion criteria. The propensity score matching was performed for 437 patients, and the subjects for the final analysis were 278. Average survival period was 1.09 (SD ±1.66) years for nonuser, 3.02 (SD ±1.77) years for users, and users exhibited a significantly longer number of years of outpatient treatments (P<0.001). CONCLUSION: The results indicated that use of the financial support can contribute to persistence with outpatient treatments.

Early diagnosis of prodromal dementia with Lewy bodies using clinical history of probable REM sleep behaviour disorder and cardiac 123 I-MIBG scintigraphy in memory clinics.

BACKGROUND: Rapid eye movement sleep behaviour disorder (RBD) is associated with reduced cardiac 123 I-metaiodobenzylguanidine (MIBG) uptake and often precedes the onset of Lewy body (LB) disorders. We investigated the role of cardiac 123 I-MIBG scintigraphy in relation to probable RBD for the clinical diagnosis of prodromal dementia with Lewy bodies (DLB) in memory clinics. METHODS: We reviewed clinical profiles of 60 consecutive patients who underwent cardiac 123 I-MIBG scintigraphy in our memory clinics. The diagnostic threshold of 2.20 was used as the cut-off for the heart-to-mediastinum ratio at the delayed phase. RESULTS: Cardiac 123 I-MIBG abnormality was identified in 28 patients at baseline; six were cognitively unimpaired, six had mild cognitive impairment (MCI)-LB, and 16 had probable DLB based on the National Institute on Aging and Alzheimer's Association Research Framework. Although the number of core features increased in accordance with the progression of three cognitive categories, there were no differences in the prevalence of probable RBD and the cardiac MIBG scintigraphy indices among them. During the observation period, two cognitively unimpaired patients with probable RBD progressed to MCI-LB, and three MCI-LB patients with probable RBD developed DLB. The prevalence of final diagnosis of probable MCI-LB or DLB was significantly higher in these patients (85%) than the remaining 32 patients without (9%). Of 25 patients with probable RBD, 22 (88%) had a cardiac 123 I-MIBG abnormality regardless of cognitive conditions. Only one patient consulted a sleep centre for the abnormal sleep behaviour before visiting our memory clinics. Regarding the gender differences, male predominance was not identified and sleep-related injury more frequently occurred in men (7/12, 58%) than in women (1/10, 10%). CONCLUSIONS: Proactive detection of probable RBD plus cardiac 123 I-MIBG abnormality provides the opportunity for an early diagnosis of prodromal DLB in memory clinics. This approach warrants further follow-up studies with polysomnographic and pathological verification.

Evaluating depression in cognitively healthy elderly people by using Mini-Mental State Examination.

AIM: We examined a method for evaluating depression with the Mini-Mental State Examination in cognitively healthy elderly people and employed the projective perspective. METHODS: In MMSE three groups-normal, depressed tendency, and depressed-completed the Mini-Mental State Examination (MMSE) and a Japanese version of the 15-item Geriatric Depression Scale. The Mini-Mental State Examination evaluated individuals' writing based on a sentence, the number of written words, and sentence content; it also assessed their copying of drawn figures. RESULTS: In the depressed group, the proportion corresponding to the characteristics of (i) to (iii) was higher than in the other two groups: (i) the calculation score was 0 or 1; (ii) subjects scored above the median in sentence writing relative to similar subjects with the same language and clinical setting; and (iii) subjects expressed feelings in their writing. One point was given for each characteristic, and we calculated the sum. Depressed subjects had a score ≥2. CONCLUSIONS: This evaluation method can differentiate depressed subjects with high accuracy (sensitivity: 77.8%, specificity: 76.4%) without placing an extra burden on the subjects.

Characteristics of dementia patients who described or did not describe the relationship between two people on the COGNISTAT speech sample.

Speech sample of Cognitive Status Examination (COGNISTAT) is a task in which examinees freely talk about what is happening in a presented picture. We investigated whether there are differences in the characteristics between patients who described or did not describe the relationship between two people in the speech sample based on age, gender, cognitive dysfunction, and type of dementia (Alzheimer's disease and dementia with Lewy bodies). The participants were 60-year-old or older patients diagnosed with Alzheimer's disease or dementia with Lewy bodies who undertook the Mini-Mental State Examination (MMSE) and COGNISTAT at a general hospital specialized in care for the elderly. MMSE and COGNISTAT were performed by a female clinical psychologist in all patients. In a stepwise logistic regression analysis using the two groups (description and no description groups) as a response variable, and the age, gender, diagnosis, MMSE score, and score of each COGNISTAT subtest as explanatory variables, the MMSE score (OR = 1.09; 95% CI [1.03, 1.15]) and gender (OR = 1.79; 95% CI [1.09, 2.93]) factors were extracted. These results indicated that patients with severer overall cognitive dysfunction and male patients were unlikely to describe the relationship between two people in a speech sample.

Factors influencing nursing home placement of patients with dementia: a retrospective, single-centre study in Japan.

AIM: This was an exploratory study to examine the factors influencing nursing home placement (NHP) in Japan. METHODS: For this analysis, 633 patients were selected. The data were collected from the clinical records of each patient. A log-rank test was performed. The time from the patient's first visit to the clinic until the nursing home placement was the independent variable. Age (<80 or ≥80 years), biological sex (male or female), Clinical Dementia Rating scale (CDR) score (overall index 0.5, 1, 2, or 3), living situation (living alone or with someone), and voxel-based specific regional analysis systems for Alzheimer's disease Z-score (<2 or ≥2) were the dependent variables. Survival curves were obtained by using the Kaplan-Meier estimate. After the log-rank test, we conducted a Cox proportional hazards regression analysis. RESULTS: The results of log-rank test indicated that all the variables could significantly influence time to NHP. Cox proportional hazards regression analysis suggested that CDR 3 exhibited the highest hazard ratio and Z-score showed the lowest hazard ratio. There were significant differences in age, sex, CDR 2, CDR 3, and living situation. CONCLUSIONS: The results indicated that the voxel-based specific regional analysis systems for Alzheimer's disease Z-score is unlikely to influence NHP. This may suggest that even if the atrophy in the medial temporal lobe is rather progressed, patients can remain living at their own home with protective factors. Future studies need to investigate the risk and protective factors of time to NHP by combining the variables.

The Use of Short Versions of the Japanese WAIS-III to Aid in Differentiation Between Alzheimer's Disease and Dementia with Lewy Bodies.

OBJECTIVE: We examined the cognitive characteristics of patients with Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) using the Wechsler Adult Intelligent Scale-Third Edition (WAIS-III). In addition, the utility of short versions of WAIS-III for estimating IQ scores and index scores were examined. METHODS: The subjects were 83 patients with probable AD, 33 patients with probable DLB, and 83 cognitively normal individuals. RESULTS: Patients with DLB showed significantly lower scores in Performance IQ and Processing Speed compared with those with AD. The short versions of WAIS-III with Information, Similarities, Arithmetic, Digit Span, Picture Completion, Digit Symbol-Coding, and Block Design demonstrated relatively small amount of error, high correlations, and reliabilities with the full version. CONCLUSIONS: The results indicated that Performance IQ and Processing Speed in WAIS-III can be an indicator for differentiating AD and DLB in WAIS-III, and a short version obtained by the Similarities, Information, Picture Completion, Block Design, Arithmetic, Digit Span, and Digit-Symbol Coding yields high accuracy and can be used to estimate full-scale IQ scores on the WAIS-III.

Differences in responses to the Rorschach test between patients with dementia with Lewy bodies and Alzheimer's disease -from the perspective of visuoperceptual impairment.

Patients with Dementia with Lewy bodies (DLB) tend to perform worse in tasks on visuoperception than patients with Alzheimer's disease (AD). The Rorschach inkblot test has its utility for assessing perceptual and visuospatial abilities. In this study, we examined the differences in responses to the Rorschach test between patients with DLB and those with AD in terms of visuoperception, and investigated the utility of the test for assessing visuoperceptual impairment in DLB. Using the comprehensive system of Rorschach test, six variables were significantly higher, and three variables were significantly lower in DLB patients compared to AD patients. Among those variables, PTI showed high sensitivity and specificity for differentiating DLB from AD. Furthermore, when the PTI score was combined with the Dd score and a number of times a patient saw an eye in a shading part of an inkblot, the sensitivity and specificity reached 90.6% and 73.1%, respectively. These results indicate that the patients with DLB perceive objects in the inkblot differently from patients with AD, and suggest that some variables of the Rorschach test could assist with neuropsychological examinations when differentiating DLB from AD.

123I-FP-CIT SPECT findings and its clinical relevance in prodromal dementia with Lewy bodies.

PURPOSE: Evidence for the prodromal stage of dementia with Lewy bodies (DLB) is very limited. To address this issue, we investigate the 123I-FP-CIT SPECT measure of dopamine transporter binding finding and its clinical relevance. METHODS: We enrolled subjects into a prodromal DLB group (PRD-DLB) (n = 20) and clinical DLB group (CLIN-DLB) (n = 18) and compared these groups with an Alzheimer's disease control group (AD) (n = 10). PRD-DLB was defined as patients having the non-motor symptoms associated with Lewy body disease (LBD) [i.e. REM sleep behavior disorder (RBD), olfactory dysfunction, autonomic dysfunction, and depression] and showing characteristic diffuse occipital hypometabolism in 18F-FDG PET. CLIN-DLB was defined as patients fulfilling the established criteria of probable DLB. Striatal specific binding ratio (SBR) of 123I-FP-CIT SPECT was used for objective group comparisons. The correlations between SBR and cognitive function (MMSE), motor symptoms (UPDRS3), and duration of LBD-associated non-motor symptoms were compared between the two DLB groups. RESULTS: Mean SBR scores of both PRD-DLB and CLIN-DLB were significantly lower than those of AD. No correlation was found between SBR and MMSE scores. Both in the CLIN-DLB and total DLB groups, SBR scores were negatively correlated with UPDRS3 scores, whereas no correlation was found in PRD-DLB. Among the LBD-related non-motor symptoms, duration of olfactory dysfunction, and RBD demonstrated negative correlation with SBR scores in PRD-DLB. CONCLUSION: 123I-FP-CIT SPECT may play a role for detecting DLB among the subjects in prodromal stage. During this stage, long-term olfactory dysfunction and/or RBD may indicate more severe degeneration of the nigro-striatal dopaminergic pathway.

Characteristics of mild cognitive impairment tending to convert into Alzheimer's disease or dementia with Lewy bodies: A follow-up study in a memory clinic.

AIM: To determine characteristics of MCI that can predict whether patients will go on to develop AD or DLB. METHODS: Ninety-three patients diagnosed with MCI underwent neuropsychological and neuroimaging examinations, and were followed-up for a mean of 44.9±19.3months. They were divided into four MCI subtypes (amnestic/non-amnestic MCI, single/multiple domain) according to neuropsychological findings, and into three other MCI categories (AD-type PET, DLB-type PET, and unknown-type PET) based on (18)F-fluorodeoxyglucose PET findings. Patients who were eventually diagnosed with AD, DLB, other dementia, or remained MCI were analyzed in relation to the groups to which they had initially been allocated at the MCI stage. RESULTS: Clinical diagnosis after follow-up determined AD in 21 patients (22.6%), DLB in 12 patients (12.9%), other dementia in 2 patients (2.2%), and non-converter in 58 patients (62.3%). Amnestic single-domain MCI and AD-type PET tended to convert into AD. Amnestic multiple-domain MCI and DLB-type PET tended to convert into DLB. A few patients with AD-type PET later developed DLB, and some with DLB-type PET later developed AD. CONCLUSIONS: Predicting which type of dementia a person with MCI will later develop might be possible based on early assessment with clinical symptoms in conjunction with neuropsychological and (18)F-fluorodeoxyglucose PET findings.

Early differential diagnosis between Alzheimer's disease and dementia with Lewy bodies: Comparison between (18)F-FDG PET and (123)I-IMP SPECT.

Both (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and (123)I-iodoamphetamine (IMP) single-photon emission computed tomography (SPECT) have been used for the differential diagnosis of Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Less information is available, however, regarding the differential diagnosis of mild cognitive impairment (MCI) due to AD and MCI due to DLB. We examined nine AD patients (AD group), nine DLB patients (DLB group), eight MCI due to AD patients (MCI-AD group), and nine MCI due to DLB patients (MCI-DLB group) with FDG PET and IMP SPECT using a well-characterized normal database and a stereotactic extraction estimation method. In the AD and DLB groups, receiver operating characteristic (ROC) analysis in the occipital regions showed significant accuracy of both FDG PET and IMP SPECT for the differential diagnosis. In the MCI-AD and MCI-DLB groups, ROC analysis showed significant accuracy of only FDG PET for the differential diagnosis. Both FDG PET and IMP SPECT would be useful for the differential diagnosis between AD and DLB. For the differential diagnosis of MCI-AD versus MCI-DLB, FDG PET would be more useful than IMP SPECT.

Prediction of later clinical course by a specific glucose metabolic pattern in non-demented patients with probable REM sleep behavior disorder admitted to a memory clinic: A case study.

The present study is a follow-up study of 11 non-demented patients with probable rapid eye movement (REM) sleep behavior disorder (RBD) at our memory clinic. During the follow-up period (mean±SD of 46.7±6.4 months), all 11 patients exhibited cognitive decline: four (Group A) exhibited core clinical features of dementia with Lewy bodies (DLB), along with severe cognitive decline, and were subsequently diagnosed as having probable DLB; four (Group B) did not exhibit core clinical features of DLB; and the remaining three (Group C) were diagnosed as having Parkinson's disease with dementia (PDD). Positron emission tomography with fluorodeoxyglucose-F18 at baseline revealed that Groups A and B exhibited glucose hypometabolism in the occipital lobe, especially in the primary visual cortex, and Group A tended to present hypometabolism in the parieto-temporal area as well. Group C tended to present hypometabolism in the medial prefrontal area and anterior cingulate gyrus. Neuropsychological examinations indicated poor performance in verbal memory and visuoperception in all groups. This case study suggests that patterns of hypometabolism and neuropsychological examinations at baseline may be indicators of the later clinical course of probable RBD patients.

Cognitive dysfunction in patients with very mild Alzheimer's disease and amnestic mild cognitive impairment showing hemispheric asymmetries of hypometabolism on ¹8F-FDG PET.

OBJECTIVE: We investigated cognitive dysfunction in patients with Alzheimer's disease (AD) and amnestic mild cognitive impairment (aMCI) who present hemispheric asymmetries of cerebral metabolic rate of glucose (CMRglc) decrease on (18) F-fluorodeoxyglucose positron emission tomography. METHODS: Based on the hemispheric asymmetries of CMRglc decrease in the posterior cingulate cortex, precuneus, and parietotemporal cortex, the patients were divided into three groups (a left-dominant hypometabolism group, a right-dominant hypometabolism group, and a non-dominant hypometabolism group). CMRglc decrease in the whole brain was controlled among the three groups. All the patients underwent mini-mental state examination (MMSE), Wechsler Memory Scale-Revised (WMS-R), and Wechsler Adult Intelligent Scale-Third (WAIS-III). RESULTS: There were no significant differences in MMSE and WAIS-III scores among the three groups. In WMS-R, the results indicated that the left-dominant group demonstrated significantly lower scores in verbal memory than the other two groups. Furthermore, the left-dominant group had a greater tendency to be diagnosed with AD rather than aMCI. CONCLUSIONS: Patients with AD and aMCI showing left-dominant hypometabolism tend to show severer impairment in verbal memory function and to be diagnosed with AD dementia.

Characteristics of depression in community-dwelling elderly people as indicated by the tree-drawing test.

BACKGROUND: The tree-drawing test (TDT) is a typical projective method, but previous studies have paid little attention to it for elderly people. We investigated the characteristics of depression in community-dwelling elderly people as indicated by the TDT. METHODS: This study was a complete enumeration survey of elderly people conducted through home visits. The contents of the survey included gender, age, presence or absence of housemates, frequency of going out, the 15-item Geriatric Depression Scale, and TDT. The subjects were divided into three groups (normal, depressed tendency, and depressed) according to the total 15-item Geriatric Depression Scale score. RESULTS: In TDT, no significant difference was observed in drooping crown, shadow of the whole tree, or shadow near the base, which have been regarded as indices of depression in younger people. However, the values concerning the size of the tree, such as the height and width of the whole tree, height and width of the crown, and number of occupied areas (of the paper), were significantly lower in the depressed group than in the other groups. In addition, the width of the trunk was significantly smaller in the depressed group than in the normal group. Subjects were classified as being in a 'depressed state' if they used 40 or fewer areas for drawing (i.e. occupied areas) and a 'non-depressed state' if they used 41 or more areas. This enabled depression to be detected (sensitivity: 71.4%; specificity: 79.9%). CONCLUSIONS: The size of the tree in TDT is suggested to reflect characteristics of depression in elderly people, such as introversion, reserve, antisocial attitude, a feeling of inferiority, weakness of ego, and lack of vigour. Furthermore, the numbers of occupied areas were found to be relatively useful in detecting depression in elderly people.

Visuoperceptual assessments for differentiating dementia with Lewy bodies and Alzheimer's disease: illusory contours and other neuropsychological examinations.

We examined the utility of illusory contours (ICs) for the differentiation of dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). Thirty-five probable DLB patients, 35 probable AD patients controlled by age, years of education, and Mini-Mental State Examination (MMSE) score, and 30 cognitively normal subjects controlled by age and years of education underwent visuoperceptual examinations including ICs, pentagon copying in MMSE, overlapping figures, clock drawing test, cube copying, and line orientation. Four items in ICs (ICs-4) were found to be significantly impaired in DLB compared with AD, and a sensitivity and a specificity of total score of ICs-4 were 88.6% and 37.1%, respectively. When a score of ICs-4 is combined with a 10-point scaled score of pentagon copying in MMSE, a sensitivity and a specificity were 77.1% and 82.9%, respectively. The present study suggests that ICs-4 can be included in neuropsychological examinations to assess visuoperceptual impairment in DLB.

Clinical profiles of dementia with Lewy bodies with and without Alzheimer's disease-like hypometabolism.

OBJECTIVES: It is well known that Alzheimer's disease (AD)-type pathology is commonly present in dementia with Lewy bodies (DLB) brains and that the degree of AD-type pathology has an influence on the clinical characteristics of DLB. Although significant hypometabolism in the temporoparietal/precuneus on [(18)F]fluoro-d-glucose ((18)F-FDG) positron emission tomography (PET) scans is considered to support a diagnosis of AD, some DLB patients also exhibit this metabolic pattern. The clinical significance of the metabolic pattern on DLB remains unknown. METHODS: Twenty-three DLB patients, 10 AD patients, and 11 controls underwent (18)F-FDG PET scans. According to the degree of hypometabolism in the parietal/precuneus regions, representing the AD-like metabolic pattern, 12 patients were placed in the DLB-AD(+) group and 11 patients were placed in the DLB-AD(-) group. The demographics and clinical variables were compared among the four groups. RESULTS: In addition to the parietal/precuneus regions, the DLB-AD(+) group exhibited significantly greater posterior cingulate hypometabolism than the DLB-AD(-) group, although occipital metabolism did not differ. The prevalence of visual hallucinations and extracampine hallucinations, and the Bender-Gestalt test score were significantly higher in the DLB-AD(+) group than the DLB-AD(-) group, although there were no differences in the demographics and other examined clinical variables between the two DLB groups. These clinical differences were absent in the DLB-AD(-) group, AD group, and controls. CONCLUSIONS: Parietal/precuneus hypometabolism may be associated with clinical characteristics in DLB patients. Further multiple imaging modalities that are sensitive to AD-type pathology are needed to reveal the neurobiological basis of the AD-like metabolic pattern.

Three presenile patients in which neuropsychological and neuroimaging examinations suggest possible progression to dementia with Lewy bodies.

We report three presenile patients who were initially suspected of having Alzheimer's disease (AD) or being in the prodromal stage of AD, regardless of visuoperceptual dysfunctions in daily living, because they lacked the core features and prodromal non-motor symptoms of dementia with Lewy bodies. Subsequently, progression to dementia with Lewy bodies was suspected based on neuropsychological and neuroimaging findings; additionally, one of the three patients suffered from visual hallucinations. Neuropsychological examinations such as subjective contours, cube copying and block design in the Wechsler Adult Intelligence Scale-III revealed visuoperceptual dysfunction in all three patients even when other cognitive functions were rather preserved. Brain magnetic resonance imaging revealed no significant brain atrophy, including in the parieto-occipital area and the hippocampus, while brain (18)F-fluorodeoxyglucose positron emission tomography demonstrated right dominant metabolic reductions in the occipital lobe, including the primary visual cortex, in all three patients. We suggest the possibility of progression to dementia with Lewy bodies, but not AD or posterior cortical atrophy. Regardless of the presence of core features and prodromal non-motor symptoms, this progression is suggested when there are difficulties only in higher-level visual processing such as subjective contours and block design in the Wechsler Adult Intelligence Scale-III, no significant atrophy of the parieto-occipital area and hippocampus on brain magnetic resonance imaging, and hypometabolism in the occipital lobe including the primary visual cortex on brain (18)F-fluorodeoxyglucose positron emission tomography.