Relationship between Loneliness and Mild Behavioral Impairment: Validation of the Japanese Version of the MBI Checklist and a Cross-Sectional Study.

Background: Mild behavioral impairment (MBI) and loneliness are associated with cognitive decline and an increased risk of dementia. Objective: Our aim was to examine the validity of the Japanese version of the MBI checklist (MBI-C) and investigate the relationship between loneliness and MBI. Methods: The participants in this cross-sectional study included 5 cognitively normal persons and 75 persons with mild cognitive impairment. MBI-C and the revised University of California at Los Angeles loneliness scale (LS) were used to assess MBI and loneliness, respectively. Diagnostic performance of MBI-C was examined using receiver operating characteristic analysis. The relationship between MBI-C and LS was examined using multiple linear regression in 67 subjects who were assessed with both scales, with MBI-C total or domain score as the dependent variable and LS as the independent variable, adjusted for age, gender, living situation, presence of visual and hearing impairment, and Mini-Mental State Examination score. Results: Per the Youden index, in this mostly MCI sample, the optimal MBI-C cut-off score was 5.5 with sensitivity 0.917 and specificity 0.949. In multiple linear regression analysis, LS score was detected as a significant predictor of MBI-C total scores, and MBI-C decreased motivation, affective dysregulation, and abnormal thought and perception scores. Conclusions: The caregiver-rated Japanese MBI-C has excellent diagnostic performance. Loneliness is associated with a greater MBI burden, especially in the decreased motivation, affective dysregulation, and abnormal thought and perception domains. Interventions for loneliness in older people may have the potential to improve MBI.

A case of cardiac metastasis of neuroendocrine tumor with 2-year follow-up.

A 55-year-old male underwent surgery for thymus gland tumors six years previously, and for lung and pancreas tumors three years previously, which were pathologically diagnosed as neuroendocrine tumors (NETs). During routine medical checkups, a giant negative T-wave was observed on the electrocardiogram. Echocardiography revealed a tumor at the apex. A surgical biopsy was performed; the tumor was diagnosed as a cardiac metastasis of NETs, and chemotherapy was initiated. Two years later, echocardiography confirmed that the tumor had not increased in size. A 2-year follow-up of NETs cardiac metastasis is rare; we therefore report this case. Learning objective: Neuroendocrine tumors are considered slowly progressing tumors, but despite the presence of cardiac metastasis, accurate diagnosis and appropriate treatment have allowed the patient to survive the disease for more than two years.

Comparison in Repetitions to Failure Between Concentric-Only and Eccentric-Only Dumbbell Arm Curl Exercise at Four Different Relative Intensities.

ABSTRACT: Shibata, K, Yamaguchi, T, Takizawa, K, and Nosaka, K. Comparison in repetitions to failure between concentric-only and eccentric-only dumbbell arm curl exercise at four different relative intensities. J Strength Cond Res 37(9): 1754-1760, 2023-The repetitions to failure (RF) were compared between concentric-only (CON) and eccentric-only (ECC) arm curl exercise for different intensities based on CON and ECC 1 repetition maximum (1RM), respectively, with 2 different inter-repetition rests. Sixteen healthy male, university students (19-22 years) participated in 6 sessions. In sessions 1 and 2, CON and ECC 1RM strength were determined. In sessions 3 to 6, CON and ECC dumbbell arm curl exercises were performed until momentary failure at the intensity of either 70, 80, 90 or 95% of CON and ECC 1RM, respectively, with the inter-repetition rest of 3 seconds (R3) for one arm and 6 seconds (R6) for the other arm in a pseudo-randomized order. A significant ( p < 0.01) muscle contraction type × intensity interaction effect was evident for both R3 and R6 conditions. RF was greater ( p < 0.01) in ECC than in CON at 70% (34.2 ± 13.3 vs 20.9 ± 5.4), 80% (22.0 ± 6.7 vs 11.6 ± 2.7), 90% (10.1 ± 3.1 vs 5.2 ± 1.3), and 95% (6.8 ± 2.1 vs 2.7 ± 0.8) for R3. RF was also greater ( p < 0.01) for ECC than for CON at 80% (24.5 ± 8.1 vs 15.6 ± 3.6), 90% (10.8 ± 2.8 vs 7.2 ± 1.8) and 95% (6.7 ± 2.4 vs 3.9 ± 1.5) for R6, with greater ( p < 0.05) RF for R6 than R3. Significant ( p < 0.01) correlations in RF were evident between CON and ECC for R3 ( r = 0.86) and R6 ( r = 0.76). Equations to estimate 1RM were derived for CON and ECC at R3 and R6 (e.g., ECC 1RM = Load × 110.0/[110.5-RF] for R3). These results suggest that fatigue is less in ECC than in CON performed at the same relative intensity.

The Kagoshima-DVT Score Is a Useful Predictive Model for Cancer-Associated Thrombosis in Patients With Gastrointestinal Cancer.

Background: Cancer-associated thrombosis (CAT) is a common complication of cancer and has received increasing attention; the Khorana Risk Score (KRS) is a recommended but insufficient risk assessment model for CAT. We propose a novel Kagoshima-DVT score (KDS) to predict preoperative deep vein thrombosis (DVT). This scoring method scores D-dimer ≥1.5 µg/mL, age ≥60 years, female sex, ongoing glucocorticoids, cancer with high risk of DVT, and prolonged immobility. The purpose of this study was to compare the performance of the KDS and KRS in predicting CAT in patients with gastrointestinal cancer. Methods and Results: In all, 250 patients without a history of thrombosis who received their first chemotherapy for gastrointestinal cancer were divided into low- (48.0%), intermediate- (38.8%), and high-risk (13.2%) groups for CAT development by the KDS. The patients' median age was 67 years and 63.2% were men. In all, 61 (27.1%) patients developed CAT (17.6%, 35.3%, and 36.4% of patients in the low-, intermediate, and high-risk groups, respectively; log-rank P=0.006). The area under the time-dependent receiver operating characteristic curve for CAT occurrence within 1 year was larger for the KDS than KRS (0.653 vs. 0.494). Conclusions: A high KDS at the start of first chemotherapy is a risk indicator for CAT development during chemotherapy. Moreover, the KDS is more useful than the KRS in predicting CAT risk.

Transient astrocytic mGluR5 expression drives synaptic plasticity and subsequent chronic pain in mice.

Activation of astrocytes has a profound effect on brain plasticity and is critical for the pathophysiology of several neurological disorders including neuropathic pain. Here, we show that metabotropic glutamate receptor 5 (mGluR5), which reemerges in astrocytes in a restricted time frame, is essential for these functions. Although mGluR5 is absent in healthy adult astrocytes, it transiently reemerges in astrocytes of the somatosensory cortex (S1). During a limited spatiotemporal time frame, astrocytic mGluR5 drives Ca2+ signals; upregulates multiple synaptogenic molecules such as Thrombospondin-1, Glypican-4, and Hevin; causes excess excitatory synaptogenesis; and produces persistent alteration of S1 neuronal activity, leading to mechanical allodynia. All of these events were abolished by the astrocyte-specific deletion of mGluR5. Astrocytes dynamically control synaptic plasticity by turning on and off a single molecule, mGluR5, which defines subsequent persistent brain functions, especially under pathological conditions.

Evaluating the Khorana risk score of gastrointestinal cancer patients during initial chemotherapy as a predictor of patient mortality: A retrospective study.

BACKGROUND: The Khorana risk score (KRS) has been recommended for predicting the incidence of cancer-associated thrombosis (CAT). However, it has been reported KRS was not useful in predicting CAT, but rather in predicting death by setting high scores for the primary tumor site or a low prevalence of severe obesity. METHODS: A total of 260 consecutive patients with no history of thrombosis and who started initial chemotherapy for gastrointestinal cancer from January 2017 to December 2018 at our hospital were divided into three groups according to KRS; they were observed until December 2019 [122 patients (46.9%) in the low-risk group, 114 patients (43.8%) in the intermediate-risk group, and 24 patients (9.2%) in the high-risk group]. The incidence of CAT and all-cause death were compared among the three groups. RESULTS: The median age of the patients was 67 years; 63.5% were men. CAT was observed in 61 patients (26.1%); 84 patients (37.9%) died during the observation period. The incidence rate of CAT was similar among the three groups (log-rank p = 0.4); but all-cause death showed a significant difference among the three groups (high-risk group: 58.2%, intermediate-risk group: 44.6%, low-risk group: 27.5%, log-rank p = 0.002). In the multivariate analysis, the high-risk KRS group remained at increased risk for all-cause death (HR, 2.83; 95% CI, 1.37-5.83; p = 0.005), but not with CAT. CONCLUSIONS: The KRS at the start of chemotherapy for gastrointestinal cancer is not effective in predicting CAT, but it is effective in predicting prognosis in patients with gastrointestinal cancer.

Goshajinkigan attenuates paclitaxel-induced neuropathic pain via cortical astrocytes.

The anticancer agents platinum derivatives and taxanes such as paclitaxel (PCX) often cause neuropathy known as chemotherapy-induced peripheral neuropathy with high frequency. However, the cellular and molecular mechanisms underlying such neuropathy largely remain unknown. Here, we show new findings that the effect of Goshajinkigan (GJG), a Japanese KAMPO medicine, inhibits PCX-induced neuropathy by acting on astrocytes. The administration of PCX in mice caused the sustained neuropathy lasting at least 4 weeks, which included mechanical allodynia and thermal hyperalgesia but not cold allodynia. PCX-evoked pain behaviors were associated with the sensitization of all primary afferent fibers. PCX did not activate microglia or astrocytes in the spinal cord. However, it significantly activated astrocytes in the primary sensory (S1) cortex without affecting S1 microglial activation there. GJG significantly inhibited the PCX-induced mechanical allodynia by 50% and thermal hyperalgesia by 90%, which was in accordance with the abolishment of astrocytic activation in the S1 cortex. Finally, the inhibition of S1 astrocytes by an astrocyte-toxin L-alpha-aminoadipic acid abolished the PCX-induced neuropathy. Our findings suggest that astrocytes in the S1 cortex would play an important role in the pathogenesis of PCX-induced neuropathy and are a potential target for its treatment.

Inflammatory reaction in the retina after focal non-convulsive status epilepticus in mice investigated with high resolution magnetic resonance and diffusion tensor imaging.

Pathophysiological consequences of focal non-convulsive status epilepticus (fNCSE) have been difficult to demonstrate in humans. In rats fNCSE pathology has been identified in the eyes. Here we evaluated the use of high-resolution 7 T structural T1-weighted magnetic resonance imaging (MRI) and 9.4 T diffusion tensor imaging (DTI) for detecting hippocampal fNCSE-induced retinal pathology ex vivo in mice. Seven weeks post-fNCSE, increased number of Iba1+ microglia were evident in the retina ipsilateral to the hemisphere with fNCSE, and morphologically more activated microglia were found in both ipsi- and contralateral retina compared to non-stimulated control mice. T1-weighted intensity measurements of the contralateral retina showed a minor increase within the outer nuclear and plexiform layers of the lateral retina. T1-weighted measurements were not performed in the ipsilateral retina due to technical difficulties. DTI fractional anisotropy(FA) values were discretely altered in the lateral part of the ipsilateral retina and unaltered in the contralateral retina. No changes were observed in the distal part of the optic nerve. The sensitivity of both imaging techniques for identifying larger retinal alteration was confirmed ex vivo in retinitis pigmentosa mice where a substantial neurodegeneration of the outer retinal layers is evident. With MR imaging a 50 % decrease in DTI FA values and significantly thinner retina in T1-weighted images were detected. We conclude that retinal pathology after fNCSE in mice is subtle and present bilaterally. High-resolution T1-weighted MRI and DTI independently did not detect the entire pathological retinal changes after fNCSE, but the combination of the two techniques indicated minor patchy structural changes.

The Economic Burden of Dementia: Evidence from a Survey of Households of People with Dementia and Their Caregivers.

Although a cognitive impairment such as dementia causes serious economic problems among older people, its impact on economic activities is unclear. This study investigated the actual conditions of economic activities and the current status of the financial support systems among people with dementia and caregivers. One hundred and five dyads participated in the survey. Each dyad consisted of an older person with Alzheimer's disease and their caregiver. The Mini-Mental State Examination (MMSE) and Functional Assessment Staging (FAST) were used to evaluate the cognitive functions of people with dementia. The caregivers were asked questions concerning the financial status of the household and their utilization of the financial support systems available to people with dementia. Average monthly care costs significantly increased according to the severity of dementia, while household income and spending incurred no significant changes. People with dementia experienced financial problems (including a large amount of erroneously purchased, unnecessary shopping), even though their assets were informally managed by their caregivers. Financial support systems such as adult guardianship and civil trust systems were rarely known and used. We proposed the propagation of the adult guardianship and civil trust systems and the development of contract guidelines for elderly customers including people with dementia.

Effects of Prolonging Eccentric Phase Duration in Parallel Back-Squat Training to Momentary Failure on Muscle Cross-Sectional Area, Squat One Repetition Maximum, and Performance Tests in University Soccer Players.

ABSTRACT: Shibata, K, Takizawa, K, Nosaka, K, and Mizuno, M. Effects of prolonging eccentric phase duration in parallel back-squat training to momentary failure on muscle cross sectional area, squat one repetition maximum, and performance tests in university soccer players. J Strength Cond Res 35(3): 668-674, 2021-This study aimed to compare 2 squat training programs repeated until momentary failure with different eccentric phase duration (2 seconds vs. 4 seconds) on the changes in muscle cross-sectional area, squat 1 repetition maximum (1RM), squat jump (SJ), and countermovement jump (CMJ) height, agility (T-test), and Yo-Yo intermittent recovery test (YY-IR2). Male university soccer players (19.9 ± 0.9 years, 172.2 ± 3.8 cm, 66.1 ± 6.6 kg) were randomly assigned to one of the 2 groups; CON for 2 seconds and ECC for 4 seconds (C2/E4, n = 11) or CON for 2 seconds and ECC for 2 seconds (C2/E2, n = 11). They performed parallel back-squat exercises twice a week for 6 weeks using 75% 1RM weight to momentary failure in each set for 3 sets with each protocol. Outcome measurements were taken before (Pre) and after 3 (Mid; 1RM, SJ, and CMJ only), and at 6 weeks (Post). One repetition maximum increased more (p < 0.05) for C2/E2 (Pre: 95.9 ± 12.2 kg, Mid: 108.2 ± 15.4 kg, Post: 113.6 ± 14.8 kg) than C2/E4 (95.5 ± 12.9 kg, 102.7 ± 15.6 kg, 105.5 ± 14.9 kg, respectively). Cross-sectional area (50% of the thigh length: 3.5 ± 2.8%), SJ (6.7 ± 8.9%) and CMJ height (6.3 ± 8.6%) increased similarly between C2/E2 and C2/E4, but no significant changes in T-test or YY-IR2 were evident in either group. These results suggest that increasing the ECC phase duration during squat exercises does not produce greater training effects when compared with a shorter ECC phase-duration program with momentary failure.

Comparison Between Two Volume-Matched Squat Exercises With and Without Momentary Failure for Changes in Hormones, Maximal Voluntary Isometric Contraction Strength, and Perceived Muscle Soreness.

ABSTRACT: Shibata, K, Takizawa, K, Tomabechi, N, Nosaka, K, and Mizuno, M. Comparison between two volume-matched squat exercises with and without momentary failure for changes in hormones, maximal voluntary isometric contraction strength and perceived muscle soreness. J Strength Cond Res 35(11): 3063-3068, 2021-The present study compared 2 squat exercises with and without momentary failure (MF) for changes in blood hormones, maximal voluntary isometric contraction (MVC) strength, and perceived muscle soreness (SOR). Ten physically active male students performed squat exercises at 75% of their 1 repetition maximum in 2 conditions. First, they performed each set to MF for 3 sets, and 2 weeks later, performed the same number of repetitions in 6 sets without MF (NMF). The rate of perceived exertion was assessed at 30 minutes after exercise. Blood lactate, serum concentrations of growth hormone (GH), testosterone, insulin-like growth factor 1 (IGF-1) and cortisol, MVC strength, and SOR were measured before and after each exercise. Rate of perceived exertion was higher (p < 0.01) in MF (8.3 ± 1.2) than in NMF (4.1 ± 1.4). Blood lactate was greater (p < 0.01) at 5 minutes after MF (7.2 ± 0.7 mM·L-1) than NMF (3.6 ± 0.7 mM·L-1). At 30 minutes after exercise, GH (MF: 12.3 ± 8.3 ng·ml-1, NMF: 4.4 ± 5.2 ng·ml-1) and cortisol (MF: 19.0 ± 4.3 µg·dl-1, NMF: 14.2 ± 4.6 µg·dl-1) were greater (p < 0.01) for MF than NMF, but no significant differences were observed between conditions for testosterone and IGF-1. Maximal voluntary isometric contraction strength decrease (6.1 ± 8.8%) at 24 hours after exercise was evident only for MF, but SOR at 24 hours after exercise was similar between MF (4.8 ± 3.3 cm) and NMF (2.5 ± 2.4 cm) conditions. These results suggest that mechanical and metabolic stimulus to the muscles were greater for MF than NMF condition.

Importance of long-term involvement for older people living in severe squalor: A case report.

Domestic squalor sometimes appears for older people with various diseases. Diogenes syndrome is characterized by unique behavior, including domestic squalor. Here, we report a case of this syndrome that was successfully treated with a multidisciplinary approach over a long period of time. In this case, the patient hoarded many things, which resulted in severe domestic squalor. It was difficult to intervene because she refused help and lost motivation. Fortunately, the patient was attending our hospital, and she gradually received treatment through a multidisciplinary team approach. Since her cognitive function and activities of daily living gradually declined, her syndrome might have been related to mild behavioral impairment. Long-term and persistent intervention by a multidisciplinary team is very important to help patients with these kinds of problems.

Effect of General Warm-Up Plus Dynamic Stretching on Endurance Running Performance in Well-Trained Male Runners.

Purpose: The purpose of this study was to compare the acute effects of general warm-up (GWU) and GWU plus dynamic stretching (GWU + DS) on endurance running performance in well-trained male runners. Method: The endurance running performances of eight well-trained long-distance male runners were assessed on a treadmill after 2 types of intervention for 5 min after running on the treadmill at a velocity equivalent to 70% maximal oxygen uptake (V̇O2max) in each athlete for 15 min. The interventions were GWU and GWU + DS. In the GWU + DS intervention, dynamic stretching was performed for ten repetitions as quickly as possible for the five muscle groups of the lower extremities. The total duration of the dynamic stretching was 3 min and 45 s. Endurance running performance was assessed at 1 min 15 s after the dynamic stretching. The endurance running performance was evaluated by the time to exhaustion (TTE) during running at a velocity equivalent to 90% [Formula: see text]O2max in each athlete. Results: The TTE (640.6 ± 220.4 s) after GWU + DS intervention was significantly (d = 1.02, p = .03) shorter than that (760.6 ± 249.1 s) after GWU intervention. Conclusions: The results demonstrated that GWU + DS intervention impaired immediate endurance performance of running at a velocity equivalent to 90% [Formula: see text]O2max in well-trained male runners compared with GWU intervention. Thus, we are not able to recommend that well-trained runners and their coaches use the protocol for GWU + DS described in this study during actual warm-ups.

Interaction between memory impairment and depressive symptoms can exacerbate anosognosia: a comparison of Alzheimer's disease with mild cognitive impairment.

OBJECTIVE: To investigate the effects of interactions between memory impairment, depressive symptoms, and anosognosia. METHODS: Anosognosia for memory impairment was assessed in 118 patients with Alzheimer's disease (AD), 47 patients with mild cognitive impairment (MCI), and 17 non-diagnosed controls (NC) using a questionnaire and evaluation of the anosognosia score as the discrepancy between ratings of the patient and a relative. Demographic characteristics, such as the relationship of the patient with the relative and the activities of daily living (ADL) were evaluated. Memory impairment was evaluated with the Rivermead Behavioral Memory Test (RBMT), depressive symptoms were evaluated using the Geriatric Depression Scale (GDS) 15 items version. RESULTS: In the MCI group, a stepwise multiple regression analysis showed an interaction between RBMT and GDS scores, and simple slope analysis indicated that scores for RBMT at low GDS (-1 standard deviation) were positively correlated with self-rated memory impairment. In the AD group, the relationship of the patient with the relative, ADL, and GDS and RBMT scores were associated with the anosognosia score. CONCLUSION: Patients with MCI who have no depressive symptoms may be able to more accurately evaluate their memory impairment than those who have depressive symptoms and patients with AD. The evaluation by relatives, depressive symptoms or ADL of patients may distort evaluation of anosognosia for memory impairment in patients with AD or MCI. It seems necessary to include not only depression scale scores but also results of objective memory tests in the patients' medical information for the correct assessment of anosognosia.

Neuroprotective effects of microglial P2Y1 receptors against ischemic neuronal injury.

Extracellular ATP, which is released from damaged cells after ischemia, activates P2 receptors. P2Y1 receptors (P2Y1R) have received considerable attention, especially in astrocytes, because their activation plays a central role in the regulation of neuron-to-glia communication. However, the functions or even existence of P2Y1R in microglia remain unknown, despite the fact that many microglial P2 receptors are involved in several brain diseases. Herein, we demonstrate the presence and functional capability of microglial P2Y1R to provide neuroprotective effects following ischemic stress. Cerebral ischemia resulted in increased microglial P2Y1R expression. The number of injured hippocampal neurons was significantly higher in P2Y1 R knockout (KO) mice than wildtype mice after forebrain ischemia. Propidium iodide (PI) uptake, a marker for dying cells, was significantly higher in P2Y1R KO hippocampal slices compared with wildtype hippocampal slices at 48 h after 40-min oxygen-glucose deprivation (OGD). Furthermore, increased PI uptake following OGD was rescued by ectopic overexpression of P2Y1R in microglia. In summary, these data suggest that microglial P2Y1R mediate neuroprotective effects against ischemic stress and OGD insult.

Effects of 3-Week Work-Matched High-Intensity Intermittent Cycling Training with Different Cadences on VO2max in University Athletes.

The aim of this study is to clarify the effects of 3-week work-matched high-intensity intermittent cycling training (HIICT) with different cadences on the VO2max of university athletes. Eighteen university athletes performed HIICT with either 60 rpm (n = 9) or 120 rpm (n = 9). The HIICT consisted of eight sets of 20 s exercise with a 10 s passive rest between each set. The initial training intensity was set at 135% of VO2max and was decreased by 5% every two sets. Athletes in both groups performed nine sessions of HIICT during a 3-week period. The total workload and achievement rate of the workload calculated before experiments in each group were used for analysis. VO2max was measured pre- and post-training. After 3 weeks of training, no significant differences in the total workload and the achievement rate of the workload were found between the two groups. VO2max similarly increased in both groups from pre- to post-training (p = 0.016), with no significant differences between the groups (p = 0.680). These results suggest that cadence during HIICT is not a training variable affecting the effect of VO2max.

Anti-Depressant Fluoxetine Reveals its Therapeutic Effect Via Astrocytes.

Although psychotropic drugs act on neurons and glial cells, how glia respond, and whether glial responses are involved in therapeutic effects are poorly understood. Here, we show that fluoxetine (FLX), an anti-depressant, mediates its anti-depressive effect by increasing the gliotransmission of ATP. FLX increased ATP exocytosis via vesicular nucleotide transporter (VNUT). FLX-induced anti-depressive behavior was decreased in astrocyte-selective VNUT-knockout mice or when VNUT was deleted in mice, but it was increased when astrocyte-selective VNUT was overexpressed in mice. This suggests that VNUT-dependent astrocytic ATP exocytosis has a critical role in the therapeutic effect of FLX. Released ATP and its metabolite adenosine act on P2Y11 and adenosine A2b receptors expressed by astrocytes, causing an increase in brain-derived neurotrophic factor in astrocytes. These findings suggest that in addition to neurons, FLX acts on astrocytes and mediates its therapeutic effects by increasing ATP gliotransmission.

Neural Correlates of Sleep Disturbance in Alzheimer's Disease: Role of the Precuneus in Sleep Disturbance.

BACKGROUND: Sleep disturbance may affect the development of Alzheimer's disease (AD), but the neural correlates of sleep disturbance in AD have not been fully clarified. OBJECTIVE: To examine the factors associated with sleep disturbance in AD. METHODS: A retrospective study was performed in 63 patients with AD. None of the patients had been prescribed antidementia or psychoactive drugs, and all underwent brain magnetic resonance imaging (MRI) before medication. Sleep disturbance was defined as a score of at least 1 point on the sleep disturbance subscale of the Neuropsychiatric Inventory (NPI). Whole brain image analysis was performed using SPM8 and VBM8. A two-sample t-test was used to compare patients with AD with (n = 19) and without (n = 44) sleep disturbance, with age and gender included as covariates. The statistical thresholds were set to an uncorrected p-value of 0.001 at the voxel level and a corrected p-value of 0.05 at the cluster level. In addition, pineal gland volume (PGV) measured using MRI, and white matter hyperintensity (WMH) assessed with the modified Fazekas scale were compared between patients with AD with and without sleep disturbance using independent group t-tests. RESULTS: In whole brain analysis, the precuneus volume in patients with AD with sleep disturbance was significantly smaller than those without sleep disturbance. There were no significant differences in PGV and WMH between the two groups. CONCLUSION: Sleep disturbance in AD was associated with reduction of precuneus volume. This suggests that the precuneus might be an important region in sleep disturbance in AD.

Differences in the neural correlates of frontal lobe tests.

BACKGROUND: The Executive Interview (EXIT25), the executive clock-drawing task (CLOX1), and the Frontal Assessment Battery (FAB) are used to assess executive function at the bedside. These tests assess distinct psychometric properties. The aim of this study was to examine differences in the neural correlates of the EXIT25, CLOX1, and FAB based on magnetic resonance imaging. METHODS: Fifty-eight subjects (30 with Alzheimer's disease, 10 with mild cognitive impairment, and 18 healthy controls) participated in this study. Multiple regression analyses were performed to examine the brain regions correlated with the EXIT25, CLOX1, and FAB scores. Age, gender, and years of education were included as covariates. Statistical thresholds were set to uncorrected P-values of 0.001 at the voxel level and 0.05 at the cluster level. RESULTS: The EXIT25 score correlated inversely with the regional grey matter volume in the left lateral frontal lobe (Brodmann areas 6, 9, 44, and 45). The CLOX1 score correlated positively with the regional grey matter volume in the right orbitofrontal cortex (Brodmann area 11) and the left supramarginal gyrus (Brodmann area 40). The FAB score correlated positively with the regional grey matter volume in the right precentral gyrus (Brodmann area 6). The left lateral frontal lobe (Brodmann area 9) and the right lateral frontal lobe (Brodmann area 46) were identified as common brain regions that showed association with EXIT25, CLOX1, and FAB based only a voxel-level threshold. CONCLUSIONS: The results of this study suggest that the EXIT25, CLOX1, and FAB may be associated with the distinct neural correlates of the frontal cortex.