Three patients with mood disorders showing catatonia and frontotemporal lobes atrophy.

Here we report the cases of three patients with mood disorders showing catatonia and frontotemporal lobe atrophy. Catatonia is a syndrome linked to frontal dysfunction that most frequently occurs in patients with mood disorders. The diagnostic criteria of catatonia and frontotemporal dementia partly overlap. In the present patients, catatonia might be closely related to frontal dysfunction caused by frontotemporal lobe atrophy. With regard to therapeutics for catatonia, we found that administering a low dose of lorazepam alone or after electroconvulsive therapy may be useful for treating and preventing catatonia. We also found that administering glutaminate antagonists such as memantine may be useful for treating lorazepam-resistant catatonia.

Effect of Rikkunshi-to on appetite loss found in elderly dementia patients: a preliminary study.

BACKGROUND: Functional gastrointestinal symptoms are frequently found in elderly dementia patients. In such a case, we attempt treatment by the administration of antidepressants or second-generation antipsychotics. However, these medications have a risk of side-effects. In the present study, we carried out oral administration of Rikkunshi-to to elderly dementia patients with appetite loss, and examined its effects on food intake. METHODS: Six elderly dementia patients were recruited from inpatients. They showed appetite loss, but no organic abnormalities of the gastrointestinal organs. These patients were given Rikkunshi-to, at 7.5 g per day, t.i.d. for 4 weeks. We examined the food intake, weight, total protein, albumin and potassium in plasma before administration and for 4 weeks after administration. In statistical analyses, the percentage of food consumed for 4 weeks was analyzed by anova. We also examined the side-effects of Rikkunshi-to. RESULTS: In patient 3, we stopped investigation after 3 weeks because of the development of cholecystitis. The values of 4 weeks in patient 3 were calculated as the mean values of 4 weeks in the other five patients. anova and Tukey's multiple comparison showed a marginally significant difference in weight between before Rikkunshi-to was given and 4 weeks after. In change of food intake, there were no significant differences between before Rikkunshi-to was given and 1 day after, 1 day and 2 days after, 2 days and 3 days after, 3 days and 1 week after, and 1 week and 2 weeks after; however, there were significant increases in food intake between other times. With regard to the side-effects, mild lower limb oedema appeared in the two patients. CONCLUSION: In the present study, we showed the effect of Rikkunshi-to in improving appetite loss in elderly dementia patients. The present study suggests that Rikkunshi-to might be useful in improving functional appetite loss in elderly dementia patients, because there are no serious side-effects.

[Limbic encephalitis caused by herpes simplex virus infection after vaccination against the influenza virus].

Various causative factors, including viral infection, autoimmunity, and paraneoplasia, are considered to be involved in the pathomechanism of limbic encephalitis. We encountered a patient who developed limbic encephalitis after vaccination against the influenza virus. In Japan, an influenza epidemic occurs every winter, and vaccination against the influenza virus is recommended. However, there have been reports of serious side effects such as the development of Guillain-Barré syndrome and acute disseminated encephalomyelitis after influenza vaccination; these findings indicate the activation of an autoimmune pathomechanism after vaccination. Here, we discuss the relationship between limbic encephalitis and influenza vaccination from the perspective of viral infection and autoimmunity. We considered that limbic encephalitis was caused by the herpes simplex virus, and hypothesized that this clinical condition rarely develops as a sole consequence of influenza vaccination but rather develops because of the activation of an autoimmune pathomechanism after vaccination.

Clinical effects of high oral dose of donepezil for patients with Alzheimer's disease in Japan.

BACKGROUND: Donepezil 10 mg/day gained approval in Japan in August 2007 for the treatment of cognitive dysfunction in advanced Alzheimer's disease. METHODS: We evaluated the efficacy and adverse effects of donepezil when the dose was increased to 10 mg/day in 61 Japanese patients with Alzheimer's disease. Cognitive function was evaluated using the Revised Hasegawa Dementia Scale and mini-mental state examination at the day before starting, and at 4, 8 and 24 weeks after starting donepezil 10 mg/day. The relationship with apolipoprotein E4 was also investigated. RESULTS: The Revised Hasegawa Dementia Scale and mini-mental state examination scores were not statistically significantly different at any time after starting donepezil 10 mg/day. It can be anticipated that donepezil 10 mg/day will especially inhibit deterioration of cognitive function in advanced Alzheimer's disease. The incidence of adverse events was 11.5%, lower than the rate of 40% or higher recorded during previous clinical trials. CONCLUSIONS: The progression of cognitive dysfunction could be inhibited by increasing the dose of donepezil to 10 mg/day. It was suggested that longer-term treatment with 5 mg/day might lead to fewer adverse events when the dose is increased to 10 mg/day.