Factors influencing confabulation in Japanese patients with Alzheimer's disease.

BACKGROUND: Confabulations are often observed in patients with Alzheimer's disease (AD) and can increase family caregivers' burdens. Previous studies have focused on the relationship between confabulation and cognitive ability. However, few studies have investigated the association between confabulation and familial factors. Here, we aimed to examine whether confabulation relates to familial factors, such as the level of family caregivers' expressed emotion or the level of functioning of the family. METHODS: Twenty-seven outpatients with AD and their family caregivers participated in this study. We examined confabulations about episodic memory, semantic memory, and future planning using the Modified Confabulation Battery (MCB). We investigated correlations between scores on the MCB and scores on the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Family Attitude Scale (FAS), and the Family Adaptability and Cohesion Evaluation Scale. Multiple regression analyses were performed using the total scores on the MCB and domain-specific scores on the MCB as dependent variables, and the scores on the MMSE, GDS, and FAS as independent variables. RESULTS: MCB scores were positively related to FAS scores (P < 0.01) and negatively to GDS scores (P < 0.05), but not to MMSE scores. Regarding the three domains the MCB measured, confabulation about episodic memory and future planning showed a positive relationship with FAS scores. CONCLUSIONS: Family attitude was the factor most related to confabulation in our study. Patients with AD may attempt to avoid confronting family caregivers' high emotional expression through confabulation, or confabulation itself might result in high emotional expression among family caregivers. Psychoeducational or therapeutic approaches for family caregivers might reduce confabulation in patients with AD.

A Procedure for Calculating the Vertical Space Height of the Sacrum When Determining Skeletal Height for Use in the Anatomical Method of Adult Stature Estimation.

Estimating stature from skeletonized remains is one of the essential parameters in the development of a biological profile. A new procedure for determining skeletal height (SKH) incorporating the vertical space height (VSH) from the anterior margin of the sacral promontory to the superior margins of the acetabulae for use in the anatomical method of stature estimation is introduced. Regression equations for stature estimation were generated from measurements of 38 American males of European ancestry from the William M. Bass Donated Skeletal Collection. The modification to the procedure results in a SKH that is highly correlated with stature (r = 0.925-0.948). Stature estimates have low standard errors of the estimate ranging from 21.79 to 25.95 mm, biases from to 0.50 to 0.94 mm, and accuracy rates from 17.71 mm to 19.45 mm. The procedure for determining the VSH, which replaces "S1 height" in traditional anatomical method models, is a key improvement to the method.

Writing Impairments in Japanese Patients with Mild Cognitive Impairment and with Mild Alzheimer's Disease.

BACKGROUND/AIMS: We investigated writing abilities in patients with the amnestic type of mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD). To examine the earliest changes in writing function, we used writing tests for both words and sentences with different types of Japanese characters (Hiragana, Katakana, and Kanji). METHODS: A total of 25 aMCI patients, 38 AD patients, and 22 healthy controls performed writing to dictation for Kana and Kanji words, copied Kanji words, and wrote in response to a picture story task. Analysis of variance was used to test the subject group effects on the scores in the above writing tasks. RESULTS: For the written Kanji words, the mild AD group performed worse than the aMCI group and the controls, but there was no difference between the aMCI group and the controls. For the picture story writing task, the mild AD and aMCI groups performed worse than the controls, but the difference between the AD and the aMCI groups was not significant. CONCLUSIONS: The mild AD group showed defects in writing Kanji characters, and the aMCI group showed impairments in narrative writing. Our study suggests that narrative writing, which demands complex integration of multiple cognitive functions, can be used to detect the subtle writing deficits in aMCI patients.

The use of tooth crown measurements in the assessment of ancestry.

As the hardest tissue in the body, teeth have the potential to offer a wealth of biological information to the forensic anthropologist, which can include the assessment of ancestry. Using a large data set of dental measurements, the efficacy of mesiodistal and buccolingual tooth dimensions to discriminate between broad, geographically based groups is explored. A general pattern is identified: African populations have the largest teeth, Asians possess teeth of intermediate size, and Europeans have the smallest teeth. In a discriminant function analysis using crown measurements of all teeth (mandibular and maxillary and excluding the third molar), individuals were correctly classified in 71.3% of cases. When the sex of the individual is known, classification is improved up to 88.1% in females and 71.9% of males (cross-validated). Based on these results, we argue that dental metrics can be regularly employed as part of the development of the biological profile.

Visual imagery while reading concrete and abstract Japanese kanji words: an fMRI study.

Neuroimaging studies have investigated differences in neural correlates between abstract and concrete concepts but this has not been done with Japanese participants. Concrete words have higher imageability than abstract words, such that they elicit more visual imagery. The present study used functional MRI to investigate brain activity of Japanese participants (N=16) during generation of visual images for written concrete or abstract Japanese kanji words. Concrete words elicited significantly more activation than abstract words in the left middle frontal gyrus (LMFG), bilateral superior frontal gyrus, and left fusiform gyrus (LFG). Psychophysiological interaction (PPI) analyses were performed to assess LMFG and LFG functional connections. LMFG activity was accompanied by increased functional interaction with the left superior parietal lobule (LSPL), and LFG activity was accompanied by increased functional interaction with the LMFG. This finding suggests that the LMFG plays an important role in visual imagery, with interactions between this region and both the LSPL and LFG.

A Validation Study of the Japanese Version of the Addenbrooke's Cognitive Examination-Revised.

The aim of this study was to validate the Japanese version of the Addenbrooke's Cognitive Examination-Revised (ACE-R) [Mori: Japanese Edition of Hodges JR's Cognitive Assessment for Clinicians, 2010] designed to detect dementia, and to compare its diagnostic accuracy with that of the Mini-Mental State Examination. The ACE-R was administered to 85 healthy individuals and 126 patients with dementia. The reliability assessment revealed a strong correlation in both groups. The internal consistency was excellent (α-coefficient = 0.88). Correlation with the Clinical Dementia Rating sum of boxes score was significant (r(s) = -0.61, p < 0.001). The area under the curve was 0.98 for the ACE-R and 0.96 for the Mini-Mental State Examination. The cut-off score of 80 showed a sensitivity of 94% and a specificity of 94%. Like the original ACE-R and the versions designed for other languages, the Japanese version of the ACE-R is a reliable and valid test for the detection of dementia.

Neural substrates for writing impairments in Japanese patients with mild Alzheimer's disease: a SPECT study.

Language is fairly well preserved in most patients with mild Alzheimer's disease, but writing ability seems to be impaired even in the early stages of the disease. To investigate the neural bases of writing impairments in Alzheimer's disease (AD), we examined the correlation between writing ability and regional cerebral blood flow (rCBF) in 52 Japanese patients with mild AD compared to 22 controls, using single photon emission computed tomography (SPECT). We found that, compared with control subjects, Kana writing to dictation and copying Kanji words were preserved in AD patients, but writing to dictating Kanji words was impaired. We classified the errors in the Kanji dictation task into four types to investigate the correlation between rCBF and the error type, as follows: non-response errors, phonologically plausible errors, non-phonologically plausible errors, and peripheral errors. Non-response errors, which indicated difficulty with retrieving Kanji graphic images, were the most frequent. When controlled for confounding factors, the number of non-response errors negatively correlated with rCBF in the left inferior parietal lobule, the posterior middle and inferior temporal gyri, and the posterior middle frontal gyrus. Thus, the impaired recall of Kanji in early Alzheimer's disease is related to dysfunctional cortical activity, which appears to be predominant in the left frontal, parietal, and temporal regions.

[Writing Kanji without semantics in a case with probable Alzheimer's disease].

We examined a patient (NM) with probable Alzheimer's disease who showed phonologically plausible errors in kanji (logogram) writing. In semantic tasks, she showed no deficits in pointing or naming but had difficulty in more complex tasks such as proverb comprehension. In reading aloud of kanji words, she could read most kanji words correctly and showed little phonologically plausible reading errors. She performed poorly in lexical decision and on-reading of one-letter kanji (Sino-Japanese pronunciation derived from the Chinese language at the time of borrowing). Writing to dictation demonstrated no mistakes in kana letters and words, but many errors in kanji, which were phonologically equivalent but semantically inappropriate. To explore the relationship between the writing errors in kanji words and comprehension of the word meanings, we selected 33 words that she made phonologically plausible writing errors. We gave her the following five tasks using these words; 1) to ask meanings of the words, 2) to dictate the words, 3) to dictate sentences including these words, 4) to discriminate appropriate target words from distracters including her own erroneous responses, and 5) to write these words again. She showed no consistent errors in these tasks. In some occasions, she could write correct kanji words without understanding word meanings. She also showed phonologically plausible writing errors in spite of describing correct word meanings. In Japanese, word meaning deficits like Gogi aphasia were thought to cause phonologically plausible writing errors. As the impairments of word meanings in NM are comparatively mild, the underpinning of her kanji agraphias might be different from that of phonologically plausible errors in Gogi aphasia. It would be suggested that she frequently wrote phonologically equivalent errors because of her lexical deficits in spite that her phonological processing was preserved. Furthermore, she would not necessarily use the semantics (word meanings) of kanji words during dictation.