Unclassified four-repeat tauopathy associated with familial parkinsonism and progressive respiratory failure.

We describe an autopsied patient with familial parkinsonism and unclassified four repeat-tau (4R-tau) aggregation. She presented with bradykinesia, truncal dystonia, and mild amnesia at the age of 61 and then exhibited body weight loss (15 kg over 8 months), sleep disturbances, and progressive respiratory failure with CO2 narcosis. She died of respiratory failure at the age of 62, 14 months after disease onset. Her brother also showed parkinsonism at the age of 58 and suddenly died 6 months later. Postmortem examination revealed 4R-tau aggregation, which was characterized by neuronal globose-type tangles or pretangles, bush-like or miscellaneous astrocytic inclusions, and coiled bodies. The temporal tip, the striatum, the substantia nigra, the tegmentum of the midbrain, the medullary reticular formation, and the spinal cord were severely involved with tau aggregation. Argyrophilic grains and ballooned neurons were also found in the medial temporal structures, however, extensions of the 4R-aggregations in the case were clearly broader than those of the argyrophilic grains. Western blot analysis of sarkosyl-insoluble fractions from brain lysates revealed prominent bands of tau at both 33 kDa and 37 kDa. Genetic examinations did not reveal any known pathogenic mutations in MAPT, DCTN-1, PSEN-1, or familial or young-onset parkinsonism-related genes. The clinical manifestations, pathologic findings, and biochemical properties of aggregated tau in our patient cannot be explained by argyrophilic grain disease or other known 4R-tauopathies alone. Our results further extend the clinical and neuropathologic spectra of 4R-tauopathy.

Cognitive function measured with the Revised Hasegawa's Dementia Scale among elderly individuals in Lao PDR.

In Lao PDR, measurement of cognitive function has rarely been conducted among elderly individuals. This study aimed to investigate the cognitive function among elderly individuals who lived at their homes with family in Lao PDR. Participants were elderly individuals aged 60 years or over registered with the local government in urban (Vientiane capital; VC) and rural areas (Khammouane province; KP). Those with serious mental/physical diseases, those who could not walk by themselves, or those who could not speak the Lao language were excluded. The information was collected through interviews with the participants and their family members. A newly developed Lao version of the Revised Hasegawa's Dementia Scale (HDS-R) was applied to measure cognitive function. The participants were 414 elderly individuals (224 males and 190 females) aged 60 to 98 years. The average HDS-R score was 23.0 among 115 men in VC, 22.7 among 92 women in VC, 20.3 among 109 men in KP, and 17.5 among 98 women in KP. The main caregiver was a daughter (40.6%) followed by a spouse (31.4%). Among 414 elderly individuals, 42 (10.0%) stated the necessity of support. Those with HDS-R < 20 accounted for 38.8% in men and 48.9% in women. The adjusted odds ratio of HDS-R < 20 was significant for those in rural areas (3.83) relative to those in urban areas. Among superficially healthy elderly individuals residing with their families, those with reduced cognitive function were more common among women and in rural areas.

Educational program in Japan for Dementia Support Doctors who support medical and care systems as liaisons for demented older adults in the community.

Now that the number of elderly people has increased and the number of dementia patients is rapidly increasing, dementia might be regarded as a common disease. Under these circumstances, the establishment of systems to support the elderly with dementia from the early stages, and to provide primary care doctors and care workers with necessary education is an urgent issue. Up to the end of 2012, a total of 2680 doctors had been certified as Dementia Support Doctors (DSD). The DSD's function and roles are: (i) to support primary care doctors and care specialists involved in the medical care, and general care of dementia patients; (ii) to facilitate multidisciplinary cooperation led by a Community General Support Center; and (iii) to give lectures about dementia to primary care doctors and educate people in the community. DSD are more skilled than primary care doctors in the following functions: differential diagnosis; outpatient services to deal with behavioral and psychological symptoms of dementia; community liaison; and home care.

Late occurrence of severe hyponatremia followed by extrapontine osmotic demyelination syndrome after successful conservative management of postpartum hemorrhage due to placenta accreta by uterine artery embolization.

Development of severe hyponatremia followed by extrapontine osmotic demyelination syndrome was reported as a significant late complication after successful conservative management of postpartum hemorrhage due to placenta accreta by uterine artery embolization.

Asymmetrical enhancement of middle-latency auditory evoked fields with aging.

We studied the effects of aging on middle-latency auditory evoked fields (P50m), and analyzed their interhemispheric differences. Magnetic responses following tone-burst stimuli to the right ear were measured in groups of 11 younger and 15 elderly subjects. The elderly subjects showed marked asymmetry in the P50m amplitudes. In the elderly group, the mean amplitude of the contralateral P50m was significantly larger (P<0.0005) than that of the ipsilateral P50m, while no asymmetry was shown in the younger group. The amplitude enlargement in the contralateral P50m showed significant correlation with age (R=0.60, P<0.005), while the ipsilateral P50m showed no correlation with age. These results suggest that the contralateral and ipsilateral auditory pathways are affected differently by ageing.