Assessment of dementia in patients with multiple system atrophy.

BACKGROUND AND PURPOSE: We investigated dementia in patients with multiple system atrophy (MSA) in order to characterize the prevalence and nature of impairments in these patients. METHODS: Fifty-eight MSA patients were recruited in our institution between April 1996 and December 2006 and investigated. RESULTS: Of 58 patients, 10 were diagnosed with dementia. There were no significant differences in age at onset, gender, duration of disease, or severity of cerebellar dysfunction between patients with and without dementia. The early and delayed heart to mediastinum (H/M) ratios obtained with (123)I-metaidobenylguanidine (MIBG) cardiac scintigraphy were significantly decreased in patients with dementia compared with those without dementia. Of the 10 patients with dementia, three were found to have cognitive decline that preceded onset of motor symptoms. White matter lesions were evident in these patients, whilst frontal atrophy was prominent in patients whose cognitive decline was preceded by onset of motor symptoms. CONCLUSIONS: Dementia in patients with MSA may be more common than previously thought, furthermore, we speculate that clinical features of dementia in these patients might be heterogeneous.

Clinical evaluation of Parkinson's disease dementia: association with aging and visual hallucination.

OBJECTIVES: In order to explore factors associated with the development of dementia in Parkinson's disease (PD) and Dementia with Lewy bodies (DLB), we systematically investigated the clinical evaluation of PD and DLB patients hospitalized in the Department of Neurology at Tottori University Hospital, Japan. RESULTS: There were 208 patients diagnosed as having PD and 39 patients diagnosed with DLB in this study. Of the patients with PD, 67 (32%) developed dementia and only five PD+ patients were considered to have cognitive impairment attributable to Alzheimer's disease (AD) or vascular dementia (VaD). Fifty-four (81%) PDD patients had visual hallucinations (VH) with or without cognitive fluctuation. The onset age of parkinsonian motor symptoms of patients with PD dementia (PDD) did not differ from that of PD patients without dementia. There was a significant inverse correlation between the onset age of motor symptoms in PD and the onset of their dementia in PDD. Seventy-five (36%) patients with PD had experienced VH and most of the PDD patients had experienced VH within 1 year before or after diagnosis of PDD. CONCLUSIONS: These results indicate that aging and VH are important factors associated with dementia in PD.

The human complement component C1R gene: the exon-intron structure and the molecular basis of allelic diversity.

Human C1r is a component of the complement system, which is a major mediator of innate immunity. In this study we investigated the exon-intron organization of the human C1R gene, which spans 11 kb from the initiation codon to the stop codon, and is very similar in exon-intron structure to the C1S gene. Six common and rare alleles, C1R*1, C1R*2, C1R*5, C1R*8, C1R*9, and C1R*13, were characterized by five mutations at amino acid positions 114, 135, 146, 167 and 244, in exons 4, 5 and 7 where the CUB1, EGF and CUB2 domains are encoded, respectively. A comparison with the cDNA of the mouse C1r gene showed that C1R*2is likely to be an ancestral allele. In addition, nine nucleotide substitutions and one length polymorphism were found in introns 2, 3, 4, 8 and 10.

Characterization of genomic rearrangements of the alpha1-acid glycoprotein/orosomucoid gene in Ghanaians.

In this study, the structure of the alpha1-acid glycoprotein (AGP), or orosomucoid (ORM), gene was investigated in a Ghanaian mother and her child, who shared an unusual variant, ORM1 S2(C), found by isoelectric focusing. Three remarkable changes of nucleotide sequence were observed: (1) The two ORM1 alleles, ORMI*S and ORMI*S2(C), had the AGP2 gene-specific sequence at one and three regions, respectively, in exon 5 to intron 5. The variant allele originating from ORMi*S was characterized by a G-to-A transition, resulting in an amino acid change from valine to methionine, which is also detected in ORM1 F2, a form that is common in Europeans. (2) The AGP2 gene of the child, inherited from the father, was duplicated, as revealed by long-range polymerase chain reaction. (3) Three new mutations were observed in two exons of the AGP2 genes of the mother and child. All of these novel genomic rearrangements, which were not observed in Japanese subjects, may have arisen through point mutation, gene conversion, and unequal crossover events. It is likely that the rearrangement of the AGP gene has often occurred in Africans.

Molecular characterization of four alpha-1-antitrypsin variant alleles found in a Japanese population: a mutation hot spot at the codon for amino acid 362.

In this study alpha-1-antitrypsin (AAT) phenotypes at the protease inhibitor (PI) locus were determined by isoelectric focusing of native and desialylated serum samples from 236 Japanese subjects living in the western part of Japan. The shifts in relative mobility between some PI types were observed before and after desialylation. This technique was useful in distinguishing between some PI M subtypes and variants. The molecular basis of four variant alleles, including two new alleles found in this study, was characterized: PI E(tokyo) [Lys(335)(AAG)--> Glu(GAG)] and PI N(nagato) [Leu(276)(CTG)-->Pro(CCG)] arose from PI M1(Val(213)) and PI M2, respectively. A new PI P(yonago) [Asp(19)(GAT)-->Ala(GCT)] originated from PI M1(Val(213)). A new PI M5(gunma) [Pro(362)(CCC)-->Ser(TCC)], arising from PI M3, was the sixth allele involving a mutation at codon 362, which is suggested to be a mutation hot spot. PI M5(gunma) was likely to show normal AAT levels and function although the mutations occurred near codon 358 for Met(358). The molecular basis of PI variant alleles found in Japanese was different from that reported in previous studies.

Effects of weight bearing on the tidemark and osteochondral junction of articular cartilage: histomorphometric analyses of 7 normal femoral heads.

To study the effect of weight bearing on the tidemark and osteochondral junction, we compared the morphology of these two boundaries in weight-bearing and less weight-bearing regions of normal human femoral heads. We measured the irregularities of the boundaries in the two regions using an X-Y digitizer connected to a computer in histological whole sections of femoral heads in 7 subjects without joint diseases. The irregularity of the tidemark was small, showing no difference between the two regions. However, the irregularity of the osteochondral junction in the weight-bearing region was greater than in the less weight-bearing region, which was confirmed by three-dimensional reconstructed images. Our findings suggest that mechanical stresses greatly influence the morphology of the osteochondral junction compared to the influence of such stresses on the tidemark, and that the marked irregularity of the osteochondral junction in the weight-bearing region is a reactive phenomenon against mechanical fragility due to simple contact between calcified cartilage and subchondral bone without fibrous connections.

A new single-nucleotide polymorphism in the seventh component of complement (C7) gene.

A new single-nucleotide polymorphism has been found in the 3' untranslated region of the complement component C7 gene. It is present with similar frequencies in the Japanese and Germans. This polymorphism would be a useful marker in the genetic study of C6 and C7 deficiencies.

Human orosomucoid polymorphism: molecular basis of the three common ORM1 alleles, ORM1*F1, ORM1*F2, and ORM1*S.

The human orosomucoid (ORM) is controlled by two closely linked loci, ORM1 and ORM2, and two tandem genes, AGP1 and AGP2, encoding the proteins produced by the two loci, have been cloned. In this study the molecular basis of ORM1 polymorphism was investigated. For the detection of mutations the products of the six exons of each gene, amplified by the polymerase chain reaction (PCR), were screened by single-strand conformation polymorphism analysis. Subsequently, the exons with an altered migration pattern were gene-specifically amplified by nested PCR. Sequencing of the gene-specific PCR products showed that the three common ORM1 alleles result from A-->G transitions at the codons for amino acid positions 20 in exon 1 and 156 in exon 5 of the AGP1 gene: ORM1*F1 was characterized by CAG (Gln) and GTG (Val), ORM1*F2, by CAG (Gln) and ATG (Met), and ORM1*S, by CGG (Arg) and GTG (Val). The phylogenesis of the genes encoding these three ORM1 alleles is discussed.

Simple and rapid determination of the acetaldehyde dehydrogenase (ALDH2) genotypes by nonradioactive single-strand conformation polymorphism analysis.

The genotyping of mitochondrial acetaldehyde dehydrogenase (ALDH2) is very important in alcohol studies. We describe an ALDH2 genotyping method based on nonradioactive single-strand conformation polymorphism (SSCP) analysis on mini-gels following amplification with a mutated primer set. The three ALDH2 genotypes were clearly and unambiguously distinguished. This method was applied to the ALDH2 genotyping of 129 unrelated Japanese. The allele frequency of ALDH2*2 was calculated to be 0.271, which was consistent with the previous data. The method proved to be simple, rapid and reliable, and dispensed with isotopic reagent and expensive restriction enzymes and equipment. The SSCP method described here is valuable in routine ALDH2 genotyping.

Development of an instrument to measure postmortem lividity and its preliminary application to estimate the time since death.

A degree of postmortem lividity was related to a subcutaneous hemoglobin concentration, which can be measured by using light absorption. On the basis of this theory, the authors have developed an instrument utilizing a light to measure the degree of postmortem lividity. By using 42 corpses whose postmortem intervals were known, the authors examined the relationship between the actual postmortem intervals and the measurements, and found that there was significant correlation between them.

[Toxicological findings in a death involving hydrogen sulfide].

A case of fatal hydrogen sulfide poisoning in a sewage disposal plant is described. Hydrogen sulfide levels were determined in several postmortem body tissues and fluids using gas chromatography with a flame photometric detection (GC-FPD). The concentrations of hydrogen sulfide in the blood, muscle, liver, lung, kidney, heart and brain were 0.305, 0.690, 1.089, 1.338, 1.170, 1.366 and 0.875 (micrograms/g or ml), respectively. The results are discussed in the light of the existing literature on the toxicological significance of hydrogen sulfide concentrations.

Rapid postmortem changes of rat striatum dopamine, serotonin, and their metabolites as monitored by brain microdialysis.

Brain microdialysis was used to monitor changes in extracellular dopamine (DA), serotonin (5-HT), and their metabolite levels in the rat striatum at death by cervical dislocation. Maximum respective 450-fold and 150-fold increases in the extracellular output of DA and 5-HT were observed within the first 30 min of death. DA and 5-HT outputs remained elevated over the following 2 h at levels about 100-fold and 50-fold above pre-death values, respectively. In contrast with monoamine outputs, the outputs of the DA metabolite, 3,4-dihydroxyphenylacetic acid (DOPAC), and the 5-HT metabolite, 5-hydroxyindoleacetic acid (5-HIAA), rapidly decreased by 10% and 20%, respectively 1 h after death. 5-Hydroxytryptophol (5-HTOL) gradually decreased after death. Before death both the extracellular DOPAC/DA and 5-HIAA/5-HT ratios were about 400; after death these ratios dropped to 0.56 and 4.0, respectively at 30 min. These observations suggested that regulation of neurotransmitter releases through the neuronal membrane and metabolisms in the rat striatum were seriously disrupted at death. This finding may be helpful in the determination of death in the field of forensic medicine.

Pathological study of diffuse axonal injury patients who died shortly after impact.

It is generally considered that axonal injury is apparent only on electron microscopy in the very early stage after a closed head injury. To clarify the pathological findings in head injury patients dying very shortly after the impact, we analyzed 8 fatal cases of diffuse axonal injury (DAI) who underwent medicolegal autopsy at the Department of Forensic Medicine of Kyoto Prefectural University of Medicine. Seven cases died within one hour after injury and another one case died 3 days after injury. We studied these cases macroscopically, microscopically, and electron microscopically. Macroscopically all cases showed the typical findings of diffuse axonal injury. Microscopical study of the cases who died within one hour revealed no characteristic findings of DAI such as appearance of retraction balls or microglia. On the other hand, in the case who died only 3 days after injury it showed the typical retraction balls. Electron microscopic study showed the remarkable destruction of cytoskeletal structure of axons in all cases. From our results, it is reasonable to speculate that DAI may be common among head injury patients who die very soon after the impact.

Central monoamines and the death process time (antemortem time) during asphyxia. An experimental study in the mouse brain.

The changes of the brain monoamines, norepinephrine (NE), dopamine (DA), and serotonin (5-HT), during acute asphyxia, caused by strangulation, anoxia, and drowning, were studied in the mouse. In several asphyxiated animal groups significant linear correlation was found between the level of monoamines, NE, DA, and 5-HT, and the death process times or antemortem times were r = 0.50, 0.98 (P less than 0.05), and 0.57, respectively. It is concluded that the level of brain NE and DA increased in the mouse that died of asphyxia, and the level of 5-HT showed only an apparent decrease in anoxia groups as compared with the control group and showed a twice as high increase in drowning groups. Especially, there was a tendency that the longer the death process times or antemortem times, the higher was the level of DA.

Development of alcohol withdrawal by voluntary alcohol intake in tumour-bearing mice.

Twenty-eight female mice of the first filial generation of a C57BL KR cross were used. Twelve mice developed tumours in the thoracoabdominal region 11 months after birth. A drastic enhancement of alcohol preference occurred within one month after the discovery of mammary adenoma and the animals eventually became drunk and remained so for several days. Of 12 mice developing tumours, 10 showed a conspicuous degree of drunkenness and decrease of body weight, with some developing tremors and wet dog shakes reminiscent of the alcohol withdrawal syndrome. The remaining 2 also displayed a marked preference for alcohol, though not to the extent of developing the drunkenness syndrome. None of 16 mice in the tumour-free group was observed to have significant alcohol preference. Most animals in the tumour-free group ingested alcohol mainly at night, whereas those in the tumour-bearing group ingested alcohol throughout the 24 hours. The blood alcohol concentrations of the drunken mice were over 4 mg/ml.