Associations between retrospectively recalled napping behavior and later development of Alzheimer's disease: association with APOE genotypes.

To evaluate putative risk factors for Alzheimer's disease (AD), we conducted a case-control study with exposure assessment performed after disease onset. In this study, we evaluated the effect of recalled habitual napping according to its duration and examined whether APOE genotype modifies the effect. The subjects were 337 patients (144 men, 193 women, age at onset and the time of study (years): 69+/-10, 73+/-9) with a diagnosis of probable AD based on the NINCDS-ADRDA criteria. Two hundred and sixty spouses of the subjects (94 men, 166 women, age at the time of study: 69+/-9) served as controls. We asked retrospectively about habitual (3 or more days per week) napping and its duration observed between 5 and 10 years before the onset of AD for cases, and between 5 and 10 years before the time of the study for controls. The analysis revealed that limited napping for up to 60 min had an apparently protective effect against the development of AD, especially for carriers of the APOEepsilon 4 allele. By contrast, napping for more than 60 min increased the risk of AD morbidity among the carriers of the allele. Habitual napping may modulate or disturb the physiological functions of sleep and circadian time-keeping according to its duration, and this might be associated with some mechanism that leads to the development of AD.

Predictors of severity of behavioral disturbance among community-dwelling elderly individuals with Alzheimer's disease: a 6-year follow-up study.

To clarify which baseline factors, including apolipoprotein E (ApoE) genotyping and caregiver characteristics, predict the future severity of behavioral disturbance among community-dwelling elderly with Alzheimer's disease (AD), we conducted a longitudinal study for up to 6 years. Fourteen kinds of behavioral disturbance were evaluated. Analyses using data from 62 subjects with at least three annual assessments revealed that the baseline severity of behavioral disturbance was the strongest predictor of future severity, followed by baseline stage of dementia or use of support services. However, ApoE epsilon4 had only a marginal effect at most. The behavioral disturbances examined in the present study appear to be innately determined phenomena rather than merely representing stages of AD.

[An analysis of community mental health services at public health centers in the Tokyo metropolitan area--services for 727 new cases during 5 years in Bunkyo-Ward].

For an overview of the community mental health services at Public Health Centers (PHCs), cases were statistically analyzed from the aspect of 3 points: the situation of psychiatric treatment at initial contact (psychiatric treatment), the person who had been living with the case at first contact (living style) and the person who contacted the PHC first (first contact person). During approximately 5 years, 463 new cases contacted the 2 PHCs in Bunkyo-Ward for consultation. Among them, 132 were under psychiatric treatment, 324 under no treatment and 7 unknown. Additionally, 264 were found to be registered on official documents, some of whom received PHC services after being listed. The percentage of schizophrenic cases in the psychiatric treatment group at first contact were higher than in the non-treatment group. More cases with psychiatric treatment were visited by PHN than without treatment. There were great differences in the first contact person among the groups classified according to living style. Especially, in the non psychiatric group, the percentage of the first contact person being other than family and relative was higher in the group who had been living alone than any other groups. Percentages of personal interview of a case, consultation by a psychiatrist in PHCs, and visiting the home of a case were different among the groups classified by psychiatric treatment, living style and first contact person. However, no difference in services outcome (total number of contacts made by a cases, relatives of cases, and other related persons), or present service utilization (continuing, discontinued, completed) among the groups classified by psychiatric treatment, living style, and first contact person was seen.

[MRI findings in studies of distal myopathy with rimmed vacuoles].

A case of distal myopathy with rimmed vacuoles was studied with MRI, which showed a characteristic distribution of the affected muscles. A 41-year-old man who presented a slowly progressive weakness in his lower legs starting 11 years previously was admitted to our hospital of further investigation. Neurological examinations showed muscular wasting and weakness in the neck flexors, the flexors of the forearm, the flexors and adductors of the thigh and the extensors of the lower legs. Needle electromyography showed a myopathic pattern. Muscle biopsy revealed a variation in fiber size, an increase in internal nuclei, fatty infiltration and scattered rimmed vacuoles in a histochemical study. Electron microscopy revealed that rimmed vacuoles contained numerous lamellar bodies and glycogen particles. T1 and T2 weighted MRI showed high signals in the m. adductor of thigh m. biceps femoris, m. semimembranosus, m. semitendinosus, m. tibialis anterior, m. tibialis posterior, m. extensor digitorum longus, m. extensor digitorum brevis, m. peroneus, and m. gastrocnemius. There were three merits for the application of MRI to distal myopathy, (1) easy detection of the affected muscles as fatty change is expressed with a high signal intensity by MRI, (2) no affection by the presence of bones in MRI, and (3) the possibility to have a transverse section and a sagittal and coronal section in MRI. In this case MRI was very useful to detect the affected muscles and to observe the progress.

Effect of cerebral ischemia and hypercapnia on cerebral pH studied with 31P-NMR and electrical activity in rat brain.

The activity of electroencephalogram (EEG) and cortical somatosensory evoked potential (SEP) was suppressed during cerebral ischemia in rats subjected to the 4-vessel occlusion. Considerable variations were demonstrated in the decrease of phosphocreatine and ATP concentration during ischemia among the rats measured with 31P-NMR, accompanied with cerebral acidification. Hypercapnia, induced in the rats studied by the inhalation of a gas mixture of 30-40% CO2, suppressed the activity of EEG and cortical SEP. The cerebral acidification observed during the ischemia was more severe than that under the hypercapnia, implying that cerebral acidification is one of the possible causes for the decrease in the electrical activity of the brain during ischemia.