[Comparison of quantitative image indexes of brain MRI between differentiates idiopathic normal pressure hydrocephalus and Alzheimer disease, predict positive response of the CSF drainage in possible idiopathic normal pressure hydrocephalus].

AIM: The clinical guidelines for idiopathic normal pressure hydrocephalus (iNPH) in Japan recommend cerebrospinal fluid (CSF) drainage. The positive response rate of the diagnostic CSF drainage is not very high because brain MRI findings of Alzheimer disease (AD) are similar to those of iNPH. Therefore, we sought to determine simple, quantitative indexes of head MRI to differentiate iNPH from AD and to predict positive response of the CSF drainage in possible iNPH. METHODS: Eighteen patients with the clinical criteria of possible iNPH who had undergone diagnostic CSF drainage were evaluated. Nineteen patients with the clinical criteria of probable AD were used as controls. VSRAD, Evans index, and previously reported indicators were measured on brain MRI in all patients. These parameters were compared between AD and iNPH, and between iNPH responders and non-responders. RESULTS: VSRAD, Evans index, bifrontal index, width and height of the temporal horn, and the maximum height of the Sylvian fissure were higher in iNPH than AD. The cutoff value of the bifrontal index, width and height of the temporal horn, and maximum height of the Sylvian fissure were 0.31, 6.0 mm, 3.13 mm, and 7.6 mm, respectively. The minimum thickness of the medial temporal lobe was higher in the CSF drainage responders than the non-responders. The cutoff value of the minimum thickness of the medial temporal lobe was 11.0 mm. CONCLUSIONS: Our results suggest that simple image indexes of brain MRI could distinguish iNPH from AD and predict positive response to CSF drainage in iNPH.

A randomized cross-over study of a traditional Japanese medicine (kampo), yokukansan, in the treatment of the behavioural and psychological symptoms of dementia.

The effectiveness and safety of yokukansan (TJ-54), a traditional Japanese medicine (kampo) for the treatment of the behavioural and psychological symptoms of dementia (BPSD), were evaluated in 106 patients diagnosed as having Alzheimer's disease (AD) (including mixed-type dementia) or dementia with Lewy bodies. Patients were randomly assigned to group A (TJ-54 treatment in period I and no treatment in period II; each period lasting 4 wk) or group B (no treatment in period I and TJ-54 treatment in period II). BPSD and cognitive functions were evaluated using the Neuropsychiatric Inventory (NPI) and the Mini-Mental State Examination (MMSE), respectively. Activities of daily living (ADL) were evaluated using Instrumental Activities of Daily Living (IADL) in outpatients and the Barthel Index in in-patients. For the safety evaluation, adverse events were investigated. Significant improvements in mean total NPI score associated with TJ-54 treatment were observed in both periods (Wilcoxon test, p=0.040 in period I and p=0.048 in period II). The mean NPI scores significantly improved during TJ-54 treatment in groups A and B (p=0.002 and p=0.007, respectively) but not during periods of no treatment. Among the NPI subscales, significant improvements were observed in delusions, hallucinations, agitation/aggression, depression, anxiety, and irritability/lability. The effects of TJ-54 persisted for 1 month without any psychological withdrawal symptoms in group A. TJ-54 did not show any effect on either cognitive function or ADL. No serious adverse reactions were observed. The present study suggests that TJ-54 is an effective and well-tolerated treatment for patients with BPSD.

[Localized cerebral blood flow changes in response to ADL-related vitality in elderly patients with dementia using single photon emission computed tomography].

AIM: To clarify the area in the brain related to responsible for vitality and volition. METHODS: We studied 123 outpatients (39 men, 84 women, 77.7+/-6.7 years old) who visited the Center for comprehensive care on memory disorders in Kyorin University Hospital. No patients were prescribed with anti-depressants, anti-anxiety agents, psychomimetics, acetylcholinesterase inhibitors, Chinese herbal medicines or cerebrovascular circulation modifying drugs. Patients with frontotemporal dementia or depression were excluded. ADL-related vitality and volition was measured by a vitality index. Cerebral brain blood flow was measured by single photon emission computed tomography (99mTc-ECD SPECT). Relative blood flow changes were calculated by Statistical Parametric Mapping (SPM). Absolute blood flow changes were calculated by a three-dimensional stereotaxic ROI template on anatomically standardised 99mTc-ECD SPECT (3D SRT). Statistically significant correlations between semi-quantitatively measured scores of vitality index and blood flow changes in SPM and 3D-SRT were tested and displayed on a brain map. RESULTS: Analysis of relative and absolute blood flow showed that the common responsible area in the brain related to vitality was the frontal lobe, fronto-cingulate gyrus, temporal lobe, basal ganglia (caudate nucleus) and thalamus. Blood flow changes in the orbital gyrus were strongly correlated with vitality index specially in the frontal lobe. CONCLUSION: ADL-related vitality is affected mainly by the blood flow in the frontal-subcortical circuit. However, deep white matter was also important to determine vitality and volition.

Analysis of the distribution of neuropathogenic retroviral antigens following PVC211 or A8-V infection.

A8-V and PVC211 are neuropathogenic strains of the Friend murine leukemia virus (Fr-MLV) that cause spongiosis in the rat brain after infection at birth. PVC211 exhibited stronger neuropathogenicity than A8-V, and induced more severe neurological symptoms such as hind-leg paralysis. These symptoms correlated with the neuropathological spread and intensity, which were more severe in the spinal cord of rats infected with PVC211 than in those infected with A8-V, without exhibiting neuropathological differences in other areas of the CNS. Interestingly, virus titers recovered from infected spinal cords were similar in PVC211 and A8-V infected animals. However, in the spinal cord infected with PVC211, glial cells attained higher immunohistochemical expression scores for the viral surface antigen, gp70 (Env) than in the A8-V infected spinal cord, although expression levels of viral antigens in blood vessel walls were similar in A8-V and PVC211 infections. Furthermore, many of those glial cells which carried viral antigens were found, by double immunostaining, to be microglia. The results suggested that the spread of viral antigen positive microglia plays an important role in forming the different neuro-pathogenicity observed in A8-V and PVC211 infections.