Relative frequencies of dementia of the Alzheimer type and vascular dementia in Japanese nursing homes.

We have studied neuropathologically 200 aged nursing home residents (101 men and 99 women) autopsied between 1976 and 1985. Seventy-three of the 200 showed dementia during life, that is, 27% and 55% of the residents in nursing homes and special nursing homes, respectively. The relative frequencies of SDAT and VD in nursing homes as a whole were the same (34%). The relative frequencies of SDAT and VD in special nursing homes, where usually high concentrations of VD have been noted, were 21% and 52%, respectively. A comparison of the results of our special nursing homes (SDAT:VD = 1:2.5) and nursing homes as a whole (SDAT:VD = 1:1) with those of Barnes and Raskind (SDAT:VD = 2:1) and Rovner et al. (SDAT:VD = 3:1) showed that the frequencies of VD in Japanese nursing homes are considerably higher than those in their American counterparts.

[A case of bilateral necrosis of the basal ganglia after hypotensive shocks].

We reported a case with bilateral necrosis of the basal ganglia after hypotensive shocks. The patient was a 69-year-old woman, who fell into a hypotensive shock (B.P. below 40 mmHg) of unknown origin during examination of her bladder cancer and was admitted into CCU. After admission, hypotensive shocks were repeated four times (B.P. below 50 mmHg each time). Neurological examination revealed a left spastic hemiplegia. Brain CT on 10th day showed bilaterally low density areas around the basal ganglia and a diagnosis of brain infarction was made. She gradually presented quadriplegia and symptomatic changes from pyramidal to extrapyramidal signs. Brain CT on 24th day showed bilateral hemorrhagic infarction of the basal ganglia with enhanced effect. On 79th day, she again fell into shock and died. Neuropathological examination of the brain was as follows. 1) laminar necrosis of the deep layers of the cerebral cortex, 2) bilateral necrosis of the hippocampal Sommer sector, 3) bilateral necrosis of the caudate nucleus, putamen and pallidum with neuronal loss and infiltration of fat granule cells, 4) sparing of the internal capsules, 5) bilateral necrosis of the reticular zone of the substantia nigra, 6) foci of fresh necrosis and loss of Purkinje cells in the cerebellum. These lesions are consistent with those of selective vulnerability in hypoxia as described by Scholz et al. An extensive distribution of cerebral as well as basal ganglia necrosis in this case was caused by repeated shocks.(ABSTRACT TRUNCATED AT 250 WORDS)