Correlation between right medial temporal lobe atrophy and persecutory delusions in patients with dementia of the Alzheimer's type demonstrated on VSRAD advance.

BACKGROUND: The relationship between focal brain atrophy and delusions in patients with Dementia of the Alzheimer's Type (DAT) is not well understood. Few studies have been reported on the association between medial temporal atrophy (MTA) and persecutory delusions in patients with DAT. We investigated the relationship between MTA and persecutory delusions in patients with DAT using voxel-based specific regional analysis system for Alzheimer's disease (VSRAD) advance software, which allows us to quantify the laterality and the degree of MTA on magnetic resonance imaging (MRI) scans. METHODS: Thirty-one patients diagnosed with DAT were recruited and scanned with a 1.5 tesla MRI scanner. All MRI data were analyzed using VSRAD advance. The target volume of interest (VOI) included the entire region of the entorhinal cortex, hippocampus, and amygdala. The degree of MTA was obtained from the averaged positive z score (Z-score) on the target VOI, with higher scores indicating more severe. These DAT patients were divided into a group with (D group: n = 13) and without (ND group: n = 18) persecutory delusions. RESULTS: In the D group, the mean the bilateral, right, and left Z-scores were 2.45, 2.69, and 2.19, respectively. These mean Z-scores of the ND group were 2.00, 2.00, and 1.95, respectively. The right Z-scores for the D group were significantly higher than those for the ND group (p < 0.05). CONCLUSIONS: These findings suggest that right MTA could contribute to the development of persecutory delusions in patients with DAT.

[An adult case suspected of recurrent measles encephalitis with psychiatric symptoms].

An adult case of suspected recurrent measles encephalitis with psychiatric symptoms is reported. A 46-year-old woman developed measles encephalitis presenting as schizophreniform disorder and recovered three months after onset. However, approximately two years later, she suffered a relapse of encephalitis presenting with psychiatric symptoms (auditory hallucination, cenesthopathy, insomnia, depressive mood) and became comatose. Following ten days of symptomatic treatment, her clinical symptoms gradually improved. Three months later, she made a remarkable recovery without neurological sequelae. Since then, she has maintained good condition for six years. The diagnosis of suspected recurrent measles encephalitis was made on the basis of the change of anti-measles IgM antibody titers. Acute relapse of disseminated encephalomyelitis (ARDEM) and multiple sclerosis (MS) were ruled out due to no abnormal finding of cerebral white matter on MRI. Six years after the recurrent episode, the titers of anti-measles IgM antibodies (EIA) in the serum were still high, suggesting that she was suffering from a chronic measles virus infection. This patient should be followed up for a longer time because there is a possibility that she might be in the latent period of subacute sclerosing panencephalitis (SSPE).