[Show abstract][Hide abstract] ABSTRACT: ABSTRACT Background: Previous studies in western countries have shown that about 30%-50% of patients with frontotemporal lobar degeneration (FTLD) have a positive family history, whereas the few epidemiological studies on FTLD done in Asia reported much lower frequencies. It is not clear the reason why the frequencies of FTLD with positive family history were lower in Asia. Furthermore, these findings were not from studies focused on family history. Therefore, it is necessary to conduct further studies on the family history of FTLD in Asia. This international multi-center research aims to investigate the family histories in patients with FTLD and related neurodegenerative diseases such as progressive supranuclear palsy (PSP), corticobasal syndrome (CBS), and motor neuron diseases in a larger Asian cohort. Methods: Participants were collected from five countries: India, Indonesia, Japan, Taiwan, and Philippines. All patients were diagnosed with behavioral variant frontotemporal dementia (bvFTD), semantic dementia (SD), progressive non-fluent aphasia (PA), frontotemporal dementia with motor neuron disease (FTD/MND), PSP, and corticobasal degeneration (CBD) according to international consensus criteria. Family histories of FTLD and related neurodegenerative diseases were investigated in each patient. Results: Ninety-one patients were included in this study. Forty-two patients were diagnosed to have bvFTD, two patients had FTD/MND, 22 had SD, 15 had PA, one had PA/CBS, five had CBS and four patients had PSP. Family history of any FTLD spectrum disorder was reported in 9.5% in bvFTD patients but in none of the SD or PA. Conclusion: In contrast to patients of the western countries, few Asian FTLD patients have positive family histories of dementia.
International Psychogeriatrics 04/2014; · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To identify patient-related factors associated with depressive state in caregivers of patients with dementia, we investigated the caregivers' and patients' characteristics in relation to the depressive state in their caregivers.
Prospective hospital-based cohort study.
Two memory clinics in Japan.
Outpatients with dementia (n = 135) and their caregivers at home.
The outpatients and their caregivers were divided into 2 groups according to the Center for Epidemiologic Studies Depression Scale for caregivers. To identify the patient-related factors that cause depressive state in caregivers, Mini-Mental State Examination (MMSE), the Physical Self-Maintenance Scale for fundamental activities of daily living (ADL), and the instrumental ADL scale (IADL) scores for instrumental ADL and the neuropsychiatric inventory (NPI) subscale score for behavioral and psychological symptoms of dementia were compared between the 2 groups. We used logistic regression to determine the independent predictors of caregiver depressive state.
There was no significant difference in MMSE score between the 2 groups. Logistic regression analysis revealed that the depressive state in caregivers was related with IADL score and delusion in NPI subscale of patients.
Depressive state in caregivers was independent of the decline in cognitive function in patients with dementia but was associated with decline in instrumental ADL and severity of delusion.
Journal of the American Medical Directors Association 03/2014; · 5.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the Japanese education system, students who fail university entrance exam often go to special preparatory schools to prepare for the following year's exam. These students are called ronin-sei. The purpose of this study was to clarify: (i) depression and somatic complaints in ronin-sei; and (ii) the association between depression, examination-related stressors, and sense of coherence (SOC).
A total of 914 ronin-sei from two preparatory schools were asked to answer a self-rating questionnaire. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D) and SOC was measured using the SOC-13 Scale.
Overall, 57.9% of subjects were considered to have depression (CES-D ≥ 16) and 19.8% had severe depression (CES-D ≥ 26). Higher CES-D scores were associated with a higher rate of somatic complaints. In hierarchical logistic regression analysis, having no one to talk to about his/her worries and having parents who disagree about the first-choice of university and faculty were independent risk factors for depression and severe depression, respectively, even after controlling for SOC.
Preparatory school students have various somatic complaints, and their depression is in part related to examination-related stressors. To maintain mental health, it is important to enhance SOC, to understand their examination-related stressors and to provide adequate support for these students.
Psychiatry and Clinical Neurosciences 02/2014; · 2.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Objective: The Cognitive Fluctuation Inventory (CFI) was developed to evaluate cognitive fluctuation in patients with dementia with Lewy bodies (DLB). The objective of this study was to assess the content validity and inter-rater reliability of the CFI. Subjects and Methods: Nine specialists in DLB treatment were invited to participate in the survey to assess the content validity of the CFI. They were asked to assess the relevance and comprehensibility of the question items. In the validation study, inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). Results: Regarding content validity, all nine specialists considered the main question and sub-questions to be relevant to cognitive fluctuation in patients with DLB. Eight out of nine specialists considered the CFI to be a comprehensive measure for detecting cognitive fluctuation in patients with DLB. In the analysis, which used data from 29 patients and their caregivers, the ICC of the CFI was 0.746, which suggests good inter-rater reliability. Conclusion: We found that the CFI showed good content validity and inter-rater reliability for evaluating cognitive fluctuation in patients with DLB. (Received April 5, 2013; Accepted September 20, 2013; Published February 1, 2014).
Brain and nerve = Shinkei kenkyū no shinpo 02/2014; 66(2):175-83.
[Show abstract][Hide abstract] ABSTRACT: Sense of coherence (SOC) is associated with a reduced risk of various health problems and is thought to be a major factor related to the ability to cope with stress. In the present study, we examined the association between caregiver burden and SOC among caregivers to persons with dementia.
[Show abstract][Hide abstract] ABSTRACT: Background
In responses to self-reported depression screening questionnaires, item non-response, which refers to the absence of answers to specific questions, is problematic. The objective of this study were (1) to clarify the features of respondents with item non-response on a self-reported elderly depression screening questionnaire (15-item geriatric depression scale; GDS-15) as compared to respondents with full responses, and (2) to compare positive depression screening rates calculated using two methods: excluding respondents with item non-response (complete case analysis; CCA) and estimating by multiplying mean scores from valid responses by the total number of GDS-15 items for respondents with item non-response.
This was a cross-sectional study conducted from 2010 to 2012. Of 4794 elderly subjects (65 years and older) living in one town in Japan 2836 community-dwelling elderly people (59.2%) were included in the analysis.
Item non-response was observed in 25.0% of respondents. Respondents with item non-response had a higher rate of depression and mental and physical problems. Respondents with depression (estimated GDS-15 score ≥6) and suicidal ideation both had a 1.6-times higher risk of item non-response on the GDS-15. The positive depression screening rate on GDS-15 by CCA was 16.5%, compared with 18.9% when calculated by the estimated GDS-15 score.
Our survey was conducted in one rural area and targeted only elderly people.
The incidence of item non-response among community-dwelling elderly people was associated with depression of the respondent. Excluding subjects with item non-response when calculating positive depression screening rates in elderly individuals causes the rate to be underestimated.
Journal of affective disorders 01/2014; 162:30–33. · 3.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purposes
The Japanese word “ronin-sei” refers to a student who has failed their university entrance examination and is preparing to re-take the examination in the following year. We aimed to determine how sleep duration is associated with daytime sleepiness or depression in ronin-sei because impaired daytime performance is known to result from sleep deprivation.
The participants in this cross-sectional study were 1075 ronin-sei and 285 university students. Sleepiness and depressive symptoms were assessed using the Epworth Sleepiness Scale (ESS) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively.
Ronin-sei had significantly shorter sleep duration and earlier bed- and rise-times than university students. There was no significant difference in CES-D between the groups; however, the ESS score of university students was significantly higher than of ronin-sei. Ronin-sei who slept for 5 to less than 6 hours had higher ESS scores than those who slept for 6 to less than 7 hours. The mean CES-D score in ronin-sei who slept less than 5 hours was significantly higher than in those who slept for 5 to less than 6 hours, from 6 to less than 7 hours, and from 7 to less than 8 hours. Ronin-sei who slept for more than 8 hours also had higher depression scores.
Sleep deprivation appears to be common among ronin-sei. Furthermore, a U-shaped relationship was found between sleep duration and depressive symptoms, revealing that ronin-sei who had too little or too much sleep were more likely to exhibit an increase in depressive symptoms.
[Show abstract][Hide abstract] ABSTRACT: In Japan, the government and media have become aware of the issues of early onset dementia (EOD), but policies for EOD have not yet been established and support systems are inadequate. To provide practical data about EOD, a two-step postal survey was performed.
A questionnaire requesting information on EOD cases was sent to target institutions in five catchment areas in Japan. According to the answers from the institutions, we estimated the prevalence of EOD using census data and determined the illnesses causing EOD. As a quality control study, the authors reviewed every diagnosis in a quarter of the reported cases using the medical and psychiatric records and neuroimaging data. This study was conducted from 2006 to 2007.
Information from 2469 patients was collected from 12 747 institutions, and 2059 subjects with EOD were identified. The estimated prevalence of EOD was 47.6 per 100 000 (95% confidence interval, 47.1-48.1) for all of Japan. Of the illnesses causing EOD, vascular dementia (VaD) was the most frequent (39.8%), followed by Alzheimer's disease.
The prevalence of EOD in Japan appeared to be similar to that in Western countries. However, unlike previously reported international experience, VaD was the most frequent cause of EOD in all catchment areas in Japan.
Psychiatry and Clinical Neurosciences 12/2013; · 2.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We assessed the value of combining (123)I-IMP brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy for the discrimination of dementia with Lewy bodies (DLB) from other types of dementia.
We subjected 252 consecutive patients with clinically suspected DLB to both (123)I-IMP brain perfusion SPECT and (123)I-MIBG myocardial scintigraphy. Patients with Parkinson's disease were included. The 252 patients were randomly assigned to an estimation (n = 152) or a validation group (n = 100). Using univariate analysis, we first analyzed the relationship between various variables and the presence or absence of DLB in estimation group and then proceeded to multivariate analysis to obtain a combined index that predicted the likelihood of DLB. The diagnostic value of the index was assessed by calculating the area under the receiver operating characteristic (ROC) curve (AUC) with the cutoff value selected from the ROC curve. We then tested the predictive accuracy of the index in validation group.
The combined index was an arithmetic expression that combined the age, early (123)I-MIBG heart-to-mediastinum uptake (E-H/M) ratio, and the parietal lobe hypoperfusion score. Values for the AUC of the combined index, the E-H/M ratio, the parietal lobe hypoperfusion score, and the patient age in validation group were 0.95, 0.90, 0.72, and 0.73, respectively. There was a significant difference in the AUC of the combined index among other indices (p < 0.05). The sensitivity, specificity, and accuracy of the combined index for a diagnosis of probable DLB in validation group were 88, 87, and 87 %, respectively.
The combinational diagnosis based on (123)I-IMP brain perfusion SPECT, (123)I-MIBG myocardial scintigraphy, and the patient age is a simple and reliable means for predicting probable DLB.
Annals of Nuclear Medicine 12/2013; · 1.41 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sense of coherence (SOC) is thought to be a major determinant in maintaining health. SOC gained attention recently in the fields of psychiatry after it was reported to be associated with a lowered risk of various health problems. However, the effect of SOC as a buffer against performance impairment caused by health problems is not well known. Thus, we aimed to examine the relationships among health problem, the degree of presenteeism (performance loss due to health problems), and SOC in adolescents.
Participants were 2824 university students (1855 males, mean age; 18.35±0.84 years). SOC and self-reported health problems were assessed using an SOC scale (29 items) and the presenteeism scale for students, respectively.
SOC scores differed between students with and without health problems (t(2822)=5.75, P<0.001). The effect size (Cohen's d) was 0.22 for this difference. In a multiple logistic regression analysis, male gender (odds ratio [OR]=0.62; 95% confidence interval [CI]=0.53-0.73), moderate SOC (within ±1 SD; OR=0.59; 95% CI=0.47-0.72), and high SOC (>1 SD; OR=0.43; 95% CI=0.33-0.58) were independently associated with a lower frequently of health problems. In addition, SOC showed a significant inverse correlation with presenteeism (r=-0.27, P<0.001).
These results suggest that application of the concept of SOC might aid in the prevention of health problems among university students. Students with a strong SOC might be less prone to a decline in performance when health problems arise.
Asian journal of psychiatry. 10/2013; 6(5):369-72.
[Show abstract][Hide abstract] ABSTRACT: Apathy includes aspontaneous, indifferent behavior, with loss of motor and affective drive. Apathy is related to the disruption, at various anatomical sites, of frontosubcortical pathways, such as anterior cingulate and bithalamic lesions. Apathy was frequently reported in patients with Alzheimer's disease, post-stroke, and frontotemporal dementia. It is very important to distinguish apathy from depression by the therapeutic view point.
Nippon rinsho. Japanese journal of clinical medicine 10/2013; 71(10):1798-803.
[Show abstract][Hide abstract] ABSTRACT: With the recent approval of several new drugs, pharmacological management of Alzheimer's disease has become more complicated in Japan. The efficacy and safety of increasing the dose of donepezil to 10 mg daily were assessed in an open-label study of patients with mild to moderate Alzheimer's disease who were showing a diminished response to 5 mg daily.
The subjects included 27 patients with mild to moderate probable Alzheimer's disease whose primary caregivers had confirmed progression of symptoms during treatment with donepezil 5 mg daily. The dose of donepezil was increased to 10 mg daily, and the Alzheimer's disease assessment scale-cognitive subscale (Japanese version), Neuropsychiatric Inventory, and Zarit caregiver burden interview scores were compared before and after dose escalation. Adverse events were also investigated.
Efficacy was evaluated in 24 patients; three dropped out because of adverse reactions. The Alzheimer's disease assessment scale score showed significant improvement after dose escalation of donepezil (P = 0.006). The total score of the Neuropsychiatric Inventory and the Zarit score showed no significant changes. However, the anxiety score of the Neuropsychiatric Inventory showed a significant increase (P = 0.028). Safety assessment revealed that the dropout rate was 11.1% and adverse reactions occurred in 40.7%. Nausea (29.6%) and loss of appetite (22.2%) were common adverse reactions.
Because cognitive function showed improvement after increasing the dose of donepezil, the dosage of this drug should probably be adjusted based on the overall severity of Alzheimer's disease as well as the progression of cognitive dysfunction.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to compare the utility of the Rivermead Behavioural Memory Test (RBMT) and the Alzheimer's Disease Assessment Scale-Cognitive part (ADAS-Cog) for the evaluation of mild cognitive impairment (MCI) or very mild Alzheimer's disease (AD).
The discriminative abilities of RBMT and ADAS-Cog were compared in the very early stage of AD or MCI patients. Furthermore, we evaluated the difference in both RBMT score and ADAS-Cog score between different severities.
Evident superiority in the false negative rate was observed in RBMT over ADAS-Cog in MCI or very mild AD. In addition, 86.7% of the subjects overlooked by ADAS-Cog were correctly detected by RBMT profile score. However, the RBMT score falls in the very early stages and the range of the RBMT score is rather narrow. As a result, it is difficult to evaluate status and follow the progression in severer cases. In contrast to RBMT, the ADAS-Cog score has a wide range and can evaluate and follow the severity in more severe cases.
RBMT is more useful than ADAS-Cog in evaluating patients with MCI or very mild AD.
Psychiatry and Clinical Neurosciences 04/2013; 67(3):148-53. · 2.04 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT Background: Dementia with Lewy bodies (DLB) is the second most common type of neurodegenerative dementia. It is frequently difficult to differentiate DLB from Alzheimer's disease (AD) and other types of dementia. This study examined the usefulness of monitoring sleep talking for the diagnosis of DLB. Methods: A total of 317 patients with dementia were selected from a consecutive series at the Dementia Clinic of Kumamoto University Hospital. Diagnostic categories consisted of probable DLB (n = 55), probable AD (n = 191), frontotemporal lobar degeneration (FTLD) (n = 16), vascular dementia (VaD) (n = 18), and other/unspecified dementia (n = 37). We evaluated sleep talking in all dementia patients and normal elderly subjects (n = 32) using an originally designed sleep talking questionnaire. Results: Sleep talking occurred most frequently in the DLB group (61.8%), followed by the VaD group (33.3%), other/unspecified dementia group (27.0%), AD group (18.8%), FTLD group (12.5%), and normal elderly subjects group (6.3%). The prevalence of sleep talking in the DLB group was significantly higher than in other groups, except in the VaD group. The sleep talking yielded high specificity (81.2%) and some sensitivity (61.8%) for the differential diagnosis of DLB from AD. Furthermore, loud sleep talking may improve the specificity (96.9%). For the differentiation of DLB from all other dementia types, the specificity of sleep talking and loud sleep talking was also high (79.4% and 95.8% respectively). Conclusions: Assessing sleep talking, especially the volume of sleep talking, may be useful in the clinical discrimination of DLB from not only AD but also from all other types of dementia.
International Psychogeriatrics 02/2013; · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Borderline personality disorder (BPD) is often manifested by maladaptive behaviours such as self-injury. The interpersonal style characteristic of BPD makes it difficult to maintain stable therapeutic relationships, with the patient often discontinuing treatment. Although dialectical behavior therapy (DBT) has been reported to benefit patients with BPD, reports in Asian countries have been few. We herein describe a 22-year-old female with BPD and a history of attempted suicide and self-injury who underwent DBT at our hospital. Methods: Our 6-month DBT consists of 4 parts: weekly psychotherapy by a psychiatrist, weekly skills training by a clinical psychologist and nurse, emergency consultations, and supervision/consultation meetings. Individual psychotherapy and skills training sessions, respectively, were conducted for this patient 24 times. Results: After completing DBT, the number of self-injuries and frequency of suicidal ideation in our patient decreased. Conclusion: Although more costly than standard treatment for BPD, a trial of DBT might be worthwhile in Japanese patients.
ASEAN Journal of Psychiatry. 01/2013; 14(1):59-61.
[Show abstract][Hide abstract] ABSTRACT: Aim: This study aimed to investigate factors associated with depression in a sample of elderly Japanese individuals in a rural community and to examine differences among factors associated with individuals living alone or living with others. Methods: Using a population-based sample from rural Japan, we assessed a total of 1552 participants aged 65 years or older by mailing a survey and evaluating responses based on the Geriatric Depression Scale. Factors associated with depression were also examined. Results: We received 964 valid responses. Depressed subjects comprised 20.5% of the sample. Living alone was significantly related to depression. In individuals living alone, depression was associated with loss of appetite, suicidal ideation, financial strain, and worries in life. However, multiple linear regression analyses revealed that the influence of living alone was negated by having a good social support system. Conclusion: These findings confirm that living alone is an important factor in depression among the elderly in a rural part of Japan. Results also confirm what others have found in Western cultures: high levels of social support, awareness of receiving social support, and willingness to receive assistance may reduce the risk of depression.
[Show abstract][Hide abstract] ABSTRACT: Background: Family members' observations of daily life are important for the diagnosis and treatment of dementia. However, elderly people are increasingly living alone, and family structures tend to differ between inner-city areas and regional areas. We aimed to compare the family caregiving infrastructure of demented elderly visiting a memory clinic. Methods: Subjects were consecutive outpatients with dementia at the memory clinic at a university hospital in two different areas. We compared subjects' demographic data, residency status, housemates and companion status at the time of their initial visit. Results: Patients in the inner-city area (n= 99) had more education and higher Mini-Mental State Examination scores than those in the regional area (n= 172). In both areas, the highest proportion of patients lived with their spouse. In the inner city, patients' housemates were either their spouse (34%) or their child (13%); 22% lived alone. In regional areas, patients lived with their spouse only (39%) or in their child's household (23%); 14% lived alone. At their initial consultation, inner-city patients were accompanied by a family member other than their spouse (49%), a spouse (27%), or they were alone (7%). In the regional area, patients' companions were their spouse (35%) or their spouse and other family members (18%); patients rarely arrived alone. Regression analysis showed that education, diagnosis, housemate state (child only), and companion state (alone) significantly influenced the living area. Conclusion: Our results suggest family caregiving infrastructure of demented elderly differ between the two areas. This may reflect changes in social structure and increased awareness regarding dementia in inner-city areas.
[Show abstract][Hide abstract] ABSTRACT: Because cholinergic deficits are prominent in dementia with Lewy bodies (DLB), we investigated the effects of a cholinesterase inhibitor, donepezil, in such patients in a randomized, double-blind, placebo-controlled exploratory phase 2 trial.
One-hundred forty patients with DLB, recruited from 48 specialty centers in Japan, were randomly assigned to receive placebo or 3, 5, or 10 mg of donepezil hydrochloride daily for 12 weeks (n = 35, 35, 33, and 37, respectively). Effects on cognitive function were assessed using the Mini-Mental State Examination (MMSE) and several domain-specific neuropsychological tests. Changes in behavior were evaluated using the Neuropsychiatric Inventory, caregiver burden using the Zarit Caregiver Burden Interview, and global function using the Clinician's Interview-Based Impression of Change-plus Caregiver Input (CIBIC-plus). Safety measures included the Unified Parkinson's Disease Rating Scale part III.
Donepezil at 5 and 10 mg/day was significantly superior to placebo on both the MMSE (5 mg: mean difference, 3.8; 95% confidence interval [CI], 2.3-5.3; p < 0.001; 10 mg: mean difference, 2.4; 95% CI, 0.9-3.9; p = 0.001) and CIBIC-plus (p < 0.001 for each); 3 mg/day was significantly superior to placebo on CIBIC-plus (p < 0.001), but not on the MMSE (p = 0.017). Significant improvements were found also in behavioral measures (p < 0.001) at 5 and 10 mg/day and caregiver burden (p = 0.004) at 10 mg/day. The safety results were consistent with the known profile of donepezil and similar among groups.
Donepezil at 5 and 10mg/day produces significant cognitive, behavioral, and global improvements that last at least 12 weeks in DLB patients, reducing caregiver burden at the highest dose. Donepezil is safe and well tolerated.
Annals of Neurology 07/2012; 72(1):41-52. · 11.19 Impact Factor