Neuropathologicai study on the nucleus basalis of Meynert in Pick\u27s disease

Thesis--University of Tsukuba, D.M.S.(B), no. 693, 1991.3.2

General Mental Health is Associated with Gait Asymmetry

Wearable sensors are being applied to real-world motion monitoring and the focus of this work is assessing health status and wellbeing. An extensive literature has documented the effects on gait control of impaired physical health, but in this project, the aim was to determine whether emotional states associated with older people’s mental health are also associated with walking mechanics. If confirmed, wearable sensors could be used to monitor affective responses. Lower limb gait mechanics of 126 healthy individuals (mean age 66.2 ± 8.38 years) were recorded using a high-speed 3D motion sensing system and they also completed a 12-item mental health status questionnaire (GHQ-12). Mean step width and minimum foot-ground clearance (MFC), indicative of tripping risk, were moderately correlated with GHQ-12. Ageing and variability (SD) of gait parameters were not significantly correlated with GHQ-12. GHQ-12 scores were, however, highly correlated with left-right gait control, indicating that greater gait symmetry was associated with better mental health. Maintaining good mental health with ageing may promote safer gait and wearable sensor technologies could be applied to gait asymmetry monitoring, possibly using a single inertial measurement unit attached to each shoe

Feasibility of Pilates for Late-Stage Frail Older Adults to Minimize Falls and Enhance Cognitive Functions

Globally, we are facing the tendency of aging, and demands for health enhancement among the older population have been steadily increasing. Among various exercise interventions, Pilates has been popularly utilized in rehabilitation; therefore, it is considered suitable for vulnerable populations. In this study, frail late-stage older adults (>75 years) participated in a modified Pilates program (30 min per session, once a week for eight weeks). Age-and condition-matched Controls were also involved as the benchmark to reveal the effect of Pilates. While only the Pilates group participated in the exercise intervention, both groups undertook the health assessments twice (before and after the intervention period). Assessments included: (i) falling risk based on 3D motion capture systems and (ii) overall cognitive functions utilizing Mini-Mental State Examination and executive function with the use of Trail Making Test-A (TMT-A). Two-dimensional mood state was also used to measure changes in mood due to Pilates intervention. An 8-week Pilates intervention was effective in achieving higher and symmetrical swing foot control. Dynamic balance at heel contact was also improved by extending the spatial margin in case of slipping. Despite the trend of positive Pilates effects on executive functions (29% improvement) confirmed by TMT-A, no significant effects were observed for cognitive functions. Positive mood changes were achieved by Pilates intervention, which may be the key for late-stage seniors to continue their participation in exercise programs. While further studies with a larger sample size are essential, Pilates appears to provide adequate exercise for the frail late-stage older population to minimize frailty

Influence of pneumonia complications on the prognosis of patients with autopsy-confirmed Alzheimer\u27s disease, dementia with Lewy bodies, and vascular dementia

BackgroundPneumonia is a major, complicated disease in patients with dementia. However, the influence of pneumonia on the prognosis of patients with varying types of dementia has not been fully evaluated.ResultsOf the 157 eligible patients, 63 (40.1%) had AD, 42 (26.8%) had DLB, and 52 (33.1%) had VaD. Pneumonia complication was observed with high incidence in each subtype of dementia, especially in DLB (90.5%). The median total duration from dementia onset to death was 8 years in AD and DLB, and 5 years in VaD. The VaD subtype had more male patients than AD or DLB (P = 0.010), and age of death in this group was the youngest among the three groups (P = 0.018). A significant difference was observed in the survival time by the Kaplan–Meier method among the three groups (P < 0.001) and among the groups with pneumonia (P = 0.002). The factors associated with shorter survival time were male gender, pneumonia complications, diabetes mellitus, age of dementia onset ≥ 75 years, and VaD.ConclusionsPneumonia complications shortened the survival time of patients with AD, DLB, and VaD

The incidence and risk factors of venous thromboembolism in Japanese inpatients with inflammatory bowel disease: a retrospective cohort study

Background/AimsVenous thromboembolism (VTE) is a major extraintestinal manifestation in inflammatory bowel disease (IBD), regarded as an independent risk factor for VTE according to reports from Western countries. However, the incidence and risk factors of VTE in Asian IBD patients are not fully understood. We aimed to reveal the incidence and risk factors of VTE in Japanese IBD inpatients.MethodsThe incidence of VTE in inpatients with IBD (n=340), gastrointestinal cancers (n=557), and other gastrointestinal diseases (n=569) treated at our hospital from 2009 to 2013 was retrospectively investigated. The characteristics and laboratory data of IBD inpatients with and without VTE were compared in univariate and multivariate analyses. Clinical courses of VTE in IBD were surveyed.ResultsVTE was detected in 7.1% of IBD inpatients, significantly higher than in gastrointestinal cancer inpatients (2.5%) and inpatients with other gastrointestinal diseases (0.88%). The incidence of VTE in ulcerative colitis (UC) patients (16.7%) was much higher than that in those with Crohn's disease (3.6%). In the univariate analysis, the risk factors were an older age, central venous catheter, prednisolone, surgery, low serum albumin, high serum C-reactive protein and D-dimer. According to a multivariate analysis, >50 years of age and surgery were the only risk factors. The in-hospital mortality rate of IBD inpatients with VTE was 4.2%.ConclusionsThe incidence of VTE with IBD, especially UC, was found to be high compared with other digestive disease, which was almost equivalent to that of Western countries. The efficacy of prophylaxis needs to be investigated in Asian IBD patients

高齢者の安全な薬物療法ガイドライン : 高齢者の精神疾患の治療から

本稿は「高齢者の安全な薬物療法ガイドライン2015」に沿って，不眠症，うつ病，認知症の行動・心理症状（BPSD）について述べる．不眠症に対するベンゾジアゼピン系薬剤の使用は特に注意が必要である．非ベンゾジアゼピン系薬剤についても同様のリスクが報告されており，使用に際して慎重さが求められる．三環系抗うつ薬は抗コリン作用が大きいため高齢発症のうつ病への使用は特に慎重さが求められる．選択的セロトニン再取り込み阻害剤も転倒リスクが報告されている．またスルピリドは使用を控えるべきである．BPSDに対して対症治療の前に抗認知症薬の効果をみることは有用である．BPSDに対する定型抗精神病薬の使用は特に慎重さが求められる．非定型抗精神病薬も必要最小限の使用量と使用期間にとどめるべきである