Effect of Simultaneous Dual-Task Training on Regional Cerebral Blood Flow in Older Adults with Amnestic Mild Cognitive Impairment

東京都立大学Tokyo Metropolitan University博士（理学療法学）doctoral thesi

Predictors of Pneumonia in Patients with Acute Stroke Assessed Using the Sub-items of the National Institutes of Health Stroke Scale Scores at Admission

【目的】急性期脳卒中患者におけるNational Institutes of Health Stroke Scale（NIHSS）は，脳卒中後の肺炎合併を予測する重要な因子の一つである．今回，基本動作に介助を要する急性期脳卒中患者の入院時NIHSS 下位項目から，入院中の肺炎合併に関連する因子を抽出することを目的とした．【方法】対象は基本動作に介助を要する急性期脳卒中患者111 名とした．入院時NIHSS 下位項目から肺炎合併の予測因子を多重ロジスティック回帰分析によって抽出した．【結果】入院時NIHSS 合計点の中央値は9 点であり，肺炎合併率は15.3％であった．肺炎合併の関連因子として意識障害－質問，顔面神経麻痺が抽出された．【結論】基本動作に介助を要する急性期脳卒中患者における肺炎合併の予測因子は，入院時NIHSS の中でも質問に答えられない意識障害や顔面神経麻痺の有無であった．The National Institutes of Health Stroke Scale （NIHSS） is an important tool for predicting pneumonia among patients with acute stroke. This study aimed to evaluate the predictors of pneumonia at admission in patients with acute stroke, who required assistance for basic mobility using the NIHSS sub-items. A total of 111 patients with acute stroke were included, and their medical record data were collected retrospectively to analyze their NIHSS sub-item scores at admission and the incidence of pneumonia during hospitalization. Logistic regression analysis was used to assess the relation between the NIHSS sub-items as independent variables and the presence of pneumonia; significance was set at p ＜ 0.05. Among the 111 patients, the incidence of pneumonia was 15.3%, and the median of NIHSS score at admission was 9 points. In the logistic regression analysis, the NIHSS sub-items, question （Odds ratio （OR） 9.41, 95% confidence interval （CI） 2.00 ─ 44.26, p = 0.005） and facial palsy （OR 1.65, 95%CI 1.08 ─ 25.01, p = 0.040） were identified as predictors of pneumonia. The presence or absence of consciousness disorder, that cannot be answered the questions such as “What month is it now?” or “How old are you?”, and facial palsy were suggested as the predictors of pneumonia based on NIHSS sub-item scores at admission for patients with acute stroke, who required assistance for basic mobility.東京都立大学学位論文甲第1247号　副論文journal articl

Characteristics of Regional Cerebral Blood Flow in Alzheimer Disease and Amnestic Mild Cognitive Impairment by Single-Photon Emission Computerized Tomography : A Cross-Sectional Study

Introduction: The regional cerebral blood flow (rCBF) distribution can affect brain functioning, leading to amnestic mild cognitive impairment (aMCI) and mild Alzheimer disease (AD). This study aimed to clarify the detailed characteristics of rCBF distribution in patients with mild AD and aMCI. Methods: This cross-sectional study from April 2015 to March 2018 included 103 older adults (mean age 78.9 years; 60% females), out of a total of 302 adults, and categorized them into 3 groups according to cognitive symptoms. The normal control (NC), aMCI, and mild AD groups included 20, 50, and 33 participants, respectively. The primary outcome was rCBF, which was compared among the 3 groups using a 2-sample t test without correction for multiple comparisons. Results: In the aMCI group, the rCBF decreased in the bilateral parietal and left frontal association cortex and the bilateral premotor cortex (p < 0.01) but increased in the bilateral cerebellum (p < 0.01). In the mild AD group, the rCBF decreased in the bilateral parietal and occipital association cortex, the bilateral premotor cortex, the left temporal and frontal association cortex, and the left limbic lobe (p < 0.01). Conversely, the rCBF increased in some parts of the cerebellum, the bilateral frontal and temporal association cortex, the left occipital association cortex, and the right premotor cortex (p < 0.01). Conclusion: Based on the analysis of the values obtained, it was inferred that the rCBF undergoes reduction and elevation in aMCI and AD patients.東京都立大学学位論文甲第1247号　副論文journal articl

Characteristics of Regional Cerebral Blood Flow in Alzheimer Disease and Amnestic Mild Cognitive Impairment by Single-Photon Emission Computerized Tomography : A Cross-Sectional Study

Introduction: The regional cerebral blood flow (rCBF) distribution can affect brain functioning, leading to amnestic mild cognitive impairment (aMCI) and mild Alzheimer disease (AD). This study aimed to clarify the detailed characteristics of rCBF distribution in patients with mild AD and aMCI. Methods: This cross-sectional study from April 2015 to March 2018 included 103 older adults (mean age 78.9 years; 60% females), out of a total of 302 adults, and categorized them into 3 groups according to cognitive symptoms. The normal control (NC), aMCI, and mild AD groups included 20, 50, and 33 participants, respectively. The primary outcome was rCBF, which was compared among the 3 groups using a 2-sample t test without correction for multiple comparisons. Results: In the aMCI group, the rCBF decreased in the bilateral parietal and left frontal association cortex and the bilateral premotor cortex (p < 0.01) but increased in the bilateral cerebellum (p < 0.01). In the mild AD group, the rCBF decreased in the bilateral parietal and occipital association cortex, the bilateral premotor cortex, the left temporal and frontal association cortex, and the left limbic lobe (p < 0.01). Conversely, the rCBF increased in some parts of the cerebellum, the bilateral frontal and temporal association cortex, the left occipital association cortex, and the right premotor cortex (p < 0.01). Conclusion: Based on the analysis of the values obtained, it was inferred that the rCBF undergoes reduction and elevation in aMCI and AD patients.東京都立大学学位論文甲第1247号　副論