Objective Delirium/dementia (collectively called cognitive spectrum disorder [CSD]) is a major issue in hospital wards. However, few reports are available on the incidence of CSD on multi‐faculty wards or on the factors contributing to it. The aim of this study was to address these issues by a neurogeriatric team (neurologists, psychiatrists, specialist nurses, and link nurses from all wards). Patients and Methods This was a retrospective study with a 12‐month recruiting period, a prospective follow‐up period of 3.0 ± 2.5 weeks, and ≥1×/week visits. We diagnosed acute‐onset delirium by the Confusion Assessment Method and analyzed underlying conditions. We also diagnosed premorbid dementia by neurocognitive examination and neuroimaging following published criteria. Results Our subjects were 723 CSD from 15 faculties, accounting for 6.5% of admissions, 393 men and 330 women, mean age 81 years. CSD was prevalent in cardiology/cardiac surgery (CAR), orthopedic surgery (OP), and neurology/neurosurgery (N), with dementia alone in ophthalmology and a combination of delirium/dementia in the other faculties. Premorbid dementia were diagnosed with Alzheimer's disease (AD), white matter disease, dementia with Lewy bodies (DLB), or some combination of these. Delirium was accompanied by worsening of gait difficulty. The ratio of brain (N) versus extra‐brain was 105 (14.5%):618 (85.5%). Severe CSD was common in DLB than AD but without statistical significance. Conclusion Total 6.5% of hospital admissions showed CSD, with CAR, OP, and N being prevalent. The ratio of brain versus extra‐brain was 14.5%:85.5%. Severe CSD was more prevalent in DLB patients than in AD patients, but without statistical significance.

<b><i>Background:</i></b> It is known that age-related brain symptoms (gait difficulty and dementia) increase the likelihood of fall-related surgery. In contrast, it is not known which types of brain disease underlie such symptoms most. <b><i>Objective:</i></b> The aim of this study was to correlate brain diseases with the types of surgeries performed at our hospital for patients who had fallen. <b><i>Methods:</i></b> This was a retrospective study at a multifaculty university hospital in Japan, with a 12-month recruiting period, a follow-up period of 3.0 ± 2.5 weeks, and ≥1×/week visits. We assembled a neurogeriatric team to diagnose brain diseases with the use of brain imaging to the extent possible and correlated the diagnoses with types of fall-related surgery. <b><i>Results:</i></b> Fall-related surgery was conducted by the orthopedics (OP) and neurosurgery (NS) faculties (total <i>n</i> = 124) at a ratio of about 2 to 1. The underlying brain diseases differed by faculty; for OP, surgery was most commonly performed in patients with a combination of white matter disease (WMD) and Alzheimer’s disease (AD) (79%) followed by dementia with Lewy bodies. In contrast, for NS, the most common surgery was for patients with alcoholism (50%) followed by a combination of WMD and AD. <b><i>Conclusion:</i></b> Fall-related surgery was performed by the OP and NS faculties at a 2 to 1 ratio. The major underlying brain diseases were a combination of WMD and AD (79%) for OP and alcoholism (50%) for NS.

The populations of older individuals (age >60 years old) continue to increase worldwide from 400 million in 1980 to 1050 million in 2020, 1 necessitating increases in medical care, particularly for the disorders that develop with age. 2 Geriatric syndrome (symptoms that are commonly seen in older individuals) includes dementia/delirium, 3 gait difficulty/fall 4 /aspiration, 5 and autonomic dysfunction. 1 Among the geriatric syndrome, the brain is contributing to dementia and gait difficulty. 3 Autonomic dysfunctions such as orthostatic hypotension, 2 overactive bladder, and constipation also increase with age. However, autonomic dysfunction in older populations has not been fully delineated, and it is suspected that neurologic etiologies might underlie this condition. 3 This review briefly summarizes (i) the brain and peripheral nerve diseases that are common in older populations; (ii) the mechanisms and management/care of autonomic dysfunction.

Although it is known that age-related brain symptoms (eg, encephalopathy; gait-speech-swallowing motor disorder [pyramidal 1 or extrapyramidal dysfunction 2 with/without sarcopenia 3 ], and dementia 4 /delirium 5 ) contribute to the risk of aspiration pneumonia (AP), it has not been known which types of brain diseases underlie AP most closely. It was reported that up to 83% of patients with white matter disease (WMD, also called small-vessel disease, accounting for motor disorder), 6 and up to 82% of patients with dementia with Lewy bodies (DLB, for both motor disorder and dementia) 2 have exhibited AP. This is in contrast to the finding that individuals with young-onset Alzheimer's disease (AD) rarely have AP.

Young-onset (< 65 years) dementia is a challenging clinical problem. A 61-year-old man visited our clinic because of a 2-year history of mild cognitive impairment of the executive disorder type. He was initially suspected of having young-onset Alzheimer’s disease due to the lack of motor signs or hippocampal atrophy by conventional brain MRI. However, he proved to have anosmia, erectile dysfunction, hypersexuality, constipation, REM sleep behavior disorder, and emotional lability; imaging findings included positive brain perfusion SPECT, nigrosome MRI, DAT scan, and MIBG myocardial scintigraphy. All these clinical imaging features led to the correct diagnosis of young-onset dementia with Lewy bodies (YOD-DLB). It is hoped that this case report will help facilitate a future prospective study to diagnose and follow YOD-DLB patients with the aim of determining appropriate management and care.