The geriatric community study was conducted by the Aichi Prefecture (Japan) Project. The psychiatric epidemiological survey was conducted using a stratified random sampling method. 3106 community residents over the age of 65 years, randomly selected from the whole Aichi Prefecture of Japan, were interviewed; 476 had suspected dementia. The second interviews and the neurologic examinations were carried out by psychiatrists. The prevalence of dementia was estimated to be 5.8% (moderate and severe, 2.2%; mild 3.6%) of the aged population in the community. Cerebrovascular dementia (CVD) or multi-infarct dementia (MID) was found in 2.8%, senile dementia of the Alzheimer type (SDAT) in 2.4%, and dementia due to other causes in 0.6%. CVD (MID) was diagnosed more frequently in men, and SDAT in women.
The occurrence and topographic analysis of granulovacuolar degeneration (GVD) in the hippocampal cortex of mentally normal controls (75 cases) and patients with Alzheimer's dementia (AD; 17 cases which included Alzheimer's disease and senile dementia of Alzheimer type), multi-infarct dementia (MID; 16 cases), Pick's disease (PD; 5 cases) and atypical dementia [5 cases; non-Alzheimer, non-Pick dementia with Fahr's syndrome (NANPDF)] were investigated. GVD was rarely found in control cases below the age of 60 years. In elderly normal brains, the statistically most representative ranking order of predilection for GVD (in decreasing severity) was: in the 60 s, CA1 > prosubiculum > CA2 (no GVD was found in the CA3 and CA4); in the 70 s, CA1 > prosubiculum > CA2 > CA3 > CA4; in the 80 s, CA1 > prosubiculum > CA2 > CA3 > CA4; in the 90 s, CA1 > prosubiculum > CA2 > CA3 > CA4. In the brains of demented patients, the rank order for GVD was: for AD, CA1 > CA2 > CA3 > prosubiculum > CA4; for MID, CA1 > prosubiculum > CA2 > CA3 > CA4; for PD, CA1 > CA2 > CA3 > prosubiculum > CA4; and for atypical dementia (NANPDF), CA1 > CA2 > prosubiculum > CA3 > CA4. The similarity of the predilection to ranking order was noted both in normal aged subjects and in MID as well as both in AD and in PD.(ABSTRACT TRUNCATED AT 250 WORDS)
In the present study the occurrence and distribution of glial fibrillary tangles (GFT) and their related structures in diffuse neurofibrillary tangles with calcification (DNTC) were investigated using Gallyas-Braak (GB) stain. Six cases neuropathologically diagnosed as DNTC were studied (two males and four females). The age at death ranged from 56 to 73 years, with an average of 63.5+/-7.5 years. GFT were classified morphologically, and their immunoreactivites for tau and ubiquitin were examined. Glial cells with GFT were identified with astrocytes and oligodendrocytes by immunostain for glial fibrillary acidic protein and transferrin, respectively. A small number of coiled bodies detected within the oligodendrocytes in the white matter of the cerebrum were positive for tau and ubiquitin. Cell clusters of thorn-shaped astrocytes were detected in the subcortical and subpial regions where gliosis occurred. Thorn-shaped astrocytes were positive for tau, but negative for ubiquitin. A small number of tuft-shaped astrocytes detected prominently in the temporal cortex and amygdala with numerous neurofibrillary tangles were positive for tau and ubiquitin. All three types of GFT were detected, especially in the temporal and limbic lobes, which were the most severely affected sites in DNTC. Moreover, various-shaped neurofibrillary tangles, aggregated rods and some argyrophilic threads were differentiated from GFT. They were positive for GB, but not detected within the glial cells.
In this manuscript, we present a case report of a patient suffering from dementia with Lewy bodies who experienced not only visual but also four other sensory hallucinations, which were interdependent and may have influenced the patient's behavior. To the best of our knowledge, based on our search of the literature, this is the first such reported case of dementia with Lewy bodies. In this paper, we review the literature related to drug therapy for dementia with Lewy bodies, and propose, based on our clinical observations, that cholinesterase inhibitors, including donepezil, should be used as first-line drugs for the treatment and management of psychotic symptoms, including all five sensory hallucinations, in dementia with Lewy bodies.Keywords: Behavioral and psychological symptoms of dementia (BPSD), cholinesterase inhibitors, complex multiple sensory hallucinations, dementia with Lewy bodies (DLB), donepezil
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