Daigo Hospital

Miyazaki-shi, Japan

Daigo Hospital

Miyazaki-shi, Japan
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Okahara K.,Keimei Memorial Hospital | Okahara K.,Shonan Hospital | Ishida Y.,University of Miyazaki | Hayashi Y.,University of Miyazaki | And 13 more authors.
Progress in Neuro-Psychopharmacology and Biological Psychiatry | Year: 2010

Yokukansan (YKS) is used frequently against behavioral and psychological symptoms of dementia (BPSD) together with donepezil in patients with Alzheimer's disease (AD). Here, we investigated the efficacy and safety of YKS in patients with AD in a non-blinded, randomized, parallel-group comparison study. Patients who had at least one symptom score of four or more on the Neuropsychiatric Inventory (NPI) subscales were enrolled in the study. The subjects were randomly assigned to the YKS-treated group (YKS/donepezil combination therapy group) and the non-YKS-treated group (donepezil monotherapy group). TSUMURA Yokukansan (TJ-54, 7.5. g, t.i.d.) was administered in a four-week study treatment period. The subjects were evaluated twice at the start (Week 0) and completion (Week 4) of the study treatment in terms of NPI, Mini-Mental Status Examination (MMSE), Disability Assessment for Dementia (DAD), Zarit Burden Interview, and Self-rating Depression Scale (SDS). The efficacy analysis was performed in 29 patients (YKS-treated group) and 32 patients (non-YKS-treated group). The NPI total score improved significantly more in the YKS-treated group than in the non-YKS-treated group. In the NPI subscales of agitation/aggression and irritability/lability, the YKS-treated group showed significantly greater improvement than the non-YKS-treated group, but no statistically significant improvement was seen with YKS in the other subscales. There were no significant differences between the YKS-treated group and the non-YKS-treated group in MMSE, DAD, Zarit Burden Interview and SDS. No adverse reactions were noted in either group. The results of this study showed that YKS is safe and effective in the treatment of BPSD in AD patients. © 2010 Elsevier Inc.


Hayashi Y.,University of Miyazaki | Ishida Y.,University of Miyazaki | Inoue T.,Daigo Hospital | Udagawa M.,Daigo Hospital | And 13 more authors.
Progress in Neuro-Psychopharmacology and Biological Psychiatry | Year: 2010

The efficacy and safety of the kampo medicine Yokukansan (YKS, TJ-54) in the treatment of behavioral and psychological symptoms of dementia (BPSD) were investigated in patients with Alzheimer's disease (AD) in an open-label study. This study included 26 patients who had been diagnosed as having AD and were not treated with donepezil hydrochloride. These patients were administered YKS (7.5. g/day) for four weeks to investigate the changes in neuropsychological test results and care burden in the period from the start to completion of the study treatment. The Neuropsychiatric Inventory (NPI) was used for evaluation of BPSD, the Mini-Mental State Examination (MMSE) for evaluation of cognitive functions, the Zarit burden interview for evaluation of the caregiver's burden, Disability Assessment of Dementia (DAD) for evaluation of activities of daily living (ADL) and Self-Rating Depression Scale (SDS) for evaluation of the caregiver's depression. No significant change was seen in MMSE and DAD after four weeks of treatment, but the mean NPI total score decreased significantly. Furthermore, among the NPI subscales, a statistically significant decrease in score was not seen, however, a clinically significant decrease was seen in terms of hallucinations, agitation, anxiety, irritability or abnormal behavior. No significant changes were seen in caregiver's burden after four weeks of treatment. No serious adverse reactions to YKS were observed. The results of this study suggested that YKS may be an effective and well-tolerated drug in the treatment of BPSD in AD patients. © 2010 Elsevier Inc.


Inamori Y.,Kagoshima University | Higuchi I.,Kagoshima University | Inoue T.,Daigo Hospital | Sakiyama Y.,Kagoshima University | And 7 more authors.
Neuromuscular Disorders | Year: 2012

Inclusion body myositis is an inflammatory myopathy characterized pathologically by rimmed vacuoles and the accumulation of amyloid-related proteins. Autopsy studies in these patients, including histochemical examinations of multiple skeletal muscles, have not yet been published. In this paper, we describe the autopsy findings of a patient with inclusion body myositis and hypertrophic cardiomyopathy. A 69-year-old man, who was a human T lymphotropic virus type 1 carrier, exhibited slowly progressive muscle weakness and atrophy, predominantly affecting the scapular, quadriceps femoris, and forearm flexor muscles. His disease course was more rapidly progressive than that typically observed; the patient died suddenly of arrhythmia 5. years after diagnosis. Autopsy findings revealed that multiple muscles, including the respiratory muscles, were involved. Longitudinal studies revealed an increased frequency of rimmed vacuoles and p62/sequestosome 1- and/or TAR DNA-binding protein 43-positive deposits in autopsied muscles, although the amount of inflammatory infiltrate appeared to be decreased. We speculated that muscle degeneration may be more closely involved in disease progression compared with autoimmunity. Genetic analysis revealed a myosin binding protein C3 mutation, which is reportedly responsible for familial hypertrophic cardiomyopathy. This mutation and human T lymphotropic virus type 1 infection may have affected the skeletal muscles of this patient. © 2012 Elsevier B.V.


Funayama M.,Red Cross | Nakagawa Y.,Edogawa Hospital | Yamaya Y.,Edogawa Hospital | Yoshino F.,Daigo Hospital | And 2 more authors.
BMC Neurology | Year: 2013

Background: Due to the nature of neurodegenerative disorders, patients with primary progressive aphasia develop cognitive impairment other than aphasia as the disorder progresses. The progression of logopenic variant primary progressive aphasia (lvPPA), however, has not been well described. In particular, praxic disorders and semantic memory deficits have rarely been reported. Case presentations: We report three patients in the initial stage of lvPPA who subsequently developed apraxia in the middle stage and developed clinically evident semantic memory deficits in the advanced stages.Conclusions: The present case series suggests that some patients with lvPPA develop an atypical type of dementia with apraxia and semantic memory deficits, suggesting that these cases should be classified as a type of early-onset Alzheimer's disease. © 2013 Funayama et al.; licensee BioMed Central Ltd.


Ito K.,National Center for Geriatrics and Gerontology | Fukuyama H.,Kyoto University | Senda M.,Institute of Biomedical Research and Innovation | Ishii K.,Kinki University | And 12 more authors.
Journal of Alzheimer's Disease | Year: 2015

Background: 18F-FDG-PET is defined as a biomarker of neuronal injury according to the revised National Institute on Aging-Alzheimer's Association criteria. Objective: The objective of this multicenter prospective cohort study was to examine the value of 18F-FDG-PET in predicting the development of Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI). Methods: In total, 114 patients with MCI at 9 participating institutions underwent clinical and neuropsychological examinations, MRI, and 18F-FDG-PET at baseline. The cases were visually classified into predefined dementia patterns by three experts. An automated analysis for 18F-FDG-PET was also performed to calculate the PET score. Subjects were followed periodically for 3 years, and progression to dementia was evaluated. Results: In 47% of the patients with MCI, progression of symptoms justified the clinical diagnosis of «probable AD». The PET visual interpretation predicted conversion to AD during 3-year follow-up with an overall diagnostic accuracy of 68%. Overall diagnostic accuracy of the PET score was better than that of PET visual interpretation at all follow-up intervals, and the optimized PET score threshold revealed the best performance at the 2-year follow-up interval with an overall diagnostic accuracy of 83%, a sensitivity of 70%, and a specificity of 90%. Multivariate logistic regression analysis identified the PET score as the most significant predictive factor distinguishing AD converters from non-converters. Conclusion: The PET score is the most statistically significant predictive factor for conversion from MCI to AD, and the diagnostic performance of the PET score is more promising for rapid converters over 2 years. © IOS Press and the authors. All rights reserved.


Tmaura T.,Osaka Electro-Communication University | Zakaria N.A.,Nara Institute of Science and Technology | Kuwae Y.,Daigo Hospital | Sekine M.,Osaka Electro-Communication University | And 2 more authors.
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS | Year: 2013

We performed a quantitative analysis of the fall-risk assessment test using a wearable inertia sensor focusing on two tests: the time up and go (TUG) test and the four square step test (FSST). These tests consist of various daily activities, such as sitting, standing, walking, stepping, and turning. The TUG test was performed by subjects at low and high fall risk, while FSST was performed by healthy elderly and hemiplegic patients with high fall risk. In general, the total performance time of activities was evaluated. Clinically, it is important to evaluate each activity for further training and management. The wearable sensor consisted of an accelerometer and angular velocity sensor. The angular velocity and angle of pitch direction were used for TUG evaluation, and those in the pitch and yaw directions at the thigh were used for FSST. Using the threshold of the angular velocity signal, we classified the phase corresponding to each activity. We then observed the characteristics of each activity and recommended suitable training and management. The wearable sensor can be used for more detailed evaluation in fall risk management. The wearable sensor can be used more detailed evaluation for fall-risk management test. © 2013 IEEE.


Kuwae Y.,Daigo Hospital | Sekine M.,Osaka Electro-Communication University | Tamura T.,Osaka Electro-Communication University | Fujimoto T.,Fujimoto Hospital | Yu W.,Chiba University
Transactions of Japanese Society for Medical and Biological Engineering | Year: 2015

Walking and balance tests are used for evaluating the effects of rehabilitation and the time taken to perform the test. The Four Square Step Test (FSST) is a useful test for evaluating balance in patients with stroke and orthopedic diseases. For the FSST, 4 bars are used to divide a floor surface into 4 areas. Subjects have to step from one area into the neighboring area in a sequence, and their movements and stability are evaluated. However, no detailed evaluation has been conducted on the transition of the forward, backward, right, and left movement phases. This study aimed at detailed evaluation of the FSST in post-stroke hemiplegic patients and elderly subjects, using wearable motion sensors comprising an accelerometer and angular velocity sensors capable of identifying the direction of the subjects' movements. Twelve post-stroke hemiplegic patients (6 left hemiplegic patients, 6 right hemiplegic patients; Brunnstrom stage of the lower limb: V) and 6 normal elderly subjects were studied. The sensor was attached to the waist and both thighs of a subject. Then FSST was administered and a video was recorded simultaneously. Using the angular velocity signals of the thigh, the four movement phases in FSST were classified. The following items were analyzed: root mean square (RMS) acceleration, RMS angular velocity, amplitude of the thigh angle, and amplitude/performing time. The time measured by the wearable motion sensors correlated with the time recorded by the monitoring video (r= 0.88, p < 0.05). The total performing time did not differ significantly between normal elderly subjects and hemiplegic patients. The RMS acceleration and RMS angular velocity for the waist were significantly different between normal elderly subjects and hemiplegic patients (p < 0.05). Furthermore, the changes in the thigh angle of patients when they stepped over the bars while performing the FSST were different between hemiplegic patients and normal elderly subjects. We conclude that the FSST using wearable motion sensors is useful for the evaluation of balance in post-stroke hemiplegic patients. © 2015, Japan Soc. of Med. Electronics and Biol. Engineering. All rights reserved.


Mitsuyama Y.,Daigo Hospital
Brain and Nerve | Year: 2011

Frontotemporal dementia (FTD) is a clinical entity that comprises at least two distinct diseases: Pick's disease with Pick bodies and frontotemporal lobar degeneration with tau-negative and ubiquitin-positive inclusions (FTLD-U). FTLD-U is now usually referred to as FTLD-TAR DNA binding protein 43 (TDP-43). FTLD-TDP-43, but not Pick's disease with tau-positive Pick bodies, is often associated with motor neuron disease (MND). More than 200 cases of this combined form, i.e., FTD-MND, have been reported in Japan. The neuropathologicall characteristics of MND in patients with FTD are essentially similar to the MND in patients without dementia. However the other characteristics of the combination of FTD and MND are such that the author has considered this disease a unique clinicopathological entity. These characteristics are as follows: (1) frontotemporal lobe-type dementia with insidious onset, usually in the presenile period; (2) neurogenic muscular wasting during the course of the illness (amyotrophic lateral sclerosis (ALS)] - or (spinal progressive muscular atrophy (SPMA)) - like symptoms); (3) duration from the onset of illness to death is 2-5 years (average duration, 30.6 months); (4) both extrapyramidal symptoms and definite sensory deficiency are less commonly observed; (5) no characteristic abnormalities in the cerebrospinal fluid (CSF) or on the electroencephalogram (EEG) in screening tests; (6) no known parental consanguinity or familial occurrence; and (7) nonspecific mild-to-slight degenerative changes in the frontotemporal cortex, hypoglossal nuclei, spinal cord, and frequently in the substantia nigra. FTD-MND is characterized by ubiquitin-immunoreactive intraneuronal inclusions in cortical layers II and III and the hippocampal dentate granule cells. The occurrence of ubiquitin-positive, tau-negative and ubiquitinated TDP-43 positive inclusions could be the key to determining the pathological background of this disease. Further studies are required clinicopathological differentiation between FTD-MND and ALS-dementia (ALS-D).


PubMed | Daigo Hospital, Juntendo University, Tokyo Metropolitan Institute of Medical Science and Yokohama Hoyu Hospital
Type: | Journal: Journal of the neurological sciences | Year: 2016

Clinical phenotypes of hereditary diffuse leukoencephalopathy with spheroids (HDLS), a familial progressive neurodegenerative disorder affecting the white matter of the brain, are heterogenous and may include behavioral and personality changes, memory impairment, parkinsonism, seizure, and spasticity. Thus, HDLS is frequently unrecognized and misdiagnosed. Heterozygous mutations located within the kinase domain of the gene encoding the colony-stimulating factor 1 receptor (CSF1R), a cell surface receptor with key roles in development and innate immunity, have been shown in HDLS. These different gene mutations may be related to the various clinical phenotypes. We report here a newly identified family with HDLS harboring a mutation in the CSF1R gene. We examined clinical and neuropathological features in three members of this family. These patients presented with affective incontinence, memory impairment, and executive dysfunction at onset, and revealed nonfluent aphasia, parkinsonism, and seizure as the disease progressed. We identified a novel CSF1R splice site mutation (c.2442+2T>C) in intron 18 for two of the patients. MRI of these patients revealed progressive, frontotemporal-predominant, confluent leukoencephalopathy. We also observed severe myelin loss, axonal degeneration, and abundant axonal spheroids, astrocytes, and microglia in the cerebral white matter, consistent with HDLS neuropathological features. Additionally, we identified atypical neuropathological findings for HDLS, including neuronal loss and gliosis with ballooned neurons and central chromatolysis in the frontal cortex and hippocampus. This report provides further evidence for the clinical and neuropathological heterogeneity of HDLS.


PubMed | Daigo Hospital
Type: Journal Article | Journal: Brain and nerve = Shinkei kenkyu no shinpo | Year: 2011

Frontotemporal dementia (FTD) is a clinical entity that comprises at least two distinct diseases: Picks disease with Pick bodies and frontotemporal lobar degeneration with tau-negative and ubiquitin-positive inclusions (FTLD-U). FTLD-U is now usually referred to as FTLD-TAR DNA binding protein 43 (TDP-43). FTLD-TDP-43, but not Picks disease with tau-positive Pick bodies, is often associated with motor neuron disease (MND). More than 200 cases of this combined form, i.e., FTD-MND, have been reported in Japan. The neuropathological characteristics of MND in patients with FTD are essentially similar to the MND in patients without dementia. However the other characteristics of the combination of FTD and MND are such that the author has considered this disease a unique clinicopathological entity. These characteristics are as follows: (1) frontotemporal lobe-type dementia with insidious onset, usually in the presenile period; (2) neurogenic muscular wasting during the course of the illness [amyotrophic lateral sclerosis (ALS)]-- or [spinal progressive muscular atrophy (SPMA)]-like symptoms); (3) duration from the onset of illness to death is 2-5 years (average duration, 30.6 months); (4) both extrapyramidal symptoms and definite sensory deficiency are less commonly observed; (5) no characteristic abnormalities in the cerebrospinal fluid (CSF) or on the electroencephalogram (EEG) in screening tests; (6) no known parental consanguinity or familial occurrence; and (7) nonspecific mild-to-slight degenerative changes in the frontotemporal cortex, hypoglossal nuclei, spinal cord, and frequently in the substantia nigra. FTD-MND is characterized by ubiquitin-immunoreactive intraneuronal inclusions in cortical layers II and III and the hippocampal dentate granule cells. The occurrence of ubiquitin-positive, tau-negative and ubiquitinated TDP-43 positive inclusions could be the key to determining the pathological background of this disease. Further studies are required clinicopathological differentiation between FTD-MND and ALS-dementia (ALS-D).

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