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Morikawa M.,Sakai City Mental Health Center | Morikawa M.,Nara Medical University | Kiuchi K.,Nara Medical University | Taoka T.,Nara Medical University | And 3 more authors.
Psychogeriatrics | Year: 2010

Background: Neuroimaging studies show increased diffusivity and decreased anisotropy in Alzheimer's disease (AD) patients by diffusion tensor imaging (DTI). Previous reports have analyzed a correlation with cognitive function and DTI parameters, but their results are inconsistent. A reason for this might be a region of interest (ROI) method, used to calculate parameters for DTI, because this method has various usages of how to place a ROI and includes summations of values for various neuronal fiber tracts, resulting in contamination of unintended fibers. To improve the instability with ROI placement, a tractography-based method might be useful. Our coworker reported decreased fractional anisotropy (FA) and increased apparent diffusion coefficient (ADC) of uncinate fasciculus (UF) in patients with AD by tractography. To confirm whether DTI parameter values are related to severity of cognitive function in patients with AD, we measured mean diffusion anisotropy and diffusivity of coregistered voxels along the tracking lines (i.e. tract of interest) of UF. Methods: The subjects were 30 patients with probable AD (NINCDSADRDA criteria). Assessment of cognitive function was carried out according to the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-cognitive component-Japanese version (ADAS-Jcog). A 1.5-T clinical magnetic resonance unit was used to obtain diffusion tensor images. Diffusion tensors were computed and fiber-tract maps were created using 'dTV II' DTI software developed by Masutani et al. We measured mean FA and ADC values along the bilateral UF. Results: FA values were positively correlated with MMSE score (r = 0.67) and were negatively correlated with ADAS-Jcog score (r = -0.62), while ADC values were negatively correlated with MMSE score (r = -0.58) and were positively correlated with ADAS-Jcog score (r = 0.59). Conclusion: FA and ADC values might reflect the severity of cognitive dysfunction. The tract-of-interest method might be a useful tool for objectively evaluating DTI parameters in AD. © 2010 The Authors Journal compilation © 2010 Japanese Psychogeriatric Society.


Tomioka K.,Nara Medical University | Ikeda H.,Red Cross | Hanaie K.,Sakai City Government Office | Morikawa M.,Sakai City Mental Health Center | And 4 more authors.
Quality of Life Research | Year: 2013

Purpose: Little is known about the usefulness of the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and a single question (SQ) in assessing hearing impairment (HI) and the impact of HI on quality of life (QOL). The objective of this study was to examine the reliability, validity, and associations with QOL measures (i.e.; subjective well-being, depressive symptoms, subjective loneliness, and physical functioning) of the HHIE-S and the SQ in the elderly community. Methods: A self-report questionnaire including HHIE-S, SQ, Philadelphia Geriatric Center Morale Scale, Geriatric Depression Scale, UCLA Loneliness Scale, and the Tokyo Metropolitan Institute of Gerontology Index of Competence was administered to community elderly (781 males and 950 females). Among them, 97 males and 100 females also responded voluntarily to a request for test-retest and auditory tests. The criterion validity was tested by using pure-tone averages. Results: Regarding the reliability of HHIE-S, Cronbach's alpha coefficient was 0.91, Spearman-Brown coefficient was 0.90, and intra-class correlation coefficient was 0.85. Regarding the test-retest reliability of SQ, kappa coefficient was 0.65. HHIE-S had significantly lower sensitivity in identifying >25-dB HI, but significantly higher specificity for the detection of >40-dB HI than SQ. HHIE-S had stronger associations with QOL measures than did SQ. Conclusions: HHIE-S had high reliability, while SQ had insufficient reliability. HHIE-S was more specific in detecting HI and more sensitive in assessing the impact of HI on QOL than SQ. HHIE-S is a more effective instrument for assessing HI and QOL research than SQ in the elderly community. © 2012 Springer Science+Business Media B.V.


Okamoto N.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | Morikawa M.,Nara Medical University | Okamoto K.,Nara Kasuga Hospital | And 9 more authors.
Brain Research | Year: 2010

It has been reported that tooth loss is associated with Alzheimer's disease (AD) and dementia. The purpose of this study was to investigate the association between tooth loss and mild memory impairment (MMI) among the elderly. We examined 3,061 community residents aged 65 years or older who had a score of 24 or more on the Mini-Mental State Examination. The subjects were divided according to their score for the three-word delayed recall test into control (score: 3 or 2) and MMI (score: 1 or 0) subjects. The subjects underwent a dental examination, an interview to determine their medical history, a self-administered questionnaire (inclusive of higher-level functional capacity, drinking and smoking habits, and frequency of going out), and a 10-m walking test. Fewer remaining teeth, going out once a week or less frequently, and a slow walking speed on a 10-m walking test were found at a significantly higher prevalence in the MMI group (n = 101) than in the control group (n = 2,960), after adjustment for sex, age, and the level of education. Multiple logistic regression analysis using these items revealed that the odds ratio of 0-10 remaining teeth for MMI was 1.71 (95% CI 1.05-2.78), compared to individuals with 22-32 remaining teeth. A significant increase was also found in a trend test to examine the increasing odds ratios of 22-32, 11-21, and 0-10 remaining teeth. We consider that tooth loss is associated with MMI later in life. © 2010 Elsevier B.V.


Kiuchi K.,Nara Medical University | Morikawa M.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | Taoka T.,Nara Medical University | And 11 more authors.
Journal of Psychiatric Research | Year: 2011

Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are different types of dementia. However, their clinical symptoms partially overlap and differential diagnosis is occasionally difficult. There is need for additional diagnostic criteria to reliably differentiate between these two conditions. Meanwhile, several imaging studies have showed inconsistent results between DLB and AD. The aim of this study was to use a tractography-based analysis to elucidate white matter alterations in subjects with DLB compared to those with AD and to controls. An understanding of the white matter connectivity differences between AD, DLB and controls will be helpful for differential diagnosis and an understanding of the pathophysiology. Twenty-six subjects with DLB, 26 with AD and 26 controls underwent magnetic resonance diffusion tensor imaging and neuropsychological assessment. Diffusion tensors were computed and fiber-tract maps were created using "dTV II" software. We measured mean fractional anisotropy (FA) values along the uncinate fasciculus (UNC), the inferior occipitofrontal fasciculus (IOFF) and the inferior longitudinal fasciculus (ILF). Both subjects with DLB and AD had lower FA values for the bilateral UNC than controls. Subjects with DLB exhibited significantly lower FA values on both sides of the IOFF and the left side of the ILF than those of controls. Although there were no significant differences between subjects with DLB and AD for any measurements, those with DLB exhibited lower FA values especially in visual-related white matter. These different changes in white matter tracts among groups could be helpful for differential diagnosis and an understanding of the pathophysiology. © 2011 Elsevier Ltd.


Okamoto N.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | Morikawa M.,Nara Medical University | Okamoto K.,Nara Kasuga Hospital | And 8 more authors.
Behavioral and Brain Functions | Year: 2010

Background: This cross-sectional study investigated the relationship between the number of remaining teeth to mild memory impairment (MMI), which is a preclinical stage of dementia, and to cognitive impairment.Methods: The subjects were aged 65 years or older and were grouped according to their score for the Mini-Mental State Examination (MMSE), the three-word delayed recall test in the MMSE, and the Geriatric Depression Scale into the control group (n = 3,696), the MMI group (n = 121), and the low MMSE score (23 or lower) group (n = 214). We collected data on the number of remaining teeth, the length of the edentulous period, health-related lifestyle, medical history, blood pressure, height, and body weight. Fasting venous blood samples were also obtained.Results: Multiple logistic regression analysis, adjusted for depressive symptoms, age, sex, length of education, and other explanatory variables, revealed that the odds ratios of 0-10 remaining teeth to 22-32 remaining teeth were 1.679 (95% CI 1.073-2.627) for MMI and 2.177 (95% CI 1.510-3.140) for a low MMSE score. A significant relationship was also found between the length of the edentulous period and the risk of a low MMSE score (odds ratio 3.102, 95% CI 1.432-6.720) (15 years or more/less than 15 years).Conclusions: Our findings suggest that tooth loss is associated with cognitive function. © 2010 Okamoto et al; licensee BioMed Central Ltd.

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