Aims: Psychiatric comorbidity and mental instability seem to be important unfavorable prognostic factors for long‐term psychosocial adjustment in gender identity disorder (GID). However, psychiatric ...comorbidity in patients with GID has rarely been assessed. In this study, we investigated the psychiatric comorbidity and life events of patients with GID in Japan.
Methods: A total of 603 consecutive patients were evaluated independently by at least two senior psychiatrists at the GID clinic using clinical information and results of examinations.
Results: Using DSM‐IV criteria, 579 patients (96.0%) were diagnosed with GID. Among the GID patients, 349 (60.3%) were the female‐to‐male (FTM) type, and 230 (39.7%) were the male‐to‐female (MTF) type. Current psychiatric comorbidity was 19.1% (44/230) among MTF patients and 12.0% (42/349) among FTM patients. The lifetime positive history of suicidal ideation and self mutilation was 76.1% and 31.7% among MTF patients, and 71.9% and 32.7% among FTM patients. Among current psychiatric diagnoses, adjustment disorder (6.7%, 38/579) and anxiety disorder (3.6%, 21/579) were relatively frequent. Mood disorder was the third most frequent (1.4%, 8/579).
Conclusions: Comparison with previous reports on the psychiatric comorbidity among GID patients revealed that the majority of GID patients had no psychiatric comorbidity. GID is a diagnostic entity in its own right, not necessarily associated with severe comorbid psychological findings.
Aim
It was recently reported that theory of mind is disturbed in mild Alzheimer's disease dementia (ADD). Some studies have reported reduced scores of ADD patients on false belief tests, even on ...first‐order false belief tests. However, few studies have pursued the neural substrate of false belief tests in patients with ADD in a real‐world setting.
Methods
Sixty‐three patients with ADD from outpatient units took the Sally–Anne test and underwent brain single‐photon emission computed tomography. Of these patients, 29 answered the Sally–Anne test correctly (successful group) and 34 incorrectly (unsuccessful group). We compared the regional cerebral blood flow between the successful and unsuccessful groups.
Results
A comparison of the two groups showed a significantly lower uptake in the bilateral posterior cingulate gyrus in the unsuccessful group than in the successful group.
Conclusions
The posterior cingulate gyrus is known to be particularly activated when individuals remember personal events and infer the mental states of others. We suppose that memory or mentalization in the posterior cingulate gyrus—or both—is essential for patients with ADD to be able to pass the Sally–Anne test.
Abstract Depressive symptoms are common in patients with Alzheimer's disease (AD) and increase the caregiver burden, although the etiology and pathologic mechanism of depressive symptoms in AD ...patients remain unclear. In this study, we tried to clarify the cerebral blood flow (CBF) correlates of depressive symptoms in AD, excluding the effect of apathy and anxiety. Seventy-nine consecutive patients with AD were recruited from outpatient units of the Memory Clinic of Okayama University Hospital. The level of depressive symptoms was evaluated using the depression domain of the Neuropsychiatric Inventory (NPI). The patients underwent brain SPECT with 99mTc-ethylcysteinate dimer. After removing the effects of age, anxiety and apathy scores of NPI, and five subscales of Addenbrooke's Cognitive Examination-revised (ACE-R), correlation analysis of NPI depression scores showed a significant cluster of voxels in the left middle frontal gyrus (Brodmann area 9), similar to the areas in the simple correlation analysis. The dorsolateral prefrontal area is significantly involved in the pathogenesis of depressive symptoms in AD, and the area on the left side especially may be closely related to the depressive symptoms revealed by NPI.
Abstract The Frontal Assessment Battery (FAB) was developed as a short bedside cognitive and behavioral battery to assess frontal lobe functions. The purpose of this study was to evaluate the ...validity and reliability of a Japanese version of the FAB to measure cognitive dysfunction in patients with dementia. We studied 25 normal subjects and 105 patients with Alzheimer's disease, n = 58, vascular dementia, n = 24, and frontotemporal dementia, n = 23. The neuropsychological test battery included the FAB, the Mini Mental State Examination (MMSE), a memory test, and the Wisconsin Card Sorting Test (Keio version: KWCST). Patients with dementia performed significantly more poorly than controls on all tests. The FAB showed a good correlation with other cognitive measures: MMSE ( r = 0.725), KWCST number of categories completed ( r = 0.654), KWCST number of perseveration errors ( r = − 0.484), and memory test ( r = 0.643). Patients with more severe Clinical Dementia Rating scores showed lower scores on the FAB. There was good inter-rater reliability ( r = 0.972), test–retest reliability ( r = 0.769), and internal consistency (Cronbach's coefficient alpha = 0.715). The FAB is a valid and reliable screening test to evaluate cognitive dysfunction among patients with dementia.
Abstract We report an autopsy case of progressive supranuclear palsy (PSP) that clinically showed only slowly progressive and symmetric upper motor neuron syndrome over a disease course of 12 years. ...A female patient initially exhibited dysarthria at the age of 65, followed by gait disturbance and dysphagia. Neurological examination at age 67 disclosed pseudobulbar palsy, spastic gait, hyperreflexia, and presence of bilateral Hoffmann and Babinski signs. However, muscle atrophy, weakness, evidence of denervation on electromyography, vertical gaze palsy, parkinsonism, gait freezing, aphasia, speech apraxia, or dementia was not noted throughout the course. She was clinically diagnosed as having motor neuron disease consistent with so-called primary lateral sclerosis. Pathological examination disclosed histopathological features of PSP, including argyrophilic and tau-positive tufted astrocytes, neurofibrillary tangles, coiled bodies, and thread-like processes in the motor cortex and superior frontal gyrus, and to a lesser degree, in the basal ganglia and brain stem nuclei. In addition, severe fibrillary gliosis was noted in the precentral gyrus and corticospinal tract, being consistent with upper motor neuron syndrome observed in this case. No TAR-DNA binding protein 43-positive lesion, FUS pathology, Bunina body, or Lewy body-like hyaline inclusion was noted in the motor cortex or lower motor neurons. These findings suggest that when tau pathology is prominent in the motor cortex but is minimal in the basal ganglia and brain stem nuclei, a PSP case can lack all classic clinical features of PSP and show only slowly progressive upper motor syndrome, consistent with clinical picture of primary lateral sclerosis.
Abstract Quality of life (QOL) has been recently recognized as the central purpose of healthcare, and positive affect is one of the core dimension of QOL. However, positive affect among patients with ...dementia or Alzheimer's disease (AD) has not received much attention in the medical research field. One hundred sixteen consecutive patients with AD were recruited from the outpatient units of the Memory Clinic of Okayama University Hospital. The positive affect score was evaluated using the positive affect domain of the Quality of Life questionnaire for Dementia (QOL-D). Patients underwent brain SPECT with 99mTc-ethylcysteinate dimer. Positive affect scores were inversely related to apathy scores, subjective depressive scores, and delusion scores. After removing the effects of age, sex, duration of education, and cognitive function, positive affect scores showed a significant correlation with regional cerebral blood flow in the left premotor and superior frontal gyri. The left premotor and superior frontal area is significantly involved in the pathogenesis of the decrease of positive affect in AD. Apathy and depression are closely related to the prefrontal area in AD, and they may affect the relationship between positive affect and the left prefrontal area.
Background: Early detection of dementia will be important for implementation of disease-modifying treatments in the near future. We aimed to investigate the diagnostic validity and reliability of the ...Japanese version of the revised Addenbrooke's Cognitive Examination (ACE-R J) for identifying mild cognitive impairment (MCI) and dementia. Methods: We translated and adapted the original ACE-R for use with a Japanese population. Standard tests for evaluating cognitive decline and dementing disorders were applied. A total of 242 subjects (controls = 73, MCI = 39, dementia = 130) participated in this study. Results: The optimal cut-off scores of ACE-R J for detecting MCI and dementia were 88/89 (sensitivity 0.87, specificity 0.92) and 82/83 (sensitivity 0.99, specificity 0.99) respectively. ACE-R J was superior to the Mini-Mental State Examination in the detection of MCI (area under the curve (AUC): 0.952 vs. 0.868), while the accuracy of the two instruments did not differ significantly in identifying dementia (AUC: 0.999 vs. 0.993). The inter-rater reliability (ICC = 0.999), test-retest reliability (ICC = 0.883), and internal consistency (Cronbach's α = 0.903) of ACE-R J were excellent. Conclusion: ACE-R J proved to be an accurate cognitive instrument for detecting MCI and mild dementia. Further neuropsychological evaluation is required for the differential diagnosis of dementia subtypes.
Background
Recently, depression with Lewy body pathology before the appearance of parkinsonism and cognitive dysfunction has been drawing attention. Low cardiac metaiodobenzylguanidine (MIBG) uptake ...is helpful for early differentiation of Lewy body disease (LBD) from late‐onset psychiatric disorders even before parkinsonism or dementia appears. In this study, we used MIBG uptake as a tool in suspected LBD, and evaluated the relationship of MIBG results to clinical characteristics and depressive symptoms.
Methods
Fifty‐two elderly inpatients with depression were included in this study. The Hamilton Depression Rating Scale (HDRS) was administered at admission, and 123I‐MIBG cardiac scintigraphy was performed. Of 52 patients, 38 had normal and 14 had reduced MIBG uptake.
Results
Correlation analyses of the late phase heart‐to‐mediastinum (H/M) ratio on the MIBG test and each item of the HDRS revealed that the H/M ratio was significantly correlated with scores of ‘agitation’, ‘anxiety‐somatic’, and ‘retardation’ on the HDRS. Mean HDRS composite scores of ‘somatic and psychic anxiety (Marcos)’ and ‘somatic anxiety/somatization factor (Pancheri)’ were higher in the low uptake group than in the normal uptake group.
Conclusion
Elderly patients with depression who manifested an obvious somatic anxiety tend to show low MIBG uptake, and are more likely to have Lewy body pathology.
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