DOES MEDICATION THERAPY CONTROL ISCHEMIC LESIONS IN THE WHITE MATTER OF BRAINS WITH DEMENTIA?

Abstract

It is suggested by diagnostic imaging that brain ischemia cannot influent only vascular dementia but also Alzheimer's type dementia, dementia with Lewy bodies and other types of dementia. We analyze the relationship between core symptoms of dementia and ischemic lesions, and also the relationship between Behavioral and Psychological Symptoms of Dementia (BPSD) and ischemic lesions. We selected 8 patients with medication therapies and 6 patients without medications at random from 80 patients with dementia in spite of types of dementia. We pursued 14 patients by retrospective study during 3 years. We extracted ischemic lesions showing 25∼35 Hounsfield Units (HU) on Computed Tomography (CT) by the system that we developed and constructed CT images on 3 dimensions. We define Ischemic Lesion Ratio (ILR) as ILR = The number of voxels of Ischemic Lesions form the top of brain to the bottom on CT images / The number of voxels of brain parenchyma from the top of brain to the bottom on CT images. We calculated ILRs in 8 patients with donepezil hydrochloride, Chinese herbal medicine; yoku-kan-san (TJ-54) or memantine hydrochloride, and 6 patients without internal medical therapy. In addition, we examined ILR, Revised Hasegawa Dementia Scale (HDS-R) and BPSD in 14 patients with or without internal medical therapy. We quantified BPSD by number of symptoms on a scale of 1 to 11, which are written as BPSD on Opinion Briefs from patients' doctors in Japanese Public Nursing Care Insurance. We analyzed the relationship between ILR and HDS-R, and the relationship between ILR and BPSD Score. Time-dependent changes of ILRs in the patients with internal medical therapy are more dynamic than in the patients without internal medical therapy. There is a positive correlation between ILR and HDS-R in the patients with non-internal therapy and between ILR and BPSD Score in the patients with internal medical therapy. These phenomena suggest that the possibilities for medication therapy of controlling the Ischemic Lesions in white matter of brain with dementia. We assume that medications therapy influents Ischemic Lesions playing important roles in the emergence of core symptoms of dementia and BPSD.