Revised Hasegawa Dementia Scale Research Articles

Long‐term effect of donepezil for Alzheimer's disease: Retrospective clinical evaluation of drug efficacy in Japanese patients

AbstractBackground: Alzheimer's disease (AD) is common in the Japanese population. In 1999, donepezil was authorized in Japan for the treatment of AD. However, because the time since donepezil was authorized is relatively short, there are few reports regarding the long‐term effects of donepezil in Japanese AD patients.Methods: In the present study, the clinical features of 72 AD patients treated at Juntendo University Urayasu Hospital were examined retrospectively in order to examine the long‐term effects of donepezil. Sixty‐two AD patients had been administrated donepezil. The effect of donepezil was evaluated using the Revised Hasegawa Dementia Scale (HDS‐R). In patients with increased points on the HDS‐R after 6 months, treatment was regarded as effective, whereas patients in whom there was no change in points on the HDS‐R were classified as ‘no change’; finally, in patients with decreased points on the HDS‐R after 6 months, treatment was regarded as non‐effective.Results: The duration of medication was divided into four groups: (i) 6 months (16 cases; 26%); (ii) 1 year (16 cases; 26%); (iii) 2 years (13 cases; 21%); and (iv) more than 3 years (11 cases; 18%). Donepezil treatment was stopped in six patients (10%) because of adverse effects. Thus, the 56 patients who continued with donepezil treatment were categorized as follows: treatment was effective in 27 cases (48%), no change was found in five cases (9%) and, in 24 cases (43%), donepezil treatment was found to be non‐effective. Differences in treatment efficacy were not related to sex, apolipoprotein E genotype or medical history. Comparative studies for the age of onset of AD and points of the HDS‐R before administration of donepezil suggest that donepezil tended to be effective in patients in whom AD developed at 71–80 years of age and with 16–20 points of the HDS‐R. In patients in whom donepezil was effective, cognition returned to the state before treatment 2 years later. However, the marked degradation of points on the HDS‐R was not seen in these cases. Conversely, the long‐term consequences for patients in whom donepezil was not effective after 6 months were similar to those for patients not treated with donepezil.Conclusion: Donepezil improved the dementia symptoms in patients in whom it was effective over the long term. We suggest that the presence of drug efficacy after 6 months is an indicator that long‐term treatment with donepezil is warranted. In particular, donepezil was effective in cases with mild to moderate AD.

Relationship between the total Revised Hasegawa Dementia Scale score and regional cerebral blood flow changes in subjects with memory impairment

Relationship between the total Revised Hasegawa Dementia Scale score and regional cerebral blood flow changes in subjects with memory impairment

A Normative Study of the Revised Hasegawa Dementia Scale: Comparison of Demographic Influences between the Revised Hasegawa Dementia Scale and the Mini-Mental Status Examination

Background/Aims: We investigated the demographic influence on the performance of the Revised Hasegawa Dementia Scale (HDS-R) and provided normative data of the HDS-R in the elderly. Methods: The HDS-R was administered to 803 community-dwelling cognitively normal elderly subjects aged 55 years or over. Cognitive disorders and psychiatric disorders were strictly excluded using the CERAD-K assessment packet and the Mini-International Neuropsychiatric Interview. The demographic influence on the performance of the HDS-R was examined using multiple linear regression analyses, and compared with that on the performance of the Mini-Mental Status Examination (MMSE) using the Chow test and t statistics. Overlapping strata were used in developing age-, education- and gender-specific normative data of the HDS-R. Results: Age, education, and gender influenced significantly the performance of the HDS-R, and explained 22.5% of the total score variance. Older age, lower education, and male gender were associated with lower performance of the HDS-R. However, the demographic influence on the HDS-R was much weaker than that on the MMSE (t = 5.578, d.f. = 800, p < 0.001). The normative data of the HDS-R stratified by age (60–69, 70–79, ≧80), education (0–6, 7–12, ≧13), and gender were presented. Conclusions: The HDS-R was more robust to demographic influences than the MMSE, and normative data may contribute to improving further its diagnostic accuracy for dementia.

Hippocampal size may contribute to prospective diagnosis of age‐related dementia

AbstractBackground: The hippocampus is a center of cognitive function and therefore hippocampal atrophy is the major factor in cognitive decline. Analysis of hippocampal size may make it possible to predict progression in cognitive impairment. To address this point, the present study investigated the relationship between hippocampal atrophy and dementia using magnetic resonance (MR) images and the Hasegawa Dementia Scale‐Revised (HDS‐R).Methods: The present study was performed on 274 subjects (14–97 years old; average, 66 years; 106 male and 168 female) who had no focal neurological deficit. Hippocampal area and whole brain area were measured in three series of coronal MR images taken from a 5‐mm slice rostrally along dorsal edge of the pons, and hippocampal size normalized by calculating summated hippocampal areas as percentages of summated whole brain areas. Dementia was screened for using HDS‐R.Results: Hippocampal size decreased and HDS‐R reduced with age. Hippocampal atrophy was highly correlated with cognitive deterioration; a critical normalized hippocampal size for HDS‐R of less than 20, which corresponds with mild cognitive impairment and dementia, was found in 65% of over 60‐years old subjects and 98% of subjects with HDS‐R of less than 20 were over 60 years old.Conclusion: There is a high probability that over 60‐year‐old people with a normalized hippocampal size of less than 1.0 would develop dementia in the future, even though their HDS‐R might presently be over 20. Measurement of hippocampal size with coronal MR imaging may therefore contribute to prospective diagnoses of age‐related dementia.

Variability of P300 in elderly patients with dementia during a single day

We recorded P300 sequentially during a single day in nine patients with dementia in a health care facility. The variability of the P300 response and the relationship between P300 and the Revised Hasegawa Dementia Scale were investigated. The sequential P300 latency and amplitude measurements varied significantly during the day, but the value changes were not related to the scheduled programs in the facility. Although there was no correlation between the values of latency or amplitude and Revised Hasegawa Dementia Scale (HDS-R), the variability index of the P300 latency correlated with the HDS-R score. Variability in the P300 response was considerable and the reproducibility was poor in elderly patients with dementia during the day, although the P300 latency was consistently prolonged. These results suggested that the variability of P300 was not due to transient changes in the level of consciousness, but was related to the latent pathology of fluctuating cognitive functions in patients with dementia.

Factors Related to Independent Social Living of Poststroke Patients with Mild Impairment

Purpose: To evaluate factors related to independent social living of poststroke patients with mild impairment who live at home after hospitalization. Participants: Forty-one participants were selected who scored 80 points or more on the Barthel Index (BI) and 25 or more points on the revised Hasegawa Dementia Scale (HDS-R). All of them returned home after receiving functional exercises for poststroke rehabilitation. Method: The functional data of inpatients and the results of a mailed questionnaire based on the Tokyo Metropolitan Institute of Gerontology (TMIG) index and the Craig Handicap Assessment and Reporting Technique, revised Japanese version (CHART-J), were compared. Results: Of the 6 CHART dimensions, Social Integration and Economic Self-sufficiency did not correlate with functional data during the hospitalized period. Participants generally scored lower in Occupation than in the other CHART dimensions with a higher standard deviation. Conclusion: From the viewpoint of functional impairment of poststroke patients, their motor function can be estimated relatively easily, but such dimensions as Social Integration and Economic Self-sufficiency are more difficult to evaluate with other methods. CHART is useful for evaluating the social activity of poststroke patients who live at home.

Neuropsychological test for the detection of dementia in elderly individuals: the Nishimura Dementia Test

AbstractBackground: Progression of the core and accessory symptoms of dementia can be slowed if drug therapies and psychosocial interventions are administered at an early stage. The aim of this study was to develop and standardize a neuropsychological test for the elderly that can detect dementia at an early stage with high sensitivity and can evaluate a wide range of severities of dementia based on assessments of various cognitive functions.Methods: A preliminary test consisting of 23 items and the Nishimura Mental State Scale for the Elderly (NM Scale), which evaluates the mental functions of elderly individuals by observing their actual behaviors in daily life, were administered to 448 elderly subjects. After applying Hayashi’s quantification theory type I to the results, we revised the preliminary test to construct a neuropsychological test for the elderly, which we named the Nishimura Dementia Test (ND Test), and standardized it. Then, we examined its validity and test–retest reliability.Results: Among the 448 subjects, there was a strong correlation between the ND Test scores and NM Scale scores. The ND Test showed a good general agreement rate for the discrimination of the severity of dementia, and good sensitivity and specificity of discrimination of dementia when compared with the actual NM Scale. Using different groups of elderly subjects, the ND Test showed validity and test–retest reliability, and the ND Test scores showed strong correlations with the Revised Hasegawa Dementia Scale scores and the Mini‐Mental State Examination scores.Conclusions: The ND Test is based on assessment of a variety of cognitive functions and can evaluate a wide range of severities of dementia with good validity and reliability.

The Frequency of Family Visits Influences the Behavioral and Psychological Symptoms of Dementia (BPSD) of Aged People with Dementia in a Nursing Home

The behavioral and psychological symptoms of dementia (BPSD) change the lifestyles of demented people and their caregivers. While various interventions in dementia have been reported, the relationship between family visits and suppression of BPSD in a nursing home has rarely been addressed. This study investigated whether the frequency of family visits was associated with a reduction in BPSD in aging people in a nursing home. Sixty-seven aged people (average age: 87.3 years), who were diagnosed as having dementia according to the Hasegawa Dementia Scale-Revised (HDS-R) score, in a nursing home were selected. They were divided into 3 groups as follows: HDS-R score of 0-9 (group A), 10-14 (group B), 15-19 (group C). The subjects were further divided into 2 groups by their average monthly frequency of family visits: 0-10 (group X) and >10 (group Y). The rates of change in the HDS-R and dementia behavior disturbance (DBD) Scale scores were calculated. The rate of change in the DBD Scale score was influenced by the frequency of family visits, and the effect was significantly greater in group X than in group Y. Among the groups, only group B showed significant differences in the rates of change in the HDS-R and DBD Scale scores, and both of these were lower in group Y than in group X. This investigation demonstrated that the frequency of family visits was associated with suppression of BPSD, and was particularly effective for subjects with moderate dementia.

LONG-TERM EFFECT OF LOW-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION OVER THE UNAFFECTED POSTERIOR PARIETAL CORTEX IN PATIENTS WITH UNILATERAL SPATIAL NEGLECT*Presented part by the 42nd Annual Congress of the Japanese Association of Rehabilitation Medicine in 2005.

To explore long-term effects on unilateral spatial neglect of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected posterior parietal cortex. Uncontrolled pilot study. Two chronic-phase patients with left-sided unilateral spatial neglect from cerebral infarction. Six rTMS sessions were undertaken for 2 weeks. Each session included 900 stimuli applied over P5 at an intensity of 95% motor thresholds and a frequency of 0.9 Hz. The Behavioural Inattention Test, either the Mini-Mental State Examination or the Revised Hasegawa Dementia Scale, Brunnstrom Recovery Stage, and Barthel Index were evaluated at 2-week intervals until 6 weeks after rTMS sessions. Single-photon emission computed tomography was performed 2 weeks before and after rTMS. Behavioural Inattention Test scores improved remarkably, especially from 2 to 4 weeks after rTMS sessions. At 6 weeks, Behavioural Inattention Test scores still remained above pre-rTMS levels. Other clinical evaluations as well as single-photon emission computed tomography showed no significant change during the study. In this small pilot study, low-frequency rTMS over the unaffected posterior parietal cortex decreased unilateral spatial neglect for at least 6 weeks.

Arterial stiffness independently predicts cardiovascular events in an elderly community — Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110–1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300–2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns.

Do Vascular Lesions and Related Risk Factors Influence Responsiveness to Donepezil Chloride in Patients with Alzheimer’s Disease?

The purpose was to identify vascular influences on the responsiveness to donepezil chloride. The study included 50 untreated probable Alzheimer’s disease patients with the Modified Hachinski Ischemic Score <4. We assessed baseline cognitive status using the Revised Hasegawa Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) and the clock drawing test (CDT). The response to 5 mg of donepezil was monitored by the CDT for 12 months. Patients were classified as true responders (TR), unchanged (UC) and non-responders according to changes on the CDT in response to treatment. High HDS-R scores, low CDT scores, low CDR and presence of hypertension (HBP) and periventricular hyperintensities (PVH) predicted a TR- or UC-type outcome. Aggravation of executive function by HBP and/or PVH and its improvement by donepezil may have been detected by the CDT.

Diagnostic Accuracy of Mini-Mental Status Examination and Revised Hasegawa Dementia Scale for Alzheimer’s Disease

To compare the diagnostic accuracies of the Revised Hasegawa Dementia Scale (HDS-R) and Mini-Mental Status Examination (MMSE) for Alzheimer’s diseases (AD), we administered them simultaneously to 82 AD patients and 82 age- and sex-matched nondemented control subjects. The area under the receiver operator curve (AUC) for AD of the HDS-R (AUC_HDS-R) and MMSE (AUC_MMSE) were bigger than 0.90 indicating that both tests are useful for detecting AD. However, AUC_HDS-R (0.952) was significantly larger than that of the AUC_MMSE(0.902) regardless of the educational level of the subjects, indicating that the HDS-R is more accurate than MMSE in diagnosing AD. Moreover, the superiority of the HDS-R (AUC_HDS-R = 0.894) to the MMSE (AUC_MMSE = 0.704) remained significant in mild AD patients alone, who are the focus of screening. In conclusion, the HDS-R is better than the MMSE as a screening instrument for AD.

Improvement in cognitive impairment after cataract surgery in elderly patients

Purpose: To evaluate whether cognitive impairment improves in elderly patients who have cataract surgery with intraocular lens (IOL) implantation. Setting: Kouki Hospital, Yamaguchi, Japan. Methods: A prospective observational study evaluated patients' scores on the Revised Hasegawa Dementia Scale (HDS-R) and the HDS-R minus 1 item regarding immediate regeneration (ie, function of vision and memory). Twenty patients (6 men, 14 women) with cognitive impairment had cataract surgery in 1 eye between March 1996 and July 2001 at Kouki Hospital, Japan. The mean age of the patients was 81.8 years (range 61 to 90 years). Twenty patients (4 men, 16 women) with cognitive impairment who did not have cataract surgery were selected as a control. The mean age in the control group was 84.3 years (range 70 to 93 years). The HDS-R was administered twice between March 1996 and July 2001. Results: The mean HDS-R scores in the cataract surgery group improved from 12.5 points ± 5.3 (SD) preoperatively to 16.6 ± 6.2 points postoperatively; the improvement was significant ( t = −5.02; P<.0001). After cataract surgery, the grade of cognitive impairment improved in 12 patients (60%), was unchanged in 7 (35%), and was worse in 1 (5%). Conclusion: Cataract surgery improved cognitive impairment in elderly Japanese patients.

Development of a brief communication ability scale for Japanese demented elderly

We developed a brief scale to evaluate communication ability of the demented elderly. This scale assesses not only abilities related to overall communication such as verbal function, judgment and emotional function, but also non-verbal communication such as eye-contact, nodding and smiling. The scale places little burden on the demented elderly subject and takes only a few minutes to perform, even if the dementia is severe. We evaluated 106 demented elderly residents of nursing homes using this brief communication ability scale, and the following results were obtained. The validity of this scale was confirmed by the high correlation coefficient between this scale and the formal caregiver questionnaire scores concerning communication ability, and the high-correlation coefficient between this scale and intellectual functions (r = -0.904), emotional functions (r = -0.841) and motor functions (r = -0.679) of dementia syndromes rating scale (Gottfries, Bråne, Steen scale; GBS scale), Hasegawa's Dementia Scale-Revised (HDS-R) (r = 0.625) and the Mini-Mental State Examination (MMS) (r = 0.733). The reliability of this scale was confirmed by the high interrater reliability coefficient of 0.828, test-retest reliability coefficient of 0.940 and Cronbach alpha coefficient of 0.938. These results indicate that the new scale is useful in the assessment of communication ability among the demented elderly.

Improving Outcome in Geriatric Peritoneal Dialysis Patients

Few data are available about elderly patients on peritoneal dialysis (PD). In the present study, we reviewed our experience with patients aged 70 years or more at the start of peritoneal dialysis (PD). This retrospective study was conducted at a single center in Japan. Of 222 patients managed using PD at our hospital between 1991 and 2001 (including 219 cases of PD first), 150 patients were aged under 70 years and 72 patients were 70 years of age or older. For the two groups of patients, we determined clinical data, erythropoietin and PD prescriptions, reasons for selecting PD (elderly patients only), urine and ultrafiltration volumes, comprehensive functional assessment, quality of life (QOL), comorbidity, technique survival rate, and causes of death. Serum creatinine, serum beta(2)-microglobulin, total dose of erythropoietin (EPO) needed to maintain hematocrit at 30%, number of continuous ambulatory peritoneal dialysis (CAPD) exchanges, and total volume of dialysis solution prescribed were significantly lower in the elderly patients as compared with patients aged under 70 years. The main reasons for starting PD in elderly patients at our hospital were advanced age (57%), patient's choice (25%), and cardiovascular complications (9%). Residual renal function was well maintained in CAPD patients aged 70 years or more as compared with patients aged under 70 years. Ultrafiltration volume was lower in the elderly CAPD patients. Scores on the Revised Hasegawa Dementia Scale, the Physical Self-Maintenance Scale, and the Instrumental Activities of Daily Living scale were significantly higher in CAPD patients than in hemodialysis patients. Subjective assessment using a linear analog scale showed a high QOL score in the elderly patients for overall feelings of well-being, mood, and anxiety. At the time of dialysis introduction, the major existing disorders in patients over 80 years of age were mostly cardiovascular disorders such as heart failure, myocardial infarction, serious arrhythmia, and cerebrovascular disease. The median technique survival in patients aged 70 years or more was 31.5 months. The main causes of death in elderly PD patients were heart failure (35.7%), peritonitis (14.3%), and cerebrovascular disease (11.9%). Peritoneal dialysis should be considered the treatment method of choice when introducing dialysis in elderly patients.

Reversible dementia in patients with chronic subdural hematomas

Neuropsychiatric changes following surgery for chronic subdural hematomas (CSDHs) were analyzed in 26 patients (21 men and five women) by using the Mini-Mental State Examination (MMSE) and the Hasegawa Dementia Scale-Revised (HDS-R) to determine factors that potentially contribute to neuropsychiatric recovery. Burr hole irrigation was performed in every patient to treat the CSDH. The patients' profiles, including age and sex, neuroimaging findings (such as hematoma volume and thickness, as well as midline shift), and preoperative and postoperative scores on the MMSE, HDS-R, and activities of daily living (ADL) scale were recorded. According to preoperative MMSE scores, eight patients (30.8%) were classified as mentally healthy and 18 (69.2%) as suffering from dementia before surgery. Nine of the 18 patients with dementia recovered to a normal psychological state following surgery. Surgery improved not only the patients' independence in ADL (p = 0.0026), but also their neuropsychiatric functions such as orientation and calculation, as estimated by scores on the MMSE (p = 0.0002) and the HDS-R (p = 0.0008). Factors affecting neuropsychiatric status on admission were midline shift (p = 0.0398) and ADL score (p = 0.0124); factors that could be used to predict neuropsychiatric recovery after surgery were patient age (p = 0.0027) and ADL score (p = 0.0193). The results of a logistic regression analysis demonstrated that significant predictors of neuropsychiatric recovery after surgery include the following: patient age (p = 0.0049, odds ratio [OR] = 0.842) and preoperative ADL (p = 0.0056, OR = 0.471), MMSE (p < 0.0001, OR = 1.895), and HDS-R (p = 0.0073, OR = 1.303) scores. Results of subgroup analyses demonstrated that patients younger than 74 years of age and those who had preoperative scores lower than 5 on the converted ADL scale, higher than 10 on the MMSE, or higher than 9 on the HDS-R on admission were found to have a significantly better recovery of neuropsychiatric functions after surgery. Dementia is reversible in many patients with CSDH, and surgery can improve not only independence in ADL, but also neuropsychiatric functions. Patients who are younger and/or those who have lower preoperative ADL scores and/or higher preoperative MMSE or HDS-R scores will achieve a good recovery with regard to neuropsychiatric functions after surgery. Estimations of neuropsychiatric function based on MMSE and HDS-R scores were found to be useful in predicting functional outcomes in patients with CSDH.

閉塞性脳血管障害患者に対する血行再建術前後の頚動脈超音波，ＳＰＥＣＴ，高次脳機能所見

We examined the usefulness of ultrasonography, single photon emission computed tomography (SPECT) and neuropsychological function assessment pre- and postoperatively in 14 patients with occlusive cerebrovascular disease who underwent surgical revascularization. Two groups were analyzed: patients who underwent carotid endarterectomy (CEA; n=7) and extracranial-intracranial (EC-IC) bypass (n=7) . The mean flow velocity (MFV) and pulsatility index (PI) of the common carotid artery (CCA), internal carotid artery (ICA) and external carotid artery (ECA) were determined by spectral pulsed Doppler ultrasonography. The cerebral blood flow (CBF) in the affected frontal lobe under resting conditions and after acetazolamide loading was evaluated using SPECT. Neuropsychological function was assessed by carrying out the kana pick-up test, revised Hasegawa dementia scale (HDS-R) and mini-mental state examination (MMS) . In the CEA group, the proximal PI of the CCA was lower and the distal PI of the ICA was higher postoperatively than preoperatively. In the EC-IC bypass group, the PI values of the CCA and ECA were lower postoperatively than preoperatively. These findings showed hemodynamic improvement of the surgically revascularized carotid arteries. Twelve of the 14 patients showed postoperative improvements in their kana pick-up test scores and the CBF evaluated by SPECT. In conclusion, surgical revascularization improves hemodynamic insufficiency and neuropsychological function in patients with occlusive cerebrovascular disease. Follow-up study using ultrasonography is useful for evaluating hemodynamic changes in patients with cerebrovascular disease.

STA-proximal MCA bypassの効果

We investigated cerebral blood flow (CBF) and metabolism in patients with hemodynamic ischemia by positron emission tomography (PET) and thermal diffusion flow meter. We also studied neuropsychological functions to evaluate the effects of surgical revascuralization.Bypass surgery of the superficial temporal artery to the proximal middle cerebral artery was performed on 26 patients satisfying the following categories: 1) stenosis or occlusive lesion in main cerebral arteries; 2) no marked focus of infarction on CT or MRI. PET was performed before and 1 month after the operation, and CBF, the cerebral metabolic rate of oxygen (CMRO2) and oxygen extraction fraction (OEF) were analyzed. Cerebrovascular reserve capacity (CVRC) was also calculated after acetazolamide challenge. CBF during the operation was continuously measured with a thermal diffusion flow meter. CO2 response of CBF was analyzed before and after anastomosis. Neuropsychological functions were evaluated by Hasegawa dementia scale revised (HDS-R), minimental state examination (MMSE) and Wechsler adult intelligence scale revised (WAIS-R).Before the operation, increase in OEF accorded with the decrease in CBF, and a significant relationship between both CBF and CVRC, and OEF and CVRC was found. A decrease in CVRC was noted prior to a decrease in CBF and elevation of OEF. CVRC caused by acetazolamide might reflect CO2 reactivity. Significant improvement of CBF and CVRC, and normalization of OEF were observed after the operation. Also, significant improvement of neuropsychological function was observed by HDS-R and WAIS-R. Disturbance in neuropsychological function might reflect elevation of OEF.

Association between social environment and aging of the brain: evaluation with the event-related potential P300

To investigate the association between social environment and aging of the brain, we studied P300 event-related evoked potentials in 95 normal elderly subjects living in different social environments. The subjects were divided into two groups: 22 healthy people living in old-age homes (average age 76.5 +/- 5.6 years, average Hasegawa Dementia Scale-Revised 27.4 +/- 2.5), and 93 healthy people living in their own homes (average age 74.1 +/- 5.4 years, average Hasegawa Dementia Scale-Revised 28.3 +/- 2.3). Target and Novelty P300 were recorded by using an auditory oddball paradigm. There were no differences in risk factors for strokes or in findings on magnetic resonance imaging between the two groups. Cognitive function (Okabe's Score and Koh's Block Design Test) were lower in those living in an old-age home than in those living in their own homes. Both target and novelty N100 examinations showed no significant differences in amplitude or latencies between the two groups. However, P300 latencies were larger among those living in an old-age home than among those living in their own homes; P300 amplitudes in the two groups were similar. Those living in an old-age home also had greater age-associated declines in function, as shown by longer latencies in target P300 than in novelty P300. Social-environmental factors are closely associated with the aging of the brain.