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Psychotic symptoms often occur as a complication in Parkinson's disease patients, and a set of criteria for Parkinson's disease with psychosis (PDPsy) has been established. Among these criteria, hallucinations are one of the specific symptoms, with visual hallucinations being the most common. While atypical antipsychotic agents are often used for the treatment of PDPsy, adverse effects, including extrapyramidal symptoms, often hinder its continuation or tolerance. There have been some reports and reviews indicating that antidepressants may be effective for PDPsy and other forms of dementia with psychosis. In this report, we present a patient with PDPsy who was treated with one of the new-generation antidepressants, mirtazapine. Mirtazapine improved the patient's refractory psychotic symptoms, especially her visual hallucinations, without worsening her motor symptoms.

Abnormal eating behaviours are specific to frontotemporal lobar degeneration and increase caregiver burden. Topiramate, an anticonvulsant, suppresses cravings for alcohol and other substances and is a potential treatment for binge eating. However, there are few reports on topiramate efficacy for abnormal eating behaviours in frontotemporal lobar degeneration patients. We present three Japanese frontotemporal lobar degeneration patients with abnormal eating behaviours. Topiramate was effective, especially for compulsive eating, in cases with distinct lobar atrophy, but not for all abnormal eating behaviours.

Aim: The aim of this study was to develop a simple diagnostic procedure for subjects at high risk of developing dementia using the Clinical Dementia Rating (CDR), which is applicable to community-based activities. Methods: This study divided 252 community-dwelling elderly with a CDR score of 0.5 into two groups based on the presence or absence of cognitive decline within the previous one year of the baseline, as assessed by a semi-structured interview. One hundred subjects were in the ‘previously progressive group’ (PP group) and 152 subjects were in the ‘previously stable group’ (PS group). After 6 years of observation, a total of 111 subjects were assessed in the follow-up investigation. Results: Among the 39 subjects from the PP group (82.9 ± 6.8 years old, 11 male, 28 female), 34 developed dementia (87%). Among the 72 subjects from the PS group (84.4 ± 6.0 years old, 22 male, 50 female), 44 developed dementia (61%). The relative risk of developing dementia for the PP group versus the PS group was 1.43. The rate of conversion to dementia was 12.9% per 100 person-years in the PP group, and 9.8% in the PS group. In the PP group, the Mini-Mental State Examination score was significantly lower and the CDR score was significantly higher than in the PS group. Conclusion: Although there have been many attempts to identify subjects with high risk of dementia, this preliminary study suggests that information about temporal changes in cognitive function is useful when performing community-based surveys.

Background: The aim of the present study was to estimate prevalence rates of dementia and its subtypes in the population aged 65 years or more in a rural area of Japan. Methods: A survey was conducted in Itoigawa, a city with 33 120 inhabitants in Niigata Prefecture, Japan. There were 7847 persons aged 65 years or older, and they comprised 23.4% of the total population. The first phase survey included questions on medical history, activities of daily living, psychiatric and behavioral symptoms and MMSE. When the responses were examined 6394 valid replies were received (81.5%) and 914 subjects were identified who were suspected of having dementia. In addition, 200 samples were selected randomly as controls from the 5480 people who were not suspected of dementia. The second phase survey was applied to a total of 1114 subjects. Pairs of psychiatrists and nurses made house-to-house visits and examined the subjects in detail. Clinical diagnoses of the subtypes of dementia were based on the criteria set out by the Consortium to Establish a Registry for Alzheimer's Disease and DSM IV. Results: The prevalence rate of dementia was estimated at 6.2% (men 4.5%, women 7.4%), which is higher than that found by previous reports in Japan. Alzheimer type dementia was the most frequent diagnosis, accounting for 4.0%, followed by vascular dementia (1.2%), other type of dementia (0.3%) and unknown dementia (0.8%). ‘Questionable dementia’, as defined by the Clinical Dementia Rating 0.5, was found in 4.4% of respondents (men 6.3%, women 3.0%). Conclusions: The prevalence of dementia in a rural area was higher than that of previous Japanese reports, and the prevalence rate of Alzheimer type dementia was much higher than that of vascular dementia.

In order to elucidate brain mechanisms that contribute to the increased tendency for vigilance dysregulation in the elderly, we examined the spatial organization of brain electric activity [electroencephalogram (EEG)] during decreasing vigilance from alertness to onset of sleep stage 2, comparing 7 old and 10 younger, healthy subjects (60-79 and 18-41 years old, respectively). Two features were analyzed: (1) change of location of the brain electric source gravity centers of the EEG frequency bands, and (2) magnitude of fluctuation of these locations over time. Multichannel EEG was analyzed into source gravity center localizations for seven EEG frequency bands, using fast Fourier transform (FFT) Dipole Approximation (first principal component-single source modeling in the frequency domain). Multivariate analysis of covariance (MANCOVA) showed: source localizations were more anterior in old than younger subjects for beta-1 and more superior for all three beta bands; from alertness to sleep, delta and theta EEG sources (inhibitory activity) changed to more posterior and superior areas, and alpha-1 and -2 (routine activity) and beta-1 and -2 sources (excitatory activity) towards anterior and superior areas. Fluctuations of the source locations of delta and beta-2 were larger on the superior--inferior axis, and of beta-2 smaller on the left-right axis in the old than younger subjects. The results suggest functional specifications (inhibitory, routine, excitatory) of cortical positron emission tomography (PET) changes reported in sleep. In sum, aging exhibits changes in spatial organization of EEG-generating neuronal assemblies; during the transition wakefulness-to-sleep, aging affects the spatial-temporal dynamics of this organization. The latter is suggested to contribute to the increased risk for consciousness disturbances in the elderly.