Examining Frontal Lobe Asymmetry and Its Potential Role in Aggressive Behaviors in Early Alzheimer's Disease.

Background: Neuropsychiatric symptoms (NPS) in patients with dementia lead to caregiver burdens and worsen the patient's prognosis. Although many neuroimaging studies have been conducted, the etiology of NPS remains complex. We hypothesize that brain structural asymmetry could play a role in the appearance of NPS. Objective: This study explores the relationship between NPS and brain asymmetry in patients with Alzheimer's disease (AD). Methods: Demographic and MRI data for 121 mild AD cases were extracted from a multicenter Japanese database. Brain asymmetry was assessed by comparing the volumes of gray matter in the left and right brain regions. NPS was evaluated using the Neuropsychiatric Inventory (NPI). Subsequently, a comprehensive assessment of the correlation between brain asymmetry and NPS was conducted. Results: Among each NPS, aggressive NPS showed a significant correlation with asymmetry in the frontal lobe, indicative of right-side atrophy (r = 0.235, p = 0.009). This correlation remained statistically significant even after adjustments for multiple comparisons (p < 0.01). Post-hoc analysis further confirmed this association (p < 0.05). In contrast, no significant correlations were found for other NPS subtypes, including affective and apathetic symptoms. Conclusions: The study suggests frontal lobe asymmetry, particularly relative atrophy in the right hemisphere, may be linked to aggressive behaviors in early AD. These findings shed light on the neurobiological underpinnings of NPS, contributing to the development of potential interventions.

[A Case of Pseudocirrhosis during Chemotherapy for Breast Cancer with Liver Metastases].

A 60-year-old woman was undergoing chemotherapy for triple-negative breast cancer and multiple liver metastases. One year and 3 months after the start of treatment, blood tests showed worsening liver function and a decrease in the platelet count. Multiple liver metastases tend to shrink on computed tomography, but pseudocirrhosis was suspected because the right lobe of the liver had atrophied and the marginal irregularities were conspicuous. The platelet count decreased because of hypersplenism, and continuing chemotherapy was difficult. Splenic artery embolization was performed by the internal medicine department, and chemotherapy was resumed once the platelet count recovered. Imaging findings consistent with cirrhosis without the typical cirrhosis histopathology are considered as pseudocirrhosis. This phenomenon has been reported for breast cancer. During chemotherapy for liver metastases, attention should be paid to its appearance. Furthermore, liver cirrhosis should be controlled, and chemotherapy should be continued in coordination with the internal medicine department.

[A Case of Late Recurrent MSI-High Stageâ B Gastric Cancer after Surgery].

Late recurrence of stage ⅠB gastric cancer with high microsatellite instability(MSI-high)is rare. Here, we report a case of MSI-high StageⅠB gastric cancer recurring more than 5 years after surgery. A 78-yaer-old man was admitted to our hospital for gastric cancer surgery. Laparoscopic distal gastrectomy was performed. Histologic examination revealed a T2(MP) N0M0, HER2-negative, StageⅠB gastric tubular adenocarcinoma. Postoperatively, the patient received chemotherapy with S-1 for 1 year. He developed liver and para-aortic lymph node metastases 5 years 1 month after surgery. Pathological genetic examination revealed a high microsatellite instability. He received pembrolizumab therapy for the recurrence. This case suggests that late recurrence occurs in patients with gastric cancer with high microsatellite instability.