Lacunar Infarcts Rather than White Matter Hyperintensity as a Predictor of Future Higher Level Functional Decline: The Ohasama Study.

OBJECTIVE: We aimed to determine the associations between silent cerebrovascular lesions, characterized by lacunar infarcts and white matter hyperintensity, and future decline in higher level functional capacity in older community-dwelling adults. MATERIALS AND METHODS: For this observational study, we selected individuals from the general population of Ohasama, a rural Japanese community. Three hundred thirty-one participants who were free of functional decline at baseline and who were at least 60 years old underwent brain magnetic resonance imaging and answered a questionnaire on higher level functional capacity derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Weassessed the relationship between silent cerebrovascular lesions with a decline in higher level functional capacity at 7 years using multiple logistic regression analysis adjusted for possible confounding factors. RESULTS: During the follow-up, 22.1% reported declines in higher level functional capacity. After adjustment for putative confounding factors, the presence of silent cerebrovascular lesions (odds ratio [95% confidence interval], 2.10 [1.05-4.21]) and both lacunar infarcts (2.04 [1.05-3.95]) and white matter hyperintensity (2.02 [1.02-3.95]) was significantly associated with the risk of functional decline at 7-year follow-up. In subscale analysis, specifically lacunar infarcts were strongly associated with the future risk of decline in intellectual activity (3.16 [1.27-7.84]). CONCLUSION: Silent cerebrovascular lesions are associated with future risk of decline in higher level functional capacity. Appropriate management of health risk factors to prevent silent cerebrovascular lesions may prevent higher level functional decline in the elderly population.

Association between white matter hyperintensity and lacunar infarction on MRI and subitem scores of the Japanese version of mini-mental state examination for testing cognitive decline: the Ohasama study.

We assessed whether subitem scores on the Mini-Mental State Examination (MMSE) associated independently with cerebral white matter hyperintensity (WMH) and lacunar infarction (LI). Magnetic resonance imaging (MRI) and neuropsychological evaluation (MMSE) were performed in 1008 elderly individuals from the Ohasama Study (348 men, 660 women [65.5%]; age 68.0 ± 6.0 [mean ± SD] years; MMSE score, 26.5 ± 2.9). The relationships between MRI findings and MMSE subitem scores were analyzed by logistic regression. Significant associations were observed between the MMSE subitems "Orientation to place" and WMH, and "Copy a figure" and LI. Pathological changes were detected by brain MRI associated with a decrease in cognitive function in healthy elderly individuals.

The association of disproportionately enlarged subarachnoid space hydrocephalus with cognitive deficit in a general population: the Ohasama study.

Disproportionately enlarged subarachnoid space hydrocephalus (DESH) is the characteristic feature of idiopathic normal pressure hydrocephalus. We aimed to characterize the prevalence, development, and association of DESH to cognitive deficit in a large population. We reviewed the data of 1384 subjects eligible for the present study among 1590 participants who underwent magnetic resonance imaging (MRI) in the Ohasama Study, a population-based study in Ohasama, Japan. The participants with Mini-Mental State Examination (MMSE) score < = 25 were assumed to have cognitive deficit and DESH was evaluated by reviewing the MRIs. We assessed the association between DESH, Evans index (EI), and cognitive deficit using multivariate logistic regression models adjusted for relevant confounders. Furthermore, we evaluated the new development of DESH and the deterioration of cognitive function in the participants with DESH. There were nine participants with DESH (0.65%), seven of whom showed cognitive deficit. DESH was significantly associated with cognitive deficit in multivariate regression analyses (odds ratio; 8.50 [95% confidence interval: 1.61-44.88]). In the 669 participants who underwent follow-up MRI, we found four participants newly presenting with DESH; the development of DESH was observed before/after the presence of EI > 0.3. We also found two participants with existing DESH showing no remarkable worsening in MMSE and EI. The present study demonstrated a positive association between the presence of DESH and cognitive deficit. DESH can develop independently of EI > 0.3, and ventricular enlargement in combination with DESH may be an important factor in the worsening of cognitive deficit.

Recognition and its impairment regarding autobiographical memories in a patient with hippocampal amnesia.

Autobiographical memories of one case (Y.K.) were assessed before and after onset of hippocampal amnesia. He was a 56-yr.-old male patient who used to work in an office. The findings can be described as follows. First, Y.K.'s recognition performance regarding his premorbid and postmorbid personal semantics along with premorbid autobiographical incidents was significantly greater than chance, and recognition of premorbid autobiographical incidents was within chance. Given information before onset, a relationship was suspected between frontal lobe dysfunction and Y.K.'s autobiographical problem. The possibility that an amnesic patient could acquire semantic information after onset is discussed.

A case report of compensation in daily life of a person with memory problems: detailed functional use of memory aids over a five-year period.

Numerous studies have been conducted on memory aids for memory-impaired people. However, it is not known how they use these memory aids in a functional, practical way. A 20-year-old patient (MH) was monitored for five years to identify what memory aids or other means she used and how she used them to compensate for her memory problems, e.g., forgetting what was said by others in a few minutes and getting lost or turning in the wrong direction on a walk or in a building. Results indicated MH did not necessarily always use memory aids such as a notebook or calendar to compensate for her memory problems, although MH and her mother reported that she frequently used them in daily life. She coped with memory problems by using various "resources" besides the memory aid. These facts suggest that it may be necessary to redefine functionally useful compensations, which include both memory aids and resources in daily life.

Developmental order driving the relationship between executive functions and theory of mind: a case study.

Several studies have suggested there is a developmental link between executive functions and theory of mind. However, the developmental order driving the relationship is not well understood. The main reason is that the development of executive function parallels the development of theory of mind in normally developing children. In this paper, a case (H.Y.) is reported. H.Y. had lived in a persistent vegetative state for 6 years after encephalitis at the age of 10. He showed a developmental order driving the relationship between executive functions and theory of mind. These findings are consistent with recent suggestions that development of executive function might be important as a predecessor of either the ability to understand false beliefs or the ability to express that understanding.

Day-to-day variability in home blood pressure is associated with cognitive decline: the Ohasama study.

Although an association between high blood pressure and cognitive decline has been reported, no studies have investigated the association between home blood pressure and cognitive decline. Home blood pressure measurements can also provide day-to-day blood pressure variability calculated as the within-participant SD. The objectives of this prospective study were to clarify whether home blood pressure has a stronger predictive power for cognitive decline than conventional blood pressure and to compare the predictive power of the averaged home blood pressure with day-to-day home blood pressure variability for cognitive decline. Of 485 participants (mean age, 63 years) who did not have cognitive decline (defined as Mini-Mental State Examination score, <24) initially, 46 developed cognitive decline after a median follow-up of 7.8 years. Each 1-SD increase in the home systolic blood pressure value showed a significant association with cognitive decline (odds ratio, 1.48; P=0.03). However, conventional systolic blood pressure was not significantly associated with cognitive decline (odds ratio, 1.24; P=0.2). The day-to-day variability in systolic blood pressure was significantly associated with cognitive decline after including home systolic blood pressure in the same model (odds ratio, 1.51; P=0.02), whereas the odds ratio of home systolic blood pressure remained positive, but it was not significant. Home blood pressure measurements can be useful for predicting future cognitive decline because they can provide information not only on blood pressure values but also on day-to-day blood pressure variability.

I cannot remember, but I know my past events: remembering and knowing in a patient with amnesic syndrome.

Case Y.K. has severe anterograde amnesia and a selective loss of specific personal episodes in his remote memories (Hirano & Noguchi, 1998). In this paper, we attempted to analyze remembering (R) and knowing (K) responses, that is, the relationship between autobiographical remembering and remembering accompanied by subjective experience. Although the rate of R responses was significantly higher than that of K responses in control subjects, Y.K.'s R responses were rare in all subtypes of remote memories. Based on these results, we conclude that Y.K.'s memories on autobiographical incident task were not based on episodic memory but rather on semantic memory. Thus, the autobiographical incidents he could recall were not episodic memory, and his semantic memory made him recall information as fact rather than episode.