Tarja Pohjasvaara, MD, PhD (Department of Neurology, Memory Research Unit, Helsinki University Central Hospital), Risto Vataja, MD, Antero Leppävuori, MD, PhD, and Timo Erkinjuntti, MD, PhD

The frequency of dementia poststroke is high, and stroke considerably increases the risk of dementia. The risk factors for dementia related to stroke are still incompletely understood. In addition to age and low level of education, different combinations of vascular risk factors and stroke features have been associated with poststroke dementia. A single explanation for poststroke dementia is not adequate; rather, multiple factors including stroke features (dysphasia, major dominant stroke syndrome), infarct features (type, side, site, number, and volume), extent and type of white matter lesions (WMLs), degree and site of atrophy, host chara-
cteristics (e.g. age, educational level), and risk factors for stroke (e.g. prior cerebrovascular disease, diabetes) each contribute to the risk of dementia poststroke.
 Dementia after first ever clinical stroke is also frequent. Cognitive decline is present prior to stroke in up to one-third of patients developing post-stroke dementia. Medial temporal lobe atrophy, a marker of an increased risk of Alzheimer’s disease (AD), is more frequent in stroke patients who have preexisting dementia or cognitive decline, as well as poststroke dementia. This may be explained by co-existing AD and cerebrovascular disease (CVD). The magnitude of this mixed dementia (AD with CVD/Vascular Dementia (VaD) ) group has been previously underestimated, and it is a diagnostic challenge in the older population.
Dementia due to CVD is a rather advanced stage of ischemic brain changes, and outcome of treatment and prevention may be limited. Accordingly, the focus should be placed on the entire spectrum of cognitive impairment related to CVD, focusing especially the early cognitive changes.

Shivani Nandi, PhD(Eisai Co., Ltd.Team Researcher, the International Research Center for Japanese Studies, Kyoto)

The Japanese government mandated the kaigohoken, or Long Term Care Insurance (LTCI) in December 1997. In view of the pressures faced by Japan as an aged society, the aim of the LTCI is to alleviate the burden of providing care for frail older people by ensuring good quality and readily available services to everyone over 65. The LTCI is thus a high profile, age-based entitlement programÅ|age based for persons 65 years of age and above, and age related disability based for ages 40 to 64. Individuals 40 years and above, including foreigners living in Japan for more than a year, are responsible in bearing a part of the financial responsibility by having to pay the mandatory premium. The benefits that the insured person receives are decided after evaluating the care requirement. Care is quantified by being categorized into six levels of increasing requirement, starting from support required, through five levels of increasing care.
 As is well known, caring for a person with dementia is further complicated by accompanying psychiatric disturbances which in turn increase caregiver burden. Thus the fundamental difficulty in dealing with the care of persons with dementia such as Alzheimer’s disease, which is the most common form of dementia, is the evaluation procedure preceding entitlement. We find that the statistical program of the LTCI employed in the initial stage of the evaluation contains discrepancies, and tends to overemphasize bed ridden patients over people with dementia. This paper is a study of the status of people with dementia in Japan, the mechanism of the assessment method, and the problems associated with it.

No Association between Presenilin 1 Intron Gene or Butyrylcholinesterase K Variantand Alzheimer’s Disease in Japanese Populations 

Yasuji Yamamoto, MD, PhD(Psychiatry and Neurology, Kobe University Graduate School of Medicine), Masahito Sengo, MD(Hyogo Institute for Aging Brain and Cognitive Disorders), Minoru Yasuda, MD, PhD(), and Kiyoshi Maeda, MD, PhD

Background: One of the purposes of this study was to examine whether apolipoprotein E (ApoE) e4 allele as a risk factor for Alzheimer’s disease (AD) may be associated with the higher prevalence of AD in women compared with men. Recently, the polymorphic K variant of the butyrylcholinesterase (BChE-K) gene and presenilin 1 (PS1) intronic polymorphism have been reported to be associated with AD respectively. Thus we have reexamined the frequency of BChE-K, PS1 intronic polymorphism, and the ApoE e4 allele in a large series of Japanese AD patients and controls.
Methods: We have genotyped a large series of Japanese AD and age- and sex-matched controls by the method of polymerase chain reaction and restriction fragment length polymorphism for ApoE, BChE-K, and PS1 intronic polymorphism.
Results: The frequency of ApoE e4 allele was significantly higher in AD patients than in controls, confirming the previous reports. In comparison between men and women, the number of individuals carrying one e4 allele was much greater in women with AD than in men with this illness. Kaplan-Meier analyses, plotting the e4 gene doses against age of onset for men and women, revealed significant differences in age-of-onset curves between men and women.

Dementia in Parkinson’s Disease: Its Incidence and a Possible Relationship with Dopa-refractory Symptoms

Atsushi Takeda, MD, PhD(Department of Neurology, Tohoku University School of Medicine), Kanae Fujihara, PhD,Akio Kikuchi, MD, PhD, Teiko Kimpara, MD, PhD, and Yasuto Itoyama, MD, PhD

Background: The diagnostic criteria for dementia in idiopathic Parkinson’s disease (PD) remain controversial. In PD, general intelligence is relatively spared, although executive function is commonly impaired.
Methods: Following the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), in this study we defined dementia in PD as a combined impairment of memory and executive function, and evaluated its incidence and its relationship with other clinical features.
Results: The prevalence of dementia among patients with PD was estimated to be 20-30% in an outpatient clinic and was found to be associated with the severity of motor impairments, especially Dopa-refractory symptoms. On the other hand, no relationships were observed between the prevalence of dementia and patient age or age of onset.
Conclusion: These data suggest that cognitive deficits, comprising dementia syndrome in PD, are mainly due to common neurodegenerative processes of non-dopaminergic systems, but not to other concomitant diseases, such as Alzheimer’s disease.

Takehide Tsuda, MD, PhD(Department of Neurology, Tohoku University School of Medicine), D.R.C. McLachlan, MD,and Yasuto Itoyama MD, PhD

Eriko Fukusho, MA(Department of Clinical Neuroscience, Psychiatry, Osaka University Graduate School of Medicine), Yu Nakamura, MD, PhD, Yujiro Kashiwagi, MD, PhD, Takashi Kudo, MD, PhD, Toshihisa Tanaka, MD, PhD, Naohiko Matsumoto, MD, Tomoyuki Kida, MD, Yuka Nakano, MD, PhD, Kazuhiro Shinosaki, MD, PhD, and Masatoshi Takeda, MD, PhD

Interrater Reliability of the Todai-shiki Observational Rating Scale (TORS) for Group Psychotherapy of Elderly Patients with Dementia

Osamu Matsuda, PhD(Department of Psychology, Faculty of Education, Tokyo Gakugei University), Yukiko Kurokawa, PhD, Masahiko Saito, MD, Kaori Maruyama, MA, and Noriko Miyamoto, BA

Tohru Takahashi, MD(Department of Psychiatry, Shinshu University School of Medicine), Tsunemi Tamaru, MD, Junko Imai, MD, Shinsuke Washizuka, MD, Hiroshi Ozawa, MD, Yuzuru Harada, MD, PhD, Akihito Morishima, MD, and Naoji Amano, MD, PhD

Kazuo Fujihara, MD (Department of Neurology, Hiroshima Red Cross and Atomic Bomb Survivors’ Hospital;Department of Neurology, Tohoku University School of Medicine), Yasuhiro Fujioka, MD, Michiya Ohta, MD,and Yasuto Itoyama, MD, PhD

Junya Nagasawa, MD (Department of Psychiatry,Shinshu University School of Medicine), Naoji Amano, MD, PhD, Miho Takahashi, and Tomoki Kaneko, MD