Clinicopathological study of dementia : the Hisayama study

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The Hisayama study is a prospective population-based clinicopathological cohort in a Japanese subrural community, Hisayama Town. Most deceased subjects have been examined by autopsy to confirm causes of death and to examine brain pathology. These features have allowed a reliable estimation of the frequency of neurodegenerative diseases relating dementia in a general population and for a detailed analysis of the difference between dementia and non-dementia. In this study we obtained following findings.(1)We have estimated the frequency of senile dementia of the neurofibrillary tangle type (SD-NFT), which was fourth frequent type of dementia (3.9%). We found that the number of NFTs in the hippocampus of SD-NFT cases did not necessarily exceed the degree of those in Alzheimer's disease and that total brain weights were significantly reduced to the same extent as Alzheimer's disease (AD), which suggest that not only the limbic NFT pathology but also some whole brain dysfunctions might caus … More e the mental deterioration.(2)To explore cyclooxygenase(COX)-2 expression in the hippocampus, we analyzed 45 consecutive autopsy subjects without dementia and 25 AD patients. The neuronal expression of COX-2 in the CA3 subdivision of the hippocampus, subiculum, entorhinal cortex and transentorhinal cortex were consistently observed in both non-demented and AD brains and COX-2 immunoreactivity correlated with age in non-demented brains. In AD patients, neurons of CA1 exhibited increased COX-2 immunoreactivity which correlated with the severity of AD pathology, this correlation was not apparent in non-demented subjects. The results suggest that COX-2 expression may be differentially regulated among subdivisions of the hippocampus and that elevated COX-2 expression in the CA1 of AD brains may be associated with AD pathology and thus cognitive dysfunction.(3)Dementia with Lewy bodies (DLB) ranks the third major dementia. To verify the validity of the revised criteria in 2005, we have analyzed 205 consecutive demented autopsy cases. LB pathology was present in 59 cases (28.8%). Female cases with DLB have a tendency for more severe LB pathology and Alzheimer-type pathology as well. The high likelihood cases and intermediate cases exhibited 0.44 and 0.94 of 3 clinical core features each on average, respectively. On the other hand, the low likelihood cases and the LB-negative cases showed only 0.19 and 0.18 each. In conclusion, it is appropriate to include both the high likelihood and intermediate cases for diagnosis of DLB. Less