著者

池内 健

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.2, pp.200-204, 2016 (Released:2016-08-10)

参考文献数

21

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Alzheimer's disease (AD) is the most common cause of dementia in adult in Japan. In AD brain, two types of pathological findings including extracellular amyloid–β deposition and intracellular phosphorylated tau accumulation are observed. Although symptomatic therapy using choline esterase inhibitor and/or memantine are available for patients with AD, no effective disease–modifying drugs that may ameliorate natural history of AD has not currently established. AD is now recognized as one of largest unmet medical need among physicians. Thus, new therapeutic targets for drugs showing the disease modifying effect need to be explored. Epidemiological studies have shown that type 2 diabetes mellitus (T2DM) is associated with a nearly two–fold increased risk of AD. Although precise mechanisms of linking T2DM and AD remains unknown, accumulating evidence suggests that insulin resistance in brain plays a pivotal role in the pathogenesis of AD. This review article focuses on molecular aspect and the pharmacological strategies from the view of insulin resistance occurring in AD brain.

著者

竹川 英宏 塚原 由佳 平田 幸一

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.3, pp.199-203, 2017 (Released:2017-10-14)

参考文献数

20

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Ischemic stroke, accounting for approximately 60% of all strokes, is classified into lacunar infarction, atherothrombotic brain infarction, cardiogenic cerebral embolism and others. Lacunar infarction and atherothrombotic brain infarction are mainly caused by arterial thrombus and cardiogenic cerebral embolism results from venous clot formation. In patients with acute ischemic stroke, neurological symptoms should be frequently assessed by NIH stroke scale (NIHSS) in order to perform thrombolytic therapy with recombinant tissue–type plasminogen activator (rt–PA). NIHSS is a simple scale for assessing neurological symptoms, which can be reliably performed by nursing staff. Blood pressure lowering therapy is basically not required in acute ischemic stroke ; however, blood pressure should be kept below 180/105mmHg and repeated blood pressure monitoring is needed, when intravenous rt–PA is considered.Because recurrence and complicating diseases are not rare in acute ischemic stroke, in addition to vital sign monitoring, careful attention should be given to Cushing phenomenon, worsening of neurological signs, infection such as pneumonia, deep vein thrombosis, fall, convulsion and abnormal respiration. Assessment of swallowing function, including repetitive saliva swallowing test and modified water swallow test, and oral care are effective in preventing pneumonia. To achieve a favorable outcome of patients with acute ischemic stroke, the cooperation of all the medical staff involved in stroke medicine is needed. Particularly, appropriate nursing care is essential in detailed observation and management of patients with acute ischemic stroke.

著者

坂井 信幸 坂井 千秋 山本 晴子 永井 洋士 吉村 紳一 今村 博敏

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.6, pp.S126, 2017 (Released:2017-11-14)

著者

織茂 智之

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.6, pp.S96, 2017 (Released:2017-11-14)

著者

波田野 琢 服部 信孝

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.6, pp.S97-S97, 2017 (Released:2017-11-14)

著者

脇田 英明 冨本 秀和

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.4, pp.506-509, 2017 (Released:2017-02-28)

参考文献数

16

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Dementia affects over 35 million people in the world with a rapidly increasing prevalence. Alzheimer's disease (AD) is the most common form of dementia.No fundamental treatment for AD has been established, and novel therapeutic strategies are pursued extensively. This progress has led to the development of numerous therapeutic strategies in the clinical testing. A long–term randomized controlled trial suggested the beneficial effects of multidomain lifestyle–based interventions to maintain cognitive functioning, Although humanized monoclonal antibodies that bind amyloid b failed to improve cognition in patients with AD, several other promising trials are currently ongoing. In patients with dementia with Lewy bodies, it has been reported that lack of interferon–β signaling causes α–synuclein pathology. In addition, new therapeutic strategies have been reported in prion disease and Huntington disease. This review overviews recent advances in basic and clinical research in dementia.

著者

柏原 建一

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.3, pp.313-317, 2016 (Released:2016-11-10)

参考文献数

8

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Parkinson's disease (PD) is a progressive disorder of the nervous system that affects motor, neuropsychiatric, sleep, autonomic, and sensory functions. Motor symptoms of PD may include tremor, bradykinesia, muscle rigidity, postural instability, and speech and swallowing disturbances. Neuropsychiatric symptoms include depression, apathy, anxiety, cognitive impairment, hallucinations, and delusions. Sleep problems include insomnia, REM sleep behavioral disorder, excessive daytime sleepiness and sudden onset of sleep. Main autonomic symptoms include constipation, urinary dysfunction, orthostatic hypotension, sexual dysfunction, drenching sweat. Anosmia and sensory symptoms also are frequent complications of PD. Diagnosis of PD is determined by detecting these symptoms. The essential criterion is parkinsonism, which is defined as bradykinesia, in combination with at least 1 of rest tremor or rigidity. In addition, diagnosis of clinically established PD requires absence of absolute exclusion criteria, at least two supportive criteria, and no red flags. Exclusion criteria includes cerebellar abnormalities, downward vertical supranuclear gaze palsy, frontotemporal dementia, parkinsonism restricted to the lower limbs, treatment with dopamine receptor blocker, etc. Drugs, deep brain stimulation (DBS), and rehabilitation are measures to manage PD. Levodopa and dopamine agonists are the cardinal drugs to treat motor symptoms. Levodopa tended to induce motor complications such as wearing off and dyskinesia if used in the larger amount of more than 400 mg/day to PD patients with younger onset. Dopamine agonists induce motor complication less frequently than levodopa, but may include hallucinations, daytime sleepiness and impulse control disorders such as hypersexuality, gambling, and eating. Apomorphine is used for quick relief. DBS is a surgical procedure to treat motor symptoms of PD. Nowadays, increasing evidences support that physical activity improve motor and non-motor symptoms of PD. Global Parkinson's disease survey steering committee concluded in 2002 that “satisfaction with the explanation of the condition at diagnosis” and “current feelings of optimism” have a significant impact on health-related quality of life of PD patients.

著者

髙嶋 博 荒田 仁 東 桂子 松浦 英治

出版者

日本神経治療学会

雑誌

神経治療学

巻号頁・発行日

vol.34, no.6, pp.S136-S136, 2017

著者

宮嶋 裕明

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.3, pp.299-302, 2016 (Released:2016-11-10)

参考文献数

11

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Iron is a bioactive metal essential for normal cellular functions. However, excessive iron leads to cell death because iron enhances oxidative stress due to the generation of highly cytotoxic hydroxyl radicals. Therefore, the tissue iron content is critically regulated by several iron metabolic molecules.

著者

武田 篤

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.3, pp.379-379, 2016 (Released:2016-11-10)

著者

田中 亮太 服部 信孝

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.34, no.1, pp.24-30, 2017 (Released:2017-05-31)

参考文献数

35

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Stoke is one of the leading cause of death in the world. Although the mortality rate after stroke decreased, there are increasing number of patients who needs daily life support after stroke. The Hisayama study demonstrated the recurrence rate of ischemic stroke was 49.7% in ten years after first ever stroke. In addition to the traditional risk factors for stroke recurrence such as age, hypertension, diabetes, smoking, there are increasing evidence the another potential risk factors including infection, insulin resistance, visceral fat, gut dysbiosis, air pollution. These potential risk factors are associate with systemic chronic inflammation that promote artherosclerosis and myocardial injury that result in recurrence of stroke. Cognitive decline is one of the critical problems after stroke. Alzheimer's pathology is frequently related to the onset of dementia after stroke and recurrence of stroke is significant risk for the dementia. The strategy to attenuate the recurrence of stroke is also effective to reduce post stroke dementia. The use of antithrombotics is main treatment for the secondary prevention. Furthermore, strict risk factor control is also able to reduce the risk of stroke recurrence. One of the long term observational study demonstrated both antithrombotic treatment and the strict risk factor control attenuated cognitive decline after stroke. We discussed these topics of chronic stage of ischemic stroke in this section.

著者

本村 政勝

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.33, no.3, pp.318-322, 2016 (Released:2016-11-10)

参考文献数

10

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Myasthenia gravis (MG) is an autoimmune neurological disorder characterized by impaired neuromuscular transmission due to circulating pathogenic autoantibodies. MG patients produce pathogenic autoantibodies against the acetylcholine receptors (AChR), muscle–specific receptor tyrosine kinase (MuSK), and low–density lipoprotein receptor–related protein 4 (Lrp4) which are localized on the postsynaptic membrane of the neuromuscular junction. This lecture provides the overview of MG in Japan including classification, epidemiology, autoantibodies, clinical manifestation, diagnosis, treatment, and prognosis, especially focusing on the new standard treatment approach according to novel MG diagnostic criteria suggested by the MG clinical guidelines for 2014. Treatments for MG are based on immunotherapy by steroids and immunosuppressants. In Japan, treatments include cholinesterase inhibitors, thymectomy, steroids, immunosuppressants, plasma exchange, and intravenous immunoglobulin therapy. However, even when utilizing all of these treatments, the proportion of MG patients achieving complete stable remission is less than 10%. The new treatment approach suggests the combination therapy from early disease stage, to reduce the risk of crisis and disease progression. The current goal of MG treatment is firstly to treat MG patients to achieve pharmacological remission as rapidly as possible using the above therapies at onset. The therapeutic protocol according to onset age, disease type, and pathogenic autoantibodies conducted in Nagasaki University Hospital is also discussed.