INTERRELATIONSHIP AMONG WALKING EXERCISE, MENTAL ACTIVITY AND BRAIN MORPHOLOGY IN PATIENTS WITH LONG-TERM CEREBRAL INFARCTION TSUNEHISA SATO, IZO SAKU

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1 INTERRELATIONSHIP AMONG WALKING EXERCISE, MENTAL ACTIVITY AND BRAIN MORPHOLOGY IN PATIENTS WITH LONG-TERM CEREBRAL INFARCTION TSUNEHISA SATO, IZO SAKURAI, YASUTAKA KOBAYASHI, TOYOTAKA MORI and UMEO KAZAMA Abstract The purpose of this study was to examine the effects of walking exercise on the mental activity of 44 elderly patients with slight, long-term cerebral infarction. Walking exercise, mental activity and brain morphology were determined by the number of steps taken per day, modified Hasegawa's dementia scales-r and computed tomography, respectively. The results are as follows : The average number of steps taken per day for the group of normal mental activity was 3489 }1692, for subnormal 2073 }980, pre-dementia 1458 }1241, and dementia 570 }1132. Sylvian fissures enlargement ratio in the normal group was 4.3 }1.7%, subnormal was 4.1 }0.8%, predementia 6.0 }2.3%, dementia 6.3 }1.8%. The difference between the right and left sylvian fissure enlargement ratio in the normal group was 1.8 }0.9% (right) vs. 2.5 }1.3% (left), subnormal: 1.7 }0.4% (right) vs. 2.5 }0.5% (left), predementia :2.6 }0.9% (right) vs. 3.4 }1.5% (left), dementia: 3.0 }1.2% (right) vs. 3.2 }0.9% (left). Cerebrum-cranial cavity ratio in the normal group was 80.6 }5.0%, subnormal 78.6 }5.0%, predementia 74.6 }4.8%, dementia 72.7 }3.4%. The lateral ventricles-cranial cavity ratio for normal was 14.3 }4.5%, subnormal 14.7 }3.1% predementia 17.3 }3.6%, dementia 16.8 }4.7%. The difference between good walking patients (over 1000steps/day) and poor walking patients (less than 1000steps/day) concerning the sylvian fissures-cranial cavity ratio (A), cerebrum-cranial cavity ratio (B) and lateral ventricles-cranial cavity ratio (C) was as follows: (A) 4.4 }1.5% vs. 6.4 }1.9% (p ƒ0.001), (B) 78.4 }6.7% vs }3.4% (p ƒ0.05), (C) 15.2 }3.9% vs }4.5%(ns). The above data indicates that there is an interrelationship among walking exercise ity and brain morphology., mental activ (Jpn. J, Phys. Fitness Sports Med. 2001, 50: ) Key word.long-term cerebral infarction, Walking exercise, Mental activity, Brain morphology, Kanagawa Medical Technology Association Department of Physiology, St, Marianna University School of Medicine Onarimon Clinic

2 484 佐藤,櫻質の形態にも良好な結果をもたらしたので,こ井,小林,森,風耐性,坐こ間位バランスが良好な症例でBrunnstrom teststagev stageviをに報告する. teststagevi以方法選んだ.外上の患者である脳萎縮など形態学的変化の評価には,頭 force/sh)を方法:対象は新川橋病院で,入院あるいは外来部CT像(機にて治療を受けている歩行可能な陳旧性脳梗塞報告を参考にして,シ体部が描出されるCT像歳,女性21名:平 (Ushikatax-plan 均年齢76歳である.患者の重症た.面度は,入院患者では,脳梗塞回復中期以降で坐位器:東用いた.T.Sandor4>ら,大の患者44名である.性別は男性23名:平均年齢74 来患者は同ルビウス裂溝断面と側脳室 360d)を積の数値は3回をプラニメーター用いて面積を測定し測定し,その平均値を用い Fig. 1. Left, Computed tomographic scan and its diagram showing cross s of cranial cavity (So), both sides of lateral ventricles (S1), cerebrum (S2) and low dencity (LDA). Right, Computed tomographic scan and its diagram showing cross s of cranial cavity (S0'), left and right sylvian fissures(s1') and cerebrum (S2'). S0:cross S1:cross S2:cross S0:cross S1:cross S2':cross of cerebrum LDA : cross Cerebral of cranial cavity of lateral ventricles of cerebrum of carnial cavity of sylvian fissure of low dencity parenchymal both of lateral ventricular both of sylvian fissures ratio=s2/s0 ~100(%) enlargement enlargement ratio=s1/s0 ~100 O ratio=s1/s0 ~100(%) (%)S 芝製X 友5)らの

3 Fig. 2. Steps per day for four groups classified by dementia screening scale for the patients of cerebrovascular disease.

4 Fig.3. Sylvian fissures-cranial cavity ratio vs four groups classified by dementia screening scale for the patients of cerebrovascular disease. Fig. 4. Difference between the left and right sylvian ratio in each group. over 1000 steps/day œless than 1000 steps/day

5 Fig. 5. Cerebrum-cranial cavity ratio vs four groups classified by dementia screening scale for the patients of cerebrovascular disease. over 1000 steps/day œless than 1000 steps day Fig. 6. Both of lateral ventricles-cranial cavity ratio vs four groups classified by dementia screening scale for the patients of cerebrovascular disease. over 1000 steps/day œless than 1000 steps/day

6 Fig.7.Difference between good walking patients (over 1000 steps/day) and poor walking patients (less than 1000 steps/day) about both of Sylvian fissures-cranial cavity ratio. over 1000 steps/day œless than 1000 steps/day Fig. 8. Difference between good walking patients (over 1000 steps/day) and poor walking patients (less than 1000steps/day) about cerebrum cranial cavity ratio. Cover 1000 steps/day Sless than 1000 steps/day

7 Fig.9. Difference between good walking patients (over 1000 steps/day) and poor walking patients (less than 1000 steps day) about both of lateral ventricles-cranial cavity ratio. Dover 1000 steps day bless than 1000 steps day Tsunehisa Satoh, Izo Sakurai, Kenichi Miyagi, Yoshihiko Hohshaku and Yasushi Tomita ; Correla tion Between Exercise And Psychiatric Function In Aged Patients With Circulatory Disease (Jpn, J. Phys. Fitness Sports Med. 1991, 40: ) 3) T. Satoh, I. Sakurai, K. Miyagi & Y. Hohshaku Walking exercise and improved neuropsychological functioning in elderly patients with cardiac disease. Journal of Internal Medicine 1995 ; 238 : ) Tamas Sandor, Ferenc Jolesz, James Tieman, Ron Kikinis, Kenneth Jones, Marilyn Albert : Compara-

8 tive Analysis of Computed Tomographic and Magne tic Resonance Imaging Scans in Alzheimer Patients and Controls. Arch Neurol : 49, Yueh Chang, Anthony Apicella, Fumihito Yoshii, Paresh Kothari et al : Predominant Left Hemisphere Metabolic Dysfunction in Dementia. Arch Neurol- Vol 46, February 1989 : ) Benjamin V. Sieger Jr, Lina Shihabuddin, Monte S. Buchsbaum, Arnold Starr, Richard J. Haier, Dirceu 7) Powell RR. Psychological effects of exercise therapy upon institutionalized geriatric mental patients. J Gerontol 1974 ; 29 : ) Diesfeldr HFA, Diesfeldr-Groenendijk H. Improving cognitive performance in psychologeriatric patients The influence of physical exercise. Age Aging 1977 ; 6 : ) Robert W. McCarley, Steven F. Faux, Martha Shen ton, Marjorie LeMay, Melanie Cane. Ruth Ballinger et al : CT Abnormalities in Schizophrenia. Arch Gen Psychiatry 1989 : 46, ) David A. Loewenstein, Warren W. Barker, Jen- C. Valladares Neto : Gender Difference in Cortical Glucose Metabolism in Alzheimer's Disease and Normal Aging. Journal of Neuropsychiatry 1996 : ) P. M. Thompson, J. Moussai, S. Zohoori, A.Goldkorn, A. A. Khan, M. S. Mega, et al : Cortical Variability and Asymmetry in Normal Aging and Alzheimer's Disease. Cerebral Cortex Sep 1998 : 8 :

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