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1 ６ ０ ８ 号 認 知 症 新 時 代 へ の 挑 戦 no.608 ク リ ニ シ ア ン ２ ０ １ ２年５月１日発行 年間１ ０回発行 発行 東京都文京区小石川４ ６ １ ０ vol.59 no.608 認知症 クリニシアン 発行人 直江 登 印刷 ひでじま 59巻4 5合併号 通巻608号 認知症新時代への挑戦 認知症新時代への挑戦 鳥取大学医学部 脳神経医科学講座脳神経内科学分野教授 中島健二 ２ 座談会 認知症を抱える本人の視点 ６ 座長 筑波大学 医学医療系臨床医学域精神医学教授 朝田 隆 川崎医科大学 神経内科特任准教授 認知症疾患医療センター副センター長 片山禎夫 こだまクリニック 院長 木之下 徹 独立行政法人国立長寿医療研究センター 第二脳機能診療科医長 武田章敬 オブザーバー 厚生労働省 老健局局長 宮島俊彦 インタビュー 本人からのメッセージ 佐藤雅彦 ２ １ 認知症のパラダイムシフト 認知症の人の生活を知る 認知症の人の生活機能障害 札幌医科大学医学部 リハビリテーション医学講座教授 石合純夫 ２ ６ 帰宅願望ともの盗られ妄想 愛媛大学大学院医学系研究科 脳とこころの医学准教授 谷向 知 ３ １ 脱抑制行動 常同行動 熊本大学医学部附属病院 神経精神科講師 橋本 衛 ３ ７ 易怒性 岩手医科大学医学部 災害医学講座特命教授 高橋 智 ４ ２ 幻覚 妄想 誤認 滋賀県立成人病センター 老年内科副部長 長濱康弘 ４ ８ 本人視点からアリセプト!を再考する! ドネペジル アリセプト は!興奮"させる薬剤か 首都大学東京 大学院人間健康科学研究科教授 繁田雅弘 ５ ６ アリセプト!の投与意義 ナーシングホームデータから言えること 大阪赤十字病院 神経内科副部長 金田大太 ６ ０ ドネペジル塩酸塩の効果をどうみるか ねぎし内科 神経内科クリニック 院長 根岸輝彦 ６ ７ 認知症治療の真のエンドポイントを考える 医療法人社団こだま会 こだまクリニック 臨床心理士 安田朝子 ７ ７ MCI で抗認知症薬を投与すべきか 神戸大学大学院医学研究科 神経内科学分野准教授 古和久朋 ８ ３ これからの認知症で果たすべき役割! アリセプト の登場は患者の受診行動にどのような変化を与えたか 受診行動からの検討 三重大学大学院医学系研究科 認知症医療学講座准教授 佐藤正之ほか ８ ９ 認知症診療１ ０年の変遷と地域連携 三重大学大学院医学系研究科 認知症医療学講座助教 木田博隆ほか ９ ４ 認知症診療でかかりつけ医に期待する役割 岡山大学 脳神経内科教授 阿部康二 ９ ９ 認知症診療でかかりつけ医が果たすべきこと 弓倉医院 院長 弓倉 整 １ ０ ６ 抗認知症薬の服薬継続の意義と薬剤師の役割 愛知学院大学薬学部 臨床薬剤学講座教授 山村恵子 １ １ １ 高齢者にやさしい剤形選択 昭和大学薬学部 薬物療法学講座 薬剤学部門准教授 倉田なおみ １ １ ７ 私の座右銘 第３ ９ ９回 鳥取大学医学部 脳神経医科学講座脳神経内科学分野教授 中島健二 表２ ７ ３ 連載 GP のためのセミナー 先端医学トレンド１２７ 大阪大学産学連携本部 脳神経制御外科学特任教授 齋藤洋一 新連載 住み慣れた地域で誰もがいきいきと暮らせるまちづくり １ ２ ４ 認知症介護研究 研修東京センター 研究部副部長 永田久美子 １ ３ ４ 連載 １/ f 聖路加国際病院 小児科部長 副院長 細谷亮太 表紙 鳥取大学医学部 脳神経医科学講座脳神経内科学分野教授 中島健二先生 CODE CN 1 608
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7 disease modifying therapy CLINICIAN 12 NO
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10 common disease behavioral and psychological symptoms of dementia 7 CLINICIAN 12 NO. 608
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15 Values people Treat people as Individuals Perspective of service user Supportive social psychology CLINICIAN 12 NO
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17 cure CLINICIAN 12 NO
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20 common disease 17 CLINICIAN 12 NO. 608
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31 limb apraxia Liepmann naturalistic actions CLINICIAN 12 NO
32 29 CLINICIAN 12 NO. 608
33 Multi-level action test Schwartz, M. F., et al. : Naturalistic action production following right hemisphere stroke. Neuropsychologia, 37, (1999) CLINICIAN 12 NO
34 Behavioral and Psychological Symptoms of Dementia 31 CLINICIAN 12 NO. 608
35 Sundown Syndrome CLINICIAN 12 NO
36 NPINeuropsychiatric Inventory 33 CLINICIAN 12 NO. 608
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39 Ikeda, M., et al. : Delusions of Japanese patients with Alzheimer s disease. Int. J. Geriatr. Psychiatry, 18, (2003) Kazui, H., et al. : Impact of emotion memory. Controlled study of the influence of emotionally charged material on declarative memory in Alzheimer s disease. Br. J. Psychiatry, 177, (2000) CLINICIAN 12 NO
40 Frontotemporal dementia Alzheimer s disease 37 CLINICIAN 12 NO. 608
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42 39 CLINICIAN 12 NO. 608
43 Rascovsky, K., et al. : Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal CLINICIAN 12 NO
44 Brain, 134, (2011) dementia. Zamboni, G., et al. : Apathy and disinhibition in frontotemporal dementia : Insights into their neural Neurology, 71, (2008) correlates. Mendez, M. F., et al. : Stereotypical movements and frontotemporal dementia. Mov. Disord., 20, (2005) Ikeda, M., et al. : Changes in appetite, food preference, and eating habits in frontotemporal dementia and Alzheimer s disease. J. Neurol. Neurosurg. Psychiatry, (2002) 73, McMurtray, A. M., et al. : Variations in regional SPECT hypoperfusion and clinical features in frontotemporal Neurology, 66, (2006) dementia. Ikeda, M. : Fronto-temporal dementia. Richie, C. W., et al. ed., Therapeutic strategies in dementia. Clinical Oxford, (2007) Publishing, Ikeda, M., et al. : Efficacy of fluvoxamine as a treatment for behavioral symptoms in frontotemporal lobar degeneration patients. Dement. Geriatr. Cogn. Disord., 17, (2004) 41 CLINICIAN 12 NO. 608
45 Behavioral and Psychological Symptoms of Dementia Mild Cognitive Impairment CLINICIAN 12 NO
46 43 CLINICIAN 12 NO. 608
47 Kitwood Kitwood CLINICIAN 12 NO
48 45 CLINICIAN 12 NO. 608
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50 12, (2009) symptoms of dementia. Int. J. Neuropsychopharmacol., the treatment of the behavioural and psychological (1997) Mizukami, K., et al. : A randomized cross-over study of a traditional Japanese medicine (kampo), yokukansan, in (2002) Kitwood, T. : Dementia Reconsidered : The Person Comes First. Open University Press, Buckingham results from the cardiovascular health study. JAMA, 288, (2004) Lyketsos, C. G., et al. : Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment :, symptoms. Alzheimer Dis. Assoc. Disord., 18 (1), associated with characteristic neuropsychiatric Hwang, T. J., et al. : Mild cognitive impairment is 47 CLINICIAN 12 NO. 608
51 hallucination illusion misidentification delusion CLINICIAN 12 NO
52 Bassiony 49 CLINICIAN 12 NO. 608
53 Ikeda CLINICIAN 12 NO
54 frontotemporal lobar degeneration Engelborghs Capgras TV CLINICIAN 12 NO. 608
55 AchEIs CLINICIAN 12 NO
56 AchEIs Shigenobu AchEIs 53 CLINICIAN 12 NO. 608
57 Rubin, E. H., et al. : The nature of psychotic symptoms in senile dementia of the Alzheimer type. J. Geriatr. Psychiatry Neurol., 1, (1988) Hirono, N., et al. : Distinctive neurobehavioral features among neurodegenerative dementias. J. Neuropsy- chiatry Clin. Neurosci., 11, (1999) Stavitsky, K., et al. : The progression of cognition, psychiatric symptoms, and functional abilities in dementia with Lewy bodies and Alzheimer disease. Arch. Neurol., 63, (2006) Aalten, P., et al. : Neuropsychiatric syndromes in dementia. Results from the European Alzheimer disease consortium : part 1. Dement. Geriatr. Cogn. Disord., 24, (2007) Engelborghs, S., et al. : Neuropsychiatric symptoms of dementia : cross-sectional analysis from a prospective, longitudinal Belgian study. Int. J. Geriatr. Psychiatry, 20, (2005) Bassiony, M. M., Lyketsos, C. G. : Delusion and hallucination in Alzheimer s disease : review of the brain decade. Psychosomatics, 44, (2003) Nagahama, Y., et al. : Classification of psychotic symptoms in dementia with Lewy bodies. Am. J. Geriatr. Psychiatry, 15, (2007) CLINICIAN 12 NO
58 risperidone therapy for delusions of theft in Alzheimer Shigenobu, K., et al. : A structured, open trial of 66, (2006) Neurology, of Neurology (2012), http : //onlinelibrary. wiley. com/ 23557/abstract Mori, T., et al. : Correlation of visual hallucinations with doi/ /ana. occipital rcbf changes by donepezil in DLB. J. Geriatr. Psychiatry Neurol., 19, (2006) Mori, E., et al. : Donepezil for dementia with Lewy clinic. bodies : A randomized, placebo-controlled trial. Annals Neurosurg. Psychiatry, 76, (2005) Nagahama, Y., et al. : The Cambridge Behavioral Neurol. Inventory : validation and application in a memory Neurosurg. Psychiatry, 75, (2004) Fuh, J. L., et al. : Neuropsychiatric profiles in patients Neurol. with Alzheimer s disease and vascular dementia. J. elderly : findings from the first Nakayama study. J. behavioral disturbances in community dwelling Ikeda, M., et al. : Dementia-associated mental and Am. J. Geriatr. Psychiatry, 11, (2003) Nagahama, Y., et al. : Neural correlates of psychotic disease. symptoms in dementia with Lewy bodies. Brain, 133, (2010) 55 CLINICIAN 12 NO. 608
59 agitation Cohen- CLINICIAN 12 NO
60 Mansfield Agitation Inventory Neuropsychiatric Inventory agitation agitation Behavioral and Psychological Symptoms of Dementia CLINICIAN 12 NO. 608
61 CLINICIAN 12 NO
62 Howard, R. J., et al. ; CALM-AD Trial Group : Donepezil for the treatment of agitation in Alzheimer s disease. N. Engl. J. Med., 357 (14), (2007) Gauthier, S., et al. ; Donepezil MSAD Study Investigators Group : Efficacy of donepezil on behavioral symptoms in patients with moderate to severe Alzheimer s disease. Int. Psychogeriatr., 14, (2002) 59 CLINICIAN 12 NO. 608
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64 61 CLINICIAN 12 NO. 608
65 Swedish Alzheimer Treatment Study Instrumental ADL CLINICIAN 12 NO
66 DOMINO study 63 CLINICIAN 12 NO. 608
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68 Geldmacher, D. S., et al. : Donepezil is associated with delayed nursing home 65 CLINICIAN 12 NO. 608
69 placement in patients with Alzheimer s disease. J. Am. Geriatr. Soc., 51 (7), (2003) http : //www8.cao.go.jp/ kourei/ishiki/h22/kiso/zentai/index.html Wattmo, C., et al. : Risk factors for nursing home placement in Alzheimer s disease : a longitudinal study of cognition, ADL, service utilization, and cholinesterase inhibitor treatment. Gerontologist, 51 (1), (2011) Mohs, R. C., et al. : A 1-year, placebo-controlled preservation of function survival study of donepezil in AD patients. Neurology, 57 (3), (2001) Howard, R., et al. : Donepezil and memantine for moderate-to-severe Alzheimer s disease. N. Engl. J. Med., 366 (10), (2012) Waldemar1, G., et al. : Effect of donepezil on emergence of apathy in mild to moderate Alzheimer s disease. Int. J. Geriatr. Psychiatry, 26, (2011) CLINICIAN 12 NO
70 Alzheimer s Disease As- 67 CLINICIAN 12 NO. 608
71 sessment Scale ADAS-cog. ADAS-cog. DT-Navi ADAS- Jcog. DT-Navi DT-Navi CLINICIAN 12 NO
72 ADAS-Jcog. ADAS-Jcog. ADAS-Jcog. ADAS-Jcog. Behavioral Pathological 69 CLINICIAN 12 NO. 608
73 in Alzheimer s Disease Behave-AD ADAS-Jcog. Behave-AD CLINICIAN 12 NO
74 ADAS-Jcog. Instrumental Activities of Daily Living ADAS-Jcog. ADAS-Jcog. 71 CLINICIAN 12 NO. 608
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76 73 CLINICIAN 12 NO. 608 repetitive Transcranial Magnetic Stimulation Barker Hz Pascual-Leone
77 CLINICIAN 12 NO Hz Hz Hz Hz
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79 CLINICIAN 12 NO George, M. S., Post, R. M. : Daily left prefrontal repetitive transcranial magnetic stimulation for acute treatment of medication-resistant depression. Am. J. Psychiatry, 168, (2011) Tani, N., Saitoh, Y., et al. : Motor cortex stimulation for levodopa-resistant akinesia : case report. Mov. Disord., 22, (2007) Leung, A., et al. : rtms for suppressing neuropathic pain: a meta-analysis. J. Pain, 10, (2009) Khedr, E. M., et al. : Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke. Neurology, 65, (2005) Rossi, S., et al. : Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin. Neurophysiol., 120, (2009)
80 EuroQol 77 CLINICIAN 12 NO. 608
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83 0.094 CLINICIAN 12 NO
84 81 CLINICIAN 12 NO. 608
85 Tanaka, T., et al. : Post-marketing survey of donepezil hydrochloride in Japanese patients with Alzheimer s disease with behavioral and psychological symptoms of dementia (BPSD). Psychogeriatrics, 8 (3), (2008) EuroQol EQ-5D, VAS National Collaborating Centre for Mental Health : NICE clinical guideline 42 ; Dementia (2006) CLINICIAN 12 NO
86 Mild Cognitive Impairment Petersen Alzheimer s disease Alzhei- 83 CLINICIAN 12 NO. 608
87 mer s Disease Neuroimaging Initiative Doody ADAS-Cog. Salloway ADAS-Cog. CLINICIAN 12 NO
88 Petersen Winblad NYU Paragraph Recall Test InDDEx 85 CLINICIAN 12 NO. 608
89 α α allosteric potentiating ligand CLINICIAN 12 NO
90 Petersen, R. C., et al. : Apolipoprotein E status as a predictor of the development of Alzheimer s disease in memory-impaired individuals. JAMA, 273 (16), (1995) Weiner, M. W., et al. : The Alzheimer s disease neuroimaging initiative : progress report and future plans. Alzheimers Dement., 6 (3), , e7 (2010) 87 CLINICIAN 12 NO. 608
91 glutamate neurotoxicity in rat cortical neurons. J. (2011) Takada, Y., et al. : Nicotinic acetylcholine receptormediated neuroprotection by donepezil against Disease Neuroimaging Initiative. Arch. Neurol., 68 (1), (2007) Schneider, L. S., et al. : Treatment with cholinesterase inhibitors and memantine of patients in the Alzheimer s impairment : the InDDEx study. Lancet Neurol., 6 (6), (22), (2008) 70 Feldman, H. H., et al. : Effect of rivastigmine on delay to diagnosis of Alzheimer s disease from mild cognitive (23), (2005) 352 Winblad, B., et al. : Safety and efficacy of galantamine in subjects with mild cognitive impairment. Neurology, trial. Neurology, 63 (4), (2004) controlled Petersen, R. C., et al. : Vitamin E and donepezil for the treatment of mild cognitive impairment. N. Engl. J. Med., 72 (18), (2009) Neurology, Salloway, S., et al. : Efficacy of donepezil in mild cognitive impairment : a randomized placebo- MCI : a 48-week randomized, placebo-controlled trial. Doody, R. S., et al. : Donepezil treatment of patients with Exp. Ther., 306 (2), (2003) Kihara, T., et al. : Galantamine modulates nicotinic Pharmacol. receptor and blocks Abeta-enhanced glutamate toxicity. Biochem. Biophys. Res. Commun., 325 (3), Zhou, X., et al. : Acteylcholinesterase inhibitor (2004) rivastigmine enhances cellular defenses in neuronal and macrophage-like cell lines. Transl. Res., 153 (3), (2009) CLINICIAN 12 NO
92 89 CLINICIAN 12 NO. 608
93 treatable dementia behavioral and psychological symptoms of dementia Mini-Mental State Examination CLINICIAN 12 NO
94 p=0.005 p=0.019 p=0.004 p = CLINICIAN 12 NO. 608
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96 symptomatic drug disease modifying drug 93 CLINICIAN 12 NO. 608
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104 behavioral and psychological symptoms of dementia 101 CLINICIAN 12 NO. 608
105 ACh ACh BCh ACh CLINICIAN 12 NO
106 ACh AChE mini-mental state examination Hasegawa s dementia scale-revised 103 CLINICIAN 12 NO. 608
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108 Abe, K., et al. : Ascorbate induced lipid peroxidation results in loss of receptor binding in Tris, but not phosphate, buffer. Biochem. Int., 11, (1985) 105 CLINICIAN 12 NO. 608
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111 BPSD CLINICIAN 12 NO
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113 http : // zaishien/ninchishou_navi/kisochishiki/ninchishou/data/ index.html CLINICIAN 12 NO
114 111 CLINICIAN 12 NO. 608
115 Clinical Dementia Rating CLINICIAN 12 NO
116 http : // nagoya-u.ac. jp/ pharmacy/ 03/ textbook/ textbook. pdf Mini- Mental State Examination 113 CLINICIAN 12 NO. 608
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118 Functional Assessment Staging 115 CLINICIAN 12 NO. 608
119 Umegaki, H., et al. : Discontinuation of donepezil for the treatment of Alzheimer s disease in geriatric practice. Int. Psychogeriatr., 20, (2008) CLINICIAN 12 NO
120 117 CLINICIAN 12 NO. 608
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123 OD-mate CLINICIAN 12 NO
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125 A.S.P.E.N. Board of Directors and The Clinical Guidelines Task Force : Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN, 26 (Suppl), 8SA (2002) CLINICIAN 12 NO
126 Therapeutic Research 123 CLINICIAN 12 NO. 608
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BPSD A 群 B 群 A 群 B 群 妄想幻覚興奮うつ不安 n mean S.D. p-value n mean S.D. p-value 0 週 p= p= 週 週
BPSD の治療 Pharmacotherapy for BPSD 筑波大学大学院人間総合科学研究科精神病態医学分野 / 准教授 * 1. はじめに 8 Behavioral psychological symptoms of dementia BPSD 図 1BPSD BPSD BPSD BPSD 2. 興奮 攻撃性の治療 2005 図 2 DLB K BPSD 図 3 心理症状 幻覚 ( 幻視
FTD off - label 79 FTD Boxer et al., 2012b Alzheimer s disease : AD Cholinesterase inhibitor : ChEI FTD FTD Mendez et al., 2007 FTD Kerssens et al., 2
78 Dementia Japan 29 : 78-85, 78 2015 原著 要旨 4 FTD 87 6 2 1/3 Off - label medication for frontotemporal dementia in Japan Shunichiro Shinagawa 1, Yusuke Yatabe 2, Kazue Shigenobu 3, Ryuji Fukuhara 2, Mamoru
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Parkinson 病の認知機能障害を MMSE と MoCA により評価した多施設共同研究 : 慶應 PD データベース Cognitive impairment in Parkinson s disease patients evaluated by the Montreal Cognitive Assessment and the Mini-Mental State Examination.
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CONTENTS 01 02-03 04-05 06-07 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 48-49 50-51 52 01 02 Mishima,Michiaki 03 04 05 06 07 09 10 11