118 Dementia Japan Vol. 31 No. 1 January 2017 表 1. DLB に対して mect を行った先行研究 Rasmussen K 2003 USA Japan Japan Japan Japan 1 2

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1 Dementia Japan 31 : , 症例報告要旨 1. はじめに 70 1 modified electroconvulsive therapy ; mect mect Modified electroconvulsive therapy in dementia with Lewy bodies with drug - resistant psychiatric symptoms : a case report Takeshi Nishida 1, Tsubasa Omi 2, Hidenori Matsunaga Department of Emergency and Critical Care, Osaka General Medical Center Bandai - higashi, Sumiyoshi, Osaka , Japan Department of Psychiatry, Osaka General Medical Center Bandai - higashi, Sumiyoshi, Osaka , Japan dementia with Lewy bodies ; DLB 2010 : BPSD : behavioral and psychological symptoms of dementia DLB DLB neuroleptic hypersensitivity DLB modified electroconvulsive therapy ; mect 1 DLB mect

2 118 Dementia Japan Vol. 31 No. 1 January 2017 表 1. DLB に対して mect を行った先行研究 Rasmussen K 2003 USA Japan Japan Japan Japan Japan 4 Takahashi S 2009 Japan 8 2. 症例提示 70 I 2 45 X 25 X X Unified Parkinson s disease rating scale UPDRS part III 22 Yahr 2 Mini Mental State Examination MMSE 14/30 : HbA1c 7.3% MRI/MRA : ICA 2 mm 1 SPECT : I - MIBG : H/M 3 DLB 3 DLB : 2005 MMSE 14 MMSE

3 1 119 図 1. 頭部 MRI/MRA 1 DLB DLB probable DLB DLB SPECT 123 I - MIBG MRI SPECT DLB DLB 1 mect mect

4 120 Dementia Japan Vol. 31 No. 1 January 2017 図 2. 図 3. 脳血流 SPECT I MIBG 心筋シンチグラフィー 123 -

5 1 121 図 4. 入院後経過図 5. S - D 曲線 (Inomata et al., 2012 より引用 ) 2016 mect deep vein thrombosis ; DVT mect 14 mect 8 4 mect ECT 考察 3.1. DLB の諸症状に対する mect の有効性 DLB mect ECT APA, 2001

6 122 Dementia Japan Vol. 31 No. 1 January 2017 DLB mect 1 Takahashi et al., 2009 ADL QOL 2008 mect DLB mect 3.2. DLB の mect に対する抵抗性 DLB mect mect mect Peterchev et al., 2010 DLB α Wakabayashi et al., 2006 Morris et al., 2015 mect Sackeim et al., 2008 ; Inomata et al., strength - duration curve ; S - D S - D rheobase 2 chronaxie S - D 5 ; Inomata et al., 2012 DLB S - D mect DLB S - D 3.3. 身体合併症のある DLB 患者に mect を施行する際の留意点 DLB mect mect ADL DVT mect pulmonary embolism ; PE mect DVT PE DVT mect DLB

7 1 123 mect 4. 結語 mect DLB DLB mect DLB mect 文献 American Psychiatric Association Committee on Electroconvulsive Therapy 2001 The Practice of Electroconvulsive Therapy : Recommendations for Treatment, Training, and Privileging, 2nd ed. A Task Force Report of the American Psychiatric Association, American Psychiatric Association, Washington, DC. Andersen K, Balldin J, Gottfries CG, et al A double - blind evaluation of electroconvulsive therapy in Parkinson s disease with on - off phenomena. Acta Neurol Scand 76 : Inomata H, Harima H, Itokawa M 2012 A case of schizophrenia successfully treated by m - ECT using long brief pulse. International Journal of Case Reports and Images 3 7 : : Lewy : McKeith IG, Dickson DW, Lowe J, et al Diagnosis and management of dementia with Lewy bodies : third report of the DLB Consortium. Neurology 27 ; : DLB : Morris M, Sanchez PE, Verret L, et al Network dysfunction in α - synuclein transgenic mice and human Lewy body dementia. Ann Clin Transl Neurol 16 ; 2 11 : mect : Peterchev AV, Rosa MA, Deng ZD, et al ECT Stimulus Parameters : Rethinking dosage. J ECT 2010 ; 26 : Rasmussen KG Jr, Russell JC, Kung S, et al Electroconvulsive therapy for patients with major depression and probable Lewy Body Dementia. The Journal of ECT 19 2 : Sackeim HA, Prudic J, Nobler MS, et al Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimulation 1 : Takahashi S, Mizukami K, Yasuno F, et al Depression associated with dementia with Lewy bodies DLB and the effect of somatotherapy. Psychogeriatrics 9 2 : ECT 35 9 : Wakabayashi K, Mori F, Takahashi H 2006 Progression pattern of neuronal loss and Lewy body pathology in the substantia nigra in Parkinson s disease. Parkinsonism Relat Disord 12 2 : S92 - S donepezil : m - ECT DLB : Probable Dementia with Lewy Bodies : 67-77

8 124 Dementia Japan Vol. 31 No. 1 January 2017 Modified electroconvulsive therapy in dementia with Lewy bodies with drug - resistant psychiatric symptoms : a case report Takeshi Nishida 1, Tsubasa Omi 2, Hidenori Matsunaga 2 1 Department of Emergency and Critical Care, Osaka General Medical Center 2 Department of Psychiatry, Osaka General Medical Center The patient was a 70 - year - old man who was diagnosed with dementia with Lewy bodies DLB when he was 69 years old. He had a gait disturbance, which was accompanied by psychological symptoms, such as hallucinations and delusions. His symptoms were improved by pharmacotherapy, however, they gradually exacerbated again. He thus underwent modified electroconvulsive therapy mect and his psychological and physical symptoms improved. It is suggested that mect may be an appropriate therapeutic option for DLB if pharmacotherapy is not effective. Address correspondence to Dr. Tsubasa Omi, Department of Psychiatry, Osaka General Medical Center Bandai - higashi, Sumiyoshi, Osaka , Japan

606 Dementia Japan Vol. 29 No. 4 October 2015 Table 1. The day care for people with severe dementia Outline Subjects Personal distribution Medical man

606 Dementia Japan Vol. 29 No. 4 October 2015 Table 1. The day care for people with severe dementia Outline Subjects Personal distribution Medical man Dementia Japan 29 : 605-614, 2015 605 原著要旨 1. はじめに 1 26 4.2 80 2 3 A survey of daycare facilities for dementia people in Japan Tohmi Osaki, Kiyoshi Maeda 1 650-0017 7-5 - 2 Medical Center for Dementia,