Rinsho Shinkeigaku (Clinical Neurology)

The 45th Annual Meeting of the Japanese Society of Neurology

Parkinson disease with dementia -responsible locus for dementia

Shigeo Murayama, M.D.1), Yuko Saito, M.D.1), Kenji Ishii, M.D.2), Kazuko Mitani, M.D.3), Kazutomi Kanemaru, M.D.3), Hiroshi Yamanouchi, M.D.3), Hiroshi Kurisaki, M.D.4) and Ichiro Imafuku, M.D.5)

1)Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology
2)Positron Medical Center, Tokyo Metropolitan Institute of Gerontology
3)Department of Neurology, Tokyo Metropolitan Geriatric Hospital
4)Department of Neurology, National Tokyo Hospital
5)Department of Neurology, Yokohama Rosai Hospital

Responsible locus for dementia in Parkinson disease (PD) was investigated. Serial 1,395 autopsy cases were studied for the combined pathology of PD and Alzheimer disease (AD). Following the one-year rule by the first Consensus Guidelines, definite AD pathology was quite rare in PD with dementia (PDD) but common in dementia with Lewy bodies (DLB). Plaque-dominant senile changes apparently enhanced neocortical Lewy-body pathology in both the conditions. About the hypometabolism in the visual cortex of PDD, a 66-year old man presented with fluctuation in hallucination commensurate with fluctuating hypometabolism. Considering the paucity in pathological changes of the visual cortex, this hypometabolism may represent functional impairment in the fiber connection. Comparative pathological studies with PD and PDD were carried out. Only one case of a 48-year-old woman, who unexpectedly died of heart failure, was free from cognitive decline, and did not show limbic and neocortical involvement. Another case of a 75-year old man with MCI presented with the similar pathology. All other cases showed clinical documentation of cognitive impairment and limbic and neocortical pathological involvement. Thus, the combination of prospective clinical and radiological studies and retrospective pathological studies (dynamic neuropathology) may be essential to investigate a role of the basal-forebrain cholinergic system.

(CLINICA NEUROL, 44: 824|826, 2004)
key words: α-synuclein, Lewy body, Dementia with Lewy bodies, basal nucleus of Meynert, Alzheimer disease

(Received: 13-May-04)