Dementia Japan 24: 10-15, 2010

Harmony of basic and clinical sciences:From a view point of pathologist, neurologist and specialist of the rehabilitation medicine

Haruyasu Yamaguchi

Gunma University School of Health Scienes

    Dementia is defined as disturbance of daily living due to cognitive deficit.  Therefore, clinician should examines precisely the activity of daily living (ADL), especially instrumental ADL.
    The author first learned neuropathology, then neurology, and finally became specialist of rehabilitation medicine.  In the dementia medicine, following 3 points is quite important:1)How is the lesion in the brain (neuropathology), 2)How is the clinical symptoms (neurology), and 3)How is the ADL.  Fortunately, the author can examine the demented patients from these 3 points of views due to my carrier.
    First, I have examined cerebral β amyloid deposition in the non-demented subjects, and found that β amyoid deposition starts from 40s of ages, and its prevalence increases with age.  Cerebral β amyloid deposition precedes the onset of Alzheimer disease 20-30 years.
    However, cerebral β amyloid deposition can be cleared by phagocytic cells; astrocytes and microglia.  I found disappearing senile plaque, which were associated with β amyloid-bearing astrocytes in the brains of non-demented subjects.
    Furthermore, clinical manifestation was not determined by the degree of neuropathological legion in the brain.  The Nun study in the USA demonstrated that some aged nuns were mentally normal even though they had typical Alzheimer pathology (Braak stage 6) in the brain.  Regenerative power (plasticity and cognitive reserve) can win degenerative legion.
    I proposed the Brain Activatin Rehabilitaiton (BRT), which enhances regenerative power of the brain.  The BAR consists of four principles; 1)the activities should be enjoyable and comfortable with the accepting atmosphere, 2)the activities should be associated with empathetic two-way communication of therapist-patient and patient-patient, 3)therapists should praise the patients naturally to enhance their motivation, 4)therapists should try to offer each patient some social role that would activate remaining abilities.  The BAR enhances patients' motivation and maximizes the use of remaining function, recruiting compensatory network and preventing disuse of brain function.
    Dementia medicine should be patient-centred.  Physician should carefully examine patients ADL and symptoms, and treat them appropriately based on their ADL and symptoms, but not CT/MRI images.

Address correspondence to Dr. Haruyasu Yamaguchi, Gunma University School of Health Scienes (3-39-15 Showa-machi, Maebashi, Gunma 371-8514, Japan)