Evaluating the involvement of Lewy body disease in geriatric psychiatry

2019 Fiscal Year Final Research Report

• Project/Area Number: 17K10331
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Psychiatric science
• Research Institution: Okayama University
• Principal Investigator: Oshima Etsuko 岡山大学, 医学部, 客員研究員 (60583094)
• Co-Investigator(Kenkyū-buntansha): 寺田 整司 岡山大学, 医歯薬学総合研究科, 准教授 (20332794)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Keywords: レビー小体病 / 認知症 / 軽度認知書具合 / 老年期精神障害 / うつ病 / 治療同意能力

Outline of Final Research Achievements

Fifty-two elderly inpatients with depression were included in this study. The Hamilton Depression Rating Scale (HDRS) was administered at admission, and 123I-MIBG cardiac scintigraphy was performed. Of 52 patients, 38 had normal and 14 had reduced MIBG uptake. Mean HDRS composite scores of ‘somatic and psychic anxiety (Marcos)’ and ‘somatic anxiety/somatization factor (Pancheri)’ were higher in the low uptake group than in the normal uptake group. Correlation analyses of the late phase heart-to-mediastinum (H/M) ratio on the MIBG test and each item of the HDRS revealed that the H/M ratio was significantly correlated with scores of ‘agitation’, ‘anxietysomatic’, and ‘retardation’ on the HDRS.
In another study, we attempted to evaluate the competency for amnestic MCI (aMCI) patients (n= 40) to make a medical choice. Not a few patients with aMCI (n= 12) were judged by a team conference to have no competency to consent to therapy even in a relatively simple and easy case.

Free Research Field

老年精神医学

Academic Significance and Societal Importance of the Research Achievements

高齢のうつ病患者では、MIBG心筋シンチでの取り込み低下を認める例が全体の1/4を占めており、レビー小体病を背景病理として有する場合が少なくないことが明らかになった。神経変性疾患を有する例では、身体的なリハビリテーションの実施や転倒予防が重要であり、薬剤過敏性も考慮する必要があるため、治療選択においても重要な差異を生じる。特に、身体症状の訴えが目立つ高齢うつ病患者では、レビー小体病を併存する可能性が高いことも明らかとなった。
また、軽度認知障害患者でも治療同意能力が低下している場合が少なくない。よって、病状や治療の説明の際には図表を活用し、記憶力に負荷の掛からない方法を採る必要がある。