BackgroundPatients with Alzheimer’s disease (AD) often present with apathy symptoms resembling the decreased motivation observed in depressed patients. Therefore, differentiating the initial phase of AD from late life depression may be difficult in some cases. Near-infrared spectroscopy (NIRS) is a functional neuroimaging modality that uses near-infrared light to measure changes in hemoglobin concentration on the cortical surface during activation tasks. The objective of this study was to investigate differences in brain activation associated with late life depression and with AD by means of NIRS.MethodsNIRS was performed in 30 patients with depression, 28 patients with AD, and 33 healthy controls, all aged 60 years or older. During two tasks, a verbal fluency task and a visuospatial task, changes in oxygenated hemoglobin concentration in the frontal and parietal cortices were investigated.ResultsIn the visuospatial task, cortical activation was lower in the depressed group than in the AD group, and significant differences were observed in the parietal cortex.ConclusionsNIRS can detect differences in brain activation between patients with late life depression and those with AD. NIRS is a promising tool for the differential diagnosis of late life depression and AD.

After 1994, when the International Psychogeriatric Association (IPA) proposed the concept of behavioral and psychological symptoms of dementia (BPSD; http://www.ipa-online.org/ipaonlinev3/ipaprograms/ taskforces/bpsd/Default.asp), BPSD began to be evaluated from a variety of standpoints. In the biological treatment of BPSD, the pathological conditions must be accurately understood by clarifying the mental symptoms of demented patients and evaluating their biological background. Figure 1 shows the psychological symptoms of BPSD on the right and the behavioral symptoms on the left. One of the psychological symptoms of BPSD reported is often a depressive state, 1 but the depressive state changes as major depression enters the regressive stage or organic depression progresses to dementia, and reduced volition gradually emerges. These organic factors may underlie the ineffectiveness of antidepressants in the treatment of geriatric depression (Fig. 2). SPECIFIC SYMPTOMS OF BPSDHirono et al. 2 compared BPSD in patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD) and reported that delusions and hallucinations were notable in DLB, that disinhibition was observed at a significantly higher frequency in FTD, that apathy was noted frequently in all three groups with no significant difference between them, and that agitation, dysphoria, anxiety, euphoria, irritability, and abberant motor function were also observed in all three groups at similar frequencies. Ikeda et al.3 compared BPSD between AD and vascular dementia (VaD) and observed a generally infrequent occurrence of symptoms of BPSD in VaD except for apathy, which was observed significantly more often in VaD than in AD. Furthermore, when the details of delusions were investigated in 53 patients with AD who experienced delusions, a delusion of theft was most frequent, occuring in 75.5% of cases, followed by delusions of 'the presence of uninvited guests' or phantom boarders in 30.2% of cases, and delusions of persecution in 27.1% of cases. 4 Capgras syndrome was seen in only 1.9% of cases.

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Aim:  The name of a disease entered in medical documents often differs from the true diagnosis in psychiatric practice. We examined the effects of different translations of ‘schizophrenia’ into Japanese on the usage of disease names in documents. Methods:  We conducted a retrospective survey of the names of diseases used in the medical documents of 250 outpatients with schizophrenia or depression. These patients had attended our department of psychiatry between 1998 and 2000. We also investigated the names of the diseases of 226 outpatients who had first visited our department between 2003 and 2007. We defined the diagnosis (based on ICD‐10) as the ‘ICD‐10 disease name’ and the name of the disease written in medical documents as the ‘disease name in documents’. We classified the documents that were used to apply for national psychiatric care and welfare services as ‘official documents’ and those submitted to others as ‘private documents’. Results:  Prior to 2000, the term ‘seishin‐bunretsu‐byo’ (‘split‐mind disease’; old translation of ‘schizophrenia’) was used in 72.3% of official documents and 3.6% of private documents. In 2003 and later, the term ‘togo‐shitcho‐sho’ (‘integration disorder’; new translation of ‘schizophrenia’) was used in 98.0% of official documents and 21.7% of private documents. Conclusion:  The use of ‘togo‐shitcho‐sho’ in official documents has become established. On the other hand, terms such as ‘nervous breakdown’ and ‘depressive state’ are still commonly used in private documents after the adoption of the new Japanese translation of schizophrenia.

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