title: [Localized cerebral blood flow changes in response to ADL-related vitality in elderly patients with dementia using single photon emission computed tomography].
abstract: OBJECTIVE
  To clarify the area in the brain related to responsible for vitality and volition.
  
  
  METHODS
  We studied 123 outpatients (39 men, 84 women, 77.7+/-6.7 years old) who visited the Center for comprehensive care on memory disorders in Kyorin University Hospital. No patients were prescribed with anti-depressants, anti-anxiety agents, psychomimetics, acetylcholinesterase inhibitors, Chinese herbal medicines or cerebrovascular circulation modifying drugs. Patients with frontotemporal dementia or depression were excluded. ADL-related vitality and volition was measured by a vitality index. Cerebral brain blood flow was measured by single photon emission computed tomography (99mTc-ECD SPECT). Relative blood flow changes were calculated by Statistical Parametric Mapping (SPM). Absolute blood flow changes were calculated by a three-dimensional stereotaxic ROI template on anatomically standardised 99mTc-ECD SPECT (3D SRT). Statistically significant correlations between semi-quantitatively measured scores of vitality index and blood flow changes in SPM and 3D-SRT were tested and displayed on a brain map.
  
  
  RESULTS
  Analysis of relative and absolute blood flow showed that the common responsible area in the brain related to vitality was the frontal lobe, fronto-cingulate gyrus, temporal lobe, basal ganglia (caudate nucleus) and thalamus. Blood flow changes in the orbital gyrus were strongly correlated with vitality index specially in the frontal lobe.
  
  
  CONCLUSIONS
  ADL-related vitality is affected mainly by the blood flow in the frontal-subcortical circuit. However, deep white matter was also important to determine vitality and volition.
authors.affiliation: Department of Geriatric Medicine, Kyorin University School of Medicine.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sonohara
authors.forename: Kenji
authors.initials: K
authors.lastname: Toba
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Nakai
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Moriya
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Koiti
authors.initials: K
authors.lastname: Kozaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuda
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D015899:Tomography, Emission-Computed, Single-Photon; D014836:Volition