The course of Alzheimer’s disease (AD) varies between individuals, and the relationship between cognitive and functional decline and the deterioration of behavioral and psychological symptoms of dementia (BPSD) is still poorly understood. Until recently, it was challenging to monitor subsequent changes in these symptoms because there was no single composite scale available that could simultaneously evaluate activities of daily living (ADL), BPSD, and cognitive function (CF) states. The present authors developed a new, brief assessment scale, the “ABC Dementia Scale” (ABC-DS), which is based on item response theory and facilitates concurrent measurement of ADL, BPSD, and CF states. We previously presented the reliability, construct validity, concurrent validity, and responsiveness of the ABC-DS. We obtained the evidence through three clinical trials featuring 1,400 subjects in total. In the present study, we performed a secondary analysis of the data obtained in the previous study. We conducted hierarchical cluster analyses that allowed us to classify 197 AD patients in terms of similarities regarding ADL, BPSD, and CF domain scores, as measured by the ABC-DS. Consequently, the scale identified subgroups of patients with global clinical dementia ratings of 1, 2, and 3. Considering our results in conjunction with the clinical experiences of the AD expert among the present authors regarding longitudinal changes in ADL, BPSD, and CF, we were able to propose potential progression pathways of AD in the form of a hypothetical roadmap.

Aim Most patients with Alzheimer's disease (AD) experience poor food intake and/or loss of appetite, which accelerates cognitive impairment. Several reports have shown that rivastigmine improves appetite in AD patients. The present study investigated the efficacy of a rivastigmine transdermal patch for the treatment of low food intake in AD patients. Methods AD patients, recruited through the Attitude Towards Food Consumption in Alzheimer's Disease Patients Revive with Rivastigmine Effects study, were recognized as experiencing either a loss of appetite or poor food intake. A rivastigmine transdermal patch was administered to study participants for 16 weeks. Patients’ food intake, bodyweight, Mini‐Mental State Examination scores and any adverse events were recorded. Results A total of 38 patients with AD (age 86.2 ± 5.4 years) were examined. Their mean Mini‐Mental State Examination score was 10.1 ± 7.0 at baseline. A significant increase in food intake amount (54.9 ± 98.0 g, P < 0.01) and food intake ratio (9.3% ± 17.6%, P < 0.01) was observed by week 1, improvements that were maintained throughout the study duration. A multiple linear regression analysis showed that no independent variables were significantly associated with changes in food intake amount or ratio. Patients in the higher Mini‐Mental State Examination subgroup showed a trend change in food intake amount, although this did not reach statistical significance (P = 0.07). Conclusions The present study suggests that a rivastigmine transdermal patch might improve poor food intake or loss of appetite in patients with AD. Geriatr Gerontol Int 2019; ••: ••–••.

Introduction: Since pheochromocytomas present with various complications due to catecholamine hypersecretion, their perioperative management needs special attention.Case presentation: A 45‐year‐old man visited our hospital with a complaint of abdominal swelling. Radiological and endocrinological assessments determined the tumor as a giant (>20 cm) cystic pheochromocytoma. After administration of doxazosin, the patient underwent radical surgery. Since the tumor was extremely large and fixed to surrounding structures, we punctured it and aspirated cystic fluid to improve the tumor's mobility. However, during the aspiration, the patient developed acute hypotension, which could be reversed by suction withdrawal and vasopressor administration. A similar event occurred during a second aspiration. Eventually, the tumor was successfully excised with negative surgical margin. The cystic fluid proved to contain extremely high concentrations of catecholamines, which might result in the hypotension.Conclusion: We report the first case who developed acute hypotension due to aspiration of cystic fluid from giant pheochromocytoma.

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is diagnosed when hepatic steatosis is proven by imaging and one of the five cardiometabolic criteria is present. The relationship between MASLD and body composition components has recently received increased research attention. However, the five cardiometabolic criteria do not include components of body composition. This study aimed to identify significant body composition factors associated with MASLD in patients undergoing health checkups. Methods: This study included a cohort of 6599 examinees who participated in a health check-up conducted between 2022 and 2023, and their data were prospectively analyzed. The inclusion criteria were undergoing abdominal ultrasonography, alcohol consumption <30 g/day for males or <20 g/day for females, and one of the five cardiometabolic criteria. Results: Finally, 3864 examinees were enrolled. In total, 1133 (51.8%) males and 454 (27.1%) females had MASLD. Sarcopenia was present in only 0.62% of males and 0.66% of females with MASLD. The MASLD group had significantly lower skeletal muscle mass/weight (SMM/WT) values than the non-MASLD group. Multivariate analysis revealed that SMM/WT was independently associated with MASLD. Conclusions: SMM/WT was significantly associated with MASLD. Therefore, muscle mass assessment using SMM/WT may be a potential marker for diagnosing MASLD.