Therapeutic Research

Objectives：To develop a 20‒minute cognitive screening tool of touch‒panel type（Tokyo Cognitive Assessment for MCI, ToCA‒MCI） to assist paramedical staff and first‒line physicians in detecting mild cognitive impairment（MCI）, a clinical state that often progresses to dementia, and to assess the reliability and validity of the ToCA‒MCI in elderly Japanese subjects. Participants：Subjects were recruited from community‒based medical health checks in 2015 and 2016. The ToCA‒MCI, the Mini‒Mental State Examination（MMSE）,the revised version of Hasegawa’s Dementia Scale（HDS‒R）, the Clock Drawing Test （CDT）, the Clinical Dementia Rating（CDR）scale, and routine neurophysiological examinations were conducted on 105 elderly subjects. Mild Alzheimer’s disease （AD） was found in 5 and MCI in 21 subjects. Among the 79 controls, age‒associated cognitive impairment（AACI）affected 22. Measurements：The ToCA‒MCI was administered to all participants. Sensitivity and specificity of the ToCA‒MCI in detecting MCI were assessed. Results：The ToCA‒MCI score was highly correlated with the MMSE（r＝0.664, p＜0.0001）, HDS‒R（r＝0.538, p＜0.0001）, CDT（r＝0.437, p＜0.0001）, and CDR（r＝－0.442, p＜0.0001）scores. The area under the receiver‒operator curve（AUC）for predicting MCI by the ToCA‒MCI was 0.9581（odds ratio＝60.9）. Using a cut‒off point of 17/18, the ToCA‒MCI demonstrated a sensitivity of 92.3％ and a specificity of 83.5％ in diagnosing MCI. Conclusion：MCI is an evolving and somewhat controversial clinical entity. The ToCA‒MCI is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE. The ToCA‒MCI could be a useful cognitive test for screening for MCI. It could be recommended for geriatric health screening in the community as a multi‒player participation‒type screening tool, and for the early detection of MCI in a primary clinical setting.

背景：胃食道逆流症（gastro‒esophageal refluxdisease：GERD）の定型症状は胸やけ，呑酸である。これらの症状発現は患者のQOL を低下させることが報告されている。目的：実臨床下において，カリウムイオン競合型アシッドブロッカー（potassium‒competitiveacid blocker：P‒CAB）であるボノプラザンとプロトンポンプ阻害薬（proton pump inhibitor：PPI）であるエソメプラゾールのGERD 症状改善効果を比較検討する。方法：2016 年10 月～2017 年1 月までに当院で内視鏡検査により逆流性食道炎（refluxesophagitis：RE）と診断した患者のうち，GlobalOverall Symptom（GOS）問診票で胸やけまたは呑酸の症状が「4（中くらいに困った）以上」と回答した患者45例を本研究の対象とした。ボノプラザン投与群（20 mg 1 日1 回を4 週間投与後，10 mg 1 日1 回もしくは20 mg 1 日1 回を4週間投与）またはエソメプラゾール投与群（20mg 1 日1 回を8 週間投与）に無作為に割り付け，投与4 週後および8 週後の症状をGOS およびFrequency Scale for Symptoms of GERD（FSSG）を用いて評価した。結果：GOS によるGERD 症状改善率は，ボノプラザン群およびエソメプラゾール群でそれぞれ4 週後55.0％および60.0％，8 週後50.0％および84.2％，胸やけ症状改善率は4 週後58.8％ および57.1％，8 週後46.2％ および86.7％，呑酸症状改善率は4 週後50.0％および64.7％，8 週後57.1％および92.3％で，いずれも8 週後においてエソメプラゾール群で有意に高い改善が認められた（いずれもp＜0.05）。GERD症状消失率はボノプラザン群およびエソメプラゾール群でそれぞれ，4 週後25.0％ および24.0％，8 週後37.5％および47.4％であった。FSSG スコア（トータルスコア，酸逆流関連症状スコア，運動不全症状スコア）は両群ともに投与前と比べて4 週後，8 週後にスコア低下が認められた。忍容性は両薬剤ともに良好であったが，ボノプラザン群の3 例で症状の悪化により投与を中止した。結論：実臨床下において，ボノプラザンおよびエソメプラゾールはいずれもGERD 患者の症状を改善した。症状改善効果にはボノプラザン群とエソメプラゾール群で差が認められたが，これには運動不全に関連する症状が影響している可能性が考えられた。

An 80‒year‒old woman with hepatitis C developed diabetes mellitus（DM）and initiated alogliptin monotherapy 25 mg/day. HbA1c improved from 10.2％ to 9.5％ by 4 weeks, 9.0％ by 7 weeks, 8.5％ by 11 weeks, 6.9％ by 17 weeks, and 6.8％ by 21 weeks. She however quitted alogliptin intake. As a result, the HbA1c levels gradually deteriorated from 6.8％ to 7.9％ by 6 weeks and to 9.4％ by 10 weeks. Five months were required to reach stable status of DM control around HbA1c 6.5％（3.4％ of improvements）, and 10 weeks were required to worsen by 2.6％. The definite, gradual, and slow improvements in DM control as well as the gradual deterioration after quitting the monotherapy could be explained by recovered β cell proliferation in the Langerhans islet.