2.1 CLINICAL EXAMINATIONS
We carried out a chest X-ray examination and evaluated degree of the
cardiac hypertrophy by cardiothoracic ratio (CTR). We evaluated the
existence of pneumonia and pleural effusion at the same time. We
performed Schellong’s test to detect orthostatic hypotension. We carried
out an electrocardiography (ECG), measured bradycardia and QT intervals,
and evaluated bradycardic changes. And we also measured brain
natriuretic peptide (BNP) to examine degree of the heart load. From
these inspections mainly, we diagnosed the autonomic nervous disorder of
the circulatory organ. A urinalysis and the interview about the
urination pattern in daytime and night diagnosed the autonomic nervous
disorder of the bladder. When we detected constipation and diarrhea, or
hypoproteinemia though patients did not suffer from a kind of
gastrointestinal disease and a meal intake was stable, we considered a
gastrointestinal peristalsis disorder. By the electroencephalography
(EEG), we detected the basic rhythm of the alpha wave and evaluated
presence of mixture of slow waves such as θ train or δ waves and mixture
of the sleep status such as βspindle and diagnosed the fluctuating
cognition (FC). When awakening (activity) mixed rest (sleep) during
daytime, we interviewed the frequency and severity of rapid eye movement
sleep behavior disorder (RBD) and frequency to be aware of a dream. As
for the examination of psychology, Mini-Mental State Examination (MMSE)
and the brief questionnaire form of the Neuropsychiatric Inventory
(NPI-Q) were held.27,28 Patients were examined about
neurologic symptoms such as parkinsonism, cerebellar ataxia and so on.
Magnetic Resonance Imaging (MRI) was performed for head scan and diffuse
or localized brain atrophies were detected together with cerebrovascular
changes. And Voxel-based Specific Regional Analysis System for
Alzheimer’s Disease (VSRAD), which is the software used widely, was
conducted.29 In the conventional study, as for the
Z-scores indicating the degree of the hippocampal atrophy, it is shown
that those values grow bigger with the brain atrophy in the progression
of dementia.30 1.0 tesla MRI and version of VSRAD plus
were used in VSRAD of MRI before September in 2017. 1.5 tesla MRI and
version of VSRAD advance 2 were used after September in 2017.