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.