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AIM: To investigate which category in the "Kihon Checklist" developed by the Japanese Ministry of Health, Labor and Welfare can predict functional decline for community-dwelling elderly people at a 2-year follow up. METHOD: We compared comprehensive geriatric assessment (CGA) between "specified elderly individuals" at high risk of requiring long-term care insurance (LTCI) and "uncertified elderly people" (neither certified under LTCI nor "specified"), and also compared CGA between the risk group and non-risk group, in subcategories of the "Kihon Checklist", such as physical strength, nutrition/oral function, overall low score on questions 1-20, houseboundness, cognitive function, and depression risk. The study population consisted of 527 elderly participants aged 75 years and older in a cross-sectional study, and 382 in a longitudinal study. CGA was assessed for basic and higher functional activities of daily living (ADL), depressive symptoms, and quality of life (QOL). The Student's t-test was used in the cross-sectional study and ANOVA with repeated measures was used in the longitudinal analysis. RESULTS: In the cross-sectional study, the risk group had lower functions in all CGA items than the non-risk group in all subcategories of the "Kihon Checklist." In the longitudinal study, Tokyo Metropolitan Institute of Gerontology Index of Competence scores and its three subscales declined in the risk group both in physical and cognitive subcategories compared with the non-risk group, whereas only one or two subscales of Tokyo Metropolitan Institute of Gerontology Index of Competence declined in "specified" and the other two subcategories of the Kihon Checklist CONCLUSION: In both cross-sectional and longitudinal studies, the assessment of physical strength and cognitive function was more useful to detect frail elderly.

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A lack of habituation in visual-evoked potentials (VEPs) is the main abnormality observed in migraineurs. However, no study of steady-state VEPs has yet evaluated pattern-reversal stimuli with respect to habituation behavior or spatial frequency. The aim of this study was to clarify habituation behavior in migraineurs between attacks and to establish characteristics of VEPs in these patients. Steady-state VEPs were sequentially recorded as checkerboard patterns in four consecutive blocks from 12 patients with migraine without aura (MO), 12 patients with migraine with aura (MA), and 12 healthy controls (HC) at four spatial frequencies of 0.5, 1.0, 2.0, and 4.0 cycles per degree (cpd) with a stimulus rate of 7.5 Hz (15 reversal/s). VEP amplitudes were consistently higher in migraineurs. However, habituation was not demonstrated in HCs, and migraineurs did not reveal a clear lack of habituation. MAs exhibited high-amplitude VEPs, depending on spatial frequency. In the MA patients, amplitude differences reached statistical significance at 2.0 cpd. The sequential amplitude changes at 0.5 cpd were significantly different in MAs compared with HCs. Migraine patients exhibited high-amplitude VEPs, which were dependent on spatial frequency, and may be related to altered excitability in pre-cortical and cortical visual processing.

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An 86-year-old, right-handed, hypertensive man suddenly experienced blurring of vision predominating in the left visual field. Neurological examinations were normal, except for left homonymous hemianopsia. Goldmann visual field testing revealed a left congruent incomplete homonymous hemianopsia with macular splitting. Brain MRI, with a T2-weighted image, demonstrated a lesion of high intensity in the right lateral geniculate body (LGB), as well as the posterior part of the caudate nucleus, posterolateral thalamus, and dorsolateral thalamus. MRA revealed severe stenosis at the second segment of right posterior cerebral artery (PCA). SPECT revealed significantly decreased blood perfusion in the striate cortex. To the best of our knowledge, this is the first case of an isolated, congruent, incomplete, homonymous hemianopsia due to lateral posterior choroidal artery (LPChA) region infarction. The LPChA possibly supplied the LGB through the PCA system. A horizontal, homonymous sectoranopia is typically the hallmark of an LPChA region infarction. However, a homonymous hemianopsia may also occur when the entire LGB has been affected. In the case of homonymous hemianopsia, LGB damage due to LPChA region infarction should be considered, in addition to lesions of the visual pathway, such as the optic tract, optic radiations, and occipital cortex.

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BACKGROUND: Although a number of studies reported different interictal findings between migraine with aura (MA) and migraine without aura (MO), the pathophysiology of the visual aura in migraine remains unclear. OBJECTIVE: To investigate the visual processing in patients who experience MA between attacks using steady-state visual evoked potentials (SSVEPs). METHODS: SSVEPs to high (98%) and low (29%) contrast black and white checkerboard gratings with two spatial frequencies (0.5 and 2.0 cpd) at 5 and 10 Hz (10 and 20 reversal/s) were recorded binocularly from 10 patients with MA, 10 patients with MO between attacks and 20 healthy controls (HC). The SSVEPs were Fourier analyzed to obtain the amplitude and phase of the second (2F) and fourth (4F) harmonic response. RESULTS: In the amplitude of 2F, at 0.5 cpd, there was significant increased amplitude in both MA and MO in comparison to HC at 5 Hz in high and low contrast. However, no significant differences were detected at 2.0 cpd in both 5 and 10 Hz in high and low contrast. In the amplitude of 4F, at 2.0 cpd, there was significant increased amplitude in MA in comparison to MO and HC at 10 Hz in high contrast. However, there were no significant differences at 0.5 cpd at both 5 and 10 Hz in high and low contrast. There were no significant phase differences between MA, MO, and HC. CONCLUSION: The high amplitude of the SSVEPs suggests that interictally migraine patients have abnormal excitability in the primary visual cortex, and this change in excitability may exist, at least partially, in the visual association cortex in MA.

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