Dementia and Oral Function
The Official Journal of Japan Research Society for Dementia and Oral Function

Case Report症例報告

補綴治療介入を行った Lewy 小体病に伴う軽度認知障害患者の長期経過観察

Long-term follow-up of patient with MCI due to Lewy body who intervened in prosthetic treatment

木本 克彦，眞鍋 雄太，井上 允，榮元 優，本間 優太，野村 太郎，川西 範繁

Katsuhiko Kimoto, Yuta Manabe, Makoto Inoue, Yu Eimoto, Yuta Honma, Taro Nomura and Norishige Kawanishi

DOI: https://doi.org/10.63587/dof.1-2.p47

抄録：
　超高齢社会に伴い認知症患者が増加する中，前病段階への先制的な予防介入が認知症発症の回避や遅延に期待されている．本症例は，補綴治療介入として全部床義歯を装着したLewy 小体病（Lewy body disease; LBD）に伴う軽度認知障害（mild cognitive impairment; MCI）患者の咀嚼機能と認知機能の変化を長期的に観察した．
　咀嚼機能は，グルコセンサーGS-II（ジーシー，東京，日本）を用いて，咀嚼能力を計測した．認知機能については，非認知症レベルすなわち軽度認知機能障害を評価するJapanese version of Montreal Cognitive Assessment （MoCA-J），認知症をスクリーニングする評価尺度であるMini-mental state examination （MMSE）およびHasegawa dementia rating scale-revised （HDS-R）， さらには手段的日常生活動作を介して社会機能を評価するLawton Instrumental Activity of Daily Living （Lawton-IADL）を用いて，定期的（６か月ごと）に評価した．認知機能は，補綴治療介入後から一時的に改善・維持が認められたものの，その後経時的に低下し，48か月後にMCI から認知症へ移行した． 24か月以降，歯科外来は未来院のため口腔ケアは実施できず，54か月の咀嚼機能は基準値を大きく下回っていた．
　医科歯科連携による日常臨床においてMCI あるいは認知症患者さらにはそのご家族や介護者に対しても口腔ケアの重要性について理解を深めてもらう必要性が示唆された．

キーワード： 長期観察，補綴治療，咀嚼機能，Lewy 小体病，認知機能

Abstract：
As the number of patients with dementia increases in an aging-skewed society, preemptive preventive interventions at the pre-disease stage that could prevent or delay the onset of dementia are increasingly pursued. We report here a case of long-term changes in masticatory and cognitive functions in a patient with mild cognitive impairment (MCI) associated with Lewy body disease (LBD) who was fitted with complete dentures as a prosthetic treatment intervention.
Masticatory function was measured using a Gluco Sensor GS-II (GC, Tokyo, Japan). Cognitive function was evaluated every 6 months using the Japanese version of the Montreal Cognitive Assessment (MoCA-J), which evaluates retention of cognitive abilities; the Mini-Mental State Examination (MMSE) and the Hasegawa Dementia Rating Scale-Revised (HDS-R), which are used to screen for dementia; and the Lawton Instrumental Activity of Daily Living (IADL), which evaluates social function through instrumental activities of daily living. Although cognitive function improved and was temporarily maintained after prosthetic treatment, it eventually declined, and symptoms progressed from MCI to LDB 48 months after initiation of treatment. Masticatory function could not be assessed after 24 months because the patient did not visit the clinic. At 54 months, masticatory function had declined to significantly lower than the reference value.
These data suggest a need for medical and dental collaboration to deepen our understanding of the impact of good oral care on patients with MCI or dementia and on their families and caregivers in daily clinical practice.

Key words： Long-term observation, Prosthetic treatment, Masticatory function, Lewy body disease, Cognitive function