Neuropathological analysis of dementia in a Japanese leprosarium.

In a neuropathological study of consecutive autopsies, prevalence and cause of dementia in a Japanese leprosarium were investigated, where more than 95% of inpatients with a mean age of 70 years are now free from active leprosy. In 10 years (1983-1992), clinically overt dementia at death was 35/136 (25.7%) in the age group over 65 years (mean age 79.4). Autopsy was performed in 85 cases (mean age 81 years), and clinically overt dementia was seen in 25 subjects (29.4%). Neuropathologically, Alzheimer's disease (AD) was seen in 9 cases (10.6%), vascular dementia (VD) in 9 cases (10.6%), mixed type in 3 cases (3.5%) and unclassified in 4 cases (4.7%). In the age group of 65-84 years, AD was 5/58 (8.6%), VD was 4/58 (6.9%), mixed type was 2/58 (3.4%), and unclassified was 1/58 (1.7%). Compared with previous Japanese general population-based data, where VD was more frequent than AD, the rate of dementia in our leprosarium was high, and pathologically confirmed AD was as common as VD. Recently, a prophylactic effect of the antileprosy and anti-inflammatory drug DDS (dapsone, 4,4'-diaminodiphenyl sulfone) has been suggested. Lepromatous patients take more DDS (51.9%) than tuberculoid patients (11.5%), however, as the dementia rate of tuberculoid leprosy (17.9%) in those 65-84 years old is similar to lepromatous leprosy (15.9%) in our study, we do not support their viewpoint.