JP2023093254A - Screening support apparatus - Google Patents

Abstract

To provide an apparatus for supporting screening which can obtain a determination result in a short time with a less invasion.SOLUTION: A screening support apparatus comprises: a transmitter which is configured to be able to receive an ultrasonic wave at a prescribed frequency focusing on a specific position to irradiate an internal jugular vein with the ultrasonic wave; a receiver which is configured to be able to measure the intensity of the reflected ultrasonic wave; a blood vessel ultrasonic inspection device which includes at least an image formation device configured to be able to show a point on an image corresponding to the specific position with the concentration difference according to the measured reflection intensity; and a determination device which is configured to be able to determine whether or not the image by the concentration difference display in the internal jugular vein shown by the blood vessel ultrasonic inspection device is a smoky echo.SELECTED DRAWING: Figure 1

Description

Applied for application of Article 30, Paragraph 2 of the Patent Law ・STROKE 2021 (46th Annual Meeting of the Japanese Stroke Society, 50th Annual Meeting of the Japanese Society of Stroke Surgery, 37th Spasm Symposium) Stroke O-018-6 ・No. The 62nd Annual Meeting of the Japanese Society of Neurology Pe-07-03 ・The 40th Annual Meeting of the Japanese Society of Cranial Ultrasound / The 24th Japanese Society of Embryo Detection and Treatment Symposium 7 ・Journal of Alzheimer's Disease 84(2)787-796

The present invention relates to an apparatus for assisting screening for Alzheimer's disease and the like. More specifically, the present invention relates to a device that assists screening for Alzheimer's disease or the like, which is less invasive and capable of producing judgment results in a short time.

Cervical ultrasonography is known as an examination for examining the state of arteriosclerosis, and examines the thickness of the wall of the carotid artery, the narrowness of the carotid artery and its degree. At that time, plaques, malformations (vasodilatation, narrowing, tortuosity of blood vessels, etc.), thyroid abnormalities, lymph node abnormalities, etc. may be discovered.

For example, Patent Literature 1 describes a disease or aortic artery provided with evaluation means for evaluating the presence, risk or degree of disease or aortic sclerosis based on the late systolic peak flow velocity _V2 calculated from the carotid artery blood flow waveform of a subject. A cure evaluation device is disclosed. Examples of diseases include dementia, Alzheimer's disease, Binswanger's disease, cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, cerebral white matter lesions, perivascular space, amyloid angiopathy, and hydrocephalus. An ultrasonic device with a transducer (for example, an ultrasonic probe) is exemplified as a blood flow measuring device.

Patent document 2 uses a device with a built-in ultrasonic displacement meter and an ultrasonic Doppler blood flow meter, attaches the probe of the ultrasonic displacement meter to a location that anatomically matches, A cervical brain characterized by measuring the blood vessel function from the horizontal axis displacement of eight blood vessels in the sinus, the internal neck, and the left and right of the vertebrae, and measuring the blood flow as a velocity of cm/sec by the ultrasonic Doppler blood flow meter. A method for measuring hemodynamics is disclosed.
Thus, the carotid artery was the primary target for neck ultrasonography.

By the way, dementia refers to a state in which cognitive functions (thinking ability, memory ability, logical reasoning ability) and behavioral ability are lost to the extent that daily life and activities are hindered. The top two causes of dementia are Alzheimer's disease and vascular dementia, caused by multiple strokes or changes in the blood supply to the brain. Alzheimer's disease is an irreversible, progressive brain disease that slowly impairs memory and thinking skills, eventually leading to loss of the ability to perform even the simplest tasks of everyday life. At present, no decisive factor for treating and completely curing Alzheimer's disease is known. Early detection of the signs of Alzheimer's disease allows more time for people with Alzheimer's disease and their families to receive appropriate treatment and plan for the future.

In connection with early detection of signs of Alzheimer's disease, reports have been made suggesting the possibility of association between memory impairment, vascular dementia, Alzheimer's disease, etc. and the jugular vein.

For example, Non-Patent Document 1 states that it suggests that there may be a link between jugular reflux and cerebral white matter changes in Alzheimer's disease patients.

(2005), although further investigation is needed, jugular reflux is associated with intracranial structural changes in patients with mild cognitive impairment and Alzheimer's disease, and jugular reflux retrogradely transmits venous hypertension to the brain. and may suggest that it causes swelling of brain tissue due to vasogenic edema.

Non-Patent Document 3 describes that transient global amnesia is considered to be a heterogeneous disease caused by various pathologies such as ischemia, hypoxia, epileptogenicity, and amyloid β toxicity. Congestion is assumed to be the prevailing pathophysiology, he said. Non-Patent Document 7 states that the essence of senile plaques, which is one of the pathological features of Alzheimer's disease, is the accumulation of amyloid β protein.

In ultrasonography, it is sometimes observed that smoke or granular images are floating with slow swirling movements. This is called a moyamoya echo (smoke like echo, smoky echo, spontaneous echo contrast). Moyamoya echo is considered to be caused by agglutination of red blood cells (approximately 8 μm in size) and rouleaux formation of red blood cells, and is an important finding indicating a tendency to form thrombi.

According to Non-Patent Document 4, moyamoya echo is seen in areas of blood flow stasis and is caused by hemagglutination, and if hemagglutination occurs, thrombi are likely to form. They reported venous moyamoya echo and blood flow disruption in the left internal jugular vein.

Non-Patent Document 5 found a heterogeneous thrombus that filled the proximal part of the left internal jugular vein and had Echolucent inside (semi-transparent to the wavelength of the sonograph), and furthermore, in the distal part of the left internal jugular vein, Mural thrombi and floating moyamoya echoes were observed.

Non-Patent Document 6 describes that Moyamoya echo is an image that reflects aggregation of red blood cells and is said to suggest a tendency to form a thrombus. It is detected indoors and even in aortic aneurysms, and while its existence is a risk of cerebrovascular disease, it is also recognized in healthy people.

JP 2020-120839 A JP-A-11-33025

Chih-Ping Chung et al. "Jugular venous reflux and white matter abnormalitiesin Alzheimer's disease: a pilot study" J. Alzheimers Dis 2014;39(3):601-9.doi: 10.3233/JAD-131112. Clive Beggs et al. "Jugular venous reflux and brain parenchyma volumes in elderly patients with mild cognitive impairment and Alzheimer's disease" BMC Neurol. 2013; 13: 157. Published online 2013 Oct 31. Masahiro Nakamori et al., "Usefulness of internal jugular vein blood flow evaluation by jugular vein echocardiography" Neurosonology 31(3): 125-129, 2018 Yoko Hakoishi et al., "A Case of Internal Jugular Vein Occlusion" Ultrasonography Techniques Vol. 22, No. 4 (1997), 8(227)-11(230) Miho Yoshikawa, et al., "A case of internal jugular vein thrombus found incidentally during carotid artery ultrasonography," Sonography Gijutsu Vol. 32, No. 4 (2007), 6(418)-9(421) Yasunori Sajida, et al., "Two cases of high-density internal jugular vein haze echoes accidentally discovered by ultrasonography," The Japanese Society of Ultrasonics in Medicine Electronic Journal Vol. 40, 2013 Akihiro Shindo, "Small vessel disease and Alzheimer's disease, Glymphatic system as an amyloid-β clearance system," Neurotherapy Vol. 36, No. 4 (2019) 524-527

SUMMARY OF THE INVENTION An object of the present invention is to provide an apparatus that supports screening for Alzheimer's disease or the like, which is less invasive and can produce judgment results in a short period of time.

As a result of intensive studies to solve the above problems, the present invention including the following aspects has been completed.

[1] A transmitter configured so that ultrasonic waves of a predetermined frequency focused on a specific position can be applied to the internal jugular vein, and the intensity of the reflected ultrasonic waves can be measured. A blood vessel ultrasound examination apparatus having at least a configured receiver and an imaging device configured to be able to show a point on the image corresponding to a specific position with a shade according to the measured reflection intensity, and A determination device configured to determine whether or not an image of the internal jugular vein displayed by a vascular ultrasonography device is a moyamoya echo,
having
Screening support device.

[2] A transmitter configured to inject ultrasonic waves of a predetermined frequency and apply them to the internal jugular vein, a receiver configured to measure the frequency of the reflected ultrasonic waves, and an internal jugular vein. A vascular ultrasonic examination apparatus having at least a blood flow measuring device configured to indicate the velocity of blood flowing in a vein according to the incident frequency and the measured reflected frequency, and the vascular ultrasonic examination apparatus A determination device configured to determine whether the velocities of retrograde blood flow and antegrade blood flow in the internal jugular vein are equal to or less than predetermined values, respectively;
having
Screening support device.

[3] The screening support device according to [1] or [2], further comprising a display device configured to indicate a disease or disease at risk of onset based on the determination made by the determination device.

[4] The screening support device according to [1], wherein the image displayed in gray scale is a moving image.
[5] The screening support device according to [2], wherein the display of speed is color-coded display.

The apparatus for assisting screening of the present invention is less invasive and can produce judgment results in a short period of time. The result of the determination is useful as one of indices for diagnosing the onset and risk of developing Alzheimer's disease and the like.

A: The left side shows the pressing position of the probe in examination of the internal carotid artery and the internal jugular vein, and the right side shows an example of a short-axis tomographic image observed by ultrasonography. B: Upper left is Moyamoya Echo (+) short-axis tomographic image, lower left is Moyamoya Echo (+) long-axis tomographic image, upper right is Moyamoya Echo (-) short-axis tomographic image, lower right is Moyamoya Echo (-) An example of a long-axis tomographic image is shown. C: Indicates the cross-sectional area (cm ² ) of the internal jugular vein. D: Indicates the diameter (cm ² ) of the internal jugular vein. E: Shows an example of measurement results of blood flow velocity in the internal jugular vein. Fig. 2 shows the correlation between the average velocity of retrograde or antegrade blood flow in the internal carotid artery (IJV) and the cognitive function score. Figure 2 shows the correlation between the mean velocity of retrograde or antegrade blood flow in the internal carotid artery (IJV) and the Phasekas scale.

A screening support apparatus of the present invention comprises a blood vessel ultrasonic examination apparatus and a determination apparatus.

A blood vessel ultrasound examination apparatus, which constitutes a screening support apparatus in one embodiment of the present invention, has at least a transmitter, a receiver, and an imaging device.
A blood vessel ultrasound examination device, which constitutes a screening support device according to another embodiment of the present invention, has at least a transmitter, a receiver, and a blood flow measurement device.
A blood vessel ultrasonic examination apparatus used in the present invention may have a transmitter, a receiver, an imaging device, and a blood flow measuring device.

The transmitter is constructed so that it can enter an ultrasonic wave of a predetermined frequency and apply it to the internal jugular vein.
On the other hand, the receiver is constructed so as to be able to measure the intensity or frequency of the reflected ultrasonic waves. The receiver may use filters or the like to eliminate artifacts.

The probe (probe) consists of a transmitter configured so that ultrasonic waves of a predetermined frequency can be applied (transmitted) to an object such as the internal jugular vein, and the strength or frequency of the reflected ultrasonic waves is measured. and a receiver configured to be able to receive.

Considering the sensitivity of observing red blood cell aggregation or rouleaux with a size of about 8 μm, which is considered to be the essence of Moyamoya echo, the center frequency of the ultrasonic wave is preferably 7 MHz or higher, more preferably 15 MHz or higher. It is preferably 30 MHz or higher. Considering deep observation, the upper limit of the center frequency of ultrasound is preferably 40 MHz.
Preferably, the ultrasound beam is narrowly focused in order to focus the ultrasound on a specific position. Convergence of ultrasonic waves is performed by forming ultrasonic waves in a spherical shape by using an acoustic lens or by making a transducer that emits ultrasonic waves spherical.

As for the probe used for tomographic imaging, it is generally preferable to use a linear probe with a visual field width of 3 to 4 cm, considering the blood vessel morphology and running depth. For observation of a portion of the internal jugular vein that runs deep, a linear probe, a convex probe, and a sector probe of around 5 MHz can be used. The probe is configured so that transmission and reception can be repeated (electronic scanning) while shifting the above-mentioned specific position little by little.

The imaging device is configured so that points on the image corresponding to specific locations can be shown with shading according to the measured reflection intensity. Then, the imaging device can display the distribution of the reflection intensity as a distribution of densities by the above-described electronic scanning, and form an image of the tomogram. An image by gray scale display may be a still image or a moving image, but a moving image (for example, a digital moving image) is preferable.

The imaging device can image, for example, short-axis and long-axis slices of the internal jugular vein.
Images are preferably displayed in a unified manner in consideration of machine learning and the like. The short-axis tomogram of the internal jugular vein can be, for example, a bird's-eye view of the subject in the supine position from the leg side. The long-axis tomogram of the internal jugular vein can be, for example, an image viewed from the right side of the subject in the supine position, or an image in which the peripheral side of the blood vessel is located on the left side. In consideration of machine learning and image viewing at other facilities, comments and body marks can be displayed on recorded images.

In the short-axis tomography, it is preferable to perform observation by applying ultrasonic waves from at least two directions, for example, from the side of the internal jugular vein and from the front of the internal jugular vein. This makes it possible to mutually compensate for poorly rendered regions.
In long-axis tomography, it is preferable to visualize the central section of the long axis of the blood vessel. When the long-axis cross-section deviates from the center of the blood vessel, the blood vessel diameter may be evaluated as small, and the blood vessel thickness may be evaluated as large. In the long-axis tomography, it is preferable to inject and observe ultrasonic waves from at least two directions, for example, from the side of the internal jugular vein and from the front of the internal jugular vein. As a result, a plurality of long-axis tomographic images can be obtained, and the possibility of more accurate determination can be expected.

For example, echo gain, focus point, dynamic range, distance resolution, image size (display depth), etc. can be mentioned as imaging condition settings, although they differ depending on the specifications of the ultrasonic inspection apparatus. Even if the specifications are the same, the imaging conditions may be subtly different for each ultrasonic inspection apparatus. Therefore, for example, in consideration of machine learning and image viewing at other facilities, in order to achieve unified imaging, conditions are set based on images of objects such as bones that have almost no change in sensitivity to ultrasound waves. can do.

The blood flow measuring device is configured to be able to indicate the velocity of blood flowing through the internal jugular vein or the direction of blood flow according to the incident frequency and the measured reflected frequency.
The blood flow measurement device can use a color Doppler method, a pulse Doppler method, or the like. Since the color Doppler method and the pulse Doppler method are known technical methods, a detailed explanation is omitted. , Hideyuki Hasegawa, "Chapter 5 Medical Ultrasound," The Institute of Electronics, Information and Communication Engineers, "Knowledge Base," Group 1-10 (Ver.1/2014.10.24).

Ultrasonic waves for blood flow measurement preferably have a center frequency of 3 to 5 MHz. Moreover, the probe used for blood flow measurement is preferably a convex probe or a sector probe from the viewpoint of easy operation and securing a better Doppler incident angle.

It is preferable that the display hues of the color Doppler method be unified. For example, blood flow toward the probe can be red (warm) and blood flowing away from the probe can be blue (cool), or vice versa. In addition, the direction of flow can be identified by displaying a color bar on the recorded image. However, although the color Doppler method displays the direction of flow by color, it is sometimes poor in quantification.

In the pulsed Doppler method, the direction of blood flow relative to the baseline of the Doppler blood flow waveform is displayed, for example, by displaying blood flow toward the probe above the baseline (positive direction) and blood flow away from the probe below the baseline (negative direction). and vice versa. In addition, the flow direction can be identified by describing the blood flow direction in the recorded image. In addition to the waveform graph display, the speed can also be displayed numerically and color-coded. Furthermore, simultaneous recording of electrocardiograms is useful when distinction between arteries and veins and evaluation of blood flow waveforms are required.

In order to measure the velocity of blood flow as accurately as possible, it is preferable to operate the probe so that the angle (Doppler incident angle) formed by the running blood vessel (direction of blood flow) and ultrasound (Doppler beam) is small. It is preferable to standardize the Doppler incident angle in consideration of machine learning and image viewing at other facilities.
Then, while observing the blood flow waveform in real time, it is possible to adjust the flow velocity range, zero shift, filter, etc. to optimum conditions and record a still image of the pulsed Doppler blood flow waveform.
In the screening test, maximum systolic blood flow velocity, end-diastolic blood flow velocity, average blood flow velocity, and, if necessary, systolic acceleration time, resistance coefficient, pulsatility coefficient, etc. can be recorded. In addition, the velocity difference between the right internal jugular vein and the left internal jugular vein and, if there is a stenosis, the velocity difference before and after that can be recorded.

The body position of the subject when observing the internal jugular vein is usually the supine position. The sitting position or posture change may be performed in consideration of the subject's condition and examination environment.
In the supine position, the chin is slightly lifted, and the face is tilted from the midline position to the opposite side of the observation side by about 30 degrees, allowing the examination to be performed in the position that is most comfortable for observation. Furthermore, depending on the body type, it may be easier to observe if a pillow or towel is inserted into the back of the scapula.

Simultaneous recording of biological signals is preferably performed for the presence or absence of moyamoya echoes and for measuring the velocity of blood flow. For example, simultaneous recording of an electrocardiogram in which the systole and diastole of the heart can be identified can be mentioned. Since bradycardia, hypotension, respiratory depression, etc. may occur during the examination, wearing an electrocardiogram is effective, and it is preferable to observe and record the respiratory status at the same time.

Artifacts such as side lobes, multiple reflections, and the like may be visualized in the ultrasonic inspection apparatus. In order to reduce it, for example, measures such as changing the incident direction of the ultrasonic waves and changing the positional relationship between the blood vessel and the surrounding tissue by pressing with a probe can be taken. Images with artifacts may affect the accuracy of machine learning and judgment. For example, in order to distinguish between true vascular lumens and false vascular lumens due to artifacts, blood flow observation can be performed using a color Doppler method or the like. The blood flow rate can be calculated based on the blood vessel inner diameter measured in the tomographic image.

A determination device, which constitutes a screening support device according to an embodiment of the present invention, is capable of determining whether or not an image of the internal jugular vein displayed by the ultrasound examination device is a moyamoya echo. It is composed of
The determination device, which constitutes the screening support device according to another embodiment of the present invention, determines whether the velocities of retrograde blood flow and antegrade blood flow in the internal jugular vein indicated by the angiographic ultrasonography device are each a predetermined value or less. It is configured to be able to determine whether or not there is.
The determination device used in the present invention determines whether or not the image of the internal jugular vein displayed by the ultrasonic angiography device is a moyamoya echo, and determining whether or not the velocities of the flow and the anterograde blood flow are each equal to or less than a predetermined value.

Determination of whether or not it is a moyamoya echo can be performed by, for example, an image discrimination device. The image discrimination device calculates the feature amount (area, center of gravity, length, position, brightness, color, etc.) of the object drawn in the image or specified by the image data, and calculates the feature of the object prepared in advance. can be contrasted with quantity. Further, the image discrimination device may perform machine learning on an image related to a moyamoya echo, and determine whether or not the image is a moyamoya echo based on the learning result.

The determination as to whether or not the velocities of the retrograde blood flow and the anterograde blood flow are equal to or less than a predetermined value can be performed, for example, by processing using an arithmetic device. The arithmetic unit is a converter configured to receive measured speed data and speed data prepared in advance (threshold value, etc.) as electrical signals, perform arithmetic processing, and output the arithmetic results. be.

The screening support device of the present invention is a display device configured to be able to indicate the onset and risk of onset of a disease based on the determination made by the determination device and, if necessary, the characteristic value and/or the recorded information. can further comprise
Diseases include, for example, dementia, Alzheimer's disease, Binswanger's disease, cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, cerebral white matter lesions, perivascular space, amyloid angiopathy, brain diseases such as hydrocephalus; angina pectoris, myocardium Cardiac diseases such as infarction, aortic aneurysm, aortic dissection, valvular disease, cardiomyopathy, atrial septal defect, cardiac tumor, heart failure, and arrhythmia; Among these, the screening support device of the present invention is suitable for screening for Alzheimer's disease because it has high accuracy in determining the risk of developing Alzheimer's disease.

Experimental examples are shown below, and the effects and the like of the screening support device of the present invention will be described.

Experimental Example First, 122 inpatients were enrolled. These patients had various diseases, eg neurological disease, dementia. Patients with severe acute stroke were excluded from the study. Severe acute stroke was hospitalized within 7 days after stroke onset and was defined by the National Health Stroke Scale at ≥20 hospitalizations. Age, gender, medical examination, AD diagnosis, cognitive function tests [short-term mental status test (MMSE), revised Hasegawa simple intelligence rating scale (HDS-R), frontal lobe function test (FAB) for all registered patients ], atrial fibrillation (AF), phasecas scale, and IJV feature values were recorded.
AD diagnosis is made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases, Eleventh Edition (ICD-11) in two neurologically blinded persons with at least 10 years of experience and jugular vein information. done by a doctor.
Vascular dementia (VaD) was also diagnosed based on the 4th Consensus Report for Dementia with Lewy Bodies (DLB) based on the diagnostic criteria of the National Institute of Neurological Disorders and Stroke. DLB Consortium Revised Diagnostic Criteria "Possible" and Revised Idiopathic Normal Pressure Hydrocephalus (iNPH) Based on Diagnostic Criteria "Possible" in Guidelines for the Management of Idiopathic Normal Pressure Hydrocephalus (3rd Edition) bottom.
The Fazekas scale assesses periventricular lesion grading and deep subcortical white matter lesion grading using the Magnetic Resonance Imaging (MRI) Fluid Attenuated Reversal Recovery (FLAIR) sequence and is a cervical scale with >5 years of experience. It was performed by two neurologists who were blinded to the vein information. We also calculated the rate of use of antiplatelet drugs or anticoagulants.

Patients diagnosed with AD were divided into two subgroups according to their MMSE score, the MMSE<10 group (low MMSE group) and the baseline MMSE ≥10 group (high MMSE group), and were analyzed according to AD severity. Analysis was carried out.

The experiments in Experimental Examples were approved by the ethics committee and approved by the institutional review board based on the guidelines (No. 20-054#Rin approval). All participants provided informed consent to participate in the experiment.

(Examination of internal jugular vein)
While the subject was lying supine on the bed, the internal jugular vein (IJV) was examined using an angiography system (ProSound Alpha 7 unit (Hitachi, Tokyo); linear probe) (Fig. 1). Specifically, in either the right IJV or the left IJV, Moyamoya echo (+) or both the right IJV and left IJV are moyamoya echoes (-), along with inspection, cross-sectional area (cm ² ), diameter (mm ), retrograde blood flow velocity (cm/s, blood flow to the brain), and anterograde blood flow velocity (cm/s, blood flow to the heart) were measured. In addition, cross-sectional area (cm ² ), diameter (mm), retrograde blood flow velocity (cm/s, blood flow to the brain) and anterograde blood flow velocity (cm/s, blood flow to the heart) ) were calculated respectively.

The first answer sought by this experiment is whether there is a correlation between AD diagnosis and IJV moyamoya echo. The second answer sought by this experiment is whether there is a correlation between the Moyamoya echo of the IJV and cognitive function, the phasecas scale or AF, and whether the cross-sectional area (cm ² ), diameter (mm) or velocity in the IJV (cm/s) are correlated to AD diagnosis, cognitive function, the phasecas scale or AF.

(Data analysis method)
All statistical analyzes were performed using JMP15 statistical software (SAS Institute, Cary, NC). Data are expressed as median ± interquartile range (IQR) and analyzed using the chi-square test, the nonparametric Wilcoxon rank sum test, or Spearman's rank correlation coefficient. Data with p<0.05 were considered statistically significant.

(result)
[Patient characteristics]
Patient characteristics are shown in Table 1. A total of 112 patients were included in this study. Seventy patients (62.5%) were hospitalized for cerebrovascular disease and 42 patients (37.5%) were hospitalized for non-cerebrovascular disease.
The rate of cranial MRI performed was 97.3%. (Three patients were unable to undergo MRI because of contraindications; two were due to permanent pacemakers and one was claustrophobic). The percentage of antiplatelets used was 43.8% and the percentage of anticoagulants used was 30.4%. Twenty-six patients (23.2%) were diagnosed with AD and a total of 22 (19.6%) had AF. Twenty-six AD patients were divided into two subgroups based on MMSE scores: low MMSE group (n=14) and high MMSE group (n=12).

[Correlation between Moyamoya echo and AD diagnosis]
Table 2 shows the results of the correlation between AD diagnosis and IJV moyamoya echo. The percentage of moyamoya echo (+) in both IJVs or either IJV was 25 out of 26 AD patients (96.2%). IJV Moyamoya Echo for AD gave a negative predictive value of 98.5% and a positive predictive value of 53.2%. According to the AD severity subgroups, there was no significant difference in the percentage of moyamoya echoes between the high and low MMSE groups.

[Correlation between Moyamoya echo and cognitive function, phasecas scale, AF or antiplatelet/anticoagulant]
Table 3 shows the results of the correlation between IJV moyamoya echo and cognitive function, phasecas scale and AF.
All cognitive function scales, MMSE, HDS-R and FAB were significantly lower in the IJV Moyamoya Echo (+) group than in the IJV Moyamoya Echo (-) group ( ^*** p<0.001, respectively, ^*** p<0.001, ^** p<0.01).

Both the phasecas scale, periventricular lesion (PVH) and deep subcortical white matter lesion (DSWMH) were significantly higher in the Moyamoya Echo (+) group than in the Moyamoya Echo (-) group (respectively, ^*** p <0.001, ^*** p<0.001).
The rate of AF was significantly higher in the Moyamoya Echo (+) group than in the Moyamoya Echo (-) group ( ^* p<0.05). All persistent AF patients (n=7) showed moyamoya echo at IJV.
There was no significant difference between the (+) and (-) groups of antiplatelet drug use.
The rate of moyamoya echo (+) was significantly higher in the (+) group using anticoagulants ( ^* p<0.05).

[Correlation between characteristic value of internal jugular vein and AD diagnosis, cognitive function, phasecas scale, AF, antiplatelet drug use or anticoagulant drug use]
The results of the correlation between the average IJV cross-sectional area (cm ² ), diameter (mm), retrograde blood flow velocity or anterograde blood flow velocity (cm/s), and cognitive function or phasecas scale Shown in FIGS. Table 4 shows the results of the correlation between each IJV feature value and AD or AF. MMSE, HDS-R, FAB, PVH, or DSWMH scores were not significantly correlated with mean cross-sectional area or diameter, but were significantly correlated with mean velocities of retrograde or antegrade blood flow. showed a correlation. Mean velocities of retrograde or antegrade blood flow in IJV were positively correlated with cognitive function scores (Fig. 2). In contrast, the mean velocity of retrograde or antegrade blood flow in IJV was negatively correlated with the phasecas scale (Fig. 3).
Mean velocities of IJV retrograde or antegrade blood flow were significantly lower in patients with a diagnosis of AD than in patients without a diagnosis of AD ( ^*** p<0.001, respectively). and ^*** p<0.001), but there was no difference in mean cross-sectional area or diameter (Table 4).
According to the AD severity subgroups, there were no significant differences in the mean velocities of IJV retrograde or antegrade blood flow between the high and low MMSE groups.
There was no significant difference in IJV feature values between the (+) and (-) antiplatelet use groups, or between the (+) and (-) anticoagulant use groups.

These results show that 1) IJV moyamoya echoes and velocities are significantly correlated with AD, but not cross-sectional area or diameter. 2) Moyamoya echoes and velocity are significantly correlated with cognitive function and phasecas scale, and 3) Moyamoya echoes are significantly correlated with AF. These findings suggest that a low average velocity of Moyamoya echo (+) of IJV or retrograde or antegrade blood flow is associated with a high risk of AD and dementia. It is useful in screening for diagnoses such as AD, suggesting that intracranial venous congestion may be associated with AD pathology.

As described above, the apparatus for assisting screening of the present invention is less invasive and can produce judgment results in a short period of time. The judgment result can be expected to be one of the risk indicators for the onset and onset of Alzheimer's disease and the like.

MMSE: Short-term Mental Status Test HDS-R: Revised Hasegawa Simple Intelligence Scale FAB: Frontal Lobe Function Test PVH: Periventricular Lesion DSWMH: Deep Subcortical White Matter Lesion

Claims (5)

A transmitter configured to emit ultrasonic waves of a predetermined frequency focused on a specific position and apply them to the internal jugular vein, and configured to measure the intensity of the reflected ultrasonic waves. A vascular ultrasound examination apparatus having at least a receiver and an imaging device configured to be able to show a point on an image corresponding to a specific position with shading according to the measured reflection intensity, and vascular ultrasound A determination device configured to determine whether or not an image of the internal jugular vein shown by the inspection device by grayscale display is a moyamoya echo,
Screening support device. A transmitter configured to inject ultrasonic waves of a predetermined frequency and apply them to the internal jugular vein, a receiver configured to measure the frequency of the reflected ultrasonic waves, and the internal jugular vein. A vascular ultrasound examination apparatus having at least a blood flow measuring device configured to indicate the velocity of flowing blood according to an incident frequency and a measured reflected frequency, and an internal jugular vein indicated by the vascular ultrasound examination apparatus A determination device configured to determine whether the velocities of the retrograde blood flow and the anterograde blood flow in the
Screening support device. 3. The screening support device according to claim 1, further comprising a display device configured to display diseases at risk of onset or onset based on the determination made by the determination device. 2. The screening support device according to claim 1, wherein the image displayed in gray scale is a moving image. 3. The screening support device according to claim 2, wherein the display of speed is a color-coded display.

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