Ryouhei Ishii

Introduction: Anxiety is a prevalent behavioral and psychological symptom of dementia (BPSD) in older adults with cognitive impairment, severely diminishing their quality of life. Although reminiscence therapy (RT) is a promising non-pharmacological intervention, objective neurophysiological methods to evaluate its immediate emotional impact remain unexplored. This pilot study proposed “Smart Reminiscence Therapy (SRT)” – a novel virtual reality (VR) system integrated with synchronized multisensory stimuli – and evaluated its immediate anxiety-reducing effects and the utility of electrophysiological measures. Methods: A single-session, single-arm pre-post exploratory design was adopted. Twenty older adults (aged 65 years or older) at a day service center, with Mini-Mental State Examination-Japanese (MMSE-J) scores of 11–30, participated. The intervention consisted of a 10-min SRT session featuring a 1960s Japanese townscape. The primary outcome was objective resting-state eye-closed frontal alpha asymmetry (FAA) via a wearable EEG device, while subjective state anxiety via the State-Trait Anxiety Inventory (STAI) was evaluated as a secondary outcome. Results: After excluding three participants with excessive artifacts, 17 participants (mean age: 85.9 ± 5.9 years; mean MMSE-J: 23.8 ± 3.8, with 64.7% clustered in the MCI-to-mild-dementia range) were analyzed. Subjective STAI scores showed a non-significant decreasing trend with a moderate effect size ( p = 0.088, r = 0.414). Conversely, the FAA index significantly increased post-intervention ( p = 0.038, Cohen’s d = 0.55). No significant correlation was found between changes in STAI and FAA (r = −0.15, p = 0.562). Conclusion: A single session of SRT was associated with an increase in FAA; however, the uncontrolled design precludes causal attribution to the intervention. The dissociation between subjective reports and neurophysiological changes suggests that FAA may complement self-reported measures by capturing aspects of acute emotional change that may be difficult to verbalize in people with cognitive impairment. The non-significant but moderate-sized reduction in STAI scores warrants confirmation in larger controlled studies.

Background/Objectives: This exploratory pilot study examined whether motor imagery ability is associated with electroencephalography (EEG) oscillatory activity during single-joint motor imagery. Methods: Eleven healthy young adults performed motor execution, kinesthetic motor imagery (KMI), and visual motor imagery (VMI) of right wrist dorsiflexion. Motor imagery ability was assessed using the Kinesthetic and Visual Imagery Questionnaire (KVIQ). Time–frequency EEG data were analyzed using cluster-based permutation tests. Based on the study hypotheses, kinesthetic KVIQ scores were examined in relation to task-onset-locked KMI activity, and visual KVIQ scores were examined in relation to task-offset-locked VMI activity. A Bonferroni-adjusted threshold of p < 0.025 was applied across the two analyses. Results: No condition-level EEG differences were observed among motor execution, KMI, and VMI. Kinesthetic KVIQ scores were negatively associated with 6.5–13 Hz activity at O1 during KMI (p = 0.024), whereas visual KVIQ scores were positively associated with post-task 10–16.5 Hz activity at F7 during VMI (p = 0.023). Both met the Bonferroni-adjusted significance threshold. The corresponding descriptive Pearson correlations were r = −0.869 and r = 0.937. Conclusions: These exploratory findings should not be interpreted as confirmatory evidence of stable brain–behavior associations; the reported correlations are descriptive summaries based on clusters selected from the same dataset. Replication in a larger, independent study with prespecified analyses and objective measures of imagery performance is needed.

Background: Simulated smiling, when an individual intentionally produces non-spontaneous smiles, can reportedly influence emotional and physiological states, but its neural and autonomic mechanisms remain unclear. Purpose: We examined whether one week of repeated simulated smiling with visual self-feedback would induce changes in brain function, autonomic nervous activity, and psychological state. Methods: Twenty healthy adults completed electroencephalogram, electrocardiogram, and psychological assessments before and then after a one-week intervention. Participants performed a daily home-based simulated smiling task while viewing their own facial expression by smartphone. During laboratory sessions before and after the one-week intervention, electroencephalogram (current source density and functional connectivity calculated by eLORETA), autonomic indices (cardio-sympathetic index, and cardio-parasympathetic index calculated by Lorenz plotting), and psychological measures (state-trait anxiety inventory) were recorded during resting and simulated smiling conditions. Results: Theta-band current source density in the medial prefrontal cortex significantly [BP1] decreased after the intervention, suggesting reduced cognitive control demands. At rest, alpha-band functional connectivity between occipital and parietal regions significantly increased after the intervention. Parasympathetic activity (cardio-parasympathetic index) increased during rest, while no autonomic changes were observed during the task. Psychological assessments showed reduction of state anxiety and increase in pleasant mood after completion of the one-week simulated smiling task. Conclusion: A brief, one-week program of repeated simulated smiling with visual self-feedback produced measurable improvements in psychological state and state-dependent alterations in central and autonomic activity. Given its simplicity, safety, and feasibility as a self-administered practice, simulated smiling may be a promising complementary approach for stress reduction and rehabilitation support.

Background: Nonagenarians with advanced cancer represent a growing yet understudied population in specialist palliative care. Objectives: To describe clinical characteristics, symptom profiles, palliative interventions, and end-of-life outcomes among patients aged 90 years and older admitted to a specialist palliative care unit in Japan. Design: Three-year retrospective descriptive case series. Methods: All patients aged ≥ 90 years admitted to a 24-bed specialist palliative care unit in a municipal acute-care hospital in western Japan between April 2020 and March 2023 ( n = 71 of 684 total admissions, 10.4%). Demographics, primary cancer site, comorbidities, presenting symptoms, opioid and sedative use, delirium, length of stay, and discharge disposition were extracted from clinical records. Results: Comorbidities were present in 95.8% (mean 2.3 ± 1.1 per patient), dementia in 56.3%; fatigue and anorexia were the most frequently documented presenting symptoms (38.0% and 33.8%), and pain was the primary complaint in 2.8%. Delirium occurred in 31.0%; 93.0% died on the unit. Conclusions: Nonagenarians in specialist palliative care frequently have dementia and non-pain-predominant symptom profiles, underscoring the need for structured assessment of both pain and non-pain symptoms.

The Zarit Caregiver Burden Interview (ZBI), including its Japanese validation by Arai and colleagues in 1997, has become one of the most widely utilised instruments for measuring caregiver burden in dementia care and psychogeriatrics worldwide. While acknowledging the instrument's clinical utility in identifying at‐risk caregivers and its historical role in legitimising caregiver experiences, this review examines the theoretical and practical limitations that have emerged from treating burden as a unitary construct amenable to simple quantification. Through the lens of network pluralism—a philosophical framework increasingly influential in psychiatry—we argue that the ZBI's psychometric reductionism has constrained our understanding of the complex, relational and emergent nature of caregiving experiences. This review critically examines three domains of concern: (1) the epistemological limitations of treating caregiver burden as a latent variable rather than an emergent network phenomenon, (2) the temporal coincidence between burden measurement instruments and healthcare policy transformations in contexts such as Japan's Long‐Term Care Insurance system and (3) the cultural and ethical implications of imposing measurement frameworks across diverse caregiving contexts. While the ZBI has demonstrated predictive validity for caregiver health outcomes and has facilitated resource allocation, the instrument's widespread adoption has occurred without adequate consideration of its theoretical assumptions and potential unintended consequences. We propose that network pluralism offers a complementary framework that preserves the practical benefits of standardised assessment while incorporating contextual, relational and systemic dimensions of caregiving. Specific recommendations for integrating network approaches into clinical practice are provided, including multi‐method assessment strategies that combine quantitative metrics with qualitative exploration of caregiver experiences, care relationships and support systems.

Aim: Japan maintains exceptionally high psychiatric bed numbers and long hospitalization durations compared to global standards. This study examined prefecture‐level associations between psychiatric bed supply, occupational therapy (OT) provision, and community welfare resources, and the average length of stay (ALOS). Methods: We performed a cross‐sectional ecological analysis utilizing the 10th National Database of Health Insurance Claims (NDB) Open Data and government hospital statistics from fiscal year 2023. Dataset aggregation covered all 47 prefectures. We calculated standardized indicators per 100,000 population for psychiatric bed density, inpatient and outpatient OT claims, and community‐based disability welfare facilities. Standardized multivariate regression modeling was employed to identify variables independently associated with ALOS, strictly evaluating the contributions of regional medical and welfare systems. Results: The analysis identified that psychiatric bed density was most strongly associated with longer ALOS, which is consistent with the supply‐induced demand hypothesis. Crucially, however, the regression model revealed that higher utilization rates of outpatient OT and a greater density of community‐based welfare facilities were significantly and independently associated with shorter ALOS. Conversely, the volume of inpatient OT provision did not demonstrate a significant independent effect on shortening hospital stays in the adjusted model. Conclusion: At the prefectural level, psychiatric bed density was independently associated with longer ALOS, whereas outpatient OT utilization and community‐based welfare facility density were independently associated with shorter ALOS. These findings suggest that community‐based therapeutic and welfare resources may be relevant to shorter hospital stays, although causal inference is limited by the cross‐sectional ecological design.

Altruistic motivation, a fundamental aspect of human behavior, commands significant neuroscience attention. This scoping review, following PRISMA-ScR guidelines, synthesizes findings from 45 fMRI, EEG, fNIRS, and autonomic nervous system (ANS) studies published between 1975 and 2024, exploring the neural basis of costly, other-oriented altruism. Our review covers experimental paradigms utilizing fMRI, EEG, and autonomic measures to interrogate neural and physiological responses associated with altruistic decision making and behavior. Importantly, inclusion was not limited to online, state-dependent, or event-related measurements; studies employing various acquisition timings were encompassed, as long as they examined neural or physiological correlates of altruistic motivation. fMRI studies consistently reveal engagement of a complex neural network, including medial and dorsolateral prefrontal cortex, temporoparietal junction, insula, and anterior cingulate cortex, integrating social cognition, value-based decision making, and emotional processing inherent in altruistic acts. EEG research highlights increased left frontal activity, indicative of approach-oriented motivation, and frontal midline theta, reflecting cognitive control during altruistic choices. ANS findings exhibit variability but tentatively suggest parasympathetic dominance in altruistic context. A key contribution is a multi-stage information-processing model of altruistic motivation, integrating these modalities from socio-affective appraisal through value computation, motivational orientation, and cognitive control to behavioral implementation. Findings elucidate the interplay of cognitive and emotional processes driving altruism, offering a nuanced conceptual framework. Future research, including longitudinal studies, cross-cultural comparisons, and ecologically valid assessments, is vital for advancing theoretical and practical understanding of the neurophysiology of altruism.

Psychiatric comorbidities in epilepsy are prevalent, disabling, and persistently undertreated due to conceptual and operational fragmentation between neurology and psychiatry. This paper proposes Network‐Pluralistic Psychiatry in Epilepsy (NPPE), a hypothesis‐generating, disease‐contextualized framework that integrates four mechanistic layers: (1) shared genetic vulnerability, (2) epileptogenic network dysfunction as a neuropsychiatric substrate, (3) a bidirectional psychosocial stress loop, and (4) societal and institutional amplifiers. NPPE moves beyond high‐level biopsychosocial heuristics by positing testable causal pathways linking genetic liability to network instability, symptom expression, and environmental feedback in epilepsy. The manuscript situates NPPE within existing integrated‐care paradigms (e.g., collaborative and stepped‐care models), proposing NPPE as a mechanistic engine to personalize measurement‐based treatment‐to‐target decisions while explicitly acknowledging feasibility constraints for advanced tools. A tiered assessment concept (Tiers 1–3) and candidate mechanism‐informed interventions are outlined as research targets rather than clinical recommendations. The paper delineates a research agenda prioritizing longitudinal, multimodal cohorts; incorporation of network biomarkers in clinical trials; evaluation of integrated‐care implementations; and attention to equity and real‐world feasibility. NPPE aims to provide a coherent, testable roadmap to transform descriptive comorbidity accounts into mechanism‐oriented, personalized neuropsychiatric care in epilepsy, contingent on rigorous validation, refinement, or falsification.