We report a case of Nothnagel syndrome with inattention. A 69-year-old laborer was admitted to our hospital for rehabilitation therapy complaining of gait disturbance a month after the onset of brainstem infarction. He had right oculomotor palsy, ataxia on the left side and upward movement limitation of the left eye. Magnetic resonance imaging demonstrated high signal intensity in the right tegmentum of the midbrain and the medial aspect of the right thalamus on T2-weighted and diffusion weighted images. This lesion involving nuclei in the medial aspect of the right thalamus, which is considered to be closely related with the reticular activating system, might explain his inattention. And it is suggested that the low blood flow in the right basal ganglia and parietal lobe revealed by his SPECT scan, could be related with that as well. We administered rehabilitation programs for his ataxia and inattention. Because diplopia is thought to be difficult to improve, we did not attempt to treat the patient's eye movement limitation. Three months after our intervention, he was able to walk without support. However, his inattention remained. Patients with brainstem infarction are apt to have plural impairments concurrently. In such cases, it is necessary to assess the treatment priority for each impairment adequately. Evidence based guidelines for the assessment of treatment priority would aid in this endeavor and the development of such guidelines is therefore expected.

Introduction : To detect major symptoms of dementia, especially symptoms of non-Alzheimer-type dementia, we tried to develop an informant-based questionnaire, the Dementia differentiation questionnaire-41 items (DDQ41).
Methods : The DDQ41 consisted of 11 questions on symptoms of early dementia (Q-Dementia11), 8 on Alzheimer's disease dementia(Q-ADD8), 9 on dementia with Lewy bodies (Q-DLB9), 8 on vascular dementia (Q-VD8), 5 on frontal lobe signs (Q-Frontal5), and additional 2 questions on urinary incontinence and speech disturbance. Caregivers of the 575 outpatients, who included only 1 diagnosis of dementia disease, checked the DDQ41.
Results : Mean score of Q-Dementia11 in the MCI group was significantly lower than that in the other dementia groups. Mean score of Q-ADD8 in the ADD group was not significantly different from that in the other dementia groups. Mean score of Q-DLB9 in the DLB group was significantly higher than that in the other dementia groups. Area under the ROC curve of Q-DLB9 was 85.6%, and sensitivity and specificity were 82.6% and 77.7%(cut-off : 3 items/4 items), respectively, for DLB.
Conclusion : We developed the DDQ41, an informant-based questionnaire sheet, for detecting symptoms of dementia. It may be useful in detecting frontal lobe signs and symptoms of non-Alzheimer-type dementia, especially those of DLB.