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ADDLBVDFTLDその他442atrist Alois Alzheimer in 19061). The patient devel-oped dementia at the young age of 51 and died within a little more than 4 years. Neuropathological findings of her brain showed senile plaques and neurofibrillary tangles. Although the concept of senile dementia was established at the time, the case was published because dementia rarely devel-oped at such a young age. Subsequently, in 1908 Kraepelin-an authority in psychiatric medicine at the time-named the disease Alzheimer’s disease. Kraepelin is known for developing the disease concepts of schizophrenia and bipolar disorder. Alzheimer was born in Würzburg in southern Germany, so to celebrate this fact the first Alzhei-mer’s Association International Conference was held in Würzburg in 1989. The house where Alzheimer was born is preserved as a museum.An autopsy case of dementia with Lewy bodies, the second most common type of dementia, was first reported by the Japanese psychiatrist Kenji Kosaka in 19762). In this case, Lewy bodies, previ-ously known to appear in the brain stem, were observed in large numbers in nerve cells in the cerebral cortex. In 1995, the first International Dementia with Lewy bodies Conference was held in England, diagnostic criteria were set and Dementia with Lewy bodies gained international recognition. After studying in Germany, Dr. Kosaka concur-rently worked in clinical practice at Tokyo Metro-politan Matsuzawa Hospital. I was also working at Matsuzawa Hospital at that time, and I was able to Figure 1　Clinical diagnosis of demented in-patients(2018)AD:Alzheimer’s disease, DLB:Dementia with Lewy bodies, VD:Vascular dementia, FTLD:Front temporal lobe degenerationreceive guidance from Dr. Kosaka. He then became a chief professor at the Department of Psychiatry, Yokohama City University.The case reports by Alzheimer and Dr. Kosaka suggested the importance closely examining cases, we encounter in daily clinical practice. Although I have been working predominantly at Juntendo Tokyo Koto Geriatric Medical Center since I become a professor, it was as a psychiatrist at Juntendo Koshigaya Hospital during the early stages of my career that I established the foundation of my interest in dementia. Here, I would like to describe the two autopsy cases of dementia that I experi-enced there. Although both of the patients were clinically diagnosed as having Alzheimer’s disease, the autopsies revealed a different definitive diag-nosis. This discrepancy became the cornerstone of my clinical practice in dementia.The first patient had prion disease. She was hospitalized at Juntendo Koshigaya Hospital for 21 years with a clinical diagnosis of Alzheimer’s disease. When I was in charge of her, she was confined to her bed and in the terminal phase of the disease. The patient, a 59-year-old woman, made me realize what the terminal phase of Alzheimer’s disease looks like. At age 38, she started to experience memory loos. At age 42, she visited the department of psychiatry at Juntendo University Hospital for the first time, and at age 43 she had difficulty living at home and was admitted to Juntendo Koshigaya Hospital. At age 46, her spontaneous speech started to decrease, and she became bedridden at age 49. At age 50, she developed myoclonus. A cranial computed tomography scan showed severe brain atrophy (Figure 2). At age 59, she died with pneu-monia and an autopsy was performed. Her brain weight was 640g. Gerstmann-Sträussler-Scheinker syndrome, a type of prion disease, was diagnosed on the basis neuropathological findings (Figure 3). Gene analysis was performed at the laboratory of professor Tateishi of Kyusyu University and revealed a point mutation at codon 145 of the prion protein3). This case is cited in the New Oxford Textbook of Psychiatry 20004).The second patient had dementia with Lewy bodies. The female patient was hospitalized in Two cases I experienced at Juntendo Koshigaya Hospital