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Neurological symptomatology is a crucial component of neurological expertise. The committee for fostering board-certified neurologists in the Japanese Society of Neurology (JSN) has hosted an educational activity for residents before the board examination, "The seminar for fostering board-certified neurologists" since 2004. In particular, the autumn seminar has been characterized by small group hands-on of neurological examinations and the evaluations of higher brain function. Besides this, hands-on seminar of neurological examinations by regional branches has been promoted by the JSN. In the Kanto Ko-shin-etsu branch, "The first hands-on seminar of neurological examinations" started in 2023 after a 3-year-suspension due to COVID-19. The most important educational activities in neuromuscular electrodiagnosis (EDx) is the "Neuromuscular diagnostics seminar" hosted since 2004 by the Japanese Society of Clinical Neurophysiology (JSCN). The majority of tutors and participants are neurologists. This seminar is also characterized by small-group, hands-on workshops. We have also run the overseas seminar, "Tokyo Super EMG hands-on," since 2013. These have undoubtedly contributed to enhancing the level of neuromuscular electrodiagnosis not only in Japan but also in other Asian countries. I have conducted studies on neurological symptomatology and neuromuscular electrodiagnosis, which are directly linked to enhancing clinical practice of neurologists through educational activities such as review articles or lectures. Due to the fact that symptomatology is crucial in neurological expertise, neurology is a basic specialty around the world except in Japan. In 2018, the JSN decided to aim to make neurology a basic specialty and continues to make efforts to attain this goal.Copyright © 2023 Japanese Society of Neurology and John Wiley & Sons Australia, Ltd.
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Objectives: The COVID-19 pandemic has been affecting everything including ECMO service. At the moment we have to equip PPE before ECPR and we thought it may influence on time to establish venoarterial ECMO and patient outcomes. Method(s): We compared OHCA-patients who underwent ECPR in our hospital before (January 2015 - March 2020) and after (April 2020 - December 2022) the Government of Japan declared a state of emergency in relation to COVID-19. Result(s): There were 32 and 9 patients in the pre- and post-COVID-19 pandemic sample. Of these, 9 (28.1%) vs. 5 (55.6%) survived extracorporeal life support (ECLS), p=0.23, and 4 (12.5%) vs. 2 (22.2%) had good neurologic outcomes (cerebral performance category 1- 2) after ECLS. Seven (21.9%) vs. 1 (12.5%) were discharged or transferred alive from the hospital (one patient of the post-COVID-19 cohort has been still hospitalised for rehabilitation), p>0.99. Mean values of low-flow time were respectively 67.3 minutes (SD 18.3) and 55.6 minutes (SD 17.1), p=0.091, and median values of time to establish ECMO from admission were respectively 32.5 minutes (IQR 15.8) and 26.0 minutes (IQR 4.0), p=0.23. Conclusion(s): There were no differences in time-toECMO or outcomes in patients who underwent ECPR for refractory OHCA before and after the COVID-19 pandemic.
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Background: Face masks are widely used in daily life because of the COVID-19 pandemic. The objective of this study was to explore the impact of wearing face masks on brain functions by using resting-state functional MRI (RS-fMRI). Methods: Scanning data from 15 healthy subjects (46.20 ± 6.67 years) were collected in this study. Each subject underwent RS-fMRI scans under two comparative conditions, wearing a KN95 mask and natural breathing (no mask). The amplitude of low frequency fluctuation (ALFF) and functional connectivity under the two conditions were analyzed and then compared using the paired t-test. Results: Compared with those of the no-mask condition, the ALFF activities when wearing masks were increased significantly in the right middle frontal gyrus, bilateral precuneus, right superior marginal gyrus, left inferior parietal gyrus, and left supplementary motor area and decreased significantly in the anterior cingulate gyrus, right fusiform gyrus, left superior temporal gyrus, bilateral lingual gyrus, and bilateral calcarine cortex (p < 0.05). Taking the posterior cingulate cortex area as a seed point, the correlations with the occipital cortex, prefrontal lobe, and motor sensory cortex were sensitive to wearing masks compared with not wearing masks (p < 0.05). Taking the medial prefrontal cortex region as a seed point, the functional connectivity with the bilateral temporal lobe, bilateral motor sensory cortex, and occipital lobe was influenced by wearing a KN95 mask (p < 0.05). Conclusion: This study demonstrated that wearing a KN95 face mask can cause short-term changes in human resting brain function. Both local neural activities and functional connectivity in brain regions were sensitive to mask wearing. However, the neural mechanism causing these changes and its impact on cognitive function still need further investigation.
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The review is dedicated the interconnection between neurodegenerative diseases, chronic pain and gut microbiota's structure and function. The gut microbiota's role in gut-brain axis, neuroimmune interaction is considered. The modern data about gut dysbiosis in Alzheimer disease, Parkinson disease, osteoarthrosis, neuropathic pain in COVID infection, muscular-skeletal pain in fibromyalgia, irritable bowel syndrome et cetera are provided. The gut microbiota's modification by means of pre and probiotics in combination with medicines and diet modification can be used for the treatment of chronic pain and dementia.Copyright © T.M. MANEVICH.
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Background: SARS-CoV-2 infection is accompanied by acute olfactory disturbance in as high as 70% of cases. This loss is associated with decreased olfactory bulb volume. As time passes, the anosmia tends to subside, but the OB volume decrease does not. Volume reductions in primary and secondary olfactory cortex are also seen following SARS-CoV-2 infection. Nevertheless, concurrent SARS-CoV-2 infection effects on olfactory discrimination, olfactory bulb volume, primary olfactory cortex and its targets have not been investigated. To explore this possibility, we measured olfactory discrimination, olfactory bulb volume, primary olfactory cortex and basal ganglia volume in patients who had SARS-CoV-2 infection more than 12 weeks previously, who were then divided into COVID and long-COVID groups on the basis of selfreported fatigue and concentration complaints. Method(s): This cross-sectional study included 25 post-infection and 19 demographically-matched, no-COVID control participants, we investigated effects on olfaction using NIH Toolbox Odor Identification Test and the Monell Smell Questionnaire. GM structure was assessed with voxel-based morphometry and manual delineation of high resolution (1mm3), T1- and T2-weighted MRI data. Linear regression was used to model group effects on GM structure, adjusting for age, sex, education and total intracranial volume. CAT12/SPM12 and R were used for image processing and statistical modeling. Result(s): Results. The NIH Toolbox Odor Identification Test failed to show differences among the groups. In contrast, the Monell Smell Questionnaire revealed persistently diminished and distorted smell in 50% of the long-COVID sample. Olfactory bulb volume was lower in the long-COVID group (p=0.02). Primary olfactory cortex volume was reduced in the long-COVID group (p=0.004). Caudate volume was also lower in the long-COVID group (p=0.04). Conclusion(s): Conclusions. In the absence of olfactory discrimination problems, long-COVID, but not COVID, patients experience persistent olfactory loss and distortion. These perceptual problems are associated with lower olfactory bulb, primary olfactory cortex, and caudate volume, suggesting that the effects of SARS-CoV-2 infection can extend beyond the olfactory periphery in some cases to affect central targets. (Figure Presented).
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The Internet of Medical Things (IoMT) system plays a role in various areas of social activity, including healthcare. Telemetry of cardiovascular function, such as blood pressure and pulse, in daily life is useful in the treatment of cardiovascular disease and stress management. However, until now, brain function monitoring technology has not been installed in the IoMT system.In this study, we used near-infrared spectroscopy (NIRS) installed in the IoMT system to evaluate whether consumers who are not medical experts can measure their own brain function correctly. In addition, the IoMT system was used to assess the long-term effects of physical exercise on physical and mental health.We studied a total of 119 healthy adults recruited from a fitness gym in Koriyama, Japan. After receiving instruction in the usage of the IoMT monitoring system including NIRS, the subjects monitored their physical and mental conditions by themselves when they visited the gym. We evaluated the relations between blood pressure (BP), pulse rate (PR), body weight (BW) and age. In addition, we evaluated the left/right asymmetry of the prefrontal cortex (PFC) at rest and BP. We calculated the laterality index at rest (LIR) for assessment of left/right asymmetry of PFC activity; a positive LIR (>0) indicates right-dominant PFC activity associated with higher stress responses, while a negative LIR (<0) indicates left-dominant PFC activity associated with lower stress responses. We studied 47 out of 119 cases who monitored their physiological conditions before and after physical exercise for 6 months for this study.The results showed that the systolic blood pressure and mean blood pressure (p < 0.05) were significantly reduced after the physical exercise for 6 months; body weight did not change significantly (p > 0.05). In addition, NIRS demonstrated that LIR changed to plus values from minus values after exercise (p < 0.01).These results show that (1) consumers who are not-medical experts can measure their own brain function correctly using NIRS; (2) after long-term physical exercise, systemic blood pressure decreased, associated with modulation of PFC activity (i.e., from right-dominant PFC activity to left-dominant activity), indicating that long-term physical exercises caused relaxation in the brain and the autonomic nervous system.
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Prefrontal Cortex , Spectroscopy, Near-Infrared , Adult , Humans , Spectroscopy, Near-Infrared/methods , Prefrontal Cortex/physiology , Functional Laterality/physiology , Exercise Therapy , Arrhythmias, Cardiac , Body WeightABSTRACT
Introduction: The long-term impact of COVID-19 on brain function remains poorly understood, despite growing concern surrounding post-acute COVID-19 syndrome (PACS). The goal of this cross-sectional, observational study was to determine whether there are significant alterations in resting brain function among non-hospitalized individuals with PACS, compared to symptomatic individuals with non-COVID infection. Methods: Data were collected for 51 individuals who tested positive for COVID-19 (mean age 41±12 yrs., 34 female) and 15 controls who had cold and flu-like symptoms but tested negative for COVID-19 (mean age 41±14 yrs., 9 female), with both groups assessed an average of 4-5 months after COVID testing. None of the participants had prior neurologic, psychiatric, or cardiovascular illness. Resting brain function was assessed via functional magnetic resonance imaging (fMRI), and self-reported symptoms were recorded. Results: Individuals with COVID-19 had lower temporal and subcortical functional connectivity relative to controls. A greater number of ongoing post-COVID symptoms was also associated with altered functional connectivity between temporal, parietal, occipital and subcortical regions. Discussion: These results provide preliminary evidence that patterns of functional connectivity distinguish PACS from non-COVID infection and correlate with the severity of clinical outcome, providing novel insights into this highly prevalent disorder.
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Objective: Havening is a psychosensory therapeutic technique that purportedly harnesses the power of touch to stimulate oxytocin release and facilitate adaptive processing of distressing thoughts/memories. Although Havening is used in clinics worldwide, with anecdotal evidence, very few empirical studies exist to support its efficacy or mechanism of action. The present study is the first to investigate the effects of Havening Touch on subjective distress, mood, brain function, and well-being. Method(s): Participants (n = 24) underwent a single session of Havening, in response to a self-reported distressing event. Mood and resting-state electroencephalography were assessed prior to, and immediately following, the session. Psychological health was assessed at baseline and 2 weeks followup via an online self-report questionnaire. Result(s): There was a greater reduction in subjective units of distress during sessions that included Havening Touch (H+) than sessions that did not include Havening Touch (H-). Electroencephalography results showed an increase in beta and a reduction in gamma activity in H+. Both groups showed reduction in negative mood states immediately following the session and better psychological health at follow-up. Conclusion(s): Findings suggest both touch and nontouch components of the intervention have therapeutic potential, and that Havening Touch may accelerate a reduction in distress during a single Havening session.Copyright © 2022 American Psychological Association
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Throughout United States history, alcohol use disorder (AUD) continues to be a national health concern. Within the last few years, pandemic stressors may also increase the potential for relapse in individuals struggling with AUD (Da et al., 2020). Medical professionals are imploring helping professionals to stay aware of this rising concern and to enhance AUD treatment options. Whereas treatments such as psychotherapy and pharmacology can be efficacious for AUD, there are also limitations to these types of interventions. AUD affects brain wave activity;while the prior mentioned treatments do not directly target brain activity, one treatment that does is neuron feed back. Neurofeed back is well documented for helping individuals with AUD, and other addiction concerns, to reach an enhanced state of regulation (Sokhadze et al., 2008). After IRB approval and participant recruitment, my supervisor and I created qEEG individualized protocols while also considering Peniston and Kulkosky's (1989, 1990) seminal neuron feed back studies that recommend certain brain wave parameters for AUD protocols. In addition, we also referred to the Scott-Kaiser modification (Scott & Kaiser, 1998) of the Peniston Protocol. The Peniston Protocol uses alpha/theta training and seeks to reduce states of stress and anxiety, while the Scott-Kaiser modification (e.g., SMR-beta modulation) aims to reduce impulsivity tendencies by remedying cognitive issues (Dousset et al., 2020). Participants were asked to complete pre and post qEEG and heart rate variability (HRV) measures along with self-report assessments of pre, post, and follow-up measures of the Alcohol Use Disorders Identification Test (AUDIT;Saunders et al., 1993), and repeated measures of a craving desire assessment after every neuron feed back session. Also, participants were asked to attend twice-weekly neuron feedback sessions for 6 weeks or at least twelve 10- to 25-minute sessions. University student clinicians and neuron feedback clinicians administered the neuron feedback sessions. Due to the pandemic and subsequent limiting factors (i.e., COVID concerns or lack of money for transportation), participants were allowed remote neuron feedback. Only one participant asked to utilize remote services. The primary purpose of this study was to determine if qEEG individualized neuron feedback protocols helped participants regulate their brain activity and reduce AUD cravings. Secondary purposes included comparing physiological data to self-report data and exploring neuron feedback session-to-session changes with a single-subject approach. This poster presentation will include pre and post qEEG z-score comparisons from NeuroGuide and pre and post HRV comparisons from BioTrace. Further, I will explore individual changes over time according to participants' neuron feedback protocols using single-case research design methods and participants' individual craving desire changes. The presentation will also entail implications for future research..
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The problem of studying the features of the dynamics of neurological deficit and cognitive functions in the early recovery period in post-COVID patients with IS and optimizing therapy is becoming of national importance and an urgent need. Purpose of the study: To study the features of the dynamics of neurological deficit and higher brain functions in the early recovery period of ischemic stroke in post-COVID patients, with an assessment of the effectiveness of modified drug and non-drug programs of rehabilitation therapy. Materials and research methods: A total of 80 patients took part in the clinical study. The patients were divided into 2 groups. Group 1 - post-COVID patients with IS, Group 2 - non-COVID patients with IS. Result(s): The inclusion of ethylmethylhydroxypyridine succinate and rivaroxaban in standard therapy met expectations and showed its positive role in reducing the recovery time of patients' functions, as determined using BDNF and cortisol biomarkers, as well as using data from the Rankin, Rivermead, MoCa and NIHHS scales. Conclusion(s): Based on the results of the obtained data, the effectiveness of the approved therapy in the rehabilitation of post-COVID patients with ischemic stroke was established. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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In the first months of the COVID-19 pandemic, we created and implemented from November 2020 to February 2021 a monthly educational pilot program of philosophical management of stress based on Science, Humanism and Epicurean Pragmatism, which was offered to employees of 26 municipalities in the Prefecture of Attica, Greece. The program named "Philosophical Distress Management Operation System” (Philo.Di.M.O.S.) is novel and unique in its kind, as it combines a certain Greek philosophical tradition (Epicurean) that concurs with modern scientific knowledge. The program was designed to be implemented in a period of crisis;therefore, it used a fast-paced, easy to learn and practice philosophical approach to stress management, based on cognitive psychotherapy. The philosophical approach to stress management has the advantage that it can be offered to most people, regardless of age and educational level. The pilot program was effective in achieving its objectives, shown by statistical comparisons of the trainees' responses to anonymous questionnaires before and after the month-long training. The successful Philo.Di.M.O.S. program, thus, based on a solid scientific and philosophical basis, offers a paradigm of stress management during crises and could be useful in Greece and internationally. © 2022, Christos Yapijakis, Evangelos Protopapadakis, George P. Chrousos.
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INTRODUCTION: Our objective was to characterize testing and treatments provided for hospitalized children with and without severe neurologic manifestations with acute SARSCoV- 2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). METHOD(S): Multinational cross-sectional study of children age < 18 y hospitalized with SARS-CoV-2-related condition between January 2020-July 2021. Admission laboratory, neurologic testing, and treatments related to SARS-CoV-2 conditions were analyzed by severe neurologic manifestation status, a composite of those with univariate logistic regression p< 0.05 for unfavorable outcome (Pediatric Cerebral Performance Category Score 3-6 at hospital discharge). Multivariable logistic regression to identify laboratory values associated with severe neurologic manifestation was performed. RESULT(S): Of 3,556 children, 818 (23%) had severe neurologic manifestation. Children with severe neurologic manifestation were younger (median 5 interquartile range [1-12] vs. 9 [1.1-14] y) and had more MIS-C vs. acute SARSCoV- 2 (35% vs. 22%), pre-existing disease (68% vs. 48%), and death (5% vs. 0.5%), all p< 0.001. Blood fibrinogen was lower in children with (341 [230, 500]) vs. without (410 [274, 537] mg/dl) severe neurologic manifestation, p< 0.001. More children with severe neurologic manifestations had electroencephalography (23% vs. 2.7%), head CT (24% vs. 6%), and brain MRI (16% vs. 4%) performed, p< 0.001, but results were not more frequently abnormal between groups. Cerebrospinal fluid was sampled in 19% vs. 9%, p< 0.001, and intracranial pressure monitors were placed in 5 (1%) vs. 14 (0.5%), p=0.179. Children with severe neurologic manifestation received more steroids (25% vs. 16%) and remdesivir (15% vs. 7%), p< 0.001. After adjustment, higher lymphocytes (odds ratio 1.0003 [95% confidence interval 1.00009, 1.0005]) and lower fibrinogen (0.998 [0.996, 0.999]), p< 0.05, were associated with severe neurologic manifestation status. CONCLUSION(S): Modest laboratory signatures of severe neurologic manifestations in children hospitalized with SARSCoV- 2 related conditions were found. Despite association with worse outcomes, relatively few children received contemporary neurological testing and SARS-CoV-2 related treatments.
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INTRODUCTION: We aimed to describe neurologic outcomes in hospitalized children diagnosed with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). METHOD(S): Multinational (n=50 centers), cross-sectional study of neurologic manifestations in children < 18 y old hospitalized with a positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020-July 2021. Multivariable logistic regression to identify risk factors for unfavorable outcome at hospital discharge (Pediatric Cerebral Performance Category Score 3-6) was performed. Severe neurologic manifestation included those with univariate logistic regression significant to p< 0.05 for unfavorable outcome: dysautonomia, stroke, encephalopathy, cardiac arrest, meningitis/encephalitis, coma, seizures, weakness, and delirium. RESULT(S): Of 3,556 children (46% female), 3333 (94%) had acute SARS-CoV-2 and 223 (6%) had MIS-C. Unfavorable outcome occurred in 368 (11%) children and 39 (1.1%) died. Children with unfavorable outcome were older (median 9 interquartile range [4-14] vs. 8 [1-14] y, p< 0.001), and more likely to have neurologic comorbidity (72% vs. 10%, p< 0.001), worse Glasgow coma scale score (GCS) group (19% with combined GCS 9-15 vs. 1.7% with GCS< 9, p< 0.001), any neurologic manifestation (52% vs. 37%, p< 0.001), and severe neurologic manifestation (48% vs. 20%, p< 0.001) compared to children with favorable outcome. In multivariate logistic regression, older age (odds ratio 1.1 95% confidence interval [1.0, 1.1], total pre-existing conditions (2.1 [1.8, 2.5]), severe neurologic manifestation (3.4 [2.0, 6.0], and worse GCS group (4.0 [2.6, 5.9]) were associated with unfavorable outcome. CONCLUSION(S): Children with severe neurologic manifestation, pre-existing conditions, and children of older age hospitalized with acute SARS-CoV-2 infection or MIS-C have worse hospital discharge outcomes. Follow-up of these children is necessary to identify and manage neurologic and functional impairment.
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Background: Public health restrictions due to the COVID-19 pandemic have affected care partners of people living with dementia and/or mental health conditions. This qualitative study explores care partners' ability to offer care, and changes and interruptions to care provision during the period of the COVID-19 pandemic (2020) in English-speaking regions worldwide. Method(s): As part of an international cross-sectional online survey, qualitative data were collected from over 1,000 English-speaking care partners of people living with dementia and/or mental health conditions. Responses to an open-ended question about ability to care were coded and analysed thematically. The analysis was undertaken by three independent interdisciplinary coding dyads. Result(s): A number of main themes and subthemes were generated through the analysis. Reduced in-person contact with the person with a brain health condition and restrictions in health and social care services created practical, psychological and emotional impacts for care partners. The lack of adequate information from health/social care services, deterioration in the condition of the person living with a brain health condition, and additional care hours/duties were identified. Care partners also mentioned the fear of virus transmission and increased awareness of public health measures as factors that changed or interrupted their ability to provide care. Conclusion(s): The ability of care partners to provide care was changed or interrupted, and disruption to routines and services available impacted on their well-being. These findings reflect the complexity of the care partner role and highlight the importance of supporting care partners, in particular during periods of service restrictions such as those experienced as a result of the pandemic. Findings will be of interest to policymakers and service providers. Copyright © 2022 the Alzheimer's Association.
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Introduction: Grief and bereavement are commonplace in clinical practice but have become a more pervasive issue because of the coronavirus 2019 pandemic. Consequently, the need for investigations, learning, and education about complicated grief and prolonged grief have been highlighted. Meanwhile, film-based teaching resources concerning grief care have been employed to complement curricula in medical education. Objective(s): To explore how the grieving experience can be better communicated and mitigated, and explain how a film-based resource can be applied to improve the understanding of this issue. Method(s): We reviewed and analyzed the meaning and cause of complicated, prolonged, disenfranchised grief, as well as related experiences (e.g., survivor guilt) featured in selected films. We discussed the interpretation of these films with medical students and faculty, based on a previously described approach [1]. Result(s): We recaptured the roles of empathic communications and resilience skills in grief care. They bring a sense of coherence (SOC) or meaning to life by prompting the sharing of grief experiences, helping to reconstruct and contextualize a person's loss, and assuaging feelings of worthlessness and hopelessness. Incidentally, recent studies have suggested that complicated and prolonged grief involves alterations in brain functioning of the reward system. Conclusion(s): This film-based approach utilizes vicarious experiences to better understand grief management. It allows the learner to more easily recognize that SOC, flexible situation-adjusted empathy, and the sharing of resources for improved communication to promote self-care are essential for patients, their families, as well as psychiatrists themselves.
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BACKGROUND: Disruptions in perinatal care and support due to the COVID-19 pandemic was an unprecedented but significant stressor among pregnant women. Various neurostructural differences have been re-ported among fetuses and infants born during the pandemic compared to pre-pandemic counterparts. The relationship between maternal stress due to pandemic related disruptions and fetal brain is yet unexamined. METHODS: Pregnant participants with healthy pregnancies were prospectively recruited in 2020-2022 in the greater Los Angeles Area. Participants completed multiple self-report assessments for experiences of pandemic related disruptions, perceived stress, and coping behaviors and underwent fetal MRI. Maternal perceived stress exposures were correlated with quantitative multimodal MRI measures of fetal brain development using multivariate models. RESULTS: Increased maternal perception of pandemic related stress positively correlated with normalized fetal brainstem volume (suggesting accelerated brainstem maturation). In contrast, increased maternal perception of pandemic related stress correlated with reduced global fetal brain temporal functional variance (suggesting reduced functional connectivity). CONCLUSIONS: We report alterations in fetal brainstem structure and global functional fetal brain activity associated with increased maternal stress due to pandemic related disruptions, suggesting altered fetal programming. Long term follow-up studies are required to better understand the sequalae of these early multi-modal brain disruptions among infants born during the COVID-19 pandemic.
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BACKGROUND: Elderly with dementia through a decline in degenerative brain function is characterized by a progressive loss of memory function and other cognitive abilities, the number of which is increasing in almost all countries. Dementia is a degenerative disease that requires long-term treatment, experienced by a number of the elderly population (over 60 years) (Vega et al., 2018). Dementia can ultimately affect social activities so that in general, it affects the independence of the elderly in daily activities. METHODS: The research design used in this research is descriptive analytical research design. The population involved in this study is the elderly in Surabaya, Indonesia, which is also the research sample for those who meet the criteria. These criteria include the elderly who are 60 years old, the elderly who are registered at the Community Health Center or Integrated Service Post, are diagnosed with dementia, do not include confirmed cases of COVID-19, live with family, have family members with a minimum high school education of at least 20 years, have and are able to operate Android mobile media, and do not suffer from complications. The sampling technique used in this study was simple random sampling with 100 respondents. RESULTS: There are three levels of independence for the elderly with dementia, namely, low independence as many as 35 respondents (35%), moderate independence as many as 51 respondents (51%), and high independence as many as 14 respondents (14%). These results are influenced by the characteristics of the elderly, family factors, and health services. CONCLUSION: Furthermore, the most of the level of independence of the elderly is moderate independence. It is hoped that the elderly can increase their level of independence. The role of various lines is needed to support this including families and health workers, but the role of the elderly itself is also an important point to increase the independence of the elderly.