Initial symptoms of early-onset dementia in Japan: nationwide survey.

AIM: The aim of this study was to investigate initial symptoms of early-onset dementia (EOD) for each dementia subtype. METHOD: We conducted a nationwide, population-based EOD prevalence study in Japan. Data were collected through service providers for people with EOD. Initial symptoms were assessed in six domains: loss of memory, difficulty in word generation, irritability, loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed. RESULTS: Participants were 770 people with EOD. Characteristic initial symptoms were observed for each EOD subtype. Loss of memory was more common in early-onset Alzheimer's disease (75.7%, P < 0.001), difficulty in word generation was more common in early-onset vascular dementia (41.3%, P < 0.001), and loss of motivation, increased mistakes in the workplace or domestically, and unusual behaviours or attitudes other than those listed were more common in early-onset frontotemporal dementia (34.9%, P < 0.001; 49.4%, P < 0.001; 34.9%, P < 0.001, respectively). In addition, we observed gender differences whereby loss of memory was more common among women and irritability was more common among men. More than half of the participants were employed at symptom onset, and 57.2% of those who were employed at the onset had initial symptoms of increased mistakes in the workplace or domestically. CONCLUSION: This report reveals differences in the frequency of initial symptoms by EOD subtype. The results contribute to increasing public awareness of the initial symptoms of EOD, which will facilitate early diagnosis and social support.

Prevalence and subtype distribution of early-onset dementia in Japan.

AIM: People living with early-onset dementia (EOD) have specific social needs. Epidemiological studies are needed to obtain current information and provide appropriate service planning. This study aimed to clarify the current prevalence and subtype distribution of EOD, as well as the services frequently used by individuals with EOD. METHODS: A multisite, population-based, two-step study was conducted. Questionnaires were sent to 26 416 candidate facilities in 12 areas with a target population of 11 630 322 to inquire whether any individuals with EOD had sought services or stayed during the last 12 months (step 1). When "yes" responses were received, additional questionnaires were sent to the facilities both to complete and to distribute to the target individuals with EOD to obtain more detailed information, including the dementia subtype (step 2). RESULTS: In step 1, valid responses were obtained from 16 848 facilities (63.8%), and 4077 cases were identified. In step 2, detailed information was obtained for 1614 cases (39.6%) from the facilities and 530 cases (13.0%) from the individuals. The national EOD prevalence rate was estimated to be 50.9/100 000 population at risk (95% confidence interval: 43.9-57.9; age range, 18-64 years). The number of individuals with EOD was estimated to be 35 700 as of 2018. Alzheimer-type dementia (52.6%) was the most frequent subtype, followed by vascular dementia (17.1%), frontotemporal dementia (9.4%), dementia due to traumatic brain injury (4.2%), dementia with Lewy bodies/Parkinson's disease dementia (4.1%), and dementia due to alcohol-related disorders (2.8%). Individuals with EOD were most frequently identified at medical centers for dementia. CONCLUSION: The prevalence rate estimated in this study was comparable to those in previous studies in Japan. However, the subtype distribution differed, with Alzheimer-type dementia being the most prominent. Based on the case identification frequencies, medical centers for dementia are expected to continue to function as the primary special health service by providing quality diagnosis and post-diagnostic support for individuals with EOD.

Multicenter population-based study on the prevalence of early onset dementia in Japan: vascular dementia as its prominent cause.

AIM: In Japan, the government and media have become aware of the issues of early onset dementia (EOD), but policies for EOD have not yet been established and support systems are inadequate. To provide practical data about EOD, a two-step postal survey was performed. METHODS: A questionnaire requesting information on EOD cases was sent to target institutions in five catchment areas in Japan. According to the answers from the institutions, we estimated the prevalence of EOD using census data and determined the illnesses causing EOD. As a quality control study, the authors reviewed every diagnosis in a quarter of the reported cases using the medical and psychiatric records and neuroimaging data. This study was conducted from 2006 to 2007. RESULTS: Information from 2469 patients was collected from 12,747 institutions, and 2059 subjects with EOD were identified. The estimated prevalence of EOD was 47.6 per 100,000 (95% confidence interval, 47.1-48.1) for all of Japan. Of the illnesses causing EOD, vascular dementia (VaD) was the most frequent (39.8%), followed by Alzheimer's disease. CONCLUSIONS: The prevalence of EOD in Japan appeared to be similar to that in Western countries. However, unlike previously reported international experience, VaD was the most frequent cause of EOD in all catchment areas in Japan.

[The meaning of the early detection of dementia].

The significance of early detection of dementia is that there is some benefit from almost all involved, especially, patients, their family, attending physicans and administration (local financial affairs), 1) Both patients and their family can recognize that dementia is not ageing but a disease. They can have the hope that early treatment of dementia can improve symptom. Moreover, their family and care givers can look after demented persons more easily by acquiring the knowledge of the official welfare system and how to cope with dementia-related problem behavior. These can reduce ill-treatment. 2) The improvement or supression of dementia symptoms, and the teaching of how to handle daily life can give attending physican an incentive to treat. 3) If the onset of dementia can be delayed for 2 years, administration can reduce expenses by 560 billion yen in all Japan, which would benefit the medical economy greatly.

[Treatment of dementia].

Drugs to treat the primary symptoms of dementia are nootropics (anti-dementia medicine). These can be divided into three stage historically. Drugs of brain metabolic improvement and blood expanssion and anti-coagulation drugs used till now, are the first stage. AChE inhibitor and glutamin receptor inhibitors used at present are second generation drugs. The cause of degenerative diseases like Alzheimer's disease is the accumulation of abnormal protein. So, fundamental medicines to prevent such accumulation are the third generation drugs. Anti-inflammation drugs, anti-cholesterol drugs, female hormones, and nerve growth factors used at present are third generation grugs. In truth, only vaccine treatment is the third stage medicine. Adjuvant treatment is also available at present This approach is not based on the elimination of various causes of cell injury, but on increasing resistance to cell injury. These methods include protection of the nerve cell membrane, supply of nerve transmission material and improvement of brain blood flow. Non-medicinal methods of treatment and prevention of dementia include mental training and body movement (exercises). These promote supply of nutrition and oxygen to the nerve cells as a result of increases in brain circulation caused by the various stimuli. In addition to training, nutrition should also be suppled at the same time.