Dementia Incidence Rate Before and After Implementing the National Responsibility Policy for Dementia Care in Patients With Vascular Risk Factors in Korea

Background@#and Purpose: The National Responsibility Policy for Dementia Care was implemented in September 2017 in Korea. This study aimed to compare dementia incidence in Seoul and Gangwon-do before and after the implementation of this policy. @*Methods@#We extracted insurance claim data from the Korean Health Insurance Review and Assessment Service for people diagnosed with diabetes, hypertension, or dyslipidemia for the first time in Seoul and Gangwon-do, Korea. We defined two enrollment groups based on the policy implementation date: 1) January 1, 2015 to December 31, 2016 (Index 1, pre-implementation), and 2) January 1, 2017 to December 31, 2018 (Index 2, postimplementation). Each group was followed up for 1 year from the time of enrollment. Then, we calculated hazard ratios to compare the incidence of dementia between the two groups, and between Seoul and Gangwon-do. @*Results@#In Seoul, the incidence of dementia was significantly lower in Index 2 than in Index 1 (hazard ratio [HR], 0.926; 95% confidence interval [CI], 0.875–0.979). However, the incidence rate did not differ between the 2 groups (HR, 1.113; 95% CI, 0.966–1.281) in Gangwon-do. In Index 1, the incidence of dementia did not differ between Seoul and Gangwon-do (HR, 1.043; 95% CI, 0.941–1.156), but in Index 2, was significantly higher in Gangwon-do than in Seoul (HR, 1.240; 95% CI, 1.109–1.386). @*Conclusions@#After implementing the National Responsibility Policy for Dementia Care, the dementia incidence rate decreased significantly in Seoul, consistent with other studies, but not in Gangwon-do.

Factors Associated with the Attitudes toward Dementia in Community Caregivers: Results from the Nationwide Survey on Dementia Care in Korea

OBJECTIVE: We investigated caregivers' attitudes toward dementia, which may play a key role in the timely treatment and optimal care of people with dementia (PWD), and patient and caregiver factors potentially associated with these attitudes. METHODS: As a part of the Nationwide Survey on Dementia Care in Korea, we evaluated the attitudes of 731 community-dwelling caregivers of PWD with the Dementia Attitude Scale (DAS). Using stepwise multiple regression analysis, we investigated the sociodemographic factors of the caregivers, the clinicodemographic factors of the PWD, and the situational factors of caregiving that may influence caregivers' attitudes. RESULTS: The mean score on the DAS total was 80.65+/-16.0 (maximum : 140). The mean score on the DAS Knowledge subscale, which reflects awareness of dementia, was 42.86+/-9.6 (maximum : 70), and that on the DAS Comfort subscale, which reflects emotional and behavioral attitudes toward dementia, was 37.79+/-10.3 (maximum : 70). Non-spouse caregiver, living in a rural area, completion of a formal care education program (caregiver factors) and female patient, high educational level, high clinical dementia rating and mild behavioral symptoms (patient factors) were associated with a high DAS total score. CONCLUSION: We found much room for improvement in caregivers' attitudes towards PWD in Korea, indicating a need for strategies to improve these attitudes, targeting the at-risk group.

Nationwide Project for Early Detection of Dementia

The rapid increase of the elderly and dementia patients has motivated psychiatrists and government officials in Korea to participate in dementia research, programs and projects more actively since the nineties. Korean association for geriatric psychiatry and Korean association for dementia were founded in 1994 and the ministry of health and welfare pronounced the 10 year project for dementia in 1995 and the dementia service program at the public health center was established by law in 1997. Several leading groups of psychiatrists have started the dementia registry and service programs with the public health centers based on local communities and their endeavor made the foundation for nationwide projects for early detection of dementia. The pilot project of registry and service for dementia has been performed with the participation of 16 hospitals and 21 public health centers in 2006. And in 2007 nationwide project for early detection of dementia has started with 60 hospitals and 85 public health centers throughout the country. This project might contribute to delay the development and progression of dementia and help to promote the quality of life in dementia patients and their families in Korea.