Increase in direct social care costs of Alzheimer's disease in Japan depending on dementia severity.

AIM: With the aging population, costs of direct social support for patients with Alzheimer's disease have grown and will continue to increase. The purpose of the present study was to estimate the cost of direct social support for Alzheimer's disease under long-term care insurance in Japan. METHODS: This cross-sectional study included 169 patients with Alzheimer's disease or mild cognitive impairment who visited a memory clinic and were followed over time. Dementia severity, use of care services and costs were analyzed. RESULTS: The use of direct social support and costs increased significantly between patients with mild, moderate and severe dementia (P < 0.001). In particular, the use of day services and short stay services increased with the severity of dementia (P < 0.001). Similar findings were obtained when participants were stratified by long-term care insurance care levels. Of 169 participants, 49 had not applied for long-term care insurance, although their dementia severity was not different from support-need level 1 and care-need level 1. Logistic regression analysis of "did not apply" and "applied and certified" groups showed significant differences not only in dementia severity, but also in age (odds ratio 1.112, 95% confidence interval 1.037-1.193, P = 0.003) and living arrangements (odds ratio 0.257, 95% confidence interval 0.076-0.862, P = 0.028). CONCLUSIONS: As the number of patients with Alzheimer's disease increases, direct social costs will increase. The findings of this study might help standardize the type of direct social support provided after diagnosis of Alzheimer's disease and contribute to the development of cost-effective care for these patients. Geriatr Gerontol Int 2019; 19: 1023-1029.

A comparative study: visual rating scores and the voxel-based specific regional analysis system for Alzheimer's disease on magnetic resonance imaging among subjects with Alzheimer's disease, mild cognitive impairment, and normal cognition.

AIM: Hippocampal atrophy shown on magnetic resonance imaging can differentiate Alzheimer's disease (AD) patients from subjects with normal cognition (NC). Simplified automated methods that use volumetric analysis, such as as the voxel-based specific regional analysis system for AD, have become widely used in Japan. However, the diagnostic value of the voxel-based specific regional analysis system compared with visual rating scores for clinical diagnosis is unclear. METHODS: Study participants consisted of 37 AD patients, 29 mild cognitive impairment (MCI) patients, and 21 NC subjects. All participants underwent neuropsychological testing and magnetic resonance imaging. The imaging was scored visually for regional brain atrophy by two raters based on a newly developed visual rating score. The voxel-based specific regional analysis system for AD scores were calculated with the analysis system's advanced software. We analyzed whether these scores aid in discriminating among AD, MCI, and NC. RESULTS: The AD group had significantly different visual rating scores, regional analysis scores, and all neuropsychological test scores than the NC group. The AD group had significantly different visual rating scores than the MCI group, and a significant difference was observed between the MCI and NC groups on regional analysis scores. Both the visual rating and regional analysis scores showed equivalent correlations with the neuropsychological test scores. CONCLUSIONS: Both the visual rating and regional analysis scores are clinically useful tools for differentiating among AD, MCI, and NC.

Longitudinal Changes in Performance on Cognitive Screening Tests in Patients with Mild Cognitive Impairment and Alzheimer Disease.

BACKGROUND: Neuropsychological tests that can track changes in cognitive functions after diagnosis of Alzheimer disease (AD) and mild cognitive impairment (MCI), including episodic memory, should be further developed. METHODS: The participants of our study consisted of 22 mild AD patients and 11 MCI patients. They were followed up for 2 years. Brief cognitive screening tests were administered to the participants. Longitudinal changes in test performance were evaluated and analyzed. RESULTS: In this longitudinal study, the Scenery Picture Memory Test (SPMT) showed significant changes over 2 years in both MCI and AD participants. The Mini-Mental State Examination (MMSE) and Word Fluency Test-vegetable showed significant changes only in AD participants. Other tests all showed little or no decline in results. CONCLUSIONS: The SPMT can be a useful tool for effectively observing changes during follow-up of MCI and AD patients.

Relative Preservation of Advanced Activities in Daily Living among Patients with Mild-to-Moderate Dementia in the Community and Overview of Support Provided by Family Caregivers.

Little is known about the extent to which advanced activities of daily living among patients with dementia are preserved and how family caregivers of these patients support them in the community. In this cross-sectional assessment of pairs of patients with dementia and their family caregivers, we evaluated basic, instrumental, and advanced activities of daily living by comparing past and present status observed by caregivers with subjective estimations by patients with dementia. We also asked about ways in which support was provided by family caregivers. Thirty-nine pairs of patients with dementia and caregivers who presented to our memory clinic were interviewed. The mean age of patients with dementia was 75.3 ± 7.0 years, and Mini-Mental State Examination scores were 22.3 ± 3.4. We found relative preservation of advanced activities of daily living compared with instrumental activities of daily living. Caregivers provided instrumental, informational, and reminding support to patients with dementia. These findings may reinforce the concept of person-centered support of patients with dementia in the community.

Both conventional indices of cognitive function and frailty predict levels of care required in a long-term care insurance program for memory clinic patients in Japan.

AIM: To delineate relationships among cognitive function, frailty and level of care required in the Japanese long-term care insurance program (LTCIP) in outpatient memory clinic patients. METHODS: This was a cross-sectional study carried out at an outpatient memory clinic. Participants were 201 cognitively impaired patients. Cognitive function was measured by the Mini-Mental State Examination (MMSE). Frailty was measured by Timed Up & Go (TUG) and grip strength. Waist circumference, body mass index, living arrangement and level of care required in the LTCIP (rank 1 minor disability to rank 7 severe disability) were also assessed. RESULTS: Mean age, MMSE score, TUG score and grip strength were 78.8 ± 6.9 years, 19.6 ± 6.1, 14.6 ± 6.7 s and 16.9 ± 7.5 kg, respectively. A total of 70 patients (34.8%) had not applied for the certification, at least in part because of their younger age and existence of family caregivers. LTCIP rank was correlated both with MMSE score (ß: -0.49, P = 0.001), grip strength (ß: -0.27, P = 0.005) and living alone (ß: -0.18, P = 0.03), but not with TUG score (ß: 0.14, P = 0.105). CONCLUSION: In outpatients of a memory clinic, care ranks, which define the upper limit of monthly benefit in the Japanese LTCIP, were influenced by age, cognitive function, frailty and living arrangements. Understanding the relationship among these parameters would be useful in predicting the needs of cognitively impaired patients and important when comparing the possible services provided by long-term care systems for them worldwide.

[Use of honorifics in all situations by a patient with semantic dementia].

We report the case of a 72-year-old man who had been given a diagnosis of semantic dementia (SD) at 64 years of age, and who began to use honorifics in all situations during the later clinical course. His initial clinical features were problems in word comprehension and naming, and some behavioural changes, including clockwatching and aberrant eating behaviours. The most prominent feature in this case was the use of honorifics in all situations, while other aspects of his language ability deteriorated. He even used honorifics with members of his family, including young grandchildren. Although it is difficult to explain the reason why the patient used honorifics in all situations, we considered 2 possibilities. The first is that although he remains able to use honorifics, he is unable to distinguish when the use of honorifics is not required. The second is that a change in emotional state, such as the "taming effect" or "placidity" that has been suggested to accompany frontotemporal lobar degeneration, might have affected his use of honorifics. The regular schedule of daycare services provides him with emotional stability because he does not have to constantly be aware of the time. Since no standard treatment has been established for SD, our experience with this case might be beneficial in caring for patients with SD.