Association of decreased frequency of conversation with depression, oral function and eating alone: A cross-sectional study of older adults during the COVID-19 pandemic.

AIM: This study examined the associations between geriatric factors and decreased opportunities for conversation among older adults amid a period of self-restraint during the COVID-19 pandemic. METHODS: A cross-sectional questionnaire-based survey was carried out in October 2020. The participants were 204 residents aged ≥65 years staying at a private care home in Kyoto city, Japan. Logistic regression analysis was carried out with the reduction of conversation opportunities as the dependent variable, and geriatric factors as independent variables after adjusting for age and sex. We compared the decreased frequency of opportunities between residents in the assisted living wing and in the nursing care wing of the private care home. RESULTS: The percentages of respondents who reported a decrease in the opportunities for conversation among themselves were 43.9% for residents in the assisted living wing and 19.7% for those in the nursing care wing. After adjusting for age and sex, the opportunities for conversation was significantly associated with the basic activities of daily living (OR 1.07, 95% CI 1.01-1.12), instrumental self-maintenance (OR 1.25, 95% CI 1.08-1.46), intellectual activity (OR 1.35, 95% CI 1.09-1.66), depression (OR 1.13, 95% CI 1.04-1.23), depressive mood (OR 3.83, 95% CI 1.98-7.42), decreased motivation (OR 3.11, 95% CI 1.58-6.12), appetite loss (OR 4.32, 95% CI 1.54-12.07), swallowing function (OR 1.05, 95% CI 1.00-1.10), chewing difficulty (OR 2.50, 95% CI 1.31-4.75) and eating alone (OR 2.5, 95% CI 1.35-4.62). CONCLUSION: Decreased opportunities for conversation was more perceived among older adults with higher daily functioning, suggesting that it is associated with depressed mood, oral function and solitary eating. Geriatr Gerontol Int 2024; 24: 385-391.

Older adults' preferences for and actual situations of artificial hydration and nutrition in end-of-life care: An 11-year follow-up study in a care home.

AIM: To clarify older adults' preferences for and actual situations of artificial hydration and nutrition (AHN) in end-of-life care in a care home. METHODS: Participants were residents of a care home who had completed advance directives regarding preferred methods of AHN from 2009 to 2018. Advance directives alone were available from April 2009 to June 2016 (Wave 1), and advance care planning for AHN including advance directives was introduced in July 2016 (Wave 2). AHN preferences included (i) intensive methods (percutaneous endoscopic gastrostomy, nasogastric tube feeding and total parenteral nutrition), (ii) drip infusion, and (iii) oral intake only. Participants were followed until the end of 2020, and we checked whether decisions about AHN were based on older adults' preferences. RESULTS: In total, 272 participants had completed advance directives. Most participants preferred "oral intake only" (59.5%), followed by drip infusion (32.0%) and intensive methods (8.5%) in advance directives. Ninety of the 272 participants completed advance directives twice; 83.3% did not change their AHN preferences from Wave 1 to Wave 2. By the end of 2020, 93 of the 272 participants died in the care home. AHN was provided according to older adults' preferences in 48.9% (oral intake only), in 51.4% (drip infusion) and in 55.6% (intensive methods) of cases respectively. CONCLUSIONS: Most participants preferred oral intake only, and their preferences were reflected in decisions about actual situations of AHN in end-of-life care. To prepare for advanced dementia and senility, early advance care planning for AHN should be promoted. Geriatr Gerontol Int 2022; 22: 581-587.

Word Processing Is Faster than Picture Processing in Alzheimer's Disease.

OBJECTIVE: Alzheimer's disease (AD) is characterized by a slow progressive impairment of episodic memory. Many studies have shown that AD exhibits deterioration of semantic memory during the course of disease progression. We previously reported that AD patients exhibited severe access disorders in the semantic memory system, using the Momentary Presentation Task (20 or 300 ms). In this study, we studied access disorder in patients with AD by the use of object difference (pictures vs words) methods. METHODS: 56 patients with probable AD (NINCDS-ADRDA, mean age 79.0 years) and 11 healthy controls (HC) (mean age 67.0 years) were studied. Ten pictures and 10 corresponding Japanese Hiragana words were presented arbitrarily for 20 and 300 ms on the monitor screen which were correctly named at the usual confrontation setting (i.e., semantic memory preserved). They were asked to name the pictures or to read the words or nonsense syllables aloud. RESULTS: The AD group showed significantly lower scores than the HC group, especially for the 20 ms condition. For the type of stimuli, the AD patients had better performances for words > pictures > nonsense syllables, although no differences for the HC group. The effect of AD severity was noted, moderate > severe stage. CONCLUSIONS: Our results suggested that the processing speed in AD patients may have reduced, even if the semantic memory were preserved. These data indicated that the difference in the processing speeds by the type of stimuli (pictures, words, and nonsense syllables) may be a character of AD patients.

Impaired Eating and Swallowing Function in Older Adults in the Community: The Kurihara Project.

Introduction: Older adults with dementia often develop aspiration pneumonia as a complication due to deterioration of swallowing function. Herein, we report our findings of eating and swallowing-related functions in elderly local residents. Methods: The subjects were 229 elderly residents in Kurihara City, including 97 healthy (Clinical Dementia Rating (CDR): 0), 108 with mild cognitive impairment (MCI) (CDR: 0.5), and 24 with dementia (CDR: 1 or higher: CDR 1+). We analyzed the relationships between the findings, eating, and swallowing, based on the database of the Kurihara Project performed from 2008 to 2010. Results: In the CDR 0.5 group, some deterioration in oral condition, oral function and swallowing function was confirmed. In the CDR 0.5 group, tooth staining, decrease in oral diadochokinesis (oral motion velocity), increased number of points below the cut-off value in a repetitive saliva swallowing test and the questionnaire, and prolonged water swallowing time were confirmed. In the CDR 1+ group, bad breath, elimination of the pharyngeal reflex, increase in disturbed soft palate elevation, and prolonged jelly swallowing time were confirmed. Conclusions: Deterioration of swallowing function was confirmed, even in subjects with mild dementia, in addition to development of problems related to food intake.

Depression and Dementia in Old-Old Population: History of Depression May Be Associated with Dementia Onset. The Tome Project.

Background: In this study, we investigated the relationship among a history of depression, depressive states, and dementia in a community-based old-old cohort. Methods: From 2012 to 2013, we recruited 200 subjects residing in Tome, Japan. Ultimately, 181 subjects were enrolled in our study and completed the whole study protocol. We used the World Mental Health-Composite International Diagnostic Interview 3.0 to evaluate whether subjects had a history of depression or other affective disorders. Simultaneously, 3.0 Tesla brain magnetic resonance imaging (MRI) was performed for each subject. Results: Of 181 subjects, 66 were normal (clinical dementia rating [CDR] = 0), 88 had MCI (CDR = 0.5), and 27 had dementia (CDR = 1 or above). Nine of the 181 subjects (4.9%) had a history of depressive episodes. CDR was significantly higher in subjects with a history of depression (0.9 vs. 0.4, p = 0.046) than in those without it. Seventy-two of the 181 subjects (39.7%) exhibited depressive symptoms. Subjects with depression exhibited lower Mini-Mental State Examination scores (21.6 vs. 23.3, p = 0.008), higher CDR scores (0.6 vs. 0.3, p = 0.004), and more atrophy of the medial temporal lobe (4.4 vs. 3.7, p = 0.036). Conclusion: A history of depression should be considered a risk factor for all-cause dementia. In the old-old population, depression is associated with a higher prevalence of dementia, lower cognitive performance, and a smaller hippocampus.

Self-rated health is associated with subsequent functional decline among older adults in Japan.

BACKGROUND: Previous studies have reported that self-rated health (SRH) predicts subsequent mortality. However, less is known about the association between SRH and functional ability. The aim of this study was to examine whether SRH predicts decline in basic activities of daily living (ADL), even after adjustment for depression, among community-dwelling older adults in Japan. METHODS: A three-year prospective cohort study was conducted among 654 residents aged 65 years and older without disability in performing basic ADL at baseline. SRH was assessed using a visual analogue scale (range; 0-100), and dichotomized into low and high groups. Information on functional ability, sociodemographic factors, depressive symptoms, and medical conditions were obtained using a self-administered questionnaire. Logistic regression analysis was used to examine the association between baseline SRH and functional decline three years later. RESULTS: One hundred and eight (16.5%) participants reported a decline in basic ADL at the three-year follow-up. Multiple logistic regression analysis showed that the low SRH group had a higher risk for functional decline compared to the high SRH group, even after controlling for potential confounding factors (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.3-4.4). Furthermore, a 10-point difference in SRH score was associated with subsequent functional decline (OR = 1.37; 95% CI = 1.16-1.61). CONCLUSIONS: SRH was an independent predictor of functional decline. SRH could be a simple assessment tool for predicting the loss or maintenance of functional ability in community-dwelling older adults. Positive self-evaluation might be useful to maintain an active lifestyle and stay healthy.

Qualitative Assessment of Instrumental Activities of Daily Living in Older Persons with Very Mild Dementia: The Kurihara Project.

BACKGROUND/AIMS: We investigated quantitative/qualitative changes of instrumental activities of daily living (IADL) in people with a Clinical Dementia Rating (CDR) of 0.5. METHODS: IADLs were evaluated in older residents: CDR of 0 (healthy) and CDR 0.5 (questionable/very mild dementia). The subjects with CDR 0.5 were divided into 2 types: the very mild Alzheimer's disease (vmAD) type and the other type including very mild subcortical vascular dementia. IADLs were evaluated quantitatively using the Lawton and the original qualitative IADL scales. RESULTS: CDR 0.5/vmAD type subjects had impairment of only one Lawton item (Shopping) compared to CDR 0 subjects. However, the CDR 0.5/vmAD type group and the CDR 0.5/other type group showed impairment of 3 items in the qualitative assessment (Shopping, Food preparation, and Mode of transportation). CONCLUSION: We suggest using both quantitative/qualitative IADL scales for assessing older adults with very mild dementia.

Impaired Picture Arrangement subscores (WAIS-III) associated with decreased place orientation and frontal/occipital blood flow in Alzheimer's disease: Implications for social judgment dysfunction. The Osaki-Tajiri Project.

Alzheimer's disease (AD) patients manifest not only memory impairment but also deficit of social judgment. However, contrary to frequently recognized deficit, only two neuropsychological tests have been established for assessing "judgment" : the Cognitive Abilities Screening Instrument domain Abstraction & judgment and the Picture Arrangement subscale of WAIS-III. For the former, we previously reported an association with decreased regional cerebral blood flow (rCBF) in the left parietal lobe. Herein, we analyzed the scores of the Picture Arrangement test. Forty-nine AD patients were classified into two groups, i.e., the high and low PA score groups. The 99mTc-ECD SPECT investigation was performed with the voxel-based analysis using SPM5. The Mini-Mental State Examination subscores of "place orientation" showed a correlation with the PA scores. The low PA score group exhibited significantly decreased rCBFs in the Left Inferior Frontal Gyrus (LIFG), Left Superior Frontal Gyrus (LSFG) and Right Occipital Lobe (ROL), compared with the high PA score group. The ability of PA may be associated with the place orientation, which may be necessary to re-arrange the pictures. The ROL was related to visual recognition. The LSFG may be involved in executive function or "frontal reasoning."

Neuroepidemiologic and Neurobehavioral Characteristics of Motoric Cognitive Risk Syndrome in an Old-Old Population: The Kurihara Project.

BACKGROUND: Recently, the concept of motoric cognitive risk (MCR) syndrome was proposed, where slow gait is considered a risk factor for conversion to dementia. AIM: To retrospectively investigate the characteristics of MCR among a population aged 75+ years, focusing on the aspects of epidemiology and neurobehavioral characteristics. METHOD: The participants were 590 residents aged 75+ years living in Kurihara who underwent MRI and neurobehavioral assessments including walking velocity. The prevalence of MCR and conversion to dementia (AD8 Dementia Screening Interview cutoff 2/8), together with the neurobehavioral characteristics of the MCR group, were analyzed. RESULTS: The prevalence was 11.1%, and the conversion ratio in the MCR group was higher than that in the non-MCR group (OR = 1.38). The MCR group had lower scores on the executive function test as well as gait velocity. CONCLUSIONS: The MCR syndrome increases the rate of conversion to dementia, and both slow gait and lower scores in executive tests, which are 'frontal-based' functions, are predictive of higher rates of conversion to dementia.

The Group Reminiscence Approach Can Increase Self-Awareness of Memory Deficits and Evoke a Life Review in People With Mild Cognitive Impairment: The Kurihara Project Data.

OBJECTIVES: The group reminiscence approach (GRA) and reality orientation (RO) are common psychosocial interventions for patients with dementia. As a qualitative evaluation of the reminiscence approach in patients with dementia, the Patient Report Outcome (PRO) is useful. The purpose of this study was to investigate the effects of GRA-RO for participants with mild cognitive impairment (MCI) using the PRO. DESIGN: A cluster randomized controlled trial. SETTING: Community-based study. PARTICIPANTS: Ninety-four patients with MCI (39 GRA-RO, 23 physical activity, and 32 cognitive training) described their impressions. INTERVENTION: Based on the database of the Kurihara Project, we retrospectively analyzed the participants' descriptions of their impressions as a PRO in the nonpharmacological interventions: GRA-RO, physical activity, and cognitive training. We categorized the descriptions according to the following 2 types: impression with content and reminiscence with life review. We assessed what they wrote regarding memory loss. The content on their life reviews was also a particular focus for the GRA-RO group. MEASUREMENTS: PRO. RESULTS: Compared with the physical activity and the clinical training groups, the GRA-RO patients described their reminiscence with life review and their own memory problems. There was no confusion of the order of events of their autobiographical memories. There was a significant time effect between the 2 family involvement groups in quality-of-life (QOL) scores, and the postintervention QOL scores were significantly better than preintervention. CONCLUSION: This study suggests that the GRA-RO in participants with MCI not only stimulates life review but also increases self-awareness of memory deficits without confusion of the order of events. Thus, the GRA-RO may improve self-esteem and develop self-awareness.

Glucose intolerance associated with hypoxia in people living at high altitudes in the Tibetan highland.

OBJECTIVES: To clarify the association between glucose intolerance and high altitudes (2900-4800 m) in a hypoxic environment in Tibetan highlanders and to verify the hypothesis that high altitude dwelling increases vulnerability to diabetes mellitus (DM) accelerated by lifestyle change or ageing. DESIGN: Cross-sectional epidemiological study on Tibetan highlanders. PARTICIPANTS: We enrolled 1258 participants aged 40-87 years. The rural population comprised farmers in Domkhar (altitude 2900-3800 m) and nomads in Haiyan (3000-3100 m), Ryuho (4400 m) and Changthang (4300-4800 m). Urban area participants were from Leh (3300 m) and Jiegu (3700 m). MAIN OUTCOME MEASURE: Participants were classified into six glucose tolerance-based groups: DM, intermediate hyperglycaemia (IHG), normoglycaemia (NG), fasting DM, fasting IHG and fasting NG. Prevalence of glucose intolerance was compared in farmers, nomads and urban dwellers. Effects of dwelling at high altitude or hypoxia on glucose intolerance were analysed with the confounding factors of age, sex, obesity, lipids, haemoglobin, hypertension and lifestyle, using multiple logistic regression. RESULTS: The prevalence of DM (fasting DM)/IHG (fasting IHG) was 8.9% (6.5%)/25.1% (12.7%), respectively, in all participants. This prevalence was higher in urban dwellers (9.5% (7.1%)/28.5% (11.7%)) and in farmers (8.5% (6.1%)/28.5% (18.3%)) compared with nomads (8.2% (5.7%)/15.7% (9.7%)) (p=0.0140/0.0001). Dwelling at high altitude was significantly associated with fasting IHG+fasting DM/fasting DM (ORs for >4500 and 3500-4499 m were 3.59/4.36 and 2.07/1.76 vs <3500 m, respectively). After adjusting for lifestyle change, hypoxaemia and polycythaemia were closely associated with glucose intolerance. CONCLUSIONS: Socioeconomic factors, hypoxaemia and the effects of altitudes >3500 m play a major role in the high prevalence of glucose intolerance in highlanders. Tibetan highlanders may be vulnerable to glucose intolerance, with polycythaemia as a sign of poor hypoxic adaptation, accelerated by lifestyle change and ageing.

Disturbed social recognition and impaired risk judgement in older residents with mild cognitive impairment after the Great East Japan Earthquake of 2011: the Tome Project.

AIM: After the Great East Japan Earthquake of 2011, we investigated the safety of residents in the affected communities. Most of the people requiring help were elderly and had previously been assessed as Clinical Dementia Rating (CDR) 0.5 (i.e. as having mild cognitive impairment (MCI)). We examined how well they understood the television news and whether they could make appropriate decisions. METHODS: This community-based study of dementia and difficulties following a disaster started in Tome, northern Japan. The subjects were 188 randomly selected older residents who underwent CDR, blood tests, magnetic resonance imaging, and cognitive tests, including an original visual risk cognition task. They were shown NHK news broadcasts from the day of the earthquake to determine whether they could understand the content. RESULTS: Neither the CDR 0 (healthy) nor the CDR 0.5 (MCI) subjects fully understood the television news. Some subjects did not recognize the danger of aftershocks and engaged in risky behaviour. CDR 0.5 subjects who exhibited such behaviour scored lower on the visual risk cognition task. CONCLUSIONS: It is noteworthy that television news is difficult to understand, even for healthy older adults. We found that MCI subjects had particular difficulties due to the disaster and suggest that risk cognition could be evaluated using visually presented materials.

Improved Diagnostic Accuracy of SPECT Through Statistical Analysis and the Detection of Hot Spots at the Primary Sensorimotor Area for the Diagnosis of Alzheimer Disease in a Community-Based Study: "The Osaki-Tajiri Project".

PURPOSE: SPECT is an important diagnostic tool for dementia. Recently, statistical analysis of SPECT has been commonly used for dementia research. In this study, we evaluated the accuracy of visual SPECT evaluation and/or statistical analysis for the diagnosis (Dx) of Alzheimer disease (AD) and other forms of dementia in our community-based study "The Osaki-Tajiri Project." PATIENTS AND METHODS: Eighty-nine consecutive outpatients with dementia were enrolled and underwent brain perfusion SPECT with 99mTc-ECD. Diagnostic accuracy of SPECT was tested using 3 methods: visual inspection (SPECT Dx), automated diagnostic tool using statistical analysis with easy Z-score imaging system (eZIS Dx), and visual inspection plus eZIS (integrated Dx). RESULTS: Integrated Dx showed the highest sensitivity, specificity, and accuracy, whereas eZIS was the second most accurate method. We also observed that a higher than expected rate of SPECT images indicated false-negative cases of AD. Among these, 50% showed hypofrontality and were diagnosed as frontotemporal lobar degeneration. These cases typically showed regional "hot spots" in the primary sensorimotor cortex (ie, a sensorimotor hot spot sign), which we determined were associated with AD rather than frontotemporal lobar degeneration. CONCLUSION: We concluded that the diagnostic abilities were improved by the integrated use of visual assessment and statistical analysis. In addition, the detection of a sensorimotor hot spot sign was useful to detect AD when hypofrontality is present and improved the ability to properly diagnose AD.

A Cluster Randomized Controlled Trial of Nonpharmacological Interventions for Old-Old Subjects with a Clinical Dementia Rating of 0.5: The Kurihara Project.

BACKGROUND: Evidence as to the benefits of nonpharmacological interventions for the boundary state between normal aging and dementia [mild cognitive impairment or a Clinical Dementia Rating (CDR) of 0.5] remains weak due to a lack of positive controls. AIMS: To directly compare the effects of cognitive interventions (CI), physical activities (PA) and a group reminiscence approach (GRA), we conducted a pilot study on the basis of a cluster randomized controlled trial design. METHOD: A total of 127 participants aged >74 years with a CDR of 0.5 were cluster randomized into three groups for CI, PA and GRA. The intervention lasted 12 weeks and consisted of weekly group sessions and home assignments. Mini-Mental State Examination (MMSE), Trail Making Test part A (TMT-A), word fluency (WF), 6-meter walk time and Quality of Life (QOL) Face Scale scores were evaluated as primary outcomes. RESULTS: Methodology-related benefits of CI and PA were found for MMSE scores and walk time, respectively. TMT-A, WF and QOL Face Scale scores improved irrespective of the methodologies used. CONCLUSIONS: Our findings suggest that CI and PA may be beneficial to cognitive and physical abilities, respectively. Executive functions and QOL may improve irrespective of the intervention methodologies used.

Mild cognitive impairment, poor episodic memory, and late-life depression are associated with cerebral cortical thinning and increased white matter hyperintensities.

In various independent studies to date, cerebral cortical thickness and white matter hyperintensity (WMH) volume have been associated with episodic memory, depression, and mild cognitive impairment (MCI). The aim of this study was to uncover variations in cortical thickness and WMH volume in association with episodic memory, depressive state, and the presence of MCI simultaneously in a single study population. The participants were 186 individuals with MCI (clinical dementia rating [CDR] of 0.5) and 136 healthy elderly controls (HCs; CDR of 0) drawn from two community-based cohort studies in northern Japan. We computed cerebral cortical thickness and WMH volume by using MR scans and statistically analyzed differences in these indices between HCs and MCI participants. We also assessed the associations of these indices with memory performance and depressive state in participants with MCI. Compared with HCs, MCI participants exhibited thinner cortices in the temporal and inferior parietal lobes and greater WMH volumes in the corona radiata and semioval center. In MCI participants, poor episodic memory was associated with thinner cortices in the left entorhinal region and increased WMH volume in the posterior periventricular regions. Compared with non-depressed MCI participants, depressed MCI participants showed reduced cortical thickness in the anterior medial temporal lobe and gyrus adjacent to the amygdala bilaterally, as well as greater WMH volume as a percentage of the total intracranial volume (WMHr). A higher WMHr was associated with cortical thinning in the frontal, temporal, and parietal regions in MCI participants. These results demonstrate that episodic memory and depression are associated with both cortical thickness and WMH volume in MCI participants. Additional longitudinal studies are needed to clarify the dynamic associations and interactions among these indices.

Inhibition of the primary motor cortex can alter one's "sense of effort": effects of low-frequency rTMS.

Studies using force-matching tasks have suggested that when we feel a "sense of effort," cortical regions may act to increase motor commands, and thus recruit additional motor units, in order to compensate for the exerted force. We hypothesized that suppressing activity in the primary motor cortex (M1), which is the source of the motor commands, would initiate the same process, and induce the same sense of effort. In a force-matching task, grip force was applied to 'right' hand and 10 healthy participants were asked to try to exert the same amount by using 'left' hand, with no visual feedback. On some trials, low-frequency, repetitive transcranial magnetic stimulation (lf-rTMS) was used to suppress the M1 and the primary somatosensory cortex (SI) in the left hemisphere, separately. Results showed that participants tended to overestimate the level of exerted force by up to 24%. In contrast, sham stimulation of the M1 and lf-rTMS over the SI did not significantly affect participants' estimations. Further, the M1 suppression resulted in a 42% reduction in motor-evoked potentials. Thus, the M1 suppression can affect our sense of effort, suggesting that compensatory neural mechanisms that increase the MI activity may play an important role in producing senses of effort.

Semantic dementia shows both storage and access disorders of semantic memory.

OBJECTIVE: Previous studies have shown that some patients with semantic dementia (SD) have memory storage disorders, while others have access disorders. Here, we report three SD cases with both disorders. METHODS: Ten pictures and ten words were prepared as visual stimuli to determine if the patients could correctly answer names and select pictures after hearing the names of items (Card Presentation Task, assessing memory storage disorder). In a second task, the viewing time was set at 20 or 300 msec (Momentary Presentation Task, evaluating memory access disorder) using items for which correct answers were given in the first task. The results were compared with those for 6 patients with Alzheimer's disease (AD). RESULTS: The SD patients had lower scores than the AD group for both tasks, suggesting both storage and access disorders. The AD group had almost perfect scores on the Card Presentation Task but showed impairment on the Momentary Presentation Task, although to a lesser extent than the SD cases. CONCLUSIONS: These results suggest that SD patients have both storage and access disorders and have more severe access disorder than patients with AD.

Disorders of "taste cognition" are associated with insular involvement in patients with Alzheimer's disease and vascular dementia: "memory of food is impaired in dementia and responsible for poor diet".

BACKGROUND: In dementia patients, dietary intake problems may occur despite the absence of swallowing problems. We investigated cognitive functions on food and taste in Alzheimer's disease (AD) and vascular dementia (VaD) patients. METHODS: Participants included 15 healthy controls (HC), 30 AD and 20 VaD patients. Food Cognition Test: Replicas of three popular foods in Japan with no odors were presented visually to each participant, with the instruction to respond with the name of each food. Replicas of food materials were subsequently presented to ask whether they were included in these foods. Taste Cognition Test: Replicas of 12 kinds of foods were presented to describe their expected tastes. RESULTS: The AD/VaD groups exhibited significantly lower scores on Food/Taste Cognition Tests compared with the HC group. These scores correlated inversely with Mini-Mental State Examination (MMSE) scores in the AD group. Decreased dietary intake was observed in 12 of the 50 patients; 8 of the 12 exhibited decreased Taste Cognition Test scores, higher than that of the normal-intake patients. There was no difference in the filter paper taste disc test between HC/AD/VaD groups. To test the hypothesis that the insula is associated with taste cognition, two MMSE-matched AD subgroups (n = 10 vs. 10) underwent positron emission tomography. Glucose metabolism in the right insula was lower in the low taste cognition subgroup. The VaD patients with insular lesions exhibited impaired Taste Cognition Test findings. CONCLUSIONS: It is important to consider the cognitive aspect of dietary intake when we care for dementia patients.