Effect of financial incentives for participation in dementia prevention and support activities: results of a web survey with persons aged 60 and older.

BACKGROUND: This study aims to elucidate the impact of financial incentives on the motivation to participate in dementia prevention activities and to provide support to people with dementia. METHODS: An online survey was completed by 1500 men and women, aged 60 or above, from the general community in Japan. When responding to questions regarding motivation for participating in dementia prevention activities and providing support to people with dementia, respondents were randomly assigned different incentive conditions. Two incentive options were used for dementia prevention activities (no incentives, and a small number of reward points). Three incentive options were used for support activities (no incentives, a small cash reward, or an in-kind time reward that allowed respondents or their family members to use similar services at a later time (time credits)). RESULTS: Financial incentives decreased motivation for participating in dementia prevention activities, while time credits significantly increased motivation to participate in providing support to people with dementia for going out of their home, when receiving a cash reward was compared with receiving no reward. No significant differences by incentive were found for participating in daily living support for those with dementia or for providing support at a dementia café where people with dementia and their families interact. CONCLUSIONS: The adverse influence of financial incentives on motivation to participate in dementia prevention suggested that financial incentives may reduce intrinsic motivation for dementia prevention activities. The positive effects of time credits in providing support to people with dementia in going out suggested that time credits might be effective for some support activities for people with dementia. Different incentive measures should be considered to raise awareness of dementia prevention and dementia support activities.

Discrepancies in persons with dementia, family members, and physician perspectives of dementia treatment: a descriptive study.

BACKGROUND: This study aims to reconsider diagnostic approaches to dementia where pharmacological approaches are not available to reverse the pathological changes caused by dementia. METHODS: A questionnaire survey was conducted with 524 physicians specialising in dementia management in Aichi, Japan, with 163 (31.1%) valid responses. The survey gathered information on the perceived merits and demerits of the early diagnosis of dementia and the priorities in treating those with mild cognitive impairment (MCI), mild dementia, and moderate or advanced dementia. In the interview survey, 27 outpatients with mild Alzheimer's disease (76.2 ± 7.6 years old; Mini-Mental State Examination score 23.3 ± 2.7 points; 21 women, six men) and 24 family members (12 spouses, 12 children) were asked about their priorities in treatment. RESULTS: A total of 61.3% of physicians answered that persons with dementia having more time to accept the diagnosis is a merit of early diagnosis, while 61.3% answered that the possibility of causing anxiety was a demerit. Around 45% of the physicians chose the option 'maintaining cognitive function' as the first priority in cases of MCI and mild dementia, while 39.3% considered it the last priority in moderate or advanced cases. About 22.2% of persons with dementia and 37.5% of their families assigned the highest priority to 'maintaining cognitive function', whereas 37.0% of persons with dementia prioritised 'maintaining quality of life for them and their families'. CONCLUSIONS: Although it is important to build therapeutic alliances among persons with dementia, their families, and physicians by sharing a common perspective for better treatment of dementia, this study suggested that the three parties do not always share the same vision. Future research is needed to determine how to build therapeutic alliances for better approaches to dementia, especially to ensure that timely diagnosis is beneficial for persons with dementia and their families.

Sally-Anne test and regional cerebral blood flow in Alzheimer's disease dementia.

AIM: It was recently reported that theory of mind is disturbed in mild Alzheimer's disease dementia (ADD). Some studies have reported reduced scores of ADD patients on false belief tests, even on first-order false belief tests. However, few studies have pursued the neural substrate of false belief tests in patients with ADD in a real-world setting. METHODS: Sixty-three patients with ADD from outpatient units took the Sally-Anne test and underwent brain single-photon emission computed tomography. Of these patients, 29 answered the Sally-Anne test correctly (successful group) and 34 incorrectly (unsuccessful group). We compared the regional cerebral blood flow between the successful and unsuccessful groups. RESULTS: A comparison of the two groups showed a significantly lower uptake in the bilateral posterior cingulate gyrus in the unsuccessful group than in the successful group. CONCLUSIONS: The posterior cingulate gyrus is known to be particularly activated when individuals remember personal events and infer the mental states of others. We suppose that memory or mentalization in the posterior cingulate gyrus-or both-is essential for patients with ADD to be able to pass the Sally-Anne test.

Gullibility may be a warning sign of Alzheimer's disease dementia.

ABSTRACTBackground:Theory of Mind reasoning, which plays a pivotal role in social interaction, is required to detect deception. Empirically, those with cognitive decline are vulnerable to deception. METHODS: Participants were 45 healthy elderly adults with clinical dementia rating (CDR) 0, and 76 outpatients: 25 with amnestic mild cognitive impairment (aMCI, CDR 0.5), 34 with mild Alzheimer's disease dementia (ADD, CDR 1), and 17 with moderate ADD (CDR 2). The task consisted of two single-frame cartoons that depicted a character with an intention to deceive another character using social signs of gaze and pointing, and participants are provided clue questions to detect the character's intentions. RESULTS: The percentage of participants who detected the character's intention decreased with ADD progression (CDR 0, 82.2%; CDR 0.5, 48.0%; CDR 1, 29.4%; and CDR 2, 0%). Total score (0-6) also decreased with ADD progression (CDR 0, 4.4 +/-1.1; CDR 0.5, 3.0 +/-1.3; CDR 1, 2.9 +/-1.5; and CDR 2, 1.6 +/-0.9). DISCUSSION AND CONCLUSIONS: The present study demonstrated that those with aMCI have difficulty in detecting other's deceiving intentions, when the intention was shown implicitly using social signs. In a previous study, we have reported that mild ADD showed difficulties in detecting intention, while aMCI succeeded in detection when the intention was depicted explicitly. These results together suggested that those with aMCI is vulnerable to deception when the intention was shown implicitly using non-verbal cues, while ADD may fail to detect the intention even when the intention was shown explicitly.

Effects of attachment to and participation in the community on motivation to participate in dementia prevention and support activities: analysis of Web survey data.

AIM: The objective of this study was to elucidate the effects of a sense of attachment to the community (attachment) and participation in community activities (participation) on motivation to participate in dementia prevention and support activities (motivation). METHODS: We conducted a nationwide Web-based questionnaire survey of 1693 men and women aged ≥20 years. The questionnaire items used in the analysis asked about the following: (i) demographic characteristics (i.e. gender, age, marital status, household income (monitor-registered data), elderly family members, number of years of residency); (ii) attachment; (iii) participation; (iv) self-assessment of dementia knowledge; (v) nursing care experience; (vi) contact with individuals with dementia; (vii) attitudes towards dementia and people with dementia; and (viii) motivation. RESULTS: Positivity towards dementia and negativity towards dementia were extracted as factors in exploratory factor analysis of attitudes towards dementia and people with dementia. Multiple regression analysis with extracted factors as dependent variables showed that attachment and participation exerted positive effects on attitudes towards dementia (both P < 0.001). The direct effects of attachment and participation on motivation were significant in hierarchical multiple regression analysis (both P < 0.001), and path analysis demonstrated the paths of the effects of attachment and participation on motivation (both P < 0.001). The bias-corrected bootstrap method showed that both attachment and participation exerted direct and indirect (via the mediation of attitudes towards dementia) effects on motivation to participate in the community (all P < 0.001). CONCLUSION: The results showed that attachment and participation were both determinants of positive attitudes towards dementia and, thus, exerted effects on motivation, both directly and indirectly. These findings suggested that the enhancement of attachment and promotion of participation could lead to the promotion of dementia prevention and support activities in communities and increase dementia awareness.

Magnetoencephalography study of the effect of attention modulation on somatosensory processing in patients with major depressive disorder.

AIMS: Although affective and/or attention modulation of somatosensory processing has been well studied, the biological bases of somatic symptoms in patients with major depressive disorder (MDD) have rarely been examined. To elucidate changes in somatosensory processing underlying somatic symptoms in patients with MDD, we conducted a magnetoencephalography study of patients with MDD and healthy controls. METHODS: After median nerve stimulation, somatosensory evoked fields (SEF) were recorded in 10 patients with MDD and 10 sex-, age-, and height-matched healthy volunteers under somatosensory attending, visually attending, and non-attending conditions. The latencies and magnitudes of N20m and P60m SEF were examined. RESULTS: In the MDD group, P60m latency was significantly prolonged, irrespective of attention modulation, whereas N20m latency and root mean squares N20m and P60m amplitudes remained unchanged. Prolonged P60m latency negatively correlated with the somatosensory threshold, which was relatively high in the MDD group. Prolonged P60m latency also negatively correlated with a state of anxiety during the examination, but not with depressive symptoms or psychotropic medication. CONCLUSIONS: These results suggested that patients with MDD experience dysfunction in somatosensory information processing, approximately 60 ms after stimuli, irrespective of attentional conditions.

The impact of subjective memory complaints on quality of life in community-dwelling older adults.

PURPOSE: The aim of this study was to evaluate the impact of memory complaints on quality of life (QOL) in elderly community dwellers with or without mild cognitive impairment (MCI). METHODS: Participants included 120 normal controls (NC) and 37 with MCI aged 65 and over. QOL was measured using the Japanese version of Satisfaction in Daily Life, and memory complaints were measured using a questionnaire consisting of four items. The relevance of QOL was evaluated with psychological factors of personality traits, sense of self-efficacy, depressive mood, self-evaluation of daily functioning, range of social activities (Life-Space Assessment), social network size, and cognitive functions including memory. The predictors of QOL were analyzed by multiple linear regression analysis. RESULTS: QOL was not significantly different between the NC and MCI groups. In both groups, QOL was positively correlated with self-efficacy, daily functioning, social network size, Life-Space Assessment, and the personality traits of extraversion and agreeableness; QOL was negatively correlated with memory complaints, depressive mood, and the personality trait of neuroticism. In regression analysis, memory complaints were a negative predictor of QOL in the MCI group, but not in the NC group. The partial correlation coefficient between QOL and memory complaints was -0.623 (P < 0.05), after scores of depressive mood and self-efficacy were controlled. Depressive mood was a common negative predictor in both groups. Positive predictors were Life-Space Assessment in the NC group and sense of self-efficacy in the MCI group. CONCLUSIONS: Memory complaints exerted a negative impact on self-rated QOL in the MCI group, whereas a negative correlation was weak in the NC group. Memory training has been widely practised in individuals with MCI to prevent the development of dementia. However, such approaches inevitably identify their memory deficits and could aggravate their awareness of memory decline. Thus, it is critical to give sufficient consideration not to reduce QOL in the intervention for those with MCI.

Relative preservation of the recognition of positive facial expression "happiness" in Alzheimer disease.

BACKGROUND: Positivity recognition bias has been reported for facial expression as well as memory and visual stimuli in aged individuals, whereas emotional facial recognition in Alzheimer disease (AD) patients is controversial, with possible involvement of confounding factors such as deficits in spatial processing of non-emotional facial features and in verbal processing to express emotions. Thus, we examined whether recognition of positive facial expressions was preserved in AD patients, by adapting a new method that eliminated the influences of these confounding factors. METHODS: Sensitivity of six basic facial expressions (happiness, sadness, surprise, anger, disgust, and fear) was evaluated in 12 outpatients with mild AD, 17 aged normal controls (ANC), and 25 young normal controls (YNC). To eliminate the factors related to non-emotional facial features, averaged faces were prepared as stimuli. To eliminate the factors related to verbal processing, the participants were required to match the images of stimulus and answer, avoiding the use of verbal labels. RESULTS: In recognition of happiness, there was no difference in sensitivity between YNC and ANC, and between ANC and AD patients. AD patients were less sensitive than ANC in recognition of sadness, surprise, and anger. ANC were less sensitive than YNC in recognition of surprise, anger, and disgust. Within the AD patient group, sensitivity of happiness was significantly higher than those of the other five expressions. CONCLUSIONS: In AD patient, recognition of happiness was relatively preserved; recognition of happiness was most sensitive and was preserved against the influences of age and disease.

Pitfall Intention Explanation Task with Clue Questions (Pitfall task): assessment of comprehending other people's behavioral intentions in Alzheimer's disease.

BACKGROUND: In Alzheimer's disease (AD) patients, deficits in contextual understanding and intentions/beliefs of other people (theory of mind; ToM) cause communication problems between patients and caregivers. To evaluate deficits of contextual understanding/ToM, we developed the Pitfall Intention Explanation Task with Clue Questions (Pitfall task). METHODS: We recruited 26 healthy older adults in clinical dementia rating (CDR) 0, and 62 outpatients: 12 with amnestic mild cognitive impairment (aMCI) in CDR 0.5; 36 mild AD in CDR 1; and 14 moderate AD in CDR 2. The Pitfall task consists of a single-frame cartoon that shows a character's intention and seven serial questions that provide clues for contextual understanding/ToM. RESULTS: The total score (0-7) was decreased with progression of AD (CDR 0, 5.4 ± 2.6; CDR 0.5, 3.7 ± 2.7; CDR 1, 1.9 ± 3.1; CDR 2, 0.0 ± 0.0; respectively). In CDR 0, two-third of the participants responded correctly without clue questions. In CDR 0.5, one-third of the participants responded correctly without clue questions, and half of them understood with the help of the clue questions. In CDR 1, one-fourth of the participants responded correctly without clue questions, and the clue questions did not increase the correct response. In CDR 2, none responded correctly. Additionally, the Pitfall task provided the chance for patients' families to observe patients' responses. CONCLUSION: Contextual understanding/ToM, a kind of social cognition, was impaired with progression of AD. The Pitfall task evaluates the function quickly with low burden for memory function, and may provide helpful clues for caregivers to achieve good communication with AD patients.

A figurative proverb test for dementia: rapid detection of disinhibition, excuse and confabulation, causing discommunication.

BACKGROUND: Communicative disability is regarded as a prominent symptom of demented patients, and many studies have been devoted to analyze deficits of lexical-semantic operations in demented patients. However, it is often observed that even patients with preserved lexical-semantic skills might fail in interactive social communication. Whereas social interaction requires pragmatic language skills, pragmatic language competencies in demented subjects have not been well understood. We propose here a brief stress-free test to detect pragmatic language deficits, focusing on non-literal understanding of figurative expression. We hypothesized that suppression of the literal interpretation was required for figurative language interpretation. METHODS: We examined 69 demented subjects, 13 subjects with mild cognitive impairment and 61 healthy controls aged 65 years or more. The subjects were asked the meaning of a familiar proverb categorized as a figurative expression. The answers were analyzed based on five factors, and scored from 0 to 5. To consider the influence of cognitive inhibition on proverb comprehension, the scores of the Stroop Colour-Word Test were compared concerning correct and incorrect answers for each factor, respectively. Furthermore, the characteristics of answers were considered in the light of excuse and confabulation qualitatively. RESULTS: The proverb comprehension scores gradually decreased significantly as dementia progressed. The literal interpretation of the proverb, which showed difficulties in figurative language comprehension, was related to disinhibition. The qualitative analysis showed that excuse and confabulation increased as the dementia stage progressed. CONCLUSIONS: Deficits in cognitive inhibition partly explains the difficulties in interactive social communication in dementia. With qualitative analysis, asking the meaning of a proverb can be a brief test applied in a clinical setting to evaluate the stage of dementia, and to illustrate disinhibition, confabulation and excuse, which might cause discommunication and psychosocial maladjustment in demented patients.

Yamaguchi fox-pigeon imitation test (YFPIT) for dementia in clinical practice.

BACKGROUND: In out-patient clinics, having simple procedures to check for signs of dementia is invaluable. In the present study, we evaluated the imitation of hand gestures to detect visuomotor deficits in dementia in clinical practice. METHODS: In all, 1219 subjects were enrolled in the present study, including 497 with Alzheimer's disease (AD), 98 with dementia with Lewy bodies (DLB), 71 with other types of dementia diseases, 175 with a Clinical Dementia Rating (CDR) of 0.5, and 378 normal controls. All subjects were aged 65 years or older. Subjects were recruited from 10 clinics and two communities. Visuomotor function was evaluated by the Yamaguchi fox-pigeon imitation test (YFPIT), which consists of a simple one-handed sign for 'fox' and a complex two-handed sign for 'pigeon', a rapid, game-like test with low psychological burden. RESULTS: The success rate (successful/total) for imitating the 'pigeon' hand gesture was reduced as the severity of the dementia increased: 85.7% in normal controls, 60.6% in CDR 0.5 (mild cognitive impairment), 39.2% in CDR 1 (mild dementia), 21.2% in CDR 2 (moderate dementia), and 5.7% in CDR 3 (severe dementia). The success rate for imitating the 'pigeon' hand gesture was higher in patients with DLB than AD within the CDR 1 group (51.2% vs 35.4%, respectively), but lower for patients with DLB than AD within the CDR 2 group (12.5% vs 24.4%, respectively). The success of imitating the hand gesture for 'fox' was similar for patients with AD and DLB. Of those subjects who failed to imitate the hand gesture for 'pigeon', 49.5% of those with AD showed the palm-palm pattern (both palms facing outward), suggesting deficits of perspective conversion from the first-person to the third-person. Conversely, 52.8% of patients with DLB showed a dorsum-dorsum pattern (both dorsa facing outwards), suggesting deterioration of visual attention and recognition. CONCLUSION: In conclusion, the YFPIT is a useful test to detect visuomotor deficits in dementia that can differentiate between AD and DLB.

Reconsidering the overdiagnosis of mild cognitive impairment for dementia prevention among adults aged ≥80 years.

A diagnosis at the stage of mild cognitive impairment (MCI) is encouraged to promote dementia prevention since intensive intervention during the mild stage is thought to be effective for dementia prevention. Many adults aged ≥80 years hope to prevent dementia; however, several issues should be considered regarding the diagnosis of MCI. First, the diagnosis of MCI is not clear-cut in actual medical practice, with the differentiation of MCI from normal states and mild dementia being blurred. Second, although MCI due to Alzheimer's disease can be differentiated from MCI without pathological changes, interventions specific to MCI due to Alzheimer's disease have not been developed. Third, the diagnosis of MCI can cause self-stigma, leading to psychological effects such as depression and anxiety for both the patients and their families, which can be risk factors for developing dementia for patients. In addition, medical resources are limited and diagnosing MCI is costly in medical human resources. Considering these issues, diagnosing MCI to promote dementia prevention should be viewed from the perspective of the individual patient's interests, especially for those aged ≥80 years. The final decision regarding receiving a diagnosis or not should be the patient's; therefore, it is necessary to increase patients' health literacy, which requires medical professionals to provide them with appropriate evidence-based information. At the same time, it is important to provide psychological support to people who have been diagnosed.

Yamaguchi fox-pigeon imitation test: a rapid test for dementia.

BACKGROUND/AIMS: We herein propose a hand-gesture imitation test, consisting of a simple one-handed sign of a 'fox' and a complex two-handed sign of a 'pigeon', as a rapid, game-like test for detecting dementia/Alzheimer disease (AD) with low psychological burden. The test measures the visuomotor function, which deteriorates in the early stages of AD. METHODS: We examined 88 demented subjects, 19 with mild cognitive impairment (MCI), and 53 normal controls aged 65 years or over. The subjects were classified according to the Clinical Dementia Rating (CDR). RESULTS: The specificity of the test was 94%, and the sensitivity was 58% in CDR 0.5 (MCI), 77% in CDR 1 (mild dementia), 75% in CDR 2 (moderate dementia), and 90% in CDR 3 (severe dementia). The test could be conducted within 1 min and no subjects refused to be tested. CONCLUSION: This brief hand-gesture imitation test can sensitively evaluate visuomotor deficits in dementia/AD, while some subjects are unaware of their failure or even that their cognitive function is being tested. We herein describe the precise protocol for worldwide use.

Overview of non-pharmacological intervention for dementia and principles of brain-activating rehabilitation.

Non-pharmacological interventions for dementia are likely to have an important role in delaying disease progression and functional decline. Research into non-pharmacological interventions has focused on the differentiation of each approach and a comparison of their effects. However, Cochrane Reviews on non-pharmacological interventions have noted the paucity of evidence regarding the effects of these interventions. The essence of non-pharmacological intervention is dependent of the patients, families, and therapists involved, with each situation inevitably being different. To obtain good results with non-pharmacological therapy, the core is not 'what' approach is taken but 'how' the therapists communicate with their patients. Here, we propose a new type of rehabilitation for dementia, namely brain-activating rehabilitation, that consists of five principles: (i) enjoyable and comfortable activities in an accepting atmosphere; (ii) activities associated with empathetic two-way communication between the therapist and patient, as well as between patients; (iii) therapists should praise patients to enhance motivation; (iv) therapists should try to offer each patient some social role that takes advantage of his/her remaining abilities; and (v) the activities should be based on errorless learning to ensure a pleasant atmosphere and to maintain a patient's dignity. The behavioral and cognitive status is not necessarily a reflection of pathological lesions in the brain; there is cognitive reserve for improvement. The aim of brain-activating rehabilitation is to enhance patients' motivation and maximize the use of their remaining function, recruiting a compensatory network, and preventing the disuse of brain function. The primary expected effect is that patients recover a desire for life, as well as their self-respect. Enhanced motivation can lead to improvements in cognitive function. Amelioration of the behavioral and psychological symptoms of dementia and improvements in activities of daily living can also be expected due to the renewed positive attitude towards life. In addition, improvements in the quality of life for both patients and caregivers is an expected outcome. To establish evidence for non-pharmacological interventions, research protocols and outcome measures should be standardized to facilitate comparison among studies, as well as meta-analysis.

Computerized visuo-spatial memory test as a supplementary screening test for dementia.

BACKGROUND: To prepare for a super-aging society, effective dementia screening tests are required. The most salient deficit appearing from the early stages of dementia/Alzheimer's disease (AD) is a deterioration in memory. The Hasegawa Dementia Scale-revised (HDS-R) and the Mini-Mental State Examination (MMSE) are widely used in Japan to screen for dementia. Both place an emphasis on memory function, but neither examines visuo-spatial memory (VSM) function, even though VSM deficits are a sensitive marker for the detection of conversion to dementia. Furthermore, brief tests of VSM that are appropriate for screening have not been standardized. Thus, in the present study, we devised a brief, computer-aided short-term VSM test. METHODS: Sixty-six aged people were evaluated. Using the Clinical Dementia Rating (CDR), it was found that 29 could be considered normal controls (NC; CDR 0), 10 had mild cognitive impairment (MCI; CDR 0.5), 15 had mild dementia (CDR 1), and 12 had moderate to severe dementia (CDR 2-3). The VSM test estimated how many locations each subject could memorize. Several numbered circles were shown on a monitor and subjects were required to memorize the location of these circles sequentially. After the numbers on the circles on the screen had disappeared, the subjects were required to indicate the circles in ascending order. A touch panel screen was used for this test to make it easier. The HDS-R was applied to subjects with MCI and dementia. RESULTS: The mean (+/-SD) VSM score in subjects with MCI (5.70 +/- 0.96) was significantly lower than that in NC subjects (6.69 +/- 0.82), but significantly higher than that in subjects classified as CDR 1 (4.67 +/- 0.87). There was no significant difference in VSM scores between subjects classified as CDR 1 and CDR 2-3 (3.80 +/- 0.80). There was a moderate significant correlation between VSM and HDS-R scores. CONCLUSION: In the present study, the VSM test detected differences in VSM function among NC subjects and subjects with MCI and mild dementia. The software program for the VSM test is distributed for free so that it can be widely used.

Promoting dementia-friendly communities to improve the well-being of individuals with and without dementia.

A community is the totality of human relationships, in which individuals live with and for others. This article discusses promoting dementia-friendly community from the perspective of human relationships within a community. Improving the social well-being of aging people is important; it is especially important for people with dementia, as dementia is a life-changing syndrome that affects all aspects of one's life, including human relationships. Dementia-friendly community requires support from the community in improving the social adaptation of people with dementia, as they experience greater difficulties in social interaction as a result of cognitive decline, especially deterioration of social cognition. They need to be empowered to stay motivated for the opportunity to maintain an active and meaningful life, despite dementia. Flexible provisions of such tailored support can be effective to improve the support network in the community to meet the individual's needs. As social and human resources are limited, it is also necessary to discuss how to share socioeconomic burdens to meet both social sustainability demands and the welfare of aging adults. More discussions that include people with dementia and their family members are required to achieve the purpose of dementia-friendly community. This is important to enhance the well-being of individuals with and without dementia, as well as the society as a whole, through dementia support and dementia prevention activities. Geriatr Gerontol Int 2020; ••: ••-••.

Rehabilitative Support for Persons with Dementia and Their Families to Acquire Self-Management Attitude and Improve Social Cognition and Sense of Cognitive Empathy.

People with dementia are often inevitably confronted with various difficulties with social interaction and communication, which is a core problem that can be improved with rehabilitative support, thus improving their quality of life. The authors propose rehabilitative support using communication via activities; co-beneficial relationship-based rehabilitation, which emphasizes the following 3 points: support for people with dementia to improve social reserves, which is the ability to overcome the decline in social cognition; support for family members for improving cognitive empathy, which is the ability to analyze the background of others' behaviors and speech; and the involvement of the practitioner to supervise and empower them. The process of intervention is as follows: (1) selecting activities for collaboration; (2) sharing information on their current situation including declined abilities; (3) enhancing cognitive empathy through dementia education; (4) designing the intervention measures together; and (5) practice and feedback. Living with dementia involves a continuous process of coping with various challenges in daily living, however, the process of effectively managing these challenges is one of the ways to improve the quality of life of people with dementia and their family members.

Social problems in daily life of patients with dementia.

AIM: Most patients with dementia frequently encounter various problems in their daily lives. Those troubles embarrass both the patients and their families, and cause problems for society. However, there have been few scientific reports on the difficulties in the daily life of patients with dementia. Therefore, we tried to clarify the frequency and characteristics of troubles experienced by patients with dementia. METHODS: Seven medical centers treating dementia patients in Okayama Prefecture, Japan, participated in this survey. A total of 737 patients were placed in one of the three groups: a dementia group (n = 478), a mild cognitive impairment group (n = 199) and a control group (n = 60). The frequency of 13 difficulties was scored for each patient. RESULTS: Among normal participants, no person caused these problems once a year or more frequently. "Massive, recurrent buying" and "acts that risk causing a fire" were reported once a year or more for >10% of mild cognitive impairment patients. "Troubles with wealth management" and "troubles with money management" were the most frequent problems of dementia patients. CONCLUSIONS: Several problems are already sometimes encountered in patients with mild cognitive impairment. It would be useful to know which social difficulties are often seen in dementia patients in order to protect the safety of the patients. It is always difficult to balance respecting the autonomy of dementia patients and ensuring their safely. Geriatr Gerontol Int 2019; 19: 113-118.

Asymmetric control mechanisms of bimanual coordination: an application of directed connectivity analysis to kinematic and functional MRI data.

Mirror-symmetrical bimanual movement is more stable than parallel bimanual movement. This is well established at the kinematic level. We used functional MRI (fMRI) to evaluate the neural substrates of the stability of mirror-symmetrical bimanual movement. Right-handed participants (n=17) rotated disks with their index fingers bimanually, both in mirror-symmetrical and asymmetrical parallel modes. We applied the Akaike causality model to both kinematic and fMRI time-series data. We hypothesized that kinematic stability is represented by the extent of neural "cross-talk": as the fraction of signals that are common to controlling both hands increases, the stability also increases. The standard deviation of the phase difference for the mirror mode was significantly smaller than that for the parallel mode, confirming that the former was more stable. We used the noise-contribution ratio (NCR), which was computed using a multivariate autoregressive model with latent variables, as a direct measure of the cross-talk between both the two hands and the bilateral primary motor cortices (M1s). The mode-by-direction interaction of the NCR was significant in both the kinematic and fMRI data. Furthermore, in both sets of data, the NCR from the right hand (left M1) to the left (right M1) was more prominent than vice versa during the mirror-symmetrical mode, whereas no difference was observed during parallel movement or rest. The asymmetric interhemispheric interaction from the left M1 to the right M1 during symmetric bimanual movement might represent cortical-level cross-talk, which contributes to the stability of symmetric bimanual movements.

Rehabilitation to live better with dementia.

The goal of dementia treatment is to improve the quality of life for both people with dementia and their families. Rehabilitation as a non-pharmacological approach, coordinated with pharmacological treatment, aims to allow patients to live better by slowing the progression, and relieving the behavioral and psychological symptoms of dementia. In dementia, the manifestation of symptoms caused by neurological impairment is modified by various factors; thus, multidimensional assessment and approaches are effective based on the concept of the International Classification of Functioning, which emphasizes the healthy components of every person's functioning. Regarding the process of rehabilitation, every person with dementia should take initiative throughout the course of rehabilitation, and shared decision-making is a fundamental requirement at every phase of intervention. The needs of rehabilitation differ depending on the stage of dementia. In the early stages, cognitive rehabilitation is needed, and interventions are carried out using preserved functions and compensatory strategies. As the disease progresses, capacities of instrumental and then basic activities of daily living deteriorate, and interventions need to be tailor-made and carried out in the context of actual living situations. In the early-to-moderate stages, prevention and management of behavioral and psychological symptoms of dementia are required. In the interventions to alleviate behavioral and psychological symptoms of dementia, it is critical to consider the individual and the meaning behind his/her behaviors from a holistic perspective. Family carers also need support, and education to learn coping strategies can be beneficial for both people with dementia and their carers. Rehabilitation can empower people with dementia and their families to live better with dementia. Geriatr Gerontol Int 2018; 18: 1529-1536.