Can dementia patients live in a community? A case of a patient in trouble with the law.

We experienced a case involving a 67-year-old man with Alzheimer's disease who exhibited criminal behaviour. Although his behaviour improved after admission to a long-term care facility, he was not able to return to his home because he was suspected of theft. At 62 years of age, he developed slowly progressive memory loss and had difficulty managing money. He was diagnosed with Alzheimer's disease and began taking galantamine. He was placed in police custody after he had tried to take another person's fuel tank early one morning. However, he was not charged with theft because he did not remember his actions. Because it was difficult for his sister to constantly monitor him, he was admitted to a long-term care facility. He displayed high emotional insecurity and continually asked when he could return home. His physical function was good, enabling him to perform various activities alone, but he experienced the delusion of theft during these activities. He appealed the decision prohibiting him from going home. However, the staff suggested that he would exhibit problematic behaviours at home, and it was decided that he should not live at home. After living at the long-term care facility for 3 years, he died of acute cardiac infarction. When a person goes to jail for committing a crime, that person can return to society after completing a jail term. That was not the case with this man with Alzheimer's disease. As such, guidelines and standards to evaluate the criminal responsibility of dementia patients need to be established.

Falling of older adults with cognitive impairment: a new home environment evaluation chart and a preliminary examination in the Wakuya Project.

It is important to evaluate the home environment because most fractures in older adults are caused by falls indoors. However, previous studies have not separated individual abilities from environments. Also, the interrelationship between falls, cognitive function, and home environments has not been clarified. Objectives: The purpose of this study was to develop an evaluation method specific to the home environment and examine the effects of environment and cognitive impairment on falls. Methods: This was a case-control study analyzing 95 older adults living in the community. A Visiting Checklist for the Home Environment (VICHe) was developed and examined for reliability and validity. Inter-rater reliability (IRR) was examined by determining Cohen's kappa and the intra-class correlation coefficient. Guttman's split-half method was used for internal consistency, and Cronbach's alpha coefficient was obtained. Criterion-related validity was confirmed by Spearman's rank correlation coefficient with the Fall Risk Index's (FRI) total score of the environmental factor items. As a preliminary study, trends in the number of falls by cognitive function and home environment were examined. Results: The VICHe obtained validity, but the IRR was inadequate. In contrast, the version that focused on the on-floor environment (VICHe-OFI) showed IRR for all items and validity through correlations with the FRI. The number of fallers increased in the cognitive impairment group when the home environment was bad. Conclusions: Reliability and validity of the VICHe-OFI were obtained. Preliminary examination using this scale indicates that falls in the home of the elderly may be more affected by the home environment as cognitive function declines.

A avaliação do ambiente doméstico é importante pois a maioria das fraturas em idosos é causada por quedas dentro de casa. No entanto, estudos anteriores não separaram as habilidades individuais dos ambientes. Além disso, a inter-relação entre quedas, função cognitiva e ambientes domésticos não foi esclarecida. Objetivo: O objetivo foi desenvolver um método de avaliação específico para o ambiente doméstico e examinar os efeitos do ambiente e do comprometimento cognitivo nas quedas. Métodos: Este estudo foi um estudo de caso-controle analisando 95 idosos residentes na comunidade. Uma Lista de Verificação de Visitas para o Ambiente Doméstico (Visiting Checklist for Home Environment ­ VICHe) foi desenvolvida e examinada quanto à confiabilidade e validade. A confiabilidade entre avaliadores (CEA) foi examinada pela determinação do kappa de Cohen e do coeficiente de correlação intraclasse. O método split-half de Guttman foi usado para consistência interna e foi obtido o coeficiente alfa de Cronbach. A validade de critério foi confirmada pelo coeficiente de correlação de Spearman com a pontuação total da escala de risco de queda (ERQ) dos itens do fator ambiental. Como um estudo preliminar, foram examinadas as tendências no número de quedas por função cognitiva e ambiente doméstico. Resultados: O VICHe obteve validade, mas a CEA foi inadequada. Por outro lado, a versão que enfocou o ambiente "no chão" (VICHe-OFI) apresentou CEA para todos os itens e validade por meio de correlações com a ERQ. O número de quedas aumentou no grupo com comprometimento cognitivo quando o ambiente doméstico era ruim. Conclusões: Obteve-se confiabilidade e validade do VICHe-OFI. O exame preliminar com essa escala indica que as quedas do idoso no domicílio podem ser mais afetadas pelo ambiente doméstico à medida que a função cognitiva diminui.

Disturbed medication management in older adults with good cognitive health and mild cognitive impairment associated with semantic memory impairment: The Wakuya Project.

AIM: For older adults with mild cognitive impairment or mild dementia, maintaining daily lives at home is also ideal for quality of life. However, they have serious problems with medication management. Although the Dementia Assessment Sheet in community-based integrated care system-21 items and the regimen comprehension scale are assessment scales for medication, there have been no reports evaluating both semantic memory and actual performance. METHODS: A total of 180 older adults aged ≥75 years were entered in the Wakuya Project. They underwent the Clinical Dementia Rating, with two original tests: (i) the original semantic memory task for taking medication including the Dementia Assessment Sheet in community-based integrated care system-21 items; and (ii) the actual performance task related to medication including regimen comprehension scale. Non-demented participants were classified into two groups based on reports from their families; that is, a good management group (n = 66) and a poor management group (n = 42), and the two original tests were analyzed as explanatory variables. RESULTS: There were no differences between the two groups for the actual performance task related to medication including regimen comprehension scale. The success rates for the actual performance task related to medication including regimen comprehension scale (good management group/poor management group) were: regimen comprehension scale 40.9/23.8, One-Day Calendar 93.9/90.5, Medicine Chest 36.4/23.8 and Sequential Behavior Task 66.7/66.7, respectively. In the original semantic memory task for taking medication including the Dementia Assessment Sheet in community-based integrated care system-21 items, logistic regression analysis showed that only the mechanism of action remained (B -2.38, SE 1.10, Wald 4.69, P-value = 0.03, OR 0.09, 95%CI 0.01-0.80). CONCLUSION: Our results suggest that disruption of medicine management might also be associated with drug semantic memory impairment between the two groups, with no difference in general cognitive and executive functions. Geriatr Gerontol Int 2023; 23: 319-325.

Falling of older adults with cognitive impairment: a new home environment evaluation chart and a preliminary examination in the Wakuya Project / Queda de idosos com comprometimento cognitivo: uma nova ficha de avaliação do ambiente domiciliar e um exame preliminar no Projeto Wakuya

ABSTRACT. It is important to evaluate the home environment because most fractures in older adults are caused by falls indoors. However, previous studies have not separated individual abilities from environments. Also, the interrelationship between falls, cognitive function, and home environments has not been clarified. Objectives: The purpose of this study was to develop an evaluation method specific to the home environment and examine the effects of environment and cognitive impairment on falls. Methods: This was a case-control study analyzing 95 older adults living in the community. A Visiting Checklist for the Home Environment (VICHe) was developed and examined for reliability and validity. Inter-rater reliability (IRR) was examined by determining Cohen's kappa and the intra-class correlation coefficient. Guttman's split-half method was used for internal consistency, and Cronbach's alpha coefficient was obtained. Criterion-related validity was confirmed by Spearman's rank correlation coefficient with the Fall Risk Index's (FRI) total score of the environmental factor items. As a preliminary study, trends in the number of falls by cognitive function and home environment were examined. Results: The VICHe obtained validity, but the IRR was inadequate. In contrast, the version that focused on the on-floor environment (VICHe-OFI) showed IRR for all items and validity through correlations with the FRI. The number of fallers increased in the cognitive impairment group when the home environment was bad. Conclusions: Reliability and validity of the VICHe-OFI were obtained. Preliminary examination using this scale indicates that falls in the home of the elderly may be more affected by the home environment as cognitive function declines.

RESUMO. A avaliação do ambiente doméstico é importante pois a maioria das fraturas em idosos é causada por quedas dentro de casa. No entanto, estudos anteriores não separaram as habilidades individuais dos ambientes. Além disso, a inter-relação entre quedas, função cognitiva e ambientes domésticos não foi esclarecida. Objetivo: O objetivo foi desenvolver um método de avaliação específico para o ambiente doméstico e examinar os efeitos do ambiente e do comprometimento cognitivo nas quedas. Métodos: Este estudo foi um estudo de caso-controle analisando 95 idosos residentes na comunidade. Uma Lista de Verificação de Visitas para o Ambiente Doméstico (Visiting Checklist for Home Environment — VICHe) foi desenvolvida e examinada quanto à confiabilidade e validade. A confiabilidade entre avaliadores (CEA) foi examinada pela determinação do kappa de Cohen e do coeficiente de correlação intraclasse. O método split-half de Guttman foi usado para consistência interna e foi obtido o coeficiente alfa de Cronbach. A validade de critério foi confirmada pelo coeficiente de correlação de Spearman com a pontuação total da escala de risco de queda (ERQ) dos itens do fator ambiental. Como um estudo preliminar, foram examinadas as tendências no número de quedas por função cognitiva e ambiente doméstico. Resultados: O VICHe obteve validade, mas a CEA foi inadequada. Por outro lado, a versão que enfocou o ambiente "no chão" (VICHe-OFI) apresentou CEA para todos os itens e validade por meio de correlações com a ERQ. O número de quedas aumentou no grupo com comprometimento cognitivo quando o ambiente doméstico era ruim. Conclusões: Obteve-se confiabilidade e validade do VICHe-OFI. O exame preliminar com essa escala indica que as quedas do idoso no domicílio podem ser mais afetadas pelo ambiente doméstico à medida que a função cognitiva diminui.

Avoiding surgery in patients with dementia: is it the correct management? / Evitar cirurgia em pacientes com demência: é o manejo correto?

ABSTRACT. Although hospitalization for dementia is increasing, Japanese doctors often refrain from surgeries considering dementia. A woman in her 80s diagnosed with Alzheimer's disease was admitted to hospital for cholelithiasis. Due to the avoidance of surgery, the inflammation was prolonged and therefore she was unable to eat. Later, she was discharged with central venous nutrition. The care burden on family resulted in her readmission to another hospital. Eventually, the inflammation was alleviated, and she was able to eat. However, it took a long time. In this study, we not only emphasize the risks but also focus on the benefits to postoperative rehabilitation. We also discuss about the benefits of invasive procedures in patients with dementia.

RESUMO. Apesar do aumento de hospitalizações por demência, os médicos japoneses geralmente se abstêm de cirurgias ao considerar a demência. Uma mulher de 80 anos diagnosticada com doença de Alzheimer foi internada no hospital por colelitíase. O adiamento da cirurgia prolongou a inflamação e a deixou incapaz de comer. Ela foi forçada a receber alta com nutrição venosa central. A sobrecarga de cuidados para a família resultou em sua readmissão em outro hospital. Eventualmente, a inflamação foi aliviada e ela conseguiu comer. No entanto, levou muito tempo. Não devemos apenas enfatizar os riscos, mas também focar nos benefícios da reabilitação pós-operatória. Gostaríamos aqui de discutir e fornecer argumentos a favor de procedimentos invasivos em pacientes com demência.