Distribution of Mini-Mental State Examination scores among urban community-dwelling older adults in Japan.

OBJECTIVES: The Mini-Mental State Examination (MMSE) is widely used as a cognitive screening test for older adults; however, cognitive performance can be affected by age, education, and sample selection bias, including time and place. The aims of this study were to examine the distribution of scores on the Japanese version of the MMSE in an urban community sample and to provide normative data for older Japanese adults. METHODS: A questionnaire survey was conducted on all residents aged 65 years and older living in an urban district in Tokyo (N = 7682). From among this population, 3000 residents were randomly selected to receive visits from trained nurses and to have their health status checked and their cognitive function examined using the MMSE. RESULTS: Of the 2786 eligible residents, the MMSE was administered to 1341 (47%) and successfully completed by 1319 (mean age, 74.4 ± 6.4 years; mean years of formal education, 12.6 ± 2.9). The median score was 28. A total of 143 residents (10.8%) had scores below the traditional 23/24 cutoff point. Younger age and higher education were associated with better performance. Greater variation was seen among the oldest and least educated residents, especially among women. CONCLUSION: The results of this study confirm that age and education affect MMSE scores. To ensure the effective use of the MMSE, it is recommended to examine scores corresponding to age and education. The normative data presented are expected to be useful for assessing MMSE scores in older individuals both in and out of the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd.

Excessive daytime sleepiness is related to subjective memory impairment in late life: a cross-sectional community-based study.

AIM: The aim of this study was to determine whether daytime sleepiness is related to subjective memory impairment among community-dwelling elderly people, after adjustment for psychosocial variables. METHODS: Questionnaires were mailed to all 5199 elderly residents living in one area of Tokyo. The questionnaires collected information about sociodemographic variables, subjective memory impairment, and excessive daytime sleepiness, which was measured by the Japanese version of the Epworth Sleepiness Scale. Information was also collected on sleep hygiene, health-related variables, and psychosocial variables, including perceived social support, social withdrawal, and work status. RESULTS: Of the 4783 questionnaires that were returned (92.0%), 4185 participants were included in the analysis (valid response rate: 80.5%), after the exclusion of questionnaires with missing data. The average score on the Japanese version of the Epworth Sleepiness Scale was 5.0 ± 3.9 for men and 4.5 ± 3.7 for women. The frequency of excessive daytime sleepiness was 8.3% for men, 5.8% for women, and 7.0% in total. Stepwise multivariate logistic regression revealed the odds ratio of excessive daytime sleepiness as a predictor of subjective memory impairment was 6.06 (95% confidence interval; 3.06-12.03). CONCLUSIONS: Elderly people who complain of daytime sleepiness are potential candidates for interventions related to dementia care after careful consideration of other possible causes of sleepiness.

The development of a self-administered dementia checklist: the examination of concurrent validity and discriminant validity.

PURPOSE: The present study aims to develop a self-administered dementia checklist to enable community-residing older adults to realize their declining functions and start using necessary services. A previous study confirmed the factorial validity and internal reliability of the checklist. The present study examined its concurrent validity and discriminant validity. METHODS: The authors conducted a 3-step study (a self-administered survey including the checklist, interviews by nurses, and interviews by doctors and psychologists) of 7,682 community-residing individuals who were over 65 years of age. The authors calculated Spearman's correlation coefficients between the scores of the checklist and the results of a psychological test to examine the concurrent validity. They also compared the average total scores of the checklist between groups with different Clinical Dementia Rating (CDR) scores to examine discriminant validity and conducted a receiver operating characteristic analysis to examine the discriminative power for dementia. RESULTS: The authors analyzed the data of 131 respondents who completed all 3 steps. The checklist scores were significantly correlated with the respondents' Mini-Mental State Examination and Frontal Assessment Battery scores. The checklist also significantly discriminated the patients with dementia (CDR = 1+) from those without dementia (CDR = 0 or 0.5). The optimal cut-off point for the two groups was 17/18 (sensitivity, 72.0%; specificity, 69.2%; positive predictive value, 69.2%; negative predictive value, 72.0%). CONCLUSION: This study confirmed the concurrent validity and discriminant validity of the self-administered dementia checklist. However, due to its insufficient discriminative power as a screening tool for older people with declining cognitive functions, the checklist is only recommended as an educational and public awareness tool.

[Development of a self-administered dementia checklist (SDC) (1): Examination of factorial validity and internal reliability].

AIM: The aim of this study was to develop a self-administered dementia checklist (SDC), in order to help community-residing older adults realize their declining functions and encourage them to begin using necessary services, and to examine its factorial validity and internal reliability. METHODS: A panel of dementia clinical experts developed a questionnaire according to pre-selected items and conducted a self-administered survey with community-residing people aged 65 + (n=2,483). The team developed a scale through an exploratory factor analysis and item response theory (IRT) analysis (Study 1). Using this scale, they conducted a self-administered survey with community-residing people aged 65 + (n=5,199), conducted another exploratory factor analysis, and developed a 10-item scale. A confirmatory factor analysis was subsequently conducted and reliability coefficients were computed. RESULTS: The exploratory factor analysis of the proposed 37 items extracted 5 factors: Factor 1 was named "subjective decline in daily living functioning," and Factor 2 was "subjective cognitive decline" in the early stage of dementia. The team developed a 20-item scale by selecting 10 items from each factor which had high factor loadings and high slope values in the IRT analysis (Study 1). After the exploratory factor analysis of the 20-item scale, they developed a 10-item scale by selecting 5 items from each factor which had strong associations. The confirmatory factor analysis verified the 2-factor model. The Cronbach α coefficients for the subscales of Factors 1 and 2 were 0.935 and 0.834, respectively, and 0.908 for the overall 10-item scale. CONCLUSION: The authors developed a 10-item SDC with 2 factors and confirmed its factorial validity and internal reliability.

[Delusions].

We have reviewed differential diagnostics and treatment of mental disorders with delusions in elderly people. Their delusions are often influenced by sensory disturbances, general medical conditions, and psychological as well as living status. Because delusions are not specific to particular disorders, differential diagnostics require assessment of other symptoms. In making a treatment plan, it is essential to consider psychosocial factors that contribute to development of delusions. The goal should be to help the patient live an ordinary life even if their delusions persist.

Characteristics of detected and undetected dementia among community-dwelling older people in Metropolitan Tokyo.

AIM: Although a series of policies have been adapted to deliver an early diagnosis of dementia, many people living with dementia remain undetected and undiagnosed. The aim of this study is to investigate the characteristics of undetected dementia in community-dwelling older people in Metropolitan Tokyo. METHODS: We conducted a three-step survey. First, the questionnaires were mailed, in total, to 7614 residents aged ≥70 years in one area in Tokyo, and 5430 were retrieved. Secondly, 2020 individuals attended the face-to-face survey, including Mini-Mental State Exam (MMSE). Thirdly, 198 of 335 individuals who scored <24 on MMSE were visited. Diagnosis of dementia, Clinical Dementia Rating and need for social support were assessed by the interdisciplinary team at their home, and psychological variables, sociological variables and sociodemographic variables were evaluated. RESULTS: Among the 198 participants, 78 (39.4%) were assessed to have dementia. Among those who had dementia, 34 had received a previous diagnosis of dementia in a clinical setting, i.e., the rate of undetected dementia among our 198 participants was 56.4%. People living with dementia without a dementia diagnosis tended to have more complex social support needs, particularly in the domains of dementia diagnosis, medical check-ups for physical conditions, continuous medical care and housing support. In addition, they exhibited signs of frailty. CONCLUSIONS: Given that people living with dementia without a dementia diagnosis are at risk of losing housing or physical health, it is a threat to human rights. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2020; ••: ••-••.

Reliability and validity of the Japanese version of a self-report (DEMQOL) and carer proxy (DEMQOL-PROXY) measure of health-related quality of life in people with dementia.

AIM: The DEMQOL is a self-report measure of subjective quality of life of people with dementia, and the DEMQOL-PROXY is a carer proxy version. The study aimed to develop Japanese versions of the DEMQOL and DEMQOL-PROXY, and test their reliability and validity. METHODS: Translation, reverse translation and equivalency evaluation by the original author were used to develop Japanese versions of the DEMQOL (DEMQOL-J) and DEMQOL-PROXY (DEMQOL-PROXY-J). Interviews were carried out with 90 pairs of people with dementia and their carers to assess their quality of life using the DEMQOL-J, DEMQOL-PROXY-J and other quality of life scales. Internal consistency was evaluated using Cronbach's alpha. Test-retest reliabilities were evaluated using intraclass correlation coefficients. Criterion validity was determined using Pearson's correlation coefficient. RESULTS: Data from 87 pairs who completed the interviews were analyzed. Cronbach's alphas for the DEMQOL-J and DEMQOL-PROXY-J were 0.930 and 0.927, respectively. For 27 pairs who were re-interviewed, the intraclass correlation coefficients for the DEMQOL-J and DEMQOL-PROXY-J were 0.942 (P < 0.001) and 0.942 (P < 0.001), respectively. Both the DEMQOL-J and DEMQOL-PROXY-J correlated significantly with other quality of life scales (the Quality of Life - Alzheimer's Disease instrument, the EuroQol-5D-3L and the World Health Organization Well-Being Index-5-J; P < 0.001). There was also a significant correlation between the DEMQOL-J and the DEMQOL-PROXY-J (r = 0.645, P ≤ 0.001). CONCLUSIONS: The DEMQOL-J and DEMQOL-PROXY-J are reliable and valid measures of dementia-specific quality of life. Geriatr Gerontol Int 2019; 19: 487-491.

Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community.

AIM: Polypharmacy is a serious medical problem among older adults. Polypharmacy can cause adverse drug reactions and is associated with frailty. Several drugs, particularly psychotropic medications, can cause cognitive impairment. Recent research also suggests that polypharmacy can cause cognitive impairment. We investigated the prevalence of polypharmacy, and examined the association between polypharmacy and cognitive impairment in a large sample of community-dwelling older adults in Japan. METHODS: A questionnaire covering sociodemographic variables was sent to all residents aged ≥65 years in an urban residential district of Tokyo, Japan (n = 7682). Next, 3000 individuals were randomly selected as study participants. A trained nurse and researcher interviewed participants in their own homes to obtain information about cognitive status, prescribed medications, and current medical history. Cognitive status was assessed using the Mini-Mental State Examination. Polypharmacy was defined as treatment with six or more prescribed medications. RESULTS: Of the 1270 respondents who completed an interview, 1152 were included in the analysis of medications. The prevalence of polypharmacy was 28.0% (n = 323). When the older adults in the medications analysis were stratified by Mini-Mental State Examination scores, polypharmacy was present in 48.3% of those scoring <24, and 25.7% of those scoring ≥24 (χ2 = 26.76, P < 0.001). After controlling for potential confounding factors (including psychotropic medications), a multivariate logistic regression analysis showed an association between polypharmacy and cognitive impairment (odds ratio 1.83, 95% confidence interval 1.10-3.02; P = 0.019). CONCLUSIONS: Polypharmacy was associated with cognitive impairment among urban community-dwelling older adults. Geriatr Gerontol Int 2017; 17: 1286-1293.

Development of the dementia assessment sheet for community-based integrated care system.

A series of our studies on the development of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) were reviewed. Study 1: to examine the distribution of scores and internal reliability of DASC-21, trained nurses and researchers visited the homes of 1341 participants aged 65 years and older and living in the community. The nurses interviewed the participants and, when possible, their family members, to complete the DASC-21. Then, the Mini-Mental State Examination was carried out to select the participants of study 2. Study 2: to examine the concurrent and discriminant validity, experienced psychiatrists and psychologists, who were blind to the findings of study 1, visited the homes of 131 subjects who were selected from the participants of study 1 and completed the Clinical Dementia Rating (CDR), the Mini-Mental State Examination and the Frontal Assessment Battery (FAB). Cronbach's coefficient alpha of the DASC-21 was 0.808-0.950. Scores of the DASC-21 significantly correlated with CDR total and box scores, Mini-Mental State Examination and Frontal Assessment Battery. In an analysis of variance, CDR had the main effect on the score of the DASC-21. Receiver operating characteristic analysis showed that the DASC-21 had sufficient discriminatory ability between dementia (CDR1+) and non-dementia (CDR0 or CDR0.5; area under the curve = 0.804-0.895). When using a cut-off point of 30/31, sensitivity was 83.3-94.1% and specificity was 77.3-86.4%. The DASC-21 has sufficient reliability and validity as a tool to evaluate impairments in daily functioning and in cognitive functions, to detect dementia, and to assess the severity of dementia in the community.