Expression of overadaptation in children through drawing a man as a projective measure: a community sample study.

BACKGROUND: Overadaptation, the behavior of individuals who follow the expectations of others as perfectly as possible, is often observed and related to maladjustment, school refusal, and physical symptoms; however, no method has been proposed yet to assess the overadaptive tendency. This study evaluated the efficacy of the Goodenough Draw-a-Man (DAM) test as a projective measure of overadaptation in children. METHODS: Eighty children (36 boys, 44 girls), aged 6-8 years, were assessed for their ability to draw a man using the DAM test. Class teachers were asked to assess whether each child was overadapting. The total and subscale DAM scores and pass rates were compared between children with a teacher-assessed tendency for overadaptation and control children, separately for girls and boys. RESULTS: The mean total DAM score was significantly higher for girls versus boys for both the overadapting children and controls. For boys, no significant differences on the total and subscale DAM scores were noted between the overadapting boys and controls. Conversely, for girls, total and three subscale DAM scores (Mouth/Nose/Ears, Hair, Fingers) were significantly higher in the overadapting girls versus controls. Moreover, for girls, the DAM pass rates on five items (ratio of head; ears present; position and shape of nose; depiction of hair, not to see the scalp; details of fingers) were higher in the overadapting girls versus controls. CONCLUSIONS: The DAM test could identify the overadaptive tendencies of girls aged 6-8 years.

Relationship between neuropsychiatric symptoms and Alzheimer's disease pathology: An in vivo positron emission tomography study.

OBJECTIVES: To investigate the relationship between amyloid-ß- and tau-based Alzheimer's disease (AD) pathologies assessed using positron emission tomography imaging and neuropsychiatric symptoms (NPS) in a sample of AD continuum including clinically normal subjects and patients with mild cognitive impairment or AD. METHODS: We analyzed datasets of the Alzheimer's disease Neuroimaging Initiative and included amyloid-positive subjects who underwent an AV-45 scan within 1 year of an AV-1451 scan (n = 99). Correlation between standardized uptake value ratio (SUVR) of AV-45 and AV-1451 and the Neuropsychiatric Inventory (NPI) score (and its four domain subscores for hyperactivity, psychosis, affective, and apathy) was evaluated. Stepwise logistic regression analysis was used to examine the influence of SUVRs on the presence of NPS. SUVRs were also tested for their ability to discriminate the group with NPS using receiver operating characteristic (ROC) curve analyses. RESULTS: Significant positive relationships were found between the total NPI score and affective symptoms and Braak 1&2 (transentorhinal region) AV-1451 SUVR. Stepwise logistic regression analysis identified tau accumulation in the area of Braak 1&2 as a significant covariate discriminating the presence of affective symptoms. The area under the ROC curve analysis showed that subjects with affective symptoms were discriminated by AV-1451 SUVR with an accuracy of 77.7%. CONCLUSIONS: Tau aggregation in the transentorhinal region, where neurodegeneration affected by tau pathology was seen in the early stage of AD, correlated with more severe NPS, especially affective symptoms. Therefore, tau pathology in the transentorhinal cortex might be associated with affective symptoms in the early stage of AD.

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.

An evaluation of the amyloid cascade model using in vivo positron emission tomographic imaging.

AIM: The amyloid cascade hypothesis posits that the accumulation of amyloid ß (Aß) is the triggering factor for Alzheimer's disease, which consecutively induces aggregation of tau, synaptic loss, and cell death. Most experimental and clinical evidence supports this model, but the available data are largely qualitative. Here, we tested the amyloid cascade hypothesis by using in vivo evaluation of positron emission tomography and magnetic resonance imaging. METHODS: Path analysis was used to estimate the relationships among Aß accumulation (PiB standardized uptake value ratio (SUVR)), tau aggregation and its related neuroinflammation (THK5351 SUVR), grey matter atrophy in the medial temporal region, and memory function in Aß-positive subjects. We also performed additional regression analyses to evaluate the effect of Aß on the toxicity of tau aggregation/neuroinflammation. RESULTS: Path analysis supported our hypothesized model: Aß accumulation affected tau aggregation/neuroinflammation in the medial temporal region, and these pathological changes caused of the grey matter atrophy and memory dysfunction. In separate regression analyses, THK5351 SUVR had a significant effect on grey matter atrophy only in PiB-positive subjects. The analysis of the interaction effect showed that the effects of THK5351 SUVR on grey matter atrophy were significantly different between PiB-positive and PiB-negative groups. When we included the effect of being an apolipoprotein E ε4 carrier as a covariate, the interaction effect remained significant. CONCLUSION: Our in vivo evaluation of positron emission tomographic and magnetic resonance imaging data supported the amyloid cascade hypothesis. In addition, it indicated that Aß not only accelerates tau aggregation/neuroinflammation but promotes its toxicity. Our findings showed the importance of understanding the role and therapeutic potential of the interaction between amyloid and tau aggregation/neuroinflammation in Alzheimer's disease.

Interaction effect of Alzheimer's disease pathology and education, occupation, and socioeconomic status as a proxy for cognitive reserve on cognitive performance: in vivo positron emission tomography study.

AIM: Educational attainment, occupation, and socioeconomic status have been regarded as major factors influencing cognitive reserve (CR). This study aimed to investigate the interaction effect of amyloid-ß/tau burden and education/occupation/socioeconomic status as a proxy for CR on cognitive performance. METHODS: We analyzed the datasets of the Alzheimer's Disease Neuroimaging Initiative. We included clinically normal subjects and patients with mild cognitive impairment or Alzheimer's disease who had undergone a florbetapir scan within 1 year of a flortaucipir (AV-1451) scan (n = 127). Partial correlation analysis between the standardized uptake value ratio of florbetapir/AV-1451 and the proxy for CR was performed with the 13-item Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) score as a covariate. Stepwise multiple linear regression analysis was performed to determine the predictors of ADAS-cog performance based on the interaction between the imaging biomarkers and the proxy for CR. RESULTS: We found a significant positive partial correlation between educational level and tau pathology in Braak stage 1/2 areas, and we observed significantly higher tau accumulation among participants with higher education when ADAS-cog score was used as a covariate. The interaction between tau and education was a good predictor of cognitive function, with higher tau accumulation showing a greater association with higher ADAS-cog score among participants with less education than among those with more education. CONCLUSION: Our findings indicate the protective effect of education against cognitive dysfunction in early-stage Alzheimer's disease pathology and suggest that education may exert a beneficial effect by reducing the adverse cognitive consequences of tau aggregation.

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.

Electromagnetic signatures of the preclinical and prodromal stages of Alzheimer's disease.

Biomarkers useful for the predementia stages of Alzheimer's disease are needed. Electroencephalography and magnetoencephalography (MEG) are expected to provide potential biomarker candidates for evaluating the predementia stages of Alzheimer's disease. However, the physiological relevance of EEG/MEG signal changes and their role in pathophysiological processes such as amyloid-ß deposition and neurodegeneration need to be elucidated. We evaluated 28 individuals with mild cognitive impairment and 38 cognitively normal individuals, all of whom were further classified into amyloid-ß-positive mild cognitive impairment (n = 17, mean age 74.7 ± 5.4 years, nine males), amyloid-ß-negative mild cognitive impairment (n = 11, mean age 73.8 ± 8.8 years, eight males), amyloid-ß-positive cognitively normal (n = 13, mean age 71.8 ± 4.4 years, seven males), and amyloid-ß-negative cognitively normal (n = 25, mean age 72.5 ± 3.4 years, 11 males) individuals using Pittsburgh compound B-PET. We measured resting state MEG for 5 min with the eyes closed, and investigated regional spectral patterns of MEG signals using atlas-based region of interest analysis. Then, the relevance of the regional spectral patterns and their associations with pathophysiological backgrounds were analysed by integrating information from Pittsburgh compound B-PET, fluorodeoxyglucose-PET, structural MRI, and cognitive tests. The results demonstrated that regional spectral patterns of resting state activity could be separated into several types of MEG signatures as follows: (i) the effects of amyloid-ß deposition were expressed as the alpha band power augmentation in medial frontal areas; (ii) the delta band power increase in the same region was associated with disease progression within the Alzheimer's disease continuum and was correlated with entorhinal atrophy and an Alzheimer's disease-like regional decrease in glucose metabolism; and (iii) the global theta power augmentation, which was previously considered to be an Alzheimer's disease-related EEG/MEG signature, was associated with general cognitive decline and hippocampal atrophy, but was not specific to Alzheimer's disease because these changes could be observed in the absence of amyloid-ß deposition. The results suggest that these MEG signatures may be useful as unique biomarkers for the predementia stages of Alzheimer's disease.

Decreased perfusion of the posterior cingulate gyri shown by a cingulate island score is a possible marker of vulnerability to behavioural and psychological symptoms of Alzheimer's disease: a pilot study.

BACKGROUND: The cingulate island score (CIScore), which indicates the Z-score ratio of the posterior cingulate gyri to the medial occipital area, has been shown to be useful for differentiating dementia with Lewy bodies from Alzheimer's disease (AD). Our aim was to investigate associations between the clinical symptoms of AD and the CIScore as an index of the relative decrease in perfusion of the posterior cingulate gyri that occurs in the early stages of AD. METHODS: Seventeen patients with early-stage AD and 13 patients with amnesic mild cognitive impairment were examined. Z-score maps of technetium-99m ethyl cysteinate dimer single-photon emission computed tomography images acquired from the patients were converted, and the CIScore was determined by using the easy Z-score imaging system. The relationships between the CIScore and clinical symptom scores were tested. RESULTS: A significant correlation was identified between the CIScore and the Neuropsychiatric Inventory Questionnaire score. No significant correlations were identified between the CIScore and other measures of cognitive function. Based on a CIScore of 0.39, we correctly differentiated patients with and without behavioural and psychological symptoms of dementia (BPSD), with a sensitivity of 72.2% and specificity of 75.0%. DISCUSSION: Using technetium-99m ethyl cysteinate dimer single-photon emission computed tomography, we observed that decreased posterior cingulate gyri perfusion, relative to the medial occipital area, in prodromal and early AD was closely associated with behavioural and psychological symptoms of dementia. Therefore, our findings suggest that CIScore is not only useful for discriminating dementia with Lewy bodies from AD, but it can also be clinically used as a specific indicator of the vulnerability to behavioural and psychological symptoms of dementia in the early stages of AD.

[Utility of a Life-trouble Scale-based care planning tool for elderly patients living in a long-term care health facility: Effects of an intervention based on person-centered care].

PURPOSE: This study aimed to clarify the utility of the Life-trouble Scale-based care planning tool for elderly patients with dementia (Life-trouble Scale, viewpoints, and care points of the elderly with dementia suffering from life troubles) in order to develop an appropriate care plan and practices in a long-term care health facility. METHOD: Participants were elderly patients with dementia who were evaluated by care staff using the abovementioned scale at baseline and after intervention (one month later) from September to December 2017. The patients were divided into an intervention group, which received care based on the Life-Trouble Inclusion Scale, and the control group, which received the usual care. The outcomes of these two groups were compared. RESULTS: The intervention and control groups comprised 14 and 12 elderly patients with dementia, respectively. More than 60% of the care staff worked with both groups. Scores on the agitation sub-scale of the NPI [please define abbreviation] and "life-trouble associated with irritation and confusion" sub-scale of the Life-Trouble Scale improved significantly in the intervention group. Among the care staff, self-efficacy related to caring for elderly patients with dementia and scores on the Emotional Exhaustion and Depersonalization sub-scales of the Japanese version of the Maslach Burnout Inventory improved significantly. CONCLUSION: The present findings suggest that care intervention using the Life-trouble Scale-based care planning tool was beneficial for both elderly patients with dementia and their care staff.

[An analysis of the reliability and validity of the Life-trouble Scale for elderly patients living in geriatric facilities].

PURPOSE: The purpose of this study was to develop the Life-trouble Scale for elderly people with dementia to concretely determine their life troubles in geriatric facilities. RESULTS: The subjects of this study were elderly people living in geriatric health services facilities whose degree of life independence was evaluated as ≥II, who had a diagnosis of dementia, and who agreed to participate in this study.The study population included 191 subjects (male, n=144, 75.4%; female, n=47, 24.6%). The average age was 85.72 (±6.96) years, the mean degree of need for nursing care was 3.73 (±1.22), and the mean MMSE score was 9.11 (±8.80).Based on the factor analysis of the Life-trouble Scale, the first factor was named, "Basic Life Behavior and Life Trouble with Communication." The second factor was named, "Life Trouble Associated with Irritation and Confusion". The third factor was named, "Trouble with Human Relations Associated with Feelings and Changes in Consciousness". The fourth factor was named, "Life Trouble Associated with Changes in Consciousness and Repeated Behavior". The Cronbach's α of the 4 factors was 0.884, and the NPI and Crichton rating scales were significantly correlated with the 4 factors. CONCLUSION: The results showed that the Life-trouble Scale had reliability and validity, and that it was useful for solving problems in geriatric health services facilities.

Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial.

PURPOSES: The aim of this study was to evaluate the safety and efficacy of the early administration haloperidol in preventing the aggravation of postoperative delirium in elderly patients. METHODS: A total of 201 patients (age ≥75 years) who underwent elective surgery were enrolled. The patients were divided into two groups: the intervention group (n = 101) received prophylactic haloperidol (5 mg); the control group (n = 100) did not. Haloperidol was administered daily during postoperative days 0-5 to the patients who presented with NEECHAM scores of 20-24 when measured at 18:00. The primary endpoint was the incidence of severe postoperative delirium. RESULTS: The incidence of severe postoperative delirium in all patients was 25.1%. The incidence of severe postoperative delirium in the intervention group (18.2%) was significantly lower than that in the control group (32.0%) (p = 0.02). The difference between the two groups was larger when the analysis was limited to the 70 patients who had NEECHAM scores of 20-24 for at least one day during postoperative days 0-5. No adverse effects of the haloperidol were observed. CONCLUSION: The prophylactic administration of haloperidol at the early stage of delirium significantly reduced the incidence of severe postoperative delirium in elderly patients. Clinical Trial Registration UMIN000007204.

The effects of quality of life on behavioral and psychological symptoms in elderly people with dementia residing at long-term care facilities.

PURPOSE: The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly). METHODS: Elderly individuals with dementia were evaluated to determine their activities of daily living (ADL; Katz), Mini-mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Quality of life inventory for the elderly with dementia (QOLD) scores. RESULTS: The subjects were recruited from intermediate welfare facilities (n = 226, 43.7%), hospitals with supportive care (n=91, 17.6%), and intermediate care facilities (n = 200, 38.7%). The mean age of the subjects was 85.18±7.13 years. The NPI scores revealed that Agitation/Aggression was high among subjects who resided in healthcare health facilities and sanatorium-type medical facilities, while Apathy/Indifference was high in those who resided in special nursing homes. Additionally, a multiple regression analysis found that most of the NPI items, when set as independent variables, displayed a significant association with the same subscale of the QOLD. CONCLUSION: When each item of the NPI was set as a dependent variable in a multiple regression analysis, the scores were significantly related to both subscales of the QOLD. It is suggested that QOL should be maintained or improved in an effort to reduce the incidence of the associated BPSDs in long-term care facilities.

Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients: a randomized, open-label prospective trial.

PURPOSE: Postoperative delirium is the most common postoperative complication in the elderly. The purpose of this study was to evaluate the safety and effectiveness of the preventive administration of low-dose haloperidol on the development of postoperative delirium after abdominal or orthopedic surgery in elderly patients. SUBJECTS: A total of 119 patients aged 75 years or older who underwent elective surgery for digestive or orthopedic disease were included in this study. METHODS: Patients were divided into those who did (intervention group, n = 59) and did not (control group, n = 60) receive 2.5 mg of haloperidol at 18:00 daily for 3 days after surgery; a randomized, open-label prospective study was performed on these groups. The primary endpoint was the incidence of postoperative delirium during the first 7 days after the operation. RESULTS: The incidence of postoperative delirium in all patients was 37.8%. No side effects involving haloperidol were noted; however, the incidences of postoperative delirium were 42.4 and 33.3% in the intervention and control groups, respectively, which were not significantly different (p = 0.309). No significant effect of the treatment was observed on the severity or persistence of postoperative delirium. CONCLUSIONS: The preventive administration of low-dose haloperidol did not induce any adverse events, but also did not significantly decrease the incidence or severity of postoperative delirium or shorten its persistence.

[Overview and assessment of cognitive function in interpreting postoperative cognitive dysfunction].

The most important point for evaluation of the post-operative cognitive dysfunction is that we understand "cognitive function". First we described the definition of the "cognitive function" and second, outlined each function (dysfunction) and introduced the main assessment methods from the view point of neuropsychology. Cognitive function (dysfunction) described in this paper includes consciousness (confusional state, disturbance of consciousness), generalized attention (disorder of generalized attention), memory (amnesia), orientation (disorientation), executive function (dysexecutive syndrome), social cognition (social cognitive impairment), language (aphasia), cognition (agnosia), behavior (apraxia), directed attention (unilateral spatial neglect), and construction (constructional disorder).

[Depression in older adults: the National Mental Care Project for People with Physical Illness].

Political attention is being increasingly directed to mental health in Japan. Mental disorders are now the fifth priority disease after cancer, stroke, acute myocardial infarction and diabetes for national medical services since April 2013. Each prefecture has to implement strategic mental healthcare plans at the regional level. With the increase in co-morbid mental and physical illnesses, patient information should be shared between psychiatric and non-psychiatric healthcare providers, and coordination is required in the healthcare systems. A better understanding of mental health between patients and medical staffs could contribute to improved access to psychiatric services in the integrated mental health care system. Collaborative care programs focusing on depression screening and management in the Mental Health Care Project for Patients with Physical Illness have been launched among six national specialized care and research centers (cancer, cardiovascular disease, diabetes, child care, geriatric care and neurology and psychiatry) since 2012. These efforts to integrate mental health care into the general health care system would help to improve psychiatric care for elderly patients with physical illnesses.

[Palliative care in patients without cancer: Impact of the end-of-life care team].

Palliative care improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by promoting the prevention and relief of suffering. Palliative care in Japan has been developed mainly for cancer patients. At the National Center for Geriatrics and Gerontology, an end-of-life care team (EOLCT) has been developed to promote palliative care for patients without cancer. In the first 6 months of its operation, 109 requests were received by the team, 40% of which were for patients without cancer or related disease, including dementia, frailty due to advanced age, chronic respiratory failure, chronic heart failure, and intractable neurologic diseases. The main purpose of the EOLCT is to alleviate suffering. The relevant activities of the team include the use of opioids, providing family care, and giving support in decision-making (advance care planning) regarding withholding; enforcement; and withdrawal of mechanical ventilators, gastric feeding tubes, and artificial alimentation. The EOLCT is also involved in ongoing discussions of ethical problems. The team is actively engaged in the activities of the Japanese Geriatric Society and contributes to the development of decision-making guidelines for end-of-life by the Ministry of Health, Labour and Welfare. The EOLCT can be helpful in promoting palliative care for patients with diseases other than cancer. The team offers support during times of difficulty and decision-making.

[Behavioral and psychological symptoms of dementia--diagnosis and treatment].

Behavioral and psychological signs and symptoms of dementia (BPSD) can be interpreted as cognitively impaired patients' responses to external stimuli. The causes of BPSD include physical, psychological, and environmental factors, although combinations of these factors usually contribute to the development of BPSD. Representative conditions that should be distinguished from dementia include delirium, aphasia, and depression. It is important to differentiate depression from apathy associated with dementia. A well-balanced combination of drug therapy and non-pharmacological methods is required for the treatment of BPSD. Non-pharmacological methods should be considered first to address moderate BPSD in particular. It is advisable to carefully provide drug treatment following environmental control and non-drug treatment, and minimize adverse effects taking into consideration the physical characteristics of the elderly. Regarding methods for formulation according to the symptom, hyper- and hypoactivity symptoms should be addressed separately.

[Effectiveness and limitation of newly approved drugs for Alzheimer's disease].

Galantamine, rivastigmine, and memantine, for the treatment of Alzheimer-type dementia, became covered by national health insurance last year in Japan. Galantamine and rivastigmine are choline esterase inhibitors, and memantine is a glutamate NMDA receptor antagonist. Galantamine also acts on the nicotinic acetylcholine receptor, in addition to ChEI, and it has an APL action and modulates the receptor function by inducing a structural change of the receptor, as its characteristics. Rivastigmine is used only in patch form, and exhibits an inhibitory effect on butyryl choline esterase. Memantine protects nerve cells by inhibiting excess actions of glutamate. These drugs are also effective for BPSD accompanying dementia. Particularly, memantine exhibits an inhibitory effect on aggressiveness and excitement, as its characteristic. The administration of these 3 drugs for diseases other than Alzheimer-type dementia is not covered by national health insurance. These are expected to be effective for dementia with Lewy bodies, but there has been no evidence reported of an effect on frontotemporal dementia. Dementia manifests diverse symptoms in the course, and consideration of the physical symptoms is indispensable. The thoughtless continuation of anti-dementia and psychiatric agents without consideration of temporary changes and diversity and changes in needs for medical care impair a patient's vital functions and QOL. Those who are involved in the treatment of dementia should always consider the clinical course and changes in needs for psychiatric and physical medical care, and novel anti-dementia drugs should be used based on these.

Role of geriatric hospitals for dementia care in the community.

In dementia care, behavioural and psychological symptoms of dementia and physical illness in patients with dementia impose a marked care burden and require medical intervention. Therefore, it is important for patients and their families to select appropriate medical institutions and facilities with nursing units specializing in the care of behavioural and psychological symptoms of dementia, such as geriatric hospitals, which are required to deal with various aspects of dementia. Geriatric hospitals should offer two treatment approaches: a care unit for patients with behavioural and psychological symptoms of dementia or dementia with physical illness, and a multidisciplinary team approach involving physicians, nurses, psychologists, and social workers who provide coping strategies for dementia patients.

[Usefulness of support from end-of-life care teams in difficult decision-making].

It is unclear how hospitals should support a patient's decision to return home to die. Thus, we retrospectively examined the usefulness of support from an End-Of-Life Care Team in such difficult decision making. The subjects included non-cancer patients and the elderly. Our results suggest that the burden of making difficult decisions decreases with support from End- Of-Life Care Teams.