Exploratory research on outcomes for individuals missing through dementia wandering in Japan.

AIM: To clarify the factors related to outcomes of individuals missing through dementia wandering. METHODS: We carried out binary logistic regression analysis with 160 family members of missing persons (88 survivors, 72 decedents). RESULTS: Living alone at the point of going missing (OR 13.45, 95% CI 1.12-161.56), being found within the local area (OR 6.36, 95% CI 2.26-17.88), and a long period between going missing and being found (OR 6.14, 95% CI 3.14-12.00) were significantly related with death. CONCLUSIONS: Early detection of missing persons is essential in preventing dementia wandering-related deaths. The time taken to locate missing dementia patients who lived alone was longer, relative to that of those who lived with others, and this increased the risk of death. Furthermore, the locations where the deceased were located tended to be local, rather than distant areas. Geriatr Gerontol Int 2019; 19: 902-906.

A Reading Model from the Perspective of Japanese Orthography: Connectionist Approach to the Hypothesis of Granularity and Transparency.

This study presents a computer simulation model of reading in Japanese syllabic kana and morphographic kanji. The model was based on the simulation model developed by Harm and Seidenberg for reading in English. The purpose of building the current model was to verify the validity of the hypothesis of granularity and transparency (HGT) postulated by Wydell and Butterworth, focusing on the granularity dimension. The HGT was developed in order to explain the behavioral dissociation between excellent reading skills in Japanese and poor reading skills in English of an English-Japanese bilingual individual as well as the relatively low incidence of developmental dyslexia in Japan. The current model was successful in simulating the granularity dimension of the HGT. The study also identified several limitations, which need to be addressed in future research.

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.

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.

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.

A study on the mortality patterns of missing and deceased persons with dementia who died due to wandering.

AIM: To clarify the mortality patterns derived from differences in the causes of death and to subsequently promote search activity and prevent the death of missing persons. METHODS: The Ministry of Health, Labour and Welfare (MHLW) performed a mail survey using a self-administered questionnaire. The families of all 388 deceased dementia patients from among all of the missing persons reports involving dementia patients that were submitted to the police in 2013, and the 10,322 missing persons with dementia (or suspected cases) were the subjects of this survey. The survey was conducted from January 5 to February 2 in 2015. We analyzed the data provided by the MHLW on 61 cases in which the cause of death was recorded; the factors that were related to the differences in the causes of death were examined using a chi-squared test (Fisher's direct method) and a residual analysis. Based on previous studies, we classified the causes of death into three categories: "drowning," "hypothermia," and "others (e.g., traumatic injury, disease progression)." RESULTS: When the cause of death was hypothermia, death often occurred between three to four days from the time that the deceased individual went missing. A significantly higher number of patients who died of other causes were found to have died on the day that they went missing. More than 40% of the drowning cases occurred on the day that the deceased individual went missing. CONCLUSION: We identified 3 patterns of mortality: (1) death on the day that the deceased individual went missing due to traumatic injury, disease progression, drowning, and other causes; (2) death due to hypothermia within a few days after the deceased individual went missing; and (3) patterns other than (1) and (2).

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.

[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.

Necessity of normative data on the Japanese version of the Wechsler Memory Scale-Revised Logical Memory subtest for old-old people.

AIM: Episodic memory is vulnerable to deterioration in people suffering from Alzheimer's disease. Currently, the Logical Memory (LM) subtest of the Wechsler Memory Scale-Revised (WMS-R) is used internationally as an operational definition to identify people with mild cognitive impairment (MCI). However, the Japanese version of the LM has not been adequately normalized for old-old people. Therefore, norms of the LM for people aged 75 years and over are required, and the effects of sex, age and education on performance were evaluated. METHODS: A total of 50 (27 female and 23 male) participants without a history of dementia and symptomatic stroke events recruited from the community and hospital populations were investigated using the Mini-Mental State Examination, the LM and some interference tasks. RESULTS: The mean scores (standard deviations) of the sample were 15.5 (5.4) on LM-I and 9.9 (6.6) on LM-II. The distributions of the LM-I and -II scores satisfied the normality assumption. The LM-I and LM-II scores correlated with age and the LM-I score correlated with educational background. CONCLUSIONS: For the Japanese version of the LM, the means, standard deviations and distribution features of the old-old sample are presented. Although the normal sample was chosen to closely match the demographic profile of the Japanese population, the present sample might have had a higher educational background than the age-matched population, especially the males. Further study is required to standardize the Japanese version of the LM subtest for each 5-year interval for latter-stage elderly people.

Reliability and validity of A Quick Test of Cognitive Speed for detecting early-stage dementia in elderly Japanese.

AIM: The aim of this study was to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) for detecting early-stage dementia in the elderly Japanese population. METHODS: A total of 280 clinical participants (180 with mild Alzheimer's disease, 43 with amnestic mild cognitive impairment, 32 with non-amnestic mild cognitive impairment and 25 control subjects) and 22 community-dwelling elderly individuals without dementia were recruited. The Clinical Dementia Rating, the Mini-Mental State Examination, and AQT were administered to all participants. The Neurobehavioral Cognitive Status Examination was also administered to clinical participants. RESULTS: The intraclass correlation coefficient for the test-retest reliability of colour-form naming time on AQT was 0.88 (95% CI, 0.74-0.95, P < 0.001). AQT colour-form naming time was significantly correlated with the Clinical Dementia Rating, the total score on the Mini-Mental State Examination, and the total score on the Neurobehavioral Cognitive Status Examination and most of its subscales. AQT colour-form naming time was significantly longer in elderly individuals with mild Alzheimer's disease, amnestic mild cognitive impairment, and non-amnestic mild cognitive impairment than in control subjects. The receiver operating characteristic curve analysis indicated that AQT colour-form naming time significantly distinguished subjects with early-stage dementia (mild Alzheimer's disease, amnestic mild cognitive impairment, and non-amnestic mild cognitive impairment) from controls. The area under the curve was estimated to be 0.88 (95%CI = 0.82-0.95). A cut-off of 71/72 seconds yielded the best sensitivity/specificity trade-off: sensitivity = 85% and specificity = 76%. CONCLUSIONS: AQT is a useful brief screening tool for detecting early-stage dementia in elderly Japanese individuals.

Brief screening tool for mild cognitive impairment in older Japanese: validation of the Japanese version of the Montreal Cognitive Assessment.

AIM: The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA-J) in older Japanese subjects. METHODS: Subjects were recruited from the outpatient memory clinic of Tokyo Metropolitan Geriatric Hospital or community-based medical health check-ups in 2008. The MoCA-J, the Mini-Mental State Examination (MMSE), the revised version of Hasegawa's Dementia Scale (HDS-R), Clinical Dementia Rating (CDR) scale, and routine neuropsychological batteries were conducted on 96 older subjects. Mild Alzheimer's disease (AD) was found in 30 subjects and MCI in 30, with 36 normal controls. RESULTS: The Cronbach's alpha of MoCA-J as an index of internal consistency was 0.74. The test-retest reliability of MoCA, using intraclass correlation coefficient between the scores at baseline survey and follow-up survey 8 weeks later was 0.88 (P < 0.001). MoCA-J score was highly correlated with MMSE (r = 0.83, P < 0.001), HDS-R (r = 0.79, P < 0.001) and CDR (r = -0.79, P < 0.001) scores. The areas under receiver-operator curves (AUC) for predicting MCI and AD groups by the MoCA-J were 0.95 (95% confidence interval [CI] = 0.90-1.00) and 0.99 (95% CI = 0.00-1.00), respectively. The corresponding values for MMSE and HDS-R were 0.85 (95% CI = 0.75-0.95) and 0.97 (95% CI = 0.00-1.00), and 0.86 (95% CI = 0.76-0.95) and 0.97 (95% CI = 0.00-1.00), respectively. Using a cut-off point of 25/26, the MoCA-J demonstrated a sensitivity of 93.0% and a specificity of 87.0% in screening MCI. CONCLUSION: The MoCA-J could be a useful cognitive test for screening MCI, and could be recommended in a primary clinical setting and for geriatric health screening in the community.

Validation of the 7-Minute Screen for the detection of early-stage Alzheimer's disease.

BACKGROUND/AIMS: The 7-Minute Screen (7MS) is a screening battery to identify individuals with a high probability of Alzheimer's disease (AD). The 7MS consists of four subtests (Temporal Orientation, Enhanced Cued Recall, Clock Drawing, and Verbal Fluency), each measuring a different aspect of cognition. The present study is designed to examine the predictive validity of the 7MS to distinguish between patients with early-stage AD and healthy control subjects. METHODS: Sixty-three patients who were diagnosed as having probable or possible AD and 91 community-dwelling elderly individuals of comparable age, sex distribution, and education were administered the 7MS (paper-and-pencil version) and other screening batteries. All patients were rated Clinical Dementia Rating (CDR) 0.5-1, categorized as early-stage AD, and all participants obtained a score of less than 6 for the Geriatric Depression Scale (15-item version). RESULTS: Mean scores for patients and controls on all the four subtests were significantly different. When using the total score of the 7MS, which was calculated by the original logistic regression formula based on all of the four subtests, the sensitivity for early-stage AD was 90.5% with a specificity of 92.3%. Correlation analysis indicated high concurrent validity between the 7MS and existing standard cognitive screening batteries (e.g., MMSE, HDS-R). In correlation analysis and multiple regression analysis, demographic effects (age, sex, and education) were not significantly associated with the total score of the 7MS in controls. CONCLUSIONS: The results showed that the 7MS had a high level of sensitivity and specificity. We also found that the 7MS was not affected by demographic characteristics. These findings demonstrated that the 7MS is a useful screening tool for discriminating patients with early-stage AD from intact individuals.

Surface dyslexia in a Japanese patient with semantic dementia: evidence for similarity-based orthography-to-phonology translation.

We studied the reading performance of a Japanese-speaking patient, TI, with bilateral but asymmetrical (left more than right) temporal-lobe atrophy, severe anomia, and poor word comprehension. Most Japanese kanji characters correspond to several different legitimate pronunciations in different contexts, with varying degrees of correspondence consistency. TI made many errors in reading aloud words that violate statistically typical character-sound correspondences, especially for less common words, but had relatively preserved ability to read aloud strings in which the assignment of the typical pronunciation for each component character yields the correct pronunciation for the whole word. The degree of consistency of character-sound correspondences affected his performance on both words and nonwords in a graded manner. One interpretation is that TI's surface dyslexic reading reflects intact direct computation of phonology from orthography, but without the additional constraint from word meaning that is, in this framework, considered critical for correct pronunciation of lower-frequency words with atypical character-sound correspondences. Another interpretation is that TI's performance reflects partially damaged lexical knowledge of whole-word orthography and phonology, coupled with spared sublexcal knowledge of character-sound correspondence rules. Whichever of these interpretations is preferred, this study offers the most detailed information yet available on the characteristics of surface dyslexia in Japanese.