[The expected role of Dementia Support Doctors in dealing with complex cases of older people with dementia].

AIM: The present studyinvestigated the roles expected of Dementia Support Doctors (DSDs) in dealing with complex cases. METHODS: The participants were attendees of the education programs organised by the Center for Promoting Dementia Support and the Medical Center for Dementia at the Tokyo Metropolitan Geriatric Hospital from April 2021 to March 2022. A self-administered postal questionnaire survey was conducted. The questionnaire included items on the basic attributes of the participants, their experiences with the issues associated with complex cases, and role expectations of consulting/collaboration partners when dealing with complex cases. RESULTS: The valid response rate was 49.3%. DSDs were expected by primary physicians, Community General Support Center staff and administrative staff to diagnose dementia and give advice on support strategies for complex cases. Primary physicians further expected them to initiate pharmacotherapy with anti-dementia drugs and address the pharmacotherapy needs for managing Behavioral and Psychological Symptoms of Dementia. It was also found that DSDs' experience with complex cases was comparable to that of the staff at the Medical Centers for Dementia. Of note, DSDs were mentioned less frequently as consulting/collaboration partners than Medical Centers for Dementia and primary physicians. CONCLUSIONS: The study showed that DSDs play an important role in dealing with complex cases. The roles of DSDs and ways to collaborate with them need to be communicated through interprofessional education.

[An examination for efficient project promotion of the initial-phase intensive support team for dementia in Akita Prefecture].

The purpose of this study was to clarify the trends in the activity of the initial-phase intensive support teams in Akita Prefecture and to, clarify the factors contributing to the more efficient promotion of future projects. A survey was conducted by questionnaire among 46 initial-phase intensive support team member for dementia. The results indicated that it is mostly maintained cooperation medical center for dementia and community support promoter for dementia. However, the question was insufficient cooperation with family doctor including visit the home. These findings suggest that it is important to disseminate information and improve awareness among the community as well as foster relationships of trust by families.

A retrospective study on the diagnosis and treatment of dementia in patients referred to the Sagamihara Municipal Medical Center for Dementia for consultation.

AIM: In Japan, the Orange Plan was formulated in 2013 to promote community-based integrated care systems, and in 2015, it was revised as the New Orange Plan. Since the introduction of these programmes, adequate research has not been carried out on how these measures affect regional dementia care. The aim of this study was to investigate the state of community-based dementia treatment through a survey of medical consultation pathways, including dementia diagnosis, at the Sagamihara Municipal Medical Center for Dementia. METHODS: The participants included 1480 patients (585 men, 895 women) who presented for consultation at the Sagamihara Municipal Medical Center for Dementia for a differential diagnosis or treatment of dementia. The relationship between the path leading to medical consultation before pharmacotherapy and post-consultation diagnosis was investigated. RESULTS: Significantly more participants who presented for consultation without a referral were not diagnosed with dementia than diagnosed. Furthermore, among participants referred from a non-psychiatric clinic, significantly more patients were diagnosed with dementia than not. A significant difference was observed in a comparison of facility types and the use or non-use of anti-dementia drugs. Notably, the rate of anti-dementia drug prescriptions was significantly higher in psychiatric hospitals and non-psychiatric clinics. Furthermore, it is possible that approximately 30% of anti-dementia drugs prescribed at each facility were not covered by insurance. CONCLUSION: Community-based integrated care systems aim to promote collaboration within each region aimed. However, appropriate pharmacotherapy methods for dementia patients have not been adequately communicated to non-specialist physicians and local residents. For this reason, human resource solutions are needed to help medical staff deepen their understanding of dementia so that they can better provide dementia support to patients.

Incidence and distribution of subtypes of early-onset dementia in Japan: A nationwide analysis based on annual performance reports of the Medical Centers for Dementia.

AIM: Investigating the incidence rate of early-onset dementia is challenging. We explored the incidence rate of early-onset dementia in Japan using annual performance reports from the Medical Centers for Dementia. METHODS: Medical Centers for Dementia are specialized health services for dementia established as part of Japan's national health program. There are 440 such centers nationwide as of 2018. Using the annual performance reports of these centers, we calculated the number of newly diagnosed cases of early-onset dementia or late-onset dementia from April 1, 2018 to March 31, 2019, and the composition ratio by diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The annual incidence rate of early-onset dementia was estimated using the number of cases as the numerator and the national population aged 18-64 years as the denominator. RESULTS: In total, 1733 of cases were diagnosed with early-onset dementia, of which 52.1% were diagnosed as major neurocognitive disorder due to Alzheimer's disease, 8.9% major frontotemporal neurocognitive disorder, 8.8% major vascular neurocognitive disorder, 7.1% substance/medication-induced major neurocognitive disorder, 6.5% major neurocognitive disorder with Lewy bodies and 3.9% major neurocognitive disorder due to another medical condition. The annual incidence rate of early-onset dementia was estimated to be 2.47/100 000 person-years. CONCLUSIONS: This study provides the first nationwide estimate of the incidence rate of early-onset dementia in Japan and suggests that Medical Centers for Dementia are important resources for the epidemiological monitoring of early-onset dementia nationwide. Geriatr Gerontol Int 2020; 20: 1050-1055..

Current activities of medical centers for dementia in Japan.

AIM: We investigated the current activities of medical centers for dementia (MCD), and proposed recommendations for a national dementia strategy. METHODS: A questionnaire was mailed to 172 hospitals designated as MCD as of 7 August 2012. RESULTS: Data from 117 MCD that adequately responded and were designated by 1 April 2012 were analyzed. The mean and median numbers of medical consultations per MCD were 1035 and 595/year (range 114-8541/year), those of patients diagnosed with dementia-related disorders were 266 and 231/year (range 3-1179/year), those of patients with dementia-related disorders admitted to the MCD hospital were 89 and 47/year (0-1176/year), and mean and median proportions of patients discharged within 2 months were 45.5 and 36.8% (range 0-100%). Outreach services in collaboration with a community general support center were provided in 23.9%, while training for community general support center staff members was carried out in 66.7%. Of MCD hospitals, 31.6% were designated as an emergency medical hospital, and of these, specialist liaison-team services for patients with dementia in the emergency room were provided in 56.8%. CONCLUSIONS: Most MCD are considered to function fairly well in line with the guidelines published by the Ministry of Health, Labour and Welfare. However, there is a huge discrepancy in the number of patients diagnosed with dementia-related disorders and the length of stay for inpatient care among facilities. To make all MCD function adequately, the activity of MCD should be monitored longitudinally using the standardized assessment methods.