DEMENTIA IN JAPAN

2014

Now is the time to research Alzheimerfs

Apr 19, 2014
The Japan Times
by Rowan Hooper

The team leader at the Laboratory for Proteolytic Neuroscience at Rikenfs Brain Science Institute is not a man usually given to making apocalyptic statements.

Yet when I asked him whether Japan should be investing more money in Alzheimerfs research, he responded with more than the usual academic plea for more money. gAlzheimerfs disease,h said Takaomi Saido, gwill destroy Japanfs social-welfare mechanisms in the near future.h

Saido, based in Wako, Saitama, is on a twin social and scientific mission: to protect Japanese society from the ravages of Alzheimerfs disease, and to uncover the secrets of how the brain ages.

Itfs interesting that he emphasizes that his mission is about protecting society. Alzheimerfs is already one of the most expensive diseases in developed countries. In the United States, it costs more than $100 billion a year. Saido is only too aware of how this will increase.

gMy social mission is to protect social-welfare mechanisms,h he told me, gbecause the socioeconomical cost of Alzheimerfs disease will be greater than the governmentfs annual income by 2050 unless the disease becomes preventable.h

That sounds like a lot of money. But the estimate for the financial burden caused by Alzheimerfs in Japan by 2050 is $500 billion a year, which is about the same as the governmentfs annual revenues. Why is the cost going to increase so much?

gPeople will be receiving much less pension after retirement and paying more taxes and hospital costs,h Saido said. So the government should invest now to save in the future. If we can find a way to treat or prevent Alzheimerfs, the number of people who suffer from dementia and the burden on caregivers will be smaller.

gAlzheimerfs research is much more cost-effective than any other research field, including stem-cell research,h Saido assured me.

As an example, Saido offered his new mice. Years in the making, these are no ordinary mice. The Riken team thinks it may revolutionize research into Alzheimerfs, and this is the scientific part of Saidofs twin mission. gMy scientific mission is to uncover the essence of brain aging, one manifestation of which leads to Alzheimerfs disease development.h

Much of the research conducted into Alzheimerfs uses mice as gmodelsh of humans. Scientists use strains of mice that have a genetic propensity to develop Alzheimerfs-like symptoms, and it might go without saying, but mice are not the same as people, and the models are not perfect.

In particular, the strain of mouse commonly used in Alzheimerfs research makes too much of a particular protein, known as amyloid precursor protein. This APP leads to the production of amyloid deposits, which are thought to cause the breakdown of neurons in the brain and which are the hallmarks of Alzheimerfs disease.

But since the mouse makes too much APP, Saido thinks much of the work done on that mouse strain ? and there has been a lot ? is flawed, and wonft help our understanding of the disease in humans. The new mouse model is a strain that produces APP and the subsequent amyloid deposits in a way that is more realistic for the actual human disease. The details have just been published in the journal Nature Neuroscience.

gThe generation of appropriate mouse models will be a major breakthrough for understanding the mechanism of the disease,h said Saido, gwhich will lead to the establishment of presymptomatic diagnosis, prevention and treatment of the disease.h

I asked Saido for any preventative advice. gTo my knowledge, the only scientifically proven measure is a daily exercise, like one hour of walking,h he said.

Much remains to be discovered about this insidious disease. But there is hope. Two recent papers in the British journal the Lancet show that in the U.K. and Denmark there is a decrease in the number of people getting Alzheimerfs disease.

The first paper shows details of two surveys of people with Alzheimerfs in the U.K., one in 1994 and the other in 2014. The researchers expected that the second survey would show more people with Alzheimerfs, since the average age of the population had increased over the intervening 20 years.

But the numbers came up some 200,000 short. The evidence suggests that people are developing Alzheimerfs at an increased age. Something appears to be delaying the onset of the disease. (The DOI reference for this paper is 10.1016/S0140-6736(13)61570-6.)

The Danish study shows that people in their 90s born in 1915 were healthier and smarter ? they performed better on cognitive tests ? than people in their 90s born in 1905. So something improved in the lifestyle or diet of people born in 1915 that seems to have protected them. (The DOI reference for this paper is 10.1016/S0140-6736(13)60777-1.)

What are we to make of this? Some might say that it shows, for developed countries at least, that better nutrition, fitness and education may be helping to reduce the reach of Alzheimerfs. Maybe thatfs true ? but only slightly. gTo conquer Alzheimerfs disease, it is essential to establish presymptomatic diagnosis and preventive medicine,h said Saido.

He also suggests that the apparent decrease in Alzheimerfs seen in the U.K. may be due to a decrease in the consumption of fish and chips. Thatfs not as glib as it might seem, as an improved diet could reduce vascular forms of dementia, which would also reduce Alzheimerfs.

But even if you doubt that the fabric of society is at risk ? or that fish and chips have much to do with it ? hefs right that we need to conquer the disease.

Rowan Hooper (@rowhoop on Twitter) is the news editor of New Scientist magazine. The second volume of Natural Selections columns translated into Japanese is published by Shinchosha at \1,500. The title is gHito wa Ima mo Shinka Shiteru (The Evolving Human).h

Osaka dementia patient remains unidentified 2 years after he was found on street

OSAKA -- An elderly man was taken into a protective custody two years ago when he was found on a street here. He suffered from severe dementia and couldn't recall his name, address or age at the time he was found by police. There were also no reports of missing persons that matched his description. While he now lives at a nursing home in the city, no one knows his true identity.

The Mainichi Shimbun visited the man at the nursing home earlier this month. When we asked him how he was doing, the man nodded and smiled. According to judicial scrivener Tetsuo Yamauchi and other people who have been named as the man's guardians by the mayor of Osaka, the man is at stage-three nursing care level (of a one to five level based on assessed care needs). He has difficulty speaking and needs assistance when using the bathroom, but he can walk by himself.

The Osaka Municipal Government named the man Taro and gave him a last name that relates to the name of the place he was found as he needed a name to register for welfare services. The local government also decided his birth year and day, judging by his appearance that he was about 70 years old. The man is now 72, according to his official documents, but some of the nursing home staff say he might be younger.

On March 11, 2012, police took the man into custody after finding him sitting on a street in the city's residential area. The man was wearing a light blue down jacket, grey sweatpants and black sneakers. He appeared to be clean. He did not have any cash or belongings and told police that he didn't know his name.

When he was found, the man was wearing an adult diaper, hinting that he might have been taken care of by someone. Nursing home staff say that he was not at a stage where he could have lived without any assistance.

The Osaka Municipal Government issued an emergency temporary protection order on March 11 and the man then entered a protection shelter. He remained unidentified after 14 days of the designated period for protection and entered the nursing home at the end of the month.

Nursing homes typically offer care for the elderly with dementia based on their background, medical history and makeup of family members. For instance, if a nursing home resident wanders about daily late in the afternoon, care workers assume that the person is trying to go home to cook dinner and work to relieve their anxiety. In the Osaka man's case, however, care workers do not have any information on the man to establish a care program for him. Yamauchi said the man had been turned down by around 30 nursing homes before finding the one where he currently lives.

Kumiko Nagata of the Dementia Care Information Network Tokyo Center said she is certain that similar cases are on the rise. "I have met people like the Osaka man, but no process has been made to understand the reality of these people. It's high time the national and local governments worked on establishing measures to tackle these problems so that people like the Osaka man can retrieve their names and go home," Nagata commented.
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April 19, 2014(Mainichi Japan)

Stroke prevention drug found to slow mild dementia

OSAKA (Kyodo) -- Researchers have found that a drug used in the prevention of strokes, cilostazol, is effective in slowing the progression of mild dementia, according to a study published Thursday in the U.S. online science journal Plos One.

The team including Masafumi Ihara, chief physician at the National Cerebral and Cardiovascular Center, said that the drug seems to improve the excretion of waste products in the brain that cause dementia.

Four million people in Japan are believed to have mild cognitive impairment, or MCI, and a half of them are set to develop dementia-related illnesses such as Alzheimer's disease within five years, according to one estimate.

The study was based on an analysis of the medical records of Alzheimer's patients who were given the drug and those who were not administered it.

The team plans to start clinical research with MCI patients this fall with Mie University, Kyoto University and Kobe University.

Dementia patients often develop vascular diseases and the team has noted that cilostazol enlarges the blood vessels to improve blood flow in the brain.

The team carried out a survey to check whether taking cilostazol in addition to dementia medications made any difference in the decline of cognitive functions in Alzheimer's patients, assigning scores on a 30-point scale.

Among those who can barely manage a social life, 36 people who were not taking cilostazol saw their scores fall by an average of 2.2 points over a year, compared with a 0.5 drop in 34 people who were taking the medicine. Improvements were even reported in some areas, but no effect was seen in patients with advanced conditions, the study said.

The team has discovered that cilostazol promotes excretion of waste products in the brain in mice with symptoms of Alzheimer's disease.

Other participants in the latest study include a research institute at the Kobe-based Foundation for Biomedical Research and Innovation.
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February 27, 2014(Mainichi Japan)

Early stage dementia sufferers among the disappeared and the dead

More than 500 people with diagnosed or suspected dementia went missing in 2012 and were later found dead, or not found at all. Some people with dementia, however, have disappeared despite showing such mild symptoms of cognitive impairment that their families had yet to notice anything was wrong.

According to research in Hokkaido's Kushiro region by disabled senior support NGO "Tanpopo no kai," in partnership with the Dementia Care Research and Training Center in Tokyo, some 20 percent of those with dementia who went missing had "early stage" symptoms so mild their families hadn't noticed their condition.

"At the onset of the illness, it's hard for even those closest to the patient to notice anything has changed. It's even hard for the patients themselves to tell," said Kumiko Nagata, head researcher at the dementia care research and training center. "I hope anyone who notices something unusual, even something very small, will consult about it with those around them."

In the early evening of Jan. 30, 2012, 84-year-old Sadao Murakami told his wife Kimiko he was heading from the post office -- about 800 meters from their home in Osaka's Naniwa Ward -- to water the plants at their old residence, also nearby. "I'll be back in a little bit," he told Kimiko, 83. She watched him pedal away on his bicycle, looking just as he always did. Kimiko did not sense anything abnormal about her husband. Sadao, however, didn't come home that night.

A week later, on Feb. 6, a passer-by found Sadao in a ditch in Hirano Ward, some 9 kilometers from his house. He was dead, his bicycle lying abandoned a short distance away. Authorities believe Sadao, lost and exhausted, succumbed to hypothermia. His body was partly wedged in the approximately 30-centimeter-wide gutter, as though he'd been trying to get out of the midwinter wind.

"What was he feeling as he was riding along on his bicycle?" Kimiko wonders. "He can't have been in a normal state of mind."

Since a month or two before he disappeared, Sadao had sometimes forgotten that he'd eaten. There were other small incidents; misplacing his room key at a hot spring resort, and losing his way on the road home. Worried, Kimiko suggested her husband visit the hospital, but he never followed her advice.

"The possibility he had dementia never really occurred to me, and I wouldn't have known which hospital to take him to anyway," she says.

"People with cognitive impairment tend to simply keep moving forward, making it hard for them to return home when out on a bicycle. You have to be careful about that," the Murakamis' family doctor told Kimiko, after she'd lost Sadao.

"Sadao hadn't noticed he was sick. I should have had him checked out as soon as I could and been more careful about him," Kimiko laments, adding that she feels regret every day. Now, with no one to share a meal with, she says she can no longer summon the will to cook for herself. "I get so lonely in the late afternoons and evenings, because I'm all by myself now," she says, adding that she hasn't yet been able to cry over the loss of her husband, not even once.

According to research by "Tanpopo no kai" and the Dementia Care Research and Training Center, there were 129 missing person cases from 1994 to 2003 in Hokkaido's Kushiro region where dementia symptoms could be confirmed in the missing, and where their families were able to say whether they'd noticed those symptoms. Of that number, 20.2 percent of the missing persons had very early stage symptoms that had gone unnoticed by their families. Another 43.4 percent had early symptoms that manifest daily, but not to the point that their families believed they could go missing.

"Pointing out symptoms of very early stage dementia can sometimes make family relations difficult," says Nagata. "It's important for the families to seek advice and cooperation from those close to the person and local support centers." Furthermore, "the patient will have their own reasons for wanting to go out. Seeing that as a problem and locking them indoors will only worsen their condition," Nagata continued. "Families can't handle this situation on their own. They need local support, and everyone from neighbors, local kids and students, to workers at shops, restaurants and public transport systems can be a big help."
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February 04, 2014(Mainichi Japan)


Japan to estimate dementia's costs to society

By Peter Levring and Christian Wienberg, Bloomberg News
January 31, 2014
Chicago Tribune

TOKYO _Japan's health ministry plans to estimate the overall societal cost of dementia, including direct medical costs and the burden that providing care puts on the families of people with the condition, by the end of fiscal 2014, according to sources.

The move is aimed at helping the government make better funding plans, cut wasteful spending related to dementia and devise measures to alleviate the burden placed on families.

The Health, Labor and Welfare Ministry intends to estimate the total amount of direct expenditures for dementia-related treatment, nursing care and the indirect costs of unpaid, informal care by the families of people with dementia.

Government data, including surveys on patients and nursing care insurance payments, can be used to determine direct medical costs, but there are currently no statistics concerning the economic impact on the families of dementia patients.

The ministry's task team plans to ask about 1,000 people nationwide to record details of the care they provide over a week to family members with the condition, including the amount of time they spend watching such relatives, feeding them and assisting them in using the bathroom. The value of such unpaid care by families will then be estimated based on nursing care workers' standard wages.

Based on the existing data, dementia treatment costs are expected to total hundreds of billions of yen, while nursing care expenditures are expected to reach up to 7 trillion yen ($68 billion). If the level of dementia-related societal costs in Japan is on par with that in Britain, which has already estimated such costs, Japan's total societal costs from dementia are likely to top 10 trillion yen.

In 2012, the World Health Organization estimated the global societal costs of dementia at $604 billion and warned of a rapid increase in the future.

Last year, the United States estimated its costs in 2010 at $215 billion (about 22 trillion yen). Denmark and Sweden also have made similar estimates and reflected them in their policy measures.

Mitsuhiro Sado, a Keio University assistant professor and expert in neuropsychiatry who leads the ministry's research team, said: "The economic impact survey isn't simply aimed at cutting costs. It's important to explore effective ways to use limited resources through such measures as reinforcing support for the families of affected people."

578 dementia sufferers died or remained unaccounted for in 2012 after going missing: survey

A total of 578 people, who had been diagnosed with dementia or were suspected of suffering from the disease, were confirmed dead or remained unaccounted for in 2012 after going missing, according to a nationwide survey conducted by the Mainichi Shimbun.

Of the 578 people, 359 were confirmed dead and 219 others were unaccounted for in 2012, according to the Mainichi survey based on data from prefectural police headquarters across the country and other sources. The findings underscore the gravity of the situation involving dementia sufferers in Japan.

The National Police Agency (NPA) has released data on the number of dementia sufferers who were registered as missing, starting with statistics for 2012, which stood at 9,607. But it also emerged that procedures leading up to the registration of missing people vary from police headquarters to police headquarters throughout the country. Because some dementia sufferers were found and placed under police protection or died before they were officially registered as missing, the actual number of people who went missing is likely to be far greater, and the number of dementia sufferers who died after going missing could also rise accordingly.

The 359 people (including those who were reported missing before 2012), who were confirmed dead, were found in forests, rivers, irrigation channels as well as in the gardens of empty houses, roads and elsewhere. Prefectural police headquarters concerned have listed the status of the 219 missing people as of the end of 2012 as "statistically unknown."

Of the 9,607 people registered as missing, Osaka Prefecture accounts for the greatest number at 2,076, followed by Hyogo Prefecture at 1,146. The two prefectures reported such large numbers, however, because their respective police headquarters have been actively urging the families of missing dementia sufferers to formally register them in writing as missing. It is part of police efforts to help determine whether there are any links to incidents or help with their own investigations.

In Kanagawa, Chiba and Saitama prefectures, meanwhile, there is a system in which police authorities list missing people as "temporarily unaccounted for" immediately after receiving reports from their families or other sources by phone or other means. Sometimes people are found at this stage, in which case they may never be officially registered as missing.

In Kanagawa Prefecture, 262 people were registered as missing, compared to 232 people in Chiba Prefecture and 146 people in Saitama Prefecture. The Metropolitan Police Department (MPD) does not have such a system, but there are cases in which it found missing people before they were formally registered as missing because searches were launched before official reports were lodged. In 2012, 350 people were formally registered as missing in Tokyo.

Elsewhere, Aichi Prefecture had 735 people who were formally registered as missing, Kyoto Prefecture 371 people, Fukuoka Prefecture 357 people and Ibaraki Prefecture 317 people. As for the number of deaths by prefecture, Osaka Prefecture had 26 people, Aichi Prefecture 19, Kagoshima Prefecture 17, Tokyo 16, Ibaraki Prefecture 15, and Hokkaido, Fukushima, Nagano and Hyogo prefectures had 14 people each.

The Mainichi survey found that there were cases in which dementia sufferers traveled far from their homes. According to the Osaka Prefectural Police, a 75-year-old man from the Osaka Prefecture city of Kadoma was found at a port in Matsuyama, Ehime Prefecture, a day after he was registered as missing in August 2012. An 83-year-old man who was living alone in the city of Osaka was taken into protective custody after straying into a pachinko parlor in Hakodate, Hokkaido, 22 days after he was registered as missing in January 2013. It is not clear how the two men got to Shikoku and Hokkaido, respectively, and how they spent their time.

While the number of people in each age bracket 70 and under who have been registered as missing has declined or remained roughly unchanged in recent years, the number of those aged 70 or older who have been registered as missing has been increasing sharply. Of the 81,111 people who were registered as missing in 2012, the number of those aged 70 or older stood at 14,228, an increase of 3,521 (33 percent) from five years earlier. The sharp increase is believed to reflect a rise in the number of dementia sufferers.
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January 29, 2014(Mainichi Japan)


Family still hunting for Alzheimer's patient missing for over a year

It has been learned that in 2012 alone, over 500 people with dementia went missing -- and were later found dead or not found at all.

The families of the missing do all they can to look for their loved ones, but in some cases even very long searches have provided no answers, no confirmation of their fates. This leaves many such families despairing that they did not do enough to protect their relatives, and waiting hopefully for the happy day when the disappeared return home.

"It's been like a nightmare. Why did this have to happen?" says 73-year-old Yae Tanaka of Kishiwada, Osaka Prefecture. It is Jan. 25, and Takaaki, Yae's husband of some 50 years, has been missing for exactly one year. On this day in 2013, at just past 9 p.m., Takaaki got out of the bath, put on his pajamas, got on his bicycle and rode into the night. He left his GPS tracking device-equipped mobile phone at home.

Takaaki, now 76, was diagnosed with Alzheimer's disease in 2003. As his symptoms worsened, he began having trouble finding his way back home when he went out, and was taken into the care of the police on several occasions. Yae and Takaaki were a household of two, and she says she stayed close and watched over him not just when they were out shopping or walking the dog, but around the house as well.

When Takaaki disappeared, every member of the Tanaka family in the area joined the search. They checked empty houses, parks, and even followed a path all the way to the mountains of neighboring Wakayama Prefecture. They walked around handing out leaflets with Takaaki's picture on it. At the beginning of February, an acquaintance of Takaaki's said she'd talked to him on Jan. 31, near a hospital a little less than a kilometer from the Tanaka home. The woman did not know he had been reported missing, and said that he told her, "It seems my dog's disappeared."

In March that year, Takaaki's bicycle was found about 5 kilometers away at a social welfare facility in Kaizuka, Osaka Prefecture. An employee said that the bike had been there "probably since the beginning of February." Police officers and dogs searched the area for some sign of where Takaaki had gone, but turned up no other clues. His family continues the search to this day, heading out to personally check on new information that might be connected to Takaaki's whereabouts.

Yae and Takaaki's children say they've never seen their parents fight and, unusual for Japan, the elder Tanakas always called each other by their first names. Takaaki's Alzheimer's may have advanced in recent years, but he joined Yae in her hobbies like tai chi and singing in a chorus group, and he was often seen with a smile on his face.

"I've lost a great treasure," Yae says, tears in her eyes. "I'm the one at fault, because I couldn't look after him. If I see him again, I want to tell him, 'I'm sorry.'"

The couple's 41-year-old son Masao, who lives in the neighborhood, added, "My dad's probably scared and lonely. I should have been more careful. I want him to come home safe and sound. If he can't do that, I just want him to come back no matter what's become of him."

More local governments are now instituting measures to help track down dementia patients who go missing, including search drills and setting up systems to send emails to registered users, with a description of the patient including a photo and their name and address.

"This could happen to anybody," says Masao. "I'd very much like to see this problem dealt with on a national scale."
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January 29, 2014(Mainichi Japan)

Govt must promote healthy lifestyle from young age to ward off dementia

The number of elderly Japanese people suffering from dementia is increasing much faster than predicted. The government must devise measures to prevent and treat the condition as quickly as possible.

According to an estimate by a research team of the Health, Labor and Welfare Ministry, the number of elderly people diagnosed with dementia has reached 4.62 million. Research results by Kyushu University indicate the number is six times the level 20 years ago.

It must be noted that an increase in people suffering from diabetes, along with the quickly aging population, has boosted the number of dementia patients. Domestic and overseas research has found that diabetics are about twice as likely as those without diabetes to develop Alzheimerfs-type dementia.

Alzheimerfs-type dementia develops as a result of the accumulation of abnormal protein in the brain. People are more likely to develop this type of dementia if they become diabetic and a large amount of insulin is produced in their bodies, because insulin, which lowers blood sugar levels, also interrupts the dissolution of the protein and thus promotes its accumulation.

Major causes for diabetes are overeating and obesity resulting from insufficient exercise. According to some data, people who pay attention to their lifestyles by exercising regularly and eating Japanese and other healthy foods are less likely to develop diabetes or dementia.

The health ministry should publicize such information, which could help people prevent these health problems by paying attention to their lifestyles from a young age.

As many as 4 million people are said to suffer from gmild cognitive impairment,h believed to be a stage before dementia. Symptoms include impaired memory and judgment. If treated at an early stage, however, it can likely be prevented from progressing to dementia, doctors say. We hope measures to prevent the condition will be established as soon as possible.

Dementia could be controlled

It is still important to diagnose dementia as early as possible, even if a patient has already developed symptoms. If treated properly, dementia patients could recover in cases where the formation of a hematoma in the brain due to a blow to the head caused it, for instance.

However, the conditions of many patients deteriorate if left undiagnosed. It is necessary to develop a system that can render an accurate diagnosis by increasing expert-staffed outpatient gforgetfulh clinics around the country.

If diagnosed early, it might be possible for people with dementia to continue their family life and jobs longer with the understanding and cooperation of their families and people around them.

Developing measures to deal with dementia is a common concern among advanced countries, whose populations are aging quickly.

Japan, the United States and six other advanced countries held the first G-8 Dementia Summit last month in London. They agreed to drastically increase research funds for dementia and share research data with the aim of establishing treatment methods by 2025.

International cooperation is essential to study dementia, which still has many unexplained elements. We think Japan, whose population is aging the fastest in the world, should lead the research. The government should play a leading role and mobilize all Japanese researchers in this field to tackle the issue.

(From The Yomiuri Shimbun, Jan. 17, 2014)

Editorial: Regional cooperation needed to care for people with dementia

Many members of the public are obviously worried that they or their parents living apart from them may suffer from dementia in the future. More hospitals and nursing care facilities for elderly people suffering from dementia may become necessary. Actually, however, many patients with dementia are living in their own homes without inflicting too much of a burden on their families. Dementia tends to be misunderstood. Members of the public need to have the correct knowledge about dementia before becoming worried about the disease.

People tend to associate dementia with delusions and wandering around, but not all patients with the disease show these symptoms. There are many people with dementia who are working or involved in volunteer activities. In recent years, some people suffering from dementia even delivered speeches and are engaged in other awareness-raising campaigns about the illness.

Delusions and wandering about are believed to be secondary symptoms caused by interactions between dementia and social factors such as patients' living environments and the quality of nursing care they receive, rather than symptoms particular to dementia. In many cases, even specialized nursing care facilities cannot look after patients and end up transferring them to mental hospitals. As such, approximately 50,000 people suffering from the disease are hospitalized at such medical institutions.

A survey conducted by a Health, Labor and Welfare Ministry study group on about 5,000 inpatients with dementia shows that the largest number of patients were hospitalized because their mental conditions had worsened. The fatigue of family members looking after the patients and difficulties in looking after them in their regional communities or at care facilities were also cited in many other cases.

At the same time, there are many cases where the secondary mental symptoms of many patients have drastically improved after only small amounts of pharmaceutical products were administered to them. Experts say that respecting patients' pride and creating a comfortable living environment for them are effective measures in improving their conditions. There are many patients with medium-degree cognitive functions who show symptoms such as suffering from delusions and wandering about, and experts say the conditions of these patients often worsen after being hospitalized.

Hideki Ueno, a doctor living in Asahi, Chiba Prefecture, has examined more than 900 patients with dementia who have shown psychiatric symptoms, but less than 40 of them needed to be admitted to mental hospitals. "Dementia needs less medication than schizophrenia and other ordinary mental disorders. Therefore, patients don't necessarily need to be hospitalized, and can be treated by doctors in their neighborhoods who have undergone certain training," Ueno says.

People tend to fear that if patients with dementia live in their own homes, they will force a heavy burden on their families. However, 56 patients with dementia were living alone in Kunitachi, western Tokyo, as of November 2013. According to a report that Kunio Nitta, a doctor in Kunitachi, has submitted to the ministry's study group, one of these patients often calls their daughter with delusions that a thief breaks into their home, one is visually impaired, another has handicapped legs and one other is forgetful. Still, their families visit them only on weekends or call them only in the morning or evening, and nursing care services at facilities or at their homes support the patients' self-reliance, along with short stays at care facilities and food delivery services.

The Kunitachi Municipal Government has worked closely with local communities to provide regional comprehensive care for dementia patients through cooperation between medical and care workers, by securing doctors in each community who can treat sufferers and through mutual assistance between neighbors in supporting the patients. The city did not allocate a massive amount of taxpayers' money from its budget to support hospitals looking after patients. Such being the case, local governments can change the current situation in which many people are forced to quit their jobs to look after senile family members and exhausted family members have no choice but to rely on mental hospitals for caring for senile people.
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January 14, 2014 (Mainichi Japan)

56-year-old dementia patient expresses agony of memory loss

"Nouns are disappearing from the world I live in." So said a 56-year-old dementia patient in the Kansai region recently in his journal to the Mainichi. As the brain disorder slowly eats away at his memory, the man writes to express his agony and anxiety.

"The world is filled with nouns. A doctor told me I had dementia. Forgetting things has become a serious illness," the man wrote after he was diagnosed with the disease in May last year. He went to see a neurosurgeon as he had become forgetful and after taking several tests, his doctor told him that he had dementia.

"A storm of anxiety flooded into me, but there was nothing I could do. I had dementia," sighed the man.

He had thought that the illness was something that only affects the elderly. He had thought dementia patients would soon start wandering about and having delusions. He was in shock and cried for three days after he was diagnosed. His wife lamented that dementia was worse than cancer and told the man not to tell others about his condition.

Fearing that he would not be able to write anything once words slip from his mind, the man started to write about his experiences and feelings. He wrote many entries in his computer in the two to three months after the diagnosis.

"I tend to forget people's names, so I take notes on my iPhone every time I succeed in remembering them. This works well. I now can remember over a dozen names of people and places I once forgot. I'm happy about that. But more than anything, nouns are disappearing from my world. Nouns like 'mug' keeps slipping out of my mind. It's quite tiring to spend each day with the fear of forgetting words."

The man became psychologically stable after seeing experts on early-onset dementia. Being able to write made him confident and, though just for a short period of time a day, he continues working. Nevertheless, the man struggles with small things like being unable to find the TV remote control or his watch.

"People tend to think that dementia patients forget the feeling of suffering, but I hope they understand that we struggle from the agony of memory loss," the man wrote.

"Dementia patients have a difficult time living in this complex society where speed is required. I hope that society becomes patient with people who forget and lose their ways," the man added.

The man concluded his journal entry in June last year, about a month after he was diagnosed, saying, "The world often disappears from my sight, but I will work my best. I ask for people's support."
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January 14, 2014(Mainichi Japan)

Railway accidents involving dementia patients a serious issue in aging society

At least 149 railway accidents involving dementia patients or those suspected of having dementia claimed the lives of 115 people in the eight-year period ending in fiscal 2012, underscoring the need for prompt measures in a rapidly aging society.

Railway companies are required to report accidents to the Ministry of Land, Infrastructure, Transport and Tourism, which the ministry compiles into official records. Through a freedom-of-information request, the Mainichi Shimbun obtained the ministry's records and police reports from fiscal 2005 on -- when the Long-Term Care Insurance Act was revised -- and found that because many accident reports did not note that those involved had dementia, the actual number of dementia patients in railway accidents may be even greater.

Many of the accidents are believed to have occurred due to wandering dementia patients entering dangerous areas that were not fenced off, or ducking under crossing bars, because they were unable to recognize the dangers of doing so. Some were found walking on tracks for several hundred meters, while others were hit by trains as they walked on bridges and in tunnels.

A 73-year-old woman who was killed in an accident in Osaka in January 2008 is believed to have climbed onto the tracks through an iron fence door located at the end of the station platform for railway staff. In other cases, people were killed as others were searching for them using information transmitted from their GPS systems.

In August 2013, the Nagoya District Court ordered the family of a dementia patient killed in a railway accident to pay approximately 7.2 million yen in damages to Central Japan Railway Co. (JR Tokai), siding with the company's claim that the family had neglected its responsibility to look after the victim. The family has since appealed the ruling.

Members of an association of families of people with dementia said it was impossible to watch dementia patients every single minute of the day, and expressed concern that being held to such heavy responsibility would stop many families from taking care of those with dementia in their own homes. In 2012, there were an estimated 8.62 million dementia patients -- including around 4 million people with mild cognitive disorders -- or about one in every four senior citizens.

The Mainichi Shimbun spoke with the bereaved families and other insiders whose names and addresses could be identified in 10 accidents involving nine railway companies, including the abovementioned case with JR Tokai.

According to the families, in addition to the ongoing JR Tokai case, Tobu Railway Corp. in two cases, and Kintetsu Corp. and the Nagoya Railroad Co. in one case each, had demanded bereaved families pay between approximately 160,000 and 1.37 million yen in damages. The company that demanded some 1.37 million sought damages for overtime wages paid to employees and the cost of alternative transport as a result of the accident. In this and another case, the amounts were reduced over the course of deliberations, but in all four cases, the bereaved families paid damages.
No compensation was demanded in the five other cases involving Hokkaido Railway Co. (JR Hokkaido), East Japan Railway Co. (JR East), West Japan Railway Co. (JR West), Kyushu Railway Co. (JR Kyushu) and Nankai Electric Railway Co. According to the bereaved families, JR East said that it would "not demand compensation because it was confirmed the person in question had dementia," and Nankai said, "While we suffered a loss of approximately 1.3 million yen, we will not demand compensation."

JR East said that it did not communicate its intentions to the family in those terms, but that it was true that the company had deliberated the case and based on the facts, decided not to demand compensation. Nankai, meanwhile, said it would refrain from commenting on the case.

While there is a trend among JR companies not to claim damages in such accidents, it is not uncommon for other railway companies to demand compensation as a rule.
According to the General Insurance Association of Japan (SONPO), personal liability insurance may cover damages caused by railway accidents. Such insurance is usually a special provision of auto and fire insurance policies, and premiums run around several thousand yen annually. But because railway accidents are not always interpreted as being subject to such insurance policies, SONPO urges consumers to confirm eligibility with insurance companies.

In fiscal 2012, 295 people died in railway accidents. Suicides, meanwhile, whose data are separated from non-suicide railway accidents, numbered at 631.
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January 13, 2014(Mainichi Japan)


Researchers to track 10,000 elderly to study effects of exercise on dementia prevention

A team of researchers will initiate a study on the effects of exercise in preventing dementia, keeping track of roughly 10,000 elderly people across Japan for four years, it has been learned.

The team -- comprised of researchers from at least 10 universities, medical institutions and local governments -- will embark on the large-scale study in fiscal 2014 and will compile a report one year after wrapping up the four-year survey. The study will look into the relationship between exercise and the incidence of dementia.

It has been generally known that exercise contributes to dementia prevention, but this will be the largest verification study of its kind in Japan. If exercise does prove to be effective in warding off dementia, the Ministry of Health, Labor and Welfare will incorporate the study results into a project to lessen the need for nursing care.

According to the team's interim plan submitted to the ministry at the end of last year, the study will cover 10,000 selected people aged 65 or older who are healthy and not forgetful. The subjects will be divided into two 5,000-member groups, with both participating in a four-year study program including classroom lectures on how to use computers, while the first group will also undergo exercise programs during the first year.

All participants will be required to carry pedometers with them to gauge their day-to-day exercise situations and the frequency of their social activities. After they complete all programs, the research team will compare the difference in the two groups, such as the incidence of dementia.
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January 01, 2014(Mainichi Japan)


2013


Movie offers heartwarming look at son caring for mom with dementia

November 16, 2013The Asahi Shimbun
By HARUKO ISHII/ Staff Writer

With Japan's rapidly aging population, manga artist Yuichi Okano wants to help people like himself who are being increasingly tasked with taking care of an elderly, impaired parent.

Okano's manga gPecoross no Haha ni Aini-ikuh (Visiting Pecorossf mother), about his daily life with his mother, who is suffering from dementia, has been made into a film that will be released nationwide on Nov. 16.

gAfter watching this movie, people of my generation who have nursed or will nurse their parents will think that they have to have a relaxed state of mind," said Okano, 63. "I also want young people to see it.h

The movie of the same title is filled with humorous scenes of a middle-aged man taking care of his mother, while taking up serious issues, such as the progression of her condition and placing her in a facility for elderly people with dementia.

The movie shows Okano's belief that forgetting things is not necessarily bad.
Okano, whose nickname is "Pecoross," taken from a small onion called "pecorosu," which his bald head looks like, divorced at age 40 in 1990 while working in Tokyo. Along with his 3-year-old son, he returned to his parentsf home in Nagasaki. Ten years later, his father died. Then, his mother, Mitsue, now 90, began to suffer from dementia.

Her symptoms progressed. She began to wander around. In addition, she would stuff her unwashed underwear into a drawer. After agonizing over what to do, Okano decided to put his mother into a facility in which elderly people suffering from dementia live in a group, along with caregivers.
In the film, a scene symbolizes the relationship between Okano and his mother. Patients with dementia often are in an unstable state of mind and, as a result, may shout abusive language.

On a train station platform, Okano is pushing his mother along in a wheelchair. Then, she suddenly shouts at him, gHey, you thief!h She also shouts, gYoufre a bad man!h
Okano immediately takes off his cap and shows his bald head. Then, she says with a smile, gOh, youfre Yuichi. What a nice bald head you have!h
In addition to this and other episodes that were described in the manga, the movie also depicts his motherfs childhood when an atomic bomb was dropped on Nagasaki near the end of World War II, and her memories of marriage and her child-rearing days.

The last scene of the movie is set at the Nagasaki Lantern Festival, in which her thoughts come and go between the past and the present.
The last scene gives power to Okanofs words: gWhen seeing my mother, I feel that forgetting things is not necessarily bad.h
In the movie, Okano is played by actor Ryo Iwamatsu, while his mother is played by actress Harue Akagi. Iwamatsu, 61, and Akagi, 89, are almost from the same generations as those of Okano and his mother.

According to Akagi, she especially empathizes with the scene in which Okano feels a sense of guilt when he puts his mother into a facility for dementia patients. Akagi also has experienced putting her dementia-stricken mother into a similar facility before she died at the age of 85.
g(A day before putting my mother into the facility), I felt depressed because I was not able to take care of my mother. I covered myself with futon (Japanese-style mattress) and wept,h Akagi recalled.
gBut when I saw my mother smiling in the facility, I thought that I should have put her into the facility earlier,h she added.

Akagi said that she wants people to feel the deep affection between a mother and her child from watching the movie.
At present, Okanofs bedridden mother is not in a state in which she can understand the movie. However, he plans to show it to her in a DVD.
gEven if she cannot understand the move, I want her to watch it,h he said.

The movie was directed by Azuma Morisaki, who is called a master of comedies. The manga gPecoross no Haha ni Aini-iku,h was published by The Nishinippon Shimbun Co., based in Fukuoka, in July 2012. It has sold about 160,000 copies partly from becoming a well-discussed topic on Facebook and other social networking services. It won an award from the Japan Cartoonists Association in fiscal 2013.



Hunt stepped up for Alzheimerfs cure


November 4, 2013
The Yomiuri Shimbun(The JapanNews)

A health ministry study group will begin a research project on Alzheimerfs disease this month, aimed at prevention and developing fundamental medicines for the condition.

Joining an international research partnership called Dominantly Inherited Alzheimer Network (DIAN), the group plans to survey patients with familial Alzheimerfs, a condition that inevitably leads to dementia, and their families. The effort is expected to help develop medicines and identify the mechanism that causes the onset of the disease.

An estimated 4.62 million elderly people in Japan have dementia, of which there are several types. Alzheimerfs dementia, which mainly causes memory problems, accounts for 70 percent of all dementia patients.

According to an overseas study, almost everyone who carries the gene for familial Alzheimerfs develops dementia, many while in their 40s and 50s. About 520 family lines with the gene have been found around the world, but the situation in Japan remains unclear.

Headed by Prof. Hiroshi Mori of Osaka City University(photo), the ministry group plans to send questionnaires to about 6,000 medical specialists in dementia and 235 medical centers for the treatment of dementia across the nation.

The surveys will examine such points as the results of medical examinations of people who are likely to have developed the disease and their families; whether the causal gene was identified; and their living situations and issues that need to be addressed.

While concealing individualsf identities, the group also plans to send questionnaires to regional chapters of Alzheimerfs Association Japan, and to interview patients and their families who are believed to belong to a few dozen family lines with Alzheimerfs in Japan.

The survey is expected to be concluded within this fiscal year. The group will clarify concerns in patientsf everyday lives and areas where they need additional help, and utilize the results to establish a support system.

Also, the group aims to participate in DIAN with Japanese family lines with the Alzheimer gene. Though it is difficult to determine when a person will develop dementia, a person with the familial Alzheimerfs gene usually develops the condition at about the same age that their parents displayed symptoms.

Therefore, the group aims to identify the mechanism for developing the disease by conducting follow-up checks on people with the familial Alzheimerfs gene, including diagnostic imaging.

DIAN began its research study of people with the gene responsible for familial Alzheimerfs in 2008, mainly led by Washington University in St. Louis. The study currently involves four nations, including Germany and Britain, and this year it began a clinical trial to administer experimental drugs and placebos to people who carry the gene but have not yet developed symptoms.

The study by the health ministry group may help develop methods of prevention or fundamental medicines by one day conducting its own clinical tests with experimental drugs and placebos on people before they develop the disease.

As the causative agents for dementia are believed to be same for familial Alzheimer and for other general types of Alzheimerfs, the study results of familial Alzheimerfs are expected to help people suffering from general Alzheimerfs as well.
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VOX POPULI: Court ruling in Nagoya too harsh for family of dementia patient

September 28, 2013
The Asahi Shimbun.

I find works by mystery writer Hideo Yokoyama uniformly good, but the short story gDokih (Motive) is an absolute gem. It is an account of an incident in which a large number of police officer IDs go missing. What gives a human touch to the tense story is the relationship between the protagonist and his father.

The son is a police officer and so was his father. After his mother dies, his father becomes mentally ill. Having lost both speech and the ability to express himself, the father becomes like ga lump of earthh and lives in an isolated ward. When the son visits him, the father lets out a yelp to a nurse. gYa!h The nurse answers him: gI know. You must be very happy.h

The son is baffled at the nursefs gfree translationh that his father is happy to see him. While the nurse understands the old manfs feelings, the son, who rarely visits him, cannot. The difficulty and pain of staying close to elderly people who are suffering from emotional disorders touch the readersf hearts. It must be all the more difficult in real life for people who look after such elderly relatives at home that their agony is beyond description.

Last month, a harsh ruling was handed down in a case concerning home nursing care. A 91-year-old man in Aichi Prefecture suffering from dementia wandered onto a railway track and was killed by a train. The train schedule was disrupted on account of the accident, causing financial damage to Central Japan Railway Co. The Nagoya District Court held the manfs wife, who was looking after him, and his son responsible and ordered them to pay 7.2 million yen ($73,000) to the railway company.

The story was reported on the lifestyle page of the Tokyo and other editions of The Asahi Shimbun dated Sept. 27. The man managed to leave the house after the wife and daughter-in-law let him out of their sight for just a very short time. The ruling determined that they failed to keep an eye on him. But no one can be watchful all the time. Isnft the responsibility the court expects them to shoulder too heavy?

At the end of gDoki,h the protagonist tells his wife that gYa!h means gIfm happy.h The wife says she knew that for a long time. At least in the story, there is hope.

Vox Populi, Vox Dei is a popular daily column that takes up a wide range of topics, including culture, arts and social trends and developments. Written by veteran Asahi Shimbun writers, the column provides useful perspectives on and insights into contemporary Japan and its culture.



Alzheimer's brain scan detects tau protein


By James Gallagher Health and science reporter
BBC News
19 September 2013

Pioneering brain imaging that can detect the build-up of destructive proteins linked to Alzheimer's has been developed by Japanese scientists.
It could lead to new ways of diagnosing the condition and of testing the effectiveness of new drugs.
The technology, reported in the journal Neuron, can identify inside a living brain clumps of a protein called tau that is closely linked to the disease.
Alzheimer's Research UK said it was promising work.
Alzheimer's disease is a problem for researchers trying to come up with a cure. The brain starts to die years before any symptoms are detected, which means drugs are probably given too late.
A diagnosis of Alzheimer's cannot be made with absolute certainty until a patient has died and their brain is examined. It is also not 100% clear what is the cause of the dementia and what are just symptoms.
One protein, called tau, is very closely linked to the disease, with tangles of tau thought to be one way in which brain cells are killed.
The team, lead by the National Institute of Radiological Sciences in Chiba, used positron emission tomography to build a 3D picture of tau in the brain.
They developed a chemical that could bind to tau and then be detected during a brain scan.
Tests on mice and people with suspected Alzheimer's showed the technology could detect tau. Dr Makoto Higuchi (photo), from the National Institute of Radiological Sciences in Japan, said: "Positron emission tomography images of tau accumulation... provide robust information on brain regions developing or at risk for tau-induced neuronal death."
The research is at an early stage, but it could eventually lead to an actual test for Alzheimer's disease.
It might also allow researchers to closely follow the impact drugs that affect tau have on the brain.
Another protein - beta amyloid - is also linked to Alzheimer's and can be detected in similar tests.
Dr Eric Karran, director of research at Alzheimer's Research UK, said: "This promising early study highlights a potential new method for detecting tau - a key player in both Alzheimer's and frontotemporal dementia - in the living brain.
"With new drugs in development designed to target tau, scans capable of visualising the protein inside the brain could be important for assessing whether treatments in clinical trials are hitting their target.
"If this method is shown to be effective, such a scan could also be a useful aid for providing people with an accurate diagnosis, as well as for monitoring disease progression."

Report: Imaging of Tau Pathology in a Tauopathy Mouse Model and in Alzheimer Patients Compared to Normal controls@Neuron, Volume 79, Issue 6, 1094-1108, 18 September 2013



Govt to help dementia sufferers

August 28, 2013
The Japan News
The Yomiuri Shimbun

The government will establish a liaison council in September tasked with eliminating boundaries between ministries and agencies in order to create a society friendly to those suffering from dementia, it has been learned.
Coming at a time when the number of elderly people suffering from dementia is growing rapidly, the initiative is aimed at making society safer for dementia victims.
The government will set up a liaison council comprising representatives from 11 relevant government bodies, and its first meeting is expected to be held in September, according to sources.
Because issues related to dementia range widely from medical and nursing care services to consumer protection and public transportation systems, the government aims to have ministries and agencies share information beyond organizational boundaries to facilitate a comprehensive approach to the problem.
According to an estimate by a study group of the Health, Labor and Welfare Ministry, there were 4.62 million people aged 65 or older suffering from dementia in the nation as of 2012, and an additional 4 million people are predicted to develop dementia in the not-distant future as baby boomers age.
Although the welfare ministry introduced, from this fiscal year, measures to enable dementia patients to live at home, it is difficult for a single ministry to create a society that can comprehensively deal with sufferers of dementia.
For example, because the number of car accidents involving elderly people suspected to be suffering from dementia has increased, the National Policy Agency should consider how to handle license renewal for the elderly. The Land, Infrastructure, Transport and Tourism Ministry also should consider improving public transportation systems, which would make it easier for dementia patients to live without driving a car.
Consumer protection is another issue that requires attention, including vicious home-visit sales scams that target the elderly, a problem that the Consumer Affairs Agency should handle.
Furthermore, the adult guardianship system, which is aimed at protecting assets of vulnerable people and is overseen by the Justice Ministry, has not been fully implemented.
Efforts to promote the understanding of dementia at schools and through lifelong education are also necessary, a problem that comes under the purview of the Education, Culture, Sports, Science and Technology Ministry.
At the first meeting of the liaison council, officials from the Cabinet Office and 10 ministries and agencies will explain measures and policies currently undertaken by each, and exchange opinions.
The welfare ministry and the Cabinet Office, which is in charge of overall policies related to the elderly, will play leading roles in council discussions to be held regularly, according to the sources.
Because the government currently lacks such a forum for comprehensive discussions about dementia, the council is expected to make substantial contributions to the promotion of various measures to improve conditions for dementia victims.
But it remains to be seen how enthusiastic ministries and agencies will be about overcoming sectionalism and cooperating with each other, observers said.


Grandma on Feeding Tube Without Consent Symbolizes Japan
Feeding tubes are so common in Japan that my family wasnft initially consulted about the procedure, which is effectively irreversible. When my mother walked into Grandmafs room the next morning and saw a tube, she dropped to her knees by the bedside and stayed there for hours, crying.
gI am sorry. I didnft mean to do this to you,h my mom repeated over and over.
As medical science becomes more sophisticated, wefre finding new ways to prolong life. When my grandma, Hisako Miyake, was born in 1916, life expectancy in Japan was around 43 years; now it is 83, the longest in the world.
When it comes to death, Japan doesnft score so well. In 2010, the Economist Intelligence Unit ranked 40 developed and developing countries on gquality of death,h based on criteria such as end-of-life cost and care and, more broadly, how well societies faced issues of death. Japan was 23.
In Japan, therefs not much talk about death. Living wills, or even discussions about end-of-life decisions, are rare. Historically, hospitals focused on extending lives of patients with little chance of recovery, said Tetsuo Kashiwagi, president of Japanfs Hospice Palliative Care Foundation.
gThatfs still the mainstream,h he said.

Aging Population
The use of feeding tubes at the end of life, which is not conventional practice in the western world, is a way of life in Japan. Twelve percent of patients who get the procedure are fed this way for five years or more, according to a survey conducted in 2011 by Japanfs hospital association.
When my grandma -- or obaachan, as I call her in Japanese - - was born, one out of 20 Japanese was over 65. Now it is one in four. By 2060, the proportion will swell to 40 percent.
The aging population has the potential to bankrupt Japan, now the worldfs third-largest economy after being surpassed by China in 2010. As the proportion of the working population declines, Japan, also the second most-indebted economy, has fewer salary-earning taxpayers to foot the bill for dependent seniors, especially because the birth rate is low and society doesnft encourage immigrant workers.

Born in 1916
Grandma spoke often of her own determination to live to 100. She was born on Dec. 27, 1916, about 18 months after World War I broke out and the same year Woodrow Wilson was re-elected president in the U.S. She grew up in a wealthy household -- her family was the dominant rice wholesaler in the historic city of Nara, Japanfs capital 1,300 years ago. The area, called Naramachi, retains many relics from its past, including wooden residences called Machiya, long, skinny buildings that doubled as shops.
When I was a teenager, she told me how shefd bump along the road in a rickshaw to the station where she took the train to Osaka to attend college. That would have been in the 1930s, when few Japanese women were getting higher education. She also told me how her pocket money was enough to buy western pastries and candies.
Grandmafs two-floor Machiya, under a pagoda-style tiled roof, was a wonderland to me. The complex, built in the early 1800s, is set inside a 700-square-meter (7,500-square-foot) plot surrounded by a mud wall. At the entrance, there was a telephone box, one of Narafs first. Its many rooms, chambers, staircases, passageways and doors were perfect for hide-and-seek.
The other attraction of visits to Grandma was her fondness for indulging my sister, brother and me with sweets.

Good-Luck Charms
Life as Grandma knew it came to an abrupt end during World War II, when the government instituted food rationing and took control of rice distribution, effectively closing the familyfs business. Over generations, rice traders plowed their profit back into buying land. When the U.S. occupation forces moved in, the farmland was taken away and redistributed to growers in 1947.
My grandma used to say that she and her friends would complain that they couldnft find anyone to marry because all the bachelors were at war. Women stitched notes with their names and addresses inside good-luck charms dispatched to soldiers.
My grandfather received one from Grandma when he was stationed in Manchuria, China. Sumio Miyake was a graduate of the Imperial Japanese Army Academy in Tokyo. He was an ambitious colonel who specialized in working out complicated mathematical equations used to predict the trajectory of a bomb. Grandpa was not only an elite officer, he also came from a higher class -- a descendant of a samurai family with acclaimed archery skills.

Fortune Lost
When he returned to his military training in Osaka, he traveled about 30 kilometers (19 miles) to Nara to thank her. They fell in love. They ultimately had three children; my father, Takashi, was the oldest.
During and after the war, the familyfs fortune was dissolved by the government.
gWe became poor all at once,h my grandma said in an interview with a magazine called Sun in 1998. That wasnft her familyfs only wartime tragedy: Grandma also lost her only brother, Hiroshi, who was sent to Manchuria to fight. His body was never found. He was declared dead in 1946, when he would have been 20.

Steak for Breakfast
After the war, a dozen of Grandmafs relatives lived in the family home. Grandma ran the household for the first time without servants, and she struggled. Still, she insisted her children enjoy English tea for breakfast, meat and Western-style meals on some occasions. When her second son, Tsutomu, brought his university friends to the house in the 1960s, she cooked them steak for breakfast.
gShe once told me she knew she had to buy cheaper meat,h my mom said, gbut her mouth instinctively told the meat shop the opposite.h
She probably kept the standard high so as not to lose face.
When I think of her, I picture her standing in her kitchen. She always wore an apron tied around her abundant waist while working in the home and liked to prepare extra food, which she gave as sacraments to the gods and spirits of ancestors she worshiped every day. She also insisted on giving expensive foods and delicacies as gifts to her extended family.
My grandpa died of a heart attack in 1984. My grandma lived alone in her home until 11 years ago, when she started to lose control of her bladder. At the age of 85, she moved in with my parents.
She took only a few things with her. Among them: the postcard Hiroshi had received from the army in Osaka advising the date he was to be interviewed for military service.

Decline Hastened
Three years after she moved in with my parents, she had a compression fracture of her spine, possibly compounded by her weight -- 60 kilograms (133 pounds) on a 1.58-meter (5-foot-2) frame. She was hospitalized for three months. Her decline hastened after that. She became frail, walked around the house with a stick and used a day-care service twice a week for bathing, which my mom wasnft strong enough to help her do.
She became fully dependent on my parents, especially my mom, her daughter-in-law. Each time I went back to see my parents in Nara -- Ifd visit every few months -- Grandma had regressed physically a little more.

Fed With Spoon
She stopped eating. She said she didnft want to use her chopsticks, so my mom started to feed her with a spoon. It sometimes took more than an hour because she chewed so much.
gI remember she said it would be so easy if she could hop to the afterlife instantly,h my mom said. gI told her that the human body isnft designed to go on for more than 90 years -- thatfs why her body canft function the way she wants it to. Her deterioration is natural.h
Still, perhaps because her decline was happening in slow motion, no one thought to ask if she had any end-of-life wishes. None of us even imagined tube-feeding.
Discussion about death within Japanese families may be difficult in part because Japanese arenft very verbal. They tend to use more ambiguous, less direct speech, said Kashiwagi, president of the Hospice Palliative Care Foundation.

eHonne and Tatemaef
Thatfs because Japanese tend to protect other peoplefs feelings to avoid conflict and enjoy harmony. Itfs the base of the concept called gHonne and Tatemaeh in Japanese: the difference between personal feelings and what people express publicly.
Views on life and death also changed over the past several decades because Japan focused on economic growth, which is materialistic, said Yoshinori Hiroi, a professor of health-care public policy at Chiba University.
gJapanese used to understand the world of life and death through Shintoism and Buddhism,h said Hiroi. Focus on economic growth after the war prevented Japanese from accepting aging and death, he said.
Grandmafs mind started to fail. She often saw dead relatives, my mom said, and her memory started to go.
gShe probably realized death is nearing when she felt so tired and began to have delusions,h my mom said one afternoon in May. gShe must have been terrified.h

Mushy Food
Last December, nine days before Grandmafs 96th birthday, my mom sent me a text message saying Grandma had been rushed to the hospital in an ambulance. Her temperature had soared to 40 degrees Celsius (104 Fahrenheit) and she was drowsy.
She was admitted to the same hospital where her husband died. My 66-year-old father saw that as a bad omen. Grandma fought on, and began eating again when my mom fed her mushy food, slowly. I rushed from Tokyo to see her and by the time I arrived, her condition was stabilizing.
Shefd developed aspiration pneumonia and had a urinary tract infection that had caused a kidney complication called pyelonephritis. Her recovery was a matter of time, the doctor said.
One afternoon, my parents cut short their visit while Grandma slept peacefully. When my mom returned the next morning, she was shocked to find a tube had been inserted into Grandmafs stomach through her nose. My mom was furious. Someone outside the family -- a nurse -- had made a decision that, as my mother saw it, could keep Grandma alive in an unnatural way for years.
My parents werenft prepared for this.

Choked on Dinner
Mom stormed off to find the nurse responsible for the tube and chided her for not trying hard enough to feed Grandma. Grandma had choked on her dinner the previous evening, the nurse responded.
The next day, the color had returned to my grandmafs face and she was more responsive, shouting gcoldh when the family touched her with cold hands. She also smiled more frequently when the family talked about her past and mumbled words as if to join the conversation.
gWe were so surprised,h Mom said. gShe was probably getting more energy from the drip than from the mushy food she was getting though the mouth.h
The family decided it would be best to replace the nasal tube with one inserted directly into her abdomen because breathing was uncomfortable for her.

Stomach Tube
On Feb. 1, she was moved to another hospital, near my parentsf house, for the surgery. Three days later, she had an endoscopy, in which a tiny camera is inserted through the mouth to peer inside the esophagus and stomach, to monitor the operation. The procedure took less than an hour and showed a perfectly functioning upper gastrointestinal tract.
With the stomach tube, she may keep going for months, if not years, while her organs continue to absorb the nutrients they need to sustain her.
Of the quarter-million patients in Japan estimated to be fed through a tube like Grandmafs, more than 90 percent are bedbound, according to the survey by Japanfs hospital association. They are, on average, 81 years old and nourished via tube for 2.3 years.
In the U.S., feeding tubes are more commonly used in patients with swallowing difficulties, such as those with neurologic conditions after a stroke, or people treated for cancer of the oral cavity or esophagus, according to the American College of Gastroenterology. For late-stage dementia patients, who have lost their ability to swallow, the intervention is controversial, the group says. It recommends assessing life expectancy and quality of life before making a decision.

Quality of Life
The American Academy of Hospice and Palliative Medicine and the American Geriatric Society recommend severely demented patients be fed by mouth. In Japan, the Geriatrics Society published guidelines in June 2012 that gave doctors leeway to reduce nutrients and remove feeding tubes with consent of the patient or the family, responding to public concern about quality of life.
A Japanese study that tracked the prognosis of 931 geriatric patients with a tube inserted directly to their abdomen said about 60 percent died of pneumonia, 14 percent from cardiac failure, 3 percent from cancer and 22 percent from other reasons.
More than 70 percent of Japanese said theyfd prefer not to be fed through a tube into the stomach if they suffered from terminal cancer or severe dementia, according to a survey by the health ministry in March. Although about 70 percent supported preparing living wills, only 3.2 percent did the work, it said.

eToo Latef
My grandmafs doctor said he would refuse to remove the tube even if my family asked that Grandma be fed orally.
gOnce itfs in -- whether itfs through nose or direct into the stomach -- you canft remove it,h my father said in May as we chatted beside Grandmafs bed. gItfs too late to make a call even if you want to.h
Japanese doctors are reluctant to stop life support on terminal sufferers because they could be prosecuted for killing patients. Doctors at Imizu City Hospital in Toyama, central Japan, were investigated for murder after the hospital found in 2006 that they had removed respirators of terminally ill patients, which led to more public discussion about setting rules for death with dignity.
gJapanese elderly are forced to live longer, and that is an abuse of medical care,h said Kanao Tsuji, director of Suidobashi Higashiguchi Clinic in Tokyo. gDoctors are making decisions based on their values, which are different by doctor. Japan needs to create an institution with specialists that can document wishes for patients and a law that protects the elderlyfs dignity.h

Grandmafs Cousin
My grandmafs cousin, Hiroko Matsuyama, died three years ago at age 96. She had cancer removed from her stomach to relieve pain shortly before her death.
gI donft know how the family and the doctor concluded that it was better to operate on her,h my father told me. gI wondered if there was a way to palliate her instead. Surgery seemed too much at such age.h
In the U.S., an average of $69,947 was spent on chronically ill Medicare patients in their last two years of life in 2010, according to the Dartmouth Institute for Health Policy and Clinical Practice. Expenditures were the highest in Los Angeles, with $112,263. Caring for patients with chronic illness in their last 24 months accounts for almost a third of total Medicare spending, the institute found.

Rising Costs
My grandmafs monthly out-of-pocket cost was about 100,000 yen ($1,005) for the first five months of her hospitalization, including consumables such as diapers and food. Thatfs 10 percent of the bill. The government picked up the remaining 90 percent through a universal health-insurance plan that sets price limits on fees and services.
Japan introduced an affordable health system in the 1960s to broaden access to acute care when tuberculosis was the nationfs top killer. Cancer and cardiovascular disease now are the most common causes of death. Those are more complicated to treat, so the system is overloaded with patients and the cost to the government is escalating.
In May, the out-of-pocket cost for Grandmafs care increased by 65,000 yen to 165,000 yen a month, reflecting a reduction in the reimbursement the hospital gets from the government for patients in long-term care. The bill exceeds Grandmafs government pension, which is like Social Security in the U.S., so my father picks up the 20,000 yen-a-month difference.

Younger Generations
I am 33 years old and deeply respectful of my elders, so many of whom built modern Japan and continue to be vital and productive. One study, in the U.K., found that seniors contribute more to society than they cost. The charity group Royal Voluntary Service in Cardiff reported in March 2011 that people older than 65 made a net contribution of 40 billion pounds ($61 billion) to the U.K. economy in 2010 through taxes, spending, providing care and volunteering, and that the contribution will grow 93 percent to 77 billion pounds by 2030.
I donft want Grandma to die. Shefs comfortable and still seems to have some connection with her shrinking world. And her children -- my father Takashi, my uncle Tsutomu and my aunt Megumi -- look so happy to see her during their frequent visits.

But Japan -- which spent the equivalent of 9.6 percent of its gross domestic product on health care in 2011, about half the 18 percent spent in the U.S. -- wonft be able to afford to give me the same level of care. Japanese born in 1955 and after will get fewer benefits -- pension, health care and elderly care -- than they have paid in taxes and contributions, according to a study by the Cabinet Officefs Economic and Social Research Institute in January 2012.

Helping Grandma
Caring for Grandma the past 11 years has taken its toll on my 61-year-old mom, Ritsuko, who weighs 90 pounds and is barely over 5 feet tall. She would run her errands, help Grandma to the toilet, sponge bathe her and change her adult nappies.
My mom was diagnosed with early-stage breast cancer in January. She had a lumpectomy, followed by radiation, and has taken on female-hormone-suppression therapy to prevent recurrence. Already a slender woman, she lost weight after the surgery and a blood test showed elevated levels of liver enzymes and bad cholesterol.
Because her first doctors didnft treat her immediately, she switched physicians late last month and was hospitalized to cure the liver damage. She has been in the hospital for more than three weeks now and is expected to be discharged once the liver enzymes drop to the normal level.

Talking About Aging
My mom and I have been discussing aging, dying and the impact on our economy over the years, and a lot more recently. My grandma and her peers lived much longer than anyone could have been expected at the time of their birth, so no one was prepared to look after them for so long, Mom said.
My mom and dadfs generation, who took care of their parents and witnessed the burden it created, think differently, she said. Their dream is gpinpin korori,h or PPK, which means to live long, healthy lives and to die naturally without suffering from illness.
gLooking at how they lived to be so old, as well as their deaths, makes us think we need to do better so as not to burden the future generations,h she said.
I visited Grandma recently at her hospital bed in Nara, a mile from where she grew up. She was curled up like a baby under a blanket.
Her creaseless face belies her 96 years. Nurses turn her over every hour or two to prevent bed sores. She weighs 90 pounds because her overall intake is about 600 calories per day, equivalent of two McDonaldfs cheeseburgers.

Light-Blue Uniforms
She shares the room with an 83-year-old woman who talks to herself and sings songs, and an 88-year-old woman who says very little. Her second roommate wears cotton gloves that are tied to her bedframe so that she canft pull out the feeding tube inserted in her nose.
Outside, nurses in light-pink, blue and white uniforms bustle along a dimly lit hallway carrying diapers, trays of tea and medications. Hints of sweat and excrement pervade the air.
Grandmafs diaper is changed every few hours by one of the nurses in a light-blue tunic. Another periodically dabs her toothless gums with a moistened sponge attached to something resembling scissors. She is bathed on Mondays and sponged on Thursdays.
Her hands are closed and tense, making it difficult for me to hold them.

Grandmafs Smile
When I said Ifd clean her eyes with wet cotton, she replied gthank you.h She smiled when my aunt Kazuko and I talked about her memories. She mumbled something, but the only word we could catch was Chieko. That was the name of her youngest sister, who died six years ago.
Three times a day -- at 9 a.m., 1 p.m. and 4:30 p.m. -- the nurse who does her gums feeds her. That is, she replaces the bottle that drains a 160 milliliter nutrient-rich white liquid through a tube inserted into her stomach.
When liquid food is administered to her, I see Grandma munching her empty mouth as if shefs chewing food. She mostly breathes through her mouth, and seems perpetually parched. When we press a wet wad of gauze to her lips, Grandma sucks on it as if it were nectar.
For a woman who asked everyone to chew 30 times at dinner because she believes itfs good for health, nothing -- neither solid nor liquid -- has passed her lips in seven months. Most probably, nothing ever will.

To contact the reporter on this story: Kanoko Matsuyama in Tokyo at kmatsuyama2@bloomberg.net
To contact the editors responsible for this story: John Brecher at jbrecher4@bloomberg.net; Jason Gale at j.gale@bloomberg.net

Jul 24, 2013
www.bloomberg.com
By Kanoko Matsuyama


The lessons Japan has for the UK on dementia
As the UK population ages, our politicians are looking at the policies of a country where one in four people is over 65

by Mayumi Hayashi
The Guardian
11 June 2013

Jeremy Hunt's recent visit to Japan passed almost unnoticed in Britain. Yet the issues he discussed with Shinzo Abe, the Japanese prime minister, and the health minister, Norihisa Tamura, touched on a problem that is likely to dominate social policy in the next decade: dementia care. One in four of the Japanese population is over 65. By 2050, the proportion will be 40%. There are already 4.6 million people with dementia in Japan. Britain, with 10 million people over 65, has 800,000 people living with dementia, at an annual direct cost to the Treasury of more than ?10.2bn pounds. By 2050, Britain is expected to have around 1.7 million dementia sufferers.

Not surprisingly, the condition has been a prominent concern to past and current policymakers. In 2009, the Labour government unveiled an ambitious dementia strategy, which aimed to improve the quality of life for people with dementia and their carers through greater understanding within society and improved services. Last year, the coalition government also emphasised the need to improve dementia care, with David Cameron launching his "challenge on dementia", which identified three major goals: better health and care, fostering "dementia-friendly" communities, and improved research.

Initial successes included a substantial increase in primary care trust funding for dementia care, but subsequent cuts in government spending resulted in reduced funding for the condition (although involving less reliance on the controversial use of antipsychotic drugs). Discussions in Whitehall about finding new, yet cost-effective, initiatives have been informed by Japan's experience. There, politicians and policymakers have focused on educating the public (even the term "dementia" was outlawed) by recruiting and mobilising volunteer dementia "supporters", and implementing a new national compulsory long-term care insurance system, offering enhanced services for people with dementia.

In Japan, within seven years of its inception in 2005, nearly 4 million people had already completed training as volunteer supporters for the country's dementia-affected population. The aim is to have 6 million supporters by 2017.

The long-term care insurance system introduced in 2000 attempted to cater for as many people with dementia as possible, with the aim of meeting their social as much as their medical needs. Ringfenced additional funding for the new system ? from taxation and insurance contributions ? was intended to guarantee improved, and theoretically fairer, access to care for eligible dementia patients, who pay a flat-rate 10% user fee. So-called group homes, seen as promoting active living in a supported environment ? similar to an extended family ? are common. Pivotal to this system is the "care navigator", who is responsible for co-ordinating integrated health and social care, and for ensuring access to round-the-clock home care, nursing visits, day centres, group homes, respite care and rehabilitation. Reinforcing the entire system is a well-developed network of day centres (the world's best per capita provision), including dedicated facilities for dementia care.

Both Labour and the coalition government have attempted to borrow aspects of Japan's approach. The search for a cheap means of buttressing dementia care has arguably been the greatest attraction of Cameron's "befriending" scheme ? clearly modelled on the Japanese dementia supporters. Unveiled last February, the scheme aims to recruit 1 million volunteer "dementia friends" by 2015. Himself an early volunteer, Cameron sees the initiative as being at the heart of "dementia-friendly communities", one of the three pillars of his dementia challenge.

But professionals question how relevant volunteer "friends" are to British needs. Many prefer the existing system of Admiral nurses (analogous to Macmillan nurses specialising in cancer care), who give specialist care to dementia sufferers and back-up to their carers. Highly trained, and so relatively expensive, these nurses are employed by the NHS, but their numbers have been affected by public spending cuts.

Assumptions that Japan can provide a model for Britain in managing the dementia timebomb may be misplaced. Crucially, Japan has not evolved a robust system of evaluating the quality of care. In contrast, Britain's approach has emphasised rigorous inspection. Organisations such as Dementia UK and the Carers Trust repeatedly stress the need for adequate support for dementia carers in order to guarantee a good quality of life for patients. Significantly, Japan has not yet produced any comparable networks of support for carers.

On the other hand, the Japanese voter typically expresses mature views on how care should be funded. The assumption is that high-quality services must be paid for. The high degree of consensus on this question is reflected in widespread support for the mandatory insurance system. But in Britain, successive governments have avoided increases in direct taxation to fund the social elements that form such an important part of care for dementia sufferers. Equally, it is taken as read in Japan that the entire system of accessible care should be properly funded and the cost shared between government (through taxation) and society at large (through insurance contributions). It is a lesson that Britain might usefully consider.

Mayumi Hayashi (photo) is a Leverhulme early career fellow at King's College London


Number of elderly with dementia in Japan reaches 4.62 mil.
TOKYO (Kyodo) -- The number of people aged 65 or older with dementia in Japan is estimated to have reached 4.62 million in 2012, accounting for about 15 percent of the total elderly population, a health ministry survey has shown.

A study group of the Health, Labor and Welfare Ministry also estimated that another 4 million elderly people in Japan suffered from mild cognitive impairment, which could evolve into dementia, in 2012, up from 3.8 million in 2010, based on a research conducted between fiscal 2009 and 2012 across Japan.

When the estimated numbers of the elderly with dementia and mild cognitive impairment are put together, the combined figure suggests one in four people aged 65 or older in Japan suffer from these symptoms.

Takashi Asada, a University of Tsukuba professor (photo) specialized in dementia, and other members of the study group collected data on 5,386 senior citizens in eight municipalities across Japan by interviewing them and their families for diagnosis.

As a result of the research, the researchers projected that 15 percent of the overall population aged 65 or older in Japan -- or 4.62 million of the 30.79 million people in that age bracket in 2012 -- have developed dementia.

As of 2010, the number of people aged 65 or older with dementia10+Œ in Japan was estimated at 4.39 million, of whom 2.7 million lived at home -- including about 430,000 who lived alone.

By age, the percentage with dementia among people aged 74 or younger stood at 10 percent or lower, but the ratio surpassed 40 percent among people aged 85 or older. In most age groups, more women developed dementia than men.

The health ministry had estimated last year that the number of elderly people with dementia in Japan reached 2.8 million in 2010 and 3.05 million in 2012, based on data collected on those in need of state-backed nursing care services.

The latest projections far exceed those estimates, underlining that many senior citizens with dementia do not use services provided under the public nursing care insurance scheme.

(June 02, 2013 Mainichi Japan)


Dementia Friendly Fujinomiya
Jeremy Hughes.
Chief Executive at Alzheimer's Society
huffingtonpost.co.uk
27/05/2013

In the shadow of iconic snow-capped Mount Fuji, a group of five shopkeepers meet to discuss how best to keep their town centre alive in the face of competition from out of town shopping malls and the buying power - and prices - the national chains can command that the local stores simply can't match.

That first meeting was over 10 years ago and the fact that I could join their meeting in April 2013 shows that they must have found a formula that keeps them in business, if not prosperous. The answer lies in valuing their customers. As Mrs Masula, chair of the Association explained, their customers are very local and elderly. They used to be supported by extended families across two or three generations, but all too often the elderly are now alone as children and grandchildren move away.

On June 16 2000, they held a one-off open day where the shop keepers came together to promote their stores and provide information and support for their customers. That one-off event has now become a monthly fixture on the 16th of each month. With around two-thirds of their customers over 60, the shopkeepers association have also seen the effect of dementia on everyday lives. So for the last three years they've been holding workshops to learn about how best to support people with dementia. It's their part of the Japanese version of England's 'Dementia Friends' programme where information sessions help everyone be understanding to those with dementia living alongside them. In Japan over 4million people have attended these sessions over the last eight years. In Fujinomiya, the shopkeepers have helped their neighbours with dementia carry on living in their own homes and the monthly shopper days include dementia information stalls. Stores display in their window a sticker that shows they are 'elderly and dementia friendly'. In some cases they have even been the first stage in getting people with Alzheimer's and other forms of dementia diagnosed, signposting their customers to professional help.

For now, there is a comforting programme of mutual benefit between the storekeepers and their customers who have dementia. But tough financial times and changing shopping habits make it increasingly hard to keep the small stores going. Part of the success of the Dementia Friends programme is that the big stores are now also realising that it's good business to be dementia friendly. Aeon, Japan's Tesco, have signed up to the programme and just out of Fujinomiya there's a big franchise drug store who have also signed up to be dementia friendly. The Manageress told me the company give time off to attend the information sessions. Small but important changes have now taken place in store. If a person with dementia is taking a long time at the checkout, then another till will be opened so the queue of potentially irritated customers is moved. The store also picks up on people who might have dementia buying abnormal drug supplies.

As in England, becoming dementia friendly is catching on across government, businesses and wider society. That's good news for people with dementia and their carers. On home turf, the Dementia Friends initiative inspired by the pioneering work in Japan is gaining speed. Our ambition is for a million people to attend an awareness session and take action on dementia. In three months from launch almost 9,000 people have already signed up.

Defeating dementia won't just happen in a lab or in a care setting. We need a step change in the way people think, talk and act about the condition and all of society has a role to play. Find out how you can get involved by visiting dementiafriends.org.uk


Ryuta Kawashima: The devil who cracked the dementia code
27 May 2013
independent.co.uk

He is the brains behind ? and face of ? a series of zany video puzzle games that keep millions of Japanese people entertained. Could they also bring back lost memories?

Ryuta Kawashima is used to children pointing at him on the street. They often shout gKawashima Devil!h Itfs the price the neuroscientist pays for being the famous face of a lucrative series of brain puzzles that he developed for Nintendo.

Kawashima appears in the videos as a disembodied, floating head with horns and a bright red face, asking gdevilishlyh hard maths and memory questions. Millions of games have been sold, earning him royalties of over $30m. But, he says, his games are more than just a fun way to learn: they could, in fact, provide a revolutionary new way to treat dementia.

The 54-year-old refused to keep the money he made from the brain puzzle series, ploughing much of it into a research centre in Japanfs Tohoku University, attached to the Institute of Development, Aging and Cancer. Kawashimafs 40-strong team of young scientists spends their days working on ways to train our working memory and stimulate the prefrontal cortex, the area of the brain that deals with problem-solving and personality. Brain exercises have been shown to expand the cortex of healthy young people, he says, gSo why not the old?h

That question animates a remarkable new documentary on Kawashimafs work. In Do You Know What My Name Is? pensioners with severe dementia at a care home in the US state of Cleveland, Ohio, are seen recovering the use of their memories after using a six-month programme of learning therapy he designed. Some are almost literally brought back to life, transformed from depressed, hollow shells slipping inexorably toward death back into sociable, happy people.

gWe neuroscientists knew that brain plasticity exists in young subjects. The new point is that we now know it exists even in the brains of dementia sufferers,h Kawashima explains.

He says stimulating the frontal cortex clearly improves memory and brainpower: gWe found that the best candidate for training working memory in people with dementia is reading aloud and performing simple arithmetic.h

Kawashima claims his own tests show an improvement in up to six out of 10 dementia sufferers, and he thinks that this can be bettered.

Dementia, a catch-all term for symptoms that include loss of memory and cognitive function, afflicts about 800,0000 people in the UK, according to the Alzheimerfs Society. The symptoms are progressive, robbing victims of memory, confidence, personality and, eventually, life as they slowly fade away. The condition costs the UK economy an estimated ?23bn a year, says the Society, and there is no known cure or preventative ? only the use of expensive drugs to delay the onset.

With the number of sufferers expected to treble worldwide from 36 million to 115 million by 2050, according to the World Health Organisation, scientists are increasingly turning to non-drug treatment.

A paper this month in the Proceedings of the National Academy of Sciences says a simple, cheap prescription of vitamins B6 and B12, and folic acid can slow the decline of grey matter. Nurses at care homes around the world use approaches such as music, art therapy and card games in an attempt to keep older brains stimulated and alive.

Japan is a test case for dementia because it is the worldfs fastest-ageing society, with nearly a quarter of the population aged 65 or older. For about a decade, thousands of private nursing homes across the country have been using Kawashimafs learning therapy, essentially a series of 30-minute brain exercises done every day, five days a week. The method has spread through word of mouth, after nurses and strapped local governments almost universally reported a slowing or even reversal of cognitive decline in subjects.

So far, however, Japanfs powerful Ministry of Health has so far refused to fund large-scale clinical trials, Kawashima laments. He believes he knows why: gMany doctors are not happy with our results because if they use our method they canft sell drugs. This is a very big market in Japan and theyfre losing a lot of money.h

Because his approach is marketed via a private company called Kumon Institute of Education, he insists he doesnft, in any case, need government help. The Ministry of Health declined to comment on his method.

As Kawashimafs fame has grown, so has interest in his work ? along with criticism. Some scientists have branded him a charlatan who has made a lot of money selling crank theories. Others say the jury is still out.

gI think he is a compelling character, and has some excellent ideas,h says Professor Clive Ballard, a researcher on dementia with University College London. gThey arenft yet well supported though by research evidence,h he adds.

The problem, Kawashima admits, is the dearth of large-scale clinical trials on his work. However, that may be changing soon. The Cleveland experiment is expected to spread elsewhere in the US and further afield too: Finlandfs government is launching a bid to translate his learning therapy into the local language and culture.

gHis work has a promise big enough to invest in a really big trial,h says Dr Juha Teperi, who is organising what he says will be a randomized sample of between 200 and 300 people. If Kawashimafs findings are repeated, git would be a really big breakthrough,h Teperi believes.

The father of four boys, Kawashima is critical of modern lifestyles which, he says, may worsen dementia in years to come. Ironically, he is highly critical video games. Playing for too long can inhibit the prefrontal cortex, he explains, because it is a passive activity, like watching TV.

gI only allowed my sons to play video games on Saturday and Sunday, for one hour each,h he says.

Do You Know What My Name Is? recently won the Audience Favourite award at the 2013 American Documentary Film Festival. The movie uses photos and family testimony to show the mental decline of accomplished, vibrant people until they eventually forget even the names of their heartbroken children.

A care worker repeatedly introduces himself to his elderly charges with the documentaryfs eponymous question. By the end of the film, remarkably, some patients can recall this information.

gItfs an example of how we can make the lives of older people liveable again,h says Kawashima.


Scientists Test A Potential Treatment Of Alzheimer's In Vitro
5/14/2013
http://www.forbes.com/

A Team of Researchers in Japan have been reprogramming cells from patients with Alzheimerfs into neurons to model the progress of the disease and develop potential therapies that can aid at least a subset of patients suffering from it.

As Ifve written before, many researchers expect that the biggest breakthroughs with stem cells are in the short term more likely to be in the realm of drug discovery rather than tissue or organ regeneration. (Not to take away from the crucial progress being made there.)

A major cause of Alzheimerfs is a protein called amyloid-ƒÀ (beta) peptide, which builds up in the brain as a form of plaque.

In certain Alzheimerfs patients with a familial mutation in amyloid proteins, the build up of AƒÀ molecules, or oligomers, in neurons and astrocytes causes stress on a particular organelle of the cell called the endoplasmic reticulum.

Among other functions, this organelle is responsible for the transporting of proteins within the cell.

The Japanese team, which included 2012 Nobel laureate Shinya Yamanaka, differentiated cells from these Alzheimerfs patients into neurons and then treated them with docosahexaenoic acid (DHA), a solution that alleviated the stress response in the neurons.

According to the paper in the April 4th issue of Cell Stem Cell:

gUsing patient neurons and astrocytes, we addressed the accumulation and possible pathological roles of intracellular AƒÀ oligomers in familial and sporadic AD. We found that AƒÀ oligomers were not proteolytically resistant and that docosahexaenoic acid (DHA) treatment attenuated cellular phenotypes of AD neural cells with intracellular AƒÀ oligomers in both familial and sporadic AD patients.

Granted that this is just one study looking at a small set of people that suffer from a disease that effects millions, I followed up with one of the paperfs authors, Haruhisa Inoue (photo right) of the Center for iPS Cell Research and Application at Kyoto University, to see if their research might lead to a concrete treatment.

gSo far several companies have showed an interest in our work,h he told me in an email. gBut not specific to DHA.h

Inoue pointed out that DHA clinical trials have been reported in the past few years, and the treatment was effective only for a group of patients with mild to moderate symptoms, and largely but not completely ineffective in another study.

gOur data might suggest that, if we identify individual patient perspective by iPSC-based analysis,h he said, gand classify the phenotypes of patientsc DHA treatment might be effective to a part of the moderate-symptoms group in addition to the mild-symptoms group.h

This is provisional, to be sure. But as the iPSC process itself improves and the neurons of thousands of Alzheimerfs patients can be studied more speedily, we may soon see many niche therapies that can be customized for different groups of Alzheimerfs sufferers.

Modeling Alzheimers Disease with iPSCs Reveals Stress Phenotypes Associated with Intracellular AƒÀ and Differential Drug Responsiveness

Cell Stem Cell, Volume 12, Issue 4, 487-496, 21 February 2013
Copyright 2013 Elsevier Inc. All rights reserved.
10.1016/j.stem.2013.01.009

Authors
Takayuki Kondo, Masashi Asai, Kayoko Tsukita, Yumiko Kutoku, Yutaka Ohsawa, Yoshihide Sunada, Keiko Imamura, Naohiro Egawa, Naoki Yahata, Keisuke Okita, Kazutoshi Takahashi, Isao Asaka, Takashi Aoi, Akira Watanabe, Kaori Watanabe, Chie Kadoya, Rie Nakano, Dai Watanabe, Kei Maruyama, Osamu Hori, Satoshi Hibino, Tominari Choshi, Tatsutoshi Nakahata, Hiroyuki Hioki, Takeshi Kaneko, Motoko Naitoh, Katsuhiro Yoshikawa, Satoko Yamawaki, Shigehiko Suzuki, Ryuji Hata, Shu-ichi Ueno, Tsuneyoshi Seki, Kazuhiro Kobayashi, Tatsushi Toda, Kazuma Murakami, Kazuhiro Irie, William L. Klein, Hiroshi Mori, Takashi Asada, Ryosuke Takahashi, Nobuhisa Iwata, Shinya Yamanaka, Haruhisa Inoue

Highlights
EFamilial and sporadic Alzheimers patient iPSC-derived neural cells were analyzed
E Intracellular AƒÀ oligomers accumulate in lines from some patients
EAƒÀ oligomer accumulation is associated with ER and oxidative stress
EDHA-alleviated ER and oxidative stresses improve cell viability

Summary
Oligomeric forms of amyloid-ƒÀ peptide (AƒÀ) are thought to play a pivotal role in the pathogenesis of Alzheimers disease (AD), but the mechanism involved is still unclear. Here, we generated induced pluripotent stem cells (iPSCs) from familial and sporadic AD patients and differentiated them into neural cells. AƒÀ oligomers accumulated in iPSC-derived neurons and astrocytes in cells from patients with a familial amyloid precursor protein (APP)-E693 mutation and sporadic AD, leading to endoplasmic reticulum (ER) and oxidative stress. The accumulated AƒÀ oligomers were not proteolytically resistant, and docosahexaenoic acid (DHA) treatment alleviated the stress responses in the AD neural cells. Differential manifestation of ER stress and DHA responsiveness may help explain variable clinical results obtained with the use of DHA treatment and suggests that DHA may in fact be effective for a subset of patients. It also illustrates how patient-specific iPSCs can be useful for analyzing AD pathogenesis and evaluating drugs.


Group homes lack sprinklers / 25% of small facilities for dementia patients unequipped for fires
More than 500 small group homes for dementia patients, or about a quarter of such facilities nationwide, are not equipped with sprinklers, a survey conducted by The Yomiuri Shimbun has found.
As small homes with less than 275 square meters of total floor space are not legally required to install sprinklers, the government has urged those facilities to install them by providing subsidies according to size.
But experts are calling for measures that better promote the installation of fire safety equipment.
"Even if facilities are small, the cost of installing sprinklers could be high in some cases because of issues with the structure or location. [The government] should consider a subsidy system that can accommodate actual conditions," one expert said.
The nationwide survey was conducted from Feb. 19 to March 22 in the wake of a fatal fire at a small group home for dementia patients in Nagasaki. Five patients died in the incident.
According to the survey results, 524 facilities, including the Nagasaki home, were not equipped with sprinklers. The survey covered 2,047 facilities in 44 prefectures. The three remaining prefectures--Akita, Yamanashi and Tottori--said they did not have the total numbers of small group home facilities.
A 2010 survey by the Health, Labor and Welfare Ministry found 2,113 small group homes nationwide.
Given these figures, it is estimated that about a quarter of small group homes are unequipped with sprinklers.
Most group homes with 275 square meters or more of floor space are equipped with sprinklers, the Yomiuri survey found.
In 2009, the ministry made it mandatory for such facilities to install sprinklers. The measure was taken after seven people were killed in a fire at a group home with about 280 square meters of floor space in Omura, Nagasaki Prefecture, in 2006. Smaller facilities became eligible for subsidies from 2010.
An official said the ministry is also investigating the actual conditions for sprinkler installment. "Based on results [of the investigation], we hope to consider improvement measures, including how financial assistance should be provided," the official said.
Prof. Yasumichi Kurata of Nishikyushu Universityiphoto right), an expert in social welfare affairs, said: "As various types of buildings including private homes are used as small group homes, it isn't always possible to install sprinklers at low costs. The subsidy system must be improved, for example, by having it cover a certain portion of actual costs spent [for installation], rather than providing subsidies according to the amount of floor space."
(Dairy Yomiuri@ Mar. 25, 2013j@


Team alleviates Alzheimer's symptoms in mice with gene therapy

A research team has used gene therapy to alleviate Alzheimer's symptoms in mice to the point where their memory became comparable to that of normal mice.
The treatment marks the first ever such success, and was accomplished by a team including Takaomi Saido(photo upper rightt), senior team leader at Riken Brain Science Institute, and Nagasaki University professor Nobuhisa Iwata(photo lowere rightt). The results were published in a British science journal on Aug. 18, and the team plans to proceed with tests on primates and then do clinical tests once they can confirm the safety of the treatment.
Alzheimer's disease occurs when an unnecessary protein called beta amyloid overstocks in the brain, destroying nerve cells. The research team in 2001 discovered an enzyme called neprilysin that breaks down beta amyloid. Afterwards, research around the world found that when this enzyme's activity falls, Alzheimer's10+Œ sets in.
The research team developed a virus carrying genes that produce neprilysin and injected it into mice with early-stage Alzheimer's disease. The beta amyloid in the mice fell by half to near the amount of a healthy mouse. When measuring the time needed by the mice to reach a goal in a maze as a test of their memory, they were about the same as regular mice.
There are around 2 million Alzheimer's patients in Japan, and it is thought to take around 20 years after the beginning of beta amyloid accumulation for symptoms to appear. Saido says, "Getting immunization after reaching a certain age could lead to prevention."
(The Mainichi March 19, 2013)
Report: Global brain delivery of neprilysin gene by intravascular administration of AAV vector in miceiScientific Reports@18 March 2013j

International Symposium on National Dementia Strategy in Tokyo

Symposium Overview
yOrganizerz
Tokyo Metropolitan Institute of Medical Science.
With the support of Tokyo Metropolitan Government, Ministry of Health, Labour and Welfare, The British Embassy, The Australian Embassy, The Netherlands Embassy, Royal Danish Embassy and Embassy of France.
Date
Tuesday 29th, January 2013 10:30`17:15
Venue
Main Hall, 3rd Floor, Belle Salle Kudan
Sumitomo Fudosan Kudan Bldg, 1-8-10 Kudan-Kita, Chiyoda-ku, Tokyo
Speakers
Alistair Burns(UK),Benoit Lavallart(France),Russell de Burgh(AUS),Nis Peter Nissen(Danmark), Julie Meerveld(Nederland), Anne Higgins(UK), Paul McCrone(UK)
Program
Session 1 : Reports from Japan, England, and France
yChairz
Masaaki Matsushita CEO, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology
yCoordinatorz
Atsushi Nishida, Tokyo Metropolitan Institute of Medical Science
(1) "Dementia Policy in Japan" Katsunoiri Hara, Chief, Health and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare(pdf1.9M)
Session 2 : Reports from Australia, Denmark, and the Netherlands
yChairz
Shinichi Ohshima President, National Center for Geriatrics and Gerontology
yCoordinatorz
Satoko Hotta, The Japan Institute for Labour Policy and Training
Session 3 : Dementia Care and Health Economics
yChairz
Masahito Sekiyama, General Coordination Officer for Dementia Policies, MHLW
yCoordinatorz
Mitsuhiro Sado, Keio University
Session 4: Panel Discussion
yChairz
Yoshiko Shiotani, Board Chairperson, Japan College of Social Work
yCoordinatorz
Shinsuke Kondo, The University of Tokyo
Website: International Symposium on National Dementia Strategy in Tokyo

Scientists discover possible new treatment for Alzheimer's

OSAKA--Japanese scientists have discovered a new way to destroy the chemical thought to cause Alzheimer's disease.
Alzheimer's is believed to result when a protein found in nerve cells degenerates into amyloid beta 42, a highly toxic substance, which then accumulates in the brain. This takes place under the influence of gamma-secretase, an enzyme that acts like a pair of scissors on the protein.
A team of scientists led by Masayasu Okochi(photo), a lecturer in clinical psychiatry at Osaka University, found that further in-vitro reactions involving the same enzyme could result in A-beta 42 being broken down into a less toxic form, A-beta 38.
Adding a form of catalyst improved the enzyme's activity, roughly doubling its efficiency in human cells, the researchers said.
So far, research into Alzheimer's therapies has focused on blocking the enzyme in order to suppress A-beta 42 generation. But this new work suggests it could be worth helping the enzyme to do its work.
"An enzyme-activating drug could have better therapeutic effects," Okochi said.
The findings have been welcomed by other experts in the field.
"The latest discovery will provide logical grounds for developing new types of drugs," said Toshiharu Suzuki, a professor of neuroscience at Hokkaido University's School of Pharmaceutical Sciences and Pharmacy. "It is also a key milestone in the efforts to understand how enzyme activity weakens."
The research results were published Jan. 3 in Cell Reports, a U.S. scientific journal.
iAsahi shimbun January 05, 2013)



2012

Robot therapy gains popularity
"You're gentle and smart. You're a good pet, aren't you?" Tomoe Wakabayashi, 92, says as she affectionately caresses her companion Paro. Paro, a seal-shaped robot, replies with a loving "Kyuuu" while wagging its tail.
Wakabayashi is a resident at Lumiere, a group home for people who suffer from dementia in Kanagawa Ward, Yokohama.
She began suffering from gaps in her memory due to dementia about five years ago. She became a resident at the facility in October 2011 after she began suffering from other dementia symptoms, including violent outbursts at her family.
When she first started living at the facility, she always sat alone in her room and didn't speak to other residents. At dinnertime, she insisted the facility let her go home.
However, since spending time with Paro, she has vastly improved.
Using robots such as Paro, a method known as "robot therapy," has been reported to help soothe and ease depression among dementia patients.
As a result, its use has become more popular in Japan and overseas.
Whenever facility employees ask her to take care of Paro, Wakabayashi begins chatting away with the robot. She smiles more often and sometimes sleeps with Paro in her arms at night.
"I'm surprised that Paro has had a better therapeutic effect than we expected," said Misako Kawasaki, the facility's manager.
According to Kawasaki, Wakabayashi seems to remember raising her children and grandchildren.
"Being with Paro probably reminds her of happy times. It seems the experience brings more energy to her life, too," Kawasaki said.
Paro has also helped cheer up and reduce stress for 17 other residents at the facility.
The robot seal was developed by the National Institute of Advanced Industrial Science and Technology (AIST) in Tsukuba, Ibaraki Prefecture, and was first sold commercially in 2005.
Paro's unique features lie in its movements. The robot has visual, touch and audio sensors built into its body, and its programming allows it to recognize stimuli by moving seven body parts in a charming manner.
Many academic theses have been written acknowledging its beneficial therapeutic effects.
So far, more than 2,200 units have been manufactured for sale in Japan and overseas.
After being put on sale, Paro was soon primarily used to help care for elderly dementia patients in the United States and Europe, where the effects of animal therapy have already been recognized.
Using real animals in therapy is difficult at medical and welfare facilities as they may potentially carry contagious diseases or bite patients. Paro, however, carries no such risk.
In the United States, the U.S. Food and Drug Administration certified Paro as a type of medical equipment. In Denmark, many local governments have introduced the robot to care for dementia patients at nursing homes.
Meanwhile, in Japan, the robot was initially bought by individuals as a pet.
However, it has been reported that an increasing number of medical and welfare facilities are buying the robot after hearing it was highly evaluated in the United States and Europe.
"[Being with Paro] probably stimulates the remaining healthy parts of the brain [in dementia patients] and calms them down," said Takanori Shibata, the senior AIST researcher who developed Paro.
"I hope Paro will play a more important role in aging societies," he said.
However, Paro costs about 400,000 yen per unit due to its complicated, high-performance technology. The price will have to be reduced if it is to be used more widely.
(Daily Yomiuri Oct. 14, 2012)



65% of mental hospitals polled by Mainichi in 3 disaster-hit prefectures see rise in inpatients

Twenty psychiatric hospitals in quake- and tsunami-hit Iwate, Miyagi and Fukushima prefectures have seen increases in the number of inpatients comparedwith before the March 2011 earthquake disaster, a recent Mainichi survey has found.
The increase reflects growing hospitalization of people who have suffered from dementia12Œ following their families' and neighbors' moves into temporary housing. It also reflects failure by mental patients to be released from hospital even if their conditions have improved.
The Mainichi polled 64 hospitals and 12 public hospitals belonging to the Japan Psychiatric Hospitals Association in the three prefectures in late August, and received responses from 31 of them.
The survey asked the 31 institutions about the number of inpatients each month in 2010, 2011 and 2012. Of them, 20 hospitals, or 65 percent -- nine in Fukushima, six in Iwate and five in Miyagi -- reported increases in the number of inpatients and seven hospitals -- four in Fukushima and three in Miyagi -- attributed the jumps to effects of the March 2011 disasters.
Kodama Hospital in Ishinomaki, Miyagi Prefecture says the number of inpatients rose by 219 between March 2011 and February 2012 to total 4,144, up from 3,925 a year before. The number has been growing since March 2012. The hospital cites a lack of houses and other local facilities as well as manpower to accommodate mental patients such as those with dementia. There are many mental patients whose symptoms of schizophrenia have worsened due to psychological shock caused by the disasters.
There were a number of hospitals which reported jumps in the number of inpatients who had been transferred from disaster-hit hospitals.
In addition to the seven hospitals, Murakami Hospital in the city of Fukushima and Minamihama Chuo Hospital in Iwanuma, Miyagi Prefecture, reported rises in the number of inpatients with dementia.
Katsutoshi Furukawa, associate professor of geriatrics at the Institute of Development, Aging and Cancer at Tohoku University (photo left), pointed out that the disasters destroyed local communities in which families had taken care of people with dementia, causing a shortage of places to accommodate those people. The conditions of some inpatients have gotten worse as people have moved from their homes to temporary houses and other locations, Furukawa said, adding it is necessary to provide places for people at risk to interact with others to prevent them from become isolated from society.
When asked about requests to local and central governments, 10 hospitals called for establishing a regional system to enable mental patients to be reintegrated into society. Izumi Hoyouin Hospital in Iwaki, Fukushima Prefecture, says it seeks specific support to provide subsidies to rehabilitation facilities such as group homes.
( The Mainichi September 15, 2012)




New 'flow of care' to steer dementia patients away from hospitals

The health ministry will step up efforts to address the increase in elderly people suffering from dementia, aiming to change the "flow of care," under a five-year program starting in fiscal 2013.
"We will create a society where people (with dementia) can continue to live in familiar places as they wish," says Kazue Fujita(right above photo), parliamentary secretary for health, labor and welfare.
With the population aging rapidly, the ministry forecasts that the number of senior citizens with dementia will reach 2.89 million in 2020, or 8.4 percent of people aged 65 or over, 3.53 million in 2030, or 10.2 percent, and 3.85 million in 2040, or 10.6 percent.
At present, if dementia patients become violent or harm themselves in their daily lives, they may be sent to a mental hospital if their families or group homes are unable to cope with them. In 2008, there were some 52,000 people with dementia in mental hospitals, up from 28,000 in 1996, and their long-term stays have become a serious problem for such facilities.
A project team set up by the ministry pointed out in a report that delays in initial responses to people who show symptoms of dementia contribute to unnecessary hospitalizations.
Fujita said that it has been widely believed people with dementia must be kept in mental hospitals or related facilities. But this "flow of care" needs to be changed, she added.
The steps the ministry will launch in fiscal 2013 include the formation of support teams of about three nurses and other dementia experts to visit families and advise on early diagnosis.
Akira Honma (right below photo), who heads a research and training center in Tokyo for caregivers of people with dementia, said that the advance of the condition is predictable if patients receive treatment from an early stage.
(The Japan Times@Sep. 6, 2012)


Promote at-home care for dementia sufferers

As the number of elderly people suffering from dementia continues to rise rapidly, it is crucial for all sectors of society to create a system that will enable such people to live at home.
According to estimates released on Aug. 24 by the Health, Labor and Welfare Ministry, more than 3 million elderly people across the country suffer from dementia. This is one out of every 10 people aged 65 or older.
The ministry estimates the figure will reach 4.7 million in 2025. The growth in the number of the aged with dementia is alarmingly faster than projected.
The faster pace is due both to the rapid graying of society and to the increased number of people who are examined and diagnosed because of successful programs to raise awareness of the problem.
Advanced dementia can lead to such symptoms as wandering away, incontinence and even violence.
In many cases, family members of people suffering from dementia have become physically and mentally exhausted taking care of them and have opted to put them into mental hospitals. Such hospitalization tends to be long-term, averaging two years and seven months.
===
Support teams envisaged
The symptoms of people suffering from dementia are often aggravated after hospitalization, apparently due to such causes as changes in living environment and inadequate medication.
It is necessary to shift the priority in supporting elderly dementia patients from hospitals to home care.
Sixty percent of the approximately 52,000 people currently hospitalized with dementia could be discharged if arrangements were put in place to support them, including a system to promote home care.
Those who are hospitalized for dementia must feel frustrated that they cannot be at home, where they accustomed to being.
To help avoid longtime hospitalization of dementia patients, the health ministry plans to implement a new set of measures to promote their care at home, starting in fiscal 2013.
Under the program, the ministry will set up support teams nationwide that will comprise such experts as nurses, public health nurses and rehabilitation therapists for intensive care of people in the early stages of cognitive decline.
The support teams will visit the homes of the elderly to hear from them and their family members, while providing suggestions about how to deal with dementia symptoms at home.
In Britain, where a similar system was introduced in 2009, the number of people hospitalized for dementia has begun to decrease sharply. We hope to see such a favorable effect in this country, too.
===
Securing personnel urgent
To deal with elderly people with advanced dementia, the ministry plans to designate about 300 medical institutions as dementia centers. To facilitate quick responses to urgent requests from the families of dementia sufferers, the ministry is studying ways to enable doctors to make house calls on short notice.
The biggest obstacle to such measures remains a shortage of personnel. It is a matter of urgency to secure medical doctors, nurses and caregivers who are well versed in caring for patients with dementia.
Securing budgetary appropriations needed to implement the envisioned programs is also difficult.
Although people suffering from senile dementia tend to be viewed as unable to perform everyday activities, in many cases they remain emotionally stable and can engage in a range of activities.
Many people with dementia serve as volunteer workers, hoping to help others in spite of their own problems.
People providing medical and nursing care to those with dementia are urged to pay due attention to them to help them live in a way suited to their needs.
Efforts in local communities to establish frameworks that will facilitate helping the aged are also important.
To this end, some local governments have taken the initiative in enhancing support for the elderly, such as encouraging members of shopping district associations to learn about dementia.
Attention should be paid to such examples.
(From The Yomiuri Shimbun, Sept. 2, 2012)
(The Daily Yomiuri Sep. 3, 2012)


Number of elderly with dementia doubles to 3 million

The number of seniors with dementia has doubled over the past 10 years to exceed 3 million, meaning 1 in 10 people aged 65 or older suffers from it, a health ministry estimate showed Friday.
The number is estimated to reach just over 3 million this year, up from almost 1.5 million in 2002, accounting for 9.9 percent of those aged 65 or older, according to the Ministry of Health, Labor and Welfare.
The estimate is based on data collected in 2010 on those in need of nursing care.
The rapid increase reflects growing public awareness of dementia and a rise in the number of people consulting with doctors and being diagnosed with it.
The ministry estimates the number of dementia patients will reach 4.1 million in 2020, or 11.3 percent of the overall elderly population, and 4.7 million in 2025, or 12.8 percent.
The ministry is planning to introduce a program in fiscal 2013 to offer medical support to dementia patients in the early stages of the disorder by forming a group of nurses and therapists to make home visits.
iJapan Times@Aug. 25, 2012j



Early care for people with dementia eyed
The Health, Labor and Welfare Ministry plans to implement from next fiscal year measures to provide at-home care for people suffering from dementia to cope with the rapidly increasing number of people with the condition.
The new measures aim to enable people with dementia to live at home for as long as possible, by having teams of specialists visit their homes during the initial stages of the condition.
The ministry also hopes the measures will keep dementia sufferers from developing progressively worsening conditions that require long-term hospitalization.
The ministry will compile a five-year plan for the measures, which local governments will incorporate into their medical and nursing care plans.
Dementia refers to a typically progressive condition characterized by memory loss and deteriorated cognition due to the death or improper functioning of brain cells as a result of diseases or other causes.
There are several types of dementia, including Alzheimer's disease.
The government estimates that there were 2.08 million people suffering from dementia in 2010, and projects this number will rise to 3.53 million in 2030--indicating that about 10 percent of elderly people will have the condition.
A central pillar of the new measures is the creation of teams comprising dementia specialists such as nurses, health care workers and therapists to provide care to people in the early stages of the condition.
The ministry plans to deploy these teams to about 4,000 nursing care consultation counters of local governments nationwide. The teams will visit the homes of elderly people who have shown symptoms of dementia, conduct interviews with them or family members and refer them to medical institutions if necessary.
For elderly people with the condition whose cognitive abilities remain intact, the team will explain how they expect the symptoms to develop and advise them on managing their assets and nursing care options.
The teams also will help them improve their living conditions, making such changes as replacing gas stoves with electric ones, and offer psychiatric care for family members of dementia sufferers.
Another pillar of the plan is "near-home" medical facilities for dementia patients, which will collaborate with the specialist teams. The ministry plans to designate 300 clinics and small and midsize hospitals for the purpose.
There have been many cases in which dementia sufferers whose symptoms escalated to include wandering and violent behavior were asked to leave nursing care facilities, and were subsequently hospitalized.
To prevent this, the specialist teams will not only visit the homes of dementia sufferers, but also relevant facilities to improve the quality of treatment and care. As a result, the ministry also will consider whether to raise medical service fees at these facilities.
These measures to deploy teams of specialists and designate near-home medical centers will be reflected in municipal governments' nursing care insurance plans and prefectural governments' regional medical care plans.
The ministry will begin trials of the system in several areas across the country this year and will produce manuals on available assistance methods.
Following the trials, the ministry aims to introduce the measures across the country. But a major obstacle remains over how to secure and develop the necessary human resources.
Britain launched a similar initiative in 2009. As a result, the number of hospitalizations due to dementia in areas where the measures were implemented was one-third that in areas without the measures.
As there have been past cases in which excessive medication has resulted in worsening symptoms, the ministry also will draw up guidelines for treatment using medication.
(The Yomiuri Shimbun@Jun. 18, 2012j


Giving a kind ear to dementia / Expert urges patience, asking the right questions to help patients express selves
Conversing with a dementia sufferer can be a challenge--for both sides. But according to dementia expert Kazuo Hasegawa, a little bit of patience by the person asking questions can make a world of difference.
Hasegawa is known for creating the "Hasegawa Dementia Scale," a widely used method for detecting dementia in elderly people. After several decades diagnosing and treating the disease--whose symptoms include memory loss, mood changes and problems with communication--Hasegawa has found that rather than pressuring a dementia patient to make a quick response, waiting until they find their own finds can help them communicate.
Hasegawa, 83, was an assistant professor at Jikei University, a professor and president at St. Marianna University School of Medicine, and also served as head of the Tokyo Dementia Care Research and Training Center.
The following is an excerpt of an interview with Hasegawa.
The Yomiuri Shimbun: What is the "Hasegawa Dementia Scale"?
Hasegawa: It's a simplified index to check whether a person might be suffering from dementia. The test uses nine questions, including "What is today's date, day, month and year?" An official decision on whether a person has dementia is made later after hearing from themselves and their family, checking images of their brain, and other factors.
In 1966, the professor who was my academic supervisor advised me to devise a criteria for diagnosing dementia patients. I completed development of the criteria in 1974. Before that, I specialized mainly in epilepsy and depression. Since developing the criteria, however, I've focused on dementia in earnest. Even now I treat dementia patients while working some days as a doctor at local clinics.
Q: How has treatment for dementia changed over the years?
A: Doctors can now administer medicine that slows the progression of symptoms, and this has become a familiar practice. They could do almost nothing years ago.
I'll never forget a pastor whom I treated in 1983. He was an expert on church music. When he began to show symptoms of dementia, he became bothered by the fact that he couldn't read scores. He then wrote down his feelings on a music sheet, such as: "I can't feel a melody in my mind. Return to me, my spirit."
After he died, I had an opportunity to see the music sheet and it deeply shocked me. I asked myself whether I could bear the sorrow of the pastor. This encounter became the starting point for me to begin treating dementia patients and keep myself mindful of the fact that I want to help them and their families.
Q: How did you devise concrete ways to treat dementia?
A: When a dementia patient is asked a question, it often takes time before he or she starts talking. It's best not to put pressure on them for a quick answer, but instead to wait patiently. It's also important to ask a question that allows them to speak in their own words.
For example, when a dementia patient is asked, "It's cold, isn't' it?" he typically responds by only saying, "Yes, it is." Patients also sometimes noncommittally nod at questions without actually listening to the words.
When I examine dementia patients, I don't ask them yes/no questions such as, "Did you sleep well?" or "Are you hungry?" These questions would only elicit one-word responses and the conversation would end right there. To avoid this, I first give them an open-ended question, such as, "Any changes in your life recently?" I look into their eyes and wait for their answer. Then, in many cases I can hear what they really want to express.
In this day and age, it seems speed is required in all aspects of life. When I meet dementia patients, I feel as if they are teaching me the importance of living in a relaxed way.
Q: Are you worried you might suffer from dementia one day?
A: It's certainly possible, and it could happen at any time. The risk of developing the disease's symptoms rises with deteriorating health or poor lifestyle habits, so I'm trying to stay in good shape by not catching colds, frequently walking and refraining from eating fatty foods.
Q: What are the important things to do to help treat dementia?
A: It is vital to establish a system in which the whole community supports dementia patients and their families. Every resident in a community needs to be involved in keeping a close eye on dementia patients and avoid prejudice against them. If neighbors are united in caring about these people, dementia patients will surely find peace of mind in a safe living environment.
(Yomiuri Shimbun @Mar. 25, 2012)


Family of three die from apparent starvation in Japan
Discovery raises questions over the official response to rising poverty levels among the elderly and the unemployed in Japan
Authorities in Japan are under pressure to explain how three members of the same family were allowed to die of apparent starvation, after their bodies were discovered two months after their deaths.
Police found the bodies of a couple believed to be in their 60s and their son, thought to be in his 30s, at their apartment in Saitama, north of Tokyo, after the building's owner said he had been unable to contact them.
Officers entered the apartment to find the victims' badly decomposed corpses lying on futons, along with the carcass of their pet cat. The fridge was empty, the cupboards contained very little food, and a few one-yen coins appeared to all the money they had.
The discovery has raised questions over the official response to rising poverty levels among the elderly and the unemployed in the world's third-biggest economy.
As far as welfare officials in Saitama were concerned, the family, residents of a city of 1.2 million, had simply ceased to exist.
The victims appear to have been left to fend for themselves, despite their failure to pay their rent and utility bills. The cause of death is still unknown, but officials believe they either starved or committed suicide.
The family was not on a list of vulnerable households that are regularly visited by officials from the city's government. Some neighbours were unaware the apartment was even occupied.
Local media reports suggest the family were too ashamed to admit they needed financial help. When approached by the firm that manages their apartment, the wife reportedly said her son was working and her husband was unable to work due to chronic back pain.
A neighbour had tried unsuccessfully to persuade the wife to contact welfare authorities after she asked for money at the end of last year, saying the family was "in trouble".
Experts voiced disbelief that the authorities had not been informed, even after the family failed to pay rent for six months and had their gas and electricity cut off. They had reportedly not received welfare payments since 2003, two years after they moved into the apartment.
"Some people have a resistance to the idea of receiving welfare or contacting local authorities," Takehiro Yoshida, a welfare lawyer, told the Asahi Shimbun newspaper. "Others are left isolated in their own communities."
Yoshida called on utilities to report cases of repeated non-payment of bills to welfare agencies.
Tokyo Electric Power and Tokyo Gas have said they do not assume poverty to be the cause of non-payment, and do not notify welfare agencies unless asked to do so by the residents themselves.
Despite enjoying one of the highest standards of living in the world, Japan is struggling to address rising rates of poverty, particularly among the elderly and disabled, a growing number of whom die in complete isolation.
In the summer of 2010, a 76-year-old man in Saitama died of heatstroke after his electricity was cut off for non-payment.
Last month, two sisters in their 40s, one of whom had a mental disability, were found dead in their freezing apartment in Japan's northernmost prefecture of Hokkaido. An 84-year-old man living in the same region was found dead alongside his wife, who had been suffering from Alzheimer's.
More than 700 people have died of apparent starvation since 2000, according to the health ministry. Fears are growing that job losses among middle-aged men and the impact of the 11 March disaster will push the number higher in the coming years.
"This is not something you'd expect in a developed country like Japan, but people are struggling to find jobs," ABC News quoted Norimichi Goishi of the Tokyo Institute for Municipal Research as saying.
"Local officials can't always reach those in need. Deaths related to starvation are a lot more common than we think."
iguardian.co.uk, 24 February 2012j


2011

Nurturing guardians for the elderly


As the graying of the population progresses, Japan will see a rapid increase in the number of elderly people living alone or suffering from senile dementia. In the past, their relatives acted like their guardians. But the spread of nuclear families will make it difficult for relatives such as siblings and children to protect elderly people.
The welfare ministry predicts that the number of senile dementia sufferers who often get lost or who cannot properly do such things as shopping, money management, taking medicine and answering phones will increase from 2.08 million in fiscal 2010 to 3.23 million in fiscal 2025. The number of households consisting of a single elderly member (65 years old or older) is predicted to rise from 4.66 million to 6.73 million in the same period.
According to the Supreme Court, under the current guardian system introduced in April 2004, some 30,000 people applied with family courts for appointment as guardians of aged people in fiscal 2010. Besides relatives, professionals such as lawyers, judicial scriveners and licensed social welfare workers were appointed as guardians.
But given the expected societal changes, it is clear that there will not be enough relatives and legal and other professionals who can serve as guardians of elderly people living alone or suffering from senile dementia. Municipal governments can play a role by giving necessary training to residents in communities so that they can serve as guardians of aged people who need them.
Under the current system, municipal mayors can ask family courts to appoint ordinary nonrelative citizens as guardians if necessary. In 2008, 1,876 such applications were made. The number increased to 3,108 in 2010. In accordance with a June 2011 revision of the welfare for the aged law, the welfare ministry, in cooperation with the Supreme Court and the Justice Ministry, is pushing a project to have nonrelative citizens serve as guardians.
Under the welfare ministry's fiscal 2011 model project with a \100 million budget, 37 municipalities, including Osaka City, are training citizens in legal matters, skills and ethics so that they can serve as guardians. It is hoped that more municipalities will nurture citizen guardians so that elderly people everywhere can live safely. Care must be taken so that guardians' ethical standards stay high.
(Japan Times 12/30/2011)


Dainippon Sumitomo to launch Alzheimer's disease drug donepezil HCl tablets in Japan

Dainippon Sumitomo Pharma Co., Ltd. (DSP) plans to launch in Japan donepezil hydrochloride tablets/OD tablets 3mg/5mg gDSPh on December 2, 2011 for the treatment of Alzheimer's disease (AD).
In domestic pharmaceuticals, DSP designates the Central Nervous System (CNS) field as one of its focus marketing areas, and offers various treatments such as atypical antipsychotics gLonasenh and gLullanh, Parkinson's disease drug gTreriefh, norepinephrine-activating neural function ameliorant gDOPSh, anti-epileptic drug gExcegranh, and serotonin-agonist antianxiety drug gSedielh. Approximately 230 CNS MRs in the CNS Sales & Marketing Division newly established in April 2011 are developing activities to provide information on these products.
DSP decided to handle a CNS generic drug as part of a plan to strengthen its product lineup in the CNS area. On June 24, 2011, DSP created gEstablished Products & Chain Pharmacies Groupsh dedicated to generic drugs in the CNS area under CNS Sales and Marketing, each under the CNS Higashi-Nippon Region, CNS Capital Region, CNS Kinki-Tokai Region and CNS Nishi-Nippon Region with the aim to promote sales of generic drugs in the CNS area.
In regard to the detailing of Donepezil hydrochloride tablets/OD tablets 3mg/5mg gDSPh, full-time CNS MRs will detail in their representative areas, while in the representative areas for general MRs, detailing will be in conjuction with the Established Products & Chain Pharmacies Groups and general MRs.
In the future, DSP will positively invest in products to contribute to the treatment of CNS disorders regardless of whether they are new or generic drugs.
Dainippon Sumitomo Pharma Co., Ltd., a Japanese-based company that broadly contributes to society through value creation based on innovative research and development activities for the betterment of healthcare and fuller lives for people worldwide.
(pharmabiz.com@November 29, 2011

Activities seen as dementia-prevention key

"Use it or lose it," an increasing number of local governments are advising their senior citizens as part of efforts to delay or prevent dementia.
To that end, more and more municipal governments are suggesting activities that allow seniors to enjoy themselves at the same time they are protecting their brains.
Such activities include making their own travel plans for trips they can take with friends and developing and using new recipes at home.
Even when the participants complete the activities, many continue to participate in similar activities on their own.
On a clear day in late September, three housewives in their 60s and 70s gathered at JR Shin-Matsudo Station in Chiba Prefecture. They had a detailed itinerary they had made themselves for a day trip, the theme of which was "admiring 800,000 red spider lilies."
The three formed a group they call "Himawari" (sunflower) to plan trips as a way to prevent dementia. They first met two years ago at a seminar on dementia prevention organized by the Matsudo municipal government in the prefecture.
Although the seminar ended four months later, the three continued to gather twice a month to discuss their original trips. They continue to take day trips together every two or three months.
Their destination this time was Gongendo, a riverbank in Satte, Saitama Prefecture, that is famous for its red spider lilies in autumn. They had obtained reference materials, including sightseeing brochures for the area, and studied the tourist attractions, history and means of transportation beforehand. They made a detailed itinerary after carefully checking bus timetables.
They reached the destination on schedule and walked along the riverbank, admiring lilies before stopping to eat lunch. One of the three, Shizue Koshiba, 75, said: "We use our brains naturally when studying the history of our destination and considering effective means of transportation. It's good to continue these activities while enjoying ourselves."

Measures cost-effective
Local governments like to use travel planning to prevent dementia because they do not need to prepare special facilities, which helps to minimize the costs of such programs.
According to Ninchisho Yobo (dementia prevention) Support Center, a nonprofit organization based in Setagaya Ward, Tokyo, the number of local governments that have antidementia programs has been increasing since about three years ago, and there are now at least 20 nationwide.
The Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, under the jurisdiction of the Tokyo metropolitan government, has developed a community-based antidementia program of seminars. Matsudo and many other local governments are using the program as a reference.
In addition to travel planning, the Tokyo program suggests such activities as cooking, using personal computers and walking for exercise. Under the program, seniors are advised to arrange and carry out activities on their own.
For travel planning, for example, they are urged to choose a theme and destination and to prepare a detailed itinerary without using a commercially available guidebook. It also urges participants to continue their activities voluntarily in groups after the seminars are completed.
The Tokyo institute, with the cooperation of the Setagaya ward government, conducted a survey on the effectiveness of the activities in the program. The survey showed that those who continued the recommended activities for three years scored higher marks in tests of memory and attention than a control group of people who did not participate in such activities.
Naomi Yatomi, a researcher at the institute who was involved in the joint survey, said: "They showed an improvement in functions that normally start to decline before the onset of dementia. We believe the program will at least delay symptoms of dementia and that people can improve their brain functions by planning and carrying out activities on their own."
Concerning the seminars organized by local governments, Yatomi said: "They are meant to be educational, but only a handful of elderly people participate. As travel planning is not difficult, I hope more people will start doing it on their own."
(Yomiuri Shimbun @Nov. 20, 2011)

Dementia patients at risk after being moved into new care facilities

Thousands of nursing home patients from three disaster-hit prefectures are living in different facilities now, raising concerns about worsening cases of dementia caused by stress from new, unfamiliar environments.
Of the 1,309 inpatient elderly care facilities in heavily damaged Iwate, Miyagi, and Fukushima prefectures, around 80 were closed after the March 11 disasters because of their buildings being destroyed or other reasons. Around 3,300 elderly patients, 500 from Iwate, 1,200 from Miyagi, and 1,600 from Fukushima, who lived in these facilities are now living in other locations. None of the three prefectures have a completely clear grasp of how many of those patients have dementia, but in total it is thought to be about 400 to 600 people, or about 20 percent, and many of these patients are showing worsening symptoms since being moved.
One nursing care facility, "Group Home Taro" in Miyako, Iwate Prefecture, had its building lost to the tsunami. The facility had nine patients with dementia, who were evacuated by facility staff. Currently, they are living in another facility, "Hohoemi no Sato," located in the same city and owned by the same organization.
Although Hohoemi no Sato has a ward dedicated to patients with dementia, there is still a problem, as the stress caused by being in an unfamiliar place or with unfamiliar people often causes worsening of dementia. Some of Group Home Taro's dementia patients were there since the facility opened in 2005. There are already said to be cases of patients becoming more difficult to communicate with.
The managing organization plans to rebuild their lost facility, but the costs present an obstacle. The organization spent about 10 million yen to convert the previous building, which had been a private inn, but because the organization was renting the property, it is not eligible for reconstruction aid money from the national government. Neither is there any such support from the local government. The organization plans to again rent a property, but it will have to once again cover the costs of converting a building.
Meanwhile, at Hohoemi no Sato, there are now 114 patients, even though the facility's maximum capacity is only 100. This came about because of the facility taking on extra patients after the disasters. The facility has managed to secure the extra help needed by rehiring former workers and taking other measures, but personnel costs have increased.
The Iwate Prefectural Government is planning to construct 22 facilities including temporary nursing homes and day rehabilitation facilities across 18 areas in three cities and two towns.
However, a person in charge at the organization in Miyako said that more help is needed: "We want the prefectural government to take patients with dementia into consideration and extend support to rebuilding facilities that can take such patients on for the long-term."
(Mainichi Japan@June 5, 2011)

Disaster hits elderly with dementia

Life as evacuees from the Great East Japan Earthquake has been extremely hard for elderly people with dementia, many of whom appear to be deteriorating as a result of stress.
Experts predict that within 30 years, 10 percent of the people in this nation will have dementia, making care for the elderly a vital aspect of disaster preparedness that some feel requires closer attention.
Staff and 18 residents of Senior Garden, a group home for aged dementia sufferers in Tomiokamachi, Fukushima Prefecture, had to evacuate the premises on March 12 due to the troubles at the Fukushima No. 1 nuclear power plant.
They moved into the building of a soba noodle shop in Kawauchimura in the prefecture.
Frequent aftershocks caused many of the residents to develop extreme anxiety and panic. One wanted to go to the toilet every 30 minutes. Another wandered around the room, repeating over and over, "I want to go back. I want to go back." Another resident began singing loudly.
The staff tried their best to calm the residents down, but manager Yoko Suzuki, 61, realized it would be difficult to care for the residents in the noodle shop.
Four days later, the group relocated to a nursing home in Fukushima. Even though the living environment there was much better, the residents' conditions continued to deteriorate.
A 100-year-old man said, "It's more terrifying than wartime." He was constantly scared and wandered around the home at night. He was eventually hospitalized with a high fever.
An 86-year-old man once ran out of the building without shoes, and was not found until an hour later by police. He developed a gastric ulcer and began coughing up blood, at which point he too was hospitalized.
"The changes to their lifestyle were too drastic," Suzuki said.
The residents are now staying with staff in eight apartments in Fukushima that Suzuki rented for use as a temporary group home.
"The residents have finally calmed down," she said. "But I want to move them back to a group home like before, with individual rooms, as soon as possible."
For relatives, caring for elderly people with dementia brings extraordinary new stresses that can be too much too handle.
Fukuchanchi, a group home in Fukushima, accepted three elderly people who after evacuating had at first moved in with relatives, but their family members were unable to take care of them adequately.
Fukuchanchi manager Kinuko Narita, 59, said: "Their symptoms have gotten worse. They wander around more, and refuse to bathe or have their clothes changed. Caring for someone with dementia is a very hard job for family members to take on by themselves."
Major threat for graying nation
"Though it's often said Japan is a graying nation, caring for people with dementia has not been factored into disaster management at all," said Satoshi Takahashi(photo@right upper), a doctor and an associate professor of Iwate Medical University.
Takahashi has been touring coastal areas of Iwate Prefecture hit by the quake and tsunami since just after March 11, visiting shelters and examining dead bodies.
More than 60 percent of people killed in the disaster were aged 60 or older.
"Many of the elderly victims probably had dementia," Takahashi said, noting that dementia sufferers might not understand evacuation instructions and could easily become lost outdoors.
In Iwate, Miyagi and Fukushima prefectures, it is estimated that at least 115,000 elderly people have dementia. Nationwide, the figure exceeds 2 million.
It is predicted that in 2040, over 3.8 million people in Japan, or about 10 percent of the nation's population, will suffer from dementia.
But there are concerns that disaster management plans do not give sufficient consideration to people with dementia. Even if they are able to evacuate, sudden changes in their living environment could be too great a burden for them.
According to a Japan Geriatrics Society guide on medical treatment for the elderly in the event of a disaster, 43 percent of dementia patients in areas affected by the Great Hanshin Earthquake showed symptoms of deterioration within a week of the disaster.
Katsuya Iijima(photo right lower), a lecturer at the department of geriatric medicine at the University of Tokyo Hospital, helped to compile the the guide. He said people with relatively mild dementia can be more vulnerable in disaster situations, because they are more aware of changes in their surroundings and living conditions.
"People with mild symptoms tend to be more prone to deteriorate," he said.
Comprehensive planning needed
Ensuring quality care for elderly people in disaster situations, and reducing the burden on family members and nursing staff who are responsible for them, must be made an urgent priority. It is wrong to expect that people will settle in temporary housing units and things will be fine.
Akiko Takahashi, a nurse at a health care center in Minami-Sanrikucho, Miyagi Prefecture, said: "It's hard to keep a close watch on dementia patients who live in temporary housing units. Their condition can worsen if they're isolated in those units. Some kind of monitoring program is needed."
The government plans to build temporary housing facilities dedicated entirely to accommodating the elderly, as well as more than 100 day-care centers and other facilities, in disaster-hit areas. But so far, land has not been secured and no staff have been recruited.
Medical and nursing staff to provide everyday assistance, as well as legal guardians to manage elderly people's financial affairs, will also be necessary.
(May. 15, 2011 Takeharu Yasuda, Keishi Takahashi and Hirofumi Noguchi / Yomiuri Shimbun Staff Writers )

Evacuee with dementia dies of exposure near shelter
TAGAMI, Niigata -- A woman with dementia has died from exposure after getting lost near a shelter here for the victims of the recent earthquake and tsunami, shedding light on the lack of sufficient support for evacuees requiring special assistance.
The 62-year-old woman, a resident of the Fukushima Prefecture town of Tomioka, was found frozen to death on March 28 on a mountain about two kilometers from a shelter in Tagami, Niigata Prefecture. The victim and her family had been moving from shelter to shelter following the magnitude 9.0 earthquake and tsunami that struck northeastern Japan on March 11.
The woman, her 67-year-old husband and three other family members took shelter in the Fukushima Prefecture city of Tamura immediately after the quake. On March 12, the family moved to another shelter in the neighboring city of Koriyama.
According to Niigata Prefectural Police and Tagami Municipal Government officials, the woman began to develop dementia a few years ago. She was able to maintain a normal life when her symptoms were mild, and it was her daily custom to walk the family's dog in the neighborhood. But when her symptoms were bad, she found it difficult to remember what she was doing just a few seconds earlier.
As the woman's life at the evacuation shelters continued, her dementia worsened. She would often forget to close the door of the facility no mater how many times she was told to do so, and her family was too worried to let her stroll around the area.
The woman's family thought her symptoms could get even worse if they continued to live at the refugee shelter, and decided to move to the home of their eldest daughter in Minamisoma, Fukushima Prefecture, on March 24, after they finally made contact with each other.
However, as the residents of Minamisoma -- located less than 30 kilometers from the quake- and tsunami-crippled Fukushima No. 1 Nuclear Power Plant -- had been instructed by the central government to stay indoors to avoid the exposure to radiation, the family had difficulties going out and buying food and other daily necessities.
They searched on the Internet for facilities in other prefectures that would accept evacuees from areas affected by the nuclear accident, and arranged to move into an evacuation shelter in Tagami, Niigata Prefecture.
The woman and her family arrived at their new shelter at around 4 p.m. on March 27. While her family explained her condition to a nurse, her second daughter took her out of the building so that the woman, who hated to be called a dementia patient, would not have to hear the conversation.
About 30 minutes later, however, the woman disappeared on their way back to the shelter from a nearby square. She was found dead by a local volunteer firefighter the next morning on a snow-covered mountain road about 2 kilometers from the facility.
According to investigators, there was about 50 centimeters of snow on the road where the woman was discovered barefoot.
An official with the municipal government of Tagami said workers at the evacuation shelter did not know the woman had dementia when she arrived at the facility.
"If we had known about her condition in advance, we might have been able to better cope with the situation," said the town official.
Following the incident, the Niigata Prefectural Government announced that it would step up efforts to confirm the health status of evacuees who required nursing care in advance and send them to an appropriate evacuation facility where they could receive continuous support.
(Mainichi Japan) April 5, 2011



2010

Elderly residents abused at nursing facility in Tochigi

UTSUNOMIYA -- Workers at a nursing facility here physically abused four elderly residents with dementia between 2008 and 2009, drawing on one patient's face and slapping another patient in the head, it has emerged.
The abuse reportedly occurred at the Utsunomiya Silver Home establishment in Utsunomiya. Hokutokai, the medical corporation that operates the nursing facility, has admitted that there was "psychological abuse," but it did not report the abuse to the Utsunomiya Municipal Government as legally required.
Nursing facility officials said four cases of abuse were uncovered at the establishment. In one case about two years ago, a female worker in her 20s took a photograph of a resident in his 80s, when he was on all fours and was wearing diapers with no shirt on. She reportedly showed the photo to colleagues, laughing at it.
In another incident in 2009, a male worker in his 30s and two female workers in their 20s reportedly drew color circles on the face of a female resident in her 80s. Other reported abuse included slapping a patient in the head and lifting a patient higher up than necessary when transferring them from a wheelchair to a bed.
Four of the workers involved were handed warnings at the end of February this year. Two of these workers plus one other worker have resigned.
The facility surveyed employees on the treatment of residents in February, and was alerted to the abuse by another employee. Facility officials apologized to the family of the resident whose face was drawn on. The other abused residents have already left the facility e and officials have not contacted them.
Under Japan's law to prevent abuse of the elderly, organizations are required to report abuse to local bodies when it is uncovered. Commenting on the reason for not filing a report, an official from Hokutokai's elderly welfare division commented: "When we questioned the workers involved, their actions were not deemed to be malicious, and the incidents were not ongoing."
iMainichi Daily News @April 16, 2010j

Manual advises families of aged, unsafe drivers

Preventing elderly relatives with signs of dementia from driving can be a difficult task, so the health ministry has prepared a manual offering suggestions on how to keep such drivers off the road.
Compiled by a study team with the Health, Labor and Welfare Ministry, the manual urges family members to look for alternative means of transportation as well as other leisure activities for elderly people to enjoy.
Under the Road Transport Law, a driver's license will be revoked or suspended if he or she is judged to be suffering from dementia. Drivers 75 or older have been required since June last year to take tests demonstrating their cognitive functions are sufficient for driving when they renew their drivers' licenses. They also can voluntarily give up and return their licenses.
However, many elderly people are reluctant to give up driving even when suffering from dementia. Family members may feel guilty trying to restrict the activities of an elderly relative and thus do not actively try to persuade them to stop.
To help address the situation, the manual lists actual cases that can serve as useful references. One man in his early 70s, for example, was diagnosed as being in the early stages of Alzheimer's disease. He sometimes forgot where he wanted to go while driving or could not park his car in a garage.
He even had an accident with his car at one point, and his doctor recommended he stop driving. The man refused, however, saying: "Driving is the most important thing in my life. I'll die if I can't drive."
His family members worked to drive for him and persuaded him to use taxis, utilizing the community's transport support service for the disabled. These efforts gradually reduced the number of times he drove a car, and he finally stopped completely of his own accord.
The manual advises family members to take such steps to help elderly people find other ways to get around or find different sources of enjoyment, such as taking hobby classes at culture centers.
Some transportation support services are available for a fee from nonprofit organizations. Local governments also subsidize elderly people's taxi fares.
Programs' contents differ depending on the region, so details should be confirmed with local governments' sections in charge of elderly and disabled people's welfare.
When people have difficulty persuading elderly family members to stop driving, the manual advises them to ride along when the elderly people drive and note whether they display the following behavior:
--Passing over the median line.
--Running over the outside line.
--Unable to park in a garage.
--Easily getting lost on unfamiliar streets.
--Panicking on unfamiliar streets.
--Unable to keep a safe distance from other cars.
The manual recommends family members consult with doctors, police and drivers' license centers if the person has such problems. Sometimes dementia patients forget they promised not to drive again. It is helpful for relatives to put doctors' notes in prominent places saying: "Your memory is failing and it's quite difficult for you to drive safely. The law also says it is very dangerous for such a person to continue driving."
If the patient starts to say, "I want to drive," the manual advises telling them, "Your doctor told you not to drive and you promised you wouldn't."
According to the study team's estimates, about 300,000 people suffering from dementia hold drivers' licenses.
"In many cases, elderly people won't be convinced if family members ask them to stop driving without giving them a chance to think," said Yumiko Arai, head of the Gerontological Policy Department at the National Institute for Longevity Sciences.
(The Yomiuri Shimbun@Apr. 6, 2010)

7 perish in Sapporo nursing home fire

SAPPORO -- Seven residents at a nursing home for elderly people with dementia here died after a fire broke out at the facility early Saturday, razing the structure, police said.
"I'm upset that something like this has happened. I want to do all I can for the bereaved families of the victims," said Michinori Taniguchi, president of the company that opened the home.
Sapporo police and firefighters said that a 24-year-old worker at the home, which was not fitted with sprinklers, made an emergency call around 2:30 a.m. Saturday, reporting a fire spreading from a heater on the first floor of the home.
Police suspect that the kerosene heater, which was reportedly kept running 24 hours a day, was the source of the deadly blaze and they are investigating the incident as a possible case of professional negligence resulting in death.
Police identified the victims as three men and four women aged between their 60s and 90s, all of whom had dementia. The female worker suffered serious injuries in the fire including burns to her throat.
A total of nine residents lived at the nursing home, but one was away at the time. Another 83-year-old woman who lived in a room nearest the entrance of the home was rescued by firefighters and avoided injury.
The nursing home had six rooms on the first floor and four on the second floor. At the time the fire broke out, the residents were believed to have been in their rooms. A dietician at the home said that there were three people who could walk by themselves on the second floor of the home. The residents' rooms were not locked, and were normally left open.
Five bodies were found on the first floor of the home and two on the second floor.
The Mirai Tonden home opened in December 2005, with approval from the Sapporo Municipal Government. Sapporo Fire Bureau officials said that inspections of fire extinguishers and emergency exit lighting -- required once a year under the Fire Service Law -- had not been carried out since August 2006, and the home had not submitted any fire prevention plan. The fire bureau had issued warnings over these two violations in September 2008 and May last year, verbally and in writing. Furthermore, the home was not fitted with sprinklers or fire alarms designed for such facilities.
The home was located in a residential district about seven kilometers northwest of JR Sapporo Station. At the time of the fire winds of over 10 meters per second were blowing in the area and a strong wind warning had been issued.
(Mainichi Japan March 13, 2010)
Editor: A nursing home in this article is a small sized and family-like group home for people with dementia. There are more than 9000 group homes through the country.

SUN Y7017, a treatment of Alzheimerfs Type Dementia to approved to launch in Japan

Daiichi Sankyo announced today that its subsidiary, ASUBIO PHARMA CO., LTD. (submitted a New Drug Application in Japan for the manufacturing and marketing of SUN Y7017 (generic name: Memantine hydrocholoride), which was developed for the treatment of Alzheimerfs type Dementia (AD).
SUN Y7017 is an N-methyl-D-aspartate (NMDA) receptor antagonist developed by Merz Pharmaceuticals GmbH (Head Office: Germany). This drug was approved for use in the treatment of AD by the European EMEA in 2002 and by the U.S. Food and Drug Administration in 2003. As of January 2010, this drug is marketed in more than 60 countries around the world, and is positioned as a standard care for AD.
By offering a new option with a distinct mechanism for the treatment of AD in Japan, Daiichi Sankyo expects to contribute to reducing the unmet needs of patients, their families, and medical professionals.
(Frontier India Pharmacetuicals News February 8th, 2010)

Restraining dementia patient upheld

A hospital acted within its legal right when staff members strapped a patient with dementia to her bed, the Supreme Court ruled Tuesday, overturning a lower court decision.
The Nagoya High Court had ordered the hospital in Ichinomiya, Aichi Prefecture, in September 2008 to pay \700,000 of compensation to the patient, ruling there was no urgent need to tie her up to prevent her
from seriously injuring herself.
"There was no other way than physically restraining the patient to prevent her from falling," ruled Takaharu Kondo, presiding justice at the top court's Third Petty Bench. "The time of restraint was minimum."
Diagnosed with dementia, the patient was admitted to the hospital due to lower back pain in October 2003 at the age of 80. She repeatedly left her bed. To try and protect her from accidents, a nurse tied her arms to the bed for several hours Nov. 16.
Under the mental health act, only mental hospitals are allowed to physically restrain patients. The hospital in Ichinomiya is not designated for treatment of mental diseases.
(The Japan Times Wednesday, Jan. 27, 2010)@


Demetnia in Japna more


Demography of dementia in Japan

1.Estimated number of the whole old people (65 and over) with dementia including AD

(from the report of Ministry of Health, Labor and Welfare)

year

Number(million)

2000

@@1,56

2005

@@1,89@

2010

@@2,26

2015

@@2,62

2020

@@2,92

2025

@@3.15

2030

@@3,30

2035

@@3,37

2040

@@3,24


2.Causes of dementia in the community among old people of the age of 65 and over by year (1987 and 1995)

(From the report of the Tokyo Metropolitan Government)

 

AD

VD

Others

Unknown causes

1987

23.7%

31.4

7.7

37.2

1995

43.1

30.1

8.1

18.7


Surveyon the use of "restraints" in medical and social services of demented elderly

-from the standpoint of families caring for people with dementia-
by Yoshio MIYAKE MD,Kyoto

Aim of research: Use of restraints is a glaring problem that relates directly to the human rights of people with dementia. In Japan, no regulations exist against the use of restraints, which results in their wide usage in medical and social service facilities. This survey attempts to study the situation of use of restraints through a questionnaire survey to families caring for someone with dementia.
Methodology: The study targeted members of AFCDE with a five-year or more history of caring for a person with dementia, as well as availing of the above mentioned facilities
Research method: Questionnaires with self addressed envelopes sent to all members in October 1998 and collected be December 1998. In the survey, restraints included any act, physical or chemical that deliberately put limitations on the mobility of the demented elderly.

Results of Study:
617 answered to queries of which 576 people had a 5 year caregiving history as well as used medical and social service facilities like:
home for elderly, geriatric day service center, geriatric care facility, hospital, day care, care house
,group homes and others

Type of restraints used which will be referred to by the numbers henceforth:

i. locking up of the whole facility (unit) which prevented free movement during the day
ii. locked in a special floor of the facility, or in a day room
iii. locked up in ones room
iv. hands and feet restrained to the bed
v. restrained to the wheel chair
vi. medicated in order to subdue movement
vii. Others

The survey yielded the following general observations regarding the use of restraints:

(i) practiced mainly in homes for the elderly for short stay
(ii) practiced mainly during short stays in geriatric care facilities and homes for the elderly
(iii) hospitals or short stays in homes for the elderly
(iv) was glaring in hospitals
(v) in hospitals and short stays at homes for elderly
(vi) Most during hospitalization

Response of families regarding use of restraints

Did not think it necessary 27%
Considered it unavoidable 50.9%
Unsure 2.1%
Others 5.2%
Unclear 14.1%

What do families think about restraints as such? (this response was to multiple choice questions)
For the safety of the individual 45.5% of the total
The following are the answers from the 576 people who made use of services

to continue treatment 16.5%
shortage of staff 43.4%
staff views about care 15.6%
staff's understanding about dementia 10.1%
management policies and philosophy of the director of the institution 17.2%
Improper structure of facilities 12.3%
Others 5.4%

Whether there was any explanation from the staff

Yes 66.7%
No 29.6%
Don't know 3.7%

or the families who received an explanation,

77.7% answered that they were convinced,
17.9% that they were not, and
4.4% were unsure.

What did the families think was necessary to abolish the use of restraints for people with dementia?
36.3% of those who responded to the multiple choice questionnaire answered that staff should be increased.

Of the 576 people who had used the services of institutions

19.2% answered that staff understanding on dementia has to be changed and improved
9.2% answered that the facilities should be improved
1.0% felt the need for a third party ombudsman


OBSERVATION
People with dementia should not be put on restraints of any kind as this hurts their dignity and human rights. In spite of the fact that in the European countries and USA use of restraints is illegal, in Japan, other than in psychiatric hospitals where it is illegal, use of restraints elsewhereis continues with impunity.Until now, information about the situation on use of restraints remained fragmented in Japan. This is what spurred AFCDE to conduct a survey of this kind for the first time targeting the caregiver families who are members of this association. Although the number of participants in this study are small, it gives a clear picture of the situation.
The striking findings are that while homes for elderly; geriatric care facilities make use of mild indirect restraints, hospitals, in contrast make use of more direct restraints. This could be attributed to the difference in the level/condition/stage of dementia of the patient.
We also find answers like "it is for the safety of the individual", "due to shortage of staff" from the family members who try to see the situation more realistically. When medical and social welfare services are forced to resort to restraints, it is their obligation to explain the reason to the family members and obtain their informed consent. This arises from the prerequisite that the hospital staff as well as the family are at a equal footing; yet in reality it is the family that is at a weaker position. The staff should bear this in mind, and the fact that it requires courage on the part of the family to put forward their demands to them.
Although, about 77.7% of the people in our study were convinced with the reasons for use of restraints, we have to be cautious about this figure. Are all of these people at an equal level with the staff of the facilities? What about the ones who are at a weaker position and thus are left with no choice? The most significant problem is the situation when restrains were continued to be used against the patients even when the family members were unconvinced about it.
Most of the families were of the opinion that an increase in the staff members would help in getting rid of the use of restrains, Furthermore, the families felt that the staff should base their care of people with dementia on a correct understanding of the ailment. In other words, one could say that the "quantity and quality" of the staff would be a decisive factor in the use or abolition of restraints.

(Translator:Ms.Shivani Nandi Ph.D.)


Annual Report on the Aging Society: 2004 (Summary) by Cabinet Office, Japan