Search

Background: There has been a significant increase in scientific investigations of the hearing‐dementia association among the research on potentially modifiable risk factors for cognitive impairment. We tested two clinical questions. Analysis 1: does persistent hearing aid (HA) use decrease the decline in cognitive function caused by ageing? Analysis 2: does cognitive function at the time of HA fitting predict future persistent HA use? Methods: This case–control study performed at two referral centres reported data obtained over a 4.5‐year period. We recruited a group of patients with cognitive decline, aged 65 or older with or without hearing loss. The intervention consisted of the use of HAs. The primary outcome measures were adherence to continuous HA use and cognitive function measured using the Japanese version of the Mini‐Mental State Examination Test and the Reading Cognitive Test Kyoto. Results: Eighteen HA users and 18 controls were included in the first analysis. HA use was associated with a deceleration of cognitive decline 12 months later. In the second analysis, 11 participants with good adherence to HA use were compared with 12 participants who showed poor adherence to HA use. Among the variables employed in this study, cognitive function measured using the Reading Cognitive Test Kyoto was significantly lower in participants with poor adherence to HA. Conclusions: HA use in cognitively impaired individuals with hearing loss can slow age‐related cognitive decline. Cognitively impaired people with hearing loss who fail to commit to HA use tend to have lower cognitive measurement scores before HA fitting. HA use is generally more challenging as people age and their cognitive abilities decline. Therefore, it is desirable that HAs be used when hearing loss and dementia are in their early stages. [ABSTRACT FROM AUTHOR]

Background: Gesture imitation, a simple tool for assessing visuospatial/visuoconstructive functions, is reportedly useful for screening and diagnosing dementia. However, gesture imitation performance in healthy older adults is largely unknown, as are the factors associated with lower performance. To address these unknowns, we examined the gesture imitation performance of a large number of community‐dwelling older adults aged ≥65 years in Arao City, Kumamoto Prefecture (southern Japan). Methods: The examiner presented the participants with eight gesture patterns and considered it a success if they could imitate them within 10 s. The success rate of each gesture imitation was calculated for three diagnostic groups: cognitively normal (CN) (n = 1184), mild cognitive impairment (MCI) (n = 237), and dementia (n = 47). Next, we reorganised the original gesture imitation battery by combining six selected gestures with the following scoring method: if the participants successfully imitated the gestures, immediately or within 5 s, two points were assigned. If they succeeded within 5–10 s, one point was assigned. The sensitivity and specificity of the battery were investigated to detect the dementia and MCI groups. Factors associated with gesture imitation battery scores were examined. Results: Except one complex gesture, the success rate of imitation in the CN group was high, approximately 90%. The sensitivity and specificity of the gesture imitation battery for discriminating between the dementia and CN groups and between the MCI and CN groups were 70%/88%, and 45%/75%, respectively. Ageing, male sex, and a diagnosis of dementia or MCI were associated with lower scores on the gesture imitation battery. Conclusion: Gesture imitation tasks alone may not be sufficient to detect MCI. However, by combining gestures with set time limits, gesture imitation tasks can be a low‐burden and effective method for detecting dementia, even in community medicine, such as during health check‐ups. [ABSTRACT FROM AUTHOR]

Aim The supermarket task, which is included in the Japanese version of the Rapid Dementia Screening Test, requires the quick (1 min) generation of words for things that can be bought in a supermarket. Cluster size and switches are investigated during this task. We investigated how the severity of dementia related to cluster size and switches on the supermarket task in patients with Alzheimer's disease. Methods We administered the Japanese version of the Rapid Dementia Screening Test to 250 patients with very mild to severe Alzheimer's disease and to 49 healthy volunteers. Patients had Mini- Mental State Examination scores from 12 to 26 and Clinical Dementia Rating scale scores from 0.5 to 3. Patients were divided into four groups based on their Clinical Dementia Rating score (0.5, 1, 2, 3). We performed statistical analyses between the four groups and control subjects based on cluster size and switch scores on the supermarket task. Results The score for cluster size and switches deteriorated according to the severity of dementia. Moreover, for subjects with a Clinical Dementia Rating score of 0.5, cluster size was impaired, but switches were intact. Conclusions Our findings indicate that the scores for cluster size and switches on the supermarket task may be useful for detecting the severity of symptoms of dementia in patients with Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Aim: Artificial nutrition, including tube feeding, continues to be given to dementia patients in numerous geriatric facilities in Japan. However, the clinical characteristics of patients receiving artificial nutrition have not been fully investigated. Therefore, we tried to evaluate the clinical features of those patients in this study. Methods: Various clinical characteristics of all inpatients at 18 of 20 psychiatric hospitals in Okayama Prefecture, Japan, with a percutaneous endoscopic gastrostomy tube, nasogastric tube, or total parenteral nutrition were evaluated. Results: Two hundred twenty ‐ one patients (5.4% of all inpatients) had been receiving artificial nutrition for more than 1 month, and 187 (130 women, 57 men; 84.6% of 221 patients) were fully investigated. The mean age was 78.3 years old, and the mean duration of artificial nutrition was 29.8 months. Eighty ‐ four patients (44.7% of 187 patients) were receiving artificial nutrition for more than 2 years. Patients with Alzheimer's disease (n = 78) formed the biggest group, schizophrenia (n = 37) the second, and vascular dementia (n = 26) the third. Conclusion: About one ‐ fifth of the subjects receiving artificial nutrition were in a vegetative state. More than a few patients with mental disorders, including schizophrenia, also received long ‐ term artificial nutrition. We should pay more attention to chronic dysphasia syndrome in mental disorders. [ABSTRACT FROM AUTHOR]

Background: The Japanese government recently announced the ‘Five ‐ Year Plan for Promotion of Measures Against Dementia (Orange Plan)’ to promote people with dementia living in their communities. To achieve this, it is imperative that patients hospitalized with behavioural and psychological symptoms of dementia (BPSD) are helped to return to their own homes. The aim of the present study was to identify predictors of home discharge among patients hospitalized for BPSD. Methods: A single ‐ centre chart review study was conducted on consecutive patients hospitalized from home between April 2006 and March 2011 for the treatment of BPSD. The frequency of discharge back to home was examined in relation to a patient's active behavioural problems and demographics at the time of admission. Diagnoses of dementia were made on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies. Results: In all, 391 patients were enrolled in the study. Of these patients, 163 (42%) returned home. Multiple logistic regression analysis identified high Mini ‐ Mental State Examination and Nishimura ‐ style senile activities of daily living scores as significant independent predictors of home discharge. In contrast, living alone and manifestation of aggressiveness at the time of admission were negatively associated with home discharge. Conclusions: Few patients hospitalized for BPSD are discharged home, and this number is affected by a patient's clinical and demographic characteristics at the time of admission. These findings should be considered in designing and implementing optimal management and care strategies for patients with BPSD. [ABSTRACT FROM AUTHOR]

Background Although demented elderly patients have impaired memory, memories of falling are not uncommon. We aim to clarify reliability of memories of falling in such patients. Methods Subjects included 62 patients (18 men, 44 women) diagnosed with dementia who resided in long-term care facilities. Mean age was 82.9 ± 7.8 years, mean Mini- Mental State Examination score was 16.4 ± 4.7 points, and mean Functional Independence Measure score was 67.9 ± 18.4 points. Subjects were asked a closed question about whether they were aware of having fallen (i.e. memories of falling) over the past year. Fear of falling was quantified using the visual analogue scale and FACES Pain Rating Scale. Scores were re-measured during retest approximately 10 days later to examine reproducibility of memories and fear of falling. Subjects whom staff had witnessed suffering a fall between baseline and retest session were excluded. Results Fall memory concordance rate was 0.84, visual analogue scale reproducibility (correlation coefficient) was 0.98, and FACES Pain Rating Scale was 0.86. No differences in Mini- Mental State Examination scores were noted between groups for whom memories of falling were or were not reproducible. No correlation was observed among Mini- Mental State Examination, Functional Independence Measure scores, and intensity of fear of falling. Conclusions There was a high concordance rate for patients' memories of falling, which suggests that falls were retained as memories. No relationship was observed between memories of falling and degree of cognitive impairment, and severe dementia did not necessarily imply memories of falling were unreliable. The reproducibility of fear of falling suggested the intensity of fear of falling was not easily altered. It was possible memories of falling and fear of falling mutually interacted to reinforce and fixate with each other, leading to the observed phenomenon. Therefore, it appeared memories of falling were retained by patients; this fact can be used in fall prevention and vital function maintenance. [ABSTRACT FROM AUTHOR]

Aim We investigated the clinical efficacy and changes in the dosages of concomitantly used psychotropic drugs in lamotrigine therapy in Alzheimer's disease with behavioural and psychological symptoms of dementia ( BPSD). Methods This study was a 16-week, preliminary open-label trial. The subjects were 40 inpatients. The outcome measures assessed were BPSD and cognitive function. BPSD was assessed with the Neuropsychiatric Inventory ( NPI) and cognitive function was assessed with the Mini- Mental State Examination. The changes in the dosages of concomitant psychotropic drugs were also assessed. Results Although the mean changes from baseline NPI scores and the two NPI subscales (anxiety and irritability) were significantly lower within the lamotrigine therapy group, no significant differences were found when we compared the lamotrigine therapy group to the control group. The mean decrease from baseline on the NPI agitation subscale, however, was significantly greater in the lamotrigine therapy group than in the control group ( P < 0.05). Furthermore, the mean decrease from baseline in the diazepam-equivalent dose was significantly greater in the lamotrigine therapy group than in the control group ( P < 0.05). Conclusions The results of this study suggest that the administration of lamotrigine to patients with severe Alzheimer's disease with BPSD may be effective and may make it possible to avoid increasing the dosage of antipsychotic medications prescribed to elderly patients. [ABSTRACT FROM AUTHOR]

Background Japan is one of the most rapidly ageing societies in the world. A number of municipalities have started services for the prevention of cognitive decline for community-dwelling elderly individuals, but the effectiveness of these services is currently insufficient. Our study explored the efficacy of a comprehensive intervention programme consisting of physical and leisure activities to prevent cognitive decline in community-dwelling elderly subjects. Method We administered a 12-week intervention programme consisting of physical and leisure activities aimed at enhancing participants' motivation to participate and support one another by providing a pleasant atmosphere, empathetic communication, praise, and errorless support. This programme for the prevention of cognitive decline was conducted as a service by the city of Maebashi. All participants underwent the Five- Cog test, which evaluated the cognitive domains of attention, memory, visuospatial function, language, and reasoning. Executive function was evaluated by the Wechsler Digit Symbol Substitution Test and Yamaguchi Kanji- Symbol Substitution Test. Subjective health status, level of social support, functional capacity, subjective quality of life, and depressive symptoms were assessed with a questionnaire. Grip strength test, timed up-and-go test, 5-m maximum walking times test, and functional reach test were performed to evaluate physical function. Fifty-two participants were randomly allocated to intervention ( n = 26) and control ( n = 26) groups. Twenty-six participants, aged between 65-87 years, received intervention once a week at a community centre. The programme was conducted by health-care professionals, with the help of senior citizen volunteers. Results The intervention group ( n = 19) showed significant improvement on the analogy task of the Five- Cog test ( F1,38 = 4.242, P = 0.046) and improved quality of life ( F1,38 = 4.773, P = 0.035) as compared to the control group ( n = 24). Conclusion A community-based 12-week intervention programme that aimed to enhance motivation to participate in activities resulted in improvements in some aspects of cognitive function and quality of life. Senior citizens who volunteered in the present intervention enabled the smooth implementation of the programme and alleviated the burden on professional staff. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate the clinical utility of the Functional Independence Measure ( FIM), and especially FIM- Cognition ( FIM- C) scores, in patients with Alzheimer's disease ( AD) and vascular dementia ( VaD), and to determine the influence of behavioural and psychological symptoms of dementia ( BPSD) on FIM- C scores. Methods This was a cross-sectional survey of 37 AD and 40 VaD patients. Cognitive function was assessed with the Cognitive Abilities Screening Instrument. Activities of daily living were evaluated with the FIM and the Barthel Index. BPSD were assessed with the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale. Results For both groups, Spearman's correlations were found between FIM- Motor and Barthel Index scores and between FIM- C and Mini Mental State Examination scores. Each FIM- C subscore was correlated with Cognitive Abilities Screening Instrument scores in both groups, except for the FIM- C Social interaction subscore in VaD. VaD patients showing Activity Disturbance and Aggressiveness on the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale had significantly lower FIM- C Memory and Social interaction subscores than those without BPSD. Conclusion The results suggest that the FIM- Motor and FIM- C scales are useful measures of physical and cognitive disabilities in patients with AD and VaD. The FIM- C profile of AD may reflect global cognitive function, while that of VaD may be more influenced by BPSD. [ABSTRACT FROM AUTHOR]

Aim Although wandering is one of the major research focuses of the behavioural psychological symptoms of dementia, assessment of wandering has mostly relied on caregiver-administered questionnaires. The purpose of this study was to compare staff-administered Algase Wandering Scale outcomes with objective temporal and spatial movement indicators obtained from the Integrated Circuit ( IC) tag monitoring system. Methods Patients with dementia were recruited from a dementia care unit in Osaka, Japan in 2007. Primary nurses administered the Algase Wandering Scale, and the temporal and spatial movements of the subjects were monitored by the IC tag. Written informed consent was obtained from each subject's proxies. Results Nurses' assessments of wandering were in agreement with the IC tag outcomes only during the day shift. Spatial movements assessed by the staff did not reflect those measured by the IC tag. Conclusion This objective measurement of wandering showed the limitations in the assessment of spatial and temporal movement by the staff. [ABSTRACT FROM AUTHOR]

Background With the recent approval of several new drugs, pharmacological management of Alzheimer's disease has become more complicated in Japan. The efficacy and safety of increasing the dose of donepezil to 10 mg daily were assessed in an open-label study of patients with mild to moderate Alzheimer's disease who were showing a diminished response to 5 mg daily. Methods The subjects included 27 patients with mild to moderate probable Alzheimer's disease whose primary caregivers had confirmed progression of symptoms during treatment with donepezil 5 mg daily. The dose of donepezil was increased to 10 mg daily, and the Alzheimer's disease assessment scale-cognitive subscale ( Japanese version), Neuropsychiatric Inventory, and Zarit caregiver burden interview scores were compared before and after dose escalation. Adverse events were also investigated. Results Efficacy was evaluated in 24 patients; three dropped out because of adverse reactions. The Alzheimer's disease assessment scale score showed significant improvement after dose escalation of donepezil ( P = 0.006). The total score of the Neuropsychiatric Inventory and the Zarit score showed no significant changes. However, the anxiety score of the Neuropsychiatric Inventory showed a significant increase ( P = 0.028). Safety assessment revealed that the dropout rate was 11.1% and adverse reactions occurred in 40.7%. Nausea (29.6%) and loss of appetite (22.2%) were common adverse reactions. Conclusions Because cognitive function showed improvement after increasing the dose of donepezil, the dosage of this drug should probably be adjusted based on the overall severity of Alzheimer's disease as well as the progression of cognitive dysfunction. [ABSTRACT FROM AUTHOR]

Background Globally, Alzheimer's disease ( AD) is becoming an increasing problem as the population ages, and the effects of lifestyle factors on cognitive decline need to be better understood. This study examined the effects of alcohol abstinence on cognitive decline in AD. Methods Cognitive function after alcohol abstinence was retrospectively reviewed in AD patients (high and low alcohol consumption groups) and then compared with an alcohol-naïve AD group. The alcohol-naïve AD group included 18 outpatients with no history of habitual drinking. The alcohol-abstinence AD group included 20 outpatients who stopped drinking after their diagnoses. The latter group was classified into high and low groups depending on the amount of they drank before abstinence. Cognitive function was evaluated with the Mini- Mental State Examination at baseline, 6 months, and 12 months. For statistical analyses, a repeated measures, two-factor anova and post-hoc multiple comparisons were performed using the Bonferroni method. Results There was a significant effect of time on Mini- Mental State Examination score, but there was no difference in the baseline scores of the alcohol-naïve and alcohol-abstinence AD groups. The score was significantly lower at 6 and 12 months than at baseline in the alcohol-naïve group, but no significant difference was seen in the alcohol-abstinence group. There was a significant interaction between time and alcohol consumption subgroup on the score, with no difference in baseline score between the low and high consumption groups. The score was significantly lower only in the high consumption group at 12 months. Conclusions In AD patients with a history of habitual drinking, abstinence was effective for reducing cognitive decline during the clinical course. However, such an effect was not seen in patients who had consumed high amounts of alcohol before diagnosis of AD. [ABSTRACT FROM AUTHOR]

Background: This multicentre open-label trial examined the efficacy and safety of the traditional Japanese medicine, or Kampo medicine, yokukansan (YKS), for behavioural and psychological symptoms of dementia (BPSD) in patients with dementia with Lewy bodies. Methods: Sixty-three dementia with Lewy bodies patients with probable BPSD (M : W, 30 : 33; mean age, 78.2 ± 5.8 years) were enrolled and treated with YKS for 4 weeks. Results: Significant improvements in Neuropsychiatric Inventory scores (mean decrease, 12.5 points; P < 0.001) and Zarit Burden Interview-Japanese edition tests (mean decrease, 3.6 points; P= 0.024) were observed. In patients who consented to an assessment after 2 weeks of treatment, a time-dependent significant improvement was observed in the Neuropsychiatric Inventory score ( n= 23; mean decrease, 14.4; P < 0.001), each subscale, including delusions and hallucinations, the Zarit Burden Interview-Japanese edition ( n= 22; mean decrease, 8.2; P < 0.01) and the behavioural pathology in Alzheimer's disease insomnia subscale. The Mini-Mental State Examination and the Disability Assessment for Dementia (DAD) showed no significant change. Adverse events were observed in 11 (18%) patients. Three patients (5%) discontinued YKS due to adverse reactions, namely, spasticity and exacerbation of BPSD, edema, and nausea. Hypokalaemia (<3.5 mEq/L) was present in four patients (6%) at the study endpoint. Worsening of extrapyramidal symptoms was not observed. Conclusion: YKS improved BPSD in dementia with Lewy bodies patients and caregiver burden scores without deterioration in cognitive function. YKS is useful for the treatment of delusions and hallucinations in BPSD. [ABSTRACT FROM AUTHOR]

Aim: We estimated the usefulness of our new scale to rate medial temporal atrophy with short inversion time inversion recovery images. Methods: Alzheimer's disease (AD) subjects ( n= 34) and non-demented subjects ( n= 19) were recruited for this study. First, coronal short inversion time inversion recovery images were scanned vertical to the long axis of hippocampus. Next, the single image in which peduncles appeared widest was adopted for estimation. The parahippocampal cerebrospinal fluid space was divided into three parts: the outer, upper and inner parts. The hippocampus was defined as a structure being of equal intensity to grey matter. Two radiologists compared each part of the parahippocampal cerebrospinal fluid space with the hippocampus and rated them on a 0-3 scale. Interrater and intrarater kappa statistics and sensitivity/specificity for the diagnosis of AD were calculated using the scores of the right, left and both sides combined. Results: There were no significant differences between AD and ND subjects with regards to sex. AD subjects had lower Mini-Mental State Examination scores and were older than non-demented subjects. Interrater and intrarater kappa statistics were 0.52-0.68 and 0.76-0.83, respectively. Sensitivity was 88.2% using the scores of both sides. Conclusions: Interrater and intrarater agreements were fair to good and good to excellent, respectively. Our new visual rating method detected medial temporal atrophy in AD patients at a highly sensitive rate. As such, we conclude that this visual rating scale is useful for judging medial temporal atrophy simply and objectively in clinical use, and it is helpful in establishing an AD diagnosis. [ABSTRACT FROM AUTHOR]

Background: Previous research has described the executive dysfunction that occurs in patients with amnestic-mild cognitive impairments (A-MCI) and early-stage Alzheimer's disease (EAD), which are comparatively similar stages of dementia. The aim of the present cross-sectional study is to evaluate executive dysfunction using the Frontal Assessment Battery (FAB) screening test in two groups and to investigate the interaction with other cognitive impairments. Methods: Among 170 consecutive patients with Alzheimer's disease or A-MCI, we recruited 48 subjects who were under 75 years of age and had been diagnosed as having either A-MCI or EAD. We then compared the total and the subtest scores of the mini-mental state examination (MMSE) and the FAB between the two groups. Moreover, we investigated the statistical interactive associations of the FAB subtest scores with the influential MMSE subtest scores or the diagnosis (A-MCI or EAD). Results: No significant differences in the age, sex ratio, duration of illness, and education years were observed between the two groups. However, significant differences in the FAB total and subtest scores (conflicting instructions and go/no-go) were found between the two groups. Furthermore, significant differences in the MMSE total and subtest scores (orientation, memory delayed recall, and attention and calculation) were also noted between the two groups. In a generalized linear model analysis, only two FAB subtest scores (conflicting instructions and go/no-go) were significantly influenced by the diagnosis (A-MCI or EAD) in a manner that was independent of the interaction with the orientation or memory delayed recall. Conclusion: The present findings suggest that the FAB total score and subtest scores reflecting interference performances (conflicting instructions and go/no-go) significantly declined in patients with EAD, independent of the disorientation and memory disorder. Such characteristics of neuropsychological screening test scores may be useful to clinicians for differentiating EAD and A-MCI at bedside. [ABSTRACT FROM AUTHOR]

Executive function deficits are commonly observed in many clinical populations, highlighting the importance of appropriate diagnostic tools to screen for these deficits. Most neuropsychological tests of executive function, however, are time-consuming and difficult to administer in the case of moderate to severe cognitive decline. The aim of the present study was to examine whether the Key Search Test, a short and easy to administer test, is a useful indicator of executive function deficits in a study sample with a diagnosis of cognitive impairment. Participants consisted of elderly people visiting the memory clinic at the department of geriatrics of a university medical center ( n= 140) and of elderly controls ( n= 37). Next to the Key Search Test, other executive function tests and a memory test were administered. Low to moderate correlations were found between the Key Search Test and other executive function tests. Furthermore, although the Key Search Test discriminated significantly between intact and impaired executive function (AUC = 0.677, P < 0.001), sensitivity and specificity were low and no optimal cut-off point could be determined. The Key Search test might not be an appropriate measure of executive functions in cognitively impaired individuals. [ABSTRACT FROM AUTHOR]

Background: We encountered eight early amnestic mild cognitive impairment (aMCI) patients (early MCI group) who did not fulfill the diagnostic criteria for aMCI. We compared the scores of neuropsychological examinations as well as the cerebral metabolic rate for glucose consumption (CMRglc) decrease on 18F-FDG PET examination between the early MCI group and 10 aMCI patients (MCI group) or six normal elderly subjects (normal group), to examine whether the current diagnostic criteria can detect early-stage aMCI. Methods: The three groups underwent Mini-Mental State Examination (MMSE), Wechsler Adult Intelligence Scale – Third Edition (WAIS-III), Wechsler Memory Scale Revised (WMS-R), magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) examinations. Results: The early MCI group did not show significant memory impairment of 1.0 SD or other cognitive dysfunctions on neuropsychological examinations, and did not fulfill the diagnostic criteria of aMCI. With one-wayanova and Tukey's HSD post-hoc test, the early MCI group showed the highest scores for WAIS-III, whereas the MCI group showed the lowest scores for WMS-R, although there were no significant differences between the early MCI and normal groups. In order to show a discrepancy in scores between WAIS-III and WMS-R, we subtracted the scores of WMS-R from WAIS-III. Consequently, the normal group showed significantly smaller differences in scores than the other groups, although there were no significant differences between the early MCI and MCI groups. 18F-FDG PET recognized a CMRglc decrease in the posterior cingulate gyrus and/or part of the parietotemporal area in both the MCI and early MCI groups, of which the extent and magnitude were weaker in the early MCI group. The normal group did not show a significant CMRglc. Conclusions: The early MCI group should be included in aMCI not only based on the discrepancy between intelligence and memory scores, but also based on the 18F-FDG PET findings. The combination of these examinations would make it possible to diagnose early-stage aMCI. [ABSTRACT FROM AUTHOR]

Background: Donepezil is effective in maintaining the cognitive function of patients with mild to moderate Alzheimer's disease (AD). However, not all patients respond to donepezil. In the present study, we examined the clinical features of responders and non-responders to long-term donepezil treatment. Methods: The present retrospective study was performed on 95 AD outpatients who had been taking donepezil for ≥2 years. All subjects underwent periodic examinations of cognitive function, namely Mini-Mental State Examination (MMSE) and Rorschach Cognitive Index (RCI), as well as clinical evaluations using the Clinical Dementia Rating (CDR) scale. Patients were divided into three groups as follows: (i) the ‘maintained’ group (MG), in which the global CDR score was maintained over the ≥2 years of treatment; (ii) the ‘declined’ group (DeG), in which the global CDR score increased one rank over the treatment period; and (iii) the ‘obvious and rapid decline’ group (ORDeG), in which the global CDR score increased two ranks early during the treatment period. Clinical features, treatment outcome, the time lag between a caregiver's recognition of the onset of dementia and the start of treatment, behavioral and psychological symptoms of dementia (BPSD), and cognitive functions were compared between the three groups. Results: Patients in the ORDeG (i.e. non-responders) were significantly younger and had a longer time lag between the onset of dementia and the start of treatment than patients in the MG ( P < 0.05). Of note, patients in the ORDeG had a longer period of executive dysfunction before treatment started than patients in the MG ( P < 0.001). Evaluation of cognitive function revealed that mean changes from baseline on the MMSE and RCI were significantly lower for patients in the ORDeG compared with the MG at 8 and 4 months, respectively ( P < 0.001 and P < 0.05, respectively). Conclusion: Donezepil non-responders are likely to be younger and to have a longer time lag between the onset of dementia and the start of treatment, in particular a longer duration of executive dysfunction. Furthermore, the non-responders do not demonstrate maintenance of cognitive functions in the short term. Thus, the early diagnosis of dementia and prompt initiation of donepezil treatment is indicated for a good outcome. To this end, it is important to educate people to recognize a deterioration of executive function in daily living. [ABSTRACT FROM AUTHOR]

Background: To prepare for a super-aging society, effective dementia screening tests are required. The most salient deficit appearing from the early stages of dementia/Alzheimer's disease (AD) is a deterioration in memory. The Hasegawa Dementia Scale-revised (HDS-R) and the Mini-Mental State Examination (MMSE) are widely used in Japan to screen for dementia. Both place an emphasis on memory function, but neither examines visuo-spatial memory (VSM) function, even though VSM deficits are a sensitive marker for the detection of conversion to dementia. Furthermore, brief tests of VSM that are appropriate for screening have not been standardized. Thus, in the present study, we devised a brief, computer-aided short-term VSM test. Methods: Sixty-six aged people were evaluated. Using the Clinical Dementia Rating (CDR), it was found that 29 could be considered normal controls (NC; CDR 0), 10 had mild cognitive impairment (MCI; CDR 0.5), 15 had mild dementia (CDR 1), and 12 had moderate to severe dementia (CDR 2–3). The VSM test estimated how many locations each subject could memorize. Several numbered circles were shown on a monitor and subjects were required to memorize the location of these circles sequentially. After the numbers on the circles on the screen had disappeared, the subjects were required to indicate the circles in ascending order. A touch panel screen was used for this test to make it easier. The HDS-R was applied to subjects with MCI and dementia. Results: The mean (±SD) VSM score in subjects with MCI (5.70 ± 0.96) was significantly lower than that in NC subjects (6.69 ± 0.82), but significantly higher than that in subjects classified as CDR 1 (4.67 ± 0.87). There was no significant difference in VSM scores between subjects classified as CDR 1 and CDR 2–3 (3.80 ± 0.80). There was a moderate significant correlation between VSM and HDS-R scores. Conclusion: In the present study, the VSM test detected differences in VSM function among NC subjects and subjects with MCI and mild dementia. The software program for the VSM test is distributed for free so that it can be widely used. [ABSTRACT FROM AUTHOR]