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When I drove with him, he said, "It's only you, Babaa with dementia, who is so rough in driving," and he gets into a fight.
 

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dementia

dementia(Nintendo,British: Dementia,alone: dementia) IsCognitive impairmentIs a type ofHuman brain OfAcquiredOnce developed normally due to organic disordersIntelligence-Intellectual IrreversiblyIt is in a state of decline.In the initial stage,AgeingbyForgetfulnessConfused withIt is easy to be done, but one of them happens in parallel (I can not cope with forgetting myself, forgetting the forgetting itself,妄想-Hallucination, Dependence, wandering, aggressive behavior,Sleeping disorder,Nursing careResistance to, pica / binge eating,DepressionState etc.).Symptoms vary from person to person, and they become more angry, anxious, and have abnormal behavior than before the onset.[1][2][3][4].

Mainly in this sectionHuman capital(Human) is described, but dementia is an animal other than human (human)dog,CatEtc.) But it also develops.In a narrow sense, it refers to "a state in which intelligence is acquired", but medically, in addition to "intelligence", "intelligence"Memory""Orientation"includingCognitive impairmentAnd "personality change"syndromeIs defined as[1][3].. On the other hand, there is a congenital organic disorder of the brain, and movement disorders and intellectual development disorders appear to be present.Intellectual disability, InnatelyCognitionIf there is an obstacleCognitive impairmentSay. simplyAgeingIt does not include the phenomenon that happens to anyone, such as poor memory.Symptoms of morbidly reduced ability, sharpening of personality, strong desire for approval, decline of rational thinking, and paranoiaPoint to[5][6].

This diseasePeople's Republic of ChinaThen.Dementia, OnceJapanese-styleChinese languagedementiaIt was called (Chiho).But in Japan2004/ToMinistry of Health, Labor and WelfareA report calling for a paraphrase to "dementia" was put together by the terminology review group.In response to this, firstAdministrationFields andSenior citizensIn the field of long-term care, the word "dementia" was abolished and replaced with "dementia".Almost paraphrased by 2007 in each medical society.Since Chinese characters have been abolished from compulsory education on the Korean Peninsula, the Chinese character "dementia" has not become a problem and remains the same today (for details).#Change of NameSee section).Because it is easy to be confused with forgetfulness in JapanThere is a place where a specialty is set up when you think that it may be dementia[7].

Dementia is the second most common disorder in the population over the age of 70[8].. 3560 million people worldwide live with dementia[6], Its economic cost is 0.5-0.6 trillion every year worldwideU.S. dollarThat's all, this isSwitzerland OfGDPExceeds (GDP)[9][6].. The number of patients is increasing by 770 million every year[6]WHO estimates that global dementia patients will double in 2030 by 2012 and more than triple by 2[10].

There is no known cure for dementia in current medicine[11][12].. Research is underway to find safe and effective treatments, but the journey is difficult[12].

Prevention is also being attempted through intellectual activities, communication with others, physical exercise, etc., and the Japan Dementia Prevention Society was organized in Japan.Alzheimer's diseaseGerman medical scientist who leaves his name inAlois AlzheimerJune 6th, which is his birthday, is designated as "Dementia Prevention Day".[13].

Along with the organic disorders of the brain that accompany aging, one of the bodies often malfunctions.社会 問題It never turned into.In recent years, it has become possible to maintain the function of the disorder due to aging of the body to some extent by medication, but the function of the brain has become apparent because the deterioration cannot be prevented by medication.

symptom

The function of the brain is lower than before, and the following various symptoms are mainly exhibited.

Core symptoms

The symptoms that are universally observed in all patients with dementia, regardless of the degree or order of occurrence, are referred to as "core symptoms". Memory disorderDisorientation(Disappearance of time/place/person),CognitionDysfunction (decreased computing and judgment,Aphasia, Agnosia, apraxia, executive function failure), etc.[15][16].

They areNerve cellIt is a symptom caused by the dropout of and is seen in all patients. It progresses gradually as the disease progresses.

Peripheral symptoms (BPSD)

In contrast to the core symptom that appears universally in all patients, the symptom that some patients have or do not have, and the difference in the type of expression is referred to as "peripheral symptom".BPSD(Behavioral and Psychological Symptoms of Dementia) "," non-cognitive symptoms ".

The main symptomsHallucination(20-30%[2]), Delusion (30-40%)[2]), wandering, abnormal eating behavior (Dysphagia), Sleep disorders, depression不安(40-50%), impatience, abuse / violence (biting), sexualityshame(Frequency of obscene remarks against the opposite sex, etc.)[15][1].

The cause of the outbreak is the behavior that seems to be abnormal from a third party in order to overcome the anxious situation in the memory, orientation, and judgment that declines as the core symptom progresses, and that is the surroundings. The anxiety progresses due to the friction of the symptom, and the symptom escalation may occur.As mentioned above, unlike core symptoms, it is seen in a certain percentage of patients, and not all patients have the same symptoms.In addition to the above, the symptoms are extremely diverse, and it is not uncommon for many peripheral symptoms to be seen at the same time.While core symptoms progress in stages of early, mild, moderate, and severe dementia, peripheral symptoms are also characterized by sudden changes in early and moderate symptoms.Initially, there are many psychological symptoms such as anxiety and depression, and when it becomes moderate, hallucinations and delusions develop.

In the past, severe symptoms appear at moderate levels, patients rapidly lose their ability to carry out daily activities, and the burden of nursing care for family members and the like continues to increase due to the appearance and seriousness of peripheral symptoms. There was a stereotype of “=moderate”, but now that it is known that a certain degree of symptoms occur even in mild cases, BPSD has come to be used as a way of dispelling that stereotype and focusing on its cause. It was

BPSD Management Guidelines in Australia[17]
AnimalDiagnosisPrevalencesymptomManagement
1No dementia--Try to prevent
2Dementia without BPSD40%-Preventive measures to slow the progression
3Dementia with mild BPSD30%Night mayhem, wandering, mild depression, lethargy, repetitive questions, shadowing[18]Primary careManagement
4Dementia with moderate BPSD20%Major depression, aggressive behavior, psychosis, sexual disinhibition, wanderingPrimary care management after consultation with a specialist
5Dementia with severe BPSD10%Serious depression, screams, and intense confusionFacilities offering specialized dementia care
6Very severe BPSD dementia1% or lessPhysical attack, severe depression, suicide tendencyManaged by a geriatric facility
7Intense BPSD dementiaRarePhysical violenceIntegrated special treatment facility

If the peripheral symptoms are too severe,Psychotropic drugsIt is not recommended as a first choice, although it may be sedated by using such as, but because it is caused by behavior as a method of solving anxiety in the anxiety state and in the state of cognitive decline as described above, Eliminating the factors that cause anxiety is the basis of coping[19].. Although an effective method to prevent the progression of core symptoms has not been established, it is possible to suppress the occurrence of peripheral symptoms by appropriate care and care methods and reach the terminal stage without clear symptoms. Proper care in the initial state is important.

Other symptoms

In clinical practice,Alzheimer's diseaseAnd white matter type multiplecerebral infarctionThere are many mergers ofGait disorder(Parkinson's syndrome.. Often accompanied by spreadability) andUrination disorder(As you proceedUrinary incontinenceAre often seen.Dementia with Lewy bodiesThen, along with dementia and hallucinations and delusions,Gait disorder,Overactive bladderIncludingAutonomic nervesDisability is often seen.

Sort

The main diseases that cause dementia are cerebrovascular disorders,Alzheimer's diseaseDegenerative diseases such as normal pressure hydrocephalus,vitaminMetabolic/nutritional disorders such asthyroidDementia is diagnosed when cognitive dysfunction, which impairs daily life due to these causes such as functional decline, appears.

Below is an approximate classification of dementia due to causative disease

  • Cerebrovascular dementia : Vascular dementia (VaD)[*1] -10-30% of patients[2][20]
    • Multiple infarction dementia Global ischemia type (including Binswanger leukoencephalopathy)
    • Multiple cerebral infarction type
    • Localized cerebral infarction type
    • Hereditary vascular dementia: CADASIL, etc.
  • Degenerative dementia
    • Alzheimer's dementia: Alzheimer's disease (AD)-40-60% of patients[2][20]
      Cognitive dysfunction, including short-term memory impairment, interferes with daily life and social life, and it is the basic condition of the disease that it is not progressive and has no local neurological symptoms.
    • (Diffuse)Dementia with Lewy bodies: Dementia of Lewy bodies (DLB)-15-20% of patients[20]
      Dementia characterized by sudden changes in hallucinations and cognitive functions.Parkinson's diseaseLewy bodies seen in the brain are found in the brain, and symptoms of Parkinson's disease are also seen. The border with Parkinson's disease with dementia is ambiguous.
    • With dementiaParkinson's disease: Parkinson's disease with dementia (PDD) [2]
      Parkinson's disease is highly associated with dementia. Of 27 studiesMeta-analysisAbout 40% of Parkinson's disease had dementia[21].. There is also meta-analysis data of about 30%[22], That study found Parkinson's disease in 3.6% of all dementia cases. Patients with Parkinson's disease are estimated to have about 5-6 times the risk of developing dementia than healthy people, and 8% of patients with Parkinson's disease developed dementia in a study that followed patients for eight years.
    • Frontotemporal dementia: Frontotemporal dementia (FTD)
      OncePick's diseaseDementia, which is called juvenile and changes in personality from the beginning, is now called FTD. Also, as a broad conceptFrontotemporal lobar degenerationFTLD: Frontotemporal Lobar Degeneration,Semantic dementia Semantic Dementia (SD)Progressive nonfluent aphasia (Progressive nonfluent aphasia, PNFA) (closely related to Primary progressive aphasia (PPA)),Progressive supranuclear palsy: Progressive supranuclear parsy (PSP) etc. are also included.
    • Huntington's disease: Huntington disease (HD) [2]
  • infection
  • Treatable (so-called'treatable dementia')

Also, about 10% of dementia patientsMixed dementia(Mixed dementia), which is commonly associated with Alzheimer's disease and other dementia (frontotemporal or vascular type)[23][24].

In the case of cerebrovascular accidents, even if microscopic lesions are found by image diagnosis, it is difficult to determine whether they are the cause of cognitive symptoms, and until now it has been diagnosed as cerebrovascular dementia (VaD). However, in reality, Alzheimer's disease is often the cause of dementia, so-called “Alzheimer's dementia with cerebrovascular disorder (mixed dementia)”, and pure VaD is 7.3%. It is said that[24].

It is sometimes classified into cortical dementia and subcortical dementia. There is also a classification of vascular disorder and degeneration, and Hachinski's ischemic score is useful in distinguishing the two to some extent. In JapanVascular dementiaWas said to be the most common, but recentlyAlzheimer's dementiaIs increasing.

Mild cognitive impairment

Mild cognitive impairment(Mild Cognitive Impairment:MCI) Is normalAgeingCognitive function is lower than expected in the process, but not dementia. It is the pre-stage of dementia,CognitionMore than a declineMemoryFunctional decline is the main symptom. Subjectively and objectivelyMemory disorderAdmit, but generalCognitionFunction and daily living ability are almost maintained. It usually takes 5 to 10 years, on average 6 to 7 years, to progress to the point where "dementia" can be diagnosed.It is estimated that 10% to 30% of mild cognitive impairment patients who visit a medical institution develop dementia annually.[25]..In addition, the risk of developing dementia is much higher in patients with other cognitive deficits than in those with only mild memory deficits (the rate of transition to dementia after 4 years is memory deficits). Only 24%, and 77% of patients with impaired language, attention, or visuospatial cognition).

More than 100 clinical trials attempting disease-modifying therapy in dementia, the so-called radical treatment, have all failed, and it is considered desirable to start treatment at least from the MCI stage.However, no cure has yet been found to reliably stop the progression of MCI to dementia, and many studies have found that dementia treatments are ineffective.[25]..Therefore, from a preventive point of view, ingredients that maintain cognitive function (DHA, Ginkgo biloba extract,ErgothioneineEtc.)Foods with functional claimsResearch is also being actively conducted.

At the MCI stage, it is often difficult to determine the underlying disease because it is mild, that is, the precursor stage of Alzheimer's disease or the precursor stage of vascular dementia, and a 2013 report. (Brain 2013) revealed that 80% of Alzheimer's disease patients over 8 years old are accompanied by some kind of cerebrovascular disorder, and intervention for cerebrovascular disorder is a precursor of Alzheimer's disease as well as vascular dementia. Expectations are rising around the world that it may also be effective against the stage MCI (called MCI due to AD).In Japan as well, a doctor-initiated clinical trial (COMCID Study) to confirm whether a therapeutic drug for cerebrovascular accidents is effective against MCI has started in May 2015.[26].

According to a report compiled by the research group of the National Center for Longevity Medicine, a four-year follow-up study of elderly people with MCI, which is said to be in the pre-stage of dementia, revealed that 4% had dementia, but 14% had It returned to normal. The study was conducted at the first time using a cognitive function test in which about 46 people aged 65 and older who were not dementia patients were followed for four years from 4200, and 2011 items based on the international MCI criteria were answered. 4 (150%) were determined to have MCI. When the same test was done four years later, 740% of those initially diagnosed with MCI returned to the normal range. This cognitive function test examines four items of memory, attention, processing speed, and executive function, but among MCI, the percentage of those with a low score of 18 item returned to normal was 4 to 46%. On the other hand, those with low scores for multiple items were in the 4% range. Among MCI, the less problematic items were, the higher the recovery rate tended to be. In addition, the proportion of people diagnosed with dementia over four years was significantly higher at 1% in those initially diagnosed with MCI, compared to 39% in those who were initially normal.[27]

Juvenile dementia

Dementia that develops before age 65[28]If it isJuvenile dementia(Young onset dementia, YOD) ".The prevalence rate is still under study, but there are data showing 45-64 males and 10-101 females per 120 population aged 61-77 years.[28].

Type 3 diabetes

Alzheimer's dementia TheDiabetes mellitusBecause it is closely related to, as another name, "Type 3 diabetesCalled "[29].

Cause

Lack of exercise

Five hours of exercise each week leads to a reduction in the number of cases of dementia[30].

Risk factor

age
It is known to be the greatest risk factor (especially Alzheimer's type). A meta-analysis based on 23 epidemiological studies showed that the incidence of Alzheimer's disease increased exponentially with age. In addition, the Bronx Aging study of 75-85 year-olds followed up with data showing that the overall incidence of dementia increases slowly until age 85 and increases sharply after age 85. There is.
Family history
If one parent has dementia, the person's risk of developing it increases by 10-30%. In particular, if one parent has early-onset Alzheimer-type dementia, the risk of developing the individual is considerably high (for example, if the onset of the parent is in the early 50s, the risk of developing the individual is approximately 20 times).
Genetic factor
Apolipoprotein E genotype e4, which is involved in neuroprotection, is said to be involved in amyloid deposition. No other gene has been established as a risk factor.
Damage caused by various drugs (medicines, herbal medicines, supplements, etc.)
Damage caused by antihypertensive agents
Drug damage due to anticholinergic agents
Benzodiazepine short-term use
Short-term use of benzodiazepines slightly increases the risk of dementia and Alzheimer's disease. However, long-term use is not associated with increased risk. This suggests that the association between short-term use and increased risk may represent treatment for prodromal symptoms.[31].
Z-drug (a popular name because many of the names start with Z in the alphabet.Z drugSee. )
In patients over the age of 60Z drugRegular use of was significantly associated with increased risk of dementia. After correctionOdds ratioWas 1.21 (95%CI: 1.13-1.29). The long-term type was a little stronger[32].
Rosacea
At the hospitalSake liquor (RosaceaPatients diagnosed withHazard ratioWas reported to be 1.42 (95%CI: 1.17-1.72) and the hazard ratio for Alzheimer's dementia was 1.92 (95%CI: 1.44-2.58). Rosacea was significantly associated with dementia, especially Alzheimer's[33].
Risk factors for arteriosclerosis
High blood pressure-Diabetes mellitus-smoking-HypercholesterolemiaAre risk factors for this disease such as cerebrovascular type and Alzheimer type.
Aging-associated Cognitive Decline (AACD)
International Geriatric Psychiatric Association has compiled diagnostic criteria as one of the concepts of "general mild cognitive impairment" that includes not only memory impairment but also cognitive decline.
Aging-related cognitive decline is a condition in which a slow decline in cognitive function over 6 months has been reported by the person or family member, and although the cognitive evaluation is also objectively abnormal, dementia has not yet been reached. Cognitive decline is (a) memory/learning, (b) attention/concentration, (c) thinking (eg problem-solving ability), (d) language (eg comprehension, word search), (e) visual-spatial cognition Corresponding to either side of.
In a study of elderly people in a region, the progression rate to dementia after 3 years was 11.1% for mild cognitive impairment and 28.6% for age-related cognitive decline. Moreover, it is reported that the proportion of mild cognitive impairment in the general elderly is only 3.2%, but that age-related cognitive decline is as high as 19.3%.
Risk of isoflavones
IsoflavoneSubjects with high intakes were at increased risk of cognitive dysfunction.on the other hand,soyProduct intake, tofu, miso, natto, and fermented soy food intake were not statistically significantly associated with cognitive dysfunction.[34]..In addition, it is a metabolite of soybean intestinal bacteria.EquolHas been reported to have the potential to reduce the risk of dementia[35].

Relationship with hearing loss

In a study by Dr. Luigi Ferrucci, director of longitudinal research at the National Institute of Aging (NIA), director of longitudinal research in Baltimore, adults with hearing loss have dementia and more than adults without hearing loss.Alzheimer's diseaseThey found that the higher the risk of developing illness and the more severe the hearing loss, the higher the risk. This study examined the relationship between hearing loss and dementia in 36 men and women aged 90-639 years.1990/None of the subjects had dementia at the start of the study. The research group conducted cognitive and hearing tests for four years,2008/They followed up for an average of about 12 years and monitored for signs of dementia and Alzheimer's disease. As a result, 125 subjects were diagnosed with "mild" hearing loss, 53 with "moderate" hearing loss, and 6 with "severe" hearing loss. Eventually, 58 were diagnosed with dementia, 37 of whom had Alzheimer's disease. The risk of dementia was slightly increased with mild hearing loss, and significantly increased in patients with moderate and severe hearing loss. In addition, it was found that more than 60% of the risk of developing dementia was associated with hearing loss in subjects aged 36 and older. The worse the deafness, the greater the risk of Alzheimer's disease, and with every 10 decibels of hearing loss, the risk of developing Alzheimer's disease increased by 20%. The research results were published in the February 2011 issue of the medical journal "Archives of Neurology". In connection with this resultAlbert Einstein College of Medicine"Bearing loss may be a biological measure of aging," said Dr. Richard B. Lipton of Health Day News, February 2, and that hearing loss may be the result of nerve cell damage. And intervene in hearingNeuronIf there is a problem withMemoryIt also serves as a marker of nerve cell damage that controls higher cognitive functions."[36].

Diagnosis

Consciousness disorderSometimes I can't diagnose.ICD-10DSM-IVEven though the diagnostic criteria are different, in general, they do not affect daily life.Memory disorder-CognitionDiagnose when there are two core symptoms of reduced function. Presence or absence of peripheral symptoms does not matter. It is imperative that the function is lower than it was before,Mental retardation(Intellectual disability)

Memory-CognitionWAIS-R (as an inspection that objectively evaluates the degree of function etc.)Wexler adult intelligence test), etc., but it is time-consuming to implement and complicated to use in daily medical care. As a simple screening test,Mini mental state inspection(MMS, MMSE) is frequently used[37][38].JapanThen.St. Marianna University of Medicine"Hasegawa dementia scale" (HDS-R) developed by Kazuo Hasegawa and others is often used.

For mild/suspicious dementia patientsEEGInspection should also be included[39].

UK National Institute of Medical Technology(NICE) isAlzheimer's dementia,Cerebrovascular dementiaThe diagnostic criteria for(English edition,Frontotemporal dementiaLund–Manchester criteria are recommended for diagnostic criteria[40].

Differential disease

Delirium, FTD,Creutzfeldt-Jakob diseaseIs suspected,EEGInspection should be considered[39].

depression,DeliriumIt is easy to be mistaken for[2][41].DeafnessBoth require discrimination.

  • Dementia slowly develops from memory impairment without diurnal variation[41].. Lack of seriousness, hesitant or angry at questions. The cause is not always identified.
  • depressionIs highly diurnal and typically gets worse in the morning[41]Relatively sharplyDepressionIt develops from symptoms. Responsible and serious, he said that he was late in answering questions or did not understand. Early awakening is also seen[41].
  • DeliriumMay have a strong diurnal variation and develop suddenly, and dialogue may not be established.[41].. There are causes such as drugs and physical diseases. Intermediate if possible deliriumUrinalysisBe sure to do[39].

Inspection

Neuropsychological examination

Starting with intelligence testsNeuropsychologyTests are used for diagnosis and evaluation of severity. Memory tests (WMS-R) and Japanese version of Rivermead Behavioral Memory (RBMT) are the standard, but they are not practical in dementia diagnosis. Therefore, the tests used for dementia are mainly described here. In the evaluation and screening of dementia, core symptoms such as memory, BPSD, and ADL are dealt with. Each uses a question-type cognitive function test and an observation-type behavioral evaluation scale. The features of each inspection are summarized below.

Question formulaObservation formula
Can be implemented with the minimum amount of informationNeed a well-understood family and nursing staff
Can be implemented by the person himselfCan be evaluated only with information from family etc.
Not possible unless the person is cooperativeCan be evaluated even if the person is rejected
Impossible if there is significant audio-visual impairmentAlmost unaffected by audio-visual impairment
Less variation depending on the operatorManual training required to reduce variability in results
Regardless of home, hospitalization, or admissionDepending on the evaluation items, you cannot be admitted to the hospital or admitted.
Cognitive impairment can be assessed but BPSD is notCognitive impairment and BPSD can be evaluated
Questionnaire scale for measuring intellectual impairment

General practitioner Assessment of Cognition (GPCOG), Mini-Cog and Memory Impairment Screen (MIS) are not common because Japanese version is not created.

Hasegawa dementia scale(HDS-R)
Kazuo HasegawaIt is a simple scale for dementia diagnosis created by and is currently most widely used in Japan. It used to be called the "Hasegawa simplified intelligence evaluation scale",2004/The name has been changed to the current one because the dementia was renamed in April to dementia. It consists of nine questions such as one's age, current date, current position and name of thing, and simple subtraction. The maximum score is 4 points, and 9 points or less are considered to be suspected of dementia. It is a simple screening test to the last, and is not used in the judgment of dementia or classification of severity. The reference average points are 30 ± 20 for non-dementia, 24.3 ± 3.9 for mild, 19.1 ± 5.0 for moderate, 15.4 ± 3.7 for altitude, and 10.7 ± 5.4 for altitude.
Mini mental state inspection (Mini-Mental State Examination, MMSE)
Internationally most popular method, recommended in the UK and Australia[37][38].. In Japan, it is often used in combination with the Hasegawa dementia scale. It consists of 11 questions with a maximum of 30 points. According to the original law, 20 points or less are dementia, but 23 points or less are general as of 2010. The memory load is lower than that of HDS-R, and the effect of years of education is known. On the other hand, there is a question, which does not exist in the Hasegawa formula, that requires a copy of a figure that determines the visual space and compositional abilities that are greatly affected by a decline in cognitive function.
Clock drawing test(Clock Drawing test, CDT)
A simple examination method to evaluate visual space and compositional ability[38].. It is a simple test that requires you to write a clock face and add a minute hand and a minute hand that indicate a specified time. The problem is that there is no consensus scoring system.
The Seven Minites Screen (7MS)
It is a test method that is excellent in distinguishing mild AD from healthy people and has high sensitivity and high specificity, but cannot be easily performed on the bedside.
Screening method for asking age and year of birth
It has been reported that screening using only two simple questions, "How old are you" and "How old were you born?" If the answer to both questions is incorrect, then it is dementia. Sensitivity was 2%, specificity was 2%, positive predictive value was 61.2%, and negative predictive value was 97.8%.[42].
Alzheimer's Disease Assessment Scale (ADAS)
The purpose is to evaluate the changes in cognitive function by cholinergic agents for clinically diagnosed AD. It is never used as a screen. The ADAS cog., a cognitive subscale of ADAS, is often used in clinical trials. In Alzheimer's dementia, the annual score change is 9-11 points, and it has been pointed out that the change is small in mild and advanced dementia and large in moderate dementia.
Severe Impairment Battery
Assess highly impaired cognitive function.
Japanese versionRivermead behavioral memory test(RBMT)
Although it is a memory test, the Japanese version includes elderly subjects in the standardization so that it can be used for dementia. The feature is that it reproduces various situations in daily life.
Japanese version Neurobehavioral Cognitive Status Examination(CONISTAT)
Multifaceted evaluation is possible.
A scale to evaluate cognitive dysfunction by observational formula
Clinical Dementia Rating (CDR)
This is the most commonly used observation-type dementia severity assessment method. Health is CDR=0, dementia is suspected CDR=0.5, mild dementia is CDR=1, moderate dementia CDR=2, and advanced dementia CDR=3.
Functinal Assessment Staging (FAST)
It is an observation-type severity assessment method that is frequently used internationally along with CDR. The objective is to comprehensively judge ADL and to judge the severity of AD among dementia. The feature is that ADL behavioral changes in border areas and mild dementia are very easy to detect. Other features are that the duration and prognosis of each stage are shown, and that the differential disease in a state showing cognitive decline at each stage is shown.
N-type elderly mental health scale (NM scale)
Compared to CDR, it can be evaluated by applying the specific situation of the subject's daily life, so it is often used in nursing homes.
Dementia screening scale based on information from caregivers
Short Memory Questionnaire (SMQ)
This scale was created by a primary caregiver who has many opportunities to interact with elderly people requiring nursing care in their daily lives in order to evaluate the degree of cognitive impairment in elderly people requiring nursing care.
Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
Info questionnaire about cognitive decline in the elderly. A short questionnaire designed to assess cognitive decline and dementia in the elderly.
Scale for assessing activities of daily living (ADL) and tool-like activities of daily living (IADL)
Physical self-Maintenance Scale (PSMS) / Instrumental Activities of Daily Living (IADL)
Evaluate based on information from family and caregivers. It is simple and can be used in daily life. The evaluation of IADL is significant because dementia impairs the rather complex IADL before basic ADL.
N-type elderly person's daily living ability evaluation scale (N-ADL)
It is a behavioral evaluation scale that evaluates the ability of elderly people and demented patients to walk, sit up, and put on and take off clothes in various activities in daily life, and then evaluates them by scoring them.
Disability Assessment for Dementia (DAD)
It is basically a scale for home-based Alzheimer's patients. It is performed in patients without motor dysfunction.
ADCS-ADL(Alzheimer's Disease Cooperative Study-ADL scale)
Evaluation is based on information from family members and caregivers. It is mainly used in clinical trials targeting AD patients.
Scale to evaluate peripheral symptoms of dementia (BPSD)
Neuropsychiatric Inventory (NPI)
A method for assessing psychological symptoms by caregivers. Delusions, hallucinations, excitement, depression, anxiety, euphoria, apathy, disinhibition, irritability, and abnormal behavior for each of the 10 items, with a frequency of 1 to 4 and a severity of 4 to 1 Evaluate with.
Behavioral Pathology in Alzheimer's Disease(Behave-AD)
It focuses on the delusions, the thieves, fear of loneliness, and sleep disorders characteristic of AD, and is used for the purpose of evaluating drug therapy.
Cohen-Mansfield Agitation Inventory (CMAI)
Focusing on actions such as tapping, stepping, and screaming, 2 questions are asked about the frequency of actions in the past 38 weeks.
Scale for assessing depression
Geriatric Depression Scale (GDS)
Elderly Depression Rating Scale. It consists of 15 questions. Criteria: 0-4 No depressive symptoms; 5-10 Mild depression; 11+ Severe depression.
Cornell Scale for depression in Dementia (CSDD)
Cornell scale for depression in dementia. It consists of 19 questions.Criteria:> 10 Probably major depression;> 18 Clear major depression.
Plural dementia rating scale
GBS scale (GBSS)
The motor function 6 items, intellectual function 11 items, emotional function 3 items, and mental symptom 6 items are classified into 6 grades. Although it is a scale that can evaluate qualitative differences as well as the severity of dementia, it is not a diagnostic purpose for dementia.
Scale to evaluate quality of life (QOL) of dementia
Japanese version Alzheimer's Disease-Health Related Quality of Life (AD-HRQ-J)
Used to assess the health-related quality of life of people with Alzheimer's disease. Asked by the caregiver of a person with AD.
Japanese version Dementia Quality of life Instrument (DQoL)
The Japanese version of DQoL consists of 29 items, consisting of 1 subscales: (2) self-esteem, (3) positive emotion, (4) negative emotion, (5) sense of belonging, and (5) aesthetics. It
Scale for assessing caregiver burden on caregivers
Burden Interview
Burden interviews are designed to reflect the stress experienced by caregivers. You will be asked to answer a series of 22 questions.

Biochemical examination

CSF Aβ

Beta amyloid(Aβ) exists as Aβ40 and Aβ42 in cerebrospinal fluid (CSF) and plasma. In elderly patients, CSF Aβ42 is decreased, but in AD patients, Aβ40 is highly decreased and Aβ40/Aβ42 ratio is increased.

CSF tau

Tau proteinIs said to rise in AD. Except for AD, there is no increase in vascular dementia, Parkinson's disease, progressive supranuclear palsy, and HIV infection. However, elevated cases have been observed in frontotemporal dementia, Lewy body dementia, corticobasal degeneration, and Creutzfeldt-Jakob disease. Phosphorylated tau is expected as a test with higher specificity for AD.

Plasma Aβ

Plasma Aβ can also be a risk factor for AD development and a marker for disease progression.

Physiology

EEG

Alzheimer's dementiaIt is known that the electroencephalogram changes in the following patients as follows. It is known that corynesterase inhibitors reduce slow waves.

  • Normal waveform
  • Poverty of α waves, mixed θ waves
  • Slow wave with low-medium amplitude θ wave
  • Large and slow waves with medium-high amplitude θ and δ waves accompanied by δ burst
  • Large slow wave low amplitude, irregular
  • Flattening

Image inspection

If there is a suspicion of dementia, it is necessary to take an image to distinguish it from other diseases and determine the dementia type.[40].

Head CT

Brain tumor,Chronic subdural hematoma,Normal pressure hydrocephalusThe aim is to detect treatable diseases such as. Brain atrophy is inferior to MRI. The evaluation of medial temporal atrophy is judged by the degree of dilation of the lateral ventricle inferior horn as an indirect finding, but the inferior horn enlargement does not always coincide with the atrophy of the hippocampus or parahippocampal gyrus.

Head MRI

statistical parametric mapping (SPM) and voxel-based morphometry (VBM) are popular. Comparing DLB with AD as a dementia differentiation, AD shows strong atrophy of the hippocampus and temporal parietal lobe cortex. It has been shown that AD is more atrophied and DLB is more atrophied in the midbrain cover. In AD, medial temporal atrophy is conspicuous in elderly onset, but temporal parietal cortex atrophy is prominent in senile onset.

SPECT

As a differentiation of dementia diseaseSingle photon emission tomography(SPECT) is very important. SPECT should be performed if the diagnosis of AD, VaD, or FTD is doubtful[40].ScintigraphySee also Blood flow is thought to reflect synaptic activity rather than the number of neurons, and in ADPapetsIt is said to have close anatomical fiber communication with the circuit ofGyrusAt the rear orWedge frontA decrease in blood flow is observed. DLB shows decreased occipital blood flow.

PET

A PET tracer that can detect amyloid plaques has been developed and is attracting attention as amyloid imaging. 11C-PIB has been most studied, and AD has a strong accumulation in the cerebral cortex such as the prefrontal cortex and the anterior wedge, whereas in normal cases, the accumulation in the cerebral cortex is poor.

Management

There is no cure other than for dementia other than those known to be treatable[1].. AChE drugs are often prescribed for early stage dementia, but the benefits are not great[43].

In the case of "treatable dementia", the causative disease is promptly treated.Chronic subdural hematoma or Normal pressure hydrocephalusIf this is the cause, surgery can cure it.

Assistance policy

For caregivers, care for dementia can be frustrating and very stressful.Psychological educationThen,neglectNot to be negative[1].. Investigate the potential caregiver to have depression[1].

Long-term care insurance,Disability pension,Day careUse of social resources such as day-care centers is also useful[1].. Specialist (Geriatrics,Psychiatric,neurologyEtc.), care worker (care workerEtc.)Team medicalIt is desirable to do[1].

Psychotherapy

For patients with mild to moderate dementia (regardless of type), NICE can be used with or without medication (to improve cognitive function)Cognitive stimulation group therapyOpportunities for participation in the Cognitive Stimulation Therapy program should be given[44]..Daytime walksOccupational therapyAdjust the day and night rhythm withLight therapy[45], Keep memories and photos at handRecollection,TV retrospectiveEtc. may be effective.

Peripheral symptoms affected by mental status such as patient's anxiety may be able to suppress the onset by removing them (Human Magnitude).

There are many non-pharmacological interventions for BPSD,Music TherapyWaitArt therapyAnd behavior management technology is effective[46].. For excited states, person-centered care, communication skills training, and dementia care mapping are effective immediately or even after 6 months in nursing homes, with music therapy and activity (standard activity status). ) Is effective but there are no long-term studies and aromatherapy and light therapy are not effective[47].

For sleep disorders in patients with dementia, drug-free methodsLight therapyThere are multiple randomized controlled trials[48].

Drug therapy

Alzheimer's dementia(AD) cognitive function improving drugs,acetylcholineAs an esterase inhibitor (AChE, anticholinergics)Donepezil(Product name Aricept),Galantamine(Product name Reminyl),Rivastigmine(Product name Ixeron, Rivas Touch) exists. NICE's 2006 guidelines recommend AChE as an option for mild to moderate AD[49].

In addition, for therapeutic drugs based on completely different pharmacological mechanismsNMDA receptorAs an antagonistMemantineThere is (trade name Memary) and NICE recommends it as an option for management of severe or moderate Alzheimer's disease unsuitable for AChE.[49].

However, these drugs should be given only when the diagnosis is confirmed and should not be used routinely[1].. NICE states that AChE and memantine should not be prescribed for vascular dementia and AChE should not be prescribed for mild cognitive impairment (MCI)[49].

Major depressionNICE suggests that antidepressants should be administered by educated specialists for dementia with[50].

BPSD management with drugs

In addition, dementia patients not only deteriorate cognitive function,insomnia,Depression, Irritability,Hallucination(Especially vision),妄想Such symptoms may be called peripheral symptoms (BPSD). For these, administration of psychotropic drugs may be effective, but psychotherapy should be tried first[1]Strive for correct use of drugs[53]Should be given carefully, monitoring side effects at low doses[52][19].. MHLW has told BPSD thatPsychotropic drugsIs not supposed to be used in principle[19].

NICE's 2006 guidelines require that drug intervention should be the first choice for BPSD only when there is a risk of serious distress or urgent self-harm or other harm[*2]According to 2013 MHLW guidelines, the first choice is non-drug intervention in principle, and consent should be obtained from patients/guardians when prescribing[19]And

Antipsychotic

The British governmentAntipsychoticAs a national strategy to reduce use because it leads to death, the usage rate of about 2006% in 17 was reduced to about 5% in 7 years, and it was reported at the Dementia G2013 Summit in 8.[54].. U.S. goal is to reduce to 2016% by the end of 16[55].

  • The American Academy of Geriatrics (AGS) recommended in 2014 that prescription of antipsychotics should not be the first choice for BPSD[51].
  • The Ministry of Health, Labor and Welfare has a guideline in 2013 that the administration of antipsychotics to BPSD is an off-label prescription, it requires a non-use posture, moderate to severe BPSD is targeted, medication intended for physical restraint,Combined use of multiple drugsShould not do[19].
  • NICE's 2006 guidelines specify that for Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia, mild to moderate BPSD increases the risk of adverse events and mortality Is not supposed to be prescribed[*3].
    • NICE also states that for DLB dementia, if mild to moderate BPSD, antipsychotics should not be prescribed due to significant adverse event risk.[56].
Herbal medicine

Distant TheItohimehagiAt the root of theShennong(Formed in the later Han-Sangoku period), it is described as “forgetting”, and it is described that it is effective for amnestic symptoms. Recent studies include reports that Doshi improved cognitive functions including memory in the elderly, and inhibition of β-amyloid (Aβ) damage to rat cortical neurons. Although it is unlikely that the description of "Shinnohon Kousei" is equivalent to the current core symptoms of dementia, amnesia-containing Kampo medicine can be considered as one of the goals of amnesia use.[57][58]

Includes "Denshi", a herbal medicine whose main focus is amnesiaChinese medicineThe extract formulation isKihito, Kami Kihito, Ginseng Yoei-to. Chinese herbs that do not include "Tenuifolia" but can be expected to be effective for dementiaYokukansan,Yokukansan Kami Chen skin half summer,Chotosan,Toki Shakuyakusan,HachimijioganThere is.[58]

Randomized controlled trial(RCT)Yokukansan(TJ54, Constituent Crude Drugs: Saiko, Choto Hook, Soshu, Fukuryo, Toki, Kawasago, Licorice) significantly suppressed BPSD, improved ADL of patients, and reduced caregiver burden Reported to let[59][60][61].

More informations
  • In the Ministry of Health (2013),AntidepressantDoes not respond to cholinesterase inhibitors in patientsDepressionWill be considered in the management of.
  • According to WHO guidelinesDiazepamProhibits the use of[11].. AGS (2014)insomnia・For excitement and delirium,BenzodiazepinesAnd otherHypnotic sedativeShould not be the first choice.
  • BifidobacteriaIt has been reported that ingestion of MCC1274 may improve cognitive function.[62].
  • 2004 years,UCLAThe research team ofAlzheimer's diseaseExperimented with a model mouseCurcuminIn the brainβ amyloidIt was shown to suppress the accumulation of amyloid and reduce amyloid plaques.[63]..There are also epidemiological findings that curcumin affects mental function.Targeted at older AsiansMini mental state inspectionShowed a relatively high score (healthy mental function) in the group that ate yellow curry more than once every 1 months[64].

From March 2015Foods with functional claimsWith the start of the system, ingredients that maintain and support cognitive functions such as memory and attention (DHA, ginkgo biloba extract,ErgothioneineEtc.) are being studied.Foods with functional claims are the responsibility of the business operator to label their functionality based on scientific evidence, and prior to sale, "clinical trials using final products" or "research reviews on final products or ingredients involved in functionality" Is notified to the Consumer Affairs Agency, and if it is accepted, it can be displayed.Mild cognitive impairmentExpected to have effects on (MCI) and peripheral symptoms (BPSD)[65][66].

Difficulty swallowing

Many patients with dementia have difficulty swallowing. However, AGS is a tube feeding method for patients with advanced dementia (Gastrostomy) Does not recommend and suggests oral intake assistance instead[51].. Gastrostomy is associated with patient upset, increasing use of physical and drug restraints, and exacerbating pressure ulcers[51]. Hangekobokuto(TJ16, constituent crude drugs half-summer, pinellia ternata, pinellia ternata, pinellia ternata, ginger) improves swallowing reflex and cough reflex in patients with cerebrovascular disorders and prevents the occurrence of aspiration pneumonia in elderly people with disorders ..[67][68][69]

Epidemiology

dementiaPrevalenceIs rare in the working age group under 65 years old with 2-10%,[8], Sudden increase after age 80, and more than half affected in Europe by age 95 and older[8].. OECD predicts that 20 years from now, Europe will have 1.5 times more dementia if the prevalence by age remains at its current pace[8].

dementiaPrevalence(By age)[71]
age60 – 64 Feet65 – 69 Feet70 – 74 Feet75 – 79 Feet80 – 84 Feet85 – 89 Feet90+
Western Europe[72]1.6%2.6%4.3%7.4%12.9%21.7%43.1%
Central Europe0.9%1.3%3.3%5.8%12.2%24.7%
Eastern Europe0.9%1.3%3.2%5.8%11.8%24.5%
米 国1.1%1.9%3.4%6.3%11.9%21.7%47.5%
Latin America1.3%2.4%4.5%8.4%15.4%28.6%63.9%
East Asia0.7%1.2%3.1%4.0%7.4%13.3%28.7%
South Asia1.3%2.1%3.5%6.1%10.6%17.8%35.4%
Southeast Asia1.6%2.6%4.2%6.9%11.6%18.7%35.4%
Australia1.8%2.8%4.5%7.5%12.5%20.3%38.3%

JapanAbout the elderly aged 65 and overPrevalenceIs 3.0-8.8% (varies widely depending on the survey), and OECD reported 2009% in 6.1.[14].. There is also an estimate that it will rise to 2026% in 10.

In 2010, the number of dementia patients in JapanAbout 462 million people(65% of the population over 15 years old)Mild cognitive impairment(MCI) was estimated to be about 400 million (13%)[73].. In 2014, the number of dementia patients in Japan was about 500 million, and the social cost was 14.5 trillion yen.National medical expensesIt was estimated to account for one-third of the total (Ministry of Health, Labor and Welfare Dementia Countermeasures Research Project)[74].. It is also expected to grow to 2035 trillion yen in 22.9.[74]..According to Ministry of Health, Labor and Welfare statistics, the number of elderly people with dementia is 2012 million in 462, 2020 million in 602, and 2025.675 million people, 2030 years744 million peopleEstimated to be[75][76].

Researchers at the University of Vermont, USA, tracked more than 30,000 people for an average of 3.4 yearsAB typeWas associated with dementia[77][78].(English editionResearchers have summarized their findings to date, may be involved in blood coagulation factors, may be prone to other than type O, and may be associated with heart disease, diabetes, hypertension, and dementia. There is a possibility that it is becoming easier to become[79]..The relevant FVIII levels in the body are in the order AB> B> A> O.[79].

Social issues

Economic cost

Economic costs for dementia account for 5.5% of health spending in the Netherlands and 3.7% in Germany[8].. Total costs are estimated to be $6450 billion globally (2010 Swiss GDP equivalent), $1680-2300 billion in the US and $2130 billion in Europe as a whole.[8].

Care problems

Regarding caregiving, many families still care for patients with dementia, but due to the large burden of caregiving.In my heartIt can develop into problems. Nursing care for patients with dementia requires 24 hours of watching, which is difficult to deal with unless it is a community. Most of the patients want their home where they die, but most of them now die in hospitals[12].

However, this problem is considered to be a family and poverty problem, and is rarely a social problem. In Japan, nearly 9% of patients are over 65 years old, and the measures for elderly dementia patients under the age of 65 (juvenile dementia) are delayed. It is said to be heavy. In long-term care insurance, patients with support needs of 65 or moreGroup home for the elderly with dementiaIs available.

Problems related to car driving

Cars with dementia suffering from poor judgmentoperationThere are also problems such as. Of each prefecturePublic Safety CommissionIs for people with dementiaDriver's licenseCan be canceled or stopped (Road Traffic LawArticle 103). The five dementia-related medical societies jointly set guidelines and, when dementia is judged, doctors tell patients and their families to stop driving andDriver's licenseExplain that they should make a refund, and recommend that they be noted in the chart.[80].

Problems surrounding railway accidents

If you have dementia (including suspicion)Railway accidentThe case caught in2005/From degree2012/It has been revealed that 8 cases have occurred in the 149 years up to the year. accidentvictimOf these, 115 have died.Railway operatorBut without considering that the accident victim has dementiacompensationThere are many cases of making claims, which are emerging as new issues such as safety measures and who is responsible for liability.[81].. The bereaved families of the victims of the accident say that it is impossible to watch them all the time around the clock, and there are strong voices that oppose the movements of railway operators.[82].

A man with dementia was JR in December 2007Kyowa StationIn an accident caused by going down the railroadJR TokaiFiled a lawsuit seeking compensation of about 720 million yen to relatives, but on March 2016, 3, the Supreme Court rejected the damages claim, which was a landmark decision for dementia patients and their families. However, the issue of how to recover the damage caused by an accident caused by an incapacitated person has emerged, including national policy.[83].

Problems with missing persons

According to a summary by the National Police Agency, in 2013, a search request (Missing personThe number of people with dementia who received notification was 1[84]Of the 2012 unknown persons reported in FY2013 and FY19,929, 2014 are unidentified as of April 4.[85].. On the other hand, there were 13 people (as of May 2013) who were protected by the police but whose identity and address were unknown.[86].

According to the announcement of the National Police Agency on June 2019, 6, the total number of missing persons with dementia reported to the police in 20 was 2018, an increase of 16,927 from the previous year, and statistics will be collected. Also, since 1064, it has increased continuously and reached the highest level. The total number of missing persons, 2012, was 87,962%, the highest ever. 19.2% or older accounted for 70%.[87]

Legal protection

Already targeted to dementia patientsBad business lawIs occurring.Malicious reformAndFinancial institutionOf dementia patientsFinancial instrumentsUnauthorized cancellation of[88], Etc. are often reported at the time of occurrence and detection, but there is little discussion about the solution. For this reason,Lawyer,Judicial scrivener,Social worker,Regional Comprehensive Support Center,Adult guardian systemMeasures are required.

In legal papers, the term "insufficient judgment" may refer to patients with dementia.

Criminal procedure

Caregiver burden

In 2018, when a man with dementia in his 70s was found wandering inside the facility with a kitchen knife, a caregiver man picked up the kitchen knife and threw it down for self-defense because it attacked. A man with dementia was slightly injured.Takayama City has determined that this is a caregiver abuse of dementia patients.Gifu Prefecture is under investigation for abuse.Nearly 9% of long-term care staff who take care of dementia patients are sexually harassed or abused[92].

Change of Name

History

Japan Geriatrics SocietyIn March 2004, Vakuto Shibayama said, "The word'dementia'isDiscriminationFrom June,Ministry of Health, Labor and WelfareAt the terminology review meeting centered on medical and welfare experts. In the process,Ministry of Health, Labor and WelfareIn addition to hearings from related organizations and experts, the company solicited opinions through a web page, etc., in order to broadly ask the public about the ideas of multiple candidates selected as alternative terms to “dementia”. As a result, the following conclusions were reached regarding "dementia" as a general term and administrative term.

  • The term "dementia" is a derogatory expression and does not accurately represent the actual state of "dementia", which hinders efforts such as early detection and early diagnosis, so it should be changed as soon as possible. Should.
  • “Dementia” is the most appropriate as a new term to replace “dementia”.
  • When changing to "dementia", it is necessary to not only publicize that the term will be changed, but also work to eliminate misunderstandings and prejudices regarding "dementia". In addition, it is necessary to promote various measures in this field even more strongly and comprehensively.

"Cognitive impairment" was the highest in the popular vote of the people, but this name was postponed because it could not be distinguished from conventional "cognitive impairment" in medicine. thus2004/12/24In addition, the report that the legal term should be changed (the report of the study group on the term replacing "dementia") was compiled.Ministry of Health, Labor and WelfareThe Health and Welfare Bureau changed the administrative term on the same date, and in accordance with the "Heisei 1224001", it became the name of the Director of Health and Welfare to the local government and related societies.dementia(Nintendo)” was issued as a request for cooperation. The relevant legal text isOrdinary DietLong-term care insurance methodThe amendment was made.

As a medical term,Japan Geriatric Psychiatry AssociationDefined "dementia" as a formal academic term and notified the 40 concerned societies. In the current medical world, "dementia" is almost paraphrased as "dementia".

Mainly in psychology and neuroscience societies, the word "cognition" has been strictly used, and as a result, we are opposed to the term dementia.[93].

Revision of administrative terms

The following are examples of amended terms from "dementia" issued by the Ministry of Health, Labor and Welfare, Director General of Health and Welfare, dated December 16, 12.

  • Dementia → dementia
  • Elderly with dementia → elderly with dementia
  • Elderly people with dementia → Elderly people with dementia
  • Group home for the elderly with dementia → Group home for the elderly with dementia

At present, the long-term care insurance law, which has been amended by the “Law to revise a part of the long-term care insurance law,” which is being deliberated at the 162nd Diet, states that “organization of the brain based on cerebrovascular disease, Alzheimer's disease, and other factors. Dementia is defined as a state in which memory function and other cognitive functions are deteriorated to the extent that changes cause problems in daily life.

Discussion of pros and cons of notation revision

The name "dementia" was said to be discriminatory because both "delusion" and "blindness" were "stupid" and "stupid".foolThis is because the kanji has the meaning of "." In factMinistry of Health, Labor and WelfareIn the questionnaire, people who "feel" discomfort or disrespect even when the name "dementia" is used as a general term or administrative term, or when it is used as a diagnosis name or disease name in hospitals, etc. , Surpassing those who don't "feel".

Regarding the decision to use “dementia” as an alternative to the name “dementia”,CognitionThere is a debate that the meaning of "" is not transmitted correctly and may not be appropriate, or it may be broken as Japanese.

PsychologyFrom the association relationship (there are no participants in the study group), "cognition" is a concept that represents the intellectual function of human beings. is there. Inappropriateness was pointed out in a joint statement issued by the Japanese Psychological Association, The Japanese Society of Basic Psychology, The Japanese Cognitive Science Society, and The Japanese Cognitive Psychological Society, and an opinion that proposes "cognitive ataxia" as an alternative Has been submitted to the Ministry of Health, Labor and Welfare.

In addition, the term "dementia" refers to "a state in which once acquired intelligence is progressively reduced due to an acquired organic disorder of the cerebrum", it expresses the symptoms more accurately than the term "dementia". There is also an opinion that

footnote

[How to use footnotes]

注 釈

  1. ^ Vascular dementia is abbreviated as VaD because VD=venereal disease=sexually transmitted disease in the West.
  2. ^ Original: People with dementia who develop non-cognitive symptoms or behavior that challenges should be offered a pharmacological intervention in the first instance only if they are severely distressed or there is an immediate risk of harm to the person or others(UK National Institute of Medical Technology 2006, Chapt.1.7.2.1)
  3. ^ Original: People with Alzheimer's disease, vascular dementia or mixed dementias with mild-to-moderate non-cognitive symptoms should not be prescribed antipsychotic drugs because of the possible increased risk of cerebrovascular adverse events and death (UK National Institute of Medical Technology 2006, Chapt.1.7.2.2)

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