Evaluation of major national dementia policies and health-care system preparedness for early medical action and implementation

A scoping review of the unique landscape and challenges associated with dementia in the Western Pacific region

Dementia is a leading public health crisis that is projected to affect 152.8 million individuals by 2050, over half of whom will be living in the Western Pacific region. To determine the challenges and opportunities for capacity building in the region, this scoping review searched databases. Our findings reveal national and ethnoracial differences in the prevalence, literacy and genetic risk factors associated with dementia syndromes, underscoring the need to identify and mitigate relevant risk factors in this region. Importantly, ∼80% of research was derived from higher income countries, where the establishment of patient registries and biobanks reflect increased efforts and allocation of resources towards understanding the pathogenesis of dementia. We discuss the need for increased public awareness through culturally-relevant policies, the potential to support patients and caregivers through digital strategies and development of regional networks to mitigate the growing social impact and economic burden of dementia in this region.

Funding

FightMND Mid-Career Fellowship, NHMRC EL1 Fellowship, NHMRC Practitioner Fellowship (1156093), NHMRC Postgraduate scholarship (2022387).

Guardians of memory: The urgency of early dementia screening in an aging society

The global aging population has led to a significant rise in the prevalence of age-related non-communicable diseases such as dementia and other cognitive disorders. In 2019, there were 57.4 million people with dementia worldwide, and this number is projected to triple by 2050. Intervening in and managing 12 potentially modifiable dementia risk factors can prevent or delay the onset and progression of about 40% of dementia cases. Neuroimaging, biomarkers, and advanced neuropsychological testing offer promising pathways for the early detection of dementia. Emphasis should be placed on educating the public about the importance of brain health and the early signs of cognitive impairment, as well as promoting dementia prevention measures. Adopting a healthy lifestyle - including a balanced diet, regular physical exercise, active social engagement, cognitive activities, and avoiding smoking and excessive alcohol consumption - can help reduce the risk of cognitive decline and prevent cognitive disorders. Government policies on dementia prevention and health care, along with early and regular dementia screening programs, can enhance the early identification and management of individuals at risk. In addition, integrating cognitive health assessments into routine medical check-ups is essential for the early screening and management of dementia.

A policy overview of Japan's progress on dementia care in a super-aged society and future challenges

Dementia is highly prevalent in Japan, a super-aged society where almost a third of the population is above 65 years old. Japan has been implementing ageing and dementia policies since 2000 and now has a wealth of experience to share with other nations who are anticipating a similar future regarding dementia. This article focuses on the 2019 National Framework for Promotion of Dementia Policies that, based on its philosophy of Inclusion and Risk Reduction, lays out five complementary strategies. Together, these five strategies encourage a whole of society approach in dementia care. We first elaborate on the activities being undertaken under each of these strategies and then discuss the future challenges that Japan needs to address. These policy and social innovations spearheaded by Japan can be useful information for other countries that are anticipating similar future as Japan.

Validity and Reliability Study of Online Cognitive Tracking Software (BEYNEX)

Background

Detecting cognitive impairment such as Alzheimer's disease early and tracking it over time is essential for individuals at risk of cognitive decline.

Objective

This research aimed to validate the Beynex app's gamified assessment tests and the Beynex Performance Index (BPI) score, which monitor cognitive performance across seven categories, considering age and education data.

Methods

Beynex test cut-off scores of participants (n = 91) were derived from the optimization function and compared to the Montreal Cognitive Assessment (MoCA) test. Validation and reliability analyses were carried out with data collected from an additional 214 participants.

Results

Beynex categorization scores showed a moderate agreement with MoCA ratings (weighted Cohen's Kappa = 0.48; 95% CI: 0.38-0.60). Calculated Cronbach's Alpha indicates good internal consistency. Test-retest reliability analysis using a linear regression line fitted to results yielded R∧2 of 0.65 with a 95% CI: 0.58, 0.71.

Discussion

Beynex's ability to reliably detect and track cognitive impairment could significantly impact public health, early intervention strategies and improve patient outcomes.

Changes in dementia treatment patterns associated with changes in the National Policy in South Korea among patients with newly diagnosed Alzheimer's disease between 2011 and 2017: results from the multicenter, retrospective CAPTAIN study

BACKGROUND

The South Korean government has been actively involved in plans to combat dementia, implementing a series of national strategies and plans since 2008. In July 2014, eligibility for mandatory long-term care insurance (LTCI) was extended to people with dementia enabling access to appropriate long-term care including the cognitive function training program and home nursing service. This study aimed to investigate changes in treatment patterns for Alzheimer's disease (AD) between July 2011 and June 2017 which spanned the 2014 revision.

METHODS

This multicenter, retrospective, observational study of patients with newly diagnosed AD analyzed electronic medical records from 17 general hospitals across South Korea. Based on their time of AD diagnosis, subjects were categorized into Cohort 1 (1 July 2011 to 30 June 2014) and Cohort 2 (1 July 2014 to 30 June 2017).

RESULTS

Subjects (N=3,997) divided into Cohorts 1 (n=1,998) and 2 (n=1,999), were mostly female (66.4%) with a mean age of 84.4 years. Cohort 1 subjects were significantly older (P<0.0001) and had a lower number of comorbidities (P=0.002) compared with Cohort 2. Mean Mini-Mental State Examination (MMSE) scores in Cohorts 1 and 2 at the time of AD diagnosis or start of initial treatment were 16.9 and 17.1, respectively (P=0.2790). At 1 year, mean MMSE scores in Cohorts 1 and 2 increased to 17.9 and 17.4, respectively (P=0.1524). Donepezil was the most frequently administered medication overall (75.0%), with comparable rates between cohorts. Rates of medication persistence were ≥98% for acetylcholinesterase inhibitor or memantine therapy. Discontinuation and switch treatment rates were significantly lower (49.7% vs. 58.0%; P<0.0001), and mean duration of initial treatment significantly longer, in Cohort 2 vs. 1 (349.3 vs. 300.2 days; P<0.0001).

CONCLUSIONS

Comparison of cohorts before and after revision of the national LTCI system for dementia patients found no significant difference in mean MMSE scores at the time of AD diagnosis or start of initial treatment. The reduction in the proportion of patients who discontinued or changed their initial treatment, and the significant increase in mean duration of treatment, were observed following revision of the LTCI policy which enabled increased patient access to long-term care.