Clinical characteristics of participants enrolled in an early identification and healthcare management program for dementia based on cluster analysis and the effectiveness of associated support efforts

Dynamics of Interaction among Professionals, Informal Supporters, and Family Caregivers of People with Dementia along the Dementia Care Pathway: A Nationwide Survey in Japan

This study aims to clarify the dynamics of information provision and human interaction to satisfy the needs of family caregivers. A questionnaire survey consisting of items on information received at and after diagnosis, persons and resources consulted, needs, and caregiver-oriented outcomes was conducted. Among the respondents, 2295 individuals who were caring for people with dementia were divided into quartiles by the time after diagnosis, and differences were statistically analyzed. The time after diagnosis in the first to fourth quartiles was 0.73 ± 0.4, 2.52 ± 0.49, 4.89 ± 0.73, and 10.82 ± 3.7 years, respectively. The number of persons consulted by family caregivers increased significantly from the first to the fourth quartiles (p < 0.001). During this time, attributes of professionals and informal supporters changed depending on the quartile. As time progressed, acceptance of the diagnosis increased, but so did its impact on the lives of family caregivers. These findings revealed differences over time in what family caregivers wanted and the dynamics of interactions that filled their needs. Informal supporters accounted for a significant proportion of the total resources. However, many family caregivers thought the information and support were insufficient. Thus, continuous reform of the care pathway is needed.

Effect of Diabetes Mellitus on Daily Functioning and Cognition of Alzheimer’s Disease Patients Evaluated by DASC-21

<b><i>Introduction:</i></b> Diabetes mellitus (DM) is a risk factor for Alzheimer’s disease (AD). It has also been pointed out that AD associated with DM may have unique characteristics. However, the characteristics of impairment in daily functioning when associated with DM have not been sufficiently investigated. <b><i>Methods:</i></b> In the present study, we compared the characteristics of 261 patients with AD diagnosed in the outpatient memory clinic of a university hospital, divided into diabetic and nondiabetic groups. The MMSE was used to assess cognitive function, and the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) was used as an observational method to assess cognitive function and activities of daily livings. The two groups were compared. Furthermore, simple and multiple regression analysis was carried out in order to find the independent association of age, sex, education, DM, and HbA1c with the DASC-21 and each individual item of the DASC-21. <b><i>Results:</i></b> Diabetic subjects were as follows: MMSE 18.8 ± 4.0, DASC-21 46.0 ± 13.2, and HbA1c 7.07 ± 1.24%, respectively. On the other hand, nondiabetic subjects were as follows: MMSE 19.0 ± 4.5 and DASC-21 42.1 ± 12.2, respectively. In the diabetic group, total score of DASC-21 was higher (DM vs. nondiabetes mellitus [NDM]: 46.0 ± 13.2 vs. 42.1 ± 12.2; <i>p</i> &#x3c; 0.05) and solving issues and common sense on the DASC-21 were higher than in the nondiabetic group (NDM) (DM vs. NDM: 8.58 ± 2.71 vs. 7.76 ± 2.66; <i>p</i> &#x3c; 0.05). Multiple regression analysis showed that the presence of DM was the significant determinant of solving issues and common sense on the DASC-21 (<i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> In AD patients, DM may be associated with impairment of solving issues and common sense.

Effects of the Participation and Involvement of Medical Professionals in Dementia Cafés on the Attendance of People with Dementia Living at Home and Their Family Caregivers

BACKGROUND

Dementia cafés have been attracting attention as a new approach to dementia care, but the effects of the participation of medical professionals remain unclear.

OBJECTIVE

To clarify the significance of collaboration between medical professionals and dementia cafés.

METHODS

Questionnaires regarding the numbers of staff and guests, whether medical professionals introduced guests, whether cafés announced their activities to medical institutions, and whether people with dementia played a role were sent to dementia cafés throughout Japan. The responding dementia cafés were then divided into two groups according to the presence or involvement of medical professionals and institutions and compared.

RESULTS

Responses were received from 148 dementia cafés, among which, medical professionals participated in 96 (64.9%). Significantly more people with dementia living at home attended cafés run or staffed with medical professionals (p = 0.021 and p = 0.017, respectively), as well as when medical professionals introduced guests to the café or when the café announced their activities to medical institutions (p = 0.001 and p = 0.002, respectively). Significantly more people with dementia played a role in cafés where medical professionals were administrators or staff (p = 0.008 and p = 0.018, respectively). Similar effects were observed for family caregivers.

CONCLUSION

The participation and involvement of medical professionals and institutions in dementia cafés increased the attendance of people with dementia, especially those living at home. These results suggest that dementia cafés are an effective hub for connecting care for dementia with medical care, and thus help avoid fragmentation in dementia care.