Higher Incidence of Deteriorated Mental Health in Older People Being Mistakenly Labeled as Dementia: A Two-Year Consecutive Community-Dwelling Study in Shanghai, China

Dementia has been increasingly paid attention by policymakers in China. However, the majority of the public has an indistinct concept of dementia and its diagnostic criteria. Therefore, many abnormal characteristics and actions of older people are labeled as having dementia while diagnosed without dementia. We examined a multi-stage cluster sample of 11,223 participants aged 60 years and above who have been clinically confirmed by general practitioners as not having dementia in 2013, and 7,861 participants were willing to participate the following study and were followed-up in 2014. To assess the differences of status of older people who were mistakenly labeled as having dementia or not, we asked main caregivers 'Do you think this older person suffers from dementia?', and found out that 244 participants had been mistakenly labeled as having dementia since 2013. Related effects were measured using international generic scales as well, and the results showed that participants with better physical status deteriorated more rapidly if they were mistakenly labeled as having dementia. Additionally, the mental health of these 244 participants also deteriorated more quickly. Older adults that were not labeled as having dementia were more willing to participate in social activities relative to their labeled counterparts. In conclusion, being mistakenly labeled as having dementia without a medical diagnosis impaired older adults' physical functioning and mental health. Moreover, the reduction of social activities of labeled older people leads to separation and social exclusion.

Emotional function in dementia patients

Behavioural and psychological symptoms of dementia, which can be considered as hyperreactivity of the emotional functioning of dementia, can be alleviated or aggravated by the behavioural and psychological symptoms of the caregiver. Comfortable stimulations of emotional function through sensory stimulations are effective methods for alleviating behavioural and psychological symptoms of dementia. Although cognitive function deteriorates with age, emotional function is often retained even in advanced years. Thus, it is recommended that care in patients with dementia be focused mainly on the stimulation of emotional function (e.g. sympathy and empathy, which are human traits), rather than relying solely on the stimulation of cognitive function.

Mini-Emotional State Examination for dementia patients

AIM

Emotional functions, as well as cognitive functions, are critical factors to assess in the care and management for dementia patients. In addition to the Mini-Mental State Examination (MMSE), we have developed a Mini-Emotional State Examination (MESE) for the examination of emotional functions in patients with dementia.

METHODS

MESE consists of a two-part questionnaire. The first probes emotional functions within the five senses (visual, auditory, tactile, smell and taste). The second explores more complex and comprehensive emotional functions including feelings of tenderness, violence, happiness and sadness, as well as emotional responses to more general human, moral and social phenomena. The questionnaire comprises 30 questions and is scaled to a 30-point healthy maximum. A total of 40 dementia patients in Sendai Tomizawa Hospital were tested with MESE.

RESULTS

MESE point scores were roughly parallel to the scores on the MMSE, but MESE scores were widely distributed, independent of MMSE score. MESE scores in nine patients exceeded 23 points.

CONCLUSION

The difference in distribution of MMSE and MESE scores show that cognitive and emotional functions are independently affected in dementia, and therefore assessment of both these functions should be cared taken into consideration in the care and management of dementia patients.