Tsuyoshi Okamura

Association between subjective memory complaints and mental health well-being in urban community-dwelling elderly in Japan

The prevalence of subjective memory complaints (SMC) among the elderly has been reported to be between 25% and 50%. Subjective memory complaints are currently the object of growing interest as a possible predictor for future dementia. However, the direct association between SMC and cognitive decline remains controversial. Our previous study based on 95 communitydwelling older adults aged 65 years and older showed that there was no relationship between objective memory impairment and SMC. Besides cognitive decline, variables such as education, sex, age and others might underlie SMC. As patients with SMC seem distressed by their subjective forgetfulness, we hypothesized that mental health well-being is an important correlate of SMC. Just a few community-based studies have investigated the relationship between SMC and mental health wellbeing in the elderly. We carried out a community-based, cross-sectional study that included 3195 Japanese persons who were: (i) community residents of Chiyoda ward, Tokyo, Japan; (ii) aged 65 years or older; and (iii) not having long-term care insurance certification. Each participant received a self-administered questionnaire. The questionnaire included items regarding SMC, sociodemographic factors (age, sex, years of education, living alone or not, at work or not, social support network) and health-related variables (subjective health, current physical illness, pain, instrumental activities of daily living [IADL], mental health well-being, daytime sleepiness), which might affect mental health well-being. Social support network was assessed by the Japanese version of the abbreviated Lubben Social Network Scale, mental health well-being by the World Health Organization Well-Being Index – five items, daytime sleepiness by the Japanese version of the Epworth Sleepiness Scale, and IADL by the Tokyo Metropolitan Institute of Gerontology Index of Competence. SMC were assessed by the question “Do you feel that your memory has worsened in the last 6 months?” Data were analyzed using PASW Statistics version 18 for Windows (SPSS, Chicago IL, USA). The stepwise linear regression analysis was carried out with SMC as the dependent factor, entering all the health-related variables, and sociodemographic factors including education, sex and age as independent variables. The significance level was set at a = 0.05. A total of 2034 participants (815 males, 1219 females) returned the questionnaire (response rate = 63.7%). The respondents’ mean age was 74.6 1 6.4 years and mean years of education was 13.2 1 3.0 years. Participants with no missing values for SMC (n = 1952) were analyzed. Among participants, 45.9% had SMC (males, 44.4%; females, 46.8%; c = 1.14, P = 0.153). The stepwise linear regression on SMC is shown in Table 1. In the final model, the significant correlates of SMC were lower mental health well-being, older age, daytime sleepiness, pain and lower IADL. The result shows mental health well-being is indeed an important correlate of SMC. In conclusion, findings of the current study, based on 2034 participants aged 65 years and older, show that SMC are significantly associated with lower mental health well-being along with older age, daytime sleepiness, pain and lower IADL among community-dwelling older adults in Japan.

Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community.

Polypharmacy is a serious medical problem among older adults. Polypharmacy can cause adverse drug reactions and is associated with frailty. Several drugs, particularly psychotropic medications, can cause cognitive impairment. Recent research also suggests that polypharmacy can cause cognitive impairment. We investigated the prevalence of polypharmacy, and examined the association between polypharmacy and cognitive impairment in a large sample of community‐dwelling older adults in Japan.

Development of the dementia assessment sheet for community-based integrated care system

A series of our studies on the development of the Dementia Assessment Sheet for Community‐based Integrated Care System 21‐items (DASC‐21) were reviewed. Study 1: to examine the distribution of scores and internal reliability of DASC‐21, trained nurses and researchers visited the homes of 1341 participants aged 65 years and older and living in the community. The nurses interviewed the participants and, when possible, their family members, to complete the DASC‐21. Then, the Mini‐Mental State Examination was carried out to select the participants of study 2. Study 2: to examine the concurrent and discriminant validity, experienced psychiatrists and psychologists, who were blind to the findings of study 1, visited the homes of 131 subjects who were selected from the participants of study 1 and completed the Clinical Dementia Rating (CDR), the Mini‐Mental State Examination and the Frontal Assessment Battery (FAB). Cronbachs coefficient alpha of the DASC‐21 was 0.808–0.950. Scores of the DASC‐21 significantly correlated with CDR total and box scores, Mini‐Mental State Examination and Frontal Assessment Battery. In an analysis of variance, CDR had the main effect on the score of the DASC‐21. Receiver operating characteristic analysis showed that the DASC‐21 had sufficient discriminatory ability between dementia (CDR1+) and non‐dementia (CDR0 or CDR0.5; area under the curve = 0.804–0.895). When using a cut‐off point of 30/31, sensitivity was 83.3–94.1% and specificity was 77.3–86.4%. The DASC‐21 has sufficient reliability and validity as a tool to evaluate impairments in daily functioning and in cognitive functions, to detect dementia, and to assess the severity of dementia in the community. Geriatr Gerontol Int 2016; 16 (Suppl. 1): 123–131.

Distribution of Mini-Mental State Examination scores among urban community-dwelling older adults in Japan.

The Mini‐Mental State Examination (MMSE) is widely used as a cognitive screening test for older adults; however, cognitive performance can be affected by age, education, and sample selection bias, including time and place. The aims of this study were to examine the distribution of scores on the Japanese version of the MMSE in an urban community sample and to provide normative data for older Japanese adults.

Excessive daytime sleepiness is related to subjective memory impairment in late life: a cross-sectional community-based study

The aim of this study was to determine whether daytime sleepiness is related to subjective memory impairment among community‐dwelling elderly people, after adjustment for psychosocial variables.

Factors associated with mental well‐being of homeless people in Japan

This study aimed to determine the frequency of low mental well‐being and associated factors among homeless people in Japan.

Characteristics of Individuals With Mental Illness in Tokyo Homeless Shelters

OBJECTIVE Japan has the largest number of psychiatric beds in the world and has been in the process of deinstitutionalization since 2004. The majority of psychiatric inpatients are elderly long-term patients, who are at risk of homelessness after they are discharged. There is little information about homeless people with mental illnesses in Japan, and the aim of this study was to describe characteristics of people with a mental illness in homeless shelters in Tokyo. METHODS A face-to-face survey was conducted from December 2012 to March 2013 by the staff of a nonprofit organization (NPO) that helps socially isolated persons. Of the 1,056 people who received help during the study period, 684 completed the survey. RESULTS Eighteen percent of the 684 survey participants had a mental illness. Of the 210 individuals who lived in shelters, one-third had a mental illness. The mean age of shelter users with mental illness was 64.9; they tended to be referred from hospitals, and their mental well-being was poorer than other NPO service users in the study. Among the service users with mental illness, those living in shelters were older than those living in the community and more likely to have a history of trouble with alcohol, poor family relationships, and impaired instrumental activities of daily living. CONCLUSIONS Unmet mental health needs were noted among discharged hospital patients living in Tokyo homeless shelters. An integrated and community-based support system with more effective health care delivery, including critical time interventions, is needed.

Psychiatric intervention and repeated admission to emergency centres due to drug overdose

Background Repeated drug overdose is a major risk factor for suicide. Data are lacking on the effect of psychiatric intervention on preventing repeated drug overdose. Aims To investigate whether psychiatric intervention was associated with reduced readmission to emergency centres due to drug overdose. Method Using a Japanese national in-patient database, we identified patients who were first admitted to emergency centres for drug overdose in 2010–2012. We used propensity score matching for patient and hospital factors to compare readmission rates between intervention (patients undergoing psychosocial assessment) and unexposed groups. Results Of 29 564 eligible patients, 13 035 underwent psychiatric intervention. In the propensity-matched 7938 pairs, 1304 patients were readmitted because of drug overdose. Readmission rate was lower in the intervention than in the unexposed group (7.3% v. 9.1% respectively, P<0.001). Conclusions Psychiatric intervention was associated with reduced readmission in patients who had taken a drug overdose. Declaration of interest None. Copyright and usage

Elderly men in Tokyo homeless shelters who are suspected of having cognitive impairment

Along with the ageing of populations of developed countries, the progressive ageing of the homeless population has also been reported. We previously reported that the mean age of shelter users in Tokyo was around 65 years. This is older than the mean age reported in Western countries, which one systematic review reported to be 40.1 years. According to Ennis et al., having cognitive impairment increases the risk of becoming and remaining homeless because it may interfere with an individual’s ability to function independently in the community. Despite its potential for increased prevalence, cognitive impairment among the homeless population in the most aged society in the world — Japan — has not been previously reported, to the best of our knowledge. The aim of this study was to assess cognitive impairment among elderly men who stay in homeless shelters in Tokyo. All participants in this study were elderly men, aged 65 years or older, who were living in homeless shelters managed by a non-profit organization (NPO) in Tokyo. A list of the names and locations of the shelter users over 65 years who participated in the NPO’s own survey was provided to our team. Then, a researcher (T. O.), who is a certified psychogeriatrician, visited the users and conducted an interview on site. The study protocol was approved by the ethics committees of the NPO and the Tokyo Metropolitan Institute of Gerontology. The NPO staff asked users if they were willing to participate in the interview. Then, those who volunteered were introduced to the researcher. Written informed consent was obtained from all participants before the investigation in front of the NPO staff. Statistical analyses were performed using the SPSS software version 22 (IBM, Armonk, NY, USA). Cognitive impairment was assessed with the MiniMental State Examination (MMSE). As in the literature, a cut-off of 23/24 was employed in this study to determine cognitive impairment. After the unstructured interview concerning the individual’s social history, the presence of major depressive episodes, suicidality, and psychotic disorders was also assessed with items adapted from the Japanese version of the Mini-International Neuropsychiatric Interview. Among the 113 individuals on the list of shelter users, 49 had left the shelters, 10 refused to participate in the study, and 54 participated. The mean age of participants was 72.8 5.9 years. They had a mean of 9.5 3.1 years of education, which is the equivalent of the nation’s compulsory educational level. Seven participants had already been diagnosed with dementia, and the staff suspected another nine participants of having dementia. Our results are shown in the Table 1. Of the 54 participants, 51 completed the MMSE. Their mean score was 16.8 7.0, and 40 of the 51 participants (78.4%) scored below the MMSE cutoff point (<24). This is higher than the results of the studies abroad. According to the literature, cognitive impairment was found between 0% and 21% of homeless people who were assessed using the MMSE (cut-off: 23/24). Contrary to our expectation, there was no difference in the mean MMSE score between those under 75 years and those over 75 years (t-test, P = 0.44). Of 50 participants, six (12.0%) were diagnosed with a major depressive episode, and four (8.0%) were at risk for suicide. Although those suffering from a depressive episode were expected to show lower cognitive function, there was no significant difference in the mean MMSE score between those with and without depressive episode (t-test, P = 0.81). No participant was suspected of having a psychotic disorder during this study. One possible explanation is that elderly people with a schizophrenic disorder and who are at risk of homelessness are already in psychiatric hospitals. Japan has the largest

A case of recurrent depressive disorder presenting with Alice in Wonderland syndrome: psychopathology and pre- and post-treatment FDG-PET findings

BackgroundAlice in Wonderland syndrome (AIWS) is a rare neuropsychiatric syndrome that typically manifests in distortion of extrapersonal visual image, altered perception of one’s body image, and a disturbed sense of the passage of distance and time. Several conditions have been reported to contribute to AIWS, although its biological basis is still unknown. Here, we present the first case demonstrating a clear concurrence of recurrent depressive disorder and AIWS. The clinical manifestations and pre- and post-treatment fluorodeoxyglucose positron-emission tomographic (FDG-PET) images provide insights into the psychopathological and biological basis of AIWS.Case presentationWe describe a 63-year-old Japanese male who developed two distinct episodes of major depression concurrent with AIWS. In addition to typical AIWS perceptual symptoms, he complained of losing the ability to intuitively grasp the seriousness of news and the value of money, which implies disturbance of high-order cognition related to estimating magnitude and worth. Both depression and AIWS remitted after treatment in each episode. Pre-treatment FDG-PET images showed significant hypometabolism in the frontal cortex and hypermetabolism in the occipital and parietal cortex. Post-treatment images showed improvement of these abnormalities.ConclusionsThe clinical co-occurrence of depressive episodes and presentation of AIWS can be interpreted to mean that they have certain functional disturbances in common. In view of incapacity, indifference, devitalization, altered perception of one’s body image, and disturbed sense of time and space, the features of AIWS analogous to those of psychotic depression imply a common psychopathological basis. These high-order brain dysfunctions are possibly associated with the metabolic abnormalities in visual and parietotemporal association cortices that we observed on the pre- and post-treatment FDG-PET images in this case, while the hypometabolism in the frontal cortex is probably associated with depressive symptoms.