Yohko Maki

Effects of Intervention Using a Community-Based Walking Program for Prevention of Mental Decline: A Randomized Controlled Trial

To evaluate the efficacy of a municipality‐led walking program under the Japanese public Long‐Term Care Insurance Act to prevent mental decline.

Factors associated with increased caregivers' burden in several cognitive stages of Alzheimer's disease.

To investigate factors associated with caregiver burden (CB) in persons caring for older adults with various cognitive stages of Alzheimers disease (AD).

Relative preservation of the recognition of positive facial expression "happiness" in Alzheimer disease.

BACKGROUND Positivity recognition bias has been reported for facial expression as well as memory and visual stimuli in aged individuals, whereas emotional facial recognition in Alzheimer disease (AD) patients is controversial, with possible involvement of confounding factors such as deficits in spatial processing of non-emotional facial features and in verbal processing to express emotions. Thus, we examined whether recognition of positive facial expressions was preserved in AD patients, by adapting a new method that eliminated the influences of these confounding factors. METHODS Sensitivity of six basic facial expressions (happiness, sadness, surprise, anger, disgust, and fear) was evaluated in 12 outpatients with mild AD, 17 aged normal controls (ANC), and 25 young normal controls (YNC). To eliminate the factors related to non-emotional facial features, averaged faces were prepared as stimuli. To eliminate the factors related to verbal processing, the participants were required to match the images of stimulus and answer, avoiding the use of verbal labels. RESULTS In recognition of happiness, there was no difference in sensitivity between YNC and ANC, and between ANC and AD patients. AD patients were less sensitive than ANC in recognition of sadness, surprise, and anger. ANC were less sensitive than YNC in recognition of surprise, anger, and disgust. Within the AD patient group, sensitivity of happiness was significantly higher than those of the other five expressions. CONCLUSIONS In AD patient, recognition of happiness was relatively preserved; recognition of happiness was most sensitive and was preserved against the influences of age and disease.

A Randomized Controlled Trial of Brain-Activating Rehabilitation for Elderly Participants with Dementia in Residential Care Homes

Background/Aims: We aimed to prove the effectiveness of brain-activating rehabilitation for dementia, which consisted of 5 principles: pleasant atmosphere, communication, praising, social role, and supportive care. Methods: The design was a randomized controlled trial that was not blinded. Fifty-four elderly participants with dementia (mean age: 85.2 years) were selected. Intervention based on the 5 principles of brain-activating rehabilitation was conducted for 1 h, twice a week, for 12 weeks (24 sessions). The control group had no treatment. Outcome measures consisted of two observation scales, namely sum of boxes in clinical dementia rating (CDR-SB) and the multidimensional observation scale for elderly subjects (MOSES), and two cognitive tests: the Hasegawa dementia scale revised (HDS-R) and trail making test A. Results: Repeated measure ANCOVA showed a significant interaction for total score of CDR-SB (F = 7.190, p = 0.015) and MOSES (F = 4.525, p = 0.038). There were no significant changes in the two cognitive test scores. Conclusion: Intervention based on the principles of brain-activating rehabilitation was effective in maintaining and improving daily life functions in elderly participants with dementia in residential care homes.

Intensive rehabilitation for dementia improved cognitive function and reduced behavioral disturbance in geriatric health service facilities in Japan

To examine the efficacy of rehabilitation for elderly individuals with dementia at intermediate facilities between hospitals and home, based on the policies for elderly individuals to promote community‐based care at home and dehospitalization.

Computerized visuo-spatial memory test as a supplementary screening test for dementia

Background:  To prepare for a super‐aging society, effective dementia screening tests are required. The most salient deficit appearing from the early stages of dementia/Alzheimers disease (AD) is a deterioration in memory. The Hasegawa Dementia Scale‐revised (HDS‐R) and the Mini‐Mental State Examination (MMSE) are widely used in Japan to screen for dementia. Both place an emphasis on memory function, but neither examines visuo‐spatial memory (VSM) function, even though VSM deficits are a sensitive marker for the detection of conversion to dementia. Furthermore, brief tests of VSM that are appropriate for screening have not been standardized. Thus, in the present study, we devised a brief, computer‐aided short‐term VSM test.

The impact of subjective memory complaints on quality of life in community-dwelling older adults

The aim of this study was to evaluate the impact of memory complaints on quality of life (QOL) in elderly community dwellers with or without mild cognitive impairment (MCI).

ORIGINAL ARTICLE: Computerized visuo-spatial memory test as a supplementary screening test for dementia

Background:  To prepare for a super‐aging society, effective dementia screening tests are required. The most salient deficit appearing from the early stages of dementia/Alzheimers disease (AD) is a deterioration in memory. The Hasegawa Dementia Scale‐revised (HDS‐R) and the Mini‐Mental State Examination (MMSE) are widely used in Japan to screen for dementia. Both place an emphasis on memory function, but neither examines visuo‐spatial memory (VSM) function, even though VSM deficits are a sensitive marker for the detection of conversion to dementia. Furthermore, brief tests of VSM that are appropriate for screening have not been standardized. Thus, in the present study, we devised a brief, computer‐aided short‐term VSM test.

Communicative Competence in Alzheimer’s Disease Metaphor and Sarcasm Comprehension

The purpose of this study was to evaluate the deficits of metaphor and sarcasm comprehension in Alzheimer’s disease (AD), as pragmatic interpretation such as metaphor and sarcasm comprehension is required in social communication. A total of 31 young normal controls, 104 aged normal controls (ANC), 42 patients with amnesic mild cognitive impairment (aMCI), and 30 patients with mild AD were evaluated by Metaphoric and Sarcastic Scenario Test, which consists of 5 metaphoric and 5 sarcastic questions with 5 answer choices. Scores were analyzed using the repeated measures analysis of variance (metaphor/sarcasm vs 4 participant groups). Sarcasm comprehension, which requires second-order Theory of Mind (ToM), started to deteriorate in ANC, and metaphor comprehension, which requires first-order ToM, started to deteriorate in aMCI, and both deteriorated as disease progressed. Literal interpretation of pragmatic language is characteristic in patients with mild AD. Such misinterpretation would result in social miscommunication, even if they still retained semantic-lexical competence.

Yamaguchi fox-pigeon imitation test: a rapid test for dementia.

Background/Aims: We herein propose a hand-gesture imitation test, consisting of a simple one-handed sign of a ‘fox’ and a complex two-handed sign of a ‘pigeon’, as a rapid, game-like test for detecting dementia/Alzheimer disease (AD) with low psychological burden. The test measures the visuomotor function, which deteriorates in the early stages of AD. Methods: We examined 88 demented subjects, 19 with mild cognitive impairment (MCI), and 53 normal controls aged 65 years or over. The subjects were classified according to the Clinical Dementia Rating (CDR). Results: The specificity of the test was 94%, and the sensitivity was 58% in CDR 0.5 (MCI), 77% in CDR 1 (mild dementia), 75% in CDR 2 (moderate dementia), and 90% in CDR 3 (severe dementia). The test could be conducted within 1 min and no subjects refused to be tested. Conclusion: This brief hand-gesture imitation test can sensitively evaluate visuomotor deficits in dementia/AD, while some subjects are unaware of their failure or even that their cognitive function is being tested. We herein describe the precise protocol for worldwide use.