[Early diagnosis, therapy, and long-term follow up of dementia]

Since the start of long term care insurance and the availability of cholinesterase inhibitor as a prescription drug in Japan, detection and diagnosis of dementia in the early stage of the disease has become an important issue. Neuropsychological screening and imaging tools usually employed for diagnosis are insufficient. The use of diagnostic criteria to designate early stage patients is still controversial. Several disease entities, including mild cognitive impairment (MCI) and age-associated memory impairment (AAMI), are not clearly defined in Japan. To study the prognosis of early stage dementia, it is important to define the diagnostic criteria. Clear identification and diagnosis of early stage dementia is important to support patients and their family members. The early detection of dementia and cognitive decline has other important aspects. One is the implication of disease diagnosis in the community; people often hesitate to use the name dementia in the early stage, even when the patients fulfill the criteria for dementia. Another aspect is the longer term follow up of the patients after early detection. For these purposes, it will become more important to emphasize a team approach consisting of medical doctors, nurses, neuropsychologists, clinical psychologists, occupational therapists and socialteam workers.