[What a psychiatrist should do in dementia care]

On June 18, 2012, a project team for dementia care in the Ministry of Health, Labour and Welfare (MHLW) released a report on future approaches in medical care for dementia. Based on this report, the "5-year plan for promoting dementia measures ("Orange Plan")" was released on September 5. The Orange Plan clearly aims to limit the roles of psychiatry in dementia care to the management of behavioral and psychological symptoms, and to minimize the involvement of psychiatry through implementation of stricter requirements for hospitalization and measures for facilitating discharge. Based on my experience, many of the patients making initial visits to outpatient clinics specializing in dementia are relatively mild cases, and they are typically aware of their condition. Among patients admitted to psychiatric wards, those in acute wards are mostly relatively young men. while those in wards for long-term care comprise mostly elderly women with complications. As opposed to the needs of patients in dementia, the medical needs recognized by policymakers are the needs of the care providers. I have stated that, based on the needs of patients, medical care for dementia should be divided as follows: early diagnosis; early psychiatric and psychological support for patients ; management of behavioral and psychological symptoms; medical care for complications; and terminal care. Furthermore, psychiatrists should be actively involved at each stage. I have also emphasized that providing high-quality psychiatric support for patients with anxiety during the mild phase of cognitive dysfunction greatly influences the subsequent course of illness.