The behavioral pattern of patients with frontotemporal dementia during the COVID-19 pandemic How the coronavirus 2019 pandemic affects patients with frontotemporal dementia?

Background: Under the COVID-19 outbreak, the Japanese government has strongly encouraged individuals to stay at home. The aim of the current study was to clarify the effects of the COVID-19 outbreak on the lifestyle of older adults with dementia or mild cognitive impairment (MCI) who live alone.Methods: Seventy-four patients with dementia or MCI aged ≥65 years, who regularly visited the dementia clinic of the

Background: Patients with diabetes are at a higher risk for cognitive decline. Thus, biomarkers that can provide early and simple detection of cognitive decline are required. Neurofilament light chain (NfL) is a cytoskeletal protein that constitutes neural axons. Plasma NfL levels are elevated when neurodegeneration occurs. Here, we investigated whether plasma NfL levels were associated with cognitive decline in patients with type 2 diabetes. Method: This study included 183 patients with type 2 diabetes who visited Osaka University Hospital. All participants were tested for cognitive function using the Mini-Mental State Examination (MMSE) and the Rivermead Behavioural Memory Test (RBMT). NfL levels were analysed in the plasma and the relationship between NfL and cognitive function was examined. Results: Lower RBMT-standardized profile scores (SPS) or MMSE scores correlated with higher plasma NfL levels (one-way analysis of variance: MMSE, P = 0.0237; RBMT-SPS, P = 0.0001). Furthermore, plasma NfL levels (β = À0.34, P = 0.0005) and age (β = À0.19, P = 0.016) were significantly associated with the RBMT score after multivariable regression adjustment. Conclusions: Plasma NfL levels were correlated with mild cognitive decline which is detected by the RBMT but not the MMSE in patients with type 2 diabetes. This suggests that plasma NfL levels may provide a valuable clinical tool for identifying mild cognitive decline in patients with diabetes.

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Introduction: In Japan, the number of automated external defibrillators (AEDs) placed in public areas has climbed up to the estimated 530,000. We reported previously that a half of out-of-hospital cardiac arrests occurred within 100 m from a public AED in urban areas. However, shocks for defibrillation were given to less than 15% of those patients. The objectives of this study was to identify the limiting factors against the use of AEDs by bystanders. Methods: A prospective survey on out-of-hospital cardiac arrest was conducted in the city of Osaka (Dec 2016 through Mar 2017) and the city of Nagoya (Dec 2016 through Nov 2017) searching for patient demographics and AED settings including; absence/presence of a public AED on the scene, attachment of AED pads, delivery of shocks before the time of EMS arrival. Results: Of 558 cases of cardiac arrest registered during the survey period, an AED had already been delivered at the patient side by the time of EMS arrival in 92 case (16.5%). Of those, pads had been attached in 89 cased (96.7%). Shocks had been advised in 35 cases (39.3%) and to all but one of those cases at least 1 shock had been given by the bystanders. There were no statistically significant differences between the groups of cases with and without AEDs at the patient side regarding the patient age (65 years [IQR: 48-74] vs 63 years [IQR49-75], p=0.84), gender (p=0.68) and the time from call to EMS arrival (7 min [IQR: 6-9] vs 7 min [IQR: 6-9], p=0.74). Cases occurring indoors had more chances of AEDs being delivered on the patient side than cases occurring outdoors (24.0% vs 7.8%, p<0.001). Conclusions: Our study indicates that once an AED is delivered at the patient side, pads are successfully attached and shocks are given if indicated in almost all cases. This suggests that finding and delivering an AED onto the patient side are the limiting factors against the use of AEDs by bystanders. In order to popularize the use of AEDs by bystanders, informing people with AED placement and clear direction to the AED location seem to be the key steps.

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Introduction: We have previously estimated the cost of and quality-adjusted life year (QALY) gained with ~200,000 AEDs placed in Japan between 2004 through 2009, and reported that the maximum likelihood estimate (MLE) of the incremental cost-effectiveness ratio (ICER) to be ~$93,980/QALY. To evaluate the robustness of the estimated ICER, we conducted a sensitivity analysis using Monte Carlo simulation. Methods: Over the study period, 3,927 patients received public access defibrillation (PAD). A control group was created by extracting, from the national database, another group of 3,927 cardiac arrest patients who did not receive PADs but otherwise matched with regard to confounders including age, sex, response time and others. The difference of the total QALY in the 2 groups yielded incremental effectiveness gained by the PAD program. The sum of the total cost for AED purchase and maintenance, cost of BLS training for first responders, and differential cost for medical care yielded the incremental cost. The value for each variable needed to calculate the incremental cost and effectiveness was randomly varied in such a way that followed the pre-defined probability density function (Table). Monte Carlo simulation was repeated 10,000 times to estimate the MLE and its 95% CI for ICER. Results: The MLE (95% CI) for the incremental cost and incremental effectiveness was ~$ 580 million (577- 583 million) and ~7,559 (6,298- 8,858) QALY, yielding ICER of $77,320 ($65,503- 92,017) /QALY (figure). Conclusions: Our estimate of the ICER seemed to be relatively robust to several assumptions. The ICER of the whole Japan PAD program seemed to be higher than desirable but still acceptable.

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