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). Cronbach's 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.Keywords: assessment tool, cognitive impairments, dementia, impairments in daily functioning, severity of dementia.
IntroductionThe community-based integrated care system is a new way of providing services. Through applying the concepts of community-based care (care that is rooted in a community) and integrated care (care that is provided in an integrated manner), it is expected to improve economic efficiency and users' satisfaction, as well as services' quality and access.1 This provision system seems especially adequate for people with dementia at risk of a deteriorating clinical condition with complex physical, mental and social problems. 2 The 2012 reform of the Long-term Care Insurance Act in Japan entrusted to local governments the task of implementing a community-based integrated care system. The Japanese Ministry of Health, Labor and Welfare used this opportunity to announce the implementation of a Five-Year Plan for Promotion of Dementia Measures (Orange Plan).3 This plan involves the creation of "Initial-phase Intensive Support Team (IPIST) for Dementia" to improve access to diagnosis and post-diagnostic community-based integrated care from the early stages of dementia. 4 This plan is nothing less than a practical attempt to implement a community-based integrated care syst...
Memory complaints exerted a negative impact on self-rated QOL in the MCI group, whereas a negative correlation was weak in the NC group. Memory training has been widely practised in individuals with MCI to prevent the development of dementia. However, such approaches inevitably identify their memory deficits and could aggravate their awareness of memory decline. Thus, it is critical to give sufficient consideration not to reduce QOL in the intervention for those with MCI.
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