Megumi Nakai’s research while affiliated with Tohoku University and other places

Objectives: The group reminiscence approach (GRA) and reality orientation (RO) are common psychosocial interventions for patients with dementia. As a qualitative evaluation of the reminiscence approach in patients with dementia, the Patient Report Outcome (PRO) is useful. The purpose of this study was to investigate the effects of GRA-RO for participants with mild cognitive impairment (MCI) using the PRO. Design: A cluster randomized controlled trial. Setting: Community-based study. Participants: Ninety-four patients with MCI (39 GRA-RO, 23 physical activity, and 32 cognitive training) described their impressions. Intervention: Based on the database of the Kurihara Project, we retrospectively analyzed the participants' descriptions of their impressions as a PRO in the nonpharmacological interventions: GRA-RO, physical activity, and cognitive training. We categorized the descriptions according to the following 2 types: impression with content and reminiscence with life review. We assessed what they wrote regarding memory loss. The content on their life reviews was also a particular focus for the GRA-RO group. Measurements: PRO. Results: Compared with the physical activity and the clinical training groups, the GRA-RO patients described their reminiscence with life review and their own memory problems. There was no confusion of the order of events of their autobiographical memories. There was a significant time effect between the 2 family involvement groups in quality-of-life (QOL) scores, and the postintervention QOL scores were significantly better than preintervention. Conclusion: This study suggests that the GRA-RO in participants with MCI not only stimulates life review but also increases self-awareness of memory deficits without confusion of the order of events. Thus, the GRA-RO may improve self-esteem and develop self-awareness.

The aim of this study was to estimate the prevalence of apathy, and to compare vascular mild cognitive impairment (vMCI), amnestic MCI (amMCI), and other type using Clinical Assessment for Spontaneity (CAS). Agreement to take part in the study was obtained from 590 community dwellers, aged ≥75 years living in Kurihara, Japan. Of the 590 subjects, 221 had a clinical dementia rating (CDR) of 0 (normal); 295 had CDR 0.5 (mild cognitive impairment; MCI); and 74 had CDR 1+ (dementia). The CDR 0.5 subjects were divided into three groups: 55 with vMCI (Erkinjuntti et al. criteria), 91 with amMCI and 149 with other type. To evaluate the various aspects of apathy, we used the three CAS subscales: clinical interview (CAS1), self-evaluation (CAS2), and caregiver assessment (CAS3). Three analyses were then performed to determine: (i) the validity of CAS; (ii) the prevalence rate of apathy in CDR 0 versus CDR 0.5 versus CDR 1+; and (iii) the prevalence rate of apathy in normal versus vMCI versus amMCI versus other type. CAS was validated with the Apathy Evaluation Scale. There were significant differences among the three CDR groups in CAS1, CAS2 and CAS3 (P < 0.001). The prevalence rate of apathy in each CAS in the CDR 1+ group was higher than the CDR 0.5 group, which was higher than the CDR 0 group. There was a significant difference in CAS3 score between the four groups (the normal and the three subgroups; P < 0.001). Apathy in vMCI was more severe than in the other three groups (P < 0.05) on CAS3 score. vMCI subjects have more severe apathy compared with amMCI subjects on caregiver assessment.