Detection, diagnosis, and treatment of Alzheimer’s disease dementia stratified by severity as reported by caregivers in Japan

Figures & data

Figure 1 Short-Memory Questionnaire score by severity level.

Notes: The ends of the boxes shown above depict the lower and upper quartiles whereas the horizontal line in the middle of each box depicts the median value. The whiskers extending from each box show the range of the lowest or first quartile (Q1) and highest or third quartile (Q3) observation, or the interquartile range (IQR). °Indicates an outlier which is defined as a data point that is more extreme than Q1 − 1.5×IQR or Q3 + 1.5×IQR. ^*Indicates an extreme outlier which is defined as a data point that is more extreme than Q1 − 3×IQR or Q3 + 3×IQR.
Abbreviation LTCI, long-term care insurance.

Table 1 Caregiver and patient demographic characteristics

Caregiver/patient demographics and characteristics	LTCI-based severity
	Low (n=37)		Medium (n=191)		High (n=72)
Caregiver age, mean (SD), minimum to maximum	51.92 (9.81)	25–69	53.83 (11.31)	20–86	55.06 (10.82)	32–96
Age groups (%, n)
18–29	2.7	1	4.2	8	0.0	0
30–39	10.8	4	6.8	13	8.3	6
40–49	18.9	7	17.3	33	18.1	13
50–64	62.2	23	61.8	118	58.3	42
65+	5.4	2	9.9	19	15.3	11
Sex of caregiver (%, n)
Female	45.9	17	47.1	90	38.9	28
Male	54.1	20	52.9	101	61.1	44
Marital status (%, n)
Single	32.4	12	26.7	51	30.6	22
Married/living with partner	54.1	20	64.4	123	61.1	44
Divorced/separated/widowed	13.5	5	8.9	17	8.3	6
Average number of adults (>18 years) dependent (financially and/or taken care of) in household, mean (SD), minimum to maximum	1.86 (1.53)	0–7	1.96 (1.86)	0–7	1.39 (1.31)	0–4
Adults (>18 years) dependent in household (%, n)
0	18.9	7	28.3	54	36.1	26
1	24.3	9	19.4	37	19.4	14
2	32.4	12	18.8	36	19.4	14
3	8.1	3	14.7	28	19.4	14
4+	16.2	6	18.8	36	5.6	4
Average number of children (<18 years) dependent (financially and/or taken care of) in household, mean (SD), minimum to maximum	0.32 (0.82)	0–3	0.29 (0.74)	0–4	0.33 (0.71)	0–3
Children (<18 years) dependent in household (%, n)
0	83.8	31	83.8	160	77.8	56
1	5.4	2	7.3	14	13.9	10
2+	10.8	4	8.9	17	8.3	6
Employed (%, n)
Not employed, disabled, retired, student, or homemaker	21.6	8	30.4	58	37.5	27
Full-time, part-time, or self-employed	78.4	29	69.6	133	62.5	45
Change in employment status due to caregiving for AD dementia patient (%, n)
No	86.5	32	72.8	139	68.1*	49
Yes	13.5	5	27.2	52	31.9*	23
Patient age, mean (SD), minimum to maximum	82.70 (4.61)	72–96	83.54 (7.80)	38–100	84.64 (8.37)	64–106
Patient age groups (%, n)
<80	18.9	7	23.6	45	26.4	19
80–84	45.9	17	30.4	58	22.2*	16
85–89	29.7	11	24.1	46	19.4	14
90+	5.4	2	22.0	42	31.9*	23
Sex of AD dementia patient (%, n)
Female	75.7	28	77.0	147	84.7	61
Male	24.3	9	23.0	44	15.3	11

Notes: Bivariate comparisons used chi-square and binomial proportion tests for categorical variables and analysis of variance (ANOVA) with Bonferroni post hoc adjustments for continuous variables compared across disease severity;

* p<0.05 for difference between the value shown and the corresponding value in the same row in the low-severity column. Zero total values for any group were not analyzed.

Abbreviations: AD, Alzheimer’s disease; LTCI, long-term care insurance.

Figure 2 Caregiver time involved in AD dementia care.

Notes: Means and CIs are provided for the total average hours of care required per day.
Abbreviations: AD, Alzheimer’s disease; LTCI, long-term care insurance.

Table 2 Caregiver involvement and intensity in AD dementia care

Caregiver status	LTCI-based severity
	Low (n=37)		Medium (n=191)		High (n=72)
Average hours/week “personally responsible for providing care,” mean (SD), minimum to maximum	34.38 (55.11)	1–168	32.45 (40.19)	1–168	43.72 (47.34)	1–168
Hours/week “personally responsible for providing care” (%, n)
1–4	37.8	14	20.9*	40	15.3*	11
5–12	24.3	9	15.7	30	13.9	10
13–24	10.8	4	28.3*	54	27.8*	20
25–72 (1–3 days)	10.8	4	22.0	42	19.4	14
73–168 (3–7 days)	16.2	6	13.1	25	23.6	17
Total average hours of care required per day, mean (SD), minimum to maximum	8.78 (7.11)	0–24	12.58* (7.72)	0–24	16.18* (8.07)	1–24
Total average hours of care required per day (%, n)
0–6	45.9	17	28.8*	55	20.8*	15
7–12	32.4	12	24.6	47	15.3*	11
13–18	10.8	4	23.0	44	16.7	12
19–24	10.8	4	23.6	45	47.2*	34
Years providing care for the AD dementia patient (%, n)
<2	13.5	5	8.4	16	0.0	0
2 to <4	32.4	12	37.7	72	23.6	17
4 to <6	16.2	6	23.6	45	20.8	15
6 to <10	10.8	4	12.6	24	33.3*	24
≥10	10.8	4	10.5	20	16.7	12
Can’t recall	16.2	6	7.3	14	5.6	4
Caregiving role (%, n)
Primary: sole or shared responsibilities	54.1	20	64.4	123	52.8	38
Secondary: shared responsibilities	45.9	17	35.6	68	47.2	34

Notes: Bivariate comparisons used chi-square and binomial proportion tests for categorical variables and analysis of variance (ANOVA) with Bonferroni post hoc adjustments for continuous variables compared across disease severity;

* p<0.05 for difference between the value shown and the corresponding value in the same row in the low-severity column. Zero total values for any group were not analyzed.

Abbreviations: AD, Alzheimer’s disease; LTCI, long-term care insurance.

Table 3 Disease history responses in the current study sample

Disease history	LTCI-based severity
	Low (n=37)		Medium (n=191)		High (n=72)
Years since diagnosis of AD dementia by HCP (%, n)
<2	16.2	6	9.9	19	0.0	0
2 to <4	29.7	11	28.3	54	13.9*	10
4 to <6	8.1	3	15.7	30	22.2	16
6 to <10	13.5	5	15.2	29	29.2	21
≥10	2.7	1	5.8	11	12.5	9
Can not recall	29.7	11	25.1	48	22.2	16
Years since AD dementia symptoms first noticed (%, n)
<2	13.5	5	4.7*	9	0.0	0
2 to <4	18.9	7	19.9	38	8.3	6
4 to <6	8.1	3	17.8	34	12.5	9
6 to <10	8.1	3	14.7	28	30.6*	22
≥10	2.7	1	8.4	16	18.1*	13
Can not recall	48.6	18	34.6	66	30.6	22
Years from when symptoms first noticed to diagnosis of AD dementia by HCP (%, n)
<1	37.8	14	35.1	67	37.5	27
1 to <2	5.4	2	17.8	34	19.4*	14
≥2	5.4	2	11.0	21	12.5	9
Missing valuesΩ	51.4	19	36.1	69	30.6*	22
Person who first noticed patient’s symptoms (%, n)
Caregiver	43.2	16	60.7*	116	61.1	44
Patient’s family	48.6	18	45.5	87	44.4	32
Patient’s friend	2.7	1	2.1	4	1.4	1
Patient himself/herself	8.1	3	1.6*	3	1.4	1
Health care provider during routine visits	13.5	5	14.1	27	12.5	9
Do not know/can not recall	5.4	2	2.6	5	1.4	1
First AD dementia symptoms exhibited (%, n)
Memory problems that interfere with daily lifea	67.6	25	76.4	146	84.7*	61
Repetitionb	51.4	19	53.9	103	62.5	45
Language and writing problemsc	27.0	10	19.4	37	29.2	21
Personality changesd	27.0	10	28.8	55	31.9	23
Disorientation and confusione	32.4	12	27.2	52	34.7	25
Lack of hygienef	21.6	8	22.0	42	23.6	17
Odd behaviorg	32.4	12	33.5	64	31.9	23
Do not know/can not recall	0.0	0	2.1	4	1.4	1
Treatment for AD dementia
Top four most frequently reported medications (%, n)
Donepezil#	45.9	17	35.1	67	30.6	22
Galantamine#	13.5	5	4.2*	8	2.8*	2
Memantine#	10.8	4	14.1	27	13.9	10
Rivastigmine#	8.1	3	5.2	10	6.9	5
Two or more of top four medications	0.0	0	16.2	31	13.9	10
Other medications±	0.0	0	1.6	3	5.6	4
No medications	21.6	8	23.6	45	26.4	19

Notes: Bivariate comparisons used chi-square and binomial proportion tests for categorical variables and analysis of variance with Bonferroni post hoc adjustments for continuous variables compared across disease severity;

* p<0.05 for difference between value shown and corresponding value in the same row in the low-severity column. Zero total values for any group were not analyzed.

Ω Missing values include responses of “do not know/can not recall” to either of the variables, “years since diagnosis of AD dementia by HCP” and “years since AD dementia symptoms first noted.”

# Exclusive of any of the other top four most frequently reported medications in the study. “Two or more of top four medications” includes those patients who were prescribed at least two of the top four medications identified in the survey: donepezil, galantamine, memantine, and rivastigmine.

± Other medications include: alprazolam, brotizolam, ethyl loflazepate, etizolam, paroxetine, quetiapine, risperidone, sertraline hypdrochloride, sodium valproate, tiapride hydrochloride, yokukansan, and zolpidem tartrate.

a Forgetting recent experiences or important dates or events;

b Repeating stories or keep asking the same questions;

c Having problems remembering basic words, speaking is contorted, the ability to read and write also declines;

d Having sudden mood swings or experiencing emotions such as getting upset or angry for no particular reason;

e Getting lost in places they used to know very well or having trouble completing familiar tasks, like cooking dinner or shaving;

f Start wearing stained clothing or stop bathing but used to be well groomed/well dressed;

g Misplacing things in inappropriate places.

Abbreviations: AD, Alzheimer’s disease; HCP, health care provider; LTCI, long-term care insurance.