Neurocognitive disorders, depending on their type, can easily cause various complications. Some of these complications are difficult to prevent, while others can be prevented with caution. In this article, based on my clinical experience, I describe some principles of drug adjustment for preventing complications that clinicians should be aware of when prescribing drugs. I also note the importance of considering that such complications may be responsible for further cognitive dysfunction. Furthermore, I warn that disregarding these principles in cases of Lewy body dementia can result in serious pitfalls.

・To eat is very important for elderly with dementia not just nutrition.

・It is necessary to accept dysphagia in different types of dementia to prevent us from trouble with dysphagia.

・The aspect of dysphagia depends on the causes of dementia.

・Dealing with dysphagia is not training to restore the function of the case, but adjust the eating environment.

The risk of falling while in hospitalization for elderly people with dementia who are admitted to an acute hospital is always accompanied as long as the human performs some action such as walking. The elderly has also received advanced medical care, and delirium, side effects from treatment, and complications are more likely to occur, and as a result, falls are increasing. In general wards, trunk restraint and the use of leave-out sensors may be used to prevent falls, and behavior may be restricted, but physical restraint is prohibited except in emergencies and unavoidable cases for the purpose of respecting the dignity and autonomy of the elderly. Therefore, we felt that a process to visualize was necessary to implement effective fall prevention measures, and we examined fall prevention care using cases. It is well known to examine the assessment of physical condition, the expansion of rest, early removal of routes, and care for the establishment of the life rhythm. In addition , it was important for the patient to think about the meaning and the reason of patient’s action when we faced with unexpected behavior. It was necessary to intentionally try to know patient’s sense of values and outlook on life in the conversation of daily care. Sharing information with other occupations, assessing patients from their respective perspectives, watching over patients from multiple occupations, evaluating ADL and IEDL, and imagining life after discharge and examining countermeasures will lead to the prevention of complications caused by hospitalization of elderly people with dementia.

The novel coronavirus infection (COVID-19) has had a strong impact on older adults. Social environment changes have reduced opportunities to go out, resulting in physical and mental illnesses, which have become a major problem. Biological factors, such as direct infection of the brain due to the virus, vascular damage, and thrombus formation, have been reported as a result of COVID-19. In contrast, as for social factors, the social environment surrounding older adults is changing. The physical and mental effects caused by difficulties in going out due to infection control measures creates social isolation. Furthermore, economic factors also have an impact. Many unresolved issues still remain. Hence, it is necessary to take careful measures to prevent harm to the patient by providing appropriate medical treatment and social support. From this viewpoint, preventing infection and suppressing the development of post-infection symptoms, from a preventive perspective, will lead to the prevention of worsening of dementia.

In 2015, a comprehensive strategy to facilitate measures to deal with dementia, the so called “new orange plan”, was formed with an aim to achieve age- and dementia-friendly communities. Thereafter, an outline of measures for dementia was proposed to promote “living together” and “prevention” in 2019. This report explains a point of view of dementia prevention in the outline, and introduces an overview of first large-scale multimodal intervention trial for prevention of dementia in Japan (J-MINT study).

Objectives: We developed an effortful relief behavior related to anxiety and worries related to cancer recurrence and progression scale (ERBA-C), to assess these behaviors directed at managing anxieties and worries about cancer recurrence and progression. Methods: Ninety-four cancer survivors completed a questionnaire battery. Results and discussion: ERBA-C had a three-factor structure consisting of ten items. The scale had adequate internal consistency and generally supported the study’s hypotheses, which is indicative of its validity. Then, participants were divided into high and low groups based on their ERBA-C scores, and their ERBA-C features were examined. Results indicated that the “body checking” subscale score was positively correlated with anxiety in the high-score group, whereas the “recreational behavior” subscale score was negatively correlated with depression only in the high-score group. The function of relief behaviors and their relationship with distress differed based on the type and frequency of each relief behavior. Conclusion: Adaptive and maladaptive effortful relief behaviors can be accurately assessed using ERBA-C.

Purpose: The present study aimed to clarify nursing practices which attempt to minimize physical restraint based on a questionnaire survey of nursing ward managers. Methods: We conducted a questionnaire survey on the status of physical restraint and activities to minimize physical restraint in each ward of 447 general hospitals in the Tokai region (Shizuoka, Gifu, Aichi, and Mie prefectures). Results: Responses were received from 42 facilities and 134 wards. The average number of inpatients was 40.5, and the average number of physically restrained patients was 9.6. Conferences to end physical restraints were biased towards daily or weekly meetings. No relationship was found between the nursing system, the night shift system, the number of conferences, and the number of physically restrained patients. Physical restraint minimization activities included “use of bedside observation sensors,” “watching nurses,” and “removal of unnecessary infusion route.” Discussion: Nurses were trying to minimize restraints in a less painful way. In order to minimize physical restraint, it is necessary to carefully assess the patient’s needs.

Reports of serotonin syndrome are increasing due to the increased use of serotonergic agents. We report the case of a patient in whom the combined use of olanzapine and tramadol, which has a serotonin-noradrenaline re-uptake inhibitor (SNRI) effect, resulted in difficulty in diagnosing serotonin syndrome. This was due to the poor recognition that tramadol has a SNRI effect and the initial use of Sternbach’s diagnostic criteria instead of Hunter’s diagnostic criteria to diagnose serotonin syndrome and because olanzapine suppressed sympathetic nerve stimulation symptoms such as fever. Serotonergic agents are widely used in the psychiatric field. Therefore, psychiatrists should have extensive knowledge about serotonin syndrome, including the serotonergic agents used in other areas, diagnostic criteria, etiology hypotheses, and treatment.

Non-convulsive status epilepticus (NCSE) has a significant impact on the quality of life (QOL) of patients and their families due to the various behavioral and psychological changes resulting from impaired consciousness. Herein, we report a case in which psychological factors modified the symptoms during NCSE and led to a change in the treatment strategy. The patient was a woman in her late 30s with intractable epilepsy who had been diagnosed with frontal NCSE. Six months prior to admission to our hospital, she began to have impaired consciousness for 2 days during a 10-day cycle and intermittent excitation with gross motor symptoms. A long-term video-EEG (LVEEG) showed decreased reactivity, generalized muscle tension, and motor symptoms in the upper arms while NCSE was recorded. However, the symptoms disappeared after saline administration, without improvement in the EEG findings. After discharge from the hospital, outpatient treatment focusing on psychological issues and medication adjustment was continued and resulted in QOL improvement. To provide comprehensive support to patients, it is important to evaluate psychological and life aspects, even in those who have already been diagnosed with intractable epilepsy.