認知症高齢者が地域で継続して生活し続けるためには，適切な支援体制の構築が必要である．この役割を担う医療機関として，

兵庫医科大学病院は，認知症の専門医療機関である

今回，

【目的】当院は2014年に北海道地域型

【対象と方法】2020年4月1日から2021年3月31日の1年間に当センターに初診で受診した248名を対象に認知症の鑑別診断を行った。

【結果】正常5%、軽度認知障害（MCI）37%、アルツハイマー型認知症（ATD）26%、混合型認知症10%。レビー小体型認知症8%､血管性認知症（VaD）6%、前頭側頭型認知症（FTD）1%、その他13%であった。

【結論】脳神経外科医の担当するセンターはATDよりMCIが多く、物忘れの早い段階で受診していた。またVaDとATDの混合型が多い傾向にあった。

In Osaka City, an initial dementia support team was established as a model project at one region comprehensive support center in 2014. In 2015 three wards were examined with different doctor requirements and in 2016 it expanded to 24 teams in all 24 wards. Most of the team members doctors are non-specialists, the dementia disease medical center laid the backup system. Dementia support physicians who were in charge of the team members told us that participation in this project made it easier to recommend medical consultation to specialized medical institutions, through cooperation with local doctors and district medical associations. The cooperation with medical institutions became smooth, and regional collaboration was promoted, and the opinion that the role of dementia support doctor in the region became clear has been increasing.

There are a lot of elderly living alone or those who are refused support among the recipients. In addition, as the need for juvenile dementia has also arisen, the Community Support Promotion Committee, together with the team, will be placed at the same regional comprehensive support center, support to difficult cases will be required, and cases where continuous support beyond 6 months are required. It was here to be responsible for assisting. For the future development of this project, strengthen regional networks and promote relationships. It is thought that support based on a long-term perspective such as human resource development is necessary. It is suggested that this project is effective as an activity in the city.

日本は少子高齢化が世界で最も進み，認知症患者数の増加と生産年齢人口の減少はとどまることがない。認知症患者と認知症患者をケアする人たちができる限りその人らしい生き方ができるように，医療現場では多職種で連携して地域での生活を支える必要がある。認知症診療の拠点として

目的：本研究は，困難事例への対応において，地域の認知症支援システムに関わる専門職が，認知症サポート医に期待する役割を明らかにすることを目的とした．方法：対象は，2021年4月から2022年3月の期間に東京都健康長寿医療センター認知症支援推進センターおよび

The prevalence of dementia is constantly increasing because of the aging population, and it emerges not only as a medical but also a social problem in the world. Shortening the time from onset to diagnosis of dementia and providing appropriate medical and nursing care information from an early stage, can lead to the start of nursing care insurance services, and may affect the prognosis of patients and their families. Since 2014, we have implemented the “Project for Establishing a Medical and Nursing Care Coordination System for Dementia Care” as a joint project with the Mie Prefectural Medical Association and established the early detection and intervention system for dementia through outreach–type dementia care. Dementia IT Screening (DITS) is conducted for patients suspected of having dementia. When the family physician suspected the patient as dementia, the physician can order DITS. Cognitive function is assessed by Mini Mental State Examination (MMSE) and Brain Function Battery (BFB). Daily life is assessed with the Action Observation Sheet (AOS) and Dementia Assessment Sheet for Community–based Integrated Care System–21 items (DASC). The dementia specialist makes a comprehensive judgment for the necessity of visiting a specialized medical doctor. From April 2015 to March 2021, 708 examinees were tested. Of these, 415 (58.6%) were recommended to see a specialist medical doctor, 276 (66.5%) were referred to a specialist medical doctor, and 192 (69.5%) were diagnosed with dementia as a result of differential diagnosis. This system can provide the post–diagnosis support to the patients with dementia and their families by enabling early diagnosis through the corroboration between family physician and specialized medical doctor. Moreover, we also can promote medical and welfare cooperation between regional comprehensive support centers, early intensive support teams for dementia, and medical institutions.

本研究は，

　熊本県の医療センターの連携担当者および包括の専門職を対象とした半構成的面接により得られたデータを質的記述的に分析し，カテゴリー化した．その結果，医療センターの在宅療養継続支援は，【トリアージ】【医療センターにつなげる】【タイムリーな介入】【地域連携システムの構築】が，在宅移行支援では，【専門的な医療の提供】【在宅移行の調整】【療養場所の選択のための支援】が行われていた．包括との連携内容では，【医療センターの役割】【医療センターと包括の日常的な連携】【包括の役割】が抽出された．

　本研究の結果から，医療センターは，【トリアージ】【タイムリーな介入】【専門的な医療の提供】という独自の役割を果たしつつ，【地域連携システムの構築】にも力を注ぎ，認知症患者の在宅支援を行っていることが明らかになった．医療センターが担うべき在宅支援で重要なことは，医療センター独自の役割を遂行することである．そのためには，包括による【地域連携システムの構築】の促進を後押しする施策が必要であると考えられた．

地域における認知症高齢者の支援には、まず認知症の症状の把握とその診断・治療・ケアへの道筋を立てる必要がある。今回、

Japan has reach to a super aging society. Especially, Dementia measures are an important subject. For that reason, Initial–phase Intensive Support Team for dementia started. As one of them, health professional staffs visit the user's home. They advise to the family, and support users in a short period. They can deal flexibly by going around various places. As a result, we can get the cooperation of medical, nursing care and the region. With that Dementia people were able to the social inclusion. Role of Occupational therapists is to understand users from the cognitive empathy perspective. Further, it is important to prepare the living environment with family and other specialists.