Living Better Together: Japan’s Bold Move To Fight Dementia Means Adapting To It

Every 3 seconds, someone in the world develops a condition that, unlike cancer, has no cure. Dementia is one of the fastest-growing syndromes, with the number of sufferers expected to triple to 150 million by 2050, according to the World Health Organization.

In Japan, dementia rates are high in part due to the country’s aging demographic. By the middle of the decade, 1 in 5 elderly Japanese are expected to be affected.

Many governments are developing national strategies for dementia. The UK has the Living Well with Dementia: National Dementia Strategy. The US has the National Plan to Address Alzheimer’s Disease.

In Japan, where the population is aging faster than in other countries, the Ministry of Health, Labour and Welfare has embarked on an initiative to train people so that they can support those with dementia. So far, about 12 million people have enlisted as “supporters” to help people with dementia live without compromises.

In 2019, Japan launched a new national strategy for dementia. The overarching goal is to strive toward a society in which people can live with a positive outlook even if they have dementia. The strategy takes consideration of the point of view of people with dementia and their families and promotes “co-existence” and “prevention.”

In sync with governmental measures, companies and local governments are also working on ways to promote co-existence in broader society and prevent dementia via the use of technology and new social systems.

Opening the Door to Each Other’s Reality

A simple and effective ways to delay the onset of dementia is to help those affected engage with the broader community. Silverwood Corp., a Japanese operator of homes for the elderly, is employing both high-tech and basic human solutions to foster such interaction.

The company’s Urayasu City facility is tucked away in a leafy alley and surrounded by bushes. From the outside, the home resembles an English wooden cottage.

Yet, the facility is anything but isolated. In fact, the home runs an open-door policy. The front door is unlocked, encouraging people from the local community to stop by and use the home’s cafeteria or buy sweets at its snack shop, which the home’s residents help to staff.

While getting lunch during a work day, people from the neighborhood naturally end up engaging and chatting with the folks from the home, some of whom have dementia, said Fumoto Shinichiro, head of the facility. In turn, the home’s residents are encouraged to interact with visitors and each other, even taking trips outside to local bath houses and so on.

The home allows locals to rent open space for private classes. Citizens with no relation to the home have come in to study English, or another topic, and ended up mingling with the residents. At one point, a private teacher ran a dance class that some of the elderly also joined, Mr, Fumoto said with a smile.

“A big principle of this facility is not to take away people’s freedom,” even if they have a condition like dementia, Mr, Fumoto said. By creating communal space for interaction, the well-being of residents has drastically improved, he said.

To make communication more meaningful, a few years ago Silverwood decided to create short films for viewing in Virtual Reality (VR) headsets that recreate what it is like for a person with dementia to navigate certain situations that others may think are very ordinary, such as travel on public transport.

Silverwood wanted to use VR’s first-person perspective to immerse the audience in the reality of those with dementia. The narrated films convey the actions and rationale of those affected by the condition.

One VR movie shows a person with visuospatial dysgnosia (a loss of spatial awareness) trying to disembark from a car. The viewer of the virtual reality film experiences a situation in which the request to disembark from a car feels akin to being asked to jump off a tall building. Thus, the cries of protestation from the person with dementia, which might seem random from the outside, have real meaning. They are based on a difference in the perceptions of reality. The film-makers sought to show the audience how gentle communication and understanding of the condition can overcome the situation.

Through word of mouth local government organizations, schools, hospitals, nursing homes, and businesses connected to social care started to contact Silverwood, asking about the project. Silverwood incorporated the films into educational seminars that try to deepen audience understanding of dementia both through a visual experience and discussion sessions.

The project has even featured in global media, prompting further inquiries for seminars from Southeast Asia and China.

“Many people think that those with dementia can no longer understand anything. That’s not true. They just have a different understanding,” said Kuroda Maiko, a member of Silverwood’s VR team. “We hoped the VR experience can help people approach those with dementia and know how to create an environment in which they feel safe and calm. It’s about finding a good co-existence, of making sure those that come into contact with people with dementia have a good understanding of the condition and can adjust their communication accordingly.”

Support for Dementia on a City-Wide Scale

Kobe City is an example of how Japan’s community care works on a larger scale. There are approximately 64,000 Kobe citizens with dementia; a further 56,000 suffer from Mind Cognitive Impairment (MCI), based on Ministry of Health, Labour and Welfare estimates¹.  The city decided that broader action was needed to improve the situation.

In 2018, Kobe became the first ordinance-designated city in Japan to pass a municipal order to establish Dementia-Friendly Community Development. By outlining the vision and the regulations framework, Kobe sent a signal to, and enlisted the support of, key local stakeholders: private businesses, academia, and citizens.

The ordinance also acted as a platform for research institutes, universities, and the Kobe Biomedical Innovation Cluster (KBIC), the city’s world-class hub for regenerative medicine, among other parties, to collaborate on finding ways to improve prevention and early intervention.

To have more people screened, Kobe City made an annual check-up for dementia free of charge. All expenses associated with a second, more detailed examination, which may involve MRI or CT scans, are also refunded.

Looking at the issue from the other side, Kobe City rolled out an accident relief system that compensates citizens who suffer injury in an accident caused by a person with dementia. The upper limit was set at 200 million yen.

Together, the diagnosis subsidy and accident relief programs are the first of their kind in Japan. The approach is now being called the “Kobe Model.” What’s more, Kobe society has shown its en masse commitment to the program by agreeing to raise local taxes to fully fund it.

Games as a Way to Prevent Cognitive Skill Loss

The strength of Japan’s approach to dementia, based on the pillars of co-existence and prevention, comes through creative use of resources and public-private-academic collaborations. When done well, the latter can lead to technological breakthroughs, business success, and better care. Among the standout cases is a cognitive function training software called the “Brain Activity Balancer CogEvo.”

Developed by local firm Total Brain Care Inc., with support from KBIC, the Life Sciences Institute, hospitals and research institutions, as well as other businesses, CogEvo uses simple shape- and number-based games to train the brain’s cognitive functions.

CogEvo uses 12 tasks to assess the five main cognitive functions: orientation, attention, memory, planning, and spatial awareness. The results of the test are visualized via charts and graphs. CogEvo’s approach has some similarity to the Mini Mental State Exam (MMSE), which is applied in many countries.

“Our main idea is to improve people’s cognitive functions, while also being able to visualize them,” which is to say: to create a picture of the brain at the time when dementia and other conditions initially develop, said Total Brain Care CEO Kawagoe Shinsuke.

The software can help a person spot early signs of cognitive decline by themselves. It intends to delay the onset and severity of dementia by promoting awareness of the condition and behavioral changes. Such careful self-monitoring can minimize impact on people and society.

Cognitive decline roughly mirrors the way that children learn cognitive skills in the first place, so it is important to find ways to help people retain those functions for longer, Mr. Kawagoe said.

Since its launch in 2016, CogEvo has been introduced in over 600 medical and care institutions in Kobe, as well as outside of the medical sphere. It is a great tool for people of all ages and conditions, said Mr. Kawagoe.

For CogEvo developers, bringing the tool to a mass audience supports a further cause: the build-up a large pool of data on human brain patterns, both from healthy people and those that have dementia. This will allow developers to map or “visualize” human cognitive functions, which will help improve treatment and act as one solution for Japan’s aging society, Mr. Kawagoe said.

Taking Health Matters into Your Own Hands

Kobe’s policies on dementia are part of a broader initiative by the municipality to improve the health of citizens, while revitalizing the local economy by encouraging public, private and academic collaborations.

“We’re promoting healthy living, but we’re also setting up platforms for innovation,” said Kobe City Health Innovation Manager, Miki Ryusuke.

One such platform is an app that gives citizens access to their Personal Health Record (PHR). A first in Japan, Kobe City launched the “My Condition Kobe” app in April 2019. Its aim is to give people control of their health data (and thus the motivation to improve their lifestyle).

In addition, the app’s data in anonymized form is offered to academic institutions that do research work with businesses. The partners can use the data to verify the effectiveness of new services or products under development. All that Kobe City asks is that businesses that utilize its data for R&D make sure the benefits somehow also trickle back down into the local community.

“As a government sector, we’re traditionally not good at creating new services, so the best way for us to accelerate innovation is by opening the data to the private sector, which can figure out the best way to use it,” Miki said.

The city encourages usage of the app with loyalty points. The points can be applied to get services such as CogEvo tests for free. In time, it is hoped that this will expand the app’s utility to allow for comprehensive healthcare analyses.

Given its public-private approach, the app’s integration of personal healthcare data and information from private healthcare tests could be used to research links between people’s diet, lifestyle, general health and the onset of dementia, among other conditions.

Japan’s approach to dementia, which involves the fusing of data, technology, and interactive human care makes the country an interesting pioneer in the field.

If the number of those afflicted by dementia globally follows the Japanese trend, the country’s co-existence and prevention strategy could become a starting point or even a model solution for other nations.