Points of View Symbiosis with Disease in Dementia

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Minoru Ito, Senior Researcher, Pharmaceutical and Industrial Policy Research Institute

1. Introduction

It is needless to say that "prevention" and "diagnosis and treatment" are important to extend healthy life expectancy, but it is equally desirable to "coexist" with diseases so that people can live with as few restrictions as possible even if they suffer from diseases. In the previous issue of the ISSP News (No.62) 1) , the author reviewed the coexistence with disease among cancer survivors and pointed out that in order to realize a society in which people can live with cancer, it is necessary to understand the situation and needs of patients, build a support system based on this understanding, provide support through collaboration among multiple professions, and provide a coordinating function to ensure this collaboration. In addition, pharmaceutical companies should contribute not only through innovative drug discovery, but also from the viewpoint of coexistence with disease. In this issue, we review the symbiosis with dementia, a disease for which the importance of countermeasures is expected to increase in Japan in the future, and discuss the contribution of pharmaceutical companies.

2. Status of dementia

According to ICD-10 (1993), dementia is "a syndrome usually caused by chronic or progressive brain disease and consisting of numerous higher brain dysfunctions, including memory, thinking, disorientation, comprehension, calculation, learning, language, and judgment .) 2) As shown in the prevalence of dementia by age group (Figure 1), the prevalence rate increases with age, from 2.9% for those aged 65-69 to 79.5% for those aged 95 and older. According to future estimates based on a longitudinal survey conducted by Hisayama-cho, Fukuoka Prefecture, the number of people with dementia in 2025 is estimated to be 6.75 million, assuming that the prevalence rate for each age group remains constant after 2012, and is expected to exceed 8 million by 2040.
（As stated in the National Policy on Dementia (June 18, 2048) 4), it is appropriate to consider that "dementia is a disease that anyone can get, and it has become familiar to many people, including those who have dementia in their family or close ones.

Figure 1 Prevalence of dementia by age group
Figure 2 Estimated future number of people with dementia

3. Concerns (needs) held by people with dementia and their families

In a summary of the "Public Opinion Survey on Dementia" conducted by the Government Public Relations Office of the Cabinet Office in December 2028, 5) it was announced what people feel anxious about when they have dementia (Figure 3). (Figure 3)

Figure 3. Anxiety about dementia (top six concerns of the respondents themselves)

The results showed that the top concerns were physical and mental burden on family members, inconvenience to others outside the family, forgetting family and memories, difficulty in daily life (shopping, cooking, driving, etc.), not knowing how to get home when going out, and financial burden.

The survey also asked respondents about the concerns they would have if a family member developed dementia (Figure 4). (Figure 4) Although the top concerns were almost the same as those that would arise if the family member himself or herself were afflicted with dementia, some respondents also expressed concern that it would be difficult to continue working as a caregiver. Such anxious feelings can be interpreted as representative of the needs of people with dementia and their families, and support focusing on this aspect is required.

Figure 4. Anxiety about dementia (family members, top 6 items)

4. History of dementia policy since 2012

An overview of dementia policies since 2012 can be considered to have gone through three main stages of transition and enhancement.

First, in June 2012, the Ministry of Health, Labor and Welfare's Dementia Study Project Team compiled the "Future Direction of Dementia Policies " 6) and in September of the same year, the "Five-Year Plan to Promote Dementia Policies (Orange Plan) 7) was released. The Orange Plan was designed to change the conventional thinking that "people with dementia have no choice but to use psychiatric hospitals and facilities," and to realize "a society in which people with dementia can continue to live in a good environment in their familiar neighborhoods as long as possible, with their wishes being respected. The seven concrete measures include: (1) creation and dissemination of standard dementia care paths, (2) early diagnosis and early response, (3) establishment of medical services that support life in the community, (4) establishment of nursing care services that support life in the community, (5) strengthening support for daily life and family in the community, (6) strengthening measures for juvenile dementia, and (7) development of human resources to provide medical and nursing care services. (vii) Training of human resources responsible for medical and long-term care services, and others.

Next, in January 2015, the "Comprehensive Strategy for Dementia Policy Promotion (New Orange Plan) - Toward the creation of dementia-friendly communities for the elderly with dementia, etc. 8) was formulated. Recognizing that the number of people with dementia is expected to further increase as the population ages, the plan states that "people with dementia should not be considered merely as supporters, but should be provided with an environment that enables them to live well with dementia. The policy also includes the following seven pillars. The following seven measures were also proposed. (1) Promotion of dissemination and awareness-raising to deepen understanding of dementia, (2) Provision of timely and appropriate medical care and nursing care according to the condition of dementia, (3) Strengthening measures for juvenile dementia, (4) Support for caregivers of persons with dementia, (5) Promotion of community development friendly to the elderly including persons with dementia, (6) Methods of prevention, diagnosis and treatment of dementia, rehabilitation models, care models, etc., and promotion of the dissemination of their results; and (7) emphasis on the perspectives of people with dementia and their families.

Most recently, in June 2019, the "Outline for Promotion of Dementia Policies " 4) (hereinafter referred to as the "Outline") was compiled, which states, "Dementia is something that anyone can have and is familiar to many people, and the aim is to delay the onset of dementia and create a society where people can live their daily lives with hope even if they have dementia, while emphasizing the perspectives of people with dementia and their families. The new concept of "prevention" has been added to the existing concept of "symbiosis," which has always been the basis of the concept. It also clearly states the goal of "delaying the onset of the disease in people in their 70s by one year over the next 10 years.

Figure 5 Five pillars of specific measures in the National Outline for the Promotion of Dementia Policies

Furthermore, based on this basic concept, the plan states that measures will be promoted along the following five pillars: (1) public awareness and support for individuals with dementia, (2) prevention, (3) support for medical care, care services, and caregivers, (4) promotion of barrier-free access to dementia, support for people with juvenile dementia, and social participation, and (5) research and development, industry promotion, and international expansion. (Figure 5)

Below, we will review the specific details and status of support for people with dementia and their families by looking at each of the measures and their progress in the outline.

5. Measures and their progress in the general framework

5-1. Public awareness-raising and support for communicating with the person with dementia

In order for people with dementia and their families to continue to live as they are in a good community environment, it is necessary to deepen society's understanding of dementia and to create a community where people with and without dementia can be part of the same society together. To this end, it is being promoted to train " dementia supporters " who have correct knowledge and understanding of dementia and who can help people with dementia and their families in the community and at their workplaces. Dementia Supporter training courses are held in municipalities and workplaces, and the number of Dementia Supporters is approximately 13.17 million10) as of the end of March 2021. The main activities of these supporters are to watch over their neighbors, hold and participate in dementia (orange) cafes (see below), and cooperate in the holding of training courses (Figure 6). (Figure 6) In the future, training courses will be expanded to include employees, children, and students in industries (retail, financial institutions, public transportation, etc.) where people with dementia are likely to interact with people in the community.

Figure 6 Status of activities of dementia supporters (top 5 items)

In addition, there is a need to develop a consultation system at " Community Comprehensive Support Centers," which are comprehensive contact points for community health and medical care and long-term care. As of the end of April 2018, there were 5,097 such centers in all municipalities13) . As of the end of April 2018, there were 5, 097 locations in all municipalities13). In recent years, the volume of work has been increasing, and strengthening the operational and staffing structure has become an issue. In addition, there is a need to disseminate information that clearly conveys how to use specific consultation and consultation centers, and the development and utilization of " dementia care paths " is being promoted. The "Dementia Care Path" is a standardized guide that outlines in advance where to consult and the flow of medical and nursing care services to be used, from the stage of prevention of the onset of dementia to the final stage of life. (Figure 7) As of the end of June 2020, 85.5% of municipalities have created this system12).

Fig. 7 Image of dementia care pass

It is believed that the sight of people with dementia being active and lively can be an opportunity to change society's view of dementia, and also give hope to many people with dementia. From the viewpoint of dispelling the uniform and negative image of dementia, it is meaningful to actively support people with dementia in communicating their stories in their own words. Projects such as appointing people with dementia to serve as " Ambassadors of Hope " to spread awareness about dementia have been promoted, and five people were appointed in January 202012).

Prevention

Dementia prevention includes delaying the onset of the disease or reducing the risk of onset (primary prevention), early detection and early response (secondary prevention), prevention of severe disease, maintenance of function, and prevention and response to behavioral and psychological symptoms (tertiary prevention). Prevention" in the general guidelines does not mean "not developing dementia," but rather "delaying the onset of dementia" and "slowing the progression of dementia even if it does occur.

It has been suggested that improving physical inactivity, preventing lifestyle-related diseases (diabetes, hypertension, etc.), and reducing social isolation and maintaining roles through social participation may contribute to dementia prevention. For this reason, it is important to promote activities in the community that utilize "places to go" for elderly people to gather, social participation activities, learning, and so on. The main activities offered at these places include exercises, tea ceremonies, and hobby activities. 6.7% of the elderly population participated in these activities in FY202815). In addition, health consultations by family doctors, public health nurses, dietitians, and other professionals may delay the onset of dementia, reduce the risk of onset, and lead to early detection and early response.

Evidence on dementia prevention is still insufficient. It is hoped that the government's comprehensive database on long-term care insurance (long-term care receipts, information on care requirements, etc.) will be utilized to improve the effectiveness of prevention, and that a new database (CHASE) on the conditions of the elderly and the content of care will be constructed to provide care that is backed up by scientific effects. Furthermore, a system for evaluation and certification of private services that are expected to contribute to dementia prevention is also being considered.

Medical treatment, care, nursing care services, and support for caregivers

It is important for those involved in dementia medical and nursing care to support people with dementia as companions so that they can maintain their familiar way of life and relationships in the community while making the most of their abilities. Based on the premise that these "principles of dementia-centered medical and nursing care" are basic principles that should be shared by all those involved in medical and nursing care, etc., it is necessary to improve the quality of medical and nursing care. It is also necessary to strengthen cooperation among various support organizations to provide timely and appropriate medical and nursing care. (Figure 8)

Fig. 8 Timely and appropriate provision of medical and nursing care

Organic collaboration among relevant local institutions is necessary for early detection and early response to persons with dementia. Local institutions such as community comprehensive support centers and family doctors are required to cooperate with specialized institutions such as medical centers for dementia to recognize a person suspected of having dementia at an early stage and respond appropriately, as well as to provide support to the person and his/her family after diagnosis. It is also important to strengthen the provision of information on dementia so that the person himself/herself becomes aware of the disease at an early stage.

Community Comprehensive Support Centers serve as the entry point for consultation in the community, and their quality is being improved through the use of the Community Comprehensive Support Center Evaluation Index and the Grant for Promotion of Strengthening the Functions of Insurers. It is also important to collaborate not only with medical, nursing care, welfare, and other institutions, but also with industries (retail, financial institutions, public transportation, etc.) that are expected to be frequently involved with people with dementia in the community. If a dementia supporter in such industries senses the possibility of dementia, it is necessary to cooperate with consultation organizations such as community comprehensive support centers as needed.

Dementia Community Support Promotion Officers " are assigned in each municipality to promote dementia policies tailored to local conditions, such as building a coordination system among local support organizations, creating and disseminating dementia care paths, conducting multidisciplinary collaborative training to improve dementia response skills (dementia life support training), and providing consultation support to people with dementia and their families. It is also responsible for coordinating the provision of necessary services in collaboration with the "Early Intensive Support Team for Dementia" (see below).

Family doctors, dentists, pharmacists, and nursing staff " are required to recognize people suspected of having dementia at an early stage during routine medical care, etc., and take appropriate measures such as guiding them to see a specialized medical institution.

Dementia support physicians " are expected to serve as consultants and advisors to family physicians in diagnosis and treatment, and to organize training programs for family physicians and disseminate correct knowledge on dementia care.

The " Intensive Initial Support Team for Dementia " consists of several specialists (dementia support physicians, medical and nursing staff) who visit people suspected of having dementia, people with dementia, and their families to provide comprehensive and intensive initial support after observation and evaluation, and to support independent living. Currently, almost all municipalities have established such centers.

The " Medical Center for Dementia Diseases " is expected to serve as a command post for regional cooperation and promote collaboration among regional consultation organizations such as the Regional Comprehensive Support Center and the Initial Intensive Support Team for Dementia, and regional health and medical institutions such as medical associations. The project also includes the establishment and operation of the Council for Medical Cooperation in Dementia Diseases, which is composed of such stakeholders, and training for dementia support physicians and other medical personnel. The project also performs specialized medical functions. These functions include differential diagnosis, selection of treatment strategies, and handling cases that require acute inpatient care such as when behavioral/psychological symptoms (BPSD) or physical complications develop. Medical centers for dementia that perform these two functions are to be established systematically in each secondary medical care area, and as of the end of June 2020, 468 such centers had been established nationwide, or 93% (310 centers) in secondary medical care areas12).

Within the regional network, family doctors, dentists, pharmacists, nurses, etc. play an important role in early detection and early response to dementia and provision of medical care. It is necessary to steadily implement training programs to improve the ability of these medical professionals to deal with dementia and to train dementia support physicians who support family doctors. In addition, people with dementia will live with various forms of care services, such as day-visit services (day-care services, home-visit nursing care, short-term residential care, etc.) and residential services (group homes for the elderly with dementia, care for specified facility residents in fee-based nursing homes, etc.), while receiving support such as community monitoring. The caregiver's ability to cope with dementia is also important. Training to improve these caregivers' ability to cope with dementia should be promoted as well; as of the end of June 2020, approximately 66,000 family doctors and 16,000 dementia support doctors have received such training. In addition, approximately 300,000 people have received training for practicing dementia caregivers12). In training to improve dementia response skills, the use of e-learning and curriculum revision based on the latest dementia policy trends are also being considered.

In addition, measures focusing on behavioral and psychological symptoms (BPSD) are being promoted as part of the dissemination and development of medical and nursing care methods. BPSD is a psychological symptom (anxiety, depression, hallucinations, delusions) and behavioral symptom (irritability, aggression, agitation, abnormal behavior, wandering) resulting from the interaction of environmental, physical, and psychological factors. 17) When BPSD is manifested, the patient's QOL may be reduced. Research on effective care, including collection of care cases, care registry research, and research utilizing big data, is desired to prevent BPSD, reduce risk, and standardize care methods in the field.

Reducing the burden on caregivers of people with dementia is also being considered. With the aging of society, the number of family caregivers in the working-age population is expected to increase, and support for balancing work and caregiving is needed. The government has indicated that it will work to improve the workplace environment to eliminate caregiver turnover by promoting the spread of the "Model for Supporting Work-Long-Term Care Balancing to Prevent Caregiver Turnover" and providing subsidies to companies that work to support such balancing. Furthermore, in order to promote family caregivers' proper understanding of people with dementia and appropriate responses, as well as to reduce the psychological burden on family caregivers, the policy also includes the promotion of " dementia cafes (Orange Cafes )" where people with dementia and their families gather, family classes, peer activities among family members, and other activities. Dementia cafés provide a place where people in the same situation can meet in the same space and form and strengthen their own horizontal ties. Recently, a guide18) for dementia cafes has been developed, taking into account the voluntary restraint from going out due to the new type of coronavirus infection, and innovations have been made to continue such cafes, such as online or completely online cafes (Fig. 9 ). (Figure 9)

Fig. 9 What is an online dementia café?

5-4. Promotion of barrier-free access to dementia, support for people with juvenile dementia, and support for social participation

The reality is that many people with dementia have reduced their opportunities to go out and socialize during their illness. A survey found that people with dementia feel anxious and uncomfortable using financial institutions, public transportation, retailers, public facilities, pharmacies, and restaurants19). (Figure 10)

Fig. 10 Types of businesses that the respondents feel uneasy or uncomfortable to use (individuals, top 5, multiple answers)

In order for people to continue to live normally in the community, the general outline states that efforts to reduce barriers in these industries should be promoted as a "dementia barrier-free" initiative. It also mentions that the establishment of a certification and commendation system for companies that are making efforts to address dementia will be considered to encourage the development of dementia-barrier-free products and services. The Japan Dementia Public-Private Council was established on April 22, 2019 to promote dementia barrier-free initiatives in a more integrated manner by bringing together the national and local governments, various industry organizations, and people with dementia, with approximately 100 organizations participating20). The Council has established the Dementia Barrier-Free Working Group, which organizes various issues toward the realization of a dementia barrier-free society and discusses how to solve them, and the Dementia The Dementia Innovation Alliance Working Group has been established to discuss the creation and social implementation of solutions that address the issues and needs of people with dementia and their supporters.

In addition, other measures are also presented, such as traffic safety, strengthening community support, promoting the use of the adult guardianship system, consumer damage prevention, and abuse prevention. The adult guardianship system is a system that appoints an assistant to protect the rights of persons with impaired judgment due to dementia, and provides support for all legal activities, including contracts related to property management and personal care (personal care) .2)

2) Juvenile dementia is a form of dementia that develops in persons under 65 years of age. According to an AMED study led by the Tokyo Metropolitan Geriatric and Gerontological Center, the number of people with juvenile dementia is estimated to be about 36, 00021). Many people with juvenile dementia are the primary caregivers in their households and may experience financial difficulties due to leave of absence or retirement. In addition, the primary caregiver tends to be the spouse, and in some cases, the elderly parent may become the caregiver. In some cases, the elderly parent may become the caregiver. Furthermore, the time when the parent is most in need, such as when raising and educating children, can cause major problems in the family21). In light of these characteristics, it is desirable that appropriate support be provided while continuing to do what they can as much as possible even after cognitive function declines. Measures such as the establishment of specialized consultation services in prefectures and the assignment of "juvenile dementia support coordinators" are being promoted. The role of the juvenile dementia support coordinator is to promote the utilization of various systems, including not only medical institutions and long-term care service institutions, but also employment, social participation, and welfare for persons with disabilities, and to promote close cooperation among the parties concerned. A more extensive network is required to be established with workplaces, industrial physicians, local party organizations, welfare service offices, etc., as needed.

5-5. Research and development, industry promotion, international expansion

The mechanisms of onset and progression of dementia are still poorly understood, and fundamental treatments and preventive methods have not yet been fully established. Therefore, it is necessary to promote research and development targeting various pathological conditions and stages, including elucidation of the mechanisms of onset and progression, prevention methods, diagnostic methods, treatment methods, and research and development of care (rehabilitation, nursing care models, etc.). In particular, the outline outlines research to elucidate the relationship between risk factors such as diabetes and the onset of dementia, to elucidate the mechanism of onset by analyzing brain images and other data, and to elucidate pathological conditions by utilizing biological samples. It also indicates that research to promote the development of biomarkers and disease-modifying drugs, and research and development of prevention methods, treatment methods, and care for BPSD should be promoted.

The establishment of a research infrastructure for dementia is another important initiative. The report mentions the establishment of a system to accelerate research, including a nationwide cohort study to clarify the history of onset and progression of dementia, risk factors, and preventive factors, a disease registry (Orange Registry), and a biobank that collects biometric information and samples.

In promoting the measures, the Japan Agency for Medical Research and Development (AMED) is expected to provide R&D support.

The following results were obtained from a search of the AMED R&D proposal database for research and development on dementia funded by AMED22) ( Fig. 11). (Figure 11)

Fig. 11 AMED-supported R&D projects on dementia

A wide range of support is being provided, focusing on treatment methods and elucidation of the mechanism of onset and progression of the disease. Dementia is a disease with a long course, and it is desirable to establish a system to continue research on a long-term and stable basis.

The general outline also indicates the need to verify technologies, services, and equipment related to dementia prevention methods and care, and to establish evaluation indices. In order to implement new products and services related to dementia in society, it is considered necessary to conduct demonstrations on a sufficient scale and establish evaluation indicators and methods that can be utilized by non-medical personnel as well as medical personnel. To this end, the Public-Private Innovation Demonstration Infrastructure Project for Dementia Control is being promoted as an AMED project23), which is a demonstration project involving not only medical and nursing care professionals, but also companies, local governments, and nursing care providers.

Through these efforts, the general outline calls for raising awareness of dementia in industry, promoting public-private partnerships, innovation creation, and social implementation, and promoting the international development of nursing care services, etc., utilizing the framework of the "Asia Health Initiative" and sharing Japan's experience as the fastest aging society in the world. The outline mentions the sharing of Japan's experience as the world's fastest aging society.

6. Consideration of the contribution of pharmaceutical companies

As the population ages, it is inevitable that the number of people with dementia will increase. However, as mentioned in the Outline, the mechanism of onset and progression of dementia is still poorly understood, and fundamental therapeutic and preventive measures have not yet been fully established. In Policy Research Institute News No. 61 (November 2020), Nakao reports the number of drugs developed (as of the end of August 2020) by treatment satisfaction and drug contribution (FY 2019). The treatment satisfaction rate for Alzheimer's disease was 21.1%, drug contribution was 25.5%, and the number of products in development was 9. The treatment satisfaction rate for vascular dementia was 30.2%, drug contribution was 27.5%, and the number of products in development was 0, the second lowest after amyotrophic lateral sclerosis24). Considering that the number of patients with amyotrophic lateral sclerosis is approximately 10,000, one can imagine the significant impact of dementia on society. On March 31, 2020, the Japan Pharmaceutical Manufacturers Association (JPMA) issued a press release announcing the start of a joint research project with the Tohoku Medical Megabank Organization (ToMMo) 25). The joint research to be conducted by sharing health information, genome information, and biological samples of 150,000 people held by ToMMo with the Pharmaceutical Manufacturers Association of Japan (hereafter referred to as "Pharmaceutical Manufacturers Association of Japan") includes research on the analysis of cognitive functions. It is hoped that pharmaceutical companies will further activate the utilization of such biobanks, nationwide cohorts, disease registries, etc., and that this will lead to innovative drug discovery as soon as possible.

Developments in the development of non-drug prevention and treatment also deserve attention: In September 2019, the National Institute for Longevity Sciences, with support from AMED, launched a randomized controlled trial of a multifactorial intervention aimed at dementia prevention. The trial will test the efficacy of a dementia prevention program that combines lifestyle-related disease management, exercise and nutritional intervention, and cognitive function training to reduce cognitive decline in elderly people at high risk of developing dementia .26) The trial will also test the effectiveness of a dementia prevention program that combines lifestyle-related disease management, exercise and nutritional intervention, and cognitive function training in reducing cognitive decline in elderly people at high risk of developing dementia. In addition, the aforementioned comprehensive database for long-term care insurance (long-term care receipt data and data on certification of need for long-term care) is being used in conjunction with medical data to improve prevention effectiveness, among other studies. In the development of non-drug prevention and treatment methods for dementia, it is desirable to address the behavioral and psychological symptoms (BPSD) mentioned above, which are based on cognitive dysfunction (core symptoms) and are influenced by environmental, physical, psychological, and other factors, and the background of BPSD is not uniform2), 2 ) In the treatment of BPSD, "the highest priority is placed on non-pharmacological intervention, exploring characteristics such as time of appearance, triggers, and environmental factors in order to seek improvement. In other words, continuous monitoring of each person with dementia, analyzing various data at the time of BPSD manifestation, and responding appropriately may be useful for prevention and treatment. The Pharmaceutical Manufacturers Association of Japan (PMAJ), in its "PMAJ Industry Vision 2025 Supplement " 27) released in May 2021, mentions the importance of promoting DX in the healthcare field and refers to the "medical deployment of mobile devices that can be used to record daily physical condition for health management. It is assumed that there is a high affinity between the prevention and treatment of BPSD and mobile devices that can continuously acquire data on daily life. We expect pharmaceutical companies to contribute to the development of non-drug prevention and treatment methods with this DX in mind.

Furthermore, there is room to consider support for and collaboration with organizations that serve the people affected by dementia. In a public opinion survey on dementia (conducted in December 2028) 5), a survey was conducted on the image of dementia (by whether or not the respondents had contact with people with dementia). The total of "can live independently as before while making up for what they cannot do" and "can live with medical and nursing care support" was 43.2% for those who had contact with the person with dementia and 33.3% for those who did not have contact with the person with dementia, showing a difference in image depending on whether or not there was a history of contact. (Figure 12) This survey seems to indicate the importance of having contact with the person with dementia.

Fig. 12 Image of dementia (by whether or not the person has contact with people with dementia)

Accurate understanding of the needs and concerns of the individuals and their families through support and collaboration with the groups concerned would be significant in terms of gaining useful insights in innovative drug discovery and the development of non-drug prevention and treatment methods. It is also assumed to be of great significance in considering the value of drugs. In Research Paper Series No. 76, "Multidimensional Evaluation of the Social Value of Pharmaceuticals," Nakano et al. reported that "reduction of nursing care burden" could be considered and evaluated in Japan as well28). In considering the value of pharmaceuticals, it would be useful to accurately grasp the actual situation of the burden of caregiving in dementia through support and collaboration with the organizations concerned. The party organizations include the Association of People with Dementia and Their Families, the National Liaison Council of Family Associations and Supporters of Young Dementia, the National Network of Male Caregivers and Supporters, and the Lewy Body Dementia Support Network, and in 2017, these four organizations established the Dementia-Related Parties and In 2017, the Liaison Council of Dementia-Related Parties and Supporters29) was established by these four organizations, and is working to look to the future of dementia. Support and collaboration that both the concerned parties' organizations and pharmaceutical companies find meaningful will be useful in terms of ensuring the continuity of support and collaboration.

Summary of pharmaceutical companies' contributions

  1. Contribution to innovative drug discovery such as disease-modifying drugs and fundamental therapies
  2. （Contribution to the development of non-drug preventive and therapeutic methods (with DX in mind)
  3. Support and collaboration that both the parties concerned and the pharmaceutical companies can feel the significance of.

6. Summary

When considering coexistence with dementia, it is important to realize a society in which not only the person with dementia but also his/her family, who is one of the main caregivers, can have a sense of purpose in life and can live as they wish. Dementia is a problem for the individual, the family, and society. From this perspective, it is fundamentally necessary to promote understanding of dementia in society, the place where the individual and family members live their daily lives. On top of that, it is desirable to understand the situation and needs of the individual and family, to build a support system based on this understanding, to provide support through multi-party collaboration including society, and to have a coordinating function to enable this collaboration. In addition, as the establishment of fundamental treatment and prevention methods is still insufficient, pharmaceutical companies are expected to contribute not only to innovative drug discovery, but also to non-drug prevention and treatment methods with DX in mind, and to provide support and collaboration that both the patient groups and the pharmaceutical companies can feel the significance of.

  • As of December 2023
    At the time of writing, Biogen and Eisai Inc. issued a news release30) stating that ADUHELMTM (adukanumab) had received expedited approval from the U.S. FDA for the treatment of Alzheimer's disease. It is hoped that this will further promote innovative drug discovery in the field of dementia by pharmaceutical companies.

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