Showing posts with label Health-Dementia. Show all posts
Showing posts with label Health-Dementia. Show all posts

October 7, 2019

They Have Dementia But Are Too Young To Retire


It's not unusual for people of working age to be diagnosed with dementia. Many are perfectly capable of carrying on for years - but employers often don't realize it.
Each time IT consultant Doug Banks goes for a job interview - and he's had two dozen since January 2018 - it always seems to turn out the same way.
At first, everything goes smoothly. The hiring manager will be impressed with all the skills and experience detailed on his lengthy 30-year CV. Doug will be asked when he can start, and, oh, is there anything else he wants to mention? 
Well, yes, Doug will say, there is something.
In 2016 he was told he had posterior cortical atrophy (PCA), also known as Benson's syndrome, a rare form of Alzheimer's disease. Many of those it affects, like 59-year-old Doug - and Terry Pratchett, the fantasy author who died in 2015 at the age of 66 - are diagnosed at a relatively young age.
Unlike others with dementia, people with PCA tend to preserve their memory until fairly late - but they typically have trouble processing images, which makes recognizing objects and faces difficult.
In his job interviews, Doug doesn't even have to bring up his dementia. He'll often just say that he has a visual impairment. All he needs is a few reasonable adjustments, such as software that allows him to speak to the computer rather than use the keyboard. Sure, no problem, he'll be told. 
Doug Banks
And then nothing happens. "I don't get the job, someone else gets it," he says. Before dementia came into his life, he says, nine times out of 10, he would have picked up the contract.
Shortly after he was given his diagnosis, Doug told his employer at the time about it. At first, Doug's line manager asked him what he needed by way of support. He seemed to be performing fine in a technical role - his typing was messy, but that could be worked around. "I'm a pragmatic person so I thought - fine, the sky hasn't fallen in, I can still go out and I can still be at work," he says. As his contract came to an end, he assumed it would be renewed. 
But the line manager told him they were looking for someone "more strategic". And hiring someone else.
And if now he were explicit about having been diagnosed with a form of dementia, he believes, the reaction from employers would be even worse: "They're scared. The first thing they think of is a memory. Then they think of old people. Then they think someone you can't speak to or converse with or do anything with - and that's it, they're going to die."
According to the Alzheimer's Society, there are 45,000 people in the UK between the ages of 30 and 65 with young-onset dementia, and 18% of them continue to work after their diagnosis. They might have mortgages to pay, as Doug did when he learned he had the condition, or they might have dependent children to provide for. Alternatively, it might just be the case that they are still perfectly capable of working, and want to keep doing so for as possible. 
What is Dementia?
Dementia refers to a set of symptoms caused by many diseases of the brain. The most common symptom is memory loss, particularly the struggle to remember recent events
Other symptoms can include difficulties with thinking and problem-solving, changes to behavior, mood, and personality, becoming lost in familiar places or being unable to find the right word in a conversation
Specific symptoms will depend on the parts of the brain that are damaged and the disease that is causing the dementia 
Alzheimer's disease is by far the most common of the diseases that cause dementia. Others include vascular dementia, dementia with Lewy bodies, frontotemporal dementia, Parkinson's disease dementia, amyotrophic lateral sclerosis and the newly discovered Late.
A survey by YouGov in April 2019 suggested that 30% assume people with dementia have stopped working. But it isn't the case, says Emma Bould from the Alzheimer's Society, which is asking people to sign up as Dementia Friends to mark World Alzheimer's Month.
"Dementia is an umbrella term - some conditions can be quite aggressive, and progress quite quickly, maybe over a couple of years," she says. "But with others, it could be five, 10, 15 years before it really starts to impact people's abilities."
In Great Britain, the Equality Act 2010 says people should not be chosen for redundancy or be forced to retire because of dementia (in Northern Ireland, they are covered by the Disability Discrimination Act). Employers are also required to make reasonable adjustments to help people with the condition do their jobs. In practice, however, it doesn't always work out like that. 
When a doctor told Bernie McCrea, 61, that she was in the early stages of dementia, she was working as a carer for adults with learning disabilities. She says she was still in shock when she called the agency that employed her on a zero-hours basis. They told her they'd get someone to cover her shifts in the future and asked her to return her uniform.
Bernie McCrea
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She didn't think much initially about the agency's reaction. It was only in the days and weeks afterward, as the implications began to sink in, that she began to consider it premature.
"I was working normally - I did my job well enough," says Bernie, from Newton Stewart, County Tyrone. "I never had one complaint about it. I was always available, day and night. I loved the work I was doing. I loved working with people. I know I could have gone on."
It's an issue that's likely to grow in salience. Globally around 50 million people are currently living with dementia, and the number of cases is forecast to reach 130 million by 2050 as populations grow older.
Tony Bayer, professor of geriatric medicine at the University of Cardiff, cites President Ronald Reagan, Prime Minister Winston Churchill, actor, and TV presenter Prunella Scales and Pratchett - who published two best-selling books after his diagnosis - as individuals who have carried out high-profile jobs while in the early stages of dementia. 
"Dementia is progressive, so unfortunately there comes a point where working isn't practical. But it progresses over months, years. It really depends where you are on that trajectory, what implications it has on day-to-day life.
"The vast majority of people with early dementia are just as safe as you and me - in fact perhaps a little bit more so, because they may take care to avoid hazardous situations."
Then there are the benefits that working may have on a person's well-being by providing routine, companionship and a sense of satisfaction - and of course an income.
For Doug, the financial implications have been severe.
His earnings "have gone from roughly £120,000 a year to zero", he says. His wife's part-time job in a local post office brings in £500 a month, and Doug is entitled to around £1,000 a month in Universal Credit and Personal Independence Payment. "That money doesn't really cover everything. We're always having to scrimp and save," says Doug. In order to clear their mortgage, they sold their house and downsized to a property in Upper Rissington, Gloucestershire. He's still too young to claim his state pension.
Doug Banks and his wife Jackie
Image captionDoug Banks and his wife Jackie
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He recognizes that, as a contractor, he was always at risk from the vagaries of short-term employment. Nonetheless, he'd rather be sharing his skills and contributing to the economy rather than claiming money from the government.
"Even now, I feel as if I've got a lot to give. I've still got all my knowledge and experience," he says. "All I can do now is stay fit and well and hope for some developments in dementia research."
Follow Jon Kelly on Twitter @mrjonkelly

May 24, 2019

A Town Designed For Dementia

2:51 min.

July 1, 2015

Brains of people with recurrent depression have fewer New Memories



The brains of people with recurrent depression have a significantly smaller hippocampus – the part of the brain most associated with forming new memories – than healthy individuals, a new global study of nearly 9,000 people reveals.

Published in Molecular Psychiatry, the ENIGMA study is co-authored by University of Sydney scholars at the Brain and Mind Research Institute.
The research is the largest international study to compare brain volumes in people with and without major depression. It highlights the need to identify and treat depression effectively when it first occurs, particularly among teenagers and young adults.
Using magnetic resonance imaged (MRI) brain scans, and clinical data from 1,728 people with major depression and 7,199 healthy individuals, the study combined 15 datasets from Europe, the USA and Australia.

Major depression is a common condition affecting at least one in six people during their lifetime. It is a serious clinical mood disorder in which feelings of sadness, frustration, loss, or anger interfere with a person’s everyday life for weeks, months or years at a time.

Key findings

The key finding that people with major depression have a smaller hippocampus confirms earlier clinical work conducted at the BMRI. In this study, the key finding was largely explained by subjects with recurrent depression. People with recurrent depression represented 65 per cent of study subjects with major depression.

People with an early age of onset of major depression (before the age of 21 years) also had a smaller hippocampus than healthy individuals, consistent with the notion that many of these young people go on to have recurrent disorders.
This image shows the location of the hippocampus in the brain.
People with an early age of onset of major depression (before the age of 21 years) also had a smaller hippocampus than healthy individuals, consistent with the notion that many of these young people go on to have recurrent disorders. Image is for illustrative purposes only.
However, people who had a first episode of major depression (34 per cent of study subjects with major depression) did not have a small hippocampus than healthy individuals, indicating that the changes are due to the adverse effects of depressive illness on the brain.

“These findings shed new light on brain structures and possible mechanisms responsible for depression,” says Associate Professor Jim Lagopoulos of the University of Sydney’s Brain and Mind Research Institute.

“Despite intensive research aimed at identifying brain structures linked to depression in recent decades, our understanding of what causes depression is still rudimentary.
“One reason for this has been the lack of sufficiently large studies, variability in the disease and treatments provided, and the complex interactions between clinical characteristics and brain structure.”

Commenting on the clinical significance of the findings, Co-Director of the Brain and Mind Research Institute, Professor Ian Hickie says: “This large study confirms the need to treat first episodes of depression effectively, particularly in teenagers and young adults, to prevent the brain changes that accompany recurrent depression.

“This is another reason that we need to ensure that young people receive effective treatments for depression – a key goal of our Centre of Research Excellence in
Optimising Early Interventions for Young People with Emerging Mood Disorder. “This new finding of smaller hippocampal volume in people with major depression may offer some support to the neurotrophic hypothesis of depression,” adds Jim Lagopoulos.

“This hypothesis argues that a range of neurobiological processes such as elevated glucocorticoid levels in those with chronic depression may induce brain shrinkage.
“Clearly, there’s a need for longitudinal studies that can track changes in hippocampal volume among people with depression over time, to better clarify whether hippocampal abnormalities result from prolonged duration of chronic stress, or represent a vulnerability factor for depression, or both,” he said.

Neuroscience News

 University of Sydney
Image Credit: Image is credited to the NIH and is in the public domain
Original Research: The study will be published in Molecular Psychiatry during the week of June 29 2015. 

March 27, 2015

A Young Film Maker Warns Millennial’s About Alzheimer

BreadheadThree years ago, filmmaker Max Lugavere’s mom started showing signs of dementia at age 59. And when he began looking for answers to the question anyone would ask—”why?”—it lead him to an unlikely source: the breadbox.
Fast-forward to today, and Lugavere, 32-years-old, just wrapped a Kickstarter campaign for his forthcoming documentary, Bread Head, which he hopes will get young people to pay attention to lifestyle practices that can help prevent Alzheimer’s, a disease not often on a 20-something’s radar until it’s way too late.
Evidence of his drive and potential for success? The campaign raised $130,880 with a $75,000 goal.
“You’re never too young or too old to start thinking about minimizing your risk for Alzheimer’s,” Lugavere says. “My point is not to say bread is responsible for Alzheimer’s. It’s that things like whole wheat bread, which is a highly processed food, are masquerading as health foods. I’m not saying that gluten is a smoking gun, but it has an affect on gut health and therefore brain health, and it’s things like this we need to pay attention to.”
The film comes at a time when the topic seems to be on everyone’s, well, minds, with Grain Brain as a recent national bestseller and top author-MDs like Dr. Drew Ramsey preaching about the connection between diet and brainpower.
We caught up with Lugavere to find out more about film, and what to expect when it debuts (most likely at festivals at the end of the year).
Bread Head
1. How did you first start down this path of research? I thought you inherited Alzheimer’s or it was a genetic Russian roulette. Some people got it and some didn’t, but that’s not the case. My mom is young. She was 59 when this all started, and she’s 62 now. I started looking at her environment, lifestyle, and diet. My mom was always “health conscious.” She tried to adhere to the guidelines. But at 59 she suddenly started showing these symptoms…
2. Is that what made you focus on the connection between Alzheimer’s and what you eat? I’m a big nutrition junkie. We have a much larger interaction [with the environment] through our gut than with our skin. So I started looking at diet. And there are profound impacts on brain health. What you eat weighs very heavily on the health of the brain.
3. Are there other causes of Alzheimer’s you plan to explore? Absolutely. One thing profoundly important is sleep. Your brain is cleaning itself during sleep of the plaque that ultimately causes Alzheimer’s. So even losing 30 minutes of sleep per day can be detrimental. We’re looking at all ways to optimize brain health.
4. What are some misconceptions about Alzheimer’s that you plan to clear up?That it’s a disease of the old. Many people are not old when they get symptoms. Also that it’s not a hereditary disease. There’s a rare form that’s hereditary, which was portrayed in Still Alice. But genes are not your destiny. It’s time to awaken people to the idea and wonder that is their own biology.
5. What does your mom think of all of this? She loves it. She keeps saying she’s going to be a movie star. She’s super into it, and she’s doing well. She’s always been my biggest supporter. —Jamie McKillop
For more information and to donate to the film, visit
(Photos: Bread Head)

November 26, 2014

Neuron Break for Dementia; Paying UK Doctors a Bounty


A proposal to pay British doctors £55 ($86) for each new diagnosis of dementia they record -- in essence, a bounty system -- is drawing fire.
An improved mouse model of fatigue could benefit patients with multiple sclerosis, fibromyalgia, and a host of other "primary" diagnoses.
PhD student Sara Adaes explores the mystery of left-handedness at Brain Blogger.
Also on that site, Jennifer Gibson, PharmD, reviews a study showing that the dorsal attention network and the default network may be more cooperative than competitive.
A new paper finds that many studies purportedly connecting behaviors to brain scan results can't be replicated.
The American Academy of Neurology is pleased that a key ally on Capitol Hill, Sen. Frank Pallone (D-N.J.), will be the ranking member on the Senate Energy and Commerce Committee. Another AAN friend, Rep. Ami Bera, MD, (D-Calif.), won a come-from-behind re-election victory.
Aurobindo Pharma USA is recalling one lot of generic 300-mg gabapentin capsules after discovering some of them were empty.
Managing Editor

November 4, 2014

10,000 Missing in Japan, the suspected Kidnapper is “Dementia”

Photographer: Noriko Hayashi/Bloomberg
Asayo Sakai, a former nurse and housewife, drinks a glass of water in her apartment. Asayo was diagnosed with... 


  • Asayo Sakai banged on the front door, demanding to be let out. She was at her daughter’s apartment, where Asayo has lived for the past six years. She has no memory of how she got there or what she’s doing there. 
    As her daughter, Akiko, blocked the way, Asayo, 87 and suffering from dementia, lashed out, hitting and biting. The scene repeated itself with agonizing predictability for a solid year until one day Akiko, exhausted, gave in and opened the door, letting Asayo wander the streets of Osaka’s busy financial center in western Japan
    “I thought, get out of here, if that’s what you want,” Akiko said. “Mom turned into a monster and I couldn’t handle her. I thought my life was over.” 
    What happened next taught Akiko things she never knew about her mother -- and herself. Asayo’s walks lasted hours upon hours and into the early morning. At first, her daughter followed from a safe distance. When police assured her they’d try to keep an eye on Asayo, she let her mom roam around the city alone. 
    It was a risky act of desperation. Yet Akiko soon discovered within her own neighborhood how Japan is trying to become more dementia-friendly. In 2013, the government started a programthat helps families and communities deal with dementia sufferers on their own. Businesses are helping as well. Asayo’s story provides a glimpse of where Japan’s policies may be headed, how far the country still has to go, and the extent to which it is providing a roadmap for other countries. 
    Akiko is among the tens of thousands of Japanese grown children and other caretakers who, lacking access to nursing homes or sufficient help at home, have been pushed to their psychological limits. 
    “People are desperate to find ways to handle dementia patients,” said Hiroko Sugawara, who runs a government-funded educational campaign on dementia. 

    Elderly Care Crisis 

    That dynamic has given rise to a growing elderly care crisis in Japan, where an estimated 10,000 seniors with dementia go missing a year. Some disappear for years, others never return or are eventually found dead. Caretakers have snapped, injuring or even killing their loved ones. In 2012, 27 seniors in Japan were murdered or died from neglect, although it’s unclear how many suffered from dementia. 
    The number of seniors abused by family members jumped 21 percent to more than 15,000 in 2012 from 2006, half of whom suffered from the condition, according to a Japan Health Ministry survey.
    While other countries are aging, none have done so as rapidly as Japan, where an estimated 8 million people suffer from dementia or show early signs of developing the disease. That’s about 6 percent of Japan’s population. By 2060, 40 percent of Japanese will be over 65, up from 24 percent today, according to National Institute of Population and Social Security Research. And as the population ages, the proportion of tax-paying workers will decrease relative to the swelling ranks of dependent seniors. 
    Funding for the stay-at-home program, at just $31 million this fiscal year, is low compared with spending on the disease by other developed countries. At the same time, the government has been raising premiums and reducing access to state-funded services as part of a broader effort to reduce spending, adding to caretakers’ difficulties. Yet the concept of care that is more humane and less expensive than locking up patients in nursing homes is one that experts say holds promise. 

    Support Network 

    As families struggle with their loved ones at home, businesses are also striving to adapt as shoppers age. Dementia patients tend to buy the same products over and over again, said Kimika Tsukada, a manager of social affairs at Aeon Co. (8267), Japan’s largest retailer. They open food packages in stores, eat without paying, and get lost in shopping malls, Tsukada said. 
    Banks also pose a challenge for forgetful seniors. Elderly customers forget PINs for ATMs or where they’ve put passbooks, said Yuriko Asahara, for two decades a Tokyo suburban branch manager of Japan Post Holdings Co., the country’s biggest holder of bank deposits. Asahara recalled a 76-year-old woman who lost her passbook nine times in a few weeks. She has been regularly accused over a 20-year period of stealing money by another woman now in her 80s. 
    The growing number of elderly with dementia wandering Japan’s stores have resulted in some unusual caregiving arrangements. Asahara sometimes helps customers who’ve lost their way get home. Or she helps them replace missing keys, or decipher complicated utility bills. 
    Both Aeon and Japan Post Holdings have programs to teach sales clerks and staff how to handle customers who show signs of dementia. Retail and bank employees are among the 5.4 million Japanese who have taken the government-funded courses. 
    Aeon’s training program, which began in 2007, has trained about 10 percent of the retailer’s 400,000 employees, Tsukada said. Mizuho Financial Group Inc. (8411), among the country’s largest banks, required all of its 1,400 floor clerks to take a class in dealing with customers with dementia. Sumitomo Life Insurance Co. had a quarter of its 40,000 employees learn about the condition. 
    “It’s time for communities to step in and help out,” said Sugawara, the government program’s director. 
    As the years have passed since Asayo first began her walks, her Osaka neighborhood of Kitahama has become an informal support network. When Shigeo Asai, 75, the building manager of Akiko’s apartment house, spots Asayo in an elevator on his monitor at, say, 6 a.m., he invites her into his office for a chat. The small talk makes her smile and she then often returns to her apartment, he said. 
    Asai has also taken to telling other tenants about Asayo’s dementia. He encouraged youngsters in the building to greet her and spread the word to their parents, who now also help if necessary, he said. 
    “Akiko let everyone see how hard it is to live with her mom,” said Asai, whose elderly sister was recently diagnosed with Alzheimer’s disease. “That’s why we help. That’s the way to go. It can happen to anybody.” 
    Keiji Hori, 67, who owns the Rivoli cafe a block away, looks out for Asayo when he opens to serve breakfast at 6 a.m. He often sees her by herself with a bag on her shoulder. 
    One recent morning, he invited Asayo in for a cup of coffee and toast until her daughter came to look for her. He took an interest after spotting Asayo yelling at her daughter, whenever Akiko tried to follow her. 
    “I see her daughter does a lot for her mom and I came to respect and support her when I can,” said Hori, who has run the shop for more than 30 years. 
    Other locals are also keeping an eye on Asayo. The area has bars, cafes and restaurants open from 6 a.m. to as late as 3 a.m. 
    “You’d think people in cities are busy and cold, but they are so heartwarming and helpful,” said Akiko. “They watch out for my mom.” 

    Asayo’s Life 

    Asayo, a former nurse and housewife in an Osaka suburb, was diagnosed with Alzheimer’s disease, the most common form of dementia, almost 10 years ago, at 77. Her husband, Masao, had died six years earlier and she had become depressed, stopped cooking, and lost weight, Akiko said. 
    For four years Asayo managed to live by herself. Then her condition worsened. She constantly rang her neighbors’ doorbells, searching for random children and her dead husband. She restocked far more mayonnaise and bananas than she needed, making piles in her kitchen. A tidy person all her life, Asayo cluttered her living room with cardboard boxes. When she tried to withdraw cash at her bank, she lost her temper, ripping apart her passbook in front of the teller. 
    In 2005, when Asayo was diagnosed with Alzheimer’s, Akiko was so distraught she bought a pack of cigarettes, lighting up for the first time since quitting smoking six years earlier. 
    “Mom would tell me she was fine living alone and that she was eating well, so I believed her,” Akiko said. “That was wrong. I shouldn’t have believed her.” 

    ‘Felt Ashamed’ 

    Asayo at first refused to move out of her two-story house in a suburb of Osaka, where she had lived for more than three decades. When Akiko finally convinced her mother to move in, she locked Asayo in the apartment to keep her safe. 
    That didn’t keep Asayo from sneaking out in the dead of night. Asayo could never remember where she lived, but she could always give her name to police. 
    “I felt ashamed to pick up my mom from police stations,” said Akiko who works at home as a freelance editor and runs an art gallery above her living quarters. 
    Asayo’s dementia had progressed to the point where many Japanese doctors would prescribe medication and send her to a hospital. In Japan, about 12 percent of dementia patients live at mental hospitals, partly because general practitioners, nurses and even nursing homes don’t have enough knowledge or resources to handle them. That compares with less than 1 percent in the U.K. and France
    Physical discomfort, large crowds or unfamiliar faces can make dementia sufferers aggressive, according to the Chicago-based Alzheimer’s Association
    Doctors prescribe treatments such as antipsychotic drugs including Bristol-Myers Squibb Co. (BMY)’s Abilify and AstraZeneca Plc (AZN)’s Seroquel. They’re used to prevent patients from harming themselves or their caretakers, said Ronald Petersen, director of Alzheimer’s Research Center at the Mayo Clinic
    Asayo had been turned down by two daycare centers because of her urge to go outside and her tendency to slap people. On a third try, she was accepted into a three-day-a-week program. That still left long evenings and nights with both mother and daughter holed up in Akiko’s duplex apartment. 
    The day Akiko relented and opened the front door started out in the usual way. Asayo had been jiggling the door, wandering around the apartment, demanding to be let out for an hour. After Asayo dashed out, she walked for four miles nonstop, said Akiko, who followed her. 

    Rediscovering Freedom 

    After that first walk, something remarkable happened. As Asayo rediscovered her freedom, her anger disappeared and her mood lightened. She was laughing, flirting with strangers and regaling her daughter’s friends with tales of her youth. 
    “Letting her wander saved us and made us happy,” Akiko said. “It was unbelievably disturbing and stressful to keep my mom in the house.” 
    Akiko shut her gallery for several months and followed Asayo everywhere. Life, if far from perfect, was immeasurably better than during the endless afternoons and nights when both felt trapped inside. 
    “We got exercise, we were around other people and we stopped driving each other crazy,” Akiko said. 
    Then Akiko took another chance. She cut out many of the drugs her mother took for Alzheimer’s, diabetes, hypertension, high cholesterol and thinning blood. Asayo became more tranquil. 
    “There was a risk that her disease would progress,” Akiko said. “But I thought it would make both of our lives much easier if she calmed down, even if her memory were lost.” 
    Asayo is down to a few pills for hypertension and elevated cholesterol levels. She no longer takes Aricept, commonly used to slow the progression of the memory loss. It has side effects, including nausea and diarrhea, in 20 percent of people who take it, according to the Mayo Clinic. 
    Side effects may have also played a role in Asayo’s agitation and violence, said Steve Iliffe, professor of Primary Care for Old People at University College London
    “Patients can’t understand or express what they’re experiencing,” Iliffe said. Akiko “was right to do that,” he said. “That’s quite bold.” 
    There were still bad days, like when Asayo wandered in and out of the house for 12 hours before entering a high-end Italian restaurant. In front of the other diners, she called her daughter “a smuggler” and demanded a waiter call the police. Akiko grabbed her 5-foot, 99-pound mother, who fought back, and dragged her outside the restaurant. 
    “You can’t imagine how much energy she has and how robust her physique is,” Akiko said, pointing to her and her mother’s calf muscles, fit from all the walks together. “She looks refreshed and walks the same distance the next day. She’s lost her sense for pain. I find it really hard to keep up with her.” 

    Wandering Alone 

    Wandering is common in dementia patients, experts say. About six in ten people with dementia may not remember names or addresses, and they can become disoriented, said the Alzheimer’s Association. While it can be dangerous if unsupervised, walking helps calm down agitated patients, Iliffe said. 
    “Walking is therapeutic and helps reduce disturbed behavior and sleep,” he said. 
    Wandering alone, though, remains controversial. Many doctors don’t like the idea that patients are at risk of physical injury. Social workers counter that everything should be done to allow patients to safely do what they want to do. 
    “The best interest may be you do lock the door,” though not necessarily always, Iliffe said. “We all take risks in some way and are managing risks, so it’s about how much risk can we tolerate for somebody who can’t remember where they live.” 

    Teaming With Police 

    Asayo has tried to walk to the port town of Moji, 260 miles west, where she grew up, the youngest of four children. Later she moved to Kasugade, three miles west of Osaka, where she was a live-in nurse as young woman and helped to treat wounded World War II soldiers or prostitutes infected with syphilis. She has tried to walk there, as well. 
    To get to these places of her past, Asayo has asked businessmen and teenagers with punk rock hairstyles to point her in the right direction. She has also hailed taxis: Akiko estimates she paid as much as 5,000 yen ($48) for drives that often end at the police station. 
    Teaming with police was another turning point. Akiko no longer considers it demeaning to end her day with a visit to the police, upon whom she’s grown increasingly dependent. She feels comfortable letting her mother wander knowing police are keeping an eye out for her, she said. Asayo has been brought to all of the eight police stations within a 1.5 mile radius of their house. 

    No Protection 

    In Japan there are no laws protecting people who lack the capacity to make decisions. Both they and their caretakers can be sued for damages. About 115 dementia patients died in train accidents in the eight years ending in 2012 and some of the victims’ families have been forced to pay damages to the railroads, according to an investigation by Mainichi newspaper, based on government statistics on train accidents and police records. 
    In 2007, a 91-year-old man suffering from dementia in Aichi prefecture in central Japan slipped away from his wife and his daughter-in-law, wandered across railroad tracks and was struck and killed by a train. The family was sued for 7.2 million yen ($67,000) in lost ticket revenue by the Central Japan Railway Co. (9022)
    The court ordered the family to pay the full amount, because the family failed to prevent the man from wandering, according to court records. The case was appealed to High Court, which reduced the payment by half, holding only the 85-year-old wife, and no other relatives, accountable. 

    New Phase 

    Asayo hasn’t sustained any serious injuries so far, though she has cut and bruised her face after tripping and falling on the street. 
    Though her memory isn’t returning, Asayo is reveling in a new phase of her life. When she isn’t wandering, she’s regaling shopkeepers and restaurant workers with yarns about her relatives, and the doctors and nurses she once worked with. She talks about her daughter’s love affairs, real or imagined, and asks about the husbands or boyfriends of any woman listening. 
    Whether true or not, her stories make people laugh, encouraging her to talk even more, Akiko said. 
    “She is like an actress or clown on stage. She loves getting attention,” said Akiko. “I am horrified to think that I might never have known this side of my mom.” 
    On a recent day, Asayo was at daycare from 9 a.m. to 5 p.m., coloring pictures, solving quizzes, bathing and eating meals and sweets with 20 other elderly people. About 90 percent of the cost is covered by the government’s universal long-term care system. The out-of-pocket bill, which comes to about 60,000 yen a month, is paid by Asayo’s pensions and her savings, Akiko said. 
    Asayo refused to have lunch a group of elderly women and sat at a corner table with a man in a wheelchair who held his lips and turned his face when he was spoonfed by a nurse. As Asayo munched her sautéed pork and a bowl of rice with her chopsticks, she encouraged the man to eat -- to make his mom proud. 
    The next day as soon as she returned from daycare, Asayo started jiggling the door, going up and down the stairs from the living area to the gallery, mumbling and calling for her dead cat Jeff. She wanted to escape to a friend’s place in the mountains. No one should worry, she said, because she’s a skilled worker and can get a job. 
    After Akiko opened the door at about 6:40 p.m., Asayo stormed out into a heat wave of 34 degrees Celsius (94 Fahrenheit). Humidity and heat filled the air as businessmen dressed in white shirts and suit slacks queued in front of bars for after-work drinks. She roamed around, calling her daughter a thief, demanding she go away, and crossed busy roads against traffic. 
    After 40 minutes, Asayo finally agreed to sit down at a restaurant. She sipped a sweetened ice coffee through a straw and ate the toppings of a margarita pizza with chopsticks. She pointed at two waiters and insisted they were Akiko’s boyfriends. 
    At about 8 p.m., she followed Akiko home, took off her top, and changed into a yellow, cotton pajama dress, which she wore inside out. She tossed two butter ball candies into each cheek, put four more in her pockets, sat on a red leather couch and waved a paper fan. 
    Asayo fell asleep without brushing her teeth, her trousers and glasses still on and the fan in her hand. 
    Akiko doesn’t press her to do things differently and leaves Asayo alone for the most part. 
    “Her remaining life is short. She should live happily as her mood dictates,” Akiko said. “I try not to stress us both by caring for her perfectly.” 

    Enriched Life 

    At 8 a.m., Akiko wakes her mother up, and sends her to the daycare. Akiko works, cleans the house, shops for groceries, and, when Asayo is back, she cooks dinner and listens to her mother’s constant banter. 
    “It was really hard at first, but I gained a lot from having her around. I’ve somehow lost a desire to do things for myself,” Akiko said. “She forced me to become an adult. I don’t really want to admit it, but my mom’s illness enriched my life.” 
    One of the many unexpected benefits of the new arrangement: the new friends in Akiko and Asayo’s lives -- neighbors, restaurant owners and policemen. 
    Akiko hopes to keep her mother home for as long as possible, she said. And she has learned to let go of the day’s tensions. 
    “You fight one day, Mom forgets it all the next day, turns into a charming lady and makes me feel silly for letting it get to me,” Akiko said. 
    “She lives in the present, forgets the past and can’t think of the future, so I try to be that way too.” 
    To contact the reporter on this story: Kanoko Matsuyama in Tokyo at
    To contact the editors responsible for this story: Rick Schine at; Anjali Cordeiro at Cecile Daurat

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