Antidementia drugs: are they effective in improving quality of life for elderly persons with dementia?

During an epidemiological survey conducted in Tokyo in 1988 by the Department of Psychiatry, Tokyo Metropolitan Institute of Gerontology, I met two demented elderly women in the course of interviewing city residents. The first woman, G., was 74 years old. When I visited her, she was almost bedridden as a result of right hemiplegia and she was lying on an unclean mattress on a floor of straw mats (at that time, elderly Japanese people did not often sleep in Western-style beds). G. was mildly demented, and her 78-year-old husband was her primary caregiver. She required his help with getting dressed, eating, and bathing, and with excretion. G. had two sons and two daughters. Her daughters lived within 5 minutes’ walking distance, and every day the older daughter delivered lunch and the younger daughter delivered dinner. G.’s sons visited their parents at night, two or three times a week. When I visited the household, I spoke with G.’s husband and younger daughter. They told me that G. and her husband received no welfare services from the ward office, and that their only income was from their pensions. When G. got a cold, her husband put her on his bicycle to take her to a nearby general practitioner; neither they nor their children had a car. Their economic status was quite low, even taking into account that the Japanese economy was generally weak at that time, and their physical environment reflected their poverty. However, I was impressed by G.’s husband’s appreciation of his children’s help and by his warm attitude toward his wife. He and his wife seemed entirely satisfied with their lives, and their facial expressions showed no depressive signs. The second person I met was a 78-year-old woman, H. She was mildly demented, and her mobility was restricted due to rheumatoid arthritis. She was also hypochondriacal. She had two sons and adaughter, and was living with her older son’s family in the house her late husband had built. Theother two children lived outside Tokyo. When I visited her, I was scrutinized by a television camera at an electric gate. It took me 2 minutes to drive from the gate to the entrance of the