by Tyra Phipps, Ed.D. (tyra.phipps@gmail.com)

Dr. Michio Ono, Neurosurgeon and Medical Director at AJISAI-EN, Japan

Dr. Michio Ono is a neurosurgeon residing in Japan.  He is the Medical Director of the health care facility for the elderly AJISAI-EN.  He was honored with the scholarship award, Takemi Program in International Health by Japan Medical Association in 2001-2002.  Dr. Ono was also a Research fellow in Neurosurgery at the University of Zürich in Zürich, Switzerland and at the University of Florida in Gainesville, Florida.  Dr. Ono has earned many certificates and diplomas.  

He speaks several languages including Spanish and English.  He has many publications and given oral presentations around the world, while conducting research and advocating palliative care of the elderly.  In correspondence during the months of April and May, 2016, he wrote, “I have seen many elderly persons with physical and mental disabilities during last seven years under public long-term care insurance (LTCI) and using dementia therapy of Kono Method in Japan.  Compared to US, Japan is still the Heaven for elderlies.  Under LTCI every Japanese people are equally accessible to care services provided through LTCI with only 10% of co-payment which is even capped depending on their income level.  How can we change current long-term care in US?”

Dr. Ono explained that dementia therapy and good long-term care must go together.  By 2025, 7.3 million (20.6% of the over 65 years of age) will be suffering from some form of dementia in Japan.  Fifty percent of dementia patients are not Alzheimer’s, but they can be violent or lethargic with or without difficulty ambulating.  If physicians give the regular dose of anti-Alzheimer’s drugs or increase doses regardless of the patients’ condition or category of dementia, patients will be more violent or more depressive and even stop eating.  Unfortunately, returning these patients to their homes means they are giving unbearable burdens to family caregivers.  In the United States, dementia is almost always equal to Alzheimer’s.  Dr. Ono compares Japan with the United States by explaining that the situation of dementia therapy is the same.  Without correct differentiation of each dementia type of Alzheimer’s disease, anti-Alzheimer’s drugs are prescribed according to the instructions of pharmaceutical companies and the guidelines made by pharmaceutical specialists.

In Japan, LTCI has faced many challenges during sixteen years since its implementation.  They are discharged from the hospital too soon, then sent home and nobody can care for them.  There is a long list to get into any institution.  We call these people, “Elderly (Care) Refugees.”  The metropolis of Tokyo is planning to build nursing homes far away from Tokyo, but it will make it difficult for family members to see their elderly loved ones.  Is this the way we want people to end their lives away from family?  It is very critical to understand dementia therapy and long-term care because not only USA but also most of Asian countries including China will soon be a highly aging population.

Dr. Ono has done research (appearing at the end of this blog post) and recommends:

Community rebuilding, caring neighbors

Community volunteers

 Supporting family caregivers

 Physicians and medical co-workers education

 Education of children respecting and caring spirit for elderlies

 Dr. Ono’s paper covers information regarding mandatory public long-term care insurance in Japan (LTCI) that started in the year 2000.  The issue deals with the rapidly aging society in Japan as compared to German and Scandinavian models.  He is presently examining the Canadian model, but notes that so many countries are struggling with the issue of eldercare and trying to solve the problem.  Dr. Ono visited Kerala, India and learned home-based palliative care for anyone in need during 2003 and 2004.  This is called “The Neighborhood Network of Palliative Care (NNPC)”.

NNPC advocates:

Rebuild spirit filled, happiness, and high true quality of life

Patients can stay at home with family till the end of life

Palliative care can be done by trained community volunteers

NNPC is funded by citizens and offers free services
Donations can be collected in boxes at shops and stations

This may be a solution for the fight against the explosion of elderly and dementia caught in the healthcare gap between rich and poor.

Dr. Ono closed with an explanation that his wife’s mother survived fifteen years in assisted living with good care and almost free in Japan.  However, lately he is very skeptical about doctors and specialists.  “If they have any loved one with dementia or a family member who needs care, they may have more empathy and have ears to hear new dementia therapy.  Sadly, there are so many unreasonable and unloving things happening in Japan.  There is child abuse and care neglect in the news daily in Japan.  Bullying weak people is very common in a modern society and even in many schools.  It seems now people are more unloving than wild animals.”

The following is from a presentation by Dr. Ono.  He advocates LTCI services of Japan and dementia therapy or the Kono Method for the United States to cope with the aging of society and dementia explosion.  He recommends meeting the challenges of dementia by using the Kono Method.

The average age of patients in our institute is 89.2 with 80% of them showing various types and stages of dementia. Patients with FTD (Frontotemporal Dementia), originally known as Pick’s disease are 50%and DLB (Dementia with Lewy Bodies) are 13%.  Patients with FTD/DLB complex clinically showing symptoms of both FTD and DLB are 13%.  We have seen FTD/DLB complex type at a fairly high rate and are the most difficult type to manage and care for.  Patients with ATD (Alzheimer’s Type Dementia) are 46% but we see relatively few of those patients because ATD usually have less BPSD (Behavioral and Psychological Symptoms of Dementia) so caregivers at home can treat and care for the individuals easier and safer compared to other types of dementia.

Recently, CBD (Corticobasal Degeneration) (3%), MSA (Multiple Symptom Atrophy), and especially PSP (Progressive Supranuclear Palsy) and (Progressive Symptom (10% of all dementia) have been diagnosed more often in our institute.  These various types of dementia exhibit unique clinical symptoms that allow us to diagnose them easily without the use of expensive imaging. CT scan would give us additional information to differentiate them better.  This might reduce the cost of care too.  The most important message here is that treatments must be specific to the type of dementia and the signs and symptoms (high tension, low tension of BPSD and/or PD (Parkinson’s Disease) like symptoms, gait disturbance, depressive state, loss of appetite, apathy, etc.) of the patient.

For example, if donepezil, which is so far the best medication for ATD (Alzheimer’s Type Dementia) is given to a patient with FTD (Frontotemporal Dementia), the patient can become more aggressive and violent.  If the same medication is used for a patient with DLB (Dementia with Lewy Bodies), it can cause more hallucinations and may increase mental cloudiness.  It is important to keep in mind the imbalance in neurotransmitters (acetylcholine, dopamine, serotonin, etc.) in the brain that may occur whenever we administer medication.

The dosage of each medication must be adjusted accordingly to each elderly patient.  Patients with DLB are hypersensitive and show increased adverse effects from regular dose of medication.  

Antidepressants, antipsychotics, and/or antiparkinson drugs must also be carefully administered from very small dosage.  More than the optimal dosage may cause imbalance of neurotransmitters in the brain and may make the symptoms worse.

Due to the increased number of dementia patients, specialists alone can no longer manage them. Primary care physicians and family practitioners must also be involved and trained in diagnosing and treating these patients since they are typically the first point of contact with these patients and also have responsibility for home care and long term care facilities.

Dr. Kazuhiko Kono developed a simple and safe method of managing dementia.  Dr. Kono has seen and treated over 20,000 dementia patients in Japan and now his method has been called the “Kono Method” and adopted by many family practitioners.  It brings patients dramatic improvements and puts a smile back on the faces of the patient, family and care workers.

Kono method is easy to master in a short time and make it possible for any physician to give good dementia therapy for the fight against the coming explosion of dementia in many countries. 

Dr. Kazuhiko Kono

From Dr. Kono’s blog webpage, the method is unique in that anyone can easily learn how to do correct differential diagnosis and classify the patient’s condition.  This is very important to plan the proper prescription of medicine for each individual.  Kono method is utilizing the latest anti-Alzheimer’s drugs as well as conventional anti-psychotic drugs to control BPSD and restore personality of dementia patients.  His significant and outstanding combination of medications combine small amount of anti-Arzheimer’s drug and anti-psychotic drugs.  It is important to note that he prescribes less than recommended quantity and stops increasing dose when patient shows improvement not as instructed by pharmaceutical companies.  In addition, he recommends very effective supplements including ferulic acid (product name 'Feru-guard', in Japan) and IV therapy.