FREQUENCY AND CHARACTERISTICS OF SILENT DEMENTIA AMONG ELDERLY JAPANESE-AMERICAN MEN - THE HONOLULU-ASIA AGING STUDY

Objective.-To determine the frequency of unrecognized dementia in a gr oup of men found to have dementia by population survey, and to identif y factors associated with the failure of a family informant to recogni ze significant memory impairment. Design and Setting.-The Honolulu-Asi a Aging Study, a population-based study of dementia among elderly Japa nese-American men living on the island of Oahu, Hawaii, Data for this study were from the dementia prevalence survey, 1991-1993.Study Partic ipants.-A total of 191 noninstitutionalized men with dementia who had a reliable family informant. Main Outcome Measures.-Failure of family informants to recognize a problem with thinking or memory in subjects with dementia, Results.-A total of 21% of family informants failed to recognize a problem with memory among subjects subsequently found to h ave dementia, Among subjects with very mild dementia, 52% of family in formants failed to recognize a significant memory problem compared wit h 13% among more severely demented subjects. Of the subjects with deme ntia whose family informants did recognize a memory problem, 53% faile d to receive a medical evaluation for this problem. For all family inf ormants, increasing age, fewer years of education, less severe dementi a, fewer behavioral complications, fewer functional disabilities, and better performance on certain tests of memory and language were signif icantly associated with the family informant's failure to recognize a problem with memory, When the family informants were wives living with husbands, less severe dementia, fewer behavioral complications, fewer functional disabilities, and intact remote memory were associated wit h unrecognized dementia. Conclusions.-Unrecognized dementia was common in our population, especially among mild cases. Cognitive screening p rograms for the elderly and public education policies designed to incr ease awareness of early signs of dementia are needed if interventions for individuals with potentially treatable dementias are to be impleme nted.