On June 10, 2022, Health and Global Policy Institute (HGPI) hosted a meeting of the advisory board for an initiative titled, “Current Issues and Future Prospects for Idiopathic Normal Pressure Hydrocephalus (iNPH) Measures – Focusing on a Form of Dementia that Improves with Treatment.” This initiative is being undertaken as one of the Dementia Policy Team’s activities for FY2022.

Projections show that the number of people living with dementia in Japan will soon exceed 7 million, and hopes are high for treatments that relieve the symptoms of dementia and address its underlying causes for better living later in life. Many diseases that cause dementia are considered difficult to treat, but iNPH is a form of dementia that improves with treatment. It is estimated that iNPH affects around 370,000 people or about 5% of all people living with dementia. As has been pointed out in recent years, the actual number of cases likely exceeds estimates due to the fact that iNPH often occurs alongside Alzheimer’s disease, the most common cause of dementia. There are many potential benefits to delivering the appropriate treatments to people with iNPH. In addition to longer life expectancies, these include fall prevention and high returns in terms of health economics. As demonstrated by developments like the adoption of the “Research Survey on Structuring Healthcare for a Treatable Form of Dementia” as a Ministry of Health, Labour and Welfare Project for the Promotion of Well-Being for Elderly People, the importance of iNPH is also growing in terms of the policy.

However, scattered issues must be addressed before iNPH treatments can be delivered to improve dementia symptoms and elevate the quality of life for as many people as possible. First, dementia is diagnosed in various clinical settings such as medical centers for dementia or the clinics of family doctors. Despite the importance of early and accurate diagnosis, it is hard to say that awareness of iNPH is high among healthcare providers compared to the various other forms of dementia. Second, after receiving diagnoses from specialists in dementia such as psychiatrists or neurologists, iNPH requires collaboration across disciplines. For example, it must involve neurosurgeons, who implant catheters at sites with poor circulation of cerebrospinal fluid (CSF) or perform shunt procedures to continuously drain excess CSF to the abdomen and relieve brain pressure. Furthermore, there are clear regional disparities in treatment, so hopes are high for steps to expand and enhance treatment provision systems to achieve nationwide equity in care.

To address these diverse issues with an all-of-society response, this project will identify necessary measures and compile policy recommendations based on multi-stakeholder discussions with industry, Government, academia, and civil society with participation from related healthcare professionals, academia, representatives of the private sector, and people living with iNPH. Based on the discussion held at the preparatory meeting in March, this advisory board meeting was held with multi-stakeholders from industry, government, academia, and civil society and covered issues and potential methods for promoting iNPH measures with a focus on the healthcare provision system.

In light of COVID-19, this meeting was held remotely using an online conferencing system.

Advisory board members (Titles omitted; in alphabetical order)

• Chifumi Iseki (Lecturer, Department of Internal Medicine III, Faculty of Medicine, Yamagata University)
• Kazunari Ishii (Department Head, Diagnostic Radiology Division, Department of Radiology, Faculty of Medicine, Kindai University)
• Hiroaki Kazui (Professor, Department of Neuropsychiatry, Kochi Medical School)
• Madoka Nakajima (Associate Professor, Department of Neurosurgery, School of Medicine, Juntendo University)
• Tomoya Sato (Manager, Head of Hydrocephalus and Dementia Care Promotion, Integra Japan)
• Shigeki Yamada (Hospital Lecturer, Department of Neurosurgery, Shiga University of Medical Science)
• Manabu Yanagiishi (Central Group, Marketing Department, Sales, and Marketing Division, Nihon Medi-Physics Co., Ltd.)

Representative of the affected party

• T.S. (70s, male)

Observer

• Aki Nakanishi (Deputy Director, Chief of Research and Development, Division of Dementia Policy and Community-Based Long-Term Care Promotion, Health and Welfare Bureau for the Elderly, Ministry of Health, Labour and Welfare (MHLW); Technical Officer (Dementia), Division of the Heath for the Elderly, MHLW)