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Clinical Therapy in Dementia and Related Diseases

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Dear Colleagues,

With the rapid aging of society, dementia has become a growing global concern, imposing substantial medical and economic burdens. Despite ongoing efforts, the absence of fundamental treatments and the critical need for advanced early diagnostic technologies remain significant challenges. At the same time, scientifically validated preventive strategies, non-pharmacological treatments, and approaches to enhance patients' quality of life (QOL) are increasingly recognized as essential.

A comprehensive, society-wide response is necessary to address this multifaceted issue. Clinical research and social support systems are pivotal areas of focus, demanding innovative solutions and interdisciplinary collaboration. This research topic seeks contributions addressing the following topics:

Development of disease-modifying therapies (DMTs);
Advancements in early diagnostic technologies;
Lifestyle interventions for dementia prevention;
Management of multimorbidity in dementia patients;
Validation of non-pharmacological treatments;
Genetic factors and personalized medicine;
Targeted treatments for dementia subtypes;
Improving care quality and nursing support;
Digital health technologies in diagnosis and treatment;
Other emerging dementia-related topics.

Dr. Takao Yamasaki
Guest Editor

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Research

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16 pages, 1447 KB

Open AccessArticle

Personalized Prediction of Clozapine Treatment Response Using Therapeutic Drug Monitoring Data in Japanese Patients with Treatment-Resistant Schizophrenia

by Tatsuo Nakahara, Yukiko Harada, Naho Nakayama, Kijiro Hashimoto, Naoya Kida, Toshiaki Onitsuka, Hiroo Noda, Kenji Murasugi, Yoshihiro Takimoto, Wataru Omori, Tsuruhei Sukegawa, Jun Shiraishi, Kouji Tanaka, Hitoshi Maesato and Takefumi Ueno

J. Clin. Med. 2025, 14(21), 7892; https://doi.org/10.3390/jcm14217892 - 6 Nov 2025

Abstract

Background: Clozapine is the only antipsychotic medication proven effective in patients with treatment-resistant schizophrenia (TRS). However, many patients have serum concentrations outside the recommended therapeutic window, and clozapine exhibits substantial interindividual variability. This study aimed to (1) examine clozapine dosage and blood concentrations in patients with TRS; (2) investigate the effects of sex and age on dosage and blood concentrations; (3) assess clinical response to clozapine treatment; and (4) develop a random forest (RF) model to predict therapeutic response using clinical and therapeutic drug monitoring (TDM) data. Methods: Dried blood spots were used to measure concentrations of clozapine, norclozapine, and clozapine N-oxide. Clinical symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). The RF algorithm was applied to analyze the relationships between biochemical and demographic factors and clinical response to clozapine. Results: A total of 754 blood samples from 167 patients were analyzed. Men received higher doses than women, and glucose levels were elevated in both sexes. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.986 for the training set and 0.852 for the testing set. Accuracy, precision, recall, and F1-score (training/testing) were 0.938/0.786, 0.936/0.736, 0.934/0.780, and 0.935/0.757, respectively. The SHapley Additive exPlanations (SHAP) analysis indicated that baseline BPRS score, treatment duration, age, and clozapine concentration were important variables contributing to the output of the model. Conclusions: Our model achieved satisfactory predictive performance for clinical response and provides valuable insights into personalized prediction of clozapine efficacy. Full article

(This article belongs to the Special Issue Clinical Therapy in Dementia and Related Diseases)

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Review

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17 pages, 595 KB

Open AccessReview

Bridging Dementia Care in Japan: The Emerging Role of General Medicine Physicians

by Takao Yamasaki

J. Clin. Med. 2025, 14(21), 7889; https://doi.org/10.3390/jcm14217889 - 6 Nov 2025

Abstract

As global populations age, dementia has become a major public health challenge that warrants sustainable, person-centered, and community-integrated models of care. In Japan, the recent introduction of board-certified general medicine (GM) physicians, trained across both family medicine and hospital general medicine, has created an opportunity to strengthen dementia care through improved continuity and coordination. This narrative review conceptually examines the emerging role of GM physicians within Japan’s Community-Based Integrated Care System and compares this evolving model with dementia care structures in the United States, the United Kingdom, and Canada. By synthesizing policy documents and published literature, this review outlines how GM physicians can serve as integrative actors bridging outpatient and inpatient care, collaborating with dementia specialists, Initial-phase Intensive Support Teams, and Community-based Comprehensive Support Centers to enhance person-centered support throughout the disease trajectory. While empirical outcome data remain limited, this conceptual framework highlights potential contributions of GM physicians to early detection, care transitions, and interdisciplinary collaboration in dementia care. However, challenges persist, including training variability, workforce shortages, and systemic fragmentation. By situating Japan’s experience within an international context, this review provides a conceptual basis for future empirical studies and policy development aimed at strengthening generalist-led dementia care in aging societies. Full article

(This article belongs to the Special Issue Clinical Therapy in Dementia and Related Diseases)

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