Nobiletin-rich Citrus reticulata peels, a kampo medicine for Alzheimer\'s disease: A case series

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Application for Long Term Care Insurance or other health services


41.1% 13.0%

Management of money for daily use


Apology to surrounding people when there is trouble


Signing the patient's signature Cancellation or cooling off after purchase


Administeration of the patient’s property


Decision-making to institutionalize to a long-term care facility



Consent for medical practice


Funeral arrangements and notification after death


Contract for an apartment or the telephone etc.


staff members of special nursing homes were requested to provide such consent.5 As medical consent has not been legally allowed for families or guardians, in December 2011 the Japan Federation of Bar Association proposed an outline of medical consent for the government.6 In this regard, advanced care planning7 that includes guardian selection should be promoted. Additionally, public guardian systems should be developed. Health professionals, especially care managers, should arrange for a guardian to meet their client’s needs. In conclusion, the present study showed a scarcity of guardians in long-term care settings, and also highlighted a fact that care managers often compensate for this lack of guardians.


Figure 1 The frequencies of substitution behaviors reported by care managers for their clients.

References 1 Summary of cases related to adult guardianship, Supreme Court of Japan. 2011. 2 Japan Cabinet Office. Annual report on the aging society. 2011. 3 Endo H. Change of dementia care management after implementation of long-term care insurance. Rinsho Shinkeigaku 2003; 43: 788– 790. 4 Progress report for medical consent. Public interest incorporated association, Center of adult guardianship, Legal Support. 2010. 5 Miyata H, Shiraishi H, Kai I, Igarashi Y, Matsushita M. Nursing home directors’ attitude toward medical decision-making and medical care for elderly people with dementia. Nihon Ronen Igakkai Zasshi 2004; 41: 528–533. 6 Japan Federation of Bar Association. Outline of surrogating medical consent for person with incapacity of the consent. 2011. [Cited 19 Mar 2012.] Available from URL: activity/document/opinion/year/2011/111215_6.html 7 NHS National End of Life Care Programme. Capacity, care planning and advance care planning in life limiting illness. A Guide for Health and Social Care Staff. 2011.

The authors appreciate the cooperation of the participants and the Aichi Prefecture Social Welfare Council. Joji Onishi,1 Yusuke Suzuki,2 Hidetoshi Endo3 and Ichiro Kai4 1 Department of Community Medicine, Nara Medical University, Kashihara, 2Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, 3 Department of Comprehensive Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, and 4Department of Social Gerontology, School of Public Health, University of Tokyo, Tokyo, Japan

Nobiletin-rich Citrus reticulata peels, a kampo medicine for Alzheimer’s disease: A case series ggi_892

Dear Editor, In our survey of new therapeutic agents for dementia,1–3 we discovered the anti-Alzheimer’s disease 236 !

doi: 10.1111/j.1447-0594.2012.00892.x


(AD) action of a citrus flavonoid nobiletin in transgenic AD mice.3 The beneficial effects of nobiletin-rich Chinpi on dementia were tested in animals, as nobiletin is a component of dried peels of Citrus reticulate, © 2013 Japan Geriatrics Society

Letters to the Editor

Figure 1 (a) Enrolment of participants and changes in the Mini-Mental State Examination (MMSE) and the Japanese version of the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-J cog) scores in 1 year. Patients with cognitive impairment were screened according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association Alzheimer’s Criteria4 and enrolled. Average dose and duration of preadministration of donepezil were 5 mg/day and 3.2 1 0.8 years in the intervention group, and 5 mg/day and 2.6 1 1.1 years in the control group, respectively. Administration of classical and atypical neuroleptics, non-steroidal anti-inflammatory drugs,5,6 statins7 and anti-hypertensive drugs,8 which were considered to influence the cognitive function, were continued in the case where they had been previously given to the patients. (b,c) Intergroup comparison of drifting of (b) MMSE and (c) ADAS-J cog. The Wilcoxon–Mann–Whitney test was used for comparisons of the calculation results between the two groups. A P-value of
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