Factors Related to Delayed Diagnosis and Care Access in Dementia: A Preliminary Descriptive Study of the ‘Blank Period’ in Japan

BACKGROUND: Timely diagnosis and initiation of care are essential for improving the quality of life of people with dementia and their families. In Japan, advocacy groups have drawn attention to the 'blank period', a phase of isolation before and after diagnosis, yet few quantitative studies have examined its determinants. This study explored factors associated with delayed diagnosis and delayed care access using the blank period framework. METHODS: This exploratory, cross-sectional study surveyed family caregivers of outpatients with dementia recruited from 78 hospitals and 27 dementia support physicians in Japan. The blank period was divided into two phases: Blank Period I (BP1, from dementia awareness to diagnosis) and Blank Period II (BP2, from diagnosis to initiation of long-term care insurance services). Participants whose BP duration exceeded the 75th percentile were categorised as having delayed diagnosis or delayed care access. Logistic regression analyses followed the purposeful variable selection strategy proposed by Bursac et al. and Zhang. RESULTS: A total of 216 questionnaires were analysed. The mean durations of BP1 and BP2 were 13.5 and 16.9 months, respectively. Delayed diagnosis was associated with female caregiver (OR = 4.51, 95% CI 1.72-11.92, p = 0.002) and patient hesitation to see a doctor (OR = 4.52, 95% CI 2.07-9.87, p < 0.001). Delayed care access (BP2) was significantly associated with patient under 65 at the time of diagnosis (OR 7.44, 95% CI 1.93-28.66, p = 0.004) and living together (OR 3.78, 95% CI 0.85-16.91, p = 0.082). CONCLUSIONS: This study identified that social factors, cultural factors and pathological factors associated with delays in diagnosis and care among people with dementia in Japan.