Keelung Chang Gung Memorial Hospital, has been serving the healthcare needs of the northern coastal community for 12 years. By integrating interdisciplinary research and innovative medical services, they have successfully established the “Happiness and Intelligence Healthcare Circle” as a cyclic care model. Since the establishment of the Dementia Co-care Center in 2019, significant clinical outcomes have been observed through survival function curve analysis comparing dementia grading deterioration and cognitive score decline in outpatient and inpatient dementia cases, showing a marked delay in the progression of the disease. The team further combines brain MRI and biomarker research, successfully identifying multiple dementia-related risk factors, providing clinical practice with a clear basis for treatment target setting.

Currently, there are approximately 50 million dementia patients worldwide, with 10 million new cases diagnosed annually. Although new drugs offer hope to patients, the high cost of treatment remains a significant challenge. Dementia care requires a holistic approach, with both pharmacological treatment and non-drug interventions needing to complement each other to achieve optimal efficacy. The Happiness and Intelligence Healthcare Circle at Keelung Chang Gung Memorial Hospital encompasses screening, medical intervention, and dementia co-care referral, ultimately assisting patients in returning to their communities and families, establishing a benchmark model for positive dementia care cycles.

“Many hospitals often separate research and service; our uniqueness lies in the deep integration of research and service across multiple specialties,” said Dr. Yi-Chia Wei, one of the leaders of Keelung Chang Gung Memorial Hospital’s Community Medical Center, and an attending neurologist. Dementia care is just one aspect of its excellent results. Since 2013, the Community Medical Research Center at Keelung Chang Gung Memorial Hospital has been implementing a large-scale “Community Cohort Medicine Health Care Program,” conducting comprehensive screenings for people over 20 years old. So far, it has served more than 15,000 residents. Through this program, the team has successfully identified many patients in suboptimal health or in need of proactive medical attention, including chronic liver and kidney disease patients, as well as those with lower willingness to seek medical help and thus more difficult to detect dementia and depression risk groups, providing timely medical intervention to effectively strengthen community residents’ health support.

Community Screening Research Combined with Brain MRI and Biomarker Analysis

The innovative combination of brain MRI analysis and biomarker research is another important innovation of the “Happiness and Intelligence Healthcare Circle”. Using diversified imaging techniques, brain MRI offers in-depth analysis of brain white matter changes related to dementia, brain functional connectivity changes, and structural changes in the brain’s gray matter, marking an essential step towards the exploration of early dementia diagnosis and treatment targets.

The brain imaging-related research is led by Dr. Yi-Chia Wei and Psychiatric Department Director Chemin Lin, working with several key domestic and international brain imaging analysis experts, including Professor Ching-Po Lin of National Yang Ming Chiao Tung University, Professor Nancy Glynn from the University of Pittsburgh, and Fang-Cheng Yeh. Dr. Yi-Chia Wei pointed out that the glymphatic system of the brain has recently been found to be closely related to dementia. The team uses diffusion-weighted imaging techniques to capture imaging indicators of brain glymphatic system activity and validate them with blood biomarkers of the glymphatic system, discovering associations with vascular arteriosclerosis, metabolic syndrome, and factors related to water metabolism and glymphatic activity. Dr. Yi-Chia Wei emphasized that effectively controlling vascular risk factors, such as obesity, dyslipidemia, and diabetes, could promote the health of the glymphatic system and subsequently delay the progression of dementia.

The use of biomarkers for diagnosing Alzheimer’s disease has become a current international trend. The team has also established associations between neurodegenerative proteins in the blood (such as amyloid beta and tau protein) and multidimensional cognitive performance and mental assessments, as well as the correlation between brain imaging features and blood neurodegenerative proteins. Dr. Yi-Chia Wei remarked that studies have shown that even before cognitive and functional decline, dynamic brain connectivity, brain white matter connectivity, and biomarkers have already started to show abnormal changes; this enables the team to identify higher risk groups at the earliest stages.

The team has published a series of international papers focusing on subjective cognitive decline, fostering a deeper understanding of early dementia in the academic community. Dr. Yi-Chia Wei also won the 2023 Ta-You Wu Memorial Award from the National Science and Technology Council for his research on early dementia, gaining recognition for scientific research and academic contributions.

Dr. Yi-Chia Wei, a neurologist at Keelung Chang Gung Memorial Hospital, whose clinical research advances the understanding of dementia in academia, recognized with the Ta-You Wu Memorial Award. Photo Credit: Keelung Chang Gung Memorial Hospital

Integrating Community and Healthcare System in Cyclic Care

Within more than 8,000 community screening participants, the team identified approximately one-third with dementia risk, one-fifth with depression risk, one-fifth with anxiety risk, and one-fifteenth with sarcopenia risk, receiving referrals for medical services not only in neurology and psychiatry but also in gastroenterology, traditional Chinese medicine, cardiology, and other specialties. Through the services of the Dementia Co-care Center, the rate of cognitive decline in dementia patients, whether assessed by the Clinical Dementia Rating Scale (CDR) or the Mini-Mental State Examination (MMSE), has shown significantly improved retardation compared to before the Center’s establishment.

“The most challenging aspect of dementia care is not only the medical issues but also the caregiving burden on families. There are significant differences before and after the establishment of the Co-care Center, which assists in linking resources from hospitals, government, patients, and caregivers,” emphasized Dr. Wei-Chieh Weng, head of Division of Neurology at Keelung Chang Gung Memorial Hospital.

The progression of dementia follows a continuous trajectory, with disability status worsening over time. Long-term tracking and timely interventions based on changes in condition are key strategies in dementia care. Based on community research, Keelung Chang Gung Memorial Hospital has established a comprehensive system for mental and cognitive, brain imaging assessment, and tracking. The referral rate to the dementia co-care service from community screening stands at 22.9%; cases and rates of transfer to community long-term care points have also increased annually, from 5.7% in 2019 to 70.2% in 2023, forming a cyclic care model. This data indicates that longitudinal care through community and in-hospital efforts significantly enhances dementia diagnosis rates and care quality. Through multi-team collaboration and diverse interventions in life, care, and cognitive enhancement activities, it is possible to effectively slow down dementia’s progression.

After the establishment of the Dementia Co-care Center at Keelung Chang Gung Memorial Hospital, early medical intervention is provided to dementia patients, effectively slowing their deterioration. Photo Credit: Keelung Chang Gung Memorial Hospital

Establishing a Large Clinical Cognitive Test Norm

Another internationally cited major achievement of the team is the establishment and publication of normative data for commonly used clinical cognitive tests. The cohort study on cognition in middle-aged and elderly individuals has been followed for 12 years since 2013, with 8,121 participants, making it the largest enrollment project currently in the nation, featuring a diverse age distribution that covers both healthy and suboptimal health groups. Based on this foundation, the team published normative data in 2022 for commonly used clinical cognitive tests such as MMSE, MoCA, and ADAS-cog. Dr. Yi-Chia Wei stated that prior to the team’s publication of this cognitive norm, the previous version was based on studies conducted two decades ago, and following its release, it has been immediately adopted and cited by research teams both domestically and internationally in their study designs, including regions such as Europe, America, and the Middle East.

*This content was translated using AI. For clarification or concerns, please contact our support team for assistance.

The Happiness and Intelligence Healthcare Circle at Keelung Chang Gung Memorial Hospital integrates cross-specialty resources, merging research with service applications. Medical research collected from the community advances the academic field’s understanding of diseases; furthermore, research outcomes are applied to clinical services, continuously safeguarding and enhancing the community’s health through long-term research and tracking, setting a model for community healthcare and care.

Photo Credit: Keelung Chang Gung Memorial Hospital