Table 1.

Criteria for Levels of Cognitive Decline in the Japanese Long-term Care Insurance System

Rank		Criteria	Examples of observable symptoms or behaviors
I		Suffers from some cognitive decline, but the daily living is almost all independent in the domestic and social spheres.
II		Manifests some symptoms/behaviors and communication difficulties that may hinder the daily activities, but can be independent if someone takes care of them.
	IIa	The above-mentioned conditions in II are observed while outside the domestic sphere.	Frequently gets lost on the street, or makes noticeable mistakes in matters that the person was previously able to handle, such as shopping, personal administrative tasks, or financial management.
	IIb	The above-mentioned conditions in II are also observed within the domestic sphere.	Is unable to manage taking medication or stay alone at home due to an inability to answer the phone or the door.
III		Occasionally manifests communication difficulties or symptoms/behaviors that hinder daily activities, thus requiring care.
	IIIa	Manifests above-mentioned conditions described in III predominantly during the day.	Has difficulty or takes time to change clothes, take meals, defecate, or urinate; puts objects into the mouth, picks up and collects objects, is incontinent, makes loud and incoherent screams, carelessly handles fire, or engages in unhygienic acts or inappropriate sexual acts, etc.
	IIIb	Manifests above-mentioned conditions described in III predominantly at night.	Same as rank IIIa.
IV		Frequently manifests difficulties communicating or symptoms/behaviors that hinder daily activities and constantly requires care.	Same as rank III.
M a		Manifests significant mental symptoms, problematic behaviors, or severe physical illnesses and requires specialized medical care.	Shows continued mental symptoms, such as delirium, delusions, and agitation, and manifests associated problematic behaviors, such as self-mutilation or harm to others.

^aNeeds special medical treatments