Kobe University

The Japan Flagship site was built on the work of the WHO Kobe City Project which seeks to bolster early detection and the management of dementia. For three years prior to the DAC-SP Early Detection Program, the site has been conducting community outreach (through mailed vouchers for a “free cognitive test”) in primary care. The blood test was conducted by specialists at Kobe University, where the digital cognitive assessment was also offered. Additionally, they collected a patient survey questionnaire for any participants who declined the blood test. The local government covered patient out-of-pocket expenses and provided liability insurance for any diagnosed participants for dementia-related accidents.  

Universal healthcare is provided in Japan. The newer tools, digital cognitive assessment (DCA) and blood-based biomarkers (BBM), were not covered by government insurance, and the Early Detection Program was implemented as a research study to enable the use of these tools.   

See Key Lessons

Site Leads

Dr. Hisatomo Kowa

Dr. Hisatomo Kowa

Professor of Neurology at Kobe University Graduate School of Health Sciences, Principal Investigator of DAC flagship project in Kobe

Key Partners

  • Kobe City Local Government
  • WHO Kobe City
  • Kobe City Chapter of the Japan Medical Association
  • Kobe City Chapter of the Japan National Insurance Association

What are the key lessons learned from the site?


Existing national policy makes buy-in and partnerships smoother.

Existing reimbursement for the early detection of dementia minimized barriers for program buy-in. In turn, cooperation with partner organizations, including those who provided some funding, was streamlined.

Goal 1: Evaluate your healthcare system context.


Operationalizing DCAs in primary care.

Some primary care providers were reluctant to move away from familiar paper-based diagnostic tools that were covered by their healthcare system. The DCA also took a significant amount of time (~30 minutes), creating barriers to adoption in clinics outside of Kobe.

Goal 5: Select your cognitive assessment tools.


Revising protocols for a new era of BBM tools/tests.

Learnings from the existing Kobe Dementia Model provided a strong foundation for the DAC-SP Early Detection Program at Kobe University. However, there were challenges in introducing BBMs to the workflow. In Japan, amyloid biomarker tests (for Alzheimer’s) can only be ordered by specialists – creating a significant barrier for scaling.