title: Why do people with dementia pretend to know the correct answer? A qualitative study on the behaviour of toritsukuroi to keep up appearances.
abstract: BACKGROUND
  Toritsukuroi is a particular type of behaviour intended to save face or preserve appearances. Clinicians often observe toritsukuroi in people with dementia, but current knowledge about this behaviour is based on clinicians' empirical knowledge rather than on observational studies. This study was designed to clarify which behaviours are related to toritsukuroi based on neuropsychological examinations.
  
  
  METHODS
  The subjects were 91 outpatients with dementia. Verbal responses, with the exceptions of 'I don't know' and erroneous answers, were recorded by certificated clinical psychologists and analyzed by qualitative study procedures. A qualitative study was separately conducted by two researchers to identify themes and types of reactions. The themes found through content analysis were organized and labelled by a senior psychiatrist.
  
  
  RESULTS
  Among the patients, 41.8% verbally responded in way to 'keep up appearances'. Six distinct thematic categories were identified through conventional content analysis: (i) refuting sudden questions; (ii) disclosing trait; (iii) disclosing experience; (iv) demonstrating slight hesitation; (v) appealing to indifference; and (vi) other.
  
  
  CONCLUSIONS
  All the responses that we defined as being toritsukuroi reflect a denial of acquired cognitive impairment. Further study is needed to clarify the association between toritsukuroi and either cognitive function or disease specificity.
authors.affiliation: Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Masateru
authors.initials: M
authors.lastname: Matsushita
authors.affiliation: Mental Health and Welfare Center, Department of Health and Welfare, Kumamoto Prefectural Goverment, Kumamoto, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yatabe
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Asuka
authors.initials: A
authors.lastname: Koyama
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ijichi
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.|Department of Speech-Language-Hearing Science, Kumamoto Health Science University, Kumamoto, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ikezaki
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Center for Medical Education and Research, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Furukawa
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.|Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ikeda
mesh_terms: D060825:Cognitive Dysfunction / Q000523:psychology*; D003704:Dementia / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012752:Shame; D012923:Social Class
keywords: 
  toritsukuroi
  ; content analysis; dementia; keeping up appearances; shame; symptomatology