‘Dementia 21’ Is Basically ‘Smiling Friends’ If It Were a Horror Manga

If you’re anything like me, you can’t watch anything horror-related without cracking wise to ease the tension while being genuinely unnerved by the terrors on display. That’s right, there are dozens of us annoying moviegoers (dozens!). And reading manga from folks like Junji Ito isn’t necessarily something you can do in one sitting on account of the relentlessly macabre body horror you can see through blinked eyelids in one ample sitting. So if you want to cozy up with a good manga this Halloween that’s less Zach Creggor Barbarian scary and more Weapons funny scary—with a hint of madcap Smiling Friends humor to ease the unease—Dementia 21 is the perfect manga for you.

Dementia 21, created by Shintaro Kago, follows Yukie Sakai, a home health aide who prides herself on her services with the elderly. Yukie is all about making her clients smile; in turn, they reward her with top marks for her selfless, dedicated in-home living services, even if it puts her out in the process. In a short amount of time, all her hard work, verging dangerously close to toxic positivity, comes close to bearing fruit when she nearly cinches the rank of best live-in nurse at Green Net, a private elder care service company.

That is, until her co-worker gets a case of the evil eye and, after a tryst with their married boss, implores him to fudge the numbers to prevent Yukie from becoming a legend as the top scorer in the three months she’s had the job. While the boss can’t acquiesce to her request, he does move some things around to set Yukie up for failure by having all her clientele be senile old folks with supernatural powers.

It would be regressive to say that Dementia 21 is a more comedic vein of Ito-style horror. Kago’s absurdist, downright phantasmagoric work is simply too wild to be confined to such a blanket, generic point of comparison. From the first moment I cracked open the book, it was exceedingly apparent that Kago’s formative surrealist influences of Salvador Dali, Yasutaka Tsutsui’s black humor, and Akira creator Katsuhiro Otomo’s dense, detailed, and expressive art style were the creative cornerstones to the immediately arresting house of work he’s built for himself in Dementia 21.

The first volume is kind of a “kisou mangaka” (bizarre manga creator) and an “ero guro nansensu” (erotic grotesque) artist, blending sexuality, horror, and absurdity in a way that distorts reality through radical visuals and provocative themes, with laughs and gasps as the binding that holds its tales together. Does that mean she has to stop AI-powered dentures from creating a hivemind to take over the world or calm the political assassinations via pulley-delivered buckets in a series of sky-rise project nursing home visits? So be it.

To give you a taste of how all of the above emphatic gesturing plays out in the manga, I’ll regale you with some of my favorite misadventures of Yuki’s from its first volume.

An honorable mention to one of the tales in which Yukie is forced to drive with an elderly man who refuses to give up his license (been there). There’s no supernatural mumbo jumbo here, just absurdist humor out the wazoo. Yuki white-knuckles it as a passenger princess on a madcap highway adventure where her town has roads and laws that allow freeways for driving under the influence, heart attacks, toxic waste, and suicides—all to Yuki’s absolute horror. Girlie just wants the patrol cop who keeps bothering them to get out of the lane if they don’t have any of those conditions and to pull them over. If not to revoke her geriatric road rage driver’s license, then at least to free her from this freeway nightmare.

But the first of my three favorite stories, in no particular order, starts with the ever-so-infectiously plucky and upbeat Yukie having to caretake a legally distinct geriatric Ultraman, using construction equipment to change his diapers and shovel gruel into a giant bowl. Things she manages well, all things considered, until his cosmic nemesis arrives one after another to challenge him in his old age. Their old-man loitering serves more as a nuisance to the townspeople, who ask her to find a way to move them right along without getting sidetracked, forgetting what they came for, and going off on non-sequiturs about nothing, wasting even more of everyone’s time. It’s a banal, fashionable paranoia-type horror tale, but also funny and low-effort despite casually saying aliens also exist in this manga as a tone setter to the type of impossible tasks Yukie will have to undertake with a smile.

My second-favorite story sees Yukie endure a hellish nurse boot camp at the behest of her overbearing mother (who, of course, was once the best in-house nurse of all time). Disappointed that Yukie still hasn’t won gold, she has her daughter black bagged and sent through the ringer at a rookie nurse bootcamp. After carrying mannequins through minefields and blistering blizzards, and under barbed wire fences (all without skimping on feeding and changing diapers), Yukie emerges as an elder care beast whose raison d’être is house care. It gets so out of hand that she winds up being detained by the U.S. military to be deployed into enemy areas, giving them elder care to quell their need to fight, eliminating wars, and achieving world peace.

And my absolute favorite tale is one where Yukie has to take care of an old lady with dementia (just like the manga’s title!). While I, through Yukie, found the elderly lady’s family a bit annoyingly eccentric, doing too much to make sure she remembered them as her favorite grandchildren, it became apparent why they were being so irritating. The catch is that a world-ending supernatural gift also touches the old lady: if she forgets anything—be it a person or a concept—they’ll explode into a mist of viscera, which she does almost immediately upon meeting Yukie. “Who are you again?” Grandkids explode. “That’s a cute dog. Whose is it?” Pup popped. Her dementia powers get even more hyperspecific with what they destroy, removing the concept of toupees, “fake tits,” and “virgin,” and having folks combust like spent firecrackers.

It’s all a delightfully shocking misadventure that doesn’t necessarily get solved but worked around, thanks to Yukie digging in deep and giving it 110 percent, helping administer an anti-dementia drug that’s fast-tracked into her client like a dagger, bringing all the forgotten concepts and people back, but in a messed-up homunculus stitched together.

Speaking anecdotally, one aspect that makes discovering Dementia 21 such a breath of fresh air as someone whose whole deal is covering manga and anime and has gotten a touch tired of just thinking about shonen or gross-out horror is that I happened upon the manga by pure chance by checking out a local brick-and-mortar bookstore. No futzing with manga reading apps‘ payment services that feel increasingly like live service gatcha games nickel and diming users, limiting how many chapters they can get in a day before coughing up more dough to “rent” them for a limited time. Just old-school commerce for cheap (since this particular second-hand donation-based bookstore sold it for $13 against its market price of $30).

So if you’re more of the comedy-horror pastiche-indulging manga reader, be sure to check out Dementia 21 and have nosy passersby on the bus rubberneck over your shoulder at the wild bits of horror and slapstick comedy beaming out of its pages like I’ve been delighting in doing since picking it up.

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