Publications (39)37.04 Total impact
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Article: A randomized controlled trial of multicomponent exercise in older adults with mild cognitive impairment.
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ABSTRACT: BACKGROUND: To examine the effect of multicomponent exercise program on memory function in older adults with mild cognitive impairment (MCI), and identify biomarkers associated with improvement of cognitive functions. METHODOLOGYPRINCIPAL FINDINGS: Subjects were 100 older adults (mean age, 75 years) with MCI. The subjects were classified to an amnestic MCI group (n = 50) with neuroimaging measures, and other MCI group (n = 50) before the randomization. Subjects in each group were randomized to either a multicomponent exercise or an education control group using a ratio of 1∶1. The exercise group exercised for 90 min/d, 2 d/wk, 40 times for 6 months. The exercise program was conducted under multitask conditions to stimulate attention and memory. The control group attended two education classes. A repeated-measures ANOVA revealed that no group × time interactions on the cognitive tests and brain atrophy in MCI patients. A sub-analysis of amnestic MCI patients for group × time interactions revealed that the exercise group exhibited significantly better Mini-Mental State Examination (p = .04) and logical memory scores (p = .04), and reducing whole brain cortical atrophy (p<.05) compared to the control group. Low total cholesterol levels before the intervention were associated with an improvement of logical memory scores (p<.05), and a higher level of brain-derived neurotrophic factor was significantly related to improved ADAS-cog scores (p<.05). CONCLUSIONSSIGNIFICANCE: The results suggested that an exercise intervention is beneficial for improving logical memory and maintaining general cognitive function and reducing whole brain cortical atrophy in older adults with amnestic MCI. Low total cholesterol and higher brain-derived neurotrophic factor may predict improvement of cognitive functions in older adults with MCI. Further studies are required to determine the positive effects of exercise on cognitive function in older adults with MCI. TRIAL REGISTRATION: UMIN-CTR UMIN000003662 ctr.cgi?function = brows&action = brows&type = summary&recptno = R000004436&language = J.PLoS ONE 01/2013; 8(4):e61483. · 4.09 Impact Factor -
Article: Surrogate by care managers for individuals with insufficient mental capacity.
Geriatrics & Gerontology International 01/2013; 13(1):235-6. -
Article: [Usefulness of support from end-of-life care teams in difficult decision-making].
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ABSTRACT: It is unclear how hospitals should support a patient's decision to return home to die. Thus, we retrospectively examined the usefulness of support from an End-Of-Life Care Team in such difficult decision making. The subjects included non-cancer patients and the elderly. Our results suggest that the burden of making difficult decisions decreases with support from End- Of-Life Care Teams.Gan to kagaku ryoho. Cancer & chemotherapy 12/2012; 39(12):1-2. -
Article: Cognitive impairments and functional declines in older adults at high risk for care needs.
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ABSTRACT: Aim: Functional status of those who have very mild cognitive impairment have not been sufficiently investigated. In the current study, we analyzed the characteristics of functional awareness in older adults who had cognitive impairment and were at high risk of requiring support/care (termed as specified elderly at high risk for care needs in the long-term care insurance scheme). Methods: The answers of a health check, which is provided by the local municipal government for those aged 75 years or older who have not been certified as eligible for care services, were analyzed. The differences of the variables between the two groups regarding yes/no answers to each of three cognition-related questions were analyzed. Then, a multiple logistic analysis was carried out to investigate the association of yes/no answers of the three cognition-related questions and the awareness of functional decline. Results: The participants who had cognitive impairment had greater awareness of functional declines. Multiple logistic regression analysis showed that subjective memory impairment and disorientation were significantly associated with a wider range of awareness of functional decline. Conclusions: Subjective cognitive impairment was associated with a wide range of awareness of functional decline in older adults at high risk for care need. Geriatr Gerontol Int 2012; ••: ••-••.Geriatrics & Gerontology International 06/2012; -
Article: Characteristics of cognitive function in early and late stages of amnestic mild cognitive impairment.
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ABSTRACT: Aim: The detection of the early stages in amnesic mild cognitive impairment (aMCI) is considered important in diagnosing progression to Alzheimer's disease. The current study sought to investigate differences in cognitive function between control subjects with no memory loss (control), and subjects in the early stage of aMCI (EMCI) and late stage of aMCI (LMCI). Methods: A total of 100 community-dwelling older adults aged 65 years and over were recruited from 1543 potential subjects. Subjects were classified into three groups based on the degree of objective memory impairment; control (n = 29), EMCI (n = 34) and LMCI (n = 37). Multiple neuropsychological tests were carried out to examine cognitive function. Results: The EMCI individuals showed lower cognitive function relative to controls; not only in logical memory, but also in letter fluency (P < 0.05). There were no significant differences in neuropsychological scores between the EMCI and LMCI groups, except for category fluency and logical memory. In addition, the EMCI subjects' logical memory score showed a significant relationship with letter fluency, category fluency and digit span backward test performance (P < 0.05). Conclusions: These results suggest that the application of multiple neuropsychological tests might be useful in diagnosing older adults with EMCI and LMCI. Geriatr Gerontol Int 2012; ••: ••-••.Geriatrics & Gerontology International 06/2012; -
Article: Dysphagia in older adults at high risk of requiring care.
Geriatrics & Gerontology International 04/2012; 12(2):359-61. -
Article: The relationship between atrophy of the medial temporal area and daily activities in older adults with mild cognitive impairment.
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ABSTRACT: Background and aims: Many studies have suggested that social network, leisure activity, and physical activity can have protective effects against dementia and Alzheimer's disease. However, previous studies have not examined the relationship between daily activities and brain atrophy in older adults. This study aimed to explore what kind of daily activities were associated with atrophy of the medial temporal area including the entorhinal cortex (MTA-ERC) in older adults. Methods: In total, 122 older adults (aged 65 and over) with subjective memory complaints or a Clinical Dementia Rating of 0.5 underwent magnetic resonance imaging, and MTA-ERC atrophy was assessed by the voxel-based morphometry method. Based on magnetic resonance imaging data, the subjects were divided into atrophy and nonatrophy groups. Daily activities were assessed using a 20-item questionnaire (e.g., instrumental activities of daily living, social activities), and we compared activity participation between the groups. Results: The atrophy group (n = 37) showed significantly lower participation in 4 out of 20 activity items (cleaning, intellectual activity, culture lessons, and using a personal computer) than the non-atrophy group (n = 85). Summed scores of these 4 items (range from 0 to 4) were significantly associated with MTA-ERC atrophy even after adjustment for age, sex, education status, and Mini-Mental State Examination score. Conclusions: In conclusion, MTA-ERC atrophy was associated with cognitive activities or household-related activities requiring planning.Aging - Clinical and Experimental Research 03/2012; -
Article: Relationship between atrophy of the medial temporal areas and cognitive functions in elderly adults with mild cognitive impairment.
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ABSTRACT: The current study sought to determine which types of cognitive function are related to atrophy of the bilateral medial temporal areas including the entorhinal cortex (MTA-ERC) in elderly adults. The subjects were 96 elderly adults (mean age 75.3 years) with mild cognitive impairment. Subjects underwent Wechsler Memory Scale-Revised, logical memory I and II (WMS-R, LM I and II), Rey complex figure retention tests after 3 and 30 min (RCF-3 min and RCF-30 min), digit span backword (DSB), digit symbol-coding (DSC), Stroop Color and Word Test-Interference List (SCWT-IL) as well as magnetic resonance imaging (MRI) and were divided into elderly adults without or with mild to moderate MTA-ERC atrophy, and those with severe atrophy. In all subjects, MTA-ERC atrophy showed significant relationships with age (r = 0.43), education (r = -0.25), WMS-R, LM I (r = -0.21), DSC (r = -0.32), and SCWT-IL (r = 0.32). The mild to moderate atrophy group showed significant relationships between MTA-ERC atrophy and age (r = 0.34), DSC (r = -0.28), and SCWT-IL (r = 0.25). In contrast, in the severe atrophy group, MTA-ERC atrophy was correlated significantly with RCF-3 min (r = -0.70) and RCF-30 min (r = -0.74). The linear regression model included demographic variables and cognitive tests; two variables to survive the step-wise analysis were age (β = 0.374) and SCWT-IL (β = 0.247) in all subjects. Age (β = 0.301), and RCF-30 min (β = -0.521) and age (β = 0.460) remained as a significant variable in the mild to moderate atrophy and severe atrophy groups, respectively. Executive function tests such as SCWT-IL may be useful as a screening tool to identify mild to moderate MTA-ERC atrophy and a decline in the RCF test may suggest severe MTA-ERC atrophy in elderly adults with MCI.European Neurology 01/2012; 67(3):168-77. · 1.81 Impact Factor -
Article: Falls in elderly at high risk of requiring care.
Geriatrics & Gerontology International 01/2012; 12(1):147-8. -
Article: The association between decline in physical functioning and atrophy of medial temporal areas in community-dwelling older adults with amnestic and nonamnestic mild cognitive impairment.
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ABSTRACT: To examine whether declining performance in aspects of physical functioning, including lower extremity muscle strength, 1-legged balance, walking speed, and exercise capacity, is associated with atrophy of medial temporal areas in community-dwelling older adults with mild cognitive impairment (MCI). Cross-sectional study. General community in Japan. Community-dwelling older adults 65 years and older with a Clinical Dementia Rating of 0.5 or memory complaints were enrolled in this study. This study examined 34 participants with amnestic MCI (aMCI) and 58 nonamnestic MCI (non-aMCI) participants. Not applicable. The following physical performance tests were conducted: muscle strength of knee extension, 1-legged standing time, 5-m walking test, and 6-minute walk test (6MWT). The z scores of the voxel-based specific regional analysis system for Alzheimer's disease were determined to assess the degree of atrophy in the bilateral medial temporal areas including the entorhinal cortex (MTA-ERC). In the aMCI group, 6MWT performance was associated with MTA-ERC atrophy (β=-.462, P=.014) after controlling for age. In the stepwise multiple regression analyses, 6MWT and body mass index were found to be significant determinants of MTA-ERC atrophy in all participants (R(2)=.275), as well as the aMCI and non-aMCI groups when analyzed separately (R(2)=.418 and R(2)=.216, respectively). A decline in exercise capacity was found to be more closely associated with atrophy of the MTA-ERC compared with other aspects of physical functioning in older adults with MCI, especially the amnestic type. These findings suggest that it is important for future studies to investigate the effects of increased aerobic activity and improved fitness on brain volume in older adults at risk of developing dementia.Archives of physical medicine and rehabilitation 12/2011; 92(12):1992-9. · 2.18 Impact Factor -
Article: [Long term care insurance and home care].
Nippon rinsho. Japanese journal of clinical medicine 12/2011; 69 Suppl 10(Pt 2):557-60. -
Article: Report from Sepulveda: A visit to the California Geriatric Evaluation Unit and Dr Rubenstein (the father of the Comprehensive Geriatric Assessment).
Geriatrics & Gerontology International 01/2011; 11(1):131-2. -
Article: Association of lower hemoglobin level with depressive mood in elderly women at high risk of requiring care.
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ABSTRACT: Despite the high prevalence of anemia and depression in the elderly, there have been few studies exploring the association between these two conditions. In the current study, we analyzed the association of hemoglobin level and depressive mood in a group of community-dwelling elderly at high risk of requiring care. All participants at a health check in a group of community-dwelling elderly (1163 men and 2651 women) filled out a basic yes/no questionnaire consisting of simple assessments of their instrumental activities of daily living (7 items), memory problems (3 items), walking status (5 items), dysphagia (3 items), nutritional status (2 items) and depressive mood (5 items). Other examinations, including blood testing, were also performed. Multiple regression analysis with the score of depressive mood in the basic checklist was performed. The hemoglobin level was set for an explanatory value after adjustment for age, blood pressure, electrocardiogram abnormality, instrumental activities of daily living, walking status, nutritional status, dysphagia and memory problems. It was found that 30.5% of women and 31.8% of men had anemia. When the subjects were divided with depressive score of 2 points or more (the highest possible score was 5) and less, those with a higher depressive score had significantly lower hemoglobin levels than those with a lower score. Multiple regression analysis showed that lower hemoglobin level was significantly associated with depressive mood only in women (P=0.046) but not in men (P=0.579). Lower hemoglobin level was significantly associated with depressive mood in elderly women at high risk for care, but not in elderly men at high risk for care.Geriatrics & Gerontology International 01/2011; 11(3):262-6. -
Article: Factors associated with carotid atherosclerosis in community-dwelling oldest elderly aged over 80 years.
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ABSTRACT: Hypertension, hyperlipidemia, impaired glucose tolerance and smoking have been known to be risk factors for atherosclerosis. Recently, it was shown that hyperhomocysteinemia is also a risk factor for cerebral vascular disease and atherosclerosis. However, it is unknown if these are also risk factors in the oldest elderly population aged 80 years or older. We carried out a cross-sectional analysis to determine the associated factors with carotid atherosclerosis in the oldest elderly living in the community. Subjects consisted of 136 oldest elderly aged 80 years or older living in the community. Blood pressure, orthostatic change of blood pressure, blood chemical parameters, height and bodyweight, lifestyle and medical history were examined. The thickness was measured of the total carotid artery intima-media complex (IMT) by carotid artery ultrasonography and used the maximum thickness (max IMT) for analysis. The factors that correlated with max IMT were age and low gamma-glutamyl transpeptidase in males, and serum homocysteine levels in females. The subjects were divided into two groups: those with a max IMT of less than 1.0 mm and those with that of 1.0 mm or more. Factors associated with max IMT were age and abstinence from alcohol in males, and orthostatic blood pressure change in females. Factors significantly associated with higher carotid artery IMT were aging in males and orthostatic blood pressure change in females. The factors associated with carotid artery IMT as an indicator of carotid atherosclerosis in community-dwelling oldest elderly aged 80 years or older were sex, aging, orthostatic blood pressure change and no alcohol intake. There were differences in risk factors for carotid atherosclerosis between the male and female population.Geriatrics & Gerontology International 04/2008; 8(1):12-8. -
Article: Increased binding potential of [(11)C]raclopride during unilateral continuous microinjection of nicotine in rat striatum observed by positron emission tomography.
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ABSTRACT: Nicotine injections and nicotine skin patches significantly improve attention, memory, and learning in Alzheimer's disease. In animal studies, nicotine improves the performance of various memory-related tasks, an effect that is thought to be mediated by the neuronal dopaminergic system as systemic administration of nicotine decreased [(11)C]raclopride binding in the anesthetized state. Since high doses of systemically administered nicotine are harmful, we administrated it directly into the rat striatum via microdialysis. We then examined the acute effects of continuous central administration of high doses of nicotine on striatal dopamine concentrations by measuring [(11)C]raclopride binding by positron emission tomography. The concentration of dopamine in the dialysates was significantly increased from basal levels when microdialysis with 100 mM nicotine was initiated. However, contrary to expectations, the binding potential (BP) of [(11)C]raclopride in the nicotine-perfused striatum was significantly higher than that in control striatum. Preinjection of mecamylamine (3 mg/kg), a nicotinic antagonist, had no effect on either extracellular dopamine levels or on the BP of [(11)C]raclopride. These findings suggest that the high dose of local nicotine administration induced mecamylamine-insensitive local increases in extracellular dopamine, but might have decreased the total amount of extracellular dopamine in the striatum.Synapse 01/2008; 61(12):943-50. · 2.94 Impact Factor -
Article: Assessment of Competency to Contract for Care Insurance in Aichi Prefecture
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ABSTRACT: Background: A nursing care insurance system went into effect in April 2000 in Japan. Under the new system, the user (person requiring care) enters a contract directly with the service provider. Hence a pertinent issue is whether or not the user has the decision-making capacity to enter a contract (competency to contract) and the degree of that capacity. The aim of the present study was to gain an understanding of the competency to contract under the new system.Methods: The subjects were elderly residents who entered a care insurance facility after April 2000. Ten institutions from among the care insurance facilities in Aichi Prefecture cooperated in this study. The study was sufficiently explained to the elderly residents and their families, and written informed consent was obtained from both. Respective municipalities were requested to allow access to the results of the nursing care certification process of the subjects, with their consent and the consent of their families. In addition, the care manager of the facility gave the residents a Mini-Test that we had prepared to determine competency to contract.Results: The results revealed that most subjects had little understanding of the care system, and surprisingly, that they were not in the care insurance facility of their own volition. The competency to contract in the dementia group was significantly lower than in the non-dementia group.Conclusion: It may be unreasonable to believe that all such people are competent to enter a contract, especially those with dementia. However, the results suggest that people with a mild care grade, even if they have dementia, may have such competency. Further study including psychiatric assessment and diagnosis of the capacity to contract is necessary.Psychogeriatrics 08/2007; 1(3):203 - 208. · 1.21 Impact Factor -
Article: Attitudes toward disclosing the diagnosis of dementia in Japan.
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ABSTRACT: The rapid increase in the elderly population in Japan has triggered a debate on whether or not patients with dementia should be informed of their diagnosis. The purpose of the present study was to investigate the attitudes of people in a large city in Japan toward the disclosure of a diagnosis of dementia. In Study 1, 2000 residents aged 40-64 and 5000 residents aged 65 and over were sampled randomly, and a structured questionnaire was sent to them by mail. In Study 2, we administered a structured interview-based questionnaire to 3949 randomly enrolled residents of Nagoya City aged 45 and over whose family member had been certified as needing long-term care. In Study 1, 79.8% of the younger respondents (n = 710) stated that they would prefer the disclosure of a hypothetical diagnosis of dementia, as did 75.5% of the older respondents (n = 2162). Furthermore, 85.1% (n = 749) of the younger respondents and 82.5% (n = 2181) of the older respondents stated that they would prefer that the patient be told his or her hypothetical diagnosis of dementia. In Study 2, in the case of care recipients without dementia, 68.3% (n = 650) of their family members preferred disclosure of a hypothetical diagnosis of dementia. Among the families of care recipients who had dementia, 58.4% (n = 301) of family members preferred disclosure. The present survey of caregivers and non-caregivers in an urban city of Japan demonstrated that the desire for disclosure of a diagnosis of dementia is relatively high.International Psychogeriatrics 05/2007; 19(2):253-65. · 2.24 Impact Factor -
Article: A comparison of depressive mood of older adults in a community, nursing homes, and a geriatric hospital: factor analysis of Geriatric Depression Scale.
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ABSTRACT: The Geriatric Depression Scale (GDS)-15 was used in 607 adults aged 65+ years living in a community, nursing homes, and a general hospital to explore characteristics of depressive mood in different care settings. Factor analysis of GDS-15 extracted 4 factors labeled unhappiness, apathy and anxiety, loss of hope and morale, and energy loss. The scale scores labeled unhappiness, apathy and anxiety, and loss of hope and morale were negatively correlated with the Barthel Index and the Mini-Mental State Examination scores. The results classified the depressive patterns into 2 types, one fitting the nursing home residents and the other fitting the hospital patients. The dominant factors of the nursing-home type were unhappiness and loss of hope and morale, and the hospital type was highly related with apathy and anxiety. The results indicate an extended utility of the GDS-15 for a deeper understanding of depressive mood in various care settings.Journal of Geriatric Psychiatry and Neurology 04/2006; 19(1):26-31. · 3.07 Impact Factor -
Article: Behavioral, psychological and physical symptoms in group homes for older adults with dementia.
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ABSTRACT: Despite the recent dissemination of group homes in Japan for older adults with dementia, the behavioral and psychological features of the residents remain unknown. To clarify the association of such features with the levels of difficulty encountered by caregivers in coping with these symptoms, we have conducted a survey to compare the frequencies of the symptoms among group homes, nursing homes and a long-term care hospital. Five hundred and eighty-six older adults aged 65 years or more were sampled. Data were consecutively collected from questionnaires given to the caregivers. The questionnaire included basic activities of daily living, the Mini-mental State Examination, frequencies of behavioral, psychological and physical symptoms, and the levels of difficulty in coping with the symptoms. In group homes, requests to go home, urinary incontinence and frequent complaining were the most commonly observed symptoms. The symptoms associated with disorientation, anxiety and depression were frequently observed in all three care settings. Most of the symptoms were more frequently observed in group homes than in the other two care settings. However, the levels of difficulty in coping with most of the symptoms were the highest in the long-term care hospital, followed in order by the group homes and nursing homes. In group homes, inappropriate sexual behavior was the symptom creating the most stress for the caregivers, followed by verbal and nonverbal abuse and changeable mood. The symptomatic traits of residents in group homes were clarified in the present study. These findings could be helpful in considering desirable placement or the improvement of eligible service provision for older adults with dementia in care facilities.International Psychogeriatrics 04/2006; 18(1):75-86. · 2.24 Impact Factor -
Article: [Comprehensive geriatric assessment for management of the elderly with diabetes mellitus].
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ABSTRACT: In medical care for the elderly patients with diabetes mellitus, there are many cases that are not indicated for active treatment, because of their impairment of activity of daily living (ADL), instrumental ADL and cognitive function, and also the presence of some complications, such as cerebrovascular disorder. On the other hand, poor glycemic control is easy to induce dehydration, bacterial infection, and cognitive disorders in the elderly. Thus, it is necessary to maintain good glycemic control to preserve better ADL. However, compulsion of strict glycemic control might rather decrease QOL of the patient. To solve such a medical dilemma, the comprehensive geriatric assessment (CGA) is useful for the individual diabetic patient.Nippon rinsho. Japanese journal of clinical medicine 02/2006; 64(1):106-11.
Top co-authors
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Institutions
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2011
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National Center for Geriatrics and Gerontology
Ōbu, Aichi-ken, Japan
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2006–2011
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Nagoya University
- Division of Geriatrics
Nagoya-shi, Aichi-ken, Japan
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