[Show abstract][Hide abstract] ABSTRACT: AimIt is very important to maintain cognitive function in patients with mild cognitive disorder. The aim of the present study was to determine whether the amount of physical activity is associated with memory function in older adults with mild cognitive disorder.MethodsA total of 47 older adults with mild cognitive disorder were studied; 30 were diagnosed with mild Alzheimer's disease and 17 with mild cognitive impairment. The global cognitive function, memory function, physical performance and amount of physical activity were measured in these patients. We divided these patients according to their walking speed (<1 m/s or >1 m/s). A total of 26 elderly patients were classified as the slow walking group, whereas 21 were classified as the normal walking group.ResultsThe normal walking group was younger and had significantly better scores than the slow walking group in physical performance. Stepwise multiple linear regression analysis showed that only the daily step counts were associated with the Scenery Picture Memory Test in patients of the slow walking group (β = 0.471, P = 0.031), but not other variables. No variable was significantly associated with the Scenery Picture Memory Test in the normal walking group.Conclusions
Memory function was strongly associated with the amount of physical activity in patients with mild cognitive disorder who showed slow walking speed. The results show that lower physical activities could be a risk factor for cognitive decline, and that cognitive function in the elderly whose motor function and cognitive function are declining can be improved by increasing the amount of physical activity. Geriatr Gerontol Int 2014; ●●: ●●–●●.
[Show abstract][Hide abstract] ABSTRACT: Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m(2) for men and 5.4 kg/m(2) for women by using dual X-ray absorptiometry, and 7.0 kg/m(2) for men and 5.7 kg/m(2) for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia.
Journal of the American Medical Directors Association 02/2014; 15(2):95-101. · 5.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine whether arterial stiffness, measured by the cardio-ankle vascular index (CAVI), is associated with skeletal muscle mass index (SMI) in Japanese community-dwelling older adults.
Data were collected from 175 participants through questionnaires and specific tests; the data included demographic, lifestyle and health characteristics, body mass index (BMI), and body composition features determined by the bioelectrical impedance analysis, ankle-brachial index, the Mini-Nutritional Assessment, handgrip strength (GS), walking speed and shuttle walking tests (SW), and arterial stiffness determined by the CAVI. Absolute SMI was dichotomized according to the first quintile, which determined low (n = 35) and normal (n = 140) SMI.
Participants with low SMI were older (P = 0.01), had more polypharmacy (P = 0.01), a lower BMI (P < 0.001), and fat mass index (P = 0.02), and had a greater risk of malnutrition (P < 0.001) than the normal group. Additionally, they showed poorer physical performance (GS and SW, P = 0.007 and 0.01, respectively) than the normal group. Furthermore, CAVI was associated with SMI even after adjustments (OR 1.82, 95% CI 1.14-2.90, P = 0.01).
Our data showed that arterial stiffness is associated with low SMI in community-dwelling older adults, even when adjusting by multiple factors, showing a close interaction of vascular aging and muscle mass decline. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 109-114.
Geriatrics & Gerontology International 02/2014; 14 Suppl 1:109-14.
[Show abstract][Hide abstract] ABSTRACT: The age-dependent loss of skeletal muscle mass is highly concerning in diverse aging populations. However, age-dependent changes in muscle mass and the visceral fat area have not been well documented in Asian populations. The aim of the present study was to evaluate the age-dependent changes in skeletal muscle mass and the visceral fat area in Japanese adults from 40 to 79 years-of-age.
This was a cross-sectional study. Healthy men (n = 16 379) and women (n = 21 660) aged 40-79 years participated in the present study. The skeletal muscle mass and visceral fat area were measured in the study participants by bioelectrical impedance. The muscle mass data were converted into the skeletal muscle mass index (SMI) by dividing the weight by the height squared (kg/m(2) ).
The SMI showed an age-dependent decrease in both sexes. Between 40 and 79 years, the total SMI decreased by 10.8% in men and by 6.4% in women. The arm SMI decreased by 12.6% in men and 4.1% in women, and the leg SMI decreased by 10.1% in men and by 7.1% in women in the same period. In contrast, the visceral fat area showed an age-dependent increase in both sexes. The visceral fat area increased by 42.9% in men and by 65.3% in women. The multiple regression analysis showed that the SMI was negatively associated with visceral obesity in both sexes.
In Japanese adults, sex-specific changes in skeletal muscle mass are more prominent in the arm than in the leg. Furthermore, the age-dependent increases in visceral adipose tissue might lead to loss of skeletal muscle mass. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 8-14.
Geriatrics & Gerontology International 02/2014; 14 Suppl 1:8-14.
[Show abstract][Hide abstract] ABSTRACT: Background/purpose
Day care centers are rapidly expanding in Brazil to meet the needs of the increasing older population. However, health profiles of their clients remain unclear. Therefore, this study aimed to investigate and compare the health conditions of users and nonusers of a day care center using a new frailty index, the Kihon Checklist.
This was a cross-sectional observational study. We recruited 59 users (mean age 81.1 ± 6.69 years) and 173 nonusers (mean age 69.9 ± 7.39 years). The nonusers were recruited at a recreational club and municipal health units, and the users were recruited at a day care center for the elderly in Brazil. Measurements consisted of questionnaires regarding sociodemographic and health-related characteristics and the Kihon Checklist.
Compared with the nonusers, users had a higher prevalence of frailty (p < 0.001) and impairment of all specific domains (instrumental activities of daily living impairment, p < 0.001; physical inactivity, p < 0.001; seclusion, p < 0.001; cognitive deficit, p < 0.001; and depression, p < 0.001). The users were also more likely to be frail [odds ratio (OR), 14.226; 95% confidence interval (CI), 5.423–37.320; p < 0.001], dependence in instrumental activities of daily living (OR, 78.845; 95% CI, 19.569–317.674; p < 0.001), physically inactive (OR, 3.509; 95% CI, 1.467–8.394; p = 0.005), cognitively impaired (OR, 5.887; 95% CI, 2.360–14.686; p < 0.001), and depressed (OR, 5.175; 95% CI, 2.322–11.531; p < 0.001) than the nonusers.
The users of the day care center were frailer than nonusers, especially with regard to independence in instrumental activities of daily living, physical strength, cognitive function, and mood. Health care workers should use the Kihon Checklist to verify frequently the condition of elderly patients to prevent worsening of frailty.
Journal of Clinical Gerontology and Geriatrics. 01/2014;
[Show abstract][Hide abstract] ABSTRACT: NF-κB is a major transcriptional factor regulating many cellular functions including inflammation; therefore, its appropriate control is of high importance. The detailed mechanism of its activation has been well characterized, but that of negative regulation is poorly understood. In this study, we showed AMAP1, an Arf-GTPase activating protein, as a negative feedback regulator for NF-κB by binding with IKKβ, an essential kinase in NF-κB signaling. Proteomics analysis identified AMAP1 as a binding protein with IKKβ. Overexpression of AMAP1 suppressed NF-κB activity by interfering the binding of IKKβ and NEMO, and deletion of AMAP1 augmented NF-κB activity. The activation of NF-κB induced translocation of AMAP1 to cytoplasm from cell membrane and nucleus, which resulted in augmented interaction of AMAP1 and IKKβ. These results demonstrated a novel role of AMAP1 as a negative feedback regulator of NF-κB, and presented it as a possible target for anti-inflammatory treatments.
[Show abstract][Hide abstract] ABSTRACT: Sarcopenia, the age-dependent loss of skeletal muscle mass, is highly prevalent among older adults in many countries; however, the prevalence of sarcopenia in healthy Japanese community-dwelling older adults is not well characterized.
The aim of this study was to evaluate the prevalence of sarcopenia and to examine the association of sarcopenia with falls and fear of falling in community-dwelling Japanese older adults.
This is a cross-sectional study.
Healthy men (568) and women (1314) aged 65 to 89 years participated in this research.
For all participants, 3 measurements were taken: skeletal muscle mass measurement using bioelectrical impedance, 10 m at a usual walking speed, and handgrip strength. Sarcopenia was defined as the presence of both poor muscle function (low physical performance or low muscle strength) and low muscle mass.
The prevalence of sarcopenia, determined using the European Working Group on Sarcopenia in Older People-suggested algorithm, in men and women aged 65 to 89 years was 21.8% and 22.1%, respectively. The prevalence of sarcopenia increased age-dependently, especially in those older than 75 years in both genders. In the young old, the prevalence of sarcopenia was higher in women than in men; however, in those older than 85 years, the prevalence of sarcopenia was lower in women than in men (P < .05). In addition, fall incidents and fear of falling were more prevalent in sarcopenic older adults than in nonsarcopenic older adults (P < .05).
These results suggest that sarcopenia is highly prevalent in community-dwelling Japanese older adults and is related to falls and fear of falling.
Journal of the American Medical Directors Association 10/2013; 14(12):911-915. · 5.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Poor sleep can affect physical and mental health, and consequently people's quality of life (QOL); however, only a few studies have addressed the potential associations of physical and mental health with quality of sleep (QOS) in Japan. The present study aimed to investigate the association of QOS with sociodemographic and lifestyle characteristics, cognitive status, nutrition, depression, seclusion, and QOL in Japanese community-dwelling older adults.
Data were collected through self-administered questionnaires and other specific tests in 145 (age 73 years [range 70-77 years]) participants. The χ(2) -test or Fisher's exact test were used to compare categorical variables stratified by QOS, and the Mann-Whitney U-test was used for continuous variables. Furthermore, logistic regression analyses were carried out to verify the associations with QOS.
The poor QOS group had more males (P < 0.05), a shorter self-reported sleep duration (P < 0.001), higher body mass index (P < 0.05) and higher risk of depression (P < 0.05), whereas the good QOS group showed higher scores in the QOL summary and domains of physical component (P < 0.01), general health (P < 0.001), bodily pain (P < 0.001) and vitality (P < 0.001). In the logistic regression model, cognitive status (OR 0.13, 95% CI 0.03-0.55), bodily pain (OR 0.91, 95% CI 0.84-1.00) and vitality (OR 0.82, 95% CI 0.73-0.92) were associated with QOS.
The present study provides evidence that QOS is linked to cognitive status, bodily pain and vitality in Japanese older adults. We maintain that screening a person's sleep characteristics in a community setting might be relevant to identify those older adults at risk of a poor QOL and frailty in the early phase, triggering further health analyses. Geriatr Gerontol Int 2013; ●●: ●●-●●.
[Show abstract][Hide abstract] ABSTRACT: Aims: The purpose of this study was to determine the cross-sectional relationship between the cognitive function and cardio-ankle vascular index (CAVI) in Japanese community-dwelling elderly subjects.Methods: A total of 179 Japanese community-dwelling elderly subjects were recruited for this study. The age, height, weight, gender and past medical history (cardiovascular disease, hypertension, diabetes mellitus, hyperlipidemia) of each participant was recorded. In addition, the degree of arterial stiffness was determined according to the CAVI, while the cognitive function was assessed using the Mini-Mental State Examination (MMSE). After dividing the cohort into two groups according to the MMSE score (≤26, >26), we used a multiple regression analysis to assign the level of the cognitive function as a dependent variable.Results: The data were statistically analyzed for the 174 participants (84 men and 90 women) who completed the data collection process without omissions. A multivariate logistic regression analysis showed that a higher weight (Odds Ratio [OR]: 1.05, 95% Confidence Interval [95% CI]: 1.00-1.11, p= 0.03), male gender (OR: 3.13, 95% CI: 1.05-9.34, p= 0.04) and lower CAVI (OR: 0.68, 95% CI: 0.48-0.96, p= 0.03) were significantly correlated with a higher MMSE score. We also found significant correlations between the MMSE and weight (OR: 1.11, 95% CI: 1.03-1.19, p= 0.01) and CAVI (OR: 0.57, 95% CI: 0.33-0.98, p= 0.04) in elderly men only using a gender-specific analysis.Conclusions: We found that the elderly subjects with a high CAVI exhibited a worse cognitive function even after adjusting for age, height, weight and gender. This finding therefore indicates the usefulness of the CAVI in the early detection of dementia.
Journal of atherosclerosis and thrombosis 09/2013; 21(1):49-55. · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To translate the Japanese Kihon Checklist (frailty index) into the Portuguese language, and to validate the use of the checklist for the assessment of the elderly Brazilian population.
A semantic analysis was carried out, along with pretesting of bilingual participants. The checklist was validated against the Edmonton Frail Scale.
A total of 188 Brazilian older adults (mean age 69.5 ± 7.47 years) participated in the present study. In the semantic analysis, six elderly participants reported no difficulty with responding to the Portuguese version of the Kihon Checklist. During pretesting with 21 bilingual participants, we found a strong correlation between the total scores of the original version of the Kihon Checklist in Japanese and the translated version in Portuguese (r = 0.764, P < 0.001). According to the validation process, which involved 161 participants, there was a significant correlation between the total scores of the Kihon Checklist and the Edmonton Frail Scale (r = 0.535, P < 0.001), and between each domain of the checklist with the total score of Edmonton Frail Scale (lifestyle τ = 0.429, P < 0.001; physical strength τ = 0.367, P < 0.001; nutrition τ = 0.211, P = 0.002; eating τ = 0.213, P = 0.001; socialization τ = 0.269, P < 0.001; memory τ = 0.285, P < 0.001; and mood τ = 0.359, P < 0.001). Furthermore, the Portuguese version of the Kihon Checklist showed satisfactory internal consistency (Cronbach's α coefficient: 0.787).
The Portuguese language version of the Kihon Checklist presented good internal consistency and validity. Therefore, we encourage its application in the elderly Brazilian population with an aim of monitoring their frailty to prevent or delay the loss of functional dependence and any other adverse health outcomes. Geriatr Gerontol Int 2013; ●●: ●●-●●.
[Show abstract][Hide abstract] ABSTRACT: Background/Purpose
Aging populations are a global public health concern. The risk of falls increases with age, so fall prevention is becoming an important health issue. However, few studies have focused on cross-cultural analyses of falls. Therefore, we aimed to compare the incidence of falls and compare anthropometric measures and physical function between active Japanese and Brazilian older adults.
Materials and methods
We measured the incidence of falls (investigated by self-reported questionnaire), body mass index (BMI), waist circumference (WC), grip strength (GS), one-legged stance (BALANCE), frequency of physical activity (PA), medication use (MU), and hospitalization history in 114 physically active community-dwelling adults 65 years of age and older in Japan (73.9 ± 4.0 years, n = 40) and Brazil (70.7 ± 4.5 years, n = 74).
The Japanese elderly were older (p < 0.01), but had a better BALANCE score (p < 0.05) than the Brazilian elderly. Nevertheless, Brazilian elderly showed higher engagement in PA and had higher BMI and WC (p < 0.01). Despite the lack of a difference in the incidence of falls between the two cohorts, Japanese elderly who fell had decreased GS compared to Japanese elderly who did not fall [odds ratio (OR): 0.83, 95% confidence interval (CI) 0.72–0.97, p < 0.05]. In Brazil, those who fell had larger WC than those who did not fall (OR: 1.07, 95% CI 1.01 – 1.13, p < 0.01).
Our results indicate that physical function (i.e., grip strength) is a more important predictor of falls in Japanese elderly. However, increasing waist size is a predictor of falls in Brazilian elderly. These findings suggest that risk factors for falls are multifactorial and vary according to setting.
Journal of Clinical Gerontology and Geriatrics. 06/2013; 4(3):89-92.
[Show abstract][Hide abstract] ABSTRACT: CKD is associated with impairments in health status, physical function, and frailty. The aim of the current prospective cohort study was to determine whether CKD predicted new LTCI need certification among community-dwelling older Japanese adults. This was a prospective cohort study. We analyzed the cohort data from a prospective study, The Japan Multicenter Aging Cohort for Care Prevention (J-MACC). We followed 8063 elderly adults for 2 years, and we analyzed the relationship between CKD and LTCI need. The outcome studied was new certification for LTCI service need during a 2-year period. We measured serum creatinine (the estimated glomerular filtration rate; eGFR), serum albumin, frailty checklist scores, and body mass index. During the 2-year follow-up, 536 subjects (6.6%) were newly certified as needing LTCI services. We stratified the cohort according to eGFR quartile and performed multivariate analyses using an eGFR value of 71.4-83.6ml/min/1.73m(2) as a reference. We found that subjects with eGFR values <60.0ml/min/1.73m(2) had a significantly elevated risk of LTCI service need (adjusted hazard ratio: 1.44 [95% CI 1.12-1.86]). Our results indicate that CKD is independently associated with new LTCI service need certification and is an important marker of frailty in older adults.
Archives of gerontology and geriatrics 04/2013; 57(3):328-332. · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our study aimed to investigate the physical performance and quality of life (QOL) as associated factors with self-rated health (SRH). Japanese community-dwelling women aged 65 years or more (n = 51; mean age = 75.3 ± 6.0) answered a questionnaire regarding socio-demographic information, SRH, QOL by the Short Form-8, and performed the physical tests, such as Timed Up and Go, Functional Reach (FR), One Leg Stand (OLS), Five Chair Stands (CS), and hand grip strength (HGS). Smoking (p = 0.04), more medical consultations (p = 0.03), and more number of medications (p = 0.001) were significantly associated with poor self-assessment of their health. Moreover, those who assessed their health condition as not so good to bad condition had lower performance in FR (p = 0.02), HGS (p = 0.04), OLS (p = 0.05), and CS (p = 0.02), and poorer QOL condition in general health (p < 0.01), bodily pain (p = 0.02), and vitality (p = 0.03) in comparison with the other SRH groups (good and/or normal). Therefore, we encouraged the use of the SRH assessment and the interpretation of its results based on the present findings such as associating the SRH of older women with their physical performance and QOL.
Read More: http://informahealthcare.com/doi/abs/10.3109/02703181.2012.759637
Physical & Occupational Therapy in Geriatrics 03/2013; 31(1):1-11.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Physicians are uncertain about what medical services should be provided to older and/or disabled patients. Better understanding of health outcome prioritization among health care providers and recipients may help the process of decision- and policy-making. For this purpose, surveys were conducted on priorities of health care outcomes for the elderly. DESIGN: Survey research. SETTING: Four groups of health care providers and four groups of health care recipients. PARTICIPANTS: A total of 2512 health care providers and 4277 recipients. MEASUREMENTS: Questionnaires were sent to more than 8000 health care providers and more than 9000 health care recipients: geriatricians, physicians who commonly see older patients or work in long term care facilities, staff members and participants in adult day care, patients in outpatient geriatric clinics, family members of patients with dementia, and community-dwelling older adults. The questionnaire asked the subjects to rank 12 measures of health care outcomes. RESULTS: The mean response rate was 49%. All health care provider groups considered "improvement of quality of life" the most important. In contrast, in health care recipient groups, "effective treatment of illness," "improvement of physical function," and "reduction of carer burden" were given high priority, whereas "improvement of quality of life" was perceived as less important. All the groups, including health care providers and recipients, ranked "reduction of mortality" the least important, followed by "avoiding institutional care." Stratification analysis showed that the results did not differ by sex, nursing care level, or the existence of relatives who required nursing care, whereas age slightly influenced the order of high-ranked measures. CONCLUSION: Priorities of health care services and their differences between providers and recipients should be taken into account in the health care of older patients and the design of health care policies and research.
Journal of the American Medical Directors Association 02/2013; · 5.30 Impact Factor