[show abstract][hide abstract] ABSTRACT: Aim: Falls are common in patients with cognitive disorder. The purpose of this study was to determine whether global brain atrophy is associated with cognitive function, physical performance and fall incidents in older adults with mild cognitive disorder. Methods: A total of 31 older adults with mild cognitive disorders (mean age 78.9 ± 7.3 years) were studied, and 10 of them had experienced falls and the others had not in the past 1 year. Cognitive function and physical performance were measured in these patients. Global brain atrophy was determined by the Voxel-Based Specific Regional Analysis System for Alzheimer's Disease software. Results: Fallers showed significantly worse scores than the non-fallers in the Global Brain Atrophy Index, Clock Drawing Test (CDT), Verbal Fluency Test (animal), maximum walking time and Timed Up & Go (TUG) Test. The Global Brain Atrophy Index was correlated with the Verbal Fluency Test (animal; r = -0.522), the Verbal Fluency Test with letter (ka; r = -0.337), CDT (r = -0.547), TUG (r = 0.276) and Five Chair Stands Test (r = 0.303) by age-adjusted correlation analyses. Stepwise regression analysis showed that the Global Brain Atrophy Index (β = 1.265, 95% CI 1.022-1.567) was a significant and independent determinant of falls (R(2) = 0.356, P = 0.003). Conclusion: Global brain atrophy might be indicated as one of the risk factors for falls in older adults with mild cognitive disorders. Geriatr Gerontol Int 2012; ••: ••-••.
[show abstract][hide abstract] ABSTRACT: Background/PurposeThe aim of this study was to examine the relationship between nurses’ clinical judgment on cognitive function by fall risk assessment and mini-mental state examination (MMSE) scores in elderly inpatients.Methods
We studied 61 consecutive hospitalized patients who received both comprehensive geriatric assessment (CGA) and fall risk assessment at the Department of Geriatric Medicine in Kyoto University Hospital from January 2006 to June 2010. During the fall risk assessment at admission, primary nurses evaluated the cognitive function by four items (with or without disorientation, impaired judgment, lack of comprehension, and memory loss), while a trained clinical assistant performed CGA including MMSE. Patients were divided into three groups according to the MMSE scores. The association between the four items of judgment by nurses and MMSE scores was then studied.ResultsThe mean age was 80.1 years and 55.7% of the patients were female. The percentage of patients judged to have impaired judgment, lack of comprehension, and memory loss was higher in patients with lower MMSE scores (impaired judgment, p for trend = 0.001; lack of comprehension, p for trend = 0.043; memory loss, p for trend = 0.001). The percentage of patients judged to have at least one of the four abnormalities was also significantly higher in patients with lower MMSE scores (p for trend <0.001). However, no significant relationship was found between disorientation and the MMSE scores. Further, nurses could not detect impaired cognition by the four items in one-third of the patients with mild impairment determined by MMSE.Conclusion
These data indicate that a comprehensive evaluation using all the four items on cognitive impairment is more effective in detecting cognitive impairment in elderly than using individual items, although one-third of cognitively impaired elderly patients may miss detection despite the use of the four items. Better approaches should be developed to identify cognitively impaired elderly patients by nurses.
Journal of Clinical Gerontology and Geriatrics. 03/2012; 3(1):21–24.
[show abstract][hide abstract] ABSTRACT: Extracellular accumulation of amyloid beta (Aβ) is a hallmark of Alzheimer's disease (AD). It has been reported that extracellular perfusion of Aβ inhibits long-term potentiation (LTP), which is strongly related to memory in animal models. However, it has recently been proposed that intracellular Aβ may be the first pathological change to occur in AD. Here, we have investigated the effect on LTP of intracellular injection of Aβ (Aβ(1-40), Aβ(1-42)) into hippocampal pyramidal cells using patch-clamp technique. We found that injection of 1 nM Aβ(1-42) completely blocked LTP, and extracellular perfusion of a p38 MAPK inhibitor or a metabotropic glutamate receptor blocker reversed these blocking effects on LTP. Furthermore, we have examined the effects of different concentrations of Aβ(1-40) and Aβ(1-42) on LTP and showed that Aβ(1-40) required a 1,000-fold higher concentration to attenuate LTP than 1 nM Aβ(1-42). These results indicate that LTP is impaired by Aβ injected into genetically wild-type neurons in the sliced hippocampus, suggesting an acute action of intracellular Aβ on the intracellular LTP-inducing machinery.
Journal of Neurophysiology 02/2012; 107(9):2526-31. · 3.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aim: To delineate relationships among cognitive function, frailty and level of care required in the Japanese long-term care insurance program (LTCIP) in outpatient memory clinic patients. Methods: This was a cross-sectional study carried out at an outpatient memory clinic. Participants were 201 cognitively impaired patients. Cognitive function was measured by the Mini-Mental State Examination (MMSE). Frailty was measured by Timed Up & Go (TUG) and grip strength. Waist circumference, body mass index, living arrangement and level of care required in the LTCIP (rank 1 minor disability to rank 7 severe disability) were also assessed. Results: Mean age, MMSE score, TUG score and grip strength were 78.8 ± 6.9 years, 19.6 ± 6.1, 14.6 ± 6.7 s and 16.9 ± 7.5 kg, respectively. A total of 70 patients (34.8%) had not applied for the certification, at least in part because of their younger age and existence of family caregivers. LTCIP rank was correlated both with MMSE score (β: -0.49, P = 0.001), grip strength (β: -0.27, P = 0.005) and living alone (β: -0.18, P = 0.03), but not with TUG score (β: 0.14, P = 0.105). Conclusion: In outpatients of a memory clinic, care ranks, which define the upper limit of monthly benefit in the Japanese LTCIP, were influenced by age, cognitive function, frailty and living arrangements. Understanding the relationship among these parameters would be useful in predicting the needs of cognitively impaired patients and important when comparing the possible services provided by long-term care systems for them worldwide. Geriatr Gerontol Int 2012; ••: ••-••.
Geriatrics & Gerontology International 02/2012; 12(4):630-6.
[show abstract][hide abstract] ABSTRACT: Little is known about the extent to which advanced activities of daily living among patients with dementia are preserved and how family caregivers of these patients support them in the community. In this cross-sectional assessment of pairs of patients with dementia and their family caregivers, we evaluated basic, instrumental, and advanced activities of daily living by comparing past and present status observed by caregivers with subjective estimations by patients with dementia. We also asked about ways in which support was provided by family caregivers. Thirty-nine pairs of patients with dementia and caregivers who presented to our memory clinic were interviewed. The mean age of patients with dementia was 75.3 ± 7.0 years, and Mini-Mental State Examination scores were 22.3 ± 3.4. We found relative preservation of advanced activities of daily living compared with instrumental activities of daily living. Caregivers provided instrumental, informational, and reminding support to patients with dementia. These findings may reinforce the concept of person-centered support of patients with dementia in the community.
International journal of Alzheimer's disease. 01/2012; 2012:418289.
[show abstract][hide abstract] ABSTRACT: Background
The number of elderly hemodialysis (HD) patients is increasing in Japan, and the psychosocial impact of HD to the elderly remains unclear. The main purpose of this study was to evaluate quality of life (QOL) of elderly patients undergoing regular HD.Methods
We examined the psychosocial status in elderly HD patients and compared it with that in healthy elderly individuals. The correlations between each item of QOL, laboratory data and comorbidities were explored. This study cohort consisted of 142 people (70 healthy elderly participants and 72 elderly HD patients). We assessed 10 items of QOL, i.e., health condition, appetite, sleep, mood, memory, family relationship, friendship, economical status, satisfaction in daily life, and happiness by visual analog scale (VAS).ResultsOverall, elderly HD patients had lower scores of VAS than healthy elderly participants, especially in sleep, mood, and happiness, but not in family relationship and friendship. Lower VAS scores for sleep were significantly correlated with the duration of HD therapy and the troubles in vascular access for HD. VAS scores for family relationship were also correlated with the duration of HD therapy.Conclusion
The QOL of elderly HD patients was poorer than that in healthy elderly individuals, particularly in sleep, mood and happiness. Further study is needed to improve the QOL of elderly HD patients. This is of great importance, since the number of elderly HD patients is estimated to escalate in the future.
Journal of Clinical Gerontology and Geriatrics. 12/2011; 2(4):116–120.
[show abstract][hide abstract] ABSTRACT: The number of hemodialysis (HD) patients is increasing along with their mean age in Japan. The assessment of their psychosocial status and quality of life (QOL) is therefore becoming more and more important along with laboratory data or comorbidities.
We examined the psychosocial status of 211 HD patients (72 elderly and 139 non-elderly) and compared the difference between elderly and non-elderly patients using a visual analogue scale (VAS). We then examined how QOL affected mortality rate in 3-year prospective follow up. We assessed 10 items of QOL: health condition, appetite, sleep, mood, memory, family relationships, friendship, economical status, life satisfaction in daily life, and happiness with qualified self-evaluating questionnaires along with laboratory data and comorbidities. Furthermore, we investigated the correlation between the scores of mood and geriatric depression scale (GDS)-15.
There was no difference in VAS scores between elderly and non-elderly patients. Lower VAS scores for appetite and mood correlated with higher mortality in HD patients, especially in the non-elderly. VAS scores for mood correlated with GDS-15 in HD patients.
More attention should be paid to appetite and the diagnosis and therapy of depressive mood to improve the prognosis of HD patients, especially for the non-elderly.
Geriatrics & Gerontology International 08/2011; 12(1):65-71.
[show abstract][hide abstract] ABSTRACT: Oligomeric amyloid β (Aβ) is currently considered to induce Alzheimer's disease (AD). We examined 2 patients with familial AD who possessed the Osaka (E693Δ) mutation in amyloid precursor protein. To the best of our knowledge, these patients are the first AD cases presumably affected with Aβ oligomers in the absence of senile plaques, and they support the Aβ oligomer hypothesis.
We evaluated the clinical course, neuropsychological data, cerebrospinal fluid biomarker levels, magnetic resonance imaging (MRI) scans, fluorodeoxyglucose-positron emission tomography (PET) scans, and Pittsburgh compound B (PiB)-PET images of these patients.
In the early stages, these patients developed memory disturbances in a similar rate to patients with sporadic AD. Despite their memory disturbances, both patients showed only limited brain atrophy on MRI and little amyloid accumulation on PiB-PET. Subsequent to the development of memory disturbances, both patients suffered from motor dysfunction, probably due to cerebellar ataxia, and, within a few years, the patients fell into an apallic state.
Familial AD patients with Osaka (E693Δ) mutation show severe dementia, cerebellar ataxia, and gait disturbances.
[show abstract][hide abstract] ABSTRACT: We report the case of a 72-year-old man who had been given a diagnosis of semantic dementia (SD) at 64 years of age, and who began to use honorifics in all situations during the later clinical course. His initial clinical features were problems in word comprehension and naming, and some behavioural changes, including clockwatching and aberrant eating behaviours. The most prominent feature in this case was the use of honorifics in all situations, while other aspects of his language ability deteriorated. He even used honorifics with members of his family, including young grandchildren. Although it is difficult to explain the reason why the patient used honorifics in all situations, we considered 2 possibilities. The first is that although he remains able to use honorifics, he is unable to distinguish when the use of honorifics is not required. The second is that a change in emotional state, such as the "taming effect" or "placidity" that has been suggested to accompany frontotemporal lobar degeneration, might have affected his use of honorifics. The regular schedule of daycare services provides him with emotional stability because he does not have to constantly be aware of the time. Since no standard treatment has been established for SD, our experience with this case might be beneficial in caring for patients with SD.
Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 01/2011; 48(5):558-64.
[show abstract][hide abstract] ABSTRACT: It is highly desirable to develop a neuropsychological screening test which is sensitive to the early stage of Alzheimer's disease (AD), and is easy to administer at the primary care physician's (PCP's) office.
Participants were 128 AD patients and 54 healthy volunteers. Brief cognitive screening tests were administered to the participants including the Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Verbal Fluency Test (VFT), a Verbal Category Cued Memory test (CCMT) and the Scenery Picture Memory Test (SPMT). In the SPMT, a scenery picture of a living room containing 23 familiar objects was used. The administration of the SPMT comprised the first shallow memory session (Pict 1) and the second deep memory session (Pict 2). The area under the receiver-operator curve (AUC) was used to compare the efficacy of SPMT with other cognitive tests.
Pict 1, which requires less than 2 min to complete, had the same AUC as Pict 2, and showed significantly larger AUC than MMSE, CDT and VFT for all (MMSE 19-23) and very mild (MMSE > or = 24) AD patients. When we conducted the similar analysis separately for those younger than 75 years and those aged 75 years or older, we obtained the same results as above among the older age group. Pict 1 showed larger AUC than CCMT in overall sample and also in the older age group, although the difference was not statistically significant.
The SPMT could be useful for detection of mild and very mild AD in settings even where time is limited.
Geriatrics & Gerontology International 04/2010; 10(2):183-90.
[show abstract][hide abstract] ABSTRACT: Little is known regarding the normative levels of leisure activities among the oldest old and the factors that explain the age-associated decline in these activities.
The sample included 303 cognitively intact community-dwelling elderly persons with no disability in Activities of Daily Living (ADL) and minimal dependency in Instrumental ADL (IADL) in Shiga prefecture, Japan. We examined (i) the nature and frequency of leisure activities, comparing the oldest old versus younger age groups; (ii) factors that explain the age-associated differences in frequencies of engagement in these activities; and (iii) domain-specific cognitive functions associated with these activities, using three summary index scores: physical and nonphysical hobby indexes and social activity index.
The oldest old (85 years old or older) showed significantly lower frequency scores in all activity indexes, compared with the youngest old (age 65-74 years). Gait speed or overall mobility consistently explained the age-associated reduction in levels of activities among the oldest old, whereas vision or hearing impairment and depressive symptoms explained only the decline in social activity. Frequency of engagement in nonphysical hobbies was significantly associated with all cognitive domains examined.
Knowing the factors that explain age-associated decline in leisure activities can help in planning strategies for maintaining activity levels among elderly persons.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 12/2008; 63(11):1193-200. · 4.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Management of dementia and cognitive decline is a major issue in geriatrics. Since the average age of society is advancing and patients of dementia are increasing, it is important to remove risk factors of dementia and cognitive decline in order to maintain quality of life in the elderly and to save cost of medicine and care. While hypertension has been known to be a risk factor of cerebrovascular events and vascular dementia, recent studies show that midlife hypertension is also a risk factor of cognitive decline and Alzheimer's disease in late life. Clinical trials and retrospective observation studies also show that treatment of hypertension decreases the risk of Alzheimer's disease. These issues are also related with the consideration of vascular factors in Alzheimer's disease. The white matter lesion as a consequence of hypertension and its meaning in Alzheimer's disease are also discussed.
Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 08/2007; 44(4):433-6.
[show abstract][hide abstract] ABSTRACT: Background: The Comprehensive Geriatric Assessment (CGA) for inpatients is very useful to improve the outcomes of elderly patients. However, most of the elderly patients are provided their care by general practitioners in primary care settings without comprehensive assessment. Concise and practical assessment is necessary for the detection of geriatric problems and sufficient care in the outpatient clinic.Methods: The CGA was introduced in the outpatient clinic for elderly people in Kyoto University Hospital and 309 patients participated in the study, where cognitive impairment, depressive symptoms, activities of daily living, and self-reported hearing and visual impairment were assessed.Results: In the patients studied, the most prevalent chief complaint was memory loss (19%). Among the patients complaining of memory loss, two-thirds of the patients were diagnosed as cognitively impaired by the Mini-Mental State Examination. Multiple logistic regression analysis showed that hearing and visual impairment was significantly associated with functional disabilities and that hearing impairment was significantly associated with depressive symptoms.Conclusions: Thus, the CGA for outpatients is useful for the detection of functional disabilities and depressive symptoms by asking about their sensory impairment as well as for the detection of cognitive impairment in elderly patients. Therefore, concise and practical assessment should be introduced in the primary care settings to improve the quality of life of elderly people.
Geriatrics & Gerontology International 06/2006; 6(2):94 - 100.
[show abstract][hide abstract] ABSTRACT: The relationships among behavioral and psychological symptoms of dementia (BPSD), cognitive impairment of Alzheimer's disease (AD) patients and the caregiver burden of their caregivers were investigated in an outpatient memory clinic.
Forty-six pairs of AD patients and their family caregivers were involved in this study. Neuropsychiatry Inventory (NPI) was used to estimate BPSD, to which memory symptoms were added as a subcategory of BPSD. MMSE, word fluency, clock drawing test and category-cued memory test were used for cognitive measurement. Zarit burden interview (ZBI) and CES-D were used to assess caregiver burden.
Among 11 BPSD subcategories, memory symptoms, apathy, depression, delusion, aggression and anxiety were prevalent BPSD was a strong determinant of caregiver burden. Among BPSD symptoms, anxiety, aggression and aberrant motor behavior were significantly related to ZBL In terms of the relationship between BPSD and cognitive impairment, the scores for delusion and apathy were significantly related to the cognitive decline. On the other hand, patients who showed symptoms related to memory and depression had higher cognitive function than those who did not.
These analyses will contribute to better assessment of AD patients and their caregivers, hopefully resulting in better support for them.
Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics 04/2006; 43(2):207-16.
[show abstract][hide abstract] ABSTRACT: Background: To determine the utility of various serum markers for assessment of cognitive and mental functions in the elderly, we performed a Comprehensive Geriatric Assessment (CGA) in the out-patient clinic in Kyoto University Hospital.Methods: We measured serum levels of dehydroepiandrosterone (DHEA), DHEA-S, malondialdehyde low-density lipoproteins (MDA-LDL), and high-sensitivity C-reactive protein (hs-CRP) in 145 patients to find the association of these markers with activities of daily living (ADL), cognitive impairment and depressive symptoms.Results: We found that the levels of hs-CRP were significantly higher in patients with lower scores in Mini-Mental State Examination (MMSE) and Kohs block design test, and higher scores in the button test, indicating that hs-CRP may be associated with the cognitive function in elderly patients. We also found that the levels of DHEA-S were lower in patients with higher scores (9 or over) on the Geriatric Depression Scale-15 (GDS), indicating that DHEA-S may be associated with depressive mode in elderly patients. Total cholesterol, high-density cholesterol (HDL-C), or albumin were not statistically different in each group studied.Conclusions: Thus, our data indicate that measuring hs-CRP and DHEA-S would be helpful to assess the cognitive function and depressive symptoms in elderly patients.
Geriatrics & Gerontology International 02/2006; 6(1):7 - 14.