Hidenori Arai

• MD. PhD
• President at National Center for Geriatrics and Gerontology

Background: Few studies have examined the characteristics of heart failure (HF) patients with cachexia using the Asian Working Group for Cachexia (AWGC) 2023 criteria. This study assessed the characteristics and clinical impact of cachexia in older adults with HF. Methods and Results: Results of laboratory measurements, echocardiography, physical f...

Background Pemafibrate, a selective peroxisome proliferator‐activated receptor alpha (PPARα) modulator (SPPARMα), has positive effects on liver‐related markers (e.g., liver stiffness determined by magnetic resonance elastography and alanine aminotransferase) in the PEMA‐FL study in patients with metabolic dysfunction‐associated steatotic liver dise...

Aim This study examined the short‐term effects of participation in Kayoi‐no‐ba – community gathering places for residents to contribute to care prevention with the support of volunteers in Japan – on frailty status during the coronavirus disease 2019 (COVID‐19) pandemic, based on a 1‐year longitudinal study of older adults. Methods Participants (...

INTRODUCTION Cognitive training is a key component of multidomain interventions to prevent cognitive decline; however, low adherence remains a challenge. In this post hoc analysis of the Japan‐Multimodal Intervention Trial for Prevention of Dementia (J‐MINT), factors associated with cognitive training adherence in older adults with mild cognitive i...

Aim Recently, some researchers have questioned the inclusion of muscle mass as a diagnostic criterion for sarcopenia. We examined the longitudinal association between the presence or absence of muscle mass assessment in sarcopenia diagnosis and the incidence of poor health outcomes. Methods This 1‐year follow‐up study included 730 Japanese outpati...

Background The vigour of our musculature wanes as the years advance, and prognosticating the concomitant trajectories throughout the course of life assumes paramount importance for judicious and timely interventions. In the present study, we aimed to establish age‐ and sex‐specific reference centiles for multiple muscle health metrics and reveal th...

Background Over 3 years have passed since the outbreak of novel coronavirus disease 2019 (COVID‐19), a disease associated with a high risk of severe illness and death among older individuals. This period has brought to light regional and social issues, including issues in overall and regional healthcare, that existed before the epidemic. “COVID‐19‐...

This study explored the relationship between fall patterns and fall-related fractures in older adults. A cross-sectional survey was conducted among community-dwelling older adults in Maibara City, Japan, focusing on falls over the past three years. Among the 1,695 reported falls, 176 fractures occurred in 120 individuals. Backward or straight-down...

Background Dementia impacts individuals, families, and society, necessitating effective prevention strategies. Objective To evaluate the feasibility of a community-adapted multi-domain intervention for dementia prevention among older adults in Obu City, Japan and how uncertainties in implementing definitive trials can be reduced. Methods A 12-mon...

Aims: Long-term safety and efficacy of pemafibrate once-daily extended-release (XR) tablets, taken in morning or evening, were evaluated in dyslipidemic patients with high triglycerides (TG). Methods: In this multicenter, randomized, open-label, parallel-group, phase 3 long-term study, dyslipidemic patients with high TG were randomly assigned to mo...

Background Intervention adherence is crucial to ensure cognitive benefits in trials designed to prevent cognitive decline. During the coronavirus disease 2019 (COVID-19) pandemic, the Japan-Multimodal Intervention Trial for the Prevention of Dementia offered live online exercise sessions to older adults with mild cognitive impairment (MCI). Object...

Background: Skin tactile perception may indicate frailty in older adults. Although gait performance is crucial for diagnosing frailty, its association with skin tactile perception has not yet been explored. Objectives: To examine the association between skin tactile perception and changes in step length, cadence, and gait speed in middle-aged an...

Background: Metabolic acidosis caused by acidogenic diets increases muscle catabolism. High acidogenic diets can increase muscle loss in older adults; however, their association with functional outcomes remains unclear. Objectives: To investigate whether high acidogenic diets increase the incidence of disability. Design: Longitudinal study. S...

Purpose Falls in older adults increase the risk of mortality and hospitalization, particularly when physical function is low. This study aimed to determine whether low physical function and muscle mass, are also valuable for predicting falls within one year in older patients who visited an outpatient clinic for frailty. Methods This prospective coh...

Background The effectiveness of multimodal lifestyle interventions to prevent dementia is being validated. Since a relatively long period (∼2 years) is required for manifesting an impact on cognitive function, the exploration of an alternative marker that exhibits changes within a comparatively brief duration, thereby prognosticating future alterat...

Background This post‐hoc subgroup analysis aimed to estimate the potential cost‐effectiveness of a Japanese multimodal intervention trial for the prevention of dementia (J‐MINT) from a societal perspective. Method Using a Markov model, we estimated the economic impact of J‐MINT on disease prevention, drawing on data from the 2019 J‐MINT trial and...

Background With its rapidly aging population, Japan has been seeing an increase in the concurrent incidence of dementia during heart failure treatment, making disease management difficult. Nevertheless, not much has been uncovered about the actual state of the treatment status and prognosis of heart failure patients with dementia. Method At the Na...

Background This post‐hoc sub‐group analysis of the Japan‐multimodal intervention trial for prevention of dementia (J‐MINT) aimed to examine the efficacy of the multi‐domain intervention in older adults with type 2 diabetes. Method J‐MINT was an 18‐month, randomized controlled trial. Participants aged 65‐85 years with mild cognitive deficits were r...

Background In Japan, effective interventions to prevent low nutrition in older people with oral frailty have not been well established. This post‐hoc sub‐group analysis of the Japan‐multimodal intervention trial for the prevention of dementia (J‐MINT) aimed to examine the efficacy of the multidomain intervention in older adults with and without ora...

Background This study aimed to examine the influence of adherence on intervention effect in the Japan‐multimodal intervention trial for the prevention of dementia (J‐MINT). Method J‐MINT was an 18‐month randomized controlled trial, and participants aged 65‐85 years with mild cognitive deficits were randomized into multidomain intervention (physica...

Background A polygenic risk score (PRS) estimates an individual’s genetic liability for diseases based on accumulated genetic variations. While the PRS has been shown to contribute to the prediction of dementia risk, its utility in predicting the effectiveness of multifactorial interventions to reduce the risk of dementia remains unclear. Methods...

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Phy...

Background Inconsistent results have been reported concerning the association between statin administration and muscle health, specifically its potential to increase the risk of sarcopenia. Given the widespread long‐term use of statins among the elderly population, the exploration of this association remains a crucial yet insufficiently examined ma...

Aim: In clinical practice, cardiologists frequently note substantial differences in coronary artery health among patients of the same age bracket. This observation led to our investigation into identifying genes that are shared between atherosclerosis and aging, as well as those that are specifically amplified in atherosclerosis alone. Methods:...

Background The association of Mini-Mental State Examination (MMSE) with microstructure of individual regions across the entire brain remains unexplored. Purpose To investigate the relationship between cognitive function and the microstructure of each brain region in the gray matter using diffusion kurtosis imaging (DKI) in older adults with mild c...

Aim This cohort study aimed to assess weight loss associated with new long‐term care insurance (LTCI) certifications over a 9‐year period, accounting for the competing risk of death. Methods We analyzed data from 3749 Japanese individuals aged ≥65 years in Kami Town, Hyogo Prefecture, Japan. Weight loss was assessed using the Kihon Checklist durin...

Objectives: This study aimed to provide evidence regarding the clinical significance of assessing intrinsic capacity (IC). Design: Longitudinal study. Setting: Frailty clinic. Participants: 351 disability-free outpatients aged ≥65 years. Measurements: Adverse health outcomes were a composite of adverse health outcomes, including mortality,...

Background Exercise therapy (ET) has an anti-inflammatory effect; however, excessive overload can exacerbate joint inflammation. This study aimed to explore the effect of personalized ET on disease activity in patients with rheumatoid arthritis (RA) who have achieved remission or low disease activity (LDA) and begun tapering molecular targeted ther...

Objective The incidence rates of dementia, mild cognitive impairment, and cancer increase with age, posing challenges to affected individuals and their families. However, there are currently no clear cancer screening guidelines for individuals with cognitive impairment. This study analyzed the impact of carer health literacy on screening behaviors...

Objectives While Community gathering places known as "kayoi-no-ba" providing communal meals play a crucial role in promoting the health of older adults, the researches supporting their operations and maintenance is limited. Social marketing has been successful in implementing strategic public health programs. This study aimed to identify factors as...

Aim Driving cessation is strongly associated with adverse health outcomes in older adults. Although numerous studies have focused on driving skill interventions for safe driving, the effects of interventions on car accidents remain unclear. We designed a randomized controlled trial to examine the effects of driving skill training on the prevention...

Objective Understanding the characteristics of falls among older adults is necessary to prevent them. These characteristics include questions such as when (month and time), where (places), who (age), what (injury), why (trigger), and how (direction) the falls occur. The objective of this study was to identify the characteristics of falls in individ...

The concept of oral frailty was first proposed in Japan in 2014 by the “Joint Working Committee on Oral Frailty,” consisting of three academic societies—the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty—to enhance public understanding of oral frailty. Oral frailty is a state...

Aims: Efficacy, safety, and pharmacokinetics of the selective PPARα modulator pemafibrate as once-daily extended-release (XR) tablets were compared with those of twice-daily immediate-release (IR) tablets in patients with hypertriglyceridemia. Methods: A multicenter, randomized, single-blind, active-controlled crossover, phase 2 clinical pharmacolo...

Skeletal muscle index measurement via dual-energy X-ray absorptiometry or bioelectrical impedance analysis is used to evaluate muscle mass when diagnosing sarcopenia. However, inherent challenges exist with these methods. We previously focused on muscle mass evaluation in the quadriceps femoris by using computed tomography (CT). In this observation...

Sarcopenia is the accelerated loss of skeletal muscle mass and function commonly, but not exclusively, associated with advancing age. It is observed across many species including humans in whom it can lead to decline in physical function and mobility as well as to increased risk of adverse outcomes including falls, fractures and premature mortality...

Sarcopenic obesity is the co‐existence of obesity and sarcopenia in individuals aged 40–75 years. The Japanese Working Group on Sarcopenic Obesity has developed diagnostic criteria tailored for the Japanese population, considering their unique characteristics compared with European populations. Our algorithm consists of two steps: screening and dia...

This study investigated the relationship between food group and the changes in sarcopenia parameters in 1 year among older outpatients. A prospective cohort study conducted between July 2017 and April 2021 included patients aged ≥ 65 years attending a frailty clinic. Food group consumption adjusted for energy and body weight was conducted using a s...

Aims: Per the package insert, pemafibrate was contraindicated for use in patients with severe renal impairment despite its biliary excretion. To validate this, we evaluated the pharmacokinetics and safety of pemafibrate for 12 weeks in patients with hypertriglyceridemia and renal impairment. Methods: In this phase 4, multicenter, placebo-controlled...

Background Gait ability can be objectively assessed using gait analysis. Three-dimensional gait analysis, the most commonly used analytical method, has limitations, such as a prolonged examination, high system costs, and inconsistently reported gait symmetry in patients with knee osteoarthritis (OA). Therefore, we aimed to evaluate the gait symmetr...

Background Anorexia of aging (AA) is a condition in older adults that includes loss of appetite and reduced food intake. There is a lack of detailed analysis of the potential influence of educational initiatives in addressing AA. This study aimed to clarify the current state of knowledge and practice regarding AA and its relationship with the avail...

This study aims to evaluate the utility of body mass index (BMI)-adjusted calf circumference (CC) in estimating skeletal muscle mass and diagnosing sarcopenia, as well as its association with falls, a common adverse event in sarcopenia. This study used cross-sectional and longitudinal designs. The CC cut-off values and the diagnosis of sarcopenia w...

Aim: To investigate medication adherence and treatment persistence in patients receiving proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) in Japan. Methods: Using an anonymized claims database from January 2015 to December 2021, data on adult patients at high risk for atherosclerotic cardiovascular disease or with...

Background: Oral and social problems can exacerbate long-term care. Understanding the relationship between social aspects and oral hypofunction can help identify high- risk factors for long-term care. Objective: This study aimed to investigate the social aspects of oral hypofunction among medical outpatients. Methods: This retrospective cross-secti...

Objective: To develop a combined index using cognitive function and instrumental activities of daily living (IADL) to discriminate between Clinical Dementia Rating (CDR) scores of 0.5 and 1 in the clinical setting, and to investigate its optimal cutoff values and internal and external validities. Methods: We included outpatients aged 65-89 years wi...

Objective In 2019, the Ministry of Health, Labour and Welfare emphasized the importance of promoting "Kayoi-no-ba" (or "places to go") initiatives according to the Plan-Do-Check-Action (PDCA) cycle. However, it proposed no specific promotion measures or standardized evaluation frameworks. This study is intended to propose a framework for local gove...

INTRODUCTION We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild cognitive impairment (MCI). METHODS Participants aged 65‐85 years with MCI were randomized into intervention (management of vascular risk factors, exercise, nutritional counseling, and cognitive training) and co...

Aims: Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator that lowers serum triglyceride levels and increases high-density lipoprotein cholesterol levels, is approved for treating dyslipidemia as twice-daily immediate-release (IR) tablets. A once-daily extended-release (XR) tablet has also been developed. We aimed to con...

Sarcopenia contributes to increased hospitalizations, cognitive impairment, falls, and all-cause mortality. Current diagnostic methods, like body Magnetic Resonance Imaging and dual-energy X-ray absorptiometry, are costly and impractical. Notably, there is no standardized approach for assessing sarcopenia in dementia clinics. We studied the associa...

Background: Behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia from the early stages and can appear even in mild cognitive impairment (MCI). However, the prognostic impact of BPSD is unclear. This study examined the association between BPSD and mortality among people with cognitive impairment. Methods: Th...

Background Social networks and social participation have protective effects on cognitive function maintenance and Alzheimer’s disease and general dementia development. Objective We aimed to investigate the association between conversations and dementia incidence in older adults. Methods This longitudinal prospective cohort study used population d...

This study aimed to investigate how intrinsic capacity (IC) deficit is associated with oral functional decline. This cross-sectional study enrolled older adults at a research hospital frailty clinic between July 2021 and May 2023. IC evaluation included the locomotion, cognition, vitality, psychology, and sensory domains. Criteria for deficits were...

Importance: Sarcopenia, the age-related loss of muscle mass and strength/function, is an important clinical condition. However, no international consensus on the definition exists. Objective: The Global Leadership Initiative in Sarcopenia (GLIS) aimed to address this by establishing the global conceptual definition of sarcopenia. Design: The GLIS...

Aim This cross‐sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5‐Item Checklist (OF‐5), among community‐dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty. Methods We pooled data from two population‐based stud...

Background: Prognostic indices can enhance personalized predictions of health burdens. However, a simple, practical and reproducible tool is lacking for clinical use. This study aimed to develop a machine learning-based prognostic index for predicting all-cause mortality in community-dwelling elderly individuals. Methods: We utilized the Healthy...

Background Muscle and bone are physiologically interconnected, but joint changes of muscle and bone with aging, and whether the muscle‐bone changes are different by sex and by country has been little studied. We examined longitudinal associations of bone mineral density (BMD) and muscle mass or muscle strength in community‐dwelling 65 years or olde...

Background Frailty often coexists with heart failure (HF), which significantly aggravates the clinical outcomes of older adults. However, studies investigating the interplay between frailty and HF in older adults are scarce. We aimed to assess the prevalence of frailty using the cumulative deficit approach and evaluate the impacts of frailty on hea...

Background Higher cholesterol absorption has been reported to be related to a higher incidence of cardiovascular events (CVEs). The KEEP (Kyushu Elderly Ezetimibe Phytosterol) study, a substudy of the EWTOPIA 75 (Ezetimibe Lipid‐Lowering Trial on Prevention of Atherosclerotic Cardiovascular Disease in 75 or Older) study, investigated the relationsh...

Aim The study aimed to investigate the association of vitality, as measured using the vitality index (Vix), with the survival outcomes of older adults with mild cognitive impairment (MCI) or dementia. Methods We analyzed data from 3731 patients in the National Center for Geriatrics and Gerontology – Life Stories of Individuals with Dementia cohort...

It is well known that Japan's population is aging, and the number of people older than 75 years is increasing significantly. Since older people, especially old individuals, are often multimorbid and cannot be always successfully treated and cared for by individual organ-specific treatment, it is essential to utilize knowledge of geriatrics when tre...

Background Non-pharmacological interventions effective for depressive mood and bilateral relationships among persons with cognitive impairment (PwCI) and their family caregivers (FCGs) have not been established. Objective To examine the feasibility of a newly developed group-based art appreciation and self-expression program (NCGG-ART) for dyads o...

Background The Japan‐multimodal intervention trial for prevention of dementia (J‐MINT) aimed to examine the efficacy of the multi‐domain intervention in the prevention of cognitive decline in older adults at high risk of dementia. Method The J‐MINT is an 18‐month, multi‐centered, randomized controlled trial. Participants aged 65‐85 years with mild...

Introduction: Dysregulation of pro-inflammatory chemokines is considered a potential mechanism for the development of age-related medical conditions such as frailty. However, evidence linking circulating chemokines with frailty remains lacking. Materials and methods: We performed a case-control study including 48 cases and 48 controls aged 65-90...

Aim Multiple risk factors are involved in geriatric syndrome (GS) occurring in older adults. Although drug therapy often contributes to GS, the specific causes among older adults in Japan remain unclear. In this study, we examined the possible prescribing cascade rate among older outpatients eligible for Late‐stage Elderly Health Insurance and eluc...

Background Although body mass index (BMI) and grip strength (GS) are both predictors of disability, their joint effect on predicting incident disability remains uncertain. We examined whether the effect of BMI on incident disability can be modulated by GS in community‐dwelling older people in Japan. Methods A total of 1486 community‐dwellers in Ja...

Purpose of review Skeletal muscle weakness and wasting also occurs in the respiratory muscles, called respiratory sarcopenia. Respiratory sarcopenia may lead to worse clinical indicators and outcomes. We present a novel definition and diagnostic criteria for respiratory sarcopenia, summarize recent reports on the association between respiratory sar...

Background Cancer cachexia is a severe complication of advanced malignancy, with few therapeutic options. To promote interprofessional care for cancer cachexia, healthcare providers' needs should be addressed in detail. This pre-planned subgroup analysis of the Global Educational Needs Evaluation: a systemic interprofessional study in cancer cachex...

Background The quadriceps muscle is one of the human body’s largest and most clinically important muscles and is evaluated using mid-thigh computed tomography (CT); however, its relationship with motor function and sarcopenia remains unclear. Herein, we investigated the relationship between the cross-sectional area (CSA) of the quadriceps muscle, C...

Background Pemafibrate, a selective PPARα modulator (SPPARMα), decreases plasma TG and increases HDL-C. The effects of pemafibrate on cardiovascular outcomes were examined in patients with type 2 diabetes, moderately high TG, and low HDL-C who were on statin therapy (the PROMINENT trial) [1]. Against our expectation, the intervention with pemafibra...

Objectives We developed a predictive model for all‐cause mortality and examined the risk factors for cause‐specific mortality among people with cognitive impairment in a Japanese memory clinic‐based cohort (2010–2018). Methods This retrospective cohort study included people aged ≥65 years with mild cognitive impairment or dementia. The survival st...

Background Multi-domain interventions effectively prevent dementia in clinical settings; however, their efficacy within local communities is unclear. This study assesses the feasibility of an adapted multi-domain intervention for dementia prevention in community-dwelling older adults. Methods The single-arm trial enrolls 60 participants from two O...

Aim This study explored longitudinally the relationship between smoking and secondhand smoke and the incidence of physical frailty in community‐dwelling Japanese older people. Methods Data collected from the National Institute for Longevity Sciences‐Longitudinal Study of Aging database from 2002 to 2012 (third to seventh wave) among older adults a...