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Aim: The Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy, and Japanese Association of Rehabilitation Nutrition proposed the definition and diagnosis of respiratory sarcopenia using low respiratory muscle strength and appendicular skeletal muscle mass (ASM; ASM/height2) instead of respiratory muscle mass; however, these parameters have not been validated. This study aimed to confirm the validity of the respiratory sarcopenia definition proposed by these four professional organizations. Methods: Participants of our cohort study in 2015 of 468 community‐dwelling older people who were evaluated for sarcopenia and underwent spirometry were included in this analysis. We determined two respiratory sarcopenia models based on low skeletal muscle mass and respiratory muscle strength. Low skeletal muscle mass was defined by low ASM/height2, and low respiratory muscle strength was defined by peak expiratory flow rate (PEFR) or percentage of predicted PEFR (%PEFR). Survival status was assessed 5 years after baseline assessment (in 2020). To evaluate the validity of the cut‐off values for PEFR and %PEFR, we determined different respiratory sarcopenia models by sequentially varying the cut‐off values for each parameter, including ASM/height2, from high to low. We subsequently calculated the hazard ratio (HR) for mortality for each respiratory sarcopenia model using the Cox proportional hazards model. Additionally, we plotted the HR for each combination of cut‐off values for ASM/height2 and PEFR or %PEFR on a three‐dimensional chart to observe the relationship between the different cut‐off values and HR. Results: A total of 31 people died during the 5‐year observation period. With ASM/height2 cut‐off values of approximately 7.0 kg/m2 for men and 5.7 kg/m2 for women and %PEFR cut‐off values of 66–75%, respiratory sarcopenia was associated with mortality risk (HR, 2.36–3.27, point estimation range). Conclusions: The definition of respiratory sarcopenia by the four professional organizations is related to future health outcomes, and this definition is valid. Geriatr Gerontol Int 2024; 24: 948–953. [ABSTRACT FROM AUTHOR]

In the current study, we assessed changes in interstitial fluid dynamics resulting after whole‐brain radiotherapy using the diffusion‐weighted image analysis along the perivascular space (DWI‐ALPS) method, which is a simplified variation of the diffusion tensor image ALPS (DTI‐ALPS) method using diffusion‐weighted imaging (DWI) with orthogonal motion‐probing gradients (MPGs). This retrospective study included 47 image sets from 22 patients who underwent whole‐brain radiotherapy for brain tumors. The data for the normal control group comprised 105 image sets from 105 participants with no pathological changes. DWI was performed with the three MPGs applied in an orthogonal direction to the imaging plane, and apparent diffusion coefficient images for the x‐, y‐, and z‐axes were retrospectively generated. The ALPS index was calculated to quantify interstitial fluid dynamics. The independent t‐test was used to compare the ALPS index between normal controls and patients who underwent whole‐brain radiotherapy. Patients were compared in all age groups and individual age groups (20–39, 40–59, and 60–84 years). We also examined the correlation between biologically equivalent doses (BEDs) and the ALPS index, as well as the correlation between white matter hyperintensity and the ALPS index. In the comparison of all age groups, the ALPS index was significantly lower (p < 0.001) in the postradiation group (1.32 ± 0.16) than in the control group (1.44 ± 0.17), suggesting that interstitial fluid dynamics were altered in patients following whole‐brain radiotherapy. Significant age group differences were found (40–59 years: p < 0.01; 60–84 years: p < 0.001), along with a weak negative correlation between BEDs (r = −0.19) and significant correlations between white matter hyperintensity and the ALPS index (r = −0.46 for periventricular white matter, r = −0.38 for deep white matter). It was concluded that the ALPS method using DWI with orthogonal MPGs suggest alteration in interstitial fluid dynamics in patients after whole‐brain radiotherapy. Further systematic prospective studies are required to investigate their association with cognitive symptoms. [ABSTRACT FROM AUTHOR]

INTRODUCTION: To detect early cognitive impairment in community‐dwelling older adults, this study explored the viability of artificial intelligence (AI)‐assisted linear acceleration and angular velocity analysis during walking. METHODS: This cross‐sectional study included 879 participants without dementia (female, 60.6%; mean age, 73.5 years) from the 2011 Comprehensive Gerontology Survey. Sensors attached to the pelvis and left ankle recorded the triaxial linear acceleration and angular velocity while the participants walked at a comfortable speed. Cognitive impairment was determined using Mini‐Mental State Examination scores. Deep learning models were used to discern the linear acceleration and angular velocity data of 12,302 walking strides. RESULTS: The models' average sensitivity, specificity, and area under the curve were 0.961, 0.643, and 0.833, respectively, across 30 testing datasets. DISCUSSION: AI‐enabled gait analysis can be used to detect signs of cognitive impairment. Integrating this AI model into smartphones may help detect dementia early, facilitating better prevention. Highlights: Artificial intelligence (AI)‐enabled gait analysis can be used to detect the early signs of cognitive decline.This AI model was constructed using data from a community‐dwelling cohort.AI‐assisted linear acceleration and angular velocity analysis during gait was used.The model may help in early detection of dementia. [ABSTRACT FROM AUTHOR]

Aim: To develop a rapid and easy screening tool to detect sarcopenia. Methods: In total, 683 community‐dwelling older adults who participated in our cohort study, the "Otassha Study," in 2019, completely responded to a questionnaire, and were diagnosed with sarcopenia were included. Participants responded to a nine‐item questionnaire, including candidate items for a new sarcopenia screening tool named rapid sarcopenia screening, based on items of the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC‐F) questionnaire. To select appropriate items for the new screeening tool, multiple logistic regression analyses were performed, with sarcopenia as the dependent variable and questionnaire responses as independent variables. The area under the curve using 10 000 bootstraps was used to assess the rapid sarcopenia screening diagnostic ability for detecting sarcopenia. Results: Responses to question nos 2 (how much can you squeeze a wet towel?), 5 (how much muscle strength do you think you have compared with that of people of your age and sex?), 7 (how fast do you usually walk?), and 9 (age‐related item) were related to sarcopenia in multiple logistic regression analysis. The area under the curve of the total score of rapid sarcopenia screening was 0.82, 0.80, and 0.81 for men, women, and overall, respectively. At a cut‐off value of 14/15, the sensitivity and specificity for sarcopenia detection were 0.73 and 0.73, respectively. Conclusions: The newly developed sarcopenia screening tool has a better diagnostic ability for sarcopenia than the SARC‐F. Rapid sarcopenia screening does not require physical function measurements, making it a useful and accessible tool among older adults to detect sarcopenia. Geriatr Gerontol Int 2023; 23: 945–950. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between vitamin D status and periodontal inflammation as determined by the periodontal inflamed surface area (PISA) in community‐dwelling older adults. Materials and Methods: This cross‐sectional study included 467 Japanese adults (mean age = 73.1 years) who underwent full‐mouth periodontal examinations and measurements of serum levels of 25‐hydroxyvitamin D (25(OH)D). We used linear regression and restricted cubic spline models to analyse the association between exposure (serum 25(OH)D) and outcome (PISA). Results: The linear regression model showed that, after adjusting for potential confounders, participants in the lowest quartile of serum 25(OH)D had 41.0 mm2 more PISA (95% confidence interval [CI]: 4.6–77.5) than the reference group (the highest quartile of serum 25(OH)D). The spline model showed that the association between serum 25(OH)D and PISA was non‐linear and restricted to the low 25(OH)D range. PISA initially sharply decreased as serum 25(OH)D increased, and then the decreasing trend slowed and plateaued. The inflection point with the minimum PISA value was a serum 25(OH)D level of 27.1 ng/mL, above which there was no decreasing trend in PISA with increasing serum 25(OH)D levels. Conclusions: Low vitamin D status had an L‐shaped association with periodontal inflammation in this cohort of Japanese adults. [ABSTRACT FROM AUTHOR]

Aim: SARC‐F, a sarcopenia screening tool, has limited use but may be beneficial for detecting sarcopenia in frail older people. This study aimed to clarify the validity of the SARC‐F questionnaire in older people. Methods: In this validation study, 74 (36 men; age, 81.9 ± 6.7 years, 38 women; age, 83 ± 6.2 years) community‐dwelling older people who attended a daycare facility participated in our study. Participants completed the SARC‐F and SARC‐calf circumference (SARC‐CalF) questionnaires, and their body composition, walk speed and grip strength were measured. Sarcopenia was determined using the Asian Working Group for Sarcopenia criteria, and the participants were divided into non‐sarcopenia and sarcopenia groups. SARC‐F and SARC‐CalF scores were evaluated using receiver operating characteristic curve analysis for sarcopenia considering the area under the curve. Internal consistency was evaluated using Cronbach's alpha. Results: The prevalence of sarcopenia, defined by physical characteristics, was 60.0% in men and 48.1% in women. The area under the curve of the SARC‐F for sarcopenia was 0.703 (95% confidence interval [CI]: 0.585–0.821, P = 0.001). Cronbach's alpha was 0.81, and the internal consistency was high. SARC‐F had lower sensitivity (0.47; 95% CI: 0.31–0.64) but higher specificity (0.78; 95% CI: 0.60–0.89) than the sensitivity and specificity of SARC‐CalF, respectively, and the sensitivity of SARC‐F was higher than that reported in previous studies. Conclusion: The SARC‐F questionnaire is more sensitive in assessing sarcopenia in low‐functioning populations and can be used as a screening tool for sarcopenia in long‐term daycare facilities for older people rather than in community‐based healthcare activities. Geriatr Gerontol Int 2022; 22: 889–893. [ABSTRACT FROM AUTHOR]

The extent to which long disability‐free survival (DFS) time can be extended according to the amount of time spent walking has not been investigated. The aim of this study was to examine the association between time spent walking per day and DFS time in older adults. We conducted a cohort study of 14 342 disability‐free individuals (aged ≥ 65 years) living in Ohsaki City, Japan. The amount of time spent walking per day (<0.5 h, 0.5–1 h, ≥1 h) by each individual in 2006 was assessed by a self‐reported questionnaire. Data on 11‐year incident functional disability were retrieved from the public Long‐Term Care Insurance database. After estimating the multivariable‐adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death), the multivariable‐adjusted 50th percentile differences (50th PDs; difference in the period until the first 50% of the composite outcome occurred) were estimated according to time spent walking. Among 114 764 person‐years, the composite outcome occurred in 7761 persons (67.6 per 1000 person‐years). The HRs (95% confidence intervals) of the composite outcome were 1.00 (reference) for <0.5 h, 0.84 (0.79, 0.88) for 0.5–1 h, and 0.78 (0.74, 0.83) for ≥1 h (p‐trend < 0.001). The 50th PDs (95% confidence intervals) of DFS time were 238 (155, 322) days longer for 0.5–1 h and 360 (265, 454) days longer for ≥1 h, in comparison with <0.5 h. The results suggest that longer time spent walking per day contributes to longer DFS time. [ABSTRACT FROM AUTHOR]

Objectives: Age‐related hearing loss (ARHL) is considered a risk factor for cognitive impairment and falls. The association may be modulated by gait performance because ARHL is related to mobility decline, which strongly contributes to cognitive impairment and falls. We investigated the interactive effects of gait and ARHL on global cognition and falls among older adults. Study Design: Retrospective cohort study. Methods: The auditory acuity of 810 community‐dwelling older adults was measured using a pure‐tone average of hearing thresholds at 1,000 and 4,000 Hz in the better‐hearing ear. Participants were then stratified as follows: normal hearing, ≤25 dB; mild hearing loss (HL), >25 and ≤40 dB; and moderate to severe HL, >40 dB. Gait speed was assessed as an indicator of gait performance and fall occurrence within the previous year. Global cognition was determined using the Montreal Cognitive Assessment (MoCA) test. Results: A total of 320 (39.5%) and 233 (28.8%) participants had mild and moderate to severe HL, respectively. Hierarchical multiple and logistic regression analyses showed interactions between gait performance and moderate hearing loss on both global cognition and the occurrence of falls. Specifically, older adults with moderate hearing loss who walked slowly showed lower MoCA scores and a higher incidence of falls, whereas those with decent gait speed did not show such a tendency. Conclusion: Our results suggest that poor gait performance might modulate the effects of ARHL, leading to cognitive decline and falls. Poor cognitive performance and falls may be prevalent in older adults with ARHL, especially in those with slower gait and moderate hearing loss. Level of Evidence: 3 Laryngoscope, 132:857–863, 2022 [ABSTRACT FROM AUTHOR]

Objective: To elucidate the relationship between physical frailty and dry mouth among community‐dwelling older adults in Japan. Background: Oral hypofunction is associated with physical frailty in older adults. Dry mouth, subjectively evaluated as xerostomia and objectively measured as hyposalivation, is highly prevalent in older adults. However, few reports have used both measures of dry mouth and investigated their association with physical frailty. Materials and Methods: This cross‐sectional study included 643 individuals (mean age, 73.9 years) from the Otassha Study in 2019. Xerostomia was assessed using the 5‐item Summated Xerostomia Inventory (SXI). Hyposalivation was assessed by measuring the amount of resting saliva using the modified cotton roll method. Frailty phenotypes were defined by weakness, slowness, weight loss, low physical activity level and exhaustion components, and served as the outcome variable. Participants with three or more components were considered physically frail, and those with one or two components were considered pre‐frail. Ordinal logistic regression analyses were performed to evaluate the associations between physical frailty and xerostomia and hyposalivation. Results: Among the participants, 4.5% and 49.8% had physical frailty and pre‐frailty, respectively. In ordinal logistic regression analysis adjusted for demographic and health characteristics, the SXI score was associated with physical frailty status (adjusted odds ratio for a one‐point increase in SXI, 1.12; 95% confidence interval, 1.06‐1.19). However, no difference was observed between the amount of resting saliva and severity of physical frailty. Conclusion: Xerostomia is associated with physical frailty among community‐dwelling older adults in Japan. Clinical Trial Registration: Not applicable. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the association between oral hypofunction and malnutrition among community‐dwelling older adults. Background: Oral hypofunction, a 7‐component phenotype of the clinical features of oral health, has been described in Japan. Data about its association with nutritional status are limited. Materials and Methods: This cross‐sectional study enrolled 715 adults (mean age, 73.5 years; range, 65‐91 years) from the Otassha Study. Oral hypofunction was defined as the presence of ≥3 of the following 7 components: poor oral hygiene; oral dryness; low occlusal force; low articulatory oral motor skill; low tongue pressure; low masticatory performance; and compromised swallowing function. The Mini Nutritional Assessment®‐Short Form (MNA®‐SF) was used to assess the nutritional status. Malnutrition was defined as having an MNA®‐SF score of seven or less. The association between oral hypofunction and nutritional status was evaluated using ordinal logistic regression analyses. Results: The prevalence rates of oral hypofunction and malnutrition were 42.7% and 4.1%, respectively. Multivariable Poisson regression analyses revealed that oral hypofunction was associated with malnutrition. The adjusted relative risk of malnutrition in the study participants with oral hypofunction was 3.00 with a 95% confidence interval of 1.29‐6.98. Conclusion: Community‐dwelling older adults whose oral functions were compromised in multiple aspects had poor nutritional status. [ABSTRACT FROM AUTHOR]

Aim: The coronavirus disease 2019 (COVID‐19) pandemic remains a major global public health issue, and it has led to restrictions in physical and social activities among community‐dwelling people, including frail older adults. This study aimed to determine the impact of the pandemic on the subjective health status and characteristics of community‐dwelling frail older adults by assessing their knowledge of infection, behaviors and negative psychological response. Methods: During October 2019, 720 older adults participated in "The Otassha Study." A year after the COVID‐19 outbreak, between June 29 and July 31, 2020, a health status questionnaire, comprising questions concerning knowledge about infection, behaviors and psychological responses during the pandemic, was sent to all participants of the health examination in 2019. Respondents were divided into the robust and frail groups, and their responses were compared. Results: Although the self‐reported health status of the older adults in both groups was worse in 2020 than in 2019, differences were not observed in the degree of deterioration between the groups. Those in the frail group had fewer resources of information related to COVID‐19 and had fewer coping behaviors for health maintenance compared with the robust group. Conclusion: Information gathering and actions aimed at health maintenance tended to be weaker among older adults with frailty, although the influence of COVID‐19 on subjective health status did not differ significantly between robust and frail adults. Therefore, robust and frail older adults may need to adopt different countermeasures to prevent worse health during this pandemic. Geriatr Gerontol Int 2021; 21: 1053–1059. [ABSTRACT FROM AUTHOR]

Aim: The Mini‐Mental State Examination is a widely used cognitive assessment tool. However, it has several limitations, including the learning effect and interrater reliability. Therefore, we developed a Computer‐Based Cognitive Assessment Tool (CompBased‐CAT), which runs on a tablet or personal computer. In this study, we examined the validity and discrimination ability of the CompBased‐CAT. Methods: Participants were recruited from the Otasha‐Kenshin study carried out in 2016. We included 773 community‐dwelling older individuals in Japan (332 men, 441 women, aged 65–97 years). CompBased‐CAT scores were converted to z‐scores, and the correlation with Mini‐Mental State Examination scores was examined using Pearson's correlation coefficient. Furthermore, the ability to discern cognitive impairment was examined using the receiver operating characteristic curve. Results: The Pearson's correlation coefficient for the Mini‐Mental State Examination scores and each task component of the CompBased‐CAT ranged from 0.24 to 0.41 (P < 0.001), and the correlation coefficient of the total z‐scores was 0.51 (P < 0.001). The sensitivity, specificity and area under the receiver operating characteristic curve of the discriminating ability of the CompBased‐CATool for cognitive impairment were 0.81, 0.77 and 0.85, respectively. Conclusions: The CompBased‐CAT certainly possesses validity, discriminating ability and utility as a new cognitive assessment tool in community‐dwelling older individuals. Geriatr Gerontol Int 2020; ••: ••–••. [ABSTRACT FROM AUTHOR]

Aim: The SARC‐F is a useful clinical index for sarcopenia screening; however, this measure has low sensitivity. Furthermore, this tool has never been validated on community‐dwelling older Japanese adults. The goal of the present study was to validate a Japanese version of the SARC‐F and confirm its suitability for Japanese samples. Methods: Participants were 734 community‐dwelling older adults in the Itabashi Ward, Japan. Bioimpedance measures, walking speed, grip strength and instrumental activities of daily living (IADL) were measured. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People, the Asian Working Group for Sarcopenia criteria and Japanese‐adjusted Asian Working Group for Sarcopenia. SARC‐F receiver operating characteristic curves for each sarcopenia measure were used to evaluate diagnostic accuracy. Physical functioning, IADL and sarcopenia screening tools were compared with the SARC‐F. Results: A total of nine men (3.1%) and 15 women (3.4%) were classified into a SARC‐F sarcopenia group. The sarcopenia group had lower physical functioning and Mini Sarcopenia Risk Assessment scores and higher frailty status than the control group. The Cronbach's alpha for the SARC‐F was 0.610, suggesting insufficient internal consistency. SARC‐F scores were related to physical functioning, IADL, and Mini Sarcopenia Risk Assessment scores. Receiver operating characteristic analyses of the SARC‐F based on each criterion showed low sensitivity, but high specificity. Conclusions: The Japanese version of the SARC‐F appears to be a useful index for reflecting physical functioning and IADL. However, it is necessary to further determine whether this tool is useful for detecting sarcopenia among community‐dwelling older adults. Geriatr Gerontol Int 2019; 19: 1172–1178. [ABSTRACT FROM AUTHOR]

Abstract: Background: An association has recently been reported between frailty and reduced masticatory function; however, the causal relationship remains unclear. Objective: The aim of this study was to clarify the relationship between masticatory function and frailty progression. Methods: Among 6699 individuals aged 65 and older (mean age 72.8 ± 5.2 years) who were invited to participate in comprehensive medical check‐ups, 418 who underwent examinations at the Tokyo Metropolitan Institute of Gerontology in both 2013 and 2015 and who met inclusion criteria were included in this study. Frailty was determined with the Kihon Checklist developed by the Japanese Ministry of Health, Labour and Welfare. The following three masticatory functions were evaluated: occlusal force, mixing ability and subjective chewing ability. The following confounding factors were investigated: age, sex, grip strength, comfortable walking speed, Mini‐Mental State Examination (MMSE) score, Self‐Rating Depression Scale (SDS) score, skeletal mass index (SMI), number of medications taken and number of remaining teeth. Statistical analysis was performed with binomial logistic regression analysis. Results: Logistic regression analysis revealed that comfortable walking speed, SDS score, MMSE score and masticatory function were significantly related to progression to frailty or pre‐frailty. Of the three masticatory function items evaluated, mixing ability and subjective chewing ability were related to frailty progression. Conclusion: Our results confirm that masticatory function was associated with the progression to pre‐frailty or frailty among community‐dwelling individuals 65 years and older over the 2‐year period of this longitudinal study. Of the masticatory function items evaluated, mixing ability and subjective chewing ability were associated with frailty progression. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The association of vascular dysfunction and amyloid beta deposition attracted attentions for its relationship with cognitive decline. Previous studies show the correlation between the declined cardiac function and the cognitive impairment. In the present study, we analysed the association between cognitive functions and cardiac parameters in community‐dwelling people with preserved ejection fraction without heart failure. Methods and results: Subjects were 108 Japanese community‐dwelling middle‐aged and older adults with preserved ejection fraction (25 men and 83 women; mean age 74.7 years). Cardiac functional parameters at rest were assessed with B‐type natriuretic peptide and echocardiography. The cardiopulmonary exercise test was used to test these parameters during exercise. Cognitive function was assessed with the Japanese version of the Montreal Cognitive Assessment (MoCA‐J). Other indices were assessed biochemically, physiologically, and physically. There were significant correlations between MoCA‐J score and age (r = −0.388), peak oxygen uptake (VO2, r = 0.201), peak VO2/heart rate (HR, r = 0.243), peak VO2/weight (r = 0.244), peak metabolic equivalents (r = 0.244), usual walking speed (r = −0.200), and the Timed Up and Go test (r = −0.230). Multiple linear regression analysis showed peak VO2/HR was an independent determinant of MoCA‐J score after adjusting for potential confounders (B = 0.424). After 6 months of exercise training with 64 subjects, we found that the per cent change of peak VO2/HR was related to the per cent change of MoCA‐J score (r = 0.296). Conclusions: These results suggested that peak VO2/HR (an index of stroke volume at peak exercise) might be associated with cognitive impairment based on the vascular cascade hypothesis. [ABSTRACT FROM AUTHOR]

Objective: Brain-derived neurotrophic factor (BDNF) is involved in the pathophysiology of psychiatric disorders in adults and elderly individuals, and as a result, the DNA methylation (DNAm) of the BDNF gene in peripheral tissues including blood has been extensively examined to develop a useful biomarker for psychiatric disorders. However, studies to date have not previously investigated the effect of age on DNAm of the BDNF gene in blood. In this context, we measured DNAm of 39 CpG units in the CpG island at the promoter of exon I of the BDNF gene.Methods: We analyzed genomic DNA from peripheral blood of 105 health Japanese women 20 to 80 years of age to identify aging-associated change in DNAm of the BDNF gene. In addition, we examined the relationship between total MMSE scores, numbers of stressful life events, and serum BDNF levels on DNAm of the BDNF gene. The DNAm rate at each CpG unit was measured using a MassArray® system (Agena Bioscience), and serum BDNF levels were measured by ELISA.Results: There was a significant correlation between DNAm and age in 13 CpGs. However, there was no significant correlation between DNAm and total MMSE scores, numbers of life events, or serum BDNF levels.Conclusion: Despite the small number of subjects and the inclusion of only female subjects, our results suggest that DNAm of 13 CpGs of the BDNF gene may be an appropriate biomarker for aging and useful for predicting increased susceptibility to age-related psychiatric disorders. [ABSTRACT FROM AUTHOR]

Aim: Diabetes is associated with not only cardiovascular and cerebrovascular disease, but also reductions in physical and cognitive function. The purpose of the present study was to determine whether muscle strength, walking ability and balance declined in Japanese community‐dwelling older adults with diabetes or prediabetes. Methods: We analyzed data from comprehensive health checkups carried out for 1689 individuals (710 men, 979 women; mean age 71.4 ± 5.6 years) between 2011 and 2016. Participants were divided into three groups: no diabetes (non‐history of diabetes and glycated hemoglobin level <5.7%), prediabetes (non‐history of diabetes, but glycated hemoglobin level was 5.7–6.4%) and diabetes (history of diabetes or glycated hemoglobin level >6.4%). Physical and cognitive function were compared between groups after adjusting for covariates. Results: Participants with diabetes showed higher levels of obesity, comorbidity, gonarthrosis, and body fat, and lower levels of physical function relative to those observed in participants with prediabetes or no diabetes. After adjusting covariates, participants with diabetes showed significantly lower grip strength (P < 0.010), slower walking speed (P < 0.005), longer Timed Up and Go test time (P < 0.007) and less time spent standing on one foot (P < 0.001) relative to those with no diabetes, but not those with prediabetes. Conclusions: Significant functional decline was observed in community‐dwelling older adults with diabetes, but not in those with prediabetes. Prevention of the progression of prediabetes to diabetes is important in avoiding reductions in physical function. Geriatr Gerontol Int 2018; 18: 1031–1037. [ABSTRACT FROM AUTHOR]

p16 activation caused by oncogenic mutations may represent oncogene‐induced senescence (OIS), a protective mechanism against oncogenic events. However, OIS can contribute to tumor development via tissue remodeling in some tumors. Erdheim–Chester disease (ECD), a rare non‐Langerhans cell histiocytosis, is one such tumor. Its clinical and histological features vary, making it difficult to diagnose. Herein, we describe an autopsy of an ECD patient. The patient underwent radiological examinations, including 18F‐fluorodeoxyglucose (FDG)‐positron emission tomography/computed tomography (PET/CT), bone scintigraphy and CT. A biopsy from the lesion with the highest FDG accumulation confirmed the presence of foamy macrophages, a diagnostic clue for ECD. Based on this finding and the clinical features, ECD was diagnosed. However, the patient died from heart dysfunction. After the autopsy, each radiologically different site showed various histological findings regarding the morphology of macrophages, fibrosis, inflammation, and p16 expression. OIS‐induced histological progression can cause certain changes observed in radiological images. In addition, in order to evaluate the increase in glucose metabolism, which can affect FDG accumulation, the expression of glucose transporter 1 and hexokinase II was also analyzed. Summarizing the radio‐histological correlation can help further both the understanding and diagnosis of ECD. [ABSTRACT FROM AUTHOR]

Aim: Statin‐associated muscle symptoms (SAMS) are the muscle‐related side‐effects of statins, but the association between statin use and physical function among community‐dwelling older adults is unclear. The objective of the present study was to examine the association between statin use and physical function among community‐dwelling older Japanese adults by considering the risk factors of statin‐associated muscle symptoms. Methods: The participants were 1022 community‐dwelling older adults aged 65–88 years, who participated in comprehensive health checkups from 2013 to 2015. Statin use in the participants (381 men and 559 women) was verified by using data from their medicine notebooks. The differences between statin use (users and non‐users) and physical functions (grip strength, knee extension torque, normal and maximum gait speed, Timed Up & Go test, one‐legged stance, quadriceps muscle thickness and echo intensity) were analyzed using the t‐test. Multiple regression analyses were also carried out to examine the association between statin use and physical function. Results: A total of 93 men (24.4%) and 154 women (27.5%) were statin users. Grip strength, normal gait speed and one‐legged stance declined significantly in statin users compared with the non‐users. In multiple regression analysis while controlling for the risk factors of statin‐associated muscle symptoms, including age, sex, body mass index and number of medicines, no independent association, between statin use and the reduction of physical functions, was observed. Conclusions: Statin use was not associated with the decline of physical function in community‐dwelling older Japanese adults. Geriatr Gerontol Int 2018; 18: 623–630. [ABSTRACT FROM AUTHOR]

Aim: Brain‐derived neurotrophic factor (BDNF) have been implicated in the progression of neuronal survival, phenotyping differentiation and maintenance of various neurons, as well as neurogenesis. We studied how BDNF affects health parameters of older adults by carrying out a health examination of community‐dwelling older adults. Methods: We measured the serum BDNF concentration of 898 older adults aged 65–84 years who participated in regional health examinations in the Tokyo area and also measured various parameters, such as the thickness of the quadriceps femoris, percentage of body fat, body mass index, grip strength, frequency of walking, and use of sleeping drugs and steroidal anti‐inflammatory drugs. Results: We obtained significant relationships between serum BDNF values and thickness of the quadriceps muscle, body mass index or percentage of body fat. Individuals holding onto something when they stood up had lower serum BDNF values than individuals not holding onto something when they stood up. Smokers had higher serum BDNF values than non‐smokers. Conclusions: Older adults who had higher serum BDNF had bigger quadriceps muscles, higher body mass index and higher body fat rate, and were also able to stand up without holding onto something from a sitting position. Geriatr Gerontol Int 2018; 18: 456–461. [ABSTRACT FROM AUTHOR]

Summary: Objective: To clarify longitudinal changes in white matter microstructures from the onset of disease in patients with West syndrome (WS) of unknown etiology. Methods: Diffusion tensor imaging (DTI) was prospectively performed at onset and at 12 and 24 months old in 17 children with WS of unknown etiology. DTI was analyzed using tract‐based spatial statistics (TBSS) and tract‐specific analysis (TSA) of 13 fiber tracts, and fractional anisotropy (FA) and mean diffusivity (MD) were compared with those of 42 age‐matched controls. Correlations of FA and MD with developmental quotient (DQ) at age 24 months were analyzed. Multiple comparisons were adjusted for using the false discovery rate (q‐value). Results: TBSS analysis at onset showed higher FA and lower MD in the corpus callosum and brainstem in patients. TSA showed lower MD in bilateral uncinate fasciculi (UF) (right: q < 0.001; left: q = 0.03) at onset in patients. TBSS showed a negative correlation between FA at onset and DQ in the right frontal lobe, whereas FA at 24 months old exhibited a positive correlation with DQ in the diffuse white matter. MD for bilateral UF at 24 months old on TSA correlated positively with DQ (q = 0.04, both). Significance: These findings may indicate the existence of cytotoxic edema in the immature white matter and dorsal brainstem at onset, and subsequent alterations in the diffuse white matter in WS of unknown etiology. Microstructural development in the UF might play important roles in cognitive development in WS. [ABSTRACT FROM AUTHOR]

Aim: Understanding the risk factors for developing subjective memory complaints (SMC) could help with early screening and treatment for cognitive impairment. The aim of the present study was to explore the risk factors for developing SMC, by focusing on gait-related variables. Methods: A total of 406 community-dwelling older adults aged 65–85 years without impending cognitive impairment participated in baseline and 1-year follow-up evaluations. A comprehensive evaluation was carried out, and included gait speed and fear of falling (FoF) assessments, and the Montreal Cognitive Assessment test. Logistic regression analyses were carried out to independently evaluate the risk factors at baseline and follow-up evaluations. Results: At baseline, 45.1% of older adults had SMC. The presence of SMC at baseline was associated with being female, subjective hearing loss and FoF. Of 223 participants who did not report SMC at baseline, 48 had newly developed SMC at follow up (21.5%). The significant predictors for developing SMC were being female and FoF, but not gait speed, and were independent of depression symptoms. The Montreal Cognitive Assessment total score at baseline was a marginally significant predictor for developing SMC at follow up (P = 0.06), but a lower score in the language domain was a significant predictor in further analysis. Conclusions: FoF was a significant risk for future development of SMC, suggesting that FoF might reflect the risk of cognitive impairment at an earlier stage, or that FoF and SMC could share the same basis of anxiety for daily activities. The mechanisms and consequence of this longitudinal relationship require further study. [ABSTRACT FROM AUTHOR]

Aim Frailty is an important predictor of the need for long-term care and hospitalization. Our aim was to categorize frailty in community-dwelling older adults. Methods The present study was carried out in 2011-2013, and consisted of 1380 individuals over 65 years of age. Participants completed the Kihon checklist, which is widely used to assess frailty in Japan, and their physical, cognitive and social function was evaluated. Non-hierarchical cluster analysis was used to statistically categorize frailty. The optimum number of clusters was determined as the point at which the external reference values (instrumental activity of daily living score, grip power, 10-m walk time, body mass index, portable fall risk index, occlusal force and Mini-Mental State Examination score) differed. Results According to the Kihon checklist, 369 (26.7%) of the 1380 study participants were considered frail. When the cluster number was increased from two to six, the scores in each subdomain of the Kihon checklist significantly differed. The estimated minimum number of clusters was five, and each of the five cluster groups had distinct characteristics. The numbers of participants in cluster groups 1-5 were 105, 78, 62, 71 and 53, respectively. Conclusions We identified five types of frailty in community-dwelling older adults in Japan: 'experience of falling,' 'pre-frailty,' 'oral frailty,' 'housebound' and 'severe frailty.' Geriatr Gerontol Int 2017; 17: 69-77. [ABSTRACT FROM AUTHOR]

Aim The first aim of the present study was to determine the construct validity of evaluating posture as a measure of physical function in elderly individuals. The second aim was to determine reference values for sternum inclination in elderly individuals when measured using a digitalized inclinometer. Methods We included 834 community-dwelling elderly individuals (350 men and 484 women) in this study. We used a digital inclinometer for measuring sternum inclination angle. We evaluated physical functions, including muscle strength, static balance, gait ability and the functional mobility of our study participants. To assess the construct validity of sternum inclination in elderly people, Pearson's correlation coefficient between sternum inclination and participant characteristics was calculated. To determine a reference value of sternum inclination by age, P for trend was calculated. Results In men, the sternum inclination angle and sternum inclination index were significantly associated with all anthropometric measures, except static balance. In women, the sternum inclination index was significantly associated with all measures, whereas the sternum inclination angle was associated with all measures except for balance and the Timed Up and Go test. Trend of sternum inclination index by age was significant. Conclusions Our results show that the sternum inclination as a measure of physical function in elderly men and women has construct validity. We determined reference values for sternum inclination of which trend by age was considered. Geriatr Gerontol Int 2016; 16: 1068-1073. [ABSTRACT FROM AUTHOR]

Objectives To examine the distribution and associated predictors of 1-year changes in the Japanese version of the Montreal Cognitive Assessment ( Mo CA- J) in community-dwelling older adults. Design Prospective cohort study. Setting Population-based cohort study in Tokyo, Japan. Participants Individuals aged 65 to 84 (N = 496). Measurements Multinomial logistic regression analysis was performed to estimate the odds of experiencing subsequent improvement in Mo CA- J performance, as opposed to stable or deteriorating, while simultaneously adjusting for baseline Mo CA- J score and major confounders. Results Mean age was 74.0 ± 4.8; mean Mo CA- J score was 23.7 ± 3.6. Only 40% had stable Mo CA- J performance; 30% experienced deterioration and 30% improvement. Age increment, hospitalization in previous year, slower Timed Up and Go ( TUG) score, and slower maximum walking speed were predictive of subsequent Mo CA- J performance deterioration. Conclusion Slower TUG and walking speed performances were independent predictors of short-term Mo CA- J deterioration. Research aimed at assessing lower-extremity performance-based tests in MCI-related decision-making is warranted. [ABSTRACT FROM AUTHOR]

Objectives A cross-sectional study was carried out to investigate the determinants of self-rated oral health among community-dwelling older people in Japan. Methods The participants were 897 (357 men and 540 women) aged 65 years and over who participated in a comprehensive geriatric health examination, which included an oral examination, a face-to-face interview assessing cognitive function, questionnaires regarding depressive symptoms and functional capacity, and a medical examination. The oral examination measured indices of oral health status: number of present teeth, number of functional teeth, occlusal force and amount of resting saliva. Multiple logistic regression analyses were carried out to determine the factors associated with poor self-rated oral health. Results The mean age of the participants was 73.5 ± 5.0 years. The prevalence of poor and rather poor self-rated oral health was 11.5% and 29.5%, respectively. Multiple logistic regression analyses showed that the number of present teeth (odds ratio [ OR] 0.97, 95% confidence intervals [ CI] 0.95-0.99), difficulty in mastication ( OR 3.20, CI 2.18-4.70), presence of xerostomia ( OR 1.43, CI 1.02-2.01), total score on the MoCA-J ( OR 1.06, CI 1.01-1.11), and reduction in frequency of leaving the house ( OR 1.64, CI 1.12-2.41) were significantly associated with poor self-rated oral health. Conclusions The present results suggested that self-rated oral health was a significant factor in oral health status as well as overall well-being among community-dwelling older Japanese people. Geriatr Gerontol Int 2015; 15: 755-761. [ABSTRACT FROM AUTHOR]

Aim To develop a simple screening test to identify older adults at high risk for sarcopenia. Methods We studied 1971 functionally independent, community-dwelling adults aged 65 years or older randomly selected from the resident register of Kashiwa city, Chiba, Japan. Data collection was carried out between September and November 2012. Sarcopenia was defined based on low muscle mass measured by bioimpedance analysis and either low muscle strength characterized by handgrip or low physical performance characterized by slow gait speed. Results The prevalence of sarcopenia was 14.2% in men and 22.1% in women. After the variable selection procedure, the final model to estimate the probability of sarcopenia included three variables: age, grip strength and calf circumference. The area under the receiver operating characteristic curve, a measure of discrimination, of the final model was 0.939 with 95% confidence interval ( CI) of 0.918-0.958 for men, and 0.909 with 95% CI of 0.887-0.931 for women. We created a score chart for each sex based on the final model. When the sum of sensitivity and specificity was maximized, sensitivity, specificity, and positive and negative predictive values for sarcopenia were 84.9%, 88.2%, 54.4%, and 97.2% for men, 75.5%, 92.0%, 72.8%, and 93.0% for women, respectively. Conclusions The presence of sarcopenia could be detected using three easily obtainable variables with high accuracy. The screening test we developed could help identify functionally independent older adults with sarcopenia who are good candidates for intervention. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 93-101. [ABSTRACT FROM AUTHOR]

Introduction We compared the efficacy of whole-body MRI ( WBMRI) with and without diffusion-weighted whole-body imaging with background body signal suppression ( DWIBS) using a 3.0- T MR scanner to [18 F] fluoro-2- D-glucose positron emission tomography with CT (integrated FDG-PET/ CT) for the detection of bone metastases in patients with differentiated thyroid carcinoma ( DTC). Methods We examined 23 patients (16 women, 7 men; mean age, 56; range 17-74) with DTC who had undergone total thyroidectomy and were hospitalised to receive [ I-131 I] therapy. All patients underwent both WBMRI with DWIBS and whole-body FDG-PET/ CT. The skeletal system was classified into 13 anatomic segments and assessed for the presence of bone metastases. Bone metastases were verified when positive findings were indicated on at least two imaging modalities: post-treated [131 I] whole-body scans, WBMRI without DWIBS ( T1-weighted images and short-inversion time inversion recovery images), [18 F]- FDG-PET and CT. Results Bone metastases were confirmed in 78/290 (27%) segments in 20 (87%) of 23 patients. The sensitivities for bone metastases on a segment basis using WBMRI with DWIBS, WBMRI without DWIBS and integrated FDG-PET/ CT were 64 of 78 (82%), 50 of 78 (64%) and 62 of 78 (79%), respectively; the difference between values of WBMRI with and without DWIBS was statistically significant ( P = 0.0015). The overall accuracies of WBMRI with DWIBS, WBMRI without DWIBS and integrated FDG-PET/ CT were 273 of 290 (94%), 261 of 290 (90%) and 272 of 290 (94%), respectively; the difference between values of MRI with and without DWIBS was also statistically significant ( P = 0.003). There were only one to three false positive segments and the difference among specificities was not statistically significant in these modalities. Conclusion Adding DWIBS improved the sensitivity and the overall accuracy of WBMRI using 3.0- T MRI for the detection of bone metastases in patients with DTC. There was no statistically significant difference in diagnostic accuracy between MRI with DWIBS and integrated FDG-PET/ CT. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effects of gadolinium-based contrast agent (GBCA) on 1H-magnetic resonance spectroscopy (MRS) of the breast at 3.0-T. Materials and Methods: Patients ( n = 98) with breast cancer (98 lesions) underwent MRS (point-resolved spectroscopy sequence [PRESS]; TR/TE, 2000/100 msec; voxel size, 15 × 15 × 15 mm) before the administration of GBCA. In 52 of those patients, MRS was also performed after the administration of GBCA. The voxel-of-interest (VOI) was placed by referring to the noncontrast-enhanced MRI (diffusion-weighted images combined with fat-suppressed T2-weighted images). We reviewed and graded the appropriateness of VOI location compared to the correlating enhancement lesions. Integral values of the choline peak at a frequency of 3.2 ppm on MRS were compared before and after the administration of GBCA. Results: The VOI was placed correctly in 64 lesions (65%), although the VOI was placed outside the targeted lesion in 34 lesions (35%). The integral value of the choline peak on MRS decreased significantly after the administration of GBCA ( P < 0.001). Conclusion: Accumulation of GBCA in breast cancer could affect the choline peak on MRS. MRS of breast cancer at 3.0-T can be recommended to be acquired before contrast-enhanced study; however, some problems remain in VOI placement with reference to the noncontrast-enhanced study. J. Magn. Reson. Imaging 2012;35:717-722. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Aim We compared skeletal muscle mass and physical function between older adults with sarcopenia and those with sarcopenic obesity. Methods Body composition and physical and cognitive function were measured for 1283 community-dwelling older adults. Participants responded to questionnaires about pain and exercise. The pure sarcopenia group (PS) included individuals with sarcopenia only. The sarcopenic obesity group (SO) included individuals with both sarcopenia and obesity. Groups were compared after adjusting for sex, age and height through propensity score matching. Results The PS and SO included 129 and 105 individuals, respectively. Comorbidities were more frequent in the SO ( P < 0.001). The SO had higher upper limb muscle mass ( P < 0.001), and had lower ratios of lower limb muscle mass to upper limb muscle mass ( P < 0.001) and of lower limb muscle mass to weight ( P < 0.001). The SO also had poorer grip power ( P = 0.007), gait times (usual pace, P = 0.001; maximum speed, P = 0.001), Timed Up and Go test ( P < 0.001), and time standing on one foot ( P = 0.005) than the PS. The SO had a higher frequency of gonalgia ( P = 0.013). After adjusting for covariates, comorbidities, upper limb muscle mass, lower limb muscle mass to upper limb muscle mass ratio, lower limb muscle mass to weight ratio, gait time, Timed Up and Go test, time standing on one foot, and gonalgia differed significantly between the PS and SO. Conclusions Sarcopenic obesity decreases the ratio of lower limb muscle mass to weight by increasing weight. It affects physical function in older Japanese adults with low weight. Decreased relative lower limb muscle mass is an important function-limiting factor in sarcopenic obesity. Geriatr Gerontol Int 2017; 17: 2602-2609. [ABSTRACT FROM AUTHOR]

Aim Self-efficacy is considered to be an important factor influencing behavior change; however, there are no existing tools to measure self-efficacy in the context of oral health among older adults. The purpose of the present study was to develop the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) for use with older adults, and to evaluate its reliability and validity. Methods The self-administered questionnaire was completed by 646 Japanese older people. The draft version of the scale consisted of 35 items that were generated to measure the three dimensions of personal beliefs in tooth brushing, observing own oral health status and oral function. We carried out a principal components factor analysis with promax rotation, and investigated the scale's internal consistency and construct validity. Results The final version of the scale consisted of three dimensions measured with 20 items. Cronbach's alpha of the GSEOH total scale was 0.924. There were significant differences ( P < 0.05) in total scores on the GSEOH for the change process of oral health behavior, and in relation to self-rated oral health. Conclusions We developed the GSEOH, with three factors and 20 items, and confirmed its reliability and validity. More studies are necessary to investigate the cross-cultural validity and reliability with larger samples from other countries. Geriatr Gerontol Int 2017; 17: 1406-1411. [ABSTRACT FROM AUTHOR]