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Aim: To examine cross‐sectional associations between continuous glucose monitoring (CGM)‐derived metrics and cerebral small vessel disease (SVD) in older adults with type 2 diabetes. Materials and Methods: In total, 80 patients with type 2 diabetes aged ≥70 years were analysed. Participants underwent CGM for 14 days. From the CGM data, we derived mean sensor glucose, percentage glucose coefficient of variation, mean amplitude of glucose excursion, time in range (TIR, 70‐180 mg/dl), time above range (TAR) and time below range metrics, glycaemia risk index and high/low blood glucose index. The presence of cerebral SVD, including lacunes, microbleeds, enlarged perivascular spaces and white matter hyperintensities, was assessed, and the total number of these findings comprised the total cerebral SVD score (0‐4). Ordinal logistic regression analyses were performed to examine the association of CGM‐derived metrics with the total SVD score. Results: The median SVD score was 1 (interquartile range 0‐2). Higher hyperglycaemic metrics, including mean sensor glucose, TAR >180 mg/dl, TAR >250 mg/dl, and high blood glucose index and glycaemia risk index, were associated with a higher total SVD score. In contrast, a higher TIR (per 10% increase) was associated with a lower total SVD score (odds ratio 0.73, 95% confidence interval 0.56‐0.95). Glycated haemoglobin, percentage glucose coefficient of variation, mean amplitude of glucose excursions, time below range and low blood glucose index were not associated with total cerebral SVD scores. Conclusions: The hyperglycaemia metrics and TIR, derived from CGM, were associated with cerebral SVD in older adults with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims/Introduction: This study aimed to characterize the global cognition and executive functions of older adults with type 1 diabetes mellitus in comparison with type 2 diabetes mellitus. Materials and Methods: This study included 37 patients with type 1 diabetes mellitus aged ≥65 years and 37 age‐ and sex‐matched patients with type 2 diabetes mellitus. Patients with dementia scoring <24 on the Mini‐Mental State Examination were excluded. General cognition, memory, classic, and practical executive function were investigated. Results: Patients with type 1 diabetes mellitus demonstrated lower psychomotor speed scores on Trail Making Tests A and B (P < 0.001, P < 0.013) than those with type 2 diabetes mellitus. The dysexecutive syndrome behavioral assessment revealed similar results in patients with types 1 and 2 diabetes mellitus. The Wechsler Memory Scale‐Revised verbal episodic memory and Montreal Cognitive Assessment Japanese version were similar in terms of general cognition, but worse delayed recall subset on the latter was associated with type 2 diabetes mellitus (P = 0.038). A worse Trail Making Test‐A performance was associated with type 1 diabetes mellitus and age (P < 0.004, P < 0.029). Conclusions: Executive function of psychomotor speed was worse in older outpatient adults without dementia with type 1 diabetes mellitus than in those with type 2 diabetes mellitus but with no significant differences in the comprehensive and practical behavioral assessment of dysexecutive syndrome. Patients with type 1 diabetes had more severely impaired executive function, whereas those with type 2 had greater impaired memory than executive function. [ABSTRACT FROM AUTHOR]

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 control groups. The primary outcome was changes in the cognitive composite score over a period of 18 months. RESULTS: Of 531 participants, 406 completed the trial. The between‐group difference in composite score changes was 0.047 (95% CI: −0.029 to 0.124). Secondary analyses indicated positive impacts of interventions on several secondary health outcomes. The interventions appeared to be particularly effective for individuals with high attendance during exercise sessions and those with the apolipoprotein E ε4 allele and elevated plasma glial fibrillary acidic protein levels. DISCUSSION: The multidomain intervention showed no efficacy in preventing cognitive decline. Further research on more efficient strategies and suitable target populations is required. Highlights: This trial evaluated the efficacy of multidomain intervention in individuals with MCI.The trial did not show a significant difference in preplanned cognitive outcomes.Interventions had positive effects on a wide range of secondary health outcomes.Those with adequate adherence or high risk of dementia benefited from interventions. [ABSTRACT FROM AUTHOR]

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 from July 2010 to September 2018. The main focus was to correlate Vix scores with the time from the initial visit to death. Vix was categorized into "moderately to severely impaired" (0–7 points), "mildly impaired" (8–9 points), and "normal" (10 points) groups. Survival outcomes were assessed using a Cox proportional hazards model, adjusted for various factors. We conducted a mediation analysis to evaluate the effect of body mass index (BMI), instrumental activities of daily living (IADL), and basic activities of daily living (BADL) on the association between vitality and mortality. Stratified analysis was also conducted for the Mini‐Mental State Examination groups. Results: We included 2740 patients with an average follow‐up of 1315 days. The mortality rate was 15.7%. The Vix distribution was 16% at 0–7 points; 40%, 8–9 points; and 44%, 10 points. Patients in the "moderately to severely impaired" category, characterized by lower Vix scores, exhibited notably higher mortality rates. Mediation effects emphasized the significant roles of BMI, IADL, and BADL in influencing survival outcomes. Conclusions: Vitality significantly influences patient survival rates. The association between vitality and mortality seems to be mediated by IADL and BADL, which has significant clinical implications. Geriatr Gerontol Int 2024; 24: 221–228. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop a patient‐centred handbook that integrates information on lifestyle modifications and psychological support strategies for individuals with mild cognitive impairment (MCI). This article provides a comprehensive record of the development process. Methods: We adopted a participatory research model for the methodology, which comprised five phases and involved an interdisciplinary team specializing in dementia and health literacy. Data were initially collected via interviews conducted among patients with MCI (n = 5) and their families (n = 5). Given the study's preliminary nature, depth and richness of the qualitative data were the key concerns for determining the sample size, rather than broad generalizability. We ensured the inclusion of diverse experiences and perspectives by facilitating the creation of patient questions (PQs) that merged scientific evidence with patient perspectives. To enhance the handbook's accessibility and utility, we continuously evaluated the same using patient interviews, health literacy tool assessments and team discussions. This comprehensive approach harmonized scientific knowledge and patient experience, leading to the development of a personalized MCI management guide. Results: The handbook comprises nine domains, encompassing 38 selected PQs: MCI, lifestyle, lifestyle‐related diseases, exercise, nutrition, social participation, cognitive training, psychological care and family support. The health literacy handbook was evaluated based on Clear Communication Index scores. The results revealed that 73.7% of the PQs were deemed difficult prerevision, whereas only 5.3% remained challenging postrevision. The formative evaluation underscored the need for more detailed explanations prerevision, whereas postrevision comments focused primarily on editorial suggestions. Conclusion: The inclusion of patients' perspectives right from the outset ensured that the handbook met their specific needs. The final version, which reflects all stakeholders' inputs, is now slated for imminent publication. Patient or Public Contribution: Patients and the public participated extensively throughout the project, from initial interviews to material evaluation and refinement. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study that examined the relationship between continuous glucose monitoring (CGM) metrics and cognitive decline in older adults with type 2 diabetes. The study found that higher mean sensor glucose (SG) and time above range (TAR) were associated with a decrease in cognitive function over a one-year period. On the other hand, a higher time in range (TIR) was associated with a lower risk of cognitive decline. These results suggest that maintaining glucose levels within the target range may be important for preventing cognitive decline in older adults with type 2 diabetes. However, more research is needed to confirm these findings. [Extracted from the article]

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 status was assessed based on the response of participants or their close relatives via a postal survey. Potential predictors including demographic and lifestyle‐related factors, functional status, and behavioral and psychological status were assessed at the first visit at the memory clinic. A backward stepwise Cox regression model was used to select predictors, and a predictive model was developed using a regression coefficient‐based scoring approach. The discrimination and calibration were assessed via Harrell's C‐statistic and a calibration plot, respectively. Results: A total of 2610 patients aged ≥65 years (men, 38.3%) were analyzed. Over a mean follow‐up of 4.1 years, 544 patients (20.8%) died. Nine predictors were selected from the sociodemographic and clinical variables: age, sex, body mass index, gait performance, physical activity, and ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). The model showed good discrimination and calibration for 1–5‐year mortality (Harrell's C‐statistic, 0.739–0.779). Some predictors were specifically associated with cause‐specific mortality. Conclusions: This predictive model has good discriminative ability for 1‐ to 5‐year mortality and can be easily implemented for people with mild cognitive impairment and all stages of dementia referred to a memory clinic. Key points: There is a paucity of mortality prediction models applicable to people with all stages of dementia, including mild cognitive impairment.Based on a memory clinic‐based cohort, we developed a model to predict 1–5‐year mortality among older adults with mild cognitive impairment and all stages of dementia with good discriminative ability and calibration.The model included 9 factors: age, sex, body mass index, gait performance, physical activity, ability for instrumental activities of daily living, cognitive function, and self‐reported comorbidities (pulmonary disease and diabetes). Some predictors were specifically associated with cause‐specific mortality.Further studies are required to investigate the external validity of the model and its usefulness for patients and informal caregivers as well as health professionals in terms of management and care planning. [ABSTRACT FROM AUTHOR]

Aim: To examine the association between continuous glucose monitoring (CGM)‐derived metrics and cognitive performance in older adults with type 2 diabetes (T2D). Materials and methods: A total of 100 outpatients with T2D aged 70 years or older were analysed. Participants underwent CGM for 14 days. As CGM‐derived metrics, mean sensor glucose (SG), glucose coefficient of variation (CV), time in range (TIR; 70‐180 mg/dl), time above range (TAR; > 180 mg/dl) and time below range (TBR; < 70 mg/dl), were calculated. Participants underwent cognitive tests, including the Japanese version of the Montreal Cognitive Assessment (MoCA‐J), a delayed word‐recall test from the Alzheimer's Disease Assessment Scale‐cognitive subscale, a digit symbol substitution test, a letter word fluency test, a trail‐making test (TMT) and digit span test (DSP). Results: In multiple regression analyses adjusted for confounders, a higher mean SG was associated with a lower performance in MoCA‐J and TMT part B (TMT‐B) (P <.05). A higher TAR was associated with a lower performance in TMT‐B and DSP‐backward (P <.05). By contrast, a higher TIR was associated with better function in TMT‐B and DSP‐backward (P <.05). Furthermore, CV and TBR were not associated with any cognitive function. Conclusion: Hyperglycaemia metrics and TIR derived from CGM are associated with cognitive functions, especially with executive function and working memory, in older adults with T2D. [ABSTRACT FROM AUTHOR]

Background: The evaluation of 11C‐DPA‐713 binding using positron emission tomography for quantifying the translocator protein can be a sensitive approach in determining the level of glial activation induced by neuroinflammation. Herein, we aimed to investigate the relationship between regional 11C‐DPA713‐binding potential (BPND) and neuropsychiatric symptoms (NPS) in amyloid‐positive Alzheimer's disease (AD) patients. Methods: Fifteen AD patients were enrolled in this study. Correlations were evaluated between the 11C‐DPA713‐BPND and Neuropsychiatric Inventory Questionnaire (NPI‐Q) scores, including scores in its four domains: agitation, psychosis, affective, and apathy. 11C‐DPA713‐BPND values were compared between groups with and without the neuropsychiatric symptoms for which a relationship was observed in the abovementioned correlation analysis. Results: A positive correlation was found between the severity of agitation and 11C‐DPA713‐BPND in the Braak 1–3 area, including the amygdala, hippocampal and parahippocampal regions, and lingual and fusiform areas. An increase in the 11C‐DPA713‐BPND was observed in AD patients with agitation. We did not find any significant effects of possible confounding factors, such as age, duration of illness, education, gender, Mini‐Mental State Examination score, cerebrospinal fluid amyloid β 42/40 ratio, and apolipoprotein E4 positivity, on either the 11C‐DPA713‐BPND or agitation score. Conclusions: Neuroinflammation in the medial temporal region and its neighbouring area was shown to be associated with the development of agitation symptoms in AD patients. Our findings extend those of previous studies showing an association between some NPS and inflammation, suggesting that immunologically based interventions for agitation can serve as an alternative treatment for dementia. [ABSTRACT FROM AUTHOR]

Aims/Introduction: To investigate the changes in the glycated hemoglobin (HbA1c) levels and the relative status of the glycemic control related to the new glycemic targets recommended by the Japan Diabetes Society/Japan Geriatrics Society Joint Committee in 2016 in patients with diabetes mellitus visiting a memory clinic from 2012 to 2020. Materials and Methods: This cross‐sectional study included 1,436 patients aged ≥65 years with diabetes. Patients were categorized into three categories as follows: category I, intact cognitive function and activities of daily living (ADL); category II, mild cognitive deficits or impaired instrumental ADL; and category III, moderate to severe cognitive impairment or impaired basic ADL. Trends in HbA1c levels, glycemic control status (optimally/poorly/excessively controlled) and proportion of individuals receiving drugs potentially associated with severe hypoglycemia among all patients and categories (I, II or III) from 2012 to 2020 were examined using linear, logistic and multinominal logistic regression models adjusted for confounding factors. Results: Between 2012 and 2020, the HbA1c levels, as well as the proportion of patients with poor glycemic control, increased, whereas the proportion of patients with excessive glycemic control and those receiving drugs potentially associated with severe hypoglycemia decreased. Conclusions: Increased levels of HbA1c and decreased proportions of individuals under excessive glycemic control might reflect recent treatment strategies that avoid hypoglycemia in older patients. Given the adverse complications associated with hyperglycemia, more flexible and individualized glycemic targets based on comprehensive assessments, including vascular complications and comorbidities, might be necessary. [ABSTRACT FROM AUTHOR]

Telemedicine has changed from a way to treat patients with limited access to hospitals to a necessary method of treatment for non‐urgent conditions during the coronavirus disease 2019 pandemic. There are two styles of telemedicine, namely "hybrid medical care" and "gateway medical care," which take advantage of the characteristics of online medical care and might become important in the near future. During hybrid medical care, a patient and their primary care physician have face‐to‐face medical care while simultaneously being examined by a specialist physician through telemedicine, leading to an overall improvement in the level of local medical care and expansion in the number of treatable diseases. Gateway medical practice is a form of telemedicine used for patients who would otherwise refuse or not receive in‐person medical care to engage in consultation with a physician. Telemedicine allows physicians to determine disease severity and triage patients, while reducing unnecessary home visits, emergency hospitalizations and the spread of infection. Telemedicine is less intense than in‐person medical care, and allows for easier collaboration with other healthcare providers. However, telemedicine is not optimal for conditions requiring a definitive diagnosis and a comprehensive understanding of the patient's medical history. It is limited by the patient's ability to use telemedicine devices, and the risk of accidental treatments and fraud. The use of telemedicine might result in the development of new, online comprehensive geriatric assessment tools and technologies. Geriatr Gerontol Int 2022; 22: 913–916. [ABSTRACT FROM AUTHOR]

Aim: Olfactory impairment is associated with cognitive impairment. However, differences between subjective and objective olfactory impairment measurements in older adults and their relationship with cognitive impairment are unclear. Methods: We assessed the relationship between cognitive and olfactory impairments via a single‐center observational study in 2020. Forty‐seven individuals who visited our memory clinic were enrolled and asked to complete objective and subjective olfactory tests. Participants had dementia, mild cognitive impairment, or normal cognition. We administered the Open Essence (a simple card‐type odor identification test) and self‐administered odor questionnaire to assess objective and subjective olfaction, respectively, and the Mini‐Mental State Examination to assess cognitive function. Results: Older age was related to decreased Open Essence scores (P < 0.001). Compared with the mild cognitive impairment and normal cognition groups, the dementia group had significantly lower Open Essence scores (P < 0.001). Cognitive impairment was also associated with decreased Open Essence scores after adjusting for age, sex, and education (P < 0.001). Participants with dementia did not obtain lower self‐administered odor questionnaire scores than those with normal cognition, and they tended to be unaware of their olfactory impairment. Conclusion: Open Essence scores significantly decreased according to the degree of cognitive impairment. Participants with dementia were unaware of their olfactory impairment, as indicated by odor questionnaire scores. Objective and subjective scores of olfaction differed in participants with dementia. Concomitant assessment of objective and subjective olfaction is useful to screen older adults with both olfactory and cognitive impairments. Geriatr Gerontol Int 2022; 22: 924–929. [ABSTRACT FROM AUTHOR]

Since the concept and operational definition of "cognitive frailty" (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia) were proposed by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, cognitive frailty has been widely investigated. This review is intended to address the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty. Although the definitions and assessments of cognitive frailty vary among researchers, older adults with both physical frailty and cognitive impairment are shown to be at higher risk of adverse health outcomes, including death, disability, hospitalization and incident dementia, than those with either condition alone. While the underlying mechanisms of cognitive frailty are still unclear, factors shown to be associated with cognitive frailty include sociodemographic factors, social status, nutritional status, geriatric syndrome, physical and cognitive activities, functional status, comorbidities, medication use, gut‐derived metabolites and structural changes in the brain. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty. Further studies are required to clarify the mechanisms through which physical frailty and cognitive impairment interact to accelerate adverse health outcomes, particularly cognitive outcomes. In addition, for older adults with cognitive frailty, an effective flow diagram from primary screening through comprehensive assessment to multidimensional intervention needs to be developed for future implementation in both clinical and community settings. Geriatr Gerontol Int 2022; 22: 99–109. [ABSTRACT FROM AUTHOR]

Aim: Executive dysfunction is pathognomonic for dementia and impedes the activities of daily living (ADL). This study aimed to examine the relationship of dementia severity with executive dysfunction and ADL in mild cognitive impairment and dementia. Methods: This single‐center study enrolled 86 patients (men, 40; women, 46; mean age, 76.1 ± 7.5 years) referred for cognitive and physical rehabilitation between October 2015 and September 2020. The Clinical Dementia Rating (CDR) was 0.5, 1, and ≥2 in 45, 30, and 11 patients, respectively. The presence and severity of executive dysfunction were assessed using the Behavioral Assessment of the Dysexecutive Syndrome–Japanese version (BADS). The ADL and instrumental ADL (IADL) were assessed using the Barthel Index and Frenchay Activities Index (FAI), respectively. We examined the relationship between CDR severity and overall BADS profile score and its sub‐items, and that between the overall BADS profile score and IADL. Results: The cognitive and executive functional assessment scores differed significantly depending on the CDR severity. The CDR severity and overall BADS profile score exhibited significant correlations. The BADS found cognitive impairment in 31%, 70%, and 100% of patients with CDR0.5, CDR1, and CDR≥2, respectively. The FAI score differed according to the CDR severity in women but not in men. The overall profile and age‐adjusted BADS scores were strongly correlated with the IADL in women but not in men. Conclusions: The greater the severity of executive dysfunction, the greater the difficulty in performing ADL. This effect was more pronounced in women and may predict dementia progression. Geriatr Gerontol Int 2021; 21: 1111–1117. [ABSTRACT FROM AUTHOR]

Background: Gait disturbance and musculoskeletal changes are evident in persons living with Alzheimer's disease (AD). Because complex gait control requires the integration of neural networks, cerebral small vessel disease (SVD), which is highly prevalent in persons with AD, might have an additional impact on gait disturbance. This study investigated whether white matter hyperintensities (WMH) are more predominantly associated with gait disturbance in persons with AD than in individuals with mild cognitive impairment (MCI) and normal cognition (NC) and further identified the regional impact of WMH on specific gait changes. Methods: This study included 396 subjects (aged 65 to 86 years, 63.9% female) diagnosed with AD (n = 187), MCI (n = 118), or NC (n = 91). WMH, lacunes, perivascular spaces, and cerebral microbleeds were assessed as markers of SVD. The volume of WMH was quantified in each brain lobe (frontal, temporal, occipital, and parietal) and sublobar regions in the basal ganglia and thalamus. Gait function was assessed using an electronic walkway. We investigated the association between regional WMH and gait disturbance in individuals with AD, MCI, and NC, adjusted for classical and musculoskeletal confounders. Results: Among markers of SVD, WMH were most associated with gait disturbance. In AD subjects, periventricular WMH in the frontal and parietal lobes were associated with slow gait speed (rs = −0.21, P = 0.007 and rs = −0.18, P = 0.019, respectively). These lesions were also associated with changes in stride time, double‐leg support time, and walking angle (all rs > 0.20, P < 0.01). Lesions in the basal ganglia and thalamus were associated with slow gait speed (rs = −0.16, P = 0.034 and rs = −0.18, P = 0.023, respectively) and greater gait speed variability (rs = 0.16, P = 0.034 and rs = 0.20, P = 0.010, respectively). MCI subjects showed only associations between sublobar lesions and shorter stride length (rs = −0.24, P = 0.016) and increased walking angle (rs = 0.32, P = 0.002). NC subjects did not show associations between WMH and gait parameters. MCI and NC subjects were more affected by muscle weakness than WMH for global gait function (rs = 0.42, P < 0.001 and rs = 0.23, P = 0.046, respectively). Conclusions: Persons with AD showed a predominant association between WMH and gait disturbance compared with MCI and NC subjects, and regional WMH had a detrimental effect on specific gait changes. [ABSTRACT FROM AUTHOR]

Aim: Cerebral small vessel disease and lower urinary tract symptoms are common in older people. However, the association between white matter hyperintensity (WMH) and overactive bladder (OAB) is not fully understood. We aimed to identify the relationship between WMH and OAB. Methods: We carried out neuropsychological testing and head magnetic resonance imaging (T2‐weighted and fluid‐attenuated inversion recovery) of 72 outpatients at a memory clinic and evaluated their Overactive Bladder Symptom Score. WMH was assessed using the Fazekas scale, and WMH volumes were determined using Software for Neuro‐Image Processing in Experimental Research. OAB was diagnosed based on a urinary urgency score (the third question of the Overactive Bladder Symptom Score) of two or higher and a total Overactive Bladder Symptom Score of three or higher. Multivariate logistic analysis was carried out, with the presence/absence of overactive bladder as the outcome variable, and age, sex, body mass index and diabetes mellitus as covariates. Results: Of the 72 participants, 17 (24%) were diagnosed with OAB. WMH assessed by the visual rating scale was not associated with OAB. However, participants with OAB showed significantly higher WMH volume than those without OAB. Regionally, participants with OAB showed high WMH volume in the frontal, occipital and parietal lobes. Multiple logistic regression analysis showed that WMH was significantly associated with OAB (OR 1.82, 95% CI 1.11–2.98), after adjustment for clinically important confounders. Conclusions: Cerebral WMH volume is associated with OAB, independent of age, sex, body mass index and diabetes mellitus. Geriatr Gerontol Int 2021; 21: 996–1002. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the ability of a group‐based multi‐component psycho‐educational intervention (GMC‐PEI) to reduce depression, and improve caregiving appraisals, coping skills of informal caregivers and the condition of people with dementia. Methods: In this randomized controlled and blinded trial, we enrolled 54 informal caregivers of people with dementia visiting the Japan National Center of Geriatrics and Gerontology, and divided them into GMC‐PEI and control groups. The intervention group received a 12‐week GMC‐PEI program that included six 2‐h structured sessions to enhance their knowledge of dementia, caregiving skills and coping skills. The control group received leaflets containing information about dementia. We evaluated caregivers' depression, caregiving time, subjective burden, caregiving appraisal and care coping skills. We also evaluated people with dementia at baseline and 12 weeks, and reassessed 20 participants from the intervention group at 24 and 48 weeks. Results: The GMC‐PEI significantly improved depression, positive appraisals of fulfillment in caregiving, affection for care recipients, self‐growth and coping skills, such as seeking formal support. Depression, fulfillment and affection for people with dementia showed a peak improvement at 24 weeks; formal support‐seeking showed a linear improvement throughout the 48‐week follow‐up period. Conclusions: The group‐based multi‐component psycho‐educational intervention reduced depression, improved self‐appraisal and enhanced coping skills in caregivers. However, emotional enhancements dissipated sooner than support‐seeking skills, suggesting that caregivers should be reviewed every 12–24 weeks. Geriatr Gerontol Int 2021; 21: 561–567. [ABSTRACT FROM AUTHOR]

Aim: Although the glycemic target in older diabetes patients is based on cognition, activities of daily living and multimorbidity in the Japanese guideline, evidence of the relationships is limited. Thus, we aimed to assess the relationship between functional category and mortality in older people with diabetes. Methods: We evaluated the data of 843 older diabetes patients in a 6‐year prospective study, and the association between functional categories and all‐cause mortality. The patients were divided into three functional categories based on cognition, instrumental activities of daily living and basic activities of daily living using the Mini‐Mental State Examination, Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index at baseline, respectively (model 1). Those with multimorbidity (≥4 of 8 morbidities) were classified into category III (model 2). The functional category assessed using eight items from the Tokyo Metropolitan Institute of Gerontology Index of Competence and Barthel Index was also constructed (model 3). Hazard ratios and 95% confidence intervals were calculated in the Cox regression analysis using age, sex, body mass index, glycated hemoglobin level, total cholesterol level, estimated glomerular filtration rate and frequency of severe hypoglycemia as covariates. Results: During the 6‐year follow up, 64 incident mortalities occurred. The hazard ratios for mortality in categories II and III (as the reference of category I) were 1.83 (95% confidence interval 1.06–3.14, P = 0.030) and 3.05 (95% confidence interval 1.12–8.26, P = 0.029) after adjustment for covariates, respectively (model 1). Models 2 and 3 showed similar associations between functional category and mortality. Conclusions: The functional categories predicted all‐cause mortality in older adults with diabetes. Geriatr Gerontol Int 2021; 21: 512–518. [ABSTRACT FROM AUTHOR]

Aim: The amyloid cascade hypothesis posits that the accumulation of amyloid β (Aβ) is the triggering factor for Alzheimer's disease, which consecutively induces aggregation of tau, synaptic loss, and cell death. Most experimental and clinical evidence supports this model, but the available data are largely qualitative. Here, we tested the amyloid cascade hypothesis by using in vivo evaluation of positron emission tomography and magnetic resonance imaging. Methods: Path analysis was used to estimate the relationships among Aβ accumulation (PiB standardized uptake value ratio (SUVR)), tau aggregation and its related neuroinflammation (THK5351 SUVR), grey matter atrophy in the medial temporal region, and memory function in Aβ‐positive subjects. We also performed additional regression analyses to evaluate the effect of Aβ on the toxicity of tau aggregation/neuroinflammation. Results: Path analysis supported our hypothesized model: Aβ accumulation affected tau aggregation/neuroinflammation in the medial temporal region, and these pathological changes caused of the grey matter atrophy and memory dysfunction. In separate regression analyses, THK5351 SUVR had a significant effect on grey matter atrophy only in PiB‐positive subjects. The analysis of the interaction effect showed that the effects of THK5351 SUVR on grey matter atrophy were significantly different between PiB‐positive and PiB‐negative groups. When we included the effect of being an apolipoprotein E ε4 carrier as a covariate, the interaction effect remained significant. Conclusion: Our in vivo evaluation of positron emission tomographic and magnetic resonance imaging data supported the amyloid cascade hypothesis. In addition, it indicated that Aβ not only accelerates tau aggregation/neuroinflammation but promotes its toxicity. Our findings showed the importance of understanding the role and therapeutic potential of the interaction between amyloid and tau aggregation/neuroinflammation in Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Aim: Selecting optimal energy intake during diet therapy for older patients with diabetes mellitus is difficult because of the large differences in physical function and comorbid diseases. In Japan, although requirements for total energy intake are calculated by multiplying a person's standard bodyweight (BW) by the amount of physical activity, evidence supporting the application of this method among older people is limited. Therefore, we aimed to assess optimal energy intake by evaluating the relationship between energy intake and mortality in older patients. Methods: We evaluated data from a 6‐year prospective follow up of 756 older patients with diabetes mellitus, and the association between baseline nutrient intake and mortality. Total energy intake and nutrients were evaluated, and energy intake per actual BW was categorized into quartiles (Q). Cox regression analysis was used for statistical analyses. Energy intake per standard BW or age‐related target BW was statistically analyzed using the same protocol. Results: Analysis of energy intake per actual BW showed that hazard ratios for mortality was significantly higher in Q1 and Q4. Similar associations were found for energy intake per standard or target BW. Subgroup analysis showed that mortality rate was the lowest in Q2 in the young‐old population and in Q3 in the old‐old population. Conclusions: A U‐shaped relationship was observed between energy intake per BW and mortality in older patients with diabetes mellitus, which suggests that the optimal energy intake per actual or target BW should encompass a wide range to prevent malnutrition and excessive nutrition in these patients. Geriatr Gerontol Int 2020; 20: 59–65. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between decline of basic activities of daily living (ADL) in each dimension and change in caregiver burden in patients with mild‐to‐moderate Alzheimer's disease. Methods: This retrospective study included 117 outpatients with Alzheimer's disease who presented to the Memory Clinic at the National Center for Geriatrics and Gerontology in Japan between September 2010 and April 2014 (mean age 77.3 ± 6.4 years; 68.6% women). Patients and their caregivers completed comprehensive geriatric assessment at baseline and at the 3‐year follow up. Caregiver burden was assessed using the Japanese version of the Zarit Burden Interview. ADL were assessed by the Barthel Index. Among patients with full points on each subitem of the Barthel Index at baseline, incident ADL decline was defined as a loss of at least 5 points at the 3‐year follow up. Other confounding factors including demographic data, cognitive function, vitality, and behavioral and psychiatric symptoms of dementia were also assessed. The longitudinal relationship between incident ADL decline and changes in caregiver burden was evaluated by multivariate linear regression, adjusted for confounding variables. Results: In descending order, declines in ADL at 3 years were noted in bathing (25.4%), bowel control (25.4%), grooming (22.9%) and bladder control (22.9%). On multivariate analyses, ADL declines in feeding (b = 17.2, P < 0.01) and bathing (b = 11.0, P = 0.02) were significantly associated with increased caregiver burden. Conclusion: Incident ADL declines in feeding and bathing are significant risk factors for increased caregiver burden in patients with Alzheimer's disease. Geriatr Gerontol Int 2019; 19: 1243–1247. [ABSTRACT FROM AUTHOR]

The goal of dementia treatment is to improve the quality of life for both people with dementia and their families. Rehabilitation as a non‐pharmacological approach, coordinated with pharmacological treatment, aims to allow patients to live better by slowing the progression, and relieving the behavioral and psychological symptoms of dementia. In dementia, the manifestation of symptoms caused by neurological impairment is modified by various factors; thus, multidimensional assessment and approaches are effective based on the concept of the International Classification of Functioning, which emphasizes the healthy components of every person's functioning. Regarding the process of rehabilitation, every person with dementia should take initiative throughout the course of rehabilitation, and shared decision‐making is a fundamental requirement at every phase of intervention. The needs of rehabilitation differ depending on the stage of dementia. In the early stages, cognitive rehabilitation is needed, and interventions are carried out using preserved functions and compensatory strategies. As the disease progresses, capacities of instrumental and then basic activities of daily living deteriorate, and interventions need to be tailor‐made and carried out in the context of actual living situations. In the early‐to‐moderate stages, prevention and management of behavioral and psychological symptoms of dementia are required. In the interventions to alleviate behavioral and psychological symptoms of dementia, it is critical to consider the individual and the meaning behind his/her behaviors from a holistic perspective. Family carers also need support, and education to learn coping strategies can be beneficial for both people with dementia and their carers. Rehabilitation can empower people with dementia and their families to live better with dementia. Geriatr Gerontol Int 2018; 18: 1529–1536. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to: (i) examine the reliability and validity of the Dementia Assessment Sheet for Community‐based Integrated Care System 21‐items for classifying patients to the appropriate categories for glycemic targets in older patients; and (ii) develop a short version of the tool and examine its reliability and validity. Methods: A total of 410 older individuals were recruited for this multicenter cross‐sectional study. We classified them into three categories used for determining the glycemic target in older patients in Japan based on cognitive functions and activities of daily living. Exploratory factor analyses were used to select the eight items of the shorter version. The reliability and validity of the assessment tools were assessed using Cronbach's alpha coefficients and receiver operating characteristic analyses, respectively. Results: The Dementia Assessment Sheet for Community‐based Integrated Care System 21‐items had three latent factors: cognitive function, instrumental activities of daily living and basic activities of daily living. The Dementia Assessment Sheet for Community‐based Integrated Care System 8‐items was developed based on each factor load quantity and was confirmed to have a strong correlation with the original version (r = 0.965, P < 0.001). Both tools significantly discriminated older adults belonging to category I from those belonging to category II or III, and category III from category I or II. Conclusions: Both tools had sufficient internal consistency and validity to classify older patients into the categories for determining the glycemic target in this population based on cognitive and daily functions. Geriatr Gerontol Int 2018; 18: 1458–1462. [ABSTRACT FROM AUTHOR]

Aim: Physical and cognitive functions are mutually associated. However, it is unknown which markers of physical functions or body composition are most strongly associated with cognition. Here, we explored the association between body composition/physical performance and comprehensive neuropsychological assessments in an effort to identify reliable markers of cognition among factors in body composition/physical performance, including both usual and maximum gait speeds. Methods: We examined a total of 161 Japanese individuals (71 men, 90 women; aged 76.3 ± 7.2 years) with a Clinical Dementia Rating of 0.5 and a Mini‐Mental State Examination score >24. A battery of neuropsychological assessments, physical functional assessments and measurements of body composition was carried out. We conducted a multiple regression analysis to investigate the associations between cognitive performance and the factors in body composition and physical performance with adjustments for age, sex, and number of school years. Results: Maximum gait speed was the factor most widely associated with cognitive performance among the factors of body composition and physical performance. Conclusion: Maximum gait speed might be the best marker for cognition in this population of older individuals. Geriatr Gerontol Int 2018; 18: 1323–1329. [ABSTRACT FROM AUTHOR]

Aim: The principal aim of the present study was to clarify what type of cognitive decline results in a decrease in the ability to carry out activities of daily living (ADL) in patients with Alzheimer's disease (AD). Methods: The participants comprised 1384 outpatients with mild AD. We used the Mini‐Mental State Examination (MMSE) and Barthel Index (BI) as indicators of basic ADL, and the Lawton Index (LI) as an indicator of instrumental ADL (IADL). We then analyzed the relationships between MMSE and BI, as well as between MMSE and LI. We also carried out a logistic regression analysis with BI and LI subitems as dependent variables, and MMSE subitems as independent variables. Results: For almost all BI and LI subitems, significantly high odds ratios (OR) were noted in MMSE “Copy the design shown” (e.g. dressing OR 3.66, toilet use OR 3.60 and transfers OR 2.80) and “Write a sentence” (e.g. ability to use telephone OR 5.24, laundry OR 2.60, grooming OR 2.50; P < 0.05). Conclusions: Visuospatial cognition had an important effect on the decrease in basic ADL and IADL. Furthermore, the subitems with minimal effect on the decrease of basic ADL and IADL differed. Therefore, it appears that specific activities have little effect on the maintenance of ADL and IADL, and that determining residual cognitive function and utilizing this as a means of compensating for decreased ADL is a useful strategy. Geriatr Gerontol Int 2018; 18: 50–56. [ABSTRACT FROM AUTHOR]

Background: Low cognitive function at baseline is a proven risk factor for mortality in people with dementia. However, the prognostic role of long‐term cognitive changes is less studied. This study examined whether cognitive changes predict mortality among people with Alzheimer's disease (AD). Method: Data were extracted from a retrospective cohort of Japanese patients attending a memory clinic between 2010 and 2018 (period of visits: M = 4.3 years, SD = 2.1), and a sample of 1,486 AD patients (baseline age 65‐95 years) was analyzed. We conducted a mail survey from 2018 to 2019 to obtain survival information from the patients or their proxies. Cognitive function was assessed by the Mini‐Mental State Examination (MMSE). Baseline age, sex, years of education, and baseline instrumental activities of daily living were included as covariates. Shared‐parameter models were used for longitudinal and time‐to‐event outcomes. Result: During the follow‐up period, 23.4% of participants died. Shared‐parameter models showed that higher levels and less steep declines in cognitive function reduced the mortality risk (MMSE intercept hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.92–0.99; MMSE slope HR 0.87; 95% CI 0.79–0.96), even after adjusting for covariates. Conclusion: Our findings suggest that cognitive changes predict mortality independently of baseline cognitive levels in people with AD. Health care professionals should recognize that patients who demonstrate steeper cognitive declines can have a worse prognosis. [ABSTRACT FROM AUTHOR]

Aim The present study aimed to examine whether nutrient intakes predicted cognitive decline among elderly patients with diabetes mellitus. Methods This study evaluated data from a 6-year prospective follow up of 237 elderly patients (aged ≥65 years) with diabetes mellitus, and the associations of baseline nutrient intakes with cognitive decline. Cognitive decline was defined as a ≥2-point decrease in the Mini-Mental State Examination (MMSE) score. Intakes of food and nutrients were assessed using a validated food frequency questionnaire, and were compared between patients with cognitive decline and intact cognition. Analysis of covariance and logistic regression analysis were used to compare the changes in the MMSE score during the follow up among intake tertile groups for each nutrient. Results Compared with men with intact cognition, the men with cognitive decline had lower baseline intakes of calcium, vitamin A, vitamin B2, pantothenate, soluble fiber, green vegetables and milk. However, no significant associations between cognitive decline and nutrient intakes were observed among women. After adjusting for age, body mass index, glycated hemoglobin levels, history of severe hypoglycemia, previous stroke and baseline MMSE score, we found that cognitive decline was significantly associated with low intakes of carotene, vitamin B2, pantothenate, calcium and green vegetables. Multiple logistic regression analysis showed that intakes of nutrients and green vegetables predicted cognitive decline after adjusting for age, body mass index, glycated hemoglobin levels, baseline MMSE score, and incident stroke during the follow up. Conclusions These findings suggest that sufficient intakes of carotene, vitamin B2, pantothenate, calcium and vegetables could help prevent cognitive decline among elderly men with diabetes mellitus. Geriatr Gerontol Int 2017; 17: 1168-1175. [ABSTRACT FROM AUTHOR]

Regulation of intracellular Ca2+ concentration ([Ca2+]i) is vital for eukaryotic organisms. Recently, we identified a Ca2+ channel (Tc IP3R) associated with intracellular Ca2+ stores in Trypanosoma cruzi, the parasitic protist that causes Chagas disease. In this study, we measured [Ca2+]i during the parasite life cycle and determined whether Tc IP3R is involved in the observed variations. Parasites expressing R- GECO1, a red fluorescent, genetically encoded Ca2+ indicator for optical imaging that fluoresces when bound to Ca2+, were produced. Using these R- GECO1-expressing parasites to measure [Ca2+]i, we found that the [Ca2+]i in epimastigotes was significantly higher than that in trypomastigotes and lower than that in amastigotes, and we observed a positive correlation between Tc IP 3 R mRNA expression and [Ca2+]i during the parasite life cycle both in vitro and in vivo. We also generated R- GECO1-expressing parasites with Tc IP3R expression levels that were approximately 65% of wild-type (wt) levels ( SKO parasites), and [Ca2+]i in the wt and SKO parasites was compared. The [Ca2+]i in SKO parasites was reduced to approximately 50-65% of that in wt parasites. These results show that Tc IP3R is the determinant of [Ca2+]i in T. cruzi. Since Ca2+ signaling is vital for these parasites, Tc IP3R is a promising drug target for Chagas disease. [ABSTRACT FROM AUTHOR]

The article explores the possibility of nurses providing prompt and practical support to high-risk family caregivers (FCs). FCs reportedly require some assistance on days when they visit a memory clinic. It also examines whether such prompt albeit brief support would reduce the extent of subjective burden among FCs.

Aim The Kihon Checklist is extensively used in Japan to identify elderly persons who are at risk of requiring support/care. We aimed to determine whether or not the Kihon Checklist can estimate frailty status defined by the Cardiovascular Health Study criteria. Methods This cross-sectional study evaluated the Kihon Checklist and activities of daily living based on self-records maintained with the assistance of nurses in a convenience sample of 164 elderly outpatients who lived without care or support. Body composition was measured using dual energy X-ray absorptiometry. Physical functions, nutritional status, cognitive function and depressive mood were assessed using standardized evaluations. Frailty status was evaluated using the Cardiovascular Health Study frailty criteria. Results The total Kihon Checklist score closely correlated with validated assessments of physical functions, nutritional state, cognitive function, depressive mood and the number of frailty phenotypes defined by the Cardiovascular Health Study criteria (ρ = 0.655, P < 0.001). The area under the receiver operating characteristics curves for the evaluation of frailty status was 0.81 for prefrailty and 0.92 for frailty. The sensitivity and the specificity were 70.3% and 78.3% for prefrailty, and 89.5% and 80.7% for frailty at total Kihon Checklist scores of 3/4 and 7/8, respectively. Conclusion The Kihon Checklist is a useful tool for frailty screening. Analyzing the results of this self-reporting questionnaire, together with other more high-tech screening modalities, will cost-effectively improve the quality of life for many elderly individuals in a timely manner. Geriatr Gerontol Int 2015; ●●: ●●-●●. [ABSTRACT FROM AUTHOR]

Aim Hearing loss is a risk factor for the progression of dementia. Cognitive improvement is occasionally found after removal of cerumen impaction. Because patients with dementia do not usually complain about cerumen impaction, detection methods are important. The present study aimed to investigate whether cerumen impaction is observable using brain magnetic resonance imaging. Methods Participants were six patients whose hearing level improved 15 dB or more unilaterally or bilaterally after the removal of cerumen impaction. A radiologist who was blind to the impaction side and whether magnetic resonance imaging scans were taken before or after impaction removal classified cerumen impaction as positive, negative or unclear. Results Three ears classified as impaction positive and five ears classified as impaction negative corresponded accurately to the presence or absence of cerumen impaction. Among four ears classified as unclear, two did and two did not have cerumen impaction. Conclusion Careful examination of the external ear canal on brain magnetic resonance imaging can be used to detect cerumen impaction. Geriatr Gerontol Int 2015; ●●: ●●-●●. [ABSTRACT FROM AUTHOR]

Aim Lower urinary tract symptoms often limit activities of daily life and impair quality of life in the elderly. The purpose of the present study was to determine whether regional white matter hyperintensity ( WMH) can predict lower urinary tract symptoms in elderly with amnestic mild cognitive impairment or Alzheimer's disease. Methods The participants were 461 patients aged 65-85 years diagnosed with amnestic mild cognitive impairment or Alzheimer's disease. Patients and their caregivers were asked about symptoms of lower urinary tract symptoms (urinary difficulty, frequency and incontinence). Cognition, behavior and psychological symptoms of dementia and medication were evaluated. WMH and brain atrophy were analyzed using an automatic segmentation program. Regional WMH was evaluated in the frontal, parietal, temporal and occipital lobes. Results Patients with urinary incontinence showed significantly greater volume of WMH. WMH increased with age, especially in the frontal lobe. WMH in the frontal lobe was closely associated with urinary incontinence after adjustment for brain atrophy and classical confounding factors. Conclusions Frontal WMH was a predictive factor for urinary incontinence in older adults with amnestic mild cognitive impairment or Alzheimer's disease. Urinary incontinence in demented older adults is not an incidental event, and careful insight into regional WMH on brain magnetic resonance imaging might greatly help in diagnosing individuals with a higher risk of urinary incontinence. Geriatr Gerontol Int 2016; 16: 167-174. [ABSTRACT FROM AUTHOR]

Aim Cerebral white matter hyperintensity ( WMH) is highly prevalent in the elderly population, and increases the risk of dementia and stroke. We investigated the relationship between ambulatory blood pressure monitoring levels and quantitatively measured WMH volumes among elderly hypertensive patients with well-controlled blood pressure ( BP) to re-evaluated effective hypertension management methods to prevent the progression of WMH. Methods Participants comprised 84 hypertensive patients aged between 65 and 75 years without symptomatic heart failure, ischemic heart disease, atrial fibrillation, stroke or cognitive dysfunction. Results Linear regression analysis showed that office BP was not associated with WMH volume increases. Raised night-time systolic BP ( P = 0.013) were associated with greater WMH volumes during ambulatory blood pressure monitoring. To clarify the effect of asleep systolic BP on WML volume, we then classified patients into two systolic BP groups as follows: <125 mmHg ( n = 47) and ≥125 mmHg ( n = 37). Baseline characteristics were almost similar in both groups, except the dipper type of circadian BP variation was significantly common in the group with night-time systolic BP <125 mmHg. However, WMH volume was greater in the group with night-time systolic BP ≥125 mmHg than that in the <125 mmHg group (9.0 ± 8.4 mL vs 4.1 ± 4.3 mL, P = 0.015). Conclusion Higher night-time systolic BP levels were observed to contribute greater WMH volumes in elderly hypertensive patients. To prevent the progression of WMH, controlling BP on the basis of ambulatory blood pressure monitoring is important. Geriatr Gerontol Int 2015; 15 (Suppl. 1): 59-65. [ABSTRACT FROM AUTHOR]

Aim To clarify growth patterns, spatial distribution and risk factors of cerebral white matter hyperintensity ( WMH) lesions on magnetic resonance imaging. Methods We analyzed volumes of cerebral WMH lesions in those who underwent brain magnetic resonance imaging as a hospital-based health check-up in 2012 and 2013 by using a computational quantitative image analysis software ( Software for NeuroImage Processing in Experimental Research). After excluding subjects not suitable for volumetric analyses because of pathological brain conditions, a total of 1047 healthy participants (mean age 56.6 years) were included for the analyses. First, the relationship of computational volumetry and conventional qualitative visual evaluation by Shinohara grading was evaluated. Volumes of WMH lesions were analyzed according to age and the different cerebral lobes. Finally, clinical risk factors associated with WMH lesions were assessed. Results Volumes of WMH lesions were significantly correlated with Shinohara grading ( P < 0.001). WMH lesions significantly enlarged with aging ( P < 0.001) except for the occipital lobe, especially in participants aged 50 years or older. Age and systolic blood pressure were significantly related to volumes of WMH lesions in all the lobes, whereas diastolic blood pressure was not related only in the occipital lobe. Conclusion Based on computational quantitative volumetric analyses, cerebral WMH lesions increased with age, and were associated with blood pressure. However, the occipital lobe was the only exception to these findings. Geriatr Gerontol Int 2015; 15 (Suppl. 1): 43-47. [ABSTRACT FROM AUTHOR]

White matter hyperintensities ( WMH) are defined as cerebral white matter changes presumed to be of vascular origin, bilateral and mostly symmetrical. They can appear as hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and as isointense or hypointense on T1-weighted magnetic resonance imaging of the brain. WMH have been focused on because of their clinical importance as a risk factor for cerebrovascular diseases and cognitive impairment. WMH are associated with geriatric syndrome, which is defined by clinical symptoms characteristic of older adults, including cognitive and functional impairment and falls. Cerebral small vessel diseases, such as WMH, might play an important role as risk factors for cerebrovascular diseases, cognitive impairment and geriatric syndrome through the mechanism of arterial stiffness. However, the vascular, physiological and metabolic roles of arterial stiffness remain unclear. Basically, arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. These changes might arise from hemodynamic stress as a result of a 'tsunami effect' on cerebral parenchyma. In the present article, we review the clinical characteristics of WMH, focusing particularly on two associations: (i) those between cerebral small vessel diseases including WMH and arterial stiffness; and (ii) those between WMH and geriatric syndrome. Geriatr Gerontol Int 2015; 15 (Suppl. 1): 17-25. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the relationship between vitamin D, white matter hyperintensity and brain atrophy in elderly women with Alzheimer's disease and amnestic mild cognitive impairment. Researchers evaluated 253 women aged 65 and older. They found that lower vitamin D levels are associated with white matter hyperintensity in women with Alzheimer's disease and mild cognitive impairment.

Hence, we developed the Positive Photo Appreciation (PPA) program which aims at preventing depressive mood by enhancing positive emotion, autonomy, and intrinsic motivation based on positive psychotherapy (PPT)1 and positive self-expression through photography. The PPA program confirmed safety and a significant short-term mood improvement effect using a randomized controlled design.2 However, the duration of the effect remains unclear - if this is sustained, it could be used to effectively and efficiently improve the mood of older adults with relatively little cost and time. Consistent with the PPT intervention studies reporting the long-term effects on positive emotions via gratitude expression and the potential self,1 SP , sp 3 SP , sp 4 we hypothesize that the PPA program would have the effects of sustained mood improvement. [Extracted from the article]

Aim Cerebral white matter lesions ( WML) are known to increase with age, as is left ventricular ( LV) diastolic dysfunction with normal contraction. Although aging is a common risk factor, the link between these diseases is not fully understood. The aim was to clarify this relationship, using the ratio between early diastolic mitral inflow and early diastolic mitral annular tissue velocity ( E/E'). E/E' measured by tissue Doppler echocardiography offers an indicator of the severity of LV diastolic dysfunction, reflecting both diastolic LV stiffness and diastolic LV filling pressure. Methods Participants comprised 75 patients aged between 65 and 75 years with normal LV contraction and no signs or history of symptomatic heart failure, ischemic heart diseases, atrial fibrillation, stroke, or cognitive dysfunction. The volume of WML was quantified on brain magnetic resonance imaging. Results The participants were classified into three groups: Low E/E', E/E' ≤ 8; Middle E/E', 8 < E/E' < 15; and High E/E', E/E' ≥ 15. WML volume was 3.6 ± 3.0 mL in Low E/E', 5.4 ± 6.5 mL in Middle E/E' and 12.0 ± 11.0 mL in High E/E', increasing significantly with increased diastolic LV stiffness ( Low vs High, P = 0.034; Middle vs High, P = 0.016). Linear regression analysis showed the positive association between the volume of WML and E/E' ratio ( r = 0.377, P = 0.0009). Conclusions This investigation identified an association between LV diastolic dysfunction and WML. Further investigations are required to clarify whether there is a direct association between the two diseases. Geriatr Gerontol Int 2014; 14 (Suppl. 2): 71-76. [ABSTRACT FROM AUTHOR]

Aim The clinical management of diabetic elderly patients with Alzheimer's disease ( AD) is hindered by several difficulties. The present study aimed to clarify the clinical characteristics and pathophysiological properties of AD in diabetic older adults. Methods A total of 91 patients with type 2 diabetes mellitus and 161 non-diabetic individuals who were diagnosed with AD were recruited. Diabetic patients were classified into two groups with glycated hemoglobin ( HbA1c) <7.0% or ≥7.0%. The demographics, cognition, daily-life function, metabolic changes, treatment, and behavioral and psychological symptoms of dementia ( BPSD), as well as brain pathophysiology, were compared among the three groups. Results Patients with higher HbA1c had increased diabetic vascular complications and impaired activities of daily living with decreased levels of serum high-molecular-weight adiponectin and 25-hydroxyvitamin D. Although cognitive status was similar among the three groups, BPSD, including apathy, overeating and excessive daytime sleeping appeared to be increased in the patients with HbA1c ≥7.0%. The frequency of apolipoprotein E4 carriers and of posterior cerebral hypoperfusion ( AD-pattern) on single-photon emission computed tomography in poorly controlled diabetic subjects was similar to that in non-diabetic AD patients, whereas diabetic patients with HbA1c <7.0% included fewer apolipoprotein E4 carriers and fewer patients with an AD pattern on single-photon emission computed tomography. Conclusion Subtypes of older diabetic patients with AD were identified based on clinical features and brain pathophysiology. Physical and psychological complications of dementia are prevalent in patients with higher HbA1c. It seems likely that difficulties in the management of diabetes with AD are due not only to non-adherence to diabetes treatment, but also several symptoms and pathophysiological characteristics of dementia. Geriatr Gerontol Int 2014; 14 (Suppl. 2): 62-70. [ABSTRACT FROM AUTHOR]

Aim To investigate factors associated with caregiver burden ( CB) in persons caring for older adults with various cognitive stages of Alzheimer's disease ( AD). Methods Participants were 1127 outpatients and their caregivers. Participants comprised 120 older adults with normal cognition ( NC), 126 with amnestic mild cognitive impairment ( aMCI) and 881 with AD. AD patients were subclassified into four groups by Mini- Mental State Examination ( MMSE) score: AD29-24 ( n = 117), AD23-18 ( n = 423), AD17-12 ( n = 254) and AD11-0 ( n = 87). Participants and their caregivers underwent comprehensive geriatric assessment batteries including Zarit Burden Interview ( ZBI) Barthel Index, Lawton Index, Dementia Behavior Disturbance Scale ( DBD) to evaluate CB, Instrumental and Basic Activity of Daily Living ( IADL/ BADL), and Behavioral and Psychological Symptoms of Dementia ( BPSD). The comorbidity of geriatric syndrome and the living situation of the patient/caregiver were also assessed. Results ZBI score was higher in patients with lower MMSE score. Multivariate regression analysis identified that DBD was consistently associated with CB in all patients; symptoms related to memory deficit were related to CB in aMCI; differential IADL, such as inability to use a telephone, use transportation, manage finances, shop, cook and take responsibility for own medication, were related to CB in AD29-24, AD23-18 and AD17-12, and geriatric syndrome including falls and motor disturbance, sleep problems, urinary incontinence, and fatigue was related to CB in AD23-18 and AD17-12. Conclusions Multiple factors including BPSD, impaired life function and geriatric syndrome were cognitive stage-dependently associated with CB. Preventive treatment of BPSD and comorbidity, and effective assistance for IADL deficits could contribute to alleviation of CB. Geriatr Gerontol Int 2014; 14 (Suppl. 2): 45-55. [ABSTRACT FROM AUTHOR]

Aim To assess the effect of cerumen impaction and its removal on hearing ability and cognitive function in elderly patients with memory disorders in Japan. Methods Pure tone audiometry ( PTA) and the Mini- Mental State Examination ( MMSE) were administered to participants before and after cerumen removal. Participants who had cerumen impaction in the better-hearing ear comprised the case group; the control group consisted of participants who either did not have cerumen impaction or had it in the worse hearing ear. Hearing and cognition changes were compared between the groups after cerumen removal. Results A total of 55 patients who completed all examinations were assigned to the case group (29 patients) or the control group (26 patients). The average hearing change was 4.6 ± 7.4 in the case group and 0.9 ± 0.9 in the control group ( P = 0.029). The average change in MMSE score was 0.7 ± 2.5 in the case group and −1.0 ± 4.1 in the control group ( P = 0.068). The case group showed a significant improvement in MMSE scores after age adjustment compared with the control group ( P = 0.049). Conclusion Hearing improved significantly in the case group relative to controls after cerumen removal. A significant cognitive improvement in the case group relative to controls was additionally observed after cerumen removal with age adjustment. Thus, the present results suggest routine ear canal examinations might benefit elderly individuals with memory disorders. Geriatr Gerontol Int 2014; 14 (Suppl. 2): 56-61. [ABSTRACT FROM AUTHOR]

Aim To investigate the association of grip strength and activities of daily living independence in older adults, using a newly-developed grip strength measuring device. Methods Patients who visited the clinic for memory disorders at the National Center for Geriatrics and Gerontology (142 men and 205 women, mean age 74.8 ± 8.8 years) were included in the present study. Their strength during gripping performance is described in detail, and following the indices were calculated: maximum strength ( MS), response time ( RT), time to MS, time to reach turning point ( TP), strength at TP, inclination from start to TP, time from TP to reach MS, inclination from TP to MS and ratio of strength ( TP/ MS). Barthel Index ( BI), total scores and scores of each subclass were used for evaluating activities of daily living independence. MS was compared between the independent and dependent groups. Correlations, using partial Pearson's coefficient adjusted for age, and Mini- Mental State Examination total score were analyzed between indices and BI by sex, side, and age groups. Results MS was significantly higher in the independent group. MS and RT were significantly related with BI total and certain subclasses in both hands, TP/ MS was significantly related in the right hand of either sex, and strength at TP was significantly related in both hands in women and in the left hand in men. Time to reach TP was particularly correlated in both hands and time from TP to reach MS in the right hand, in men. The correlation of indices varied by sex, hand side and age group, especially in men aged in their 70s, and in women aged less than 70 years and women aged in their 80s. Conclusion MS was shown to be useful, but some of the newly defined indices, such as RT, strength at TP, and elements regarding before and after TP until reaching MS, were also suggested to be useful. Geriatr Gerontol Int 2014; 14 (Suppl. 2): 77-86. [ABSTRACT FROM AUTHOR]

Aim The National Center for Geriatrics and Gerontology has begun to provide educational support for family caregivers through interdisciplinary programs focusing on patients in the early stage of dementia. These interdisciplinary programs have established two domains for the purpose of 'educational support': cure domains (medical care, medication) and care domains (nursing care, welfare). In the present study, we examined the learning needs and post-learning attitude changes of patients and their families who participated in these programs in order to assess the effectiveness of an interdisciplinary program of educational support in each of these domains. Methods A total of 170 participants (51 dementia patients, 119 family members) were included in the study. Data were obtained from electronic health records, and through a written survey administered before and immediately after each program. Results A high percentage of patients and family members desired knowledge about the progression and symptoms of dementia, as well as measures to prevent progression, both of which fall under the medical care content. For patients, education in the medical care content increased their motivation to live. For families, education in the medical and nursing care contents promoted their understanding of dementia, while education in medication and welfare contents improved their skills for handling dementia patients and their symptoms. Conclusion Both patients and family members expressed a need to learn medical care content, including the progression and disease symptoms of dementia, and methods to prevent the progression of dementia symptoms. Their responses showed that learning medical care was effective for understanding dementia. We suggested that medical care content was the core of interdisciplinary educational support for early-stage dementia patients and their family members. Geriatr Gerontol Int 2014; 14 (Suppl. 2): 28-34. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to identify a useful neuropsychological instrument for making a differential clinical diagnosis between Alzheimer's disease ( AD) and dementia with Lewy bodies ( DLB). Methods We examined 402 AD and 38 DLB patients with neuropsychological tests that covered general cognition, frontal lobe cognitive function, non-verbal abstract reasoning, working memory and attention, and verbal memory. Discriminant analysis using a stepwise method was performed to identify the measures best able to discriminate between AD and DLB. Results The AD patients performed significantly worse than the DLB patients on orientation to time, delayed recall subtests on the Mini- Mental State Examination, and logical memory subtests 1 and 2 of the Revised Wechsler Memory Scale. The DLB patients performed significantly worse than the AD patients on the attention, repetition, and pentagon copying subtests of the Mini- Mental State Examination, the constructional praxis subtests of the Alzheimer's Disease Assessment Scale-cognitive component- Japanese version, the Frontal Assessment Battery total score, Raven's Coloured Progressive Matrices ( RCPM) sets A, AB, and B, and backward digit span. Discriminant analyses between AD and DLB established the key variables as Logical Memory 1, Logical Memory 2, backward digit span, RCPM, and delayed recall on the Mini- Mental State Examination. We inferred the AD-DLB discriminant index from the following discriminant analyses: AD-DLB discriminant index = (Backward digit span score + RCPM set B score) − (Logical Memory 1 score + Logical Memory 2 score), which offered a highly favourable value for diagnostic utility. Conclusions The AD-DLB discriminant index, consisting of backward digit span, RCPM set B, and logical memory 1 and 2, is useful to differentiate between AD and DLB. [ABSTRACT FROM AUTHOR]

Oh, what a difference an S makes: A thioribose analogue (cADPtR, see scheme) of cyclic ADP‐ribose (cADPR) was synthesized that is stable and has structural and electrostatic features similar to those of cADPR. cADPtR is the first stable equivalent of cADPR that is as active as cADPR in various cellular systems, making it useful for investigating Ca2+ ion‐release signaling pathways. [ABSTRACT FROM AUTHOR]