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Dual sensory impairment (DSI) of hearing and vision in older adults may limit lifestyle activities of daily living and contribute to a reduced life space. This study aimed to investigate how DSI is associated with specific lifestyle activities and predicts changes in mobility in life space.Participants comprised 4214 older adults (52.3 % female, mean age 75.8 years) who met the study's inclusion criteria. The participants were divided into three groups according to the number of sensory impairments: (1) no sensory impairment (NSI), (2) single sensory impairment (SSI), and (3) DSI.We investigated the association between DSI and specific lifestyle activities at baseline. The Active Mobility Index (AMI) was used to assess life-space. Two years later, the association between DSI and life-space mobility was verified using multinomial logistic regression analysis.DSI was more likely to have limited people's instrumental activities of daily living and cognitive, social, and productive activities at baseline (P 0.05). In the adjusted model with potential covariates, people with DSI had a lower life-space score at 2 years than people with NSI (odds ratio [OR] = 1.40, 95 % confidence interval [CI]: 1.01-1.95), but the difference was not significant for SSI (OR = 0.98, 95 % CI: 0.78-1.24).This study suggested that DSI was a factor that limited various activities and narrowed the life-space mobility of older adults. Prevention of DSI may be important for community-dwelling older adults to maintain a more active lifestyle.

Falls and fear of falling (FoF) inhibit healthy longevity and have been suggested to be associated with cognitive function. However, the domains of cognitive function that are associated with them remain controversial. It is speculated that clarifying this will help in the assessment of health status and interventions in the community.To analyse the associations between fall history and FoF and multidimensional cognitive function in independent community-dwelling older adults.The data from 9759 (73.3 ± 5.4 years, 59.9% women) older individuals enrolled in the cross-sectional ORANGE study were analysed. Simple questions were used to assess fall history in the past year and current FoF. Assessments of multidimensional cognitive function were performed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) to evaluate memory, attention, executive function, and processing speed. The independent associations of fall history and FoF with multidimensional cognitive function were assessed using multivariate linear regressions adjusted for potential confounding variables.A total of 18.3% and 35.4% of participants presented with fall history and FoF, respectively. Fall history (p = 0.008) and FoF (p = 0.002) were significantly associated with memory. FoF, but not fall history was associated with attention (p = 0.004), executive function (p 0.01), and processing speed (p 0.01).In independent community-dwelling older adults, fall history was associated only with the memory domain; in contrast, fear of falling was associated with multidimensional cognitive function. This study provides weak evidence suggesting the need to assess falls and FoF in all situations involving independent community-dwelling older adults.

The purpose of this study was to investigate the associations of the timing and nutritional characteristics of bedtime meals with sleep quality in nurses after rotating night shifts. In total, 128 nurses from a university hospital in South Korea participated in this cross-sectional study. Data were collected on the first night of two or three consecutive routine night shifts. Participants recorded all food eaten before going to bed after work. An accelerometer was used to objectively measure sleep quality, and subjective sleep quality was assessed by self-report using the Korean version of the Verran and Snyder-Halpern Sleep Scale. The associations of timing and nutritional characteristics of bedtime meals with sleep quality after night shifts were analyzed using multivariate linear regression. A short time interval between meals and sleep was associated with longer objectively measured total sleep time (β = −0.37, p = 0.002), and the proportion of protein in meals was associated with better objectively measured sleep efficiency (β = 0.31, p = 0.007). The shorter the time interval, the better the subjective sleep quality (β = −0.23, p = 0.048), and high-calorie meals were positively associated with subjective sleep quality (β = 0.23, p = 0.043). Based on our findings, we encourage nurses to have protein-rich meals after night shifts and reduce the delay between meals and sleep. Although high-calorie meals were shown to have a positive effect on subjective sleep quality, it is necessary to confirm this effect through additional research.

Subjective cognitive decline (SCD) in older adults has been identified as a risk factor for dementia. However, the literature is inconsistent, and the underlying mechanisms are not well understood. We aimed to determine whether older adults with SCD had more modifiable protective factors against the risk of dementia and a lower risk of developing objective cognitive decline (OCD). We included 4363 older adults (71.7 ± 5.3 [mean ± standard deviation] years of age; 2239 women) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. SCD, OCD, and protective factors against dementia, such as lifestyle and activity, were assessed using interviews and objective cognitive-assessment tools. Based on initial cognitive status, participants were categorized into normal cognition, SCD-only, OCD-only, and both SCD and OCD groups. After 4 years, participants were classified as having either no impairment or mild or global cognitive impairment (i.e., OCD). Binomial logistic regression analyses were performed with the cognitive statuses of the groups at follow-up and baseline as the dependent and independent variables, respectively. After adjusting for potential confounding factors, we found that the SCD-only group had more modifiable protective factors against the risk of dementia than the OCD-only group. Community-dwelling older adults with normal cognition or those part of the SCD-only group had a lower risk of developing OCD during the 4-year follow-up, which may have been due to having more modifiable protective factors against the risk of dementia. Additionally, these factors may contribute to the inconsistencies in the literature on SCD outcomes.

This study investigated the effectiveness of electrical muscle stimulation (EMS) with resistance exercise training (ERT) and resistance exercise training (RT) on physical and brain function in middle-aged and older women. Method: Forty-eight participants were randomly allocated into three groups: (i) ERT (n = 16), (ii) RT (n = 16), and (iii) control group (n = 16). The intervention session was 50 min long and performed three times/week for four weeks. The ERT group performed quadriceps setting, straight leg raises, and ankle pump exercises while constantly receiving EMS on their quadriceps muscle on both legs. The RT group performed the same exercise without EMS. Physical function was measured using skeletal muscle mass index (SMI), handgrip strength, gait speed, five times sit-to-stand test (FTSS) and timed up-and-go test (TUG). Brain function was assessed with electroencephalogram measurement of whole brain activity. Results: After four-week intervention, significant improvements were observed in SMI (p < 0.01), phase angle (p < 0.05), and gait speed (p < 0.05) in the ERT group compared to the control group. ERT also increased muscle strength (p < 0.05) and mobility in lower limbs as observed in FTSS and TUG tests (p < 0.05) at post-intervention compared to the baseline. In the ERT group, significant positive changes were observed in Beta1 band power, Theta band power, and Alpha1 band whole brain connectivity (p < 0.005) compared to the control group. Conclusions: Our findings showed that ERT can improve muscle and brain function in middle-aged and older adults during a four-week intervention program whereas significant improvements were not observed with RT. Therefore might be one of the feasible alternative intervention to RT for the prevention of muscle loss whilst improving brain function for middle-aged and older population.

Background Deteriorated skeletal muscle condition, including sarcopenia, is a risk factor for disability in older adults. Promoting physical activity is a useful treatment for sarcopenia. However, optimal intensity of physical activity according to sarcopenia characteristics is unclear. Methods This longitudinal cohort study enrolled 2149 community‐dwelling older adults (women 55.7%, mean age: 75.5 ± 4.0 years). Five‐year disability incidence defined by Japanese long‐term care insurance certification and accelerometer‐measured physical activities (light‐intensity physical activity [LPA] and moderate‐to‐vigorous intensity physical activity [MVPA]), which were adjusted for potential confounders, was analysed using cox‐proportional hazard model stratified by sarcopenia characteristics based on the diagnostic algorithm by the Asian working group for sarcopenia (robust, low physical function, low muscle mass, and sarcopenia). The sarcopenia group was defined as low muscle mass and low physical function (weakness and/or slowness). The low muscle mass and low physical function groups were each defined by these characteristics alone. Muscle mass was analysed via bioelectrical impedance analysis. Each intensity of physical activity times was divided by median values. Results The disability incidence rate was 15.4%, excluding those who could not be followed up. Mean LPA times were 43.8 ± 18.0, 45.6 ± 17.5, 45.4 ± 16.6, 40.8 ± 18.6, and 41.4 ± 18.5 min/day and MVPA times were 24.6 ± 17.6, 26.3 ± 18.3, 27.2 ± 17.3, 21.6 ± 16.3, and 21.5 ± 16.4 min/day in all participants, the robust, low muscle mass, low physical function, and sarcopenia groups, respectively. For all participants, higher MVPA was associated with disability incidence [hazard ratios (HR), 0.63; 95% confidence interval (95% CI), 0.49–0.81; P

Introduction: A cutoff speed of 1.0 m/s for walking at a comfortable pace is critical for predicting future functional decline. However, some older adults with walking speeds below the cutoff point maintain an independent living. We aimed to identify specific predictors of disability development in older adults with slow walking speeds in contrast to those with a normal walking speed. Methods: This prospective cohort study on 11,987 community-dwelling independent Japanese older adults (mean age, 73.6±5.4 years) was conducted between 2011 and 2015. Participants were classified into slow walking speed (comfortable walking speed slower than 1.0 m/s) and normal walking speed (speed of 1.0 m/s or faster) groups and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional hazards regression models were used to identify predictors of disability development in the slow and normal walking groups. Results: Overall, 26.7% of participants had a slow walking speed. At follow-up, 11.3% and 2.7% of participants in the slow and normal walking groups, respectively, developed disability (p < 0.01). Cox regression models revealed that age (hazard ratio 1.08, 95% confidence interval 1.06–1.11), walking speed (0.10, 0.05–0.20), grip strength (0.97, 0.95–0.99), Parkinson’s disease (4.16, 2.05–8.44), and Symbol Digit Substitution Test (SDST) score (0.98, 0.96–1.00) were significantly associated with disability incidence in the slow walking group. In the normal walking group, age, grip strength, cognition, 15-item Geriatric Depression Scale (GDS) score, and reduced participation in outdoor activity were significantly associated with disability incidence; however, there was no significant association with walking speed. Conclusions: Decreased walking speeds have considerably greater impact on disability development in older adults with a slow walking speed than in those with a normal walking speed. Health-care providers should explore modifiable factors for reducing walking speed; they should also encourage improvement of risk factors such as muscle weakness and depression to reduce disability risk in older adults with slow walking speeds.

This study aimed to clarify the association between hand function, including grip strength and hand dexterity, assessed using snap fasteners, and mild cognitive impairment (MCI) in older adults with normal global cognitive function.A total of 228 functionally independent older adults (mean age 77.7 ± 6.1 years) participated in this study. None of the participants had a history of dementia diagnosis, and all the participants had a Mini-Mental State Examination score of ≥24. Participants were evaluated for hand function using grip strength and snap fastener tests, and for cognitive function using the National Center for Geriatrics and Gerontology-Functional Assessment Tool.A total of 72 participants (31.6%) were diagnosed with MCI. The slow snap fastener test group had a higher proportion of participants with MCI (p 0.001) and impairments in memory (p = 0.010), attention (p = 0.043), executive function (p 0.001), and processing speed (p = 0.044) compared to the fast snap fastener test group. The slow speed of fastening snap fasteners was significantly associated with MCI and impairment in memory, attention, executive function, and processing speed (MCI: adjusted odds ratio (AOR) = 3.88, 95% confidence interval (CI) = 1.64-9.19; memory: AOR = 5.73, 95% CI = 1.58-20.82; attention: AOR = 3.95, 95% CI = 1.10-14.11; executive function: AOR = 7.22, 95% CI = 1.78-29.24; processing speed: AOR = 7.52, 95% CI = 1.19-47.66) according to the multiple logistic regression analysis. Grip strength was not significantly associated with cognitive impairment.Thus, hand dexterity assessed using the snap fastener test was associated with MCI in older adults with normal global cognitive function. Hand dexterity assessment using the snap fastener test is useful for detecting MCI in apparently healthy older adults.

This study aimed to examine the linear and nonlinear associations between sleep duration and gait speed and the risk of developing mild cognitive impairment (MCI) in community-dwelling older adults. Participants were 233 older adults who met the study inclusion criteria. The MCI diagnosis was based on medical evaluations through a clinical interview conducted by a dementia specialist. Self-reported sleep duration was evaluated using the Pittsburgh Sleep Quality Index. The usual gait speed was calculated from the time taken to walk along a 4 m walkway. Multivariate logistic regression analysis was used to calculate the odds ratio (OR) and the 95% confidence interval (95% CI) of developing MCI in relation to sleep duration and gait speed. Generalized additive models were used to examine the dose–response relationships between sleep duration, gait speed, and the risk of developing MCI. Slower gait speed (OR: 1.84, 95%; CI: 1.00–3.13) and poor sleep duration (OR: 1.76, 95%; CI: 1.00–3.35) were associated with the risk of developing MCI, compared with their optimal status. In addition, the combination of poor sleep and slower gait was associated with a higher risk of developing MCI than optimal sleep duration and gait speed (OR: 3.13, 95%; CI: 1.93–5.14). Furthermore, gait speed and sleep duration were non-linearly associated with the risk of developing MCI. These results highlight the complex interplay and synergism between sleep duration and gait abilities on the risk of developing MCI in older adults. In addition, our results suggest that slower gait speed (480 min) sleep duration may be linked to MCI risks through underlying pathways.

Objectives The updated definition of sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP2) recommends both low muscle mass and quality to diagnose sarcopenia; concurrent poor physical performance is considered indicative of severe sarcopenia; however, the relationship between the revised definition and disability incidence among Japanese older adults is unclear. Therefore, we aimed to examine the associations between EWGSOP2-defined sarcopenia and disability incidence among community-dwelling older Japanese adults. Design Nationwide study. Setting and participants We included 4561 individuals aged ≥65 years and enrolled in the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes (NCGG-SGS). Methods Skeletal muscle mass was assessed using a bioimpedance analysis device; handgrip strength and walking speed were measured as physical performance indicators. We used the Asian Working Group for Sarcopenia cutoffs to define low muscle mass and poor physical performance. We stratified all participants into nonsarcopenia, sarcopenia, and severe sarcopenia groups. Disability incidence was prospectively determined over 49 months using data extracted from the Japanese long-term care insurance system. Results The prevalence of sarcopenia and severe sarcopenia was 3.4% and 1.7%, respectively. Participants with any form of sarcopenia were at a higher risk of disability [hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.27-2.49]. Although participants with severe sarcopenia showed a higher risk of disability (HR 2.00, 95% CI 1.32-3.02), there was no significant disability risk in the sarcopenia group (HR 1.54, 95% CI 0.97-2.46). Grip strength (HR 0.96, 95% CI 0.94-0.98) and walking speed (HR 0.19, 95% CI 0.12-0.30) negatively correlated with disability incidence. Conclusions and implications Severe sarcopenia, involving low muscle mass and poor physical performance, might increase disability risk in older adults, as opposed to low muscle mass alone. Further studies are needed to determine whether sarcopenia without poor physical performance increases disability risk.

Objectives Investigating the lifestyle activity patterns of urban community-dwelling Japanese older adults, focusing on physical frailty and cognitive impairment. Design Cross-sectional study. Setting and Participants Participants comprised 8003 older adults (4489 women; mean age: 72.5 years, SD = ±6.1, range 60-95 years) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. Methods Participants reported on their lifestyle activity status, including using public transport, grocery shopping, light exercise, gardening, money management, meeting friends, participating in events, and travel. Several potential confounding variables, such as demographic characteristics, were considered. We assessed their lifestyle activity patterns using a latent class analysis and defined physical frailty by either slow walking speed or poor grip strength. Cognitive impairment was defined by participants exhibiting more than 1 of the following symptoms: poor word list memory, poor attention, reduced executive function, and low processing speed test scores. We also examined the relationship between their lifestyle activity patterns and physical frailty and cognitive impairment. Results The overall prevalence of robustness, physical frailty, cognitive impairment, and frailty and cognitive impairment was 54.6%, 21.4%, 13.3%, and 10.7%, respectively. We defined 4 classes using latent class analysis: greater engagement in multidomain activities, lower engagement in going-out activities, lower engagement in cognitive and physical activities, and lower engagement in multidomain activities. Moreover, physical frailty and cognitive impairment were independently associated with lower engagement in going-out activity, lower engagement in cognitive and physical activities, and lower engagement in multidomain activities, after adjusting for covariates. Conclusions and Implications Considering an older adult's lifestyle activity patterns in their day-to-day practice, clinicians can deliver more older adult-centered care, which in turn might lead to better outcomes in the primary prevention of disease.

AIM The prevalence of diabetes generally increases with age, and older adults with diabetes are at a higher risk of adverse outcomes. Visceral fat accumulation is a well-known risk factor for diabetes in middle-aged adults, and its association with diabetes increases with age. The present study investigated the association between visceral fat and risk of diabetes in older adults that is yet to be completely elucidated. METHODS This cross-sectional study enrolled 2850 community-dwelling older adults. Participants underwent abdominal bioelectrical impedance analysis to estimate the visceral fat area (VFA). The risk of diabetes was assessed using the value of hemoglobin A1c according to the diagnostic criteria of diabetes. We examined the relationship of VFA and risk of diabetes, and explored the optimal cut-off value stratified by sex. RESULTS In total, 47 of 1640 (2.9%) women and 41 of 1210 (3.4%) men had a high risk of diabetes. Higher values of VFA in units of 10 cm2 were significantly associated with a higher risk of diabetes for both women (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [95% CI]: 1.02-1.34) and men (aOR: 1.18; 95% CI: 1.06-1.31) in multivariate logistic regression analysis. The cut-off value to classify 30% of subjects into high VFA (72 cm2 ) had a relatively higher sensitivity of 0.660 and was significantly associated with a higher risk of diabetes for women (aOR: 3.49; 95% CI: 1.54-8.12), whereas all cut-off values we examined had no relation in men. CONCLUSIONS Increases in VFA is associated with a high risk of diabetes in older adults but the optimal cut-off value is inconclusive in men. Geriatr Gerontol Int 2021; ••: ••-••.

Introduction: The prevalence of hearing and visual impairment (HI and VI) and dual sensory impairment (DSI), which is a combination of both, is increasing as the population ages. These sensory impairments are expected to increase the cognitive load of information processing from hearing and vision and impair appropriate cognitive processing. Although an association between DSI and cognitive decline has been reported, a more detailed study of the effects on each cognitive domain is required. This study aimed to investigate the prevalence of self-reported sensory impairment in community-dwelling older adults and to examine the impact of DSI on the severity of mild cognitive impairment (MCI) and on each cognitive domain (memory, attention, executive function, and processing speed). Methods: The participants were recruited from a sub-cohort of the National Center for Geriatric Gerontology-Study on Geriatric Syndromes (NCGG-SGS) conducted by the National Center for Geriatrics and Gerontology. We included 4,471 community-dwelling older adults (age: 75.9 ± 4.3 years; females: 52.3%) who fulfilled the inclusion criteria. The HI and VI were identified using a self-report questionnaire. Cognitive and other parameters were also assessed by trained staff. Logistic regression analysis was used to evaluate the relationship between the presence of HI and VI and the severity of MCI, and functional decline in each cognitive domain. Results: DSI was identified in 11.4% of community-dwelling older adults. Regarding sensory impairment and MCI severity, the odds ratio (OR) for single-domain MCI was significantly higher in VI (OR: 1.31; 95% CI: 1.06–1.61), and the OR for multiple-domain MCI was significantly higher in DSI (OR: 1.58; 95% CI: 1.10–2.29). In relation to the four cognitive domains, ORs for impaired executive function were higher for VI and DSI (VI, OR: 1.37; 95% CI: 1.09–1.72. DSI, OR: 1.39; 95% CI: 1.06–1.81). DSI also exhibited a higher odds ratio for reduced processing speed (OR: 2.03; 95% CI: 1.42–2.91). Discussion/Conclusion: DSI is predicted to increase as the population ages and is associated with various health problems. Further, DSI has been reported to decrease quality of life, which needed to establish appropriate treatment and prevention measures.

Background Both pain interference and depressive symptoms have certain effects on dementia, and these are reciprocally related. However, comorbid effects of pain interference and depressive symptoms on dementia have not been examined in detail. Objective This longitudinal study aimed to examine the combined effects of pain interference and depressive symptoms on the incidence of dementia in community-dwelling elderly individuals. Methods This prospective cohort study with a 36-month follow-up period included 4,326 community-dwelling elderly individuals without dementia at baseline. Pain interference and depressive symptoms were assessed for every participant at baseline. We collected medical records in the Japanese public health insurance system to identify the incidence of dementia for 36 months. Results The incidence rates of dementia during the follow-up period in the control, pain-interference, depressive-symptoms, and comorbid group were 3.2%, 6.2%, 7.9%, and 11.3%, respectively. A Cox regression analysis showed that the hazard ratios for the incidence of dementia were 1.85 (95% CI: 1.13-3.03) in the pain interference group, 1.87 (95% CI: 1.27-2.76) in the depressive symptoms group, and 2.20 (95% CI: 1.26-3.84) in the comorbid group, after adjusting for covariates. Conclusion The coexistence of pain interference and depressive symptoms had a greater effect on the incidence of dementia than either condition alone in community-dwelling elderly individuals. Pain interference and depressive symptoms are known as common comorbid conditions and often form a negative cycle that accelerates the worsening of the individual symptoms of both. Thus, the comorbidity of these conditions may require monitoring for the prevention of dementia.

The number of socially isolated older adults has increased owing to the coronavirus disease pandemic, thus leading to a decrease in cognitive functions among this group. Smartphone use is expected to be a reasonable preventive measure against cognitive decline in this social context. Thus, this study aimed to investigate the influence of social isolation and smartphone use on cognitive functions in community-dwelling older adults.We divided 4,601 community-dwelling older adults into four groups based on their levels of social isolation and smartphone use. Then, we conducted cognitive functions tests including a word list memory task, trail-making test, and symbol digit substitution task. Social isolation was defined when participants met two or more of the following measures: domestic isolation, less social contact, and social disengagement. We used an analysis of covariance adjusted by background information to measure between-group differences in levels of cognitive functions and social isolation. A linear regression model was used to analyze the association of standardized scores of cognitive function tests with smartphone use.Smartphone users' scores of the symbol digit substitution task were superior compared with both non-users with social isolation and without. All cognitive functions were associated with smartphone use among non-socially and socially isolated participants. Socially isolated older adults showed an association only between trail making test- part A and smartphone use.Smartphone use was associated with cognitive functions (memory, attentional function, executive function, and processing speed) even in socially isolated community-dwelling older adults.

The present study developed a simplified decision-tree algorithm for fall prediction with easily measurable predictors using data from a longitudinal cohort study: 2520 community-dwelling older adults aged 65 years or older participated. Fall history, age, sex, fear of falling, prescribed medication, knee osteoarthritis, lower limb pain, gait speed, and timed up and go test were assessed in the baseline survey as fall predictors. Moreover, recent falls were assessed in the follow-up survey. We created a fall-prediction algorithm using decision-tree analysis (C5.0) that included 14 nodes with six predictors, and the model could stratify the probabilities of fall incidence ranging from 30.4% to 71.9%. Additionally, the decision-tree model outperformed a logistic regression model with respect to the area under the curve (0.70 vs. 0.64), accuracy (0.65 vs. 0.62), sensitivity (0.62 vs. 0.50), positive predictive value (0.66 vs. 0.65), and negative predictive value (0.64 vs. 0.59). Our decision-tree model consists of common and easily measurable fall predictors, and its white-box algorithm can explain the reasons for risk stratification, therefore, it can be implemented in clinical practices. Our findings provide useful information for the early screening of fall risk and the promotion of timely strategies for fall prevention in community and clinical settings.

With a worldwide aging population, the prevention of disability in older adults has become an important issue. Therefore, the purpose of this study was to develop a model for predicting disability risk in older adults based on multiple factors, using a decision tree analysis. This model may be used with a mobile application when it is difficult to interview older adults, and to obtain individualized information for prioritizing interventions.We examined the data from a cohort study conducted by the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. We included 12,000 older adults without a disability and performed a decision tree analysis using the Chi-square automatic interaction detection (CHAID) algorithm.Among the 12,000 participants without a disability, 11,503 and 497 participants remained disability-free and developed disability, respectively. The CHAID analysis identified 24 end nodes with five levels of partition and 16 partitioning variables for 34 questionnaire variables, with incident disability probabilities ranging from 0.0% to 96.7%. The classification accuracy and area under the curve of the CHAID model were 73.4% and 0.76, respectively. We found that maintaining mental health was important for older adults in their 80s and older, and that lifestyles and geriatric syndromes were important factors for those in their 70s.The magnitude of the influences on the risk of developing a disability differ by age group. The results of this study may provide useful information for the development of mobile applications that predict the risk of developing disability and create tailor-made interventions.

We investigated the effectiveness of virtual-reality-based cognitive training (VRCT) and exercise on the brain, cognitive, physical and activity of older adults with mild cognitive impairment (MCI). Methods: This study included 99 participants (70.8 ± 5.4) with MCI in the VRCT, exercise, and control groups. The VRCT consisted of a series of games targeting different brain functions such as executive function, memory, and attention. Twenty-four sessions of VRCT (three days/week) were performed, and each session was 100 min long. Exercise intervention consisted of aerobic and resistance trainings performed in 24 sessions for 60 min (2 times/week for 12 weeks). Global cognitive function was measured using the Mini-Mental State Examination (MMSE) test. Resting-state electroencephalography (EEG) of the neural oscillatory activity in different frequency bands was performed. Physical function was measured using handgrip strength (HGS) and gait speed. Results: After the intervention period, VRCT significantly improved the MMSE scores (p < 0.05), and the exercise group had significantly improved HGS and MMSE scores (p < 0.05) compared to baseline. One-way analysis of variance (ANOVA) of resting-state EEG showed a decreased theta/beta power ratio (TBR) (p < 0.05) in the central region of the brain in the exercise group compared to the control group. Although not statistically significant, the VRCT group also showed a decreased TBR compared to the control group. The analysis of covariance (ANCOVA) test showed a significant decrease in theta band power in the VRCT group compared to the exercise group and a decrease in delta/alpha ratio in the exercise group compared to the VRCT group. Conclusion: Our findings suggest that VRCT and exercise training enhances brain, cognitive, and physical health in older adults with MCI. Further studies with a larger population sample to identify the effect of VRCT in combination with exercise training are required to yield peak benefits for patients with MCI.

Objective: To examine the association between driving and structural brain volume in older individuals. Methods: In this cross-sectional study, high-resolution magnetic resonance imaging was performed in 1063 older adults. We examined global brain measures, including gray and white matter volumes and subcortical volume, using the FreeSurfer program. Participants were divided into non-drivers, those who drove < 7 days a week, and every day drivers. They were further classified into a non-driving group, an active group (drove 10 km at least once a week), and a less-active group (drove 10 km less than once a week). Results: Drivers had a larger hippocampal volume than non-drivers (p = 0.048). Low-frequency drivers had a larger occipital cortex volume than non-drivers and high-frequency drivers (p = 0.007). Active drivers had larger temporal cortex volumes than non-active drivers (p = 0.020), larger cingulate cortex volumes than non-drivers and less-active drivers (p = 0.002), and larger hippocampus volumes than non-drivers (p = 0.019). A post-hoc analysis revealed no significant between-group differences in the amygdala. Conclusions: Driving was associated with diminished hippocampal brain atrophy in older adults. Active drivers with a larger life space exhibited less brain atrophy in several regions, including the temporal and cingulate cortices.

Promoting physical activity (PA) among older adults with cognitive decline is important for maintaining and improving their health. Identifying psychological and environmental PA correlates in this population can help develop effective strategies for PA promotion. Since past findings with healthy older adults may not generalize to those with cognitive decline, this study offers data on how self-efficacy, self-regulation, and social-environmental factors were associated with PA among a group of older adults with cognitive decline. We report secondary analysis of baseline data from a randomized control study of 262 older participants ( M = 76.2 years) who showed a decline in global cognitive function as defined by Mini-Mental State Examination scores between 21 and 24. The participants’ PA was measured by an accelerometer, and participants completed questionnaires measuring self-efficacy, self-regulation, social support, social network, and demographic variables. In this study, we evaluated the participants' neighborhood environment with a geographic information system and found through stepwise multiple regression analyses that self-efficacy, gender, and age were associated with PA variables, while self-regulation and environmental factors were not. Thus, perceived self-efficacy was an important psychological correlate of PA in this group of older adults with cognitive decline. PA promotion interventions for this population should attend to self-efficacy, gender, and age.

Background Older adults with cognitive decline are vulnerable to various health problems. Going out of home for longer time could be beneficial for their health. Identifying modifiable predictors is essential for developing effective strategies that would increase time spent out-of-home by older adults. This study examined social and physical environmental predictors of objectively measured out-of-home time spent among older adults with cognitive decline. Methods This study was a secondary analysis of a randomized controlled trial (n = 147). Out-of-home time per day was measured by a Global Positioning System at baseline and 1-year follow-up. Baseline data of social environment (living alone, social network [Japanese version of the Lubben Social Network Scale]), objective physical environment (road network distance from each home address to nearest supermarket store, convenience store, and public transportation), and demographic factors (gender, age, education, driving status, fear of falling) were examined as potential predictors. Results After adjusting main effects of allocation group, time of measures, and their interactive effect, a mixed model showed that younger age (p = 0.044), current driving status (p = 0.039), and stronger social network (p = 0.003) were predictors of out-of-home time. However, none of the physical environmental factors significantly predicted outdoor time. Conclusions The present study found that social network was a predictor of objectively measured out-of-home time among older adults with global cognitive decline. A sufficient social network might help increase out-of-home time among them. However, the influence of physical environment on out-of-home time might be small.

Objectives This study aimed to examine the effectiveness of a multicomponent intervention combining physical, cognitive, and social activities developed to promote community activity in improving cognitive function in older adults with mild cognitive impairment (MCI). Design Single-blind randomized controlled trial. Setting A total of 83 Japanese older adults with MCI participated in the study from April to September 2017. Interventions Participants were randomly assigned to either the multicomponent intervention group (n = 41), attending 90-minute physical, cognitive, or social activity sessions using community resources twice weekly, or the health education control group (n = 42). Outcomes The primary outcomes were cognitive functions, and the secondary outcomes were grip strength, walking speed, depressive symptoms, physical activities, number of outdoor activities, and conversation time. Results Analysis using linear mixed models revealed significantly greater improvements in the intervention group in spatial working memory (p = 0.024) following intervention compared with the control group. Time spent in moderate-to-vigorous physical activity (p = 0.048) and step count (p = 0.059) decreased from the baseline post-intervention in the control group, whereas the baseline was maintained in the intervention group. No significant between-group differences were found post-intervention in the other primary and secondary outcomes. Conclusions This study showed that a 24-week multicomponent intervention program was effective in improving spatial working memory and maintaining physical activity in older adults with MCI. A follow-up investigation is required to determine whether continuation of physical, cognitive, and social activity can prevent dementia or reverse MCI in older adults.

Introduction Numerous studies have focused on nonpharmacological interventions on cognitive function and the effects of cognitive function on daily living. However, effects of behavior change techniques that promote physical, cognitive, and social activities on cognitive function and incident dementia in the elderly are yet to be elucidated. In this study, we aimed to design a single-blind, randomized controlled trial to study dementia prevention effects of behavior change techniques, using an accelerometer and a newly developed daily activity booklet in community-living older adults. Methods The study cohort comprised 5390 individuals aged 65 years and older who were randomized into one of the following three groups: accelerometer group (n = 1508), accelerometer and daily activity booklet group (n = 1180), or a control group (n = 2702; vs. accelerometer group [n = 1509] vs. accelerometer and daily activity booklet group [n = 1193]). Incident dementia was diagnosed based on the Japanese Health Insurance System data. The participants without dementia at baseline, who are diagnosed with dementia over a 36-month follow-up period, are considered to have incident dementia. The participants of the accelerometer group were asked to wear the accelerometer everyday and visit a site having data readers to download the accelerometer data every month. The subjects of the booklet group were requested to not only wear the accelerometer but also record the physical, cognitive, and social activities. The participants receive a feedback report from the data of the accelerometer and booklet. Discussion The study has the potential to provide the first evidence of effectiveness of the self-monitoring tools in incident dementia. In case our trial results suggest a delayed dementia onset upon self-monitoring interventions, the study protocol will provide a cost-effective and safe method for maintaining a healthy cognitive aging., Highlights • We aim to study dementia prevention effects of behavior change techniques. • The study may shed light on the effect of self-monitoring in dementia prevention. • The findings may provide a safe method for maintaining a healthy cognitive aging.

Background Established clinical assessments for detecting dementia risk often require time, cost, and face-to-face meetings. We aimed to develop a Simplified Telephone Assessment for Dementia risk (STAD) (a new screening tool utilizing telephonic interviews to predict dementia risk) and examine the predictive validity of the STAD for the incidence of dementia. Methods We developed STAD based on a combination of literature review, statistical analysis, and expert opinion. We selected 12 binary questions on subjective cognitive complaints, depressive symptoms, and lifestyle activities. In the validation study, we used STAD for 4298 community-dwelling older adults and observed the incidence of dementia during the 24-month follow-up period. The total score of STAD ranging from 0 to 12 was calculated, and the cut-off point for dementia incidence was determined using the Youden index. The survival rate of dementia incidence according to the cut-off points was determined. Furthermore, we used a decision-tree model (classification and regression tree, CART) to enhance the predictive ability of STAD for dementia risk screening. Results The cut-off point of STAD was set at 4/5. Participants scoring ≥ 5 points showed a significantly higher risk of dementia than those scoring ≤ 4 points, even after adjusting for covariates (hazard ratio [95% confidence interval], 2.67 [1.40–5.08]). A decision tree model using the CART algorithm was constructed using 12 nodes with three STAD items. It showed better performance for dementia prediction in terms of accuracy and specificity as compared to the logistic regression model, although its sensitivity was worse than the logistic regression model. Conclusions We developed a 12-item questionnaire, STAD, as a screening tool to predict dementia risk utilizing telephonic interviews and confirmed its predictive validity. Our findings might provide useful information for early screening of dementia risk and enable bridging between community and clinical settings. Additionally, STAD could be employed without face-to-face meetings in a short time; therefore, it may be a suitable screening tool for community-dwelling older adults who have negative attitudes toward clinical examination or are non-adherent to follow-up assessments in clinical trials.

The relationship between the incidence of disability and cognitive function has been clarified, but whether life satisfaction is related to this relationship is unclear. Therefore, the purpose of this study was to clarify whether life satisfaction is related to the relationship between the incidence of disability and mild cognitive impairment. We included 2563 older adults from the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes. Baseline measurements included cognitive, life satisfaction, and demographic characteristics. Life satisfaction was measured using the Life Satisfaction Scale, which was stratified into three levels based on the score: lower, moderate, and higher. Associations between disability incidence and mild cognitive impairment were examined for each group according to life satisfaction, and monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from the baseline. At a 35.5-month mean follow-up, 150 participants had developed a disability. The potential confounding factors adjusted hazard for incidence of disability in the group with lower life satisfaction was 1.88 (CI: 1.05–3.35, p = 0.034) for mild cognitive impairment. Mild cognitive impairment was associated with disability incidence, and the effect was more pronounced among older adults with lower life satisfaction.

Identifying the relationship between physical and social activity and disability among community-dwelling older adults may provide important information for implementing tailored interventions to prevent disability progression. The aim of this study was to determine the effect of the number of social activities on the relationship between walking habits and disability incidence in older adults. We included 2873 older adults (mean age, 73.1 years, SD, ±5.9 years) from the National Center for Geriatrics and Gerontology—Study of Geriatric Syndromes. Baseline measurements, including frequencies of physical and social activities, health conditions, physical function, cognitive function, metabolic parameters, and other potential disability risk factors (for example, the number of years of education), monthly assessment for disability was monitored through long-term care insurance certification for at least 2 years from baseline. During a mean follow-up of 35.1 months (SD, 6.4 months), 133 participants developed disability. The disability incidence was 19.0 and 27.9 per 1000 person-years for participants who walked more (≥3 times per week) and less (≤3 times per week) frequently, respectively. The potential confounding factor-adjusted disability hazard ratio was 0.67 (95% confidence interval, 0.46 to 0.96, p = 0.030). The relationship between habitual walking and the number of social activities was statistically significant (p = 0.004). The reduction of disability risk by walking was greater among participants with fewer social activities. Habitual walking was associated with disability incidence, with a more pronounced effect among older adults who were less likely to engage in social activities.

Objective The purpose of the study was to estimate, using an isotemporal substitution model, the effect of replacing sedentary behavior (SB) with physical activity on the incidence of disability in community-dwelling older adults. Methods This 2-year longitudinal cohort study enrolled 3691 community-dwelling older adults (57.2% women; mean age = 74.0 [SD = 5.0] years). Individuals with dementia, stroke, Parkinson disease, depression, low Mini-Mental State Examination scores, dependence on basic activities of daily living, and missing data were excluded. Physical activity and potential confounding factors were investigated as a baseline survey of disability incidence, defined by Japanese long-term care insurance certification, for 2 years in 2 regions. Physical activity data (SB, light-intensity physical activity, and moderate- to vigorous-intensity physical activity [MVPA]) were measured using triaxial accelerometers for 14 days, and daily mean time spent in each physical activity parameter was computed in increments of 10 minutes. The relationship between baseline physical activity and disability incidence adjusted for potential confounders was analyzed using multilevel Cox proportional hazards regression analyses with an isotemporal substitution model. Results The disability incidence rate was 3.8%, excluding individuals who could not be followed-up. Replacing 10 minutes of SB per day with MVPA was associated with a decreased disability incidence (hazard ratio = 0.870; 95% CI = 0.766–0.988), whereas no evidence was found for replacing SB with light-intensity physical activity (hazard ratio = 0.980; 95% CI = 0.873–1.10). Conclusions Replacing SB with MVPA was associated with a lower risk of disability. These findings are helpful for establishing disability prevention strategies. Impact These results suggest that feasible changes in daily behavior, such as replacing 10 minutes of SB with MVPA daily, might have a protective effect on disability incidence. Clarifying these associations is useful for developing disability prevention strategies and may help reduce the incidence of disability in community-dwelling older adults.

Objective The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. Methods A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48 ± 2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to “Are you afraid of falling?”) at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. Results Multivariable logistic regression showed that prefrailty or frailty increase the risk of not only future falls (odds ratio [OR]: 1.57; 95% CI = 1.20–2.05) but also FOF (OR: 1.33; 95%CI = 1.05–1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95% CI = 1.19–2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95% CI = 1.04–1.68). Conclusions Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. Impact Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high risk not only for falls but also for FOF.

Objective Older adults in Japan are tackling health-related challenges brought by comprehensive geriatric symptoms, such as physical and cognitive problems and social-psychological issues. In this nationwide study, we mainly focused on the Kihon checklist (KCL) as certificated necessity of long-term care for Japanese older adults and investigated whether the KCL score was associated with geriatric depression. In addition, we aimed to identify critical factors that influence the relationship between the KCL score and geriatric depression. Methods This survey was a cross-sectional observational study design, performed from 2013 to 2019. A total of 8,760 participants aged 65 years and over were recruited from five cohorts in Japan, consisting of 6,755 persons in Chubu, 1,328 in Kanto, 481 in Kyushu, 49 in Shikoku and 147 in Tohoku. After obtaining informed consent from each participant, assessments were conducted, and outcomes were evaluated according to the ORANGE protocol. We collected data on demographics, KCL, physical, cognitive and mental evaluations. To clarify the relationship between the KCL and geriatric depression or critical factors, a random intercept model of multi-level models was estimated using individual and provincial variables depending on five cohorts. Results The KCL score was correlated with depression status. Moreover, the results of a random intercept model showed that the KCL score and geriatric depression were associated, and its association was affected by provincial factors of slow walking speed, polypharmacy and sex difference. Conclusions These results suggest that provincial factors of low walking performance, polypharmacy and sex difference (female) might be clinically targeted to improve the KCL score in older adults.