Hiroki Kayama

Effect of a Kinect-Based Exercise Game on Improving Executive Cognitive Performance in Community-Dwelling Elderly: Case Control Study

Decrease of Dual-Task (DT) ability is known to be one of fall-risk factors. We developed a new game concept, Dual-Task Tai Chi (DTTC), using Kinect (Microsoft Co.), a motion-capture device, and demonstrated that the DTTC test can quantitatively evaluate various functions that are known risk factors for falling in elderly adults. Moreover, DT training has been attracting attention as a way to improve balance and DT ability. However, only a few studies have reported that it improves cognitive performance. Therefore, the purpose of this study was to demonstrate whether or not a 12-week program of DTTC training would effectively improve cognitive functions. A total of 41 elderly individuals (training group: n = 26, control group: n = 15) participated in this study and their cognitive functions were assessed before and after DTTC training. Significant differences were observed between the two groups with significant group x time interactions for the executive cognitive function measure: t:. trail-making test (part Bpart A) (p <; 0.05). The results suggest that DTTC training is effective for improving executive cognitive functions.

Chronic kidney disease (CKD) is an independent risk factor for long-term care insurance (LTCI) need certification among older Japanese adults: A two-year prospective cohort study

CKD is associated with impairments in health status, physical function, and frailty. The aim of the current prospective cohort study was to determine whether CKD predicted new LTCI need certification among community-dwelling older Japanese adults. This was a prospective cohort study. We analyzed the cohort data from a prospective study, The Japan Multicenter Aging Cohort for Care Prevention (J-MACC). We followed 8063 elderly adults for 2 years, and we analyzed the relationship between CKD and LTCI need. The outcome studied was new certification for LTCI service need during a 2-year period. We measured serum creatinine (the estimated glomerular filtration rate; eGFR), serum albumin, frailty checklist scores, and body mass index. During the 2-year follow-up, 536 subjects (6.6%) were newly certified as needing LTCI services. We stratified the cohort according to eGFR quartile and performed multivariate analyses using an eGFR value of 71.4-83.6 ml/min/1.73 m(2) as a reference. We found that subjects with eGFR values <60.0 ml/min/1.73 m(2) had a significantly elevated risk of LTCI service need (adjusted hazard ratio: 1.44 [95% CI 1.12-1.86]). Our results indicate that CKD is independently associated with new LTCI service need certification and is an important marker of frailty in older adults.

Efficacy of an Exercise Game Based on Kinect in Improving Physical Performances of Fall Risk Factors in Community-Dwelling Older Adults

OBJECTIVE The purpose of this study was to demonstrate whether a 12-week program of training with dual-task Tai Chi (DTTC), which is a new concept game we developed using Kinect (Microsoft, Redmond, WA), would be effective in improving physical functions of fall risk factors. MATERIALS AND METHODS This study examined balance, muscle strength, locomotive ability, and dual-task ability in community-dwelling older adults (75.4±6.3 years) before and after 12 weeks of DTTC training (training group [TG]; n=32) or standardized training (control group [CG]; n=41). Primary end points were based on the difference in physical functions between the TG and the CG. RESULTS Significant differences were observed between the two groups with significant group×time interaction for the following physical function measures: timed up-and-go (TUG) (P<0.01), one-leg standing (OLS) (P<0.05), and 5 chair stand (5-CS) (P<0.05). There were no significant differences among the other measures: 10-m walking time under standard conditions, manual-task conditions, and cognitive-task conditions, 10-m maximal walking time, and Functional Reach test scores. Thus, the scores of TUG, OLS, and 5-CS in the TG improved significantly with DTTC training compared with the CG. CONCLUSIONS The results suggest that the DTTC training is effective in improving balance ability and mobility, which are risk factors for falls.

Cognitive decline predicts long-term care insurance requirement certification in community-dwelling older Japanese adults: a prospective cohort study.

Aim: The purpose of this prospective cohort study is to examine whether cognitive decline is an independent predictor of new long-term care insurance (LTCI) requirement certifications in Japan. Methods: A total of 5,765 community-dwelling older Japanese adults who, at baseline, were independent in terms of their activities of daily living participated in this study and were followed up for 18 months. The outcome measure was the number of new LTCI requirement certifications during the 18-month period of the study. We collected demographic information through questionnaires and assessed cognitive skills with the Cognitive Performance Scale (CPS). The participants were divided into 3 groups according to CPS scores (0, 1, and 2 or greater). Results: During the 18-month period, 399 subjects (6.9%) became newly certified for LTCI services. In a multivariate Cox proportional hazards model, older participants with a CPS score of 1 (adjusted HR: 1.39, 95% CI: 1.08-1.77) and 2 or greater (adjusted HR: 2.27, 95% CI: 1.74-2.96) were significantly more likely to receive an LTCI certification compared to those with a CPS score of 0. Conclusions: Cognitive decline is an independent predictor of new LTCI requirement certifications and the severity of cognitive decline in elderly adults is positively associated with receiving an LTCI requirement certification in Japan.

Arterial Stiffness Predicts Cognitive Decline in Japanese Community-dwelling Elderly Subjects: A One-year Follow-up Study

AIM The purpose of this study was to determine whether arterial stiffness can be used to predict one-year changes in the cognitive function in Japanese community-dwelling elderly subjects. METHODS A total of 103 Japanese community-dwelling elderly patients joined this study. Information regarding the age, height, weight, gender and past medical history of each participant was obtained. Additionally, arterial stiffness was determined according to the cardio-ankle vascular index (CAVI), and the cognitive function was assessed with the Mini-Mental State Examination (MMSE). One year later, we performed the MMSE in the same subjects. After dividing the cohort according to the 80th percentile of the CAVI (normal and arterial stiffness [AS] groups), we examined whether the degree of cognitive decline, as determined using the pre- and post-MMSE, was significantly different based on the severity of arterial stiffness, adjusted for age, BMI, gender and the pre-MMSE scores. RESULTS Of the 103 subjects who participated in the pre-data collection, 74 (38 men and 36 women, 73.4±4.0 years) joined the post-data collection. We found a significant difference in the change in the post-MMSE scores between the normal and AS groups (pre-MMSE: normal group [27.4±2.1] and AS group [26.9±2.4] and post-MMSE: normal group [27.2±2.1] and AS group [25.5±2.3], F=5.95, p=0.02). For each domain of the MMSE, the changes in MMSE-attention-and-calculation (F=5.11, p=0.03) and MMSE-language (F=4.32, p=0.04) were significantly different according to an ANCOVA. CONCLUSIONS We found that arterial stiffness predicts cognitive decline in Japanese community-dwelling elderly subjects regardless of the initial level of the global cognitive function. This finding indicates the potential use of the degree of arterial stiffness as an indicator for preventing or delaying the onset of dementia in the elderly.

Shoe-fit is correlated with exercise tolerance in community-dwelling elderly people

Purpose: Maintenance of physical activity significantly affects quality of life, and the frequency of physical activity depends upon exercise tolerance. However, there is minimal information on the external factors that contribute to exercise tolerance. The aim of this study was to examine the association between exercise tolerance and shoe-fit in community-dwelling elderly people. Methods: Subjects were 155 elderly, healthy, community-dwelling Japanese volunteers. Exercise tolerance (Shuttle Walk Test [SWT]), 10-m walking time (10mWT), and forced expiratory volume in 1 second (FEV1) were measured. Shoe-fit was assessed and participants were divided into three groups according to the heel-fit of their shoes (Too Loose, Loose, Fit). Group scores in the above variables were compared. Further, a multivariate logistic regression model using a stepwise method was performed to investigate which shoe-fit factors were independently associated with SWT. Results: No significant differences in age, gender, body mass index, 10mWT, FEV1, or presence or absence of pain sites were observed between the three groups. The Fit (p = 0.001) and Loose (p = 0.008) groups had significantly higher SWT score than the Too Loose group. Multivariate logistic regression analysis showed that poor heel-fit was significantly correlated with a low SWT score, even following adjustments for age, gender, 10mWT and FEV1 (odds ratio: 0.25, 95% confidence interval: 0.07–0.95, p = 0.04). Conclusions: This study demonstrates that heel-fit is associated with exercise tolerance in community-dwelling elderly people. It is important for elderly people to wear adequate fit shoes in order to enhance physical functions and prevent declining physical functions.

Development of a system for the assessment of a dual-task performance based on a motion-capture device

Abstract The authors produced a dual task (DT) that provided a dynamic balance task and a cognitive task in a game system using motion sensors and virtual images. There had been no DT where a cognitive task needs a dynamic balance task that requires full-body motions. We developed and evaluated a game system to assess the performance of the DT. The DT was to solve a Sudoku puzzle using full-body motions like Tái Chi. An ability to perform a DT is intimately related to risk of falls. To evaluate the developed system, we compared the performance of elderly people and young people. Generally, elderly people are at a higher risk of falls. Twenty elderly community-dwelling adults (mean age, 73.0±6.2 years) and 16 young adults (mean age, 21.8±1.0 years) participated in this study. To compare the two groups, we applied an independent-samples t-test. The time taken for the elderly people was 60.6±43.2 s, whereas the time taken for the young people was 16.0±4.8 s. The difference is statistically significant (p<0.05). This result suggests that the developed game system is useful for the evaluation of the DT performance.