Keitaro Makino

Comorbid Mild Cognitive Impairment and Depressive Symptoms Predict Future Dementia in Community Older Adults: A 24-Month Follow-Up Longitudinal Study.

Background Older adults with mild cognitive impairment (MCI) are non-demented, but demonstrate cognitive dysfunction, and have significantly higher risk of progressing to dementia. A better understanding of more sensitive risk factors, such as combination of cognitive and psychological status, for progression of MCI to dementia may be crucial for prevention of development of dementia. Objective To examine MCI, depressive symptoms, and comorbid MCI and depressive symptoms as risk factors for development of dementia. Methods A total of 3,663 community-dwelling older people were included in this prospective longitudinal study. MCI was determined by age- and education-adjusted objective cognitive impairment using computerized comprehensive cognitive measures including memory, attention/executive function, and processing speed. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and defined by a GDS score of 6 or more. Results During the 24-month follow-up period, 72 participants (2.0%) developed dementia. Baseline MCI was significantly associated with an increased risk of incident dementia (hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.8-5.5) but depressive symptoms were not (2.0; 1.0-4.2) after adjusting for age, sex, education, prescribed medications, and walking speed. Participants with comorbid MCI and depressive symptoms at baseline had a higher risk of developing dementia (HR, 4.8; 2.3-10.5). Conclusion Although MCI and depressive symptoms may be associated with increased risk for incident dementia independently, comorbid MCI and depressive symptoms have a significantly greater impact on dementia development among community-dwelling older adults.

Subjective physical and cognitive age among community-dwelling older people aged 75 years and older: differences with chronological age and its associated factors

Objective: The aim of this cross-sectional study was to determine the associations between self-reported subjective physical and cognitive age, and actual physical and cognitive functions among community-dwelling older people aged 75 years and older. Method: The sample comprised 275 older adults aged 75–91 years. Two questions were asked regarding subjective age: ‘How old do you feel physically?’ and ‘How old do you feel cognitively?’ To assess physical functions, we measured handgrip strength, knee extension strength, standing balance and walking speed. Tests of attention, executive function, processing speed and memory were performed to assess actual cognitive function. Results: Subjective physical and cognitive age was associated with performance on all of the physical and cognitive tests, respectively (p < 0.01). We also found that older adults who reported themselves as feeling older than their chronological age had a slower walking speed and lower scores for word-list memory recall than those who did not report themselves as feeling older than their actual age. Conclusion: These findings suggest that promoting a fast walking speed and good memory function may help to maintain a younger subjective physical and cognitive age in older adults aged 75 years and older.

The association between anorexia of aging and physical frailty: Results from the national center for geriatrics and gerontology’s study of geriatric syndromes

OBJECTIVES The present study examined the association between anorexia of aging and physical frailty among older people. STUDY DESIGN An observational, cross-sectional cohort design was used with a sample of 4417 elderly Japanese citizens living in a community setting. MAIN OUTCOME MEASURES Frailty was operationalized as the following frailty components: slowness, weakness, exhaustion, low level of physical activity, and weight loss. Participants were grouped as non-frail, pre-frail, and frail, and categorized as anorexic or not using questionnaire cutoff scores. Measured covariates were as follows: sociodemographic variables, medical history, life style, body mass index, blood nutrition data, self-rated health, depressive symptoms, and cognitive function. RESULTS The prevalence of anorexia of aging in each group was as follows: non-frail, 7.9%; pre-frail, 14.8%; frail, 21.2% (P for trend<0.001). After adjusting for all covariates, independent associations were identified between anorexia of aging and slowness (OR 1.42, 95% CI: 1.14-1.75, P=0.002), exhaustion (OR 1.39, 95% CI: 1.11-1.74, P=0.004) and weight loss (OR 1.37, 95% CI: 1.05-1.79, P=0.019), but not weakness or low level of physical activity. CONCLUSIONS Anorexia of aging is importantly associated with frailty and the following frailty components: slowness, exhaustion, and weight loss. Future research should prospectively examine frailtys causal connection with anorexia of aging.

Subjective Memory Complaints are Associated with Incident Dementia in Cognitively Intact Older People, but Not in Those with Cognitive Impairment: A 24-Month Prospective Cohort Study

OBJECTIVE Although subjective memory complaints (SMCs) are considered a risk factor for incident dementia in older people, the effect might differ based on cognitive function. The aim of the present study was to investigate whether the effect of SMCs on the incidence of dementia in older people differed based on cognitive function. DESIGN A 24-month follow-up cohort study. SETTING Japanese community. PARTICIPANTS Prospective, longitudinal data for incident dementia were collected for 3,672 participants (mean age: 71.7 years; 46.5% men) for up to 24 months. MEASUREMENTS Baseline measurements included covariates for incident dementia, SMCs, and cognitive function. Associations between SMCs, cognitive impairment, and incident dementia were examined using Cox proportional hazards models. RESULTS Incidences of dementia in the cognitively intact without SMC, cognitively intact with SMC, cognitive impairment without SMC, and cognitive impairment with SMC groups were 0.3%, 1.8%, 3.4%, and 4.8%, respectively. In the cognitively intact participants, SMCs were associated with a significantly higher risk of dementia (hazard ratio [HR]: 4.95, 95% confidence interval [CI]: 1.52-16.11, p = 0.008). Incident dementia with cognitive impairment was not significantly different based on SMC presence (p = 0.527). Participants with cognitive impairment in multiple domains had a significantly higher risk of incident dementia (HR: 2.07, 95% CI: 1.01-4.24, p = 0.046) CONCLUSION: SMCs were related with dementia in cognitively intact older people, but not in those with cognitive impairment.Multiple domains of cognitive impairment were associated with a higher risk of incident dementia.

Association Between Insulin-Like Growth Factor-1 and Frailty Among Older Adults

ObjectivesFrailty is a course experienced in advanced aging. Identification of a biological factor associated with frailty is required. Although serum insulin-like growth factor-1 (IGF-1) is a potential factor related with frailty, consensus has not been reached regarding this relationship. This study aimed to investigate the association between IGF-1 and frailty in older adults.DesignCross-sectional study.SettingCohort study that was part of the “National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes.”ParticipantsThe study participants were 4133 older adults (mean age, 71.8 ± 5.4 years).MeasurementsWe assessed serum IGF-1 levels and frailty status and collected demographic variables, including cognitive function, as covariates.ResultsFrailty and pre-frailty were present in 274 subjects (7%) and 1930 subjects (47%), respectively. Subjects were divided into four groups based on quartiles of IGF-1 levels. Multinomial logistic analysis showed that the lowest group had significant odds of pre-frailty (crude model: odds ratio [OR] 1.58, 95% confidence interval [CI] 1.30–1.90, p <.001; adjusted model: OR 1.38, 95% CI 1.13–1.68, p =.002) and frailty (crude model: OR 3.42, 95% CI 2.38-4.92, p <.001; adjusted model: OR 1.54, 95% CI 1.02–2.32, p =.039), compared with the highest group.ConclusionLower serum IGF-1 levels were independently related with frailty in older adults.

Social Frailty Leads to the Development of Physical Frailty among Physically Non-Frail Adults: A Four-Year Follow-Up Longitudinal Cohort Study

Social frailty domains may play an important role in preventing physical decline and disability. The aim of this study is to examine the impact of social frailty as a risk factor for the future development of physical frailty among community-dwelling older adults who are not yet physically frail. A total of 1226 physically non-frail older adults were analyzed to provide a baseline. Participants completed a longitudinal assessment of their physical frailty 48 months later. Their baseline social frailty was determined based on their responses to five questions, which identified participants who went out less frequently, rarely visited friends, felt less like helping friends or family, lived alone and did not talk to another person every day. Participants with none of these characteristics were considered not to be socially frail; those with one characteristic were considered socially pre-frail; and those with two or more characteristics were considered socially frail. At the four-year follow-up assessment, 24 participants (2.0%) had developed physical frailty and 440 (35.9%) had developed physical pre-frailty. The rates of developing physical frailty and pre-frailty were 1.6% and 34.2%, respectively, in the socially non-frail group; 2.4% and 38.8%, respectively, in the socially pre-frail group; and 6.8% and 54.5%, respectively, in the socially frail group. Participants classified as socially frail at the baseline had an increased risk of developing physical frailty, compared with participants who were not socially frail (OR = 3.93, 95% CI = 1.02–15.15). Participants who were socially frail at the baseline also had an increased risk of developing physical pre-frailty (OR = 2.50, 95% CI = 1.30–4.80). Among independent community-dwelling older adults who are not physically frail, those who are socially frail may be at greater risk of developing physical frailty in the near future. Social frailty may precede (and lead to the development of) physical frailty.

Fear of falling and gait parameters in older adults with and without fall history

Fear of falling (FOF) is associated with spatial and temporal gait parameters in older adults. FOF is prevalent among older adults, both those with and without fall history. It is still unclear whether the relationships between FOF and gait parameters are affected by fall history. The aim of the present study was to compare gait parameters by the presence of FOF and fall history.

Associations between Serum 25-Hydroxyvitamin D Concentration and Physical Performance in Old-Old People Living in a Northern Area of Japan

Purpose: The present study aimed to investigate the relationship between serum 25-hydroxyvitamin D [25(OH) D] levels and physical performance, including muscle strength, balance, and gait speed, in older individuals living in a northern area of Japan (latitude approximately 43°north). Subjects: This was a cross-sectional analysis of 273 community-based older individuals (160 women; mean age, 80.0 years), who participated in the “Population-based and Inspiring Potential Activity for Old-old Inhabitants (PIPAOI)”study. Methods: We collected blood samples to determine serum 25(OH) D levels, and we assessed physical performance according to hand grip strength, knee extensor strength, static standing balance, hip walking distance, normal walking speed, and the results of the Timed-Up-and-Go (TUG) test. The other variables were fall experience in the year prior to the study, the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIGIC), frequency of going outdoors, sun exposure, and exercise habits. Correlations between serum 25(OH) D levels and physical performance as well as other variables were assessed using Pearson’s and Spearman’s correlation analyses. We performed an analysis of covariance (ANCOVA) controlled for age, sex, body mass index, sun exposure, and exercise habits to minimize the influence of confounders on physical performance. Results: We found significant associations between serum 25(OH) D levels and sex (rs=-0.19), bone density as measured by speed of sound in bone (r=0.16), grip strength (r=0.19), frequency of going outdoors (rs=0.16), sun exposure (rs=0.25), and TMIGIC (rs=0.15). After controlling for age, sex, BMI, sun exposure, and exercise habits, total length of the center of gravity of participants with 25(OH)D insufficiency were significantly longer than those of participants with sufficient 25(OH)D levels (p<0.05). Conclusion: Our results suggest that it is important for community-based older individuals to maintain sufficient 25(OH) D levels in order to avoid lowering physical performance.

Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study

Fear of falling (FOF) is a major health problem for older adults, present not just in fallers, but also nonfallers. This study examined the impact of FOF and fall history on disability incidence among community‐dwelling older adults from a prospective cohort study.

Physical Activity during Winter in Old-Old Women Associated with Physical Performance after One Year: A Prospective Study

Background. The aim of this study was to evaluate whether the decline of physical activity during winter influences physical performances (after 1 year) in old-old women. Methods. Fifty-three Japanese women (mean age: 78.4 ± 3.2 years) participated in this study. Data of physical activity was collected by using an accelerometer at baseline and 3-month follow-up, and participants who decreased step counts in this period were defined as declining groups. We measured grip strength, knee extensor strength, total length of the center of gravity, hip walking distance, and maximum walking speed to evaluate physical performances at baseline and 1-year follow-up. Repeated-measures analysis of variance determined the difference in physical performance between declining groups and maintenance group with maintained or improved step counts. Results. Daily step counts for 22 older women (41.5%) decreased during winter. A statistically significant interaction effect between group and time was found for maximum walking speed (F(1,50) = 5.23, p = 0.03). Post hoc comparisons revealed that walking speed in the maintenance group significantly increased compared with baseline (p = 0.01); the declining group showed no significant change (p = 0.44). Conclusion. Change of physical activity during winter influences the physical performance level after 1 year in community-dwelling old-old women, particularly its effect on maximum walking speed.