Masayuki Ishine

Arterial stiffness independently predicts cardiovascular events in an elderly community : Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110-1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300-2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns.

Stroke-Independent Association Between Metabolic Syndrome and Functional Dependence, Depression, and Low Quality of Life in Elderly Community-Dwelling Brazilian People

OBJECTIVES: Metabolic syndrome (Met.S) is a risk factor for stroke, dementia, and ischemic heart disease (IHD). It is unclear whether Met.S is an independent risk factor for functional dependence, depression, cognitive impairment, and low health‐related quality of life (HRQoL) in a population free of clinical stroke.

A CLOSE ASSOCIATION BETWEEN HEARING IMPAIRMENT AND ACTIVITIES OF DAILY LIVING, DEPRESSION, AND QUALITY OF LIFE IN COMMUNITY‐DWELLING OLDER PEOPLE IN JAPAN

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Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan : VII. Khon Khen in Thailand

Background:  The objective of the present study is to compare the findings of comprehensive geriatric assessment between community‐dwelling elderly people in Korea and in Japan.

Food diversity is closely associated with activities of daily living, depression, and quality of life in community-dwelling elderly people.

The authors are grateful to Ms. Ng Ada Fong Ting for her support during the study. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this letter. Author Contributions: Mr. Wong, Prof. Masters, Dr. Maxwell, and Prof. Abernethy were responsible for study design, data analyses, interpretation of the results, and finalization of the letter. Mr. Wong was responsible for recruitment of participants, data collection, and drafting the letter. Sponsor’s Role: None.

Cardio-Ankle Vascular Index as a Predictor of Cognitive Impairment in Community-Dwelling Elderly People: Four-Year Follow-Up

Background/Aim: The relation between markers of generalized atherosclerosis and cognitive impairment in old age is controversial. The aim of the study was to evaluate the cardio-ankle vascular index (CAVI) as a predictor of longitudinal changes in cognitive function in older individuals. Methods: We evaluated the cognitive function in elderly people with high (AS(+)) and low (AS(–)) values of CAVI each year over 4 years. Results: The changes in the Hasegawa Dementia Scale Revised (HDS-R) and the mini-mental state examination (MMSE) at 4 years were significantly larger in the AS(+) group (AS(+) vs. AS(–) = –1.8 ± 4.4 vs. 0.3 ± 2.8 points and –1.1 ± 3.0 vs. 0.1 ± 2.3 points, p = 0.008 and 0.03, respectively). The annual changes in the HDS-R were significantly decreased from baseline at 1 year later to 4 years later in AS(+) (baseline vs. 1, 2, 3, 4 years = 26.5 vs. 25.0, 25.5, 25.7, 24.8 points, p < 0.001); in comparison, the annual changes in MMSE significantly decreased from the baseline over the 4 years in AS (+) (baseline vs. 1, 2, 3, 4 years = 26.8 vs. 26.2, 25.8, 26.4, 25.7 points, p = 0.002). Conclusion: The results of this study suggest that elderly people with a high CAVI value are at a greater risk of cognitive decline.

Chronoecological health watch of arterial stiffness and neuro-cardio-pulmonary function in elderly community at high altitude (3524 m), compared with Japanese town

Effects of high altitude on arterial stiffness and neuro-cardio-pulmonary function were studied. Blood pressure (BP) and heart rate (HR) were measured in a sitting position on resting Ladakhis, living at an altitude of 3250-4647 m (Phey village, 3250 m: 17 men and 55 women; Chumathang village, 4193 m: 29 men and 47 women; Sumdo village, 4540 m: 38 men and 57 women; and Korzok village, 4647 m: 84 men and 70 women). The neuro-cardio-pulmonary function, including the Kohs block design test, the Up and Go, the Functional Reach and the Button tests, was examined in 40 elderly subjects (19 men and 21 women, mean age: 74.7 +/- 3.3 years) in Leh, Ladakh (altitude: 3524 m), for comparison with 324 elderly citizens (97 men and 227 women, mean age: 80.7 +/- 4.7 years) of Tosa, Japan (altitude: 250 m). Cardio-Ankle Vascular Index (CAVI) was measured as the heart-ankle pulse wave velocity (PWV) in these subjects using a VaSera CAVI instrument (Fukuda Denshi, Tokyo). SpO(2) decreased while Hb and diastolic BP increased with increasing altitude. At higher altitude, residents were younger and leaner. Women in Leh vs. Tosa had a poorer cognitive function, estimated by the Kohs block design test (3.7 +/- 3.6 vs. 16.4 +/- 9.6 points, P < 0.0001) and poorer ADL functions (Functional Reach: 13.7 +/- 7.0 cm vs. 25.3 +/- 8.7 cm, P < 0.0001; Button test: 22.5 +/- 4.8 vs. 14.8 +/- 5.7 s, P < 0.0001). Time estimation was shorter at high altitude (60-s estimation with counting: 41.1% shorter in men and 23.0% shorter in women). A higher voltage of the QRS complex was observed in the ECG of Leh residents, but two times measurement of CAVI showed no statistically significant differences between Leh and Tosa (two times of CAVI measures; 9.49 vs. 10.01 m/s and 9.41 vs. 10.05 m/s, respectively), suggesting that most residents succeed to adapt sufficiently to the high-altitude environment. However, correlation of CAVI with age shows several cases who show an extreme increase in CAVI. Thus, for the prevention of stroke and other adverse cardiovascular outcomes, including dementia, CAVI may be very useful, especially at high altitude. In conclusion, elderly people living at high altitude have a higher risk of cardiovascular disease than low-latitude peers. To determine how these indices are associated with maintained cognitive function deserves further study by the longitudinal follow-up of these communities in terms of longevity and aging in relation to their neuro-cardio-pulmonary function.

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China IV: Comparison of food diversity and its relation to health of Han and Tibetan elderly

Aim:  To examine the association between food diversity and health status of Han and Tibetan elderly highlanders in Qinghai Plateau, China.

COMMUNITY-DWELLING ELDERLY FALLERS IN JAPAN ARE OLDER, MORE DISABLED, AND MORE DEPRESSED THAN NONFALLERS

To the Editor: We read with interest the article published by Somadder et al. The authors document a correlation between depressive symptoms and self-reported numbers of falls in older subjects attending a day hospital in the United Kingdom. They reported that there were no significant differences in age, comorbidities, or performance on activities of daily living (ADLs) between fallers and infrequent fallers in their small population. We reexamined this important issue in community-dwelling elderly people in Japan and found findings different from those of Somadder et al. The study population consisted of 1,261 people aged 65 and older (men 529, women 732, mean age 75.4 7.2) living in T town, Kochi Prefecture, Japan. Fallers were screened using self-reported questionnaires, along with additional tests of ADLs and subjective quality of life (QOL) for community-dwelling older people in 2006. The question ‘‘Do you have any history of a fall within the past year?’’ was used for detecting fallers. Subjects who answered yes to the question were considered to be fallers. For the assessment of basic ADLs, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 0 (completely dependent) to 3 (completely independent) to obtain a basic ADL score (0–21). For advanced ADLs, the Tokyo Metropolitan Institute of Gerontology index of competence rating scale of 0 to 13 was used. This scale includes instrumental self-maintenance (0–5), intellectual activity (0–4), and social role (0–4). Five indicators of QOL (sense of subjective health, relationship with family, relationship with friends, financial satisfaction, and subjective happiness) were rated on a 100-mm visual analogue scale (worst QOL on the left end of the scale, best to the right). The 15-item Geriatric Depression Scale (GDS15) was used for the assessment of depression; a score of 10 or more was considered to indicate depression. A fall risk index with a score ranging from 0 (low risk of fall) to 21 (high risk of fall) was added to those and used for the assessment of risk of falls. Statview version 5.0 (SAS Institute, Inc., Cary, NC) was used for calculating chi-square tests for categorical variables, unpaired t-test for continuous variables, and Spearman correlation (rs) between number of falls and GDS-15 and between fall risk index and GDS-15. The proportion of fallers was 31.6% in this population. Fallers were significantly older (76.9 vs 74.7) and had significantly lower scores for each item of the ADLs and QOLs than nonfallers, even after the adjustment for age (Table 1). The proportion of subjects with depression was significantly

Comprehensive geriatric assessment of elderly highlanders in Qinghai, China I: Activities of daily living, quality of life and metabolic syndrome

Aim:  To reveal the comparison of comprehensive geriatric functions of elderly highlanders in Qinghai Plateau in China among three different ethnic groups.