Mika Sugiyama

Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment

Aim:  The Montreal Cognitive Assessment (MoCA), developed by Dr Nasreddine (Nasreddine et al. 2005), is a brief cognitive screening tool for detecting older people with mild cognitive impairment (MCI). We examined the reliability and validity of the Japanese version of the MoCA (MoCA‐J) in older Japanese subjects.

Effects of Intervention Using a Community-Based Walking Program for Prevention of Mental Decline: A Randomized Controlled Trial

To evaluate the efficacy of a municipality‐led walking program under the Japanese public Long‐Term Care Insurance Act to prevent mental decline.

Association between subjective memory complaints and mental health well-being in urban community-dwelling elderly in Japan

The prevalence of subjective memory complaints (SMC) among the elderly has been reported to be between 25% and 50%. Subjective memory complaints are currently the object of growing interest as a possible predictor for future dementia. However, the direct association between SMC and cognitive decline remains controversial. Our previous study based on 95 communitydwelling older adults aged 65 years and older showed that there was no relationship between objective memory impairment and SMC. Besides cognitive decline, variables such as education, sex, age and others might underlie SMC. As patients with SMC seem distressed by their subjective forgetfulness, we hypothesized that mental health well-being is an important correlate of SMC. Just a few community-based studies have investigated the relationship between SMC and mental health wellbeing in the elderly. We carried out a community-based, cross-sectional study that included 3195 Japanese persons who were: (i) community residents of Chiyoda ward, Tokyo, Japan; (ii) aged 65 years or older; and (iii) not having long-term care insurance certification. Each participant received a self-administered questionnaire. The questionnaire included items regarding SMC, sociodemographic factors (age, sex, years of education, living alone or not, at work or not, social support network) and health-related variables (subjective health, current physical illness, pain, instrumental activities of daily living [IADL], mental health well-being, daytime sleepiness), which might affect mental health well-being. Social support network was assessed by the Japanese version of the abbreviated Lubben Social Network Scale, mental health well-being by the World Health Organization Well-Being Index – five items, daytime sleepiness by the Japanese version of the Epworth Sleepiness Scale, and IADL by the Tokyo Metropolitan Institute of Gerontology Index of Competence. SMC were assessed by the question “Do you feel that your memory has worsened in the last 6 months?” Data were analyzed using PASW Statistics version 18 for Windows (SPSS, Chicago IL, USA). The stepwise linear regression analysis was carried out with SMC as the dependent factor, entering all the health-related variables, and sociodemographic factors including education, sex and age as independent variables. The significance level was set at a = 0.05. A total of 2034 participants (815 males, 1219 females) returned the questionnaire (response rate = 63.7%). The respondents’ mean age was 74.6 1 6.4 years and mean years of education was 13.2 1 3.0 years. Participants with no missing values for SMC (n = 1952) were analyzed. Among participants, 45.9% had SMC (males, 44.4%; females, 46.8%; c = 1.14, P = 0.153). The stepwise linear regression on SMC is shown in Table 1. In the final model, the significant correlates of SMC were lower mental health well-being, older age, daytime sleepiness, pain and lower IADL. The result shows mental health well-being is indeed an important correlate of SMC. In conclusion, findings of the current study, based on 2034 participants aged 65 years and older, show that SMC are significantly associated with lower mental health well-being along with older age, daytime sleepiness, pain and lower IADL among community-dwelling older adults in Japan.

Walking exercise and cognitive functions in community-dwelling older adults: preliminary results of a randomized controlled trial.

The number of epidemiological studies reporting that physical activity (e.g., walking, jogging, yoga, aerobic exercise, strength training) may reduce the risk of cognitive decline in older adults has increased recently. Among the activities, walking exercise is widely adopted as an intervention program to prevent mental decline in many municipalities. However, it is not well known whether these exercise interventions were found to have robust benefits for cognition in older adults. We conducted a pilot study of a randomized controlled trial to evaluate the effectiveness of 20-week walking exercise intervention in maintaining and/or improving cognitive function in community-dwelling older adults and to determine what types of cognitive domains are more susceptible to the intervention. Sixty-five healthy community-dwelling older individuals were randomly allocated to an exercise (N=31) or to control (N=34) groups (see Table 1). The intervention was intended to facilitate walking habits. Each exercise session was conducted once a week and consisted of 30min exercise period and 60min group walk with six to seven people. Cognitive measures were collected at baseline and after 20weeks. The following neuropsychological tests were administered to assess four different domains of cognition (attention/cognitive speed, memory, language, visuospatial function).

Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community.

Polypharmacy is a serious medical problem among older adults. Polypharmacy can cause adverse drug reactions and is associated with frailty. Several drugs, particularly psychotropic medications, can cause cognitive impairment. Recent research also suggests that polypharmacy can cause cognitive impairment. We investigated the prevalence of polypharmacy, and examined the association between polypharmacy and cognitive impairment in a large sample of community‐dwelling older adults in Japan.

Development of the dementia assessment sheet for community-based integrated care system

A series of our studies on the development of the Dementia Assessment Sheet for Community‐based Integrated Care System 21‐items (DASC‐21) were reviewed. Study 1: to examine the distribution of scores and internal reliability of DASC‐21, trained nurses and researchers visited the homes of 1341 participants aged 65 years and older and living in the community. The nurses interviewed the participants and, when possible, their family members, to complete the DASC‐21. Then, the Mini‐Mental State Examination was carried out to select the participants of study 2. Study 2: to examine the concurrent and discriminant validity, experienced psychiatrists and psychologists, who were blind to the findings of study 1, visited the homes of 131 subjects who were selected from the participants of study 1 and completed the Clinical Dementia Rating (CDR), the Mini‐Mental State Examination and the Frontal Assessment Battery (FAB). Cronbachs coefficient alpha of the DASC‐21 was 0.808–0.950. Scores of the DASC‐21 significantly correlated with CDR total and box scores, Mini‐Mental State Examination and Frontal Assessment Battery. In an analysis of variance, CDR had the main effect on the score of the DASC‐21. Receiver operating characteristic analysis showed that the DASC‐21 had sufficient discriminatory ability between dementia (CDR1+) and non‐dementia (CDR0 or CDR0.5; area under the curve = 0.804–0.895). When using a cut‐off point of 30/31, sensitivity was 83.3–94.1% and specificity was 77.3–86.4%. The DASC‐21 has sufficient reliability and validity as a tool to evaluate impairments in daily functioning and in cognitive functions, to detect dementia, and to assess the severity of dementia in the community. Geriatr Gerontol Int 2016; 16 (Suppl. 1): 123–131.

Distribution of Mini-Mental State Examination scores among urban community-dwelling older adults in Japan.

The Mini‐Mental State Examination (MMSE) is widely used as a cognitive screening test for older adults; however, cognitive performance can be affected by age, education, and sample selection bias, including time and place. The aims of this study were to examine the distribution of scores on the Japanese version of the MMSE in an urban community sample and to provide normative data for older Japanese adults.

Excessive daytime sleepiness is related to subjective memory impairment in late life: a cross-sectional community-based study

The aim of this study was to determine whether daytime sleepiness is related to subjective memory impairment among community‐dwelling elderly people, after adjustment for psychosocial variables.

Is community social capital associated with subjective symptoms of dementia among older people? A cross-sectional study in Japan: Social capital and dementia symptoms

Many studies have reported the preventive effects of community social capital on health outcomes, such as mortality and incidence of diseases. However, evidence on the association between community social capital and dementia‐related outcomes remains sparse. The present study examined the contextual association of social capital with subjective symptoms of dementia among community‐dwelling older adults in Japan, using a population‐based, large‐scale questionnaire survey.

Prevalence of depressed mood and loss of interest among community-dwelling older people: Large-scale questionnaire survey and visiting intervention: Depressed mood and loss of interest

Late‐life depression is identified less often by general practitioners than depression in younger adults, but failure to have late‐life depression recognized in a primary care setting can have fatal consequences. The aim of the present study was to examine the prevalence of depressed mood and loss of interest, and identify associated factors among community‐dwelling older adults in a large‐scale study.