Shunsuke Murata

Prevalence and associated factors of sarcopenia in elderly subjects with amnestic mild cognitive impairment or Alzheimer disease.

BACKGROUND To date, very little is known about the nature of sarcopenia in subjects with cognitive impairment. The aims of this study were firstly to clarify the prevalence of sarcopenia at various stages of cognitive impairment, and secondly to examine factors related to sarcopenia in men and women with cognitive impairment. METHOD The subjects were 418 outpatients (normal cognition; NC: 35, amnestic mild cognitive impairment; aMCI: 40, Alzheimer disease; AD: 343) who attended the Memory Clinic at the National Center for Geriatrics and Gerontology of Japan during the period from October 2010 to July 2014. Cognitive status, vitality, depressive mood, body mass index, hand grip strength, timed up and go test, skeletal muscle mass and serum levels of 25-hydroxyvitamin D, albumin and creatinine were assessed. Sarcopenia was defined as the presence of both poor muscle function (low physical performance or low muscle strength) and low muscle mass. We performed the univariate and multivariate logistic regression analyses to explore factors associated with sarcopenia. RESULTS The overall prevalence of sarcopenia was 21.1% (NC = 8.6%, aMCI = 12.5%, AD = 23.3%). In both sexes, factors associated with sarcopenia were age (P < .01), body mass index (P < .001) and vitality (P < .05). In women, serum level of 25-hydroxyvitamin D was associated with sarcopenia (P < .05). CONCLUSION Low vitality could be a dementia-specific risk factor for sarcopenia. Prevention of sarcopenia in patients with cognitive impairment should be approached from physical and psychologic points of view.

Association between gait abnormality and malnutrition in a community-dwelling elderly population

Malnutrition is common in older adults, and contributes to the risk of falls and functional impairment. Gait performance also contributes to falls and functional impairment; however, the association between malnutrition and gait performance remains unclear. The purpose of the present study was to investigate the association between malnutrition risk and gait performance.

Sarcopenia is Associated With Impairment of Activities of Daily Living in Japanese Patients With Early-Stage Alzheimer Disease.

Alzheimer disease (AD) is the most common type of dementia. Since there is no basic treatment for AD at present, prevention of AD and care of AD patients are the most urgent challenges. Besides progressive neuropsychiatric deficits, impairment of activities of daily living (ADL) is a characteristic feature of AD.1 The diagnosis and clinical stages of AD are determined by the degree of ADL impairment.2 Prevention of ADL impairment is thus crucial for successful management of AD. Although reasons for ADL impairment in AD may be multifactorial, and include cognitive decline and behavioral and psychological symptoms of dementia (BPSD),3 the detailed mechanism of ADL impairment remains unclear. Recently, nutritional problems and sarcopenia, which is a concept consisting of decreased muscle mass and strength with mobility impairment,4 have received attention in relation to impaired cognitive function. Weight loss often occurs before the diagnosis of dementia, and progresses as disease severity increases. In early-stage AD, total lean mass is reduced and associated with brain atrophy and cognitive function.5 Moreover, our previous study showed that the prevalence of sarcopenia was increased in patients with mild cognitive impairment and AD compared with that in subjects with normal cognition. In addition, factors associated with sarcopenia include low vitality, which is the most common psychiatric symptom of dementia.6 It seems that dementia-associated symptoms such as cognitive decline and low vitality induce sarcopenia even in earlystage AD, resulting in ADL impairment, while decreased muscle mass and strength promote further cognitive decline.5 To our knowledge, very little is known about the impact of sarcopenia on ADL impairment in AD patients. We hypothesized that sarcopenia plays a pivotal role in ADL impairment even in early-stage AD. The aim of this study was to clarify the factors associated with ADL impairment, with consideration of the involvement of sarcopenia in early-stage AD.

Association between the Cardio-Ankle Vascular Index and Executive Function in Community-Dwelling Elderly People.

AIM The aim of this study was to investigate the cross-sectional association between arterial stiffness (AS) measured with the cardio-ankle vascular index (CAVI) and executive function in community-dwelling elderly people. METHODS Subjects were 140 community-dwelling elderly people who participated in the study at Kobe, Japan during the period of August-September 2014, of which 126 (mean age±SD: 73.2±6.1, female: 67.5%) met the inclusion criteria and completed the study. Age, sex, body mass index, global cognition, existence of chronic disease, medication, smoking history, and years of education were assessed. The degree of AS was assessed using CAVI. Executive function was assessed using the Category Word Fluency Test (CWFT), Letter Word Fluency Test (LWFT), and Digit Symbol Substitution Test (DSST). We used a correlation analysis and multiple linear regression analysis to investigate whether higher CAVI was independently associated with lower executive function. RESULTS In the univariate analysis, higher mean CAVI correlated with lower CWFT (rho=－0.21, p=0.020), LWFT (rho=－0.32, p＜0.001), and DSST (rho=－0.31, p＜0.001). In the multivariate analysis, higher mean CAVI was associated with lower LWFT (β=－0.21, p=0.046) after adjusting for confounding factors, although there was no association with CWFT (β=－0.05, p=0.61) and DSST (β=－0.06, p=0.51). CONCLUSIONS We found that high CAVI was associated with lower LWFT. These results suggest that arterial stiffness is associated with lower performance in phonemic fluency.

Association Between Objectively Measured Physical Activity and the Number of Chronic Musculoskeletal Pain Sites in Community-Dwelling Older Adults

Objective. Physical inactivity is recognized as a pandemic health problem. The association of pain with physical activity, particularly when measured objectively, in older adults is unclear. This study investigates the association of number of chronic musculoskeletal pain sites and pain severity with objectively measured physical activity in community‐dwelling older adults. Design. Observational study. Setting. Community. Subjects. We analyzed 267 community‐dwelling older adults (mean age = 75.3 years, 67.0% women). Methods. Number of chronic musculoskeletal pain sites and pain severity were measured using a self‐reported questionnaire. Mean steps per day and mean minutes of light physical activity per day and moderate to vigorous physical activity per day were measured using an accelerometer. Linear regression models were applied to analyze the association of number of chronic musculoskeletal pain sites and pain severity with physical activity. Results. The results suggest that a higher number of chronic musculoskeletal pain sites is associated with lower step count (beta = −333.5, 95% confidence interval = −655.9 to −11.0, P < 0.05) and moderate to vigorous physical activity (beta = −2.5, 95% confidence interval = −4.7 to −0.4, P < 0.05) even after adjustment for age, gender, years of schooling, obesity, alcohol habits, smoking status, number of comorbidities, recent surgery, and depressive symptoms. Conclusions. Our results suggest that the number of chronic musculoskeletal pain sites is associated with low physical activity in older adults. Therefore, low physical activity due to chronic musculoskeletal pain should not be overlooked.

The associations between physical activity, including physical activity intensity, and fear of falling differs by fear severity in older adults living in the community

Objectives Fear of falling (FoF) is common in older adults. Physical activity decreases as FoF increases. However, this association between physical activity and FoF may vary depending on activity intensity. The current study was performed to explore the associations between FoF and step count, light-intensity physical activity (LPA), and moderate/vigorous-intensity physical activity (MVPA), in community-dwelling older adults. Methods This cross-sectional observational study was held at a local community association center, with 242 older adults living independently in the community (mean age: 75.1 5.4 years). FoF was defined using the Falls Efficacy Scale-International and categorized into three levels (low, moderate, and high). Physical activity was measured using a uniaxial accelerometer worn for 7 consecutive days, and by calculating daily step count, LPA, and MVPA, over this period. Results Step count and physical activity intensity showed significant linear trends across FoF severity (p < 0.01, respectively). High FoF decreased step count by approximately 2000 steps/day. Further, high FoF was significantly associated with short durations of both LPA and MVPA. Additionally, moderate FoF was associated with decreased LPA duration, even after adjustment for confounding variables. Discussions Physical activity decreased concomitantly with a rise in FoF severity. Moreover, the association between physical activity and FoF differed by physical activity intensity level in community-dwelling older adults. Further studies are needed to investigate the causal relationship between FoF and objective physical activity in this population.

Association between pain-related fear and presenteeism among eldercare workers with low back pain

Presenteeism (work productivity loss at work) and low back pain (LBP) are prevalent among eldercare workers. Presenteeism is a serious emerging problem in an occupational setting. While many studies report the impact of pain‐related fear on absenteeism, its impact on presenteeism remains unclear.

Is Active Commuting to Work Related to Work Performance Among Male Office Workers

Objective: This study aimed to elucidate the association between active commuting to work (ACW) and work performance among male office workers. Methods: This cross-sectional study included 331 male office workers (age 44.0 ± 11.5 years), with ACW assessed on a self-reported questionnaire and then categorized into non-ACW (0 to 19 minutes) and ACW (≥20 minutes). Work performance [World Health Organization Health and Work Performance Questionnaire (HPQ)] was categorized as high (≥50) and low (<50). Multiple logistic regression models were used to examine the association between ACW and HPQ. Results: We found that 42.2% respondents adopted ACW. After adjusting for demographic data, lifestyle factors, and depressive symptoms, ACW was significantly associated with high HPQ (odds ratio: 2.43; 95% confidence interval: 1.30 to 4.54). Conclusions: In male office workers, ACW was independently associated with higher work performance.

The severity and number of musculoskeletal pain associated with gait in community-dwelling elderly individuals

BACKGROUND The association of quantitative gait characteristics, such as gait variability with musculoskeletal pain is poorly understood. We aimed to examine whether gait speed and gait variability are associated with musculoskeletal pain assessed by the severity and the number of sites in community-dwelling elderly individuals. METHODS A total of 176 elderly individuals participated in this study. The wireless motion-recording sensor units were attached to the lower trunk and heel during gait, and an autocorrelation coefficient was calculated in three directions as parameters of gait variability of trunk movement. Musculoskeletal pain was assessed in two aspects: severity and the number of sites. RESULTS Moderate/severe pain intensity was significantly associated with slow gait speed and low AC in a mediolateral direction (P=0.024 and 0.026, respectively). Participants with musculoskeletal pain in multiple sites had significantly lower autocorrelation coefficient in mediolateral direction than did those without pain (P=0.003). CONCLUSIONS Presence of moderate/severe pain intensity in at least one site or any-intensity pain in multiple sites is associated with slower gait speed and higher gait variability of trunk movement in well-functioning elderly individuals living in the community. Additional studies are necessary to elucidate the causal relationships between musculoskeletal pain and gait.

Association between chronic musculoskeletal pain and executive function in community‐dwelling older adults

We examined the association of chronic musculoskeletal pain with executive function in community‐dwelling older adults.