Taiki Sugimoto

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 metabolic syndrome and disability due to low back pain among care workers

OBJECTIVES To elucidate the association between metabolic syndrome (MetS) and disability due to low back pain (LBP) among care workers. MATERIAL AND METHODS This cross-sectional study enrolled 656 care workers having experienced LBP in the year prior to the year of this study. The Roland-Morris Disability questionnaire (RDQ) and self-reported questionnaires regarding LBP, fear of movement, depressive symptom, psychosocial factors, intensity of pain, and duration of pain were administered, and a medical examination was performed. Metabolic syndrome was defined according to the international definition agreed in 2009. Out of the 656 care workers, we included 316 care workers (response rate: 48.2%) who had fully completed the questionnaires as the study sample (males: 13.6%, median age = 51 years old, range: 35-74 years old). To examine the association between MetS and the level of disability due to LBP, we used the Poisson regression analysis and estimated crude and adjusted prevalence ratios (PR). RESULTS Out of the 316 care workers, 52 (16.5%) were diagnosed as having MetS. Metabolic syndrome was significantly associated with the RDQ score (adjusted PR: 1.57, 95% confidence interval (CI): 1.17-2.11) after adjusting for covariates, such as age, sex, fear of movement, job demands, social support, intensity of pain, and duration of pain. CONCLUSIONS This study showed that MetS was independently associated with disability due to LBP among care workers. A multidisciplinary intervention taking MetS into consideration may be an effective way to reduce disability due to LBP in people with both LBP and MetS. Int J Occup Med Environ Health 2018;31(2):165-172.

Status of glycemic control in elderly patients with cognitive impairment treated by general practitioners relative to the glycemic targets recommended for elderly patients by the Japan Diabetes Society/Japan Geriatrics Society Joint Committee: A retrospec

We investigated the status of glycemic control in elderly patients with cognitive impairment relative to the glycemic targets recommended for elderly patients by the Japan Diabetes Society (JDS)/Japan Geriatrics Society (JGS) Joint Committee. Our results indicated that use of drugs associated with severe hypoglycemia led to excessively lower HbA1c in many patients in categories II and III.

Decreased Glucose Metabolism in Medial Prefrontal Areas is Associated with Nutritional Status in Patients with Prodromal and Early Alzheimer’s Disease

BACKGROUND Weight loss is frequently observed in patients with Alzheimers disease (AD); however, the underlying mechanisms are not well understood. OBJECTS To clarify the associations between nutritional status and AD-related brain changes using Pittsburgh Compound-B (PiB)-PET, fluorodeoxyglucose (FDG)-PET, and structural MRI. METHODS The subjects were 34 amyloid-β (Aβ)-positive individuals with mild cognitive impairment or early AD (prodromal/early AD), and 55 Aβ-negative cognitively normal (CN) subjects who attended the Multimodal Neuroimaging for AD Diagnosis (MULNIAD) study. Nutritional status of the subjects was assessed by body mass index and waist to height ratio (waist circumference/height). The associations between nutritional status and brain changes were examined by multiple regression analysis using statistical parametric mapping. RESULTS In the prodromal/early AD group, nutritional status was significantly positively correlated with regional cerebral glucose metabolism (rCGM) in the medial prefrontal cortices, while different topographical associations were seen in the CN group, suggesting these changes were AD-specific. Aβ deposition and gray matter volume were not significantly associated with nutritional status. Sub-analysis in the prodromal/early AD group demonstrated that fat mass index, but not fat-free mass index, was positively correlated with rCGM in the medial prefrontal areas. CONCLUSION This present study provides preliminary results suggesting that hypometabolism in the medial prefrontal areas is specifically associated with AD-related weight loss, and decrease in fat mass may have a key role.

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.

[Abdominal obesity mediates the association between a low physical activity and a decline in gait speed in community-dwelling elderly people: A cross-sectional study].

AIM A low physical activity leads to obesity and a decline in the physical function. The aim of this cross-sectional study was to examine whether the association between a low physical activity and low physical function was mediated by obesity. METHODS A total of 73 community-dwelling elderly people participated in this study. The analysis included 56 participants without knee and hip osteoarthritis, low cognitive function (the Mini Mental State Examination score <24) and rheumatoid arthritis (mean age±SD: 73.3±4.1, female: 50%). The daily step count was collected as a measure of physical activity by a single axial accelerometer. The physical function was measured by the gait speed. Obesity was measured by the body mass index and waist circumference. To assess whether the association between the physical activity and physical function was mediated by obesity, linear regression models were fitted according to Baron and Kenny procedures for a mediation analysis. A p value <0.05 was considered to be statistically significant. RESULTS The body mass index did not act as a mediator in the association between the physical activity and gait speed, whereas the waist circumference acted as a full mediator in the association between the physical activity and gait speed. CONCLUSION An increased waist circumference mediates the association between a low physical activity and a low physical function in community-dwelling elderly people.

ALTERED REGIONAL CEREBRAL GLUCOSE METABOLISM IN PATIENTS WITH PRODROMAL AND EARLY ALZHEIMER’S DISEASE ASSOCIATED WITH NUTRITIONAL STATUS

lobe atrophy and F -AV1451 PET imaging revealed uptake in the temporal and frontal lobes, as well as in the basal ganglia (Fig 1 C). The regional uptake of F -AV1451 correlated strongly with the tau aggregates revealed using immunohistochemistry (R 1⁄4 0.80, P < 0.01; Fig 2). All cases exhibited negative amyloid (F -flutemetamol) PET scans. Conclusions:The in vivo uptake of F-AV1451 reflects the regional amount of tau aggregates revealed by neuropathological examination. Further, tau pathology inMAPT mutation carriers is accurately detected with F -AV1451 PET, which consequently can be used to track the effects of anti-tau therapies in this patient group.