Takayuki Hotta

Differential Association of Frailty With Cognitive Decline and Sarcopenia in Community-Dwelling Older Adults

OBJECTIVES Frailty in older adults is a serious problem because of various adverse health outcomes in many countries with aging populations, such as Japan. The purpose of this study was to determine whether frailty and pre-frailty are associated with cognitive decline and sarcopenia in community-dwelling older adults. DESIGN This is a cross-sectional study. SETTING Japan. PARTICIPANTS The participants were 273 Japanese community-dwelling older women aged 65 years and older. MEASUREMENTS We used the frailty criteria developed by the Cardiovascular Health Study to define physical frailty. We divided the cohort into nonfrail, prefrail, and frail according to frailty scores. Cognitive decline and memory decline were defined by using the Mini-Mental State Examination and Scenery Picture Memory Test, respectively. Sarcopenia was defined according to the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. RESULTS In the multivariate logistic regression analysis by using non-frail participants as the reference, pre-frail elderly individuals were significantly more likely to have sarcopenia than non-frail elderly individuals [odds ratio (OR): 2.77, 95% confidence interval (CI): 1.05-9.26], but not cognitive decline or memory decline. Frail elderly individuals were significantly more likely to have cognitive decline (OR: 5.76, 95% CI: 1.20-27.6), memory decline (OR: 5.53, 95% CI: 1.64-18.7) and sarcopenia (OR: 19.1, 95% CI: 3.73-98.0) than non-frail elderly individuals. CONCLUSIONS Sarcopenia was associated with pre-frailty and frailty, whereas cognitive decline was associated only with frailty.

Arterial Stiffness Predicts Cognitive Decline in Japanese Community-dwelling Elderly Subjects: A One-year Follow-up Study

AIM The purpose of this study was to determine whether arterial stiffness can be used to predict one-year changes in the cognitive function in Japanese community-dwelling elderly subjects. METHODS A total of 103 Japanese community-dwelling elderly patients joined this study. Information regarding the age, height, weight, gender and past medical history of each participant was obtained. Additionally, arterial stiffness was determined according to the cardio-ankle vascular index (CAVI), and the cognitive function was assessed with the Mini-Mental State Examination (MMSE). One year later, we performed the MMSE in the same subjects. After dividing the cohort according to the 80th percentile of the CAVI (normal and arterial stiffness [AS] groups), we examined whether the degree of cognitive decline, as determined using the pre- and post-MMSE, was significantly different based on the severity of arterial stiffness, adjusted for age, BMI, gender and the pre-MMSE scores. RESULTS Of the 103 subjects who participated in the pre-data collection, 74 (38 men and 36 women, 73.4±4.0 years) joined the post-data collection. We found a significant difference in the change in the post-MMSE scores between the normal and AS groups (pre-MMSE: normal group [27.4±2.1] and AS group [26.9±2.4] and post-MMSE: normal group [27.2±2.1] and AS group [25.5±2.3], F=5.95, p=0.02). For each domain of the MMSE, the changes in MMSE-attention-and-calculation (F=5.11, p=0.03) and MMSE-language (F=4.32, p=0.04) were significantly different according to an ANCOVA. CONCLUSIONS We found that arterial stiffness predicts cognitive decline in Japanese community-dwelling elderly subjects regardless of the initial level of the global cognitive function. This finding indicates the potential use of the degree of arterial stiffness as an indicator for preventing or delaying the onset of dementia in the elderly.

Children with flat feet have weaker toe grip strength than those having a normal arch.

[Purpose] This study investigated the relationship between toe grip strength and foot posture in children. [Subjects and Methods] A total of 619 children participated in this study. The foot posture of the participants was measured using a foot printer and toe grip strength was measured using a toe grip dynamometer. Children were classified into 3 groups; flatfoot, normal, and high arch, according to Staheli’s arch index. The differences in demographic data and toe grip strength among each foot posture group were analyzed by analysis of variance. Additionally, toe grip strength differences were analyzed by analysis of covariance, adjusted to body mass index, age, and gender. [Results] The number of participants classified as flatfoot, normal, and high arch were 110 (17.8%), 468 (75.6%), and 41 (6.6%), respectively. The toe grip strength of flatfoot children was significantly lower than in normal children, as shown by both analysis of variance and analysis of covariance. [Conclusion] A significant difference was detected in toe grip strength between the low arch and normal foot groups. Therefore, it is suggested that training to increase toe grip strength during childhood may prevent the formation of flat feet or help in the development of arch.

The Association between Pregnancy-Related Discomforts and Pre-Pregnancy Body Mass Index in Japanese Women

Objective: To determine the association between pregnancy-related discomforts and pre-pregnancy body mass index in a longitudinal study. Methods: The study included 355 pregnant women (age, 31.1 ± 4.1 years). Participants were divided into three groups according to their pre-pregnancy body mass index: the low body mass index group, normal body mass index group, and high body mass index group. The occurrence of pregnancy-related discomforts during the second and third trimesters was investigated. Binomial logistic regression analysis was used to examine the association between pre-pregnancy body mass index and pregnancy-related discomforts experienced during the last two trimesters. Results: The occurrence of most pregnancy-related discomforts increased in the third trimester, while that of constipation and shoulder stiffness or headache decreased. Based on logistic regression analysis, pre-pregnancy body mass index was significantly associated with various discomforts. The occurrence of hip joint or pubis pain (odds ratio/95% confidence interval = 2.38/1.14–4.95) during the second trimester, and sleeping difficulty (2.00/1.09–3.67), hand or finger stiffness (3.00/1.36–6.45), leg cramps (2.29/1.32–3.98), low back pain (2.20/1.29– 3.75), hip joint or pubis pain (2.14/1.23–3.73), and shoulder stiffness or headache (2.01/1.06–3.82) during the third trimester was significantly higher in the high body mass index group than in the normal body mass index group. The low body mass index group exhibited a significantly a higher occurrence of shoulder stiffness or headache (2.84/1.35–5.96) during the second trimester and constipation (2.28/1.08–4.82) during the third trimester than the normal body mass index group. Conclusion: The occurrence of discomforts decreased or increased during pregnancy. Furthermore, both prepregnancy high and low body mass index represent important risk factors for many pregnancy-related discomforts, compared with a pre-pregnancy normal body mass index.

Body Characteristics of Professional Japanese Keirin Cyclists: Flexibility, Pelvic Tilt, and Muscle Strength

OBJECTIVE: To identify muscle imbalances and pelvic tilt with implications for low back pain in Keirin cyclists. METHODS: We enrolled 16 Keirin cyclists (mean age, 32.2 ± 8.6 years) and 16 college students as controls (24.3 ± 2.3 years). We measured pelvic tilt, heel-buttock distance (HBD), iliopsoas flexibility (using the Thomas test), hamstring flexibility (using the straight-leg-raise [SLR] test), finger floor distance (FFD), and isometric and isokinetic hamstring and quadriceps muscle strength. These parameters were compared between the two groups, as well as between the right and left sides, by using the Mann-Whitney U test or unpaired t test. RESULTS: The results of this study revealed a significant anterior pelvic tilt at standing position and significantly higher HBD, SLR, and FFD in the Keirin cyclists than in the controls. The isokinetic muscle strength of the quadriceps and hamstring, and the hamstring-to-quadriceps ratio at high angular velocity were significantly greater in the Keirin cyclists. No significant differences were found between the right and left sides. CONCLUSION: This study revealed that the Keirin cyclists had an anterior pelvic tilt and imbalance in hip muscle flexibility, but the difference between the right and left sides were not significant.

Age-Related Decline in Chest Wall Mobility: A Cross-Sectional Study Among Community- Dwelling Elderly Women

CONTEXT Chest wall mobility is strongly related to respiratory function; however, the effect of aging on chest wall mobility-and the level at which this mobility is most affected-remains unclear. OBJECTIVE To investigate age-related differences in chest wall mobility and respiratory function among elderly women in different age groups. METHODS This cross-sectional observational study was performed in Himeji City in Hyogo Prefecture and Ayabe City in Kyoto Prefecture in Japan. Inclusion criteria were female sex, age 65 years or older, community resident, and ability to ambulate independently, with or without an assistive device. Thoracic excursion at the axillary and xiphoid levels and at the level of the tenth rib was measured with measuring tape. Respiratory function, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), was assessed by spirometry, and FVC percent predicted (%FVC), FEV1 percent predicted (%FEV1), and FEV1/FVC were calculated. Chest wall mobility and respiratory function were compared among 4 age groups. RESULTS Of 251 potential participants, 132 met the inclusion criteria. Participants were divided into 4 age groups: group 1, 65 to 69 years; group 2, 70 to 74 years; group 3, 75 to 79 years; and group 4, 80 years or older. Statistically significant differences were found in thoracic excursion at the axillary level between groups 1 and 4 and between groups 2 and 4 when adjusted for height and weight (F4.52, P=.01). In addition, statistically significant differences were found in the FVC and FEV1 values between groups 1 and 3 and between groups 2 and 3 (FVC: F4.97, P=.01; FEV1: F6.17, P=.01). CONCLUSION Chest wall mobility at the axillary level and respiratory function decreased with age in community-dwelling women aged 65 years or older. Further longitudinal studies are required to clarify the effects of aging on chest wall mobility and respiratory function.

Association of Lumbopelvic Pain with Pelvic Alignment and Gait Pattern during Pregnancy

Study background: Management of lumbopelvic pain (LPP) during pregnancy is important and the anatomical and movement aspects may be related to LPP. This study aimed to investigate the association of LPP with pelvic alignment and gait pattern during pregnancy.Methods: Fifty-seven pregnant women were categorized into either the LPP or non-LPP (NLPP) group. Anterior pelvic tilt and bilateral difference in pelvic tilt as pelvic asymmetry were measured. An inertial measurement unit was attached at the participants’ L3 spinous process to measure 3-axes acceleration during gait. The degrees of movement symmetry, gait variability, and trunk movement were expressed as the autocorrelation peak (AC), coefficient of variance, and root mean square (RMS), respectively. An independent t-test was used to investigate differences in pelvic alignment and gait parameters between the groups. Multivariate stepwise logistic regression analysis was used to identify parameters that affected LPP. Additionally, multivariate linear regression analyses were performed to determine the parameters affected by LPP. Each significant parameter (from the previous analysis) was included as a dependent variable. Meanwhile, the presence or absence of LPP, BMI, and pregnancy months were included as explanatory variables.Results: In the LPP group, pelvic asymmetry was significantly higher, and the AC and RMS were significantly lower than that in the NLPP group. In the multivariate analysis, pelvic asymmetry and AC significantly affected LPP, while LPP significantly affected pelvic asymmetry and RMS. Conclusion: Pelvic asymmetry and movement asymmetry during gait affect LPP, while LPP affect pelvic asymmetry and trunk movement during gait. Therefore, evaluating both of the pelvic alignment and gait pattern especially focusing on asymmetry is important for management LPP during pregnancy.

Association between comprehensive health literacy and frailty level in community-dwelling older adults: A cross-sectional study in Japan

The present study explored the association between comprehensive health literacy and frailty level in community‐dwelling older adults in Japan.