Yuma Nozaki

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.

Plasma brain natriuretic peptide level in older outpatients with heart failure is associated with physical frailty, especially with the slowness domain

Objective To determine the association between plasma brain natriuretic peptide (BNP) level in patients with heart failure (HF) and physical frailty as well as with each domain of physical frailty. Methods Two hundred and six outpatients of cardiovascular medicine aged 60 years and older who had been hospitalized for HF or had been given a prescription medication for HF were included. Physical frailty was assessed using the following five domains: slowness, weakness, exhaustion, low activity, and shrinking, according to the Cardiovascular Health Study. Patients were divided into nonfrailty and frailty groups according to frailty scores. Plasma BNP level was measured. The 6-min walk test was performed to measure endurance. Results Plasma BNP was significantly different between the two groups (frailty group: 158.0 ± 214.7 pg/mL, nonfrailty group: 65.2 ± 88.0 pg/mL, P < 0.01). Multivariate logistic regression analysis revealed log-transformed plasma BNP (Log BNP) was significantly associated with physical frailty (OR: 1.68, 95% CI: 1.11–2.56), and Log BNP was significantly associated with the slowness domain (walking speed < 1.0 m/s) of physical frailty (OR: 1.75, 95% CI: 1.15–2.67). Additionally, Log BNP was negatively correlated to the 6-minute walk distance (6MWD) (ρ = −0.37, P < 0.01), while 6MWD was positively correlated to walking speed (ρ = 0.66, P < 0.01). Conclusions Plasma BNP level was related to physical frailty, especially in the slowness domain. Endurance may intervene in the associations between plasma BNP level and walking speed.

Cognitive impairment is associated with the absence of fear of falling in community‐dwelling frail older adults

The purpose of the present study was to explore the association between cognitive function and fear of falling in frail/non‐frail older adults in a community setting.

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.

Comparison of Pelvic Alignment among Never-Pregnant Women, Pregnant Women and Postpartum Women (Pelvic Alignment and Pregnancy)

Objective: To compare the pelvic alignment among never-pregnant women, pregnant women, and postpartum women. Methods: A total of 177 nulliparous women (mean age, 18.9 ± 1.0 years), 45 pregnant women between the third and tenth month of pregnancy (mean age, 29.4 ± 3.8 years), and 124 primiparous women between the first and sixth months after delivery (mean age, 30.1 ± 4.4 years) were enrolled in this study. Pelvic alignment was measured by using the anterior superior iliac spine (ASIS) and posterior superior iliac spines (PSIS) as landmarks. The bilateral difference of pelvic tilt was defined as pelvic asymmetry (PA), the distance between bilateral ASIS was defined as the anterior width of the pelvis (AWP), and the distance between the bilateral PSIS was defined as the posterior width of the pelvis (PWP). Results: PA of the pregnant group and postpartum group were significantly greater than the never-pregnant group (2.8 ± 2.4°, 4.2 ± 3.0°, and 3.7 ± 3.2°, respectively, p < 0.001). AWP of the pregnant and postpartum group was wider than the never-pregnant group (24.9 ± 0.3 cm, 24.1 ± 0.1 cm, and 23.6 ± 0.2 cm, respectively, p < 0.001). PWP of the pregnant and postpartum group was narrower than the never-pregnant group (8.2 ± 0.3 cm, 8.6 ± 0.1 cm, and 9.2 ± 0.1 cm, respectively, p = 0.008). In the multivariate regression analysis using never-pregnant women as the reference, pregnant and postpartum women were significantly more likely to have greater PA (β = 0.156, 0.156), wider AWP (β = 0.116, 0.202), and narrower PWP (β = -0.132, -0.147) than never-pregnant women. Conclusions: We found that the alignment of the pelvis was different among never-pregnant, pregnant, and postpartum women.

Subjective cognitive decline and fall risk in community-dwelling older adults with or without objective cognitive decline

BackgroundThe association between subjective cognitive decline and falls has not been clearly determined.AimsOur aim was to explore the effect of subjective cognitive decline on falls in community-dwelling older adults with or without objective cognitive decline.MethodsWe included 470 older adults (mean age 73.6 ± 5.2; 329 women) living in the community and obtained data on fall history directly from the participants. Subjective cognitive decline was assessed using a self-administered question. Objective cognitive function was measured using the Mini-Mental State Examination. Statistical analyses were carried out separately for participants with objective cognitive decline and those without.ResultsA multiple logistic regression analysis showed that, among participants without objective cognitive decline, subjective cognitive decline was positively associated with falls [OR 1.91; 95% confidence interval (CI) 1.17–3.12; p = 0.01). Conversely, among participants with objective cognitive decline, subjective cognitive decline was negatively associated with falls (OR 0.07; 95% CI 0.01–0.85, p = 0.04).DiscussionThe result suggests that the objective–subjective disparity may affect falls in community-dwelling older adults.ConclusionsThe presence of subjective cognitive decline was significantly positively associated with falls among cognitively intact older adults. However, among their cognitively impaired peers, the absence of subjective cognitive decline was positively associated with falls.

Reply to the Letter to the Editor by Mori et al

older adults. It is very important to examine the relationship between sarcopenia and cognitive decline. Another study also found an association between sarcopenia and cognitive impairment,2 and sarcopenia intervention, such as rehabilitation nutrition,3 may contribute to prevent dementia. However, we have several concerns regarding the participants and statistical analyses. First, there appear to be some issues with the variables used in the multivariate logistic regression analysis. In this logistic regression analysis, the model consisted of 7 independent variables (age, sex, body mass index, educational background, family structure, pre-Mini-Mental State Examination [MMSE] scores, and the presence or absence of cognitive deterioration). We think that a reliable logistic regression analysis requires 10 or more events per independent variable.4 Otherwise, the regression coefficients are biased.4 In this study, at least 70 events were needed for 7 independent variables for the analysis to be stable. The regression model used in the study by Nishiguchi et al1 appears to be unstable, because of its relatively small sample size. A total of 131 participants were examined and the maximum possible number of events (the side with fewer numbers of participants with/without cognitive decline) was 65. However, the authors did not describe the number of participants who were classified into the cognitive deterioration group. Second, the number of participants with sarcopenia among 79 participants (38%) who did not complete the follow-up survey was not mentioned. If many of the 79 participants were diagnosed with sarcopenia, the interpretation of the research results might be quite different, because there were only 10 participants in the sarcopenia group. Therefore, the authors should describe the number of participants with sarcopenia, MMSE scores, and reasons for the incompletion of the follow-up survey of the 79 participants. Finally, interpretation of the 2-way analysis of covariance (ANCOVA) is difficult. The authors did not clearly describe whether the dependent variable was the rate of change of MMSE or postMMSE score. In addition, they set more than 1 covariate, although they did not indicate whether or not they examined the interaction between the covariates. Existence of interaction between the covariates may be associated with the results of the 2-way ANCOVA. It would be helpful if the authors could address these concerns so as to clarify their findings.

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 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.