Yuto Tashiro

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.

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.

Effect of Capacitive and Resistive Electric Transfer on Tissue Temperature,Muscle Flexibility, and Blood Circulation

Introduction: The differences between Capacitive and Resistive electric transfer (CRet) and hot pack (HP) in their effects on tissue temperature, muscle flexibility, and blood circulation are unknown. This study aimed to clarify the effect of CRet and HP on tissue temperature, muscle flexibility, and blood circulation. Methods: The participants were 13 healthy adults. They randomly performed three 15-minute interventions: (1) CRet, (2) HP, and (3) without powered CRet (sham). The intervention and measurement were applied to the right hamstring muscle. INDIBA® activ ProRecovery HCR902 was used in the CRet trial. The moist heat method was used in the HP trial. The measurement indexes were superficial temperature (ST), 10-mm deep temperature (DT), and 20-mm DT; the passive straight leg raise (SLR) test; and oxygenated (oxy), deoxygenated (deoxy), and total (total) hemoglobin (Hb) concentrations. Each index was measured for 30 minutes after the intervention and the amount of change (Δ) from the pre-intervention value was calculated. Results: ΔST, Δ10 mmDT, Δ20 mmDT, Δoxy-Hb, and Δtotal-Hb were significantly higher in the CRet and HP trials than in the sham trial for 30 minutes after the intervention (p<0.05). ΔSLR was significantly higher in the CRet trial than in the HP trial from 15 to 30 minutes after the intervention (p<0.01) Conclusion: Our results indicate that CRet is an efficient method for preventing and treating musculoskeletal injuries and improve muscle flexibility. In addition, it can improve blood circulation as well as HP can.

Effect of Capacitive and Resistive electric transfer on haemoglobin saturation and tissue temperature

Abstract Purpose: This study aims to evaluate the effects of Capacitive and Resistive electric transfer (CRet) and hotpack (HP) on haemoglobin saturation and tissue temperature. Materials and methods: The participants were 13 healthy males (mean age 24.5 ± 3.0). They underwent three interventions on different days: (1) CRet (CRet group), (2) HP (HP group) and (3) CRet without power (sham group). The intervention and measurement were applied at the lower paraspinal muscle. Indiba® active ProRecovery HCR902 was used in the CRet group, and the moist heat method was used in the HP group. Oxygenated, deoxygenated and total haemoglobin (oxy-Hb, deoxy-Hb, total-Hb) counts were measured before and after the 15-min interventions, together with the temperature at the skin surface, and at depths of 10 mm and 20 mm (ST, 10mmDT and 20mmDT, respectively). The haemoglobin saturation and tissue temperature were measured until 30 min after the intervention and were collected at 5-min intervals. Statistical analysis was performed for each index by using the Mann–Whitney U test for comparisons between all groups at each time point. Results: Total-Hb and oxy-Hb were significantly higher in the CRet group than in the HP group continuously for 30 min after the intervention. The 10mmDT and 20mmDT were significantly higher in the CRet group than in the HP group from 10- to 30 min after intervention. Conclusions: The effect on haemoglobin saturation was higher in the CRet group than in the HP group. In addition, the CRet intervention warmed deep tissue more effectively than HP intervention.

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.

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.

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.