Faculty Profiles - MAKIZAKO Hyuma

Papers - MAKIZAKO Hyuma

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Uemura Kazuki, Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Park Hyuntae, Suzuki Takao . Age-related changes in prefrontal oxygenation during memory encoding and retrieval. . Geriatr Gerontol Int16 ( 12 ) 1296 - 1304 2016.12

Language：English Publishing type：Research paper (scientific journal)

AIM: Memory dysfunction is a major component of age-related cognitive decline, and is a marker of cognitive impairment. Emerging evidence suggests that the prefrontal cortex is required for maintenance of memory functions. The purpose of the present study was to elucidate age-related changes in prefrontal oxygenation during memory encoding and retrieval using near-infrared spectroscopy. METHODS: We examined 21 young (mean age 24.3 years), 52 young-old (mean age 69.7 years) and 50 old-old (mean age 79.5 years) participants. The concentration of oxyhemoglobin, which is a reliable biomarker of changes in regional cerebral blood flow, in the right and left prefrontal cortex was measured during encoding and delayed retrieval of a list of 10 target words. The average number of correct answers in the retrieval task was used as a measure of task performance. RESULTS: During encoding, oxyhemoglobin was significantly and bilaterally lower in young-old and old-old participants compared with young participants. Meanwhile, during retrieval, only old-old participants showed significantly decreased oxyhemoglobin compared with young and young-old participants. The old-old participants showed fewer correct answers in the retrieval period than the young and young-old participants. CONCLUSIONS: Old-old participants showed reduced prefrontal oxygenation during both encoding and retrieval, and decreased memory performance compared with younger participants. It is necessary for the clinical application of near-infrared spectroscopy to consider the effects of demographic variables on cerebral oxygenation. Geriatr Gerontol Int 2016; 16: 1296-1304.

DOI： 10.1111/ggi.12642

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Makino Keitaro, Suzuki Takao . Comorbid Mild Cognitive Impairment and Depressive Symptoms Predict Future Dementia in Community Older Adults: A 24-Month Follow-Up Longitudinal Study. . J Alzheimers Dis54 ( 4 ) 1473 - 1482 2016.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Older adults with mild cognitive impairment (MCI) are non-demented, but demonstrate cognitive dysfunction, and have significantly higher risk of progressing to dementia. A better understanding of more sensitive risk factors, such as combination of cognitive and psychological status, for progression of MCI to dementia may be crucial for prevention of development of dementia. OBJECTIVE: To examine MCI, depressive symptoms, and comorbid MCI and depressive symptoms as risk factors for development of dementia. METHODS: A total of 3,663 community-dwelling older people were included in this prospective longitudinal study. MCI was determined by age- and education-adjusted objective cognitive impairment using computerized comprehensive cognitive measures including memory, attention/executive function, and processing speed. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and defined by a GDS score of 6 or more. RESULTS: During the 24-month follow-up period, 72 participants (2.0%) developed dementia. Baseline MCI was significantly associated with an increased risk of incident dementia (hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.8-5.5) but depressive symptoms were not (2.0; 1.0-4.2) after adjusting for age, sex, education, prescribed medications, and walking speed. Participants with comorbid MCI and depressive symptoms at baseline had a higher risk of developing dementia (HR, 4.8; 2.3-10.5). CONCLUSION: Although MCI and depressive symptoms may be associated with increased risk for incident dementia independently, comorbid MCI and depressive symptoms have a significantly greater impact on dementia development among community-dwelling older adults.

DOI： 10.3233/JAD-160244

Ihira Hikaru, Makizako Hyuma, Mizumoto Atsushi, Makino Keitarou, Matsuyama Kiyoji, Furuna Taketo . Age-Related Differences in Postural Control and Attentional Cost During Tasks Performed in a One-Legged Standing Posture. . J Geriatr Phys Ther39 ( 4 ) 159 - 164 2016.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND AND PURPOSE: In dual-task situations, postural control is closely associated with attentional cost. Previous studies have reported age-related differences between attentional cost and postural control, but little is known about the association in conditions with a one-legged standing posture. The purpose of this study was to determine age-related differences in postural control and attentional cost while performing tasks at various difficulty levels in a one-legged standing posture. METHODS: In total, 29 healthy older adults aged 64 to 78 years [15 males, 14 females, mean (SD) = 71.0 (3.8) years] and 29 healthy young adults aged 20 to 26 years [14 males, 15 females, mean (SD) = 22.5 (1.5) years] participated in this study. We measured the reaction time, trunk accelerations, and lower limb muscle activity under 3 different one-legged standing conditions-on a firm surface, on a soft surface with a urethane mat, and on a softer more unstable surface with 2 piled urethane mats. Reaction time as an indication of attentional cost was measured by pressing a handheld button as quickly as possible in response to an auditory stimulus. A 2-way repeated-measures analysis of variance was performed to examine the differences between the 3 task conditions and the 2 age groups for each outcome. RESULTS AND DISCUSSION: Trunk accelerations showed a statistically significant group-by-condition interaction in the anteroposterior (F = 9.1, P < .05), mediolateral (F = 9.9, P < .05), and vertical (F = 9.3, P < .05) directions. Muscle activity did not show a statistically significant group-by-condition interaction, but there was a significant main effect of condition in the tibialis anterior muscle (F = 33.1, P < .01) and medial gastrocnemius muscle (F = 14.7, P < .01) in young adults and the tibialis anterior muscle (F = 24.8, P < .01) and medial gastrocnemius muscle (F = 10.8, P < .01) in older adults. In addition, there was a statistically significant interaction in reaction time (F = 8.2, P < .05) for group-by-condition. CONCLUSIONS: The study results confirmed that reaction times in older adults are more prolonged than young adults in the same challenging postural control condition.

DOI： 10.1519/JPT.0000000000000063

Sungchul Lee, Sangyoon Lee, Kazuhiro Harada, Seongryu Bae, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Hyuntae Park, Takao Suzuki, Hiroyuki Shimada . Relationship between chronic kidney disease with diabetes or hypertension and frailty in community-dwelling Japanese older adults. . Geriatrics & gerontology international17 ( 10 ) 1527 - 1533 2016.9Reviewed

Language：English Publishing type：Research paper (scientific journal)

AIM: The aim of the present study was to evaluate the relationship between kidney function with concomitant diabetes or hypertension and frailty in community-dwelling Japanese older adults. METHODS: The participants were 9606 residents (community-dwelling Japanese older adults) who completed baseline assessments. The estimated glomerular filtration rate (mL/min/1.73 m2 ) was determined according to the serum creatinine level, and participants were classified into four mutually exclusive categories: ≥60.0 (normal range), 45.0-59.9, 30.0-44.9 and <30.0 mL/min/1.73 m2 . Frailty status was defined using five criteria as described by Fried: slow gait speed, muscle weakness, low physical activity, exhaustion and unintentional weight loss. Participants who met three, four or five criteria satisfied the definition of having frailty. Multivariate logistic regression was used to examine the relationships between estimated glomerular filtration rate and frailty. RESULTS: After multivariate adjustment, participants with lower kidney function (estimated glomerular filtration rate <30.0 mL/min/1.73 m2 ) were more frail (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.01-3.59). In addition, individuals with a history of diabetes (OR 2.76, 95% CI 1.21-8.24) or hypertension (OR 2.53, 95% CI 1.45-5.12) showed a significantly increased risk of frailty in the lower kidney function group, regardless of multivariate controls. Furthermore, the analyses showed an even greater increase in the risk of frailty in patients with a history of both diabetes and hypertension (OR 3.67, 95% CI 1.13-14.1) CONCLUSIONS: A lower level of kidney function was associated with a higher risk of frailty in community-dwelling Japanese older adults. Geriatr Gerontol Int 2017; 17: 1527-1533.

DOI： 10.1111/ggi.12910

Tsutsumimoto Kota, Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Suzuki Takao . Effects of group exercise programmes on quality of life in older adults with mild cognitive impairment: preliminary results from a randomized controlled trial. . Psychogeriatrics16 ( 5 ) 327 - 328 2016.9

Nakakubo Sho, Doi Takehiko, Makizako Hyuma, Tsutsumimoto Kota, Hotta Ryo, Ono Rei, Suzuki Takao, Shimada Hiroyuki . Sleep Duration and Excessive Daytime Sleepiness Are Associated With Incidence of Disability in Community-Dwelling Older Adults. . J Am Med Dir Assoc17 ( 8 ) 768.e1 - 768.e5 2016.8

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Although sleep disturbances are associated with disability among older adults, no longitudinal study has examined the impact of sleep assessed based on both sleep quality and quantity on incident disability. This study examined whether sleep duration and excessive daytime sleepiness were associated with incidence of disability in community-dwelling older adults. METHODS: A total of 4756 older adults (53.3% women, mean age 71.9 years) met the entry criteria for this study. We measured monthly incident disability, defined as the onset of being certified for personal support or care as required by Japanese public long-term care insurance during the preceding 24 months. Sleep duration, excessive daytime sleepiness (EDS), and demographic factors were assessed at baseline. Cox's proportional hazard regression analysis estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of incidence of disability according to the 3 categories of sleep duration (short: </=6.0 hours, mid: 6.1 to 8.9 hours, long: >/=9.0 hours), and we used mid duration sleepers as the reference group. RESULTS: Long sleep duration (HR 1.43, 95% CI 1.04-1.97) and presence of EDS (HR 1.41, 95% CI 1.01-1.98) were associated with higher rates of incident disability. Furthermore, a combination of sleep duration and EDS was associated with a higher rate of incident disability than the mid and no EDS group (HR 2.25, 95% CI 1.36-3.70). CONCLUSION: Long sleep duration and EDS affected the incident of disability; thus, older adults with both sleep patterns may require an intervention to alter their sleep habit.

DOI： 10.1016/j.jamda.2016.05.020

Takehiko Doi, Helena M Blumen, Joe Verghese, Hiroyuki Shimada, Hyuma Makizako, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Takao Suzuki . Gray matter volume and dual-task gait performance in mild cognitive impairment. . Brain imaging and behavior11 ( 3 ) 887 - 898 2016.7Reviewed International journal

Language：English Publishing type：Research paper (scientific journal)

Dual-task gait performance is impaired in older adults with mild cognitive impairment, but the brain substrates associated with dual-task gait performance are not well-established. The relationship between gray matter and gait speed under single-task and dual-task conditions (walking while counting backward) was examined in 560 seniors with mild cognitive impairment (non-amnestic mild cognitive impairment: n = 270; mean age = 72.4 yrs., 63.6 % women; amnestic mild cognitive impairment: n = 290; mean age = 73.4 yrs., 45.4 % women). Multivariate covariance-based analyses of magnetic resonance imaging data, adjusted for potential confounders including single-task gait speed, were performed to identify gray matter patterns associated with dual-task gait speed. There were no differences in gait speed or cognitive performance during dual-task gait between individuals with non-amnestic mild cognitive impairment and amnestic mild cognitive impairment. Overall, increased dual-task gait speed was associated with a gray matter pattern of increased volume in medial frontal gyrus, superior frontal gyrus, anterior cingulate, cingulate, precuneus, fusiform gyrus, middle occipital gyrus, inferior temporal gyrus and middle temporal gyrus. The relationship between dual-task gait speed and brain substrates also differed by mild cognitive impairment subtype. Our study revealed a pattern of gray matter regions associated with dual-task performance. Although dual-task gait performance was similar in amnestic and non-amnestic mild cognitive impairment, the gray matter patterns associated with dual-task gait performance differed by mild cognitive impairment subtype. These findings suggest that the brain substrates supporting dual-task gait performance in amnestic and non-amnestic subtypes are different, and consequently may respond differently to interventions, or require different interventions.

DOI： 10.1007/s11682-016-9562-1,

Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko . [Exercise and Physical Activity for Dementia Prevention]. . Brain Nerve68 ( 7 ) 799 - 808 2016.7

Language：Japanese Publishing type：Research paper (scientific journal)

The effects of exercise and physical activity on cognitive function and brain health have been established by longitudinal and intervention studies. However, it is not clear whether exercise has positive effects on cognitive function in older adults with mild cognitive impairment. Further studies, including a ramdomized controlled trial with a larger sample size, are required to identify the effects of exercise and multicomponent intervention on cognitive function in the older adults with mild cognitive impairment. It is also important to identify the adequate duration, frequency, and intensity of exercise intervention that is most effective for older individuals.

DOI： 10.11477/mf.1416200512

Sungchul Lee, Hiroyuki Shimada, Sangyoon Lee, Hyuma Makizako, Takehiko Doi, Kazuhiro Harada, Seongryu Bae, Kenji Harada, Ryo Hotta, Kota Tsutsumimoto, Daisuke Yoshida, Sho Nakakubo, Yuya Anan, Hyuntae Park, Takao Suzuki . Association between sedentary time and kidney function in community-dwelling elderly Japanese people. . Geriatrics & gerontology international17 ( 5 ) 730 - 736 2016.6Reviewed

Language：English Publishing type：Research paper (scientific journal)

AIM: The aim of the present study was to evaluate the relationship between sedentary time and declines in kidney function among community-dwelling older adults. METHODS: Participants comprised 10 242 community-dwelling older adults who were participating in the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. Sedentary time was determined by asking participants to record the total amount of hours usually spent sitting each day, with values divided into quartiles of 0 to <4 h (reference), 4 to <6 h, 6 to <8 h and ≥8 h of sitting time per day. The estimated glomerular filtration rate was determined according to creatinine levels, and participants were classified into two categories: ≥60.0 or <60 mL/min/1.73 m2 . RESULTS: After multivariate adjustment, the highest quartiles of sedentary time showed a higher rate of kidney function decline than those in the lowest quartile (odds ratio 1.42, 95% CI 1.02-1.37). In addition, participants with a history of cancer (odds ratio 1.18, 95% CI 1.01-1.39) or hypertension (odds ratio 1.38; 95% CI 1.07-1.60) had significantly increased risks of kidney function decline in the highest sedentary time group, regardless of multivariate control. Furthermore, analyses showed an increased risk of kidney function decline for a history of both cancer and hypertension (odds ratio 2.02, 95% CI 1.08-3.80). CONCLUSIONS: A higher level of sedentary time was associated with kidney function decline among community-dwelling older adults. Geriatr Gerontol Int 2017; 17: 730-736.

DOI： 10.1111/ggi.12779

Uemura Kazuki, Shimada Hiroyuki, Doi Takehiko, Makizako Hyuma, Tsutsumimoto Kota, Park Hyuntae, Suzuki Takao . Reduced prefrontal oxygenation in mild cognitive impairment during memory retrieval. . Int J Geriatr Psychiatry31 ( 6 ) 583 - 591 2016.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Memory impairment is considered a hallmark of amnestic mild cognitive impairment (aMCI) and dementia. Emerging evidence suggests that the prefrontal lobe is required to maintain memory functions. The purpose of this study was to clarify whether older adults with aMCI have decreased prefrontal oxygenation during memory encoding and retrieval compared with age-matched healthy older adults, using multi-channel near-infrared spectroscopy. METHODS: We examined 64 older adults with aMCI (mean 71.8 years) and 66 cognitively healthy control subjects comparable in age and gender (mean 71.7 years). The concentration of oxy-hemoglobin, which is a reliable biomarker of changes in regional cerebral blood flow, was measured in the prefrontal cortex during encoding and delayed retrieval of a list of 10 target words. Task performance was evaluated as average number of correct answers in the retrieval task. RESULTS: Subjects with aMCI showed reduced activation in the bilateral dorsolateral cortex (approximately Brodmann area 9) and provided fewer correct answers in the retrieval period than control subjects. There were no significant differences during encoding. CONCLUSIONS: Reduced activation in the dorsolateral cortex during retrieval may cause deficits in memory performance, which may be used as a marker of aMCI. Further studies are required to examine the predictive validity of this decreased activation pattern for the incidence of Alzheimer's disease.

DOI： 10.1002/gps.4363

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Suzuki Takao . Insulin-Like Growth Factor-1 Related to Disability Among Older Adults. . J Gerontol A Biol Sci Med Sci71 ( 6 ) 797 - 802 2016.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Disability is a crucial health problem in aging. Identifying a biological contributory factor would be useful. Serum insulin-like growth factor-1 (IGF-1) plays an important role in the endocrine system and is associated with frailty. However, there is no consensus about the relationship between IGF-1 and disability. This study aimed to examine whether IGF-1 related to incident disability among older adults. METHODS: The study included 4,133 older adults (mean age, 71.8+/-5.4 years) who were participants in the "Obu Study of Health Promotion for the Elderly" cohort study. We collected information on demographic variables, measured gait speed, Mini Mental State Examination score, and serum IGF-1 at baseline. During follow-up, incident disability was monitored by Long-Term Care Insurance certification. RESULTS: Disability was observed in 212 participants during a mean follow-up duration period of 29.2 months. A log rank test indicated that lower levels of serum IGF-1 were related to incident disability (p = .004). A Cox hazard regression showed a lower quartile in IGF-1 related to disability compared with the highest quartile (Q4), even when adjusting for covariates including gait speed and Mini Mental State Examination score (Q1: hazard ratio = 1.72, 95% confidence intervals: 1.06-2.81; Q2: hazard ratio = 1.64, 95% confidence intervals: 0.99-2.71; Q3: hazard ratio = 1.31, 95% confidence intervals: 0.76-2.25). In the analysis, stratified by sex, there was also significant relationship between IGF-1 and disability among women, but not men. CONCLUSIONS: Lower serum IGF-1 was independently related to disability among older adults.

DOI： 10.1093/gerona/glv167

Tsutsumimoto Kota, Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Yoshida Daisuke, Uemura Kazuki, Anan Yuya, Park Hyuntae, Suzuki Takao . Self-reported exhaustion associated with physical activity among older adults. . Geriatr Gerontol Int16 ( 5 ) 625 - 630 2016.5

Language：English Publishing type：Research paper (scientific journal)

AIM: Self-reported exhaustion (SE) is a clinical complaint that is associated with a wide range of chronic diseases. However, the association of SE with physical activity, physical function or cognitive function among the older adult Japanese population is unclear. The present study aimed to determine the prevalence of SE, as well as whether physical function, cognitive function and physical activity were significant covariates. METHODS: A total of 4607 adults (mean age 71 years) were considered eligible for participation based on the study criteria. SE was evaluated using the Study of Osteoporotic Fracture Index. We also evaluated physical activity, physical function (grip strength, Timed Up & Go) and cognitive function (Mini-Mental State Examination, Trail Making Test part A and B, Symbol Digit Substitution Task). RESULTS: The prevalence of SE ranged from 40.9% to 55.0%, and significantly increased with age. The results of the multiple logistic regression analyses showed that in the adjusted model of the 65-69 years age group, physical activity, Timed Up & Go and Symbol Digit Substitution Task were independently associated with SE. In the 70-79 years age group, physical activity, Timed Up & Go, Trail Making Test part A and B and Symbol Digit Substitution Task were independently associated with exhaustion. Only physical activity was associated with exhaustion in the >/=80 years age group. CONCLUSIONS: The prevalence of SE increased with age in the older adult Japanese population. Exhaustion was strongly associated with reduced daily physical activity, especially in those aged >/=80 years. Further studies should be carried out to determine if physical activity causes SE. Geriatr Gerontol Int 2016; 16: 625-630.

DOI： 10.1111/ggi.12528

Shimada Hiroyuki, Tsutsumimoto Kota, Lee Sangyoon, Doi Takehiko, Makizako Hyuma, Lee Songchul, Harada Kazuhiro, Hotta Ryo, Bae Seongryu, Nakakubo Sho, Uemura Kazuki, Park Hyuntae, Suzuki Takao . Driving continuity in cognitively impaired older drivers. . Geriatr Gerontol Int16 ( 4 ) 508 - 514 2016.4

Language：English Publishing type：Research paper (scientific journal)

AIM: Cognitive impairment can negatively affect driving performance and increase the risk of driving errors, leading to vehicle crashes. We used a population-based survey to identify the prevalence of cognitive impairments in older drivers. METHODS: A total of 10,073 older adults were enrolled in the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. We characterized general cognitive impairment using the Mini-Mental State Examination (MMSE). We also used the National Center for Geriatrics and Gerontology-Functional Assessment Tool, which includes six tasks to assess word list memory, logical memory, attention and executive function, processing speed, and visuospatial skill. RESULTS: Just 15% of older women with moderate cognitive decline (MMSE </=20) drove, whereas 61% of older men with moderate cognitive decline drove. Cognitively normal participants (MMSE score 27 and over) scored significantly better on six cognitive tests compared with those with mild (MMSE score 21-26) or moderate cognitive decline, and those in the mild cognitive decline group scored significantly better on six cognitive tests than those in the moderate cognitive decline group. CONCLUSION: A total of 61% of older men with moderate cognitive decline did not cease driving. These older drivers showed poor cognitive performance in multiple domains compared with those with normal and mild cognitive decline. Further studies are required to clarify the relationships between cognitive decline and car crashes in these high-risk populations.

DOI： 10.1111/ggi.12504

Shimada Hiroyuki, Uemura Kazuki, Makizako Hyuma, Doi Takehiko, Lee Sangyoon, Suzuki Takao . Performance on the flanker task predicts driving cessation in older adults. . Int J Geriatr Psychiatry31 ( 2 ) 169 - 175 2016.2

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: This study examined the predictive validity of flanker tasks on driving cessation in older drivers. The flanker task comprises a set of response inhibition tests used to assess the ability to suppress responses. METHODS: A total of 2805 older drivers aged >/=65 years at baseline participated in this study. We conducted several baseline assessments focused on physical and psychological health as well as cognitive performance. Fifteen months after the baseline measurements, we collected information about the current driving status of the participants. RESULTS: Forty-eight participants (1.7%) ceased driving during the 15-month period following the assessment. Logistic regression models identified the following as significant predictors of driving cessation: performance on the trail-making test (parts A and B), digit symbol substitution test scores, story memory, and flanker task scores for the total, congruent, and incongruent conditions. The flanker task scores for the total, congruent, and incongruent conditions were significant predictors in the fully adjusted logistic model. CONCLUSION: The flanker task was more important than assessments of general cognition, including memory, attention, executive control, and processing speed, in predicting driving cessation. The flanker task may be useful for identifying driving cessation in older adults.

DOI： 10.1002/gps.4308

Tsutsumimoto Kota, Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Hotta Ryo, Nakakubo Sho, Suzuki Takao . Combined Effect of Slow Gait Speed and Depressive Symptoms on Incident Disability in Older Adults. . J Am Med Dir Assoc17 ( 2 ) 123 - 127 2016.2

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: To elucidate whether a combination of slow gait speed and depressive symptoms result in higher risk of incident disability in older adults than either symptom individually. DESIGN: Prospective cohort study. SETTING: Obu City, Aichi Prefecture, Japan. PARTICIPANTS: Participants were 4038 older adults (48.7% male, mean age = 71 years) who met the study inclusion criteria. MEASUREMENTS: Longitudinal data on incident disability were collected up to 33 months [median 31 months (interquartile range 29-32 months)] after baseline. We monitored monthly incident disability, defined as Japanese long-term care insurance certification for personal support or care. Baseline measurements included covariates for incident disability, gait speed, and the Geriatric Depression Scale for assessing depressive symptoms. The associations between slow gait, depressive symptoms, or their co-occurrence, and incident disability were examined. RESULTS: Control participants were the reference in an adjusted Cox proportional hazard regression model. Participants with co-occurring slow gait and depressive symptoms showed a greater risk of incident disability [hazard ratio (HR) 3.08, confidence interval (CI) 95% 2.00-4.75]. Greater risk was also found for participants with slow gait speed alone (HR 2.44, CI 95% 1.71-3.47) and depressive symptoms alone (HR 1.60, CI 95% 1.01-2.53). CONCLUSIONS: Older adults with both risk factors may require early detection and physical and psychological intervention.

DOI： 10.1016/j.jamda.2015.08.012

Harada Kazuhiro, Lee Sangyoon, Park Hyuntae, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Uemura Kazuki, Suzuki Takao . Going outdoors and cognitive function among community-dwelling older adults: Moderating role of physical function. . Geriatr Gerontol Int16 ( 1 ) 65 - 73 2016.1

Language：English Publishing type：Research paper (scientific journal)

AIMS: Identifying the risk factors of cognitive impairment is essential for implementing effective prevention strategies for dementia. Previous studies have shown that the frequency of going outdoors is inversely associated with cognitive decline. Little research has examined whether the relationship between going outdoors and cognitive decline varies with physical functioning in older adults. The aim of the present study was to examine the relationship between going outdoors and cognitive function in older adults with and without physical function limitations. METHODS: The present study analyzed the data of 4450 individuals (aged 65 years or older) who participated in the Obu Study of Health Promotion for the Elderly. The measures were the Mini-Mental State Examination (MMSE), going outdoors (at least once a week or not), self-reported physical function limitations (with or without), and demographic and health-related factors as potential confounders. RESULTS: Analysis of covariance and post-hoc comparisons showed that although going outdoors at least once a week was associated with higher MMSE scores among older adults with limited physical function, it was not significantly associated with the MMSE scores among older adults without limited physical function. Similarly, logistic regression analyses, stratified by physical function, showed a significant association between going outdoors and MMSE (<24 points or not) among older adults with limited physical function. CONCLUSIONS: The results show that going outdoors less than once a week is associated with decreased cognitive function among older adults with limited physical function, but it is not associated with cognitive function among older adults without limited physical function.

DOI： 10.1111/ggi.12437

Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Lee Sangyoon, Suzuki Takao . Cognitive Impairment and Disability in Older Japanese Adults. . PLoS One11 ( 7 ) e0158720 - e0158720 2016

Language：English Publishing type：Research paper (scientific journal)

The prevalence of disability is increasing due to an expanding aging population and an increasing incidence of chronic health problems. Cognitive impairment may predict the development of disability in older adults. Therefore, we examined the association of mild cognitive impairment (MCI) and/or general cognitive impairment (GCI, defined as a Mini Mental State Examination [MMSE] score of 20-23) with the development of disability in a cohort of Japanese community-dwelling older adults. A total of 4290 participants (aged >/=65 years) enrolled in the Obu Study of Health Promotion for the Elderly were classified according to the presence and degree of cognitive impairment as follows: cognitively healthy, GCI, MCI single domain (MCIs), MCIs with GCI, MCI multiple domain (MCIm), and MCIm with GCI. MMSE scores, risk factors for dementia, and incidences of new disability were recorded. After an average of 29.5 months, 205 participants (4.8%) experienced a new onset of disability. All subtypes of cognitive impairment showed significant relationships with disability except for GCI alone. The following hazard ratios (HRs) were determined: MCIs (HR, 2.04; 95% CI, 1.39-3.00), MCIs with GCI (HR, 2.10; 95% CI, 1.21-3.62), MCIm (HR, 2.32; 95% CI, 1.39-3.85), and MCIm with GCI (HR, 4.23; 95% CI, 2.73-6.57). These results indicate that cognitive impairment may be related to an increased risk for the development of disability. Healthcare providers should implement global cognitive assessments to identify MCI and GCI and consider preventive interventions for disability, especially in older persons.

DOI： 10.1371/journal.pone.0158720,

Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Doi Takehiko . Driving and Incidence of Functional Limitation in Older People: A Prospective Population-Based Study. . Gerontology62 ( 6 ) 636 - 643 2016

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Many studies have examined the negative social and health consequences of driving cessation in later life. However, whether the transition to driving cessation results in the incidence of functional limitation in older people remains unclear. OBJECTIVE: The aim of this study was to examine whether driving cessation was associated with the incidence of functional limitation in older Japanese individuals. METHODS: The study included 3,556 participants (mean age: 71.5 +/- 5.3 years, 50.2% women) enrolled in the 'Obu Study of Health Promotion for the Elderly' cohort study between August 2011 and February 2012. The participants were classified into three groups according to their driving status: driving, driving cessation, and nondriving. We assessed new incidence of functional limitation over a 24- month period and examined several confounding factors. RESULTS: The incidence rates for functional limitation in the driving, driving cessation, and nondriving groups were 0.9, 10.8, and 5.6%, respectively (p < 0.001). The fully adjusted Cox proportional hazard model showed that hazard ratios (HRs) for functional limitation in nondrivers [HR: 2.37, 95% confidence interval (CI): 1.27-4.44] and those who had ceased driving (HR: 7.80, 95% CI: 2.61-23.36) were significantly higher relative to those observed in current drivers. CONCLUSION: Driving cessation exerted a strong impact on the risk of functional limitation. Further study is required to determine appropriate intervention strategies to help older people to maintain the abilities required for safe driving and delay the functional limitation associated with driving cessation.

DOI： 10.1159/000448036

Shimada H, Makizako H, Lee S, Doi T, Lee S, Tsutsumimoto K, Harada K, Hotta R, Bae S, Nakakubo S, Harada K, Suzuki T . Impact of Cognitive Frailty on Daily Activities in Older Persons. . J Nutr Health Aging20 ( 7 ) 729 - 735 2016

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: To identify the relationships between physical and/or cognitive frailty and instrumental activities of daily living (IADL) functioning in community living older persons. DESIGN: Cross sectional observation study. SETTING: Data extracted from the 2011-2013 of the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes (NCGG-SGS) database. PARTICIPANTS: A total of 8,864 older adults aged >/= 65 years who were enrolled in the NCGG-SGS. MEASUREMENTS: We characterized physical frailty as limitations in three or more of the following five domains: slow walking speed, muscle weakness, exhaustion, low activity and weight loss. To screen for cognitive impairment, we used the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) which included tests of word list memory, attention and executive function (tablet version of the Trail Making Test, part A and B), and processing speed (tablet version of the Digit Symbol Substitution Test). Two or more cognitive impairments indicated by an age-adjusted score of at least 1.5 standard deviations below the reference threshold was characterized as cognitive impairment. Each participant reported on their IADL status (use of public transportation, shopping, management of finances, and housekeeping) and several potential confounders such as demographic characteristics. RESULTS: The overall prevalence of physical frailty, cognitive impairment, and cognitive frailty, i.e. co-occurrence of frailty and cognitive impairment, was 7.2%, 5.2%, and 1.2%, respectively. We found significant relationships between IADL limitations and physical frailty (Odds Ratio (OR) 1.24, 95% confidence interval (95% CI) 1.01 to 1.52), cognitive impairment (OR 1.71, 95% CI 1.39 to 2.11), and cognitive frailty (OR 2.63, 95% CI 1.74 to 3.97). CONCLUSION: Using the NCGG-SGS frailty criteria, we found more participants with physical frailty than with cognitive frailty. The individuals with cognitive frailty had the highest risks of IADL limitations. Future investigation is necessary to determine whether this population is at increased risk for incidence of disability or mortality.

DOI： 10.1007/s12603-016-0685-2

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Suzuki Takao . Mild Cognitive Impairment, Slow Gait, and Risk of Disability: A Prospective Study. . J Am Med Dir Assoc16 ( 12 ) 1082 - 1086 2015.12

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: Mild cognitive impairment (MCI) may be a risk for disability, and co-occurrence of slow gait (SG) and MCI may increase this risk. DESIGN: Prospective study. SETTING: General community. PARTICIPANTS: The study included 3482 older adults (mean age: 71.4 years) without disability at baseline. MEASUREMENTS: We collected information on demographic variables, measured gait speed and cognitive function to diagnose MCI at baseline. During the follow-up period, the incident disability was monitored. Participants were divided into groups without MCI and SG (control), with SG without MCI (SG), without SG and with MCI in single (sMCI) or multiple (mMCI) domains, and with SG and MCI in single (sMCI + SG) and multiple (mMCI + SG) domains. RESULTS: During follow-up, 134 participants developed disability (mean follow-up: 29.4 months). The proportions of incident disability were higher in the MCI with SG, MCI, and SG groups, compared with the control group. SG [hazard ratio 2.27 (95% confidence interval: 1.38-3.73)], mMCI [2.56 (1.31-5.02)], sMCI + SG [2.46 (1.21-5.00)], and mMCI + SG [3.48 (1.79-6.76)] participants had risks for disability. CONCLUSIONS: Co-occurrence of SG and MCI in multiple domains has a higher risk of disability than each condition alone.

DOI： 10.1016/j.jamda.2015.07.007

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