Faculty Profiles - MAKIZAKO Hyuma

Papers - MAKIZAKO Hyuma

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Uemura Kazuki, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Lee Sangyoon, Umegaki Hiroyuki, Kuzuya Masafumi, Suzuki Takao . Effects of Mild Cognitive Impairment on the Development of Fear of Falling in Older Adults: A Prospective Cohort Study. . J Am Med Dir Assoc16 ( 12 ) 1104.e9 - 1104.13 2015.12

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

OBJECTIVES: The aim of this study was to determine whether mild cognitive impairment (MCI) affects the development of fear of falling (FoF) in older adults. DESIGN: Prospective cohort study. SETTING: The Obu Study for Health Promotion in the Elderly, Japan. PARTICIPANTS: A total of 1700 community-dwelling people aged 65 years or older without FoF at baseline participated. MEASUREMENTS: FoF and related variables, such as physical function, self-rated health, depression, and total number of medication doses, were investigated at baseline. Participants also underwent cognitive tests and were divided into cognitive healthy and MCI. Fifteen months after the baseline measurements, we collected information about the status of FoF and fall incidence during the 15-month follow-up. RESULTS: At the 15-month follow-up survey, 452 participants (26.5%) reported the development of FoF. Logistic regression analysis showed that MCI (odds ratio [95% CI] = 1.41 [1.07-1.87]) and a fall incident (3.00 [2.23-4.07]) during follow-up independently predicted the development of FoF, after controlling for demographic factors, physical function, self-rated health, and depression. The odds ratio for the development of FoF in participants with both MCI and a fall incident compared with those without them was 7.34 (4.06-13.3), after controlling for confounding factors. CONCLUSION: MCI predicts the new onset of FoF in older adults, especially when they have experience with falling. Aside from the risk of falling, it is suggested that individuals with MCI are an at-risk population for FoF and related negative consequences in terms of postfall syndrome.

DOI： 10.1016/j.jamda.2015.09.014

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Suzuki Takao . Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment. . Age (Dordr)37 ( 6 ) 120 - 120 2015.12

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

The linkage between gait and cognition has been shown in cases of white matter lesion (WML) that affect gait in older adults. Dual-task walking is believed to be cognitively demanding and to alter trunk movement, and gait impairment in people with mild cognitive impairment (MCI) is highlighted under this condition. However, the association between dual-task walking and structural changes in the brain, particularly with WML, in people with MCI is still unclear. The aim of this study was to examine the association between trunk stability during dual-task walking and WML in 560 older adults with MCI. We measured magnetic resonance imaging (MRI) and gait variables. Gait variables included harmonic ratio in vertical, mediolateral, and anteroposterior directions, analyzed using a tri-axial accelerometer attached to the lower trunk. Walking conditions were normal walking and dual-task walking (counting backwards while walking) conditions. Demographical data and brain atrophy were measured as covariates. Subjects were classified into non-severe WML (n = 451, mean age = 73.2 years) and severe WML (n = 109, mean age = 75.9 years) groups. Linear mixed-effects model analysis controlled for covariates showed dual-task-related changes in all harmonic ratios associated with WML (p < 0.05). Even after adjustment for executive function, harmonic ratio in the mediolateral direction was significantly associated with WML (p < 0.05). Our findings revealed that WMLs were associated with trunk stability in dual-task walking. Further studies are required to investigate the neural basis for deficits in gait ability among MCI subjects.

DOI： 10.1007/s11357-015-9858-x,

Doi Takehiko, Verghese Joe, Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Suzuki Takao . Motoric Cognitive Risk Syndrome: Prevalence and Risk Factors in Japanese Seniors. . J Am Med Dir Assoc16 ( 12 ) 1103.e21 - 1103.e25 2015.12

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

OBJECTIVES: Motoric cognitive syndrome (MCR), a newly described predementia syndrome characterized by cognitive complaints and slow gait, is associated with increased risk of developing dementia. Due to the potential differences in health, behavioral, and lifestyle factors between races that can influence dementia risk, it is important to examine risk factors for MCR in different countries. This study aimed to report the prevalence as well as modifiable factors associated with MCR in Japanese community-dwelling older adults. DESIGN: A cross-sectional design. SETTING: General community. PARTICIPANTS: A total of 9683 older adults (52% women, mean age: 73.6 years) participating in the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes. MEASUREMENTS: Participants were screened for presence of MCR at baseline. The association of selected modifiable risk factors (medical illness, depressive symptoms, and falls) and lifestyle variables (obesity, physical inactivity, smoking, and alcohol consumption) with MCR was examined using multivariate logistic regression analysis. RESULTS: At cross-section, 619 participants met criteria for MCR, with an overall prevalence 6.4% (95% CI 5.9-6.9). A higher prevalence of MCR was seen with advancing age (P < .001), but there were no sex differences. Diabetes (adjusted odds ratio [OR] 1.47, P = .001), depressive symptoms (OR 3.57, P < .001), and falls (OR 1.45, P < .001) were associated with increased risk of MCR. Among the lifestyle factors, obesity (OR 1.26, P = .018) and physical inactivity (OR 1.57, P < .001) were associated with increased risk of MCR. CONCLUSION: MCR is common in the elderly Japanese population. The potentially modifiable risk and lifestyle factors identified for MCR should be further studied to develop interventions.

DOI： 10.1016/j.jamda.2015.09.003

Makizako Hyuma, Tsutsumimoto Kota, Doi Takehiko, Hotta Ryo, Nakakubo Sho, Liu-Ambrose Teresa, Shimada Hiroyuki . Effects of exercise and horticultural intervention on the brain and mental health in older adults with depressive symptoms and memory problems: study protocol for a randomized controlled trial [UMIN000018547]. . Trials16 499 - 499 2015.11

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

BACKGROUND: Depressive symptoms and memory problems are significant risk factors for dementia. Exercise can reduce depressive symptoms and improve cognitive function in older people. In addition, the benefits of horticultural activity on physical and mental well-being have been demonstrated in people with dementia. Although evidence of such non-pharmacological interventions is mounting, no studies have examined whether physical exercise and horticultural activity exert a positive impact on brain and mental health (e.g., depressive symptoms) in non-demented older adults at high risk of cognitive impairment and depression. Therefore, we propose a randomized controlled trial to assess the efficacy and efficiency of physical exercise and horticultural activity in improving brain and mental health in community-dwelling older adults with memory problems and depressive symptoms. METHODS/DESIGN: The 20-week randomized controlled trial will include 90 community-dwelling adults aged 65 years or older with memory problems and depressive symptoms. Participants will be randomized to one of three experiments: exercise, horticultural activity, or educational control group, using a 1:1:1 allocation ratio. The combined exercise program and horticultural activity program will consist of 20 weekly 90-minute sessions. Participants in the exercise group will practice aerobic exercise, muscle strength training, postural balance retraining, and dual-task training. The horticultural activity program will include crop-related activities, such as field cultivation, growing, and harvesting. Participants in the educational control group will attend two 90-minute educational classes during the 6-month trial period. Depressive symptoms and memory performance will be measured by the Geriatric Depression Scale-15, and the Logical Memory subtests of the Wechsler Memory Scale-Revised will be used to measure depressive symptoms and memory performance as primary outcomes, at baseline (prior to randomization), immediately following intervention (6 months from baseline), and 6 months after intervention. Hippocampal volume will be measured at baseline and immediately after intervention, using magnetic resonance imaging. Secondary outcomes will comprise cognitive function, including language, attention/executive performance, and processing speed; brain-derived neurotrophic-factor serum levels; and health-related quality of life. DISCUSSION: This intervention study will determine the clinical importance and efficacy of physical exercise and horticultural activity as non-pharmacological interventions in community-dwelling older adults at high risk of poor brain and mental health. TRIAL REGISTRATION: UMIN000018547 ; registered 7 August 2015.

DOI： 10.1186/s13063-015-1032-3,

Makizako Hyuma, Shimada Hiroyuki, Tsutsumimoto Kota, Lee Sanyoon, Doi Takehiko, Nakakubo Sho, Hotta Ryo, Suzuki Takao . Social Frailty in Community-Dwelling Older Adults as a Risk Factor for Disability. . J Am Med Dir Assoc16 ( 11 ) 1003.e7 - 1003.11 2015.11

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

OBJECTIVE: To determine social frailty status using simple questions and to examine the association between social frailty and disability onset among community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: Japanese community. PARTICIPANTS: A total of 4304 adults age >/=65 years living in the community participated in a baseline assessment from 2011 to 2012. They were followed monthly for incident certification of care needs during the 2 years after the baseline assessment. MEASUREMENTS: Care-needs certification in the national long-term care insurance system of Japan; a self-reported questionnaire including 7 items to define social frailty status, adjustment for several potential confounders such as demographic characteristics; and Kaplan-Meier survival curves for disability incidence by social frailty. RESULTS: During the 2 years, 144 participants (3.3%) were certified as requiring long-term care insurance in accordance with incident disability. Five of the 7 items in the self-reported questionnaire were significantly associated with disability incidence. In the adjusted model including potential covariates, participants who were defined as having social frailty (>/=2/5) (hazard ratio 1.66, 95% confidence interval 1.00-2.74) and prefrailty (=1/5) (hazard ratio 1.53, 95% confidence interval 1.02-2.531), based on 5 items at the baseline assessment, had an increased risk of disability compared with nonfrail participants (=0/5). CONCLUSIONS: Social frailty, assessed using simple questions regarding living alone, going out less frequently compared with the prior year, visiting friends sometimes, feeling helpful to friends or family, and talking with someone every day, has a strong impact on the risk of future disability among community-dwelling older people.

DOI： 10.1016/j.jamda.2015.08.023

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Tsutsumimoto Kota, Suzuki Takao . Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study. . BMJ Open5 ( 9 ) e008462 - e008462 2015.9

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

OBJECTIVE: To examine the relationship between physical frailty and risk of disability, and to identify the component(s) of frailty with the most impact on disability in community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: A Japanese community. PARTICIPANTS: 4341 older adults aged >/=65 living in the community participated in a baseline assessment from 2011 to 2012 and were followed for 2 years. MAIN OUTCOME MEASURES: Care-needs certification in the national long-term care insurance (LTCI) system of Japan, type of physical frailty (robust, prefrail, frail) and subitems (slowness, weakness, exhaustion, low activity, weight loss), adjusted for several potential confounders such as demographic characteristics, analysed with Kaplan-Meier survival curves for incidence of disability by frailty phenotype. RESULTS: During the 2-year follow-up period, 168 participants (3.9%) began using the LTCI system for incidence of disability. Participants classified as frail (HR 4.65, 95% CI 2.63 to 8.22) or prefrail (2.52, 1.56 to 4.07) at the baseline assessment had an increased risk of disability incidence compared with robust participants. Analyses for subitems of frailty showed that slowness (2.32, 1.62 to 3.33), weakness (1.90, 1.35 to 2.68) and weight loss (1.61, 1.13 to 2.31) were related to increased risk of disability incidence. In stratified analyses, participants who were classified as frail and who had lower cognitive function had the highest percentage (30.3%) of disability incidence during the 2 years after baseline assessment. CONCLUSIONS: Physical frailty, even being prefrail, had a strong impact on the risk of future disability. Some components of frailty, such as slowness, weakness and weight loss, are strongly associated with incident disability in community-dwelling older adults.

DOI： 10.1136/bmjopen-2015-008462

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Tsutsumimoto Kota, Lee Sangyoon, Suzuki Takao . Onset of Disability According to Mild Cognitive Impairment Subtype in Community-Dwelling Older Adults in Japan. . J Am Geriatr Soc63 ( 9 ) 1959 - 1961 2015.9

Tsutsumimoto Kota, Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Suzuki Takao . Set-Shifting Ability Is Associated with Gray Matter Volume in Older People with Mild Cognitive Impairment. . Dement Geriatr Cogn Dis Extra5 ( 3 ) 395 - 403 2015.9

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

BACKGROUND/AIMS: An understanding of the association between gray matter volume and executive functioning could provide strategies to reduce dementia risk in older people with mild cognitive impairment (MCI). METHODS: In a cross-sectional analysis, we assessed executive functioning in 83 older people with MCI using three standard neuropsychological tests: set shifting (difference between Trail Making Test Parts B and A), working memory (difference between Digit Span forward and backward from the Wechsler Adult Intelligence Scale-IV), and selective attention/response inhibition (difference between the second and third conditions of the color- and picture-word Stroop test). Gray matter volume was computed from brain MRIs and SIENAX from FSL software. RESULTS: Gray matter volume was significantly associated with set-shifting performance after accounting for age, gender, body mass index, education, and global cognition (standardized beta = -0.376, p = 0.001), but not with working memory or selective attention/response inhibition. CONCLUSION: The executive function of set-shifting ability was correlated with gray matter volume in older people with MCI.

DOI： 10.1159/000438721,

Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Suzuki Takao . Incidence of Disability in Frail Older Persons With or Without Slow Walking Speed. . J Am Med Dir Assoc16 ( 8 ) 690 - 696 2015.8

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

OBJECTIVE: To identify the differences of incidence of disability between frail older persons with and without slow walking speed. DESIGN: Prospective cohort study. SETTING: Japanese community. PARTICIPANTS: A total of l4,081 older adults aged >/=65 years living in the community, participated in a baseline assessment and were followed for incidence of disability for 29.5 months. MEASUREMENTS: Care-needs certification in the national long-term care insurance system of Japan, physical frailty (slow walking speed, muscle weakness, exhaustion, low activity, weight loss), adjusted for several potential confounders such as demographic characteristics; Kaplan-Meier survival curves for incident disability by physical frailty with and without slow walking speed. RESULTS: During the follow-up period, 198 participants (4.9%) were certified as requiring long-term care insurance in accordance with incident disability. Participants who had prefrailty without slow walking speed (hazard ratio 1.86, 95% confidence interval 1.19-2.92), prefrailty with slow walking speed (3.62, 2.19-5.96), frailty without slow walking speed (4.33, 2.00-9.39), and frailty with slow walking speed (4.68, 2.72-8.05) at the baseline assessment had an increased risk of incident disability compared with nonfrail participants. In stratified analyses, frail older men and frail participants with low cognitive performance had the highest risk of incidence of disability. CONCLUSION: The presence of frailty or even prefrailty when older adults showed slow walking speed increased the risk of future disability in community-dwelling older adults.

DOI： 10.1016/j.jamda.2015.03.019

Doi Takehiko, Shimada Hiroyuki, Park Hyuntae, Makizako Hyuma, Tsutsumimoto Kota, Uemura Kazuki, Nakakubo Sho, Hotta Ryo, Suzuki Takao . Cognitive function and falling among older adults with mild cognitive impairment and slow gait. . Geriatr Gerontol Int15 ( 8 ) 1073 - 1078 2015.8

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

AIM: To examine the association of the combination of slow gait and mild cognitive impairment (MCI) with cognitive function and falling in community-dwelling older people. METHODS: Participants were selected from the Obu Study of Health Promotion for the Elderly (n = 3400), and underwent gait examination and a battery of neuropsychological examinations, including the Mini-Mental State Examination and the National Center for Geriatrics and Gerontology Functional Assessment Tool (tablet version of Trail Making Test Part A and B, Symbol Digit Substitution Task, Figure selection task, Word memory and Story memory), and were interviewed with a series of questionnaires including medical history, physical activity, geriatric depression scale and fall history. RESULTS: Participants were classified into control (n = 2281), slow gait speed (SG; n = 278), MCI (n = 673) and MCI with SG (MCI+SG; n = 168) groups. All cognitive functions were significantly affected by the group factor, even adjusting for participant characteristics as covariates (P < 0.001). Post-hoc analysis showed that the control group had better performance than the other groups, and the MCI+SG group had worse performance than the other groups in all cognitive functions (all P < 0.05). In multiple logistic regression analysis, SG and MCI were independently associated with falling (all P < 0.05), and MCI+SG had a higher odds ratio for falling (adjusted OR 1.99, 95% CI 1.08-3.65). CONCLUSIONS: Our findings support the idea that slow gait and MCI were related, and concurrently associated with falling. Motor function among MCI subjects should be focused on to assess profile risks.

DOI： 10.1111/ggi.12407

Hotta Ryo, Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Yoshida Daisuke, Anan Yuya, Tsutsumimoto Kota, Uemura Kazuki, Park Hyuntae, Suzuki Takao . Cigarette smoking and cognitive health in elderly Japanese. . Am J Health Behav39 ( 3 ) 294 - 300 2015.5

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

OBJECTIVE: To examine the relationships between smoking status and various domains of cognitive function in community-dwelling elderly subjects. METHODS: Participants (N = 4348) were asked about smoking status, demographic variables, and lifestyle factors, and underwent multidimensional neurocognitive tests. RESULTS: All analyses were conducted separately by sex. Women never smokers exhibited significantly better scores than past and/or current smokers in some neurocognitive tests. Among men, never smokers had significantly higher scores, such as in the Symbol Digit Substitution Test. Multiple linear regression analysis showed that pack-years (history of smoking) were significantly associated with the Symbol Digit Substitution Test in men. CONCLUSIONS: Smoking status may be associated with a decline in processing speed, and this decline varies by sex.

DOI： 10.5993/AJHB.39.3.1

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Uemura Kazuki, Suzuki Takao . Apolipoprotein E genotype and physical function among older people with mild cognitive impairment. . Geriatr Gerontol Int15 ( 4 ) 422 - 427 2015.4

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

AIM: Mild cognitive impairment (MCI) is conceptualized as prodromal of Alzheimer's disease (AD). Declined physical function is one of the risk factors for progression to AD, whereas genetic factors, especially the apolipoprotein E epsilon4 allele (APOE4), also contribute to the risk of AD and affect the risk factors. However, the association between APOE4 and physical function in MCI is still unclear. To elucidate the association, we carried out the present study to compare physical function between APOE4 carriers and non-carriers in MCI. METHODS: The study included 386 MCI patients (mean age 71.6 years) who were classified into APOE4 carrier and non-carrier groups. The participants' characteristics were assessed by face-to-face interviews. Grip strength, five chair stand test, walking speed and 6-min walking test were measured as physical functions. RESULTS: In univariate analysis, the APOE4 carrier group had decreased walking speed compared with the non-carrier group (P < 0.05), but other measures of physical function were not significantly different between the groups. The linear regression model showed a significant association between walking speed and APOE4 after adjusting for covariates (P < 0.05). CONCLUSIONS: The present study showed that APOE4 carrier participants with MCI had decreased walking speed compared with non-carrier participants. Thus, APOE4 genotypes should be considered as a potential mediator when the measure of walking speed is used as a risk factor of dementia in older adults with MCI. Further studies using prospective data are required to clarify the relationship between physical function and genetic factors in MCI.

DOI： 10.1111/ggi.12291

Lee SungChul, Shimada Hiroyuki, Park Hyuntae, Makizako Hyuma, Lee Sangyoon, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Suzuki Takao . The association between kidney function and cognitive decline in community-dwelling, elderly Japanese people. . J Am Med Dir Assoc16 ( 4 ) 349.e1 - 349.e5 2015.4

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

OBJECTIVES: The aim of this study was to evaluate the relationship between chronic kidney disease (CKD) and cognitive decline in community-dwelling older adults without dementia. DESIGN: Cross-sectional. SETTING: Obu Study of Health Promotion for the Elderly in Japan. PARTICIPANTS: The participants were 4686 residents (community-dwelling older adults without dementia) who completed baseline assessments. MEASUREMENTS: The estimated glomerular filtration rate (eGFR, mL/min/1.73 m(2)) was determined according to the creatinine level, and participants were classified into three mutually exclusive categories: normal (>/=60.0 mL/min/1.73 m(2)), mild CKD (45.0-59.9 mL/min/1.73 m(2)), or moderate to severe CKD (<45.0 mL/min/1.73 m(2)). Cognitive function was assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool. Multivariate logistic regression was used to examine the relationships between eGFR and cognitive decline. RESULTS: After multivariate adjustment, participants with lower eGFR had lower cognitive function scores on most domains (P < .05). In particular, participants with advanced CKD (eGFR <45 mL/min/1.73 m(2)) were more likely to have significant cognitive decline on the Trail Making Test part A (odds ratio = 2.347, 95% confidence interval = 1.525-3.614) and the Symbol Digit Substitution Task (odds ratio = 2.308, 95% confidence interval = 1.486-3.585) than those with normal and mild CKD. CONCLUSIONS: A lower level of kidney function was associated with lower cognitive performance in attention and processing speed. These results suggest that eGFR might be an effective method to screen for cognitive decline in community-dwelling older adults.

DOI： 10.1016/j.jamda.2014.12.009

Makizako Hyuma, Kabe Norihito, Takano Asami, Isobe Kanako . Use of the Berg Balance Scale to predict independent gait after stroke: a study of an inpatient population in Japan. . PM R7 ( 4 ) 392 - 399 2015.4

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

OBJECTIVE: To examine whether the Berg Balance Scale (BBS) score on admission and after 1 month can be used to predict the Functional Independence Measure (FIM) walking level 6 or 7 (modified independent and independent gait respectively) after 3 months and to determine the optimal BBS cut-off score for predicting independent gait among inpatients with first stroke in a rehabilitation facility. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation facility (Kaifukuki). PARTICIPANTS: Two hundred fifty-one consecutive patients with first stroke and nonindependent gait on admission. OUTCOME MEASURES: BBS on admission and after 1 month and FIM on admission and after 3 months. RESULTS: Area under the receiver operating characteristic curves for predicting independent gait after 3 months were 0.81 (95% confidence interval [CI], 0.75-0.88) for BBS score on admission; the optimal cut-off score being >/=13 (63% sensitivity; 90% specificity). Achieving greater cut-off score on admission was significantly associated with subsequent independent gait (odds ratio, 9.7; 95% CI, 4.38-21.36; P < .001). A subanalysis of patients with poor balance on admission (BBS score <13; n = 191) showed area under the receiver operating characteristic curves for predicting independent gait after 3 months of 0.88 (95% CI, 0.80-0.95) for BBS scores 1 month after admission. In this subgroup, BBS scores at 1 month of >/=27 were significantly associated with subsequent independent gait (odds ratio, 21.6, 95% CI, 6.40-73.20; P < .001). CONCLUSIONS: Admission BBS scores predicted FIM walking level 6 or 7, which denotes modified independent or independent gait, after 3 months, the optimal cut-off for BBS scores being >/=13 among inpatients with first stroke in a rehabilitation facility. Patients with poor balance on admission whose BBS scores had improved to >/=27 at 1 month after admission were likely to achieve modified independent or independent gait within 3 months after admission.

DOI： 10.1016/j.pmrj.2015.01.009

Makizako Hyuma, Liu-Ambrose Teresa, Shimada Hiroyuki, Doi Takehiko, Park Hyuntae, Tsutsumimoto Kota, Uemura Kazuki, Suzuki Takao . Moderate-intensity physical activity, hippocampal volume, and memory in older adults with mild cognitive impairment. . J Gerontol A Biol Sci Med Sci70 ( 4 ) 480 - 486 2015.4

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

BACKGROUND: Greater physical activity (PA) is associated with better memory performance and greater hippocampal volume in older adults. However, most studies to date assessed PA via questionnaires and thereby lacked objective characterization of PA (eg, intensity, duration, etc.). Thus, we currently do not have a comprehensive understanding of PA characteristics that are important for neuroprotection, especially among older adults with mild cognitive impairment (MCI). Thus, using triaxial accelerometers, we examined the association between light- and moderate-intensity PA, total duration of PA, hippocampal volume, and memory in older adults with MCI. METHODS: This cross-sectional study involved 310 older adults with MCI who completed neuropsychological tests of memory, and structural magnetic resonance imaging. Participants were instructed to wear the accelerometer on an elastic band on their hip at all times for 2 weeks. Average daily duration of light, moderate, and total PA (min/day) was calculated. RESULTS: Moderate PA was associated with hippocampal volume (beta = .167, p = .003) after controlling for age, but light PA (beta = -.021, p = .713) and total PA (beta = .011, p = .844) were not. Both light and moderate PAs were not associated with memory performance. Structural equation modeling demonstrated that moderate PA was not directly associated with memory but significantly contributed to hippocampal volume; hippocampal volume loss was significantly and directly associated with poor memory performance. CONCLUSIONS: Our results suggest that the benefits of moderate PA on memory among older adults with MCI are mediated by hippocampal volume. Furthermore, light PA may not reduce dementia risk among older adults with MCI.

DOI： 10.1093/gerona/glu136

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Tsutsumimoto Kota, Lee Sangyoon, Hotta Ryo, Nakakubo Sho, Harada Kazuhiro, Lee Sungchul, Bae Seongryu, Harada Kenji, Suzuki Takao . Cognitive functioning and walking speed in older adults as predictors of limitations in self-reported instrumental activity of daily living: prospective findings from the Obu Study of Health Promotion for the Elderly. . Int J Environ Res Public Health12 ( 3 ) 3002 - 3013 2015.3

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

Our aim was to determine whether baseline measures of cognitive functioning, walking speed, and depressive status are independent predictors of limitations in instrumental activities of daily living (IADL) in older adults. The cross-sectional study involved 1329 community-dwelling adults, aged 75 years or older. At baseline, the Mini-Mental State Examination (MMSE), Symbol Digit Substitution Test (SDST), Geriatric Depressive Scale (GDS), and a word list memory task were completed, and self-reported IADLs and walking speed were recorded. The longitudinal study involved 948 participants without baseline IADL limitation, which was assessed at baseline and 15-month follow up, using the three Kihon Checklist subitems. In cross-sectional analyses, participants with IADL limitation demonstrated greater GDS scores, slower walking speeds, and lower MMSE, word list memory task, and SDST (only for women) scores relative to those without IADL limitation. In the longitudinal analyses, baseline walking speed (men: OR 0.98; women: OR 0.97, p<0.05) and word list memory task scores (men: OR 0.84; women: OR 0.83, p<0.05) in both sexes and SDST scores in women (OR 0.96, p=0.04) were independent predictors of subsequent IADL limitation. Walking speed, memory, and processing speed may be independent predictors of IADL limitation in older adults.

DOI： 10.3390/ijerph120303002

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Yoshida Daisuke, Anan Yuya, Tsutsumimoto Kota, Uemura Kazuki, Liu-Ambrose Teresa, Park Hyuntae, Lee Sanyoon, Suzuki Takao . Physical frailty predicts incident depressive symptoms in elderly people: prospective findings from the Obu Study of Health Promotion for the Elderly. . J Am Med Dir Assoc16 ( 3 ) 194 - 199 2015.3

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

OBJECTIVE: The purpose of this study was to determine whether frailty is an important and independent predictor of incident depressive symptoms in elderly people without depressive symptoms at baseline. DESIGN: Fifteen-month prospective study. SETTING: General community in Japan. PARTICIPANTS: A total of 3025 community-dwelling elderly people aged 65 years or over without depressive symptoms at baseline. MEASUREMENTS: The self-rated 15-item Geriatric Depression Scale was used to assess symptoms of depression with a score of 6 or more at baseline and 15-month follow-up. Participants underwent a structural interview designed to obtain demographic factors and frailty status, and completed cognitive testing with the Mini-Mental State Examination and physical performance testing with the Short Physical Performance Battery as potential predictors. RESULTS: At a 15-month follow-up survey, 226 participants (7.5%) reported the development of depressive symptoms. We found that frailty and poor self-rated general health (adjusted odds ratio 1.86, 95% confidence interval 1.30-2.66, P < .01) were independent predictors of incident depressive symptoms. The odds ratio for depressive symptoms in participants with frailty compared with robust participants was 1.86 (95% confidence interval 1.05-3.28, P = .03) after adjusting for demographic factors, self-rated general health, behavior, living arrangements, Mini-Mental State Examination, Short Physical Performance Battery, and Geriatric Depression Scale scores at baseline. CONCLUSIONS: Our findings suggested that frailty and poor self-rated general health were independent predictors of depressive symptoms in community-dwelling elderly people.

DOI： 10.1016/j.jamda.2014.08.017

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Suzuki Takao . Association of insulin-like growth factor-1 with mild cognitive impairment and slow gait speed. . Neurobiol Aging36 ( 2 ) 942 - 947 2015.2

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

The decrease in serum insulin-like growth factor-1 (IGF-I) with aging is related to the neurobiological processes in Alzheimer's disease. IGF-1 mediates effects of physical exercise on the brain, and cognition has a common pathophysiology with physical function, particularly with gait. The aim of this study was to examine whether mild cognitive impairment (MCI) and slow gait are associated with the serum IGF-1 level. A population survey was conducted in 3355 participants (mean age, 71.4 years). Cognitive functions (attention, executive function, processing speed, visuospatial skill, and memory), gait speed, and demographic variables were measured. All cognitive functions and gait speed were associated with the IGF-1 level (p < 0.001). The association of IGF-1 with slow gait was weakened by adjustment for covariates, but MCI and the combination of MCI and slow gait were independently related to the IGF-1 level in multivariate analysis (p < 0.05). Our findings support the association of a low IGF-1 level with reduced cognitive function and gait speed, particularly with a combination of MCI and slow gait.

DOI： 10.1016/j.neurobiolaging.2014.10.035

Doi Takehiko, Makizako Hyuma, Shimada Hiroyuki, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Park Hyuntae, Suzuki Takao . Objectively measured physical activity, brain atrophy, and white matter lesions in older adults with mild cognitive impairment. . Exp Gerontol62 1 - 6 2015.2

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

Physical activity may help to prevent or delay brain atrophy. Numerous studies have shown associations between physical activity and age-related changes in the brain. However, most of these studies involved self-reported physical activity, not objectively measured physical activity. Therefore, the aim of this study was to examine the association between objectively measured physical activity, as determined using accelerometers, and brain magnetic resonance imaging (MRI) measures in older adults with mild cognitive impairment (MCI). We analyzed 323 older subjects with MCI (mean age 71.4 years) who were recruited from the participants of the Obu Study of Health Promotion for the Elderly. We recorded demographic data and measured physical activity using a tri-axial accelerometer. Physical activity was classified as light-intensity physical activity (LPA) or moderate-to-vigorous physical activity (MVPA). Brain atrophy and the severity of white matter lesions (WML) were determined by MRI. Low levels of LPA and MVPA were associated with severe WML. Subjects with severe WML were older, had lower mobility, and had greater brain atrophy than subjects with mild WML (all P<0.05). Multivariate analysis revealed that more MVPA was associated with less brain atrophy, even after adjustment for WML (beta=-0.126, P=0.015), but LPA was not (beta=-0.102, P=0.136). Our study revealed that objectively measured physical activity, especially MVPA, was associated with brain atrophy in MCI subjects, even after adjusting for WML. These findings support the hypothesis that physical activity plays a crucial role in maintaining brain health.

DOI： 10.1016/j.exger.2014.12.011

Ihira Hikaru, Furuna Taketo, Mizumoto Atsushi, Makino Keitaro, Saitoh Shigeyuki, Ohnishi Hirofumi, Shimada Hiroyuki, Makizako Hyuma . Subjective physical and cognitive age among community-dwelling older people aged 75 years and older: differences with chronological age and its associated factors. . Aging Ment Health19 ( 8 ) 756 - 761 2015

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

OBJECTIVE: The aim of this cross-sectional study was to determine the associations between self-reported subjective physical and cognitive age, and actual physical and cognitive functions among community-dwelling older people aged 75 years and older. METHOD: The sample comprised 275 older adults aged 75-91 years. Two questions were asked regarding subjective age: 'How old do you feel physically?' and 'How old do you feel cognitively?' To assess physical functions, we measured handgrip strength, knee extension strength, standing balance and walking speed. Tests of attention, executive function, processing speed and memory were performed to assess actual cognitive function. RESULTS: Subjective physical and cognitive age was associated with performance on all of the physical and cognitive tests, respectively (p < 0.01). We also found that older adults who reported themselves as feeling older than their chronological age had a slower walking speed and lower scores for word-list memory recall than those who did not report themselves as feeling older than their actual age. CONCLUSION: These findings suggest that promoting a fast walking speed and good memory function may help to maintain a younger subjective physical and cognitive age in older adults aged 75 years and older.

DOI： 10.1080/13607863.2014.967169

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