研究者詳細 - 牧迫　飛雄馬

論文 - 牧迫　飛雄馬

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Makizako Hyuma, Doi Takehiko, Shimada Hiroyuki, Park Hyuntae, Uemura Kazuki, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Suzuki Takao . Relationship between going outdoors daily and activation of the prefrontal cortex during verbal fluency tasks (VFTs) among older adults: a near-infrared spectroscopy study. . Arch Gerontol Geriatr56 ( 1 ) 118 - 123 2013年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

This study sought to investigate the relationship between going outdoor daily and prefrontal cortex activation during execution of the VFT using near-infrared spectroscopy (NIRS) in community-dwelling older adults. Blood oxygenation changes in left and right prefrontal cortices were measured in twenty older adults (mean age 76.1 +/- 6.7 years) by NIRS during VFT performance. In this task, participants were required to pronounce as many nouns as possible beginning with the letters "Shi," "I," and "Re." Changes in oxygenated hemoglobin (oxy-Hb) levels during the VFT were compared between two groups defined by the frequency of going outdoors: daily or non-daily within a week. Participants in both groups exhibited significantly increased oxy-Hb levels in the left and right prefrontal cortices during the VFT compared to a resting baseline condition. After controlling for age and gender, there were significant group-by-condition interactions on oxy-Hb levels with less activation during the execution of the VFT over both cortices in the non-daily group (left: F=4.76, p=0.04; right: F=6.32, p=0.02). These findings indicate that going outdoors daily is associated with increased activation in the prefrontal cortices during VFT performance in community-dwelling older adults.

DOI： 10.1016/j.archger.2012.08.017

Uemura Kazuki, Shimada Hiroyuki, Makizako Hyuma, Yoshida Daisuke, Doi Takehiko, Yamada Minoru, Suzuki Takao . Factors associated with life-space in older adults with amnestic mild cognitive impairment. . Geriatr Gerontol Int13 ( 1 ) 161 - 166 2013年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

AIM: Restriction of life-space is associated with physical performance and functional decline in older adults. Little is known about the factors associated with life-space in older adults with amnestic mild cognitive impairment (aMCI). The purpose of this study was to identify factors associated with life-space in older adults with aMCI. METHODS: The study participants were 69 older adults (mean age 74.5 years, males 56.5%) who were identified with aMCI. Life-space mobility was measured using a Japanese translation of the life-space assessment (LSA). Age, sex, cognitive function (general function, executive function and processing speed), physical performance, instrumental activities of daily living status (IADL) and fear of falling (FoF) were measured as potential relevant factors. RESULTS: Univariate analysis showed that the LSA was associated with FoF, sex, physical performance, processing speed and IADL. In the stepwise regression analysis, FoF, processing speed and IADL maintained a significant association with the LSA scores, although sex and physical performance did not reach significance. CONCLUSION: The results suggest that the restrictions of life-space in older adults with aMCI were more affected by the FoF, slower processing speed and restricted IADL than sex or physical performance.

DOI： 10.1111/j.1447-0594.2012.00878.x

Uemura Kazuki, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Suzuki Takao . Cognitive function affects trainability for physical performance in exercise intervention among older adults with mild cognitive impairment. . Clin Interv Aging8 97 - 102 2013年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Although much evidence supports the hypothesis that cognitive function and physical function are interrelated, it is unclear whether cognitive decline with mild cognitive impairment influences trainability of physical performance in exercise intervention. The purpose of this study was to examine the association between cognitive function at baseline and change in physical performance after exercise intervention in older adults with mild cognitive impairment. METHODS: Forty-four older adults diagnosed with mild cognitive impairment based on the Peterson criteria (mean age 74.8 years) consented to and completed a 6-month twice weekly exercise intervention. The Timed Up and Go (TUG) test was used as a measure of physical performance. The Mini-Mental State Examination (MMSE), Trail Making Test Part B, Geriatric Depression Scale, baseline muscle strength of knee extension, and attendance rate of intervention, were measured as factors for predicting trainability. RESULTS: In the correlation analysis, the change in TUG showed modest correlations with attendance rate in the exercise program (r = -0.354, P = 0.027) and MMSE at baseline (r = -0.321, P = 0.034). A multiple regression analysis revealed that change in TUG was independently associated with attendance rate (beta = -0.322, P = 0.026) and MMSE score (beta = -0.295, P = 0.041), controlling for age and gender. CONCLUSION: General cognitive function was associated with improvements in physical performance after exercise intervention in subjects with mild cognitive impairment. Further research is needed to examine the effects of exercise programs designed to address cognitive obstacles in older adults with mild cognitive impairment.

DOI： 10.2147/CIA.S39434,

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Lee Sangyoon, Park Hyuntae, Tsutsumimoto Kota, Uemura Kazuki, Yoshida Daisuke, Anan Yuya, Suzuki Takao . Cognitive activities and instrumental activity of daily living in older adults with mild cognitive impairment. . Dement Geriatr Cogn Dis Extra3 ( 1 ) 398 - 406 2013年

記述言語：英語掲載種別：研究論文（学術雑誌）

AIMS: This study aimed to identify differences in the implementation of cognitive activities and instrumental activities of daily living (IADLs) between healthy individuals and subjects with mild cognitive impairment (MCI). METHODS: The study included 2,498 cognitively healthy subjects (mean age, 71.2 +/- 5.1 years) and 809 MCI subjects (mean age, 71.8 +/- 5.4 years). The subjects were interviewed regarding their participation in cognitive activities and the implementation of IADLs. RESULTS: We found a significant association between participation in any cognitive activities (p < 0.001), using a bus or a train (p < 0.001), and MCI. After adjusting for covariates, cognitive activity of any type remained significantly associated with MCI (p < 0.005) but not with the implementation of IADLs. CONCLUSIONS: Our study revealed that greater participation in cognitive activity was associated with lower odds of MCI. Participation in cognitive activities may reflect differences between healthy and MCI subjects. To clarify the causal relationship between cognitive activities and MCI, further studies are required.

DOI： 10.1159/000355553,

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Park Hyuntae, Yoshida Daisuke, Suzuki Takao . Six-minute walking distance correlated with memory and brain volume in older adults with mild cognitive impairment: a voxel-based morphometry study. . Dement Geriatr Cogn Dis Extra3 ( 1 ) 223 - 232 2013年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND/AIMS: High fitness levels play an important role in maintaining memory function and delaying the progression of structural brain changes in older people at risk of developing dementia. However, it is unclear which specific regions of the brain volume are associated with exercise capacity. We investigated whether exercise capacity, determined by a 6-min walking distance (6MWD), is associated with measures of logical and visual memory and where gray matter regions correlate with exercise capacity in older adults with mild cognitive impairment (MCI). METHODS: Ninety-one community-dwelling older adults with MCI completed a 6-min walking test, structural magnetic resonance imaging scanning, and memory tests. The Wechsler Memory Scale-Revised Logical Memory and Rey-Osterrieth Complex Figure Tests were used to assess logical and visual memory, respectively. RESULTS: The logical and visual memory tests were positively correlated with the 6MWD (p < 0.01). Poor performance in the 6MWD was correlated with a reduced cerebral gray matter volume in the left middle temporal gyrus, middle occipital gyrus, and hippocampus in older adults with MCI. CONCLUSIONS: These results suggest that a better 6MWD performance may be related to better memory function and the maintenance of gray matter volume in older adults with MCI.

DOI： 10.1159/000354189,

Suzuki Takao, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Ito Kengo, Shimokata Hiroshi, Washimi Yukihiko, Endo Hidetoshi, Kato Takashi . A randomized controlled trial of multicomponent exercise in older adults with mild cognitive impairment. . PLoS One8 ( 4 ) e61483 - e61483 2013年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: To examine the effect of multicomponent exercise program on memory function in older adults with mild cognitive impairment (MCI), and identify biomarkers associated with improvement of cognitive functions. METHODOLOGY/PRINCIPAL FINDINGS: Subjects were 100 older adults (mean age, 75 years) with MCI. The subjects were classified to an amnestic MCI group (n = 50) with neuroimaging measures, and other MCI group (n = 50) before the randomization. Subjects in each group were randomized to either a multicomponent exercise or an education control group using a ratio of 1ratio1. The exercise group exercised for 90 min/d, 2 d/wk, 40 times for 6 months. The exercise program was conducted under multitask conditions to stimulate attention and memory. The control group attended two education classes. A repeated-measures ANOVA revealed that no group x time interactions on the cognitive tests and brain atrophy in MCI patients. A sub-analysis of amnestic MCI patients for group x time interactions revealed that the exercise group exhibited significantly better Mini-Mental State Examination (p = .04) and logical memory scores (p = .04), and reducing whole brain cortical atrophy (p<.05) compared to the control group. Low total cholesterol levels before the intervention were associated with an improvement of logical memory scores (p<.05), and a higher level of brain-derived neurotrophic factor was significantly related to improved ADAS-cog scores (p<.05). CONCLUSIONS/SIGNIFICANCE: The results suggested that an exercise intervention is beneficial for improving logical memory and maintaining general cognitive function and reducing whole brain cortical atrophy in older adults with amnestic MCI. Low total cholesterol and higher brain-derived neurotrophic factor may predict improvement of cognitive functions in older adults with MCI. Further studies are required to determine the positive effects of exercise on cognitive function in older adults with MCI. TRIAL REGISTRATION: UMIN-CTR UMIN000003662 ctr.cgi&quest;function&hairsp;=&hairsp;brows&action&hairsp;=&hairsp ;brows&type&hairsp;=&hairsp;summary&recptno&hairsp;=&hairsp;R000004 436&language&hairsp;=&hairsp;J.

DOI： 10.1371/journal.pone.0061483,

Shimada Hiroyuki, Suzuki Takao, Suzukawa Megumi, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Uemura Kazuki, Ito Tadashi, Lee Sangyoon, Park Hyuntae . Performance-based assessments and demand for personal care in older Japanese people: a cross-sectional study. . BMJ Open3 ( 4 ) 2013年

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVES: To identify appropriate clinical tests for determining the demand for personal care in older Japanese people. DESIGN: Cross-sectional observation study. SETTING: Obu Study of Health Promotion for the Elderly (Obu, Aichi) and Tsukui Ordered Useful Care for Health (241 day-care centres) cohorts in Japan. PARTICIPANTS: A total of 10 351 individuals aged 65 years or older (6791 with personal care and 3560 without personal care) participated in the study. MEASURES: Physical performance tests included grip strength, the chair stand test, walking speed at a comfortable pace, and the timed up-and-go test. Personal care was defined as participants who had been certified in the national social long-term care insurance in Japan. RESULTS: Individuals who received personal care showed a significantly poorer performance than those without personal care for all physical performance tests (p<0.001). Gait speed was the most useful of the physical performance tests to determine the demand for personal care (receiver operating characteristic curve statistics: men, 0.92; women, 0.94; sensitivity: men, 86; women, 90; specificity: men, 85; women, 85). After adjustment for age, sex, cognitive impairment and other physical tests, all physical performance tests were individually associated with the demand for personal care. A slow gait speed (<1 m/s) was more strongly correlated with the demand for personal care than other performance measures (gait speed OR: 5.9; 95% CI: 5.0 to 6.9). CONCLUSIONS: Clinical tests of physical performance are associated with the demand for personal care in older people. Preventive strategies to maintain physical independence may be required in older adults who show a gait speed slower than 1 m/s. Further research is necessary to confirm these preliminary results.

DOI： 10.1136/bmjopen-2012-002424

Makizako Hyuma, Doi Takehiko, Shimada Hiroyuki, Yoshida Daisuke, Tsutsumimoto Kota, Uemura Kazuki, Suzuki Takao . Does a multicomponent exercise program improve dual-task performance in amnestic mild cognitive impairment? A randomized controlled trial. . Aging Clin Exp Res24 ( 6 ) 640 - 646 2012年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: There has been much interest in exercise interventions as a primary behavioral prevention strategy against cognitive decline. The aim of this study was to evaluate the effect of a multicomponent exercise program on physical and dual-task performances in community-dwelling older adults with amnestic mild cognitive impairment (aMCI). METHODS: Fifty older adults (23 women) with aMCI (mean age, 76 years) were randomized to an intervention (n=25) or a control group (n=25). The intervention group received a multicomponent exercise program for 90 minutes/day, 2 days/week, or 40 times over six months. The multicomponent exercises included aerobic exercise, muscle strength training and postural balance retraining, which was conducted under multi-task conditions to stimulate attention and memory. Participants in the control group attended two health promotion education classes within six months. Physical and dual-task performances were measured before randomization and after six months. Dual-task performances using reaction times with balance and cognitive demands were measured. RESULTS: The improvement effects on dual-task performances with both balance and cognitive demands were not statistically significant: reaction time with balance demand F1,45=3.3, p=0.07, and cognitive demand F1,45=2.6, p=0.12. However, there was a significant group-by-time interaction on maximal walking speed, which decreased significantly in the control group (F1,45=5.9, p=0.02). CONCLUSION: This six-month multicomponent exercise program improved maximal walking speed in older adults with aMCI; however, it did not improve dual-task performances assessed by reaction times.

DOI： 10.3275/8760

Suzuki Takao, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Uemura Kazuki, Lee Sangyoon, Park Hyuntae . Effects of multicomponent exercise on cognitive function in older adults with amnestic mild cognitive impairment: a randomized controlled trial. . BMC Neurol12 128 - 128 2012年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

UNLABELLED: BACKGROUND: To examine the effects of a multicomponent exercise program on the cognitive function of older adults with amnestic mild cognitive impairment (aMCI). METHODS: DESIGN: Twelve months, randomized controlled trial; SETTING: Community center in Japan; PARTICIPANTS: Fifty older adults (27 men) with aMCI ranging in age from 65 to 93 years (mean age, 75 years); INTERVENTION: Subjects were randomized into either a multicomponent exercise (n = 25) or an education control group (n = 25). Subjects in the multicomponent exercise group exercised under the supervision of physiotherapists for 90 min/d, 2 d/wk, for a total of 80 times over 12 months. The exercises included aerobic exercises, muscle strength training, and postural balance retraining, and were conducted using multiple conditions to stimulate cognitive functions. Subjects in the control group attended three education classes regarding health during the 12-month period. MEASUREMENTS were administered before, after the 6-month, and after the 12-month intervention period; MEASUREMENTS: The performance measures included the mini-mental state examination, logical memory subtest of the Wechsler memory scale-revised, digit symbol coding test, letter and categorical verbal fluency test, and the Stroop color word test. RESULTS: The mean adherence to the exercise program was 79.2%. Improvements of cognitive function following multicomponent exercise were superior at treatment end (group x time interactions for the mini-mental state examination (P = 0.04), logical memory of immediate recall (P = 0.03), and letter verbal fluency test (P = 0.02)). The logical memory of delayed recall, digit symbol coding, and Stroop color word test showed main effects of time, although there were no group x time interactions. CONCLUSIONS: This study indicates that exercise improves or supports, at least partly, cognitive performance in older adults with aMCI.

DOI： 10.1186/1471-2377-12-128

Yoshida Daisuke, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Ito Kengo, Kato Takashi, Shimokata Hiroshi, Washimi Yukihiko, Endo Hidetoshi, Suzuki Takao . The relationship between atrophy of the medial temporal area and daily activities in older adults with mild cognitive impairment. . Aging Clin Exp Res24 ( 5 ) 423 - 429 2012年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: Many studies have suggested that social network, leisure activity, and physical activity can have protective effects against dementia and Alzheimer's disease. However, previous studies have not examined the relationship between daily activities and brain atrophy in older adults. This study aimed to explore what kind of daily activities were associated with atrophy of the medial temporal area including the entorhinal cortex (MTA-ERC) in older adults. METHODS: In total, 122 older adults (aged 65 and over) with subjective memory complaints or a Clinical Dementia Rating of 0.5 underwent magnetic resonance imaging, and MTA-ERC atrophy was assessed by the voxel- based morphometry method. Based on magnetic resonance imaging data, the subjects were divided into atrophy and non-atrophy groups. Daily activities were assessed using a 20-item questionnaire (e.g., instrumental activities of daily living, social activities), and we compared activity participation between the groups. RESULTS: The atrophy group (n=37) showed significantly lower participation in 4 out of 20 activity items (cleaning, intellectual activity, culture lessons, and using a personal computer) than the non-atrophy group (n=85). Summed scores of these 4 items (range from 0 to 4) were significantly associated with MTA-ERC atrophy even after adjustment for age, sex, education status, and Mini-Mental State Examination score. CONCLUSIONS: In conclusion, MTAERC atrophy was associated with cognitive activities or household-related activities requiring planning.

DOI： 10.3275/8297

Doi Takehiko, Makizako Hyuma, Shimada Hiroyuki, Yoshida Daisuke, Ito Kengo, Kato Takashi, Ando Hiroshi, Suzuki Takao . Brain atrophy and trunk stability during dual-task walking among older adults. . J Gerontol A Biol Sci Med Sci67 ( 7 ) 790 - 795 2012年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Dual-task walking is believed to be more cognitively demanding than normal walking and alters trunk movement among older adults. However, the possible association between brain atrophy and spatiotemporal gait parameters, particularly during dual-task walking, is poorly understood. In this study, we examined the relationship between dual-task walking and brain atrophy. METHODS: One hundred ten elderly adults (aged 65-94 years, women n = 55) underwent magnetic resonance imaging scanning and gait experiments under normal and dual-task walking conditions. Linear accelerations of the trunk were measured in vertical, anteroposterior, and mediolateral directions using a triaxial accelerometer attached to the lower trunk. Gait speed, stride length, and cadence were recorded. The harmonic ratio, a measure of trunk stability, was computed separately in each direction to evaluate the smoothness of trunk movement during walking. Brain atrophy was quantitatively assessed using magnetic resonance image data. RESULTS: Gait speed, stride length, cadence, and harmonic ratio in all directions were lower in dual-task walking than in normal walking (p < .05). The dual-task-related changes in harmonic ratio were independently correlated with brain atrophy adjusted for subject characteristics only in the vertical direction (p < .05). CONCLUSIONS: Our findings support the hypothesis that dual-task walking is more cognitively demanding than normal walking. Decreased trunk stability during dual-task walking is associated with brain atrophy. Additional studies are necessary to elucidate the effects of regional brain atrophy on the control of walking.

DOI： 10.1093/gerona/glr214

Uemura Kazuki, Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Suzuki Takao . Effects of exercise intervention on vascular risk factors in older adults with mild cognitive impairment: a randomized controlled trial. . Dement Geriatr Cogn Dis Extra2 ( 1 ) 445 - 455 2012年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

AIMS: The purpose of this study is to clarify the effects of exercise intervention on vascular risk factors in older adults with mild cognitive impairment (MCI). METHODS: Community-dwelling older adults who met the definition of MCI using the Petersen criteria (n = 100; mean age = 75.3 years) were randomly allocated to the exercise (n = 50) or education control group (n = 50). Participants in the exercise group exercised under the supervision of physiotherapists for 90 min/day, 2 days/week, 80 times for 12 months. Anthropometric profiles, blood markers, blood pressure, and physical fitness (the 6-min walking test) were measured. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C risk ratio measurements were taken from blood samples. RESULTS: The exercise group showed significantly reduced TC and TC/HDL-C risk ratio after training compared with baseline levels (p < 0.001, p = 0.004). However, no significant reduction was found for the control group (p = 0.09, p = 0.09). Physical fitness also significantly improved after exercise intervention compared with the control group (p < 0.0001). CONCLUSION: Exercise intervention was associated with positive changes in important vascular risk factors related to cognitive decline and vascular disease in older adults with MCI.

DOI： 10.1159/000343486,

Shimada Hiroyuki, Kato Takashi, Ito Kengo, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Shimokata Hiroshi, Washimi Yukihiko, Endo Hidetoshi, Suzuki Takao . Relationship between atrophy of the medial temporal areas and cognitive functions in elderly adults with mild cognitive impairment. . Eur Neurol67 ( 3 ) 168 - 177 2012年

記述言語：英語掲載種別：研究論文（学術雑誌）

AIM: The current study sought to determine which types of cognitive function are related to atrophy of the bilateral medial temporal areas including the entorhinal cortex (MTA-ERC) in elderly adults. METHODS: The subjects were 96 elderly adults (mean age 75.3 years) with mild cognitive impairment. Subjects underwent Wechsler Memory Scale-Revised, logical memory I and II (WMS-R, LM I and II), Rey complex figure retention tests after 3 and 30 min (RCF-3 min and RCF-30 min), digit span backword (DSB), digit symbol-coding (DSC), Stroop Color and Word Test-Interference List (SCWT-IL) as well as magnetic resonance imaging (MRI) and were divided into elderly adults without or with mild to moderate MTA-ERC atrophy, and those with severe atrophy. RESULTS: In all subjects, MTA-ERC atrophy showed significant relationships with age (r = 0.43), education (r = -0.25), WMS-R, LM I (r = -0.21), DSC (r = -0.32), and SCWT-IL (r = 0.32). The mild to moderate atrophy group showed significant relationships between MTA-ERC atrophy and age (r = 0.34), DSC (r = -0.28), and SCWT-IL (r = 0.25). In contrast, in the severe atrophy group, MTA-ERC atrophy was correlated significantly with RCF-3 min (r = -0.70) and RCF-30 min (r = -0.74). The linear regression model included demographic variables and cognitive tests; two variables to survive the step-wise analysis were age (beta = 0.374) and SCWT-IL (beta = 0.247) in all subjects. Age (beta = 0.301), and RCF-30 min (beta = -0.521) and age (beta = 0.460) remained as a significant variable in the mild to moderate atrophy and severe atrophy groups, respectively. CONCLUSION: Executive function tests such as SCWT-IL may be useful as a screening tool to identify mild to moderate MTA-ERC atrophy and a decline in the RCF test may suggest severe MTA-ERC atrophy in elderly adults with MCI.

DOI： 10.1159/000334845

Oya Toshihisa, Uchiyama Yasushi, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Uemura Kazuki, Suzuki Takao . [Factors associated with fear of falling among community-dwelling elderly adults without reduced performance in instrumental activities of daily living]. . Nihon Ronen Igakkai Zasshi49 ( 4 ) 457 - 462 2012年

記述言語：日本語掲載種別：研究論文（学術雑誌）

AIM: The purpose of this study was to examine factors related to fear of falling (FOF) in elderly adults who showed no reduced performance regarding independent instrumental activities of daily living (IADL). METHODS: A total of 119 elderly adults participated in the study (mean age, 75.7+/-7.2 years, women, n=60). We investigated the prevalence of FOF, anamnesis, medications, body pain, and history of falls, the Geriatric Depression Scale, International Physical Activity Questionnaire, Life-Space Assessment (LSA). The Timed Up and Go test (TUG) and one-legged standing time were measured to evaluate physical performance. Participants were divided into elderly adults with FOF (FOF group) and those without FOF (non-FOF group). The unpaired t-test or chi-square test was used for group comparisons. Multiple logistic regression analysis was then performed to examine the factors associated with FOF. RESULTS: The prevalence of FOF was 51.3% overall. The FOF group had a higher prevalence of anamnesis, body pain, and history of falls than the non-FOF group. The FOF group had lower LSA scores, longer durations on the TUG, and shorter durations on the one-legged standing test than the non-FOF group. On multiple logistic regression analysis, LSA (total score, 120 points) was significantly associated with FOF (odds ratio: 0.96, 95% confidence interval=0.93-0.99). CONCLUSION: Fear of falling was significantly associated with life space in community-dwelling elderly adults who showed no reduced performance regarding IADL. In future, it will be necessary to clarify any possible causal relationship by longitudinal investigations.

Ohnuma Takeshi, Makizako Hyuma, Abe Tsutomu, Miura Hisayuki, Shimada Hiroyuki . [Predictors of interruptions to living at home in elderly people enrolled in a home visit rehabilitation service]. . Nihon Ronen Igakkai Zasshi49 ( 2 ) 214 - 221 2012年

記述言語：日本語掲載種別：研究論文（学術雑誌）

AIM: The purpose of this study was to determine the predictors of interruption to living at home as a result of death, hospitalization, or admission to a long-term care facility in frail elderly people enrolled in a home visit rehabilitation service. METHODS: A total of 311 patients entered a home visit rehabilitation service within a study period of 1 September, 2005 to 31 March, 2010, 146 of whom met the criteria to be enrolled in this study and gave consent. Of these, 73 received a continuous home visit rehabilitation service (continuous group) of over 2 years and 73 experienced interruption to this service due to death, hospitalization, or admission to a long-term care facility (interruption group). The following physical, social, and medical factors were recorded and analyzed: age, sex, care level, disease diagnoses, gait disability, cognitive impairment, living with another person and cause of the interruption to the home-visit rehabilitation service. We compared each item between the interruption and continuous groups. Logistic regression analysis was used to identify the significant predictors of interruptions to living at home. RESULTS: Patients in the interruption group demonstrated significantly lower functioning in activities of daily living (ADL), gait ability and lower cognitive status, and higher rates of respiratory diseases and cancer compared with the continuous group. On logistic regression analysis, ADL score (odds ratio [OR]=0.97, p<0.01), and the presence of respiratory diseases (OR=4.35, p=0.04) and cancer (OR=13.46, p<0.01) were significantly associated with interruptions to living at home. CONCLUSIONS: Lower ADL functioning, respiratory diseases and cancer were significant predictors of interruption to living at home in frail elderly adults.

Uemura Kazuki, Shimada Hiroyuki, Makizako Hyuma, Yoshida Daisuke, Doi Takehiko, Tsutsumimoto Kota, Suzuki Takao . A lower prevalence of self-reported fear of falling is associated with memory decline among older adults. . Gerontology58 ( 5 ) 413 - 418 2012年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: In spite of a number of reports about various factors associated with the fear of falling (FoF) among older adults (such as age and physical function), the relationship between FoF and cognitive decline remains unclear. OBJECTIVE: To determine which cognitive function is related with the prevalence of FoF in older adults. METHODS: Participants were 101 older adults (mean age 75.1 years; 48.5% males). Of these, 54 older adults (53.4%) were classified as the fear group on the basis of the presence of FoF. Age, gender, the Timed Up and Go test (TUG), fall history, the Alzheimer's Disease Assessment Scale, the Wechsler Memory Scale-Revised-Logical Memory I (WMS-LM I), the delayed memory test, digit symbol coding, digit span and verbal fluency were measured as potential relevant factors. RESULTS: Logistic regression analysis revealed that TUG [odds ratio (OR) 1.43, 95% confidence interval (CI) 1.12-1.83; p = 0.004], WMS-LM I (OR 1.20, 95% CI 1.07-1.35; p = 0.002) and fall history (OR 4.38, 95% CI 1.53-12.51; p = 0.006) were independently associated with FoF. CONCLUSIONS: The results suggest that a lower prevalence of self-reported FoF is associated with memory decline among older adults. Insensitivity to FoF may be one of the characteristics of psychological change with memory decline.

DOI： 10.1159/000336988

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Yoshida Daisuke, Ito Kengo, Kato Takashi, Shimokata Hiroshi, Washimi Yukihiko, Endo Hidetoshi, Suzuki Takao . The association between decline in physical functioning and atrophy of medial temporal areas in community-dwelling older adults with amnestic and nonamnestic mild cognitive impairment. . Arch Phys Med Rehabil92 ( 12 ) 1992 - 1999 2011年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: To examine whether declining performance in aspects of physical functioning, including lower extremity muscle strength, 1-legged balance, walking speed, and exercise capacity, is associated with atrophy of medial temporal areas in community-dwelling older adults with mild cognitive impairment (MCI). DESIGN: Cross-sectional study. SETTING: General community in Japan. PARTICIPANTS: Community-dwelling older adults 65 years and older with a Clinical Dementia Rating of 0.5 or memory complaints were enrolled in this study. This study examined 34 participants with amnestic MCI (aMCI) and 58 nonamnestic MCI (non-aMCI) participants. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The following physical performance tests were conducted: muscle strength of knee extension, 1-legged standing time, 5-m walking test, and 6-minute walk test (6MWT). The z scores of the voxel-based specific regional analysis system for Alzheimer's disease were determined to assess the degree of atrophy in the bilateral medial temporal areas including the entorhinal cortex (MTA-ERC). RESULTS: In the aMCI group, 6MWT performance was associated with MTA-ERC atrophy (beta=-.462, P=.014) after controlling for age. In the stepwise multiple regression analyses, 6MWT and body mass index were found to be significant determinants of MTA-ERC atrophy in all participants (R(2)=.275), as well as the aMCI and non-aMCI groups when analyzed separately (R(2)=.418 and R(2)=.216, respectively). CONCLUSIONS: A decline in exercise capacity was found to be more closely associated with atrophy of the MTA-ERC compared with other aspects of physical functioning in older adults with MCI, especially the amnestic type. These findings suggest that it is important for future studies to investigate the effects of increased aerobic activity and improved fitness on brain volume in older adults at risk of developing dementia.

DOI： 10.1016/j.apmr.2011.07.195

Shimada Hiroyuki, Tiedemann Anne, Lord Stephen R, Suzukawa Megumi, Makizako Hyuma, Kobayashi Kumiko, Suzuki Takao . Physical factors underlying the association between lower walking performance and falls in older people: a structural equation model. . Arch Gerontol Geriatr53 ( 2 ) 131 - 134 2011年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

The purpose of this study was to determine the interrelationships between lower limb muscle performance, balance, gait and falls in older people using structural equation modeling. Study participants were two hundred and thirteen people aged 65 years and older (mean age, 80.0 +/- 7.1 years), who used day-care services in Japan. The outcome measures were the history of falls three months retrospectively and physical risk factors for falling, including performance in the chair stand test (CST), one-leg standing test (OLS), tandem walk test, 6m walking time, and the timed up-and-go (TUG) test. Thirty-nine (18.3%) of the 213 participants had fallen at least one or more times during the preceding 3 months. The fall group had significantly slower 6m walking speed and took significantly longer to undertake the TUG test than the non-fall group. In a structural equation model, performance in the CST contributed significantly to gait function, and low gait function was significantly and directly associated with falls in older people. This suggests that task-specific strength exercise as well as general mobility retraining should be important components of exercise programs designed to reduce falls in older people.

DOI： 10.1016/j.archger.2010.11.003

Makizako Hyuma, Furuna Taketo, Shimada Hiroyuki, Ihira Hikaru, Kimura Mika, Uchiyama Eiichi, Oddsson Lars I E . Association between a history of falls and the ability to multi-task in community-dwelling older people. . Aging Clin Exp Res22 ( 5-6 ) 427 - 432 2010年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: Many older people fall when they perform tasks which require increased attention. The aim of this study was to determine differences in reaction times, during simple-, dual- and triple-task conditions requiring differing levels of motor coordination, balance control and cognitive attention, between groups of fallers and non-fallers in community-dwelling older individuals. METHODS: The study involved the recruitment of 87 older individuals living at home, 57 women and 30 men aged 75 to 91 years. Reaction times, measured by pushing a handheld button as quickly as possible in response to a visual stimulus, were measured in four conditions: 1) quiet standing (simple-task); 2) counting backward during quiet standing (dual-task with cognitive demand); 3) stepping in place (dual-task with balance demand); and 4) counting backward while stepping in place (triple-task with cognitive and balance demands). RESULTS: Twenty-nine (33.3%) participants had fallen at least once during the past year. There were no statistically significant differences in reaction times between non-fallers and fallers during any of the tasks. Reaction times were significantly longer during the dual- and triple-tasks compared with the simple-task conditions in both groups. The ratio between reaction times during dual-tasks with balance demands (stepping in place) and those in the simple-task condition were significantly related to a history of falls and showed the highest odds ratio (OR 3.16, 95% CI 1.06- 9.45, p=0.04). CONCLUSIONS: Relative changes in reaction times during a dual-task with balance demands were related to a history of falls in community-dwelling older individuals. Reaction times in dual-task conditions with a balance demand were more sensitive to past falls than those during a dual-task with cognitive demands.

DOI： 10.3275/6763

Suzukawa Megumi, Shimada Hiroyuki, Makizako Hyuma, Watanabe Shuichiro, Suzuki Takao . [Incidence of falls and fractures in disabled elderly people utilizing long-term care insurance]. . Nihon Ronen Igakkai Zasshi46 ( 4 ) 334 - 340 2009年7月

記述言語：日本語掲載種別：研究論文（学術雑誌）

AIM: To investigate the incidence of falls and fall-related fractures in disabled elderly people utilizing long-term care insurance, and influence of gender, age, disabled level is examined. METHODS: Subjects were 8,335 elderly people (mean age, 82.2+/-7.4 years). Falls and fractures were investigated retrospectively for the one year study period either via a self-report questionnaire, or via care workers and/or family members when the subjects had cognitive impairments. The care workers gave are a free description about for the fall that had occurred when using the facilities. RESULTS: Men showed significantly higher rate of falls (26.8%) than women (24.6%). In women, there was a significant difference in fall rates between the severely disabled group (26.4%) and the moderately disabled group (23.5%). Women showed a significantly higher rate of fractures (12.2%) than that of men (4.5%). In relationship between fall-related fractures and potential correlates, there was a significant relation between women and the fall-related fractures [OR 2.5, 95%CI 1.7-3.6]. The severely disabled group showed a significantly higher rate of falls in the toilet, on the other hand, the moderately disabled group showed significantly higher rate of falls during exercise and recreation or standing. CONCLUSION: The rate of falls in women was lower than men in this study population. The result may be affected by the lower proportion of women in the moderately disabled group compared with men. Only gender was significantly associated with the incidence of fall-related fractures in disabled elderly people.

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