Faculty Profiles - MAKIZAKO Hyuma

Hyuma Makizako, Ryoji Kiyama, Daisaku Nishimoto, Ikuko Nishio, Tomomi Masumitsu, Yuriko Ikeda, Misako Hisamatsu, Sachiko Shimizu, Masami Mizuno, Mikiyo Wakamatsu, Naomi Inoue, Takayuki Tabira, Tadasu Ohshige, Ayako Yamashita, Satoshi Nagano, Ku-Ohl Project Team . Association between Regular Exercise and Self-Rated Health and Sleep Quality among Adults in Japan during the COVID-19 Pandemic. . International journal of environmental research and public health18 ( 19 ) 2021.10Reviewed International journal

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

Regular exercise may be associated with better self-rated health and sleep status. However, this correlation among various age groups, such as young, middle-aged, and older people, as well as during the COVID-19 pandemic, has not been examined. This study examined the correlation between regular exercise and self-rated health and sleep quality among adults in Japan during the COVID-19 pandemic. Data were collected using an online survey conducted between February 26 and 27, 2021. A total of 1410 adults in Japan (age range, 20-86 years) completed the online survey. Regular exercise was divided into: (1) more than 30 min of moderate exercise a day, (2) more than 2 days per week, and (3) continuous for 1 year or longer. Self-rated health and sleep quality were assessed using the Likert scale. After adjusting for multiple confounders, regular exercise was correlated with decreased poor self-rated health and poor sleep quality in middle-aged adults; however, no significant correlation was observed among young and older adults. The promotion of regular exercise among middle-aged people during the COVID-19 pandemic may contribute to better self-rated health and sleep quality status.

DOI： 10.3390/ijerph181910515

Hyuma Makizako, Shoma Akaida, Saki Shono, Ryuhei Shiiba, Yoshiaki Taniguchi, Daijo Shiratsuchi, Yuki Nakai . Physical Activity and Perceived Physical Fitness during the COVID-19 Epidemic: A Population of 40- to 69-Year-Olds in Japan. . International journal of environmental research and public health18 ( 9 ) 2021.4Reviewed International journal

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

The COVID-19 pandemic has caused an abrupt change in lifestyle for many people with restrictions, often leading to a decrease in physical activity (PA), and thus contributing to a negative perception of health status. The purpose of this study was to examine the effects of the COVID-19 epidemic on physical activity and perceived physical fitness in Japanese adults aged 40 to 69 years. Data were collected from an online survey conducted between October 19 and 28, 2020. The analytic sample consisted of 1989 Japanese adults (mean age, 50.1 ± 6.9 years; women, 38.9%) who were aged between 40 and 69 years and completed the online survey. Overall, the PA time per week decreased by 32.4% between October 2019 and April 2020. A decrease in PA time was recorded in October 2020; however, a decline of 15.5% was observed. Compared to individuals who did not perceive a decline in physical fitness, individuals who perceived declining physical fitness during the COVID-19 state of emergency demonstrated a greater decrease in PA time in April 2020 (-50.5%), and this trend continued into October 2020 (-25.0%). These findings may indicate that Japanese adults aged 40 to 69 years who perceived declining physical fitness experienced a greater decrease in physical activity.

DOI： 10.3390/ijerph18094832

Hyuma Makizako, Yuki Nakai, Daijo Shiratsuchi, Tomomi Akanuma, Kaori Yokoyama, Yuriko Matsuzaki-Kihara, Hiroto Yoshida . Perceived declining physical and cognitive fitness during the COVID-19 state of emergency among community-dwelling Japanese old-old adults. . Geriatrics & gerontology international21 ( 4 ) 364 - 369 2021.4Reviewed

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

AIM: Perceived health status, including physical and cognitive fitness, will be negatively associated with future health conditions among old-old adults. The coronavirus disease 2019 (COVID-19) pandemic has caused sudden changes in lifestyle. Thus, this study examined the associations of participation in an exercise class before the COVID-19 pandemic and the exercise habits and disruption to the rhythms of daily life during the COVID-19 state of emergency with perceived declining physical and cognitive fitness among community-dwelling old-old adults. METHODS: In July 2020, we carried out a mail survey of community-dwelling old-old adults aged between 77 and 99 years in Bibai, Hokkaido, Japan, to determine their perceived declining physical and cognitive fitness during the COVID-19 state of emergency. RESULTS: Of the 774 responders, 339 (43.8%) participants reported a decline in physical fitness, whereas 259 (33.5%) perceived declining cognitive fitness during the COVID-19 state of emergency. In a multivariate logistic regression model adjusted for potential confounders, exercise habits during the COVID-19 state of emergency were significantly associated with a lower perception of declining physical fitness. Disruption to the rhythms of daily life during the COVID-19 state of emergency was significantly associated with a higher perception of declining physical and cognitive fitness. CONCLUSIONS: Approximately half and more than one-third of community-dwelling old-old adults perceived declining physical and cognitive fitness, respectively, during the COVID-19 state of emergency. During this period, exercise habits were positively correlated with perceived health status among old-old adults, whereas disruption to the rhythms of daily life was negatively correlated. Geriatr Gerontol Int 2021; ••: ••-••.

DOI： 10.1111/ggi.14140

Naoki Saji, Hyuma Makizako, Hiroyuki Suzuki, Yuki Nakai, Takayuki Tabira, Shuichi Obuchi, Hisashi Kawai, Kenta Murotani, Naomi Katayama, Kenji Toba, Yasue Uchida, Tsutomu Nakashima . Hearing impairment is associated with cognitive function in community-dwelling older adults: A cross-sectional study. . Archives of gerontology and geriatrics93 104302 - 104302 2021.3Reviewed International journal

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

BACKGROUND: Hearing impairment (HI) is associated with dementia. However, the cognitive screening tasks effective in older community dwellers presenting with HI are unclear. METHODS: We retrospectively and cross-sectionally investigated the associations between HI and cognitive function assessed with screening tasks using data from two healthcare check-up programs for community dwellers ≥65 years old in 2018. We examined demographics, risk factors, cognitive function, hearing condition, lifestyles, and self-care levels. Cognitive function was assessed using the clock drawing task and the delayed three words recall task. Hearing condition was assessed using questionnaires on the use of hearing aids and HI during conversation situations. Multivariate analysis was used to identify independent associations between HI and cognitive assessment tasks. RESULTS: We analyzed 1602 eligible participants (61.9% women; 74.3 ± 6.5 years old). Hearing aid users (n = 90) were older (80 vs. 73 years, respectively; p < 0.001) and less likely to draw the clock correctly (71.1% vs. 80.1% years, respectively; p = 0.044) than non-hearing aid users. Multivariate logistic regression analysis showed that HI was associated with inability to draw the clock correctly (odds ratio 1.60, 95% confidence interval 1.12-2.26; p = 0.011), independent of age, living alone, memory impairment, and impaired self-care levels. CONCLUSION: Hearing impairment is independently associated with cognitive decline assessed by the clock drawing task. The clock drawing task may be useful for identifying an increased risk of dementia in older subjects presenting with HI.

DOI： 10.1016/j.archger.2020.104302

Institutional Repository URL

Saji N, Makizako H, Suzuki H, Nakai Y, Tabira T, Obuchi S, Kawai H, Murotani K, Katayama N, Toba K, Uchida Y, Nakashima T. . Hearing impairment is associated with cognitive function in community-dwelling older adults: A cross-sectional study . Arch Gerontol Geriatr93 2021.3Reviewed

Saji N, Suzuki H, Katayama N, Makizako H, Uchida Y, Nakashima T. . Sensory impairment: A preventable risk factor in older adults . Arch Gerontol Geriatr93 2021.3Reviewed

和田あゆみ, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 佐藤菜々, 木山良二, 田平隆行, 窪薗琢郎, 竹中俊宏, 大石充 . 地域在住高齢者における社会的フレイルとうつ傾向との関連 . 鹿児島大学医学部保健学科紀要31 ( 1 ) 11 - 18 2021.3Reviewed

Authorship：Corresponding author Language：Japanese Publisher：鹿児島大学医学部保健学科

地域コホート研究(垂水研究2018)のデータを用いて、地域在住高齢者における社会的フレイルとうつ傾向との関連について横断観察研究を行った。対象は研究に対する同意が得られた65歳以上の地域在住高齢者859名であった。最終的に社会的フレイルの有無および高齢者用うつ尺度短縮版(GDS15)、その他基本属性に欠損のない812名(男性304名、女性508名、平均年齢74.8歳)を有効回答とし分析対象とした。対象者のうち社会的フレイルを有する者は112名(13.8%)であった。社会的フレイルを有する者は社会的フレイルを有しない者と比較し、高齢で、GDS15の点数は高く、歩行速度、握力が低下していた。社会的フレイルを有する者でうつ傾向のある者は37名(33.0%)で、社会的フレイルを有さない者でうつ傾向のある者90名(12.9%)と比較して有意に高い割合であった。ロジスティック回帰分析の結果からも社会的フレイルはうつ傾向と関連していることが示された。

Daijo Shiratsuchi, Hyuma Makizako, Yuki Nakai, Yoshiaki Taniguchi, Tomomi Akanuma, Kaori Yokoyama, Yuriko Matsuzaki-Kihara, Hiroto Yoshida . Association of Health Literacy with the Implementation of Exercise during the Declaration of COVID-19 State of Emergency among Japanese Community-Dwelling Old-Old Adults. . International journal of environmental research and public health18 ( 4 ) 1 - 9 2021.2Reviewed International journal

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal)

Health literacy is important for promoting and maintaining good health in old-old adults. It may influence the implementation of exercise in the coronavirus disease epidemic. The present cross-sectional study investigated the association of each dimension of health literacy with the implementation of exercise during the declaration of a state of emergency due to coronavirus disease in community-dwelling old-old adults. We collected data from 483 community-dwelling old-old adults (52.8% women) aged between 77 and 99 years who participated in a mail survey. Participants were divided into exercise or nonexercise groups based on the implementation of exercise during the declaration of a state of emergency. Health literacy was assessed using a 14-item health literacy scale. There were 327 (67.7%) participants in the exercise group and 156 (32.3%) in the nonexercise group. A significantly higher score of health literacy was observed in the exercise group than in the nonexercise group (communicative health literacy score = 14.0 ± 3.6 vs. 12.7 ± 3.8, p = 0.001). In a multivariate logistic regression model adjusted for potential confounders, high communicative health literacy scores were significantly associated with the implementation of exercise during the declaration of a state of emergency (odds ratio = 1.88, 95% confidence interval = 1.20-2.93). Approximately two-thirds of community-dwelling old-old adults implement exercise during the declaration of a state of emergency. High communicative health literacy was associated with the implementation of exercise during this period.

DOI： 10.3390/ijerph18042100

Takao Suzuki, Yukiko Nishita, Seungwon Jeong, Hiroyuki Shimada, Rei Otsuka, Katsunori Kondo, Hunkyung Kim, Yoshinori Fujiwara, Shuichi Awata, Akihiko Kitamura, Shuichi Obuchi, Katsuya Iijima, Noriko Yoshimura, Shuichiro Watanabe, Minoru Yamada, Kenji Toba, Hyuma Makizako . Are Japanese older adults rejuvenating? Changes in health-related measures among older community dwellers in the last decade. . Rejuvenation research24 ( 1 ) 37 - 48 2021.2Reviewed International journal

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

During the last three decades, Japan has become one of the world's top countries for longevity, and the increase in average life expectancy is accompanied by a sharp rise in older population aged 65 years and above to approximately 28%. This study aimed to examine the changes in major health-related measures including physical constitution, physical function, and functional capacity of community-dwelling Japanese older people in the last decade. From the data of 13 longitudinal cohort studies on aging conducted in Japan with a total of 13,441 older subjects, the present study analyzed the changes in six indices that are related to health and functioning of the older people; height, weight, BMI, walking speed, grip strength, and instrumental ADL, between 2007 (± 2 years) and 2017 (± 2 years). Comparison of data for the two periods between subjects matched for age group and gender evidently showed better health status and a slower decline in most of the health-related measures in 2017 compared to a decade ago. The results of the present study indicate that the phenomenon of "rejuvenation" is occurring among the new generation of Japanese older adults, and the importance of this older population as a social resource in the super-aged society should be re-acknowledged.

DOI： 10.1089/rej.2019.2291

Kiuchi Y, Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Kimura M, Kanouchi H, Takenaka T, Kubozono T, Ohishi M. . The Association between Dietary Variety and Physical Frailty in Community-Dwelling Older Adults . Healthcare9 ( 1 ) 32 2021.1Reviewed

Makizako H., Shiratsuchi D., Miyake Y., Tabira K., Tateishi M., Akaida S., Nishi H., Fukumori M., Baba Y., Kobayashi M., Takihara T. . Effects of catechin-enriched green tea combined with exercise on physical performance and muscle mass in community-dwelling older adults: A cluster-randomized, placebo-controlled trial . Archives of Gerontology and Geriatrics147 106260 2026.8

Language：Japanese Publisher：Archives of Gerontology and Geriatrics

Background: Catechin could improve physical performance through enhanced muscle recovery and mitochondria function. Clinical evidence regarding the effect of catechin supplementation on muscle strength and physical performance in older adults remains scarce. Objectives: This community-based randomized controlled trial investigated the effects of catechin-enriched green tea combined with exercise on physical performance and muscle mass in community-dwelling older adults. Methods: Seventy-eight adults aged ≥60 years who perceived themselves as experiencing weakness or slowness were randomly assigned to either an intervention group (exercise plus catechin-enriched green tea, n = 45) or a control group (exercise plus placebo, n = 33). All participants attended regular community self-management group exercise classes and a supplementary 60 min exercise session once per month. The intervention group consumed catechin-enriched green tea, providing 613 mg of catechin per day for 24 weeks. Results: Fifty-one of the 78 randomized participants completed the trial with high adherence (≥60%). In the intent-to-treat analysis, there were no statistically significant differences in physical performance tests or muscle mass between the groups at pre- and post-intervention assessments by the linear mixed-effects models. The percentage change in knee extension strength over 24 weeks differed significantly between the intervention and control groups (P = 0.016). Catechin-enriched green tea intake was associated with changes in Titin N-terminal fragment. Conclusions: The combination of catechin-enriched green tea and exercise had a beneficial effect on lower limb muscle strength in community-dwelling older adults who perceived a decline in physical performance.

DOI： 10.1016/j.archger.2026.106260

Araki Y., Kawasoe S., Kubozono T., Yoshimoto J., Kishi M., Suzuki S., Makizako H., Ohishi M. . Habitual natto consumption is inversely associated with mild cognitive impairment and depressive symptoms in older Japanese adults: A cross-sectional study . Nutrition Research150 174 - 183 2026.6

Language：Japanese Publisher：Nutrition Research

The association of the consumption of natto, a traditional Japanese fermented food, with mild cognitive impairment (MCI) and depressive symptoms remains poorly understood. We hypothesized that natto consumption may be negatively associated with MCI and depressive symptoms among older Japanese adults. We analyzed 616 individuals aged 65 years and older in the logistic regression model. We adjusted for age, sex, living alone, educational level, medication history, physical frailty, dietary diversity, tofu/atsuage (fried tofu) consumption habits, and miso soup consumption habits. The logistic regression analysis showed that natto consumption habits were negatively associated with MCI, even after adjustment (odds ratio [OR]: 0.63; p = .025). Natto consumption habits were also negatively associated with depressive symptoms (OR: 0.63; p = .037). Our findings indicate that natto consumption may be a simple and sustainable approach for maintaining cognitive function and mental health.

DOI： 10.1016/j.nutres.2026.04.009

Daijo Shiratsuchi, Hyuma Makizako, Kento Tabira, Yuto Miyake, Takuro Kubozono, Mitsuru Ohishi . Comparative associations of height- and body mass index-adjusted muscle mass with sarcopenia under the Asian Working Group for Sarcopenia 2025 consensus . Archives of Gerontology and Geriatrics143 106153 - 106153 2026.4

Tabira K, Shiratsuchi D, Miyake Y, Makizako H . Low Body Mass Index Increases Frailty Risk in Old-Old Adults: Findings From a 3-Year Longitudinal Study. . Geriatrics & gerontology international26 ( 4 ) e70474 2026.4

Language：English Publisher：Geriatrics and Gerontology International

Objectives: Frailty risk increases with age. It is important to understand how body mass index (BMI) relates to changes in frailty risk among adults aged 75 years and older (old–old adults). We examined the longitudinal association between baseline BMI and changes in frailty risk over 3 years. Methods: This 3-year retrospective cohort study included 515 old–old adults (median age 79.3 years; 45.0% male) who participated in the Latter-Stage Older Persons Health Checkup in Amami City, Japan. Participants were categorized into three BMI groups: < 21.5, 21.5–24.9, and ≥ 25.0 kg/m2. Frailty risk was assessed using the Old–Old Questionnaire for Medical Checkups, a validated tool for assessing multidimensional frailty. Thirteen items were analyzed, excluding smoking and social support domains, to better examine the association between BMI and frailty risk. Higher scores indicate a greater frailty risk. We used linear mixed-effects models to analyze the associations between BMI categories at baseline and changes in frailty risk. Results: The BMI < 21.5 kg/m2 group participants reported a greater annual increase in frailty risk compared with those in the BMI 21.5–24.9 kg/m2 group (β = 0.17, Standard error = 0.07, p = 0.014). The BMI ≥ 25.0 kg/m2 group participants reported no significant change in frailty risk compared with those in the BMI 21.5–24.9 kg/m2 group (β = −0.01, Standard error = 0.06, p = 0.821). Conclusion: Old–old adults with a BMI of ≤ 21.5 kg/m2 experienced a more pronounced increase in frailty risk over the 3-year follow-up period.

DOI： 10.1111/ggi.70474

Satake S., Osuka Y., Kozaki K., Makizako H., Shiratsuchi D., Akaida S., Tateishi M., Inoue T., Maeda K., Yamamoto K., Rakugi H., Akishita M., Arai H. . HQ6: Do Interventions or Assessments Using Digital Health Services Improve Sarcopenia Among Older Adults With Sarcopenia?: English Translation of the Japanese Guideline for Digital Health for the Prevention and Improvement of Sarcopenia and Frailty . Geriatrics and Gerontology International26 ( S1 ) 63 - 67 2026.4

Maeda K., Iijima K., Makizako H., Shiratsuchi D., Akaida S., Tateishi M., Inoue T., Yamamoto K., Rakugi H., Akishita M., Arai H. . HQ4: Do Interventions and Assessments That Use Digital Health Services Prevent Sarcopenia in Older Adults?: English Translation of the Japanese Guideline for Digital Health for the Prevention and Improvement of Sarcopenia and Frailty . Geriatrics and Gerontology International26 ( S1 ) 44 - 50 2026.4

田平健人, 牧迫飛雄馬 . 特集デジタルリハ 2.0─AI･ウェアラブル･デジタルツインが創る個別化治療ウェアラブルデバイスによる運動機能のモニタリング . J. of Clinical Rehabilitation35 ( 3 ) 253 - 258 2026.3

Rei Otsuka, Shu Zhang, Yukiko Nishita, Chikako Tange, Mana Tateishi, Hyuma Makizako, Kaori Kinoshita, Fumihiro Mizokami, Mai Kabayama, Kei Kamide, Shosuke Satake, Hidenori Arai . Heatmap of 10-year disability risk according to the frailty-intrinsic capacity (FR-IC) index in older Japanese adults. . Archives of gerontology and geriatrics142 106119 - 106119 2026.3International journal

三宅悠斗, 白土大成, 田平健人, 牧迫飛雄馬 . 地域在住高齢者における起立動作時の床反力と1年後の転倒および転倒恐怖感との関連 . 日本転倒予防学会誌12 79 - 88 2026.3

Suguru Shimokihara, Takayuki Tabira, Michio Maruta, Hyuma Makizako, Gwanghee Han, Taishiro Kamasaki, Yoshihiko Akasaki, Yuma Hidaka, Yusuke Kumura, Wataru Kukizaki, Takuro Kubozono, Mitsuru Ohishi . Longitudinal associations between satisfaction with meaningful activities and domains of frailty in community-dwelling older adults: A 2-year prospective cohort study . BRITISH JOURNAL OF OCCUPATIONAL THERAPY 2026.2

Ohta M., Kaimoto K., Makizako H., Aburada S., Imamura K., Manabe H., Takenaka T., Kubozono T., Ohishi M., Kuwabara A., Kanouchi H. . Association Between Serum Pyridoxal 5′-Phosphate and Frailty Risk in Community-Dwelling Older Japanese Adults . Geriatrics and Gerontology International26 ( 2 ) e70412 2026.2

Language：Japanese Publisher：Geriatrics and Gerontology International

Background: Pyridoxal 5′-phosphate (PLP) is the coenzyme form of vitamin B<inf>6</inf>. PLP is essential for amino acid metabolism, protein turnover, and neurotransmitter synthesis. Plasma or serum PLP concentration is used as an indicator of vitamin B<inf>6</inf> status. A deficiency in PLP may be a risk factor for frailty. While previous cross-sectional studies have associated low plasma or serum PLP levels with frailty, this association has not yet been examined in older Japanese adults. Methods: We analyzed data from 419 community-dwelling individuals aged ≥ 65 years in Tarumizu City, Kagoshima, Japan. Participants with relevant medical histories, missing data, or extreme values were excluded. Frailty was assessed using J-CHS criteria. Serum PLP concentrations were divided into quartiles (Q1–Q4). Logistic regression was used to estimate the Odds ratios (ORs) for pre-frailty/frailty after adjusting for demographic, lifestyle, and clinical factors. Results: Pre-frailty/frailty prevalence was 62%, 40%, 57%, and 57% in Q1–Q4, respectively. The proportion of pre-frailty/frailty was the lowest in Q2. Compared to Q2, adjusted ORs were 1.94 (95% CI: 1.06–3.59; p = 0.033) in Q1, 1.68 (95% CI: 0.93–3.07; p = 0.089) in Q3, and 1.86 (95% CI: 1.01–3.47; p = 0.047) in Q4. Conclusion: The relationship between PLP levels and pre-frailty/frailty was found to be non-linear. The lowest prevalence was observed in Q2, whereas both low and high PLP levels were associated with increased ORs of pre-frailty/frailty. Further prospective studies are needed to clarify the causal relationship in older Japanese adults.

DOI： 10.1111/ggi.70412

Shimokihara Suguru, Tabira Takayuki, Maruta Michio, Makizako Hyuma, Han Gwanghee, Kamasaki Taishiro, Akasaki Yoshihiko, Hidaka Yuma, Kumura Yusuke, Kukizaki Wataru, Kubozono Takuro, Ohishi Mitsuru . Associations Between the Diverse Aspects of Psychological Frailty and Health-Related Outcomes in Community-Dwelling Older Adults: A Cross-Sectional Study(タイトル和訳中) . Psychogeriatrics26 ( 1 ) psyg.70115 - psyg.70115 2026.1

Yoshihiko Akasaki, Suguru Shimokihara, Yuma Hidaka, Michio Maruta, Gwanghee Han, Taishiro Kamasaki, Yusuke Kumura, Wataru Kukizaki, Rena Nakahara, Hyuma Makizako, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Satisfaction with Meaningful Activities and Sleep in Community-Dwelling Older Adults: Cross-Sectional Study . Clinical Gerontologist 1 - 15 2025.12

牧迫飛雄馬 . 特集によせて . 日本サルコペニア・フレイル学会誌9 ( 3 ) 351 - 351 2025.11

牧迫飛雄馬 . 編集後記 . 日本サルコペニア・フレイル学会誌9 ( 3 ) 428 - 428 2025.11

Suguru Shimokihara, Takayuki Tabira, Michio Maruta, Hyuma Makizako, Gwanghee Han, Taishiro Kamasaki, Yoshihiko Akasaki, Yuma Hidaka, Yusuke Kumura, Wataru Kukizaki, Takuro Kubozono, Mitsuru Ohishi . Associations Between the Diverse Aspects of Psychological Frailty and Health‐Related Outcomes in Community‐Dwelling Older Adults: A Cross‐Sectional Study . Psychogeriatrics26 ( 1 ) e70115 2025.11

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

ABSTRACT

Background

Psychological frailty (PsF), encompassing cognitive and emotional vulnerabilities, remains understudied despite its potential impact on health outcomes in older adults. This cross‐sectional study aimed to explore the characteristics of diverse aspects of PsF, including cognitive frailty (CF), lower cognitive function, and affective frailty (AF), and to examine their associations with health‐related outcomes in community‐dwelling older adults.

Methods

Data were analysed from 420 community‐dwelling older adults participating in the Tarumizu Study in Japan, excluding those exhibiting physical or social frailty. Participants were categorised into Robust, Lower cognitive function, CF, AF, and Multi‐domain PsF groups. AF was assessed using five items from the Geriatric Depression Scale, focusing on emotional vulnerability. Health outcomes included self‐rated health, subjective memory complaints (SMC), and functional ability of daily living. Associations were analysed using adjusted multiple regression models controlling for covariates.

Results

PsF was present in 39.5% of the cohort (lower cognitive function: 18.1%, CF: 7.6%, AF: 11.0%, Multi‐domain PsF: 2.9%). In the adjusted models, only AF showed a significant positive association with SMC (adjusted risk ratio = 1.62, 95% CI: 1.06–2.42, p = 0.023). No significant associations were found between any PsF domain and subjective health or daily functional ability in the adjusted models.

Conclusions

AF, characterised by emotional vulnerability, was uniquely associated with SMC, suggesting emotional factors may play a more central role than cognitive decline in shaping perceptions of memory problems. These findings highlight the heterogeneous nature of PsF and underscore the need for nuanced assessments to inform targeted prevention and intervention strategies.

DOI： 10.1111/psyg.70115

Daijo Shiratsuchi, Yuto Miyake, Ryota Kuratsu, Hiroki Nishi, Manami Fukumori, Shoko Atae, Ryoji Kiyama, Rieko Kosakamoto, Hiromi Tanaka, Hyuma Makizako . Is psychological engagement more important than participation? Volunteer activity and subjective cognitive function in older adults . Aging Clinical and Experimental Research37 ( 1 ) 332 2025.11

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Background

While previous studies have shown inconsistent associations between volunteer participation and cognitive health in later life, less attention has been paid to qualitative aspects of engagement. This study examined whether psychological engagement in volunteer activities is associated with subjective cognitive function in community-dwelling older adults.

Method

This cross-sectional study included 431 community-dwelling older adults (mean age: 78.2 ± 5.7 years; 90.0% female) from self-management exercise class. Volunteer activity status was assessed using a self-reported participation questionnaire. Psychological engagement (Volunteer Engagement; VE) was evaluated using a three-item version of the Utrecht Work Engagement Scale adapted for volunteer settings. Based on VE scores, the participants were categorized into three groups: non-volunteers, low-engagement volunteers, and high-engagement volunteers. Subjective cognitive function was assessed using three self-reported items addressing memory complaints and disorientation, derived from the Kihon Checklist. Logistic regression analyses were conducted to examine the associations between (1) volunteer activity status and (2) VE scores with low cognitive function, adjusting for relevant covariates.

Results

Of 431 participants, 60.1% reported volunteering. There was no significant association between being a volunteer and low cognitive function. In contrast, high-engagement volunteers had significantly lower odds of low cognitive function than non-volunteers (OR = 0.51, 95% CI: 0.27–0.97). No significant differences were observed between low-engagement volunteers and non-volunteers.

Conclusions

These findings suggest that psychological engagement in volunteer activities rather than mere participation may be more closely related to the subjective cognitive health of older adults. Highlighting this engagement may help inform policies and programs for promoting cognitive health.

DOI： 10.1007/s40520-025-03245-8

Other Link： https://link.springer.com/article/10.1007/s40520-025-03245-8/fulltext.html

牧迫飛雄馬 . 特集医療関係者が知っておきたいロコモ･サルコペニア･フレイルフレイルの評価･判定法 . 関節外科　基礎と臨床44 ( 11 ) 1121 - 1129 2025.11

牧迫飛雄馬 . 【医療関係者が知っておきたいロコモ・サルコペニア・フレイル】フレイルの評価・判定法 . 関節外科44 ( 11 ) 1121 - 1129 2025.11

Language：Japanese Publisher：(株)メジカルビュー社

＜文献概要＞フレイルの評価および判定においては,表現型モデルと欠損累積モデルによるフレイルの捉え方を整理したうえで,具体的な評価指標を活用することが必要である。身体的なフレイルは,改訂日本語版CHS基準による評価・判定が浸透しつつある。フレイルには多様な要因が関連するため,多様な視点による評価やフレイルの包括的な評価が可能な指標の適用など,評価の目的や評価結果に基づく対策や支援を考慮した活用が望まれる。

Yoshihiko Akasaki, Suguru Shimokihara, Yuma Hidaka, Michio Maruta, Gwanghee Han, Taishiro Kamasaki, Yusuke Kumura, Wataru Kukizaki, Rena Nakahara, Hyuma Makizako, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Changes in satisfaction with meaningful activities and subsequent subjective memory complaints: a two-wave longitudinal analysis of Japanese older adults . Aging & Mental Health30 ( 3 ) 1 - 12 2025.10

Preface to the special issue on "Cardiopulmonary Function and Exercise Load" . Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics62 ( 4 ) 363 - 363 2025.10

Yuma Hidaka, Takayuki Tabira, Michio Maruta, Hyuma Makizako, Gwanghee Han, Suguru Shimokihara, Yoshihiko Akasaki, Taishiro Kamasaki, Wataru Kukizaki, Rena Nakahara, Takuro Kubozono, Mitsuru Ohishi . Satisfaction with grave visitation and depressive symptoms among community-dwelling older Japanese adults . Mental Health, Religion & Culture28 ( 1 ) 1 - 15 2025.10

牧迫飛雄馬 . 【リハビリテーション栄養のポピュレーションアプローチ】デジタルデバイスによるアプローチ . リハビリテーション栄養9 ( 2 ) 178 - 183 2025.10

Language：Japanese Publisher：(一社)日本リハビリテーション栄養学会

デジタル技術は著しい速度で進歩しており,サルコペニアの評価指標となる身体機能や骨格筋量に対するデジタルデバイスを用いた運動介入によるランダム化比較対照試験の効果も報告されつつある.とりわけ,フレイルやサルコペニアに対する予防・改善の方策は,積極的な身体活動のほか,食生活の改善,社会活動の促進など多岐にわたり,多面的な支援におけるデジタルデバイス活用によるエビデンスの蓄積が望まれる.一方,個人情報の取り扱い,ユーザーとなる高齢者のデバイス利用スキルの習熟など,高齢者に対するデジタルデバイスによるアプローチでは検討すべき課題も少なくはない.効果的な健康寿命の延伸対策を促進するためには,デジタルデバイスを活用したアプローチのさらなる展開が期待される.(著者抄録)

Daijo Shiratsuchi, Hyuma Makizako, Shoma Akaida, Yuto Miyake, Ryoji Kiyama, Takayuki Tabira, Mana Tateishi, Rei Otsuka, Toshihiro Takenaka, Takuro Kubozono, Mitsuru Ohishi . Combinations of intrinsic capacity and frailty and their associations with self-rated health in community-dwelling older adults . Aging Clinical and Experimental Research37 ( 1 ) 275 2025.9

吉村芳弘, 牧迫飛雄馬 . 第12回日本サルコペニア・フレイル学会大会長より . 日本サルコペニア・フレイル学会誌9 ( 1 ) 109 - 109 2025.8

牧迫飛雄馬 . 特集認知症に対するリハビリテーション医療コグニサイズ . J. of Clinical Rehabilitation34 ( 9 ) 910 - 916 2025.8

牧迫飛雄馬 . 【認知症に対するリハビリテーション医療】コグニサイズ . Journal of Clinical Rehabilitation34 ( 9 ) 910 - 916 2025.8

Language：Japanese Publisher：医歯薬出版(株)

＜文献概要＞内容のポイントQ&A　Q1 コグニサイズとは何か?コグニサイズとは,cognition(=認知)とexercise(=運動)を掛け合わせた造語であり,国立長寿医療研究センターで開発された認知機能低下の抑制を目指した運動プログラムである.脳機能の賦活を目的とした運動と知的な刺激の伴う活動を組み合わせた方法の1つとして,コグニサイズが推奨される.Q2 コグニサイズの対象は?主観的に認知機能低下の自覚がある,もしくは軽度認知障害といった認知機能に軽度の問題を有する高齢者において,コグニサイズによる認知機能の維持・改善に効果が期待される.認知機能に問題のない健常高齢者においても認知機能低下の予防に推奨されるが,認知症の診断のある中等度以上の認知機能障害を有する場合は,混乱を招く恐れがあるため,注意を要する.Q3 コグニサイズの効果は?軽度認知障害を有する地域在住高齢者を対象として,コグニサイズを含めた多面的運動プログラムでの介入によって,全体的な認知機能や言語流暢性,記憶機能に対する改善もしくは維持の効果が確認されている.さらに,脳萎縮に対する進行抑制効果が認められている.また,集団で行うことで,コグニサイズをきっかけとした他者との交流機会を引き出す環境にも有用となる.Q4 地域で新たに行うためにはどうすればよいか?コグニサイズには,個人で実施できる内容と集団で実施する内容が想定されている.個人でできるコグニサイズは,パンフレットや動画サイト等を参考にして,自宅での家事の合間や普段行う運動の追加メニューとして行うことが取り入れやすいかもしれない.また,集団で行うコグニサイズは,地域での運動教室やサロン活動でレクリエーションの1つとして,参加者同士で楽しみながら始めてみることが推奨される.

NAKAHARA Rena, TABIRA Takayuki, SHIMOKIHARA Suguru, AKASAKI Yoshihiko, HIDAKA Yuma, KUKIZAKI Wataru, KAMASAKI Taishiro, MATSUNAGA Shuto, KUMURA Yusuke, MARUTA Michio, HAN Gwanghee, MAKIZAKO Hyuma, SUGAWARA Hideki, TERAZONO Hideyuki, KUBOZONO Takuro, OHISHI Mitsuru . Characteristics of medication management in community-dwelling older adults with subjective memory complaints . Japanese Journal of Geriatric Therapy4 ( 0 ) n/a 2025.7

Language：Japanese Publisher：The Japan Geriatric Therapy Society

【Aim】 The purpose of this study was to clarify the characteristics of medication management among community-dwelling older adults with subjective memory complaints (SMC) and to examine the association between SMC and medication management. 【Methods】 A total of 690 aged 65 years or older in the community cohort study in 2019 participated. Of these, 573 who met the inclusion criteria were analyzed. Participants were divided into two groups according to the presence or absence of SMC, and associations with medication management items were analyzed using Fisher's exact test for categorical variables and the unpaired t-test for continuous variables. In addition, binomial logistic regression analysis was conducted with SMC as the dependent variable and medication management items as the independent variables, adjusted for demographic variables. 【Results】 Among the community-dwelling older adults in this study, 206 were in the healthy group and 367 were in the SMC group. Covariate-adjusted binomial logistic regression analysis showed that "having residual medication" (OR: 1.62, 95% CI: 1.01 to 2.59, p = 0.04) and "depressive symptoms" (OR: 1.48, 95% CI: 1.20 to 1.69, p < 0.001) were significantly associated with SMC. 【Conclusion】 The characteristics of medication management among community-dwelling older adults with SMC were significantly associated with "residual medication". Understanding the presence or absence of residual medications from the SMC stage and taking measures to address the factors that led to residual medications may help reduce the burden of caregivers in managing medications.

DOI： 10.57270/jgts.2024_013_oa

Yuma Hidaka, Suguru Shimokihara, Yoshihiko Akasaki, Michio Maruta, Gwanghee Han, Taishiro Kamasaki, Yusuke Kumura, Wataru Kukizaki, Rena Nakahara, Hyuma Makizako, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Longitudinal Relationship Between Grave Visitation and Depressive Symptoms Among Community-Dwelling Older Adults. . Clinical gerontologist49 ( 2 ) 1 - 12 2025.7International journal

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

OBJECTIVES: Participating in religious activities benefits older adults' mental health; however, the effects of grave visitation, a significant religious practice in Japan, on older adults' mental health remain unclear. Therefore, this study examined the relationship between grave visitation frequency and depressive symptoms. METHODS: A prospective cohort study of 273 community-dwelling older adults in Japan was conducted with baseline (2018) and follow-up (2022) assessments. Participants were categorized by visitation frequency: more or less than once a week. Changes in visitation frequency were classified as continued high, decreased, continued low, or increased. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS-15). Multivariable linear regressions were used to examine the association between visitation and depressive symptoms. RESULTS: Lower visitation at baseline was associated with worse GDS-15 scores in the follow-up. Those with decreased or continued low visitation had significantly worse depressive symptoms. After adjusting for baseline GDS-15 scores and covariates, the decreased group had significantly worse depressive symptoms than the continued high group. CONCLUSIONS: The findings indicate that changes in grave visitation frequency are significantly associated with depressive symptoms. CLINICAL IMPLICATIONS: Supporting older adults' access to grave visitation through transportation or community programs may help maintain their well-being and emotional health.

DOI： 10.1080/07317115.2025.2538105

Ryota Takaoka, Keitaro Nishi, Maya Nakamura, Haruka Yoshinaga, Yusaku Noma, Yodai Hayashi, Sayaka Yuda, Yumiko Mishima, Momoko Ishikawa, Yusei Yanagita, Kouta Yamashiro, Kenichi Kume, Yuhei Matsuda, Takahiro Kanno, Hyuma Makizako, Toshihiro Takenaka, Takuro Kubozono, Mitsuru Ohishi, Tatsuo Okui . Association between malnutrition and low tongue pressure in community-dwelling older people: a population-based cohort study. . Scientific reports15 ( 1 ) 25420 - 25420 2025.7International journal

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

The aim of this study was to analyze the data from a cohort study of community-dwelling older people to clarify the impact of low tongue pressure on the onset of malnutrition. The analysis was divided into a baseline and a longitudinal analysis. The baseline analysis included 765 people (median age: 74 years; 276 men and 489 women), and the longitudinal analysis included 100 people (median age: 72 years; 33 men and 67 women). The baseline analysis showed that tongue pressure and the diagnosis of low tongue pressure using a cut-off of 30 kPa were associated with the risk of malnutrition (tongue pressure: odds ratio [OR] = 0.972, 95% confidence interval [95% CI] = 0.953-0.992, p = 0.006; the diagnosis of low tongue pressure: OR = 1.555, 95% CI = 1.050-2.302, p = 0.027). In the longitudinal analysis, tongue pressure and the diagnosis of low tongue pressure at baseline were associated with the onset of the risk of malnutrition after 4 years (tongue pressure: OR = 0.952, 95% CI = 0.907-0.998, p = 0.041; the diagnosis of low tongue pressure: OR = 2.698, 95% CI = 1.148-6.341; p = 0.023). In community-dwelling older people, low tongue pressure could increase the risk of future malnutrition.

DOI： 10.1038/s41598-025-11229-x

中原伶奈, 田平隆行, 下木原俊, 赤崎義彦, 日高雄磨, 久木崎航, 釜崎大志郎, 松永修歩, 久村悠祐, 丸田道雄, 韓こう煕, 牧迫飛雄馬, 菅原英輝, 寺薗英之, 窪薗琢郎, 大石充 . 主観的記憶障害を有する地域在住高齢者の服薬管理の特徴　高齢化率40%を超える地域における横断的研究 . 日本老年療法学会誌4 jgts.2024_013_OA - jgts.2024_013_OA 2025.7

Language：Japanese Publisher：(一社)日本老年療法学会

【目的】認知症の前臨床期である主観的記憶障害(SMC)段階からの複雑なIADL評価は重要であるが,SMC段階での服薬管理状況を詳しく調べた報告は希少である。本研究では,SMCを有する地域在住高齢者の服薬管理の具体的な特徴を明らかにすることを目的とした。【方法】本研究は,横断観察研究である。2019年度における地域コホート研究に参加した65歳以上の高齢者690名のうち,除外基準に該当する者を除外した573名を解析対象とした。対象者をSMCの有無で2群に分け,服薬状況調査項目との関連について2群間比較および共変量で調整した二項ロジスティック回帰分析を行った。【結果】対象者のうち,健常群が206名,SMC群が367名であり,共変量調整した二項ロジスティック回帰分析の結果,「残薬あり」(OR:1.62,95%CI:1.01-2.59,p=0.04)と「抑うつ症状」(OR:1.48,95%CI:1.20-1.69,p<0.001)はSMCと有意に関連した。【結論】地域在住高齢者において,SMCの段階から残薬の有無を把握し,服薬管理の早期支援を行うことは,認知機能低下が進行した際に服薬管理の介護負担を軽減し,残薬問題を解消する一助になる可能性がある。(著者抄録)

牧迫飛雄馬, 白土大成, 三宅悠斗, 赤井田将真, 立石麻奈, 窪薗琢郎, 竹中俊宏, 大塚礼, 大石充 . 内在的能力は身体的フレイルの悪化および改善要因となり得るか? 5年間の前向き研究 . 日本老年医学会雑誌62 ( Suppl. ) 44 - 44 2025.5

立石麻奈, 西田裕紀子, 久保田彩, 小坂井留美, 丹下智香子, 下方浩史, 安藤富士子, 牧迫飛雄馬, 大塚礼 . 地域住民における中学・高校での運動歴と中高年期の大腿骨頸部骨密度の縦断変化 . 日本老年医学会雑誌62 ( Suppl. ) 212 - 212 2025.5

牧迫飛雄馬 . おさえておきたい転倒･転落予防の基本知識と現場での応用 7.転倒･転落の主な原因と対策:⑥ 環境 . J. of Clinical Rehabilitation34 ( 4 ) 421 - 426 2025.4

牧迫飛雄馬 . 特集科学的介護科学的介護を推進するための理学療法士の役割と期待 . 理学療法ジャーナル59 ( 3 ) 322 - 327 2025.3

Yumiko Mishima, Maya Nakamura, Yuhei Matsuda, Keitaro Nishi, Ryota Takaoka, Takahiro Kanno, Toshihiro Takenaka, Takayuki Tabira, Hyuma Makizako, Takuro Kubozono, Mitsuru Ohishi, Tsuyoshi Sugiura, Tatsuo Okui, On Behalf Of The Collaborative Group . Association Between Cognitive Impairment and Poor Oral Function in Community-Dwelling Older People: A Cross-Sectional Study. . Healthcare (Basel, Switzerland)13 ( 6 ) 2025.3International journal

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

BACKGROUND/OBJECTIVES: The population of Japan has a high life expectancy, but there is room for improvement in terms of the country's healthy life expectancy. The long period of care dependency among Japan's elderly is also a major economic health challenge. Dementia is a major factor in the need for care, and its prevention is a crucial and urgent challenge. There are recent reports of a possible association between changes in oral function and cognitive impairment, but the details of this association remain unclear. To clarify the relationship between poor oral function and cognitive impairment, we conducted an exploratory investigation using a cognitive function assessment (Mini-Cog) administered in a large-scale study and its relevance to oral function. METHODS: The study population was 678 community-dwelling individuals aged ≥65 years living in Tarumizu city, Japan, in 2019. Cognitive function was assessed using the Mini-Cog test, and the oral survey was a modification of the content of the Oral Hypofunction Examination as defined by the Japanese Society of Gerodontology. RESULTS: The participants' median age was 73 years. The oral function results revealed median scores below the oral hypofunction criterion for occlusal force, tongue pressure, oral diadochokinesis, and swallowing function. The results of a binomial logistic regression analysis indicated that tongue-lip motor function was independently associated with oral function in relation to cognitive impairment. CONCLUSIONS: The oral function associated with cognitive impairment in this study was tongue-lip motor function. Aiming to improve this function may prevent the exacerbation of cognitive impairment.

DOI： 10.3390/healthcare13060589

牧芳昭, 森田秋子, 山田将成, 加藤涼平, 牧迫飛雄馬 . 回復期リハビリテーション病棟入院患者における行動観察評価による認知機能障害と転倒との関連性 . 日本転倒予防学会誌11 31 - 38 2025.3

Language：Japanese Publisher：(一社)日本転倒予防学会

【目的】本研究の目的は,回復期リハビリテーション病棟の入院患者に対して,行動観察から評価される認知関連行動アセスメント(以下CBA)の総合点から判定した認知機能障害の重症度と転倒の関連性を検討することであった。【方法】本研究は後ろ向きコホート研究であり,対象は2019年4月から2021年3月までの期間に当院回復期リハビリテーション病棟に入院した患者とした。認知機能障害の評価はCBAを使用し,転倒の有無は電子カルテ内の転倒・転落事故報告書の記録から調査した。入院時のCBAと入院早期の転倒との関連性を検証するため,入院1ヵ月以内の転倒を集計対象とし,入院1ヵ月以内で転倒を認めた者を転倒群,認めなかった者を非転倒群とした。転倒と非転倒の2群とCBA重症度とのクロス集計から,どの組み合わせが期待値から大きく乖離しているかを確認するために残差分析を行い,調整済み残差を算出した。そして,入院後1ヵ月以内の転倒の有無を従属変数とし,CBA重症度を独立変数とした2項ロジスティック回帰分析を行った。【結果】本研究の解析対象は879名であり,年齢の中央値は76(四分位範囲:65-83)歳であった。転倒群(68名)は非転倒群(811名)よりもCBA重症度が最重度～中等度の者の割合が多かった。また,転倒群におけるCBA重症度の内訳では,最重度4名(5.9%),重度24名(35.3%),中等度24名(35.3%),軽度11名(16.2%),良好5名(7.4%)であった。残差分析の結果,転倒群ではCBA重度(p<0.01)の者が有意に多く,非転倒群ではCBA軽度(p<0.01)の者が有意に多かった。入院後1ヵ月以内の転倒の有無を従属変数としたロジスティック回帰分析は,70歳以上などの転倒に関連する因子を共変量として調整しても,転倒とCBA重度の有無との関連性は有意であった(オッズ比1.92;95%CI,1.00-3.68;p<0.05)。【結論】回復期リハビリテーション病棟の入院患者における入院患者のCBA重症度は,入院1ヵ月以内の転倒発生と有意に関連していた。(著者抄録)

牧迫飛雄馬 . 【科学的介護】科学的介護を推進するための理学療法士の役割と期待 . 理学療法ジャーナル59 ( 3 ) 322 - 327 2025.3

Shiratsuchi Daijo, Makizako Hyuma, Akaida Shoma, Tateishi Mana, Taniguchi Yoshiaki, Takenaka Toshihiro, Kubozono Takuro, Ohishi Mitsuru . Association of metabolic syndrome and low physical function with mild cognitive impairment in community-dwelling older adults: a cross-sectional analysis from the Tarumizu Study . Japanese Journal of Cardiovascular Disease Prevention60 ( 1 ) 36 - 43 2025.2

Language：Japanese Publisher：The Japanese Society of Cardiovascular Disease Prevention

Objectives: To clarify the association between metabolic syndrome (MetS; Metabolic Syndrome), comorbid physical decline, and mild cognitive impairment (MCI) in community-dwelling older adults.Methods: A cross-sectional analysis of 554 community-dwelling older adults aged 65 years or older (mean age 73.7±6.2 years, 63.4% women) was conducted using data from the Tarumizu Study 2019. MetS was determined using the criteria of the International Diabetes Federation, and physical function decline was judged as applicable if either or both grip strength (<28 kg for men and <18 kg for women) and usual walking speed (<1.0 m/sec) were below the cutoff values. Based on the presence or absence of MetS and physical decline, patients were operationally classified into four groups: robust group, MetS alone group (MetS group), physical decline alone group (physical decline group), and MetS and physical decline coexisting group (coexisting group). MCI was assessed by the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) for memory, attention, executive function, and processing speed. Participants were considered to have MCI if they scored 1.5 SD or more below the norm, which takes into account age and education, on any of the tests. Logistic regression analysis was performed with MCI as the dependent variable and the four groups defined by the presence of MetS and physical decline as independent variables, with age, sex, educational history, and number of medications as covariates.Results: Participants characteristics were 191 (34.5%) in the robust group, 218 (39.4%) in the MetS group, 62 (11.2%) in the physical decline group, and 83 (15.0%) in the coexisting group. Logistic regression analysis showed that, compared with the robust group, the physical decline group (odds ratio: 2.39, 95% confidence interval: 1.17-4.87) and the coexisting group (odds ratio: 2.41, 95% confidence interval: 1.21-4.79) each had a significant association with MCI. On the other hand, the MetS group showed no significant association with MCI compared with the robust group.Conclusion: The presence of physical functional decline and the coexistence of MetS and physical decline are associated with MCI among community-dwelling older persons.

DOI： 10.11381/jjcdp.60.1_36

MAKI Yoshiaki, MORITA Akiko, YAMADA Masanari, KATO Ryohei, MAKIZAKO Hyuma . Association between Cognitive Dysfunction and Falls by Behavioral Observation Assessment in Hospitalized Patients in the Recovery Phase Rehabilitation Wards . JapaneseJournal of Fall Prevention11 ( 1 ) 31 - 38 2025.2

Language：Japanese Publisher：The Japanese Society for Fall Prevention

【Objective】This study aimed to investigate whether the severity of cognitive impairment, as determined from the total score of Cognitive-related Behavioral Assessment（CBA）, which is based on behavioral observations, is associated with falls in patients admitted to rehabilitation wards.【Methods】This retrospective cohort study included patients admitted to the recovery unit between April 2019 and March 2021. CBA was used to assess cognitive impairment, and falls were investigated using the records of the Falls and Falls Incident Report Form in the electronic medical record. To test the association between CBA on admission and falls early in hospitalization, falls within one month of admission were included in the tally, and those with falls within one month of admission were included in the fall group, while those without falls were included in the non-fall group. From the cross-tabulation of the two groups of falls and non-falls and CBA severity, a residual analysis was performed to identify the combination that deviated significantly from the expected values, and the adjusted residuals were calculated. Logistic regression analysis was performed with the presence of falls within one month of admission as the dependent variable and CBA severity as the independent variable.【Results】This study included 879 patients, with a median age of 76 years（interquartile range：65-83）years. The fall group（68 patients）had a higher proportion of patients with the most severe to moderate CBA severity than the non-fall group（811 patients）. CBA severity in the fall group was as follows：most severe, 4（5.9 ％）；severe, 24（35.3 ％）；moderate, 24（35.3 ％）；mild, 11（16.2 ％）；and normal, 5（7.4 ％）. Residual analysis showed that significantly more patients in the fall group had severe CBA（p ＜0.01）and significantly more patients in the non-fall group had mild CBA（p ＜0.01）. Logistic regression analysis using the presence or absence of falls within one month of admission as the dependent variable showed that the association between falls and CBA severity was significant（odds ratio 1.92；95 ％ CI, 1.00-3.68；p ＜0.05）, even after adjustment for factors related to falls, such as age 70 years or older, as covariates.【Conclusions】 Severe CBA severity was significantly associated with the risk of early falls in hospitalized patients in recovery units.

DOI： 10.11335/tentouyobou.11.1_31

白土大成, 牧迫飛雄馬, 赤井田将真, 立石麻奈, 谷口善昭, 竹中俊宏, 窪薗琢郎, 大石充 . 高齢者におけるメタボリックシンドロームおよび身体機能低下と軽度認知障害との関連　垂水研究による横断分析 . 日本循環器病予防学会誌60 ( 1 ) 36 - 43 2025.2

Language：Japanese Publisher：(一社)日本循環器病予防学会

【目的】地域在住高齢者を対象にメタボリックシンドローム(MetS;Metabolic Syndrome)および身体機能低下の併存と軽度認知機能障害(MCI;Mild Cognitive Impairment)の関連を検討することを目的とした。【方法】垂水研究2019に参加した65歳以上の地域在住高齢者554名(平均年齢73.7±6.2歳、女性63.4%)のデータを横断的に分析した。MetSは国際糖尿病連合の基準を用いて判定した。身体機能は握力(男性<28kg、女性<18kg)および通常歩行速度(<1.0m/秒)で評価し、いずれか、または両方がカットオフ値未満であれば、身体機能低下ありと判定した。MetSおよび身体機能低下の有無から,健常群、MetS単独群(Mets群)、身体機能低下単独群(身体機能低下群)、MetSおよび身体機能低下併存群(併存群)の4群に分類した。認知機能は、National Center for Geriatrics and Gerontology Functional Assessment Tool(NCGG-FAT)により記憶力、注意機能、遂行機能、情報処理速度を評価し、いずれかの領域で年齢と教育歴を考慮した参照値より1.5SD以上の低下を認めた者をMCIの該当と判定した。MCIの有無を従属変数、MetSおよび身体機能低下の有無で定義された4群を独立変数とし、年齢、性別、教育歴、服薬数を共変量としたロジスティック回帰分析を実施した。【結果】健常群が191名(34.5%)、MetS群が218名(39.4%)、身体機能低下群が62名(11.2%)、併存群が83名(15.0%)であった。ロジスティック回帰分析の結果、健常群と比較し、身体機能低下群(オッズ比:2.39、95%信頼区間:1.17-4.87)、併存群(オッズ比:2.41、95%信頼区間:1.21-4.79)のそれぞれがMCIと有意な関連を認めた。一方、MetS単独群では健常群と比較したMCIと有意な関連を認めなかった。【結論】地域在住高齢者において身体機能低下を有すること、およびMetSと身体機能低下が併存していることはMCIを有することと関連することが示唆された。(著者抄録)

Yuto Kiuchi, Kota Tsutsumimoto, Kazuhei Nishimoto, Yuka Misu, Shinnosuke Nosaka, Tomoka Ohata, Hyuma Makizako, Hiroyuki Shimada . Association of trajectories of physical frailty status and incident disability in community-dwelling older adults: A longitudinal study. . Geriatrics & gerontology international25 ( 2 ) 220 - 225 2025.1

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

AIM: Frailty is a mediator between robustness and functional disability. This study examined the association between remission of frailty and incident disability. METHODS: The present study analyzed longitudinal data from 2601 community-dwelling older adults who were aged ≥65 years (mean age 70.8 ± 4.5 years, 1307 women [50.2%]) using the Cardiovascular Health Study criteria. Next, examining changes in status from wave 1 (2011) to wave 2 (2015), participants were categorized into a frailty group (those who remained or became frail), a remission of frailty group (those who were frail and became robust) and a robust group (those who remained robust). Cox proportional hazard modeling was used to determine the change of frailty status from wave 1 to wave 2, as well as incident disability at wave 2 (median duration 35 months). RESULTS: Of those participants who started in the frailty or prefrailty groups at wave 1, 15.8% had an improved frailty status at the 47-month follow up. After adjusting for covariates at baseline, the Cox proportional hazard regression models showed that the hazard ratio of disability among participants who remained robust was significantly less than for those who were in the frailty group (hazard ratio 0.515; 95% confidence interval 0.333-0.796). CONCLUSION: Our data confirm that among those whose frailty status improved, the risk of disability was lower than for those who remained frail. Geriatr Gerontol Int 2025; ••: ••-••.

DOI： 10.1111/ggi.15063

Makizako Hyuma . Cognitive Function and Falls . The Japanese Journal of Rehabilitation Medicine62 ( 1 ) 39 - 44 2025.1

Hyuma Makizako, Daijo Shiratsuchi, Shoma Akaida, Mana Tateishi, Keisuke Maeda, Katsuya Iijima, Hiroyuki Shimada, Tatsuro Inoue, Minoru Yamada, Ryo Momosaki, Hidetaka Wakabayashi, Koichi Yamamoto, Hidenori Arai . Effects of digital-based interventions on the outcomes of the eligibility criteria for sarcopenia in healthy older adults: a systematic review and meta-analysis . Ageing Research Reviews104 102663 - 102663 2025.1International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

BACKGROUND: While the digital-based interventions targeting older adults to prevent age-related health problems such as sarcopenia have grown rapidly in recent years, there are no meta-analyses indicating synthesized pooled estimates. OBJECTIVE: To examine the effects of digital-based interventions on sarcopenia-related measures, including physical performance and muscle mass, in healthy community-dwelling older adults. METHODS: Systematic searches were performed on MEDLINE, Web of Science, and Cochrane Library for eligible studies published up to 31 March 2023. The mean difference with a 95 % confidence interval was calculated. Methodological quality was assessed using Cochrane RoB 2.0. The GRADE criteria were used to assess evidence certainty. RESULTS: Thirteen randomized controlled trials with 742 participants were included in the meta-analysis. Handgrip strength, usual walking speed, five times sit-to-stand performance, and 30-second chair stand test showed significant enhancements with the digital-based interventions. However, there were no significant effects of digital-based interventions in appendicular muscle mass. The overall evidence certainty was low. CONCLUSIONS: Although digital-based interventions for healthy older adults are effective in improving physical functions, evidence certainty is low. Additional randomized controlled trials are thus required to further validate the findings.

DOI： 10.1016/j.arr.2025.102663

Otsuka R., Nishita Y., Makizako H., Kinoshita K., Tange C., Tateishi M., Zhang S., Kubota S., Fujikawa K., Ando F., Shimokata H., Mizokami F., Ogayu T., Kabayama M., Kamide K., Satake S., Arai H. . A frailty-intrinsic capacity index to predict disability in community-dwelling older Japanese adults . Journal of Aging Research and Lifestyle14 100042 2025.1

Language：Japanese Publisher：Journal of Aging Research and Lifestyle

Purpose: We constructed and validated a frailty-intrinsic capacity (FR-IC) index for predicting disability in community-dwelling older Japanese adults. Methods: This longitudinal cohort study included 1179 participants aged ≥60 years (mean age: 71.3 ± 7.4 years, 51 % men). A multidisciplinary geriatric team constructed a 35-item FR-IC index (score range: 0: robust to 1: severe frailty, accumulation model) comprising 15 domains incorporating the intrinsic capacity concept (IC-Vision, IC-Hearing, IC-Locomotor capacity, IC-Cognition, IC-Vitality, and IC-Psychological capacity) based on questionnaires widely used in Japan. To test predictive validity, age- and sex-adjusted Cox proportional hazard models estimated hazard ratios (HRs) for incident disability (care need levels ≥1) by FR-IC index quartiles using the cohort study's existing data. Results: The mean FR-IC index score (32 items, three missing) was 0.08±0.05 (range: 0.00–0.31). During a mean follow-up of 9.0 ± 2.8 years, 284 (24 %) adults developed a disability. Compared with the lowest quartile, the adjusted HRs for developing an incident disability in the second to fourth quartiles were 2.32 (95 % confidence interval: 1.15–5.33), 3.18 (1.64–7.15), and 4.15 (2.14–9.32), respectively. The area under the curve of the FR-IC index for incident disability was 0.86. Among healthy participants, defined as robust by the baseline phenotypic physical frailty assessment (n = 437), sex- and age-adjusted HRs for incident support care through the second to third tertiles were 1.72 (0.79–4.30) and 2.51(1.17–6.22), respectively (trend P = 0.028). Conclusions: The novel FR-IC index can predict future disability among community-dwelling older Japanese adults. Integrating IC into frailty assessments provides a more comprehensive measure of aging.

DOI： 10.1016/j.jarlif.2025.100042

牧迫飛雄馬 . 【リハビリテーション医療における転倒予防】認知機能と転倒 . The Japanese Journal of Rehabilitation Medicine62 ( 1 ) 39 - 44 2025.1

Language：Japanese Publisher：(公社)日本リハビリテーション医学会

高齢期での転倒発生には,筋力低下や歩行障害,バランス障害などのほか,認知障害が独立した危険因子となる.軽度認知障害を有する高齢者では転倒リスクが増大し,身体機能の低下が併存するとさらに転倒リスクが顕著となる.そのため,転倒を予防する戦略として運動介入による効果が期待されるが,確立された転倒予防の方法が存在する状況ではない.個々の転倒リスクを考慮したうえでリハビリテーション専門職による管理や指導の下での運動介入に加えて,多職種で連携した生活環境も考慮した包括的な支援が必要となる.また,二重課題下での運動を適切に注意配分しながら遂行するようなプログラムは転倒予防の効果も期待される.(著者抄録)

Hiroyuki Shimada, Takehiko Doi, Kota Tsutsumimoto, Keitaro Makino, Kenji Harada, Kouki Tomida, Masanori Morikawa, Hyuma Makizako . A New Computer-Based Cognitive Measure for Early Detection of Dementia Risk (Japan Cognitive Function Test): Validation Study. . Journal of medical Internet research27 e59015 2025International journal

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

BACKGROUND: The emergence of disease-modifying treatment options for Alzheimer disease is creating a paradigm shift in strategies to identify patients with mild symptoms in primary care settings. Systematic reviews on digital cognitive tests reported that most showed diagnostic performance comparable with that of paper-and-pencil tests for mild cognitive impairment and dementia. However, most studies have small sample sizes, with fewer than 100 individuals, and are based on case-control or cross-sectional designs. OBJECTIVE: This study aimed to examine the predictive validity of the Japanese Cognitive Function Test (J-Cog), a new computerized cognitive battery test, for dementia development. METHODS: We randomly assigned 2520 older adults (average age 72.7, SD 6.7 years) to derivation and validation groups to determine and validate cutoff points for the onset of dementia. The Mini-Mental State Examination (MMSE) was used for comparison purposes. The J-Cog consists of 12 tasks that assess orientation, designation, attention and calculation, mental rotation, verbal fluency, sentence completion, working memory, logical reasoning, attention, common knowledge, word memory recall, and episodic memory recall. The onset of dementia was monitored for 60 months. In the derivation group, receiver operating characteristic curves were plotted to determine the MMSE and J-Cog cutoff points that best discriminated between the groups with and without dementia. In the validation group, Cox proportional regression models were developed to predict the associations of the group classified using the cutoff points of the J-Cog or MMSE with dementia incidence. Harrell C-statistic was estimated to summarize how well a predicted risk score described an observed sequence of events. The Akaike information criterion was calculated for relative goodness of fit, where lower absolute values indicate a better model fit. RESULTS: Significant hazard ratios (HRs) for dementia incidence were found using the MMSE cutoff between 23 and 24 point (HR 1.93, 95% CI 1.13-3.27) and the J-Cog cutoff between 43 and 44 points (HR 2.42, 95% CI 1.50-3.93). In the total validation group, the C-statistic was above 0.8 for all cutoff points. Akaike information criterion with MMSE cutoff between 23 and 24 points as a reference showed a poor fit for MMSE cutoff between 28 and 29 points, and a good fit for the J-Cog cutoff between 43 and 44 points. CONCLUSIONS: The J-Cog has higher accuracy in predicting the development of dementia than the MMSE and has advantages for use in the community as a test of cognitive function, which can be administered by nonprofessionals.

DOI： 10.2196/59015

Masato Nishiwaki, Seiya Takada, Shotaro Otsuka, Hyuma Makizako, Harutoshi Sakakima, Naoto Shiomi, Satomi Ooba, Naoyuki Matsumoto, Kiyoshi Kikuchi . Effects of agricultural or gardening physical activity on cardiovascular disease and dementia-related markers via arterial stiffness, cognitive function, and cerebral white matter status: results from cross-sectional and interventional studies. . Frontiers in public health13 1509528 - 1509528 2025International journal

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

BACKGROUND: Agricultural or gardening physical activity (AGPA) offers potential as a simple strategy to improve cardiovascular disease and dementia-related markers; however, the actual preventive effects remain unclear. Our objective was to investigate AGPA regarding related markers of cardiovascular disease and dementia using cross-sectional and interventional approaches. METHODS AND RESULTS: In Study 1, community-based older individuals were assessed, and 30 individuals who performed AGPA (AG group) and 30 1:1 age-, sex-, and objective activity-matched controls were cross-sectionally compared (mean age, 75 ± 6 y). Arterial stiffness (pulse wave velocity) was lower and hand-finger dexterity (pegboard test) was higher in the AG vs. control groups. The interventional results of Study 2 (secondary analysis of a randomized controlled trial) confirmed that consistent AGPA might regress white matter hyperintensities in older individuals. CONCLUSION: Our findings suggest that consistent AGPA perse may improve cardiovascular disease and dementia-related markers in older healthy individuals via arterial stiffness, cognitive function, and cerebral white matter status. This information could have major implications for integrated strategies for lifelong health. SECONDARY ANALYSIS OF CLINICAL TRIALS STUDY 2: Study for Decreasing Depressive Symptoms and Increasing Memory Performance in the older adults (Trial registration number UMIN000018547, Date of registration 2015/08/07), URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000021462.

DOI： 10.3389/fpubh.2025.1509528

Ayano Tezuka, Takuro Kubozono, Yuichi Akasaki, Shin Kawasoe, Satoko Ojima, Satoshi Yamaguchi, Koji Higuchi, Hyuma Makizako, So Kuwahata, Toshihiro Takenaka, Mayuka Maeda, Seisuke Fujiwara, Mitsuru Ohishi . Impact of frailty and daily living functioning on home blood pressure measurement status. . Blood pressure monitoring 2025International journal

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

OBJECTIVE: Home blood pressure (BP) measurement is important for adequate BP control in patients with hypertension. BP targets for frail older adults need to be determined on an individual basis. This study aimed to examine the effect of frailty on home BP measurement status. METHODS: This study enrolled 682 older participants from a community cohort study conducted in Tarumizu City in 2019. We explained that home BP monitors could be lent free of charge to participants who wished to measure their BP at home. We evaluated frailty and daily living functions, such as technology usage, information practice, life management, and social engagement. We investigated how these indicators were associated with the desire to borrow home BP monitors and adherence to home BP measurements. RESULTS: A total of 304 participants agreed to borrow the home BP monitors. Multivariable logistic analysis revealed that the presence of frailty, low technology usage, and information practice were negatively associated with borrowing a home BP monitor, independent of age, sex, BMI, smoking history, and the presence of hypertension, diabetes, and dyslipidaemia. In contrast, the presence of prefrailty and frailty was positively associated with daily home BP measurements, independent of age, sex, BMI, smoking history, presence of hypertension, diabetes, and dyslipidaemia. CONCLUSION: Frailty is associated with a lower desire to monitor home BP, but is associated with higher adherence to home BP monitoring once it is initiated.

DOI： 10.1097/MBP.0000000000000767

Kikuchi K., Takada S., Otsuka S., Nakanishi K., Sakakima H., Makizako H., Tahara N., Uchikado H., Shiomi N., Ooba S., Matsumoto N., Nishiwaki M. . Agricultural or gardening physical activity may slow neurovascular aging and prevent stroke and dementia: an experimental and cross-sectional study . Frontiers in Aging Neuroscience17 1676259 2025

Language：Japanese Publisher：Frontiers in Aging Neuroscience

Background: Agricultural or gardening activity (also known as hobby farming) is a simple strategy that may be effective for maintaining health and preventing lifestyle-related diseases. However, its preventive effect on the development of conditions associated with neurovascular aging (e.g., stroke and dementia) remains unclear. Objective: To comprehensively investigate the preventive role of regular agricultural or gardening physical activity (AGPA) in neurovascular aging and its underlying mechanisms using two approaches. Methods: We conducted an experimental study in which we assessed arterial stiffness, cognitive performance (Flanker and Stroop tests), and circulating biomarkers (e.g., plasmin-α2-plasmin inhibitor complexes, nitric oxide, brain-derived neurotrophic factor) in 12 male students (average age: 22 ± 1 years) before and after three 40-min interventions (resting, cycling, and simulated AGPA) under controlled conditions. We also conducted a cross-sectional study, in which we recruited 161 (79 in the AGPA group and 82 in the control group) hospital-based older individuals (average age: 78 ± 5 years) and assessed their history of stroke, cognitive function, and brain magnetic resonance imaging (MRI) findings. Results: In the experimental study, simulated AGPA reduced arterial stiffness, improved executive cognitive function, and elevated circulating plasmin-α2-plasmin inhibitor complexes, nitric oxide, and brain-derived neurotrophic factor. Brain MRI-assessed cerebral white matter hyperintensities caused by reduced blood flow to brain tissue and stroke prevalence were lower, and cognitive scores (as assessed by the Hasegawa Dementia Scale-Revised) were higher in the AGPA group than in the control group. Conclusion: Our findings suggest that regular AGPA is associated with markers of slower neurovascular aging in older individuals. AGPA induces a combination of general physical activity-related and specific AGPA-related effects; moreover, it may offer similar or even greater benefits than physical activity alone. Therefore, habitual AGPA may serve as an effective preventive strategy for neurovascular aging.

DOI： 10.3389/fnagi.2025.1676259

伊香孝則, 白土大成, 赤井田将真, 三宅悠斗, 立石麻奈, 倉津諒大, 牧迫飛雄馬 . 一過性のバーチャルリアリティ運動が実行機能と脳血流変化に与える影響 . 理学療法かごしま4 ( 0 ) 23 - 30 2025

Language：Japanese Publisher：公益社団法人鹿児島県理学療法士協会

本研究は，健常な若年成人において，コントロール条件，実運動条件，バーチャルリアリティ（以下，VR）運動条件の3条件を実施し，条件前後での実行機能課題中における脳血流変化および実行機能課題成績の変化を比較検討することを目的とした。14名（平均年齢22.4 ± 1.7歳）を対象に，各条件の実施前後でタブレット端末を用いたストループ課題と近赤外線分光法による前頭前野の脳血流変化を測定した。各条件の実施前後におけるストループ課題の完遂時間は，コントロール条件（p ＝0.005），実運動条件（p = 0.031），VR運動条件（p = 0.022）のすべての条件で有意に短縮したが，有意な脳血流の変化は認めなかった。学習効果がみられた4名を除外した追加解析では，有意な脳血流の変化は認めなかったが，VR運動条件のみストループ課題の完遂時間が有意に短縮した（p = 0.022）。実運動条件，VR運動条件に
おいて各条件前後での実行機能課題中の脳血流変化は認められなかったが，一過性のVR運動が実行機能の改善に有益である可能性が示唆された。

DOI： 10.57357/ptkagoshima.4.0_23

宮崎宣丞, 竹下康文, 荒木草太, 中島将武, 福田将史, 井上真, 川俣洸翔, 末永卓也, 平田晃士, 國分秀真, 川田将之, 木山良二, 牧迫飛雄馬 . 地域在住者における加齢に伴う歩き始めの歩行戦略の変化 . 基礎理学療法学28 ( Supplement ) S2-1 - S2-1 2025

Daijo Shiratsuchi, Yoshiaki Taniguchi, Shoma Akaida, Mana Tateishi, Yuto Kiuchi, Ryota Kuratsu, Hyuma Makizako . Influence of exercise and dietary habits on the association of alpha‐actinin‐3 gene polymorphisms with physical function and body composition in community‐dwelling individuals aged 60 years and older . Geriatrics & Gerontology International25 ( 2 ) 173 - 181 2024.12

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

Aim

Alpha‐actinin 3 (ACTN3) is associated with diminished physical function and muscle mass in older individuals. However, the effects of lifestyle on this relationship remain unclear. This study explored whether the association between ACTN3 polymorphisms and physical function and body composition varied based on exercise and dietary habits.

Methods

A longitudinal analysis of 197 community‐dwelling individuals aged 60 years and older (mean age 72.5 ± 5.9 years, 60.9% women) in the Tarumizu study provided data on ACTN3 gene polymorphisms, with surveys completed in 2019 and 2022 (mean follow‐up 1156 ± 80.0 days). Physical performance (grip strength, walking speed) and body composition (body weight, appendicular skeletal muscle mass [ASMM], and fat mass) were assessed. Genetic polymorphisms were analyzed in oral mucosa samples and categorized into type R allele carriers and type XX alleles (homozygous for minor alleles). Median values determined exercise habits (≤4 days/week or ≥5 days/week) and dietary habits based on high‐protein‐food frequency scores.

Results

The proportion of type XX genetic polymorphism was 26.4%. Two‐way repeated‐measures analysis of covariance showed a significant interaction between genetic polymorphism and time for ASMM (F = 10.552, P = 0.002) in the ≤4 days/week exercise habits group. Significant interactions were observed in grip strength (F = 7.013, P = 0.009) and ASMM (F = 5.347, P = 0.023) for the ≤11 score high‐protein‐intake group.

Conclusions

This association may contribute to accelerated age‐related changes in physical performance and body composition, particularly among individuals with type XX genetic polymorphism who have low exercise habits and a limited intake of high‐protein foods. Geriatr Gerontol Int 2024; ••: ••–••.

DOI： 10.1111/ggi.15042

Yoshihiko Akasaki, Takayuki Tabira, Michio Maruta, Hyuma Makizako, Suguru Shimokihara, Yuma Hidaka, Taishiro Kamasaki, Wataru Kukizako, Takuro Kubozono, Mitsuru Ohishi . Subjective Memory Complaints Related to Satisfaction With Meaningful Activities Among Community-Dwelling Older Adults . Cureus16 ( 11 ) e73433 2024.11International journal

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Objective This study explores the relationship between subjective memory complaints (SMC) and satisfaction with meaningful activities among community-dwelling older adults. Methods Data were analyzed from 539 older adults without cognitive decline (mean age 74.6 ± 6.1 years, 65.0% female) who participated in a community-based health check survey (Tarumizu Study, 2019). SMC was assessed using four questionnaires, and SMC was determined when at least one of the four questionnaires was applicable. From the Aid for Decision-making in Occupation Choice (ADOC), participants selected meaningful activities. Satisfaction with these selected activities was also evaluated. Satisfaction levels were compared between participants with and without SMC, and the relationship between SMC and satisfaction with meaningful activities was analyzed using multivariate analyses. Results The prevalence of SMC was 63.2% (n = 339). Participants with SMC reported lower satisfaction with meaningful activities compared to those without SMC (p = 0.012). Notably, participants who responded positively to SMC-2 ("Do you forget where you have left things more than you used to?") (p = 0.027) and SMC-4 ("Do other people find you forgetful?") (p = 0.004) had significantly lower satisfaction with meaningful activities. Logistic regression analyses revealed a significant relationship between SMC and satisfaction with meaningful activities after adjusting for covariates (OR, 0.79; 95% CI, 0.633-0.996; p = 0.046). Conclusions There is a relationship between SMC and satisfaction with meaningful activities among community-dwelling older adults. Participation in and satisfaction with meaningful activities may play a role in developing effective support for individuals with SMC.

DOI： 10.7759/cureus.73433

Tateishi Mana, Akaida Shoma, Taniguchi Yoshiaki, Kiuchi Yuto, Shiratsuchi Daijo, Makizako Hyuma . The difference in effect between individual exercise and collective exercise in older adults with frailty-A randomized controlled trial- . Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics61 ( 4 ) 447 - 455 2024.10

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japan Geriatrics Society

Aim: To examine the influence of exercises, including individual and collective exercises, on older adults with frail and prefrail.Methods: We enrolled 21 older adults with pre-frail and frail (77.1±3.3 years, 90.5% women). The participants were randomly divided into 2 groups: an individual group (n=11) and a collective group (n=10). They performed exercises for 90 minutes once a week for 12 weeks. The individual groups underwent a multi-component exercise program that included strength training using a training machine. The collective group underwent a multi-component exercise program that included strength training in a chair. We evaluated body composition and physical and cognitive functions. These functions were compared before and after the intervention in each group, and the rates of change in the evaluated items were compared between the 2 groups.Results: In the individual group, after the intervention, BMI (p=0.03) and fat mass (p<0.01) decreased, and the 5 Stand Test (p<0.01) and walking speed (p=0.02) improved. In the collective group, the intervention, 5 Stand Test (p<0.01) and information processing (p=0.03) improved after the intervention. Furthermore, the rate of improvement in the 5 Stand Test was higher in the individual group than in the collective group (p<0.01). Conclusions: In the individual exercise group, the physical function improved and fat mass decreased. The cognitive function improved in the collective exercise group. These findings could serve as the basis for formulating an effective exercise program for frail older adults.

DOI： 10.3143/geriatrics.61.447

Daijo Shiratsuchi, Yoshiaki Taniguchi, Yuto Kiuchi, Shoma Akaida, Hyuma Makizako . Association of alpha-actinin-3 genotype with muscle mass and physical function in community-dwelling older adults . European Geriatric Medicine16 ( 1 ) 15 - 22 2024.10International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Purpose

Polymorphisms (rs1815739; R577X) in the gene encoding alpha-actinin-3 (ACTN3) are thought to be associated with body composition and physical function in older people and athletes. RR homozygotes are associated with greater expression of ACTN3 protein in muscle than the X-allele carriers. We aimed to investigate the association between ACTN3 R577X polymorphism and appendicular skeletal muscle mass, walking speed, and muscle strength in older adults.

Methods

A cross-sectional analysis was performed on 265 community-dwelling older adults (mean age 74.0 ± 5.8 years, 63.4% female) who provided data on ACTN3 gene polymorphisms and completed surveys in the Tarumizu study conducted between 2018 and 2019. Genetic polymorphisms were categorized as RR homozygous and X allele. Muscle mass was assessed using the appendicular skeletal muscle mass index (ASMI), and physical function was assessed based on walking speed and relative muscle strength. Those in the bottom 25% for each sex were considered “low” and the association with ACTN3 genotype was examined.

Results

Considering ACTN3 polymorphism, 72 participants were RR homozygotes (27.2%) and 193 were X-allele carriers (72.8%). After adjusting for potential confounders, RR homozygosity was associated with not having low muscle mass (odds ratio 0.39, 95% confidence interval 0.19–0.82, p = 0.013) but not with low walking speed and muscle strength.

Conclusion

The association between ACTN3 genotype and physical function in community-dwelling older adults is not clear; however, it is considered to be associated with muscle mass.

DOI： 10.1007/s41999-024-01080-0

Other Link： https://link.springer.com/article/10.1007/s41999-024-01080-0/fulltext.html

Yuto Kiuchi, Kota Tsutsumimoto, Kazuhei Nishimoto, Yuka Misu, Tomoka Ohata, Hyuma Makizako, Hiroyuki Shimada . Effect of eating alone and depression symptoms on incident disability among community-dwelling older adults . Nutrition129 112599 - 112599 2024.10International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

OBJECTIVES: The intent of the present study was to elucidate the association of eating alone and depressive symptoms with the development of disability among community-dwelling older adults, using a longitudinal study. METHOD: Participants included 4648 Japanese older adults (mean age 73.8 ± 5.4 years; 44.3% men) aged ≥ 65 years at the time of the examination. Eating status was divided into two categories: "Eating with others at least once a day" and "Other." The 15-item Geriatric Depression Scale was used to measure depressive symptoms. Incident disability was certified by long-term care insurance (median duration: 36 months). RESULTS: During a median follow-up at 36 months, 8.0% of the participants developed an incident disability. Adjusted for covariates, the participants who ate alone were associated with a higher hazard ratio of incident disability compared to those who ate with others (hazard ratio: 1.36, 95% confidence interval: 1.05-1.75). However, adjusted for the covariate depressive symptoms, eating alone was not significantly associated with incident disability. Structural equation models revealed that the indirect model confirmed eating alone habits were associated with disability via depressive symptoms. CONCLUSIONS: This study confirmed that eating alone was associated with an incident disability after adjusting for the covariates. Furthermore, the present study suggests an indirect relationship between eating alone and incident disability via depressive symptoms, the result of the structural equation model.

DOI： 10.1016/j.nut.2024.112599

立石麻奈, 赤井田将真, 谷口善昭, 木内悠人, 白土大成, 牧迫飛雄馬 . フレイル高齢者に対する個別運動と集団運動による効果の相違の検証　ランダム化比較試験 . 日本老年医学会雑誌61 ( 4 ) 447 - 455 2024.10

Language：Japanese Publisher：(一社)日本老年医学会

目的:フレイルの予防・改善を目的とした運動介入において個別運動または集団運動といった運動の実施形態の違いは異なった効果をもたらすことが考えられる.本研究は地域在住のフレイルおよびプレフレイル高齢者を対象に運動介入形態の違い(個別または集団)が心身機能に及ぼす影響を明らかにすることを目的とした.方法:フレイルまたはプレフレイルを有する高齢者21名(平均77.1±3.3歳,女性90.5%)を個別群11名と集団群10名にランダムに割りつけ,週1回90分の運動を12週間実施した.個別群はトレーニングマシンを使用して行う筋力トレーニングを含むマルチコンポーネント運動プログラム,集団群は椅子座位中心,自重での筋力トレーニングを含むマルチコンポーネント運動プログラムを実施した.評価項目は身体組成,身体機能,認知機能とした.介入前後の比較および,群間における変化率の比較を行った.結果:介入前後の比較において個別群でBMI(p=0.03),体脂肪量(p<0.01)で有意な減少が認められ,5回立ち座り(p<0.01),歩行速度(p=0.02)が有意に改善した.集団群では,5回立ち座り(p<0.01),情報処理機能(p=0.03)で有意な改善が認められた.群間における変化率の比較では5回立ち座りにおいて個別群は集団群と比較して有意な改善が認められた(p=0.01).結論:運動の実施形態に関わらず,身体機能の改善が示され,個別群のみでBMI,体脂肪量の減少,集団群のみで認知機能の改善がみられた.フレイルおよびプレフレイル高齢者における運動介入において運動の実施形態による効果の特性を考慮することは,個人の背景に則した運動プログラム作成の一助になりうる.(著者抄録)

白土大成, 赤井田将真, 三宅悠斗, 竹中俊宏, 窪薗琢郎, 大石充, 大塚礼, 牧迫飛雄馬 . 地域在住高齢者におけるフレイルおよび内在的能力と主観的健康感の関連 . 日本サルコペニア・フレイル学会雑誌8 ( Suppl. ) 175 - 175 2024.10

Hyuma Makizako, Shoma Akaida, Mana Tateishi, Daijo Shiratsuchi, Ryoji Kiyama, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi . A Three-Year Longitudinal Follow-Up Study: Does Mild Cognitive Impairment Accelerate Age-Related Changes in Physical Function and Body Composition? . Cureus16 ( 9 ) e68605 2024.9International journal

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Age-related declines in physical function, body composition, and cognitive function are interrelated. This prospective study aimed to examine the impact of mild cognitive impairment (MCI) on age-related changes in physical function and body composition among community-dwelling older adults. We analyzed data from 180 older adults (aged ≥70 years) who completed a longitudinal assessment of physical function and body composition in the community. Physical function included grip strength and time taken to walk 10 m at normal and maximum pace. Body composition assessments calculated the body mass index (BMI) and appendicular skeletal muscle index (ASMI) using bioelectrical impedance analysis at baseline and three-year follow-up assessments. MCI was defined as values below the age- and education-adjusted reference threshold in several tests, including memory, attention, executive function, and processing speed. Participants were divided into the MCI and non-MCI groups based on their MCI status at baseline. A two-way repeated-measures analysis of covariance (ANCOVA), adjusting for age and gender, was used to analyze the group (MCI and non-MCI) by time (baseline and three-year follow-up) interaction. Thirty participants (16.7%) had MCI at baseline. The repeated-measures ANCOVA indicated that no variables had significant group by time interactions. Stratified analyses by gender (repeated-measures ANCOVA, adjusted for age) confirmed a significant group by time interaction on BMI (F=5.63, p=0.02) and ASMI (F=6.33, p=0.01) among women. Older women with MCI may experience a greater impact of the acceleration of shrinking and age-related decline in muscle mass. The close associations of MCI with shrinking and muscle mass loss have important implications for targeting interventions among MCI women.

DOI： 10.7759/cureus.68605

古谷直弘, 四宮明宏, 白土大成, 土方麻衣, 坂本勇斗, 武藤健人, 牧迫飛雄馬 . 胃癌・大腸癌患者における術前のPossible Sarcopeniaと術後の合併症および在院日数との関連　後ろ向き観察研究 . 日本がん・リンパ浮腫理学療法学会誌2 39 - 47 2024.9

Language：Japanese Publisher：(一社)日本がん・リンパ浮腫理学療法学会

【目的】本研究の目的は、胃癌または大腸癌を有する患者の術前のPossible Sarcopenia(PS)と握力の低下、5回椅子起立時間の延長と術後の合併症の発生および在院日数との関連を検討することとした。【方法】対象は、胃癌または大腸癌の術後に自宅退院した患者75例とした。Asian Working Group for Sarco-penia 2019に準じて術前のPS、握力の低下、5回椅子起立時間の延長を判定し、術後の合併症の発生と在院日数との関連を調査した。【結果】術前のPSは、術後の合併症の発生と在院日数の長期化との関連が認められた。握力の低下、5回椅子起立時間の延長は、術後の合併症の発生と在院日数の長期化との関連が認められなかった。【結論】術前のPSは、胃癌または大腸癌を有する患者の術後の合併症の発生と在院日数の長期化との関連が示唆された。(著者抄録)

Tomoya Ishigaki, Shogo Misu, Toshinori Miyashita, Daisuke Matsumoto, Midori Kamiya, Akio Okamae, Tatsuya Ogawa, Hikaru Ihira, Yoshiaki Taniguchi, Takeshi Ohnuma, Tomohisa Chibana, Natsu Morikawa, Tome Ikezoe, Hyuma Makizako . Effects of Walking-Only Intervention on Physical Function, Fall-Related Outcomes, and Health-Related Quality of Life in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. . Journal of aging and physical activity33 ( 1 ) 1 - 13 2024.8Reviewed International journal

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

This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

DOI： 10.1123/japa.2023-0183

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J05647&link_issn=&doc_id=20240905070009&doc_link_id=%2Feh0ohrou%2F2024%2F001801%2F010%2F0107-0116%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feh0ohrou%2F2024%2F001801%2F010%2F0107-0116%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

鈴木隆雄, 鄭丞媛, 西田裕紀子, 大塚礼, 島田裕之, 牧迫飛雄馬, 金憲経, 大渕修一, 河合恒, 藤原佳典, 阿部巧, 小島成実, 平野浩彦, 増井幸恵, 稲垣宏樹, 吉田祐子, 飯島勝矢, 吉村典子, 山田実, 渡辺修一郎, 近藤克則, 村木功, 岩佐一 . 地域在宅高齢者における高次生活機能について　ILSA-JにおけるJST版活動能力指標の分析から . 応用老年学18 ( 1 ) 107 - 116 2024.8

Language：Japanese Publisher：(一社)日本応用老年学会

日本は急速な超高齢社会を迎え,平均寿命の著しい伸びとともに,高齢者の生活機能も大きく変容し,健康水準の高い活力ある高齢者が増加している.本研究では,我が国の地域在宅高齢者を対象とした老化に関する多数のコホート研究の統合研究(「長寿コホートの統合的研究;Integrated Longitudinal Study on Aging in Japan:ILSA-J」)で収集された高次生活機能評価指標であるJST版活動能力指標(JST-IC)を用いて,現代の地域在宅高齢者における生活活動能力の現状を報告した.JST-ICでは総合スコアおよび4項目の下位尺度(新機器利用,情報収集,生活マネジメント,社会参加)について性別および年齢階級別の平均値と標準偏差を算出した.その結果,男女間では情報収集以外の全ての項目で性差が認められ,年齢階級間では男女ともに全ての項目で有意差が認められ,加齢に伴いスコアは低下していた.本研究では,高齢者の高次生活機能の一端を明らかにし,今後の利活用に資する資料とした.(著者抄録)

鈴木隆雄, JEONG Seungwon, 鈴木隆雄, JEONG Seungwon, 西田裕紀子, 大塚礼, 島田裕之, 牧迫飛雄馬, KIM Hunkyung, KIM Hunkyung, 大渕修一, 河合恒, 藤原佳典, 阿部巧, 小島成実, 平野浩彦, 増井幸恵, 稲垣宏樹, 吉田祐子, 飯島勝矢, 飯島勝矢, 吉村典子, 山田実, 渡辺修一郎, 近藤克則, 近藤克則, 村木功, 岩佐一 . High Level of Functional Capacity Assessed by Japan Science and Technology Agency Index of Competence among Community-Dwelling Older Adults in Japan: Findings from the ILSA-J integrated Cohort Study. . 応用老年学18 ( 1 ) 107 - 116 2024.8

鈴木隆雄, 鄭丞媛, 西田裕紀子, 大塚礼, 島田裕之, 牧迫飛雄馬, 金憲経, 大渕修一, 河合恒, 藤原佳典, 阿部巧, 小島成実, 平野浩彦, 増井幸恵, 稲垣宏樹, 吉田祐子, 飯島勝矢, 吉村典子, 山田実, 渡辺修一郎, 近藤克則, 村木功, 岩佐一 . 地域在宅高齢者における高次生活機能について ILSA-JにおけるJST版活動能力指標の分析から . 応用老年学18 ( 1 ) 107 - 116 2024.8

Language：Japanese Publisher：(一社)日本応用老年学会

Yuto Kiuchi, Hyuma Makizako, Mika Kimura, Yuki Nakai, Yoshiaki Taniguchi, Shoma Akaida, Mana Tateishi, Takuro Kubozono, Toshihiro Takenaka, Hiroyuki Shimada, Mitsuru Ohishi . Association of combined low physical activity and low dietary diversity with mild cognitive impairment among community-dwelling Japanese older adults. . Annals of geriatric medicine and research28 ( 4 ) 453 - 459 2024.7International journal

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

OBJECTIVE: This study aimed to investigate the potential association between the combination of low physical activity and low dietary diversity with mild cognitive impairment (MCI) in older Japanese adults. METHODS: Data from 600 older adults (mean age 74.1 ± 6.4 years; 62.0% women) were analyzed. We evaluated dietary variety based on the Food Frequency Score (FFS) (maximum 30 points) by assessing the one-week consumption frequencies of ten foods. An FFS of ≤ 16 indicated low dietary diversity. We assessed MCI using the National Center for Geriatrics and Gerontology (NCGG) Functional Assessment Tool. Physical activity levels was determined based on participant responses to two questions: "Do you engage in moderate levels of physical exercise or sports aimed at health?" and "Do you engage in low levels of physical exercise aimed at health?". Participants who responded "No" to both questions were classified as having low physical activity levels. We classified the participants into robust, low-dietary diversity, low-physical activity, and coexistence groups. RESULTS: The overall prevalence of MCI was 20.7%, with rates in the robust, low dietary diversity, low physical activity, and coexistence groups of 17.7%, 24.7%, 25.0%, and 41.9%, respectively. Multiple logistic regression analysis revealed that low dietary diversity and physical activity were associated with MCI in older adults (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.22-6.28). CONCLUSIONS: The results of the present study demonstrated the association of the co-occurrence of low dietary diversity and low physical activity with MCI. Older adults with both risk factors may require early detection, as well as physical activity and dietary interventions.

DOI： 10.4235/agmr.24.0080

Tatsuya Fukuei, Shoma Akaida, Yoshiaki Taniguchi, Daijo Shiratsuchi, Yuto Kiuchi, Mana Tateishi, Yukari Aishita, Ryota Kuratsu, Hyuma Makizako . Associations between driving status, frequency of transport use after driving cessation, and social frailty among middle-aged and older people aged 60 years and older . Annals of Geriatric Medicine and Research28 ( 4 ) 437 - 444 2024.7International journal

Language：English Publishing type：Research paper (scientific journal) Publisher：The Korean Geriatrics Society

BACKGROUND: The use of transport other than cars is a modifiable factor in the association between driving cessation and social frailty. Clarifying this relationship may serve as a new preventive measure against social frailty among current non-drivers. This study examined the potential association of driving status and transport use with social frailty, as well as between the frequency of transport use and social frailty, among current non-drivers. METHODS: This study included 977 middle-aged and older adults (average age, 65.3±4.8 years). The participants were classified as transport users (more than a few times a week) and transport non-users (less than a few times a month). Based on driving status and transport use, the groups were further classified into current driver, current non-driver/transport user, and current non-driver/transport non-user groups. The relationships between driving status, transport use, and social frailty were examined using multiple logistic regression. RESULTS: The current non-driver group and the transport non-user group were significant association with a higher social frailty. The current non-driver/transport user group showed no association with social frailty compared with the current driver group. The odds ratio for the social frailty rate for The current non-driver/transport non-user group was 2.14 (95% confidence interval, 1.25-3.73). CONCLUSIONS: Participants who neither drive nor take transport showed significant associations with increased social frailty. Compared with current driver/transport use, current non-driver/transport non-use was associated with social frailty.

DOI： 10.4235/agmr.24.0071

Hyuma Makizako, Shoma Akaida, Daijo Shiratsuchi, Mana Tateishi . Are middle-aged and older adult users of physical activity monitors more physically active and at a lower risk of locomotive syndrome? Cross-sectional Web-based Online Survey . Annals of Geriatric Medicine and Research28 ( 3 ) 323 - 329 2024.5International journal

Language：English Publishing type：Research paper (scientific journal) Publisher：The Korean Geriatrics Society

BACKGROUND: Physical inactivity is a risk factor for locomotive syndromes and functional limitations in middle-aged and older adults. Therefore, strategies to promote physical activity should be considered. This study investigated whether users of physical activity monitors were more physically active and exhibited a lower risk of locomotive syndrome, compared with non-users. METHODS: We analyzed data from 742 Japanese adults aged 60-79 years. The participants were surveyed for their use of physical activity monitors in their daily lives. We also assessed the prevalence of locomotive syndrome. RESULTS: We observed significantly higher physical activity levels in users compared with non-users. Moreover, the use of a physical activity monitor was significantly associated with decreased odds of locomotive syndrome (adjusted odds ratio [aOR]=0.48). Significantly lower risk of locomotive syndrome were observed in individuals who had used a monitor for >2 years (aOR=0.42) or had set a personal step goal (aOR=0.32). CONCLUSION: Physical activity monitoring may increase engagement in physical activity-associated behavior. Therefore, monitoring could serve as a useful tool to promote physical health in middle-aged and older adults.

DOI： 10.4235/agmr.24.0040

牧迫飛雄馬 . 認知症の基礎知識とリハビリテーション 11. 軽度認知障害(MCI)とリハビリテーション . J. of Clinical Rehabilitation33 ( 5 ) 486 - 489 2024.5

Daijo Shiratsuchi, Hyuma Makizako, Shoma Akaida, Mana Tateishi, Hirohiko Hirano, Katsuya Iijima, Minoru Yamada, Narumi Kojima, Shuichi Obuchi, Yoshinori Fujiwara, Hiroshi Murayama, Yukiko Nishita, Seungwon Jeong, Rei Otsuka, Takumi Abe, Takao Suzuki . Associations between information and communication technology use and frailty in community-dwelling old-old adults: results from the ILSA-J. . European geriatric medicine15 ( 3 ) 621 - 627 2024.5International journal

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

OBJECTIVES: Frailty is a significant cause of adverse health events including long-term care and hospitalization. Although information and communication technology (ICT) has become an integral part of modern life, it remains unclear whether ICT use is associated with frailty. DESIGN: A cross-sectional study (Integrated Longitudinal Studies on Aging in Japan, ILSA-J). SETTING AND PARTICIPANTS: Aged 75 and older data from the ILSA-J in 2017 (n = 2893). METHODS: ICT use was measured using the technology usage sub-items of the Japan Science and Technology Agency Index of Competence. Specifically, the use of mobile phones, ATMs, DVD players, and sending e-mails were rated as "yes" (able to do) or "no" (unable to do), with the first quintile (≤1 point) defined as ICT non-users. Frailty was assessed using the Japanese version of the Cardiovascular Health Study criteria based on the phenotype model (e.g., weight loss, slowness, weakness, exhaustion, and low activity). Further, multivariate logistic regression analysis analyzed its association with ICT use. Subgroup analyses were stratified according to gender, years of education, and living arrangements. RESULTS: Higher ICT use was not associated with frailty after adjusting for covariates (odds ratio [OR]: 0.53; 95%CI 0.39-0.73). Similar associations were found in the sub-groups of women (OR 0.45, 95%CI 0.30-0.66), <13 years of education (OR 0.48, 95%CI 0.34-0.67), living alone (OR 0.46, 95%CI 0.27-0.79), and living together (OR 0.57, 95%CI 0.38-0.85). No association existed between using ICT and frailty in the sub-groups of men and ≥13 years of education. CONCLUSIONS AND IMPLICATIONS: Higher ICT use is associated with the absence of frailty in individuals 75 years and older. Such benefits may be particularly pronounced in women, those with lower levels of education, and older adults living alone or with others.

DOI： 10.1007/s41999-024-00979-y

赤井田将真, 田平隆行, 立石麻奈, 白土大成, 下木原俊, 倉津諒大, 赤崎義彦, 日高雄磨, 牧迫飛雄馬 . 地域在住高齢者における意味のある活動の満足度および遂行度が3年後の認知機能に及ぼす影響 . 日本老年医学会雑誌61 ( Suppl. ) 138 - 138 2024.5

Yuto Kiuchi, Hyuma Makizako, Yuki Nakai, Yoshiaki Taniguchi, Shoma Akaida, Mana Tateishi, Mika Kimura, Toshihiro Takenaka, Takuro Kubozono, Kota Tsutsumimoto, Hiroyuki Shimada, Mitsuru Ohishi . Associations of eating out and dietary diversity with mild cognitive impairment among in community-dwelling older adults. . Annals of geriatric medicine and research28 ( 3 ) 266 - 272 2024.4Reviewed International journal

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

BACKGROUND: Dementia is a critical later life health issue that occurs among members of aging societies. This study examined the relationships between eating out, dietary diversity, and mild cognitive impairment (MCI) among community-dwelling older adults. METHODS: We analyzed data from 597 older adults (median age 73.0 years [interquartile range 69.0-78.0] and 62.6% females). We applied the Food Frequency Score (FFS) to evaluate diet variety and the weekly consumption frequencies of ten food items were determined. The Functional Assessment Tool from the National Center for Geriatrics and Gerontology was used to evaluate MCI. Finally, we asked the participants how often they ate out each month; those who replied 'none' were categorized into the "non-eating out" group. RESULTS: The overall prevalence of MCI was 122 (20.4%), with a higher prevalence in the low dietary diversity group than in the high dietary diversity group (28.6% vs. 18.6%). After adjusting for covariates, the participants who self-described as not eating out were independently associated with low dietary diversity (odds ratio [OR]: 1.97, 95% confidence interval [CI]: 1.20-3.20), while low dietary diversity was associated with MCI (OR: 1.72, 95% CI: 1.02-2.87). Structural equation models revealed that not eating out had no direct effect on MCI but was associated with MCI via low dietary diversity (root mean square error of approximation = 0.030, goodness-of-fit index=0.999, and adjusted goodness-of-fit index = 0.984). CONCLUSIONS: Although non-eating out may not have a direct effect on MCI, an indirect relationship may exist between eating-out habits and MCI via dietary diversity status.

DOI： 10.4235/agmr.23.0218

Takumi Abe, Yoshinori Fujiwara, Akihiko Kitamura, Yu Nofuji, Yukiko Nishita, Hyuma Makizako, Seungwon Jeong, Masanori Iwasaki, Minoru Yamada, Narumi Kojima, Katsuya Iijima, Shuichi Obuchi, Ken Shinmura, Rei Otsuka, Takao Suzuki . Higher-level competence: Results from the Integrated Longitudinal Studies on Aging in Japan (ILSA-J) on the shape of associations with impaired physical and cognitive functions. . Geriatrics & gerontology international24 ( 4 ) 352 - 358 2024.4

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

AIM: This study aimed to examine the relationships between levels of competence and impaired physical and cognitive functions in older adults. METHODS: We used a data set of the Integrated Longitudinal Studies on Aging in Japan for 2017 including 5475 community-dwelling older adults. Levels of competence were assessed using the Japan Science and Technology Agency Index of Competence (JST-IC). Grip strength (low grip strength: <28 kg for men and <18 kg for women) and gait speed (slow gait speed: <1.0 m/s for both sexes) were evaluated as physical function measurements, and the Mini-Mental State Examination (cognitive decline: <24 on the Mini-Mental State Examination) was used to assess cognitive function. RESULTS: The JST-IC had areas under the curve estimated from receiver operating characteristic analysis ranging from 0.65 to 0.73 for detecting low function as assessed by these tests. Restricted cubic spline curves showed that the shape of the association between the JST-IC and impaired function depended on sex and the test used. The comparison between perfect and imperfect JST-IC scores showed significant differences in the prevalence of low grip strength in both sexes, slow gait speed in women, and cognitive decline in men. CONCLUSIONS: It may be insufficient to identify those with impaired physical or cognitive function using the JST-IC. The shape of the association with the JST-IC varies across their measurements. Our findings can help interpret JST-IC scores in the context of low physical and cognitive functions. Geriatr Gerontol Int 2024; 24: 352-358.

DOI： 10.1111/ggi.14839

Abe Takumi, Fujiwara Yoshinori, Kitamura Akihiko, Nofuji Yu, Nishita Yukiko, Makizako Hyuma, Jeong Seungwon, Iwasaki Masanori, Yamada Minoru, Kojima Narumi, Iijima Katsuya, Obuchi Shuichi, Shinmura Ken, Otsuka Rei, Suzuki Takao . Higher-level competence: Results from the Integrated Longitudinal Studies on Aging in Japan(ILSA-J) on the shape of associations with impaired physical and cognitive functions(タイトル和訳中) . Geriatrics & Gerontology International24 ( 4 ) 352 - 358 2024.4

Language：English Publisher：John Wiley & Sons Australia, Ltd

地域在住高齢者の活動能力と身体機能および認知機能の低下との関連を検討した。2017年に長寿コホートの総合的研究(ILSA-J)でデータを収集した地域在住高齢者を対象とした。活動能力は科学技術振興機構版活動能力指標(JST-IC)スコアで評価した。身体機能として握力(男性28kg未満、女性18kg未満を握力低下と定義)と歩行速度(男女とも1.0m/秒未満を歩行速度低下と定義)を測定し、認知機能としてミニメンタルステート検査(24点未満を認知機能低下と定義)を行った。高齢者5475名(男性2021名;平均75.5±6.2歳、女性3454名;平均74.3±5.6歳)を解析した。ROC解析で、JST-ICによる機能低下検出の曲線下面積は0.65～0.73の範囲であった。制限付き三次スプライン曲線で、JST-ICと機能低下との関連の形状は、性別と検査の種類に依存することが示された。JST-IC満点とそれ以外を比較すると、男女とも握力の低さ、女性の歩行速度の低下、男性の認知機能低下の有病率に有意差が認められた。以上より、身体機能または認知機能が低下した人の特定にJST-ICでは不十分な可能性が示唆された。

牧迫飛雄馬 . 産官学連携による中高齢者を対象とした地域コホート研究̶垂水研究̶ . 日本予防理学療法学会学術大会プログラム・抄録集2.Suppl.No.1 ( 0 ) 94 - 94 2024.3

Language：Japanese Publisher：日本予防理学療法学会

【背景と研究フィールド】垂水研究のフィールドとなる鹿児島県垂水市は大隅半島の北西部に位置しており、養殖 (ブリ・カンパチ)、農業 (野菜・果物)、畜産 (豚)が盛んな地方都市である。人口は13,550人 (2021年6月1日時点の推計人口)、高齢化率は約42％と高齢化の進展が顕著であり、小中学校の統廃合も進み、少子化も大きな課題となっている。 【取組概要】垂水研究は、中高齢 (40歳以上)の市民を対象とした包括的な健康チェックのほか、健康チェックの結果報告会、健康支援のための介入試験、市報での情報還元などで構成され、これらの取組は「たるみず元気プロジェクト」という名称で広く市民に周知している。垂水研究の健康チェックから得られたデータを基にして、健康寿命延伸のための事業や施策へ反映させていくことを目指している。垂水研究の中核的な研究事業内容は、毎年実施している40歳以上の市民を対象とした包括的な健康チェックである。健康チェックでは、医師による問診や一般的な健康状態 (服薬状況含む)に関する質問調査の他、心電図、動脈硬化、身体機能 (筋力、歩行など)、認知機能、身体組成、口腔機能、栄養調査、血液検査、日常生活に関する調査など、 1300項目を超えるデータ変数を取得している。 【大学・行政・地域基幹病院との協働】垂水研究は、大学・行政・地域基幹病院との綿密な協働体制で実施している。医療専門職に関しては、医師、歯科医師、看護師、保健師、理学療法士、作業療法士、言語聴覚士、薬剤師、管理栄養士などの多職種が関わっており、専門の研究領域も高血圧内科、老年学、栄養学、運動学、バイオメカニクス (生体力学)、精神・心理学など多岐にわたる。大学院生や学部生が調査に参加し、教育的な支援体制としての貢献度も高い。また、地域企業も参画し、市民への周知のみならず、地元企業への周知も進んでおり、多方面で地域活性化の事業への発展が期待されている。 【研究成果】これまでに垂水研究で得られた学術的な成果は国際誌31編 (2023年4月現在)で公開されている。また、日本人高齢者の健康水準の特性と推移に関する総合的プラットフォームの形成を目的とした「長寿コホートの総合的研究 (ILSA-J)」 ( 事務局：国立長寿医療研究センター、研究代表：鈴木隆雄)に参画しており、日本人高齢者の老化の変容に関する統合的分析に寄与している。 【倫理的配慮】本発表に関する研究は、鹿児島大学疫学研究等倫理委員会 (170351 疫-改10、200054疫)の承認を得て実施されている。

DOI： 10.57304/jsptpsuppl.2.suppl.no.1.0_94

牧野圭太郎, 土井剛彦, 堤本広大, 片山脩, 山口亨, von Fingerhut Georg, 山際大樹, 牧迫飛雄馬, 島田裕之 . 地域高齢者のライフイベントと社会的健康度：ポジティブおよびネガティブな側面からの検討 . 日本予防理学療法学会学術大会プログラム・抄録集2.Suppl.No.1 ( 0 ) 26 - 26 2024.3

Language：Japanese Publisher：日本予防理学療法学会

【はじめに、目的】 近年、高齢期の健康状態の指標として、身体、認知、心理的な健康度に加え、社会的な健康度を評価することの重要性が認識されており、これを表す概念の1つとして社会的フレイルが提唱された。社会的フレイルは障害発生や死亡のリスクに影響することが報告されているが、社会的フレイルの発生に影響する因子については未だ十分に検討されていない。本研究では、高齢期に経験するポジティブおよびネガティブなライフイベントが社会的健康度に及ぼす影響について、操作的に定義した社会的フレイルを用いて検討した。 【方法】 対象はベースライン時点で社会的フレイルのない地域高齢者 2,174名とした。社会的フレイルは、1)独居である、2)外出頻度の減少、3)友人を訪ねることがない、4)誰とも話さない日がある、5)家族や友人の役に立っている気がしない、の5項目のうち2項目以上に該当する場合と定義し、ベースライン (2011年)と4年後 (2015年)において評価した。ライフイベントは先行研究に基づき、ポジティブなイベントの有無 (「子や孫の結婚」「孫やひ孫の誕生」「新たな友人との出会い」のうち1つ以上)と、ネガティブなイベントの有無 (「経済的困難さの増大」「配偶者の病気や怪我」「家族や友人の死」のうち1つ以上)を、ベースラインから15カ月間について評価した。 【結果】 多変量ロジスティック回帰分析の結果、ネガティブなライフイベントの経験 (1つ以上)は社会的フレイル発生と関連しなかった (オッズ比: 1.17、95%信頼区間: 0.83-1.59)が、ポジティブなライフイベントの経験 (1つ以上)は社会的フレイル発生のリスク低下と関連した (オッズ比: 0.48、95%信頼区間: 0.34-0.67)。さらに、ポジティブなライフイベントと社会的フレイルとの関連は、同期間にネガティブなイベントも経験した対象者 (1,059名)に限定した感度分析においても保たれた (オッズ比: 0.55、95%信頼区間: 0.34-0.88)。 【考察】 ポジティブなライフイベントは社会的フレイル発生に保護的に働く可能性があり、社会的健康度の維持向上に向けた戦略立案に有用な知見が得られたと考えられる。一方、本研究ではネガティブなイベントは社会的フレイルと関連しなかったが、先行研究では社会的孤立や孤独感との関連が報告されており、今後は個々のライフイベントの内容や社会的健康度の評価指標の違いを加味した追加検証が必要である。 【倫理的配慮】本研究は、著者所属機関の倫理・利益相反委員会の承認を受けて実施した。ヘルシンキ宣言の趣旨に沿い、対象者には本研究の主旨および目的を口頭と書面にて説明を行い、書面にて同意を得た上で本研究を実施した。

DOI： 10.57304/jsptpsuppl.2.suppl.no.1.0_26

谷口善昭, 赤井田将真, 白土大成, 立石麻奈, 牧迫飛雄馬 . 60歳以上の中高齢者における勇気ある思考や行動と主観的健康感との関連性 . 日本予防理学療法学会学術大会プログラム・抄録集2.Suppl.No.1 ( 0 ) 197 - 197 2024.3

Language：Japanese Publisher：日本予防理学療法学会

【目的】 パーソナリティは、疾患や死亡リスクと関連性が示されており、なかでも勇気ある思考や行動は、健康的な生活を送るうえで重要な要素となり得る。主観的健康感は、健康増進を考えるうえで重要な指標のひとつである。本研究は勇気ある思考や行動と主観的健康感との関連性を明らかにすることを目的とした。 【方法】 Yahoo!クラウドソーシング利用者へのWEB調査 (2021年6月21日～28日)で同意が得られ、適格基準を満たした60歳以上の中高齢者750名 (平均65.2±4.8歳、女性31.6%)を横断的に分析した。勇気は、Values in Action Inventory of Strengths (VIA-IS)の一部である8つの質問に対して、5件法で回答を得た (1：全くあてはまらない～5：とてもよくあてはまる)。主観的健康感は、「あなたは普段ご自分で健康だと思いますか」の質問に対する回答から不良群 (健康ではない・あまり健康ではない)と良好群 (まぁ健康な方だと思う・非常に健康だと思う)に分類した。従属変数に主観的健康感、独立変数は勇気、さらに勇気の下位項目である勇敢、勤勉、誠実性、熱意としたロジスティック回帰分析を行った (共変量：年齢、性別、服薬数、精神的健康度 (K6))。その後、性別で層別化したロジスティック回帰分析を行った。 【結果】 主観的健康感の良好群は71.6%、不良群は28.4%であった。ロジスティック回帰分析の結果、勇気の得点が高いほど主観的健康感が良好群であるオッズ比 (OR)と95％信頼区間 (95％CI)は 1.12 (95%CI 1.07-1.18)と有意な関連性を認めた。また、勇気のすべての下位項目と主観的健康感で有意な関連を認めた (勇敢OR1.14、95%CI 1.01-1.28、勤勉OR1.21、95%CI 1.06-1.38、誠実性OR1.34、95%CI 1.16-1.54、熱意OR1.32、95%CI 1.15-1.53)。男性では勇気 (OR1.15、95%CI 1.09-1.22)、勤勉 (OR1.24、95%CI 1.07-1.45)、誠実性 (OR1.50、95%CI 1.26-1.77)、熱意 (OR1.46、95%CI 1.23-1.73)において主観的健康感と有意な関連性を認めたが、女性では勇気のすべての項目で主観的健康感との関連性を認めなかった。 【考察】 60歳以上の中高齢者において、勇気の得点が高いほど主観的健康感が良好であることが示唆され、特に男性では勇気があるほど主観的健康感が良好であった。理学療法の場面において、性別を考慮しながら勇気ある思考や行動ができるようにサポートすることは、主観的健康感を高めることにつながるかもしれない。 【倫理的配慮】 本研究は、鹿児島大学疫学研究等倫理委員会の承認 (210020疫)を得て実施した。対象者には、目的と内容を文章にて提示し、同意を得た。

DOI： 10.57304/jsptpsuppl.2.suppl.no.1.0_197

MIYAKE Yuto, AKAIDA Shoma, SHIRATSUCHI Daijo, TATEISHI Mana, KURATSU Ryota, MAKIZAKO Hyuma . Relationship between sleep quality and physical function in community-dwelling older adults: Exploring mediating factors through covariance structure analysis . Japanese Journal of Geriatric Therapy3 ( 0 ) n/a 2024.3

Language：Japanese Publisher：The Japan Geriatric Therapy Society

【Aim】 The aim of this study was to investigate the relationship between subjective sleep quality and physical function, and explore the mediating factors of psychological function and physical activity.【Methods】 A cross-sectional analysis was conducted. Data from 573 community-dwelling older individuals (mean age 74.1 ± 6.4 years, 61.8% women) who participated in a health check survey (Tarumizu Study 2019) were analyzed. Using covariance structure analysis, an optimal model was constructed with subjective sleep quality as the starting point and physical function as the ultimate outcome. The model fit was examined separately for men and women. A hypothetical model was established with latent variables for subjective sleep quality, physical function, psychological function, and physical activity. Model fit indices, including CMIN/DF, GFI, AGFI, CFI, and RMSEA, were used to assess the goodness of fit.【Results】 For men, a well-fitting model that met statistical significance was not obtained. Conversely, for women, the model (CMIN/DF = 1.592, GFI = 0.964, AGFI = 0.944, CFI = 0.954, RMSEA = 0.041) achieved a statistically significant level, indicating that subjective sleep quality was related to psychological function and indirectly related to physical function through the mediating factor of physical activity.【Conclusions】 In community-dwelling older women, poor subjective sleep quality suggests a decline in psychological function, leading to a decrease in physical activity and ultimately contributing to a decline in physical function.

DOI： 10.57270/jgts.2023_017_oa

牧迫飛雄馬 . 高齢期における認知機能と転倒 . 日本転倒予防学会誌10 ( 1 ) 35 - 35 2024.3

Hyuma Makizako, Yuki Nakai, Shoma Akaida, Yoshiaki Taniguchi, Takaki Miwa, Shigeto Morimoto . Association of olfactory and gustatory function with memory among community-dwelling independent older adults. . Annals of geriatric medicine and research28 ( 2 ) 178 - 183 2024.3International journal

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

BACKGROUND: This study examined the association between memory function and reduced olfactory and gustatory function among independent community-dwelling older adults. METHODS: This cross-sectional study included 127 older adults (65.4% women). We assessed their memory, odor, and taste identification skills. Open essence (OE) test and taste strips (TS) were used to identify hyposmia (OE test ≤6) and hypogeusia (TS test ≤8), respectively. RESULTS: Participants with severe hyposmia had significantly poorer memory functions compared to participants without severe hyposmia. After adjusting for covariates, multivariate logistic regression models revealed a significant association between immediate recognition performance and a decreased likelihood of severe hyposmia (odds ratio = 0.65, 95% confidence interval = 0.47-0.90). We observed no significant association between taste function and memory. CONCLUSIONS: Memory function may be associated with olfactory impairment but not with gustatory function in older adults.

DOI： 10.4235/agmr.23.0217

三宅悠斗, 赤井田将真, 白土大成, 立石麻奈, 倉津諒大, 牧迫飛雄馬 . 地域在住高齢者における睡眠の質と身体機能との関連性　共分散構造分析による介在する要因の検討 . 日本老年療法学会誌3 jgts.2023_017_OA - jgts.2023_017_OA 2024.3

Language：Japanese Publisher：(一社)日本老年療法学会

【目的】主観的な睡眠の質と身体機能との関連性には,精神・心理的機能と身体活動量が介在すると仮説を立て,これらの関連性を検討することを目的とした。【方法】健康チェック(垂水研究2019)に参加した65歳以上の地域在住高齢者573名(平均年齢74.1±6.4歳,女性61.8%)を対象として横断的に分析した。共分散構造分析を用いて,主観的な睡眠の質を起点とし,身体機能を最終アウトカムとした最適モデルを構築し,男女別でモデルの適合度を確認した。主観的な睡眠の質,身体機能,精神・心理的機能,身体活動を潜在変数とした仮説モデルを設定し,モデルの適合度指標には,CMIN/DF,GFI,AGFI,CFI,RMSEAを用いた。【結果】男性では,適合度が統計学的な水準を満たす良好なモデルが得られなかった。一方で,女性では主観的な睡眠の質が精神・心理的機能に関連し,身体活動量を介して身体機能に間接的に関連するモデル(CMIN/DF=1.592,GFI=0.964,AGFI=0.944,CFI=0.954,RMSEA=0.041)で高い適合度が得られた。【結論】地域在住高齢女性において,主観的な睡眠の質が不良であることが,精神・心理的機能の低下や身体活動量の低下を介して,身体機能の低下に関連することが示唆された。(著者抄録)

牧迫飛雄馬 . 【新たなフレイル対策】フレイルの基礎知識 . 理学療法福岡 ( 37 ) 7 - 12 2024.3

Language：Japanese Publisher：(公社)福岡県理学療法士会

2014年に日本老年医学会から"Frailty"の日本語訳として"フレイル"を使用する提言がなされ、健康寿命の延伸を促進するうえでもフレイルの対策が重要な課題として挙げられている。フレイルの特徴として、健常と機能障害(例えば、要介護等)を有する状態の中間に位置する段階であること、身体的な問題だけではなく認知・心理・精神的な問題や社会的な問題も含む多面性を有すること、適切な対処によってフレイルは改善できるという可逆性を有すること、が示されている。フレイルの基礎的な知識を整理し、多面的な視点による早期からの対策を促進する取り組みが必要となる。(著者抄録)

Shoma Akaida, Yoshiaki Taniguchi, Yuki Nakai, Yuto Kiuchi, Mana Tateishi, Daijo Shiratsuchi, Toshihiro Takenaka, Takuro Kubozono, Mitsuru Ohishi, Hyuma Makizako . Independent Association Between Cognitive Frailty and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults. . Gerontology70 ( 5 ) 499 - 506 2024.2International journal

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

Introduction Although arterial stiffness has been suggested to be associated with poor physical function and mild cognitive impairment (MCI), its association with cognitive frailty (CF), a comorbidity of both, is unclear. This study aims to examine the association between CF and arterial stiffness in community-dwelling older adults. Methods A cross-sectional analysis of 511 community-dwelling older adults aged 65 years or older (mean age 73.6 ± 6.2 years, 63.6% women), who participated in a community cohort study (Tarumizu Study, 2019), was conducted. Poor physical function was defined as either slowness (walking speed < 1.0 m/sec), or weakness (grip strength < 28 kg for men and < 18 kg for women). MCI was defined by the National Center for Geriatrics and Gerontology Functional Assessment Tool as a decline of at least 1.5 standard deviation from age- and education-adjusted baseline values in any one of the four cognitive domains (memory, attention, executive, and information processing). CF was defined as the combination of poor physical function and MCI. Arterial stiffness was measured using the Cardio-Ankle Vascular Index (CAVI), and the average of the left and right sides (mean CAVI) was used. Results Multinomial logistic regression analysis adjusted for covariates was performed with the four groups of robust, poor physical function, MCI, and CF as dependent variables and mean CAVI as an independent variable. Using the robust group as reference, the poor physical function and MCI groups showed no significant relationship with the mean CAVI. The mean CAVI was significantly higher in the CF group (odds ratio 1.62, 95% confidence interval 1.14-2.29). Conclusion A significant association was found between CF and the higher CAVI (progression of arterial stiffness). Careful observation and control of CAVI, which is also an indicator of arterial stiffness, may be a potential target for preventive interventions for CF.

DOI： 10.1159/000536653

Keitaro Makino, Takehiko Doi, Kota Tsutsumimoto, Osamu Katayama, Ryo Yamaguchi, von Fingerhut Georg, Daiki Yamagiwa, Hyuma Makizako, Hiroyuki Shimada . Impacts of Negative and Positive Life Events on Development of Social Frailty among Community-Dwelling Older Adults . Journal of the American Medical Directors Association25 ( 4 ) 690 - 696.e1 2024.2International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

OBJECTIVES: This study aimed to examine the impact of negative and positive life events on the development of social frailty. DESIGN: Population-based longitudinal study. SETTING AND PARTICIPANTS: This study was set in the Japanese community cohort and included 2174 adults aged ≥65 years without social frailty at baseline. METHODS: We assessed the experiences of 6 negative and positive life events (increase in economic difficulties, illness or injury of spouse, death of family or friends, marriage of children or grandchildren, birth of grandchildren or great-grandchildren, and making new friends) in the 15 months after baseline. We followed the social frailty status of the participants and identified the development of social frailty 48 months after the baseline. Social frailty was operationally defined as having 2 or more of Makizako's 5 items (going out less frequently, rarely visiting friends, not feeling helpful to friends or family, living alone, and not talking to someone daily). RESULTS: Among 2174 participants without social frailty at baseline, 161 (7.4%) developed social frailty after 48 months. Multivariate logistic regression models on each life event and development of social frailty showed that illness or injury of spouse was significantly associated with a higher risk of subsequent social frailty [adjusted odds ratio (OR), 1.74; 95% CI, 1.10-2.74] and making new friends was significantly associated with lower risk of subsequent social frailty (adjusted OR, 0.38; 95% CI, 0.27-0.54). No significant ORs of social frailty were found for other life events. CONCLUSIONS AND IMPLICATIONS: Life events in later life have both positive and negative impacts on the development of social frailty, depending on the nature of the event. To prevent social frailty, it may be important to monitor negative life events and promote positive life events in later life.

DOI： 10.1016/j.jamda.2024.02.002

Yuto Kiuchi, Kota Tsutsumimoto, Kazuhei Nishimoto, Yuka Misu, Tomoka Ohata, Hyuma Makizako, Hiroyuki Shimada . Association between dietary diversity and chronic kidney disease in community-dwelling older adults . European Geriatric Medicine15 ( 2 ) 545 - 552 2024.1International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

OBJECTIVE: The present study examined whether dietary diversity is associated with chronic kidney disease (CKD) in community-dwelling older Japanese adults. METHODS: Participants comprised 8,195 older adults (mean age was 74.0 ± 5.6 years; 42.7% were men) in this cross-sectional study. In this study, CKD was defined as estimated Glomerular Filtration Rate (eGFR) < 45 mL/min/1.73 m2. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Participants with an FFS of 16 or fewer points were defined as having low dietary diversity. RESULTS: The prevalence of CKD was 376 (4.6%), and the low dietary diversity group had higher prevalence (5.6%) compared with the high and low dietary diversity group (4.3%). Multiple logistic regression analysis revealed low dietary diversity was associated with CKD in older adults (OR 1.30, 95%CI 1.01-1.68). Stratified analysis showed that low dietary diversity was independently associated with CKD (OR 1.43, 95% CI 1.07-1.91) in older adults with hypertension, but not in adults without hypertension (OR 0.94, 95% CI 0.54-1.64). CONCLUSIONS AND IMPLICATIONS: This cross-sectional study revealed that low dietary diversity was associated with CKD among older adults. Furthermore, low dietary diversity was associated with CKD among older adults with hypertension.

DOI： 10.1007/s41999-023-00927-2

Other Link： https://link.springer.com/article/10.1007/s41999-023-00927-2/fulltext.html

宮崎宣丞, 竹下康文, 中井雄貴, 荒木草太, 川田将之, 木山良二, 牧迫飛雄馬 . 地域在住高齢女性における歩行速度増大の戦略と歩行パラメータ,身体機能の関連 . 基礎理学療法学26 ( Suppl.1 ) 117 - 117 2024.1

Kiuchi Yuto, Doi Takehiko, Tsutsumimoto Kota, Nakakubo Sho, Kurita Satoshi, Nishimoto Kazuhei, Makizako Hyuma, Shimada Hiroyuki . Association between dietary diversity and cognitive impairment in community-dwelling older adults(タイトル和訳中) . Geriatrics & Gerontology International24 ( 1 ) 75 - 81 2024.1

Language：English Publisher：John Wiley & Sons Australia, Ltd

地域在住高齢者における摂取食品の多様性と認知機能との関連を検討するため、横断研究を実施した。2017年から2018年までの日本人高齢者8,987例(男性44.3%、平均73.9歳)を評価対象とした。ミニメンタルステート検査を用いて軽度認知障害(MCI)と全般的な認知機能低下(GCI)を評価したところ、MCIを17.1%(1538例)、GCIを8.4%(753例)に認めた。多変量ロジスティック回帰分析の結果、食品摂取多様性のある高齢者では、MCI、GCIのリスクが有意に低かった。

Shoma Akaida, Daijo Shiratsuchi, Mana Tateishi, Ryota Kuratsu, Hyuma Makizako . Life satisfaction and awareness of meaningful activities among middle-aged adults: A population-based study . British Journal of Occupational Therapy87 ( 9 ) 556 - 563 2024International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications

Introduction:

Meaningful activities have been suggested to contribute to life satisfaction. Investigating the association between the awareness of meaningful activities and life satisfaction will help us develop a population-based occupational therapy strategy. The purpose of this study was to investigate the proportion of people who were aware of meaningful activities among middle-aged adults, and the relationship between the awareness of meaningful activities and life satisfaction.

Method:

A cross-sectional analysis was conducted on 2698 middle-aged adults who participated in an online survey conducted in Japan by the Y-Cloud system. Participants responded to demographic questions, life satisfaction, and awareness of meaningful activities. We examined the association between the awareness of meaningful activities and life satisfaction using binomial logistic regression analysis.

Results:

Of the respondents, 77.4% were aware of meaningful activities. Binomial logistic regression analysis adjusted for covariates showed that the awareness of meaningful activities was significantly associated with higher life satisfaction (odds ratio, 2.97; 95% confidence interval: 2.45–3.61, p < 0.001).

Conclusion:

The results suggest the value of presenting that the awareness of meaningful activities should be considered in preventive population-based occupational therapy strategies for life satisfaction.

DOI： 10.1177/03080226241253110

Other Link： https://journals.sagepub.com/doi/full-xml/10.1177/03080226241253110

Shotaro Otsuka, Kiyoshi Kikuchi, Yasufumi Takeshita, Seiya Takada, Akira Tani, Harutoshi Sakakima, Ikuro Maruyama, Hyuma Makizako . Relationship between physical activity and cerebral white matter hyperintensity volumes in older adults with depressive symptoms and mild memory impairment: a cross-sectional study. . Frontiers in aging neuroscience16 1337397 - 1337397 2024International journal

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

INTRODUCTION: Cerebral white matter hyperintensities (WMHs) are commonly found in the aging brain and have been implicated in the initiation and severity of many central nervous system diseases. Furthermore, an increased WMH volume indicates reduced brain health in older adults. This study investigated the association between WMH volume and physical activity in older adults with depressive symptoms (DS) and mild memory impairment (MMI). Factors associated with the WMH volume were also investigated. METHODS: A total of 57 individuals aged over 65 years with DS and MMI were included in this study. The participants underwent magnetic resonance imaging to quantify WMH volumes. After WMH volume was accumulated, normalized to the total intracranial volume (TIV), the percentage of WMH volume was calculated. In addition, all participants wore a triaxial accelerometer for 2 weeks, and the average daily physical activity and number of steps were measured. The levels of blood biomarkers including cortisol, interleukin-6 (IL-6), brain-derived insulin-like growth factor-1, and brain-derived neurotrophic factor were measured. Motor and cognitive functions were also assessed. RESULTS: Faster maximum walking speed and longer time spent engaged in moderate physical activity were associated with a smaller percent of WMH volume, whereas higher serum IL-6 levels were associated with a larger percent of WMH volume. The number of steps per day, time spent engaged in low levels of physical activity, cognitive function, and all other measured biomarkers were not significantly associated with percent of WMH volume. DISCUSSION: Higher blood inflammatory cytokine levels, shorter duration of moderate physical activity, and lower maximum walking speed were associated with a higher percent of WMH volume. Our results provide useful information for maintaining brain health in older adults at a high risk of developing dementia and may contribute to the development of preventive medicine for brain health.

DOI： 10.3389/fnagi.2024.1337397

Association between Preoperative Possible Sarcopenia Related Postoperative Complications and Length of Hospital Stay in Patients with Gastric and Colorectal Cancer . Japanese Journal of Physical Therapy for Oncology and Lymphedemaadvpub ( 0 ) 39 - 47 2024

Language：Japanese Publisher：Japanese Society of Physical Therapy Oncology Lymphedema

Objective: To evaluate the associations between preoperative possible sarcopenia (PS) related postoperative complications and prolonged duration of hospitalization in patients with gastric or colorectal cancer by measuring handgrip strength decline and five-time sit-to-stand test delay. Methods: Seventy-five patients who were admitted to an acute hospital and discharged after surgery were included in this study. We determined preoperative PS, hand grip strength decline, and five-time sit-to-stand test delay according to the Asian Working Group for Sarcopenia 2019 to establish the association between the occurrence of postoperative complications and length of hospital stay. Results: Although PS was significantly associated with the occurrence of postoperative complications and prolonged duration of hospitalization postoperatively. Hand grip strength decline and five-time sit-to-stand test delay were not significantly associated with the occurrence of postoperative complications and prolonged duration of hospitalization. Conclusion: Our findings show that preoperative PS is associated with the occurrence of postoperative complications and prolonged duration of hospitalization in patients with gastric and colorectal cancer.

DOI： 10.60366/jjptol.jjptol-r5-a11

Shoma Akaida, Takayuki Tabira, Mana Tateishi, Daijo Shiratsuchi, Suguru Shimokihara, Ryota Kuratsu, Yoshihiko Akasaki, Yuma Hidaka, Hyuma Makizako . Averting older adults' memory function decline via meaningful activities: a follow-up longitudinal study . European Geriatric Medicine15 ( 6 ) 1793 - 1801 2024International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Purpose

The purpose of the study was to investigate the effects of satisfaction with meaningful activities and their performance on the memory function among community-dwelling older adults 3 years later.

Methods

A longitudinal analysis was conducted on 288 community-dwelling older adults aged 65 years and more who had completed the survey in 2019 and 2022 as participants in the Tarumizu Study. Meaningful activities were assessed in 2019 using the Aid for Decision-Making in Occupation Choice for activities. Satisfaction with and performance of meaningful activities were assessed, and the bottom 25% were classified into two groups: low satisfaction and low performance. Memory function was assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool in 2019 and 2022. Changes in memory function over 3 years were analyzed by satisfaction and performance of meaningful activities.

Results

Two-way analysis of variance with group (satisfaction with and performance of meaningful activities) and time (2019 and 2022) as factors showed no statistically significant group-time interaction for memory in the satisfaction with meaningful activities group (F = 1.4, p = 0.24). Meanwhile, a statistically significant group-time interaction was observed for memory in the meaningful activity performance group, indicating that high performance of meaningful activities may play a protective role against memory decline (F = 7.4, p = 0.007).

Conclusion

Higher performance of meaningful activities may protect against age-related changes in memory. A careful assessment of meaningful activities, and engagement that enhances performance may be useful in designing health support against memory decline.

DOI： 10.1007/s41999-024-01044-4

Other Link： https://link.springer.com/article/10.1007/s41999-024-01044-4/fulltext.html

Suzuki Takao, Jeong Seungwon, Nishida Yukiko, Otsuka Rei, Shimada Hiroyuki, Makizako Hyuma, Kim Hunkyung, Obuchi Shuichi, Kawai Hisashi, Fujiwara Yoshinori, Abe Takumi, Kojima Narumi, Hirano Hirohiko, Masui Yukie, Inagaki Hiroki, Yoshida Yuko, Iijima Katsuya, Yoshimura Noriko, Yamada Minoru, Watanabe Shuichiro, Kondo Katsunori, Muraki Isao, Iwasa Hajime . High Level of Functional Capacity Assessed by Japan Science and Technology Agency Index of Competence among Community-Dwelling Older Adults in Japan: Findings from the ILSA-J integrated Cohort Study. . Applied Gerontology18 ( 1 ) 107 - 116 2024

Language：Japanese Publisher：Society for Applied Gerontology - Japan

Japan has rapidly become a super-aging society, resulting in a significant increase in average life expectancy. According to the changes of the society, the functional capacity of older adult has improved significantly, and the number of vivid older people is increasing. The “Japan Science Technology Agency Index of Competence（JST-IC）is a recently developed to assess such higher functional capacity of the older adults.In this study, we used data of JST-IC which have been collected in the “Integrated Longitudinal Study on Aging in Japan: ILSA-J” and evaluated the status of the functional capacity of the community-dwelling older people.The average and standard deviation of JST-IC score were calculated by gender and age-group for the total score and the four subscales（social engagement, technology usage, information practice and life management）. As a result, gender differences were observed in all items except information practice, and significant differences were found between age groups in all items for both men and women, with scores decreasing with age. These data will shed light on some of the high level of functional capacity of the older people and will be a useful resource for future utilization of the JST-IC.

DOI： 10.60455/sagj.18.1_107

Suguru Shimokihara, Takayuki Tabira, Michio Maruta, Hyuma Makizako, Gwanghee Han, Yuriko Ikeda, Taishiro Kamasaki, Yoshihiko Akasaki, Yuma Hidaka, Yusuke Kumura, Wataru Kukizaki, Rena Nakahara, Shuto Matsunaga, Leiya Medina, Takuro Kubozono, Mitsuru Ohishi . Smartphone Proficiency in Community-Dwelling Older Adults is Associated With Higher-Level Competence and Physical Function: A Population-Based Age-Specific Cross-Sectional Study . Journal of Applied Gerontology44 ( 1 ) 7334648241261885 - 61 2024International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications

With the rapid development of information and communication technology, smartphone ownership has increased among older adults. While previous research has examined the impact of smartphone use on the health of older adults, this study focuses on the less-explored relationship between smartphone use, proficiency, and health-related outcomes including higher-level competence. The study was a cross-sectional survey of 208 community-dwelling older adults who used smartphones daily. Smartphone use, including years of use and applications, was assessed and categorized by age group. Health-related outcomes were measured, including cognitive and psychological function, higher-level competence, basic daily abilities, and physical function. The results indicated that smartphone proficiency decreased with age, with older adults primarily using basic smartphone applications. Notably, higher smartphone proficiency was positively associated with higher-level competence and physical functions. The study underscores the importance of considering smartphone proficiency when assessing older adults’ life skills and physical performance in our digital society.

DOI： 10.1177/07334648241261885

Other Link： https://journals.sagepub.com/doi/full-xml/10.1177/07334648241261885

Shoma Akaida, Hyuma Makizako, Mana Tateishi, Daijo Shiratsuchi, Yoshiaki Taniguchi, Yuto Kiuchi, Ryoji Kiyama, Toshihiro Takenaka, Takuro Kubozono, Mitsuru Ohishi . Importance of Lifestyle Activities for Older Adults’ Psychosomatic Functions After Driving Cessation: Interpretation by a Mixed-Methods Study . Journal of Applied Gerontology44 ( 4 ) 7334648241277043 - 541 2024International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：SAGE Publications

Older adults who cease driving are more likely to experience psychosomatic decline than those who continue driving. This mixed-methods study was intended to examine differences in psychosomatic functions depending on driving status and lifestyle activities, and factors affecting engagement in additional lifestyle activities after driving cessation. The quantitative analysis included individuals aged 60 and above. Driving status, lifestyle activities, and psychosomatic functions were assessed. For qualitative analysis, semi-structured interviews were conducted with the driving-cessation group to determine the factors affecting involvement in various lifestyle activities after driving cessation. Analysis of covariance was used for quantitative data, while text mining and qualitative inductive analysis were used for qualitative data. Older adults who engaged in more lifestyle activities walked faster than those who engaged in fewer lifestyle activities, even after driving cessation. Actively using local and personal resources may increase engagement in lifestyle activities after driving cessation.

DOI： 10.1177/07334648241277043

Other Link： https://journals.sagepub.com/doi/full-xml/10.1177/07334648241277043

Keitaro Makino, Parminder Raina, Lauren E Griffith, Sangyoon Lee, Kenji Harada, Ippei Chiba, Osamu Katayama, Kouki Tomida, Masanori Morikawa, Hyuma Makizako, Hiroyuki Shimada . Physical frailty and survival time after the onset of functional disability: Is there a sex difference? . Journal of the American Geriatrics Society72 ( 2 ) 399 - 409 2023.12International journal

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

BACKGROUND: Physical frailty accelerates the timing of both subsequent disability and death; however, evidence regarding the impact of frailty on the period from disability onset to death and sex differences of this impact is lacking. The aim of this study was to examine the relationship among physical frailty, disability, death, and sex differences. METHODS: This Japanese cohort study included 10,524 community-dwelling people aged ≥65 years. Physical frailty was operationalized by key phenotypes as per Fried's criteria (slowness, weakness, exhaustion, weight loss, and low activity) at baseline. We calculated hazard ratios (HRs) with 95% confidence intervals (CIs) for disability onset and post-disability survival according to the frailty status. RESULTS: During a 5-year follow-up, the risk of disability onset for pre-frailty (HR: 1.74, 95% CI: 1.51-2.00) and frailty (HR: 3.27, 95% CI: 2.77-3.87) were significantly higher than that for robust people. Furthermore, among participants who developed disabilities within 5 years (n = 1481), the risk of post-disability death for pre-frailty was not different from that for robust (HR: 1.49, 95% CI: 0.99-2.24), but frailty showed a higher risk of post-disability death than did robust people. (HR: 1.75, 95% CI: 1.13-2.72). In the sex-stratified analysis, although the female group showed no association between frailty status and post-disability death (HR: 1.21, 95% CI: 0.63-2.33 in pre-frailty; HR: 1.24, 95% CI: 0.60-2.57 in frailty), the male group showed higher risk of post-disability death in both pre-frailty (HR: 1.74, 95% CI: 1.03-2.96) and frailty (HR: 2.32, 95% CI: 1.32-4.09). CONCLUSIONS: Physical frailty shortens the period from disability onset to death. Additionally, the impact of frailty on post-disability death is greater for males than for females. Our findings suggest that physical frailty is an important clinical indicator distinct from disability and that interventions to prevent and address frailty in men need further investigation.

DOI： 10.1111/jgs.18725

Yuto Kiuchi, Takehiko Doi, Kota Tsutsumimoto, Sho Nakakubo, Satoshi Kurita, Kazuhei Nishimoto, Hyuma Makizako, Hiroyuki Shimada . Association between dietary diversity and cognitive impairment in community‐dwelling older adults . Geriatrics & Gerontology International24 ( 1 ) 75 - 81 2023.12

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

Aim

The present study aimed to examine whether dietary diversity is associated with cognitive impairment, including mild cognitive impairment (MCI), in community‐dwelling older Japanese adults.

Methods

This cross‐sectional study was carried out in a general community setting. MCI and global cognitive impairment (GCI) were assessed using the Mini‐Mental State Examination and National Center for Geriatrics and Gerontology‐Functional Assessment Tool, which are multicomponent neurocognitive tests that include memory attention, executive function and processing speed. Dietary diversity was assessed using the diet variety score. The diet variety score assessed the 1‐week consumption frequency of 10 food groups, and either 0 or 1 point was allocated to each category based on the following responses: (i) “eat almost every day” (1 point); and (ii) “not eaten almost daily” (0 points). Older adults with a diet variety score of ≥3 points were defined as having high dietary diversity.

Results

Data included 8987 older adults (mean age 73.9 ± 5.5 years; men 44.3%). The overall prevalences of MCI and GCI were 17.1% (n = 1538) and 8.4% (n = 753), respectively. The proportion of patients with a high dietary diversity was 69.9% (n = 6286). Multinomial logistic regression analysis revealed high dietary diversity was associated with MCI (OR 0.83, 95% CI 0.73–0.94) and GCI (OR 0.77, 95% CI 0.65–0.92) after adjusting for covariates.

Conclusions

This study had a large sample size of older Japanese adults, and showed that high dietary diversity was associated with a lower proportion of MCI and GCI among older adults. Geriatr Gerontol Int 2023; ••: ••–••.

DOI： 10.1111/ggi.14762

Yuto Kiuchi, Kota Tsutsumimoto, Takehiko Doi, Satoshi Kurita, Kazuhei Nishimoto, Hyuma Makizako, Hiroyuki Shimada . Effect of dietary diversity on incident of disability in community-dwelling older adults with sarcopenia: A 40-month follow-up longitudinal study. . Maturitas179 107887 - 107887 2023.11International journal

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

BACKGROUND: Sarcopenia is a clinical issue in older adults that leads to serious adverse health outcomes, including disability. The present study investigated whether dietary diversity affects the incidence of disability in older adults with sarcopenia. METHOD: Participants were 759 Japanese older adults with sarcopenia (mean age 77.2 ± 6.0 years; 44.4 % men) who were aged ≥65 years at the time of the examination. Sarcopenia was diagnosed according to the recommendations of the European Working Group on Sarcopenia in Older People 2. Dietary diversity was assessed using a diet variety score. This diet variety score assessed the one-week consumption frequency of ten food groups, according to the following responses: "eat almost every day" (1 point), or "not eaten almost daily" (0 points). Older adults with a diet variety score of 3 or more points were defined as having high dietary diversity. Incident disability was certified by long-term care insurance (mean follow-up duration 32 months). RESULTS: The cumulative disability incidence rates in the older adults with low dietary diversity and high dietary diversity were 23.3 % and 16.9 %, respectively. Cox proportional hazards regression analysis revealed high dietary diversity was associated with a lower risk of incident disability in older adults with sarcopenia (hazard ratio 0.66, 95 % confidence interval 0.47-0.92; p = 0.015), after adjusting for covariates. CONCLUSIONS: This longitudinal study revealed that high dietary diversity is associated with a lower risk of incident disability among sarcopenic Japanese older adults.

DOI： 10.1016/j.maturitas.2023.107887

赤井田将真, 赤井田将真, 白土大成, 白土大成, 木内悠人, 木内悠人, 立石麻奈, 牧迫飛雄馬 . Association between experience of car driving and cognitive function in community-dwelling older women . 日本作業療法学会抄録集(CD-ROM)57回 ON - 6 2023.11

Daijo Shiratsuchi, Hyuma Makizako, Mana Tateishi, Shoma Akaida, Chika Tagata, Makoto Kobayashi, Takanobu Takihara . Association between muscle weakness and cap-grasping patterns when opening plastic bottles in community-dwelling older adults. . Geriatrics & gerontology international23 ( 10 ) 758 - 760 2023.10

立石麻奈, 赤井田将真, 桑原祐一, 牧迫飛雄馬 . フレイル高齢者における運動教室が社会交流および運動習慣構築の促進につながった事例 . 日本老年医学会雑誌60 ( 4 ) 482 - 482 2023.10

赤井田将真, 立石麻奈, 谷口善昭, 木内悠人, 福榮竜也, 白土大成, 愛下由香里, 窪薗琢郎, 大石充, 牧迫飛雄馬 . 自動車運転をしていない地域在住後期高齢女性における免許保有歴と認知機能の関連 . 日本老年医学会雑誌60 ( 4 ) 483 - 483 2023.10

牧迫飛雄馬 . こころのゆとり . 日本予防理学療法学会雑誌3 ( 1 ) 1 - 1 2023.9

牧迫飛雄馬 . 特集によせて . 日本サルコペニア・フレイル学会誌7 ( 1 ) 4 - 4 2023.6

Sota Araki, Ryoji Kiyama, Yuki Nakai, Masayuki Kawada, Takasuke Miyazaki, Yasufumi Takeshita, Hyuma Makizako . Sex differences in age-related differences in joint motion during gait in community-dwelling middle-age and older individuals. . Gait & posture103 153 - 158 2023.6International journal

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

BACKGROUND: Walking is the most important mode of human locomotion; however, the ability to walk often decreases with age. Age-related differences in lower-limb kinematics during gait may differ depending on sex. However, the question of the compounded effects of age and sex on gait kinematics remains unsolved. RESEARCH QUESTION: The present study aimed to clarify the interaction between age and sex in differences in gait kinematics of community-dwelling middle-age and older individuals. METHODS: This study included 836 community-dwelling middle-age and older adults (61.8 % female). Joint motion during comfortable gait was measured using magnetic and inertial measurement units. Hip, knee, and ankle joint angles were calculated in the sagittal plane. Participants were divided into four groups according to age: 50-59, 60-69, 70-79, and 80-89 years. The interaction of sex and age on spatiotemporal gait parameters and the peak value of joint angles was analyzed using two-way analysis of variance (ANOVA) and Tukey's post hoc test. RESULTS: Gait speed (F = 43.92, P < 0.001), step length (F = 73.00, P < 0.001), hip extension (F = 12.89, P = 0.002), knee flexion (F = 39.99, P < 0.001), and ankle plantar flexion (F = 27.43, P < 0.001) significantly decreased with age. Significant differences according to sex were observed in all parameters except gait speed. Significant age and sex interaction effects were observed for knee flexion (F = 4.97, P = 0.002) and ankle dorsiflexion (F = 4.04, P = 0.007). SIGNIFICANCE: A significant interaction effect of age and sex was observed for peak angle of knee flexion and ankle dorsiflexion during gait. In particular, the knee flexion angle among females during gait began to decrease from 60 years of age, and the decreasing trend was faster and more prominent than that among males.

DOI： 10.1016/j.gaitpost.2023.05.009

Kento Muto, Daijo Shiratsuchi, Kazuki Nanbu, Hayato Sakamoto, Naohiro Furuya, Kazushi Nakamura, Mitani Yushi, Nako Tsujita, Hyuma Makizako . Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination. . Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association32 ( 8 ) 107145 - 107145 2023.5International journal

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

OBJECTIVES: We aimed to determine if achieving a 10-m walk target within the first week of stroke onset correlates with independent outdoor walking at discharge and discharge to home for patients with stroke. MATERIALS AND METHODS: This study included 226 patients transferred to the subacute rehabilitation hospital (SRH) between January 2018 and March 2021. Data obtained from hospital records included age, sex, stroke type, lesion side, body mass index, presence of acute treatment, length of days from onset to physical therapy intervention, National Institutes of Health Stroke Scale, length of hospital stay, Functional Independence Measure score, and the ability to complete the 10 m walk target within the first week of stroke onset. The primary outcomes were independent outdoor walking ability and discharge destination from the SRH. A logistic regression analysis was performed to determine if the 10 m walking ability correlated with the outdoor walking ability and discharge destination. RESULTS: Compared with the inability to walk 10 m, walking 10 m independently walking within the first week of stroke onset correlated with the ability to walk independently outdoors at discharge (odds ratio [OR]: 4.38, p = 0.003) and being discharged home (OR: 4.52, p = 0.002), whereas, walking 10 m with assistance was associated with being discharged home (OR: 3.09, p = 0.043). CONCLUSIONS: The ability to walk 10 m within the first week of stroke onset may be a helpful marker for prognosis.

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107145

阿部巧, 藤原佳典, 北村明彦, 野藤悠, 西田裕紀子, 牧迫飛雄馬, 鄭丞媛, 大塚礼, 鈴木隆雄, 岩崎正則, 山田実, 小島成実, 飯島勝矢, 大渕修一, 新村健, 島田裕之, 鈴木宏幸, 吉村典子, 渡辺修一郎, 村木功, 近藤克則 . JST版活動能力指標との関連性における身体機能と認知機能の差異長寿コホートの総合的研究(ILSA-J) . 日本老年医学会雑誌60 ( Suppl. ) 148 - 149 2023.5

鈴木隆雄, 西田裕紀子, 牧迫飛雄馬, 鄭丞媛, 島田裕之, 大塚礼, 阿部巧 . 地域在住高齢者の健康関連変数の2007年から2017年の推移長寿コホートの総合的研究(ILSA-J) . 日本老年医学会雑誌60 ( Suppl. ) 177 - 178 2023.5

大塚礼, 西田裕紀子, 牧迫飛雄馬, 鄭丞媛, 阿部巧, 島田裕之, 鈴木隆雄, 藤原佳典, 大渕修一, 鈴木宏幸, 岩崎正則, 小島成実, 飯島勝矢, 吉村典子, 渡辺修一郎, 山田実, 村木功, 近藤克則, 新村健 . 地域在住高齢者のサルコペニア頻度の2012年から2017年の推移長寿コホートの総合的研究(ILSA-J) . 日本老年医学会雑誌60 ( Suppl. ) 49 - 50 2023.5

白土大成, 谷口善昭, 赤井田将真, 立石麻奈, 木内悠人, 愛下由香里, 福榮竜也, 倉津諒大, 牧迫飛雄馬 . 地域在住高齢者におけるペットボトル開栓時のキャップ把持パターンと筋力低下の関連性 . 日本老年医学会雑誌60 ( Suppl. ) 177 - 177 2023.5

倉津諒大, 谷口善昭, 木内悠人, 赤井田将真, 白土大成, 立石麻奈, 福榮竜也, 愛下由香里, 牧迫飛雄馬 . 地域在住高齢者におけるMotoric cognitive risk syndromeと転倒恐怖感との関連 . 日本老年医学会雑誌60 ( Suppl. ) 158 - 159 2023.5

赤井田将真, 立石麻奈, 谷口善昭, 白土大成, 木内悠人, 窪薗琢郎, 大石充, 牧迫飛雄馬 . 地域在住中高齢者の自動車運転実施状況および生活活動と身体機能,筋量との関連 . 日本老年医学会雑誌60 ( Suppl. ) 136 - 136 2023.5

牧迫飛雄馬, 赤井田将真, 立石麻奈, 白土大成, 谷口善昭, 竹中俊宏, 窪薗琢郎, 大石充 . α-アクチニン3遺伝子多型が身体機能の加齢変化に及ぼす影響 3年間の縦断観察研究 . 日本老年医学会雑誌60 ( Suppl. ) 145 - 146 2023.5

Hidaka Yuma, Tabira Takayuki, Maruta Michio, Makizako Hyuma, Ikeda Yuriko, Nakamura Atsushi, Han Gwanghee, Miyata Hironori, Shimokihara Suguru, Akasaki Yoshihiko, Kamasaki Taishiro, Kubozono Takuro, Ohishi Mitsuru . Relationship between grave visitation and apathy among community-dwelling older adults(タイトル和訳中) . Psychogeriatrics23 ( 3 ) 401 - 410 2023.5

Language：English Publisher：John Wiley & Sons Australia, Ltd

垂水研究に参加した高齢者を対象として、墓参りと抑うつ症状およびアパシーとの関連を調べた。評価項目は高齢者うつ尺度、墓参りに関する項目(墓参りの有無、頻度、移動時間、移動手段、供花)などとした。高齢者を墓参状況により、頻繁群240名(週1回以上、平均74.9±6.4歳、女性170名)、不定期群346名(週1回未満、平均73.8±6.4歳、女性195名)、非墓参群52名(墓参せず、平均74.6±7.1歳、女性32名)に分けて検討した。その結果、非墓参群は墓参群と比較して、アパシー有病率が有意に高かった。潜在的共変量調整後のポアソン回帰分析の結果、非墓参群はアパシーと有意に関連していた。以上のように、高齢者において墓参りをしないこととアパシーには有意な関連があることが示された。

赤井田将真, 立石麻奈, 白土大成, 谷口善昭, 竹中俊宏, 窪薗琢郎, 大石充, 牧迫飛雄馬 . 地域在住高齢者における社会的交流および外出頻度と動脈硬化の関連 . 日本循環器病予防学会誌58 ( 2 ) 153 - 153 2023.5

白土大成, 牧迫飛雄馬, 赤井田将真, 立石麻奈, 谷口善昭, 竹中俊宏, 窪薗琢郎, 大石充 . 地域在住高齢者におけるメタボリックシンドロームおよび身体機能低下の併存と認知機能の関連 . 日本循環器病予防学会誌58 ( 2 ) 165 - 165 2023.5

白土大成, 立石麻奈, 牧迫飛雄馬 . COVID-19 and frailty-Social aspects of frailty- . Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics60 ( 2 ) 127 - 134 2023.4

Sakamoto Hayato, Shiratsuchi Daijo, Makizako Hyuma . Effectiveness of WiiⓇ-based rehabilitation in Patients with Brain Tumors: . Journal of allied health sciences14 ( 1 ) 45 - 52 2023.4

Language：Japanese Publisher：Society of Allied Health Sciences

【Objective】In recent years, the use of virtual reality technology has spread rapidly in the medical and welfare fields and has also found its way in rehabilitation. Nintendo WiiⓇ is one of the most widely used virtual reality systems in the world owing to its ease of use, cost, and accessibility at home. However, to date, the reports of its use in patients with brain tumors are limited. Therefore, this study aimed to evaluate the effectiveness of WiiⓇ‐based rehabilitation for patients with brain tumors.【Methods】A scoping review was conducted using PubMed (MEDLINE), the Cochrane Library, and Ichu‐shi Web databases as well as a hand search of the English and Japanese literature from 2006 to 2021. Prior to the literature search, keywords and synonyms related to brain tumors and WiiⓇ were identified, and a search formula was developed to include them. Articles were selected based on a specific inclusion and exclusion criteria.【Results】Of the 155 identified studies, three were eligible for review. Subjects included pediatric and adult patients with brain tumors. WiiⓇ‐based rehabilitation was shown to be effective for physical function, activities of daily living (ADL), motivation for physical activity, and distraction from the hospital environment for patients with brain tumors.【Conclusion】WiiⓇ‐based rehabilitation was suggested to improve physical function, ADL, and mental status in patients with brain tumors. However, the number of the studies included━only three━was insufficient to demonstrate the efficacy of WiiⓇ‐based rehabilitation in terms of the study design. We therefore hope that more rigorously designed intervention studies will validate its efficacy.

DOI： 10.15563/jalliedhealthsci.14.45

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01214&link_issn=&doc_id=20230529130005&doc_link_id=10.3143%2Fgeriatrics.60.127&url=https%3A%2F%2Fdoi.org%2F10.3143%2Fgeriatrics.60.127&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

坂本勇斗, 白土大成, 牧迫飛雄馬 . 脳腫瘍患者に対するWiiの介入効果　スコーピングレビュー . 保健医療学雑誌14 ( 1 ) 45 - 52 2023.4

Language：Japanese Publisher：保健医療学学会

【目的】任天堂Wii(以下,Wii)は活用の用途が拡大しリハビリテーション(以下,リハ)に応用されるが,脳腫瘍患者を対象にした報告は限られている.今回,脳腫瘍患者に対するWiiリハの有効性を評価することを目的とした.【方法】PubMed,Cochrane Library,医学中央雑誌の各電子データベースとハンドサーチを用いたスコーピングレビューを行った.対象期間は2006年～2021年,言語は日本語と英語とした.【結果】検索された155件から3件が選択された.Wiiリハは脳腫瘍患者の身体機能やADL,身体活動への動機づけ,入院環境からの気晴らしについて有効であることが示唆された.【結論】Wiiリハは脳腫瘍患者の身体機能やADL,精神面を改善する可能性が示唆された一方,選択されたのは3件のみで,いずれも研究デザインの側面でWiiリハの有効性を明示するには不十分であった.さらに厳密なデザインの介入研究により効果を検証することが望ましい.(著者抄録)

白土大成, 立石麻奈, 牧迫飛雄馬 . 【COVID-19とフレイルの実際】COVID-19とフレイルの実際フレイルの社会的側面 . 日本老年医学会雑誌60 ( 2 ) 127 - 134 2023.4

Language：Japanese Publisher：(一社)日本老年医学会

COVID-19の流行拡大によって,地域でのサロンや通いの場などの互助活動は多大な制約を受ける状況となった.フレイルの入口となり得る社会とのつながりが損なわれる事態が懸念される一方で,運動教室を通じて社会交流の活性や社会活動が促進される事例も経験される.感染症の拡大防止と並行して,社会面からのフレイル対策として新たなコミュニケーションツールの活用を含めた社会とのつながりや自助による健康増進も再考していく必要がある.(著者抄録)

愛下由香里, 牧迫飛雄馬, 宇都良大, 福榮竜也, 谷口善昭, 白土大成, 赤井田将真, 立石麻奈, 木内悠人, 倉津諒大, 田中梨美子, 柳正和, 連利博 . 看護師におけるワーク・エンゲイジメントと腰痛、ストレスおよび自己効力感の関連性 . 産業衛生学雑誌65 ( 臨増 ) 514 - 514 2023.4

白土大成, 立石麻奈, 牧迫飛雄馬 . 【COVID-19とフレイルの実際】COVID-19とフレイルの実際フレイルの社会的側面 . 日本老年医学会雑誌60 ( 2 ) 127 - 134 2023.4

Language：Japanese Publisher：(一社)日本老年医学会

白土大成, 立石麻奈, 牧迫飛雄馬 . 【COVID-19とフレイルの実際】COVID-19とフレイルの実際　フレイルの社会的側面 . 日本老年医学会雑誌60 ( 2 ) 127 - 134 2023.4

Language：Japanese Publisher：(一社)日本老年医学会

牧迫飛雄馬 . 【生活場面における身体活動量の測定と運動指導の要点】生活場面における身体活動量測定の意義と運動指導の要点 . 理学療法40 ( 4 ) 292 - 299 2023.4

Language：Japanese Publisher：(株)メディカルプレス

1.身体活動とは安静時よりも多くのエネルギーを消費するすべての動作を指し,「運動」と「生活活動」によって構成される.2.身体活動量の評価には主観的もしくは客観的な方法が用いられ,それぞれの利点と欠点を考慮して活用する必要がある.3.身体活動を促進する際には,個人にとっての望ましい水準を考慮して運動方法を指導することに加えて,習慣化のための工夫をすることや,生活場面における身体活動量の増加を促す指導に焦点化することも重要となる.(著者抄録)

Michio Maruta, Takayuki Tabira, Suguru Shimokihara, Hyuma Makizako, Yuriko Ikeda, Gwanghee Han, Yoshihiko Akasaki, Yuma Hidaka, Rena Nakahara, Taishiro Kamasaki, Wataru Kukizaki, Takuro Kubozono, Mitsuru Ohishi . Changes in Satisfaction with Meaningful Activities and Onset of Depressive Symptoms among Community-Dwelling Japanese Older Adults: A Population-Based Study Before and During the COVID-19 Pandemic. . Journal of the American Medical Directors Association24 ( 5 ) 702 - 709.e3 2023.3International journal

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

OBJECTIVES: This study aimed to clarify the association between changes in satisfaction with meaningful activities and the occurrence of depressive symptoms before and during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: A population-based prospective cohort study (Tarumizu Study). SETTING AND PARTICIPANTS: A total of 231 community-dwelling older adults aged ≥65 years without depressive symptoms at baseline. METHODS: The participants completed baseline (June to December 2018, before the COVID-19 pandemic) and follow-up (September to December 2021, during the COVID-19 pandemic) assessments. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, and their satisfaction levels were evaluated. Satisfaction with the most meaningful activities was assessed as to whether it was maintained/improved or decreased at follow-up. RESULTS: In the follow-up survey, 31 (14.3%) participants reported the occurrence of depressive symptoms. Compared with before the COVID-19 pandemic, the rates of meaningful activities during the COVID-19 pandemic decreased for interpersonal interaction and social life and increased for leisure, sports, self-care, and domestic life. Logistic regression analysis revealed that changes in satisfaction with meaningful activity were associated with the occurrence of depressive symptoms after adjusting for demographic variables, baseline GDS scores, cognitive and physical status, and instrumental activities of daily living (odds ratio, 2.78; 95% confidence interval, 1.17-6.59, P = .020). CONCLUSIONS AND IMPLICATIONS: To avoid decreasing satisfaction with meaningful activities, supporting older adults may be protective against the occurrence of depressive symptoms. Our findings highlight the need for health care professionals to not only encourage older adults to participate in activities for their mental health but also consider whether the activities are meaningful or satisfying for them.

DOI： 10.1016/j.jamda.2023.03.010

尾川達也, 合田秀人, 石垣智也, 齋藤崇志, 脇田正徳, 杉田翔, 牧迫飛雄馬, 池添冬芽 . 地域理学療法におけるアウトカム評価指標の使用状況と必要条件および障壁　日本地域理学療法学会会員を対象としたwebアンケート調査 . 地域理学療法学2 39 - 51 2023.3

Language：Japanese Publisher：(一社)日本地域理学療法学会

【目的】地域理学療法の標準化されたアウトカム評価指標(Standardized Outcome Measures: SOM)の作成・普及に向け,アウトカム評価指標の使用状況と必要条件,および障壁を調査することを目的とした.【方法】日本地域理学療法学会会員の中で要介護認定者への通所,訪問,施設サービスに従事する者を対象にwebアンケートを実施した.【結果】回答数は188名.アウトカム評価指標の使用に対して83.5%は重要と認識している一方,日常的に使用している者は44.7%であった.必要条件としては,尺度特性で信頼性や変化の検出可能性,測定方法で評価に必要な準備物や金銭的負担,実施時間が各々上位2つであった.また,障壁としては,教育不足や仲間と話す機会の不足が上位2つであった.【結論】アウトカム評価指標への重要性に対する認識と実際の使用状況との間に乖離を認めた.アウトカム評価指標の日常的な使用に至るには,実用性を考慮したSOMの作成と地域理学療法に特徴的な障壁に対処していく必要があると考える.(著者抄録)

Yuma Hidaka, Takayuki Tabira, Michio Maruta, Hyuma Makizako, Yuriko Ikeda, Atsushi Nakamura, Gwanghee Han, Hironori Miyata, Suguru Shimokihara, Yoshihiko Akasaki, Taishiro Kamasaki, Takuro Kubozono, Mitsuru Ohishi . Relationship between grave visitation and apathy among community‐dwelling older adults . Psychogeriatrics23 ( 3 ) 401 - 410 2023.2International journal

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

BACKGROUND: It has been shown that involvement in religious activities has a positive impact on psychological aspects. In this study, the relationship between grave visitation, a standard religious activity in Japan, and depression and apathy symptoms was investigated among older adults in Japan. METHODS: A total of 638 older adults who participated in a community-based health check survey (Tarumizu Study 2019) were interviewed regarding the presence or absence of grave visitation, frequency, travel time, means of transportation, and flower offerings. Apathy and depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). The participants were categorised into three grave visitation groups, namely, frequent (more than once per week), occasional (less than once per week), and non-visiting. Outcomes were compared between the frequency groups, and Poisson regression analysis was used to investigate the relationship between grave visitation frequency and apathy and depression. RESULTS: Of the participants, 91.8% reported regular grave visitation. The non-visiting group had a significantly higher prevalence of apathy symptoms (44.2%) than the visiting groups. Furthermore, using the frequent group as the reference, Poisson regression analysis adjusted for potential covariates demonstrated that no grave visitation was significantly related to apathy (prevalence ratio, 1.43; 95% confidence interval, 1.00-2.05, P = 0.049). CONCLUSIONS: Not practising grave visitation was significantly related to apathy among older adults. Helping older adults to visit graves may prevent apathy by facilitating motivation and increasing activity.

DOI： 10.1111/psyg.12945

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/psyg.12945

Midori Kamiya, Hikaru Ihira, Yoshiaki Taniguchi, Daisuke Matsumoto, Tomoya Ishigaki, Akio Okamae, Tatsuya Ogawa, Shogo Misu, Toshinori Miyashita, Takeshi Ohnuma, Tomohisa Chibana, Natsu Morikawa, Tome Ikezoe, Hyuma Makizako . Low-intensity resistance training to improve knee extension strength in community-dwelling older adults: Systematic review and meta-analysis of randomized controlled studies . Experimental Gerontology172 112041 - 112041 2023.2International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

AIM: The purpose of this systematic review and meta-analysis was to investigate the effects of low-intensity resistance training on knee extension strength with respect to intensity, frequency, duration and training site in community-dwelling older adults. METHODS: A literature search was conducted for articles published up to December 2018 on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), OTseeker and Ichushi-Web. Randomized controlled trials involving resistance training with <60 % one repetition maximum (1RM) in community-dwelling older adults aged 60 years and older were eligible. RESULTS: In total, 7 studies involving 275 participants were included in the meta-analysis. The results showed significant improvements in knee extension strength with low-intensity resistance training [standardized mean difference (SMD) 0.62, 95 % confidence interval (CI) 0.32 to 0.91]. In subgroup analyses, significant improvements were observed in the group with intensity at 50-60 % 1RM (0.83, 0.46 to 1.19), but not in the group at 40 % or less 1RM (0.30, 95%CI: -0.08 to 0.68). Concerning frequency, there were significant improvements in knee strength for those receiving training three times (0.90, 0.52 to 1.27) and two times (0.36, 0.03 to 0.69) per week, with a significant difference between the groups (p = 0.04). CONCLUSIONS: Low-intensity resistance training should be considered as an effective intervention to improve knee extension strength in community-dwelling older adults. Older adults may show more improvement in knee extension strength if intensity of the training is set at 50-60 % 1RM and frequency of training is three times per week.

DOI： 10.1016/j.exger.2022.112041

Yoshiaki Maki, Akiko Morita, Hyuma Makizako . Association between the Cognitive-Related Behavioral Assessment Severity Stage and Activities of Daily Living Required for Discharge to Home in Patients with Stroke: A Cross-Sectional Study. . International journal of environmental research and public health20 ( 4 ) 2023.2International journal

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

This study aimed to characterize cognitive function examined using Cognitive-related Behavioral Assessment (CBA) in activities of daily living (ADLs). According to CBA severity at discharge, 791 patients were assigned to five groups (most severe, severe, moderate, mild, and normal). The total scores for Functional Independence Measure (FIM) motor items were compared for each group. Multiple logistic regression analysis was performed to clarify the association between CBA severity and independence in ADL items. Independence in each ADL according to CBA severity was 0-4.8%, 26.8-45.0%, 84.3-91.0%, and 97.2-100% for all ADLs in the most severe to severe, moderate, mild, and normal groups, respectively. Significant differences were found in the FIM motor score according to CBA severity between the groups (p < 0.01). A mild or normal CBA was associated with a higher odds ratio (OR) for dressing the upper body (OR = 21.90; 95% confidence interval (CI), 13.50-35.70), bladder management (OR = 11.60; 95% CI, 7.21-18.60), transfers to the bed/chair/wheelchair (OR = 18.30; 95% CI, 11.40-29.40), transfers to the toilet (OR = 18.30; 95% CI, 11.40-29.30), and walking (OR = 6.60; 95% CI, 10.60-26.10). A CBA severity greater than mild (23 points) was associated with independence in ADLs that are important for discharge to home.

DOI： 10.3390/ijerph20043005

Daisaku Nishimoto, Shimpei Kodama, Ikuko Nishio, Hyuma Makizako, Ku-Ohl Project Team . Association between the Perception of Behavior Change and Habitual Exercise during COVID-19: A Cross-Sectional Online Survey in Japan. . International journal of environmental research and public health20 ( 1 ) 2023.1International journal

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

In general, the perception of behavior change may be associated with habitual exercise. However, this association might not be well-understood due to the state of emergency of the COVID-19 pandemic. This study collected data from 1499 internet users aged 20-86 years living in Japan who participated in the online survey from 26 to 27 February 2021. Having a perception of behavior change was defined as preparation, action, and maintenance of the transtheoretical model. The habitual exercise was defined as 600 metabolic equivalent min/week or more based on the International Physical Activity Questionnaire. Multivariate logistic regression analysis was used to calculate the odds ratio of habitual exercise and a 95% confidence interval was estimated after adjusting for related factors. We found that perception of behavior change was positively associated with habitual exercise (adjusted odds ratio = 2.41, 95%CI = 1.89-3.08), and similar associations were found in states of emergency (2.69, 1.97-3.69) and non-emergency (2.01, 1.34-3.01). Moreover, women were negatively associated in all analyses with habitual exercise compared to men (0.63, 0.49-0.80; 0.65, 0.44-0.96; 0.62, and 0.45-0.84, respectively). Thus, the perception of behavior change may be involved in the implementation of habitual exercise, suggesting that women face difficulties in engaging in habitual exercise.

DOI： 10.3390/ijerph20010356

OGAWA Tatsuya, GODA Shuto, ISHIGAKI Tomoya, SAITO Takashi, WAKIDA Masanori, SUGITA Sho, MAKIZAKO Hyuma, IKEZOE Tome . Practice, requirements, and barriers to outcome measures in community-based physical therapy . Japanese Journal of Community-based Comprehensive Physical Therapyadvpub ( 0 ) 39 - 51 2023

Language：Japanese Publisher：Japanese Society of Community-based Comprehensive Physical Therapy

Objective: To investigate the practice, requirements, and barriers to the development and disperse of standardized outcome measures (SOM) for community-based physical therapy.Methods: A web-based questionnaire was sent to members of the Japanese Society of Community-based Comprehensive Physical Therapy who are engaged in day-care, home-visit, and facility services to people requiring long-term care.Results: A total of 188 responded to the survey. While 83.5% recognized the importance of using outcome measures, only 44.7% used them routinely. The top two requirements were reliability and detectability of change for the scale characteristics, and the measurement method were the preparation and financial burden required for the assessment, and the time required to conduct the assessment. The top two barriers were lack of education and lack of opportunities to talk with peers.Conclusion: We found a gap between the recognition of the importance of outcome measures and their implementation. In order to reach routine use of outcome measures, it is necessary to development SOM that take into account practicality and address barriers characteristic of community-based physical therapy.

DOI： 10.57351/jjccpt.jjccpt22004

牧迫飛雄馬 . 高齢期における運動機能に対する介入効果は遺伝子多型に影響されるのか？ . 運動器理学療法学3 ( Supplement ) S60 - S60 2023

宮﨑宣丞, 竹下康文, 中井雄貴, 荒木草太, 川田将之, 木山良二, 牧迫飛雄馬 . 地域在住高齢女性における歩行速度増大の戦略と歩行パラメータ，身体機能の関連 . 基礎理学療法学26 ( Supplement ) S117-2 - S117-2 2023

Yuriko Ikeda, Takayuki Tabira, Tadasu Ohshige, Tomomi Masumitsu, Hyuma Makizako, Ku-Ohl Project Member . Association between Sleep Onset Problem and Subjective Cognitive Complaints among Japanese Older Adults during the Coronavirus Disease 2019 Pandemic. . International journal of environmental research and public health20 ( 1 ) 2022.12International journal

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

Older adults are more likely to have age-related sleep problems, which may result in the reduction of cognitive functions. This study was designed to examine the relationship between sleep onset problem and subjective cognitive complaints (SCC) among community-dwelling older adults during the coronavirus disease 2019 pandemic. In this study, 186 older adults aged 65 and above were enrolled and were instructed to respond to an online survey. This survey comprised questions regarding sleep quality (four items such as sleep duration, use of sleep medication), SCC (six domains), and sociodemographic information (eight items such as age, gender, stress condition). We classified the participants into two groups according to the presence or absence of sleep onset problem and examined the relationship between each SCC domain. The sleep onset problem (+) (n = 70) group had significantly higher frequency of scheduled memory decline, misplacement, disorientation in time, word recall decline, and forgetfulness. Furthermore, the sleep onset problem affected the participants' scheduled memory after adjusted for potential covariates (OR, 2.28; 95%CI, 1.13-4.73; p = 0.02). Older adults with sleep onset problem may need to be evaluated for SCC and supported in term of both sleep status and SCC.

DOI： 10.3390/ijerph20010156

白土大成, 牧迫飛雄馬, 赤井田将真, 生野佐紀, 椎葉竜平, 谷口善昭, 富岡一俊, 木内悠人, 立石麻奈, 中井雄貴 . ウィズコロナにおける勤労者の腰痛の変化とプレゼンティーズムとの関連 . 日本予防理学療法学会学術大会プログラム・抄録集1.Suppl.No.1 ( 0 ) 55 - 55 2022.12

Language：Japanese Publisher：日本予防理学療法学会

【はじめに、目的】勤労者の健康上の問題として腰痛があり、腰痛はプレゼンティーズム（健康上の問題による労働遂行能力の低下）を引き起こす要因のひとつとされている。COVID-19の流行はテレワークの導入など働き方に大きな変化をもたらしており、勤労者の腰痛やプレゼンティーズムに影響を与えている可能性がある。これらを検討し対策に結び付けることは産業理学療法の領域において重要である。本研究はCOVID-19流行前後における勤労者の腰痛の変化とプレゼンティーズムとの関連を明らかにすることを目的とした。【方法】本研究は、2020年10月に実施したオンライン調査による横断研究である。40-64歳の勤労者1865名（平均年齢49.6 ± 6.6歳、女性29.1%）を解析対象とした。腰痛の変化は、COVID-19流行以降に痛くなり始めた、悪くなった、変化しなかった、良くなった、腰痛なしから択一式にて調査した。痛くなり始めた、悪くなったと回答した者を腰痛悪化とした。労働生産性はWork Productivity and Activity Impairment Questionnaireを使用し、2019年10月、2020年10月の2時点におけるプレゼンティーズムを評価した。プレゼンティーズムを0点（仕事への影響なし）から10点（完全な仕事の妨げ）の11段階で評価し、先行研究に準じて1点以上をプレゼンティーズムありとした。COVID-19流行前の2019年10月時点でプレゼンティーズムなしの1328名（流行前プレゼンティーズムなし群）と同時点でプレゼンティーズムありの537名（流行前プレゼンティーズムあり群）の2群に分類した。コロナ禍の2020年10月時点でプレゼンティーズムのスコアが上昇していれば、流行前プレゼンティーズムなし群はプレゼンティーズム発生、流行前プレゼンティーズムあり群はプレゼンティーズム悪化とした。各群で従属変数を2020年時点でのプレゼンティーズム発生あるいは悪化、独立変数を腰痛悪化とし、腰痛の変化とプレゼンティーズムとの関連を検討した。共変量には年齢、性別、独居、教育歴、うつ病の既往、産業分類、勤務形態の変化（テレワーク）を投入した。【結果】流行前プレゼンティーズムなし群の102名（7.7%）に腰痛悪化、117名（8.8%）にプレゼンティーズム発生を認めた。また、流行前プレゼンティーズムあり群の107名（19.9%）に腰痛悪化、139名（25.9%）にプレゼンティーズム悪化を認めた。共変量で調整したロジスティック回帰分析の結果、それぞれの群において腰痛悪化は独立して2020年時点のプレゼンティーズム発生（OR：4.26、95%CI：2.41-7.52）あるいは悪化（OR：1.80、95%CI：1.07-3.01）と有意に関連していた。【結論】COVID-19の流行は一部の勤労者の腰痛を悪化させている可能性があり、腰痛悪化とプレゼンティーズムとの関連が示唆された。今後は感染症流行下において、身体機能や人間工学の知識を有する理学療法士が腰痛対策を行うことの有効性を検証する必要がある。【倫理的配慮、説明と同意】本研究は、ヘルシンキ宣言および人を対象とする医学系研究に関する倫理指針に基づき、対象者のプライバシーおよび個人情報の保護、研究内容について十分に説明し対象者から同意を得た。また、鹿児島大学疫学研究等倫理委員会からの承認（200101）を得て実施した。

DOI： 10.57304/jsptpsuppl.1.suppl.no.1.0_55

谷口善昭, 中井雄貴, 赤井田将真, 立石麻奈, 木内悠人, 牧迫飛雄馬 . 地域在住高齢者における筋量、握力、認知機能が社会的フレイルの変化におよぼす影響 . 日本予防理学療法学会学術大会プログラム・抄録集1.Suppl.No.2 ( 0 ) 8 - 8 2022.12

Language：Japanese Publisher：日本予防理学療法学会

【はじめに、目的】フレイルは、身体的、精神・心理的、社会的といった多様な側面を持ち、可逆性を有することが知られている。社会的フレイルは身体・認知機能の低下より先行して起こるとされているが、社会的フレイルの変化に対して身体機能や認知機能が影響をおよぼす可能性がある。本研究は、地域在住高齢者を対象に筋量、握力、認知機能が社会的フレイルの変化におよぼす影響を調査することを目的とした。【方法】本研究は、2018年および2019年の地域健康チェック（垂水研究）の両方に参加した65歳以上の高齢者のうち、1回目の測定から2回目の測定まで8～16ヵ月経過（平均345.7±47.9日）している者を対象とした。さらに主要項目に欠損がなく、要介護認定を受けている者を除外した422名（平均年齢 73.8歳、女性64.2%）を解析した。社会的フレイル判定は5 項目（独居、昨年より外出頻度の減少、友人の家を訪ねていない、家族や友人の役に立っていない、誰とも毎日会話をしていない）にて回答を求め、該当数が1項目以下をロバスト、2項目以上を社会的フレイルとした。筋量は、生体電気インピーダンス法にて測定し、四肢骨格筋指数が男性7.0 kg/m 2、女性5.7kg/m 2未満を筋量低下とした。握力は、男性28kg、女性18kg未満を握力低下とした。認知機能は、NCGG-FATで記憶、注意機能、実行機能、情報処理速度を測定し、年齢と教育歴を考慮した標準値より1.5SD以上の低下を1つ以上の領域で認めた者を認知機能低下とした。【結果】ベースライン時に社会的フレイルがロバストであった者（369名）のうち、社会的フレイルに移行した割合は11.1%であった。また、ベースライン時に社会的フレイルであった者（53名）のうち、ロバストへ改善した割合は34.0%であった。従属変数をロバストからの低下の有無、独立変数を筋量低下、握力低下、認知機能低下としたロジスティック回帰分析の結果、筋量が低下している者はロバストから社会的フレイルへ移行する可能性が高いことが示された（調整済オッズ比2.19、95%信頼区間1.11-4.29、共変量：年齢、性別）。従属変数を社会的フレイルからの改善の有無としたロジスティック回帰分析では、すべての独立変数に有意差は認めなかった。【結論】約1年間において、ロバストから社会的フレイルに移行した者は、筋量が低下している者が多く、筋量を高めておくことは社会的フレイルの予防につながる可能性がある。また、社会的フレイルからロバストへ改善した者と社会的フレイルのままだった者では、筋量・握力・認知機能に差がみられず、理学療法においても心身機能に対するアプローチだけでなく、社会的なつながりを促すことによって、社会的フレイルを改善できるかもしれない。【倫理的配慮，説明と同意】鹿児島大学疫学研究等倫理委員会の承認（170351疫）を得て実施した。ヘルシンキ宣言に基づき、対象者には研究内容について口頭と書面にて説明し同意を得た。

DOI： 10.57304/jsptpsuppl.1.suppl.no.2.0_8

福榮竜也, 牧迫飛雄馬, 谷口善昭, 赤井田将真, 白土大成, 木内悠人, 立石麻奈, 愛下由香里, 富岡一俊, 中井雄貴 . 地域在住高齢者における座位の中断回数および連続座位パターンとサルコペニアの関連性 . 日本予防理学療法学会学術大会プログラム・抄録集1.Suppl.No.2 ( 0 ) 4 - 4 2022.12

Language：Japanese Publisher：日本予防理学療法学会

【はじめに、目的】座位行動（Sedentary Behavior：以下、SB）は、エネルギー消費量が1.5METs 以下の覚醒行動であり、SBの蓄積は非感染性疾患の発生や死亡率の増加など、様々な有害事象と関連する。昨今、活動量計を使用し、座位中断回数（以下、Break数）や1回当たりのSBの連続量（以下、SB Bout）など、より詳細なSBの様式を分析した研究が報告されている。SB時間の延長は、サルコペニアのリスクを増大させることが報告されているが、これまでは質問紙にてSB時間を評価した研究が多く、活動量計にて評価される詳細なSBの様式とサルコペニアの関係性は不明な点が多い。これらが明らかとなれば、サルコペニアの新たな対策の知見となる可能性がある。本研究では、サルコペニアに対するBreak数と長時間SB Boutの関係性について検討した。【方法】地域コホート研究（垂水研究2018）の参加者において、三軸加速度計（HJA-750C Active style Pro オムロンヘルスケア社）にて活動量を計測した地域在住高齢者265名のうち、主要データに欠損がなく基準を満たした208名（74.7±5.9歳、女性59.3%）を対象とした。活動量データの有効基準は週4日以上かつ1日10時間以上とし、活動量の評価項目は、SB時間（分/日）、中高強度身体活動（以下、MVPA）時間（分/日）、Break数（回/座位1時間）、30分以上SB Bout 数、60分以上SB Bout数（いずれも回/日）とした。計測機器の装着時間（分/日）も計測した。サルコペニアは四肢骨格筋指数、握力、歩行速度にて判定した。統計解析は、サルコペニア群と非サルコペニア群の2群間比較を実施した。また、サルコペニアの有無を従属変数、Break数と30分以上、60分以上のSB Bout数を独立変数とした3通りのロジスティック回帰分析を行った。共変量は年齢、性別、MVPA時間とした。【結果】対象者のサルコペニアの割合は17.3%であった。マンホイットニー検定の結果、Break数は非サルコペニア群7.9（6.3 ‐9.4）回、サルコペニア群6.7（4.7-8.1）回であり、非サルコペニア群が有意に多く（p＜0.01）、60分以上SB Bout数は非サルコペニア群0.9（0.6-1.3）回、サルコペニア群1.4（0.8-1.6）回と有意にサルコペニア群の回数が多かった（p＜0.01）。ロジスティック回帰分析の結果、Break数とサルコペニアの関連は、オッズ比0.81（95%CI：0.68-0.95）、60分以上SB Bout数とサルコペニアの関連は、オッズ比2.08（95%CI：1.27-3.47）であり、いずれも有意にサルコペニアと関連していた。30分以上SB Bout数はサルコペニアと有意な関連を認めなかった。【結論】MVPA時間と独立して、1時間当たりの座位中断回数と60分以上連続する座位行動の回数はサルコペニアと関連していた。高齢者のサルコペニアに対する理学療法を講じる上で身体活動量の増大は重要であるが、日常生活における座位行動の中断や縮減に着目した指導・介入が重要である事が示唆された。【倫理的配慮，説明と同意】鹿児島大学疫学研究等倫理委員会の承認（170351疫）を得て実施した。ヘルシンキ宣言に基づき、対象者には研究内容について口頭と書面にて説明し同意を得た。

DOI： 10.57304/jsptpsuppl.1.suppl.no.2.0_4

椎葉竜平, 中井雄貴, 富岡一俊, 谷口善昭, 白土大成, 木内悠人, 竹中俊宏, 窪薗琢郎, 大石充, 牧迫飛雄馬 . 地域在住高齢者における前糖尿病および糖尿病と筋量、筋力、身体機能との関係 . 日本予防理学療法学会学術大会プログラム・抄録集1.Suppl.No.1 ( 0 ) 6 - 6 2022.12

Language：Japanese Publisher：日本予防理学療法学会

【はじめに、目的】サルコペニアは転倒や死亡のリスクを増大させる要因であり、サルコペニアの危険因子のひとつには糖尿病が挙げられる。血糖値が糖尿病の基準には満たないが、正常より高い状態は前糖尿病と分類され、前糖尿病は糖尿病へ進行するリスクが高い。サルコペニアの割合はHbA1c値に比例して増加すると報告されており、前糖尿病の段階からサルコペニアの診断基準である筋量、筋力、身体機能が低下している可能性がある。これらを検討することは早期から機能低下を把握する上で重要である。本研究では、地域在住高齢者における前糖尿病および糖尿病と筋量、筋力、身体機能の関係を検討した。【方法】地域コホート研究（垂水研究2019）に参加した地域在住高齢者687名のうち、脳卒中、認知症の既往、要介護認定者を除く609名（平均74.0±6.3歳、女性62.1%）を対象とした。基礎情報として、年齢、性別、内服数、糖尿病の病歴を聴取した。四肢骨格筋指数（生体電気インピーダンス法）、握力、5回椅子立ち上がりテスト、HbA1c値を測定した。HbA1c値が5.7%未満を非糖尿病群、5.7～6.4%を前糖尿病群とし、6.5%以上または糖尿病の既往がある者を糖尿病群と分類した。四肢骨格筋指数は男性7.0kg/m 2 未満、女性5.7kg/m 2 未満を筋量低下、握力は男性28kg未満、女性18kg未満を筋力低下とした。また、5回椅子立ち上がりテストは12秒以上を身体機能低下とした。筋量低下、筋力低下、身体機能低下のそれぞれを従属変数とし、糖尿病分類（非糖尿病群、前糖尿病群、糖尿病群）を独立変数としたロジスティック回帰分析を行った。共変量は年齢、性別、多剤併用の有無および筋量低下の有無、筋力低下の有無または身体機能低下の有無とした。【結果】前糖尿病および糖尿病を有する者の割合はそれぞれ25.0%、15.1% であった。各群における筋量低下の割合は、非糖尿病群40.5%、前糖尿病群33.6%、糖尿病群23.9%であった。筋力低下の割合は、非糖尿病群20.3%、前糖尿病群25.7％、糖尿病群32.6%であった。また、身体機能低下の割合は、非糖尿病群6.6%、前糖尿病群7.9%、糖尿病群14.1%であった。非糖尿病群と比較して前糖尿病群では筋力低下のオッズ比が1.70（95%信頼区間：1.02-2.82）と有意に高かった。非糖尿病群と比較して糖尿病群では筋量低下のオッズ比が0.37（95%信頼区間：0.20-0.69）と有意に低かった。また、糖尿病群では筋力低下のオッズ比が2.10（95%信頼区間：1.15-3.85）、身体機能低下のオッズ比が2.28（95%信頼区間：1.00-5.17）と有意に高かった。【結論】非糖尿病の者と比較して、前糖尿病を有する者では筋力が低下しており、糖尿病を有する者では筋量は保持しているが、筋力および身体機能が低下していることが示唆された。筋力低下や身体機能低下は将来の日常生活動作能力の低下に影響するため、前糖尿病や糖尿病を有する者は早期から運動介入を検討することが必要だろう。【倫理的配慮、説明と同意】本研究は鹿児島大学疫学研究等倫理委員会の承認（170351疫）を得て実施した。ヘルシンキ宣言に基づき、対象者には研究内容について口頭と書面にて説明をし、同意を得た。

DOI： 10.57304/jsptpsuppl.1.suppl.no.1.0_6

牧迫飛雄馬, 赤井田将真, 白土大成, 立石麻奈, 谷口善昭, 愛下由香里, 福榮竜也, 木内悠人, 倉津諒大 . 中年者におけるコロナ禍での外出自粛で自覚された身体の衰えが腰痛発生へ与える影響 . 日本予防理学療法学会学術大会プログラム・抄録集1.Suppl.No.2 ( 0 ) 17 - 17 2022.12

Language：Japanese Publisher：日本予防理学療法学会

【はじめに、目的】新型コロナウイルス感染症（COVID-19）の流行下では様々な生活様式の変化が生じ、日常生活での活動制限により、身体の衰えを感じることが少なくない。とくに中年期での腰痛の発生は労働生産性の低下を招く危険があり、予防が重要であると考えられる。本研究では、中年者を対象として外出自粛の生活で自覚された身体の衰えが腰痛の発生に影響するかを検証することを目的とした。【方法】40歳以上のYahoo!クラウドソーシング登録者を対象に縦断的なインターネット調査を行った。初回調査（2020年10月19日～28日）で回答のあった3,000名に追跡調査（2022年4月8日～22日）を行い、1787名から回答が得られた。そのうち、取込基準を満たし、初回調査で腰痛を有していなかった40～59歳の中年者846名（平均49.0±5.2歳、女性35.0%）を分析対象とした。初回調査から18か月経過した追跡調査において、腰痛ありと回答した者を腰痛の発生とした。初回調査では2020年4月～5月に発出された緊急事態宣言等に伴う外出自粛の影響を受けて身体の衰えを感じるか否かを聴取し、外出自粛による身体の衰えの自覚の有無を判定した。初回調査時点での1日の座位時間（分／日）を国際標準化身体活動質問票で調べた。コロナ禍での腰痛発生の有無と外出自粛による身体の衰えの自覚の有無をχ2検定で比較した。また、腰痛発生を従属変数、外出自粛による身体の衰えの自覚の有無を独立変数としたロジスティック回帰分析を行い、オッズ比と95%信頼区間を算出した（年齢、性別、仕事の有無、BMI、座位時間を共変量）。【結果】18か月後の腰痛の発生者は74名（8.8%）であり、初回調査において外出自粛による身体の衰えの自覚を有する者は221名（26.1%）であった。腰痛の発生者における外出自粛による身体の衰えの自覚を有する者の割合は37.8%であり、腰痛の未発生者での25.0%と比較して有意に高い割合であった（p=0.02）。ロジスティック回帰分析の結果、腰痛の新規発生に対する外出自粛による身体の衰えの自覚ありの調整済みオッズ比は1.94（95%信頼区間1.17̶3.21）であり、コロナ禍での身体の衰えの自覚は将来の腰痛発生に有意に関連することが示された。【結論】コロナ禍の18か月間の追跡調査で、約1割の中年者で腰痛の発生が認められ、2020年4月頃の外出自粛生活で自覚された身体の衰えが腰痛の発生に関連していることが示唆された。腰痛発生を予防するうえで、自粛を余儀なくされる状況においても、心身機能の維持や生活習慣の改善等によって自覚される身体の健康観を維持することの重要性が確認された。腰痛の予防・改善を図るための理学療法評価および介入を行う上でコロナ渦における身体の衰えの自覚を加味することは有益であると考える。【倫理的配慮，説明と同意】鹿児島大学疫学研究等倫理審査委員会の承認を得た（承認番号：200101疫‐改1）。

DOI： 10.57304/jsptpsuppl.1.suppl.no.2.0_17

Masumitsu Tomomi, Kubozono Takuro, Miyata Masaaki, Makizako Hyuma, Tabira Takayuki, Takenaka Toshihiro, Kawasoe Shin, Tokushige Akihiro, Niwa Sayoko, Ohishi Mitsuru . Association of Sleep Duration and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults(タイトル和訳中) . Journal of Atherosclerosis and Thrombosis29 ( 12 ) 1864 - 1871 2022.12

Language：English Publisher：(一社)日本動脈硬化学会

65歳以上の地域住民を対象に、心臓足首血管指数(CAVI)と自己報告による睡眠の時間・質の関連性を横断的に調査した。2018～2019年に健康診断を受けた鹿児島県垂水市の高齢者コホート(垂水研究)から、65歳以上の997名(女性622名、年齢中央値74歳)を解析に組み入れた。睡眠時間で3群に分類した。その結果、睡眠時間が8時間以上であった長睡眠群は110名(女性56名、年齢中央値77歳)、6～8時間の中睡眠群は438名(女性269名、年齢中央値74歳)、6時間未満の短睡眠群は449名(女性297名、年齢中央値73歳)であった。この3群で平均CAVIを比較すると、長睡眠群では9.6±1.3となり、中睡眠群(9.1±1.2)または短睡眠群(9.1±1.1)よりも有意に高かった(P<0.001)。各種の因子(年齢、性別、収縮期血圧、現喫煙状態、BMI、運動頻度、学歴、フレイル、睡眠薬、睡眠の質、昼寝時間)で調整を行った多変量回帰分析の結果、長睡眠群のCAVIは中睡眠群よりも有意に高い(p=0.016)ことが証明された。こうした結果とは対照的に、睡眠の質とCAVIの有意な関連性は示されなかった。本解析結果から、高齢者では睡眠時間が長いことが動脈硬化度と相関し、睡眠の質は相関しないことが示唆された。

Yoshihiko Akasaki, Takayuki Tabira, Michio Maruta, Hyuma Makizako, Masaaki Miyata, Gwanghee Han, Yuriko Ikeda, Atsushi Nakamura, Suguru Shimokihara, Yuma Hidaka, Taishiro Kamasaki, Takuro Kubozono, Mitsuru Ohishi . Social Frailty and Meaningful Activities among Community-Dwelling Older Adults with Heart Disease . International Journal of Environmental Research and Public Health19 ( 22 ) 15167 - 15167 2022.11International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：MDPI AG

Patients with heart disease are more likely to experience social frailty due to physical inactivity, which may affect meaningful activities such as hobbies. This study aimed to investigate (1) the association between heart disease and social frailty in community-dwelling older adults and (2) the characteristics of meaningful activities in community-dwelling older adults with heart disease. Data from 630 older adults who participated in a community-based health survey were obtained, including clinical history, meaningful activities, social frailty and psychosomatic functions. Participants were divided into two groups: those with heart disease (n = 79) and those without (n = 551), and comparisons were made. Social frailty was observed in 23.7% of participants with heart disease, and logistic regression revealed significant associations with heart disease and social frailty after adjusting for potential covariates (OR, 1.97; 95% CI, 1.06 3.67; p = 0.032). Participants with heart disease did not differ significantly in terms of satisfaction or performance; their frequency of engagement in meaningful activities was significantly lower than without heart disease (p = 0.041). These results suggest that heart disease and social frailty are associated in community-dwelling older adults, and that this demographic is inclined to engage in meaningful activities less frequently.

DOI： 10.3390/ijerph192215167

Akio Okamae, Tatsuya Ogawa, Hyuma Makizako, Daisuke Matsumoto, Tomoya Ishigaki, Midori Kamiya, Toshinori Miyashita, Hikaru Ihira, Yoshiaki Taniguchi, Shogo Misu, Takeshi Ohnuma, Tomohisa Chibana, Natsu Morikawa, Tome Ikezoe . Efficacy of Therapeutic Exercise on Activities of Daily Living and Cognitive Function Among Older Residents in Long-term Care Facilities: A Systematic Review and Meta-analysis of Randomized Controlled Trials . Archives of Physical Medicine and Rehabilitation104 ( 5 ) 812 - 823 2022.11International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

OBJECTIVES: This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities. DATA SOURCES: PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018. STUDY SELECTION: Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes. DATA EXTRACTION: Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS: A total of 11 RCTs with 1280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD]=0. 22, 95% confidence interval [CI]: 0.02, 0.42, P=.03). Subgroup analyses indicated that interventions conducted ≥3 days per week [SMD=0.42, 95% CI 0.02, 0.82, P=.04] had a significant benefit on ADL. For cognitive function, group exercise and ≥3 days/week of intervention had a significant benefit (group exercise: mean difference [MD]=3.36, 95% CI 0.91, 5.80, P=.007; ≥3 days/week of intervention: MD=2.28, 95% CI 0.07, 4.49, P=.04). CONCLUSIONS: Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

DOI： 10.1016/j.apmr.2022.11.002

Shoma Akaida, Takayuki Tabira, Yuki Nakai, Michio Maruta, Yoshiaki Taniguchi, Kazutoshi Tomioka, Nana Sato, Ayumi Wada, Hyuma Makizako . Are satisfaction and performance of meaningful activities associated with frailty in older adults? . Archives of gerontology and geriatrics105 104845 - 104845 2022.10International journal

SHIRATSUCHI Daijo, MAKIZAKO Hyuma, AKAIDA Shoma, SHONO Saki, SHIIBA Ryuhei, TANIGUCHI Yoshiaki, TOMIOKA Kazutoshi, SATO Nana, WADA Ayumi, KIUCHI Yuto, TATEISHI Mana, NAKAI Yuki . Association of Changes in Low Back Pain in Workers and Presenteeism Following an Epidemic of Novel Coronavirus Infection . Physical Therapy Japan49 ( 5 ) 339 - 347 2022.10

Language：Japanese Publisher：Japanese Society of Physical Therapy

Objective: To determine the association between changes in low back pain and in presenteeism in workers before and after the epidemic of the new coronavirus (COVID-19), and to further examine the association by assessing changes in working patterns.Methods: A cross-sectional analysis was conducted on 1865 workers (mean age 49.6±6.6 years) who participated in an online survey. We investigated changes in low back pain and presenteeism associated with the COVID-19 epidemic and examined the relationship between worsening low back pain and presenteeism.Results: Worsening of low back pain was significantly associated with the occurrence of presenteeism in the group without pre-epidemic presenteeism (odds ratio: 4.26, p<0.01) and worsening of presenteeism in the group with pre-epidemic presenteeism (odds ratio: 1.80, p=0.01).Conclusion: The worsening of low back pain following the COVID-19 epidemic was associated with presenteeism, and this association was particularly strong in a group of people who were continuously engaged in office work.

DOI： 10.15063/rigaku.12259

Yoshiaki Taniguchi, Hyuma Makizako, Yuki Nakai, Yuto Kiuchi, Shoma Akaida, Mana Tateishi, Toshihiko Takenaka, Takuro Kubozono, Mitsuru Ohishi . Associations of the Alpha-Actinin Three Genotype with Bone and Muscle Mass Loss among Middle-Aged and Older Adults. . Journal of clinical medicine11 ( 20 ) 2022.10International journal

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

Bone and muscle mass loss are known to occur simultaneously. The alpha-actinin three (ACTN3) genotype has been shown to potentially affect bone and muscle mass. In this study, we investigated the association between the ACTN3 genotype and bone and muscle mass loss in community-dwelling adults aged ≥ 60 years. This study was a cross-sectional analysis of data from 295 participants who participated in a community health checkup. The ACTN3 genotypes were classified as RR, RX, or XX types. Bone mass loss was defined as a calcaneal speed of sound T-score of <-1.32 and <-1.37, and muscle mass loss was defined as an appendicular skeletal muscle index of <7.0 kg/m2 and <5.7 kg/m2 in men and women, respectively. The percentages of XX, RX, and RR in the combined bone and muscle mass loss group were 33.8%, 30.8%, and 16.7%, respectively, with a significantly higher trend for XX. Multinomial logistic regression analysis showed that XX had an odds ratio of 3.00 (95% confidence interval 1.05-8.54) of being in the combined bone and muscle mass loss group compared to the RR group (covariates: age, sex, grip strength, and medications). The ACTN3 genotype of XX is associated with a higher rate of comorbid bone and muscle mass loss. Therefore, ACTN3 genotyping should be considered for preventing combined bone and muscle mass loss.

DOI： 10.3390/jcm11206172

Yuto Kiuchi, Takehiko Doi, Kota Tsutsumimoto, Sho Nakakubo, Satoshi Kurita, Kazuhei Nishimoto, Hyuma Makizako, Hiroyuki Shimada . Association between dietary diversity and sarcopenia in community-dwelling older adults . Nutrition106 111896 - 111896 2022.10International journal

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier {BV}

OBJECTIVES: The aim of this study was to examine whether dietary diversity is associated with sarcopenia in community-dwelling older Japanese adults. METHODS: We used a cross-sectional large cohort data set from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. Data from 9080 older adults (mean age 74 ± 5.6 y; 44.4% were men) were included in this cross-sectional study. Sarcopenia was assessed using muscle mass, muscle strength, and physical performance represented by gait speed. We assessed 1-wk consumption frequency of food types, including meat, fish/shellfish, eggs, milk, soybean products, green and yellow vegetables, potatoes, fruits, seaweeds, fats, and oil. Consumption frequency was allotted to each category for the following responses: eat almost every day, eat 3 or 4 /wkd, eat 1 or 2 d/wk, and hardly ever eat. Poor dietary diversity was defined as those who responded hardly ever eat for any of the 10 foods. RESULTS: This study revealed that 2647 participants (29.2%) had poor dietary diversity. Poor dietary diversity was associated with confirmed sarcopenia (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.08-1.96) and severe sarcopenia (OR, 1.58; 95% CI, 1.08-2.39). Furthermore, poor dietary diversity of low-protein foods was significantly associated with sarcopenia (OR, 1.57; 95% CI, 1.13-2.20) as well as poor dietary diversity of high-protein foods (OR, 1.47; 95% CI, 1.12-1.92). CONCLUSIONS: This cross-sectional study revealed that poor dietary diversity was associated with sarcopenia among older adults. Ingestion of low-protein foods and high-protein foods is infrequently associated with sarcopenia and ingestion of high-protein foods.

DOI： 10.1016/j.nut.2022.111896

白土大成, 牧迫飛雄馬, 赤井田将真, 生野佐紀, 椎葉竜平, 谷口善昭, 富岡一俊, 佐藤菜々, 和田あゆみ, 木内悠人, 立石麻奈, 中井雄貴 . 新型コロナウイルス感染症の流行に伴う就労者の腰痛変化とプレゼンティーズムとの関連 . 理学療法学49 ( 5 ) 339 - 347 2022.10

Language：Japanese Publisher：(一社)日本理学療法学会連合

【目的】新型コロナウイルス感染症(以下,COVID-19)の流行前後における就労者の腰痛変化とプレゼンティーズムとの関連を検討し,さらに勤務形態の変化との関連性を明らかにする。【方法】WEB調査で回答のあった就労者1865名(平均年齢49.6±6.6歳)を横断的に解析した。COVID-19流行に伴う腰痛およびプレゼンティーズムの変化を調査し,腰痛悪化とプレゼンティーズムとの関連性を検討した。【結果】腰痛悪化は,流行前プレゼンティーズムなし群におけるプレゼンティーズム発生(オッズ比:4.26,p<0.01),流行前プレゼンティーズムあり群におけるプレゼンティーズム悪化(オッズ比:1.80,p=0.01)と有意に関連していた。【結論】COVID-19の流行に伴う腰痛悪化はプレゼンティーズムと関連することが示唆され,特にその関連性は継続してオフィスワークに従事している集団において強い傾向を認めた。(著者抄録)

牧迫飛雄馬 . 認知症・フレイルからみた糖尿病合併症の重症化予防の重要性 . 日本糖尿病理学療法学雑誌2 ( Supplement ) 6 - 6 2022.9

Language：Japanese Publisher：一般社団法人日本糖尿病理学療法学会

糖尿病，高血圧，肥満，喫煙などの生活習慣に関わる要因は，認知症の重大な危険因子とされている．とくに，糖尿病は認知症および認知機能障害の発生リスクを増大させるだけでなく，認知機能が低下している中高齢者では将来の糖尿病発症リスクを増大させることが報告されており，双方からの予防対策が重要である．さらに，糖尿病に至らずとも，HbA1c が5.7～6.4％程度の前糖尿病に該当する者でも認知症の発症リスクが高く，さらには脳萎縮の進行が懸念されている．また，糖尿病を合併するフレイル高齢者では，要介護の発生リスクが増大することが報告されており，糖尿病の診断基準に該当しなくとも，前糖尿病の段階からフレイルや身体機能の低下を惹起するリスクが高いことが示唆されている．このように，糖尿病の診断に至らずとも，その前段階である前糖尿病においても，認知症およびフレイルの発生リスクは高く，より早期からの血糖コントロールおよび重症化の予防が重要であろう．認知症の発症者では，発症の10～12 年程前から身体活動量は低下してくることが指摘されており，継続した身体活動の促進に取り組むことが望ましい．とくに，65 歳以上の高齢者では，座位時間を身体活動（強度は問わない）に置き換えることや，1 週間で150～300 分以上の中強度の有酸素運動，もしくは75～150 分の高強度の有酸素運動に取り組むことが推奨されている．有酸素運動を中心とした身体活動の向上によって，認知症の発症の予防や遅延に効果が期待されている．認知機能の維持・改善に対するより効果的な運動療法としては，運動による身体活動の促進のみではなく，知的な刺激が伴う活動を付加することが推奨される．とりわけ，認知機能の低下が疑われる状態においては，運動のみによる介入では認知機能の改善には限界があると言わざるを得ず，知的な刺激の伴う活動を加えることで認知機能が維持・改善することが期待されている．フレイルに対しては，筋力トレーニングを中心として，有酸素運動，柔軟運動，バランス運動を含めた多面的な運動が推奨されている．血糖コントロールの改善を目指すうえでは，具体的な運動方法の提示とともに，いかに継続できるかの支援も重要であろう．

DOI： 10.51106/ptdm.2.supplement_6

Yukiko Nishita, Hyuma Makizako, Seungwon Jeong, Rei Otsuka, Hunkyung Kim, Shuichi Obuchi, Yoshinori Fujiwara, Yuki Ohara, Shuichi Awata, Minoru Yamada, Katsuya Iijima, Hiroyuki Shimada, Takao Suzuki . Temporal trends in cognitive function among community-dwelling older adults in Japan: Findings from the ILSA-J integrated cohort study. . Archives of gerontology and geriatrics102 104718 - 104718 2022.9International journal

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

BACKGROUND: As the population ages, it is important to consider whether older adults tend to have healthier lives. This study examined temporal trends in cognitive function among community-dwelling Japanese older adults. METHODS: The data source for this study was Integrated Longitudinal Studies on Aging in Japan (ILSA-J). We collected representative values for the Mini-Mental State Examination (MMSE) score obtained in 2010 and 2017; mean, standard deviation, and prevalence of ≤23 as cognitive impairment and ≥28 as intact cognitive function. Six cohorts (n=8,575) in 2010 and seven cohorts (n=6,089) in 2017 were included (age range 65-89). One-group meta-analyses were conducted to calculate pooled means of MMSE scores, the pooled prevalence of MMSE scores ≤23 and ≥28, and 95% confidence intervals (CIs). RESULTS: The mean MMSE score was higher in 2017 than in 2010 for all age groups in both men and women. The prevalence of MMSE ≤23 was lower in 2017 than in 2010 for all age groups for men and was lower in 2017 than in 2010 for all age groups other than for women aged 75-79 years. The prevalence of MMSE ≥28 was higher in 2017 than in 2010 for all age groups in both men and women. In addition, the pooled means of years of education was lower in 2010 than in 2017, which might be an explanatory factor. CONCLUSIONS: This study suggests that the cognitive function of community-dwelling Japanese older adults has improved in recent years. Future studies need to identify factors associated with the improvement.

DOI： 10.1016/j.archger.2022.104718

Maruta Michio, Shimokihara Suguru, Makizako Hyuma, Ikeda Yuriko, Han Gwanghee, Akasaki Yoshihiko, Hidaka Yuma, Kamasaki Taishiro, Kubozono Takuro, Ohishi Mitsuru, Tabira Takayuki . Associations between apathy and comprehensive frailty as assessed by the Kihon Checklist among community-dwelling Japanese older adults(和訳中) . Psychogeriatrics22 ( 5 ) 651 - 658 2022.9

Language：English Publisher：John Wiley & Sons Australia, Ltd

地域在住高齢者におけるアパシーとフレイルとの横断的な関連について検討した。健康診断調査(垂水調査)に参加した地域在住高齢者882名(平均74.4±6.4歳、女性62.1%)を対象とした。アパシーはGeriatric Depression Scale-3Aで評価し、フレイルは基本チェックリスト(下位尺度;日常生活関連動作、運動器機能、低栄養状態、口腔機能、閉じこもり、認知機能)で評価した。その結果、209名(23.7%)でアパシーが認められた。交絡因子調整後の多項ロジスティック回帰分析の結果、アパシーはプレフレイルおよびフレイルと有意に関連していた。アパシーを有する高齢者では有さない高齢者と比較して、基本チェックリストの日常生活関連動作、運動器機能、口腔機能、認知機能に問題を呈する割合が有意に高かった。以上から、包括的なフレイル評価の重要性が示され、アパシーは老年期の健康に広範かつ有害な影響を及ぼす可能性が示唆された。

田平隆行, 池田由里子, 益満智美, 大重匡, 牧迫飛雄馬 . Relationship between hobbies and their satisfaction and subjective cognitive complains in older adults . 日本作業療法学会抄録集(CD-ROM)56回 OJ - 5 2022.9

牧迫飛雄馬, 赤井田将真, 立石麻奈, 谷口善昭, 白土大成 . 60歳以上の中高齢者におけるフレイルと転倒恐怖感との関連 . 日本転倒予防学会誌9 ( 2 ) 138 - 138 2022.9

牧迫飛雄馬, 立石麻奈 . 【ポストコロナ時代に向けた高齢者の孤立対策～予防から支援まで～】地域高齢者の孤立予防のための運動を介した社会活動の促進 . Geriatric Medicine60 ( 8 ) 707 - 710 2022.8

Language：Japanese Publisher：(株)ライフ・サイエンス

■新型コロナウイルス感染症の流行に伴い、日常での諸々の活動は制限を余儀なくされ、特に高齢者においては孤立や孤独のリスクが増大することが懸念される。高齢期における習慣的な運動は、心身機能や生活の質(QOL)の向上に有用となることが示されており、さらには運動行動を介して社会活動を促進することも期待され、孤立予防のための手段の1つともなり得る。コロナ禍における孤立や孤独の回避に対する対策が必要であると考えられた事例から、孤立予防のための運動を介した社会活動の促進のあり方について再考が必要であろう。(著者抄録)

Language：Japanese Publisher：(株)ライフ・サイエンス

牧迫飛雄馬 . 【予防医学と健康増進学】運動習慣で健康増進と疾病予防は達成できるか . 老年科6 ( 2 ) 98 - 104 2022.8

益満智美, 宮田昌明, 丹羽さよ子, 牧迫飛雄馬, 田平隆行, 窪薗拓郎, 川添晋, 徳重明央, 大石充 . 地域在住高齢者における睡眠時間と血管硬化度との検討 . 日本動脈硬化学会総会プログラム・抄録集54回 262 - 262 2022.7

Michio Maruta, Suguru Shimokihara, Hyuma Makizako, Yuriko Ikeda, Gwanghee Han, Yoshihiko Akasaki, Yuma Hidaka, Taishiro Kamasaki, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Associations between apathy and comprehensive frailty as assessed by the Kihon Checklist among community‐dwelling Japanese older adults . Psychogeriatrics22 ( 5 ) 651 - 658 2022.6International journal

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

BACKGROUND: Frailty is a multidimensional condition characterised by reduced physical and psychological resilience. Older adults also frequently demonstrate apathy, suggesting that it shares similar neuro-physiological pathways with frailty. This cross-sectional study aimed to investigate the association between apathy and frailty as defined by a comprehensive assessment. METHODS: We analyzed 882 older adults (mean age: 74.4 ± 6.4 years; 62.1% female) who participated in a community-based health check survey (Tarumizu Study). Apathy was measured by the Geriatric Depression Scale-3A, a three-item subset of the Geriatric Depression Scale-15, and frailty by the Kihon Checklist of physical, psychological, functional, and social status. Associations were examined by multinomial logistic regression with frailty status (robust, pre-frailty, frailty) as the dependent variable, apathy as the independent variable, and sociodemographic factors, medications, cognitive function, functional capacity, and mood symptoms as potential confounders. RESULTS: Apathy was observed in 23.7% of individuals, and logistic regression revealed significant associations with both pre-frailty and frailty after confounder adjustment (pre-frailty: odds ratio (OR) 1.80, 95% CI 1.22-2.64; frailty: OR 3.24, 95% CI 1.63-6.42). Participants with apathy also exhibited greater deficits in the Kihon Checklist subdomains instrumental activities of daily living (P = 0.022), physical function (P < 0.001), oral function (P < 0.001), and cognitive function (P = 0.001). CONCLUSIONS: Our findings underscore the importance of comprehensive frailty assessment and demonstrate that apathy can have pervasive deleterious effects on geriatric health.

DOI： 10.1111/psyg.12867

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/psyg.12867

AKAIDA Shoma, NAKAI Yuki, TOMIOKA Kazutoshi, TANIGUCHI Yoshiaki, TATEISHI Mana, TABIRA Takayuki, TAKENAKA Toshihiro, KUBOZONO Takuro, OHISHI Mitsuru, MAKIZAKO Hyuma . Association between car accidents and falls among community-dwelling older drivers . Japanese Journal of Geriatric Therapy1 ( 0 ) 1 - 6 2022.6Reviewed

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japan Geriatric Therapy Society

【Aim】 This study aimed to examine the association between car accident history and fall history among community-dwelling older drivers.【Methods】 A cross-sectional analysis was conducted on 602 older drivers (mean age: 72.8 ± 5.6 years, women: 50.0%) who participated in the regional cohort study (Tarumizu Research 2018, 2019) and were driving at 65 years or older. For car accident history, we listened to their accident history for the past two years and classified it into “accident history” and “no accident history.” The fall history was classified into “with fall history” and “no fall history” based on the presence or absence of falls in the past year. In the statistical analysis, a binomial logistic regression analysis was performed with accident history as the dependent variable, fall history as the independent variable, and age and sex as the covariates.【Results】 It was found that 5.6% of the subjects had a history of car accidents, and 13.0% had a history of falls. Among those with a history of car accidents, a significantly higher percentage of people had a history of falls than among those with no history of car accidents (p = 0.003). The logistic regression analysis showed that having a history of falls was significantly associated with having a history of car accidents (odds ratio: 3.12, 95% confidence interval: 1.42–6.85, p = 0.004).【Conclusions】 The results suggested an association between a history of car accidents and a history of falls among community-dwelling older drivers.

DOI： 10.57270/jgts.2022_007

赤井田将真, 中井雄貴, 富岡一俊, 谷口善昭, 立石麻奈, 田平隆行, 竹中俊宏, 窪薗琢郎, 大石充, 牧迫飛雄馬 . 地域在住高齢者ドライバーにおける自動車事故歴と転倒歴の関係 . 日本老年療法学会誌1 1 - 6 2022.6

Language：Japanese Publisher：(一社)日本老年療法学会

地域在住高齢者ドライバーにおける自動車事故歴と転倒歴の関連性について検討した。地域コホート研究(垂水研究2018または2019)に参加した地域在住高齢者1029名のうち、調査時点で自動車運転免許を保有しており自動車運転をしている602名(女性50.0%、平均72.8±5.6歳)を対象とした。過去2年間の自動車事故経験者(事故歴あり)は34名(女性55.9%、平均72.7±4.9歳)、事故歴なしは568名(女性49.6%、平均72.9±5.7歳)であった。過去1年間の転倒経験者は78名(13.0%)であった。事故歴あり群は事故歴なし群に比べ転倒歴を有する割合が有意に高かった。事故歴とその他の変数(年齢、性別、多剤併用、運転頻度、運転距離、GDS-15、身体機能低下、MCI)の関係については群間での有意な差は認められなかった。二項ロジスティック回帰分析では、転倒歴を有することは事故歴を有することと有意な関連を認めた。

Language：Japanese Publisher：(一社)日本老年療法学会

Hironori Miyata, Michio Maruta, Hyuma Makizako, Gwanghee Han, Yuriko Ikeda, Atsushi Nakamura, Keiichiro Tokuda, Suguru Shimokihara, Shoma Akaida, Yuma Hidaka, Yoshihiko Akasaki, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Association between satisfaction with meaningful activities and social frailty in community-dwelling Japanese older adults . Archives of Gerontology and Geriatrics100 104665 - 104665 2022.5Reviewed International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

OBJECTIVES: This cross-sectional study investigates the associations among satisfaction with meaningful activities, and social frailty in community-dwelling Japanese older adults. METHODS: We analyzed data from 596 older adults (mean age 74.2 ± 6.4 years, female 63.6%) who participated in the Tarumizu Study 2019, a community-based health survey. Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice (ADOC) tool. Satisfaction was evaluated from 1 to 5, and those who were assigned a rating of 4 or 5 were operationally classified as the high satisfaction group (n = 487), with others occupying the low satisfaction group (n = 109). Both groups were evaluated based on the ADOC, social frailty (Makizako's five items), physical function, depressive symptoms, cognitive function, and higher-level competence. RESULTS: Of the 596 participants, 18.7% showed prevalence of social frailty. The low satisfaction group had a significantly higher prevalence of social frailty (low satisfaction 28.4% vs. high satisfaction 16.4%, P = 0.004) and depressive symptoms (low satisfaction 30.3% vs. high satisfaction 17.9%, P<0.01), and poor higher-level competence (P = 0.026) than the high satisfaction group. Logistic regression analysis showed that social frailty (Odds Ratio 1.78, 95% Confidence Interval 1.068-2.990, P = 0.027) was significantly associated with satisfaction with meaningful activity after adjusting for covariates. We found no significant differences in categories of meaningful activities between the low and high satisfaction groups (P = 0.549). CONCLUSIONS: This study suggested that social frailty was associated with satisfaction with meaningful activities, regardless of the degree or category of satisfaction.

DOI： 10.1016/j.archger.2022.104665

Akaida Shoma, Nakai Yuki, Shiratsuchi Daijo, Tomioka Kazutoshi, Taniguchi Yoshiaki, Sato Nana, Wada Ayumi, Kiuchi Yuto, Shono Saki, Shiiba Ryuhei, Tateishi Mana, Makizako Hyuma . Association of self-rated health with type and frequency of social interaction during the declaration of COVID-19 state of emergency among Japanese community-dwelling oldest-old adults(和訳中) . Geriatrics & Gerontology International22 ( 5 ) 405 - 411 2022.5

Language：English Publisher：John Wiley & Sons Australia, Ltd

社会活動が制限された新型コロナウイルス感染症による緊急事態宣言期間における地域在住超高齢者の社会的交流とその後の自己評価健康度(SRH)との関連について検討した。北海道美唄市に在住する超高齢者1112名を対象に自記式質問紙調査を実施した。質問紙では、人口動態変数、2020年3月時点(緊急事態中)の社会的交流の種類(対面、非対面)および頻度、調査時(2020年7月、緊急事態後)のSRHを尋ねた。解答を得た889名のうち、基準を満たした612名(平均83.0±4.3歳、女性51.8%)を解析した。男性では社会的交流とSRHとに有意な関連はみられなかったが、女性では緊急事態宣言中に週1回以上、対面および非対面での交流がいずれもあった者はなかった者よりもSRHが高かった(オッズ比:2.17、95%CI:1.07～4.41)。以上から、対面での交流が制限される状況でも、女性では少なくとも週に1回、対面および非対面での交流の機会を持つことがSRHに有益である可能性が示唆された。

立石麻奈, 赤井田将真, 生野佐紀, 椎葉竜平, 谷口善昭, 木内悠人, 白土大成, 牧迫飛雄馬 . フレイル高齢者に対する個別運動と集団運動の介入効果の違いランダム化比較試験 . 日本老年医学会雑誌59 ( Suppl. ) 120 - 120 2022.5

牧迫飛雄馬, 赤井田将真, 白土大成, 立石麻奈, 生野佐紀 . 歩数計の利用と身体活動量およびロコモティブシンドロームとの関連 . 日本老年医学会雑誌59 ( Suppl. ) 111 - 111 2022.5

白土大成, 谷口善昭, 木内悠人, 赤井田将真, 窪薗琢郎, 大石充, 牧迫飛雄馬 . 地域在住高齢者におけるα-アクチニン3遺伝子多型と筋量および身体機能との関連 . 日本老年医学会雑誌59 ( Suppl. ) 111 - 111 2022.5

赤井田将真, 生野佐紀, 立石麻奈, 谷口善昭, 白土大成, 牧迫飛雄馬 . 中高齢者の人生における最大の後悔が生じる生活領域と性差に関する研究 . 日本老年医学会雑誌59 ( Suppl. ) 132 - 133 2022.5

牧迫飛雄馬 . 【フレイル予防によるわが国の健康長寿戦略-産学官民協働による健康長寿まちづくり】Key words　介護予防 . カレントテラピー40 ( 5 ) 504 - 504 2022.5

谷口善昭, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 窪薗琢郎, 竹中俊宏, 大石充 . 地域在住高齢者における骨量および筋量の低下と身体活動との関連性 . 理学療法学49 ( 2 ) 131 - 138 2022.4

Language：Japanese Publisher：(一社)日本理学療法学会連合

【目的】地域在住高齢者における骨量・筋量低下と身体活動との関連性を明らかにすることを目的とした。【方法】地域コホート研究(垂水研究2018)に参加した地域在住高齢者173名を分析対象とした。骨量低下は%YAMが70%以下とし,筋量低下は四肢骨格筋指数がサルコペニアの基準より低いものとした。身体活動量は3軸加速度計を用いて,座位行動時間延長,中高強度身体活動時間低下,歩数低下の有無に分類した。骨量・筋量をもとに正常群,骨量低下群,筋量低下群,骨量・筋量低下群の4群に分類し,基本情報および身体活動を比較した。【結果】骨量・筋量低下群は正常群と比べて中高強度身体活動時間が有意に減少していた(オッズ比3.29,p<0.05,共変量:年齢(5歳階級),性別,歩行速度低下,うつ傾向)。【結論】骨量・筋量低下を併存している高齢者は,中高強度身体活動時間が減少していることが示唆された。(著者抄録)

MAIZAKO Hyuma, SHIRATSUCHI Daijo, SHIIBA Ryuhei, TANIGUCHI Yoshiaki, KUBOZONO Takuro, OHISHI Mitsuru . Correlation of sarcopenia with orthopedic disorders, history of falls, and polypharmacy among community-dwelling older adults . Journal of Physical Therapy for Prevention1 ( 0 ) 19 - 24 2022.3Reviewed

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Society of physical therapy for prevention

Objective: This study aimed to examine the correlation of sarcopenia with orthopedic disorders, history of falls, and polypharmacy among community-dwelling older adults.Methods: Data from 905 older adults who participated in community-based health check-up were analyzed. Participants were asked to provide their history of orthopedic disorders, number of prescription medicines, and experience of fall during the past year. Sarcopenia was assessed based on the AWGS2019 criteria.Results: The prevalence rate of sarcopenia was 18.3 % (n = 166). Although participants with osteoporosis showed a higher prevalence rate, there were no associations of sarcopenia with osteoarthritis and spinal disease. In the logistic regression analyses, there was no significant association between orthopedic disorders and sarcopenia, whereas history of falls (odds ratio = 1.65) and polypharmacy (≥6) (odds ratio = 1.56) were significantly associated with sarcopenia.Conclusions: A higher prevalence rate of sarcopenia was observed in older adults with osteoporosis. However, there was no significant association found between sarcopenia and orthopedic disorders, including osteoporosis in the multivariate analysis, whereas history of falls and polypharmacy were determined as associated factors with sarcopenia among community-dwelling older adults.

DOI： 10.57304/jptp.1.0_19

Taniguchi Yoshiaki, Nakai Yuki, Tomioka Kazutoshi, Kubozono Takuro, Takenaka Toshihiro, Ohishi Mitsuru, Makizako Hyuma . Relationship between bone mass and the frequency of stair usage in community-dwelling older adults . Japanese Journal of Community-based Comprehensive Physical Therapy1 ( 0 ) 18 - 23 2022.3

Language：Japanese Publisher：Japanese Society of Community-based Comprehensive Physical Therapy

Objective: The purpose of this study was to determine the relationship between the measured mass of the calcaneus bone and the number of stairs used by community-dwelling older adults. Methods: Data obtained from 169 older adults who participated in a community-based health-check survey (Tarumizu Study 2018) were analyzed. Bone mass was measured using the speed of sound of the calcaneal bone and the obtained values were considered to be low when the percentage of the %YAM of the SOS was ≤ 70%. The frequency of stair usage was classified into two groups: 0 and 1 or more times per day at home, and three sub-groups comprising of: 0–2, 3–7, and 8 or more times per week outside home. Results: The results of logistic regression analysis, in which the dependent variable was the presence or absence of bone loss, and the independent variable was the number of stairs used, showed no significant association with the number of stairs used at home. The number of times the stairs were used outside home was set at 0–2 times as a reference, and bone loss was significantly reduced by 8 times or more (odds ratio 0.32, 95% confidence interval 0.11 –0.97, p = 0.045, covariates: age, gender, ASMI, grip strength, walking speed). Conclusion: It was suggested that the frequent use of stairs outside the home may aid in suppressing bone loss. It could be concluded that the use of stairs in activities including going out may affect bone mass as the frequency of stair usage in the house is not relevant.

DOI： 10.57351/jjccpt.1.0_18

Shoma Akaida, Yuki Nakai, Daijo Shiratsuchi, Kazutoshi Tomioka, Yoshiaki Taniguchi, Nana Sato, Ayumi Wada, Yuto Kiuchi, Saki Shono, Ryuhei Shiiba, Mana Tateishi, Hyuma Makizako . Association of self-rated health with type and frequency of social interaction during the declaration of COVID-19 state of emergency among Japanese community-dwelling oldest-old adults . GERIATRICS & GERONTOLOGY INTERNATIONAL22 ( 5 ) 405 - 411 2022.3

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

Aim To investigate whether the type and frequency of social interaction during the state of emergency due to coronavirus disease were associated with self-rated health (SRH) after the state of emergency. Methods Data from a cross-sectional study were collected for 889 oldest-old adults in Bibai City, Hokkaido, Japan. In total, 612 participants (mean age: 83.0 +/- 4.3 years; women: 51.8%) were included in the analysis, taking biological sex into account. The self-reported questionnaire included questions about demographic variables, SRH (July 2020, after the emergency), and the type and frequency of social interaction (March 2020, during the state of emergency). Results There was no significant association between social interaction and SRH in men (P > 0.05). Women who had social interactions (both face-to-face and non-face-to-face) more than once a week during the state of emergency reported higher SRH after the emergency than those who did not (odds ratio 2.17, 95% confidence interval 1.07-4.41). Conclusions Having both types of interaction more than once a week during the state of emergency was related to higher SRH after the emergency among oldest-old women. It is suggested that having opportunities for both types of interaction at least once a week would potentially be beneficial for high SRH in women, even in situations where the declaration of a state of emergency restricts face-to-face interaction. Geriatr Gerontol Int 2022; center dot center dot: center dot center dot-center dot center dot.

DOI： 10.1111/ggi.14379

Michio Maruta, Hyuma Makizako, Yuriko Ikeda, Gwanghee Han, Suguru Shimokihara, Hironori Miyata, Atsushi Nakamura, Keiichiro Tokuda, Takuro Kubozono, Mitsuru Ohishi, Kounosuke Tomori, Shoma Akaida, Takayuki Tabira . Characteristics of meaningful activities in community-dwelling Japanese older adults with pre-frailty and frailty . Archives of Gerontology and Geriatrics99 104616 - 104616 2022.3Reviewed International journal

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

OBJECTIVES: This cross-sectional study aimed to clarify the association between physical and social frailty, cognitive impairment, and meaningful activity in older adults. METHODS: Data were obtained from 747 older adults (mean age, 74.7 ± 6.2 years; women, 63.9%) who participated in a community-based health check survey (Tarumizu Study 2018). Physical frailty, cognitive impairment, and social frailty were evaluated using the Fried phenotype model (exhibiting one or more of the criteria, including having a pre-frailty status); computerized cognitive test including memory, attention, executive functions, and processing speed (having a score below an age-education adjusted reference threshold in one or more domains); and Makizako's 5 items (exhibiting one or more of the criteria, including having a pre-frailty status), respectively. Participants selected meaningful activities from the 95 activities included in the Aid for Decision-Making in Occupation Choice, after which their satisfaction and performance were evaluated. Meaningful activities were categorized into physical activity, cognitive activity, social activity, and other daily activity. RESULTS: The physical frailty group was significantly less likely to choose physical activity over other activities (p < 0.05). The cognitive impairment group was significantly less likely to choose cognitive activity over other activities (p < 0.01). The multi-domain frailty group (including cognitive impairment) was significantly less likely to choose social activity over other activities (p < 0.05). No significant differences in satisfaction and performance were observed according to frailty status. CONCLUSIONS: Our findings indicated that physical and social frailty and cognitive impairment may affect participation in meaningful activities corresponding to these domains.

DOI： 10.1016/j.archger.2021.104616

MAKIZAKO Hyuma, AKAIDA Shoma, TATEISHI Mana, MATSUNO Takaya, SUZUKI Shingo, HIRATSUKA Tatsuya, TAKENAKA Toshihiro, KUBOZONO Takuro, OHISHI Mitsuru . Modifiable factors related to mild cognitive impairment in community-dwelling older adults: A cross-sectional study using a propensity score-matched analysis . Japanese Journal of Geriatric Therapy1 ( 0 ) 1 - 7 2022.3

Language：Japanese Publisher：The Japan Geriatric Therapy Society

【Aim】 This study aimed to determine the modifiable risk factors related to mild cognitive impairment (MCI) and associations between combinations of those factors and MCI in community-dwelling older adults.【Methods】 This cross-sectional study included a total of 578 community-dwelling older adults (aged ≥ 65 years) who had undergone health checkups and were divided into MCI (n = 289) and non-MCI (n = 289) groups. Non-MCI participants were selected through propensity score matching to balance age and gender. The modifiable factors related with MCI were determined and categorized based on those combinations using a decision tree analysis.【Results】 Weakness (grip strength < 28 kg for men, < 18 kg for women), poor sleep quality, and social inactivity (non-participate in regional events) were determined as and categorized based on combinations of those factors. The lowest prevalence rate of MCI was in the non-weakness and non-poor sleep quality group (37.7%) and the highest was in the weakness and social inactivity group (82.0%).【Conclusions】 The combinational status that maintained muscle strength and better sleep quality could be associated with a lower risk of cognitive deficits. However, older adults with weakness and social inactivity would have a greater risk of MCI. Maintenance of muscle strength, sleep quality, and social activity may be helpful in preventing cognitive decline among community-dwelling older adults. When any of those factors decline, the other factors should be maintained for cognitive health.

DOI： 10.57270/jgts.2022_006

Takuro Kubozono, Yuichi Akasaki, Shin Kawasoe, Satoko Ojima, Takeko Kawabata, Hyuma Makizako, So Kuwahata, Toshihiro Takenaka, Mayuka Maeda, Seisuke Fujiwara, Ken Miyagawa, Yoshiyuki Ikeda, Mitsuru Ohishi . The relationship between day-to-day variability in home blood pressure measurement and multiple organ function. . Hypertension research : official journal of the Japanese Society of Hypertension45 ( 3 ) 474 - 482 2022.3International journal

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

Blood pressure variability (BPV) is associated with the prognosis of cardiovascular diseases. However, it is unclear how BPV is related to various organs. The aim of this study is to investigate the association between BPV and multiple organ functions. A total of three hundred fifteen participants (114 males; mean age: 70 ± 9 years) participated in a community health checkup held in Tarumizu City. Home blood pressure (BP) was measured using a HEM-9700T (OMRON Healthcare, Kyoto, Japan). Day-to-day BPV was evaluated by the coefficient of variation (CV) of home BP measured in the morning for one month. N-terminal pro B-type natriuretic peptide (NT-pro BNP) and high-sensitivity (hs-)troponin T were measured as cardiac biomarkers. Liver stiffness and renal function were evaluated using the Fibrous-4 (Fib4) index and estimated glomerular filtration rate (eGFR), respectively. NT-pro BNP and hs-troponin T were divided by the median value. Fib4 index greater than 2.67 and eGFR less than 60 mL/min/1.73 m2 were defined as high Fib4 index and low eGFR, respectively. In a multivariable logistic regression analysis, the CV of systolic BP was significantly associated with high NT-pro BNP, high Fib 4 index, and low eGFR, but not with high hs-troponin T. In contrast, the CV of diastolic BP was not associated with low eGFR, and the other three biomarkers had the same results as systolic BP. In conclusion, day-to-day BPV of systolic BP is independently associated with NT-pro BNP, eGFR, and Fib4 index, but not with hs-troponin T. In contrast, diastolic BPV was not found to be associated with eGFR.

DOI： 10.1038/s41440-021-00818-8

牧迫飛雄馬, 白土大成, 椎葉竜平, 谷口善昭, 窪薗琢郎, 大石充 . 地域在住高齢者における運動器疾患、転倒歴および多剤併用とサルコペニアとの関連 . 日本予防理学療法学会雑誌1 19 - 24 2022.3

Language：Japanese Publisher：(一社)日本予防理学療法学会

【目的】地域在住高齢者における運動器疾患,転倒歴および多剤併用とサルコペニアとの関連性を調べることを目的とした。【方法】地域コホート研究に参加した高齢者905名を対象とし,運動器疾患の有無,1日の服薬数,過去1年間での転倒歴を聴取した。サルコペニアはAWGS2019の基準で判定した。【結果】全対象者のうちの166名(18.3%)がサルコペニアに該当した。骨粗鬆症を有する者ではサルコペニアの該当者が有意に多かったが,脊椎疾患および変形性関節症とサルコペニアとの関連は認められなかった。ロジスティック回帰分析の結果,運動器疾患とサルコペニアの関連は確認されず,多剤併用(6剤以上)(オッズ比1.56)および転倒歴(オッズ比1.65)がサルコペニアと有意に関連していた。【結論】骨粗鬆症を有する高齢者ではサルコペニアに該当する者の割合が高かったものの,多変量解析においてはサルコペニアと運動器疾患との関連性は認められず,多剤併用および転倒歴がサルコペニアと関連する要因として抽出された。(著者抄録)

谷口善昭, 中井雄貴, 富岡一俊, 窪園琢郎, 竹中俊宏, 大石充, 牧迫飛雄馬 . 地域在住高齢者における骨量低下と階段使用頻度との関連性 . 地域理学療法学1 18 - 23 2022.3

Language：Japanese Publisher：(一社)日本地域理学療法学会

【目的】本研究は,地域在住高齢者における踵骨の骨量と階段使用頻度との関連性を調べることを目的とした.【方法】地域コホート研究(垂水研究2018)に参加した高齢者169名を横断的に分析した.骨量は%YAMが70%以下を骨量低下とした.階段使用頻度について,自宅内階段は1日0回と1回以上の2群,自宅外階段は週0〜2回・3〜7回・8回以上の3群に分類した.【結果】従属変数を骨量低下の有無,独立変数を階段使用頻度としたロジスティック回帰分析の結果,自宅内の階段使用頻度に有意な関連は認められなかったものの,自宅外の階段使用頻度0〜2回を参照とし,8回以上では有意に骨量低下が減少した(オッズ比0.32,95%信頼区間0.11-0.97,p=0.045,共変量:年齢,性別,ASMI,握力,歩行速度).【結論】自宅外での階段の使用頻度が多いと骨量低下の抑制に有用となり得る可能性が示唆された.自宅内の階段使用頻度は関連しておらず,外出を含めた階段の使用が骨量に影響を与えている可能性がある.(著者抄録)

Kubozono Takuro, Akasaki Yuichi, Kawasoe Shin, Ojima Satoko, Kawabata Takeko, Makizako Hyuma, Kuwahata So, Takenaka Toshihiro, Maeda Mayuka, Fujiwara Seisuke, Miyagawa Ken, Ikeda Yoshiyuki, Ohishi Mitsuru . 家庭血圧測定の日間変動と複数臓器の機能との関係(The relationship between day-to-day variability in home blood pressure measurement and multiple organ function) . Hypertension Research45 ( 3 ) 474 - 482 2022.3

Language：English Publisher：Nature Publishing Group

鹿児島県の地域健診受診者315名(女性201名、平均70±9歳)を対象に、血圧変動と臓器機能の関連について検討した。1ヵ月間(連日、起床後1時間以内)の家庭血圧値の変動係数(CV)四分位群間で心機能(脳性ナトリウム利尿ペプチド前駆体N端フラグメント(NT-proBNP)と高感度トロポニンT)、肝機能(Fib4 index)、腎機能(推算糸球体濾過量;eGFR)を比較した。多変量ロジスティック回帰分析の結果、収縮期血圧CV高位群ほどeGFR低値(<60mL/min/1.73m2)、Fib4 index高値(>2.67)、NT-proBNP高値(>70pg/mL[中央値])のオッズ比が高かった。高感度トロポニンT高値(>0.007ng/mL[中央値])との関連は全群で認められなかった。拡張期血圧CV高位群はNT-proBNP高値のオッズ比が高く、最高四分位群はFib4 index高値のオッズ比も高かったが、eGFR低値および高感度トロポニンT高値との関連はみられなかった。以上から、家庭血圧の日間変動は心臓、肝臓、腎臓のバイオマーカーと独立して関連していることが示された。

牧迫飛雄馬, 赤井田将真, 立石麻奈, 松野孝也, 鈴木真吾, 平塚達也, 竹中俊宏, 窪薗琢郎, 大石充 . 地域在住高齢者の軽度認知障害と関連する可変因子　傾向スコア・マッチング法を用いた横断研究 . 日本老年療法学会誌1 1 - 7 2022.3

Language：Japanese Publisher：(一社)日本老年療法学会

地域在住高齢者の軽度認知障害(Mild Cognitive Impairment:MCI)に関連する可変因子を探索し、それらの組み合わせによるMCIとの関連を傾向スコア・マッチング法を用いて検討することを目的に、地域コホート研究の参加者で年齢と性別でマッチングされた65歳以上の高齢者578名(MCI群289名[平均年齢76.4±6.4歳]、非MCI群289名[平均年齢75.9±6.5歳])を対象に、身体機能評価(握力、通常歩行速度)および質問紙による生活状況の調査を行った。決定木分析の結果、握力低下(男性28kg未満、女性18kg未満)、睡眠の質の低下、社会参加(地域の祭りや行事などへの参加)の有無の組み合わせによりグループが形成され、MCIの割合は握力低下なし+睡眠の質の低下なし群(グループI)で最も低く(37.7%)、握力低下あり+地域行事の参加なしの群(グループIV)で最も高かった(82.0%)。

Language：Japanese Publisher：(一社)日本地域理学療法学会

牧迫飛雄馬, 白土大成, 白土大成, 椎葉竜平, 椎葉竜平, 谷口善昭, 谷口善昭, 窪薗琢郎, 大石充 . Correlation of sarcopenia with orthopedic disorders, history of falls, and polypharmacy among community-dwelling older adults . 日本予防理学療法学会雑誌(Web)1 19 - 24 2022.3

Yu Kume, Ayuto Kodama, Tomoko Takahashi, Sangyoon Lee, Hyuma Makizako, Tsuyosi Ono, Hiroyuki Shimada, Hidetaka Ota . Social frailty is independently associated with geriatric depression among older adults living in northern Japan: A cross-sectional study of ORANGE registry. . Geriatrics & gerontology international22 ( 2 ) 145 - 151 2022.2

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

AIM: To clarify prevalence of social frailty among older adults living in a rural Japanese community, and factors associated with social frailty status. METHODS: In total, 322 adults aged ≥65 years living in a Japanese rural community took part in the study from 2018 to 2020. Social frailty was defined as deficiencies of: (i) living alone; (ii) talking with someone every day; (iii) feeling helpful to friends or family; (iv) going out less frequently compared with last year; and (v) visiting friends sometimes. Social frail status was categorized as robust (0), social prefrail (1), and social frail (≥2), according to the summated score of Makizako's criteria. Multiple logistic regression analysis was applied to clarify factors associated with social frailty status. RESULTS: Final samples were classified into 68 persons with social frailty, 98 persons with social prefrailty and 147 persons as robust. We observed the prevalence of social frailty (21.7%) and social prefrailty (31.3%) and the GDS-15 had significantly high scores in the social frail groups. Social frailty was significantly associated with the GDS-15 score (odds ratio, 1.33; 95% CI, 1.19-1.49) and TMT-A (odds ratio, 1.04; 95% CI, 1.01-1.08) and GDS-15 (odds ratio, 1.13; 95% CI, 1.03-1.26) were extracted as independent variables of social prefrail status, with adjustment for demographics, polypharmacy and lifestyle-related diseases. CONCLUSIONS: Our results suggest that social frailty tends to be increasing gradually in a Japanese rural area, and social prefrailty might be potentially associated with attentional function, as well as the GDS-15 score. Geriatr Gerontol Int 2022; 22: 145-151.

DOI： 10.1111/ggi.14330

Kume Yu, Kodama Ayuto, Takahashi Tomoko, Lee Sangyoon, Makizako Hyuma, Ono Tsuyosi, Shimada Hiroyuki, Ota Hidetaka . Social frailty is independently associated with geriatric depression among older adults living in northern Japan: A cross-sectional study of ORANGE registry(和訳中) . Geriatrics & Gerontology International22 ( 2 ) 145 - 151 2022.2

Language：English Publisher：John Wiley & Sons Australia, Ltd

2018～2020年に秋田県在住の65歳以上高齢者313名を対象とした横断研究(ORANGE研究)を実施し、社会的フレイルの割合および社会的フレイル状態に関連する因子について検討した。社会的フレイルの評価には牧迫の社会的フレイル基準(独居、毎日誰かと話す、友人や家族の役に立っていると感じる、昨年と比べて外出の頻度が減った、時々友人宅を訪問する)を使用した。参加者を健常群147名(0点;平均74.6±5.7歳、女性64.6%)、社会的プレフレイル98名(1点;平均75.7±5.9歳、女性71.4%)、社会的フレイル68名(2～5点;平均74.8±5.9歳、女性70.6%)に分けて検討した。評価項目は人口統計学的特徴、各種認知機能検査(word list memory、TMT-A、TMT-B、Symbol Digit Substitution Task)、GDS-15などとした。人口統計学特徴、ポリファーマシー、生活習慣病を調整後の多変量ロジスティック回帰分析の結果、社会的フレイルではGDS-15スコア、社会的プレフレイルではTMT-AおよびGDS-15が予測因子であることが示された(オッズ比1.33、1.04、1.13)。以上から、社会的プレフレイルは、GDS-15スコアのみならず、注意機能と関連する可能性があることを示唆された。

牧迫飛雄馬 . 【地域包括ケアにおけるリーダーシップ】疫学的分析に基づく地域包括ケア . 老年科5 ( 2 ) 95 - 100 2022.2

Ayuto Kodama, Yu Kume, Sangyoon Lee, Hyuma Makizako, Hiroyuki Shimada, Tomoko Takahashi, Tsuyoshi Ono, Hidetaka Ota . Impact of COVID-19 Pandemic Exacerbation of Depressive Symptoms for Social Frailty from the ORANGE Registry . International Journal of Environmental Research and Public Health19 ( 2 ) 2022.1International journal

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

Background: Recent longitudinal studies have reported proportion of frailty transition in older individuals during the COVID-19 pandemic. Our study aimed at clarifying the impact of social frailty in community-dwelling older adults during the COVID-19 pandemic and at identifying factors that can predict transition to social frailty. Methods: We performed this study from 2019 (before declaration of the state of emergency over the rising number of COVID-19 cases) to 2020 (after declaration of the emergency). We applied Makizako’s social frail index to our study subjects at the baseline and classified into robust, social prefrailty, and social frailty groups. Multiple logistic regression analysis was performed using robust, social prefrailty, or social frailty status as dependent variable. Results: Analysis by the Kruskal–Wallis test revealed significant differences in the score on the GDS-15 among the robust, social prefrailty, and social frailty groups (p < 0.05). Furthermore, multiple regression analysis identified a significant association between the social frailty status and the score on GDS-15 (odds ratio, 1.57; 95% confidence interval (95% CI), 1.15–2.13; p = 0.001). Conclusion: The increase in the rate of transition of elderly individuals to the social frailty group could have been related to the implementation of the stay-at-home order as part of the countermeasures for COVID-19. Furthermore, the increased prevalence of depressive symptoms associated with the stay-at-home order could also have influenced the increase in the prevalence of social frailty during the COVID-19 pandemic.

DOI： 10.3390/ijerph19020986

Mika Kimura, Ai Moriyasu, Hyuma Makizako . Positive Association between High Protein Food Intake Frequency and Physical Performance and Higher-Level Functional Capacity in Daily Life. . Nutrients14 ( 1 ) 2022.1International journal

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

Nutritional factors, including low protein intake and poor dietary variety, affect age-associated impairment in physical performance resulting in physical frailty. This cross-sectional study investigated the association between intake frequency of major high protein foods and both physical performance and higher-level functional capacity using the food frequency score (FFS) and high protein food frequency score (PFFS) among community-dwelling older adults. The data of 1185 older adults categorized into quartiles based on FFS and PFFS were analyzed. After adjusting for covariates, FFS and PFFS were significantly associated with physical performance [FFS, usual gait speed (p for trend = 0.007); PFFS, usual gait speed (p for trend < 0.001), maximum gait speed (p for trend = 0.002), timed up and go (p for trend = 0.025)], and higher-level functional capacity [FFS (p for trend < 0.001); PFFS (p for trend < 0.001)]. After excluding PFFS data, the participants' scores were associated with only higher-level functional capacity. Multi-regression analysis with higher-level functional capacity as the covariate showed that FFS and PFFS were significantly correlated with physical performance. Hence, improving food intake frequency, particularly that of high protein foods, and dietary variety may help maintain higher-level functional capacity and physical performance in community-dwelling older adults.

DOI： 10.3390/nu14010072

生野佐紀, 赤井田将真, 椎葉竜平, 白土大成, 谷口善昭, 木内悠人, 立石麻奈, 中井雄貴, 牧迫飛雄馬 . COVID-19の流行に伴う緊急事態宣言中の生活習慣の変化と主観的幸福感との関係 . Journal of Epidemiology32 ( Suppl.1 ) 114 - 114 2022.1

Yuki Nakai, Hyuma Makizako, Daijo Shiratsuchi, Yoshiaki Taniguchi, Shoma Akaida, Mana Tateishi, Tomomi Akanuma, Kaori Yokoyama . Association of Sleep Quality Status With Worsening Low Back or Knee Pain During The COVID-19 State of Emergency Among Old-Old Adults. . Pain management nursing : official journal of the American Society of Pain Management Nurses23 ( 4 ) 473 - 477 2022International journal

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

BACKGROUND: Poor sleep quality has a negative effect on pain among older adults. During the coronavirus disease 2019 (COVID-19) state of emergency, lifestyle changes can cause psychologic stressors and lead to poor sleep quality. AIM: This study examined whether sleep quality status was associated with low back or knee pain changes during the COVID-19 state of emergency among community-dwelling Japanese old-old adults. DESIGN: Cross-sectional investigation. METHODS: In July 2020, during the COVID-19 epidemic, we conducted a postal survey for old-old adults aged ≥77 years and collected data on 597 participants. For those who had low back or knee pain at the time of the survey (in July), characteristics such as low back pain, knee pain, changes in pain status, and sleep quality status during the COVID-19 state of emergency (in March) were assessed. RESULTS: Data from 597 participants showed the prevalence of low back pain (50.6%) and knee pain (40.7%) in July. Of those with low back or knee pain, 374 had pain changes during the state of emergency, with 12.3% worsening. Of these, 23.9% had poor sleep quality in March compared to non-change (p = .008). In a multivariate logistic regression model adjusted for potential confounders, poor sleep quality was significantly associated with pain worsening (odds ratio 2.80, 95% confidence interval 1.26-6.22). CONCLUSIONS: During the COVID-19 state of emergency, poor sleep quality was associated with worsening low back or knee pain. This may indicate the need to pay attention to poor sleep quality to prevent the exacerbation of pain among old-old adults.

DOI： 10.1016/j.pmn.2022.01.001

TANIGUCHI Yoshiaki, MAKIZAKO Hyuma, NAKAI Yuki, TOMIOKA Kazutoshi, KUBOZONO Takuro, TAKENAKA Toshihiro, OHISHI Mitsuru . Associations between Low Bone Mass, Low Muscle Mass, and Physical Activity in Community-dwelling Older Adults . Physical Therapy Japan49 ( 2 ) 131 - 138 2022Reviewed

Language：Japanese Publisher：Japanese Society of Physical Therapy

Objective: The purpose of this study was to examine the relationship between low bone mass, low muscle mass, and physical activity in community-dwelling older adults.Methods: Data obtained from 173 older adults who participated in a community-based health-check survey (Tarumizu Study 2018) were analyzed. Bone mass was measured using the speed of sound (SOS) of the calcaneal bone and was considered low when the percentage of the %YAM of the SOS was ≤70%. Muscle mass was assessed based on the criteria for sarcopenia by the AWGS. Physical activity was measured using an accelerometer to determine whether there was an increase in sedentary activity time, a decrease in MVPA time, and a decrease in step count Classified. The groups were classified into healthy (normal bone and muscle masses), low bone mass (only bone mass decreased), low muscle mass (only muscle mass decreased), and low bone/muscle mass groups (both bone and muscle masses decreased).Results: As a result of logistic regression analysis, MVPA time was significantly decreased in the bone loss and muscle loss groups compared with the normal group (odds ratio, 3.29; p<0.05; covariates: age [5 years], sex, depression tendency, and decreased walking speed).Conclusion: This study indicated that MVPA levels were lower in the older adults who had lower bone and muscle masses.

DOI： 10.15063/rigaku.12150

Other Link： https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-19H03978/

Masumitsu Tomomi, Kubozono Takuro, Miyata Masaaki, Makizako Hyuma, Tabira Takayuki, Takenaka Toshihiro, Kawasoe Shin, Tokushige Akihiro, Niwa Sayoko, Ohishi Mitsuru . Association of Sleep Duration and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults . Journal of Atherosclerosis and Thrombosisadvpub ( 0 ) 1864 - 1871 2022

Language：English Publishing type：Research paper (scientific journal) Publisher：Japan Atherosclerosis Society

Aim: This study aims to investigate the association of the Cardio-Ankle Vascular Index (CAVI) with self-reported sleep duration and sleep quality in community-dwelling older adults aged ≥ 65 years. Methods: The Tarumizu Study was a cohort of community-based health checkups conducted in the Tarumizu City, Japan, in 2018 and 2019. In total, 997 participants aged ≥ 65 years (median age, 74 years) were examined. We obtained the average sleep duration and sleep quality using self-reported questionnaires and classified them into three separate groups according to sleep duration (＜6 h, 6–8 h, and ≥ 8 h) and sleep quality (good, medium, and poor). The arterial stiffness was measured using the CAVI. Results: As per our findings, the CAVI was significantly higher in the ≥ 8 h sleep group (CAVI=9.6±1.3) than in the ＜6 h (CAVI=9.1±1.1) or 6–8 h (CAVI=9.1±1.2) groups (p＜0.001). After adjustment for age, sex, systolic blood pressure, current smoking status, body mass index, frequency of exercise, educational background, frailty, sleep medication, sleep quality, and nap duration, multivariable regression analysis demonstrated that the CAVI was significantly higher in the ≥ 8 h group than in the 6–8 h group (p=0.016). In contrast, multivariable regression analysis showed that there was no significant association between sleep quality and CAVI. Conclusions: A significant association was noted between long sleep duration (≥ 8 h) and elevated CAVI in community-dwelling older adults aged ≥ 65 years. We, therefore, suggest that long sleep duration, not sleep quality, is correlated with arterial stiffness in older adults.

DOI： 10.5551/jat.63594

Daijo Shiratsuchi, Hyuma Makizako, Yuki Nakai, Seongryu Bae, Sangyoon Lee, Hunkyung Kim, Yuriko Matsuzaki-Kihara, Ichiro Miyano, Hidetaka Ota, Hiroyuki Shimada . Associations of fall history and fear of falling with multidimensional cognitive function in independent community-dwelling older adults: findings from ORANGE study. . Aging clinical and experimental research34 ( 12 ) 2985 - 2992 2022International journal

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

BACKGROUND: Falls and fear of falling (FoF) inhibit healthy longevity and have been suggested to be associated with cognitive function. However, the domains of cognitive function that are associated with them remain controversial. It is speculated that clarifying this will help in the assessment of health status and interventions in the community. AIM: To analyse the associations between fall history and FoF and multidimensional cognitive function in independent community-dwelling older adults. METHODS: The data from 9759 (73.3 ± 5.4 years, 59.9% women) older individuals enrolled in the cross-sectional ORANGE study were analysed. Simple questions were used to assess fall history in the past year and current FoF. Assessments of multidimensional cognitive function were performed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) to evaluate memory, attention, executive function, and processing speed. The independent associations of fall history and FoF with multidimensional cognitive function were assessed using multivariate linear regressions adjusted for potential confounding variables. RESULTS: A total of 18.3% and 35.4% of participants presented with fall history and FoF, respectively. Fall history (p = 0.008) and FoF (p = 0.002) were significantly associated with memory. FoF, but not fall history was associated with attention (p = 0.004), executive function (p < 0.01), and processing speed (p < 0.01). CONCLUSION: In independent community-dwelling older adults, fall history was associated only with the memory domain; in contrast, fear of falling was associated with multidimensional cognitive function. This study provides weak evidence suggesting the need to assess falls and FoF in all situations involving independent community-dwelling older adults.

DOI： 10.1007/s40520-022-02235-4

Keitaro Nishi, Hiroaki Kanouchi, Akihiko Tanaka, Maya Nakamura, Tomofumi Hamada, Yumiko Mishima, Yuichi Goto, Kenichi Kume, Mahiro Beppu, Hiroshi Hijioka, Hiroaki Tabata, Kazuki Mori, Yoshinori Uchino, Kouta Yamashiro, Yoshiaki Matsumura, Yutaro Higashi, Hyuma Makizako, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi, Tsuyoshi Sugiura . Relationship between Oral Hypofunction, and Protein Intake: A Cross-Sectional Study in Local Community-Dwelling Adults. . Nutrients13 ( 12 ) 2021.12International journal

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

Few studies have investigated the relationship between nutritional status and comprehensive assessment of oral hypofunction, especially protein intake-related sarcopenia. Thus, we explored these relationships in a large-scale cross-sectional cohort study using the seven-item evaluation for oral hypofunction and Diet History Questionnaire for nutritional assessment. We used the data from 1004 individuals who participated in the 2019 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan for analysis. We found that individuals with oral hypofunction were significantly older with a lower skeletal muscle index. Although there were few foods that had a significant difference between the groups with and without oral hypofunction, the consumption of beans and meats was significantly lower in women and men in the oral hypofunction group, respectively. According to the lower limit of the tentative dietary goal defined in Japan, comprehensive evaluation of oral hypofunction was significantly and independently associated with protein intake in both men and women (odds ratio, 1.70; 95% confidence interval, 1.21-2.35). In conclusion, we found that oral hypofunction was associated with targeted protein intake for sarcopenia and frailty prevention in middle-aged and older community-dwelling adults. Comprehensive evaluation of oral function with intervention in cases of hypofunction could inform clinicians to better prevent sarcopenia.

DOI： 10.3390/nu13124377

Atsushi Nakamura, Michio Maruta, Hyuma Makizako, Masaaki Miyata, Hironori Miyata, Gwanghee Han, Yuriko Ikeda, Suguru Shimokihara, Keiichiro Tokuda, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Meaningful Activities and Psychosomatic Functions in Japanese Older Adults after Driving Cessation. . International journal of environmental research and public health18 ( 24 ) 2021.12Reviewed International journal

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

The purpose of this cross-sectional study was to analyse the differences in meaningful activities and psychosomatic function depending on the driving status of community-dwelling older adults. Data from 594 older adults were obtained, including activities meaningful to individuals and psychosomatic functions, such as grip strength, depression, cognitive function, and ability of activity. Participants were divided into active driving (n = 549) and after driving cessation (n = 45) groups. In addition, the active driving group was operationally divided into three groups: high-frequency group (n = 387), medium group (n = 119), and infrequent group (n = 42). In the after driving cessation group, grip strength, and Japan Science and Technology Agency Index of Competence scores were significantly lower. Furthermore, the proportion of apathy and physical and social frailty was significantly higher in the after driving cessation group. Regarding meaningful activity, domestic life scores in the after driving cessation group were significantly higher than those of the active driving group. Decreased driving frequency in the active driving group was associated with weak muscle strength, lack of interest, and low activity. This study demonstrated that meaningful activity differed based on the driving status. Hence, we should support the activities of older adults who are considering driving cessation.

DOI： 10.3390/ijerph182413270

Ayumi Wada, Hyuma Makizako, Yuki Nakai, Kazutoshi Tomioka, Yoshiaki Taniguchi, Nana Sato, Yuto Kiuchi, Ryoji Kiyama, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi . Association between cognitive frailty and higher-level competence among community-dwelling older adults. . Archives of gerontology and geriatrics99 104589 - 104589 2021.11International journal

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

OBJECTIVES: The purpose of this cross-sectional study was to examine the association between cognitive frailty (CF) and higher-level competence among community-dwelling older adults. METHODS: Data from 871 older adults (aged ≥ 65 years, mean age 74.3 years, 61.5% women) who had participated in a community-based health check survey (Tarumizu Study 2018-2019) were analyzed. CF was defined as comorbid physical frailty and mild cognitive impairment (MCI). We defined physical frailty as either slow walking speed or poor grip strength. MCI was defined as values below the age- and education-adjusted reference threshold in several tests. Participants were categorized into four groups: robust, physical frailty, MCI, and CF. Higher-level competence was assessed using the Japan Science and Technology Agency Index of Competence (JST-IC). The JST-IC consists of 16 items and four subscales (technology usage, information practice, life management and social engagement). The bottom 20-30% score of the JST-IC and each subscale corresponded to poor higher-level competence. RESULTS: The prevalence of CF was 14.4%. Multivariate logistic regression analysis showed that, CF was significantly associated with poor higher-level competence (odds ratio 1.92, 95% confidence interval 1.18-3.13) after adjusting for covariates. Using a similar analysis to assess the JST-IC subscales, CF was associated with limitations on technology usage (odds ratio 2.29, 95% confidence interval 1.36-3.85) and low social engagement (odds ratio 1.62, 95% confidence interval 1.00-2.61). CONCLUSIONS: This study suggests that CF is associated with poor higher-level competence, especially limitations on technology usage and low social engagement.

DOI： 10.1016/j.archger.2021.104589

Takasuke Miyazaki, Ryoji Kiyama, Yuki Nakai, Masayuki Kawada, Yasufumi Takeshita, Sota Araki, Hiroyuki Hayashi, Naoto Higashi, Hyuma Makizako . The Relationship between Leg Extension Angle at Late Stance and Knee Flexion Angle at Swing Phase during Gait in Community-Dwelling Older Adults. . International journal of environmental research and public health18 ( 22 ) 2021.11International journal

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

This study aimed to clarify the relationship between leg extension angle and knee flexion angle during gait in older adults. The subjects of this cross-sectional study were 588 community-dwelling older adults (74.6 ± 6.1 y). Segment angles and acceleration were measured using five inertial measurement units during comfortable gait, and bilateral knee and hip joint angles, and leg extension angle, reflecting whole lower limb extension at late stance, were calculated. Propulsion force was estimated using the increase in velocity calculated from anterior acceleration of the sacrum during late stance. Correlation analysis showed that leg extension angle was associated with knee flexion angle at swing phase and hip extension angle and increase in velocity at late stance (r = 0.444-508, p < 0.001). Multiple regression analysis showed that knee flexion angle at mid-swing was more affected by leg extension angle (β = 0.296, p < 0.001) than by gait speed (β = 0.219, p < 0.001) and maximum hip extension angle (β = -0.150, p < 0.001). These findings indicate that leg extension angle may be a meaningful parameter for improving gait function in older adults due to the association with knee kinematics during swing as well as propulsion force at late stance.

DOI： 10.3390/ijerph182211925

Takasuke Miyazaki, Ryoji Kiyama, Yuki Nakai, Masayuki Kawada, Yasufumi Takeshita, Sota Araki, Hyuma Makizako . Relationships between Gait Regularity and Cognitive Function, including Cognitive Domains and Mild Cognitive Impairment, in Community-Dwelling Older People. . Healthcare (Basel, Switzerland)9 ( 11 ) 2021.11International journal

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

The aim of this cross-sectional study was to examine the correlations between gait regularity, cognitive functions including cognitive domains, and the mild cognitive impairment (MCI) in community-dwelling older people. This study included 463 older adults (63.4% women, mean age: 74.1), and their step and stride regularity along the three-axis components was estimated from trunk acceleration, which was measured by inertial measurement units during a comfortable gait. Four aspects of cognitive function were assessed using a tablet computer: attention, executive function, processing speed, and memory, and participants were classified into those with or without MCI. The vertical component of stride and step regularity was associated with attention and executive function (r = -0.176--0.109, p ≤ 0.019), and processing speed (r = 0.152, p < 0.001), after it was adjusted for age and gait speed. The low vertical component of step regularity was related to the MCI after it was adjusted for covariates (OR 0.019; p = 0.016). The results revealed that cognitive function could affect gait regularity, and the vertical component of gait regularity, as measured by a wearable sensor, could play an important role in investigating cognitive decline in older people.

DOI： 10.3390/healthcare9111571

白土大成, 椎葉竜平, 牧迫飛雄馬 . 【疾患別にみたサルコペニアに対する理学療法の考え方と実際】運動器疾患患者のサルコペニアに対する理学療法の考え方と実際 . 理学療法38 ( 11 ) 988 - 995 2021.11

Language：Japanese Publisher：(株)メディカルプレス

1.運動器疾患を有する患者ではサルコペニアの併存が懸念され、運動器疾患に起因もしくは併存する骨格筋量の減少および筋力の低下に対するアプローチを検討することが求められる。2.運動器疾患患者では、骨量減少を伴うオステオサルコペニアによる脆弱性骨折のリスク増大に対する対策を考慮する必要がある。3.高齢の運動器疾患患者の身体機能評価においては、疾患そのものに関する評価のみならずサルコペニアに関する評価を実施し、サルコペニアの予防・改善を含めた活動や社会参加のための包括的な介入方針を検討することが求められる。(著者抄録)

Tatsuya Hirase, Minoru Okita, Yuki Nakai, Shoma Akaida, Saki Shono, Hyuma Makizako . Pain and physical activity changes during the COVID-19 state of emergency among Japanese adults aged 40 years or older . Medicine100 ( 41 ) e27533 - e27533 2021.10Reviewed International journal

Language：English Publishing type：Research paper (scientific journal) Publisher：Ovid Technologies (Wolters Kluwer Health)

ABSTRACT: Understanding the relationship between pain and physical activity (PA) levels is beneficial for maintaining good health status. However, the impact of pain on changes in PA during the coronavirus disease 2019 (COVID-19) pandemic is unknown. The purpose of this study was to examine whether PA levels pre-, during, and post-COVID-19 state of emergency differ between Japanese adults who had pain after the COVID-19 state of emergency and those who did not.Data were collected from a cross-sectional online survey conducted between October 19 and 28, 2020. The analytic sample consisted of 1967 Japanese adults aged ≥40 years who completed the online survey. Participants completed questionnaires on the presence of pain and duration of PA, defined as the total PA time per week based on activity frequency and time. Participants were asked to report their PA at 3 time points: October 2019 (before the COVID-19 pandemic), April 2020 (during the COVID-19 state of emergency), and October 2020 (after the COVID-19 state of emergency).Among participants aged ≥60 years who reported pain in October 2020, the total PA time was significantly lower than participants who did not report having pain. Furthermore, the total PA time in April 2020 was significantly lower than that in October 2019; however, no significant difference in total PA time was observed between April and October 2020. Among participants aged 40 to 59 years, no significant differences were observed in total PA times at the 3 time points between those with and without pain. In addition, the total PA time in October 2020 significantly increased compared to that in April 2020, although it significantly decreased in April 2020 compared to October 2019.This study suggests that older adults with pain have lower PA levels after the COVID-19 state of emergency.

DOI： 10.1097/MD.0000000000027533

赤井田将真, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 立石麻奈, 田平隆行, 竹中俊宏, 窪薗琢郎, 大石充 . 地域在住高齢者における自動車事故歴と転倒歴との関連 . 日本老年医学会雑誌58 ( 4 ) 663 - 663 2021.10

立石麻奈, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 赤井田将真, 和田あゆみ, 佐藤菜々, 窪薗琢郎, 大石充 . 転倒歴を有さない地域在住高齢女性における転倒恐怖感と身体活動量との関連 . 日本老年医学会雑誌58 ( 4 ) 663 - 663 2021.10

牧迫飛雄馬, 窪薗琢郎, 大石充 . 【日本における高齢者コホート研究の成果と現状】垂水研究 . 老年内科4 ( 4 ) 405 - 409 2021.10

Kentaro Jujo, Nobuyuki Kagiyama, Kazuya Saito, Kentaro Kamiya, Hiroshi Saito, Yuki Ogasahara, Emi Maekawa, Masaaki Konishi, Takeshi Kitai, Kentaro Iwata, Hiroshi Wada, Takatoshi Kasai, Hirofumi Nagamatsu, Tetsuya Ozawa, Katsuya Izawa, Shuhei Yamamoto, Naoki Aizawa, Ryusuke Yonezawa, Kazuhiro Oka, Hyuma Makizako, Shin-Ichi Momomura, Yuya Matsue . Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE-HF Registry Subanalysis. . Journal of the American Heart Association10 ( 17 ) e019954 2021.9Reviewed International journal

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

Background Frailty is conceptualized as an accumulation of deficits in multiple areas and is strongly associated with the prognosis of heart failure (HF). However, the social domain of frailty is less well investigated. We prospectively evaluated the clinical characteristics and prognostic impact of social frailty (SF) in elderly patients with HF. Methods and Results FRAGILE-HF (prevalence and prognostic value of physical and social frailty in geriatric patients hospitalized for heart failure) is a multicenter, prospective cohort study focusing on patients hospitalized for HF and aged ≥65 years. We defined SF by Makizako's 5 items, which have been validated as associated with future disability. The primary end point was a composite of all-cause death and rehospitalization because of HF. The impact of SF on all-cause mortality alone was also evaluated. Among 1240 enrolled patients, 825 (66.5%) had SF. During the 1-year observation period after discharge, the rates of the combined end point and all-cause mortality were significantly higher in patients with SF than in those without SF (Log-rank test: both P < 0.05). SF remained as significantly associated with both the combined end point (hazard ratio, 1.30; 95% CI, 1.02-1.66; P = 0.038) and all-cause mortality (hazard ratio, 1.53; 95% CI, 1.01-2.30; P = 0.044), even after adjusting for key clinical risk factors. Furthermore, SF showed significant incremental prognostic value over known risk factors for both the combined end point (net-reclassification improvement: 0.189, 95% CI, 0.063-0.316, P = 0.003) and all-cause mortality (net-reclassification improvement: 0.234, 95% CI, 0.073-0.395, P = 0.004). Conclusions Among hospitalized geriatric patients with HF, two thirds have SF. Evaluating SF provides additive prognostic information in elderly patients with HF. Registration URL: https://upload.umin.ac.jp/. Unique identifier: UMIN000023929.

DOI： 10.1161/JAHA.120.019954

牧迫飛雄馬 . 書評 -太田　進,藤田玲美,大古拓史(著)-｢動画でわかる運動器理学療法臨床実習スキル｣ . 理学療法ジャーナル55 ( 7 ) 778 - 778 2021.7

牧迫飛雄馬, 赤井田将真 . 【認知症-最近の動向】認知機能低下に対する運動療法の効果 . カレントテラピー39 ( 7 ) 656 - 661 2021.7

Language：Japanese Publisher：(株)ライフメディコム

身体活動の不足は、認知症の発症や認知機能の低下に強く関連するため、身体活動を向上させて活動的なライフスタイルを確立することは、認知機能の低下を抑制するために重要な要因である。定期的な運動習慣を有する高齢者では、将来の認知症発症のリスクが軽減され、運動介入による認知機能低下の抑制に対する効果が期待される。特に、有酸素運動を中心とした身体活動の向上は、認知症の発症の予防や遅延に効果が期待されている。認知機能の維持・改善に対するより効果的な運動療法においては、運動による身体活動の促進のみではなく、知的な刺激が伴う活動を付加することが推奨される。高齢期における認知機能の低下を抑制するためには、一時的な運動療法にとどまらず、習慣化できるようにいかに支援するかも重要なポイントとなる。(著者抄録)

谷口善昭, 牧迫飛雄馬, 富岡一俊, 中井雄貴, 佐藤菜々, 和田あゆみ, 木山良二, 窪薗琢郎, 竹中俊宏, 大石充 . 地域在住高齢女性における骨粗鬆症と身体・認知・社会的フレイルとの関係 . 日本サルコペニア・フレイル学会誌5 ( 1 ) 96 - 103 2021.6

Language：Japanese Publisher：一般社団法人日本サルコペニア・フレイル学会

［目　的］ 地域在住高齢女性における骨粗鬆症と身体・認知・社会的フレイルとの関係を明らかにする。 ［方　法］ 地域での健康チェックに参加した高齢女性265名を分析対象とした。骨粗鬆症の有無，身体・認知・社会的フレイルを評価し，身体・社会的フレイルに関しては，プレフレイルとフレイルを合わせてプレフレイル以上とした。骨粗鬆症を従属変数とし，身体的プレフレイル以上，認知的フレイル，社会的プレフレイル以上を独立変数としたロジスティック回帰分析を行い，さらに前期・後期高齢女性に分けてオッズ比を算出した。 ［結　果］ 年齢，内服数，教育歴，BMI，関節リウマチの有無，呼吸器疾患の有無で傾向スコアを算出し，傾向スコアで調整したロジスティック回帰分析の結果，後期高齢女性において骨粗鬆症と社会的プレフレイル以上が関連していた（オッズ比3.14，95％ CI1.25-7.93，p＝0.02）。 ［結　論］ 地域在住後期高齢女性において，社会的フレイルは骨粗鬆症のリスクを高める可能性がある。

DOI： 10.69303/jjasf.5.1_96

Keitaro Makino, Sangyoon Lee, Seongryu Bae, Ippei Chiba, Kenji Harada, Osamu Katayama, Yohei Shinkai, Hyuma Makizako, Hiroyuki Shimada . Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study. . Physical therapy101 ( 6 ) 2021.6Reviewed International journal

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

OBJECTIVE: The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. METHODS: A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48 ± 2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to "Are you afraid of falling?") at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. RESULTS: Multivariable logistic regression showed that prefrailty or frailty increase the risk of not only future falls (odds ratio [OR]: 1.57; 95% CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95% CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95% CI = 1.04-1.68). CONCLUSIONS: Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. IMPACT: Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high risk not only for falls but also for FOF.

DOI： 10.1093/ptj/pzab059

西田裕紀子, 牧迫飛雄馬, 鄭丞媛, 大塚礼, 藤原佳典, 北村明彦, 鈴木宏幸, 渡辺修一郎, 近藤克則, 島田裕之, 鈴木隆雄 . 地域在住高齢者の認知機能の時代的推移長寿コホートの総合的研究(ILSA-J)より . 老年社会科学43 ( 2 ) 163 - 163 2021.6

谷口善昭, 牧迫飛雄馬, 富岡一俊, 中井雄貴, 佐藤菜々, 和田あゆみ, 木山良二, 窪薗琢郎, 竹中俊宏, 大石充 . 地域在住高齢女性における骨粗鬆症と身体・認知・社会的フレイルとの関係 . 日本サルコペニア・フレイル学会雑誌5 ( 1 ) 96 - 103 2021.6

Language：Japanese Publisher：(一社)日本サルコペニア・フレイル学会

[目的]地域在住高齢女性における骨粗鬆症と身体・認知・社会的フレイルとの関係を明らかにする。[方法]地域での健康チェックに参加した高齢女性265名を分析対象とした。骨粗鬆症の有無、身体・認知・社会的フレイルを評価し、身体・社会的フレイルに関しては、プレフレイルとフレイルを合わせてプレフレイル以上とした。骨粗鬆症を従属変数とし、身体的プレフレイル以上、認知的フレイル、社会的プレフレイル以上を独立変数としたロジスティック回帰分析を行い、さらに前期・後期高齢女性に分けてオッズ比を算出した。[結果]年齢、内服数、教育歴、BMI、関節リウマチの有無、呼吸器疾患の有無で傾向スコアを算出し、傾向スコアで調整したロジスティック回帰分析の結果、後期高齢女性において骨粗鬆症と社会的プレフレイル以上が関連していた(オッズ比3.14、95%CI1.25-7.93、p=0.02)。[結論]地域在住後期高齢女性において、社会的フレイルは骨粗鬆症のリスクを高める可能性がある。(著者抄録)

佐藤菜々, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 和田あゆみ, 木山良二, 堤本広大, 窪薗琢郎, 竹中俊宏, 大石充 . 地域在住高齢者における社会参加とサルコペニアとの関連 . 日本サルコペニア・フレイル学会雑誌5 ( 1 ) 73 - 80 2021.6

Language：Japanese Publisher：(一社)日本サルコペニア・フレイル学会

[目的]地域在住高齢者における社会参加とサルコペニアとの関連を明らかにすることを目的とした。[方法]地域コホート研究(垂水研究2018)に参加した65歳以上の地域在住高齢者859名のうち、脳卒中等の既往歴のない751名を分析対象とした。Asian Working Group for Sarcopenia2019に基づいてサルコペニアの有無、またJST版活動能力指標の社会参加に関する4項目より社会参加の状況を評価した。[結果]サルコペニアを有する者では、社会参加得点が有意に低値であった(p<0.001)。従属変数をサルコペニアの有無、独立変数を社会参加得点としたロジスティック回帰分析の結果、社会参加とサルコペニアに有意な関連を認めた(オッズ比0.83、95%信頼区間0.71-0.97)(共変量:年齢、性別、教育歴、服薬数、転倒歴、運動習慣、うつ傾向、認知機能)。[結論]地域在住高齢者の社会参加状況はサルコペニアと関連することが示唆された。(著者抄録)

丸田道雄, 牧迫飛雄馬, 池田由里子, 韓こう煕, 中村篤, 宮田浩紀, 下木原俊, 大勝巌, 大勝秀樹, 田平隆行 . 地域在住高齢者が重要とする活動の満足度と抑うつ症状の関連 . 日本作業療法研究学会雑誌24 ( 1 ) 62 - 63 2021.5

赤井田将真, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 和田あゆみ, 佐藤菜々, 丸田道雄, 田平隆行 . 地域在住高齢者における意味のある活動の満足度とフレイルの関係 . 日本作業療法研究学会雑誌24 ( 1 ) 76 - 76 2021.5

Maya Nakamura, Tomofumi Hamada, Akihiko Tanaka, Keitaro Nishi, Kenichi Kume, Yuichi Goto, Mahiro Beppu, Hiroshi Hijioka, Yutaro Higashi, Hiroaki Tabata, Kazuki Mori, Yumiko Mishima, Yoshinori Uchino, Kouta Yamashiro, Yoshiaki Matsumura, Hyuma Makizako, Takuro Kubozono, Takayuki Tabira, Toshihiro Takenaka, Mitsuru Ohishi, Tsuyoshi Sugiura . Association of Oral Hypofunction with Frailty, Sarcopenia, and Mild Cognitive Impairment: A Cross-Sectional Study of Community-Dwelling Japanese Older Adults. . Journal of clinical medicine10 ( 8 ) 2021.4Reviewed International journal

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

Oral hypofunction is a new concept that addresses the oral function of older adults. Few studies have investigated the relationship between oral hypofunction and general health conditions such as frailty, sarcopenia, and mild cognitive impairment. This paper explores these relationships in a large-scale, cross-sectional cohort study. The relationships of oral hypofunction with frailty, sarcopenia, and mild cognitive impairment were examined using data from 832 individuals who participated in the 2018 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan. Individuals with frailty, sarcopenia, and mild cognitive impairment had significantly higher rates of oral hypofunction. Frailty was independently associated with deterioration of the swallowing function (odds ratio 2.56; 95% confidence interval, 1.26-5.20), and mild cognitive impairment was independently associated with reduced occlusal force (odds ratio 1.48; 95% confidence interval, 1.05-2.08) and decreased tongue pressure (odds ratio 1.77; 95% confidence interval, 1.28-2.43). There was no independent association found between sarcopenia and oral function. In conclusion, early intervention for related factors such as deterioration of the swallowing function in frailty, reduced occlusal force, and decreased tongue pressure in mild cognitive impairment could lead to the prevention of general hypofunction in older adults.

DOI： 10.3390/jcm10081626

牧迫飛雄馬 . 特集整形外科疾患の運動療法-最近の進歩サルコペニアに対する運動療法 . 整形･災害外科64 ( 4 ) 457 - 464 2021.4

Yu Kume, Tomoko Takahashi, Yuki Itakura, Sangyoon Lee, Hyuma Makizako, Tsuyosi Ono, Hiroyuki Shimada, Hidetaka Ota . Polypharmacy and Lack of Joy Are Related to Physical Frailty among Northern Japanese Community-Dwellers from the ORANGE Cohort Study . Gerontology67 ( 2 ) 184 - 193 2021.4Reviewed International journal

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

Introduction: A prevalence of frailty is gradually increasing with the progress of aging in Japan, and critical challenges regarding early diagnosis and prevention of frailty were necessary in community. Although previous studies have well documented the characteristics of physical disability, there is limited information on frail state differences among older adults in Japanese rural areas. The aim of our cross-sectional observational study was to clarify the association of frail status in northern Japanese community-dwellers aged 65 or more. Methods: 345 participants were recruited from 2018 to 2020, and after getting informed consent from each participant, assessments and outcomes were evaluated according to the ORANGE protocol. We applied the frailty index of Gerontology-the Study of Geriatric Syndromes (NCGG-SGS) to classify frailty status by collecting data of demographics and psychosocial status using the Kihon checklist (KCL) and cognitive domains used by the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). Results: Our subjects included 313 older adults divided into 138 robust, 163 prefrail, and 12 frail. For statistical analysis, we found that the frail group had a lower educational duration, worsened KCL items, lower cognitive functions, and a tendency toward depression compared to the other groups. Moreover, physical frailty and cognitive decline were related, and polypharmacy and a lack of joy in daily life were explanatory variables of frail status. Conclusions: We suggest that KCL is important for frail discrimination, and in order to prevent physical frailty, our community should take care of not only exercise and nutrition but also cognitive functioning and depressive tendencies. In particular, polypharmacy and the presence of fun in your life are possible to be related to frailty.

DOI： 10.1159/000511986

Takuro Kubozono, Yuichi Akasaki, Shin Kawasoe, Satoko Ojima, Takeko Kawabata, Hyuma Makizako, So Kuwahata, Toshihiro Takenaka, Mayuka Maeda, Mayu Ohno, Mika Kijimuta, Seisuke Fujiwara, Ken Miyagawa, Mitsuru Ohishi . The relationship between home blood pressure measurement and room temperature in a Japanese general population. . Hypertension research : official journal of the Japanese Society of Hypertension44 ( 4 ) 454 - 463 2021.4Reviewed International journal

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

Blood pressure (BP) is influenced by various factors, and it is known that temperature and BP have a negative relationship. However, few reports have examined the relationship between BP and temperature throughout the day in the same participant over time. Therefore, this study aimed to investigate the relationship between BP and temperature in the morning and evening in the same participants during a time period of ~1 year. In total, 401 participants, who participated in a community-based health checkup survey in Tarumizu, Japan, were enrolled. Five participants were excluded due to missing data. All participants measured their BP and the room temperature at home using a blood pressure monitor (HEM-9700T, OMRON Healthcare, Kyoto, Japan). The mean systolic BP (SBP) and diastolic BP (DBP) in the morning were significantly higher than the mean of the measurements taken in the evening (SBP: morning vs. evening 128 ± 15 mmHg vs. 122 ± 14 mmHg, P < 0.0001; DBP: morning vs. evening 77 ± 10 mmHg vs. 72 ± 8 mmHg, P < 0.0001). Using a linear mixed model with participants as a random effect, SBP and DBP were significantly associated with temperature in both the morning and evening. In the morning, in almost every month except July, a significant association between SBP and temperature was observed. However, there was a significant relationship between evening BP and temperature in all months. In conclusion, BP was significantly related to temperature in both the morning and evening during the year-long study. Furthermore, BP and temperature were significantly associated in all months except morning measurements in July.

DOI： 10.1038/s41440-020-00564-3

Kobozono Takuro, Akasaki Yuichi, Kawasoe Shin, Ojima Satoko, Kawabata Takeko, Makizako Hyuma, Kuwahata So, Takenaka Toshihiro, Maeda Mayuka, Ohno Mayu, Kijimuta Mika, Fujiwara Seisuke, Miyagawa Ken, Ohishi Mitsuru . The relationship between home blood pressure measurement and room temperature in a Japanese general population(和訳中) . Hypertension Research44 ( 4 ) 454 - 463 2021.4

Language：English Publisher：Nature Publishing Group

朝夕に自宅で測定した血圧と、同時に記録した室温との関係性を調査した。地域健康診断を受診した参加者395名(男性136名、女性259名、平均71±8歳)を被験者とし、血圧モニターを使用して自宅で血圧と室温を測定した。平均収縮期血圧(SBP)と拡張期血圧(DBP)は、それぞれ139±18mmHgと80±11mmHgで、191名が降圧薬を使用していた。朝のSBPとDBPは、夕方の平均測定値の平均よりも有意に高かった。変量効果としての家庭血圧と室温との関連を検討した線形混合モデルでは、SBPとDBPは朝夕両方の気温と有意に関連していた。7月以外の月の朝においてSBPと気温の間に有意な関連が観察されたが、夕方の血圧と気温の間には全ての月で有意な関連がみられた。血圧は、1年間の研究期間中、朝夕の両方で気温と有意に関連していた。また気温は7月の朝の血圧測定値を除き、全ての月で血圧に有意に影響していた。

Makizako Hyuma, Nakai Yuki, Shiratsuchi Daijo, Akanuma Tomomi, Yokoyama Kaori, Matsuzaki-Kihara Yuriko, Yoshida Hiroto . COVID-19緊急事態宣言下での日本人後期高齢者における体力低下および認知機能低下の認識(Perceived declining physical and cognitive fitness during the COVID-19 state of emergency among community-dwelling Japanese old-old adults) . Geriatrics & Gerontology International21 ( 4 ) 364 - 369 2021.4

Language：English Publisher：John Wiley & Sons Australia, Ltd

2020年7月に北海道美唄市在住の地域在住後期高齢者1112名を対象として、COVID-19緊急事態宣言下での体力・認知機能低下の認識に関する質問紙調査を郵送法により実施した。調査項目は、年齢、性別、居住形態、病歴、ポリファーマシー、高齢者うつ尺度、体力低下や認知機能低下の認識の有無、緊急事態宣言前の運動教室への参加状況、緊急事態宣言下での運動習慣(週に2回以上、30分以上)や日常生活リズムの乱れの有無などとした。774名(女性433名、平均83.3±4.4歳)を解析対象とした。その結果、COVID-19緊急事態下で体力低下を認識していたのは339名(43.8%)、認知機能低下を認識していたのは259名(33.5%)であった。潜在的交絡因子を調整した多変量ロジスティック回帰モデルの結果、COVID-19緊急事態宣言下での運動習慣は体力低下の認識の低さと有意に関連していた。また、COVID-19緊急事態宣言下での日常生活リズムの乱れは、体力低下および認知機能低下の認識が高いことと有意に関連していた。

牧迫飛雄馬 . 【整形外科疾患の運動療法-最近の進歩】サルコペニアに対する運動療法　最新の知見 . 整形・災害外科64 ( 4 ) 457 - 464 2021.4

Language：Japanese Publisher：金原出版(株)

＜文献概要＞サルコペニアは,高齢期にみられる骨格筋量の減少と筋力もしくは身体機能(歩行速度など)の低下により定義される。サルコペニアは,2016年に国際疾病分類(ICD-10)においてM62.84のコードを取得しており,サルコペニアの治療やリハビリテーション,予防の重要性がさらに高まると考えられる。サルコペニアの定義や分類が整理されつつあるが,サルコペニアの判定方法については臨床的な活用可能性も考慮され,改訂がなされている。現状においては,サルコペニアの予防・改善のためには運動と栄養改善による介入戦略が有効であろうと考えられる。特に,運動療法に関しては,筋力トレーニングを中心とした多面的な運動プログラムが推奨される。しかし,サルコペニアに対する運動介入のエビデンスは十分なレベルではないため,さらにエビデンスが蓄積されていくことが望まれる。

Osamu Iritani, Tazuo Okuno, Takaki Miwa, Hyuma Makizako, Fumino Okutani, Tetsuo Kashibayashi, Kumiko Suzuki, Hideo Hara, Eri Mori, Shusaku Omoto, Hirokazu Suzuki, Minori Shibata, Hiroaki Adachi, Kenji Kondo, Yumi Umeda-Kameyama, Kumie Kodera, Shigeto Morimoto . Olfactory-cognitive index distinguishes involvement of frontal lobe shrinkage, as in sarcopenia from shrinkage of medial temporal areas, and global brain, as in Kihon Checklist frailty/dependence, in older adults with progression of normal cognition to Alzheimer's disease . GERIATRICS & GERONTOLOGY INTERNATIONAL21 ( 3 ) 291 - 298 2021.3Reviewed

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

Aim: Olfactory impairment as a prodromal symptom, as well as sarcopenia, frailty and dependence as geriatric syndromes, is often associated with cognitive decline in older adults with progression of Alzheimer's disease. The present study aimed to evaluate the associations of olfactory and cognitive decline with these geriatric syndromes, and with structural changes of the brain in older adults.Methods: The participants were 135 older adults (47 men and 88 women, mean age 79.5 years), consisting of 64 with normal cognition, 23 with mild cognitive impairment and 48 with Alzheimer's disease. Olfactory function was evaluated by the Open Essence odor identification test. Shrinkage of the regional brain was determined by magnetic resonance imaging.Results: Logistic regression analysis with Open Essence, Mini-Mental State Examination, age and sex as covariates showed higher olfactory-cognitive index (|coefficient for Open Essence (a) / coefficient for Mini-Mental State Examination (b)|) in participants with sarcopenia (Asia Working Group for Sarcopenia), and lower values of (|a/b|) in participants with Barthel Index dependence, Kihon Checklist frailty, Lawton Index dependence and support/care-need certification as objective variables. Logistic regression analysis adjusted by age and sex also showed significant shrinkage of the frontal lobe in participants with AWGS sarcopenia, especially in women, and shrinkage of the medial temporal areas and global brain in participants with Kihon Checklist frailty/dependence.Conclusions: Olfactory-cognitive index (|a/b|) might be a useful tool to distinguish involvement of frontal lobe shrinkage, as in sarcopenia from shrinkage of the medial temporal areas, and global brain, as in frailty/dependence, in older adults with progression of normal cognition to Alzheimer's disease.

DOI： 10.1111/ggi.14128

Iritani Osamu, Okuno Tazuo, Miwa Takaki, Makizako Hyuma, Okutani Fumino, Kashibayashi Tetsuo, Suzuki Kumiko, Hara Hideo, Mori Eri, Omoto Shusaku, Suzuki Hirokazu, Shibata Minori, Adachi Hiroaki, Kondo Kenji, Umeda-Kameyama Yumi, Kodera Kumie, Morimoto Shigeto . Olfactory-cognitive index distinguishes involvement of frontal lobe shrinkage, as in sarcopenia from shrinkage of medial temporal areas, and global brain, as in Kihon Checklist frailty/dependence, in older adults with progression of normal cognition to Alzheimer's disease(和訳中) . Geriatrics & Gerontology International21 ( 3 ) 291 - 298 2021.3

Language：English Publisher：John Wiley & Sons Australia, Ltd

高齢者135名(男性47名、女性88名、平均79.5歳)を対象として、嗅覚や認知機能低下、老年症候群、脳の構造変化との関連を評価した。認知機能正常64名、MCI 23名、アルツハイマー病48名であった。評価項目は年齢、性別、Open Essenceによる嗅覚機能、ミニメンタルステート検査、AWGSによるサルコペニア、補正四肢筋量、握力、歩行速度、Barthel ADL、基本チェックリストによるフレイル、LawtonのIADLスケール、要介護・要支援認定、脳MRI所見などとした。嗅覚認知指数(|a/b|)をロジスティック回帰式(老年症候群の発生=a[OE]+b[MMSE]+c[年齢]+d[性別]+e)より算出した。ロジスティック回帰分析の結果、サルコペニア患者では嗅覚認知指数が高く、フレイル、Barthel ADLおよびIADLにおける非自立者、要介護・要支援認定者では嗅覚認知指数が低かった。また、サルコペニア患者のうち特に女性では前頭葉の有意な萎縮が認められ、フレイル/非自立者では側頭葉内側部および全脳の萎縮がみられた。

牧迫飛雄馬, 木山良二, 中井雄貴, 富岡一俊, 谷口善昭, 竹中俊宏 . サルコペニアに対する運動療法の標準化と効果の検証　ランダム化比較対照試験 . 大和証券ヘルス財団研究業績集 ( 44 ) 113 - 117 2021.3

Language：Japanese Publisher：(公財)大和証券ヘルス財団

サルコペニアを有する高齢者を対象として、運動群と対照群にランダムに割り付け、サルコペニアに対する運動療法の効果を検証した。対象者を運動群(36名)と対照群(36名)にランダムに割り付け、3ヵ月間の介入前後での身体機能と大腿筋量(MRI画像)の変化を比較した。運動介入は、ゴムバンドによる筋力トレーニングを中心とした多面的運動プログラムを週1回(60分)の頻度で12回実施した。欠損値補正を行ったITT(intention-to-treat)解析で3ヵ月間の変化を比較した。その結果、5回立ち座りテストとTimed UP and Goで群と時間(介入前後)の有意な交互作用を認め、運動群での改善を認めた。大腿の筋面積・筋体積の変化では、運動群で減少を抑制する傾向であったが、有意な交互作用は認められなかった。また、サブグループ解析として、同運動教室に参加していた高齢者15名(平均年齢78.1±6.4歳、女性80%)を対象に、新型コロナウイルス感染症の感染拡大予防対策に伴う外出自粛時期前後での身体活動量の変化を調べた。緊急事態宣言前に比べて緊急事態宣言中では2割の者で町外への外出(生活空間レベル5)をしておらず、身体活動量と生活空間(LSA)スコアが低下傾向であったが、有意な変化ではなかった。身体活動量も有意な変化はなかった。運動教室に参加していた高齢者においては、緊急事態宣言中における生活範囲の顕著な変化および身体活動量の低下は認められなかった。

佐藤菜々, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 木山良二, 和田あゆみ, 窪園琢郎, 竹中俊宏, 大石充 . 地域在住高齢者における社会参加とサルコペニアの関連性 . 理学療法学47 ( Suppl.1 ) 25 - 25 2021.3

富岡一俊, 牧迫飛雄馬, 中井雄貴, 谷口善昭, 木山良二, 和田あゆみ, 佐藤奈々, 窪園琢朗, 竹中俊宏, 大石充 . 地域在住高齢者における身体活動量と身体・認知機能および身体組成との関連性 . 理学療法学47 ( Suppl.1 ) 12 - 12 2021.3

WADA, Ayumi, MAKIZAKO, Hyuma, NAKAI, Yuki, TOMIOKA, Kazutoshi, TANIGUCHI, Yoshiaki, SATO, Nana, KIYAMA, Ryoji, TABIRA, Takayuki, KUBOZONO, Takuro, TAKENAKA, Toshihiro, OHISHI, Mitsuru . The Association between Social Frailty and Depressive Symptoms in Community-dwelling Older Adults . Bulletin of the School of Health Sciences, Faculty of Medicine, Kagoshima University31 ( 1 ) 11 - 18 2021.3

Language：Japanese

PURPOSE: Social and psychological problems can have a negative impact on older adults’ healthy life expectancy. A better understanding of the aspects associated with social frailty and strategies for its prevention could, be useful for psychological health in older adults. The purpose of this study was to examine the association between social frailty and depressive symptoms in community-dwelling older adults. METHOD: Data from 812 community-dwelling older adults (aged ? 65 years, mean age 74.8 years, 62.6% female), who had participated in a community-based health check survey (Tarumizu Study 2018) were analyzed. Older adults who were requiring long-term care and having a history of dementia and depression were excluded. Social frailty was defined using responses to five questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone and not talking with someone every day). If two or more items out of the five were defined as social frailty. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS15), and a total score of 5 or more were considered as depressive symptoms. RESULTS: The prevalence of social frailty was 13.8%. Participants with social frailty showed a higher prevalence of depressive symptoms than those without (33.0% versus 12.9%, p < 0.01). Four items (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family and not talking with someone every day) were associated with a high percentage of depressive symptoms (p < 0.01). Based on the results of logistic regression analysis, social frailty was significantly associated with depressive symptoms (odds ratio 3.04, 95% confidence interval 1.88?4.92), after adjusting for sex, age, education, grip strength, walking speed and Mini-Cog total score. CONCLUSION: The results of this study suggested that social frailty was associated with depressive symptoms. Moreover, the social aspects of frailty could have a negative impact on psychological health. Further longitudinal studies will be needed to examine the causal relationship between social frailty and depression and the effect of interventions on social aspects.

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牧迫飛雄馬 . 【フレイル予防・対策:基礎研究から臨床、そして地域へ】フレイルの全体像を学ぶ　フレイルとは　多面性とフレイルサイクル . Advances in Aging and Health Research2020 19 - 26 2021.3

Kaori Kaimoto, Mikako Yamashita, Taro Suzuki, Hyuma Makizako, Chihaya Koriyama, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi, Hiroaki Kanouchi, The Tarumizu Study Diet Group . Association of Protein and Magnesium Intake with Prevalence of Prefrailty and Frailty in Community-Dwelling Older Japanese Women . J Nutr Sci Vitaminol67 ( 1 ) 39 - 47 2021.2Reviewed

Kaimoto Kaori, Yamashita Mikako, Suzuki Taro, Makizako Hyuma, Koriyama Chihaya, Kubozono Takuro, Takenaka Toshihiro, Ohishi Mitsuru, Kanouchi Hiroaki, the Tarumizu Study Diet Group . Association of Protein and Magnesium Intake with Prevalence of Prefrailty and Frailty in Community-Dwelling Older Japanese Women(和訳中) . Journal of Nutritional Science and Vitaminology67 ( 1 ) 39 - 47 2021.2

Language：English Publisher：(公社)日本栄養・食糧学会

高齢者815名(女性515名、平均74.9歳)を対象に、栄養素摂取状況とプレフレイル(疲労感、動作緩慢、虚弱、活動量低下、または体重減少のいずれか一つ以上の存在)との関係について検討した。男性の52%および女性の54%がプレフレイルに該当した。男性では栄養素摂取状況とプレフレイルの間に有意な関連はみられなかった。女性の場合、健常群と比較して、プレフレイル群はビタミンKとB群(B1、B2、葉酸、パントテン酸)、リン、カリウム、カルシウム、マグネシウム、鉄、亜鉛、銅の摂取量が有意に少なかった。このうちプレフレイルに関連する有意な変数として抽出されたのはマグネシウムのみであった。マグネシウム摂取量の四分位別にみた女性のプレフレイルの調整オッズ比(95%信頼区間)は、第1分位を基準として、第2分位が0.52(0.29〜0.92,p=0.024)、第3分位が0.51(0.28〜0.95,p=0.033)、第4分位が0.38(0.19〜0.74,p=0.005)であった。以上から、高齢日本人女性において、マグネシウムはプレフレイル予防に重要な栄養素であると考えられた。

牧迫飛雄馬, 谷口善昭 . 脆弱性骨折による運動器障害とその予防-理学療法のエビデンスを踏まえて- 高齢期におけるオステオサルコペニアのリスクと対策 . 日本骨粗鬆症学会雑誌7 ( 1 ) 141 - 145 2021.2

牧迫飛雄馬 . リハビリテーション職種が知っておくべき臨床統計　基礎から最新の話題まで母集団とサンプル、パラメータの推定 . Journal of Clinical Rehabilitation30 ( 1 ) 71 - 75 2021.1

Yu Kume, Seongryu Bae, Sangyoon Lee, Hyuma Makizako, Yuriko Matsuzaki-Kihara, Ichiro Miyano, Hunkyung Kim, Hiroyuki Shimada, Hidetaka Ota . Association between Kihon check list score and geriatric depression among older adults from ORANGE registry . PLoS ONE16 ( 6 ) e0252723 2021Reviewed International journal

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

Objective Older adults in Japan are tackling health-related challenges brought by comprehensive geriatric symptoms, such as physical and cognitive problems and social-psychological issues. In this nationwide study, we mainly focused on the Kihon checklist (KCL) as certificated necessity of long-term care for Japanese older adults and investigated whether the KCL score was associated with geriatric depression. In addition, we aimed to identify critical factors that influence the relationship between the KCL score and geriatric depression. Methods This survey was a cross-sectional observational study design, performed from 2013 to 2019. A total of 8, 760 participants aged 65 years and over were recruited from five cohorts in Japan, consisting of 6, 755 persons in Chubu, 1, 328 in Kanto, 481 in Kyushu, 49 in Shikoku and 147 in Tohoku. After obtaining informed consent from each participant, assessments were conducted, and outcomes were evaluated according to the ORANGE protocol. We collected data on demographics, KCL, physical, cognitive and mental evaluations. To clarify the relationship between the KCL and geriatric depression or critical factors, a random intercept model of multi-level models was estimated using individual and provincial variables depending on five cohorts. Results The KCL score was correlated with depression status. Moreover, the results of a random intercept model showed that the KCL score and geriatric depression were associated, and its association was affected by provincial factors of slow walking speed, polypharmacy and sex difference. Conclusions These results suggest that provincial factors of low walking performance, polypharmacy and sex difference (female) might be clinically targeted to improve the KCL score in older adults.

DOI： 10.1371/journal.pone.0252723

Michio Maruta, Hyuma Makizako, Yuriko Ikeda, Hironori Miyata, Atsushi Nakamura, Gwanghee Han, Suguru Shimokihara, Keiichiro Tokuda, Takuro Kubozono, Mitsuru Ohishi, Takayuki Tabira . Association between apathy and satisfaction with meaningful activities in older adults with mild cognitive impairment: A population‐based cross‐sectional study . International Journal of Geriatric Psychiatry36 ( 7 ) 1065 - 1074 2021Reviewed International journal

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

OBJECTIVES: This cross-sectional study aimed to clarify the relationship between apathy, meaningful activities, and satisfaction with such activities of older adults with mild cognitive impairment (MCI). METHODS: We analyzed 235 older adults with MCI (≥65 years, mean age: 76.9 ± 6.4 years, women: 63.4%) who participated in a community-based health check survey (Tarumizu Study 2018). MCI was defined as at least 1.5 SD below the reference threshold (age- and education-adjusted score) on one or more of the computerized cognitive test including memory, attention, executive functions, and processing speed. Apathy symptoms were assessed using three of the 15 items of Geriatric Depression Scale. Participants selected meaningful activities from the 95 activities of the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. RESULTS: Apathy in MCI was prevalent by 23.8%. The categories of meaningful activities revealed no difference, with, or without apathy. Logistic regression analysis showed that activity satisfaction was significantly associated with apathy after adjusting for age, sex, education, instrumental activities of daily living, depressive symptoms, and MCI subtype (OR, 0.62; 95% CI, 0.44-0.88, p = 0.008). CONCLUSIONS: Satisfaction with the activities that are deemed meaningful is associated with apathy among community-dwelling older adults with MCI.

DOI： 10.1002/gps.5544

Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/gps.5544

Makizako Hyuma, Akaida Shoma . Age Related Psychological Changes . Physical Therapy Japan48 ( 2 ) 242 - 247 2021

Kaori Kaimoto, Mikako Yamashita, Taro Suzuki, Hyuma Makizako, Chihaya Koriyama, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi, Hiroaki Kanouchi, The Tarumizu Study Diet Group . Association of Protein and Magnesium Intake with Prevalence of Prefrailty and Frailty in Community-Dwelling Older Japanese Women. . Journal of nutritional science and vitaminology67 ( 1 ) 39 - 47 2021

Language：English Publishing type：Research paper (scientific journal) Publisher：Center for Academic Publications Japan

We examined the association between nutrient intake and prefrailty. Data from 815 older people (63% women) who participated in a community-based health check survey (Tarumizu Study) were analyzed. Prefrailty were defined using five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). Participants with one or more components were considered to belong to the prefrailty group. Nutrition intake was estimated from a validated brief-type self-administered diet history questionnaire. Among the participants, 154 men (52%) and 278 women (54%) were found to be in a status of prefrailty. In men, there were no significant associations between nutrient intake and prefrailty. In women, carbohydrate intake was slightly higher in prefrailty group. Vitamins K, B1, B2, folic acid, pantothenic acid, phosphorus, potassium, calcium, magnesium, iron, zinc, and copper intake was significantly lower in the prefrailty group. Among the nutrients, magnesium was identified as a significant covariate of prefrailty using a stepwise regression method. In women adjusted ORs (95%CI, p value) for prefrailty in the first, second, third, and fourth quartiles of magnesium intake were 1.00 (reference), 0.52 (0.29-0.92, 0.024), 0.51 (0.28-0.95, 0.033), and 0.38 (0.19-0.74, 0.005), respectively, by multivariate logistic regression analysis (variates: age, body mass index, energy intake, supplement use, osteoporosis, magnesium, and protein intake). Protein intake did not related to prefrailty. Protein intake might be sufficient to prevent prefrailty in the present study. We propose magnesium to be an important micronutrient that prevents prefrailty in community-dwelling older Japanese women.

DOI： 10.3177/jnsv.67.39

Yuto Kiuchi, Hyuma Makizako, Yuki Nakai, Kazutoshi Tomioka, Yoshiaki Taniguchi, Mika Kimura, Hiroaki Kanouchi, Toshihiro Takenaka, Takuro Kubozono, Mitsuru Ohishi . The Association between Dietary Variety and Physical Frailty in Community-Dwelling Older Adults. . Healthcare (Basel, Switzerland)9 ( 1 ) 2021International journal

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

The aim of this cross-sectional study was to examine the association between diet variety and physical frailty in community-dwelling older adults. Data of 577 older adults (mean age: 74.0 ± 6.3 years, women: 62.5%) were analyzed. Diet variety was assessed using the Food Frequency Score (FFS) (maximum, 30 points). The FFS assessed the one-week consumption frequency of ten foods (meat, fish/shellfish, eggs, milk & dairy products, soybean products, green & yellow vegetables, potatoes, fruits, seafood, and fats & oil). Physical frailty was assessed using Fried's component (slowness, weakness, exhaustion, low physical activity, and weight loss). The participants were classified into frail, pre-frail, and non-frail groups. The prevalence of physical frailty was 6.6%. This study found significant associations between physical frailty and low FFS after adjusting for covariates (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.84-0.97, p < 0.01). The optimal cutoff point of the FFS for physical frailty was ≤16 points. FFS lower than the cutoff point were significantly associated with physical frailty after adjusting for covariates (OR 3.46, 95% CI 1.60-7.50, p < 0.01). Diet variety assessed using the FFS cutoff value of ≤16 points was related to the physical frailty status in community-dwelling older adults.

DOI： 10.3390/healthcare9010032

Hyuma Makizako, Hiroyuki Shimada, Kota Tsutsumimoto, Keitaro Makino, Sho Nakakubo, Hideaki Ishii, Takao Suzuki, Takehiko Doi . Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS. . Gerontology67 ( 6 ) 1 - 10 2021International journal

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

INTRODUCTION: Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations. OBJECTIVE: The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults. METHODS: The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan's public LTCI system during the 29 months. RESULTS: During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system's care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54-9.66) or pre-frail (2.40, 1.58-3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were \6,434 ($63.1) for robust, \19,324 ($189.5) for pre-frail, and \147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services. DISCUSSION/CONCLUSION: Frail community-dwelling older adults had a higher risk of requiring the LTCI system's care-needs certification and the subsequent total LTCI costs.

DOI： 10.1159/000514679

Keitaro Makino, Sangyoon Lee, Seongryu Bae, Ippei Chiba, Kenji Harada, Osamu Katayama, Yohei Shinkai, Hyuma Makizako, Hiroyuki Shimada . Diabetes and Prediabetes Inhibit Reversion from Mild Cognitive Impairment to Normal Cognition. . Journal of the American Medical Directors Association22 ( 9 ) 1912 - 1918 2021International journal

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

OBJECTIVES: Diabetes and prediabetes contribute to an increased risk of cognitive decline and dementia. Currently, it remains unclear whether elevated blood HbA1c levels, including prediabetes levels, affect reversion from mild cognitive impairment (MCI) to normal cognition. This study, therefore, aimed to examine the prospective associations of diabetes and prediabetes with reversion from MCI to normal cognition among community-dwelling older adults. DESIGN: Longitudinal cohort study with a 4-year follow-up. SETTING AND PARTICIPANTS: Community-dwelling older adults with MCI, aged ≥65 years at baseline (n = 787). METHODS: Participants' medical history of diabetes and blood HbA1c levels at baseline were assessed, and they were classified as control, prediabetes, and diabetes. Objective cognitive screening was performed using a multicomponent neurocognitive test at baseline and follow-up. Reversion from MCI to normal cognition over 4 years was determined. In the longitudinal analysis, we performed multiple imputations to adjust for a selection bias and loss of information. RESULTS: The reversion rates of MCI in the control, prediabetes, and diabetes groups were 63.4%, 55.6%, and 42.9%, respectively, in the completed follow-up dataset, and 54.6%, 47.2%, and 34.1%, respectively, in the imputed dataset. Multivariate logistic regression showed that diabetes decreases the probability of MCI reversion both before and after multiple imputations [odds ratio (OR) 0.37; 95% confidence interval (CI) 0.18-0.74 for before imputation, OR 0.37; 95% CI 0.19-0.72 for after imputation]. Furthermore, prediabetes also showed significantly decreased probabilities of MCI reversion both before and after multiple imputations (OR 0.57; 95% CI 0.34-0.94 for before imputation, OR 0.60; 95% CI 0.37-0.97 for after imputation). CONCLUSIONS AND IMPLICATIONS: Diabetes and prediabetes could inhibit MCI reversion. Adequate glycemic control may be effective in enhancing the reversion from MCI to normal cognition in a community setting.

DOI： 10.1016/j.jamda.2021.02.033

NAKAI Yuki, TOMIOKA Kazutoshi, TANIGUCHI Yoshiaki, TAKENAKA Toshihiro, MAKIZAKO Hyuma . Changes in Physical Activity Levels between before and during the COVID-19 Outbreak of Older Community-dwelling Adults: A Survey of Older Adults Who Participated in Exercise Programs . Rigakuryoho Kagaku36 ( 1 ) 35 - 40 2021

Language：Japanese Publisher：The Society of Physical Therapy Science

[Purpose] This study examined the changes in physical activity (PA) levels before and during the COVID-19 outbreak of older Japanese community-dwelling adults participating in exercise programs. [Participants and Methods] This observational study recruited 15 older adults. Participants were required to continuously wear an accelerometer on an elastic band on their hips for a week. Average daily duration of light, moderate, and total PA (min/day), as well as daily steps were calculated. Life-space assessment (LSA) scores were also assessed using a questionnaire. [Results] Although all participants reached 5 levels (from home to out of town) before the COVID-19 state of emergency declaration, 20% of them did not reach 5 levels during the state of emergency. Thus, there were no significant changes in any of the physical activity parameters and LSA before and during the declaration of emergency. [Conclusion] This study concludes that there was no significant decrease in physical activity levels among older community-dwelling adults participating in exercise programs before the COVID-19 outbreak in April 2020.

DOI： 10.1589/rika.36.35

H. Makizako, Y. Nishita, S. Jeong, R. Otsuka, H. Shimada, K. Iijima, S. Obuchi, H. Kim, A. Kitamura, Y. Ohara, S. Awata, N. Yoshimura, M. Yamada, K. Toba, T. Suzuki . TRENDS IN THE PREVALENCE OF FRAILTY IN JAPAN: A META-ANALYSIS FROM THE ILSA-J . The Journal of frailty & aging10 ( 3 ) 211 - 218 2021

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

OBJECTIVE: To examine whether age-specific prevalence of frailty in Japan changed between 2012 and 2017. DESIGN: This study performed meta-analyses of data collected from 2012 to 2017 using the Integrated Longitudinal Studies on Aging in Japan (ILSA-J), a collection of representative Japanese cohort studies. SETTING: The ILSA-J studies were conducted on community-living older adults. PARTICIPANTS: ILSA-J studies were considered eligible for analysis if they assessed physical frailty status and presence of frailty in the sample. Seven studies were analyzed for 2012 (±1 year; n = 10312) and eight studies were analyzed for 2017 (±1 year; n = 7010). Five studies were analyzed for both 2012 and 2017. MEASUREMENTS: The study assessed the prevalence of frailty and frailty status according to 5 criteria: slowness, weakness, low activity, exhaustion, and weight loss. RESULTS: The overall prevalence of physical frailty was 7.0% in 2012 and 5.3% in 2017. The prevalence of frailty, especially in people 70 years and older, tended to decrease in 2017 compared to 2012. Slight decreases were found in the prevalence of frailty subitems including weight loss, slowness, exhaustion, and low activity between 2012 and 2017, but change in the prevalence of weakness was weaker than other components. CONCLUSIONS: The prevalence of physical frailty decreased from 2012 to 2017. There are age- and gender-related variations in the decrease of each component of frailty.

DOI： 10.14283/jfa.2020.68

牧迫飛雄馬 . 日常生活での運動を再考する:─運動量さえ増えればいいのか？─ . 理学療法学Supplement48 ( 0 ) C - 61-C-61 2021

Language：Japanese Publisher：公益社団法人日本理学療法士協会

日常生活において，運動によって身体活動を促進することは，全世代を通して心身に効果的であることはおそらく疑いの余地はないであろう。身体活動の減少は，喫煙，高血圧に次いで日本人の死亡に及ぼす危険因子とされており，さまざまな疾患の発症リスクを増大させる（Ikeda N, et al. 2011）。とくに，高齢期の日常生活における身体活動（physical activity）を促進することは，健康寿命の延伸を目指すうえでの重要な課題のひとつと考える。　習慣的な運動や積極的な身体活動は，認知症の発症リスクを低減させることにも寄与するとされている。週3回以上の運動習慣（15分以上の運動：ウォーキング，ハイキング，サイクリング，スイミング，水中運動，有酸素運動や柔軟体操，筋力トレーニングやストレッチングなど）を有する者では，週3回未満の者に比べて認知症を発症する危険が約38％低かったことが報告されている（Larson EB, et al. 2006）。さらに，運動習慣が認知症の発症に及ぼす影響は，軽度から中等度の運動機能の低下を認めた高齢者ほど顕著であった。つまり，やや運動機能の低下が生じ始めた時期に，より意識的に身体活動を維持・向上しておくことの重要性を示している。また，日常的な運動習慣は，加齢による脳萎縮の抑制に対しても効果的であることが期待されている（Cabral DF, et al. 2019）。　しかしながら，身体的活動を増加させるほどに望ましいかについては慎重になるべきである。高齢女性16,741名を対象に1日の歩数と死亡発生との関連を縦断的に調べた報告によると，約7,500歩に達するまでは1日歩数の増加は死亡リスク低減と関連したが，1日10,000歩に達することの付加的な利得は認められなかった（Lee IM, et al. 2019）。　一般的に健康的な心身機能を維持するためには週150分（1日30分，週5日間）程度の中強度程度（やや速歩き相当）の運動の実施が推奨されている（Nelson ME, 2007）。しかし，高齢者にとっては中強度以上の負荷を伴う運動はさまざまな障壁やリスクを抱えることも少なくない。低強度から中強度の運動による身体活動（週3回程度）であっても，将来の認知障害の発生が有意に低くなることが報告されており（Sofi F, et al. 2011），たとえ低強度から中強度程度の負荷の運動であっても習慣化することが高齢期の認知機能低下の予防に有効であるかもしれない。さらに，アルツハイマー病を発症する9～10年程度前から身体活動量が低下し始めるとされている（Sabia S, et al. 2017）。そのため，一時的に運動習慣を習得して身体活動量を高めるだけではなく，高めた身体活動量を維持する生活スタイルをいかにして確立するかがさらに重要である。　日常におけるさまざまな活動には，身体的活動（physical activity）の他，知的活動（cognitive activity），社会的活動（social activity）などがあり，これらが高齢期における健康関連指標へ影響を及ぼすことが示唆されている。日常でこれらの活動をいかに多面的に促進していくかが健康長寿の鍵になると考えられ，理学療法には対象者の活動の多様性と継続性を支援することも重要な対策のひとつと考えられる。

DOI： 10.14900/cjpt.48S1.C-61

牧迫飛雄馬, 大石充, 中井雄貴, 桑波田聡, 富岡一俊, 谷口善昭, 佐藤菜々, 和田あゆみ, 竹中俊宏, 窪薗琢郎 . 地域在住高齢者の睡眠と主観的健康感 . 理学療法学Supplement48 ( 0 ) E - 71_1-E-71_1 2021

木内悠人, 大石充, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 佐藤菜々, 和田あゆみ, 竹中俊宏, 窪薗琢郎 . 地域在住高齢者における認知的フレイルと手段的日常生活動作能力の関係 . 理学療法学Supplement48 ( 0 ) E - 108_1-E-108_1 2021

佐藤菜々, 大石充, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 和田あゆみ, 木山良二, 窪園琢郎, 竹中俊宏 . 地域在住高齢者における筋量および筋力と歩行パラメータとの関連性 . 理学療法学Supplement48 ( 0 ) E - 69_2-E-69_2 2021

牧迫飛雄馬 . COVID-19と地域理学療法:─特別チームの活動と地域における課題─ . 理学療法学Supplement48 ( 0 ) B - 46-B-46 2021

Language：Japanese Publisher：公益社団法人日本理学療法士協会

新型コロナウイルス（COVID-19）感染拡大に伴う緊急事態宣言発令以降，外出の自粛要請をはじめとする多くの対策がなされた。その結果，地域・在宅で生活する高齢者や要介護者は活動の制限を余儀なくされ，諸機能の低下を招いた者も認められた。このような状況の中，本学会では感染予防や自粛中の関わり方など，COVID-19に関する情報共有をはじめ，実務に有益な情報の発信や調査・報告などを行うため，有志による特別チームを立ち上げ，活動を行ってきた。　緊急事態宣言の解除以降は，地域の通いの場の再開や医療・介護サービスの実施にあたって，感染予防の徹底を図るとともに，新しい日常生活様式を踏まえた介入方法を模索しながら活動を行っている。また，第2波，第3波への備えや新たな地域交流・社会参加を目指すために必要な情報，事例を提示するとともに，アンケート調査の結果などから得られた臨床の課題についても取り組み始めている。　この特別シンポジウムでは，特別チームの活動について報告するとともに，現状の課題を踏まえ，その解決に向けた対策など，何かしらの情報提供や方向性を提示できれば幸いです。

DOI： 10.14900/cjpt.48S1.B-46

牧迫飛雄馬 . 高齢期におけるオステオサルコペニアのリスクと対策 . 日本骨粗鬆症学会雑誌7 141 - 145 2021

Naoki Saji, Hiroyuki Suzuki, Naomi Katayama, Hyuma Makizako, Yasue Uchida, Tsutomu Nakashima . Sensory impairment: A preventable risk factor in older adults. . Archives of gerontology and geriatrics93 104300 - 104300 2021International journal

改元香, 山下三香子, 鈴木太朗, 牧迫飛雄馬, 郡山千早, 窪薗琢郎, 竹中俊宏, 大石充, 叶内宏明 . フレイル予防と栄養 . New Diet Therapy36 ( 3 ) 59 - 66 2020.12

丸田道雄, 牧迫飛雄馬, 中村篤, 大勝秀樹, 田平隆行 . フレイル状態の地域在住高齢者が生活の中で重要とする活動の特徴 . 日本作業療法学会抄録集54回 OJ - 7 2020.9

中村篤, 牧迫飛雄馬, 丸田道雄, 宮田浩紀, 田平隆行 . 運転を中断した地域在住高齢者の生活上重要な作業の特徴および抑うつとの関連 . 日本作業療法学会抄録集54回 OJ - 2 2020.9

Hirase T, Makizako H, Okubo Y, Lord SR, Okita M, Nakai Y, Takenaka T, Kubozono T, Ohishi M. . Falls in Community-Dwelling Older Adults with Lower Back or Knee Pain Are Associated with Cognitive and Emotional Factors . Int J Environ Res Public Health17 ( 14 ) 4960 2020.7Reviewed

Tatsuya Hirase, Hyuma Makizako, Yoshiro Okubo, Stephen R. Lord, Minoru Okita, Yuki Nakai, Toshihiro Takenaka, Takuro Kubozono, Mitsuru Ohishi . Falls in Community-Dwelling Older Adults with Lower Back or Knee Pain Are Associated with Cognitive and Emotional Factors . International Journal of Environmental Research and Public Health17 ( 14 ) 1 - 8 2020.7Reviewed

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：MDPI AG

(1) Background: The present study aimed to examine physical, cognitive and emotional factors affecting falls in community-dwelling older adults with and without pain; (2) Methods: Data from 789 older adults who participated in a community-based health survey were analyzed. Participants completed questionnaires on the presence of pain and previous falls. Muscle weakness (handgrip strength < 26.0 kg for men and < 18.0 kg for women) and low skeletal muscle mass (appendicular skeletal muscle mass index < 7.0 kg/m2 for men and < 5.7 kg/m2 for women) were determined. Mild cognitive impairment (MCI) and depressive symptoms were assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and 15-item geriatric depression scale (GDS-15), respectively; (3) Results: In participants with pain, MCI and GDS-15 were associated with previous falls after adjusting for age, sex, education and medication use. In participants without pain, muscle weakness and low skeletal muscle mass were associated with previous falls when adjusting for the above covariates; (4) Conclusions: Falls in participants with pain were associated with cognitive and emotional factors, whereas falls in those without pain were associated with physical factors. Fall prevention interventions for older adults with pain may require tailored strategies to address cognitive and emotional factors.

DOI： 10.3390/ijerph17144960

牧迫飛雄馬, 田平隆行, 沖利通, 根路銘安仁 . 保健系大学院におけるディプロマ・ポリシー到達度に対する学生自己評価とその関連要因 . 医学教育51 ( Suppl. ) 241 - 241 2020.7

荒木草太, 木山良二, 牧迫飛雄馬, 川田将之, 宮崎宣丞, 竹下康文, 中井雄貴, 林浩之, 東直人, 窪薗琢郎, 中村俊博, 竹中俊宏, 大石充 . 地域在住高齢者における加齢による歩容の変化 . The Japanese Journal of Rehabilitation Medicine57 ( 特別号 ) 2 - 4 2020.7

Nakai Y, Tomioka K, Taniguchi Y, Sato N, Wada A, Kiyama R, Tsutsumimoto K, Ohishi M, Kiuchi Y, Kubozono T, Takenaka T. . Effects of a Multicomponent Exercise Program in Physical Function and Muscle Mass in Sarcopenic/Pre-Sarcopenic Adults. . J Clin Med9 ( 5 ) 2020.5Reviewed

中井雄貴, 富岡一俊, 谷口善昭, 木山良二, 佐藤菜々, 和田あゆみ, 窪園琢郎, 大石充, 牧迫飛雄馬 . 地域在住高齢者における腰痛および膝痛と身体機能との関連急性および慢性疼痛が歩行速度や握力に及ぼす影響 . 理学療法学47 ( 2 ) 146 - 152 2020.4

Language：Japanese Publisher：(公社)日本理学療法士協会

【目的】地域在住高齢者の有する腰痛と膝痛が、急性もしくは慢性疼痛であるかの違いによって身体機能に及ぼす影響を明らかにする。【方法】地域コホート研究(垂水研究2018)に参加した65歳以上の高齢者735名を対象とした。質問紙により急性・慢性疼痛の有無を聴取し、歩行速度および握力との関連を分析した。【結果】ロジスティック回帰分析の結果、慢性疼痛の有無は歩行速度低下と有意に関連していたが(調整後オッズ比2.55、p=0.001)、急性疼痛との関連はなかった(調整後オッズ比1.19、p=0.632)(年齢、性別、GDS-15、内服薬数、ASMI、握力を共変量)。急性・慢性疼痛の有無と握力低下との関連はなかった(急性疼痛有無:調整後オッズ比1.22、p=0.477。慢性疼痛有無:調整後オッズ比0.85、p=0.530)。【結論】地域在住高齢者において、慢性疼痛を有することと歩行速度低下との関連が示唆された。(著者抄録)

Maruta M, Makizako H, Ikeda Y, Miyata H, Nakamura A, Han G, Shimokihara S, Tokuda K, Kubozono T, Ohishi M, Tomori K, Tabira T . Associations between Depressive Symptoms and Satisfaction with Meaningful Activities in Community-Dwelling Japanese Older Adults. . J Clin Med9 ( 3 ) 2020.3Reviewed

Michio Maruta, Hyuma Makizako, Yuriko Ikeda, Hironori Miyata, Atsushi Nakamura, Gwanghee Han, Suguru Shimokihara, Keiichiro Tokuda, Takuro Kubozono, Mitsuru Ohishi, Kounosuke Tomori, Takayuki Tabira . Associations between Depressive Symptoms and Satisfaction with Meaningful Activities in Community-Dwelling Japanese Older Adults. . Journal of clinical medicine9 ( 3 ) 2020.3International journal

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

The aim of this cross-sectional study was to investigate relationships between individuals' ratings of satisfaction and performance of activities that they found meaningful and depressive symptoms. Data was obtained from 806 older adults (mean age 74.9 ± 6.3 years, women = 63.0%) who participated in a community-based health check survey (Tarumizu Study 2018). Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Non-linear logistic regression analyses were used separately by gender to examine the association between satisfaction and performance of meaningful activities and depressive symptoms. The prevalence of depressive symptoms was 15.8%. We found no significant difference between meaningful activity choice between older adults with depressive symptoms and those without, in both men and women. After adjusting for potential covariates, satisfaction was associated with depressive symptoms in both men (OR 0.52, 95% CI 0.35-0.77) and women (OR 0.67, 95% CI 0.49-0.91), but performance was limited in women (OR 0.87, 95% CI 0.77-0.99). Our findings suggest that depressive symptoms are associated with satisfaction in meaningful activities regardless of activity categories.

DOI： 10.3390/jcm9030795

Kim MJ, Tsutsumimoto K, Doi T, Nakakubo S, Kurita S, Makizako H, Shimada H. . Relationships between cognitive leisure activities and cognitive function in older adults with depressive symptoms: a cross-sectional study. . BMJ Open10 ( 2 ) 2020.2Reviewed

Min Ji Kim, Kota Tsutsumimoto, Takehiko Doi, Sho Nakakubo, Satoshi Kurita, Hyuma Makizako, Hiroyuki Shimada . Relationships between cognitive leisure activities and cognitive function in older adults with depressive symptoms: a cross-sectional study. . BMJ open10 ( 2 ) e032679 2020.2International journal

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

OBJECTIVES: The current study aimed to elucidate the associations between cognitive leisure activities and cognitive function in an older population stratified by having or not having depressive symptoms. DESIGN: A retrospective cross-sectional study based on a self-report questionnaire. SETTING: Annual health check-ups in a rural community in Japan. PARTICIPANTS: A total of 11 010 community-dwelling older adults aged ≥65 years (mean age: 74.0±5.4 years) was examined. Participants with missing data for the main outcome (n=1630) were excluded. OUTCOME MEASURES: Cognitive impairment was defined as at least 1.5 SD below the reference threshold (age-adjusted and education-adjusted score) on two of more of the tests in the National Center for Geriatrics and Gerontology-Functional Assessment Tool. Depressive symptoms were defined by a 15-item Geriatric Depression Scale score ≥6. We assessed the frequency of participation in cognitive leisure activities using the validated scale (score: 0-42). A score of ≥8 points was defined as frequent participation in cognitive leisure activities. RESULTS: A total of 12.6% (n=1186) of the participants had depressive symptoms. There was a significant association between cognitive leisure activities and cognitive impairment in older adults (adjusted OR=0.77, 95% CI=0.65 to 0.94). In older adults with depressive symptoms, a higher frequency of cognitive leisure activities was negatively associated with cognitive impairment (adjusted OR=0.45, 95% CI=0.28 to 0.70). In contrast, there was no significant association in older adults without depressive symptoms (adjusted OR=0.85, 95% CI=0.70 to 1.02). CONCLUSIONS: Engaging in cognitive leisure activities in late life is associated with better cognitive function in older adults with depressive symptoms.

DOI： 10.1136/bmjopen-2019-032679

Yuki Nakai, Hyuma Makizako, Ryoji Kiyama, Kazutoshi Tomioka, Yoshiaki Taniguchi, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi . Association between Chronic Pain and Physical Frailty in Community-Dwelling Older Adults. . International journal of environmental research and public health17 ( 1 ) 2020.1Reviewed International journal

Makizako H, Tsutsumimoto K, Doi T, Makino K, Nakakubo S, Teresa LA, Shimada H . Exercise and Horticultural Programs for Older Adults with Depressive Symptoms and Memory Problems. A Randomized Controlled Trial. . J Clin Med9 ( 1 ) 2019.12Reviewed

Hyuma Makizako, Kota Tsutsumimoto, Takehiko Doi, Keitaro Makino, Sho Nakakubo, Teresa Liu-Ambrose, Hiroyuki Shimada . Exercise and Horticultural Programs for Older Adults with Depressive Symptoms and Memory Problems: A Randomized Controlled Trial. . Journal of clinical medicine9 ( 1 ) 2019.12Reviewed International journal

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

Depressive symptoms and memory problems are risk factors for dementia. Exercise can reduce these in older people, and horticultural activity can benefit people with dementia. This study assessed the efficacy of exercise and horticultural interventions for community-dwelling older adults with depressive symptoms and mild memory decline. In this randomized controlled trial, older adults (n = 89) were assigned to exercise, horticultural, or control groups. Exercise and horticultural programs included 20 weekly 90-minute sessions. The control group attended two 90-minute classes. Outcomes were assessed at baseline, and then 6- and 12-months post-intervention. Primary outcome measures were the Geriatric Depression Scale-15 (GDS-15) and Wechsler Memory Scale-Revised. Walking speed, two-minute walking test scores, social network, life space, and subjective daily physical activity were secondary outcome measures. Compared with the control group, the exercise group obtained higher immediate and delayed recall logical memory scores, and the increase in immediate recall scores remained 12-months post-intervention. Two-minute walking performance improved in the exercise group, but not after 12 months. GDS-15 scores showed no significant improvements. The horticultural and control groups showed no differences. Exercise may improve memory, while horticultural activity may not. The effects of exercise and horticultural interventions on depressive symptoms remain unclear.

DOI： 10.3390/jcm9010099

Makizako H, Nakai Y, Tomioka K, Taniguchi Y . Prevalence of sarcopenia defined using the Asia Working Group for Sarcopenia criteria in Japanese community-dwelling older adults. A systematic review and meta-analysis. . Phys Ther Res22 ( 2 ) 53 - 57 2019.11Invited Reviewed

Hirase T, Makizako H, Okubo Y, Lord SR, Inokuchi S, Okita M. . Chronic pain is independently associated with social frailty in community-dwelling older adults. . Geriatr Gerontol Int19 ( 11 ) 1153 - 1156 2019.11Reviewed

Kume Y, Takahashi T, Itakura Y, Lee S, Makizako H, Ono T, Shimada H, Ota H . Characteristics of Mild Cognitive Impairment in Northern Japanese Community-Dwellers from the ORANGE Registry. . J Clin Med8 ( 11 ) 2019.11Reviewed

Yu Kume, Tomoko Takahashi, Yuki Itakura, Sangyoon Lee, Hyuma Makizako, Tsuyosi Ono, Hiroyuki Shimada, Hidetaka Ota . Characteristics of Mild Cognitive Impairment in Northern Japanese Community-Dwellers from the ORANGE Registry. . Journal of clinical medicine8 ( 11 ) 2019.11Reviewed International journal

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

A gradually increasing prevalence of mild cognitive impairment (MCI) is recognized in the super-aging society that Japan faces, and early detection and intervention in community-dwellers with MCI are critical issues to prevent dementia. Although many previous studies have revealed MCI/non-MCI differences in older individuals, information on the prevalence and characteristics of MCI in rural older adults is limited. The aim of this study was to investigate differential characteristics between older adults with and without MCI. The investigation was conducted over one year from 2018 to 2019. Participants were recruited from Akita in northern Japan. Neuropsychological assessments were applied to classify MCI, including the National Center for Geriatrics and Gerontology Functional Assessment Tool (NCGG-FAT) and the Touch panel-type Dementia Assessment Scale (TDAS) based on the Alzheimer's disease assessment scale. Our samples consisted of 103 older adults divided into 54 non-MCI and 49 MCI. The MCI group had lower scores of all cognitive items. Our results showed that individuals with MCI had significantly slower walking speed (WS) and worse geriatric depression scale (GDS) compared to non-MCI. In addition, WS was significantly associated with some cognitive items in non-MCI, but not in MCI. Finally, we showed that predictive variables of MCI were WS and GDS. Our study provides important information about MCI in rural community-dwellers. We suggest that older adults living in a super-aging society should receive lower limb training, and avoiding depression in older adults through interaction of community-dwellers may contribute to preventing the onset of MCI.

DOI： 10.3390/jcm8111937

Hirase T, Makizako H, Okubo Y, Lord SR, Inokuchi S, Okita M . Chronic pain is independently associated with social frailty in community-dwelling older adults. . Geriatrics & gerontology international19 ( 11 ) 1153 - 1156 2019.11Reviewed

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

AIM: The present study aimed to determine whether measures of chronic pain are associated with social frailty in community-dwelling older adults. METHODS: Participants comprised 248 older adults who enrolled for community-based exercise classes. Chronic pain was defined as the presence of significant pain-related symptoms within the past month that had continued for at least 6 months. Social frailty was defined as positive responses to two of the following five questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone and not talking with someone every day). Physical function was assessed using the Chair Stand and Timed Up and Go tests. RESULTS: A total of 55 participants (22.2%) met the criteria for social frailty. A total of 28 socially frail participants (50.9%) and 56 of the socially integrated participants (29.0%) reported chronic pain. The presence of chronic pain was significantly associated with social frailty after adjusting for age, sex and physical function measures (odds ratio 2.13, 95% confidence interval 1.01-4.48). Chronic pain was also significantly associated with three social frailty items: going out less frequently, rarely visiting friends and feeling unhelpful to friends or family. CONCLUSIONS: Chronic pain was independently associated with social frailty in community-dwelling older adults. Simple assessments of chronic pain and subsequent pain management interventions might be beneficial for older people with social frailty. Geriatr Gerontol Int 2019; 19: 1153-1156.

DOI： 10.1111/ggi.13785

Makizako H . Frailty and Sarcopenia as a Geriatric Syndrome in Community-Dwelling Older Adults. . Int J Environ Res Public Health16 ( 20 ) 2019.10Invited Reviewed

Sho Nakakubo, Takehiko Doi, Hyuma Makizako, Kota Tsutsumimoto, Satoshi Kurita, Minji Kim, Hideaki Ishii, Takao Suzuki, Hiroyuki Shimada . Association of sleep condition and social frailty in community-dwelling older people. . Geriatrics & gerontology international19 ( 9 ) 885 - 889 2019.9Reviewed

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

AIM: This cross-sectional study examined whether sleep duration and excessive daytime sleepiness (EDS) were associated with social frailty in community-dwelling older people. METHODS: A total of 4427 community-dwelling older people (51.4% women, mean age 71.9 years) who met the entry criteria were included in this study. Social frailty was assessed by five questions, relating to going out less frequently than last year, not visiting friends sometimes, not feeling helpful to friends or family, living alone and not talking with someone every day. Participants with two or more components were defined as having social frailty. Sleep duration and EDS were assessed by self-reported questionnaire. Logistic regression analysis estimated odds ratios and 95% confidence intervals of social frailty according to EDS or the three categories of sleep duration (short ≤6.0 h, medium 6.1-8.9 h, long ≥9.0 h), and we used medium-duration sleepers as the reference group. RESULTS: Among all participants, the prevalence of social frailty in each sleep duration group was as follows: long 18.3%, short 9.9% and medium 9.7% (P < 0.001). The prevalence of social frailty in participants with EDS was 17.1% (no EDS 10.2%, P < 0.001). Long sleep duration (odds ratio 1.46, 95% confidence interval 1.14-1.84) and presence of EDS (hazard ratio 1.32, 95% confidence interval 1.02-1.71) were associated with higher rates of social frailty after adjustments for several covariates. CONCLUSIONS: Long sleep duration and EDS were associated with social frailty; thus, older people with both sleep patterns would have a higher risk of progression of social frailty. Geriatr Gerontol Int 2019; 19: 885-889.

DOI： 10.1111/ggi.13734

Nakakubo S, Doi T, Makizako H, Tsutsumimoto K, Kurita S, Kim M, Ishii H,Suzuki T, Shimada H. . Association of sleep condition and social frailty in community-dwelling older people. . Geriatr Gerontol Int19 ( 9 ) 885 - 889 2019.9Reviewed

Nakakubo S, Doi T, Makizako H, Tsutsumimoto K, Hotta R, Kurita S, Kim M,Suzuki T, Shimada H. . Sleep condition and cognitive decline in Japanese community-dwelling older　people: Data from a 4-year longitudinal study . J Sleep Res28 ( 4 ) e12803 2019.8Reviewed

Sho Nakakubo, Takehiko Doi, Hyuma Makizako, Kota Tsutsumimoto, Ryo Hotta, Satoshi Kurita, Minji Kim, Takao Suzuki, Hiroyuki Shimada . Sleep condition and cognitive decline in Japanese community-dwelling older people: Data from a 4-year longitudinal study. . Journal of sleep research28 ( 4 ) e12803 2019.8Reviewed International journal

Language：English

This study examined whether sleep duration and excessive daytime sleepiness (EDS) are related to cognitive decline among community-dwelling older adults with intact cognition at baseline, using 4-year longitudinal data. A total of 3,151 community-dwelling older individuals aged ≥65 years were studied. They were assessed for cognitive function, including memory, attention, executive function and processing speed. Cognitive impairment was defined based on a score >1.5 standard deviations below the age- and education-specific mean. Cognitive decline was defined in one or more cognitive tests at follow-up. Self-reported sleep duration (short, ≤6.0 hr; medium, 6.1-8.9 hr; long, ≥9.0 hr) and EDS at first-wave examination were assessed and logistic regression analyses were used to examine the associations of sleep duration and EDS with cognitive status at second-wave examination. The incidence of cognitive decline differed significantly among the sleep-duration groups (short, 15.9%; medium, 11.9%; long, 20.1%; p = 0.001). The prevalence of having EDS was 13.1%, which was associated with a higher rate of cognitive decline than having no EDS (18.9% vs. 12.5%, p = 0.004). Long sleep duration compared with medium sleep duration (OR, 1.50; 95% CI, 1.05-2.13) and EDS (1.43; 1.01-2.03) independently impacted the incidence of cognitive decline. The results were similar after multiple imputations (long, 1.68, 1.12-2.52; EDS, 1.55, 1.05-2.29). In conclusion, our study revealed that both long sleep duration and EDS were independent risk factors associated with cognitive decline after 4 years among older adults.

DOI： 10.1111/jsr.12803

桑波田聡, 立志公史郎, 毛利翔悟, 手塚綾乃, 安部智, 竹中俊宏, 牧迫飛雄馬, 叶内宏明, 窪薗琢郎, 大石充 . エネルギー摂取過多高齢者の生活機能・生活習慣の特徴垂水研究からの報告 . 日本老年医学会雑誌56 ( Suppl. ) 115 - 116 2019.5

赤崎雄一, 杉浦剛, 牧迫飛雄馬, 田平隆行, 桑波田聡, 大石充 . 未治療高血圧の要因分析垂水研究からの考察 . 日本高血圧学会臨床高血圧フォーラムプログラム・抄録集8回 199 - 199 2019.5

宮崎宣丞, 木山良二, 牧迫飛雄馬, 川田将之, 竹下康文, 林浩之, 米和徳, 窪薗琢郎, 竹中俊宏, 大石充 . 地域在住高齢者におけるサルコペニアと歩行パラメーターの関連 . 日本老年医学会雑誌56 ( Suppl. ) 120 - 120 2019.5Reviewed

赤崎雄一, 杉浦剛, 牧迫飛雄馬, 田平隆行, 桑波田聡, 大石充 . コントロール不良高血圧の要因分析垂水研究からの考察 . 日本高血圧学会臨床高血圧フォーラムプログラム・抄録集8回 175 - 175 2019.5

Nakai Y, Makizako H, Kiyama R, Tomioka K, Taniguchi Y, Kubozono T, Takenaka T, Ohishi M. . Association between chronic pain and physical frailty in community-dwelling older adults. . Int J Environ Res Public Health16 ( 8 ) 2019.4Reviewed

Maruta M, Tabira T, Makizako H, Sagari A, Miyata H, Yoshimitsu K, Han G, Yoshiura K, Kawagoe M. . Impact of outpatient rehabilitation service in preventing the deterioration of the care-needs level among Japanese older adults availing long-term care insurance. A Propensity Score Matched Retrospective Study. . Int J Environ Res Public Health 16 ( 7 ) 2019.4Reviewed

Taniguchi Y, Makizako H, Kiyama R, Tomioka K, Nakai Y, Kubozono T, Takenaka T, Ohishi M. . The Association between osteoporosis and grip strength and skeletal muscle mass in community-dwelling older women. . Int J Environ Res Public Health16 ( 7 ) 2019.4Reviewed

Language：English

This cross-sectional study investigated the association between chronic pain and physical frailty in community-dwelling older adults. We analyzed data obtained from 323 older adults (women: 74.6%) who participated in a community-based health check survey (the Tarumizu Study, 2017). Physical frailty was defined in terms of five parameters (exhaustion, slowness, weakness, low physical activity, and weight loss). We assessed the prevalence of chronic low back and knee pain using questionnaires. Participants whose pain had lasted ≥two months were considered to have chronic pain. Among all participants, 138 (42.7%) had chronic pain, and 171 (53.0%) were categorized as having physical frailty or pre-frailty. Logistic regression analysis showed that chronic pain was significantly associated with the group combining frailty and pre-frailty (odds ratio 1.68, 95% confidence interval 1.03-2.76, p = 0.040) after adjustment for age, sex, body mass index, score on the 15-item Geriatric Depression Scale, and medications. Comparing the proportions of chronic pain among participants who responded to the sub-items, exhaustion (yes: 65.9%, no: 39.4%) demonstrated a significant association (p < 0.001). Chronic pain could be associated with the group combining frailty and pre-frailty and is particularly associated with exhaustion in community-dwelling older adults. Therefore, there is a need for early intervention and consideration of the role of exhaustion when devising interventions for physical frailty in older individuals with chronic pain.

DOI： 10.3390/ijerph16081330

Michio Maruta, Takayuki Tabira, Hyuma Makizako, Akira Sagari, Hironori Miyata, Koji Yoshimitsu, Gwanghee Han, Kazuhiro Yoshiura, Masahiro Kawagoe . Impact of Outpatient Rehabilitation Service in Preventing the Deterioration of the Care-Needs Level Among Japanese Older Adults Availing Long-Term Care Insurance: A Propensity Score Matched Retrospective Study. . International journal of environmental research and public health16 ( 7 ) 2019.4International journal

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

Outpatient rehabilitation (OR) and outpatient day long-term care (ODLC) services are frequently used by older adult patients in Japan. However, there is a need to clarify that OR service, which has more rehabilitation professionals than ODLC, has the role of providing rehabilitation. This retrospective study examined the impact of OR services by comparing the two services based on City A data from the care-needs certification survey conducted between 2015 to 2017. We performed a propensity score matched analysis to compare the changes in the care level and function of OR and ODLC users after two years. The results showed that OR users showed a lower deterioration in care levels and less decline in the activities of daily living (ADL) in dementia and adaptation to social life. In the analysis of older adults requiring support, OR users had a lower deterioration in care levels and less decline in the ADL in dementia and behavioral and psychological symptoms than ODLC users did. There was no difference between the two services with respect to older adults requiring long-term care. The OR service has had an increasingly preventive effect on the deterioration of care levels compared to the ODLC service, which was particularly evident in older adults requiring support.

DOI： 10.3390/ijerph16071292

Yoshiaki Taniguchi, Hyuma Makizako, Ryoji Kiyama, Kazutoshi Tomioka, Yuki Nakai, Takuro Kubozono, Toshihiro Takenaka, Mitsuru Ohishi . The Association between Osteoporosis and Grip Strength and Skeletal Muscle Mass in Community-Dwelling Older Women. . International journal of environmental research and public health16 ( 7 ) 2019.4Reviewed International journal

Language：English

This cross-sectional study investigated the association between osteoporosis, grip strength, and skeletal muscle mass in community-dwelling older women. Data obtained from 265 older women who participated in a community-based health check survey (Tarumizu Study) were analyzed. Face-to-face interviews with participants revealed their history of osteoporosis. Appendicular skeletal muscle mass was assessed through bioelectrical impedance analysis, and appendicular skeletal muscle index was calculated. Dominant grip strength was also assessed. Loss of skeletal muscle mass (appendicular skeletal muscle mass < 5.7 kg/m²) and muscle weakness (grip strength < 18 kg) were determined based on criteria for sarcopenia put forth by the Asian Working Group for Sarcopenia. The prevalence rates of osteoporosis, muscle weakness, and loss of skeletal muscle mass were 27.2%, 28.7%, and 50.2%, respectively. Loss of skeletal muscle mass was more prevalent in participants with osteoporosis than in those without (65.3% vs. 44.6%, p < 0.01). The association between osteoporosis and muscle strength was not significant (30.6% vs. 28.0%, p = 0.68). After covariate adjustment, loss of skeletal muscle mass was found to be independently associated with osteoporosis (odds ratio 2.56, 95% confidence interval 1.33⁻4.91). In sum, osteoporosis was found to be associated with loss of skeletal muscle mass, but not with muscle weakness in community-dwelling older women.

DOI： 10.3390/ijerph16071228

Lee Sungchul, Lee Sangyoon, Bae Seongryu, Harada Kazuhiro, Jung Songee, Makizako Hyuma, Shimada Hiroyuki . Impact of sedentary time on chronic kidney disease and disability incidence in community-dwelling Japanese older adults: A 4-year prospective cohort study . Journal of Aging and Physical Activity27 ( 2 ) 184 - 190 2019.4Reviewed International journal

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

This study examined the association between the estimated glomerular filtration rate (eGFR) and disability incidence according to sedentary time in community-dwelling Japanese older adults. This prospective cohort study sampled 5,104 community-dwelling older adults (≥65 years) enrolled in a health promotion study in a general population. The participants (n = 4,457; ≥65 years) were monitored for inclusion in the long-term care insurance system for 4 years. This study used blood samples to assess eGFR. Cox proportional regression analysis was used to determine predictors of disability. In total, 461 participants (10.3%) became newly certified as needing long-term care insurance services. Cox regression models were adjusted for multiple confounders: eGFR < 45 ml/min/1.73 m2 (hazard ratio = 1.741, 95% confidence interval [1.193-2.539]) and eGFR < 45 ml/min/1.73 m2 with high sedentary time (≥8 hr) (hazard ratio = 4.367, 95% confidence interval [2.021-9.438]) remained significantly associated with disability incidence. Our findings suggest that in the case of chronic kidney disease, the disability incidence rate may be affected by sedentary time.

DOI： 10.1123/japa.2017-0326

Shimada H, Doi T, Lee S, Makizako H. . Reversible predictors of reversion from mild cognitive impairment to normal cognition: a 4-year longitudinal study. . Alzheimers Res Ther11 ( 1 ) 24 2019.3Reviewed

Hiroyuki Shimada, Takehiko Doi, Sangyoon Lee, Hyuma Makizako . Reversible predictors of reversion from mild cognitive impairment to normal cognition: a 4-year longitudinal study. . Alzheimer's research & therapy11 ( 1 ) 24 - 24 2019.3Reviewed International journal

Language：English

BACKGROUND: Although previous studies have revealed many factors related to mild cognitive impairment (MCI) reversion, information about reversible factors related MCI reversion is limited, impeding the development of intervention strategies. The aim of the present study was to examine whether reversible factors such as lifestyle activities are associated with MCI reversion in elderly individuals using the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes database. A total of 396 community-living older adults (age ≥ 65 years) participated in the study. They were classified as reverters or non-reverters from mild cognitive impairment to normal cognition. We assessed lifestyle activities, potential confounding factors of cognitive decline, and reversion of mild cognitive impairment. RESULTS: In a completed data set of 396 participants, 202 participants (51.0%) reverted from MCI to normal cognition. The reversion rate in participants for whom we imputed data was 34.3%. In the imputed group, a logistic regression model showed that the odds ratios (ORs) for reversion were significantly higher in participants who drove a car (OR 1.50, 95% confidence interval (CI) 1.41-1.60), used a map to travel to unfamiliar places (OR 1.12, 95% CI 1.06-1.18), read books or newspapers (OR 1.54, 95% CI 1.37-1.73), took cultural classes (OR 1.10, 95% CI 1.04-1.15), attended meetings in the community (OR 1.22, 95% CI 1.16-1.28), participated in hobbies or sports activities (OR 1.09, 95% CI 1.03-1.16), and engaged in fieldwork or gardening (OR 1.14, 95% CI 1.08-1.21). The imputed sample showed that non-reverters were more likely to discontinue fieldwork or gardening (11.0% vs. 6.1%) than reverters during the follow-up period. CONCLUSIONS: Specific lifestyle activities may play important roles in MCI reversion in older adults. The longitudinal data indicate that it is reasonable to recommend that individuals continue to engage in fieldwork or gardening to increase their chance of recovery from MCI.

DOI： 10.1186/s13195-019-0480-5

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02464&link_issn=&doc_id=20190305030008&doc_link_id=%2Faj2rsizd%2F2019%2F003002%2F009%2F0177-0184%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faj2rsizd%2F2019%2F003002%2F009%2F0177-0184%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

丸田道雄, 田平隆行, 牧迫飛雄馬, 韓こう煕, 吉満孝二, 中村篤, 窪薗琢郎, 大石充 . 地域在住独居高齢者における心の理論課題成績と社会参加との関連 . 老年精神医学雑誌30 ( 2 ) 177 - 184 2019.2

Language：Japanese Publisher：(株)ワールドプランニング

本研究は、独居高齢者に焦点をあてて、心の理論と社会参加の関連について検討した。鹿児島県垂水市における垂水研究2017に参加した地域在住高齢者のうち独居者102人を対象とした。調査項目は、心の理論、年齢、性別、認知機能、抑うつ状態、社会参加、外出頻度、毎日の他者との会話の有無とした。心の理論の一次的信念課題はサリーとアン課題とし、同課題に「アンが宝物を移す様子を窓からサリーが見ている」という内容を加え「アンは、戻ってきたサリーがどこを探すと思うか」と質問し、二次的信念課題とした。一次的・二次的信念課題それぞれで、正解と不正解の2群に分けて単変量解析を行い、有意差を認めた項目を独立変数、正解・不正解を従属変数としたロジスティック回帰分析を行った。その結果、二次的信念課題において、社会参加が関連因子として抽出された。独居高齢者において、心の理論を保つために社会参加を支援することの重要性が示唆された。(著者抄録)

Hideaki Ishii, H. Makizako, T. Doi, K. Tsutsumimoto, H. Shimada . Associations of Skeletal Muscle Mass, Lower-Extremity Functioning, and Cognitive Impairment in Community-Dwelling Older People in Japan . The journal of nutrition, health & aging23 ( 1 ) 35 - 41 2019.1

Makizako H, Kubozono T, Kiyama R, Takenaka T, Kuwahata S, Tabira T, Kanoya T, Horinouchi K, Shimada H, Ohishi M . Associations of social frailty with loss of muscle mass and muscle weakness among community-dwelling older adults. . Geriatrics & gerontology international19 ( 1 ) 76 - 80 2019.1Invited Reviewed

Ishii H, Makizako H, Doi T, Tsytynuniti K, Shimada H. . Associations of skeletal muscle mass, lower-extremity functioning, and cognitive impairment in community-dwelling older people in Japan . J Nutr Health Aging23 ( 1 ) 35 - 41 2019Reviewed

丸田道雄，田平隆行，牧迫飛雄馬，韓侊熙，吉満孝二，中村篤，窪園琢郎，大石充 . 地域在住独居高齢者における心の理論課題成績と社会参加との関連． . 老年精神医学雑誌30 ( 2 ) 177 - 184 2019Reviewed

木村美佳，守安愛，牧迫飛雄馬，伊平井平光，古名丈人 . 介護予防を目的とした郵便による食習慣介入の効果：積雪・寒冷・過疎地域在住高齢者における検討． . 日本公衛誌66 ( 11 ) 681 - 689 2019Reviewed

Hiroyuki Shimada, Ryo Hotta, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Sho Nakakubo, Keitaro Makino . Effects of Driving Skill Training on Safe Driving in Older Adults with Mild Cognitive Impairment. . Gerontology65 ( 1 ) 90 - 97 2019Reviewed International journal

Language：English

BACKGROUND: Driving cessation is strongly associated with adverse health outcomes in the older adults. Although there were numerous documentations of driving rehabilitation in disabled adults, the effects of interventions on safe driving were not clear in older adults with cognitive impairment who had low driving skills. OBJECTIVE: This randomized controlled trial was designed to determine whether a safe driving skill program consisting of classroom and on-road training could enhance driving performance of older drivers with cognitive impairment in Japan. METHODS: A total of 160 community-living older drivers participated in the randomized controlled trial with blinded endpoint assessment. Participants randomized to intervention underwent 10 1-h classroom sessions and 10 1-h on-road sessions focused on common problem areas of older drivers. Controls received 1 classroom education. On-road driving performance was assessed by certified driving school instructors in a driving school. The participants carried out dynamic vision and cognitive performance tests. RESULTS: One hundred and forty-six (intervention group, n = 71) subjects completed the 3-month follow-up. Mean adherence to classroom-based vision training and driving simulator training and on-road training programs, including the 71 participants, was 99.0 ± 6.4 and 99.0 ± 7.2%, respectively. Regarding the safe driving skill score, there were group × time interactions (p < 0.01) indicating benefits of the intervention over time. Although there were no significant group × time interactions in cognitive tests, dynamic vision showed group × time interactions (p < 0.01). CONCLUSION: The driving skill program significantly improved safe driving performance in older adults with cognitive impairment who were at a potentially high risk of a car accident.

DOI： 10.1159/000487759

Hyuma Makizako, Yuki Nakai, Kazutoshi Tomioka, Yoshiaki Taniguchi . Prevalence of sarcopenia defined using the Asia Working Group for Sarcopenia criteria in Japanese community-dwelling older adults: A systematic review and meta-analysis. . Physical therapy research22 ( 2 ) 53 - 57 2019Reviewed

Language：English

The aim of this systematic review and meta-analyses was to calculate the pooled prevalence of sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) criteria among Japanese community-dwelling older adults. Data from 8 studies were used to determine the prevalence of sarcopenia in the overall population and in men; data from 9 studies were used to determine that of women. The pooled prevalence rates of sarcopenia using random-effects models were 9.9% (95% confidence interval [CI], 6.2%-15.4%) overall; 9.8% (95% CI, 6.2%-15.2%) among men; and 10.1% (95% CI, 6.4%-15.5%) among women. These findings would be useful to inform community-based strategies and advanced research addressing sarcopenia prevention.

DOI： 10.1298/ptr.R0005

田平隆行, 牧迫飛雄馬, 吉満孝二, 丸田道雄, 池田由里子, 中村篤, 下木原俊, 徳田圭一郎, 竹中俊宏, 窪薗琢郎, 大石充 . 地域在住高齢者における墓参り行動と心身機能、生活機能との関連 . 日本作業療法研究学会雑誌21 ( 2 ) 63 - 63 2018.12

Doi T, Makizako H, Tsutsumimoto K, Nakakubo S, Kim MJ, Kurita S, Hotta R, Shimada H. . Transitional status and modifiable risk of frailty in Japanese older adults: A prospective cohort study. . Geriatrics & Gerontology International18 ( 11 ) 1562 - 1566 2018.11Reviewed

Takehiko Doi, Hyuma Makizako, Kota Tsutsumimoto, Sho Nakakubo, Min-Ji Kim, Satoshi Kurita, Ryo Hotta, Hiroyuki Shimada . Transitional status and modifiable risk of frailty in Japanese older adults: A prospective cohort study. . Geriatrics & gerontology international18 ( 11 ) 1562 - 1566 2018.11Reviewed

Language：English

AIM: The purpose of the present study was to identify risk factors for physical frailty and to understand the transitional status of frailty. METHODS: The participants were 4676 older adults in the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. Physical frailty status was classified as robust, pre-frail and frail at baseline and 4-year follow up (mean follow up 47.9 ± 1.8 months). Data for demographic variables, medical conditions, fall, depressive symptoms and cognitive function were also collected. Multiple imputation was used to reduce selection bias and loss of information. RESULTS: Progression occurred from a robust to frail status in 52 participants (2.6%) and from pre-frailty to frailty in 281 participants (12.0%). Mortality increased with frailty status at baseline: robust 46 (2.3%), pre-frail 112 (4.8%) and frail 54 (15.6%). In logistic regression analysis, age (OR 1.10, 95% CI 1.06-1.13), sex (men; OR 0.67, 95% CI 0.46-0.95), body mass index (OR 1.06, 95% CI 1.01-1.12]), fall (OR 1.92, 95% CI 1.31-2.81), Geriatric Depression Scale (OR 1.15, 95% CI 1.08-1.22), Mini-Mental State Examination (OR 0.87, 95% CI 0.82-0.93) and education (OR 0.91, 95% CI 0.85-0.98), were related with new incident frailty. Among participants in the pre-frail class at baseline, exhaustion (OR 3.24, 95% CI 1.97-5.34), physical inactivity (OR 3.09, 95% CI 1.94-4.93), lower muscle strength (OR 3.77, 95% CI 2.35-6.03) and lower mobility (OR 2.54, 95% CI 1.57-4.10) were related to progression to frailty (all P < 0.05). CONCLUSIONS: The results of the present prospective study provide key information on the transitional status of frailty and the risk factors for progression to frailty. A further study is required to determine the pathophysiological changes that underlie the transition to frailty. Geriatr Gerontol Int 2018; 18: 1562-1566.

DOI： 10.1111/ggi.13525

Kota Tsutsumimoto, Takehiko Doi, Hyuma Makizako, Ryo Hotta, Sho Nakakubo, Keitaro Makino, Takao Suzuki, Hiroyuki Shimada . Aging-related anorexia and its association with disability and frailty. . Journal of cachexia, sarcopenia and muscle9 ( 5 ) 834 - 843 2018.10Reviewed International journal

Language：English

BACKGROUND: Anorexia of ageing may be a precursor to various geriatric syndromes. We elucidated whether anorexia of ageing had a significant impact on incident disability and investigated whether anorexia of ageing had a direct association with future disability or an indirect association with disability via frailty. METHODS: This study employed an observational, longitudinal, cohort design in a community setting. Participants were 4393 older adults (75.9 ± 4.3 years). Anorexia of ageing was assessed by a simplified nutritional appetite questionnaire. Frailty was operationalized as slowness, weakness, exhaustion, low physical activity, and weight loss. Participants who had none of these characteristics were considered robust, those with one or two characteristics were considered pre-frail, and those with three or more characteristics were considered frail. We examined sociodemographic variables (age, sex, and education), medical history (medication and chronic disease history), lifestyle factors (smoking and drinking habits and living arrangement), body mass index, blood nutrition data, depressive symptoms, physical functioning, and cognitive functioning. RESULTS: The prevalence of anorexia of ageing was 10.7% (n = 468). The proportion of physical frailty, pre-frailty, and robustness were 8.4, 52.0, and 39.6%, respectively, in the without anorexia of ageing group, and 20.3, 57.7, and 22.0%, respectively, in the anorexia of ageing group (P < 0.001). During a 2-year follow-up, the prevalence proportion of disability was 5.6% in the without anorexia of ageing group and 10.7% in the anorexia of ageing group (P < 0.001). Adjusted for covariates (except for frailty status), the participants with anorexia of ageing had an independently associated higher risk of incident disability compared with those without anorexia of ageing (hazard ratio: 1.43, 95% confidence interval: 1.04-1.95, P = 0.03). However, adjusted for covariates (including frailty status), anorexia of ageing was not significantly associated with incident disability (P = 0.09). Structural equation models revealed that anorexia of ageing had no direct effect on disability; however, anorexia of ageing was associated with frailty. CONCLUSIONS: Older adults with anorexia of ageing had a higher proportion of frailty and a higher prevalence proportion of disability compared with those without anorexia of ageing. Although anorexia of ageing may not have a direct effect on incident disability, the structural equation model suggests an indirect relationship between anorexia of ageing and incident disability via frailty status.

DOI： 10.1002/jcsm.12330

Sho Nakakubo, Takehiko Doi, Hyuma Makizako, Kota Tsutsumimoto, Ryo Hotta, Satoshi Kurita, Minji Kim, Takao Suzuki, Hiroyuki Shimada . Association of walk ratio during normal gait speed and fall in community-dwelling elderly people. . Gait & posture66 151 - 154 2018.10Reviewed International journal

Language：English

BACKGROUND: Walk ratio (WR), calculated by dividing step length by cadence, can be used to represent the gait characteristics of human beings to maintain their gait speed. RESEARCH QUESTION: The aim of this study was to examine whether WR could distinguish fallers from community-dwelling elderly people. METHODS: We recruited 9205 elderly people (mean age: 73.7 ± 5.6 years, 4218 men and 4987 women) from the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. Fall history was assessed by face-to-face interview, and "fallers" were defined as people who had fallen at least once within the past year. WR was calculated as corrected step length divided by corrected cadence, and we divided the subjects into three groups according to the tertile of WR (T1, T2, and T3). We also stratified the participants by gait speed (<1.0 or ≥1.0 m/s). RESULTS: With reference to the T3 group, the T1 group had a higher odds ratio (OR) of falling in the past year [OR: 1.24, 95% confidence interval (CI): 1.09-1.41], even after adjusting for other covariates. After stratification by gait speed, the same multivariate analyses were conducted. In the participants who walked at 1.0 m/s or faster, the T1 group had a higher OR [1.27, 95% confidence interval (CI): 1.10-1.48], while there was no significant association with fall rate among those who walked slower than 1.0 m/s. SIGNIFICANCE: This study revealed that the smallest WR was independently associated with falling in the past year among community-dwelling elderly people, especially elderly people with no deterioration of gait speed. These results suggest that intervention regarding gait pattern, especially WR, would help to prevent falls.

DOI： 10.1016/j.gaitpost.2018.08.030

Hiroyuki Shimada, Hyuma Makizako, Sangyoon Lee, Takehiko Doi, SungChul Lee . Lifestyle activities and the risk of dementia in older Japanese adults. . Geriatrics & gerontology international18 ( 10 ) 1491 - 1496 2018.10Reviewed

Language：English

AIM: The prevalence of dementia is rising due to increases in the aging population and chronic health conditions. The present study examined whether lifestyle activities, including instrumental activities of daily living and social roles, were associated with dementia incidence in Japanese community-dwelling older adults. METHODS: This longitudinal study involved 4564 participants (age ≥65 years) who were classified by age and sex. Lifestyle activities, risk factors for dementia and incidence of new dementia were recorded. RESULTS: After an average of 42.6 months, 219 participants (4.8%) experienced a new onset of dementia. Survival analyses using the Cox proportional hazards regression model showed that the probability of dementia was significantly lower in participants who engaged in daily conversation (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.35-0.89, P = 0.015), driving a car (HR 0.63, 95% CI 0.45-0.88, P = 0.007), shopping (HR 0.57, 95% CI 0.34-0.96, P = 0.033) and field work or gardening (HR 0.71, 95% CI 0.54-0.94, P = 0.016). CONCLUSIONS: We concluded that specific lifestyle activities might play an important role in preventing dementia in older adults. The activities that prevent dementia might differ depending on sex and age. Geriatr Gerontol Int 2018; 18: 1491-1496.

DOI： 10.1111/ggi.13504

Takehiko Doi, Hyuma Makizako, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Keitaro Makino, Takao Suzuki, Hiroyuki Shimada . Combined effects of mild cognitive impairment and slow gait on risk of dementia. . Experimental gerontology110 146 - 150 2018.9Reviewed International journal

Language：English

BACKGROUND: Mild cognitive impairment (MCI) is a high risk of conversion to dementia and gait dysfunction is also a risk for dementia. The goal of the study was to examine if co-occurrence of MCI and slow gait (SG) increases the risk of dementia. METHODS: A prospective study was conducted in 3937 older adults who did not have dementia at baseline. Participants were classified into groups based on status of MCI and SG: without MCI and SG (control), without MCI and with SG (SG), without SG and with MCI in a single domain (sMCI) or multiple domains (mMCI), sMCI and SG (sMCI + SG), and mMCI and SG (mMCI + SG). Incident dementia was followed monthly. Cox proportional hazards regression models were used to calculate the hazard ratio for incident dementia in each group. RESULTS: During a mean follow-up period of 43 months, 182 subjects had incident dementia. MCI was a risk factor for dementia and SG increased the risk, even after adjusting for covariates (SG: HR = 1.31 (0.81-2.14), 95% CI = 0.276, sMCI: HR = 1.87, 95% CI = 1.21-2.88, p = .005; mMCI: HR = 3.36, 95% CI = 1.98-5.71, p < .001; sMCI + SG: HR = 3.33, 95% CI = 1.92-5.77, p < .001; mMCI + SG: HR = 5.02, 95% CI = 2.75-9.14, p < .001). CONCLUSIONS: Co-occurrence of MCI and SG has a high risk of dementia compared to that of each condition alone. Evaluation of both gait and cognition is useful in risk assessment of dementia.

DOI： 10.1016/j.exger.2018.06.002

丸田道雄, 韓こう煕, 吉満孝二, 牧迫飛雄馬, 田平隆行 . 地域在住独居高齢者における心の理論課題成績と社会参加との関連 . 日本作業療法学会抄録集52回 OJ - 1 2018.9

Hiroyuki Shimada, Takehiko Doi, Sangyoon Lee, Hyuma Makizako, Liang-Kung Chen, Hidenori Arai . Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People. . Journal of clinical medicine7 ( 9 ) 2018.8Reviewed International journal

Language：English

Cognitive frailty, defined as the presence of both frailty and cognitive impairment, is a risk factor for adverse events in older adults. However, prevalence rates of cognitive frailty are low (1.1⁻2.5%), so primary screening is unsuitable in community settings. The aim of the study was to examine whether a new definition of cognitive frailty, which was developed for primary screening, is useful to predict incident dementia in community-dwelling older adults. A total of 4570 older adults participated in the study (2326 women; average age, 71.9 ± 5.5 years). We defined physical frailty as the presence of ≥1 of the following symptoms: slow walking speed and muscle weakness. Cognitive impairment was defined as ≥1 symptom of cognitive impairment, indicated by an age- and education-adjusted score that was ≥1.5 standard deviations below the reference threshold in word list memory, attention, executive function, and processing speed tests. Cognitive frailty was defined as comorbid physical frailty and cognitive impairment. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. The prevalence rates of physical frailty, cognitive impairment, and cognitive frailty were 17.5%, 15.3%, and 9.8%, respectively. Cognitive impairment (hazard ratio [HR]: 2.06, 95% confidence interval [95% CI]: 1.41⁻3.02) and cognitive frailty (HR: 3.43, 95% CI: 2.37⁻4.97) were found to be significant risk factors for dementia. However, the association between dementia and physical frailty was not significant (HR: 1.13, 95% CI: 0.76⁻1.69). Individuals with comorbid physical frailty and cognitive impairment could have a higher risk of dementia than healthy older adults or older adults with either physical frailty or cognitive impairment alone.

DOI： 10.3390/jcm7090250

Hiroyuki Shimada, Hyuma Makizako, Takehiko Doi, Hyuntae Park, Kota Tsutsumimoto, Joe Verghese, Takao Suzuki . Effects of Combined Physical and Cognitive Exercises on Cognition and Mobility in Patients With Mild Cognitive Impairment: A Randomized Clinical Trial. . Journal of the American Medical Directors Association19 ( 7 ) 584 - 591 2018.7Reviewed International journal

Language：English

IMPORTANCE: Although participation in physical and cognitive activities is encouraged to reduce the risk of dementia, the preventive efficacy of these activities for patients with mild cognitive impairment is unestablished. OBJECTIVE: To compare the cognitive and mobility effects of a 40-week program of combined cognitive and physical activity with those of a health education program. DESIGN: A randomized, parallel, single-blind controlled trial. SETTING: A population-based study of participants recruited from Obu, a residential suburb of Nagoya, Japan. PARTICIPANTS: Between August 2011 and February 2012, we evaluated 945 adults 65 years or older with mild cognitive impairment, enrolled 308, and randomly assigned them to the combined activity group (n = 154) or the health education control group (n = 154). INTERVENTIONS: The combined activity program involved weekly 90-minute sessions for 40 weeks focused on physical and cognitive activities. The control group attended 90-minute health promotion classes thrice during the 40-week trial period. MEASUREMENT: The outcome measures were assessed at the study's beginning and end by personnel blinded to mild cognitive impairment subtype and group. The primary endpoints were postintervention changes in scores on (1) the Mini-Mental State Examination as a measure of general cognitive status and memory, (2) the Wechsler Memory Scale-Revised-Logical Memory II, and (3) the Rey Auditory Verbal Learning Test. We applied mobility assessments and assessed brain atrophy with magnetic resonance imaging. RESULTS: Compared with the control group, the combined activity group showed significantly greater scores on the Mini-Mental State Examination (difference = 0.8 points, P = .012) and Wechsler Memory Scale-Revised-Logical Memory II (difference = 1.0, P = .004), significant improvements in mobility and the nonmemory domains and reduced left medial temporal lobe atrophy in amnestic mild cognitive impairment (Z-score difference = -31.3, P < .05). CONCLUSION: Combined physical and cognitive activity improves or maintains cognitive and physical performance in older adults with mild cognitive impairment, especially the amnestic type.

DOI： 10.1016/j.jamda.2017.09.019

Kazuki Uemura, Hyuma Makizako, Sangyoon Lee, Takehiko Doi, Sungchul Lee, Kota Tsutsumimoto, Hiroyuki Shimada . The impact of sarcopenia on incident homebound status among community-dwelling older adults: A prospective cohort study. . Maturitas113 26 - 31 2018.7Reviewed International journal

Language：English

OBJECTIVES: Whether sarcopenia predicts incident homebound status remains unclear. This prospective cohort study aimed to determine the impact of sarcopenia on the incidence of homebound status in community-dwelling older adults. METHODS: The study included 3958 community-dwelling elderly people aged ≥65 years who were not homebound at baseline. Sarcopenia was defined as the presence of both poor muscle function (low physical performance or low muscle strength) and low muscle mass. Potential confounding factors, such as physical status, mental status, and level of social participation, were also assessed. Fifteen months after the baseline measurements, data regarding the incidence of homebound status were obtained using a postal survey. RESULTS: In the 15-month follow-up survey, 83 participants (2.1%, 95% confidence interval = 1.6-2.5) were reported to have become homebound. A multiple logistic regression analysis indicated that age (odds ratio = 1.06, 95% confidence interval = 1.02-1.10), sarcopenia (1.98, 1.04-3.77), and limited contact with friends (1.82, 1.03-3.23) were independently associated with an increased risk of becoming homebound. In a stratified analysis for age group, a significant odds ratio for low level of social role (2.50, 1.06-5.91) was observed in young-old subjects (aged 65-74 years), whereas significant odds ratios for sarcopenia (2.80, 1.33-5.91) and physical inactivity (2.85, 1.28-6.37) were observed in old-old subjects (aged 75 years and over). CONCLUSION: Sarcopenia had a strong impact on the risk of becoming homebound. Particularly in old-old subjects, sarcopenia and physical inactivity may impair people's ability to engage in activities outside the home much more than either their mental status or their level of social participation.

DOI： 10.1016/j.maturitas.2018.03.007

Ryo Hotta, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Sho Nakakubo, Keitaro Makino, Hiroyuki Shimada . Cognitive function and unsafe driving acts during an on-road test among community-dwelling older adults with cognitive impairments. . Geriatrics & gerontology international18 ( 6 ) 847 - 852 2018.6Reviewed

Language：English

AIM: To examine the relationship between cognitive function and unsafe driving acts among community-dwelling older adults with cognitive impairments. METHODS: Participants (n = 160) were older residents of Obu, Japan, aged ≥65 years with cognitive impairments. They regularly drove and were assessed for the number of unsafe driving acts without adequate verification during an on-road test. We also evaluated cognitive function (attention, executive function and processing speed). Other examined variables included demographics, driving characteristics and visual condition. RESULTS: Participants were classified into two groups according to the number of unsafe driving acts as follows: high group (≥4 unsafe driving acts) and low group (≤3 unsafe driving acts). The high group participants were older in age (P < 0.001) and obtained a lower score on the symbol digit substitution task (P = 0.002) than the low group. The number of unsafe driving acts showed modest significant positive correlations with age (r = 0.396, P < 0.001). The symbol digit substitution task score was significantly associated with the number of unsafe driving acts (β = -0.196, P < 0.05) after adjusting for age group. CONCLUSIONS: Processing speed was associated with unsafe driving acts that became worse with increasing age. Future study will be required to longitudinally examine the influence of processing speed on traffic accidents for those with cognitive impairments. Geriatr Gerontol Int 2018; 18: 847-852.

DOI： 10.1111/ggi.13260

Kota Tsutsumimoto, Takehiko Doi, Hyuma Makizako, Ryo Hotta, Sho Nakakubo, Minji Kim, Satoshi Kurita, Takao Suzuki, Hiroyuki Shimada . Social Frailty Has a Stronger Impact on the Onset of Depressive Symptoms than Physical Frailty or Cognitive Impairment: A 4-Year Follow-up Longitudinal Cohort Study. . Journal of the American Medical Directors Association19 ( 6 ) 504 - 510 2018.6Reviewed International journal

Language：English

OBJECTIVES: To examine the association between each type of frailty status and the incidence rate of depressive symptoms among community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: General communities in Japan. PARTICIPANTS: Participants comprised 3538 older Japanese adults. MEASUREMENTS: We assessed our participants in terms of frailty status (physical frailty, cognitive impairment, and social frailty), depressive symptoms (geriatric depression scale ≥6), and other covariates, and excluded those who showed evidence of depression. Then, after a 4-year interval, we again assessed the participants for depressive symptoms. Physical frailty was defined by the Fried criteria, showing 1 or more of these were physical frailty. To screen for cognitive impairment, receiving a score below an age-education adjusted reference threshold in 1 or more tests was cognitive impairment. Finally, social frailty was defined using 5 questions, and those who answered positively to 1 or more of these were considered to have social frailty. RESULTS: After multiple imputations, the incidence rate of depressive symptoms after 4 years of follow-up was 7.2%. The incidence rates of depressive symptoms for each frailty status were as follows: 9.6% for physical frailty vs 4.6% without, 9.3% for cognitive impairment vs 6.5% without, and 12.0% for social frailty vs 5.1% without. Finally, through the application of multivariable logistic regression analysis, the incidence of depressive symptoms was found to have a significant association with social frailty (odds ratio 1.55; 95% confidence interval 1.10-2.20) but not with physical frailty or cognitive impairment. CONCLUSIONS: This study revealed that social frailty, in comparison with physical frailty and cognitive impairment, is more strongly associated with incidences of depressive symptoms among elderly.

DOI： 10.1016/j.jamda.2018.02.008

Shimada H, Doi T, Lee S, Makizako H, Chen LK, Arai H. . Cognitive frailty predicts incident dementia among community-dwelling older people. . Journal of Clinical Medicine7 ( 9 ) 2018.5Reviewed

富岡一俊, 宮崎宣丞, 竹下康文, 園田耕一, 加治智和, 桑波田聡, 安部智, 竹中俊宏, 牧迫飛雄馬, 窪薗琢郎, 大石充 . 垂水研究からみた地方高齢者の運動習慣と血圧パイロット・スタディから見えてきたもの . 日本高血圧学会臨床高血圧フォーラムプログラム・抄録集7回 161 - 161 2018.5Reviewed

牧迫飛雄馬, 窪薗琢郎, 木山良二, 竹中俊宏, 桑波田聡, 田平隆行, 鹿屋勉, 堀之内貢子, 島田裕之, 大石充 . 高齢者の社会的フレイルと骨格筋量、握力との関連 . 日本老年医学会雑誌55 ( Suppl. ) 118 - 118 2018.5

Makino K, Makizako H, Doi T, Tsutsumimoto K, Hotta R, Nakakubo S, Suzuki T, Shimada H. . Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study . Int J Geriatr Psychiatry33 ( 4 ) 658 - 662 2018.4Reviewed

Keitaro Makino, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Takao Suzuki, Hiroyuki Shimada . Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study. . International journal of geriatric psychiatry33 ( 4 ) 658 - 662 2018.4Reviewed International journal

Language：English

OBJECTIVE: Fear of falling (FOF) is a major health problem for older adults, present not just in fallers, but also nonfallers. This study examined the impact of FOF and fall history on disability incidence among community-dwelling older adults from a prospective cohort study. METHODS: A total of 5104 older adults living in community settings participated in baseline assessment and were followed up for about 4 years (median 52 mo, range 49-55 mo). At baseline, participants were assessed the presence of FOF and their fall history, and divided into 4 groups: Fall (-) FOF (-), Fall (+) FOF (-), Fall (-) FOF (+), and Fall (+) FOF (+). Disability incidence was defined as national long-term care insurance certification for personal support or care. RESULTS: During the follow-up period, 429 participants (9.9%) were newly certified as having a disability and needing personal support for long-term care insurance. Fall (-) FOF (+) group and Fall (+) FOF (+) group showed a significantly higher risk of disability incidence than Fall (-) FOF (-) group even after adjusting for covariates (Fall (-) FOF (+): hazard ratio 1.28, 95% confidence interval, 1.01-1.62, Fall (+) FOF (+): hazard ratio 1.44, 95% confidence interval, 1.05-1.98). CONCLUSIONS: Fear of falling could be a simple and useful predictor of disability incidence in community-dwelling older adults. Identifying and decreasing fall risk factors may prevent fall-related injuries, but excessive FOF may be associated with increased risk of disability incidence.

DOI： 10.1002/gps.4837

川田将之, 木山良二, 牧迫飛雄馬, 窪薗琢郎 . ウェアラブルセンサーを用いた臨床応用可能な歩行トレーニングシステムの開発 . 若手研究者のための健康科学研究助成成果報告書 ( 33 ) 72 - 76 2018.4

Makizako H, Tsutsumimoto K, Shimada H, Arai H . Social frailty among community-dwelling older adults: Recommended assessments and implications . Ann Geriatr Med Res22 ( 1 ) 3 - 8 2018.3Reviewed

Makizako H, Shimada H, Doi T, Tsutsumimoto K, Hotta R, Nakakubo S, Makino K, Lee S . Social frailty leads to the development of physical frailty among physically non-frail adults: A four-year follow-up longitudinal cohort study . Int J Environ Res Public Health15 ( 3 ) 2018.3Reviewed

Hyuma Makizako, Hiroyuki Shimada, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Keitaro Makino, Sangyoon Lee . Social Frailty Leads to the Development of Physical Frailty among Physically Non-Frail Adults: A Four-Year Follow-Up Longitudinal Cohort Study. . International journal of environmental research and public health15 ( 3 ) 2018.3Reviewed International journal

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

Social frailty domains may play an important role in preventing physical decline and disability. The aim of this study is to examine the impact of social frailty as a risk factor for the future development of physical frailty among community-dwelling older adults who are not yet physically frail. A total of 1226 physically non-frail older adults were analyzed to provide a baseline. Participants completed a longitudinal assessment of their physical frailty 48 months later. Their baseline social frailty was determined based on their responses to five questions, which identified participants who went out less frequently, rarely visited friends, felt less like helping friends or family, lived alone and did not talk to another person every day. Participants with none of these characteristics were considered not to be socially frail; those with one characteristic were considered socially pre-frail; and those with two or more characteristics were considered socially frail. At the four-year follow-up assessment, 24 participants (2.0%) had developed physical frailty and 440 (35.9%) had developed physical pre-frailty. The rates of developing physical frailty and pre-frailty were 1.6% and 34.2%, respectively, in the socially non-frail group; 2.4% and 38.8%, respectively, in the socially pre-frail group; and 6.8% and 54.5%, respectively, in the socially frail group. Participants classified as socially frail at the baseline had an increased risk of developing physical frailty, compared with participants who were not socially frail (OR = 3.93, 95% CI = 1.02-15.15). Participants who were socially frail at the baseline also had an increased risk of developing physical pre-frailty (OR = 2.50, 95% CI = 1.30-4.80). Among independent community-dwelling older adults who are not physically frail, those who are socially frail may be at greater risk of developing physical frailty in the near future. Social frailty may precede (and lead to the development of) physical frailty.

DOI： 10.3390/ijerph15030490

Lee S, Lee S, Bae S, Harada K, Jung S, Imaoka M, Makizako H, Doi T, Shimada H. . Relationship between chronic kidney disease without diabetes mellitus and components of frailty in community-dwelling Japanese older adults . Geriatr Gerontol Int18 ( 2 ) 286 - 292 2018.2Reviewed

Kazuki Uemura, Hyuma Makizako, Sangyoon Lee, Takehiko Doi, Songchul Lee, Kota Tsutsumimoto, Hiroyuki Shimada . Behavioral protective factors of increased depressive symptoms in community-dwelling older adults: A prospective cohort study. . International journal of geriatric psychiatry33 ( 2 ) e234 - e241 2018.2Reviewed International journal

Language：English

BACKGROUND: It remains unclear what kinds of behavior prevent the development of geriatric depression. This study aimed to elucidate behavioral predictors of increased depressive symptoms in older adults focusing on gender differences. METHODS: A total of 3106 community-dwelling older people aged older than or equal to 65 years without depressive symptoms at baseline participated. The 15-item Geriatric Depression Scale was used to assess depressive symptoms with a score of 6 or more at baseline and 15 month follow-up. Behavioral status was investigated by using dichotomous questions about the aspects of physical, cognitive, and social activities. Each category included 3 specific items. Demographic data and other potential confounding factors were also assessed. RESULTS: In the 15 month follow-up survey, 239 participants (7.7%) reported increased depressive symptoms. Multiple logistic regression analysis indicated that engagement in light physical exercise (odds ratio = 0.74, 95%, CI = 0.56-0.98), taking enrichment lessons (0.62, 0.46-0.85), using a personal computer (0.68, 0.48-0.97), participation in events at the community center (0.54, 0.40-0.72), and attending a community meeting (0.69, 0.52-0.92) were independently associated with lower risk of increased depressive symptoms. In a separate analysis for each gender, significant odds ratios of using a personal computer were observed in men, whereas significant odds ratios of light physical exercise, participation in events at the community center, and attending a community meeting were observed in women. CONCLUSIONS: Light physical exercise, taking lessons, usage of a computer, and participation in community events showed protective effects against depressive symptoms. However, the significance of each behavioral factor may vary according to gender.

DOI： 10.1002/gps.4776

Sho Nakakubo, Takehiko Doi, Hiroyuki Shimada, Rei Ono, Hyuma Makizako, Kota Tsutsumimoto, Ryo Hotta, Takao Suzuki . The Association Between Excessive Daytime Sleepiness and Gait Parameters in Community-Dwelling Older Adults: Cross-Sectional Findings From the Obu Study of Health Promotion for the Elderly. . Journal of aging and health30 ( 2 ) 213 - 228 2018.2Reviewed International journal

Language：English

OBJECTIVE: This study examined the association between excessive daytime sleepiness (EDS) and gait characteristics (e.g., speed, variability) in community-dwelling older adults. METHOD: This cross-sectional study included 3,901 individuals aged ≥65 years. Participants answered questions about EDS, sleep duration, and other sleep-related symptoms. Gait speed, stride length, and the variability in stride length were assessed by using a stopwatch and a WalkWay device. RESULTS: EDS was significantly associated with slower gait speed among younger subjects (<75 years, p = .021) and with both slower gait speed ( p = .045) and greater variability in stride length among older subjects (≥75 years, p = .048) in a multivariate analysis adjusted for age, sex, body mass index, medication, number of comorbidities, and education. DISCUSSION: EDS associates with gait ability, particularly in older old adults. Further prospective studies are needed to determine the causal association between gait ability and sleep disturbances, including EDS.

DOI： 10.1177/0898264316673253

Sungchul Lee, Sangyoon Lee, Seongryu Bae, Kazuhiro Harada, Songee Jung, Masakazu Imaoka, Hyuma Makizako, Takehiko Doi, Hiroyuki Shimada . Relationship between chronic kidney disease without diabetes mellitus and components of frailty in community-dwelling Japanese older adults. . Geriatrics & gerontology international18 ( 2 ) 286 - 292 2018.2Reviewed

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

AIM: To evaluate the relationship between kidney function without diabetes and components of the frailty phenotype in community-dwelling Japanese older adults. METHODS: Participants were 8343 residents who completed baseline assessments, classified into four categories according to eGFR. Frailty status was defined using five criteria: (i) slow gait speed; (ii) muscle weakness; (iii) low physical activity; (iv) exhaustion; and (v) unintentional weight loss. RESULTS: After multivariate adjustment, participants with the lowest kidney function were at higher risk of frailty (OR 1.57, 95% CI 1.02-3.50) than those with normal kidney function. In addition, after adjustment for multiple confounders, estimated glomerular filtration rate <30 was associated with a greater risk of the individual frailty components of weight loss (OR 2.14, 95% CI 1.11-4.12), low physical activity (OR 1.35, 95% CI, 1.01-2.54) and slowness (OR 1.82, 95% CI 1.36-3.77) compared with estimated glomerular filtration rate ≥60. CONCLUSIONS: Lower kidney function was associated with a higher risk of weight loss, low physical activity and slowness among community-dwelling Japanese older adults. Geriatr Gerontol Int 2018; 18: 286-292.

DOI： 10.1111/ggi.13180

吉松竜貴, 加辺憲人, 橋本祥行, 牧迫飛雄馬 . 回復期脳卒中患者の歩行自立予測信号検出分析による臨床応用を目指した検討 . 理学療法科学33 ( 1 ) 145 - 150 2018.2Reviewed

Language：Japanese Publisher：(一社)理学療法科学学会

[目的]脳卒中患者の回復期リハビリテーション病棟入院時情報から3ヵ月後の歩行自立を判別するための予測チャートを作成すること。[対象と方法]初発脳卒中患者251例を対象として、入院時の身体機能と認知機能、基本動作自立度、バランス能力、日常生活自立度から入院3ヵ月後の歩行自立を予測するための決定木を、信号検出分析法にて求めた。[結果]起居動作能力、バランス能力、認知機能が有意な予測因子として抽出され、入院3ヵ月後の歩行自立を予測するための決定木が得られた。[結語]脳卒中の回復期に適応した歩行自立の予測チャートが作成された。(著者抄録)

Takehiko Doi, H. Makizako, K. Tsutsumimoto, R. Hotta, S. Nakakubo, K. Makino, T. Suzuki, H. Shimada . Association Between Insulin-Like Growth Factor-1 and Frailty Among Older Adults . Journal of Nutrition, Health and Aging22 ( 1 ) 68 - 72 2018.1Reviewed

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer-Verlag France

Objectives: Frailty is a course experienced in advanced aging. Identification of a biological factor associated with frailty is required. Although serum insulin-like growth factor-1 (IGF-1) is a potential factor related with frailty, consensus has not been reached regarding this relationship. This study aimed to investigate the association between IGF-1 and frailty in older adults. Design: Cross-sectional study. Setting: Cohort study that was part of the “National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes.” Participants: The study participants were 4133 older adults (mean age, 71.8 ± 5.4 years). Measurements: We assessed serum IGF-1 levels and frailty status and collected demographic variables, including cognitive function, as covariates. Results: Frailty and pre-frailty were present in 274 subjects (7%) and 1930 subjects (47%), respectively. Subjects were divided into four groups based on quartiles of IGF-1 levels. Multinomial logistic analysis showed that the lowest group had significant odds of pre-frailty (crude model: odds ratio [OR] 1.58, 95% confidence interval [CI] 1.30–1.90, p OpenSPiltSPi.001
adjusted model: OR 1.38, 95% CI 1.13–1.68, p =.002) and frailty (crude model: OR 3.42, 95% CI 2.38-4.92, p OpenSPiltSPi.001
adjusted model: OR 1.54, 95% CI 1.02–2.32, p =.039), compared with the highest group. Conclusion: Lower serum IGF-1 levels were independently related with frailty in older adults.

DOI： 10.1007/s12603-017-0916-1

Ryo Hotta, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Sho Nakakubo, Keitaro Makino, Takao Suzuki, Hiroyuki Shimada . Healthy Behaviors and Incidence of Disability in Community-Dwelling Elderly. . American journal of health behavior42 ( 1 ) 51 - 58 2018.1Reviewed International journal

Language：English

OBJECTIVES: In this paper and prospective study, we examine the number of healthy behaviors and the incidence of disability in community-dwelling older adults aged 65 years and older. METHODS: Participants (N = 4483) were residents of Obu, Japan who were asked about regular exercise, smoking status, and sleep duration. Demographic variables, history of disease, physi- cal function, and cognitive function were measured as confounders. Information about disabil- ity was obtained from the Obu City Office. RESULTS: At 24 months after baseline assessment, 165 participants (3.7%) were certified as having disability. Participants with 2 healthy behaviors had a 1.61-fold increased risk of disability (95% CI: 1.08 -2.42) compared with those with 3 healthy behaviors; those with one or no healthy behaviors had a 2.01-fold risk (95% CI: 1.26-3.19) even though adjusting for confounders. CONCLUSIONS: The number of healthy behaviors was associated with the incidence of disability, with the hazard ratios increasing progressively as the number of healthy behaviors decreased.

DOI： 10.5993/AJHB.42.1.5

Makizako H, Shimada H, Hotta R, Doi T, Tsutsumimoto K, Nakakubo S, Makino K . Associations of traffic near-miss incident with attention and executive function among Japanese older drivers . Gerontology64 ( 5 ) 495 - 502 2018Reviewed

Shimada H, Makizako H, Tsutsumimoto K, Doi T, Lee S, Suzuki T . Cognitive Frailty and Incidence of Dementia in Older Persons . J Prev Alzheimers Dis5 ( 1 ) 42 - 48 2018Reviewed

Doi T, Makizako H, Tsutsumimoto K, Hotta R, Nakakubo S, Makino K, Suzuki T, Shimada H . Association between Insulin-Like Growth Factor-1 and Frailty among Older Adults . J Nutr Health Aging22 ( 1 ) 68 - 72 2018Reviewed

Nakakubo S, Makizako H, Doi T, Tsutsumimoto K, Hotta R, Lee S, Lee S, Bae S, Makino K, Suzuki T, Shimada H. . Long and short sleep duration and physical frailty in community-dwelling older adults. . The journal of nutrition, health & aging22 ( 9 ) 1066 - 1071 2018Reviewed

Shimada H, Makizako H, Doi T, Park H, Tsutsumimoto K, Verghese J, Suzuki T. . Effects of combined physical and cognitive exercises on cognition and mobility in patients with mild cognitive impairment: A randomized clinical trial. . Journal of the American Medical Directors Association19 ( 7 ) 584 - 597 2018Reviewed

Uemura K, Makizako H, Lee S, Doi T, Lee S, Tsutsumimoto K, Shimada H. . Behavioral protective factors of increased depressive symptoms in community-dwelling older adults: a prospective cohort study . Int J Geriatr Psychiatry33 ( 2 ) 2018Reviewed

Hotta R, Makizako H, Doi T, Tsutsumimoto K, Nakakubo S, Makino K, Shimada H. . Cognitive function and unsafe driving acts during an on-road test among community-dwelling older adults with cognitive impairments . Geriatrics & Gerontology International42 ( 1 ) 847 - 852 2018Reviewed

Hotta R, Makizako H, Doi T, Tsutsumimoto K, Nakakubo S, Makino K, Suzuki T, Shimada H. . Healthy behaviors and incidence of disability in community-dwelling elderly . American Journal of Health Behavior42 ( 1 ) 51 - 58 2018Reviewed

Shimada H, Makizako H, Tsutsumimoto K, Doi T, Lee S, Suzuki T. . Cognitive frailty and incidence of dementia in older persons . Journal of Prevention of Alzheimer'Disease5 ( 1 ) 42 - 48 2018Reviewed

Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Kim M, Kurita S, Suzuki T, Shimada H. . Social frailty has a stronger impact on the onset of depressive symptoms than physical frailty or cognitive impairment: A 4-year follow-up longitudinal cohort study . Journal of the American Medical Directors Association19 ( 6 ) 504 - 510 2018Reviewed

Uemura K, Makizako H, Lee S, Doi T, Lee S, Tsutsumimoto K, Shimada H. . The impacts of sarcopenia on incident homebound status among community-dwelling older adults: a prospective cohort study . Maturitas113 26 - 31 2018Reviewed

Doi T, Makizako H, Tsutsumimoto K, Hotta R, Nakakubo S, Makino K, Suzuki T, Shimada H. . Combined effects of mild cognitive impairment and slow gait on risk of dementia. . Experimental Gerontology10 146 - 150 2018Reviewed

Bae S, Lee S, Lee S, Harada K, Makizako H, Park H, Shimada H. . Combined effect of self-reported hearing problems and social activities on incident disability in Japanese older adults: A population-based longitudinal study . Maturitas115 51 - 55 2018Reviewed

Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Makino K, Suzuki T, Shimada H. . Aging-related anorexia and its association with disability and frailty. . Journal of Cachexia, Sarcopenia and Muscle9 ( 5 ) 834 - 843 2018Reviewed

Shimada H, Makizako H, Lee S, Doi T, Lee S. . Lifestyle activities and the risk of dementia in older Japanese adults. . Geriatrics & Gerontology International18 ( 10 ) 1491 - 1496 2018Reviewed

Nakakubo S, Doi T, Makizako H, Tsutsumimoto K, Hotta R, Kurita S, Kim M, Suzuki T, Shimada H. . Association of walk ratio during normal gait speed and fall in community-dwelling elderly people. . Gait & Posture66 151 - 154 2018Reviewed

Nakakubo S, Doi T, Shimada H, Ono R, Makizako H, Tsutsumimoto K, Hotta R, Suzuki T. . The association between excessive daytime sleepiness and gait parameters in community-dwelling older adults: Cross-sectional findings from the Obu Study of Health Promotion for the Elderly (OSHPE). . Journal of Aging and Health30 ( 2 ) 213 - 228 2018Reviewed

Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Makino K, Suzuki T, Shimada H. . Cognitive frailty is associated with fall-related fracture among older people. . The journal of nutrition, health & aging22 ( 10 ) 1216 - 1220 2018Reviewed

YOSHIMATSU Tatsuki, KABE Norihito, HASHIMOTO Yoshiyuki, MAKIZAKO Hyuma . Prediction of Gait Independence of Stroke Patients through Signal Detection Analysis in the Convalescent Period . Rigakuryoho Kagaku33 ( 1 ) 145 - 150 2018Reviewed

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Society of Physical Therapy Science

[Purpose] This study developed a chart for predicting stroke patients' independence of gait during the convalescent period. [Subjects and Methods] Two hundred fifty-one first-time stroke patients were enrolled in this study. Physical and cognitive functions, basic movement ability, balance ability and activities of daily living were evaluated on admission to a rehabilitation ward for the convalescent stage. Based on this information, a decision tree for predicting independence of gait three months later was developed using signal detection analysis. [Results] Independence in rising motion, balance ability, and cognitive function were extracted as significant predictors. A valid and reliable decision tree was developed. [Conclusion] A chart for predicting independence of gait was developed. This chart is appropriate for the convalescent period after stroke.

DOI： 10.1589/rika.33.145

Makizako H, Tsutsumimoto K, Shimada H, Arai H . Social frailty among community-dwelling older adults: Recommended assessments and implications. . Ann Geriatr Med Res22 ( 1 ) 3 - 8 2018Reviewed

Hyuma Makizako . Combined effect of self-reported hearing problems and social activities on incident disability in Japanese older adults: A population-based longitudinal study. . Maturitas115 51 - 55 2018Reviewed

Shimada H, Makizako H, Tsutsumimoto K, Doi T, Lee S, Suzuki T . Cognitive Frailty and Incidence of Dementia in Older Persons. . J Prev Alzheimers Dis5 ( 1 ) 42 - 48 2018Reviewed

Shimada H, Makizako H, Park H, Doi T, Lee S. . Validity of the National Center for Geriatrics and Gerontology-Functional Assessment Tool and Mini-Mental State Examination for detecting the incidence of dementia in older Japanese adults . Geriatr Gerontol Int17 ( 12 ) 2383 - 2388 2017.12Reviewed

Hyuma Makizako, Hiroyuki Shimada, Takehiko Doi, Kota Tsutumimoto, Daisuke Yoshida, Takao Suzuki . Effects of a community disability prevention program for frail older adults at 48-month follow up. . Geriatrics & gerontology international17 ( 12 ) 2347 - 2353 2017.12Reviewed

Language：English

AIM: The present prospective study was carried out to determine whether participation in community-based intervention studies exerted a positive impact on disability prevention in older adults with physical frailty. METHODS: A total of 514 community-dwelling older adults (aged ≥65 years) with physical frailty who had undergone baseline assessment and participated in community-based intervention studies (participants) or did not (non-participants) were included in the present study. Non-participants were selected through propensity score matching, to balance potential covariates at baseline. Disability incidence was followed up at 48 months as a main outcome. Demographic data (age, sex and medical history), global cognitive function, grip strength, walking speed, and blood test results including serum albumin and brain-derived neurotrophic factor at baseline were included as covariates. RESULTS: Disability incidence rates differed significantly between participants (11.3%) and non-participants (19.8%) of community-based intervention studies during the 48-month follow-up period (P = 0.007). Participation in community-based intervention studies (hazard ratio 0.55, 95% confidence interval 0.35-0.88) was significantly associated with the incidence of disability in older adults with physical frailty. CONCLUSIONS: Participation in community-based intervention studies could reduce the incidence of disability in older adults with physical frailty. Thus, strategies designed to increase the number of participants in community-based intervention programs should be considered in community-based approaches for the prevention of disability in older adults with physical frailty. Geriatr Gerontol Int 2017; 17: 2347-2353.

DOI： 10.1111/ggi.13072

Keitaro Makino, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Takao Suzuki, Hiroyuki Shimada . Fear of falling and gait parameters in older adults with and without fall history. . Geriatrics & gerontology international17 ( 12 ) 2455 - 2459 2017.12Reviewed

Language：English

AIM: Fear of falling (FOF) is associated with spatial and temporal gait parameters in older adults. FOF is prevalent among older adults, both those with and without fall history. It is still unclear whether the relationships between FOF and gait parameters are affected by fall history. The aim of the present study was to compare gait parameters by the presence of FOF and fall history. METHODS: A total of 3575 older adults (mean age 71.7 years, 49.7% female) met the inclusion criteria for the present study. We assessed the presence of fall history and FOF by face-to-face interview, and gait parameters (gait speed, stride length, step rate, double support time and variation of stride length) at a comfortable speed using a computerized electronic walkway. RESULTS: Prevalences of fall history and FOF were as follows: non-fallers without FOF 52.6% (n = 1881); fallers without FOF 6.3% (n = 227); non-fallers with FOF 34.4% (n = 1229); and fallers with FOF 6.7% (n = 238). Analysis of covariance showed significant differences among the four groups in all gait variables even after adjusting for age, sex and number of medications used. It should be noted that non-fallers with FOF showed significantly slower gait speed, shorter stride length and longer double support time than did non-fallers without FOF (P < 0.001). CONCLUSIONS: The present results suggest that spatial and temporal gait parameters are influenced by FOF, even in the absence of fall history. The assessment of FOF might be helpful for better understanding of age-related changes in gait control. Geriatr Gerontol Int 2017; 17: 2455-2459.

DOI： 10.1111/ggi.13102

Hiroyuki Shimada, Hyuma Makizako, Hyuntae Park, Takehiko Doi, Sangyoon Lee . Validity of the National Center for Geriatrics and Gerontology-Functional Assessment Tool and Mini-Mental State Examination for detecting the incidence of dementia in older Japanese adults. . Geriatrics & gerontology international17 ( 12 ) 2383 - 2388 2017.12Reviewed

Language：English

AIM: Numerous neuropsychological tests are implemented in the clinical setting. However, a readily available cognitive test is required to detect the risk of dementia in the community setting. METHODS: A total of 4151 persons aged ≥65 years participated in the present prospective cohort study. We assessed cognitive performance using the Mini-Mental State Examination and the National Center for Geriatrics and Gerontology-Functional Assessment Tool. The National Center for Geriatrics and Gerontology-Functional Assessment Tool includes tests of story and word list memory, attention and executive function, processing speed, and visuospatial skill to screen for cognitive impairment. All measurements were transformed to Z-scores to compare among the cognitive tests. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. RESULTS: After an average of 43 months, 180 (4.3%) participants were diagnosed with dementia. Survival analyses showed that the probability of dementia was significantly associated with all cognitive tests, except for visuospatial skill. The processing speed test showed the highest hazard ratios for the incidence of dementia (Z-score: hazard ratio 0.61, 95% confidence interval 0.50-0.75, P < 0.01). In subgroup analysis, there were no significant relationships between cognitive tests and the incidence of dementia in participants without global cognitive impairment. CONCLUSIONS: We conclude that the National Center for Geriatrics and Gerontology-Functional Assessment Tool, as well as the Mini-Mental State Examination, play an important role in detecting the risk of dementia in the community setting. Further analysis is required to identify the risk of dementia in older people without global cognitive impairment. Geriatr Gerontol Int 2017; 17: 2383-2388.

DOI： 10.1111/ggi.13079

菱川法和, 牧迫飛雄馬, 森田秋子 . 回復期脳卒中患者に対する認知関連行動アセスメントの評価者間信頼性の検討 . 愛知県理学療法学会誌29 ( 2 ) 69 - 75 2017.12

Language：Japanese Publisher：(NPO)愛知県理学療法学会

【目的】回復期脳卒中患者に対する認知関連行動アセスメント(以下、CBA)の評価者間信頼性を検討した。【方法】理学療法士6名と日常業務でCBAを用いた評価を実施しており十分な臨床経験を有する言語聴覚士を評価者とし、脳卒中患者21名のCBAにおける6領域の重症度を5段階で評価させた。評価者間信頼性の検討は、理学療法士6名の評価結果と理学療法士を臨床経験年数で分けた2群の評価結果を言語聴覚士の評価結果を外的基準に比較して、領域別得点は重み付きκ係数、合計点は級内相関係数(2,1)を算出した。さらに、合計点はBland-Altman分析により系統誤差を確認した後、標準誤差を算出した。【結果】評価者間信頼性は重み付きκ係数が0.62〜0.92、級内相関係数(2,1)が0.86〜0.91と高かった。系統誤差の存在はなく、標準誤差は2〜3点であった。【結論】CBAの評価者間信頼性は高く、今後は多様な職種や環境での連携においても臨床応用が期待できると考えた。(著者抄録)

Seongryu Bae, Hiroyuki Shimada, Hyuntae Park, Sangyoon Lee, Hyuma Makizako, Takehiko Doi, Daisuke Yoshida, Kota Tsutsumimoto, Yuya Anan, Takao Suzuki . Association between body composition parameters and risk of mild cognitive impairment in older Japanese adults. . Geriatrics & gerontology international17 ( 11 ) 2053 - 2059 2017.11Reviewed

Language：English

AIM: The aim of the present study was to investigate the association between various body composition parameters and the risk of mild cognitive impairment (MCI) in older Japanese adults, as well as potential sex-related differences in the risk of MCI. METHODS: Participants underwent cognitive tests, and were divided into 840 participants with MCI (mean age 71.9 ± 5.5 years) and 1740 without MCI (mean age 71.3 ± 5.2 years). Body composition parameters were measured using a bioelectrical impedance analyzer. Multiple logistic regression analysis was then carried out to examine the associations between body composition parameters and risk of MCI. RESULTS: After adjusting for confounding factors, those in the lowest quartile for fat-free mass had a higher risk of MCI than those in the highest quartile (men: odds ratio [OR] 1.96, 95% confidence interval CI 1.24-3.10; women: OR 1.49, 95% CI 1.01-2.19). Loss of muscle mass in the upper (OR 2.17, 95% CI 1.40-3.37) and lower (OR 1.99, 95% CI 1.25-3.15) limbs was associated with a higher MCI risk in men. However, only loss of muscle mass in the lower limbs was associated with a higher MCI risk (OR 1.61, 95% CI 1.06-2.44) in women. No associations were found between obesity measures and MCI. CONCLUSIONS: We found that loss of fat-free mass was associated with MCI in older adults, regardless of sex. We also found that appendicular muscle mass was more closely associated with MCI in men than in women. These results suggest that the association between appendicular muscle mass and MCI might have different underlying mechanisms based on sex. Geriatr Gerontol Int 2017; 17: 2053-2059.

DOI： 10.1111/ggi.13018

Bae S, Shimada H, Lee S, Makizako H, Lee S, Harada K, Doi T, Tsutsumimoto K, Hotta R, Nakakubo S, Park P, Suzuki T . The relationships between components of metabolic syndrome and mild cognitive impairment subtypes: A cross-sectional of Japanese older adults . J Alzheimers Dis 2017.10Reviewed

Shimada H, Makizako H, Doi T, Lee S, Lee S . Conversion and reversion rates in Japanese older people with mild cognitive impairment . J Am Med Dir Assoc 2017.9Reviewed

Hiroyuki Shimada, Hyuma Makizako, Takehiko Doi, SungChul Lee, Sangyoon Lee . Conversion and Reversion Rates in Japanese Older People With Mild Cognitive Impairment. . Journal of the American Medical Directors Association18 ( 9 ) 808.e1 - 808.e6 2017.9Reviewed International journal

Language：English

OBJECTIVES: Approximately 25% of individuals who are diagnosed with amnestic mild cognitive impairment (aMCI) revert to normal cognition (NC) rather than progressing to Alzheimer disease (AD). However, the prevalence of progression and reversion among older people in Asia remains unclear. DESIGN: A prospective cohort study. SETTING: A community in Japan. PARTICIPANTS: A total of 4153 individuals without dementia aged ≥65 years were classified as having NC, aMCI single domain (aMCIs), non-aMCI single domain (naMCIs), aMCI multiple domain (aMCIm), non-aMCI multiple domain (naMCIm), or global cognitive impairment (GCI). MEASUREMENTS: The National Center for Geriatrics and Gerontology-Functional Assessment Tool and the Mini-Mental State Examination were used to conduct cognitive screening. The participants completed baseline (August 2011 to June 2012) and follow-up (August 2015 to June 2016) assessments. We followed up monthly for newly incident AD, as recorded by the Japanese National Health Insurance and Later-Stage Medical Care systems. Multiple imputation was used to adjust for selection bias and loss of information. RESULTS: At 4-year follow-up, the reversion rates to NC in aMCIs, naMCIs, aMCIm, naMCIm, and GCI were 38.7%, 57.0%, 25.7%, 20.9%, and 43.7%, respectively. Of the participants with NC, aMCIs, naMCIs, aMCIm, naMCIm, and GCI at baseline, 4.7%, 4.5%, 13.1%, 20.6%, 21.6%, and 14.3%, respectively, were subsequently diagnosed with AD. We found significant associations between incident AD and naMCIs [hazard ratio (HR) compared to NC: 2.18, 95% confidence interval (CI): 1.45-3.26], and between AD and aMCIm (HR: 4.39, 95% CI: 2.06-9.39) and between AD and naMCIm (HR: 3.60, 95% CI: 2.13-6.08). However, the association between incident AD and aMCIs and between AD and GCI did not reach significance. CONCLUSION: Reversion to NC from MCI and GCI was frequent, and individuals with aMCIs and GCI did not show higher risk of incident AD than those with NC. Older adults with multiple cognitive impairments may be potential targets for preventing dementia.

DOI： 10.1016/j.jamda.2017.05.017

Makizako H, Shimada H, Doi T, Tsutsumimoto K, Lee S, Lee S, Harada K, Hotta R, Nakakubo S, Bae S, Harada K, Yoshida D, Uemura K, Anan Y, Park H, Suzuki T . Age-dependent changes in physical performance and body composition in community-dwelling Japanese older adults . J Cachexia Sarcopenia Muscle 2017.8Reviewed

Hyuma Makizako, Hiroyuki Shimada, Takehiko Doi, Kota Tsutsumimoto, Sangyoon Lee, Sung Chul Lee, Kazuhiro Harada, Ryo Hotta, Sho Nakakubo, Seongryu Bae, Kenji Harada, Daisuke Yoshida, Kazuki Uemura, Yuya Anan, Hyuntae Park, Takao Suzuki . Age-dependent changes in physical performance and body composition in community-dwelling Japanese older adults. . Journal of cachexia, sarcopenia and muscle8 ( 4 ) 607 - 614 2017.8Reviewed International journal

Language：English

BACKGROUND: The aim of this study was to describe the age-dependent changes in the parameters of physical performance and body composition in Japanese older adults who are independently dwelling in the community. We also examined whether the age-dependent changes differ among physical performance and body composition parameters. METHODS: Cross-sectional data from 10 092 community-dwelling older adults (mean age 73.6 years; 5296 women) were analyzed. The measures of physical performance included hand-grip strength, the five-times-sit-to-stand test, and walking speed. Body composition parameters (body weight, fat mass, and appendicular skeletal muscle mass) were measured with a bioelectrical impedance analyser. Correlations between age and the physical performance and body composition parameters were tested. The T-scores of physical performance and body composition measurements were calculated and presented according to 5-year age groups to examine the differences in age-dependent changes in physical performance and body composition parameters. RESULTS: All physical performance measures significantly decreased with aging. The cumulative mean T-scores according to age group showed different age-dependent changes between body mass index (BMI) and appendicular skeletal muscle mass index (ASMI) (cumulative mean T-score change of BMI and ASMI of -5.7 to -2.9 and -12.7 to -12.1, respectively). The slope declines in age-associated changes were greater in grip strength (β = -0.77, 95% confidence interval = -0.82 to -0.76) for men and in walking speed (β = -0.95, 95% confidence interval = -0.99 to -0.90) for women. CONCLUSIONS: The patterns of age-dependent decreases in physical performance measures differed among parameters and between sexes. There is a possibility of a difference in the age-related slope patterns among parameters; decreases in grip strength in men and walking speed in women may be more prominent with advancing age. Furthermore, the decrease in ASMI with age is more striking than that of BMI.

DOI： 10.1002/jcsm.12197

Doi T, Shimada H, Makizako H, Tsutsumimoto K, Verghese J, Suzuki T . Motoric Cognitive Risk Syndrome: Association with Incident Dementia and Disability . J Alzheimers Dis 2017.7Reviewed

Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Makino K, Suzuki T, Shimada H . Association of Social Frailty with Both Cognitive and Physical Deficits among Older People . J Am Med Dir Assoc 2017.7Reviewed

Kota Tsutsumimoto, Takehiko Doi, Hyuma Makizako, Ryo Hotta, Sho Nakakubo, Keitaro Makino, Takao Suzuki, Hiroyuki Shimada . Association of Social Frailty With Both Cognitive and Physical Deficits Among Older People. . Journal of the American Medical Directors Association18 ( 7 ) 603 - 607 2017.7Reviewed International journal

Language：English

OBJECTIVES: Our objective was to investigate the association between social frailty and cognitive and physical function among older adults. DESIGN: This was a cross-sectional study. SETTING: We examined community-dwelling adults in Japan. PARTICIPANTS: Participants comprised 4425 older Japanese people from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. MEASUREMENTS: Social frailty was defined by using responses to 5 questions (going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone every day). Participants showing none of these components were considered nonfrail; those showing 1 component were considered prefrail; and those showing 2 or more components were considered frail. To screen for cognitive deficits, we assessed memory, attention, executive function, and processing speed. Having 2 or more tests with age-adjusted scores of at least 1.5 standard deviations below the reference threshold was sufficient to be characterized as cognitively deficient. To screen for physical function deficits, we assessed walking speed (<1.0 m/s cut-off) and grip strength (<26 kg for men; <18 kg for women cut-off). Scoring below the cut-off point on 1 or more tests was sufficient to be characterized as physically deficient. RESULTS: The prevalence of social frailty was the following: nonfrailty, 64.1% (N = 2835); social prefrailty, 24.8% (N = 1097); social frailty, 11.1% (N = 493; P for trend < .001). All cognitive function tests (word list memory, Trail Making Test parts A and B, and the symbol digit-substitution task) significantly varied between social frailty groups; physical function (gait speed and grip strength) also varied between social frailty groups (all Ps for trend <.001). Referred to social nonfrailty, social frailty was independently associated with each cognitive deficit (odds ratio = 1.61, 95% confidence interval 1.13-2.30) and deficits in physical function (odds ratio = 1.99, 95% confidence interval 1.57-2.52) after adjusting for covariates. CONCLUSIONS: This study revealed that social frailty is associated with both cognitive and physical function among Japanese older adults. And social frailty status was also negatively associated with physical function. Further studies are needed to elucidate if a casual association exists between social frailty and cognitive and physical function.

DOI： 10.1016/j.jamda.2017.02.004

Shimada H, Ishii K, Makizako H, Ishiwata K, Oda K, Suzukawa M . Effects of exercise on brain activity during walking in older adults: a randomized controlled trial . J Neuroeng Rehabil 2017.5Reviewed

Hiroyuki Shimada, Kenji Ishii, Hyuma Makizako, Kiichi Ishiwata, Keiichi Oda, Megumi Suzukawa . Effects of exercise on brain activity during walking in older adults: a randomized controlled trial . JOURNAL OF NEUROENGINEERING AND REHABILITATION14 ( 1 ) 50 2017.5Reviewed

Language：English Publishing type：Research paper (scientific journal) Publisher：BIOMED CENTRAL LTD

Background: Physical activity may preserve neuronal plasticity, increase synapse formation, and cause the release of hormonal factors that promote neurogenesis and neuronal function. Previous studies have reported enhanced neurocognitive function following exercise training. However, the specific cortical regions activated during exercise training remain largely undefined. In this study, we quantitatively and objectively evaluated the effects of exercise on brain activity during walking in healthy older adults.
Methods: A total of 24 elderly women (75-83 years old) were randomly allocated to either an intervention group or a control group. Those in the intervention group attended 3 months of biweekly 90-min sessions focused on aerobic exercise, strength training, and physical therapy. We monitored changes in regional cerebral glucose metabolism during walking in both groups using positron emission tomography (PET) and [F-18] fluorodeoxyglucose (FDG).
Results: All subjects completed the 3-month experiment and the adherence to the exercise program was 100%. Compared with the control group, the intervention group showed a significantly greater step length in the right foot after 3 months of physical activity. The FDG-PET assessment revealed a significant post-intervention increase in regional glucose metabolism in the left posterior entorhinal cortex, left superior temporal gyrus, and right superior temporopolar area in the intervention group. Interestingly, the control group showed a relative increase in regional glucose metabolism in the left premotor and supplemental motor areas, left and right somatosensory association cortex, and right primary visual cortex after the 3-month period. We found no significant differences in FDG uptake between the intervention and control groups before vs. after the intervention.
Conclusion: Exercise training increased activity in specific brain regions, such as the precuneus and entorhinal cortices, which play an important role in episodic and spatial memory. Further investigation is required to confirm whether alterations in glucose metabolism within these regions during walking directly promote physical and cognitive performance.

DOI： 10.1186/s12984-017-0263-9

Takehiko Doi, Joe Verghese, Hyuma Makizako, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Takao Suzuki, Hiroyuki Shimada . Effects of Cognitive Leisure Activity on Cognition in Mild Cognitive Impairment: Results of a Randomized Controlled Trial. . Journal of the American Medical Directors Association18 ( 8 ) 686 - 691 2017.4Reviewed International journal

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

OBJECTIVE: To test the hypothesis that a long-term, structured cognitive leisure activity program is more effective than a health education program at reducing the risk of further cognitive decline in older adults with mild cognitive impairment syndrome (MCI), a high risk for dementia. DESIGN: A 3-arm, single-blind randomized controlled trial. SETTING: Community. PARTICIPANTS: A total of 201 Japanese adults with MCI (mean age: 76.0 years, 52% women). INTERVENTIONS: Participants were randomized into 1 of 2 cognitive leisure activity programs (60 minutes weekly for 40 weeks): dance (n = 67) and playing musical instruments (n = 67), or a health education control group (n = 67). MEASUREMENTS: Primary outcomes were memory function changes at 40 weeks. Secondary outcomes included changes in Mini-Mental State Examination and nonmemory domain (Trail Making Tests A and B) scores. RESULTS: At 40 weeks, the dance group showed improved memory recall scores compared with controls [mean change (SD): dance group 0.73 (1.9) vs controls 0.01 (1.9); P = .011], whereas the music group did not show an improvement compared with controls (P = .123). Both dance [mean change (SD): 0.29 (2.6); P = .026] and music groups [mean change (SD): 0.46 (2.1); P = .008] showed improved Mini-Mental State Examination scores compared with controls [mean change (SD): -0.36 (2.3)]. No difference in the nonmemory cognitive tests was observed. CONCLUSIONS: Long-term cognitive leisure activity programs involving dance or playing musical instruments resulted in improvements in memory and general cognitive function compared with a health education program in older adults with MCI. TRIAL REGISTRATION: UMIN-CTR UMIN000014261.

DOI： 10.1016/j.jamda.2017.02.013

吉松竜貴, 橋本祥行, 照屋康治, 八塩ゆり子, 加辺憲人, 澤龍一, 牧迫飛雄馬 . 入院時に起居動作が自立していない回復期脳卒中患者の退院時歩行自立を予測する要因について . 理学療法学44 ( Suppl.2 ) O - 5 2017.4Reviewed

Hyuma Makizako, Hiroyuki Shimada, Takehiko Doi, Kota Tsutsumimoto, Sho Nakakubo, Ryo Hotta, Takao Suzuki . Predictive Cutoff Values of the Five-Times Sit-to-Stand Test and the Timed "Up & Go" Test for Disability Incidence in Older People Dwelling in the Community . PHYSICAL THERAPY97 ( 4 ) 417 - 424 2017.3Reviewed

Language：English Publishing type：Research paper (scientific journal) Publisher：OXFORD UNIV PRESS INC

Background. Lower extremity functioning is important for maintaining activity in elderly people. Optimal cutoff points for standard measurements of lower extremity functioning would help identify elderly people who are not disabled but have a high risk of developing disability.
Objective. The purposes of this study were: (1) to determine the optimal cutoff points of the Five-Times Sit-to-Stand Test and the Timed "Up & Go" Test for predicting the development of disability and (2) to examine the impact of poor performance on both tests on the prediction of the risk of disability in elderly people dwelling in the community.
Design. This was a prospective cohort study.
Methods. A population of 4,335 elderly people dwelling in the community (mean age=71.7 years; 51.6% women) participated in baseline assessments. Participants were monitored for 2 years for the development of disability.
Results. During the 2-year follow-up period, 161 participants (3.7%) developed disability. The optimal cutoff points of the Five-Times Sit-to-Stand Test and the Timed "Up & Go" Test for predicting the development of disability were greater than or equal to 10 seconds and greater than or equal to 9 seconds, respectively. Participants with poor performance on the Five-Times Sit-to-Stand Test (hazard ratio= 1.88; 95% CI= 1.11-3.20), the Timed " Up & Go" Test (hazard ratio= 2.24; 95% CI= 1.42-3.53), or both tests (hazard ratio= 2.78; 95% CI= 1.78-4.33) at the baseline assessment had a significantly higher risk of developing disability than participants who had better lower extremity functioning.
Limitations. All participants had good initial functioning and participated in assessments on their own. Causes of disability were not assessed.
Conclusions. Assessments of lower extremity functioning with the Five-Times Sit-toStand Test and the Timed "Up & Go" Test, especially poor performance on both tests, were good predictors of future disability in elderly people dwelling in the community.

DOI： 10.2522/ptj.20150665

Kota Tsutsumimoto, Takehiko Doi, Hyuma Makizako, Ryo Hotta, Sho Nakakubo, Keitaro Makino, Takao Suzuki, Hiroyuki Shimada . The association between anorexia of aging and physical frailty: Results from the national center for geriatrics and gerontology's study of geriatric syndromes. . Maturitas97 32 - 37 2017.3Reviewed International journal

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

OBJECTIVES: The present study examined the association between anorexia of aging and physical frailty among older people. STUDY DESIGN: An observational, cross-sectional cohort design was used with a sample of 4417 elderly Japanese citizens living in a community setting. MAIN OUTCOME MEASURES: Frailty was operationalized as the following frailty components: slowness, weakness, exhaustion, low level of physical activity, and weight loss. Participants were grouped as non-frail, pre-frail, and frail, and categorized as anorexic or not using questionnaire cutoff scores. Measured covariates were as follows: sociodemographic variables, medical history, life style, body mass index, blood nutrition data, self-rated health, depressive symptoms, and cognitive function. RESULTS: The prevalence of anorexia of aging in each group was as follows: non-frail, 7.9%; pre-frail, 14.8%; frail, 21.2% (P for trend<0.001). After adjusting for all covariates, independent associations were identified between anorexia of aging and slowness (OR 1.42, 95% CI: 1.14-1.75, P=0.002), exhaustion (OR 1.39, 95% CI: 1.11-1.74, P=0.004) and weight loss (OR 1.37, 95% CI: 1.05-1.79, P=0.019), but not weakness or low level of physical activity. CONCLUSIONS: Anorexia of aging is importantly associated with frailty and the following frailty components: slowness, exhaustion, and weight loss. Future research should prospectively examine frailty's causal connection with anorexia of aging.

DOI： 10.1016/j.maturitas.2016.12.005

Sho Nakakubo, Hyuma Makizako, Takehiko Doi, Kota Tsutsumimoto, Sangyoon Lee, Sungchul Lee, Ryo Hotta, Seongryu Bae, Takao Suzuki, Hiroyuki Shimada . Impact of poor sleep quality and physical inactivity on cognitive function in community-dwelling older adults. . Geriatrics & gerontology international17 ( 11 ) 1823 - 1828 2017.2Reviewed

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

AIM: The purpose of the present study was to examine whether the combination of subjective sleep quality and physical activity is associated with cognitive performance among community-dwelling older adults. METHODS: Cross-sectional data on 5381 older adults who participated in part of the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes were analyzed. We assessed general cognitive impairment using the Mini-Mental State Examination, and also assessed story memory, attention, executive function and processing speed using the National Center for Geriatrics and Gerontology Functional Assessment Tool. Physical activity was assessed using two questionnaires, and participants were categorized as active or inactive. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, and participants were categorized as having poor (PS) or good sleep quality (GS). RESULTS: Participants in the inactive + PS group had worse performances than those in the active + GS group in all cognitive measures (Mini-Mental State Examination: P = 0.008, story memory: P = 0.007, other cognitive measures: P < 0.001), and also had worse performances than those in the inactive + GS and active + PS groups in the trail-making test, part B, and the symbol digit substitution test (P < 0.001, respectively). Additionally, participants in the inactive + GS group had worse performances than in the active + GS in the trail-making test, part B, and the symbol digit substitution test (P = 0.002 and P = 0.001, respectively). CONCLUSIONS: Inactivity and poor sleep quality were associated with poor cognitive performance among community-dwelling older adults. The combination of poor sleep quality and physical inactivity also worsened cognitive performance. Geriatr Gerontol Int 2017; 17: 1823-1828.

DOI： 10.1111/ggi.12973

Kota Tsutsumimoto, Hyuma Makizako, Takehiko Doi, Ryo Hotta, Sho Nakakubo, Hiroyuki Shimada, Takao Suzuki . Prospective associations between sedentary behaviour and incident depressive symptoms in older people: a 15-month longitudinal cohort study. . International journal of geriatric psychiatry32 ( 2 ) 193 - 200 2017.2Reviewed International journal

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

OBJECTIVE: This study aimed to investigate whether sitting time, as a form of sedentary behaviour, is related to incident depressive symptoms in older people. METHODS: This study included 3503 participants (mean age 71.7 years, 50.1% female) from the 'Obu Study of Health Promotion for the Elderly' cohort study. At baseline and then 15 months later, the participants reported their status of depressive symptoms using the 15-item Geriatric Depression Scale. During the baseline assessment, the participants were also asked about their sedentary behaviour on weekdays over the past 7 days and, from there, categorized into three groups (<240, 240-480, ≥480 min/day). Demographic data and the other health behaviours were also assessed at the baseline. RESULTS: Cross-sectional analysis revealed that 437 participants (12.0%) had depressive symptoms. In a prospective analysis, the logistic regression model revealed that the odds ratio for depressive symptom incidence was higher in participants who, at baseline, spent 480 min or more per day sitting (1.636; 95% confidence interval [CI] 1.015 to 2.636, p = 0.043), and in those who spent 240-480 min (1.605; 95% CI 1.085 to 2.375, p = 0.018) in comparison with those who spent less than 240 min. CONCLUSIONS: Sedentary behaviour significantly affects the risk of incident depressive symptoms. Further research is needed to develop an intervention strategy to manage depressive symptoms, as the second most common cause of burden of disease among older adults. Copyright © 2016 John Wiley & Sons, Ltd.

DOI： 10.1002/gps.4461

Kota Tsutsumimoto, Hyuma Makizako, Takehiko Doi, Ryo Hotta, Sho Nakakubo, Keitaro Makino, Hiroyuki Shimada, Takao Suzuki . Subjective Memory Complaints are Associated with Incident Dementia in Cognitively Intact Older People, but Not in Those with Cognitive Impairment: A 24-Month Prospective Cohort Study . AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY25 ( 6 ) 607 - 616 2017.1Reviewed

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

Objective: Although subjective memory complaints (SMCs) are considered a risk factor for incident dementia in older people, the effect might differ based on cognitive function. The aim of the present study was to investigate whether the effect of SMCs on the incidence of dementia in older people differed based on cognitive function. Design: A 24-month follow-up cohort study. Setting: Japanese community. Participants: Prospective, longitudinal data for incident dementia were collected for 3,672 participants (mean age: 71.7 years; 46.5% men) for up to 24 months. Measurements: Baseline measurements included covariates for incident dementia, SMCs, and cognitive function. Associations between SMCs, cognitive impairment, and incident dementia were examined using Cox proportional hazards models. Results: Incidences of dementia in the cognitively intact without SMC, cognitively intact with SMC, cognitive impairment without SMC, and cognitive impairment with SMC groups were 0.3%, 1.8%, 3.4%, and 4.8%, respectively. In the cognitively intact participants, SMCs were associated with a significantly higher risk of dementia (hazard ratio [HR]: 4.95, 95% confidence interval [CI]: 1.52-16.11, p = 0.008). Incident dementia with cognitive impairment was not significantly different based on SMC presence (p = 0.527). Participants with cognitive impairment in multiple domains had a significantly higher risk of incident dementia (HR: 2.07, 95% CI: 1.01-4.24, p = 0.046) Conclusion: SMCs were related with dementia in cognitively intact older people, but not in those with cognitive impairment. Multiple domains of cognitive impairment were associated with a higher risk of incident dementia.

DOI： 10.1016/j.jagp.2016.12.008

Hotta R, Makizako H, Doi T, Tsutsumimoto K, Nakakubo S, Makino K, Suzuki T, Shimada H . Healthy Behaviors and Incidence of Disability in Community-Dwelling Elderly . Am J Health Behav42 ( 1 ) 51 - 58 2017.1Reviewed

土井剛彦, 牧迫飛雄馬, 堤本広大, 中窪翔, 牧野圭太郎, 堀田亮, 鈴木隆雄, 島田裕之 . 軽度認知機能障害と歩行速度低下により認知症の発症リスクは増加するか？ . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】歩行能力低下は軽度認知障害（mild cognitive impairment：MCI）や認知症を有する高齢者の問題点の一つとして認識されている。MCIは，認知症を発症するリスクが高い一方で，健常への改善も認められるため，認知症予防ひいては介護予防の対象として着目すべきであると考えられている。しかし，MCI高齢者において歩行速度低下を伴う場合に，認知症の発症リスクが増加するかについては未だ明らかにされていない。本研究は，縦断研究を実施し，歩行速度低下が認知症のリスクにどのような影響を与えるかをMCIに着目して検討することを目的とした。【方法】本研究は，National Center for Geriatrics and Gerontology-Study of Geriatric Syndromesの参加者の中から，2011年度に実施した調査に参加した65歳以上の者とし，ベースラインにおいて認知症，パーキンソン病，脳卒中の病歴がある者，MMSEが24点未満の者，診療情報が得られない者を除外した3749名を対象とした。ベースラインにて測定した歩行速度，認知機能，一般特性，服薬数，Geriatric Depression Scale，身体活動習慣に加え，医療診療情報から得られる追跡期間中の認知症の発症をアウトカムとした。歩行が1.0m/s未満の場合を歩行速度低下とし，認知症ではなく日常生活が自立し全般的認知機能は保たれているが，NCGG-FATによる認知機能評価で客観的な認知機能低下を認めた者をMCIとした。【結果】対象者3749名（平均年齢72歳，女性53％）を，歩行速度低下とMCIのいずれにも該当しない群（control群：n＝2608），歩行速度低下のみを有する群（SG群：n=358），MCIのみを有する群（MCI群：n=628），歩行速度低下とMCIの両方を有する群（MCI+SG群：n=155）に群分けした。追跡期間中（平均追跡期間：42.7ヶ月）に認知症を発症した者は168名であった。目的変数に認知症の発症，説明変数に歩行速度とMCIによる群要因を設定し，その他の測定項目を共変量として調整した生存分析を実施した結果，control群に比べ，SG群（HR：1.12，95%CI：0.67-1.87）は認知症の発症との有意な関係は認めなかったが，MCI群（HR：2.05，95%CI：1.39-3.01）ならびにMCI+SG群（HR：3.49，95%CI：2.17-5.63）は認知症の発症と有意な関係性を有していた。【結論】MCI高齢者における歩行能力低下は認知症のリスクを増加させることが明らかになった。高齢者が認知機能障害を有する場合には，認知機能だけではなく歩行能力を評価し，適切なリスク評価を考慮して介入を行う必要があると考えられる。

DOI： 10.14900/cjpt.2016.1520

今岡真和, 鄭松伊, 島田裕之, 李相侖, 牧迫飛雄馬, 李成喆, 土井剛彦, 堤本広大, 中窪翔, 牧野圭太郎, 裵成琉 . 軽度認知機能低下がサルコペニア有病者の新規要介護発生リスクへ与える影響：24ヵ月間の前向き研究 . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】サルコペニアは加齢に伴う筋量や筋力の低下を特徴とする症候群であり，理学療法の重要な対象となる。一方，軽度認知機能低下は認知症発症のリスクだけでなく身体機能低下のリスクにもなるため，要介護発生のリスクを増加させる要因の一つと考えられる。しかし，サルコペニアと軽度認知機能低下が併存する高齢者の要介護発生リスクは未だ明らかではなく，そのような者では要介護発生リスクがさらに高いことが予想され，予防理学療法のより重要な適応となる可能性が極めて高い。そこで，地域在住高齢者を対象とした2年間の前方視的な調査を行い，サルコペニアおよび軽度認知機能低下と要介護発生状況との関連を調査した。【方法】対象は，National Center for Geriatrics and Gerontology-Study of Geriatric Syndromesの70歳以上の健診受診者5257名のうち，パーキンソン病，脳卒中，うつ病の既往歴がある者，要介護認定者，MMSE21点未満の者，測定項目に欠損がある者，ペースメーカー使用者，死亡または市外転居した者を除く3900名とした。ベースライン評価は骨格筋量，握力，歩行速度，Mini-Mental State Examination（以下：MMSE），Geriatric Depression Scale（以下：GDS），薬剤投与数，教育年数，アルコール摂取，喫煙，その他基本属性を調査した。サルコペニアはAsian Working Group for Sarcopeniaのアルゴリズムにより判定を行い，認知機能低下はMMSEが26点以下の者とした。ベースライン以降の24か月間における新規要支援・要介護発生の有無を調べた。統計解析は，ベースライン評価によって健常群，サルコペニア群，軽度認知機能低下群，サルコペニアと軽度認知機能低下の併存群の4群に分け，Log-rank検定およびCox比例ハザード回帰分析を行い，有意水準は5%未満とした。【結果】調査対象3900名のうち，健常群1788名，サルコペニア群120名，軽度認知機能低下群1853名，併存群139名であり，288名（7.4%）が2年間で要支援・要介護を新規に発生した。各群の新規要支援・要介護発生率は，健常群5.1%，サルコペニア群8.3%，軽度認知機能低下群8.6%，併存群18.7%であり，Log-rank検定の結果，併存群とその他3群に有意差があった（p＜0.05）。Cox比例ハザード回帰分析による健常群に対する要介護発生のハザード比は性，年齢，体重，GDS，喫煙，教育年数の調整モデルにおいて，サルコペニア群1.05（信頼区間：0.54-2.02），軽度認知機能低下群1.47（信頼区間：1.12-1.90），併存群1.97（信頼区間1.25-3.10）であり，軽度認知機能低下群と併存群は有意に新規要介護発生との関連が認められた。【結論】健常高齢者と比較して，サルコペニアと軽度認知機能低下を併存する者は約2倍，軽度認知機能低下のみでは約1.5倍の要介護発生リスクであることが示唆された。そのため，サルコペニアの有無に加え，認知機能を評価することは新規要介護リスクを客観的に把握するために有用である。

DOI： 10.14900/cjpt.2016.1522

堤本広大, 土井剛彦, 牧迫飛雄馬, 堀田亮, 中窪翔, 牧野圭太郎, 島田裕之 . 身体的フレイル高齢者の認知機能低下は，転倒後の骨折発生と強い関連を有する . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】身体的フレイルとは包括的に機能が低下した脆弱化した状態を指し，健常高齢者と要介護高齢者の中間的存在とされている。要介護の主要因の一つである転倒は，要介護リスクが高いフレイル高齢者において，特に予防すべき事象である。近年，認知機能の低下が，転倒リスクを高めることが明らかとなってきている。フレイル高齢者の転倒予防を考えていく上で，認知機能低下が転倒とどのように関連しているのか検討することが必要だが，十分に明らかにされていない。そこで，本研究の目的は身体的フレイル高齢者における認知機能低下と転倒との関連性を検討することとする。【方法】地域高齢者10885名のうち，パーキンソン病・認知症既往者，MMSEが21点未満の者，基本的ADLに障害のある者を除く9990名（平均73.5歳）を対象とした。歩行速度低下，筋力低下，体重減少，易疲労感，身体活動量低下の5項目の内，3項目以上が該当したものを身体的フレイルと判定した。認知機能に関しては，記憶・注意機能・遂行機能・処理速度の評価を行い，年齢・教育歴で標準化したデータにもとづき1.5SD以上の機能低下を1領域でも認めた者は認知機能低下ありと定義した。その上で，健常群，認知機能低下群，フレイル群，フレイル+認知機能低下群の4群に分けた。転倒については，過去1年間の転倒経験の有無を聴取し，転倒に伴う骨折の有無も合わせて聴取した。統計解析は，従属変数に転倒経験の有無，独立変数に群要因（健常群を参照値）と共変量を投入した多変量ロジスティック回帰分析を実施した。【結果】転倒経験のある者は，健常群15.7%，認定機能低下群18.6%，フレイル群28.4%，フレイル+認知機能低下群31.6％であった。転倒経験の有無を従属変数としたロジスティック回帰分析において，健常群を参照としたオッズ比は，認知機能低下群で1.17（95%CI 1.03－1.34），フレイル群で1.48（95%CI 1.19－1.83），フレイル+認知機能低下群で1.77（95%CI 1.39－2.27）であった。転倒経験を有する者を抽出し，転倒後の骨折経験の有無を従属変数としたロジスティック回帰分析において，健常群を参照値としたオッズ比は，フレイル+認知機能群にのみ有意な関連が認められた（2.56（95%CI 1.36－4.85））。【結論】転倒に伴う骨折については，身体的フレイルと認定機能低下を併せ持つ高齢者のみ関連性みられた。横断研究のため，因果関係は言及できないが身体的フレイルに認知機能低下が合わさることにより，転倒回避行動の遅延などが生じ，転倒後に生じる骨折との関連が強くなるのではないかと考えられる。一方で，転倒後に骨折した身体的フレイル高齢者の認知機能が低下しているということも考えられるため，今後は前方視的な研究の中で関係性を検討する必要がある。

DOI： 10.14900/cjpt.2016.1494

島田裕之, 牧迫飛雄馬, 土井剛彦, 堤本広大, 中窪翔, 牧野圭太郎 . 認知的フレイルが認知症発症に及ぼす影響 . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】認知的フレイルは，身体的フレイルと認知障害を合併した状態として定義され，概念的枠組みが整理されつつある。ただし，その概念を操作的に測定可能な変数に定義して，認知的フレイルが認知症発症に対する影響を調べた研究はない。そこで本研究では，高齢者を対象として，身体的フレイル，認知障害，そしてそれらを合併した認知的フレイルの状況を調べ，認知症発症を追跡調査することで，認知的フレイルと認知症発症との関係を明らかにすることを目的とした。【方法】対象者は愛知県大府市に在住する65歳以上の高齢者4,072名であった。身体的フレイルは，歩行速度低下，筋力低下，疲労感，身体活動低下，体重減少の5つの項目のうち3つ以上の異常とした。認知障害は，National Center for Geriatrics and Gerontology-Functional Assessment Toolの記憶，注意，実行機能，処理速度検査を用いて，5歳年齢階級の平均値から1.5標準偏差以上の認知機能の低下が2つ以上ある状態を認知障害ありとした。認知症の発症情報は，診療情報明細書情報から取得し，24か月間の追跡調査を実施した。統計解析は，混乱要因を調整したCox比例ハザードモデルを用いて，健常，身体的フレイル，認知障害，認知的フレイルの各群における認知症発症を比較した。【結果】身体的フレイル，認知障害，認知的フレイルの有症率は，それぞれ5.1%，5.5%，1.1%であった。追跡期間中，認知症を発症した者は81名（2.0%）であった。健常，身体的フレイル，認知障害，認知的フレイルの各群における認知症発症率は，それぞれ1.3%，5.8%，6.3%，18.6%となり，認知的フレイルにおける発症率が高かった。Cox比例ハザードモデルによる分析の結果，健常な高齢者に対するハザード比は，身体的フレイル1.95（95%信頼区間：0.97-3.91），認知障害3.85（95%信頼区間：2.09-7.10），認知的フレイル6.19（95%信頼区間：2.73-13.99）となり，認知的フレイルにおいて高い認知症発症の危険性が認められた。【結論】身体と認知的問題を合併した高齢者は，認知症になる危険性が高いことが明らかとなった。今後は，これらの高齢者に有効な認知症予防の介入方法を検証していく必要がある。

DOI： 10.14900/cjpt.2016.1297

上村一貴, 牧迫飛雄馬, 李相侖, 土井剛彦, 李成喆, 堤本広大, 島田裕之 . 老年期の抑うつ状態を予防する活動は何か？:―身体/認知/社会の3側面からの検討― . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】老年期の抑うつ状態は，生活の質を低下させるだけでなく，認知症や生活機能障害の要因となることから，予防的対策が重要と考えられる。メンタルヘルスの維持・改善には多様な生活習慣要因が関連していることが予想されるが，身体/認知/社会活動のように複数の側面から抑うつ状態発生に及ぼす影響を明らかとした研究はない。本研究の目的は，老年期における抑うつ状態の新規発生を前向きに調査し，身体/認知/社会の3つの側面からの比較検討により，予防に寄与する活動を明らかにすることである。【方法】愛知県における高齢者機能健診に参加した5,104名のうち，うつ病・パーキンソン病・認知症の既往者，要介護認定者，Mini-Mental State Examination（MMSE）で18点未満者，ベースラインの時点で抑うつ状態であった者を除いて，約15か月後の追跡調査に回答の得られた3,106名（男性1,580名，女性1,526名，平均年齢71.5歳）を最終的な分析対象とした。抑うつ症状はベースラインと15か月後に，Geriatric Depression Scale（GDS）により評価し，6点以上を抑うつ状態ありと判定した。質問紙により活動状況の調査を行い，【身体活動：①散歩・ウォーキング，②軽い運動・体操，③スポーツ】，【知的活動：①習い事，②ビデオ・DVDの操作，③パソコンの使用】，【社会活動：①家族友人の相談にのること，②公民館での行事・催し物への参加，③地区の会合等への出席】の9項目について実施の有無を聴取した。その他の測定項目は，基本属性（年齢，性，教育歴），Short Physical Performance Battery，MMSE，飲酒・喫煙習慣，主観的健康観，家族構成，服薬数とした。抑うつ状態の新規発生の有無を従属変数，各活動の有無を独立変数，その他の測定項目を調整因子とした多重ロジスティック回帰分析を性別ごとに行った。【結果】239名（7.7%）で抑うつ状態が新規発生した。多重ロジスティック回帰分析の結果，有意となったのは，男性では習い事（OR［95%CI］=0.59［0.35-0.99］），ビデオ・DVDの操作（0.64［0.42-0.97］），パソコンの使用（0.51［0.32-083］）であり，女性では軽い運動・体操（0.65［0.44-0.95］），習い事（0.65［0.44-0.97］），公民館での行事・催し物への参加（0.39［0.26-0.58］），地区の会合等への出席（0.49［0.33-0.73］）であった。【結論】男性では電子機器の使用のような知的活動が，女性では身体活動や地域行事・会合への参加のような社会活動が抑うつ状態の発生と独立して関連していた。老年期の抑うつ状態の保護因子となる活動には性差がみられ，性別によって異なる予防的アプローチが必要となる可能性が考えられた。

DOI： 10.14900/cjpt.2016.1517

牧野圭太郎, 牧迫飛雄馬, 土井剛彦, 堤本広大, 堀田亮, 中窪翔, 鈴木隆雄, 島田裕之 . 地域高齢者の慢性疼痛の強さ別にみた身体活動特性の違い . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】慢性疼痛を有する高齢者は，痛みを回避しようと過剰に身体活動量を制限させることで心身の虚弱化および痛み自体のさらなる悪化が引き起こされる悪循環に陥りやすいと考えられている。したがって，慢性期では痛みの強さに応じて無理のない範囲で身体活動を維持させることが重要と考えられる。本研究では，慢性疼痛を有する高齢者の身体活動に関する基礎的知見を得るため，大規模横断調査から痛みの強さ別に身体活動特性の違いを検討した。【方法】National Center for Geriatrics and Gerontology-Study of Geriatric Syndromesの参加者のうち，2013年度の調査に参加し活動量計による身体活動量評価を実施した地域在住高齢者2,366名（75.7±4.1歳）を分析対象とした。なお，要介護認定を受けている者，認知症，脳卒中，パーキンソン病の既往を有する者は除外した。また，急性疼痛を持つ者，腰または膝以外の部位に痛みがある者，医師による運動制限を受けている者についても分析から除外した。基本属性として年齢，性別，1日の服薬数，歩行速度，Mini-Mental State Examination（MMSE）を評価した。慢性疼痛は，腰または膝に2ヶ月以上継続した痛みがある場合を慢性疼痛ありとし，痛みの強さ別に3段階で評価した（疼痛なし/軽度の慢性疼痛あり/中等度以上の慢性疼痛あり）。身体活動の指標には，3軸加速度計内臓の活動量計で計測した1日あたりの歩数と強度別の身体活動時間を用いた。統計解析として，対象者を疼痛なし群，軽度群，中等度以上群に分類し，3群間で基本属性および各身体活動指標を比較した。【結果】2,366名のうち，906名（38.3%）が慢性疼痛を有しており，そのうち軽度の慢性疼痛が546名，中等度以上の慢性疼痛が360名であった。慢性疼痛の強さによる一元配置分散分析の結果，MMSEを除く全ての基本属性に有意な主効果が認められた（p＜0.01）。各群における歩数の平均値は，疼痛なし群で5,371歩，軽度群で4,770歩，中等度以上群で4,338歩であった。年齢と性別を共変量とした共分散分析および事後検定の結果，歩数および中強度（3METs）以上の身体活動時間に関しては，軽度群と中等度以上群で疼痛なし群よりも少なく（p＜0.01），軽度群と中等度以上群の間に有意差はみられなかった。低強度（1.5～2.9METs）の身体活動時間に関しては，中等度以上群は疼痛なし群よりも少なかった（p＜0.05）のに対し，軽度群は他の群との間に有意差はみられなかった。【結論】慢性疼痛を有する高齢者において，身体活動量は慢性疼痛の強さと関連することが示唆され，慢性疼痛が軽度の者は低強度の活動に関しては疼痛のない者と同程度の活動量が維持されていた。慢性疼痛の強さによって異なる強度の身体活動が制限されることを示した本研究結果は，慢性疼痛を有する高齢者の身体活動の維持促進を目的とした理学療法介入にとって有用な知見を提供するものと考える。

DOI： 10.14900/cjpt.2016.1604

橋立博幸, 島田裕之, 牧迫飛雄馬, 土井剛彦, 堤本広大 . 地域在住高齢者における通常歩行速度の最小可検変化量と年齢による差異 . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】通常歩行速度は歩行能力を示す代表的な指標であり，主要な日常生活活動に反映され，転倒や虚弱と密接に関連する重要な評価として用いられている。とくに地域在住高齢者における介護・転倒・認知症の効果的な予防を図るためには，有害事象のリスクを早期に検出するためだけでなく，予防・改善の介入効果を客観的に判断する評価指標とその参考値が求められる。評価における測定誤差の限界域を表す最小可検変化量（MDC）は，測定値が測定誤差以上の変化を示したかどうかを判断する参考値になるが，大規模研究による地域在住高齢者の年齢や性別を考慮した通常歩行速度のMDCを示した報告は乏しい。本研究では，地域在住高齢者において，性別と各年代の違いによる通常歩行速度の差異を検証するとともに，各年代における通常歩行速度のMDCを大規模集団の横断データによって明らかとすることを目的とした。【方法】対象は，愛知県における高齢者機能健診に参加した65歳以上の地域在住高齢者5104人のうち，脳血管疾患，パーキンソン病，認知症の既往者，要介護認定者を除外し，通常歩行速度の測定が可能であった4637人とした。調査項目は通常歩行速度であり，実際には6.6mの直線歩行路における中央2.4mの歩行区間を通常速度にて歩行した際の所要時間をWalkwayにて測定し，2回測定した値を速度に換算して分析に用いた。全対象者を男女別で5歳ごとの年齢階級の群（65-69歳，70-74歳，75-79歳，80-84歳，85歳以上）に分類し，通常歩行速度について年齢および性別による差異を検討するために2元配置分散分析および多重比較検定を用いて比較するとともに，各群において通常歩行速度の級内相関係数（ICC），測定標準誤差（SEM），およびMDC95を算出した。【結果】全対象者における通常歩行速度は1回目1.20±0.22m/s，2回目1.26±0.22m/sであり，級内相関係数ICC（2,1）0.92，ICC（2,2）0.96，SEM 0.06m/s，MDC95 0.17m/sであった。2元配置分散分析の結果，年代および性別による有意な主効果（p＜0.01）と交互作用（p＜0.001）を示した。また，多重比較検定の結果，男女ともに年代別のすべての群間に有意差が認められ，年齢階級の高さに順じて有意な低値を示した。さらに，各群における通常歩行速度のMDC95を算出した結果，0.15～0.18m/sであった。【結論】本研究における通常歩行速度の測定は，臨床的に有用とされる高い再現性を示した。近年の先行研究（Mangione KK, et al., 2010）では，地域在住高齢者における通常歩行速度についてSEM 0.08m/s，MDC 0.19m/sと報告されているが，通常歩行速度の平均値が年齢の高さに順じて有意に低い値を示すとともに，年齢階級の差によって通常歩行速度のMDCにおいても0.01～0.03m/s程度の差異が生じていた。本研究における大規模集団の横断データによって算出された通常歩行速度の平均値およびMDCは，地域高齢者の予防的介入に活用できる参考値になると考えられた。

DOI： 10.14900/cjpt.2016.1525

牧迫飛雄馬, 鈴木隆雄, 島田裕之, 土井剛彦, 堤本広大, 李相侖, 李成喆, 堀田亮, 中窪翔, 裵成琉 . 地域在住高齢者における身体機能と身体組成の評価指標による加齢変化の違い . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】筋力や歩行の身体機能は加齢で低下し，体重や筋量などの身体組成指標も加齢の影響を受ける。しかし，これらの指標の加齢変化が日本人高齢者でどのような特徴を有しているかは十分なデータが示されていない。本研究では，身体機能評価の握力，椅子の立ち座りテスト（Five-Times-Sit-to-Stand：FTSS），歩行速度および身体組成評価の体重，脂肪量，四肢筋量の各指標における加齢変化を確認し，これらの加齢変化パターンが指標によって異なるかを横断データで検証した。加齢の影響を考慮するうえで重視すべき指標を提唱することが本研究の意義となる。【方法】健診に参加した地域高齢者10885名のうち，パーキンソン病・脳卒中の既往者，MMSE18点未満者を除く10092名（平均73.6歳）を対象とした。身体機能は握力，FTSS，歩行速度で評価した。身体組成は多周波体組成計MC-980A（TANITA）で体重，脂肪量，四肢筋量を計測し，体重を身長の二乗で除したbody mass index（BMI）と四肢筋量を身長の二乗で除したappendicular skeletal mass index（ASMI）を算出した。統計解析では，各指標と年齢との関係は相関分析で調べ，各指標における加齢変化パターンの相違を検証するために，65～69歳の測定値が基準となるように65～69歳の男女ごとの平均値と標準偏差から個人のTスコア（50＋10×（測定値－65～69歳の平均値）/65～69歳の標準偏差）を算出した。身体機能（握力，FTSS，歩行速度）および身体組成評価（BMI，ASMI）について，年齢（5歳区分）と各指標を要因とした二元配置分散分析を行った（危険率5%未満）。【結果】身体機能のすべての指標が年齢と有意な相関関係を認め，加齢に伴い身体機能が低下していた。身体組成では，体重と四肢筋量が年齢と有意な負の相関関係を認め，脂肪量は男性で年齢との相関は有意ではなく（r=-0.02，P=0.19），女性では非常に弱い相関関係であった（r=-0.05，P＜0.01）。Tスコア変化から各指標の加齢変化パターンを比較すると，男女ともに身体機能および身体組成のいずれにおいても有意な交互作用を認め（身体機能：F=10.0（男性），F=15.0（女性），P＜0.01；身体組成：F=19.7（男性），F=58.0（女性），P＜0.01），指標によって加齢変化パターンが異なっていた。男性では握力，女性では歩行速度で加齢による低下が顕著であり，身体組成はBMIよりもASMIで加齢による低下が男女ともに顕著であった。【結論】身体機能の加齢変化は指標によって異なり，男性では握力，女性では歩行速度の低下が顕著であり，身体組成では体重よりも四肢筋量が加齢の影響を受けやすいことが示唆された。四肢筋量の低下が顕著であることより，身体組成の評価のなかでも骨格筋量の加齢変化を抑制することは重要であることが確認された。加齢で低下しやすい指標は異なることが示唆されたことは，身体機能および身体組成の加齢低下の抑制を推進するうえで，考慮すべき重要な情報になると考えられた。

DOI： 10.14900/cjpt.2016.1296

中窪翔, 牧迫飛雄馬, 土井剛彦, 堤本広大, 堀田亮, 牧野圭太郎, 鈴木隆雄, 島田裕之 . 地域在住高齢者における歩行比からみた歩行パターンと転倒の関連性 . 理学療法学Supplement2016 ( 0 ) 2017

Language：Japanese Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】高齢期における歩行速度の低下は重要な転倒リスクのひとつである。歩行速度は歩幅と歩行率（ケイデンス）から決定され，この両因子から求める歩行比（歩幅/ケイデンス）は歩行速度を維持するための戦略を表す個人の歩行パターンと捉えられる。しかし，歩行比と転倒の関連性については十分に検討されていない。本研究の目的は，地域在住高齢者を対象に歩行比と転倒の関連性を横断的に検討することである。【方法】National Center for Geriatrics and Gerontology-Study of Geriatric Syndromesに参加した65歳以上の地域在住高齢者10,885名のうち，アルツハイマー病，パーキンソン病，脳卒中の現病および既往のある者，MMSEが18点未満の者，欠損値がある者を除外した9,205名（女性4,987名，平均年齢73.7±5.6歳）を解析対象とした。ANIMA社製ウォークWay MV-1000を用いて通常歩行速度にて歩行評価を実施し，歩行速度，歩幅，ケイデンスを評価指標とした。歩行比は歩幅をケイデンスで除して算出し（m/（step/min）），3分位の値を基に対象者を3群（T1，T2：参照，T3）に群分けした。なお，各歩行指標は，関谷ら（1996年）の報告に準じて身長を用いて補正した。転倒経験は，過去1年間の転倒経験の有無を聴取した。共変量として，基本属性，病歴，服薬数，転倒恐怖感の有無，平均歩行時間（分/日）を聴取し，Body Mass Index，うつ症状（Geriatric Depression Scale），MMSEを評価した。統計解析は，転倒の有無を従属変数，歩行速度低下（1.0m/秒未満）の有無および歩行比を独立変数とした多重ロジスティック回帰分析を実施した。さらに，歩行速度の低下の有無による関係性の違いを検討するために歩行速度1.0m/秒以上および未満で層分けして同様の分析を実施した。有意水準は5%未満とした。【結果】全対象者における過去1年間の転倒経験率は17.6％であった。転倒経験に対して，歩行速度低下の有無と歩行比を同時投入した結果，歩行速度低下および歩行比の値が小さいT1群において有意な関係性を示した（歩行速度　OR：1.40，95%CI：1.21-1.62，歩行比　OR：1.18，95%CI：1.03-1.35）。さらに，1.0m/秒未満の群（1,496名）での解析では歩行比は転倒と有意な関連性を認めなかったが，1.0m/秒以上の群（7,709名）ではT1群において転倒と有意な関連性を認めた（OR：1.29，95%CI：1.11-1.50）。【結論】本研究より，歩行速度が低下している群では歩行比と過去1年の転倒経験との間に有意な関連性はみられなかったが，歩行速度を維持できている群においては，歩行比が小さいことが転倒経験と関連していることが示唆された。歩行比が小さいことは，歩幅の減少，あるいはケイデンスの増加を反映しており，歩行速度の維持のためにケイデンスを増加させる戦略を選択していると考えられる。今後は，このような歩行戦略の違いが将来の転倒発生と関連するかについて，縦断的な検討する必要である。

DOI： 10.14900/cjpt.2016.1484

Takehiko Doi, Hiroyuki Shimada, Hyuma Makizako, Kota Tsutsumimoto, Joe Verghese, Takao Suzuki . Motoric Cognitive Risk Syndrome: Association with Incident Dementia and Disability. . Journal of Alzheimer's disease : JAD59 ( 1 ) 77 - 84 2017Reviewed International journal

Language：English

BACKGROUND: It is important to examine the etiology of motoric cognitive risk syndrome (MCR) and its association with dementia and disability to obtain biological insights and to develop preventive strategies. OBJECTIVE: This study aimed to examine the association of MCR with incidence of dementia and disability in a Japanese community-dwelling sample of older adults. METHODS: Participants were 4,235 older adults (50% women, mean age: 72.0 years). MCR was diagnosed at baseline using established criteria in non-demented seniors with self-reported cognitive complaints and slow gait. Incident cases of dementia were identified from insurance data monthly. Disability was regarded as certification by long-term care insurance. RESULTS: At baseline, 265 participants (6.3%) met criteria for MCR. During follow-up (mean duration: 29 months), there were 138 incident cases of dementia (3.3%) and 207 incident cases of disability (4.9%). Cox-proportional hazards models, adjusted for demographical data, lifestyle, and medical conditions, showed that presence of MCR at baseline was a major risk factor for developing dementia (HR 2.49, 95% CI 1.52-4.10, p < 0.001). MCR also predicted risk for disability (HR 1.69, 95% CI 1.08-2.02, p < 0.001). CONCLUSIONS: MCR is helpful in the short-term prediction of risk for dementia and disability in the elderly Japanese population. Identification of seniors with MCR is recommended for early detection and instituting preventive measures for reducing the risk of dementia and disability.

DOI： 10.3233/JAD-170195

Seongryu Bae, Hiroyuki Shimada, Sangyoon Lee, Hyuma Makizako, Sungchul Lee, Kazuhiro Harada, Takehiko Doi, Kota Tsutsumimoto, Ryo Hotta, Sho Nakakubo, Hyuntae Park, Takao Suzuki . The Relationships Between Components of Metabolic Syndrome and Mild Cognitive Impairment Subtypes: A Cross-Sectional Study of Japanese Older Adults. . Journal of Alzheimer's disease : JAD60 ( 3 ) 913 - 921 2017Reviewed International journal

Language：English

BACKGROUND: The associations between components of metabolic syndrome (MetS) and mild cognitive impairment (MCI) subtypes remain unclear. OBJECTIVE: The study aim was to identify the prevalence of MetS for MCI subtypes and to investigate sex differences in the association between MetS and MCI subtypes in older Japanese adults. METHODS: The study analyzed data from 3,312 men and women aged 70 years or more. MetS was diagnosed according to International Diabetes Federation criteria. Participants completed cognitive tests and were categorized into normal cognition, amnestic MCI (aMCI), and non-amnestic MCI (naMCI). The associations between MetS and its components and MCI subtypes were analyzed using multiple logistic regression. RESULTS: MetS prevalence was greater in participants with naMCI (men: p = 0.030; women: p = 0.040). Participants with naMCI showed higher odds ratios (OR) of MetS (men: 2.45, 95% confidence intervals (CI): 1.13-5.32; women: OR: 1.94, 95% CI: 1.12-3.39) compared with participants with normal cognition. MetS was not associated with aMCI. Analysis of MetS components showed that raised glucose (OR: 1.62, 95% CI: 1.19-2.22) and reduced high-density lipoprotein cholesterol (OR: 1.97, 95% CI: 1.25-3.12) were associated with naMCI in men. In women, raised blood pressure (OR: 1.42, 95% CI: 1.03-1.94) and raised glucose (OR: 1.32, 95% CI: 1.02-1.71) were associated with naMCI. CONCLUSION: MetS was associated only with naMCI regardless of sex, which suggests etiologic differences in MCI subtypes. We also found sex differences in the relationship between naMCI risk and MetS and its components.

DOI： 10.3233/JAD-161230

MAKIZAKO Hyuma, SHIMADA Hiroyuki, DOI Takehiko, TSUTSUMIMOTO Kota, HOTTA Ryo, NAKAKUBO Sho, MAKINO Keitaro, SUZUKI Takao . The Modified Version of the Short Physical Performance Battery for Community-dwelling Japanese Older Adults . Physical Therapy Japan44 ( 3 ) 197 - 206 2017

Language：Japanese Publisher：Japanese Society of Physical Therapy

Purpose: The aims of this study were to modify the Short Physical Performance Battery (SPPB) to validate its use with community-dwelling Japanese older adults and to examine the impact of the modified SPPB based on a community-based score (SPPB-com) on a scale assessing the new onset of need of care according to long-term care insurance (LTCI).Methods: A population of 4,328 community-dwelling older individuals (mean age = 71.8 years) participated in this prospective study. The participants were assessed using the original version of the SPPB (0-12 points) at baseline assessment and were followed up with for 24 months to examine the new onset of need of care according to LTCI. The SPPB-com (0-10 points), as the modified version of the SPPB, was calculated based on this sample’s performance on SPPB components including walking speed, chair stand test, and standing balance.Results: Of the 4,328 participants, 78.7% achieved a perfect score (12 points) on the original SPPB, while 10.5% achieved a perfect score (10 points) on the SPPB-com. The participants who scored less than 4 points on the SPPB-com showed the greatest incident rates of onset of need of care during the 24-month follow-up period (12.8%). In the adjusted model, which included potential covariates, age, sex (women), Mini-Mental State Examination scores, and SPPB-com scores were significantly related to increased risk of the new onset of need of care.Conclusion: The SPPB-com, which was modified to validate its use for community-dwelling Japanese older adults, may be useful in evaluating greater risks of disability.

DOI： 10.15063/rigaku.11253

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

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

Tsutsumimoto Kota, Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Uemura Kazuki, Ando Hiroshi, Suzuki Takao . Self-reported Exhaustion is Associated with Small Life Space in Older Adults with Mild Cognitive Impairment. . J Phys Ther Sci26 ( 12 ) 1979 - 1983 2014.12

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

[Purpose] Older adults experience exhaustion-induced health problems, such as poor physical function and low physical activity levels. The associations between self-reported exhaustion and physical function and activity are not clear in older adults with mild cognitive impairment (MCI). The aim of this study was to investigate the relationships between self-reported exhaustion and physical function and activity in older adults with mild cognitive impairment. [Subjects] A total of 356 older adults with mild cognitive impairment (mean age = 71.6 +/- 0.3 years, 50.8% women) were included in this study. [Methods] Self-reported exhaustion was identified by one item from the Study of Osteoporotic Fractures index. Gait speed, gait endurance, and life space were also assessed. [Results] Sixty-two participants reported having exhaustion, giving a 17.4% prevalence of self-reported exhaustion among these individuals. Logistic regression analysis showed that the Life-Space Assessment score was the only parameter significantly independently associated with exhaustion status (adjusted odds ratio 0.97, 95% confidence interval 0.95-0.99). [Conclusion] These results suggest that self-reported exhaustion is associated with life space. Future research is needed to identify ways for older people with MCI to improve their exhaustion status.

DOI： 10.1589/jpts.26.1979,

Shimada Hiroyuki, Park Hyuntae, Makizako Hyuma, Doi Takehiko, Lee Sangyoon, Suzuki Takao . Depressive symptoms and cognitive performance in older adults. . J Psychiatr Res57 149 - 156 2014.10

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

Many longitudinal studies have found that older adults with depressive symptoms or depression have increased risk of cognitive impairment. We investigated the relationships between depressive symptoms or depression, cognitive function, serum brain-derived neurotrophic factor (BDNF), and volumetric MRI measurements in older adults. A total of 4352 individuals aged 65 years or older (mean age 72 years) participated in the study. We investigated medical history and geriatric depression scale-15 (GDS-15) items to determine depression and depressive symptoms. Cognitive tests included the mini-mental state examination (MMSE), story memory, word list memory, trail-making tests, and the symbol digit substitution task. Of the 4352 participants, 570 (13%) fulfilled the criteria for depressive symptoms (GDS-15: 6 + points) and 87 (2%) were diagnosed with depression. All cognitive tests showed significant differences between the 'no depressive symptoms', 'depressive symptoms', and 'depression' groups. The 'depressive symptoms' and 'depression' groups showed lower serum BDNF (p < 0.001) concentrations than the 'no depressive symptoms' group. The 'depressive symptoms' group exhibited greater atrophy of the right medial temporal lobe than did the 'no depressive symptoms' group (p = 0.023). These results suggest that memory, executive function, and processing speed examinations are useful to identify cognitive decline in older adults who have depressive symptoms and depression. Serum BDNF concentration and atrophy of the right medial temporal lobe may in part mediate the relationships between depressive symptoms and cognitive decline.

DOI： 10.1016/j.jpsychires.2014.06.004

Uemura Kazuki, Shimada Hiroyuki, Doi Takehiko, Makizako Hyuma, Park Hyuntae, Suzuki Takao . Depressive symptoms in older adults are associated with decreased cerebral oxygenation of the prefrontal cortex during a trail-making test. . Arch Gerontol Geriatr59 ( 2 ) 422 - 428 2014.9

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

Growing evidence supports the relationships between depressive symptoms, cognitive decline, and brain structural changes in older adults. The purpose of this study was to determine whether depressive symptoms are related to cerebral oxygenation during cognitive tasks in older adults. In this study, 80 elderly subjects (73.9 +/- 5.4 years, 34 males) were evaluated using multi-channel Near-infrared spectroscopy. Concentration changes (mmolcm/l) in oxy-hemoglobin (oxy-Hb), as the most reliable available indicator of changes in regional cerebral blood flow, in the right and left prefrontal cortex were measured during the Trail Making Test Part B (TMT-B). Depressive symptoms were assessed using the short Geriatric Depression Scale (GDS). Subjects were divided into a depressive group (GDS greater than or equal to 6) and non-depressive group (GDS lower than 6). In results, Oxy-Hb activation during the TMT-B was significantly smaller in the depressive group (n=13) than in the non-depressive group (n=67) in both the right and left prefrontal cortex. In the multivariate analysis, GDS scores were significantly negatively correlated with oxy-Hb activation after adjusting for age, gender and educational history (right, beta=-0.32, p=0.002; left, beta=-0.25, p=0.02). Less prefrontal activation in older adults with depressive symptoms may account for decline in executive function. Further studies are needed to investigate the influence of the less brain activation associated with depressive symptoms on future cognitive decline and structural brain changes in older adults.

DOI： 10.1016/j.archger.2014.07.003

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Uemura Kazuki, Anan Yuya, Park Hyuntae, Lee Sangyoon, Ito Tadashi, Suzuki Takao . The combined status of physical performance and depressive symptoms is strongly associated with a history of falling in community-dwelling elderly: cross-sectional findings from the Obu Study of Health Promotion for the Elderly (OSHPE). . Arch Gerontol Geriatr58 ( 3 ) 327 - 331 2014.5

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

The purpose of this study was to examine whether the combined factors of physical performance, depressive symptoms and cognitive status are significantly associated with a history of falling in community-dwelling elderly. We performed a cross-sectional community-based survey, the OSHPE, from August 2011 to February 2012. In total, 5104 community-dwelling older adults aged 65 years and older (mean age 72.0) participated in the OSHPE. Participants underwent a grip strength (GS) test, chair stand test (CST), Timed Up & Go (TUG) test, Geriatric Depression Scale (GDS), and Mini-Mental State Examination (MMSE). Of the 4481 participants who met our requirements, 645 (14.4%) participants reported falling at least once in the past year. In a signal detection analysis (SDA), we found that the combination of GDS (>/=6 points) and TUG (>/=10.6 s) had the highest fall rate (36.4%), and the combination of GDS (<6 points) and CST (<11.1 s) had the lowest fall rate (11.7%). The highest fall rate group had a significantly higher odds ratio (OR) compared with the lowest fall rate group after adjusting for other potentially confounding variables [OR 3.12 (95% confidence interval (CI) 2.08-4.68) p<0.001]. The combination of depressive symptoms, TUG, and CST performance was strongly associated with a history of falling in community-dwelling elderly.

DOI： 10.1016/j.archger.2014.01.001

Uemura Kazuki, Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Yoshida Daisuke, Anan Yuya, Ito Tadashi, Lee Sangyoon, Park Hyuntae, Suzuki Takao . Effects of mild and global cognitive impairment on the prevalence of fear of falling in community-dwelling older adults. . Maturitas78 ( 1 ) 62 - 66 2014.5

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

OBJECTIVES: Few studies have reported the relationship between fear of falling (FoF) and mild and global cognitive impairment in community-dwelling older adults. We aimed to determine whether the status of cognitive impairment affects the prevalence of FoF in community-dwelling older adults. STUDY DESIGN: Cross-sectional study among 4474 community-dwelling older adults who participated in the Obu Study of Health Promotion for the Elderly. MAIN OUTCOME MEASURES: Participants underwent cognitive tests and were divided into three groups: cognitive healthy, mild cognitive impairment (MCI), and global cognitive impairment (GCI). FoF and related variables, such as fall history, physical function, and depression, were also investigated. RESULTS: The prevalence of FoF was significantly different by group (p<0.001; healthy: 43.6%, MCI: 50.6%, GCI: 40.6%). Logistic regression analysis showed that GCI (odds ratio=0.63; 95% confidence interval=0.526-0.76) was independently associated with FoF, after controlling for confounding factors. Older adults with GCI showed the lowest prevalence of FoF, although they had the lowest physical function comparing with the other groups (p<0.001). CONCLUSION: MCI and GCI in community-dwelling older adults affect the prevalence of FoF in a completely different manner. Further study is required to determine whether insensitivity to FoF with GCI increases the risk of falling in older adults.

DOI： 10.1016/j.maturitas.2014.02.018

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Tsutsumimoto Kota, Uemura Kazuki, Anan Yuya, Suzuki Takao . Cognitive function and gait speed under normal and dual-task walking among older adults with mild cognitive impairment. . BMC Neurol14 67 - 67 2014.4

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

BACKGROUND: Gait ability and cognitive function are interrelated during both normal walking (NW) and dual-task walking (DTW), and gait ability is thus adversely affected by cognitive impairment in both situations. However, this association is insufficiently understood in people with mild cognitive impairment (MCI). Here, we conducted a study with MCI participants, to examine whether the association depends on walking conditions and MCI subtypes. METHODS: We classified 389 elderly adults into amnestic MCI (n = 191) and non-amnestic MCI (n = 198), assessed their cognitive functions, and administered gait experiments under NW and DTW conditions. Gait ability was defined as gait speed. Five aspects of cognitive function were assessed: processing speed, executive function, working memory, verbal memory, and visual memory. RESULTS: Regression analysis adjusted for covariates showed a significant association between cognitive functions and gait speed. Processing speed and executive function correlated with gait speed during both NW and DTW (p < .05). Gait speed during DTW was also significantly associated with working memory (p < .001). Visual memory was associated during NW and DTW, particularly for amnestic MCI participants (p < .05). CONCLUSIONS: Our findings support the idea that the association between gait speed and cognitive function depends on walking condition and MCI subtypes. Additional studies are necessary to determine the neural basis for the disruption in gait control in older adults with MCI.

DOI： 10.1186/1471-2377-14-67

Yoshida Daisuke, Suzuki Takao, Shimada Hiroyuki, Park Hyuntae, Makizako Hyuma, Doi Takehiko, Anan Yuya, Tsutsumimoto Kota, Uemura Kazuki, Ito Tadashi, Lee Sangyoon . Using two different algorithms to determine the prevalence of sarcopenia. . Geriatr Gerontol Int14 Suppl 1 46 - 51 2014.2

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

AIM: Several operative definitions and screening methods for sarcopenia have been proposed in previous studies; however, the opinions of researchers still differ. We compared the prevalence of sarcopenia using two different algorithms: (i) the European working group on sarcopenia in older people (EWGSOP)-suggested algorithm using gait speed as the first step; and (ii) the muscle mass and strength algorithm. METHODS: A population-based, cross-sectional survey of adults aged over 65 years was carried out. Data on a total of 4811 participants were available for analysis. Gait speed, grip strength and appendicular skeletal muscle mass were assessed to determine sarcopenia. Appendicular skeletal muscle mass was estimated from bioimpedance analysis measurements and expressed as skeletal muscle mass index. Grip strength and skeletal muscle mass index were considered to be low if they fell below the threshold of the lowest 20% of values measured in a subset of healthy subjects. We compared the prevalence rates of sarcopenia determined by the two algorithms. RESULTS: The prevalence rate of sarcopenia in a representative sample of older Japanese adults was 8.2% for men and 6.8% for women based on the EWGSOP algorithm. The two algorithms identified the same participants as sarcopenic, the only difference being the EWGSOP algorithm classified an additional seven participants (0.15%) into sarcopenia compared with the muscle mass and strength algorithm. CONCLUSION: It is debatable whether inclusion of gait speed is necessary when screening for sarcopenia in community-dwelling older adults. Future research should examine the necessity of including gait speed in algorithms and the validity of cut-off values.

DOI： 10.1111/ggi.12210

Makizako Mihoko, Makizako Hyuma, Doi Takehiko, Uemura Kazuki, Tsutsumimoto Kota, Miyaguchi Hideki, Shimada Hiroyuki . Olfactory identification and cognitive performance in community-dwelling older adults with mild cognitive impairment. . Chem Senses39 ( 1 ) 39 - 46 2014.1

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

Olfactory impairment constitutes one of the earliest signs of Alzheimer's disease in older adults with mild cognitive impairment. We investigated which aspects of neuropsychological measures are correlated with olfactory identification performance among older adults with mild cognitive impairment. Total of 220 participants with mild cognitive impairment (mean age 71.7 years) were examined. Odor identification was assessed using the Open Essence test. Participants underwent comprehensive neurocognitive evaluation, including measures of verbal memory, visual memory, working memory, attention/executive function, and processing speed. We examined associations between olfactory function and cognitive performance scores. Participants with severe hyposmia exhibited significantly poor verbal and visual memory performance, attention/executive function, and slower processing speed scores compared with those without severe hyposmia. In multivariable logistic regression models, better performance scores on verbal and visual memory were significantly associated with decreased likelihood of severe hyposmia after adjusting for age, sex, education, and other cognitive performance scores. These findings suggest that olfactory impairment might be more closely associated with memory loss compared with other aspects of cognitive functioning in mild cognitive impairment subjects.

DOI： 10.1093/chemse/bjt052

Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Uemura Kazuki, Lee Sangyoon, Park Hyuntae, Suzuki Takao . A large, cross-sectional observational study of serum BDNF, cognitive function, and mild cognitive impairment in the elderly. . Front Aging Neurosci6 69 - 69 2014

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

OBJECTIVE: The clinical relationship between brain-derived neurotrophic factor (BDNF) and cognitive function or mild cognitive impairment (MCI) is not well-understood. The purpose of this study was to identify the relationship between serum BDNF and cognitive function and MCI, and determine whether serum BDNF level might be a useful biomarker for assessing risk for MCI in older people. MATERIALS AND METHODS: A total of 4463 individuals aged 65 years or older (mean age 72 years) participating in the study. We measured performance in a battery of neuropsychological and cognitive function tests; serum BDNF concentration. RESULTS: Eight hundred twenty-seven participants (18.8%) had MCI. After adjustment for sex, age, education level, diabetes, and current smoking, serum BDNF was associated with poorer performance in the story memory, and digit symbol substitution task scores. Serum BDNF was marginally associated with the presence of MCI (odds ratio, 95% confidence interval: 1.41, 1.00-1.99) when BDNF was 1.5 SD lower than the mean value standardized for sex and age, education level, diabetes, and current smoking. CONCLUSION: Low serum BDNF was associated with lower cognitive test scores and MCI. Future prospective studies should establish the discriminative value of serum BDNF for the risk of MCI.

DOI： 10.3389/fnagi.2014.00069

Makizako Hyuma, Shimada Hiroyuki, Park Hyuntae, Doi Takehiko, Yoshida Daisuke, Uemura Kazuki, Tsutsumimoto Kota, Suzuki Takao . Evaluation of multidimensional neurocognitive function using a tablet personal computer: test-retest reliability and validity in community-dwelling older adults. . Geriatr Gerontol Int13 ( 4 ) 860 - 866 2013.10

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

AIM: This study sought to confirm the test-retest reliability and validity of the National Center for Geriatrics and Gerontology functional assessment tool (NCGG-FAT), a newly developed assessment of multidimensional neurocognitive function using a tablet personal computer (PC). METHODS: This study included 20 community-dwelling older adults (9 females, aged 65-81 years). Participants were administered the NCGG-FAT twice, separated by approximately 30 days to determine test-retest reliability. To test the validity of the measure, participants underwent established neurocognitive measurements, including memory, attention, executive function, processing speed and visuospatial function within a week from the first administration of the NCGG-FAT. RESULTS: Test-retest reliability was in an acceptable range for each component of the NCGG-FAT, with intraclass correlation coefficients ranging from 0.764 to 0.942. Each task in the NCGG-FAT showed a moderate to high correlation with scores on widely-used conventional neurocognitive tests (r = 0.496 to 0.842). CONCLUSION: We found that the NCGG-FAT using a tablet PC was reliable in a sample of community-dwelling older adults. The NCGG-FAT might be useful for cognitive screening in population-based samples and outcomes, enabling assessment of the effects of intervention on multidimensional cognitive function among older adults.

DOI： 10.1111/ggi.12014

Doi Takehiko, Makizako Hyuma, Shimada Hiroyuki, Park Hyuntae, Tsutsumimoto Kota, Uemura Kazuki, Suzuki Takao . Brain activation during dual-task walking and executive function among older adults with mild cognitive impairment: a fNIRS study. . Aging Clin Exp Res25 ( 5 ) 539 - 544 2013.10

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

BACKGROUND AND AIMS: Dual-task walking (DTW) is thought to involve activation of the prefrontal cortex in healthy adults and to be affected by cognitive impairment. However, it is unclear whether prefrontal cortex activation is involved in DTW in older adults with mild cognitive impairment. This study examined brain activation during DTW among older adults with mild cognitive impairment using functional near-infrared spectroscopy. METHODS: Sixteen older adults (aged 75.4 +/- 7.2 years, women n = 6) performed gait experiments under normal walking and DTW conditions. We used a design with 60-s blocks consisting of a 10-s rest standing as pre-resting period, a 20-s walking task period, and a 30-s rest standing as post-resting period. Walking speed was measured during a 20-s walking task. Changes in oxy-hemoglobin were measured in the prefrontal area during gait experiments. RESULTS: Walking speed was slower during DTW compared with normal walking (p < 0.001). The oxy-hemoglobin level during DTW was higher than during normal walking (p < 0.001) and was correlated with executive function, as measured by Stroop interference (p < 0.05). CONCLUSION: Our findings indicate that DTW is associated with prefrontal activation among older adults with mild cognitive impairment. The brain activation during DTW was correlated with executive function. Additional studies are necessary to elucidate the effects of cognitive impairment on the association between prefrontal activity and walking under various conditions.

DOI： 10.1007/s40520-013-0119-5

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Park Hyuntae, Yoshida Daisuke, Uemura Kazuki, Tsutsumimoto Kota, Liu-Ambrose Teresa, Suzuki Takao . Poor balance and lower gray matter volume predict falls in older adults with mild cognitive impairment. . BMC Neurol13 102 - 102 2013.8

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

BACKGROUND: The risk of falling is associated with cognitive dysfunction. Older adults with mild cognitive impairment (MCI) exhibit an accelerated reduction of brain volume, and face an increased risk of falling. The current study examined the relationship between baseline physical performance, baseline gray matter volume and falls during a 12-month follow-up period among community-dwelling older adults with MCI. METHODS: Forty-two older adults with MCI (75.6 years, 43% women) underwent structural magnetic resonance imaging and baseline physical performance assessment, including knee-extension strength, one-legged standing time, and walking speed with normal pace. 'Fallers' were defined as people who had one or more falls during the 12-month follow-up period. RESULTS: Of the 42 participants, 26.2% (n = 11) experienced at least one fall during the 12-month follow-up period. Fallers exhibited slower walking speed and shorter one-legged standing time compared with non-fallers (both p < .01). One-legged standing time (sec) (standardized odds ratio [95% confidence interval]: 0.89 [0.81, 0.98], p = .02) was associated with a significantly lower rate of falls during the 12-month follow-up after adjusting for age, sex, body mass index, and history of falling in the past year at baseline. Voxel-based morphometry was used to examine differences in baseline gray matter volume between fallers and non-fallers, revealing that fallers exhibited a significantly greater reduction in the bilateral middle frontal gyrus and superior frontal gyrus. CONCLUSIONS: Poor balance predicts falls over 12 months, and baseline lower gray matter densities in the middle frontal gyrus and superior frontal gyrus were associated with falls in older adults with MCI. Maintaining physical function, especially balance, and brain structural changes through many sorts of prevention strategies in the early stage of cognitive decline may contribute to decreasing the risk of falls in older adults with MCI.

DOI： 10.1186/1471-2377-13-102

Shimada Hiroyuki, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Uemura Kazuki, Ito Tadashi, Lee Sangyoon, Park Hyuntae, Suzuki Takao . Combined prevalence of frailty and mild cognitive impairment in a population of elderly Japanese people. . J Am Med Dir Assoc14 ( 7 ) 518 - 524 2013.7

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

OBJECTIVE: Preventive strategies for frailty and mild cognitive impairment (MCI) are important for avoiding future functional decline and dementia in older adults. The purpose of this study was to use a population-based survey to ascertain the single and combined prevalence of frailty and MCI and to identify the relationships between frailty and MCI in older Japanese adults. DESIGN: Cross-sectional study. SETTING: General community. PARTICIPANTS: A total of 5104 older adults (aged 65 years or older, mean age 71 years) who were enrolled in the Obu Study of Health Promotion for the Elderly (OSHPE). MEASUREMENTS: Each participant underwent detailed physical and cognitive testing to assess frailty and MCI. We considered the frailty phenotype to be characterized by limitations in 3 or more of the following 5 domains: mobility, strength, endurance, physical activity, and nutrition. Screening for MCI included a standardized personal interview, the Mini-Mental State Examination, and the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT), which included 8 tasks used to assess logical memory (immediate and delayed recognition), word list memory (immediate and delayed recall), attention and executive function (tablet version of Trail Making Test-part A and B), processing speed (tablet version of digit symbol substitution test), and visuospatial skill (figure selection). RESULTS: The overall prevalence of frailty, MCI, and frailty and MCI combined was 11.3%, 18.8%, and 2.7%, respectively. We found significant relationships between frailty and MCI (the odds ratio adjusted for age, sex, and education was 2.0 (95% confidence interval 1.5-2.5). CONCLUSIONS: Using the OSHPE criteria, we found more participants with MCI than with frailty. The prevalence of frailty and MCI combined was 2.7% in our population. Future investigation is necessary to determine whether this population is at increased risk for disability or mortality.

DOI： 10.1016/j.jamda.2013.03.010

Shimada Hiroyuki, Ishii Kenji, Ishiwata Kiichi, Oda Keiichi, Suzukawa Megumi, Makizako Hyuma, Doi Takehiko, Suzuki Takao . Gait adaptability and brain activity during unaccustomed treadmill walking in healthy elderly females. . Gait Posture38 ( 2 ) 203 - 208 2013.6

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

This study evaluated brain activity during unaccustomed treadmill walking using positron emission tomography (PET) and [(18)F]fluorodeoxyglucose. Twenty-four healthy elderly females (75-82 years) participated in this study. Two PET scans were performed after 25 min of rest and after walking for 25 min at 2.0 km/h on a treadmill. Participants were divided into low and high step-length variability groups according to the median coefficient of variation in step length during treadmill walking. We compared the regional changes in brain glucose metabolism between the two groups. The most prominent relative activations during treadmill walking compared to rest in both groups were found in the primary sensorimotor areas, occipital lobe, and anterior and posterior lobe of the cerebellum. The high step-length variability group showed significant relative deactivations in the frontal lobe and the inferior temporal gyrus during treadmill walking. There was a significant relative activation of the primary sensorimotor area in the low step-length variability group compared to the high step-length variability group (P = 0.022). Compared to the low step-length variability group, the high step-length variability group exhibited a greater relative deactivation in the white matter of the middle and superior temporal gyrus (P = 0.032) and hippocampus (P = 0.034) during treadmill walking compared to resting. These results suggest that activation of the primary sensorimotor area, prefrontal area, and temporal lobe, especially the hippocampus, is associated with gait adaptability during unaccustomed treadmill walking.

DOI： 10.1016/j.gaitpost.2012.11.008

Makizako Hyuma, Doi Takehiko, Shimada Hiroyuki, Yoshida Daisuke, Takayama Yuko, Suzuki Takao . Relationship between dual-task performance and neurocognitive measures in older adults with mild cognitive impairment. . Geriatr Gerontol Int13 ( 2 ) 314 - 321 2013.4

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

AIM: The aim of this study was to examine the relationship between dual-task performance and neurocognitive measures in community-dwelling older people with mild cognitive impairment (MCI). METHODS: A total of 98 subjects (mean age 74.8 years, 52.0% female) participated in the study. We compared 36 participants with amnestic MCI (aMCI) with 62 participants with non-amnestic MCI (non-aMCI) on dual-task performance as measured by reaction time responses. The relationships between dual-task performance and multiple domains of neurocognitive functions, including general cognitive function, visual memory, working memory, executive function and processing speed, were examined. RESULTS: Although there were no statistically significant group differences in simple reaction times (P = 0.734), the aMCI group showed significantly slower dual-task reaction times than the non-aMCI group (P = 0.012). Using multiple regression analysis, we found that there was a significant relationship between executive function and dual-task reaction times (beta = 0.298, P = 0.006). CONCLUSION: These results showed that aMCI subjects showed a specific deficit in dual-task performance compared with non-aMCI subjects, and poor dual-task performance was associated with declines in executive function in older people with MCI. Future longitudinal and interventional studies should investigate the use of dual-task testing with varying levels of cognitive demand in older adults at risk of dementia.

DOI： 10.1111/j.1447-0594.2012.00898.x

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Yoshida Daisuke, Shimokata Hiroshi, Ito Kengo, Washimi Yukihiko, Endo Hidetoshi, Suzuki Takao . Characteristics of cognitive function in early and late stages of amnestic mild cognitive impairment. . Geriatr Gerontol Int13 ( 1 ) 83 - 89 2013.1

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

AIM: The detection of the early stages in amnesic mild cognitive impairment (aMCI) is considered important in diagnosing progression to Alzheimer's disease. The current study sought to investigate differences in cognitive function between control subjects with no memory loss (control), and subjects in the early stage of aMCI (EMCI) and late stage of aMCI (LMCI). METHODS: A total of 100 community-dwelling older adults aged 65 years and over were recruited from 1543 potential subjects. Subjects were classified into three groups based on the degree of objective memory impairment; control (n=29), EMCI (n=34) and LMCI (n=37). Multiple neuropsychological tests were carried out to examine cognitive function. RESULTS: The EMCI individuals showed lower cognitive function relative to controls; not only in logical memory, but also in letter fluency (P<0.05). There were no significant differences in neuropsychological scores between the EMCI and LMCI groups, except for category fluency and logical memory. In addition, the EMCI subjects' logical memory score showed a significant relationship with letter fluency, category fluency and digit span backward test performance (P<0.05). CONCLUSIONS: These results suggest that the application of multiple neuropsychological tests might be useful in diagnosing older adults with EMCI and LMCI.

DOI： 10.1111/j.1447-0594.2012.00865.x

Doi Takehiko, Makizako Hyuma, Shimada Hiroyuki, Yoshida Daisuke, Tsutsumimoto Kota, Sawa Ryuichi, Misu Shogo, Suzuki Takao . Effects of multicomponent exercise on spatial-temporal gait parameters among the elderly with amnestic mild cognitive impairment (aMCI): preliminary results from a randomized controlled trial (RCT). . Arch Gerontol Geriatr56 ( 1 ) 104 - 108 2013.1

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

Exercise training has been shown to increase physical function in the elderly. However, the effects of exercise on elderly individuals with amnestic aMCI are unclear. The aim of this RCT was to investigate the effect of multicomponent exercise on gait in the elderly. Fifty elderly individuals with aMCI (age: 65-92 years) participated in the study and were randomly allocated to a multicomponent exercise or control group. Multicomponent exercise training was performed for 90 min, twice a week over six months. Gait was analyzed at baseline and after the six month intervention. Gait analysis was performed on an eleven meter walkway at each subject's comfortable walking speed. A miniature tri-axial accelerometer was attached to the L3 spinous process and was used to analyze gait speed, stride length, stride time, and the harmonic ratio (HR) (representing the smoothness of trunk movement). There were no differences in the participant characteristics or gait parameters between the groups at baseline. After adjustment for covariates the multicomponent exercise program had a significant (p<0.05) effect on gait speed, stride length, and the vertical HR. Through improving gait, multicomponent exercise training improves the physical health of the elderly with aMCI.

DOI： 10.1016/j.archger.2012.09.003

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 2013.1

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

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 2013.1

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

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

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

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,

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

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

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

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

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, 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

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

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,

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

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

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, 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 2012.12

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

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 2012.10

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

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 2012.10

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

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 2012.6

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

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 2012.1

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

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

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

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

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

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

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

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

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

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 2011.12

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

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 2011.9

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

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 2010.10

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

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 2009.7

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

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.

Makizako Hyuma, Abe Tsutomu, Shimada Hiroyuki, Ohnuma Takeshi, Furuna Taketo, Nakamura Yoshio . Combined effect of factors associated with burdens on primary caregiver. . Geriatr Gerontol Int9 ( 2 ) 183 - 189 2009.6

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

BACKGROUND: It is argued that a multidimensional approach is necessary for burden assessment. Reducing caregiver burden is a social problem in the ageing Japan society. We examined the combined effect of factors affecting the care burden among community-dwelling handicapped people and their caregivers. METHODS: The participants were 49 handicapped people (aged 53-104 years) who received home-visit rehabilitation, and their 49 caregivers (age 42-85 years). Caregivers were provided questionnaires consisting of questions on social support, subjective well-being, self-efficacy with regard to care continuation, the Motor Fitness Scale and caregiver burden. Care recipients were assessed using the Bedside Mobility Scale and the Barthel Index. RESULTS: We prepared the hypothesis model using structural equation modeling with the bootstrap method within outcome measures. The hypothesis model did not fit the data well. The impact of the Motor Fitness Scale was shifted from the caregiver burden to care self-efficacy and well-being, having a cooperator for care and variable of spouse caregiver or others associated with caregiver well-being in the revised model. The fit of the revised model was acceptable (goodness of fit index, 0.903; comparative fit index, 0.998; root mean square error of approximation, 0.017). In the revised model, the care recipients' disabled state was associated with caregiver burden. In addition, higher burden and poor motor fitness of caregivers might lead to lower care self-efficacy in providing continuous care and lower caregiver well-being. CONCLUSION: These findings suggested that the program to reduce caregiver burden should focus on aspects of the care recipients' disabled state, the caregivers' well-being, fitness, and care self-efficacy.

DOI： 10.1111/j.1447-0594.2009.00523.x

Makizako Hyuma, Abe Tsutomu, Abe Keiichiro, Kobayashi Satomi, Koguchi Rie, Onuma Takeshi, Shimada Hiroyuki, Nakamura Yoshio . [Factors burdening the caregiving relatives of community-dwelling disable Japanese people]. . Nihon Ronen Igakkai Zasshi45 ( 1 ) 59 - 67 2008.1

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

AIM: This study examined the factors associated with burdens on the primary caregivers of community-dwelling disabled people. METHODS: Participants were 78 disabled people (40 men, 38 women; mean age 77.8+/-11.5 years) who received home-based physical therapy and/or occupational therapy, and their 78 caregivers (20 men, 58 women; mean age 66.8+/-10.2 years). The caregiver burden was assessed using the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8). In addition, the primary caregivers completed questionnaires about burdens arising from supporting the activities of daily living (ADL) using a visual analogue scale, available social support, subjective well-being, and the Motor Fitness Scale. The performance of the disabled subjects was assessed using the Bedside Mobility Scale and the Barthel Index. The disabled subjects and the caregivers were divided into higher burden (J-ZBI_8 score, 10 points and over) and lower burden groups (J-ZBI_8 score, 9 points and under) to compare the group differences in the measurements. RESULTS: The disabled participants in the lower burden group (n=41) showed significantly higher Bedside Mobility Scale scores and Barthel Index scores than those in the higher burden group (n=37). The primary caregivers in the higher burden group showed significantly higher burden due to supporting the ADL, lower subjective well-being, and lower social support as compared to those in the lower-burden group. CONCLUSION: The burden levels of the primary caregivers relating to the mobility and ADL of their recipients were assessed. The caregivers with higher burden showed less social support and low subjective well-being.

中井雄貴, 富岡一俊, 谷口善昭, 竹中俊宏, 牧迫飛雄馬 . COVID-19対策に伴う外出自粛時期の地域在住高齢者における身体活動量変化　運動教室に参加していた高齢者を対象とした調査 . 理学療法科学36 ( 1 ) 35 - 40 2021.2

Publisher：(一社)理学療法科学学会

[目的]新型コロナウイルス感染症(COVID-19)の感染拡大予防対策に伴う外出自粛時期前後での運動教室に参加していた地域在住高齢者における身体活動量の変化を調べた。[対象と方法]対象は地域在住高齢者15名、2019年9月(緊急事態宣言前)と2020年4月(緊急事態宣言中)における身体活動量と生活空間(LSA)の変化を比較した。身体活動量は3軸加速度計を用いて計測した。[結果]緊急事態宣言前に比べて緊急事態宣言中は2割の者で町外への外出(生活空間レベル5)をしておらず、LSAスコアが低下傾向であったが、有意な変化ではなかった。身体活動量も有意な変化はなかった。[結語]2020年4月中旬時点において運動教室に参加していた高齢者は、生活範囲の顕著な変化および身体活動量の低下は認められなかった。(著者抄録)

Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Sato N, Wada A, Kiyama R, Tsutsumimoto K, Ohishi M, Kiuchi Y, Kubozono T, Takenaka T . Effects of a Multicomponent Exercise Program in Physical Function and Muscle Mass in Sarcopenic/Pre-Sarcopenic Adults. . Journal of clinical medicine9 ( 5 ) 2020.5

中井雄貴, 富岡一俊, 谷口善昭, 木山良二, 佐藤菜々, 和田あゆみ, 窪園琢郎, 大石充, 牧迫飛雄馬 . 地域在住高齢者における腰痛および膝痛と身体機能との関連　急性および慢性疼痛が歩行速度や握力に及ぼす影響 . 理学療法学47 ( 2 ) 146 - 152 2020.4

Publisher：(公社)日本理学療法士協会

平井達也, 牧迫飛雄馬, 石川康伸, 若月勇輝, 吉元勇輝 . 転倒経験の有無が歩行の主観的評価と客観的運動評価の関連性に与える影響 . 理学療法科学35 ( 2 ) 263 - 266 2020.4

Publisher：(一社)理学療法科学学会

[目的]自己の歩行に対する主観的な評価である日本語版modified Gait Efficacy Scale(日本語版mGES)と客観的な運動機能評価との関連性が転倒経験の有無により異なるかを検討すること。[対象と方法]対象は65歳以上の地域在住高齢者で転倒経験により転倒群13名と非転倒群50名に分けた。日本語版mGES、重心動揺、Timed up and go(TUG)の測定を行った。[結果]転倒経験の有無にかかわらず、日本語版mGESと重心動揺との関連は認められなかった。日本語版mGESとTUGでは、非転倒群のみで有意な相関関係を認め、転倒群では有意な関連を認めなかった。[結語]歩行の主観的評価と客観的評価の関連性は転倒経験の有無によって異なることが示唆された。(著者抄録)

NAKAI Yuki, TOMIOKA Kazutoshi, TANIGUCHI Yoshiaki, KIYAMA Ryoji, SATO Nana, WADA Ayumi, KUBOZONO Takuro, OHISHI Mitsuru, MAKIZAKO Hyuma . Association of Back and Knee Pain with Physical Function in Community-dwelling Older Adults:Effects of Acute/Chronic Pain on Gait Speed and Grip Strength . Physical Therapy Japan47 ( 2 ) 146 - 152 2020

Publisher：Japanese Society of Physical Therapy

Purpose: Approximately 80% of community-dwelling older adults present with musculoskeletal pain accompanied by low gait speed and grip strength. This study investigated the effects of acute or chronic back and knee pain on gait speed and grip strength in community-dwelling older adults.Methods: This study included 735 community-dwelling older adults (aged ≥65 years, mean age 74.8 years, 62.9% women) (Tarumizu study 2018). Type of pain (acute vs. chronic) was determined using a questionnaire. We investigated the association between acute or chronic pain and low gait speed (<1.0 m/s) and low grip strength (men <26 kg, women <18 kg).Results: Of the 735 participants, 347 (47.2%) reported no pain, 144 (19.6%) reported acute pain, and 244 (33.2%) reported chronic pain. Low back and knee pain were observed in 121 participants (16.5%), of which 46 (38.0%) reported acute pain and 75 (62.0%) reported chronic pain. Logistic regression analysis revealed that low gait speed was significantly associated with chronic pain (adjusted odds ratio 2.55, p = 0.001) but not with acute pain (adjusted odds ratio 1.19, p = 0.632) (adjusted for age, sex, the 15-item Geriatric Depression Scale, medication use, the Appendicular Skeletal Muscle Mass Index, and grip strength). Notably, no association was observed between pain and low grip strength.Conclusion: Community-dwelling older adults with chronic low back and knee pain showed low gait speed.

DOI： 10.15063/rigaku.11722

HIRAI Tatsuya, MAKIZAKO Hyuma, ISHIKAWA Yasunobu, WAKATSUKI Yuuki, YOSHIMOTO Yuuki . Effects of Fall Experience on the Relationship between Subjective Assessment of Walking and Objective Motor Assessment . Rigakuryoho Kagaku35 ( 2 ) 263 - 266 2020

Publisher：The Society of Physical Therapy Science

[Purpose] The purpose of this study was to examine whether experience of falls affects the relationship between subjective assessment of walking and objective motor assessment. [Participants and Methods] Sixty-three community-dwelling elderly aged over 65 years old were the participants. They were divided into a fall group (n=13) and a no-fall group (n=50). The Japanese version of the modified Gait Efficacy Scale (mGES), center of gravity sway, and the Timed up and go test (TUG) were evaluated. [Results] There was no association between mGES and the center of gravity sway, irrespective of fall experience. mGES and TUG showed a significant correlation in the no-fall group, but no significant association in the fall group. [Conclusion] The relationship between subjective and objective assessments of walking differed depending on the experience of falls.

DOI： 10.1589/rika.35.263

佐藤菜々, 大石充, 牧迫飛雄馬, 中井雄貴, 富岡一俊, 谷口善昭, 木山良二, 和田あゆみ, 窪園琢郎, 竹中俊宏 . 地域在住高齢者における社会参加とサルコペニアの関連性 . 理学療法学Supplement47 ( 0 ) I - 41_2-I-41_2 2020

牧迫飛雄馬 . 高齢者における活動の再考 . 理学療法学Supplement47 ( 0 ) I - 5-I-5 2020

Publisher：公益社団法人日本理学療法士協会

高齢期の日常生活における「活動（activity）」を促進することは，健康寿命の延伸を目指すうえでの重要な課題のひとつと考える。ここでは，日常におけるさまざまな活動を「身体的活動（physical activity）」，「知的活動（cognitive activity）」，「社会的活動（social activity）」の大きく3つに分類して，高齢期におけるこれらの活動が健康関連指標へ及ぼす影響から，その意義と活動を促進するための取組について紹介する。　身体的活動は，心疾患やがん，認知症などの発症リスクを軽減させることに寄与することが，数多くの先行研究によって報告されており，健康長寿のために身体的活動を促進することへ疑う余地はないであろう。しかしながら，身体的活動を増加させるほどに望ましいかについては慎重になるべきであろう。Leeら（2019）が高齢女性16,741名を対象に1日の歩数と死亡発生との関連を縦断的に調べたところ，約7,500歩に達するまでは1日歩数の増加は死亡リスク低減と関連したが，1日10,000歩に達することの付加的な利得は認められなかった。　知的活動には，読書やパソコンの利用，ゲームなどが含まれ，これらの活動は認知症や軽度認知障害（mild cognitive impairment: MCI）の発症に対しての保護的な役割が報告されている。日常的なこれらの知的活動の促進は，認知機能の低下を抑制するうえで重要であろう。　社会的活動においては，より複雑で高度な能力が求められることが多く，社会的活動は認知症の発症のほか，うつの発生の抑制にも有効であることが報告されている。　これらの活動を日常生活において促進するためには，きっかけづくりと継続のためのモチベーションの維持が重要であり，いかに日常でのこれらの活動を多面的に促進していくかが健康長寿の鍵になると考えられる。

DOI： 10.14900/cjpt.47S1.I-5

牧迫飛雄馬 . 脳とからだの健康対策～認知症・介護予防の理論と実践～ . 関東甲信越ブロック理学療法士学会38 ( 0 ) 2020

Publisher：社団法人日本理学療法士協会関東甲信越ブロック協議会

「健康は第一の富である」（詩人・思想家、ラルフ・ワルド・エマーソン）と言われことがあるように、何事を行うにも健康であることが基本であり、我々にとって健康とは何事にも替えがたい優先順位の極めて高い状態と言えるかもしれません。　2016年（平成28年）国民生活基礎調査によると、介護・支援が必要となった主な原因で最も多いのは認知症（18.0％）となっています。2000年に介護保険が始まって以来、介護の原因として最も多かった脳血管疾患（脳卒中）を認知症が上回る状況です。また、要支援者に限ってみてみると、高齢による衰弱（16.6％：第２位）、骨折・転倒（15.2％：第３位）といった疾病とは分類しがたい原因が上位を占めています。そのため、記憶や注意力といった認知機能、筋力や歩行能力といった身体機能を良好な状態に維持することは、介護予防の観点から急務の課題となっています。　『認知症』は予防できるのでしょうか･･･。現在のところ、認知症の予防または認知症の発症を遅らせることができる確な方法は明らかとなっていません。しかし、徐々に認知機能が衰えていく状況をくいとめて、認知機能を向上させ、脳機能を良好に維持して鍛えていくことで、認知症の発症を遅らせることができるのではないかと期待されています。　その効果的は方法のひとつが、身体活動を促進することであるとされています。運動は比較的に低コストで実施が可能であり、認知症予防の取組の中核的な役割を果たす可能性が示唆されています。しかし、運動によって脳賦活を促進することを目指すうえでは、単純な運動課題では脳活動の活性化を促すことは難しいと言わざるを得ません。そのため、認知機能の改善・維持に対して効果的な介入方法を実践するためには、筋力トレーニングおよび柔軟運動、有酸素運動、脳賦活を促進する運動、健康行動技法などを効率的に組み合わせることが必要であり、とりわけ認知課題を負荷しながら（二重課題、多重課題）の有酸素運動などによって、より効率的に脳の活性化を図ることが期待されています。　本講演では、日常のなかでもできる認知症および要介護の予防のための実践方法を交えながら、基本的な考え方を紹介します。認知症の予防、介護予防のための基本的な考え方と日常のなかで実践できる予防方法を習得し、明日からの生活に活かしてみませんか。

DOI： 10.14901/ptkanbloc.38.0_0020

富岡一俊, 大石充, 牧迫飛雄馬, 中井雄貴, 谷口善昭, 木山良二, 和田あゆみ, 佐藤奈々, 窪園琢朗, 竹中俊宏 . 地域在住高齢者における身体活動量と身体・認知機能および身体組成との関連性 . 理学療法学Supplement47 ( 0 ) I - 28_1-I-28_1 2020

Makizako Hyuma, Nakai Yuki, Tomioka Kazutoshi, Taniguchi Yoshiaki . 日本人地域在住高齢者におけるAsia Working Group for Sarcopeniaの診断基準を用いて定義されたサルコペニアの有症率　システマティックレビューとメタアナリシス(Prevalence of sarcopenia defined using the Asia Working Group for Sarcopenia criteria in Japanese community-dwelling older adults: A systematic review and meta-analysis) . Physical Therapy Research22 ( 2 ) 53 - 57 2019.12

木村美佳, 守安愛, 牧迫飛雄馬, 井平光, 古名丈人 . 介護予防を目的とした郵便による食習慣介入の効果　積雪・寒冷・過疎地域在住高齢者における検討 . 日本公衆衛生雑誌66 ( 11 ) 681 - 689 2019.11

Publisher：日本公衆衛生学会

目的食と運動の介護予防プログラムTAKE10!を用いて、郵便を利用した通信型の介入を行い、集客型の介護予防教室で認められたような食習慣の変化が認められるかどうかを検証し、集客型の教室が開催できない地域や時期における本プログラムの活用について考察する。方法北海道の積雪寒冷過疎地域3町村に在住の70歳以上の高齢者143人(平均年齢77.6±5.0歳、男性45人、女性98人)を郵便による通信型介入を5ヵ月間行う介入群(72人)と行わない対照群(71人)に無作為に割付け、このうち、介入前後の調査会に出席し、質問紙を提出した介入群48人、対照群37人を解析対象者とし、介入前後の質問紙による調査(10の食品群の摂取頻度、Dietary Variety Score(DVS)、Food Frequency Score(FFS))から食習慣を比較した。また、介入群を調理従事群と非従事群に分け、両群のDVS、FFSの変化を解析した。結果介入群は介入前と比較して介入後に、9食品群の摂取頻度、DVS、FFSが有意に増加したが、対照群には有意な変化が認められず、2群間における交互作用が認められた。また、調理従事群、非従事群の両群においてDVS、FFSは介入前後で有意に増加した。結論 TAKE10!プログラムは、通信型の介入が受け入れ可能な対象者において、集客型と同様な食習慣の変化ならびに、同一世帯内での共有を期待できると考えられ、集客型の教室が開催できない地域や時期においての活用は有効であると思われる。(著者抄録)

Hirase Tatsuya, Makizako Hyuma, Okubo Yoshiro, Lord Stephen R., Inokuchi Shigeru, Okita Minoru . 地域在住高齢者の慢性痛は社会的フレイルと独立して関連する(Chronic pain is independently associated with social frailty in community-dwelling older adults) . Geriatrics & Gerontology International19 ( 11 ) 1153 - 1156 2019.11

Publisher：John Wiley & Sons Australia, Ltd

地域のエクササイズ教室に参加した地域在住高齢者248名(平均79.1±6.0歳、女性83.1%)を対象に、慢性痛と社会的フレイルとの関連を横断的に検討した。慢性痛の定義は、過去1ヵ月以内に6ヵ月以上持続する疼痛関連症状があることとした。社会的フレイルの定義は、五つの質問(外出頻度が少ない、友人を訪ねることがほとんどない、友人や家族の役にたたないと感じる、独居、他人との会話が毎日ない)のうち二つに該当する場合とした。身体機能は、椅子立ち上がりテストとTimed Up and Goテストを用いて評価した。55名(22.2%)が社会的フレイル基準に合致した。慢性痛の有病率は、社会的フレイル例50.9%、非社会的フレイル例29.0%であった(p=0.002)。年齢、性別、身体機能を調整後、慢性痛は社会的フレイルと有意に相関した(OR 2.13,95%CI 1.01〜4.48)。慢性痛は、外出頻度が少ないこと、友人を訪ねることがほとんどないこと、友人や家族の役にたたないと感じることとも有意に相関した。

Nakakubo Sho, Doi Takehiko, Makizako Hyuma, Tsutsumimoto Kota, Kurita Satoshi, Kim Minji, Ishii Hideaki, Suzuki Takao, Shimada Hiroyuki . 地域在住高齢者における睡眠状態と社会的フレイルの関連性(Association of sleep condition and social frailty in community-dwelling older people) . Geriatrics & Gerontology International19 ( 9 ) 885 - 889 2019.9

Publisher：John Wiley & Sons Australia, Ltd

地域在住高齢者4427名(女性51.4%、平均71.9歳)を対象に、睡眠時間および日中の過度な眠気(EDS)は社会的フレイルと関連するかを調べた。社会的フレイルは、「去年に比べて外出頻度が減少した」「友人の家を訪ねていない」「友人や家族の役に立っていない」「独居」「毎日だれかと会話していない」の五つの質問で評価し、このうち2項目以上該当した参加者を社会的フレイルと判定した。睡眠時間とEDSは自記式質問票により評価した。全参加者のうち、社会的フレイルの有症率は睡眠時間9時間以上群で18.3%、6時間未満群で9.9%、6.1〜8.9時間群で9.7%であった。EDSを呈する高齢者の社会的フレイル有症率は17.1%であった。複数の共変量で補正後、長い睡眠時間とEDSを呈することは社会的フレイルの高い有症率と関連することが示された。

牧野圭太郎, 牧迫飛雄馬, 李相侖, 李成哲, 裴成琉, 鄭松伊, 新海陽平, 島田裕之 . 抑うつ高齢者の身体活動量とBDNFおよび脳容量との関連　慢性疼痛の有無に着目した縦断観察研究 . 若手研究者のための健康科学研究助成成果報告書 ( 34 ) 46 - 50 2019.4

Publisher：(公財)明治安田厚生事業団

抑うつ高齢者の身体活動量、BDNFおよび脳容量の変化に慢性疼痛が与える影響について検討した。高齢者機能健診に参加した65歳以上の地域在住高齢者59名(男性31名、女性28名、平均73.3±6.0歳)を対象とした。慢性疼痛なし群は36名、慢性疼痛あり群は23名であった。慢性疼痛あり群における各アウトカムの変化量同士の相関分析の結果、ΔGDS(老年期うつ病評価尺度)得点とΔMTL(内側側頭部)萎縮領域の割合との間に有意な正の相関関係が、Δ全脳萎縮領域の割合とΔ歩数との間に有意な負の相関関係が、Δ歩数とΔMVPA(中強度以上の身体活動)との間に有意な正の相関関係が認められた。一方、慢性疼痛なし群における各アウトカムの変化量同士の相関分析の結果では、慢性疼痛あり群と同様にΔ歩数とΔMVPAとの間に有意な正の相関関係が認められたものの、その他の有意な相関関係は認められなかった。

Publisher：(株)ワールドプランニング

Makizako Hyuma, Kubozono Takuro, Kiyama Ryoji, Takenaka Toshihiro, Kuwahata So, Tabira Takayuki, Kanoya Tsutomu, Horinouchi Kouko, Shimada Hiroyuki, Ohishi Mitsuru . 地域在住高齢者における社会的フレイルと筋量喪失および筋力低下との関連(Associations of social frailty with loss of muscle mass and muscle weakness among community-dwelling older adults) . Geriatrics & Gerontology International19 ( 1 ) 76 - 80 2019.1

Publisher：John Wiley & Sons Australia, Ltd

地域在住高齢者の社会的フレイル状態と筋量喪失および筋力低下の関連を調べるため、横断研究を実施した。2017年に垂水市で実施された地域健診に参加した高齢者353名(女性264名、平均75.4±6.5歳)のデータを用いた。社会的フレイルは、外出頻度の低さ、友人訪問がめったにないこと、友人・家族に対する無力感、独居、毎日の会話がないことのうち2つ以上を満たす場合とした。生体電気インピーダンス法を用いて四肢の骨格筋量を評価し、四肢の骨格筋量指数を算出した。さらに、利き手の握力を測定した。社会的フレイルの発生は14.7%に認められた。社会的フレイルの参加者は、社会的フレイルのない参加者と比較して筋力低下および骨格筋量喪失の割合が高いことが示された。共変量の影響を補正後、社会的フレイルは筋力低下と独立して関連したが、骨格筋量との独立した関連は認められなかった。

KIMURA Mika, MORIYASU Ai, MAKIZAKO Hyuma, IHIRA Hikaru, FURUNA Taketo . Mail-based intervention for improvement of dietary habits among community-dwelling older adults living in heavy snowfall regions . Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH)66 ( 11 ) 681 - 689 2019

Publisher：Japanese Society of Public Health

Objectives　The aim of this study was to investigate the effect of mail-based intervention using the TAKE10! Program to improve dietary habits in cases where direct intervention is not possible.Methods　Subjects aged 70-91 years (77.6±5.0) were randomly assigned to two groups: 72 in the intervention group and 71 in the control group. The intervention group received monthly mail, which included self-check sheets (TAKE10! Check sheet and TAKE10! Calendar) and a letter with feedback and comments for 5 months. The outcome measures were changes in the intake frequency of 10 food groups, Dietary Variety Score (DVS), and Food Frequency Score (FFS).Results　Compared to baseline, the post-intervention intake frequencies for 9 of 10 food groups, DVS, and FFS significantly increased in the intervention group. No significant differences were observed between baseline and post-intervention in the control group. In the subgroup analysis of the intervention group, post-intervention DVS and FFS of both subjects who cooked their own food and those who did not showed significant increases compared to baseline.Conclusion　The mail-based TAKE10! Program resulted in improved dietary habits and could be shared with families in addition to direct interventions and could also be used in regions with inadequate transportation systems or frequent poor weather conditions.

DOI： 10.11236/jph.66.11_681

谷口善昭, 牧迫飛雄馬, 富岡一俊, 木山良二, 窪薗琢郎, 大石充 . 地域在住高齢女性における骨粗鬆症と握力、歩行速度、筋量との関係 . 理学療法学Supplement46 ( 0 ) G - 62_2-G-62_2 2019

Publisher：公益社団法人日本理学療法士協会

【はじめに・目的】2013年の国民生活基礎調査（厚生労働省）による要介護原因をみると，転倒・骨折は12.2％を占め，特に女性では15.4％と認知症に次いで第2位となっている．転倒・骨折には骨粗鬆症やサルコペニアが大きく関与することが推察され，特に骨粗鬆症を有する高齢女性では転倒による骨折リスクが大きい．2005年における我が国の骨粗鬆症患者数は1280万人とされており，サルコペニア有病率は7.5％～8.2％と推測され，これらの有病率は高齢者の増加に伴い今後も増えていくことが予想される．骨粗鬆症とサルコペニア対策は，我が国において喫緊の課題となっており，骨粗鬆症とサルコペニアの関連性を調べた研究はみられるものの，骨粗鬆症と握力，歩行速度，筋量をそれぞれ検討した研究は限られている． そこで今回，地域在住高齢女性における骨粗鬆症と握力，歩行速度，筋量との関係を明らかにすることを目的とした．【方法】垂水研究2017に参加した地域在住高齢者380名のうち，主要データに欠損の無い高齢女性266名を分析対象とした．研究デザインは横断研究であり，調査項目として年齢，骨粗鬆症の有無などの基本情報を聴取し，握力，歩行速度，四肢骨格筋量（生体電気インピーダンス法）を測定した．握力は18㎏，歩行速度は1.0m/s，補正四肢骨格筋量（ASMI，四肢骨格筋量㎏/身長m2）は5.7kg/m2を基準とし，それぞれの値を下回った場合を握力低下，歩行速度低下，筋量低下と定義した．これらの低下の有無と骨粗鬆症の有無の割合をχ2検定で比較した．また，握力低下，歩行速度低下，筋量低下のそれぞれを従属変数とし，独立変数を骨粗鬆症の有無，共変量に年齢を投入したロジスティック回帰分析を行った．【結果】骨粗鬆症の有病率は27.3％で，握力低下は28.6％，歩行速度低下は4.9％，筋量低下は50.0％が該当し，骨粗鬆症のある者では有意に筋量低下に該当する者の割合が高かった（p＝0.013）．ロジスティック回帰分析においても，筋量低下は骨粗鬆症と有意に関連しており（OR 2.0，95％CI 1.2-3.5，p＝0.014），年齢で調整したモデルにおいても筋量低下と骨粗鬆症との関連性は有意であった（OR 1.9，95％CI 1.1-3.4，p＝0.028）．【結論】骨粗鬆症を有する地域在住高齢女性において，筋力や歩行速度の低下は認められないものの，筋量が低下している可能性が示唆された．筋量の低下は，将来的に筋力や運動機能の低下を招き，転倒・骨折へと繋がっていく可能性が高い．骨粗鬆症を有する高齢女性においては，筋力や運動機能の評価だけではなく筋量を測定することにより，将来の運動機能低下や転倒・骨折予防のための介入の必要性を把握することが可能と思われる．今回は，問診のみで骨粗鬆症の有無を分類したため，骨粗鬆症の診断を受けていない対象者のなかにも骨密度が低下している者が含まれる可能性がある．今後は骨密度を測定し身体機能や筋量との関係性を検証する必要がある．【倫理的配慮，説明と同意】本研究は鹿児島大学大学院医歯学総合研究科疫学研究等倫理委員会の承認を受けて行った．ヘルシンキ宣言に基づき，参加者に文書と口頭にて説明し同意を得た．

DOI： 10.14900/cjpt.46S1.G-62_2

土井剛彦, 堤本広大, 中窪翔, 牧野圭太郎, 牧迫飛雄馬, 島田裕之 . 認知症の発症と関連する歩行指標の検討 . 理学療法学Supplement46 ( 0 ) C - 91_2-C-91_2 2019

Publisher：公益社団法人日本理学療法士協会

【はじめに、目的】高齢者の歩行は、歩行速度だけでなく時空間指標を用いて多角的に歩行能力を評価する必要があると考えられている。歩行能力低下が認知機能低下や認知症と関連することが、疫学や脳画像データを用いた研究において歩行速度を中心に検討されてきた。しかし、歩行速度を含む歩行の時空間指標において、どの指標が認知症の発症と関連しているのかについては未だ十分な知見が得られていない。そこで、本研究は、時空間指標を用いて歩行能力を評価し、各指標が認知症の発症とどのような関係を有しているかについて、縦断調査により検討することを目的とした。【方法】本研究は、National Center for Geriatrics and Gerontology - Study of Geriatric Syndromesデータベースより、2011年度に実施した調査に参加した者を抽出し、診療情報が得られない者、ベースラインにおいて認知症、パーキンソン病、脳卒中の病歴がある者、歩行測定が完遂出来なかった者を除く、4161名を対象にした。ベースラインにて、シート式下肢加重計（ウォークWay）を用いて歩行計測をした。計測路は2.4ｍ、加速・減速路は各々2mとし、通常歩行条件を5回計測した。歩行速度（m/s）の計測に加え、ストライド長（m）の平均ならびにcoefficient of variation（CV: %）を算出した。共変量として、一般特性、医学情報、服薬数、認知機能、身体活動習慣を聴取した。医療診療情報をもとに、追跡期間中の認知症の発症をアウトカムとした。【結果】対象者4161名（平均年齢72歳、女性53％）から、追跡期間（中央値44ヶ月）内に打ち切りになった者（死亡：114名、転出：36名）を除き、245名に認知症の発症がみられた。Cox比例ハザードモデルを用いた解析において、共変量無しのモデルでは歩行速度、ストライド長、ストライドCVの各指標において認知症の発症と有意な関連性が認められた（all p < 0.05）。しかし、共変量を投入したモデルでは歩行速度（hazard ratio(HR): 0.39 [95%CI: 0.20-0.74]）、ストライド長（HR: 0.33 [0.15-0.74]）と認知症の発症に有意な関連性が見られ、ストライドCVでは有意な関係性はみられなかった（HR: 1.05 [0.98-1.11]）。【結論】歩行能力の低下の中でも、歩行速度ならびにストライド長が認知症の発症に対して有意な関連性を有していた。認知症のリスク評価を行う場合には、認知機能評価だけでなく歩行能力についてもあわせて評価し、各個人の機能低下に応じた介入を行う必要があると考えられる。【倫理的配慮，説明と同意】本研究は、著者所属機関の倫理・利益相反委員会の承認を受け、対象者に対し本研究の主旨および目的を口頭と書面にて説明を行い、同意を得た後に実施した。

DOI： 10.14900/cjpt.46S1.C-91_2

牧迫飛雄馬 . 日本の予防理学療法領域が行うべき研究課題とその展望 . 理学療法学Supplement46 ( 0 ) C - 27-C-27 2019

Publisher：公益社団法人日本理学療法士協会

近年，理学療法の領域に限らず，疾病発症や障害発生の予防を目的とした取組の重要性はより一層に高まっており，社会ニーズに対応した研究課題としても重要な位置づけとなっている。とりわけ，予防理学療法領域においては，疾患の領域を問わずに発症予防のほか，重度化予防，さらには再発予防に至るまで，一連で包括的な視野が必要であり，すべてのライフステージが対象となり得るため，予防理学療法領域としての研究対象も幅広い。　「予防」を達成するための戦略には，大きくは二つの重要な視点が求められるものと考える。ひとつは，目指すべき予防のターゲットにおける危険因子をいかに低減していくか，である。もうひとつは，保護因子をいかに強めていくかである。そのため，予防理学療法領域で行うべき課題として，予防すべき事象の危険因子と保護因子をどれだけ同定できるかが大切であろう。次には，その危険因子を低減し，保護因子を強化するための効果的な方法を明らかにすることであろう。さらには，そのことによって，まさに「予防」を達成できたかを示すことが最終的な目標となるであろう。これらの課題を達成するためには，研究課題と同時に，どのようなアウトカムを設定するかが非常に重要となる。また，その「予防」が達成されることの意義を明確にすることも重要であり，かつ，その意義が社会に与える影響を考慮することで，予防理学療法に関わる研究の社会還元価値がさらに高まるものと考える。　本講演では，これまでに予防理学療法に関わるテーマで報告してきた研究成果の一部を紹介するとともに，これまでの研究活動を通して感じる今後の課題や展望についての意見を提示し，ディスカッションの基となる話題を提供したいと考える。

DOI： 10.14900/cjpt.46S1.C-27

牧野圭太郎, 土井剛彦, 堤本広大, 中窪翔, 牧迫飛雄馬, 島田裕之 . 地域高齢者における身体的フレイルが4年後の転倒および転倒恐怖感に及ぼす影響 . 理学療法学Supplement46 ( 0 ) C - 55_2-C-55_2 2019

Publisher：公益社団法人日本理学療法士協会

【はじめに、目的】高齢者の転倒恐怖感は、歩行能力の低下や活動制限、ADL低下などと関連し、直近の転倒経験がない高齢者にも存在することが明らかにされている。近年、身体的フレイルはその後の転倒発生リスクを増大させることが報告されているが、身体的フレイルが転倒恐怖感に及ぼす影響は十分に明らかにされていない。 本研究では、地域高齢者を対象とした4年間の縦断調査のデータから、身体的フレイルが4年後の転倒および転倒恐怖感に及ぼす影響を検討した。【方法】高齢者機能健診National Center for Geriatrics and Gerontology - Study of Geriatric Syndromesのデータベースのうち、2011年のベースライン調査と2015年の追跡調査の両方に参加した地域高齢者2,470名（平均71.1±4.7歳）を本研究の分析対象とした。なお、ベースライン時点で要支援・要介護認定、認知症、脳卒中、パーキンソン病、うつ病を有する者、Mini-Mental State Examination（MMSE）が20点未満の者は除外した。 ベースライン特性として、年齢、性別、服薬数、Geriatric Depression Scale、MMSE、身体的フレイルを評価した。なお、身体的フレイルに関しては、体重減少、筋力低下、疲労感、歩行速度低下、身体活動低下のうち1～2項目該当した場合をプレ・フレイル、3項目以上該当した場合をフレイルとした。アウトカムとして、ベースラインおよび4年後における過去1年間の転倒経験と転倒恐怖感を聴取した。【結果】2,470名のうち、1,170名（47.4%）が身体的プレ・フレイル、90名（3.6%）が身体的フレイルであった。また、ベースラインにおいて318名（12.9%）が過去1年間に転倒経験があり、1,024名（41.5%）が転倒恐怖感を有していた。 ベースラインで転倒経験がない2,152名におけるロジスティック回帰分析の結果、4年後に転倒経験を有する確率は、ベースラインでプレ・フレイルもしくはフレイルであった者はそうでない者に対してオッズ比1.57（95%CI 1.20-2.04）であった（転倒恐怖感を含むベースライン特性による調整後, p<0.01）。同様に、ベースラインで転倒恐怖感がない1,446名におけるロジスティック回帰分析の結果、4年後に転倒恐怖感を有する確率は、ベースラインでプレ・フレイルもしくはフレイルであった者はそうでない者に対してオッズ比1.31（95%CI 1.03-1.66）であった（転倒経験を含むベースライン特性による調整後, p<0.05）。【結論】地域高齢者において、身体的フレイルはその後の転倒発生に加え、転倒恐怖感にも影響する可能性が示された。高齢者の転倒恐怖感は転倒リスクとなるだけではなく、転倒経験から独立して要介護リスクとなることが先行研究で報告されているが、身体的フレイルの予防は転倒恐怖感の予防にも繋がる可能性があると考えられる。今後、転倒状況や転倒恐怖感についての時系列データを用いたより詳細な検討を行っていく必要がある。【倫理的配慮，説明と同意】本研究は、著者所属機関の倫理・利益相反委員会の承認を受けて実施した。ヘルシンキ宣言の趣旨に沿い、対象者には本研究の主旨および目的を口頭と書面にて説明を行い、書面にて同意を得た上で本研究を実施した。

DOI： 10.14900/cjpt.46S1.C-55_2

中窪翔, 土井剛彦, 牧迫飛雄馬, 堤本広大, 牧野圭太郎, 島田裕之 . 地域高齢者における睡眠状況と社会的フレイルの関連性の検討 . 理学療法学Supplement46 ( 0 ) C - 88_2-C-88_2 2019

Publisher：公益社団法人日本理学療法士協会

【はじめに、目的】 高齢期において重要とされるフレイルのなかでも、社会的な側面に着目した社会的フレイルは、身体機能低下や障害発生に影響を与えることが報告されており、予防すべきものの一つであると考えられる。一方で、高齢期の機能維持において重要な睡眠状況との関連性については、十分に検討がなされていないのが現状である。本研究は、地域在住高齢者を対象として睡眠時間および過度の日中の眠気（excessive daytime sleepiness: EDS）と社会的フレイルの関連性を横断的に検討することを目的した。【方法】 高齢者機能健診National Center for Geriatrics and Gerontology - Study of Geriatric Syndromesに参加した65歳以上の地域在住高齢者5,104名のうち、アルツハイマー病、パーキンソン病、うつ病の既往のある者、及びMini-Mental State Examinationが20点未満の者、欠損値がある者を除外した4,482名 (女性2,312名，男性2,170名，平均年齢72.0±5.5歳) を本研究の分析対象とした。睡眠状態の評価として、聴取した就寝時間と起床時間より睡眠時間を算出し、6時間以下、6～9時間、9時間以上の3群に群分けした。また、EDSは「日中、昼寝が必要なくらい眠くなることがありますか？」という質問に対して4件法で聴取し、「ほとんどいつも」と回答した者をEDSありとした。社会的フレイルは、独居である（はい）、去年に比べて外出頻度が減少した（はい）、友達の家を訪ねることがある（いいえ）、友達や家族の役に立っていると思う（いいえ）、毎日誰かと会話している（いいえ）の5項目のうち2項目以上該当した者をフレイルと判定した。睡眠時間およびEDSを独立変数、社会的フレイルを従属変数とした多重ロジスティック回帰分析（年齢、性別、教育歴、服薬数、BMI、うつ症状、歩行速度、MMSE、一日の平均歩行時間、喫煙歴、飲酒歴、慢性疾患で調整）を実施した。有意水準は5%未満とした。【結果】睡眠時間が6時間以下の者は462名（10.3%）、9時間以上の者は770名（17.2%）であり、EDSを有する者は636名（14.2%）であった。また、社会的フレイルの有症率は495名（11.0%）であった。ロジスティック回帰分析の結果、睡眠時間が9時間以上（OR=1.46，95%CI: 1.14-1.87）およびEDSを有すること（OR=1.32，95%CI: 1.02-1.71）が有意な関連性を示した。【結論】 睡眠時間が長いことおよび過度の日中の眠気を有することが社会的フレイルと関連していることが明らかとなった。社会的フレイルを中心としたさらなる機能低下を予防するための理学療法的介入を講じる上で、睡眠状況の把握、改善の重要性を示す一助となると考えられる。今後は因果関係を示すために縦断的な検討が必要である。【倫理的配慮，説明と同意】本研究は、著者所属機関の倫理・利益相反委員会の承認を受けて実施した。ヘルシンキ宣言の趣旨に沿い、対象者には本研究の主旨および目的を口頭と書面にて説明を行い、書面にて同意を得た上で本研究を実施した。

DOI： 10.14900/cjpt.46S1.C-88_2

富岡一俊, 牧迫飛雄馬, 木山良二, 谷口義昭, 桑波田聡, 竹中俊宏, 窪薗琢郎, 大石充 . 地域在住高齢者における精神・認知機能とサルコペニアとの関連 . 理学療法学Supplement46 ( 0 ) G - 96_2-G-96_2 2019

Publisher：公益社団法人日本理学療法士協会

【はじめに・目的】サルコペニアは加齢に伴う筋量や筋力の低下を特徴とする症候群であり，その改善や予防の対策は理学療法の重要な対象となる。近年，高齢者の認知・精神機能がサルコペニアに影響することが注目されているが，軽度認知機能低下（MCI）と抑うつ傾向について高齢者のサルコペニアとの関連性は未だ明らかではない。本研究は，横断的な調査を行い，MCIおよび抑うつ傾向とサルコペニアとの関連性を検討することを目的とした。 【方法】垂水研究2017に参加した地域在住高齢者380名のうち，認知症やうつ病の既往歴がある者，測定項目に欠損がある者を除く65歳以上の350 名（女性263名)を分析対象とした。Body mass index（BMI)，四肢骨格筋量 (生体電気インピーダンス法)，握力，通常歩行速度，National Center for Geriatrics and Gerontology functional assessment tool（NCGG-FAT)，Geriatric depression scale 15 （GDS-15)により，身体・精神・認知機能を評価し，病歴や教育年数などの基本属性を聴取した。また，骨格筋量はAppendicular Skeletal Muscle Mass Index (ASMI) (kg/m2) を算出し，Asian Working Group for Sarcopenia のアルゴリズムに従い，ASMI，歩行速度，握力の参照値からサルコペニアを定義した。NCGG-FATで年齢と教育歴を考慮した標準値より1.5SD以上の低下を認めた者をMCIとし，GDS-15が6点以上の者を抑うつ傾向とした。統計解析は，サルコペニア該当者と非該当者の2群に分け，カイ二乗検定およびロジスティック回帰分析を行い，MCIおよび抑うつ傾向とサルコペニアとの関係を調べた。有意水準は5% 未満とした。 【結果】サルコペニア該当者77名（22%），非該当者273名（78%）であった。サルコペニアの有無を従属変数として，年齢，教育年数，BMI，MCI，抑うつ傾向を独立変数としたロジスティック回帰分析（強制投入法）の結果，MCI（OR 2.72，95%CI 1.48-4.99，p=0.001）と抑うつ傾向（OR 2.54，95%CI 1.19-5.43，p=0.016）のいずれともに，サルコペニアと有意に関連していた。 【結論】本研究による横断的な分析の結果，MCIと抑うつ傾向はいずれともサルコペニアと関連があることが示唆された。この結果は，サルコペニアの予防戦略を検討する上で，認知機能や抑うつの評価を行う重要性を示していると考える。今後は，これらの関連性が将来的なサルコペニアの発生，要介護状態にどのように影響するのか縦断的に調査する必要がある。 【倫理的配慮，説明と同意】本研究は，鹿児島大学大学院医歯学総合研究科疫学研究等倫理委員会の承認を得て実施した。発表に関連し，開示すべき利益相反関係にある企業などはない。また，対象者には書面と口頭にて研究の目的・趣旨を十分に説明し，研究に対する参加の同意を得た。

DOI： 10.14900/cjpt.46S1.G-96_2

上村一貴, 牧迫飛雄馬, 李相侖, 土井剛彦, 李成喆, 堤本広大, 島田裕之 . 地域在住高齢者におけるサルコペニアと閉じこもり発生の関連:ー前向きコホート研究ー . 理学療法学Supplement46 ( 0 ) G - 90_1-G-90_1 2019

Publisher：公益社団法人日本理学療法士協会

【はじめに・目的】高齢者の閉じこもり予防は、運動器の機能向上や認知機能低下予防とともに介護予防事業で取り組むべき課題の一つとして重要視されている。現状では、すでに閉じこもり状態にある高齢者の特徴を報告する研究が多い一方で、縦断研究は少なく、閉じこもり発生を予測する因子については不明な点が多い。特にサルコペニアは、閉じこもり発生の強力な危険因子となることが予想されるが、両者の関連性は明らかでない。本研究の目的は、高齢者のサルコペニアと閉じこもり発生の関連性を明らかにすることであり、危険因子の解明によって閉じこもり予防のための理学療法介入の開発に寄与することが期待される。【方法】愛知県における高齢者機能健診に参加した5,104名のうち、要介護認定者、ベースラインで閉じこもり状態であった者を除いて、約15か月後の追跡調査に回答の得られた3,958名（男性1,980名、平均年齢71.8歳）を最終的な分析対象とした。閉じこもり状態の判定は、国内で広く使用される定義に倣い、「週に1回以上は外出していますか。」の質問に、いいえと回答した場合とした。サルコペニアはAsian Working Group for Sarcopeniaのアルゴリズムを用い、生体インピーダンス法(TANITA , MC-980A)による筋量と身体機能（握力または歩行速度）の両方の低下を有するものとした。基本属性（年齢，性，教育歴）に加えて、閉じこもり状態との関連が予想される因子として、【身体的要因：①身体活動、②転倒経験、③下肢痛】、【精神的要因：①抑うつ症状(Geriatric Depression Scale)、②認知機能(Mini–Mental State Examination)、③転倒恐怖感】、【社会的要因：①家族構成、②社会的役割、③友人との交流】の9項目を評価した。閉じこもりの発生の有無を従属変数、サルコペニアとその他の測定項目を独立因子とした多重ロジスティック回帰分析を全対象者、および年齢層別(前期高齢者／後期高齢者)に行った。【結果】83名(2.1%)で閉じこもり状態が新規発生した。多重ロジスティック回帰分析の結果、有意となったのは、年齢(OR[95%CI]=1.06 [1.02–1.10])、サルコペニア(1.98 [1.04–3.77])、友人との交流の減少(1.82 [1.03–3.23])であった。年齢層別分析の結果、前期高齢者では、社会的役割の減少(2.50 [1.06–5.91])が、後期高齢者ではサルコペニア(2.80 [1.06–5.91])と身体活動低下(2.85 [1.28–6.37])が新規の閉じこもり発生と関連していた。【結論】サルコペニアは、身体活動低下とともに後期高齢者の閉じこもりの独立した危険因子であった。一方で前期高齢者では社会的役割の減少と閉じこもり発生に有意な関連がみられた。閉じこもり予防のための理学療法介入を検討する上で、年齢層によってフォーカスすべき危険因子が異なることが示唆された。【倫理的配慮，説明と同意】本研究はヘルシンキ宣言に則り、対象者に研究の目的や検査内容、個人情報の保護について口頭と書面にて十分に説明した上で同意を得た。国立長寿医療研究センターの倫理・利益相反委員会の承認を受けて実施した。

DOI： 10.14900/cjpt.46S1.G-90_1

Doi Takehiko, Makizako Hyuma, Tsutsumimoto Kota, Nakakubo Sho, Kim Min-Ji, Kurita Satoshi, Hotta Ryo, Shimada Hiroyuki . 日本人高齢者におけるフレイルの移行状態と修正可能なリスク　前向きコホート研究(Transitional status and modifiable risk of frailty in Japanese older adults: A prospective cohort study) . Geriatrics & Gerontology International18 ( 11 ) 1562 - 1566 2018.11

Publisher：John Wiley & Sons Australia, Ltd

日本人集団ベースの大規模コホート研究であるNational Center for Geriatrics and Gerontology-Study of Geriatric Syndromesに参加した高齢者4676名を対象に、フレイルの発現頻度とリスク因子との関連を評価した。ベースライン時と4年の追跡時における身体的フレイル状態を健常者、前フレイル、フレイルに分類した。平均追跡期間は47.9±1.8ヵ月であった。人口統計学的変数、医学的状態、転倒、うつ症状、認知機能に関する情報も収集した。52例(2.6%)が健常者からフレイル状態に進行した。前フレイルからフレイルへの進行は281例(12.0%)で認めた。死亡率はベースラインにおけるフレイル状態と共に上昇した。健常者46名(2.3%)、前フレイル112名(4.8%)、フレイル54例(15.6%)であった。ロジスティック回帰分析では、年齢、性別、BMI、転倒、老年期うつ病評価尺度、ミニメンタルステート検査、教育が新規フレイル発症と関連していた。ベースライン時点で前フレイル状態の参加者は、消耗、運動不足、筋力低下、可動性低下がフレイル進行と関連した。

Shimada Hiroyuki, Makizako Hyuma, Lee Sangyoon, Doi Takehiko, Lee SungChul . 日本人高齢者のライフスタイル行動と認知症リスク(Lifestyle activities and the risk of dementia in older Japanese adults) . Geriatrics & Gerontology International18 ( 10 ) 1491 - 1496 2018.10

Publisher：John Wiley & Sons Australia, Ltd

知的活動や毎日の活動に参加していない高齢者はそれらの活動に参加している高齢者に比べて認知症発症のリスクが高いとの仮説を立て、これを検証した。調査対象は愛知県大府市在住の65歳以上の高齢者4564名(男性2275名、女性2289名、平均71.7±5.3歳)であった。これらの参加者が従事するライフスタイル行動数は平均10.6±2.4個であった。平均42.6ヵ月後、219名(4.8%)が新たに認知症を発症した。コックス比例ハザード回帰モデルによる生存分析では、日常会話(HR 0.56,95%CI 0.35〜0.89,P=0.015)、車の運転(HR 0.63,95%CI 0.45〜0.88,P=0.007)、買い物(HR 0.57,95%CI 0.34〜0.96,P=0.033)、野外活動/園芸(HR 0.71,95%CI 0.54〜0.94,P=0.016)を行う機会が多い参加者は認知症となる確率が有意に低かった。以上から、特定のライフスタイル行動は高齢者の認知症予防に重要な役割を果たす可能性があることが示された。

Bae S. . Combined effect of self-reported hearing problems and level of social activities on the risk of disability in Japanese older adults: A population-based longitudinal study . Maturitas115 51 - 55 2018.9

Makizako H. . Associations of Near-Miss Traffic Incidents with Attention and Executive Function among Older Japanese Drivers . Gerontology64 ( 5 ) 495 - 502 2018.8

Hotta Ryo, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Nakakubo Sho, Makino Keitaro, Shimada Hiroyuki . 認知障害を有する地域在住高齢者における路上試験中の認知機能と不安全運転行動(Cognitive function and unsafe driving acts during an on-road test among community-dwelling older adults with cognitive impairments) . Geriatrics & Gerontology International18 ( 6 ) 847 - 852 2018.6

Publisher：John Wiley & Sons Australia, Ltd

認知障害を有する地域在住高齢者において、不安全運転行動と認知機能との関連を調べた。65歳以上で、習慣的(週3回以上)に車の運転をしている高齢者159名を対象に、認知機能を調べ、路上試験中の不安全運転行動を評価した。不安全運転行動数に基づき、被験者を不安全運転行動が4回以上の高頻度群142名(男性70.4%、平均73.1±5.8歳)と3回以下の低頻度群17名(男性76.5%、平均67.9±3.6歳)に分けた。高頻度群は有意に年齢が高く、1日の運転回数が少なく、symbol digit substitution task(SDST)スコアが低かった。高頻度群は適切な確認なしの不安全運転行動が低頻度群よりも多かった。不安全運転行動数は年齢と中程度に有意に正に関連した。SDSTスコアは年齢群の補正後、不安全運転行動数と有意に関連した。

Makizako H. . Social frailty among community-dwelling older adults: Recommended assessments and implications . Annals of Geriatric Medicine and Research22 ( 1 ) 3 - 8 2018.3

吉松竜貴, 加辺憲人, 橋本祥行, 牧迫飛雄馬 . 回復期脳卒中患者の歩行自立予測　信号検出分析による臨床応用を目指した検討 . 理学療法科学33 ( 1 ) 145 - 150 2018.2

Publisher：(一社)理学療法科学学会

Lee Sungchul, Lee Sangyoon, Bae Seongryu, Harada Kazuhiro, Jung Songee, Imaoka Masakazu, Makizako Hyuma, Doi Takehiko, Shimada Hiroyuki . 地域在住日本人高齢者における糖尿病非合併の慢性腎疾患とフレイル構成要素との関連(Relationship between chronic kidney disease without diabetes mellitus and components of frailty in community-dwelling Japanese older adults) . Geriatrics & Gerontology International18 ( 2 ) 286 - 292 2018.2

Publisher：John Wiley & Sons Australia, Ltd

地域在住日本人高齢者における糖尿病歴のない慢性腎疾患(CKD)とフレイル構成要素との関連を調べた。参加者の住民8343名(男性3790名、平均73.7±5.5歳;女性4553名、平均73.5±5.5歳)を対象にベースライン評価を実施し、推定糸球体濾過量(eGFR)により四つのカテゴリーに分類した。フレイルの状態については、遅い歩行速度、筋力の弱さ、低い身体活動、極度の疲労、意図的でない体重減少の基準により定義した。多変量補正後、腎機能が最も低い群の参加者は腎機能正常の参加者と比較してフレイルのリスクが高かった(OR 1.57,95%CI 1.02〜3.50)。複数の交絡因子で補正後、eGFR 30未満はeGFR 60以上と比較して、体重減少(OR 2.14,95%CI 1.11〜4.12)、低い身体活動(OR 1.35,95%CI 1.01〜2.54)、遅いこと(OR 1.82,95%CI 1.36〜3.77)等の個別のフレイル構成要素の高リスクに関連することが示された。

Makizako Hyuma, Shimada Hiroyuki, Doi Takehiko, Tsutumimoto Kota, Yoshida Daisuke, Suzuki Takao . フレイル高齢者に対する地域障害予防プログラムの48ヵ月後の効果(Effects of a community disability prevention program for frail older adults at 48-month follow up) . Geriatrics & Gerontology International17 ( 12 ) 2347 - 2353 2017.12

Publisher：John Wiley & Sons Australia, Ltd

フレイルを呈する地域在住高齢者514名を対象に、地域ベースの介入が障害予防に及ぼす影響について検討した。介入群257名(男性144名、女性113名、平均73.0±5.5歳)と非介入群(対照群)257名(男性142名、女性115名、平均73.2±5.9歳)に分類し、48ヵ月後の障害の発症率を比較検討した。さらに、介入プログラムの変数として想定される患者基礎データ、ベースライン時の全般的認知機能、握力、歩行速度、血液検査データを調査した。介入プログラムとして、歩行運動と健康教育を実施した。介入群257名うち147名が歩行運動、110名が健康教育クラスへの参加であった。48ヵ月後の障害の発症率は介入群が11.3%、対照群が19.8%であった(p=0.007)。障害を発症した者では服薬数、高齢、女性、高血圧患者が多かった。握力や歩行速度などの身体機能レベルは、障害を呈した者の方が低値を示していた。生存分析の結果、介入プログラムへの参加者の方が非参加者と比較して障害の発症可能性が有意に低値であった。また、高血圧、癌、服薬数、握力、血清中アルブミン等の交絡因子を補正後のCox比例ハザード回帰モデルでも、地域ベースの介入プログラムによって、障害の発症リスクが有意に低くなることが示された。

Makino Keitaro, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Suzuki Takao, Shimada Hiroyuki . 転倒歴ありおよび転倒歴のない高齢者における転倒の恐れと歩行パラメータ(Fear of falling and gait parameters in older adults with and without fall history) . Geriatrics & Gerontology International17 ( 12 ) 2455 - 2459 2017.12

Publisher：John Wiley & Sons Australia, Ltd

高齢者3575名(男性1800名、女性1775名、平均71.7歳)を対象に、転倒の恐れ、転倒歴と歩行パラメータとの関連について検討した。対面インタビューによって転倒歴と転倒の恐れの有無を調査し、歩行速度、歩幅、ステップレート等の歩行パラメータの測定を行った。その結果、過去1年以内の転倒歴を有するのは465名(13.0%)、転倒の恐れを有するのは1467名(41.0%)であった。転倒の恐れを有する者では、そうでない者と比較して転倒歴が有意に高く、転倒歴を有する者では転倒の恐れを有する比率が有意に高値であった。年齢、性別、服薬数を補正後、歩行パラメータに関して有意な群間差が認められた。転倒の恐れを有する非転倒者では転倒の恐れがない非転倒者と比較して、歩行速度が有意に遅く、歩幅が短く、両脚時間が延長していた。同様に、転倒の恐れを有する転倒者では転倒の恐れがない転倒者と比較して、歩行速度が有意に遅く、歩幅が短く、ステップレートが低値であり、両脚時間が延長していた。転倒の恐れがない転倒者と転倒の恐れがない非転倒者では、歩行パラメータに差はなかった。高齢者の歩行パラメータは、転倒歴ではなく、転倒の恐れによって影響を受けることが示唆された。

Shimada Hiroyuki, Makizako Hyuma, Park Hyuntae, Doi Takehiko, Lee Sangyoon . 日本人高齢者の認知症発症率を検出するNational Center for Geriatrics and Gerontology-Functional Assessment Toolとミニ・メンタル・ステート検査の妥当性(Validity of the National Center for Geriatrics and Gerontology-Functional Assessment Tool and Mini-Mental State Examination for detecting the incidence of dementia in older Japanese adults) . Geriatrics & Gerontology International17 ( 12 ) 2383 - 2388 2017.12

Publisher：John Wiley & Sons Australia, Ltd

日本人の65歳以上の高齢者4151名(男性2038名、女性2113名、平均71.6±5.3歳)を対象に、認知症リスクの検出に用いられるNational Center for Geriatrics and Gerontology-Functional Assessment Tool(NCGG-FAT)とミニ・メンタル・ステート検査(MMSE)の妥当性について検討した。認知機能障害のスクリーニングには、NCGG-FATのうち物語・単語リスト記憶、注意・実行機能、処理速度、視空間スキルの各項目を評価した。平均43ヵ月のフォローアップ期間中、認知症と診断されたのは180名(4.3%)であった。認知機能テストと認知症発症率との関係を評価したCox比例ハザード回帰モデルでは、図形選択を除く各検査の成績と認知症リスクに関連が認められ、全補正後モデルでは認知症発症率と単語リスト記憶課題、Trail Making Test(TMT)-A、TMT-B、Symbol Digit Substitution Test(SDST)、MMSEとの間に有意な関連が認められた。このうち、SDSTは中等度の分類精度を示していた。また、サブグループ解析では、全般的認知障害のない被験者では認知機能検査と認知症発症率との有意な関連はなかった。NCGG-FATは高齢者の認知症リスク検出に有用なツールであることが示された。

Publisher：(NPO)愛知県理学療法学会

Nakakubo Sho, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Lee Sangyoon, Lee Sungchul, Hotta Ryo, Bae Seongryu, Suzuki Takao, Shimada Hiroyuki . 地域在住高齢者において睡眠の質不良と運動不足が認知機能に及ぼす影響(Impact of poor sleep quality and physical inactivity on cognitive function in community-dwelling older adults) . Geriatrics & Gerontology International17 ( 11 ) 1823 - 1828 2017.11

Publisher：John Wiley & Sons Australia, Ltd

地域高齢者において、睡眠の質が低く且つ身体活動が低い高齢者は認知機能が低い、という仮説を検証した。2013年、大府市と名古屋市において調査を施行し、地域高齢者5381名を解析対象とした。ミニメンタルステート検査(MMSE)によって認知障害の有無を検討し、National Center for Geriatrics and Gerontology Functional Assessment Toolを用いてstory memory、注意、executive function、処理速度を評価した。さらに、質問票調査によって身体活動性を評価し、睡眠の質とともに認知機能との関連を検討した。その結果、身体活動あり+睡眠の質良好(Active+GS)群が2049名(男性1160名、女性889名、平均74.43±4.90歳)、身体活動あり+睡眠の質不良(Active+PS)群が803名(男性324名、女性479名、平均74.90±4.60歳)、運動不足+睡眠の質良好(Inactive+GS)群が1741名(男性827名、女性914名、平均75.56±5.37歳)、運動不足+睡眠の質不良(Inactive+PS)群が788名(男性278名、女性510名、平均75.79±5.37歳)であった。認知機能に関して群間差が認められ、inactive+PS群はactive+GS群よりもすべての認知機能検査結果が不良で、active+PS群はactive+GS群よりもtrail-making test,part B(TMT-B)とsymbol digit substitution task(SDST)の成績が劣っていた。以上、運動不足で睡眠の質が低い地域高齢者は認知機能が低い傾向にあることが示された。

Bae Seongryu, Shimada Hiroyuki, Park Hyuntae, Lee Sangyoon, Makizako Hyuma, Doi Takehiko, Yoshida Daisuke, Tsutsumimoto Kota, Anan Yuya, Suzuki Takao . 日本人高齢者における体組成パラメータと軽度認知障害リスクとの関連(Association between body composition parameters and risk of mild cognitive impairment in older Japanese adults) . Geriatrics & Gerontology International17 ( 11 ) 2053 - 2059 2017.11

Publisher：John Wiley & Sons Australia, Ltd

日本人高齢者2580名を対象に、体組成パラメータと軽度認知障害(MCI)リスクとの関連、リスクに及ぼす性差の影響を検討した。認知機能検査でMCIを認める840名(男性395名、女性445名、平均71.9±5.5歳)とMCIのない1740名(男性807名、女性933名、平均71.3±5.2歳)に分類し、体組成パラメータとの関連を評価した。その結果、BMI、体重、体脂肪量(FM)に関して、MCI群と非MCI群との間に男女とも有意差は認められなかった。一方、除脂肪量(FFM)と体肢筋量(AMM)はMCI群の方が非MCI群より低く、上肢と下肢の筋量は男性MCI群の方が低値を示していた。女性では、上肢筋量とMCIとの関連はみられず、下肢筋量はMCI群で低下していた。また、男女ともFFMの最低四分位群では最高四分位群と比較してMCIが高リスクであり、男性ではAMMの最低四分位群でMCIリスクが高くなっていた。さらに、男性では上肢・下肢筋量の最低四分位群でMCIリスクが高値を示していた。高齢者における体組成パラメータのうち、男女ともに除脂肪量の低下とMCIが関連し、男性では体肢筋量とMCIとの間に関連があることが示された。

Lee Sungchul, Lee Sangyoon, Harada Kazuhiro, Bae Seongryu, Makizako Hyuma, Doi Takehiko, Tsutsumimoto Kota, Hotta Ryo, Nakakubo Sho, Park Hyuntae, Suzuki Takao, Shimada Hiroyuki . 地域在住の日本人高齢者における糖尿病または高血圧合併慢性腎臓病とフレイルとの関係(Relationship between chronic kidney disease with diabetes or hypertension and frailty in community-dwelling Japanese older adults) . Geriatrics & Gerontology International17 ( 10 ) 1527 - 1533 2017.10

Publisher：John Wiley & Sons Australia, Ltd

地域高齢者において糖尿病または高血圧を伴う腎機能とフレイルとの関連について検討した。全国調査に参加した9606名の地域高齢者を解析対象とした。推定糸球体濾過量(eGFR)値によって、60.0mL/分/1.73m2群、45.0〜59.9mL/分/1.73m2群、30.0〜44.9mL/分/1.73m2群、30.0mL/分/1.73m2未満群に分類し、フレイルの状況との関連を評価した。フレイルと判定されたのは888名(男性363名、女性525名、平均78.2±5.9歳)、フレイルなしとされたのは8718名(男性4206名、女性4512名、平均73.1±5.3歳)であった。フレイルを呈する者の方が合併症の罹患が多く、女性が多数であった。eGFRが60.0mL/分/1.73m2の正常範囲にあるフレイル者は他の三つのカテゴリー(45.0〜59.9mL/分/1.73m2群、30.0〜44.9mL/分/1.73m2群、30.0mL/分/1.73m2)と比較して少なかった。また、高血圧または糖尿病の病歴を有する者では、eGFRが低値を示す群においてフレイルのリスクが有意に高く、高血圧と糖尿病の両者の病歴を有するとさらにリスクが高まることが明らかになった。日本人高齢者において、腎機能の低下はフレイル発症の高リスクと関連することが示された。

牧迫飛雄馬, 島田裕之, 土井剛彦, 堤本広大, 堀田亮, 中窪翔, 牧野圭太郎, 鈴木隆雄 . 地域在住日本人高齢者に適したShort Physical Performance Batteryの算出方法の修正 . 理学療法学44 ( 3 ) 197 - 206 2017.6

Publisher：(公社)日本理学療法士協会

【目的】地域在住高齢者に適するようにShort Physical Performance Battery(以下、SPPB)算出方法の修正を試みた。【方法】高齢者4,328名をSPPB(0〜12点)で評価し、歩行速度と椅子立ち座りは対象者の測定値(四分位)を基に、立位バランスは立位保持の出来高によって配点した地域高齢者向けのSPPB community-based score(以下、SPPB-com)(0〜10点)を算出し、24ヵ月の要介護発生との関連を調べた。【結果】対象者の78.7%でSPPBが、10.5%でSPPB-comが満点であった。SPPB-comが4点以下で要支援・要介護発生率が高く(12.8%)、SPPB-com、年齢、女性、MMSEが要支援・要介護発生と有意に関連していた。【結論】SPPBを再得点化したSPPB-comは地域在住高齢者の要支援・要介護リスクを把握する指標として有益となることが示唆された。(著者抄録)

Lee Sungchul, Shimada Hiroyuki, Lee Sangyoon, Makizako Hyuma, Doi Takehiko, Harada Kazuhiro, Bae Seongryu, Harada Kenji, Hotta Ryo, Tsutsumimoto Kota, Yoshida Daisuke, Nakakubo Sho, Anan Yuya, Park Hyuntae, Suzuki Takao . 日本人の地域在住高齢者における座位時間と腎機能の関連性(Association between sedentary time and kidney function in community-dwelling elderly Japanese people) . Geriatrics & Gerontology International17 ( 5 ) 730 - 736 2017.5

Publisher：John Wiley & Sons Australia, Ltd

日本人の地域在住高齢者における座位時間と腎機能低下の関連について評価した。国立長寿医療研究センターが実施した老年症候群に関する研究("National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes")の65歳以上の参加者のうち、ベースラインに慢性腎臓病を認めなかった10,242例を対象とした。多重ロジスティック回帰分析において交絡因子を調整後、座位時間が上位4分の1の群(8時間以上)では下位4分の1の群(4時間未満)に比べ、腎機能低下(推定糸球体濾過量<60mL/min/1.73m2)のリスクが高かった。また座位時間が上位4分の1の群では、高血圧の既往あるいは癌および高血圧の既往を有するサブグループで腎機能低下リスクが増大していた。日本人の地域在住高齢者において、座位時間の上位レベルは腎機能低下と独立した関連を有することが示された。

吉松竜貴, 橋本祥行, 照屋康治, 八塩ゆり子, 加辺憲人, 澤龍一, 牧迫飛雄馬 . 入院時に起居動作が自立していない回復期脳卒中患者の退院時歩行自立を予測する要因について . 理学療法学Supplement2016 ( 0 ) 2017

Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】脳卒中の予後予測において，機能的重症例に焦点をあてた機能的予後に関する検討は少ない。そこで，本研究の目的は，起居動作が自立しないまま回復期リハビリテーション病棟（以下，回復期病棟）に入院した脳卒中患者が，退院時に歩行動作が自立できるか否かを推察するために重要な入院時点での患者情報について探索することとした。【方法】対象は，船橋市立リハビリテーション病院の回復期病棟に入院した初発の脳梗塞もしくは脳内出血患者145例とした。このうち，入院当日の病棟カンファレンスで起居動作が自立していると判断された42例（28.9％）を除く103例（男性59例，女性44例，平均年齢69±12歳）を分析の対象とした。研究デザインは後方視的観察研究であり，アウトカムを退院時病棟内歩行自立と定め，これに関連する入院時情報を調査した。入院時情報は，対象の基本的属性（性別，年齢，身長，体重），医学的情報（疾患種別，損傷側，発症からこの入院までの日数），高次脳機能障害の有無（意識障害，失語症，失行症，半側空間無視，注意障害，病識低下，記憶障害），機能障害（下肢Brunnstrom stage（BRS）がIII以下である，中等度以上の感覚障害がある，健側筋力が低下している），動作能力（Berg Balance Scale（BBS））とした。統計学的解析として，退院までに病棟内歩行が自立した者（自立群）とそうでない者（非自立群）の2群に分類し，入院時の情報について単変量解析（対応のないt検定，Mann-WhitneyのU検定，χ2検定による群間比較）を行った。次に，単変量解析にて有意差を認めた変数を独立変数，退院時病棟内歩行自立を従属変数とした多変量解析（多重ロジスティック回帰分析）を行った。最後に，多変量解析にて有意性が維持された連続変数についてReceiver Operating Characteristic（ROC）解析を行い，退院時病棟内歩行自立に対するカットオフ値を求めた。【結果】自立群は47例（45.6％），非自立群は56例（54.4％）であった。群間比較にて，自立群は，非自立群に比べ，有意に男性が多く（p＜0.05），若く（p＜0.01），高次脳機能障害の該当数が少なく（p＜0.05），BRSが低い例が少なく（p＜0.01），健側筋力低下例が少なく（p＜0.001），BBSが高かった（p＜0.001）。多重ロジスティック回帰分析にて，3項目以上の高次脳機能障害を有すること（オッズ比0.17，p＜0.05）とBBS（オッズ比1.11，p＜0.001）が，交絡因子での調整後も有意性を維持した。ROC解析にて，BBSのカットオフ値は22（感度0.76，特異度0.91，曲線下面積0.86，p＜0.001）と算出された。【結論】初発脳卒中患者において，回復期病棟への入院までに起居動作が自立していなくとも，高次脳機能障害が少なく，座位や起立などの抗重力能力が高ければ（BBS＞22），回復期病棟を退院するまでに整備された屋内環境での歩行が自立する可能性が高まる。

DOI： 10.14900/cjpt.2016.0991

Neuropsychological Function and Risk of Falling in Older Adults . JapaneseJournal of Fall Prevention3 ( 3 ) 5 - 10 2017

Doi Takehiko, Shimada Hiroyuki, Makizako Hyuma, Suzuki Takao . Multicomponent exercise to improve cognition in older adults with mild cognitive impairment: JAEE Research Project "Evidence from Intervention Studies" . Research in Exercise Epidemiology19 ( 2 ) 102 - 109 2017

Publisher：Japanese Association of Exercise Epidemiology

We tested the effect of multicomponent exercise program on cognition in older adults with mild cognitive impairment (MCI) by a randomized controlled trial. The program had positive effects on cognitive functions and brain atrophy. We demonstrated detail about program and examined the generalizability. The multicomponent exercise program had a log-term continuity due to high feasibility. The program was widely used in a clinical setting, particularly preventive project, and easily accepted because an exercise program could be conducted without a specific environment. Further investigations were required to develop the evident strategy for preventing dementia.

DOI： 10.24804/ree.19.102

牧迫飛雄馬 . 老化とフレイル:―早期発見と効果的介入をデータから考える― . 理学療法の歩み28 ( 1 ) 3 - 10 2017

Publisher：公益社団法人日本理学療法士協会宮城県理学療法士会

フレイルは，高齢期において生理的予備能が低下することでストレスに対する脆弱性が亢進して不健康を引き起こしやすい状態と定義され，身体的な問題のみならず，精神・心理的問題，さらには社会的問題を含む概念とされる。しかし，これらの多側面でのフレイル判定方法が十分に確立している状況には至っていない。身体的フレイルに関しては，国際的に概ね共通した理解が図られており，わが国での大規模コホート研究によるデータも蓄積されてきており，地域高齢者における身体的フレイルの有症率は7.4％程度とされている。身体的フレイルと判定されると，悪化の一途をたどるわけではなく，適切な介入によって身体機能やADL能力の向上，さらにはフレイルからの脱却が期待されている。認知的フレイルや社会的フレイルに対しても，効果的な介入手段の検討が必要であり，個別を対象とした介入に留まらず，フレイル予防のための地域での人的・物的資源の拡充を含めた地域社会の環境体制の充実も課題のひとつであろう。

DOI： 10.11342/mpta.28.3

井平光, 古名丈人, 牧野圭太郎, 木原由里子, 志水宏太郎, 山口亨, 伊藤一成, 田井啓太, 牧迫飛雄馬, 島田裕之 . 地域在住高齢者のがん罹患に関する自己報告の妥当性検証 . 理学療法学Supplement2016 ( 0 ) 2017

Publisher：公益社団法人日本理学療法士協会

【はじめに，目的】がん罹患の高齢化を背景に，高齢がん罹患者の運動機能に着目した報告が増加している。実際に，高齢がん罹患者の歩行機能や筋力が低下していることが示されており，この対象への改善策が課題となっている。これらの報告のなかで，がんの罹患を判断するために，基本的には調査時の自己報告によって得られた情報を採用する場合が多い。しかしながら，その自己報告が正確なものであるかどうかは検証が必要であり，特に高齢者のがん罹患に関する妥当性の検証はなされていない。本研究では，75歳以上の地域在住高齢者を対象に，がん罹患に関する自己報告の妥当性を検証し，自己報告の有無による縦断的な機能変化を明らかにすることを目的とした。【方法】対象は，測定調査会に参加した75歳以上の地域在住高齢者411名のうち，がん罹患に関する調査データに不備のあった1名を除外した410名（男性169名，女性241名，平均年齢80.0±4.1歳）とした。ベースライン時におけるがんの自己報告については，がん罹患の有無，罹患時期，がんの種類などを面接聴取した。また，がんの発症を同定するために，後期高齢者医療制度における診療報酬請求（レセプト）情報を活用した。さらに，機能指標として運動機能，認知機能，および健康関連指標を測定した。統計解析は，レセプト情報によってがん罹患を同定された者のうち，がんの罹患を自ら報告した高齢者の陽性的中率を算出し，自己報告による妥当性を検証した。また，がん罹患者を自己報告群と非自己報告群に分類し，2群間の各変数を比較した。さらに，2群間における各機能の縦断的変化についても検討した。【結果】レセプト情報によると，ベースライン調査の時点でがんに罹患していた者は51名だった。このうち，がんに罹患したことを自ら報告した高齢者は28名であり，陽性的中率は54.9%だった。報告群と非報告群の比較では，年齢（p=0.710）と性別（p=0.601）に有意な差は認められなかった。また，測定したすべての変数で有意な差は認められなかった。さらに，二元配置分散分析の結果からも，交互作用の見られた項目はなかった。【結論】国立がん研究センターによると，40～69歳を対象とした自己報告によるがん罹患の陽性的中率は53%であった。本研究においても同等の結果が得られ，がん罹患に関しては自己報告による調査だけでは正確に把握することが難しいことを示唆するものであった。理由として，高齢者のなかにはがんに対して誤った理解や病識を有している方がおり，自らをがん罹患者と表出することに抵抗感がある可能性が挙げられた。また，自己報告の有無によって諸機能の差異は認められず，将来的な機能低下に影響を及ぼすことも明らかにされなかった。今後は，がん罹患の陽性的中率を上げる工夫をするとともに，虚弱な高齢がん罹患者に対して機能向上を目的としたアプローチを検討する必要がある。

DOI： 10.14900/cjpt.2016.1596

加辺憲人, 板橋健太, 吉松竜貴, 澤龍一, 西田裕介, 牧迫飛雄馬 . O-056 訪問リハビリテーション利用者における屋外活動範囲の促進・阻害因子に関する研究 . 関東甲信越ブロック理学療法士学会36 ( 0 ) 56 - 56 2017

Publisher：社団法人日本理学療法士協会関東甲信越ブロック協議会

【目的】訪問リハの利用者には，通所系サービスを利用しても活動範囲を拡大できない者がいる．本研究では，活動範囲と身体機能，年齢・性別，同居者有無，利用サービスなどの基本情報との関連する要因を明らかにすることを目的とした．【方法】平成28 年6月1日から29 年3月31日に訪問リハを利用していた265 名（男性127名，女性138 名，76 ±11歳）を対象とした．基本情報の他，訪問環境でも評価可能でエビデンスレベルが高いと判断した指標：握力，Bed side Mobility scale(BMS)，Short-form Berg Balance Scale（SF-BBS），Short Physical Performance Battery(SPPB)，FIM，Life Space Assessment(LSA) を評価した．LSA の最大活動レベルが3 以上235 名（屋外群）と3 未満30 名（屋内群）の2 群に分け群間比較を行った．更に，基本情報，FIM（認知），通所サービス利用有無を調整因子とし，LSA3 以上と未満を分ける指標を検定した．統計処理には対応のないt 検定，Mann-WhitneyU 検定，χ二乗検定，Fisher 正確確率検定，多重ロジスティック回帰分析を統計ソフトSPSS にて解析し，有意水準は5% とした．【倫理的配慮】ヘルシンキ宣言に基づき，筆者所属病院の倫理委員会で承認を得た．【結果】屋内群と屋外群で握力，BMS，SF-BBS，SPPB，FIM 運動，FIM 認知の項目で群間に有意な差を認めた．屋内群と屋外群を分ける因子としては，独居（OR=0.29，CI=0.115-0.78）が阻害因子であり，握力（OR=1.09，CI=1.01-1.17）が促進因子であった．【考察】握力は，全身的な体力を反映している有用な指標とされており，活動範囲を想定する重要な項目であると考える．渡辺ら（2005）は高齢期で家に閉じこもっている現象自体が将来の要介護や死亡発生率を高めると報告している．本研究の結果より，特に独居者に対しては利用開始時から介護支援専門員等と生活スタイルを含めた支援の在り方を意識する必要があることが確認できた．

DOI： 10.14901/ptkanbloc.36.0_56