The Association of Sleep Habits and Advancing Age in Japanese Older Adults: Results from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes.

BACKGROUND: The association of sleep habits with "advancing age among older adults" is not fully understood. OBJECTIVES: The purpose of the present study was to examine the association of sleep habits with advancing age among community-dwelling older adults in Japan. METHODS: A total of 18,005 older people (mean age: 73.2 ± 6.0 years; 8,070 men and 9,935 women) from the National Center for Geriatrics and Gerontology Study of Geriatric Syndromes were analyzed. Participants were asked in face-to-face interviews about the times they usually go to bed, fall asleep, wake-up, and get up. The amount of time spent in bed and self-reported sleep duration were then calculated from the differences between these times. As other parameters, the subjects were also asked about sleep latency, time spent in bed after waking up, number of nocturnal awakenings, and duration of napping in a typical day. RESULTS: The results of the Jonckheere-Terpstra test showed that all sleep parameters shifted to an earlier time (going to bed, falling asleep, waking up, and getting out of bed), longer duration (sleep duration, time spent in bed, sleep latency, time spent in bed after waking up, and napping), or more nocturnal awakenings with advancing age (all p < 0.01). Among the men, the time of waking up was not significantly associated with age, while among the women, the time of getting up was not significantly associated with age. CONCLUSION: These results from a large cohort show the age-related trends of sleep habits in community-dwelling older adults in Japan. Our results revealed that a longer duration and earlier timing of sleep are associated with advancing age.

Mild Condition for the Deoxygenation of α-Heteroaryl-Substituted Methanol Derivatives.

A mild condition via PPh3/I2/imidazole for the deoxygenation of substituted methanol derivatives has been identified. This metal-free process was found to proceed well on secondary or tertiary alcohols substituted with one or two heteroaryl groups, and it tolerates acid-sensitive heterocycles. This condition works for methanol derivatives substituted with 2-pyridyl, 4-pyridyl, or other heterocyclic groups, allowing the negative charge formed during the reaction to resonate to a nitrogen atom. Methanol derivatives substituted with 3-pyridyl or heterocyclic groups that do not allow the negative charge formed during the reaction to resonate to a nitrogen atom will not undergo deoxygenation under this condition.

Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS.

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.

Effect of financial incentives for participation in dementia prevention and support activities: results of a web survey with persons aged 60 and older.

BACKGROUND: This study aims to elucidate the impact of financial incentives on the motivation to participate in dementia prevention activities and to provide support to people with dementia. METHODS: An online survey was completed by 1500 men and women, aged 60 or above, from the general community in Japan. When responding to questions regarding motivation for participating in dementia prevention activities and providing support to people with dementia, respondents were randomly assigned different incentive conditions. Two incentive options were used for dementia prevention activities (no incentives, and a small number of reward points). Three incentive options were used for support activities (no incentives, a small cash reward, or an in-kind time reward that allowed respondents or their family members to use similar services at a later time (time credits)). RESULTS: Financial incentives decreased motivation for participating in dementia prevention activities, while time credits significantly increased motivation to participate in providing support to people with dementia for going out of their home, when receiving a cash reward was compared with receiving no reward. No significant differences by incentive were found for participating in daily living support for those with dementia or for providing support at a dementia café where people with dementia and their families interact. CONCLUSIONS: The adverse influence of financial incentives on motivation to participate in dementia prevention suggested that financial incentives may reduce intrinsic motivation for dementia prevention activities. The positive effects of time credits in providing support to people with dementia in going out suggested that time credits might be effective for some support activities for people with dementia. Different incentive measures should be considered to raise awareness of dementia prevention and dementia support activities.

Discrepancies in persons with dementia, family members, and physician perspectives of dementia treatment: a descriptive study.

BACKGROUND: This study aims to reconsider diagnostic approaches to dementia where pharmacological approaches are not available to reverse the pathological changes caused by dementia. METHODS: A questionnaire survey was conducted with 524 physicians specialising in dementia management in Aichi, Japan, with 163 (31.1%) valid responses. The survey gathered information on the perceived merits and demerits of the early diagnosis of dementia and the priorities in treating those with mild cognitive impairment (MCI), mild dementia, and moderate or advanced dementia. In the interview survey, 27 outpatients with mild Alzheimer's disease (76.2 ± 7.6 years old; Mini-Mental State Examination score 23.3 ± 2.7 points; 21 women, six men) and 24 family members (12 spouses, 12 children) were asked about their priorities in treatment. RESULTS: A total of 61.3% of physicians answered that persons with dementia having more time to accept the diagnosis is a merit of early diagnosis, while 61.3% answered that the possibility of causing anxiety was a demerit. Around 45% of the physicians chose the option 'maintaining cognitive function' as the first priority in cases of MCI and mild dementia, while 39.3% considered it the last priority in moderate or advanced cases. About 22.2% of persons with dementia and 37.5% of their families assigned the highest priority to 'maintaining cognitive function', whereas 37.0% of persons with dementia prioritised 'maintaining quality of life for them and their families'. CONCLUSIONS: Although it is important to build therapeutic alliances among persons with dementia, their families, and physicians by sharing a common perspective for better treatment of dementia, this study suggested that the three parties do not always share the same vision. Future research is needed to determine how to build therapeutic alliances for better approaches to dementia, especially to ensure that timely diagnosis is beneficial for persons with dementia and their families.

Assessment of eldecalcitol and alendronate effect on postural balance control in aged women with osteoporosis.

INTRODUCTION: Older people aged over 75 are more prone to falls because physical functions become deteriorated along with aging, and also fracture risk is strongly correlated with age. We evaluated the effects of anti-osteoporosis agents, eldecalcitol (ELD) and alendronate (ALN) on physical functions by assessing dynamic and static postural balance in aged patients with osteoporosis. MATERIALS AND METHODS: A randomized, open-label, controlled clinical trial has been conducted with 124 female patients aged 65 or over with osteoporosis. Patients were randomly assigned to receive either 0.75 µg of ELD once-a-day or 35 mg of ALN once-a-week for 24 weeks. The primary endpoint was the change in a postural balance index, adjusted composite equilibrium score (CES) of sensory organization test (SOT). The SOT equilibrium scores, leg muscle strength, and other physical functions were also evaluated. RESULTS: The Adjusted CES increased from baseline by 6.10% in the ELD group and 6.28% in the ALN group. There was no statistically significant difference between the two groups. The static postural balance at fixed platform were maintained in the ELD group, but declined in the ALN group. The dynamic postural balance at swaying platform and knee extension power increased from baseline in both groups. CONCLUSIONS: These results suggest that ELD and ALN treatments may each be beneficial to improve postural balance control in older patients with osteoporosis via different mechanisms of action.

Sleep condition and cognitive decline in Japanese community-dwelling older people: Data from a 4-year longitudinal study.

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.

Exercise type and activities of daily living disability in older women: An 8-year population-based cohort study.

BACKGROUND: Exercise may reduce the risk of disability for activities of daily living (ADL), but the degree of associations between specific exercise types and such a risk remains unclear. This study aimed to examine the longitudinal associations between exercise types and the incidence of ADL disability in older women. METHODS: This 8-year population-based prospective cohort study enrolled 1003 community-dwelling older Japanese women without ADL disability in the baseline surveys. In the baseline surveys, all participants were asked whether or not they participated in any of 16 exercise types through a face-to-face interview. ADL were assessed using a modified form of the Katz index that comprised five ADL tasks. ADL disability was defined as dependence in at least one ADL task during the 8-year follow-up period. Binary logistic regression analyses were applied to obtain adjusted odds ratios (ORs) and 95% confident intervals (CIs) for the incidence of ADL disability based on participation or non-participation in each exercise type. RESULTS: Activities of daily living disability was noted in 130 participants (13.0%) over the 8-year follow-up period. After adjustment for confounders and other exercise types, participation in dancing, compared to non-participation, was associated with a significantly lower OR (0.27; 95% CI: 0.09-0.75) for incident ADL disability. There were no significant associations between other exercise types and incident ADL disability. CONCLUSION: Dancing was significantly and independently associated with a lower incidence of ADL disability. Thus, dancing may solely contribute to a reduced risk of ADL disability in older women.

Association between exercise type and the decline in instrumental activities of daily living in community-dwelling older women: A 4-year prospective study.

Exercise can delay the decline of instrumental activities of daily living (IADL), although it remains unclear which specific exercise types are associated with such a delay. This 4-year prospective cohort study in Japan aimed to identify the longitudinal associations between exercise types and the onset of IADL decline in older women. Between 2008 and 2012, 1082 community-dwelling older women aged ≥75 years participated in this study. Participations in 16 exercise types based on a face-to-face interview at baseline were used as independent variables. The primary study outcome was a decline in IADL as assessed using the instrumental self-maintenance subscale of the Tokyo Metropolitan Institute of Gerontology index of competence. An IADL decline was defined as a decrease of ≥1 point over the 4-year follow-up period and was used as the dependent variable. Adjusted odds ratios (ORs) and 95% confident intervals (CIs) for IADL decline based on participation or non-participation in each exercise type were obtained using logistic regression analyses. An IADL decline was observed in 151 participants (13.9%) over the 4-year follow-up period. After adjustment for potential confounders, participation in calisthenics had a significantly lower OR (0.62; 95% CI 0.42-0.90) for IADL decline. There were no significant associations between other specific exercise types and IADL decline. In conclusion, participation in calisthenics was significantly and independently associated with delayed IADL decline in older women aged ≥75 years. Thus, calisthenics may be a useful exercise to slow IADL decline in this age group.

Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study.

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.

Assessing competence at a higher level among older adults: development of the Japan Science and Technology Agency Index of Competence (JST-IC).

BACKGROUND AND AIMS: Older adults' ever-improving health and changing lifestyles necessitate the development of a scale that can better measure their competence at a higher level. We developed the Japan Science and Technology Agency Index of Competence (JST-IC) via item analysis and assessed its psychometric properties. METHODS: Participants were 1306 community-dwelling older adults (623 men and 683 women, 74.0 ± 2.8 years old) who completed the 54-item draft JST-IC to determine their level of independence. Three procedures (including item selection, factor analyses, and reliability and validity analyses) were conducted to finalize the JST-IC and evaluate its psychometric properties. RESULTS: The item selection resulted in exclusion of 26 items for the following reasons: (a) 15 because of very high ratios (80% or more) of responders who answered "yes", (b) one because of gender differences (phi coefficient = 0.34), (c) five because of their weak association with the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) (Pearson correlation coefficient of 0.30 or smaller), and (d) five because of redundancy of meaning with other items. Through factor analyses, we selected 16 items with a four-factor solution for the final version. JST-IC score exhibited a near-normal distribution and significant gender and age differences, and had moderate correlations with size of social network and level of subjective well-being and strong correlations with TMIG-IC score, physical fitness, and health literacy. CONCLUSIONS: The JST-IC is useful for assessing competence at a higher level in community-dwelling older adults.

On the Origin of Complex Adaptive Traits: Progress Since the Darwin Versus Mivart Debate.

The evolutionary origin of complex adaptive traits has been a controversial topic in the history of evolutionary biology. Although Darwin argued for the gradual origins of complex adaptive traits within the theory of natural selection, Mivart insisted that natural selection could not account for the incipient stages of complex traits. The debate starting from Darwin and Mivart eventually engendered two opposite views: gradualism and saltationism. Although this has been a long-standing debate, the issue remains unresolved. However, recent studies have interrogated classic examples of complex traits, such as the asymmetrical eyes of flatfishes and leaf mimicry of butterfly wings, whose origins were debated by Darwin and Mivart. Here, I review recent findings as a starting point to provide a modern picture of the evolution of complex adaptive traits. First, I summarize the empirical evidence that unveils the evolutionary steps toward complex traits. I then argue that the evolution of complex traits could be understood within the concept of "reducible complexity." Through these discussions, I propose a conceptual framework for the formation of complex traits, named as reducible-composable multicomponent systems, that satisfy two major characteristics: reducibility into a sum of subcomponents and composability to construct traits from various additional and combinatorial arrangements of the subcomponents. This conceptual framework provides an analytical foundation for exploring evolutionary pathways to build up complex traits. This review provides certain essential avenues for deciphering the origin of complex adaptive traits.

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.

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.

Prospective associations between sedentary behaviour and incident depressive symptoms in older people: a 15-month longitudinal cohort study.

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.

Sox5 functions as a fate switch in medaka pigment cell development.

Mechanisms generating diverse cell types from multipotent progenitors are crucial for normal development. Neural crest cells (NCCs) are multipotent stem cells that give rise to numerous cell-types, including pigment cells. Medaka has four types of NCC-derived pigment cells (xanthophores, leucophores, melanophores and iridophores), making medaka pigment cell development an excellent model for studying the mechanisms controlling specification of distinct cell types from a multipotent progenitor. Medaka many leucophores-3 (ml-3) mutant embryos exhibit a unique phenotype characterized by excessive formation of leucophores and absence of xanthophores. We show that ml-3 encodes sox5, which is expressed in premigratory NCCs and differentiating xanthophores. Cell transplantation studies reveal a cell-autonomous role of sox5 in the xanthophore lineage. pax7a is expressed in NCCs and required for both xanthophore and leucophore lineages; we demonstrate that Sox5 functions downstream of Pax7a. We propose a model in which multipotent NCCs first give rise to pax7a-positive partially fate-restricted intermediate progenitors for xanthophores and leucophores; some of these progenitors then express sox5, and as a result of Sox5 action develop into xanthophores. Our results provide the first demonstration that Sox5 can function as a molecular switch driving specification of a specific cell-fate (xanthophore) from a partially-restricted, but still multipotent, progenitor (the shared xanthophore-leucophore progenitor).

Joint Association of Neighborhood Environment and Fear of Falling on Physical Activity Among Frail Older Adults.

This study examined associations between perceived neighborhood environment and physical activity among frail older adults and whether these associations are moderated by fear of falling. Participants were 238 frail older adults. Daily step counts and duration of moderate-to-vigorous physical activity were measured using an accelerometer. Participants completed the abbreviated Neighborhood Environment Walkability Scale; fear of falling and demographic and health-related factors were measured by a questionnaire. The interaction between crime safety and fear of falling was significantly associated with step count (p = .009) and moderate-to-vigorous physical activity (p = .018) in multiple regression analysis. Stratified according to fear of falling, crime safety was significantly associated with steps (p = .007) and moderate-to-vigorous physical activity (p = .030) in the low fear of falling group. The results suggest that crime safety is associated with physical activity among frail older adults, and this association is moderated by fear of falling.

[Update on recent progress in vitamin D research. EldecalcitolR and Fall Prevention.]

In the elderly, vitamin D deficiency results not only in impaired bone mineralization, but also myopathy. Low vitamin D has also been shown to be associated with decline of muscle strength, sarcopenia, functional limitation, and disability. Several recent studies have shown that low serum vitamin D concentration is associated with lower physical function and falls in older adults. In this article, the author reviews a relationship between falls and serum vitamin D concentration of the elderly living in the community, and also introduces the major results from a recent randomized controlled trial on prevention of decline of fall-related balance performance by the treatment with newly developed active vitamin D(EldecalcitolR )among the women with age 65 years old and over and diagnosed as osteoporosis.

Performance on the flanker task predicts driving cessation in older adults.

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.

Reduced prefrontal oxygenation in mild cognitive impairment during memory retrieval.

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.

[Anesthesia for War Surgery in Northern Iraq].

This report is on the anesthesia for war surgery at an emergency hospital in Northern Iraq. The major point in war surgery is not to close the wound after its debridement. The infection is the major threat for all surgical operations, and when the infection exists the first priority is to eradicate it, not the ICU treatment without its eradication. For bleeding patients, intrave- nous anesthetics should be used carefully, and also permissive hypotension should be considered until the bleeding is stopped. Knowing the anesthesia for war surgery is to broaden your daily anesthetic skills.