Effect of various exercises on frailty among older adults with subjective cognitive concerns: a randomised controlled trial.

BACKGROUND: Physical exercise has been linked to reduced frailty, but there is insufficient evidence of beneficial effects in community-dwelling older adults with subjective cognitive concerns. OBJECTIVE: This study aimed to clarify the effects of physical exercise in this population. DESIGN: Single-blind randomised controlled trial. SETTING: Community sports centres. PARTICIPANTS: Residents aged 65-85 years were screened using the Kihon checklist; those with subjective cognitive concerns were invited for eligibility assessment. In total, 415 community-dwelling older adults were enrolled and randomised. METHODS: This trial investigated the effects of aerobic training (AT), resistance training (RT) and combined training (AT+RT) programs on reducing frailty. All participants were randomised into one of the three intervention groups or the control group. Participants in the intervention groups underwent a group training program and self-paced home training for 26 weeks. The control group received lectures about health promotion. A 95-item frailty index (FI) was utilised to determine the effects of training. Participants were followed up at weeks 26 and 52. RESULTS: At baseline, mean age of all participants (47% women) was 72.3 ± 4.6 years, with a mean FI score of 0.3 ± 0.1. Compared with control group, AT improved total FI by 0.020 (CI -0.039 to -0.001, effect size -0.275) and the depression and anxiety component of FI by 0.051 (CI -0.084 to -0.018, effect size -0.469) at week 26, but the effects waned at week 52. No significant differences in FI were found in RT and AT+RT groups at weeks 26 and 52. CONCLUSIONS: A 26-week AT reduced frailty modestly, especially in the depression and anxiety component, in older adults with subjective cognitive concerns.

The prevalence of homebound individuals in the elderly population: a survey in a city area in Japan.

Being homebound has been reported to be associated with a number of conditions. In the current study, the incidence of homebound individuals was surveyed in an urban city area in Japan. The city office randomly enrolled 5,000 residents of Nagoya City aged 65 and over. A questionnaire was sent to their principal caregivers by mail, and 3,444 (68.9 %) subjects returned the survey. The investigators obtained the totally anonymous data from the city office. This study was approved by the Ethics Committee of Nagoya University Graduate School of Medicine. In the present study, the data of 3,053 (61.1 %) subjects for whom complete sets of data were available were employed for statistical analysis. The questionnaire included the following items: age, sex, the status of public long-term care insurance certification (none, support-level, care-level), self-rated health (good, fair, poor, very poor), states of living (single living, with only spouse, with other family members), and the frequency of outside excursions per a week (every day, once in a few day, one a week, rarely). An individual was defined as being homebound if his or her frequency of outside excursions was less than once per week. he incidence of the homebound elderly in the elderly population over 65 years old was 14.4 % in the current study. The status of certification in public long-term care insurance was associated with being homebound. Self-rated health was significantly worse in homebound individuals than in those non-homebound. The current survey found 14.4 % of the elderly was home-bound in a large city in Japan.

Association of fear of falling with cognitive function and physical activity in older community-dwelling adults.

PURPOSE: This study addressed a two-part question. First, is cognitive decline associated with fear of falling (FoF)? Second, if this association is observed, is there also an association between FoF and physical activity (PA) independent of cognitive decline? METHODS: Participants in the study were community-dwelling Japanese residents between 65 and 85 years of age (N = 458, mean age = 72.4 ± 4.6, male = 53.7%). Step counts were recorded, as was objectively measured PA, divided into (1) low-intensity PA and (2) moderate- and vigorous-intensity PA. Three groups were determined based on FoF: low, moderate, and high. Neuropsychological tests were also conducted. RESULTS: Participants with high FoF had slower processing speed. low-intensity PA was associated with only high FoF, but after controlling for processing speed, the significance of this association was attenuated. Shorter time of moderate- and vigorous-intensity PA was associated with high FoF, even in the full model controlling for other factors. All FoF levels were associated with lower step counts. CONCLUSION: older community-dwelling adults with high FoF were found to have had declined cognitive speed/ Second, both moderate and high FoF were associated with moderate- and vigorous-intensity PA and step counts in older community-dwelling adults, with the high FoF group performing shorter time of moderate- and vigorous-intensity PA and fewer steps.

Effect of Various Exercises on Intrinsic Capacity in Older Adults With Subjective Cognitive Concerns.

OBJECTIVES: Physical activity is associated with improvement in overall health and well-being, but robust evidence with comprehensive assessment of general health is lacking. This study aimed to clarify the effects of physical activity on intrinsic capacity among community-dwelling older adults with subjective memory concerns. DESIGN: A single-blind randomized controlled trial compared aerobic training (AT), resistance training (RT), and combined training (AT+RT) programs for improving general health evaluated by intrinsic capacity. SETTING: Toyota, Japan. PARTICIPANTS: Residents (65-85 years old) who screened positive for subjective memory concerns using the Kihon checklist were invited for eligibility assessment. In total, 415 community-dwelling older adults were enrolled and randomized into the AT, RT, AT+RT, and control groups. METHODS: Participants in the intervention groups underwent a group training program and self-paced home training for 26 weeks. The control group received lectures about health promotion. Intrinsic capacity (IC), constructed based on locomotion, cognition, psychological function, and vitality domains, was used to assess general health at baseline, week 26, and week 52. Between-group differences were exhibited with Z-score change in individual domain and combination of all domains. RESULTS: At baseline, mean age of all participants (47% women) was 72.3 ± 4.6 years, with a mean composited IC Z-score of -0.2 ± 0.5. Overall, AT and RT improved composite IC Z-scores by 0.17 (95% confidence interval [CI] 0.03-0.30) and 0.17 (95% CI 0.05-0.28) at week 26, respectively, but the beneficial effects waned at week 52. No significant differences in composite IC Z-scores were found in the AT+RT group at weeks 26 and 52. CONCLUSIONS AND IMPLICATIONS: Twenty-six-week AT with self-paced home training and RT with self-paced home training improve IC among community-dwelling older adults with subjective memory concerns, but the benefits waned subsequently. It will be required to develop optimal interventions that have a continuous beneficial effect on IC among community-dwelling older adults.

Short- and long-term effects of different exercise programs on the gait performance of older adults with subjective cognitive decline: A randomized controlled trial.

BACKGROUND: Older adults, especially those with cognitive decline, often have poor gait performance, which results in poor clinical outcomes due to falls or decreased daily physical activity. The effects of various exercises on gait performance have been studied, whereas the short-term and long-term effects of different exercise modalities remain unknown. OBJECTIVE: To compare the short- and long-term effects of aerobic training (AT), resistance training (RT), and combined training (CT) on the gait performance of community-dwelling older adults with subjective cognitive decline (SCD). DESIGN: A four-arm, randomized controlled trial. SETTING AND SUBJECTS: 388 community-dwelling older adults with SCD (mean age, 72.3 years). METHODS: Participants attended an exercise or education class twice a week for 26 weeks. 10 gait performance parameters were examined at baseline, post-intervention (Week 26), and after 26 weeks of follow-up (Week 52) using an electronic walkway system. RESULTS: The mean adherence of exercise sessions was 82.5 to 85.9%. All exercise intervention induced an improvement in gait speed, stride time, cadence, stride length, and double-support time at Week 26 (p < .05), without significant intergroup differences among exercise interventions. However, only RT showed a significant effect on some spatiotemporal gait parameters at Week 52. The analyses for the gait variability parameters showed mild effects of all exercise interventions. CONCLUSION: All of the exercise programs examined had a positive short-term effect on spatiotemporal gait parameters of older adults with SCD, despite no effect on gait variability parameters. RT are most recommended when long-lasting effects are the primary aim.

Effects of Aerobic, Resistance, or Combined Exercise Training Among Older Adults with Subjective Memory Complaints: A Randomized Controlled Trial.

BACKGROUND: Physical exercise is suggested to be effective for preventing cognitive decline in older adults, but the relative efficacy of different types of exercise have yet to be clarified. OBJECTIVE: This single-blinded randomized controlled trial was designed to investigate the differential effects of aerobic exercise training (AT), resistance exercise training (RT), and combined exercise training (CT) on cognition in older adults with subjective memory complaints (SMC). METHODS: Community-dwelling older adults with SMC (n = 415; mean age = 72.3 years old) were randomly assigned to one of the four groups: AT, RT, CT, or control group. The study consisted of two phases: a 26-week intervention and a 26-week follow-up. The participants were evaluated at baseline, 26 weeks (postintervention), and 52 weeks (follow-up). The primary outcome of this study was memory function, which was assessed using the Logical Memory II subtest of the Wechsler Memory Scale-Revised (WMS-R) score. The secondary outcomes included global cognitive function, verbal fluency, working memory, processing speed, and executive functions. RESULTS: Intention-to-treat analysis by a mixed-effect model repeated measure showed that the AT group had significantly improved performance on the WMS-R Logical Memory II test (2.74 [1.82-3.66] points) than the control group (1.36 [0.44-2.28] points) at the postintervention assessment (p = 0.037). The effect was more pronounced in those without amnesia than those with amnesia. No significant improvement was observed in the RT and CT groups. CONCLUSION: This study suggests that AT intervention can improve delayed memory in community-dwelling older adults, particularly in individuals without objective memory decline.

Falls in community-dwelling prefrail older adults.

Frailty has been established as a risk factor for falls, and prefrailty also seems a risk; however, few studies have focused on the association between falls and each of the five components of frailty proposed by Fried. In the present study, we sought to elucidate the association between prefrailty and falls, and moreover, the association of frailty component with falls. Participants were community-dwelling older people who had cognitive complaints but not dementia (N = 447, male 54.6%). Prefrailty was defined as exhibiting one or two of the five Fried criteria. Frail individuals were excluded. Background characteristics were compared between the prefrail and robust groups, and multiple regression analysis was performed to investigate the associations between fall history within the past year and factors that were significantly different between the groups. We also performed logistic regression analysis with adjustment for age, education and gender to assess associations with frailty components. We found that prefrailty was associated with fall history. Depressed mood was also significantly associated with fall history. Among the five frailty criteria, exhaustion was significantly associated with falls. Prefrailty, especially the criteria of exhaustion, and depressed mood were associated with fall history.

[Impact of driving cessation on daily transportation utility in elderly people with cognitive decline: a survey of patients in the memory clinic of an urban university hospital].

AIM: In the present study our goal was to explore the impact of driving cessation on daily transportation utility in older people with cognitive decline. METHODS: A total of 101 older persons participated in our survey of responding of a questionnaire about driving and other methods for traveling, administered at the memory clinic of the geriatric outpatient unit of Nagoya University Hospital. Of this total, 48 (47.5%) still had driving licenses, 16 (15.8%) had licenses that had expired, and 37 (36.6%) had no driving experience. RESULTS: The majority of license holders (77.1%) were active drivers, and we found that license holders tend to utilize public transport loss than older people without driving experience. Furthermore, among those who had ceased driving, there was a contrast in daily transportation utility between those with dementia and those without dementia, with the former accessing public transport less frequently. CONCLUSION: When clinicians advise drivers with dementia to cease driving, these patients need special attention to assist them in providing alternative ways of transportation.

Association between sarcopenia and depressive mood in urban-dwelling older adults: A cross-sectional study.

AIM: The aim of the present study was to examine the relationship between depressive mood and diagnostic components of sarcopenia. METHODS: The study used baseline data of participants in the Toyota Prevention Intervention for Cognitive Decline and Sarcopenia study. Participants in this cross-sectional study were 432 older adults (46.5% women, mean age 72.5 ± 4.7 years). We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia, and all participants were classified into a sarcopenia or healthy control group. The skeletal muscle mass was measured by bioelectrical impedance. Depressive mood was assessed using the Geriatric Depression Scale-15 (range 0-15). RESULTS: Among the 432 participants, 9.5% were classified as having sarcopenia. The mean ± SD Geriatric Depression Scale-15 scores in the control and sarcopenia groups were significantly different at 3.9 ± 2.8 and 5.3 ± 3.3, respectively (P = 0.003). Furthermore, depressive mood was significantly more prevalent in the sarcopenia group (P = 0.011). Multiple linear regression analysis showed that the Geriatric Depression Scale score was associated with grip strength (ß = -0.23, P = 0.004) and walking speed (ß = -0.15, P = 0.006), but not skeletal muscle mass index (ß = -0.16, P = 0.142), after controlling for demographic factors, chronic diseases, inflammatory markers and physical activity. CONCLUSIONS: Sarcopenia was associated with depressive mood. In terms of the diagnostic components of sarcopenia, depressive mood was not associated with decreased muscle mass, but was associated with low muscle strength and low physical performance. Geriatr Gerontol Int 2019; 19: 508-512.

Higher and Lower Muscle Echo Intensity in Elderly Individuals Is Distinguished by Muscle Size, Physical Performance and Daily Physical Activity.

This study was performed to identify factors that discriminate muscle echo intensity (EI) among parameters of body composition, physical function and daily physical activity in elderly individuals. A total of 209 men and women (73.7 ± 2.8 y) were evaluated. EI was measured on ultrasonographic axial thigh muscle images. The participants were categorized into the low, mid and high EI groups. We measured the skeletal muscle mass index (SMI) and physical functions. The high EI group exhibited a significantly lower SMI, slower 5-m walking time and shorter 6-min walking distance than the low EI group and had a shorter moderate-intensity activity time than the mid EI group. As a result of the discriminant analysis, elderly individuals were categorized into EI groups by SMI, daily activity and physical function. The data indicate that morphologic and functional parameters and the daily activity level help to discriminate higher and lower muscle EI.

Objectively measured physical activity and cognitive function in urban-dwelling older adults.

AIM: Physical activity (PA) and cognition have reportedly been associated with each other. However, it remains to be elucidated what intensities of PA are most strongly associated with cognition. In the current study, we aimed to determine the association between the intensities of objectively measured PA and cognitive function. METHODS: The present study was a cross-sectional analysis of the data obtained at registration in a randomized control trial in Toyota, Japan. Participants were community-dwelling older adults who had cognitive complaints. A battery of neuropsychological and physical assessments was carried out. Daily PA data were collected with the activity monitor. PA was categorized into one of three activity levels defined as light (<3.0 metabolic equivalents; LPA), moderate and vigorous (3.0 metabolic equivalents) activity. Partial correlation analysis was used to investigate the correlation between PA and cognition, with adjustments for age, sex and school years. We then carried out a multiple regression analysis to investigate the association of cognitive performance with PA, adjusting for insulin resistance or depressive mood. RESULTS: Partial correlation adjusted for age, sex and schooling years showed that LPA was significantly correlated with the Digit Symbol Substitution test, Trail Making Test (TMT) part A and TMT-B, whereas moderate and vigorous activity showed no correlations. Multiple regression analysis with several models with different adjustments showed that LPA was associated with the Digit Symbol Substitution test, TMT-A and TMT-B independently from insulin resistance or depressive mood. CONCLUSIONS: In the current study, we found that LPA was significantly associated with the performance of executive functional assessments. Geriatr Gerontol Int 2018; 18: 922-928.

Maximum gait speed is associated with a wide range of cognitive functions in Japanese older adults with a Clinical Dementia Rating of 0.5.

AIM: Physical and cognitive functions are mutually associated. However, it is unknown which markers of physical functions or body composition are most strongly associated with cognition. Here, we explored the association between body composition/physical performance and comprehensive neuropsychological assessments in an effort to identify reliable markers of cognition among factors in body composition/physical performance, including both usual and maximum gait speeds. METHODS: We examined a total of 161 Japanese individuals (71 men, 90 women; aged 76.3 ± 7.2 years) with a Clinical Dementia Rating of 0.5 and a Mini-Mental State Examination score >24. A battery of neuropsychological assessments, physical functional assessments and measurements of body composition was carried out. We conducted a multiple regression analysis to investigate the associations between cognitive performance and the factors in body composition and physical performance with adjustments for age, sex, and number of school years. RESULTS: Maximum gait speed was the factor most widely associated with cognitive performance among the factors of body composition and physical performance. CONCLUSION: Maximum gait speed might be the best marker for cognition in this population of older individuals. Geriatr Gerontol Int 2018; 18: 1323-1329.

Association between insulin resistance and objective measurement of physical activity in community-dwelling older adults without diabetes mellitus.

AIMS: The main objective of this study was to determine the association between objectively measured physical activity (PA) and cardiometabolic risk factors, particularly insulin resistance (IR), in Japanese community-dwelling older adults without diabetes mellitus. METHODS: Daily PA was measured by accelerometers in 388 community-dwelling older adults. IR was determined using homeostasis model assessment of insulin resistance (HOMA-IR). Regression analyses adjusted by age and sex were performed to determine the association of light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), or total steps per day with cardiometabolic risk factors. Then, multiple regression analysis was performed with HOMA-IR as an independent variable and those factors with p < 10% in the regression analysis as explanatory variables. RESULTS: Objectively measured LPA was negatively associated with systolic blood pressure, diastolic blood pressure, waist circumference, body mass index, and triglyceride (TG) and positively associated with high-density lipoprotein cholesterol (HDL-C). LPA was also negatively associated with IR. Total steps per day also had significant association with IR. MVPA was associated with TG, HDL-C, and IR. Multiple regression analysis showed that the association between LPA and IR was independent of other covariates, whereas that between MVPA and IR was lost after adjustment for other covariates. CONCLUSION: IR was associated with LPA or total steps, but not with MVPA, in community-dwelling older adults without diabetes mellitus.

Relationship between cardiac autonomic function and cognitive function in Alzheimer's disease.

AIM: Alzheimer's disease (AD) affects many central nervous structures and neurotransmitter systems. These changes affect not only cognitive function, but also cardiac autonomic function. However, the functional relationship between cardiac autonomic function and cognition in AD has not yet been investigated. The objective of the present study was to evaluate the association between cardiac autonomic function measured by heart rate variability and cognitive function in AD. METHODS: A total of 78 AD patients were recruited for this study. Cardiac autonomic function was evaluated using heart rate variability analysis. Multiple linear regression analysis was used to model the association between heart rate variability and cognitive function (global cognitive function, memory, executive function and processing speed), after adjustment for covariates. RESULTS: Global cognitive function was negatively associated with sympathetic modulation (low-to-high frequency power ratio). Memory performance was positively associated with parasympathetic modulation (high frequency power) and negatively associated with sympathetic modulation (low-to-high frequency power ratio). These associations were independent of age, sex, educational years, diabetes, hypertension and cholinesterase inhibitor use. CONCLUSIONS: Cognitive function, especially in the areas of memory, is associated with cardiac autonomic function in AD. Specifically, lower cognitive performance was found to be associated with significantly higher cardiac sympathetic and lower parasympathetic function in AD. Geriatr Gerontol Int 2017; 17: 92-98.

The Associations among Insulin Resistance, Hyperglycemia, Physical Performance, Diabetes Mellitus, and Cognitive Function in Relatively Healthy Older Adults with Subtle Cognitive Dysfunction.

Insulin resistance (IR), diabetes mellitus (DM), sarcopenia, and cognitive dysfunction are thought to be mutually associated. We conducted a comprehensive assessment of the relationships among IR, gait speed, hyperglycemia, and DM by cross-sectionally analyzing the baseline data of an interventional study for cognitive preservation with physical exercise (the TOyota Preventional Intervention for Cognitive decline and Sarcopenia [TOPICS]). The participants (n = 444) were relatively healthy older individuals who had mild cognitive impairment without dementia, and 61 of the participants had DM. Slow gait speed and hyperglycemia were associated with cognitive dysfunction, mainly in the executive function domain, whereas IR was associated with memory impairment. The participants with DM had lower general cognition and executive function. Executive dysfunction in the DM participants seemed to be partly explained by hyperglycemia and/or slow gait speed. Our findings confirmed that IR, DM, sarcopenia, and cognitive dysfunction are mutually associated in complex ways. Understanding the mechanisms underlying these associations will lead to effective strategies to prevent and treat cognitive dysfunction in older individuals.

Neuroanatomical correlates of error types on the Clock Drawing Test in Alzheimer's disease patients.

AIM: We sought to identify the relationship between regional cerebral blood flow (rCBF) and error types on the Clock Drawing Test (CDT) in patients with Alzheimer's disease (AD). METHOD: The CDT was administered to 142 patients with AD. We used the Mendez scoring method. Their rCBF values were measured by single-photon emission computed tomography. The correlation between the CDT total score and rCBF was examined on a voxel-by-voxel basis. After we excluded 37 patients whose drawings were inappropriate for assessing the CDT error types, we examined the relationships between each error type on the CDT and rCBF. RESULTS: Total score on the CDT was positively correlated with rCBF in the left posterior middle temporal lobe. We also found relationships between the error "non-existence of number 2, or not pointing toward number 2" and the left frontal lobe; the error "uneven number spacing" and the bilateral frontal lobe; "deviation of the clock center" and the left frontal lobe; "missing numbers" and the right parietal lobe; "uneven number distance from edge" and the right parietal and the temporal lobes; "same length hands" and the bilateral temporal lobe; and "unclosed circle" and the left temporal lobe. CONCLUSIONS: Each error type on the CDT appears to relate to a different brain region. These findings will be useful in the understanding of CDT performances and the underlying neuropsychological pathology. Geriatr Gerontol Int 2016; 16: 777-784.

Relationship between small cerebral white matter lesions and cognitive function in patients with Alzheimer's disease and amnestic mild cognitive impairment.

AIM: The main purpose of the present study was to investigate the influence of small cerebral white matter lesions on cognitive functions, and its difference by clinical stage. METHODS: A total of 160 patients with Alzheimer's disease and 40 older adults with amnestic mild cognitive impairment were enrolled in the present study. The Fazekas rating scale was used for the semi-quantitative measurement of white matter lesions. Participants whose scales were more than grade 2 were excluded. Associations between the degree of small white matter lesions and cognitive functions including memory, verbal fluency, working memory, processing speed, and executive function were examined. RESULTS: We found that small white matter lesions influenced the performances of neuropsychological tests differently between Alzheimer's disease and amnestic mild cognitive impairment. Analysis of covariance showed significant effects of interaction on a test that assessed categorical verbal fluency. In the amnestic mild cognitive impairment group, small periventricular white matter hyperintensities were significantly associated with poor performances in categorical verbal fluency; whereas in the Alzheimer's disease group, such associations were not observed. Deep white matter hyperintensities did not influence any cognitive functions examined in both groups. CONCLUSIONS: The results suggested the involvement of periventricular small white matter lesions on impairment in verbal fluency, and such influence might be different depending on an individual's clinical stage.