[Cut-off point of the risk assessment scale for the 9-year risk of functional disability].

Objectives　This study aimed to examine the cut-off point of the Risk Assessment Scale (RAS) for predicting the 9-year risk of functional disability among older Japanese adults.Methods　This prospective, 9-year follow-up study used data from the Sasaguri Genkimon Study in Fukuoka. Of the 2,629 older adults who did not have functional disabilities and participated in the baseline survey in 2011, 2,254 with complete data were included in the analysis. The RAS was assessed using a questionnaire that showed good predictive and external validity for the 3-year risk of functional disability. The outcome was the incidence of functional disability during follow-up, which was defined as a new certification for the need for support or care. The cut-off point of the RAS was estimated as the point indicating the maximum χ2 value of the log-rank test. The predictive validity of the RAS for functional disability was examined using C-statistics for the total score, and sensitivity and specificity for the cut-off point, respectively. Participants were then categorized into two groups according to the cut-off point (high-score and low-score groups). Hazard ratio (HR) and 95% confidence interval (95% CI) of the 9-year risk of functional disability for the high-score group compared with the low-score group were calculated using the Cox proportional hazard model. In the multivariate model, HR was adjusted for living alone, education, economic status, drinking, smoking, and multimorbidity.Results　New functional disability was certified in 647 participants (28.7%) during a median follow-up period of 8.75 years. The cut-off point for functional disability was 13/14. The C-statistic was 0.774, and the sensitivity and specificity were 0.726 and 0.712, respectively. Compared to the low-score group (0-13 points), the HR (95% CI) of the high-score group (≥ 14 points) for incident functional disability in 9 years was 5.50 (4.62-6.54) in the crude model, and 4.81 (4.00-5.78) in the multivariate model (P<.001).Conclusion　This study, with its long follow-up period of 9 years, demonstrated that the 13/14 cut-off point of the RAS is suitable for the long-term assessment of functional disability risk. Our results suggest the possibility of using the 13/14 cut-off point of the RAS as a promising tool to grasp the risk of functional disability over a longer time frame, highlighting the potential for early prevention and intervention.

Accelerometer-measured sedentary behavior and risk of functional disability in older Japanese adults: a 9-year prospective cohort study.

BACKGROUND: The associations of sedentary time and patterns with functional disability among older adults remain unclear, and few studies have accounted for the co-dependency of sedentary behavior and physical activities when modeling sedentary behavior with risk of functional disability. We aimed to examine the associations between sedentary time and patterns and risk of incident functional disability, and assess whether replacing sedentary time with light physical activity (LPA) or moderate-to-vigorous intensity physical activity (MVPA) is associated with reduced risk of functional disability in community-dwelling older adults. METHODS: A total of 1,687 Japanese adults aged ≥ 65 years without functional disability at baseline were prospectively followed-up for 9 years (2011-2020). Functional disability was ascertained using the national database of Japan's Long-term Care Insurance System. Sedentary time and patterns, LPA, and MVPA were measured using a tri-axial accelerometer secured to participants' waists. RESULTS: During follow-up, 466 participants developed functional disability. Compared with the lowest quartile of total sedentary time, the multivariable-adjusted hazard ratios (95% confidence intervals) of functional disability for the second, third, and top quartiles were 1.21 (0.91‒1.62), 1.45 (1.10‒1.92), and 1.40 (1.05‒1.88) (p for trend = 0.01). After further adjusting for MVPA, total sedentary time was no longer significantly associated with the risk of functional disability (p for trend = 0.41). Replacing 10 min/day of sedentary time with the same amount of MVPA (but not LPA) was significantly associated with a 12% reduced risk of functional disability (hazard ratio [95% confidence interval]: 0.88 [0.84‒0.92]). No significant association was observed between sedentary bout length and functional disability. CONCLUSION: Higher levels of total sedentary time were associated with an increased risk of incident functional disability. However, this association was not independent of MVPA. Replacing sedentary time with MVPA, but not LPA, was associated with reduced risk of functional disability in older adults.

Sex differences in dementia risk and risk factors: Individual-participant data analysis using 21 cohorts across six continents from the COSMIC consortium.

INTRODUCTION: Sex differences in dementia risk, and risk factor (RF) associations with dementia, remain uncertain across diverse ethno-regional groups. METHODS: A total of 29,850 participants (58% women) from 21 cohorts across six continents were included in an individual participant data meta-analysis. Sex-specific hazard ratios (HRs), and women-to-men ratio of hazard ratios (RHRs) for associations between RFs and all-cause dementia were derived from mixed-effect Cox models. RESULTS: Incident dementia occurred in 2089 (66% women) participants over 4.6 years (median). Women had higher dementia risk (HR, 1.12 [1.02, 1.23]) than men, particularly in low- and lower-middle-income economies. Associations between longer education and former alcohol use with dementia risk (RHR, 1.01 [1.00, 1.03] per year, and 0.55 [0.38, 0.79], respectively) were stronger for men than women; otherwise, there were no discernible sex differences in other RFs. DISCUSSION: Dementia risk was higher in women than men, with possible variations by country-level income settings, but most RFs appear to work similarly in women and men.

Potential utility of physical function measures to improve the risk prediction of functional disability in community-dwelling older Japanese adults: a prospective study.

BACKGROUND: While gait speed, one-leg standing balance, and handgrip strength have been shown to be independent predictors for functional disability, it is unclear whether such simple measures of physical function contribute to improved risk prediction of functional disability in older adults. METHODS: A total of 1,591 adults aged ≥ 65 years and without functional disability at baseline were followed up for up to 7.9 years. Functional disability was identified using the database of Japan's Long-term Care Insurance System. Maximum gait speed, one-leg standing time, and handgrip strength were measured at baseline. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association of physical function and functional disability incidence. The incremental predictive value of each physical function measure for risk prediction was quantified using the difference in overall C-statistic, category-free net reclassification improvement (NRI), and integrated discrimination improvement (IDI) index. RESULTS: During follow-up (median: 7.8 years), functional disability was identified in 384 participants. All of the physical function measures were inversely associated with the risk of functional disability, independent of potential confounding factors. The multivariable adjusted HRs (95 % CIs) for functional disability per one standard deviation increment of maximum gait speed, one-leg-standing time, and hand grip strength were 0.73 (0.65-0.83), 0.68 (0.59-0.79), and 0.72 (0.59-0.86), respectively. Incorporation of each of maximum gait speed, one-leg-stand time, and hand grip strength into a basic model with other risk factors significantly improved C-statistic from 0.770 (95 % CIs, 0.751-0.794) to 0.778 (0.759-0.803), 0.782 (0.760-0.805), and 0.775 (0.756-0.800), respectively (all p < 0.05). A model including all three measures had the highest C-statistic of 0.787 (0.765-0.810). The improvements in risk prediction were also confirmed by category-free NRI and IDI index. CONCLUSIONS: Adding any of the three measures to a basic model with other known risk factors significantly improved the prediction of functional disability and addition of all three measures provided further improvement of the prediction in older Japanese adults. These data provide robust evidence to support the practical utility of incorporating these simple physical function measures into functional disability risk prediction tools.

Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study.

BACKGROUND: With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. METHODS AND FINDINGS: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. CONCLUSIONS: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.

Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: a collaborative cohort study.

BACKGROUND: The prevalence of dementia varies around the world, potentially contributed to by international differences in rates of age-related cognitive decline. Our primary goal was to investigate how rates of age-related decline in cognitive test performance varied among international cohort studies of cognitive aging. We also determined the extent to which sex, educational attainment, and apolipoprotein E ε4 allele (APOE*4) carrier status were associated with decline. METHODS AND FINDINGS: We harmonized longitudinal data for 14 cohorts from 12 countries (Australia, Brazil, France, Greece, Hong Kong, Italy, Japan, Singapore, Spain, South Korea, United Kingdom, United States), for a total of 42,170 individuals aged 54-105 y (42% male), including 3.3% with dementia at baseline. The studies began between 1989 and 2011, with all but three ongoing, and each had 2-16 assessment waves (median = 3) and a follow-up duration of 2-15 y. We analyzed standardized Mini-Mental State Examination (MMSE) and memory, processing speed, language, and executive functioning test scores using linear mixed models, adjusted for sex and education, and meta-analytic techniques. Performance on all cognitive measures declined with age, with the most rapid rate of change pooled across cohorts a moderate -0.26 standard deviations per decade (SD/decade) (95% confidence interval [CI] [-0.35, -0.16], p < 0.001) for processing speed. Rates of decline accelerated slightly with age, with executive functioning showing the largest additional rate of decline with every further decade of age (-0.07 SD/decade, 95% CI [-0.10, -0.03], p = 0.002). There was a considerable degree of heterogeneity in the associations across cohorts, including a slightly faster decline (p = 0.021) on the MMSE for Asians (-0.20 SD/decade, 95% CI [-0.28, -0.12], p < 0.001) than for whites (-0.09 SD/decade, 95% CI [-0.16, -0.02], p = 0.009). Males declined on the MMSE at a slightly slower rate than females (difference = 0.023 SD/decade, 95% CI [0.011, 0.035], p < 0.001), and every additional year of education was associated with a rate of decline slightly slower for the MMSE (0.004 SD/decade less, 95% CI [0.002, 0.006], p = 0.001), but slightly faster for language (-0.007 SD/decade more, 95% CI [-0.011, -0.003], p = 0.001). APOE*4 carriers declined slightly more rapidly than non-carriers on most cognitive measures, with processing speed showing the greatest difference (-0.08 SD/decade, 95% CI [-0.15, -0.01], p = 0.019). The same overall pattern of results was found when analyses were repeated with baseline dementia cases excluded. We used only one test to represent cognitive domains, and though a prototypical one, we nevertheless urge caution in generalizing the results to domains rather than viewing them as test-specific associations. This study lacked cohorts from Africa, India, and mainland China. CONCLUSIONS: Cognitive performance declined with age, and more rapidly with increasing age, across samples from diverse ethnocultural groups and geographical regions. Associations varied across cohorts, suggesting that different rates of cognitive decline might contribute to the global variation in dementia prevalence. However, the many similarities and consistent associations with education and APOE genotype indicate a need to explore how international differences in associations with other risk factors such as genetics, cardiovascular health, and lifestyle are involved. Future studies should attempt to use multiple tests for each cognitive domain and feature populations from ethnocultural groups and geographical regions for which we lacked data.

Sedentary bout durations and metabolic syndrome among working adults: a prospective cohort study.

BACKGROUND: This study aimed to examine the associations between time spent in prolonged and non-prolonged sedentary bouts and the development of metabolic syndrome. METHODS: We used data from a prospective study of Japanese workers. Baseline examination was conducted between 2010 and 2011. A total of 430 office workers (58 women) aged 40-64 years without metabolic syndrome were followed up by annual health checkups until 2014. Metabolic syndrome was defined as having ≥ 3 out of 5 diagnostic criteria from the Joint Interim Statement 2009 definition. Sedentary time was assessed using a tri-axial accelerometer. Time spent in total, prolonged (accumulated ≥ 30 min) and non-prolonged sedentary bouts (accumulated < 30 min) was calculated. Cox proportional hazards models were used to estimate the risk of developing metabolic syndrome. RESULTS: During a median follow-up of 3 years, 83 participants developed metabolic syndrome. After adjustment for age, sex, education, smoking, and family income, positive associations were observed between time spent in prolonged sedentary bouts and the development of metabolic syndrome. After additional adjustment for moderate-to-vigorous physical activity, those in the three highest quartiles of time spent in prolonged sedentary bouts showed higher risk of metabolic syndrome compared to the lowest quartile group, with adjusted hazard ratios (95 % confidence intervals) of 2.72 (1.30 - 5.73), 2.42 (1.11 - 5.50), and 2.85 (1.31 - 6.18), respectively. No associations were seen for time spent in total and non-prolonged sedentary bouts. CONCLUSIONS: Sedentary behavior accumulated in a prolonged manner was associated with an increased risk of metabolic syndrome. In devising public health recommendations for the prevention of metabolic disease, the avoidance of prolonged uninterrupted periods of sedentary behavior should be considered.

Association between participation in social activity and physical fitness in community-dwelling older Japanese adults.

Purpose This study aimed to examine the relationship between participation in social activity and both, composite and individual measures of physical fitness in community-dwelling older adults.Methods This study was conducted using baseline data from the Sasaguri Genkimon Study (SGS), a longitudinal cohort study conducted in 2011. Participants were 1,365 community-dwelling men and women aged 65 years or above, who did not require certified nursing care and who resided in Sasaguri, a town located east of the Fukuoka metropolitan area. Participation in social activity was assessed by asking participants whether they engaged in any of eight social activities. Physical fitness tests assessed participants' handgrip strength and knee extension strength as measures of muscle strength, and their one-leg standing time, 5-m maximum gait speed, and 5-repetition sit-to-stand rate as measures of their physical performance. Multiple linear regression and logistic regression analyses were conducted to assess the relationship between participation in social activity and each measure of physical fitness, adjusting for sex; age; body mass index; socioeconomic status; solitary living; exercise, habitual drinking and smoking; accelerometer-measured, moderate-to-vigorous physical activity; cognitive function; instrumental activities of daily living; distress; social network; and comorbidities.Results A total of 83.6% of the participants were engaged in at least one social activity. After adjusting for potential confounders, engagement in social activity was positively associated with a higher composite physical fitness score, faster gait speed and 5-repetition sit-to-stand rate, and longer one-leg standing time (P=0.008, P=0.030, P=0.034, and P=0.009, respectively).Conclusion Participation in social activity was significantly associated with physical fitness, specifically those related to locomotive function. These associations were independent of various confounders including socioeconomic status, and comorbidities.

Screening for frailty phenotype with objectively-measured physical activity in a west Japanese suburban community: evidence from the Sasaguri Genkimon Study.

BACKGROUND: The low physical activity domain of the frailty phenotype has been assessed with various self-reported questionnaires, which are prone to possible recall bias and a lack of diagnostic accuracy. The primary purpose of this study was to define the low physical activity domain of the frailty phenotype using accelerometer-based measurement and to evaluate the internal construct validity among older community-dwellers. Secondly, we examined potential correlates of frailty in this population. METHODS: We conducted a cross-sectional study of 1,527 community-dwelling older men and women aged 65 and over. Data were drawn from the baseline survey of the Sasaguri Genkimon Study, a cohort study carried out in a west Japanese suburban community. Frailty phenotypes were defined by the following five components: unintentional weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. Of these criteria, physical activity was objectively measured with a tri-axial accelerometer. To confirm our measure's internal validity, we performed a latent class analysis (LCA) to assess whether the five components could aggregate statistically into a syndrome. We examined the correlates of frailty using multiple stepwise logistic regression models. RESULTS: The estimated prevalence of frailty was 9.3% (95% confidence intervals, CI, 8.4-11.2); 43.9% were pre-frail (95% CI, 41.5-46.4). The percentage of low physical activity was 19.5%. Objectively-assessed physical activity and other components aggregated statistically into a syndrome. Overall, increased age, poorer self-perceived health, depressive and anxiety symptoms, not consuming alcohol, no engagement in social activities, and cognitive impairment were associated with increased odds of frailty status, independent of co-morbidities. CONCLUSIONS: This study confirmed the internal construct validity of the frailty phenotype that defined the low energy expenditure domain with the objective measurement of physical activity. Accelerometry may potentially standardize the measurement of low physical activity and improve the diagnostic accuracy of the frailty phenotype criteria in primary care setting. The potential role of factors associated with frailty merits further studies to explore their clinical application.

Tri-Axial Accelerometer-Determined Daily Physical Activity and Sedentary Behavior of Suburban Community-Dwelling Older Japanese Adults.

Knowledge regarding accelerometer-derived physical activity (PA) and sedentary behavior (SED) levels is scarce for Japanese older adults. The aims of this study were therefore to 1) describe levels of PA and SED in Japanese community-dwelling older adults, using tri-axial accelerometer; 2) examine the variation of PA and SED with respect to sex, age, and body mass index (BMI). Participants of this study were from the baseline survey of the Sasaguri Genkimon Study, who were 65 years or older and not certified as those requiring long-term care. PA was assessed objectively for seven consecutive days using tri-axial accelerometer. A total of 1,739 participants (median age: 72 years, men: 38.0%) with valid PA data were included. Overall, participants in the present study spent 54.5% of their waking time being sedentary and 45.5% being active, of which 5.4% was moderate-to-vigorous physical activity (MVPA). Women accumulated more minutes of light physical activity (LPA) and MVPA compared with men. In contrast, men spent more time being sedentary. Mean steps per day did not differ between sexes. Furthermore, participants with higher BMI (BMI ≥25) had lower PA levels, and longer SED compared with those with lower BMI (BMI <). PA levels were lower and SED was longer with age. The present study is the first to demonstrate that the levels of PA and SED differed by sex, age, and BMI in Japanese community-dwelling older adults. In particular, women were more active compared with men, providing unique insight into the current level of PA in older adults. Data presented in the study will enable further investigation of additional determinants of PA and SED in order to develop effective population-based intervention strategies to promote PA and reduce prolonged SED in the Japanese population and possibly other rapidly aging societies. Key pointsAccelerometer, that is capable to assess PA more precisely in large scale epidemiological studies, provides opportunity for improving understanding of daily PA in older adults.This study first demonstrated that the levels of PA and SED differed by sex, age, and BMI in Japanese community-dwelling older people.Women were more active compared with men, in terms of more minutes of MVPA.

Identifying associations between sedentary time and cardio-metabolic risk factors in working adults using objective and subjective measures: a cross-sectional analysis.

BACKGROUND: Sedentary behavior has been reported to be associated with metabolic and vascular health independent of moderate-to-vigorous physical activity (MVPA). In order to select appropriate options to measure sedentary behavior in practice and research settings, it is worthwhile to characterize the extent to which objective and subjective measures of sedentary behavior quantify adverse health risks in the same population. This cross-sectional analysis compared accelerometer-derived and self-reported sedentary time to identify their association with cardio-metabolic risk factors. METHODS: Cross-sectional analysis was conducted using data from 661 Japanese workers (145 women) aged 20-64 years. Participants wore a tri-axial accelerometer device for 10 consecutive days and completed the Japan Atherosclerosis Longitudinal Study Physical Activity Questionnaire. Data on body mass index, waist circumference, resting blood pressure, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, total:HDL cholesterol ratio, blood glucose, and glycosylated hemoglobin (HbA1c) were obtained from annual health examinations. RESULTS: Both accelerometer-derived and self-reported sedentary time were deleteriously associated with triglycerides, HDL-cholesterol, total:HDL ratio, and HbA1c after adjustment for potential confounders including MVPA. There were no significant differences in regression coefficients between the two measures. Thus, the magnitude of the associations of both measures with cardio-metabolic risk factors was similar, despite poor agreement between them. Occupational sedentary time was correlated with both measures of total sedentary time, and more consistently associated with cardio-metabolic risk factors than sedentary leisure time. CONCLUSIONS: Both accelerometer and self-report measurements are similarly associated with cardio-metabolic risk factors in a Japanese working adult population. Subjective and objective measures of sedentary behaviors appear to capture different aspects of behaviors. Further efforts to establish data processing methods integrating objective and subjective measures are needed to more effectively assess sedentary time's relationship to health outcomes.

Physical Fitness Measures as Potential Markers of Low Cognitive Function in Japanese Community-Dwelling Older Adults without Apparent Cognitive Problems.

Detecting signs of cognitive impairment as early as possible is one of the most urgent challenges in preventive care of dementia. It has still been unclear whether physical fitness measures can serve as markers of low cognitive function, a sign of cognitive impairment, in older people free from dementia. The aim of the present study was to examine an association between each of five physical fitness measures and global cognition in Japanese community-dwelling older adults without apparent cognitive problems. The baseline research of the Sasaguri Genkimon Study was conducted from May to August 2011 in Sasaguri town, Fukuoka, Japan. Of the 2,629 baseline subjects who were aged 65 years or older and not certified as individuals requiring nursing care by the town, 1,552 participants without apparent cognitive problems (Mini-Mental State Examination score ≥24) were involved in the present study (59.0% of the baseline subjects, median age: 72 years, men: 40.1%). Global cognitive function was measured by the Japanese version of the Montreal Cognitive Assessment. Handgrip strength, leg strength, sit-to-stand rate, gait speed, and one-leg stand time were examined as physical fitness measures. In multiple linear regression analyses, each of the five physical fitness measures was positively associated with the Montreal Cognitive Assessment score after adjusting for age and sex (p < 0.001). These associations were preserved after additional adjustment for years of formal education, body mass index, and other confounding factors (p < 0.001). The present study first demonstrated the associations between multiple aspects of physical fitness and global cognitive function in Japanese community-dwelling older people without apparent cognitive problems. These results suggest that each of the physical fitness measures has a potential as a single marker of low cognitive function in older populations free from dementia and thereby can be useful in community-based preventive care of dementia. Key pointsThere is a great need for identifying lifestyle-related markers which help detect subtle cognitive impairment in the preclinical or earlier phase of dementia.In the present study, each of the five physical fitness measures employed was linearly and positively associated with the Montreal Cognitive Assessment score in the present older adults without apparent cognitive problems, after adjusting for age, sex, education, body mass index, and other confounding factors.The results suggest the potential of each physical fitness measure as a single lifestyle-related marker of low cognitive function in the population, which can be useful in community-based preventive care of dementia.

Normative data for the montreal cognitive assessment in a Japanese community-dwelling older population.

BACKGROUND: Although the Montreal Cognitive Assessment (MoCA) is acknowledged as a promising neuropsychological tool, its normative data for older populations have not been established yet. The purpose of this study was to provide normative data for the MoCA in Japanese community-dwelling older people. METHODS: In a Japanese town, 1,977 participants aged 65 years or older (mean age 73.6 years; male 41.3%) completed MoCA tests. After descriptive and regression analyses, normative data were developed for MoCA scores in the population. RESULTS: The mean MoCA score observed (21.8 points) was lower than that for normal controls (27.4 points) in the original validation study of the MoCA. Additionally, 82.6% of MoCA scores fell below the standard cutoff of 26 points for detecting mild cognitive impairment (MCI). The regression analysis showed that higher age and fewer years of formal education were associated with lower MoCA scores (p < 0.001). Normative data for MoCA scores were presented with respect to age and education. CONCLUSION: This study provided normative data for the MoCA in a Japanese community-dwelling older population. This research also suggests that conventional use of the MoCA as a screening tool for MCI might be problematic in cultures different from that in which the cutoff was developed.

Longitudinal Changes in Moderate to Vigorous Physical Activity in Community-Dwelling Older Men and Women: A 2-Year Prospective Cohort Study in Japan.

BACKGROUND: To examine longitudinal changes in accelerometer-measured moderate to vigorous physical activity (MVPA) and associated factors of changes in MVPA among community-dwelling older Japanese men and women over 2 years of follow-up. METHODS: In total, 601 participants (72.2 [5.4] y, 40.6% men) were included. MVPA was assessed at baseline (2011) and follow-up (2013) using triaxial accelerometers. Sex-stratified multiple linear regression models were used to identify associated factors of changes in MVPA. RESULTS: On average, a significant decrease in MVPA over 2 years was observed only in women (P < .001). Higher baseline MVPA levels and older age were significantly associated with a decrease in MVPA over 2 years in both men and women. Men who were currently drinking (vs no) and had faster maximum gait speed showed statistically significant increases in MVPA. Women who had very poor/poor economic status (vs fair/good) and were socially isolated (vs no) showed statistically significant increases in MVPA over 2 years, while those who had fear of falling (vs no) and poor/fair self-rated health (vs good/very good) showed statistically significant decreases in MVPA over 2 years. CONCLUSIONS: Our findings showed different associated factors of changes in MVPA by sex, suggesting the importance of accounting for sex differences in terms of developing specific intervention strategies for promoting MVPA among older men and women.

Changes of Oral and Physical Functions in Older Japanese Who Participated in Keyboard Harmonica and Exercise Classes during COVID-19-Related Movement Restrictions.

Many older people have restricted activities or movements because of the coronavirus disease 2019 (COVID-19) pandemic, which causes concerns about secondary health problems. This study aimed to investigate how frailty-prevention activities implemented by local governments have changed the health of community-dwelling older people during the COVID-19 pandemic. In this observational study, the participants were 23 older Japanese people who took part in keyboard harmonica or exercise classes in 2021. Oral function examination and physical function tests were conducted at baseline and after 10 months of follow-up. In each class, the participants met 15 times and worked on assignments at home. The results showed that oral diadochokinesis/pa/, which represents lip dexterity, improved during 10 months (from 6.6 to 6.8 times/s, p < 0.046); however, grip strength (p < 0.005) and total skeletal muscle mass (p < 0.017) decreased in the keyboard harmonica group. In the exercise group, a statistically significant difference was found only in grip strength, which decreased (p < 0.003). The oral and physical functions of older people who participated in frailty-prevention activities implemented by local governments characteristically changed. Moreover, activity restrictions during the COVID-19 pandemic may have caused decreased grip strength.

Correlates of Gait Speed Among Older Adults From 6 Countries: Findings From the COSMIC Collaboration.

BACKGROUND: Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates across Australian, Asian, and African countries. METHODS: We used data from 6 population-based cohorts of adults aged 65+ from 6 countries and 3 continents (N = 6 472), with samples ranging from 231 to 1 913. All cohorts are members of the Cohort Studies of Memory in an International Consortium collaboration. We investigated whether clinical (body mass index [BMI], hypertension, stroke, apolipoprotein status), psychological (cognition, mood, general health), and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models were controlled for age, sex, and education, and were sex-stratified. RESULTS: Age- and sex-standardized usual gait speed means ranged from 0.61 to 1.06 m/s and rapid gait speed means ranged from 1.16 to 1.64 m/s. Lower BMI and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely nonsignificant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex, except physical activity, where the greater intensity was associated with usual gait among men but not women. CONCLUSIONS: This study is among the first to describe the usual and rapid gait speeds across older adults in Africa, Asia, and Australia.

Feasibility of the Remote Physical Activity Follow-Up Intervention after the Face-to-Face Program for Healthy Middle-Aged Adults: A Randomized Trial Using ICT and Mobile Technology.

Although the effectiveness of face-to-face and remote intervention for increasing and maintaining physical activity (PA) have been compared, the effect of combining the two forms of intervention is unknown. The purpose of this study was to examine the feasibility of the remote PA follow-up intervention after the face-to-face PA program on changing PA behaviors and some health outcomes in healthy middle-aged adults. As a secondary analysis, we also attempted a preliminary analysis of the difference in the number of behavior change interviews in the remote PA follow-up intervention. After the face-to-face intervention, 30 healthy subjects were randomly divided into four behavior change coaching interviews (BCI4 group) or three BCI (BCI3 group). The results of this study showed that body weight, body fat mass, and waist circumference were significantly reduced after face-to-face intervention, and were further reduced after remote PA follow-up intervention. However, the difference in the number of BCI affected only body fat mass. The remote PA follow-up intervention may have potential to maintain the effects of face-to-face intervention. In the future, it is necessary to refine the research design and conduct a full-scale intervention study.

Predictive ability of the total score of the Kihon checklist for the incidence of functional disability in older Japanese adults: An 8-year prospective study.

AIM: To investigate the association between the total score of the Kihon checklist (t-KCL score) and functional disability over an 8-year follow-up period, and to examine whether the t-KCL score in the basic model with risk factors contributes to the incremental predictive ability for functional disability among older adults. METHODS: We followed 2209 older adults aged ≥65 years without functional disability at baseline. The t-KCL score was determined using a baseline survey questionnaire. Functional disability was defined based on information from long-term care certifications. The association between the t-KCL score and functional disability was examined using the Cox proportional hazards model. The incremental predictive ability of the t-KCL score for functional disability was evaluated by the difference of the C-statistic, category-free net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: The median follow-up period was 7.8 years, and 557 participants developed functional disability. The adjusted hazard ratio (95% confidence interval [CI]) of functional disability for a 1-point increase of the t-KCL score was 1.08 (1.06-1.10). Adding the t-KCL score to the basic model significantly improved the C-statistic (95% CI) from 0.747 (0.728-0.768) to 0.760 (0.741-0.781). When the t-KCL score was added to the basic model, the NRI and IDI were 0.187 (95% CI: 0.095-0.287) and 0.020 (95% CI: 0.012-0.027), respectively. CONCLUSIONS: The t-KCL score had an independent positive association with functional disability over an 8-year follow-up. Furthermore, adding the t-KCL score to the basic model improved the predictive ability for functional disability. Geriatr Gerontol Int 2022; 22: 723-729.

Intermittent Exercise at Lactate Threshold Induces Lower Acute Stress than Its Continuous Counterpart in Middle-to-Older Aged Men.

This study aimed to compare the degree of exhaustion and trophic effects between continuous exercise (CE) and intermittent exercise (IE) at lactate threshold (LT) intensity. Seven healthy men (age: 43-69 years) performed the following three experimental tests in a randomized crossover order: (1) control; (2) CE, performed as a 20-min of cycling at LT intensity; and (3) IE, performed as 20 sets of a one-min bout of cycling at LT intensity with a 30-s rest between every two sets. Heart rate (HR), blood lactate concentration (LA), rating of perceived exertion (RPE), catecholamines, cortisol, growth hormone, insulin-like growth factor (IGF)-1, and brain-derived neurotrophic factor (BDNF) were measured. The sampling timing in each test was as follows: 10 min before the onset of exercise, at the 25%, 50%, and 100% time points of exercise, and at 10 min after exercise. IE was found to be accompanied by a lower degree of exhaustion than CE in measures of HR, LA, RPE, catecholamines, and cortisol. In terms of trophic effects, both of IGF-1 and BDNF increased in CE, while a marginal increase of BDNF was observed in IE. The results indicated that IE induces lower stress than CE, but may not be effective for inducing trophic effects.

Associations of Objectively-Measured Sedentary Time and Patterns with Cognitive Function in Non-Demented Japanese Older Adults: A Cross-Sectional Study.

This study aimed to investigate the cross-sectional associations of objectively-measured sedentary time and patterns with cognitive function in Japanese older adults. A total of 1681 non-demented community-dwelling older adults (aged 73 ± 6, 62.1% women) were included. Total sedentary time, prolonged sedentary time (accumulated in ≥30 min bouts) and mean sedentary bout length were assessed using a tri-axial accelerometer. Global and domain-specific cognitive functions were measured using the Montreal Cognitive Assessment. The average of total sedentary time and prolonged sedentary time were 462 ± 125 and 186 ± 111 min/day, respectively. Greater prolonged sedentary time, but not total sedentary time, was significantly associated with poorer performance in the orientation domain even after controlling for moderate-to-vigorous physical activity (p for trend = 0.002). A significant inverse association was also observed between mean sedentary bout length and the orientation domain (p for trend = 0.009). No significant associations were observed for global cognitive function or other cognitive domains. Sedentary time accumulated in prolonged bouts, but not total sedentary time, was inversely associated with orientation ability among older adults. Our results encourage further researches to confirm the role of prolonged sedentary time in changes to cognitive domains over time among older adults.