[Characteristics of elderly patients diagnosed with delusional disorders during the COVID-19 pandemic: A study in a memory clinic].

AIM: Since the declaration of an emergency following the spread of COVID-19, the number of elderly patients complaining of delusions has increased. Therefore, we investigated the characteristics of patients diagnosed with delusional disorders in our clinic. METHODS: A total of 1,884 patients ≥ 65 years old who visited the Center for Comprehensive Care on Memory Disorders at Kyorin University Hospital from January 2017 to December 2021 were included in the study. The 17 patients diagnosed with delusional disorders were divided into 2 groups based on the timing of the first declaration of emergency, and the characteristics of each group were investigated. RESULTS: Seven patients were diagnosed with delusional disorder before the first declaration of emergency and 10 after the declaration. The proportion of patients increased by approximately three-fold after the declaration. Post-emergency patients were less motivated to be active than those encountered before the declaration, and many had no history of mental illness. Seven of the 10 post-emergency patients visited the Memory Clinic within 1 year of the onset of delusions. CONCLUSIONS: After the first declaration of an emergency, elderly patients with no history of psychiatric disorders acutely developed delusional disorders.The physical and psychological effects of COVID-19 on the elderly should be considered.

Relationship between arterial stiffness and cognitive function in outpatients with dementia and mild cognitive impairment compared with community residents without dementia.

BACKGROUND: It is unclear whether the dementia patients with Alzheimer's disease (AD) and vascular dementia (VaD) and mixed dementia (MIX, including AD and VaD) would have more developed arterial stiffness as compared with local residents without dementia. The aim of this study was to assess arterial stiffness and cognitive function in different types of dementia patients [AD, VaD, MIX and mild cognitive impairment (MCI)] and community residents without dementia. METHODS: This was a single-center, cross-sectional observational study. We studied a cohort of 600 elderly outpatients with a complaint of memory loss, who were divided into four groups (AD, VaD, MIX and MCI). In addition, they were compared with 55 age-matched local residents without dementia (Controls). We assessed arterial stiffness by brachial-ankle pulse wave velocity (baPWV) and the global cognitive function by the Mini-Mental State Examination (MMSE). RESULTS: The baPWV was higher in AD, VaD and MIX than in MCI and in Controls (P < 0.05). The baPWV was higher in MCI than in Controls (P = 0.021), while MMSE were compatible between them (P = 0.119). The higher baPWV predicted the presence of AD, VaD, MIX and MCI with the odds ratio of 6.46, 8.74, 6.16 and 6.19, respectively. In contrast, there were no difference in baPWV among three different types of dementia (P = 0.191). The linear relationship between baPWV and MMSE was observed in the elderly with MMSE ≥ 23 (R = 0.452, P = 0.033), while it was not in dementia patients (MMSE < 23). CONCLUSIONS: The findings suggest that MCI and dementia patients have stiffer arteries as compared with age-matched local residents, although global cognitive function may be comparable between MCI and the local residents.

[Changes in first-time patients in an outpatient memory clinic -The impact of the declaration of a state of emergency].

AIM: With the spread of the new coronavirus infection (COVID-19) and the resulting declaration of a state of emergency, many medical institutions refrained from providing medical care, and patients themselves refrained from visiting hospitals. We also stopped accepting new patients to our outpatient memory loss clinic. We examined whether or not there was any change in the patients who visited our clinic after the state of emergency was lifted. METHODS: A total of 517 first-time patients ≥65 years old who visited the Center for Comprehensive Care on Memory Disorders at Kyorin University Hospital from July 2019 to June 2021 were included in the study. Patients were grouped by quarter, and their physical characteristics, frailty, and Comprehensive Geriatric Assessment (CGA) findings were compared. RESULTS: Patients who were first seen in July-September 2020 (Q3) had a higher number of medications and greater proportion of frailty than those who were first-time patients in other periods. Regarding the sub-indices, weight loss (48.6%) and the percentage of those complaining of fatigue (37.5%) were significantly higher in Q3 than in other periods. Regarding the CGA findings, the Vitality Index was significantly lower, and among the sub-items, appetite and motivation for activity were lower in Q3 than in other periods. CONCLUSIONS: First-time outpatients at the outpatient memory clinic in Q3 of 2020 had a higher rate of frailty and lower motivation than first-time patients at other times.The spread of COVID-19 infection and behavioral restrictions due to the declaration of a state of emergency may have contributed to the progression of frailty among outpatients with memory loss.

Clinical characteristics of older adults with hypertension and unrecognized cognitive impairment.

To treat older patients with hypertension, it is important to detect cognitive impairment at an early stage because of its potential influence on treatment efficacy and functional prognosis. In this study, we aimed to identify the incidence and determinants of cognitive impairment in hypertensive patients aged 65 years and above who visited our outpatient clinic and were not previously diagnosed with cognitive impairment. Among 312 patients with hypertension, we found that 35% (n = 109) and 7.7% (n = 24) had cognitive impairment and dementia, respectively, as defined by the Mini-Mental State Examination (≤27 or ≤23, respectively). Patients with cognitive impairment were older, had lower levels of education, and had lower instrumental activities of daily living (IADL) scores than those without cognitive impairment. Multiple regression analysis revealed that age and IADL were associated with cognitive impairment in patients with hypertension. Regarding the treatment of hypertension, the office and home blood pressure levels, number of antihypertensive medications prescribed, and proportion of the use of each antihypertensive drug was equivalent between patients with and without cognitive impairment. Finally, patients with unrecognized cognitive impairment showed distinct clinical characteristics, including high antihypertensive medication burden and preserved IADL, when compared to hypertensive patients in the different cohorts of definitive mild cognitive impairment of a similar age. These findings suggest that older hypertensive patients are at a high risk of masked cognitive decline, even if they are functionally independent.

Relationship between cerebral blood flow estimated by transcranial Doppler ultrasound and single-photon emission computed tomography in elderly people with dementia.

Transcranial Doppler (TCD) ultrasonography is a noninvasive technique allowing continuous recording of cerebral blood flow (CBF) velocity. However, it is unclear whether the CBF estimated by TCD would be reliable for the comparison between individuals. The present study aimed to clarify the relationship between middle cerebral artery blood flow (MCA BF) measured by TCD and regional and total CBF measured by single-photon emission computed tomography (SPECT-CBF) with a quantification software program, a three-dimensional stereotaxic region of interest template. We recruited 91 elderly subjects with and without dementia. MCA blood flow velocity (MCA V) and middle cerebral artery cross-sectional area (AM) were measured by TCD and magnetic resonance angiography, respectively. MCA BF was calculated by the product of MCA V and AM. Diastolic or mean MCA V and MCA BF were significantly correlated with SPECT-CBF in several segments. Interestingly, the correlation coefficient in the temporal segment of SPECT-CBF was higher than those of the other segments. Moreover, correlations between MCA BF and SPECT-CBF were stronger as compared with those between MCA V and SPECT-CBF. These findings suggest that both mean MCA V and MCA BF with TCD ultrasonography would be useful for CBF comparison between individuals especially in the temporal region, although estimated blood flow with arterial area seems to be better than using simple flow velocity. NEW & NOTEWORTHY Correlations between middle cerebral artery blood flow (MCA BF) calculated by the product of MCA blood flow velocity (MCA V) and middle cerebral artery cross-sectional area and regional and total cerebral blood flow (CBF) measured by single-photon emission computed tomography (SPECT-CBF) were stronger as compared with those between MCA V and SPECT-CBF. These findings suggest that both mean MCA V and MCA BF would be useful for CBF comparison between individuals although estimated blood flow with arterial area seems to be better than using simple flow velocity.

Effects of golf training on cognition in older adults: a randomised controlled trial.

BACKGROUND: Although research indicates that a physically active lifestyle has the potential to prevent cognitive decline and dementia, the optimal type of physical activity/exercise remains unclear. The present study aimed to determine the cognitive benefits of a golf-training programme in community-dwelling older adults. METHODS: We conducted a randomised controlled trial between August 2016 and June 2017 at a general golf course. Participants included 106 Japanese adults aged 65 and older. Participants were randomly assigned to either a 24-week (90-120 min sessions/week) golf-training group or a health education control group. Postintervention changes in Mini-mental State Examination (MMSE) and National Centre for Geriatrics and Gerontology-Functional Assessment Tool scores were regarded as primary outcome measures. Secondary outcome measures included changes in physical performance and Geriatric Depression Scale (GDS) scores. RESULTS: A total of 100 participants (golf training, n=53; control, n=47) completed the assessments after the 24-week intervention period. The adherence to the golf programme was 96.2% (51/53 participants). Analysis using linear mixed models revealed that the golf training group exhibited significantly greater improvements in immediate logical memory (p=0.033), delayed logical memory (p=0.009) and composite logical memory (p=0.013) scores than the control group. However, no significant changes in MMSE, word memory, Trail Making Test or Symbol Digital Substitution Test scores were observed. In addition, no significant changes in grip strength, walking speed or GDS were observed. CONCLUSIONS: Golf-based exercise interventions may improve logical memory in older adults, but no significant changes in other cognitive tests. Further follow-up investigations are required to determine whether the observed effects are associated with delayed onset of mild cognitive impairment or Alzheimer's disease in older adults. TRIAL REGISTRATION NUMBER: UMIN-CTR UMIN000024797; Pre-results.

Relationship between the severity of cerebral white matter hyperintensities and sympathetic nervous activity in older adults.

AIM: White matter hyperintensities (WMH), visualized on brain magnetic resonance imaging, represent an abnormality related to the development of geriatric syndromes. Recently, it has been found that low sympathetic nervous activity might be associated with physical and cognitive dysfunction in older adults. Therefore, we investigated the relationship between the severity of cerebral WMH and sympathetic nervous activity, measured by the heart rate variability. METHODS: We carried out a cross-sectional study of 39 older patients. Holter recording was carried out for 30 min. From the RR intervals on the electrocardiogram, the standard deviation of the normal-to-normal intervals, the standard deviation of all normal-to-normal intervals in all the five segments of the entire recording, low frequency (LF), high frequency (HF) and LF/HF were calculated. In regard to the WMH, periventricular hyperintensities and deep white matter hyperintensities (DWMH) were rated according to the Fazekas classification. The WMH were also rated semiquantitatively according to the methods developed by Junque (periventricular hyperintensities) and de Groot (DWMH). RESULTS: The LF/HF showed significant negative correlations with the total and regional periventricular hyperintensities, as well as DWMH. Multiple regression analysis showed that the negative associations remained significant between the LF/HF and DWMH (total, temporal, occipital). Furthermore, fall risk index significantly correlated with the LF/HF, total and the occipital DWMH. CONCLUSIONS: The severity of the DWMH was associated with the LF/HF and the fall risk, one of the important geriatric syndromes, suggesting that WMH, sympathetic nervous dysfunction and geriatric syndrome are interrelated to each other. Geriatr Gerontol Int 2018; 18: 569-575.

Sarcopenia and its relationship with falling among outpatients attending a geriatric and memory clinic at Kyorin University Hospital.

AIM: The aim of the present study was to investigate the prevalence of sarcopenia in outpatients attending a geriatric and memory clinic and to investigate its relationship with falling. METHODS: We investigated the prevalence of sarcopenia (according to the EWGSOP criteria) among 283 outpatients that were all ≥65 years of age, and who attended the geriatric and memory clinic at Kyorin University Hospital. We also examined comorbidities, CGA items, and fall-related measures, and analyzed the relationships between these factors and sarcopenia. RESULTS: Seventy men (60.9%) and 88 women (52.4%) were diagnosed with sarcopenia. The sarcopenic men were older, had lower BMI values, and had a higher prevalence of dementia. The sarcopenic women had lower BMI values, and a higher prevalence of dyslipidemia. ASMI was not associated with walking speed or fall-related measures, whereas grip strength and walking speed were associated with each other and both were associated with fall-related measures. Ninety-one patients (32.2%) experienced a fall in the previous year. The prevalence of sarcopenia and ASMI among fallers and non-fallers did not differ to a statistically significant extent, whereas the fallers had lower grip strength and walking speed. A multiple logistic regression analysis revealed that weak grip strength in men and slow walking speed and the presence of diabetes in women were significant risk factors for falling. CONCLUSIONS: The frequency of sarcopenia in outpatients attending the geriatric and memory clinic was higher than that in the community-dwelling elderly individuals. Falls were more related to the patients' muscle strength and walking speed than their muscle mass or the presence of sarcopenia itself.

Antioxidant activities of a peptide derived from chicken dark meat.

Antioxidant activities against hypochlorite ions and peroxyl radicals of a chicken dark meat hydrolysate digested with pepsin were examined with the myoglobin method based on the structure change of myoglobin due to redox reaction with reactive oxygen species (ROS). A peptide that showed strong antioxidant activity against the peroxyl radical was isolated from the hydrolysate using HPLC equipped with a hydrophobic-interacting column. The sequence of the first five amino acid residues of the peptide was determined as YASGR (Tyr-Ala-Ser-Gly-Arg), and this sequence matched with the amino acid residues 143-147 of chicken ß-actin (GenBank: CAA25004.1). The synthetic peptide YASGR showed very high antioxidant activity against the peroxyl radical. Antioxidant activities of the free amino acids, confirmed that the tyrosine residue of this peptide was possibly responsible for antioxidant activity.

[The characteristics of a comprehensive geriatric assessment in patients with mild cognitive impairment with a cerebral white matter lesion].

AIM: Vascular dementia may be referred to as "treatable dementia" because its development and progress can be inhibited by intervention in the early stage. In particular, cerebral white matter lesions are readily encountered the clinical setting. In this study, we aimed to clarify the phenomenon and symptoms of patients with mild cognitive impairment (MCI) with cerebral white matter lesions prior to the onset of dementia. METHODS: The subjects included 181 cases diagnosed with MCI among 643 consecutive new patients of the Center for Comprehensive Care on Memory Disorder at Kyorin University Hospital from January 1, 2013 to January 31, 2014. Patients with particular diseases were excluded. An interview, physical examination, comprehensive geriatric assessment, brain MRI and SPECT were performed for all subjects. The cerebral white matter lesions were evaluated using the modified Fazekas scale. We defined Grades 0 and 1 as the group without apparent cerebral white matter lesions and Grades 2 and 3 as the group with apparent cerebral white matter lesions. We compared the laboratory findings and outcomes of these two groups. RESULTS: The age of the group with apparent cerebral white matter lesions was significantly higher than the group without apparent cerebral white matter lesions (P<0.05). No significant difference was observed regarding gender, MMSE, or "vegetable" term retrieval. A significant difference was observed in the total score and the subordinate component of the 21-item fall risk index and geriatric depression scale between the groups (P<0.05). Additionally, a significant difference was observed regarding the subordinate component of the instrumental ADL, the Dementia Behavior Disturbance Scale and the Zarit Care Burden Scale between the groups (P<0.05). CONCLUSIONS: Our results suggest that the presence of white matter lesions at the stage of MCI has a significant relationship to care burden due to the deterioration of ADL, risk of falling, and the presence of depression and behavior disorders. We speculate that our results are useful for the explanation of the characteristics of MCI with white matter lesion to the patients and the care givers. Furthermore, these results may lead to improvements in the appropriate approach, intervention and appropriate nursing of such patients.

Correlation between the serum eicosapentanoic acid-to-arachidonic acid ratio and the severity of cerebral white matter hyperintensities in older adults with memory disorder.

AIM: The relationships of n-3 polyunsaturated fatty acids, such as docosahexaenoic acid and eicosapentaenoic acid (EPA), to stroke and cardiovascular events have been studied extensively. The present study was undertaken to analyze the relationships of the severity of cerebral white matter hyperintensities (WMH) to the blood polyunsaturated fatty acids level and the ratio of serum EPA level to the serum arachidonic acid (AA) level (EPA/AA ratio) among older adults. METHODS: A total of 150 patients underwent diagnostic magnetic resonance imaging and blood sampling under the fasting state. In regard to WMH, the periventricular hyperintensities and deep white matter hyperintensities were rated according to the Fazekas classification. The serum docosahexaenoic acid, EPA, AA, dihomo-γ-linolenic acid and EPA/AA ratio were compared in relation to the grade of severity of WMH. Furthermore, multiple regression analysis was carried out with age, sex and atherosclerosis risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking status) as the covariables, serum polyunsaturated fatty acids level as an independent variable and Fazekas grade as the dependent variable. RESULTS: A rise of the periventricular hyperintensities grade was associated with a significant reduction of the mean EPA level (P < 0.05) and EPA/AA ratio (P < 0.05). The multiple regression analysis identified a significant negative correlation between the periventricular hyperintensities grade and the serum EPA/AA ratio (ß = -0.215, P < 0.05). CONCLUSION: These results suggest that the serum EPA/AA ratio have an important role in the formation and progression of WMH.

The first case of human protothecosis caused by Prototheca zopfii in Japan.

This report describes a fatal case Prototheca zopfii genotype 2 infection in an immunosuppressed patient. The patient was a 62-year-old housewife who presented general malaise in April 2011. Hairy cell leukemia was highly suspected. Chemotherapy was started because the patient developed severe pancytopenia in October 2011. Itraconazole capsules (100 mg/day) and trimethoprim (320 mg/day) plus sulfamethoxazole (1600 mg/day) combinations were orally administered for prophylaxis of fungal infections. Of BacT/ALERT 3D FA aerobic culture bottles and FN anaerobic culture bottles, only FA aerobic blood culture bottles produced positive reactions when the patient developed fever in January 2012. Gram-staining of blood culture bottles revealed Gram-negative elliptical sporangia. Culturing on Sabouraud dextrose agar produced smooth and creamy white, yeast-like colonies. Partial DNA sequences of the nuclear 18S rDNA and 28S rDNA D1/D2 domains of the isolated strain were identical to those of P. zopfii genotype 2. The MICs and minimal lethal concentrations of antifungals revealed that it was susceptible to amphotericin B and itraconazole. The patient died, at which time plasma (1 â†’ 3)-ß-D-glucan was positive (131 pg/mL).

Development and usefulness of a new questionnaire for assessing geriatric syndrome.

AIM: To assess the validity and reliability of a pre-visit questionnaire newly developed to identify geriatric conditions in older adults in an outpatient clinical setting. METHODS: A new self-administered questionnaire consisting of 17 items was distributed to 277 patients or their caregivers visiting a memory clinic. The questionnaire was designed to address common symptoms associated with an increasing age based on yes/no responses with symptom-oriented questions avoiding the use of 'jargon'. The patients also underwent comprehensive geriatric assessments (CGAs), as well as tests of the Barthel index, Lawton instrumental activities of daily living, mini-mental state examination (MMSE), geriatric depression scale and vitality index to assess construct validity in a factor analysis. The differences in the prevalence of symptoms between the patients and their caregivers were also assessed. RESULTS: The factor analysis detected eight components that included symptoms referring to gait disturbance, numbness, urinary incontinence, insomnia or body weight loss and were significantly correlated with the measurements of the CGA. Cronbach's alpha coefficient for the internal consistency of the questionnaire was 0.729. The caregivers tended to respond to the questionnaire for older patients (81.6±5.5 vs. 76±9.7 years of age for patients with caregivers as responders versus patients as responders respectively, p<0.001) and those with lower MMSE scores (19.4±5.8 vs. 24.8±4.2 points, p<0.001). A higher prevalence of falls and episodes of delusions was observed among the patients with caregivers as responders. CONCLUSIONS: These results demonstrate that the current questionnaire is a valid and reliable instrument for use in clinical practice and that obtaining collateral source information is essential for assessing significant geriatric symptoms. Such information also provides clinicians with a guide to conducting more detailed evaluations of geriatric conditions and aids in the diagnostic process in older patients with multidisciplinary complications.

Efficacy of combined use of three non-invasive atherosclerosis tests to predict vascular events in the elderly; carotid intima-media thickness, flow-mediated dilation of brachial artery and pulse wave velocity.

BACKGROUND: Intima-media thickness (IMT) of the carotid artery, flow-mediated dilation (FMD) of the brachial artery, and pulse wave velocity of the central artery (PWV) have been widely used to evaluate progression of atherosclerosis. Our previous work has revealed that IMT, FMD and PWV are related to each other, and the combination of these measurements was useful in identifying patients with atherosclerotic disease. The aim of the present study was to investigate whether combination of these measurements would predict future cardiovascular events better than each test alone. METHODS AND RESULTS: From November 2000 to March 2008, 274 consecutive elderly subjects (men/women; 114/160, mean age; 71 ± 12 years) were enrolled in this study. We measured IMT, FMD, and PWV in all of these subjects and followed them for a mean of 41 ± 28 months. During the follow-up period, vascular events occurred in 42 patients (15.3%). IMT (hazard ratio = 1.28 [95%CI, 1.09-1.50], p = 0.002 per 0.1 mm increase in mean IMT) and brachial-ankle (ba) PWV (hazard ratio = 1.06 [95%CI, 1.01-1.10], p = 0.015 per 1 m/s increase in baPWV) were independent predictors of future vascular events by Cox proportional hazard analysis, although FMD did not reach statistical significance (hazard ratio = 0.85 [95%CI, 0.72-1.01], p = 0.062 per 1% increase in %FMD). Importantly, the number of tests showing results in the worst tertile was a more powerful predictor (hazard ratio = 2.21 [95%CI, 1.42-3.43], p = 0.0004 for number of tests showing worst tertile) of future vascular events than either IMT, baPWV, or FMD alone. When both IMT and baPWV (with respective cut-off values of 0.98 mm and 19.1 m/s) were taken into consideration, the efficacy increased as compared with each test alone (odds ratio 4.9). CONCLUSION: These results indicate that IMT and baPWV, especially when combined, are useful in predicting future vascular events in elderly subjects.

Relationship between interleukin-6 and cerebral deep white matter and periventricular hyperintensity in elderly women.

AIM: We evaluated the relationships between serum levels of high-sensitivity C-reactive protein (hsCRP) and interleukin (IL)-6 with the severity of leukoaraiosis. METHODS: One hundred and thirty-seven elderly women who attended the Center for Comprehensive Care on Memory Disorders at Kyorin University Hospital were enrolled in this study. Leukoaraiosis was assessed by periventricular hyperintensity (PVH) score and deep white matter hyperintensity (DWMH) score. RESULTS: Serum log IL-6 level correlated with PVH and DWMH scores, but hsCRP did not. By multinomial logistic analysis, IL-6 was significantly related to DWMH score, independent of age and systolic blood pressure. CONCLUSION: IL-6 is presumably an important marker of leukoaraiosis, as is the case with silent cerebral infarction.

White matter lesions as a feature of cognitive impairment, low vitality and other symptoms of geriatric syndrome in the elderly.

AIM: White matter lesions (WML) are common findings on magnetic resonance imaging (MRI) in elderly persons. In this study, we analyzed the relation of WML with global cognitive function, depression, vitality/volition, and 19 symptoms of geriatric syndrome in Japanese elderly patients who attended three university geriatric outpatient clinics. METHODS: Two hundred and eighty-six subjects (103 men and 183 women; mean +/- standard deviation age, 74.5 +/- 7.8 years) were included in this study. MRI scans were performed for the diagnosis of WML, and the severity of periventricular and deep white matter hyperintensities (PVH and DWMH) was rated semiquantitatively. Concurrently, all subjects underwent tests of cognitive function, depressive state and vitality, and were examined for 19 symptoms of geriatric syndrome. RESULTS: The study subjects showed cognitive decline, depression and low vitality, all to a mild extent. Univariate linear regression analysis showed a negative correlation between the severity of WML and cognitive function or vitality. Multiple logistic analysis revealed that the severity of WML was a significant determinant of cognitive impairment and low vitality, after adjustment for confounding factors such as age, sex and concomitant diseases. PVH and/or DWMH score was significantly greater in subjects who exhibited 13 out of 19 symptoms of geriatric syndrome. Logistic regression analysis indicated that WML were associated with psychological disorders, gait disturbance, urinary problems and parkinsonism. CONCLUSION: WML were associated with various symptoms of functional decline in older persons. Evaluating WML in relation to functional decline would be important for preventing disability in elderly people.