Exploring the association between number of teeth, food intake, and cognitive function: A 9-year longitudinal study.

OBJECTIVES: This study aimed to investigate the association between the number of teeth, food intake, and cognitive function in Japanese community-dwelling older adults. METHODS: This 9-year longitudinal study included a total of 293 analyzable participants who participated in baseline and follow-up surveys. Dental status (number of teeth and periodontal pocket depth), dietary assessment using the brief-type self-administered diet history questionnaire, cognitive function, and the following confounding factors were evaluated: educational level, financial satisfaction, living situation, smoking and drinking habits, history of chronic diseases, apolipoprotein E-ε4 carrier, body mass index, handgrip strength, instrumental activities of daily living, and depressive symptomatology. The Japanese version of the Montreal Cognitive Assessment was used to evaluate cognitive function. A multinomial logistic regression analysis for the intake level of each food categorized into three groups (low, moderate, high), and a generalized estimating equation (GEE) for cognitive function over nine years were performed. RESULTS: After controlling for confounding factors, the number of teeth was shown to be associated with the intake of green-yellow vegetables and meat. Furthermore, the GEE indicated that the lowest quartile of intake of green-yellow vegetables significantly associated with lower cognitive function (unstandardized regression coefficient [B] = -0.96, 95 % confidence interval [CI]: -1.72 to -0.20), and the lowest quartile of intake of meat significantly associated with lower cognitive function (B = -1.42, 95 % CI: -2.27 to -0.58). CONCLUSIONS: The intake of green and yellow vegetables and meat, which is influenced by the number of teeth, was associated with cognitive function in Japanese community-dwelling older adults. CLINICAL SIGNIFICANCE: There are few studies that have examined the association between oral health, food intake, and cognitive function. This 9-year longitudinal study suggests that it is important to maintain natural teeth to enable the functional means to consume green-yellow vegetables and meat, and thereby help maintain cognitive function.

Survival time analysis of remaining teeth following replacement of unilateral free-end missing teeth: A comparison between fixed implant-supported prostheses and removable partial dentures.

OBJECTIVES: This retrospective study aimed to investigate the differences in tooth loss rate between fixed implant-supported prostheses (FISPs) and removable partial dentures (RPDs) in cases of unilateral free-end missing teeth. MATERIALS AND METHODS: The data of 324 patients who underwent treatment with FISPs or RPDs for unilateral free-end missing teeth and satisfied the applicable criteria, were evaluated (47 in the FISPs group and 277 in the RPDs group). After propensity score (PS) matching, which was used to extract patients with similar background factors related to prosthetic selection at baseline, survival time analyses were performed with tooth loss as the endpoint. The adjusted variables were age, sex, number of restored teeth, periodontal status, and the practicing dentist's experience in years. The remaining teeth were classified into subcategories in relation to the missing molars. RESULTS: Overall, 58 patients (29 in each group) selected by PS matching were evaluated in the final analysis. The total number of lost teeth was 35 (FISPs group: n = 10; RPDs group: n = 25). The mean (±SD) period to tooth loss and the 10-year survival rates in the FISPs and RPDs groups were 51.6 (±30.1) months and 42.3 (±29.7) months, 70.5% and 16.4%, respectively. The log-rank test showed that significantly longer survival time in FISPs compared with RPDs. CONCLUSIONS: After adjustments for confounding factors using PS matching, replacing unilateral free-end missing teeth with FISPs may exhibit a lower tooth loss rate in adjacent and contralateral teeth compared to replacing with RPDs.

The relationship between changes in occlusal support and masticatory performance using 6-year longitudinal data from the SONIC study.

OBJECTIVES: Reduced occlusal support is thought to be related to a decline in masticatory performance. However, previous research in this field was based on cross-sectional studies. In this study, we conducted a 6-year longitudinal observation of older adults living in the community and examined the associations of changes in occlusal support with masticatory performance. METHODS: Of the 864 participants aged 72-74 years in the SONIC study, 488 who were followed up (median follow-up period 5.92 years) and had no missing data were included in this study. Participants were divided into three groups according to the number of occlusal support zones in the posterior area: Complete occlusion (four zones), Reduced occlusion (one to three zones), and Collapsed occlusion (no occlusal support zone). Longitudinal analysis of the relationship between occlusal support and masticatory performance was undertaken with linear mixed-effects models. RESULTS: Sex, occlusal force, number of unreplaced missing teeth, aging, and occlusal support change were significantly related to masticatory performance. Furthermore, the interaction term between change in occlusal support and aging was a significant explanatory variable for the decline in masticatory performance. The interaction was strongest in the group that changed from Complete or Reduced occlusion to Collapsed occlusion. This result indicates that the loss of occlusal support is a major factor contributing to declining masticatory performance. CONCLUSIONS: The decline of occlusal support was greatly associated with the deterioration of masticatory performance. Our results suggest that older adults need to prevent the collapse of posterior occlusal support to maintain their masticatory performance. CLINICAL SIGNIFICANCE: Occlusal support is important for preserving masticatory performance in older adults. Preventing the loss of molars and retaining occlusal support may contribute to maintaining food intake diversity and nutritional status, thereby improving quality of life. Dental professionals need to carefully examine dental status to assess the risk of occlusal collapse.

Relationship between Energy Intake and Changes in Thigh Echo Intensity during the Acute Phase of Stroke in Older Patients with Hemiplegia.

OBJECTIVE: The aim of this study was to investigate the relationship between energy intake and changes in thigh echo intensity (TEI) during the acute phase of stroke in older patients with hemiplegia. SUBJECTS AND METHODS: Older hemiplegic inpatients with stroke were enrolled in this post hoc analysis of a prospective observational study. Patients were divided into 2 groups according to energy intake during the 7 days after admission as follows: energy sufficient (ES) and energy insufficient (EIS) groups. The outcome was the rate of changes in TEI of the paralyzed and nonparalyzed sides between admission and after 4 weeks. A decrease in skeletal muscle quality is defined as an increase in intramuscular adipose tissues, which shows as an increase in echo intensity. RESULTS: The study included 44 males and 39 females (median age 81 years). The rate of change of TEI in each group was as follows: +4.5% in the ES/paralyzed group, +6.7% in the EIS/paralyzed group, -0.9% in the ES/nonparalyzed group, and +4.4% in the EIS/nonparalyzed group. The univariate analyses showed no significant difference in the rate of change in TEI between ES and EIS groups in both paralyzed side (p = 0.190) and nonparalyzed side (p = 0.183). Multivariate analysis showed that higher energy intake was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side (B = -4.115, 95% confidence interval, -7.127 to -1.103). CONCLUSIONS: Higher energy intake during 7 days after admission was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side upon admission and after 4 weeks.

The Controlling Nutritional Status score as a functional prognostic marker in patients with acute stroke: A multicenter retrospective cohort study.

OBJECTIVE: The aim of this study was to assess whether undernutrition on hospital admission, as evaluated by the Controlling Nutritional Status (CONUT) score, has an effect on the improvement in functional and cognitive activities of daily living (ADL) in adult patients with acute stroke. METHODS: We retrospectively analyzed data of patients ≥20 y of age with acute stroke between July 2015 and June 2017 in the Noto Liaison Council for Cerebral Stroke of Japan database. We divided the patients into two groups based in CONUT score on admission: high CONUT (5-12), indicating undernutrition, and low CONUT (0 -4), indicating no undernutrition. The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. RESULTS: Data for 702 patients were extracted from the database. Of the 702 patients, 47.6% were women. A significant difference was found in the motor FIM gain between the two groups. A low CONUT score on admission was independently associated with motor FIM gain (partial regression coefficient ß = -2.874; 95% confidence interval [CI], -5.470 to -0.278). In contrast, a low CONUT score on admission was not independently associated with cognitive FIM gain (ß = -0.229; 95% CI, -0.889 to 0.430). CONCLUSIONS: Undernutrition as determined by the CONUT score on admission was an independent predictor of poor motor FIM gain in adult patients with acute stroke. It was not an independent predictor for poor cognitive FIM gain.

Energy intake during the acute phase and changes in femoral muscle thickness in older hemiplegic inpatients with stroke.

OBJECTIVE: The purpose of this study was to clarify the relationship between changes in lower limb muscle mass and energy intake during the acute phase in older hemiplegic inpatients with stroke. METHODS: A prospective cohort study was performed in 157 consecutive older patients with stroke. Patients were categorized into two groups of energy sufficiency/non-sufficiency based on their daily energy intake during the first week after admission, and compared with regard to change in femur muscle thickness (ΔFMT) between admission and after the four-week period in paralysis/non-paralysis limbs. FMT was determined using B-mode ultrasound imaging with an 8-MHz transducer. RESULTS: The study included 42 men and 54 women (mean age 81 T 6 y). At one week after admission, 57 patients were classified into the energy sufficiency group, and 39 were in the energy shortage group. ΔFMT in each group: -3.7 ± 5.1 mm in the paralysis/sufficiency group, -5.2 ± 5.2 mm in the paralysis/shortage group, -1.5 ± 3.9 mm in the non-paralysis/sufficiency group and -3.9 ± 3.2 mm in the non-paralysis/shortage group. No significant difference was observed in the ΔFMT between the sufficiency group and the non-sufficiency group in the paralysis limb (P = 0.159); a significant difference was observed in the non-paralysis limb (P = 0.002). The multivariate regression analysis showed that energy sufficiency were independently associated with ΔFMT in the non-paralysis limb (unadjusted coefficient = 1.592; 95% confidence interval = 0.072 to 3.112, P = 0.040). CONCLUSIONS: Energy intake could affect ΔFMT on the non-paralysis side in older stroke inpatients.

Nurse-led cognitive-behavioral group therapy for recovery of self-esteem in patients with mental disorders: A pilot study.

AIM: To design a program targeting recovery of self-esteem in patients with mental disorders, and to clarify the changes after the program to determine its effectiveness. METHODS: This study employed a one group pre- and post design, which comprised baseline, post-intervention, and 3 month follow-up phases, and recruited 41 Japanese patients with mental disorders living in the community. The authors administered the nurse-led group cognitive-behavioral therapy program for the recovery of self-esteem, which comprised 12 sessions, to the participants. The follow-up investigations were conducted immediately and 3 months after the program. The present authors used the Rosenberg Self-Esteem Scale (RSES), Profile of Mood States (POMS), Subjective Well-Being Inventory (SUBI), and Test to Determine the Characteristics of Ideas as subjective measures and the Brief Psychiatric Rating Scale (BPRS) as an objective measure. RESULTS: After controlling for the factors of medication and use of social services, improvement was observed in all measures of evaluation. The authors identified improvement at post-intervention and follow up. The scores for the RSES, BPRS, confidence in coping, and inadequate mental mastery at post-intervention and follow up were significantly higher than those at baseline, and these beneficial effects were maintained 3 months after the program. CONCLUSION: The program may aid in recovering and maintaining self-esteem of patients suffering from mental disorders. However, it is necessary to conduct a randomized controlled clinical trial to confirm these findings.

Cognitive Behavioral Therapy in Psychiatric Nursing in Japan.

Psychiatric nurses have played a significant role in disseminating cognitive behavioral therapy (CBT) in Western countries; however, in Japan, the application, practice, efficiency, and quality control of CBT in the psychiatric nursing field are unclear. This study conducted a literature review to assess the current status of CBT practice and research in psychiatric nursing in Japan. Three English databases (MEDLINE, CINAHL, and PsycINFO) and two Japanese databases (Ichushi-Web and CiNii) were searched with predetermined keywords. Fifty-five articles met eligibility criteria: 46 case studies and 9 comparative studies. It was found that CBT took place primarily in inpatient settings and targeted schizophrenia and mood disorders. Although there were only a few comparative studies, each concluded that CBT was effective. However, CBT recipients and outcome measures were diverse, and nurses were not the only CBT practitioners in most reports. Only a few articles included the description of CBT training and supervision. This literature review clarified the current status of CBT in psychiatric nursing in Japan and identified important implications for future practice and research: performing CBT in a variety of settings and for a wide range of psychiatric disorders, conducting randomized controlled trials, and establishing pre- and postqualification training system.

Reliability and validity of the Japanese version of the 24-item Dysfunctional Attitude Scale.

BACKGROUND: The 24-item Dysfunctional Attitude Scale (DAS-24) is a short version of the Dysfunctional Attitude Scale, which is a self-report inventory for depressogenic schemata. OBJECTIVE: The object of this study was to examine the reliability and validity of the Japanese version of the DAS-24 (DAS-24-J). METHODS: Subjects consisted of non-clinical sample 1 (248 university students), non-clinical sample 2 (872 Japanese company employees) and a clinical sample (59 depressed out-patients). RESULTS: Internal consistency was satisfactory in all three samples, Cronbach's α coefficient being higher than 0.85. Test-retest reliability was satisfactory in non-clinical sample 1. The interclass correlation coefficient was 0.79 and there was no significant difference in the average score of DAS-24-J between the two points. The DAS-24-J showed satisfactory concurrent validity with the Japanese Irrational Belief Test-20 (r= 0.76); Automatic Thoughts Questionnaire - Revised total (r= 0.46), negative (r= 0.53) and positive (r=-0.41); and the Beck Depression Inventory-II (r= 0.44 for non-clinical sample, r= 0.63 for clinical sample). The clinical sample showed a significantly higher DAS-24-J score than non-clinical sample 2. According to a factor analysis combining all three samples, three factors were extracted: factor 1 (11 items) corresponded with 'achievement' in the original version, factor 2 (6 items) with 'self-control' and factor 3 (5 items) with 'dependency'. CONCLUSION: The DAS-24-J is a reliable and valid instrument to measure depressogenic schemata in Japanese.