Reliability and Validity of the Japanese Version of the Assessment of Readiness for Mobility Transition (ARMT-J) for Japanese Elderly.

The Assessment of Readiness for Mobility Transition (ARMT) questionnaire assesses individuals' emotional and attitudinal readiness related to mobility as they age. This study aimed to examine the reliability and validity of the Japanese version of the ARMT (ARMT-J). The ARMT-J and related variables were administered to 173 patients and staff members undergoing rehabilitation at hospitals in Japan. Construct validity was first examined using confirmatory factor analysis (CFA) to confirm cross-cultural validity. For structural validity, the optimal number of factors was confirmed using a Velicer's minimum average partial test and parallel analysis, followed by exploratory factor analysis (EFA). Finally, a CFA was performed using the most appropriate model. Internal consistency, test-retest reliability, standard error of measurement (SEM), and smallest detectable change (SDC) were assessed for reliability. The CFA fit for the factor structure of the original ARMT was low. Therefore, the EFA was conducted with two to four factors. The optimal factor structure was three factors, with a Cronbach's alpha coefficient and Cohen's weighted kappa coefficient of 0.85 and 0.76, respectively. The intraclass correlation coefficient (ICC) of the test-retest was 0.93, the SEM was 0.72, and the SDC was 2.00. The model fit was good for the ARMT-J, with a three-factor structure.

Bayesian analysis of the association between effective strategies of multimodal nonpharmacological intervention and characteristics of cognitive function in nursing home residents with cognitive impairment: A cross-sectional study.

The cognitive function of nursing home (NH) residents with cognitive impairment (CI) tends to decline over time. An effective multimodal non-pharmacological intervention (MNPI) strategy is needed to improve the cognitive function of NH residents with CI.The aim of this study was to clarify the cognitive function characteristics of NH residents with CI in whom a non-pharmacological intervention (NPI) can be implemented, consisting of MNPI using a Bayesian analysis, and to incorporate suggestions to make the MNPI strategy as effective as possible.This study had a cross-sectional design. The 61 subjects were selected from the residents of 5 NHs, of whom 90.16% were female, and the mean (standard deviation) age was 87.20 ±â€Š6.90. Analyses were performed using a hierarchical Bayesian model, and the global and specific cognitive functions as assessed by the Japanese version of the Neurobehavioral Cognitive Status Examination were the response variables. Three types of NPI (cognitive enhancement NPI, physical NPI, psychological and psychosocial NPI), and activities of daily living (ADL), as assessed by the Barthel index, were the explanatory variables.Cognitive enhancement NPI was revealed to have no association with any cognitive function. Physical NPI was negatively associated with orientation [OR 0.31 (95% credible interval (95% CI) -2.33, -0.10)], comprehension [OR 0.16 (95% CI -2.78, -0.95)] and naming [OR 0.49 (95% CI -1.47, -0.02)]. Psychological and psychosocial NPI was positively associated with comprehension [OR 3.67 (95% CI 0.52, 2.13)]. Barthel index was positively associated with total Japanese version of the Neurobehavioral Cognitive Status Examination [OR 1.74 (95% CI 0.08, 2.12)], comprehension [OR 3.49 (95% CI 0.45, 4.67)], repetition [OR 10.07 (95% CI 0.53, 9.01)], naming [OR 2.24 (95% CI 0.07, 3.20)], and calculations [OR 18.82 (95% CI 2.71, 9.40)].The implementation of MNPI should be preceded by cognitive enhancement NPI and physical NPI. Providing ADL enhancing NPI in response to cognitive improvement may be an effective strategy. Providing cognitive enhancement NPI, physical NPI, psychological, and psychosocial NPI, as well as ADL-enhancing NPI at the same time, is also an effective strategy for subjects with mild dementia who are considered to have relatively high cognitive functions.

A Systematic Review of Multimodal Non-Pharmacological Interventions for Cognitive Function in Older People with Dementia in Nursing Homes.

INTRODUCTION: Multimodal non-pharmacological interventions (MNPIs) have been reported to be effective in improving the cognitive function. Therefore, it is necessary to study these interventions in older people with dementia (PWD) in nursing homes (NHs). AIMS: This study aimed to investigate the effects, contents, frequency, duration, length, and form of MNPIs on the global and specific cognitive functions of PWD in NHs through a systematic review, and to consider what kind of intervention design is most effective. METHODS: A systematic search of peer-reviewed literature published between January 2008 and October 2018 was performed on the PubMed, Cochrane Library, Web of Science and CINAHL databases. RESULTS: Six randomized controlled trials (RCTs) and one non-RCTs were extracted from electronic databases, and a review was carried out. CONCLUSION: Our review suggests that MNPIs may improve the global, executive function and memory of PWD in NHs. The combination of exercise, cognitive training and activities of daily living, and intervention at least 3 times a week over at least 8 weeks with, at least 30 min per session using the integrated form is recommended for improving the global and specific cognitive functions of PWD in NHs.

Combination Treatment of Low-Frequency Repetitive Transcranial Magnetic Stimulation and Intensive Occupational Therapy for Ataxic Hemiparesis due to Thalamic Hemorrhage.

BACKGROUND: Both low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) are clinically beneficial for post-stroke patients with upper-limb hemiparesis. However, the usefulness of LF-rTMS and intensive OT for ataxic hemiparesis (AH) is unknown. METHODS: The study subjects included 7 patients with AH. All patients had ataxia and mild hemiparesis without a sensory disturbance that was due to thalamic hemorrhage. Each patient was scheduled to receive 20-min rTMS at 1 Hz at the contralesional cerebral hemisphere followed by 120-min intensive OT, daily for 21 sessions. The primary outcome was the motor function of the affected upper limb that was evaluated by using the Fugl-Meyer Assessment (FMA). In addition, the International Cooperative Ataxia Rating Scale (ICARS) score was determined to assess the severity of ataxia. RESULTS: All patients completed the protocol without any adverse effects. The FMA score significantly increased after treatment. Notably, the ICARS score also significantly decreased. CONCLUSIONS: Our proposed combination treatment is a safe and feasible neurorehabilitative intervention for patients with AH due to thalamic hemorrhage. Our results demonstrate the possibility that rTMS in combination with intensive OT could improve motor function and alleviated ataxia in patients with AH.

Validity and reliability of the Japanese version of the FIM + FAM in patients with cerebrovascular accident.

BACKGROUND AND AIM: The study aim was to investigate the validity and reliability of the Functional Independence Measure and Functional Assessment Measure (FIM + FAM), which is unfamiliar in Japan, by using its Japanese version (FIM + FAM-j) in patients with cerebrovascular accident (CVA). MATERIAL AND METHODS: Forty-two CVA patients participated. Criterion validity was examined by correlating the full scale and subscales of FIM + FAM-j with several well-established measurements using Spearman's correlation coefficient. Reliability was evaluated by internal consistency (tested by Cronbach's alpha coefficient) and intra-rater reliability (tested by Kendall's tau correlation coefficient). RESULTS: Good-to-excellent criterion validity was found between the full scale and motor subscales of the FIM + FAM-j and the Barthel Index, National Institutes of Health Stroke Scale, modified Rankin Scale, and lower extremity Brunnstrom Recovery Stage. High internal consistency was observed within the full-scale FIM + FAM-j and the motor and cognitive subscales (Cronbach's alphas were 0.968, 0.954, and 0.948, respectively). Additionally, good intra-rater reliability was observed within the full scale and motor subscales, and excellent reliability for the cognitive subscales (taus were 0.83, 0.80, and 0.98, respectively). CONCLUSION AND SIGNIFICANCE: This study showed that the FIM + FAM-j demonstrated acceptable levels of validity and reliability when used for CVA as a measure of disability.

The effect of apheresis on adhesion molecules.

The adhesion molecules on the leukocytes and the endothelial cells mediate interaction between their cells. The plasma levels of soluble adhesion molecules increase in patients with ischemic heart disease, atherosclerotic aortic disease. Hypercholesterolemia is one of risk factors for atherosclerosis, and it is considered that the expression of adhesion molecules in endothelial cells is related to the development of atherosclerosis. Low-density lipoprotein (LDL) apheresis has been applied to patients with hypercholesterolemia. LDL apheresis may have an effect on adhesion molecules in patients with hypercholesterolemia.