Association between mild cognitive impairment and trajectory-based spatial parameters during timed up and go test using a laser range sensor.

BACKGROUND: The Timed Up and Go (TUG) test may be a useful tool to detect not only mobility impairment but also possible cognitive impairment. In this cross-sectional study, we used the TUG test to investigate the associations between trajectory-based spatial parameters measured by laser range sensor (LRS) and cognitive impairment in community-dwelling older adults. METHODS: The participants were 63 community-dwelling older adults (mean age, 73.0 ± 6.3 years). The trajectory-based spatial parameters during the TUG test were measured using an LRS. In each forward and backward phase, we calculated the minimum distance from the marker, the maximum distance from the x-axis (center line), the length of the trajectories, and the area of region surrounded by the trajectory of the center of gravity and the x-axis (center line). We measured mild cognitive impairment using the Mini-Mental State Examination score (26/27 was the cut-off score for defining mild cognitive impairment). RESULTS: Compared with participants with normal cognitive function, those with mild cognitive impairment exhibited the following trajectory-based spatial parameters: short minimum distance from the marker (p = 0.044), narrow area of center of gravity in the forward phase (p = 0.012), and a large forward/whole phase ratio of the area of the center of gravity (p = 0.026) during the TUG test. In multivariate logistic regression analyses, a short minimum distance from the marker (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.69-0.98), narrow area of the center of gravity in the forward phase (OR: 0.01, 95% CI: 0.00-0.36), and large forward/whole phase ratio of the area of the center of gravity (OR: 0.94, 95% CI: 0.88-0.99) were independently associated with mild cognitive impairment. CONCLUSIONS: In conclusion, our results indicate that some of the trajectory-based spatial parameters measured by LRS during the TUG test were independently associated with cognitive impairment in older adults. In particular, older adults with cognitive impairment exhibit shorter minimum distances from the marker and asymmetrical trajectories during the TUG test.

Generating linear regression model to predict motor functions by use of laser range finder during TUG.

PURPOSE: The purpose of this study was to investigate which spatial and temporal parameters of the Timed Up and Go (TUG) test are associated with motor function in elderly individuals. METHODS: This study included 99 community-dwelling women aged 72.9 ± 6.3 years. Step length, step width, single support time, variability of the aforementioned parameters, gait velocity, cadence, reaction time from starting signal to first step, and minimum distance between the foot and a marker placed to 3 in front of the chair were measured using our analysis system. The 10-m walk test, five times sit-to-stand (FTSTS) test, and one-leg standing (OLS) test were used to assess motor function. Stepwise multivariate linear regression analysis was used to determine which TUG test parameters were associated with each motor function test. Finally, we calculated a predictive model for each motor function test using each regression coefficient. RESULTS: In stepwise linear regression analysis, step length and cadence were significantly associated with the 10-m walk test, FTSTS and OLS test. Reaction time was associated with the FTSTS test, and step width was associated with the OLS test. Each predictive model showed a strong correlation with the 10-m walk test and OLS test (P < 0.01), which was not significant higher correlation than TUG test time. CONCLUSION: We showed which TUG test parameters were associated with each motor function test. Moreover, the TUG test time regarded as the lower extremity function and mobility has strong predictive ability in each motor function test.

Association between comprehensive health literacy and frailty level in community-dwelling older adults: A cross-sectional study in Japan.

AIM: The present study explored the association between comprehensive health literacy and frailty level in community-dwelling older adults in Japan. METHODS: This was a cross-sectional study. We enrolled 517 community-dwelling older adults (mean age 73.2 ± 6.3 years; 410 women). We divided the cohort into two groups, non-frail and any-frail, based on Fried Frailty Index scores. We assessed comprehensive health literacy using a 14-item health literacy scale, and classified the participants as having high or low health literacy. We carried out multivariate logistic regression analysis in which the dependent variable was the presence of non-frailty and the independent variable was the presence of high health literacy. The analysis was adjusted for age, sex, body mass index, educational history and cognitive function. RESULTS: There were 132 (25.5%) and 385 (74.5%) participants in the non-frail and any-frail groups, respectively. The analysis showed that high health literacy was independently associated with the non-frail group (odds ratio 1.64, 95% confidence interval 1.03-2.61). CONCLUSIONS: The results showed that high health literacy was associated with non-frailty. This result implies that comprehensive health literacy might play a salient role in maintaining good health status in community-dwelling older adults in Japan. Geriatr Gerontol Int 2017; 17: 804-809.

The association between plantar heel pain and running surfaces in competitive long-distance male runners.

BACKGROUND: Plantar heel pain (PHP) is a common complaint, and is most often caused by plantar fasciitis. Plantar fasciitis is reported to be associated with running surfaces, however the association between PHP and running surfaces has not previously been revealed in an epidemiological investigation. Therefore, the purpose of the current study was to examine the association between PHP and running surfaces. METHODS: This is a cross-sectional study. A total of 347 competitive long-distance male runners participated in this study. The participants completed an original questionnaire, which included items assessing demographic characteristics, training characteristics focusing on running surfaces (soft surface, hard surface and tartan), and the prevalence of PHP during the previous 12 months. A logistic regression analysis was used to identify the effect of running surfaces on PHP. RESULTS: We found that 21.9% of participants had experienced PHP during the previous 12 months. The multivariate logistic regression analysis, after adjusting for demographic and training characteristics, revealed that running on tartan was associated with PHP (odds ratio 2.82, 95% confidence interval 1.42 to 5.61; P<0.01). CONCLUSIONS: Our findings suggest that running more than 25% on tartan is associated with PHP in competitive long-distance male runners.

Children with flat feet have weaker toe grip strength than those having a normal arch.

[Purpose] This study investigated the relationship between toe grip strength and foot posture in children. [Subjects and Methods] A total of 619 children participated in this study. The foot posture of the participants was measured using a foot printer and toe grip strength was measured using a toe grip dynamometer. Children were classified into 3 groups; flatfoot, normal, and high arch, according to Staheli's arch index. The differences in demographic data and toe grip strength among each foot posture group were analyzed by analysis of variance. Additionally, toe grip strength differences were analyzed by analysis of covariance, adjusted to body mass index, age, and gender. [Results] The number of participants classified as flatfoot, normal, and high arch were 110 (17.8%), 468 (75.6%), and 41 (6.6%), respectively. The toe grip strength of flatfoot children was significantly lower than in normal children, as shown by both analysis of variance and analysis of covariance. [Conclusion] A significant difference was detected in toe grip strength between the low arch and normal foot groups. Therefore, it is suggested that training to increase toe grip strength during childhood may prevent the formation of flat feet or help in the development of arch.

Age-related decline in chest wall mobility: a cross-sectional study among community-dwelling elderly women.

CONTEXT: Chest wall mobility is strongly related to respiratory function; however, the effect of aging on chest wall mobility-and the level at which this mobility is most affected-remains unclear. OBJECTIVE: To investigate age-related differences in chest wall mobility and respiratory function among elderly women in different age groups. METHODS: This cross-sectional observational study was performed in Himeji City in Hyogo Prefecture and Ayabe City in Kyoto Prefecture in Japan. Inclusion criteria were female sex, age 65 years or older, community resident, and ability to ambulate independently, with or without an assistive device. Thoracic excursion at the axillary and xiphoid levels and at the level of the tenth rib was measured with measuring tape. Respiratory function, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), was assessed by spirometry, and FVC percent predicted (%FVC), FEV1 percent predicted (%FEV1), and FEV1/FVC were calculated. Chest wall mobility and respiratory function were compared among 4 age groups. RESULTS: Of 251 potential participants, 132 met the inclusion criteria. Participants were divided into 4 age groups: group 1, 65 to 69 years; group 2, 70 to 74 years; group 3, 75 to 79 years; and group 4, 80 years or older. Statistically significant differences were found in thoracic excursion at the axillary level between groups 1 and 4 and between groups 2 and 4 when adjusted for height and weight (F4.52, P=.01). In addition, statistically significant differences were found in the FVC and FEV1 values between groups 1 and 3 and between groups 2 and 3 (FVC: F4.97, P=.01; FEV1: F6.17, P=.01). CONCLUSION: Chest wall mobility at the axillary level and respiratory function decreased with age in community-dwelling women aged 65 years or older. Further longitudinal studies are required to clarify the effects of aging on chest wall mobility and respiratory function.

Functional Movement Screen for Predicting Running Injuries in 18- to 24-Year-Old Competitive Male Runners.

The purpose of this study was to investigate whether the functional movement screen (FMS) could predict running injuries in competitive runners. Eighty-four competitive male runners (average age = 20.0 ± 1.1 years) participated. Each subject performed the FMS, which consisted of 7 movement tests (each score range: 0-3, total score range: 0-21), during the preseason. The incidence of running injuries (time lost because of injury ≤ 4 weeks) was investigated through a follow-up survey during the 6-month season. Mann-Whitney U-tests were used to investigate which movement tests were significantly associated with running injuries. The receiver-operator characteristic (ROC) analysis was used to determine the cutoff. The mean FMS composite score was 14.1 ± 2.3. The ROC analysis determined the cutoff at 14/15 (sensitivity = 0.73, specificity = 0.54), suggesting that the composite score had a low predictability for running injuries. However, the total scores (0-6) from the deep squat (DS) and active straight leg raise (ASLR) tests (DS and ASLR), which were significant with the U-test, had relatively high predictability at the cutoff of 3/4 (sensitivity = 0.73, specificity = 0.74). Furthermore, the multivariate logistic regression analysis revealed that the DS and ASLR scores of ≤3 significantly influenced the incidence of running injuries after adjusting for subjects' characteristics (odds ratio = 9.7, 95% confidence interval = 2.1-44.4). Thus, the current study identified the DS and ASLR score as a more effective method than the composite score to screen the risk of running injuries in competitive male runners.

Factors associating with shuttle walking test results in community-dwelling elderly people.

BACKGROUND: The shuttle walking test (SWT) is a simple, widely used method for assessing endurance performance in the elderly. Despite widespread community use, its associated factors are unclear. AIMS: We aim to identify previously undefined SWT association factors in community-dwelling elderly people. METHODS: Herein, 149 healthy elderly Japanese subjects performed the SWT, and were assessed for height, weight, smoking history, 10-m walk time, Timed Up and Go (TUG) scores, handgrip strength, skeletal mass index (SMI), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), cardio-ankle vascular index, and ankle brachial index. We divided men and women into higher and lower SWT score groups, compared between-group parameters, and performed stepwise multivariate logistic regression analysis to identify factors independently associated with SWT scores. RESULTS: Age, BMI, 10-m walk time, TUG score, SMI, FVC (L; %-predicted), and FEV1 (L; %-predicted) were significantly different between SWT score groups for men, while in women, significant differences were observed in age, TUG score, handgrip strength, FVC (L; %-predicted), and FEV1 (L; %-predicted) (p < 0.05). In the multivariate logistic regression model, 10-m walk time, and FEV1 showed significant associations with SWT results in men; among women, age was the only significantly associated factor (p < 0.05). CONCLUSIONS: Results indicate that better lung function and shorter walk time independently associate with SWT results in community-dwelling men; in women, age is the only association. Our findings may offer insight when considering the focus of community exercise programs among the elderly.

Arterial Stiffness Predicts Cognitive Decline in Japanese Community-dwelling Elderly Subjects: A One-year Follow-up Study.

AIM: The purpose of this study was to determine whether arterial stiffness can be used to predict one-year changes in the cognitive function in Japanese community-dwelling elderly subjects. METHODS: A total of 103 Japanese community-dwelling elderly patients joined this study. Information regarding the age, height, weight, gender and past medical history of each participant was obtained. Additionally, arterial stiffness was determined according to the cardio-ankle vascular index (CAVI), and the cognitive function was assessed with the Mini-Mental State Examination (MMSE). One year later, we performed the MMSE in the same subjects. After dividing the cohort according to the 80th percentile of the CAVI (normal and arterial stiffness [AS] groups), we examined whether the degree of cognitive decline, as determined using the pre- and post-MMSE, was significantly different based on the severity of arterial stiffness, adjusted for age, BMI, gender and the pre-MMSE scores. RESULTS: Of the 103 subjects who participated in the pre-data collection, 74 (38 men and 36 women, 73.4±4.0 years) joined the post-data collection. We found a significant difference in the change in the post-MMSE scores between the normal and AS groups (pre-MMSE: normal group [27.4±2.1] and AS group [26.9±2.4] and post-MMSE: normal group [27.2±2.1] and AS group [25.5±2.3], F=5.95, p=0.02). For each domain of the MMSE, the changes in MMSE-attention-and-calculation (F=5.11, p=0.03) and MMSE-language (F=4.32, p=0.04) were significantly different according to an ANCOVA. CONCLUSIONS: We found that arterial stiffness predicts cognitive decline in Japanese community-dwelling elderly subjects regardless of the initial level of the global cognitive function. This finding indicates the potential use of the degree of arterial stiffness as an indicator for preventing or delaying the onset of dementia in the elderly.

The physiological characteristics of community-dwelling elderly Japanese with airflow limitation: a cross-sectional study.

BACKGROUND AND AIMS: The aim of this study was to investigate the physiological characteristics of community-dwelling elderly subjects, aged ≥65 years, with airflow limitation in the Japanese community. METHODS: Subjects were recruited through local press advertisement, and 180 individuals were enrolled. Data on age, body mass index (BMI), gender, smoking history, and past medical history were obtained, as were pulmonary function parameters, skeletal muscle mass index, and physical activity. RESULTS: The final study population comprised 161 participants from whom we obtained valid spirometry results. The mean age of this population was 73.4 ± 4.4 years, and 78 participants (48.4 %) were men. The prevalence of airflow limitation was 29.2 % (n = 47). Subjects with airflow limitation were significantly older (P = 0.01) and had poorer pulmonary function (P < 0.01), lower BMI (P < 0.01), and lower skeletal muscle mass index (P = 0.03) than healthy elderly subjects. Furthermore, skeletal muscle mass index was significantly correlated with the percentage of predicted forced vital capacity (r = 0.45, P < 0.05) and forced expiratory volume in 1 s (r = 0.50, P < 0.05) only in men with airflow limitation. CONCLUSIONS: We found that the skeletal muscle mass index was significantly reduced in community-dwelling elderly with airflow limitation, and the skeletal muscle mass index was correlated with pulmonary function only in men with airflow limitation.

Differential association of frailty with cognitive decline and sarcopenia in community-dwelling older adults.

OBJECTIVES: Frailty in older adults is a serious problem because of various adverse health outcomes in many countries with aging populations, such as Japan. The purpose of this study was to determine whether frailty and pre-frailty are associated with cognitive decline and sarcopenia in community-dwelling older adults. DESIGN: This is a cross-sectional study. SETTING: Japan. PARTICIPANTS: The participants were 273 Japanese community-dwelling older women aged 65 years and older. MEASUREMENTS: We used the frailty criteria developed by the Cardiovascular Health Study to define physical frailty. We divided the cohort into nonfrail, prefrail, and frail according to frailty scores. Cognitive decline and memory decline were defined by using the Mini-Mental State Examination and Scenery Picture Memory Test, respectively. Sarcopenia was defined according to the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia. RESULTS: In the multivariate logistic regression analysis by using non-frail participants as the reference, pre-frail elderly individuals were significantly more likely to have sarcopenia than non-frail elderly individuals [odds ratio (OR): 2.77, 95% confidence interval (CI): 1.05-9.26], but not cognitive decline or memory decline. Frail elderly individuals were significantly more likely to have cognitive decline (OR: 5.76, 95% CI: 1.20-27.6), memory decline (OR: 5.53, 95% CI: 1.64-18.7) and sarcopenia (OR: 19.1, 95% CI: 3.73-98.0) than non-frail elderly individuals. CONCLUSIONS: Sarcopenia was associated with pre-frailty and frailty, whereas cognitive decline was associated only with frailty.

Arterial stiffness determined according to the cardio-ankle vascular index(CAVI) is associated with mild cognitive decline in community-dwelling elderly subjects.

AIMS: The purpose of this study was to determine the cross-sectional relationship between the cognitive function and cardio-ankle vascular index(CAVI) in Japanese community-dwelling elderly subjects. METHODS: A total of 179 Japanese community-dwelling elderly subjects were recruited for this study. The age, height, weight, gender and past medical history(cardiovascular disease, hypertension, diabetes mellitus, hyperlipidemia) of each participant was recorded. In addition, the degree of arterial stiffness was determined according to the CAVI, while the cognitive function was assessed using the Mini-Mental State Examination(MMSE). After dividing the cohort into two groups according to the MMSE score(≤26, ＞26), we used a multiple regression analysis to assign the level of the cognitive function as a dependent variable. RESULTS: The data were statistically analyzed for the 174 participants(84 men and 90 women) who completed the data collection process without omissions. A multivariate logistic regression analysis showed that a higher weight(Odds Ratio [OR]: 1.05, 95% Confidence Interval [95% CI]: 1.00- 1.11, p=0.03), male gender(OR: 3.13, 95% CI: 1.05-9.34, p=0.04) and lower CAVI(OR: 0.68, 95% CI: 0.48-0.96, p=0.03) were significantly correlated with a higher MMSE score. We also found significant correlations between the MMSE and weight(OR: 1.11, 95% CI: 1.03-1.19, p=0.01) and CAVI(OR: 0.57, 95% CI: 0.33-0.98, p=0.04) in elderly men only using a gender-specific analysis. CONCLUSIONS: We found that the elderly subjects with a high CAVI exhibited a worse cognitive function even after adjusting for age, height, weight and gender. This finding therefore indicates the usefulness of the CAVI in the early detection of dementia.

Two common founder mutations of the fanconi anemia group G gene FANCG/XRCC9 in the Japanese population.

Fanconi anemia (FA) is a rare autosomal recessive disorder of hematopoiesis with eight complementation groups (FA-A, B, C, D1, D2, E, F and G). To date, seven of the FA genes have been identified. Although extensive analyses in Western countries revealed that the subgroup prevalence and mutational spectrum vary depending on the ethnic background, not much data is available on Asian populations. In the present study, 45 unrelated FA families in Japan were screened for FA gene mutations and 10 families with biallelic pathogenic mutations of FANCG/XRCC9, the gene for FA-G, were identified. A splice mutation IVS3+1G>C was detected in all 9 Japanese families, among whom 4 were homozygous and 5 were heterozygous. Among the heterozygotes, three carried 1066C>T in the second allele. In addition, a family homozygous for 1066C>T with Korean ethnicity was identified. Haplotype analysis by means of 9 microsatellite markers spanning the FANCG locus indicates that IVS3+1G>C and 1066C>T are in complete association with distinct ancestry haplotypes. Our data suggest that IVS3+1G>C arose in the Japanese ancestors at a relatively early time, whereas 1066C>T later on migrated from Korea. The two founder mutations with distinct origins account for most of FANCG mutant alleles in the Japanese population.

Heterogeneous activation of the Fanconi anemia pathway by patient-derived FANCA mutants.

Fanconi anemia (FA) is an autosomal recessive disorder of hematopoiesis characterized by hypersensitivity to DNA crosslinkers such as mitomycin C (MMC). There is growing evidence for a model of the FA pathway, wherein a nuclear multiprotein complex of five FA proteins (FANCA, C, E, F and G) regulates activation of FANCD2 into a monoubiquitinated form, which, collaborating with the BRCA1 machinery, affects cellular response to DNA damage. However, the role of the FA pathway in defective DNA damage response caused by various mutant forms of FA proteins has not been fully assessed. In the present study, 21 patient-derived FANCA mutants with a missense or a small in-frame deletion were expressed in FANCA-deficient fibroblasts and examined for complementation of MMC sensitivity and for reconstitution of the FA pathway: FANCA phosphorylation, interaction with FANCC, FANCF and FANCG and nuclear localization and FANCD2 monoubiquitination. The altered FANCA proteins complemented MMC sensitivity at different grades: five proteins (group I) behaved like wild-type FANCA, whereas the other proteins were either mildly (group II, n=4) or severely (group III, n=12) impaired. Group I proteins showed an apparently normal reconstitution of the FA pathway, thus they may be pathogenic by reducing endogenous expression or possibly benign polymorphisms. Reconstitution of the FA pathway by group II and III mutants closely correlated with cellular sensitivity to MMC. The different activation of the FA pathway may partly account for the phenotypic variation seen in FA patients.