Effects of L-carnitine supplementation on the quality of life in diabetic patients with muscle cramps.

Diabetic patients often suffer from muscle cramps. This study aimed to compare the quality of life (QOL) of diabetic patients with and without muscle cramps and to investigate the effect of L-carnitine supplementation in diabetic patients with muscle cramps. A total of 91 patients with diabetes were enrolled in this study: 69 patients with muscle cramps and 22 patients without muscle cramps. Muscle cramps and QOL were evaluated using the muscle cramp questionnaire and the Short Form 36 health survey version 2 (SF-36), respectively. Clinical characteristics were compared between diabetic patients with and without muscle cramps. In the prospective portion of the study, 25 diabetic patients with muscle cramps received L-carnitine supplementation (600 mg/day orally) for 4 months. The questionnaires were administered before and after supplementation. The SF-36 scores in diabetic patients with muscle cramps were lower than those in patients without muscle cramps on the subscales of physical function, role physical, bodily pain, vitality, general health, and social function. In the 25 patients with muscle cramps who received L-carnitine supplementation, the monthly frequency of muscle cramps and Wong-Baker FACES® Pain Rating Scale scores were significantly decreased. Scores on the following SF-36 subscales improved after L-carnitine supplementation: body pain, vitality, social function, and role emotional. This study demonstrated that muscle cramps decrease the QOL in patients with diabetes, and L-carnitine supplementation may improve the QOL by reducing the frequency and severity of muscle cramps in these patients.

Association between Functional Capacity Decline and Nutritional Status Based on the Nutrition Screening Initiative Checklist: A 2-Year Cohort Study of Japanese Community-Dwelling Elderly.

AIM: To assess whether nutritional status based on the Nutrition Screening Initiative Checklist is useful for predicting functional capacity decline in community-dwelling Japanese elderly. METHODS: This two-year observational cohort study included 536 community-dwelling Japanese (65 years and older at baseline) who were independent in both activities and instrumental activities of daily living. Demographic attributes, chronic illness, lifestyle-related habits, nutritional status, functional capacity, and anthropometric measurements were assessed, with decline in functional capacity used as the outcome measure. RESULTS: Subjects were classified into three groups as follows based on the Nutrition Screening Initiative Checklist: low (59.5%), moderate (23.7%), and high (16.8%) nutritional risk. Significant differences were found between nutritional status and the following four baseline variables: age, hypertension, cerebrovascular diseases, and current smoking. However, no significant differences were evident between nutritional status and sex, body mass index, diabetes, drinking habit, or exercise habit. Logistic regression analysis adjusted for age, sex, body mass index, hypertension, cerebrovascular diseases and smoking habit showed that the high nutritional risk group was significantly associated with a decline in both activities of daily living (odds ratio: 4.96; 95% confidence interval (CI): 1.59-15.50) and instrumental activities of daily living (OR: 2.58; 95% CI: 1.31-5.06) compared with the low nutritional risk group. CONCLUSIONS: Poor nutritional status based on the Nutrition Screening Initiative Checklist was associated with a decline in functional capacity over a 2-year period in community-dwelling Japanese elderly. These results suggest that the Nutrition Screening Initiative Checklist is a suitable tool for predicting functional capacity decline in community-dwelling elderly.

Decreased ß-Cell Function Is Associated with Reduced Skeletal Muscle Mass in Japanese Subjects without Diabetes.

BACKGROUND: Decreased insulin secretion has a great impact on the incidence of type 2 diabetes in Japanese subjects. It is not clear whether ß-cell function is related to muscle mass in subjects without diabetes. We investigated the relationship between ß-cell function and skeletal muscle mass in Japanese subjects without diabetes. METHODS: The study included 1098 subjects (538 men and 560 women) aged 40 to 79 years, without diabetes (fasting glucose lower than 126 mg/dL and glycosylated hemoglobin lower than 6.5%), who consulted Osaka Medical College Health Science Clinic for a medical examination. Appendicular muscle mass was measured by bioelectrical impedance analysis. Appendicular muscle mass index was calculated as appendicular muscle mass divided by height squared (kg/m2). The homeostatic model assessment of ß-cell function was used to assess ß-cell function. The homeostatic model assessment of insulin resistance was used as a measure of insulin resistance. The association between appendicular muscle mass index and clinical parameters of ß-cell function and insulin resistance was examined. RESULTS: Log-transformed homeostatic model assessment of ß-cell function and Log-transformed homeostatic model assessment of insulin resistance showed a normal distribution. In both men and women, there was a significant positive correlation between appendicular muscle mass index and clinical parameters of ß-cell function and insulin resistance. Tertile analysis, following stratification according to appendicular muscle mass index, found that low appendicular muscle mass index was significantly associated with the Log homeostatic model assessment of ß-cell function and Log-transformed homeostatic model assessment of insulin resistance. CONCLUSION: This study shows that decreased ß cell function is associated with reduced skeletal muscle mass in Japanese subjects without diabetes.

Quality of life (QOL) of the community-dwelling elderly and associated factors: a population-based study in urban areas of China.

OBJECTIVE: China has the most elderly people. Maintaining and improving the QOL of the elderly has emerged as a particularly important issue. This population-based study aimed to examine the QOL of the urban elderly and to clarify the associated factors. METHODS: A cross-sectional study was performed in Liaoning Province. The elderly people without senile dementia composed our study population and were interviewed from March to November, 2012 with questionnaires pertaining to QOL (SF-36), cognitive ability, demographic characteristics, health status, behavioral factors, and social-psychological factors. 4067 effective responses were received (effective response rate: 86.0%). After further cognitive screening, 3714 participants were included as the subjects. RESULTS: The mean scores of physical component summary (PCS) and mental component summary (MCS) were 53.7±21.5 (mean±SD) and 58.9±18.9, respectively. With adjustment for age and sex, general linear model analysis showed that, in standardized estimate (ß) sequence, PCS was significantly associated with chronic disease, taking a walk, visual ability, sleeping quality, marital status, alcohol consumption, hearing ability, smoking, neighborhood relationships, filial piety, ethnicity, and regular diet, and MCS was associated with chronic disease, sleeping quality, taking a walk, visual ability, marital status, ethnicity, filial piety, regular diet, alcohol consumption, smoking, and hearing ability. CONCLUSIONS: The community-dwelling elderly in urban areas had a low level of QOL. To improve QOL, the maintenance of health conditions was crucial. Efforts to encourage the elderly to perform feasible exercise and develop good lifestyles should be focused on. Also, children's filial duty to their parents should be enhanced.

The current situation of voluntary vaccination and the factors influencing its coverage among children in Takatsuki, Japan: focus on Hib and pneumococcal vaccines.

This study aimed to understand the current scenario of voluntary vaccination and the factors influencing its coverage among 18-month-old children of Takatsuki City, Japan. Based on 1167 parents responses, we found that voluntary vaccination coverage rates were low when compared with routine vaccination rates. The children who were not the first born of the family and who had young and poorly educated parents were less likely to receive voluntary vaccination. Japanese government-supported vaccines, such as Haemophilus influenzae type b and pneumococcal vaccine, had a higher coverage than the vaccines for which parents had to bear the entire vaccination cost. Furthermore, it was found that mass communication media and family pediatricians were effective means to disseminate voluntary vaccination-related information. We envisage that an active participation of medical professionals, easy access to vaccinations, and mass awareness programs will increase voluntary vaccination coverage in Takatsuki.

Correlation between muscle strength and muscle mass, and their association with walking speed, in community-dwelling elderly Japanese individuals.

OBJECTIVES: We aimed to assess the correlation between muscle strength and muscle mass based on sex and age, and their association with walking speed, which is a health predictor for independent living, in elderly Japanese individuals. METHODS: The participants included 318 (111 men, 207 women) community-dwelling elderly Japanese individuals aged ≥65 years. Knee extension strength was assessed as an indicator of muscle strength, and bioelectrical impedance analysis was used to measure muscle mass. The maximum walking speed of participants was recorded. All measurements were categorized based on sex and age groups as follows: young-old (age, 65-74 years) and old-old (age, ≥75 years). RESULTS: Appendicular muscle mass and knee extension strength decreased with age in both men and women. In men, knee extension strength showed significant positive correlations with leg and appendicular muscle mass in both young-old and old-old age groups. However, in women, only the old-old age group showed significant positive correlations between knee extension strength and leg and appendicular muscle mass. Muscle strength was significantly positively correlated with maximum walking speed in all groups, whereas muscle mass was not significantly correlated with maximum walking speed in men and women. CONCLUSIONS: Muscle strength was significantly correlated with muscle mass in both age groups in men. However, in women, the correlation between muscle strength and muscle mass differed according to age. This finding suggests that the relationship between muscle strength and muscle mass differs according to sex and age. Muscle strength showed significant correlation with walking speed in both men and women in both age groups. These findings suggest that it is necessary to recognize that muscle strength is different from muscle mass, and that an individualized approach to prevent decline of muscle strength and muscle mass is necessary for health promotion in elderly.

Sarcopenia and falls in community-dwelling elderly subjects in Japan: Defining sarcopenia according to criteria of the European Working Group on Sarcopenia in Older People.

This study assessed the association between sarcopenia (using the definition of the European Working Group on Sarcopenia in Older People) and fall in the past year among community-dwelling Japanese elderly. Subjects were 1110 community-dwelling Japanese aged 65 or older. We used bioelectrical impedance analysis (BIA) to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance in a baseline study. "Sarcopenia" was characterized by low muscle mass and low muscle strength or low physical performance. "Presarcopenia" was characterized only by low muscle mass. Subjects who did not have any of these deficiencies were classified as "normal." We then administered a questionnaire assessing age, sex, household status, chronic illness, lifestyle-related habits, and fall. This study showed the prevalence of fall was 16.9% and 21.3% in men and women, respectively, while that of sarcopenia was 13.4% and 14.9% in men and women, respectively. In men and women, the prevalence of sarcopenia was higher among those who had fallen. A logistic regression analysis using age, body fat, current drinker status, and physical inactivity for men, and age, body fat, smoking, and diabetes for women as covariate variables revealed that sarcopenia was significantly associated with a history of fall. The odds ratio for fall in the sarcopenia group relative to the normal group was 4.42 (95%CI 2.08-9.39) in men and 2.34 (95%CI 1.39-3.94) in women. This study revealed sarcopenia to be associated with falling in elderly Japanese. Sarcopenia prevention interventions may help prevent falls among elderly individuals.

Association between skeletal muscle mass and insulin secretion in patients with type 2 diabetes mellitus.

Recent research has indicated a relationship between skeletal muscle mass and insulin resistance in patients with type 2 diabetes mellitus (T2DM). However, no study has examined the relationship between skeletal muscle mass and insulin secretion in patients with Japanese T2DM. This study aimed to fill this research gap by investigating the relationship between skeletal muscle mass and clinical parameters of T2DM with special reference to the effect of sex or age on the relationship. We examined 138 consecutive T2DM patients who presented at a single center. Anthropomorphic measurement was conducted and skeletal muscle mass was determined by bioelectrical impedance analysis for calculating skeletal muscle index (SMI) as the ratio of appendicular muscle mass (AMM) to total body weight. Fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) were levels, and values of stimulated C-peptide immunoreactivity (CPR) were determined by glucagon stimulation testing. Statistical analysis showed that AMM was negatively correlated with age in T2DM patients, whereas SMI had no correlation with either FPG or HbA1c levels. On the other hand, SMI was found to be negatively correlated with the log-transformed stimulated CPR values in male patients <65 years (r = -0.40, p < 0.05) and in female patients <65 years (r = -0.40, p < 0.05). The results of multivariate analysis suggest a strong association between the log-transformed stimulated CPR value and SMI. These findings indicate that increased endogenous insulin secretion is associated with lower skeletal muscle mass in T2DM patients who are <65 years of age.

Handgrip strength as a predictor of higher-level competence decline among community-dwelling Japanese elderly in an urban area during a 4-year follow-up.

This 4-year observational study examined whether handgrip strength can predict functional decline in higher-level competence in a cohort of urban community-dwelling Japanese elderly. Subjects were 406 community-dwelling Japanese, 65 years or older at baseline who scored as "independent in higher-level competence" (11 and over) according to the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). Independent variables were handgrip strength and usual walking speed at baseline survey. Dependent variables were functional status in higher-level competence at 4-year follow-up. Logistic regression analysis, after adjustment for age and body mass index (BMI), revealed that handgrip strength was significantly correlated with decline of higher-level competence in both sexes. Usual walking speed was significantly correlated with decline in higher-level competence only in women. This study revealed that handgrip strength is a predictor for decline in higher-level competence in urban community-dwelling Japanese elderly men and women. Results suggest that handgrip strength may be used to screen for functional capacity decline in community-dwelling elderly.

Association of sarcopenia with functional decline in community-dwelling elderly subjects in Japan.

AIM: The present study aimed to determine the association of sarcopenia, defined by muscle mass, muscle strength and physical performance, with functional disability from a 2-year cohort study of community-dwelling elderly Japanese people. METHOD: Participants were 743 community-dwelling elderly Japanese people aged 65 years or older. We used bioelectrical impedance analysis (BIA) to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance in a baseline study. Functional disability was defined using an activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale at baseline and during follow-up examinations 2 years later. Logistic regression analysis, adjusted for age and body mass index, was used to examine the association between sarcopenia and the occurrence of functional disability. RESULTS: In the present study, 7.8% of men and 10.2% of women were classified as having sarcopenia. Among sarcopenia patients in the baseline study, 36.8% of men and 18.8% of women became dependent in ADL at 2-year follow up. From the logistic regression analysis adjusted by age and body mass index, sarcopenia was significantly associated with the occurrences of physical disability compared with normal subjects in both men and women. CONCLUSIONS: Sarcopenia, defined by muscle mass, muscle strength and physical performance, was associated with functional decline over a 2-year period in elderly Japanese. Interventions to prevent sarcopenia are very important to prevent functional decline among elderly individuals.

[Factors related to sarcopenia in community-dwelling elderly subjects in Japan].

OBJECTIVES: This study aimed at determining the factors associated with sarcopenia, defined as low muscle mass and strength and low physical performance, in community-dwelling elderly subjects in Japan. METHODS: The subjects included 1,074 elderly, community-dwelling Japanese people aged 65 years or older. We measured appendicular muscle mass (AMM) by bioelectrical impedance analysis, grip strength, and usual walking speed. A low muscle mass was defined by the AMM index (AMI, weight [kg]/height [m(2)] as >2 standard deviations below the mean AMI for normal young subjects. The lowest quartile for grip strength and usual walking speed were classified as low muscle strength and low physical performance, respectively. "Sarcopenia" was characterized by a low muscle mass, combined with either a low muscle strength or low physical performance. Subjects without low muscle mass or strength and low physical performance were classified as "normal." Subjects were classified as being "intermediate" if they were neither "sarcopenic" nor "normal." Items in the questionnaire included residential status, past medical history, admission during the past year, smoking and drinking habits, leisure-time physical activity, health status, depression, masticatory ability, and dietary variety score. RESULTS: Sarcopenia was identified in 13.7% of men and 15.5% of women. Among men, a large proportion of subjects with sarcopenia had poor masticatory ability and a low dietary variety score compared with normal or intermediate subjects. Among women, a large proportion of the subjects with sarcopenia lived alone, had poor exercise habits, considered themselves to be unhealthy, and had poor masticatory ability compared with normal or intermediate subjects. A multiple logistic regression analysis showed that age and dietary variety in men and age and masticatory ability in women were associated with sarcopenia. CONCLUSION: The present study carried out in Japan showed that sarcopenia, assessed by muscle mass, muscle strength, and physical performance, was associated with age, dietary variety score (in men), and masticatory ability (in women).

Occlusal support including that from artificial teeth as an indicator for health promotion among community-dwelling elderly in Japan.

AIM: The Eichner index (EI) is used to evaluate occlusal support. However, this index is based on existing natural tooth contact. This study aimed to establish whether a modified EI that included artificial teeth reflected individual oral condition of elderly people, and to clarify the relationship between this index and: (i) mental condition; (ii) physical condition; and (iii) physical function. METHODS: We recruited 286 people (145 men, 141 women) aged 65-79 years. They were divided into three groups by modified EI, and then underwent assessment of oral condition. After establishing that the index was clearly related to oral condition, we investigated psychological factors (satisfaction with life, self-rated health and anxiety regarding falling), indicators of walking and balance (Timed Up & Go test [TUG] and one-leg standing balance), physical condition (higher-level functional capacity [HLFC]: instrumental activities of daily living [IADL], intellectual activity and social role; continuous walking over 15 min; and frequency of outings), and health history in the previous year (history of hospital admissions and falls). RESULTS: Modified EI was a good indicator of occlusal condition. The index was significantly correlated in men with satisfaction with life, TUG test, one-leg standing balance, overall HLFC and HLFC-IADL, and in women with TUG test, one-leg standing balance and HLFC-Intellectual activity. CONCLUSION: The evaluation of occlusal support including that from artificial teeth is beneficial in the elderly as an indicator of health and oral function, in particular firm bite.

Association between sarcopenia and higher-level functional capacity in daily living in community-dwelling elderly subjects in Japan.

This study aimed to determine the association between sarcopenia, defined by muscle mass, muscle strength, and physical performance, and higher-level functional capacity in community-dwelling Japanese elderly people. Subjects were 1158 elderly, community-dwelling Japanese people aged 65 or older. We used bioelectrical impedance analysis to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance. Sarcopenia was characterized by low muscle mass, plus low muscle strength or low physical performance. Subjects without low muscle mass, low muscle strength, and low physical performance were classified as "normal." Examination of higher-level functional capacity was performed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The TMIG-IC is a 13-item questionnaire completed by the subject; it contains five questions on self-maintenance and four questions each on intellectual activity and social role. Sarcopenia was identified in 11.3% and 10.7% of men and women, respectively. The percentage of disability for instrumental activities of daily living (IADL) was 39.0% in men with sarcopenia and 30.6% in women with sarcopenia. After adjustment for age, in men, sarcopenia was significantly associated with IADL disability compared with intermediate and normal subjects. In women, sarcopenia was significantly associated with every subscale of the TMIG-IC disability compared with intermediate and normal subjects. This study revealed that sarcopenia, defined by muscle mass, muscle strength, and physical performance, had a significant association with disability in higher-level functional capacity in elderly Japanese subjects. Interventions to prevent sarcopenia may prevent higher-level functional disability among elderly people.

Association between muscle mass and disability in performing instrumental activities of daily living (IADL) in community-dwelling elderly in Japan.

This study describes the association between low muscle mass and disability in performing IADL in elderly, community-dwelling Japanese subjects. Subjects were 1268 elderly, community-dwelling Japanese aged 65 years or older. Low muscle mass was defined by appendicular muscle mass index (AMI, weight [kg]/height [m(2)]), measured by bioelectrical impedance analysis (BIA). We classified "middle" AMI as a value 1-2 standard deviation (SD) below the young normal mean of AMI and "low" as more than 2 SD below the young normal mean. Examination of IADL was performed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) questionnaire. In this study, 17.2% and 26.2% of elderly men and women, respectively, were classified as having low muscle mass. There was a significant association with age and the change from normal to middle to low muscle mass in both men and women. The prevalence of IADL disability also increased significantly as muscle mass decreased. After adjustment for age and BMI, low muscle mass was significantly associated with IADL disability in men and women. Furthermore, middle muscle mass was significantly associated with IADL disability in women. This study revealed that low muscle mass, defined as a value 2 SD below the mean of young adults, had a significant association with IADL disability in elderly Japanese. Interventions to prevent age-related losses in muscle mass may be an effective strategy to prevent IADL disability among the elderly.

[Comparison of diagnostic criteria for the metabolic syndrome among Japanese university faculty].

OBJECTIVES: Diagnostic criteria for the metabolic syndrome (Mets) in Japan have been set by the Medical Committee of the Japanese Association of Medical Sciences (Med), the National Health and Nutrition Examination Survey (Nat), specific health checkups (Ckup), and second medical examination by Worker's Accident Compensation Insurance System (Wor). The purpose of this study was to compare classification of the metabolic syndrome by different organizational criteria and to investigate underlying differences. METHODS: All faculty members of a university in Osaka, Japan, underwent mandatory health checkups in September 2008. The demographic distribution included 769 males (mean age, 49 +/- 12 years) and 415 females (mean age, 43 +/- 10 years). Using the Med, Nat, Ckup and Wor criteria, individuals were assessed for the MetS and pre-metabolic syndrome (pre-Mets), strongly suspected metabolic syndrome (S-Mets) and assumed pre-metabolic syndrome (A-pre-Mets), as well as a positive support level (PSL) and a motivational support level (MSL). All faculty members were categorized into a morbid group (Mets, S-Mets, PSL, and FB) or a pre-morbid group (pre-Mets, A-pre-Mets, and MSL) based on medical data and smoking habits. The incidence of morbid and pre-morbid individuals was compared across the four criteria and analyzed based on gender and age (under 40 and 40 or over). RESULTS: Male incidences for the morbid and pre-morbid classifications were 17% and 20% with Med, 9% and 23% with Nat, 27% and 14% with Ckup, and 1.4% and 0% with Wor. There were significant differences across criteria sets in both the morbid and pre-morbid groups, with significantly greater numbers of males than females, and higher prevalences in those aged 40 or over than in their younger counterparts. Males aged under 40 classified into the pre-morbid group comprised 18% in Med, 16% in Nat, and 13% in Ckup. CONCLUSION: The different disease incidences found between Med and Ckup data in males aged 40 or over might be attributed to varying criteria for blood glucose levels, while Wor data may be influenced by the higher level of blood pressure set as a criterion with this approach. It will be important to continuously validate currently established criteria to identify the actual prevalence of MetS in Japan. Furthermore, incorporation of waist circumference and BMI for females, and a positive approach for young males, may be critical for future developments.

[Objective assessment of walking in housebound elderly who are able to go out alone].

AIM: The aim of this study was to objectively assess the risk parameters associated with walking in housebound elderly. METHODS: The subjects were 622 community-dwelling elderly (210 men and 375 women: age 65-85) with independence in activities of daily living (ADL). We administered questionnaires pertaining to housebound factors and measured walking parameters, twice, in May 2008 and May 2009. Housebound status was defined as leaving the house no more than once a week, and non-housebound status as more than once every 2-3 days. We measured the following walking parameters: usual and maximum walking speed, timed up and go, obstacle-negotiating gait, stair-climbing, and number of daily steps. RESULTS: The overall prevalence of housebound status was 10.0% in men and 8.5% in women. No statistically significant differences were seen in the prevalence of housebound status between genders or age groups. In men, maximum walking speed, timed up and go, and daily steps were slower or less in housebound than in non-housebound subjects. In women, all walking parameters, except usual walking speed, were slower or less in housebound than in non-housebound subjects. Logistic regression analysis showed that obstacle-negotiating gait was a risk factor for men (odds ratio 2.49), and for women, all walking parameters, except walking at usual speed, were risk factors, with the highest odds ratio of 4.77 for obstacle-negotiating gait. A slower obstacle-negotiating gait was a risk factor for housebound status for both men and women. CONCLUSION: Compared with non-housebound subjects, housebound elderly with the ability to go out alone had a similar usual walking speed but a slower obstacle-negotiating gait.

[Aging changes in muscle mass of Japanese].

AIM: The purpose of this study is To examine the influence of age on muscle mass in a Japanese population for health promotion. METHODS: Subjects were 4,003 community-dwelling Japanese men and women. We employed four-frequency bioelectrical impedance analysis to estimate upper and lower limbs, trunk and whole body muscle mass. RESULTS: Men showed significantly more muscle mass in all parts of the body compared to women. There was a curvilinear relationship between age and muscle mass in both men and women. For all parts of the body, the slope of the regression line between age and muscle mass was greater in men than women. The changes in muscle mass with advancing age were different in each part of the body. In the upper limbs, there was little change with advancing age in both men and women. In the lower limbs, the decrease in muscle mass began after two decades, with the reduction in this muscle mass the greatest of all parts of the body with advancing age. In the trunk, the slope of the regression line increased from the second to the fifth decade, after which the slope decreased. CONCLUSIONS: These findings indicated that lower limb muscle mass was the first to begin to decrease and also showed the greatest decrease. For health promotion, it was seen as important to maintain muscle mass from at least middle age, with particular emphasis on the lower limbs.

Association between the Trail Making Test and physical performance in elderly Japanese.

AIM: The Trail Making Test (TMT) is used in Western countries as an indicator of executive function, but there is little information regarding its use in Japan. Our previous initial study showed that the TMT was significantly associated with mobility-related functions among elderly Japanese living in the community and in this study, we increased the number of participants to clarify that result. METHODS: The TMT, comprised of two parts (part A and part B), was administered to 493 subjects aged 65 years or older (164 men, 329 women). Our assessment used the time difference (DeltaTMT) between parts B and A, and eight physical performance indicators: four of preventive care (usual walking speed, timed Up & Go [TUG], one-leg standing balance and handgrip strength) and four movement parameters (maximum walking speed, dual-task TUG, stair climbing and obstacle-negotiating gait). RESULTS: The median DeltaTMT score was 64.01 s for men and 65.56 s for women. The DeltaTMT score increased with age, and there was no difference between sexes. Multinomial logistic regression analysis showed that a poor DeltaTMT was related to low tertiles for all physical performances. It related to the intermediate tertile of TUG and maximum walking speed, dual-task TUG, stair climbing and obstacle-negotiating gait. CONCLUSION: The TMT reflects complex walking performance, so it can be a useful synthetic indicator for health programs promoting independence in elderly Japanese.

Obstacle-negotiating gait and related physical measurement indicators for the community-dwelling elderly in Japan.

The aim of this study is to assess obstacle-negotiating gait (ONG) and explore its related physical factors. Subjects comprised 571 community-dwelling persons (195 men and 376 women) age>or=65 years and without cognitive impairment. ONG, timed up and go (TUG), and stair-climbing were measured and their relations were assessed. Walking ability (usual walking speed=UWS and daily walking steps=DWS), balance deficiency, and musculoskeletal function (handgrip strength and bone health) were examined objectively to explore ONG related physical factors. Logistic regression and general linear model analysis were performed with adjustment for age and body mass index (BMI). Time of ONG was 7.72s in men and 8.93s in women. Logistic regression analysis showed that the fast tertiles of ONG corresponding to the fast levels of TUG and stair-climbing had the highest odds ratio values. General linear model analysis showed that ONG was significantly associated with UWS and balance deficiency (no) in men, and with UWS, handgrip strength, DWS and balance deficiency (no) in women. Overall, ONG was considerably associated with falls screening tools and its determinants were also the main causes of falls. Training in ONG could be an attractive strategy for the prevention of falls among the elderly.