Japan-Multimodal Intervention Trial for the Prevention of Dementia: A randomized controlled trial.

INTRODUCTION: We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild cognitive impairment (MCI). METHODS: Participants aged 65-85 years with MCI were randomized into intervention (management of vascular risk factors, exercise, nutritional counseling, and cognitive training) and control groups. The primary outcome was changes in the cognitive composite score over a period of 18 months. RESULTS: Of 531 participants, 406 completed the trial. The between-group difference in composite score changes was 0.047 (95% CI: -0.029 to 0.124). Secondary analyses indicated positive impacts of interventions on several secondary health outcomes. The interventions appeared to be particularly effective for individuals with high attendance during exercise sessions and those with the apolipoprotein E ε4 allele and elevated plasma glial fibrillary acidic protein levels. DISCUSSION: The multidomain intervention showed no efficacy in preventing cognitive decline. Further research on more efficient strategies and suitable target populations is required. HIGHLIGHTS: This trial evaluated the efficacy of multidomain intervention in individuals with MCI. The trial did not show a significant difference in preplanned cognitive outcomes. Interventions had positive effects on a wide range of secondary health outcomes. Those with adequate adherence or high risk of dementia benefited from interventions.

Effects of fear of COVID-19 on older volunteers' willingness to continue their activities: REPRINTS cohort study.

AIM: This study examined the effects of fear of COVID-19 on older volunteers' willingness to continue activities that required face-to-face interactions. METHODS: From September to November 2020, a self-administered questionnaire survey was conducted with 481 older adult volunteers. A total of 423 responses were collected; 343 had no missing items and were included in the analysis. Analysis items included willingness to continue volunteer activities, fear of COVID-19, mental and physical health, and a group of items related to factors influencing the continuation of volunteer activities. RESULTS: The structural analysis of covariance indicated that volunteer orientation, which included items considered to be factors for continuing volunteer activities, had a significant positive influence on the willingness to continue activities. Fear of COVID-19 had a significant negative effect on the latent variable mental and physical health, which consisted of a subjective sense of health, but fear of COVID-19 and physical and mental health had no significant effect on the willingness to continue volunteering. CONCLUSIONS: Our results suggest that the willingness of older adults to continue volunteer activities during the COVID-19 pandemic is influenced by their volunteer orientation and is not affected by their fear of COVID-19. Geriatr Gerontol Int 2024; 24: 370-376.

Bidirectional associations of high-level cognitive domains with hand motor function and gait speed in high-functioning older adults: A 7-year study.

BACKGROUND: Whether age-related decline in the musculoskeletal system may contribute to a decline in cognitive performance or vice versa is unclear. Understanding the direction of their associations and the extent to which upper and lower extremities similarly predict subtle changes in high-level cognitive performance will help elucidate their mechanisms, especially that of the hand dexterity. METHODS: We evaluated the bidirectional associations of motor performance and high-level cognitive domains in 165 highly cognitively and physically healthy older adults. Motor performance tests consisted of handgrip strength, hand dexterity, assessed with the Purdue Pegboard Test (PPT), and usual and maximum gait speeds. High-level cognitive measures included executive function and information processing speed. The Trail Making Test (TMT)B and the letter and category fluency tests (LFT and CFT) evaluated executive function, while the TMTA and Digit Symbol assessed processing speed. Measurements were taken at baseline and at 2-, 5- and 7-year follow-up. RESULTS: Generalized linear mixed-effect models showed that baseline hand dexterity and its trajectory predicted changes in TMTB, CFT, TMTA, and Digit Symbol over time, and vice versa. Baseline maximum gait speed was associated with LFT over time and vice versa. No associations were found for handgrip and usual gait speed. CONCLUSION: The positive bidirectional association observed both in hand dexterity and maximum gait speed with executive function performance and that of hand dexterity with processing speed over time highlights a reciprocal relationship where each factor affects the other and both factors are dependent on each other, suggesting commonality in their neural basis.

Perceptions of older adults and generativity among older citizens in Japan: a descriptive cross-sectional study.

BACKGROUND: As the population ages worldwide, including in Japan, there is a growing expectation for older adults to remain active participants in society. The act of sharing one's experiences and knowledge with younger generations through social engagement not only enriches the lives of older individuals, but also holds significant value for our society. In this study, we examined both positive and negative perceptions of older adults and investigated the correlation between these perceptions and generativity among older citizens. Additionally, we evaluated the impact of life satisfaction on these factors. METHODS: We conducted a survey of 100 older adults in Japan (mean age, 71.68 years) and utilized multiple regression analyses, using positive and negative perceptions of older adults, life satisfaction, and demographic factors as independent variables. The sub-categories of generativity-namely, generative action, concern, and accomplishment-were used as dependent variables. RESULTS: Participants who held a more positive perception of older adults demonstrated a higher level of generative actions and concerns. Additionally, participants who reported higher levels of life satisfaction also exhibited more generative actions, concerns, and accomplishments. Conversely, those who held a more negative perception of older adults were found to have higher levels of generative actions. CONCLUSION: Enhancing positive perceptions of older adults among them can boost the sub-categories of generativity. This study, which was conducted from an exploratory perspective, has several limitations, including a potential sampling bias. A more comprehensive examination of the relationship between perceptions of older adults and generativity is anticipated in future research.

Association between reasons for employment and burnout tendencies among rehabilitation technology professionals.

[Purpose] The deterioration in the psychological states of healthcare workers may impact the quality and quantity of medical care provided to patients, leading to unfavorable treatment outcomes. Thus, we aimed to investigate the relationship between reasons for employment and the mental health status of rehabilitation technology professionals in Japan. A cross-sectional survey was conducted using a questionnaire to gather relevant data. [Participants and Methods] Data from 112 rehabilitation technology professionals, including physical and occupational therapists as well as speech-language pathologists, were analyzed. Questionnaires were utilized to collect data on participant characteristics, reasons for employment, virtual competence, self-esteem, burnout levels, self-compassion responses, subjective health assessments, and feelings of isolation. [Results] Multiple regression analysis indicated that the regression coefficients of the Lubben Social Network Scale-6, the World Health Organization-five well-being index, the virtual ability scale, the self-esteem scale, and the reasons for employment scale scores were -0.168, -0.191, -0.273, -0.197, and -0.329, respectively. Additionally, structural equation modeling was used to verify the goodness-of-fit indices. The burnout scale scores exhibited a satisfactory fit with the Lubben Social Network Scale-6, the World Health Organization-five well-being index, the virtual ability scale, the self-esteem scale, and the reasons for employment, as indicated by all goodness-of-fit indices. [Conclusion] This study revealed a significant association between the reason for employment and burnout tendency, which was found to be the strongest. Therefore, it is important to know the reason for employment to ascertain burnout tendencies. Conversely, as associations were also found for several adjustment variables, it is necessary to consider not only the reasons for employment but also other factors when assessing burnout tendencies.

Evaluation of the usefulness of a paper-pencil group cognitive assessment for older adults in the community.

BACKGROUND: As the older population increases, the need for early detection of cognitive decline is also increasing. In this study, we examined whether our paper-pencil type group examination for cognitive assessment (PAPLICA) could detect the effects of years of education and aging. METHODS: PAPLICA was conducted on 829 older people. The inclusion criteria were age 60 years or older and the ability to come to the event site alone. The exclusion criteria were participants with a medical or psychiatric disorder or dementia.One examiner conducted the test on a group of approximately 10-20 people in approximately 25 min. Participants were instructed on tackling the issues projected on the projector, and their answers were recorded in a response booklet. RESULTS: An independent sample t-test was performed for years of education, and ANCOVA was performed for aging. Among the test items included in PAPLICA, the Speed I and Letter fluency tests were unable to detect the effects of aging. Furthermore, the age at which the effect of aging manifests varies depending on the test item. For instance, a decline in scores in the Speed I and Picture ECR Free recall tests was observed in the 70-74 age group; for that of Word DRT, Picture ECR cued recall, and Similarity, in the 75-79 age group; for CFT, in the 80-84 age group, and for CLOX, the decline was observed in the 85 ≤ age group. CONCLUSIONS: PAPLICA, similar to other neuropsychological tests, was able to detect the effects of years of education and aging. Future testing should be conducted on different demographics to identify the differences in patterns of cognitive decline.

Cognitive, physical, and mental profiles of older adults with misplaced self-evaluation of hearing loss.

BACKGROUND: Although inconsistency between objective and subjective hearing loss among older adults has been suggested, a systematic examination of the cognitive and physical functioning among such older adults is lacking. Our objective was to assess the cognitive, physical, and mental profiles associated with the discrepancy. METHODS: The auditory acuity of 696 community-dwelling older adults was evaluated using a pure-tone average of hearing thresholds at 1.0 and 4.0 kHz in the better-hearing ear. Participants were then stratified as follows: normal hearing ≤ 25 dB, mild loss >25 dB and ≤40 dB, and moderate loss >40 dB and ≤70 dB. Global cognition, gait speed, and depressive symptoms were also assessed. RESULTS: Among older adults, 63.5% of those with mild hearing loss and 22.2% of those with moderate hearing loss did not recognize hearing difficulties. Significantly lower cognition and gait performance were observed in those with moderate hearing loss without subjective hearing loss (i.e., overestimation of hearing acuity) than in those with subjective hearing loss. Furthermore, older adults with subjective hearing loss showed a higher tendency toward depression than those without subjective hearing loss, irrespective of objective hearing loss. CONCLUSIONS: Our results suggest that failure to recognize a high level of age-related hearing loss may be related to impaired cognition and gait performance among older adults. Subjective hearing loss may indicate a tendency toward depression.

Normative Data of the Trail Making Test Among Urban Community-Dwelling Older Adults in Japan.

Introduction: Population aging is likely to increase the number of people with dementia living in urban areas. The Trail Making Test (TMT) is widely used as a cognitive task to measure attention and executive function among older adults. Normative data from a sample of community-dwelling older adults are required to evaluate the executive function of this population. The purpose of this study was to examine the Trail Making Test completion rate and completion time among urban community-dwelling older adults in Japan. Methods: A survey was conducted at a local venue or during a home visit (n = 1,966). Cognitive tests were conducted as a part of the survey, and TMT Parts A (TMT-A) and B (TMT-B) were completed after the completion of the Japanese version of the Mini-Mental State Examination (MMSE-J). Testers recorded TMT completion status, completion time, and the number of errors observed. Results: In the TMT-A, 1,913 (99.5%) participants understood the instructions, and 1,904 (99.1%) participants completed the task within the time limit of 240 s. In the TMT-B, 1,839 (95.9%) participants understood the instructions, and 1,584 (82.6%) participants completed the task within the time limit of 300 s. The completion rate of TMT-B was 90.2 and 41.8% for participants with an MMSE-J score of >23 points and ≦23 points, respectively. Results of multiple regression analyses showed that age, education, and the MMSE-J score were associated with completion time in both TMTs. Conclusion: In both TMTs, completion time was associated with age, education, and general cognitive function. However, not all participants completed the TMT-B, and the completion rate was relatively low among participants with low MMSE-J scores. These findings may help interpret future TMT assessments.

Suicide Prevention Program with Cooperation from Senior Volunteers, Governments, and Schools: A Study of the Intervention Effects of "Educational Lessons Regarding SOS Output" Focusing on Junior High School Students.

As a suicide countermeasure for young people, implementing "SOS output education" that provides young people with opportunities and approaches to seeking support with community cooperation can be expected to reduce lifelong suicide risk. We implemented an "SOS output education" for junior high school students with cooperation from educators, government staff, and older people working as community volunteers. A total of 188 students were allocated to an intervention group and a waiting group. Outcome assessments were implemented at three points in time: before the program (Time 1), after the program (Time 2), and three months after the program (Time 3). Results showed that the number of people with worries increased in the intervention group compared with the waiting group between Time 1 and Time 2. There was also an increase in people with "reliable adults" between Time 1 and Time 3, and people with "adults who you can talk to at any time" increased between Time 2 and Time 3 in the intervention group. By implementing the SOS output education program with community cooperation, an increase was observed in the intervention group in terms of support-seeking awareness and the number of people with reliable adults and with adults who they can talk to at any time.

Electrolyzed hydrogen-rich water for oxidative stress suppression and improvement of insulin resistance: a multicenter prospective double-blind randomized control trial.

INTRODUCTION: Electrolyzed hydrogen-rich water (EHW) is known to have suppressive effects on oxidative stress (OS). However, its benefit in type 2 diabetes mellitus (T2DM) remains unclear. This study aimed to investigate the effect of EHW on T2DM. METHODS: This was a multicenter, prospective, double-blind, randomized controlled trial of 50 patients with T2DM who were assigned to the EHW or filtered water (FW) groups. The primary endpoint was changes in insulin resistance (IR) evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). OS markers such as urinary 8-hydroxy-2'-deoxyguanosine excretion (8-OHdG), plasma diacron-reactive oxygen metabolites (d-ROM), and plasma biological antioxidant potential (BAP) and other clinical data, including serum lactate concentration (lactate), were evaluated. RESULTS: There were no significant differences in the changes in HOMA-IR between the EHW and FW groups. However, lactate levels decreased significantly in the EHW group, and this decrease was significantly correlated with a reduction in HOMA-IR, fasting plasma glucose, and fasting plasma insulin level. Serum lactate level also significantly correlated to decreased insulin bolus secretion after 90 min with glucose loading in the EHW subjects with HOMA-IR > 1.73. No EHW treatment-related adverse effects were observed. CONCLUSION: There were no significant effect of EHW in the change in HOMA-IR in this study; larger-scale and longer-term study are needed to verify the effects of EHW in T2DM patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13340-021-00524-3.

Gait and Age-Related Hearing Loss Interactions on Global Cognition and Falls.

OBJECTIVES: Age-related hearing loss (ARHL) is considered a risk factor for cognitive impairment and falls. The association may be modulated by gait performance because ARHL is related to mobility decline, which strongly contributes to cognitive impairment and falls. We investigated the interactive effects of gait and ARHL on global cognition and falls among older adults. STUDY DESIGN: Retrospective cohort study. METHODS: The auditory acuity of 810 community-dwelling older adults was measured using a pure-tone average of hearing thresholds at 1,000 and 4,000 Hz in the better-hearing ear. Participants were then stratified as follows: normal hearing, ≤25 dB; mild hearing loss (HL), >25 and ≤40 dB; and moderate to severe HL, >40 dB. Gait speed was assessed as an indicator of gait performance and fall occurrence within the previous year. Global cognition was determined using the Montreal Cognitive Assessment (MoCA) test. RESULTS: A total of 320 (39.5%) and 233 (28.8%) participants had mild and moderate to severe HL, respectively. Hierarchical multiple and logistic regression analyses showed interactions between gait performance and moderate hearing loss on both global cognition and the occurrence of falls. Specifically, older adults with moderate hearing loss who walked slowly showed lower MoCA scores and a higher incidence of falls, whereas those with decent gait speed did not show such a tendency. CONCLUSION: Our results suggest that poor gait performance might modulate the effects of ARHL, leading to cognitive decline and falls. Poor cognitive performance and falls may be prevalent in older adults with ARHL, especially in those with slower gait and moderate hearing loss. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:857-863, 2022.

Effects of an unsupervised Nordic walking intervention on cognitive and physical function among older women engaging in volunteer activity.

BACKGROUND: Nordic walking (NW) has been reported as a safe and effective exercise mode. However, the effects of NW on cognitive function are unknown. This study examined the effects of an unsupervised NW intervention on cognitive and physical function among older women engaging in volunteering. METHODS: Forty-seven women aged ≥70 years were enrolled and assigned into three groups (NW (n = 16); walking (n = 19); control group (n = 12)) based on residential areas. Participants in NW and walking groups received a pedometer and recorded daily step counts. The NW group received poles and 2 h of NW instruction. Participants were encouraged to perform the exercise individually more than once a week during the 3-month intervention. As baseline and follow-up assessments, cognitive function (Montreal Cognitive Assessment [MoCA-J] and Trail Making Test), physical function (handgrip strength, walking speed, balance ability, the Timed Up and Go test, and functional capacity), and objective physical activity were evaluated. RESULTS: In the NW group, physical activity, maximal walking speed, and MoCA-J scores were improved during the intervention period. In the walking group, physical activity was increased after the intervention. Analysis of covariance showed that maximal walking speed among the NW group significantly improved compared with the walking group. Sub-group analysis of participants who exercised more than once a week showed that handgrip strength, gait speed, and MoCA-J scores were significantly improved in the NW compared with the walking group. CONCLUSION: NW intervention improved cognitive and physical function compared with simple walking among older women.

Association of age-related cognitive and obstacle avoidance performances.

An association between cognitive impairment and tripping over obstacles during locomotion in older adults has been suggested. However, owing to its memory-guided movement, whether this is more pronounced in the trailing limb is poorly known. We examined age-related changes in stepping over, focusing on trailing limb movements, and their association with cognitive performance. Age-related changes in obstacle avoidance were examined by comparing the foot kinematics of 105 older and 103 younger adults when stepping over an obstacle. The difference in the clearance between the leading and trailing limbs (Δ clearance) was calculated to determine the degree of decrement in the clearance of the trailing limb. A cognitive test battery was used to evaluate cognitive function among older adults to assess their association with Δ clearance. Older adults showed a significantly lower clearance of the trailing limb than young adults, resulting in greater Δ clearance. Significant correlations were observed between greater Δ clearance and scores on the Montreal Cognitive Assessment and immediate recall of the Wechsler Memory Scale-Revised Logical Memory test. Therefore, memory functions may contribute to the control of trailing limb movements, which can secure a safety margin to avoid stumbling over an obstacle during obstacle avoidance locomotion.

Randomized Controlled Trial of the Picture Book Reading Program on Cognitive Function in Middle-Aged People.

Background: To delay cognitive decline, it is important to engage actively in preventive activities from middle age (50-64 years of age). We have developed a cognitive intervention program using picture book reading, and demonstrated that it is effective for improving memory in older adults. However, the effect of the intervention on memory and other cognitive functions in middle-aged people has not been examined. The current study investigated the effects of the picture book reading program on cognitive function in middle-aged people. Methods: This single-blind (examiners were blinded) randomized controlled trial was conducted in Tokyo, Japan. A total of 65 participants were randomly assigned to the intervention group (IG) (n = 32), in which members attended 12 picture book reading classes held once a week, or the active control group (CG) (n = 33), in which members received lectures on health maintenance. Cognitive tests were conducted before and after the intervention. The primary outcome was memory, and the secondary outcomes were verbal function and executive function. Results: The results showed that there was no significant difference between the IG and the CG in change scores (post minus pre) for memory. On the other hand, there was a significant difference in change scores of the category fluency, which is a measure of verbal function, suggesting improvements in IG compared to CG. There were also no significant differences in executive function. Conclusions: The results indicated that our previous finding of an improvement in memory function in older adults was not found in middle-aged people. However, the findings suggest that the picture book reading program may affect lexical access ability in verbal function among middle-aged people. Because maintaining verbal function is important for daily communication, these findings suggest that this program may be a useful countermeasure for cognitive decline in middle-aged people. Clinical Trial Registration: University Hospital Medical Information Network Clinical Trial Registry, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048012, Identifier: UMIN 000042071.

Hearing loss and increased gait variability among older adults.

BACKGROUND: The influence of age-related hearing loss on slow gait has been suggested; however, whether it is associated with increased gait variability, an important predictor of fall risk, remains unclear. RESEARCH QUESTION: Is poor auditory acuity associated with increased gait variability, and does this gait change relate to accidental falls among older adults with hearing loss? METHODS: We studied 107 older adults (mean age, 76.5 years; 80.5 % women). Auditory acuity was measured using a pure tone average (PTA) of hearing thresholds for 0.5-4 kHz tones in the better-hearing ear. Hearing loss was defined as a PTA of >25 dB. Gait speed and spatiotemporal variability (i.e., stride length and time variabilities) were assessed using a 5-m electronic walkway. We also assessed the occurrence of multiple falls within the previous year. RESULTS: Fifty-two participants (48.6 %) experienced hearing loss. Multiple regression analysis adjusted for potential covariates showed that poor PTA was associated with slower gait speed and stride length variability, but not stride time variability. Among older adults with hearing loss, fall occurrence was associated with an increased stride length variability and not a slow gait or increased stride time variability. SIGNIFICANCE: The association between hearing loss and increased gait variability observed in the present study suggests that age-related hearing loss can jeopardize gait control during daily activities. This leads to increased gait variability and increased risk of accidental falls. Our results provide additional information on how age-related hearing loss increases the risk of falls.

Motor Imagery Deficits in High-Functioning Older Adults and Its Impact on Fear of Falling and Falls.

BACKGROUND: Older adults at risk of falling or who have fear of falling (FoF) present a discrepancy between "imagined" and "performed" actions. Using the gait-related motor imagery paradigm, we investigated whether prediction accuracy in motor execution is associated with the onset of FoF and with prospective falls among older adults with FoF. METHODS: A cohort of 184 community-dwelling older adults was tested for imaginary and executed Timed Up and Go (TUG) tests at a fast pace at baseline. They were first asked to imagine performing TUG and estimate the time taken to complete it (iTUG) and then to perform the actual trial (aTUG); the difference between the 2 times was calculated. Prospective falls were monitored between baseline and 2-year follow-up of FoF assessment. RESULTS: At follow-up, 27 of 85 participants without FoF at baseline (31.8%) had developed FoF. Twenty-seven of 99 participants (27.2%) with FoF at baseline experienced falls. A significantly shorter iTUG duration, when compared with aTUG, was observed in those who developed FoF or experienced multiple prospective falls, indicating overestimation of their TUG performance. The adjusted logistic regression model showed that a greater ΔTUG (ie, tendency to overestimate) at baseline was associated with an increased risk of new-onset FoF among those without FoF at baseline and multiple prospective falls among those with FoF at baseline. CONCLUSIONS: Deficits in motor imagery (ie, overestimation of physical capabilities), reflecting impairment in motor planning, could provide an additional explanation of the high risk of FoF and recurrent falls among people with FoF.

Changes in Self-estimated Step-Over Ability Among Older Adults: A 3-Year Follow-up Study.

OBJECTIVES: There is a growing body of literature examining age-related overestimation of one's own physical ability, which is a potential risk of falls in older adults, but it is unclear what leads them to overestimate. This study aimed to examine 3-year longitudinal changes in self-estimated step-over ability, along with one key risk factor: low frequency of going outdoors (FG), which is a measure of poor daily physical activity. METHOD: This cohort study included 116 community-dwelling older adults who participated in baseline and 3-year follow-up assessments. The step-over test was used to measure both the self-estimated step-over bar height (EH) and the actual bar height (AH). Low FG was defined as going outdoors either every few days or less at baseline. RESULTS: The number of participants who overestimated their step-over ability (EH > AH) significantly increased from 10.3% to 22.4% over the study period. AH was significantly lower at follow-up than at baseline in both participants with low and high FGs. Conversely, among participants with low FG, EH was significantly higher at follow-up than at baseline, resulting in increased self-estimation error toward overestimation. Regression model showed that low FG was independently associated with increased error in estimation (i.e., tendency to overestimate) at follow-up. DISCUSSION: The present study indicated that self-overestimated physical ability in older adults is not only due to decreased physical ability but also due to increased self-estimation of one's ability as a function of low FG. Active lifestyle may be critical for maintaining accurate estimations of one's own physical ability.

Association between the frequency of daily intellectual activities and cognitive domains: A cross-sectional study in older adults with complaints of forgetfulness.

OBJECTIVES: Frequent engagement in intellectual activities has been shown to reduce the risk of developing dementia. The present study sought to examine the association between the frequency of daily intellectual activities and cognitive domains in older adults with complaints of forgetfulness. METHODS: A cross-sectional study was conducted as a part of regional health examination in Tokyo from 2014 to 2016. A total of 436 participants were asked the frequency of intellectual activities in four categories: 1) reading, 2) writing, 3) using technology, and 4) watching TV and listening to the radio. The Japanese version of the Montreal Cognitive Assessment (MoCA-J) scale was used for the cognitive assessments. The relationships between MoCA-J scores and each intellectual activity were explored. RESULTS: Binominal logistic regression analysis revealed that the frequencies of reading, writing, and using technology were significantly related to the language and attention, language, and memory domains, respectively, even after adjusting for demographic characteristics. CONCLUSIONS: The results suggested that the frequency of daily intellectual activities differed depending on the activity type, and each activity was related to a specific cognitive domain.