Calculation of trunk muscle mass and trunk muscle quality indices for walking independence in asian patients with hip fractures.

BACKGROUND & AIMS: This study aimed to investigate the association between trunk muscle mass and muscle quality, as evaluated by bioelectrical impedance analysis (BIA), and the ability to walk independently in patients with hip fractures. Cutoff values for quantitative and qualitative indicators of the trunk muscles were also calculated. METHODS: This study included 181 patients with hip fractures who were admitted to a convalescent rehabilitation ward. Trunk muscle mass and phase angle of the participants were evaluated on admission. The phase angle in this study was defined as the trunk muscle quality index (TMQI). Patients were classified into the independent (functional independence measure [FIM]-walk score ≥6; n = 101) and non-independent (FIM-walk score ≤5; n = 80) walking groups according to the FIM mobility scores at discharge. RESULTS: The independent group had a higher FIM gain than the non-independent group (37.0 ± 13.6 vs. 27.1 ± 13.5, p < 0.001). Logistic regression analysis showed that the trunk muscle mass index (TMI) and TMQI were associated with the ability to walk independently. Furthermore, cutoff values of TMI and TMQI for male and female to estimate the ability to walk independently were 6.5 kg/m2 and 5.7 kg/m2, and 4.5° and 3.4°, respectively. CONCLUSION: TMI and TMQI are related to the ability to walk independently in patients with hip fractures. These results suggest the importance of improving trunk muscle mass and muscle quality during rehabilitation of patients with hip fractures.

Impact of increased trunk muscle mass on trunk function and activities of daily living in older individuals with cerebral infarction.

BACKGROUND & AIMS: The association between trunk muscle mass or trunk function or trunk muscle strength and activities of daily living (ADLs) has been reported, but no studies have examined the impact of increased trunk muscle mass on trunk function or ADL. This study aimed to determine whether increased trunk muscle mass is associated with trunk function and ADL in older individuals with cerebral infarction during rehabilitation. METHODS: This retrospective observational study enrolled 158 patients with cerebral infarction aged ≥65 years who were admitted for post-stroke rehabilitation. The trunk muscle mass index (TMI) was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into two groups: one with increased TMI (64 participants; 41 %) and the other without TMI increase (94 participants; 59 %). Multiple linear regression analysis was performed with functional assessment for control of trunk (FACT) or functional independence measure (FIM)-motor gain as the objective variable and increased TMI group as the explanatory variable. RESULTS: We analyzed a total of 158 patients (79.5 ± 7.8 years of age, 51.9 % men). TMI increase was independently associated with FACT gain (coefficient = 1.413, 95 % confidence interval = 0.34-2.49, P = 0.010), but not with FIM-motor gain. CONCLUSIONS: The results suggest that increased TMI is independently associated with recovery of trunk function. Further prospective studies are needed to elucidate the relationship between increased TMI and ADL.

Visualizing the translational activation of a particular mRNA in zebrafish embryos using in situ hybridization and proximity ligation assay.

Fertilized eggs initiate translation of stored mRNAs in spatially and temporally controlled manners. Here, we present a protocol for visualizing spatial and temporal translation in zebrafish embryos by fluorescence in situ hybridization and proximity ligation assay. We describe steps for labeling newly synthesized proteins and mRNA, visualizing mRNA translation and mRNA, sample mounting, and observation. Coupling detection of mRNA molecules with their translation sites is useful for understanding the molecular and cellular mechanisms that drive embryo development. For complete details on the use and execution of this protocol, please refer to Sato et al.1 and Takada et al.2.

Reduced Cross-Sectional Area of the Gluteus Medius Muscle is Associated With Decreased Activities of Daily Living in Older Adult Patients With Hip Fractures.

We investigated the association between the cross-sectional area (CSA) of the gluteus medius muscle (GMM) and activities of daily living in patients with hip fractures. This retrospective cohort study comprised 111 patients aged ≥65 years who underwent hip fracture rehabilitation. The CSA of the GMM was measured using computed tomography scans in the early stages of hospitalization. The group with decreased CSA of the GMM had a median GMI ≤17 cm2/m2 for male patients and ≤16 cm2/m2 for female patients. Patients in the group with decreased CSA of the GMM had lower functional independence measure gains than those in the control group. After adjusting for confounders, we found that decreased CSA of the GMM was significantly associated with lower functional independence measure gains (ß: -0.432, p < .001). In patients with hip fractures, decreased CSA of the GMM was associated with decreased activities of daily living.

Correlation between trunk function improvement and recovery of activities of daily living after stroke in older adult patients.

OBJECTIVES: To examine the impact of improved trunk function on activities of daily living in stroke patients using the Functional Independence Measure (FIM). METHODS: This retrospective observational study was conducted on patients aged ≥ 65 years who had cerebral infarction. Patients were divided into a group with improved trunk function and a group without trunk function improvement based on the difference between the calculated Functional Assessment for Control of Trunk (FACT) gain at discharge and admission. RESULTS: Of the 218 patients (mean age, 79.5 ± 7.9 years; 56.9% were men) included, 110 patients had improved FACT scores. Multiple linear regression analysis revealed that the group with improved FACT scores had higher FIM gain (coefficient = 7.562, 95% confidence interval = 3.870-11.253, P < 0.001). Multivariate logistic regression showed that the factors associated with FACT score improvement were the Mini Nutritional Assessment Short-Form score at admission, National Institutes of Health Stroke Scale score at admission, FACT score at admission, length of hospital stay, and period of rehabilitation. DISCUSSIONS: Improvement in trunk function suggests a positive correlation with the recovery of activities of daily living in patients with cerebral infarction. This relationship should be further validated through prospective observational studies.

Oxytocin receptor-expressing neurons in the medial preoptic area are essential for lactation, whereas those in the lateral septum are not critical for maternal behavior.

INTRODUCTION: In nurturing systems, the oxytocin (Oxt)-oxytocin receptor (Oxtr) system is important for parturition, and essential for lactation and parental behavior. Among the nerve nuclei that express Oxtr, the lateral septal nucleus (LS) and medial preoptic area (MPOA) are representative regions that control maternal behavior. METHODS: We investigated the role of Oxtr- and Oxtr-expressing neurons, located in the LS and MPOA, in regulating maternal behavior by regulating Oxtr expression in a region-specific manner using recombinant mice and adeno-associated viruses. We quantified the prolactin (Prl) concentrations in the pituitary gland and plasma when Oxtr expression in the MPOA was reduced. RESULTS: The endogenous Oxtr gene in the neurons of the LS did not seem to play an essential role in maternal behavior. Conversely, decreased Oxtr expression in the MPOA increased the frequency of pups being left outside the nest and reduced their survival rate. Deletion of Oxtr in MPOA neurons prevented elevation of Prl levels in plasma and pituitary at postpartum day 2. DISCUSSION/CONCLUSION: Oxtr-expressing neurons in the MPOA are involved in the postpartum production of Prl. We confirmed the essential functions of Oxtr-expressing neurons and the Oxtr gene itself in the MPOA for the sustainability of maternal behavior, which involved Oxtr-dependent induction of Prl.

Mature mRNA processing that deletes 3' end sequences directs translational activation and embryonic development.

Eggs accumulate thousands of translationally repressed mRNAs that are translated into proteins after fertilization to direct diverse developmental processes. However, molecular mechanisms underlying the translation of stored mRNAs after fertilization remain unclear. Here, we report a previously unknown RNA processing of 3' end sequences of mature mRNAs that activates the translation of stored mRNAs. Specifically, 9 to 72 nucleotides at the 3' ends of zebrafish pou5f3 and mouse Pou5f1 mRNAs were deleted in the early stages of development. Reporter assays illustrated the effective translation of the truncated forms of mRNAs. Moreover, promotion and inhibition of the shortening of 3' ends accelerated and attenuated Pou5f3 accumulation, respectively, resulting in defective development. Identification of proteins binding to unprocessed and/or processed mRNAs revealed that mRNA shortening acts as molecular switches. Comprehensive analysis revealed that >250 mRNAs underwent this processing. Therefore, our results provide a molecular principle that triggers the translational activation and directs development.

Relationship between Trunk Muscle Mass Index at Admission and Walking Independence in Patients with Hip Fracture.

Objectives: This study aimed to investigate the relationship between trunk muscle mass index (TMI), appendicular skeletal muscle mass index (ASMI), and walking independence in patients aged 65 years and older undergoing rehabilitation for hip fracture. Methods: This retrospective, observational study was conducted in a convalescent rehabilitation ward and included 314 patients (aged ≥65 years) with hip fracture. The patients were classified into the independence group [functional independence measure (FIM)-walk score ≥6] or the non-independence group (FIM-walk score ≤5) according to the mobility item score among the motor FIM items at the time of discharge. Age, sex, TMI, ASMI, and Mini Nutritional Assessment-Short Form (MNA-SF) data were also extracted. Between-group and multivariate analyses were performed to evaluate the factors associated with walking independence. Results: The independence group had higher TMI (males: 6.6±0.9 vs. 5.6±1.0 kg/m2, P <0.001; females: 6.1±0.8 vs. 5.7±1.0 kg/m2, P <0.001), ASMI (males: 6.7±1.1 vs. 5.9±1.3 kg/m2, P=0.004; females: 5.3±0.9 vs. 4.7±0.8 kg/m2, P <0.001), MMSE-J (21.5±4.9 vs. 16.4±4.5 points, P <0.001), and MNA-SF [median (interquartile range): 8 (6-9) vs. 7 (5-8) points, P <0.001] than the non-independence group. Multivariate analysis showed that TMI at admission was significantly associated with walking independence (odds ratio: 1.86, 95% confidence interval: 1.28-2.72, P <0.001). Conclusions: This study suggests that a higher TMI at admission was important for acquiring walking independence in patients with hip fracture and shows the importance of early evaluation of TMI during hospitalization of patients with hip fracture.

Preoperatively diagnosed intraductal oncocytic papillary neoplasm of the pancreas with prominent invasion: a case report.

Previously considered as one of the less-invasive subtypes of intraductal papillary mucinous neoplasm, intraductal oncocytic papillary neoplasm (IOPN) has recently been acknowledged as a new entity of pancreatic tumor. We herein present a case of preoperatively diagnosable IOPN invasion in the stomach and colon. A 78-year-old woman was referred to our hospital for evaluation of anorexia and gastroesophageal reflux. Upper gastrointestinal endoscopy revealed a gastric subepithelial lesion with ulcerated mucosa that required hemostasis. Computed tomography revealed a 96-mm-diameter solid tumor with a well-defined border and centrally positioned necrotic area, extending from the stomach to the transverse colon and pancreatic tail. Because it was suspected to be a pancreatic solid tumor with direct stomach invasion, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) was performed, which led to a preoperative diagnosis of IOPN. Moreover, laparoscopic pancreatosplenectomy, proximal gastrectomy, and transverse colectomy were performed. Analysis of the surgical specimen revealed that the tumor was IOPN and had invaded the stomach and transverse colon. Lymph node metastasis was also confirmed. These findings indicate that IOPN can manifest as an invasive tumor, and EUS-FNB may be equally helpful for assessing the invaded area of a cystic lesion as it is for a solid lesion.

Adrenaline-resistant anaphylactic shock caused by contrast medium in a patient after risperidone overdose: a case report.

BACKGROUND: In Japan, the use of risperidone in combination with adrenaline is contraindicated, except in cases of anaphylaxis. Therefore, there is limited clinical evidence regarding the interaction of these two drugs. Here, we report the clinical course of a case of adrenaline-resistant anaphylactic shock induced by a contrast medium injection after a risperidone overdose. CASE PRESENTATION: A man in his 30s was transported to our hospital after attempting suicide by taking 10 mg of risperidone and jumping from a height of 10 m. To determine the location and severity of his injuries, he was injected with an iodinated contrast medium, after which he developed generalized erythema and hypotension and was diagnosed with anaphylactic shock. A 0.5 mg dose of adrenaline was administered with no improvement, followed by another 0.5 mg dose that did not change his blood pressure. After infusion of a sodium bicarbonate solution (8.4%), administration of fresh frozen plasma, and additional administration of adrenaline (0.6-1.2 µg/min), his blood pressure improved, and he recovered from the anaphylactic shock. CONCLUSIONS: This was a rare case of a risperidone overdose followed by adrenaline-resistant anaphylactic shock. The resistance is likely associated with the high blood concentration of risperidone. Our findings indicate that the potential for decreased adrenergic responsiveness should be considered in patients undergoing risperidone treatment in the event of anaphylactic shock.

Unique image findings around "kissing" distal anterior cerebral artery aneurysms in addition to perianeurysmal edema: A case report.

Background: Some aneurysms cause edema formation in the surrounding brain parenchyma and are thought to reflect various phenomena occurring in the aneurysm. Some authors highlighted perianeurysmal edema (PAE) as a finding that indicates higher risk of rupture of the aneurysm. On the other hand, there are no reports of image changes in the surrounding brain parenchyma of aneurysm other than edema formation. Case Description: We describe a 63-year-old man with unique signal change in the surrounding brain parenchyma of "kissing" distal anterior cerebral artery aneurysms completely different from PAE. The large and partially thrombosed aneurysm presented well-defined signal change surrounding brain parenchyma in addition to PAE. Intraoperative findings revealed the signal change as a space of retaining serous fluid. Drain the fluid and clipping was made for the both anterior cerebral artery aneurysms. The postoperative course was uneventful and his headache was improved the day after the surgery. The perianeurysmal signal change was also disappeared immediately after the surgery except for the PAE. Conclusion: This case demonstrates a rare phenomenon of signal change around the aneurysm, and there is a possibility that the unique finding exists as an early manifestation of intracerebral hematoma associated with aneurysm rupture.

Intraductal oncocytic papillary neoplasm of the pancreas: clinical and radiological features compared to those of intraductal papillary mucinous neoplasm.

PURPOSE: This study aimed to characterize the clinical and imaging findings of intraductal oncocytic papillary neoplasm of the pancreas (IOPN-P) compared to those of intraductal papillary mucinous adenoma/carcinoma (IPMA/IPMC). METHODS: This multi-institutional retrospective study reviewed the clinical, imaging, and pathological findings of 21 patients with pathologically proven IOPN-P. Twenty-one computed tomography (CT) and magnetic resonance imaging, and seven 18F-fluorodeoxyglucose (FDG)-positron emission tomography were performed before surgery. The following findings were evaluated: preoperative blood test results, lesion size and location, pancreatic duct diameter, contrast-enhancement effect, bile duct and peripancreatic invasion, maximum standardized uptake (SUVmax) value, and pathological stromal invasion. RESULTS: Serum carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) levels were significantly higher in the IPMN/IPMC group than in the IOPN-P group. Except in one patient, IOPN-P showed multifocal cystic lesions with solid components or a tumor in the main pancreatic duct (MPD) with dilatation. IOPN-P had a higher frequency of solid parts and a lower frequency of downstream MPD dilatation than IPMA. IPMC showed smaller overall cyst size, more radiological peripancreatic invasion, and worse recurrence-free and overall survival than IOPN-P. The average SUVmax value of IOPN-P was 7.5. Pathologically, 17 of the 21 IOPN-Ps had a malignant component, and six showed stromal invasion. CONCLUSION: IOPN-P shows cystic-solid lesions similar to IPMC but has lower serum CEA and CA19-9 levels, larger overall cyst size, lower frequency of peripancreatic invasion, and more favorable prognosis than IPMC. Moreover, the high FDG uptake by IOPN-Ps may be a characteristic finding of this study.

Determination of a Low Skeletal Muscle Mass Index Using the Mass of the Gluteus Medius in Older Patients With Hip Fractures.

This study evaluated the relationship between the muscle mass of the gluteus medius (GM) and skeletal muscle mass index (SMI) measured in patients with hip fractures. In this study, 141 patients with hip fractures were divided into those with high or low SMI. The GM index (GMI) was calculated by dividing the GM by the square of the height in meters. The correlation between GMI and SMI was subsequently analyzed, and cutoff values for determining the loss of skeletal muscle mass were calculated using the receiver operating characteristic curve. GMI and SMI showed a positive correlation for both sexes (male: r = .890, female: r = .626, p < .001). The GMI cutoff values were 19.460 cm2/m2 for males and 17.850 cm2/m2 for females. Skeletal muscle mass evaluation of the GM could contribute to hip fracture recovery by improving mobility and facilitating the early diagnosis of loss of SMM.

Signature of spin-triplet exciton condensations in LaCoO3 at ultrahigh magnetic fields up to 600 T.

Bose-Einstein condensation of electron-hole pairs, exciton condensation, has been effortfully investigated since predicted 60 years ago. Irrefutable evidence has still been lacking due to experimental difficulties in verifying the condensation of the charge neutral and non-magnetic spin-singlet excitons. Whilst, condensation of spin-triplet excitons is a promising frontier because spin supercurrent and spin-Seebeck effects will be observable. A canonical cobaltite LaCoO3 under very high magnetic fields is a propitious candidate, yet to be verified. Here, we unveil the exotic phase diagram of LaCoO3 up to 600 T generated using the electromagnetic flux compression method and the state-of-the-art magnetostriction gauge. We found the continuous magnetostriction curves and a bending structure, which suggest the emergence of two distinct spin-triplet exciton condensates. By constructing a phenomenological model, we showed that quantum fluctuations of excitons are crucial for the field-induced successive transitions. The spin-triplet exciton condensation in a cobaltite, which is three-dimensional and thermally equilibrated, opens up a novel venue for spintronics technologies with spin-supercurrent such as a spin Josephson junction.

Nationwide analysis of antimicrobial resistance in pathogenic Escherichia coli strains isolated from diseased swine over 29 years in Japan.

Pathogenic Escherichia coli strains are important causes of several swine diseases that result in significant economic losses worldwide. In Japan, the use of antimicrobials in swine is much higher than that in other farm animals every year. Antimicrobial resistance in pathogenic E. coli strains also heavily impacts the swine industry due to the limited treatment options and an increase in the potential risk of the One Health crisis. In 2016, we investigated 684 Japanese isolates of swine pathogenic E. coli belonging to four major serogroups and reported the emergence and increase in the highly multidrug-resistant serogroups O116 and OSB9 and the appearance of colistin-resistant strains. In the present study, by expanding our previous analysis, we determined the serotypes and antimicrobial resistance of 1,708 E. coli strains isolated from diseased swine between 1991 and 2019 in Japan and found recent increases in the prevalences of multidrug-resistant strains and minor serogroup strains. Among the antimicrobials examined in this study that have been approved for animal use, a third-generation cephalosporin was found to be effective against the most isolates (resistance rate: 1.2%) but not against highly multidrug-resistant strains. We also analyzed the susceptibilities of the 1,708 isolates to apramycin and bicozamycin, both which are available for treating swine in Japan, and found that the rates of resistance to apramycin and bicozamycin were low (6.7% and 5.8%, respectively), and both antimicrobials are more effective (resistance rates: 2.7% and 5.4%, respectively) than third-generation cephalosporins (resistance rate: 16.2%) against highly multidrug-resistant strains.

Gallbladder fossa nodularity in the liver typically observed in patients with alcoholic liver disease; comparison with chronic hepatitis C patients.

BACKGROUND AND PURPOSE: Gallbladder fossa nodularity (GBFN) is often observed in patients with alcoholic liver disease (ALD), and we hypothesized this may be due to the cholecystic venous drainage (CVD), sparing this area from portal perfusion containing alcohol absorbed in the alimentary tract, and also escaping from alcohol-induced fibrotic and atrophic change of the liver parenchyma. The purpose of this study is to verify our hypothesis, using chronic hepatitis C (CHC) patients as a control. MATERIALS AND METHODS: Between 2013 and 2017, consecutive 45 ALD and 46 CHC patients who had contrast-enhanced CT were retrospectively recruited. Those who had interventions or disease involvement around gallbladder fossa were excluded. All CT images, and angiography-assisted CT(ang-CT) images , when available, were reviewed. GBFN was subjectively classified into grades 0-3, depending upon the conspicuity of nodularity, which was compared between the groups, and was also correlated to various clinicoradiological factors, including the alcohol consumption grades (ACG). RESULTS: GBFN was more frequently observed in ALD than in CHC patients, and higher grade GBFN was associated with ALD rather than CHC (all p < 0.05). Multivariable analysis revealed independently significant factors related to GBFN grades were ACG and albumin-bilirubin grades. Ang-CT images were available in 11 patients, all of whom exhibited portal perfusion diminishment and faint arterial enhancement, suggesting CVD, at the region of GBFN. When GBFN grade 3 was considered to discriminate ALD from CHC, the value of sensitivity/specificity/accuracy is 9%/100%/55%. CONCLUSION: GBFN may represent spared liver tissue from alcohol-containing portal venous perfusion due to CVD, which may serve as an adjunctive sign of ALD or alcohol overconsumption with high specificity, but low sensitivity.

Fusion imaging of single-photon emission computed tomography and magnetic resonance lymphangiography for post-Fontan chylothorax.

A preschool male patient with an extensive cardiac surgical history developed refractory chylothorax after a total cavopulmonary connection. Neither lymphoscintigraphy nor single-photon emission computed tomography (SPECT)/computed tomography could identify the lymphatic system leakage sites. Non-contrast heavy T2-weighted magnetic resonance lymphangiography (MRL) was performed to visualize the lymphatic system. Nevertheless, distinguishing lymphatic ducts from other watery structures of the patient remained difficult. Therefore, non-contrast MRL and SPECT images were fused. This hybrid diagnostic tool elucidated the pathophysiology of the prolonged chylothorax; pulmonary lymphatic perfusion syndrome and illustrated the anatomical connection of the thoracic duct and an abnormally dilated lymphatic network in the neck and left hilar regions. Subsequent intranodal lymphangiography with ethiodized oil confirmed these findings. SPECT/MRL may become an alternative modality for revealing the mechanism of prolonged chylothorax by visualizing the lymphatic system when dynamic contrast-enhanced magnetic resonance lymphangiography is unavailable.

Catheter Intervention for Flow Regulatory Clips on Palliative Shunts and Conduits in Patients with Congenital Heart Disease.

Catheter intervention (CI) for a Blalock-Taussig shunt (BTS) or a ventricle-to-pulmonary artery conduit (VPC) is often required after a palliative surgery for congenital heart disease. Flow regulatory clips help improve interstage mortality; their use necessitates CIs to prevent cyanosis. To study the CI outcomes in patients who underwent palliative surgery with either BTSs or VPCs with flow regulatory clips. This single-center retrospective study evaluated demographic characteristics and interventional outcomes of 49 consecutive pediatric patients who required CI for BTS (BTS group) or VPC (VPC group) between January 2008 and September 2018. Overall, 34 and 18 procedures were performed in the BTS and VPC groups, respectively. Moreover, 19/32 (59.3%) and 12/17 (70.1%) patients from the BTS and VPC groups had flow regulatory clips, respectively. All clips were unclipped successfully; one patient in each group underwent staged unclipping. A higher proportion of "clipped patients" underwent CI due to desaturation [clipped vs. non-clipped: BTS, 10/20 (50.0%) vs. 3/14 (21.4%), p = 0.092; VPC, 9/13 (69.2%) vs. 1/5 (20.0%), p = 0.060]. Most clipped patients successfully progressed to the next stage [BTS, 19/20 (95.0%); VPC, 12/13 (92.3%)]. Severe adverse events (SAEs) were more frequent in the VPC group than in the BTS group [3/13 (23.1%) vs. 0/20 (0%), p = 0.024]. Two patients developed an atrioventricular block (requiring an atropine infusion), while one died due to pulmonary overcirculation. While the indication of CI was cyanosis for a higher proportion of clipped patients, all clips were unclipped successfully. The incidence of CI-related SAEs was higher in the VPC group than in the BTS group.

Cardiac MRI for Fontan candidates after intrapulmonary-artery septation.

Intrapulmonary-artery septoplasty may be effective for establishing two-lung Fontan circulation in patients with unilateral pulmonary circulation. However, evaluation of the function of each lung by conventional modalities can be challenging in these patients due to differing sources of blood flow to the left and right lungs following intrapulmonary-artery septation. Herein, we report a case in which two-lung Fontan circulation was successfully achieved after using cardiac MRI along with conventional modalities to evaluate pulmonary circulation.

Indicators of Improvement in Performing Activities of Daily Living Among Older Patients Undergoing Rehabilitation Following Hip Fractures.

This study aimed to evaluate the relationship between improvement in activities of daily living (ADL) and cognitive status during rehabilitation and assess factors associated with ADL improvement among older patients undergoing rehabilitation after hip fractures. This retrospective cohort study comprised 306 patients aged ≥80 years who underwent hip fracture rehabilitation. The functional independence measure gain during rehabilitation was significantly lower in the group with abnormal cognition than in the group with normal cognition. Mini-Mental State Examination, Charlson Comorbidity Index, daily duration of rehabilitation, and length of hospitalization for rehabilitation were independent factors associated with functional independence measure gain during rehabilitation in the multivariate regression analysis. Although older patients with cognitive impairment had lower ADL improvements during hip fracture rehabilitation, such patients may be able to improve their ADL by undergoing intensive and long rehabilitation programs. They should not refrain from such rehabilitation programs due to older age, fracture, and cognitive impairment.