Independent Association between Cognitive Frailty and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults.

INTRODUCTION: Although arterial stiffness has been suggested to be associated with poor physical function and mild cognitive impairment (MCI), its association with cognitive frailty (CF), a comorbidity of both, is unclear. This study aims to examine the association between CF and arterial stiffness in community-dwelling older adults. METHODS: A cross-sectional analysis of 511 community-dwelling older adults aged 65 years or older (mean age 73.6 ± 6.2 years, 63.6% women), who participated in a community cohort study (Tarumizu Study, 2019), was conducted. Poor physical function was defined as either slowness (walking speed <1.0 m/s) or weakness (grip strength <28 kg for men and <18 kg for women). MCI was defined by the National Center for Geriatrics and Gerontology Functional Assessment Tool as a decline of at least 1.5 standard deviation from age- and education-adjusted baseline values in any one of the four cognitive domains (memory, attention, executive, and information processing). CF was defined as the combination of poor physical function and MCI. Arterial stiffness was measured using the Cardio-Ankle Vascular Index (CAVI), and the average of the left and right sides (mean CAVI) was used. RESULTS: Multinomial logistic regression analysis adjusted for covariates was performed with the four groups of robust, poor physical function, MCI, and CF as dependent variables and mean CAVI as an independent variable. Using the robust group as reference, the poor physical function and MCI groups showed no significant relationship with the mean CAVI. The mean CAVI was significantly higher in the CF group (odds ratio 1.62, 95% confidence interval: 1.14-2.29). CONCLUSION: A significant association was found between CF and the higher CAVI (progression of arterial stiffness). Careful observation and control of CAVI, which is also an indicator of arterial stiffness, may be a potential target for preventive interventions for CF.

Effects of Walking-Only Intervention on Physical Function, Fall-Related Outcomes, and Health-Related Quality of Life in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

This study aimed to determine the effects of walking-only intervention (walking was the only exercise in which people participated) on physical function, fall-related outcomes, and health-related quality of life in community-dwelling older adults. We conducted a systematic search across five electronic databases, assessing risk of bias using Minds Manual for Guideline Development. Meta-analyses were performed, and pooled standardized mean differences were calculated. Nine studies (a total of 1,309 participants) were included, showing that walking-only interventions improved walking endurance (standardized mean difference: 1.11, 95% confidence interval: [0.08, 2.15]) and health-related quality of life (standardized mean difference: 0.71, 95% confidence interval: [0.18, 1.25]). However, there were no significant improvements in other outcomes. The certainty of the evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach for all outcomes was graded as very low, primarily due to significant inconsistency and imprecision. Our results suggest that walking-only intervention can be effective for enhancing walking endurance and health-related quality of life for community-dwelling older adults. Further studies are required to investigate the effects of walking-only intervention. This need stems from the limited number of randomized controlled trials, heterogeneous intervention settings and results, and the very low certainty of the evidence.

Efficacy of Therapeutic Exercise on Activities of Daily Living and Cognitive Function Among Older Residents in Long-term Care Facilities: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVES: This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities. DATA SOURCES: PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018. STUDY SELECTION: Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes. DATA EXTRACTION: Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS: A total of 11 RCTs with 1280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD]=0. 22, 95% confidence interval [CI]: 0.02, 0.42, P=.03). Subgroup analyses indicated that interventions conducted ≥3 days per week [SMD=0.42, 95% CI 0.02, 0.82, P=.04] had a significant benefit on ADL. For cognitive function, group exercise and ≥3 days/week of intervention had a significant benefit (group exercise: mean difference [MD]=3.36, 95% CI 0.91, 5.80, P=.007; ≥3 days/week of intervention: MD=2.28, 95% CI 0.07, 4.49, P=.04). CONCLUSIONS: Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination.

OBJECTIVES: We aimed to determine if achieving a 10-m walk target within the first week of stroke onset correlates with independent outdoor walking at discharge and discharge to home for patients with stroke. MATERIALS AND METHODS: This study included 226 patients transferred to the subacute rehabilitation hospital (SRH) between January 2018 and March 2021. Data obtained from hospital records included age, sex, stroke type, lesion side, body mass index, presence of acute treatment, length of days from onset to physical therapy intervention, National Institutes of Health Stroke Scale, length of hospital stay, Functional Independence Measure score, and the ability to complete the 10 m walk target within the first week of stroke onset. The primary outcomes were independent outdoor walking ability and discharge destination from the SRH. A logistic regression analysis was performed to determine if the 10 m walking ability correlated with the outdoor walking ability and discharge destination. RESULTS: Compared with the inability to walk 10 m, walking 10 m independently walking within the first week of stroke onset correlated with the ability to walk independently outdoors at discharge (odds ratio [OR]: 4.38, p = 0.003) and being discharged home (OR: 4.52, p = 0.002), whereas, walking 10 m with assistance was associated with being discharged home (OR: 3.09, p = 0.043). CONCLUSIONS: The ability to walk 10 m within the first week of stroke onset may be a helpful marker for prognosis.

Relationship between grave visitation and apathy among community-dwelling older adults.

BACKGROUND: It has been shown that involvement in religious activities has a positive impact on psychological aspects. In this study, the relationship between grave visitation, a standard religious activity in Japan, and depression and apathy symptoms was investigated among older adults in Japan. METHODS: A total of 638 older adults who participated in a community-based health check survey (Tarumizu Study 2019) were interviewed regarding the presence or absence of grave visitation, frequency, travel time, means of transportation, and flower offerings. Apathy and depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS-15). The participants were categorised into three grave visitation groups, namely, frequent (more than once per week), occasional (less than once per week), and non-visiting. Outcomes were compared between the frequency groups, and Poisson regression analysis was used to investigate the relationship between grave visitation frequency and apathy and depression. RESULTS: Of the participants, 91.8% reported regular grave visitation. The non-visiting group had a significantly higher prevalence of apathy symptoms (44.2%) than the visiting groups. Furthermore, using the frequent group as the reference, Poisson regression analysis adjusted for potential covariates demonstrated that no grave visitation was significantly related to apathy (prevalence ratio, 1.43; 95% confidence interval, 1.00-2.05, P = 0.049). CONCLUSIONS: Not practising grave visitation was significantly related to apathy among older adults. Helping older adults to visit graves may prevent apathy by facilitating motivation and increasing activity.

Associations of fall history and fear of falling with multidimensional cognitive function in independent community-dwelling older adults: findings from ORANGE study.

BACKGROUND: Falls and fear of falling (FoF) inhibit healthy longevity and have been suggested to be associated with cognitive function. However, the domains of cognitive function that are associated with them remain controversial. It is speculated that clarifying this will help in the assessment of health status and interventions in the community. AIM: To analyse the associations between fall history and FoF and multidimensional cognitive function in independent community-dwelling older adults. METHODS: The data from 9759 (73.3 ± 5.4 years, 59.9% women) older individuals enrolled in the cross-sectional ORANGE study were analysed. Simple questions were used to assess fall history in the past year and current FoF. Assessments of multidimensional cognitive function were performed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT) to evaluate memory, attention, executive function, and processing speed. The independent associations of fall history and FoF with multidimensional cognitive function were assessed using multivariate linear regressions adjusted for potential confounding variables. RESULTS: A total of 18.3% and 35.4% of participants presented with fall history and FoF, respectively. Fall history (p = 0.008) and FoF (p = 0.002) were significantly associated with memory. FoF, but not fall history was associated with attention (p = 0.004), executive function (p < 0.01), and processing speed (p < 0.01). CONCLUSION: In independent community-dwelling older adults, fall history was associated only with the memory domain; in contrast, fear of falling was associated with multidimensional cognitive function. This study provides weak evidence suggesting the need to assess falls and FoF in all situations involving independent community-dwelling older adults.

Association of Sleep Quality Status With Worsening Low Back or Knee Pain During The COVID-19 State of Emergency Among Old-Old Adults.

BACKGROUND: Poor sleep quality has a negative effect on pain among older adults. During the coronavirus disease 2019 (COVID-19) state of emergency, lifestyle changes can cause psychologic stressors and lead to poor sleep quality. AIM: This study examined whether sleep quality status was associated with low back or knee pain changes during the COVID-19 state of emergency among community-dwelling Japanese old-old adults. DESIGN: Cross-sectional investigation. METHODS: In July 2020, during the COVID-19 epidemic, we conducted a postal survey for old-old adults aged ≥77 years and collected data on 597 participants. For those who had low back or knee pain at the time of the survey (in July), characteristics such as low back pain, knee pain, changes in pain status, and sleep quality status during the COVID-19 state of emergency (in March) were assessed. RESULTS: Data from 597 participants showed the prevalence of low back pain (50.6%) and knee pain (40.7%) in July. Of those with low back or knee pain, 374 had pain changes during the state of emergency, with 12.3% worsening. Of these, 23.9% had poor sleep quality in March compared to non-change (p = .008). In a multivariate logistic regression model adjusted for potential confounders, poor sleep quality was significantly associated with pain worsening (odds ratio 2.80, 95% confidence interval 1.26-6.22). CONCLUSIONS: During the COVID-19 state of emergency, poor sleep quality was associated with worsening low back or knee pain. This may indicate the need to pay attention to poor sleep quality to prevent the exacerbation of pain among old-old adults.

Associations between apathy and comprehensive frailty as assessed by the Kihon Checklist among community-dwelling Japanese older adults.

BACKGROUND: Frailty is a multidimensional condition characterised by reduced physical and psychological resilience. Older adults also frequently demonstrate apathy, suggesting that it shares similar neuro-physiological pathways with frailty. This cross-sectional study aimed to investigate the association between apathy and frailty as defined by a comprehensive assessment. METHODS: We analyzed 882 older adults (mean age: 74.4 ± 6.4 years; 62.1% female) who participated in a community-based health check survey (Tarumizu Study). Apathy was measured by the Geriatric Depression Scale-3A, a three-item subset of the Geriatric Depression Scale-15, and frailty by the Kihon Checklist of physical, psychological, functional, and social status. Associations were examined by multinomial logistic regression with frailty status (robust, pre-frailty, frailty) as the dependent variable, apathy as the independent variable, and sociodemographic factors, medications, cognitive function, functional capacity, and mood symptoms as potential confounders. RESULTS: Apathy was observed in 23.7% of individuals, and logistic regression revealed significant associations with both pre-frailty and frailty after confounder adjustment (pre-frailty: odds ratio (OR) 1.80, 95% CI 1.22-2.64; frailty: OR 3.24, 95% CI 1.63-6.42). Participants with apathy also exhibited greater deficits in the Kihon Checklist subdomains instrumental activities of daily living (P = 0.022), physical function (P < 0.001), oral function (P < 0.001), and cognitive function (P = 0.001). CONCLUSIONS: Our findings underscore the importance of comprehensive frailty assessment and demonstrate that apathy can have pervasive deleterious effects on geriatric health.

Association between apathy and satisfaction with meaningful activities in older adults with mild cognitive impairment: A population-based cross-sectional study.

OBJECTIVES: This cross-sectional study aimed to clarify the relationship between apathy, meaningful activities, and satisfaction with such activities of older adults with mild cognitive impairment (MCI). METHODS: We analyzed 235 older adults with MCI (≥65 years, mean age: 76.9 ± 6.4 years, women: 63.4%) who participated in a community-based health check survey (Tarumizu Study 2018). MCI was defined as at least 1.5 SD below the reference threshold (age- and education-adjusted score) on one or more of the computerized cognitive test including memory, attention, executive functions, and processing speed. Apathy symptoms were assessed using three of the 15 items of Geriatric Depression Scale. Participants selected meaningful activities from the 95 activities of the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. RESULTS: Apathy in MCI was prevalent by 23.8%. The categories of meaningful activities revealed no difference, with, or without apathy. Logistic regression analysis showed that activity satisfaction was significantly associated with apathy after adjusting for age, sex, education, instrumental activities of daily living, depressive symptoms, and MCI subtype (OR, 0.62; 95% CI, 0.44-0.88, p = 0.008). CONCLUSIONS: Satisfaction with the activities that are deemed meaningful is associated with apathy among community-dwelling older adults with MCI.

Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS.

INTRODUCTION: Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations. OBJECTIVE: The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults. METHODS: The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan's public LTCI system during the 29 months. RESULTS: During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system's care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54-9.66) or pre-frail (2.40, 1.58-3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were ¥6,434 ($63.1) for robust, ¥19,324 ($189.5) for pre-frail, and ¥147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services. DISCUSSION/CONCLUSION: Frail community-dwelling older adults had a higher risk of requiring the LTCI system's care-needs certification and the subsequent total LTCI costs.

Polypharmacy and Lack of Joy Are Related to Physical Frailty among Northern Japanese Community-Dwellers from the ORANGE Cohort Study.

INTRODUCTION: A prevalence of frailty is gradually increasing with the progress of aging in Japan, and critical challenges regarding early diagnosis and prevention of frailty were necessary in community. Although previous studies have well documented the characteristics of physical disability, there is limited information on frail state differences among older adults in Japanese rural areas. The aim of our cross-sectional observational study was to clarify the association of frail status in northern Japanese community-dwellers aged 65 or more. METHODS: 345 participants were recruited from 2018 to 2020, and after getting informed consent from each participant, assessments and outcomes were evaluated according to the ORANGE protocol. We applied the frailty index of Gerontology-the Study of Geriatric Syndromes (NCGG-SGS) to classify frailty status by collecting data of demographics and psychosocial status using the Kihon checklist (KCL) and cognitive domains used by the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). RESULTS: Our subjects included 313 older adults divided into 138 robust, 163 prefrail, and 12 frail. For statistical analysis, we found that the frail group had a lower educational duration, worsened KCL items, lower cognitive functions, and a tendency toward depression compared to the other groups. Moreover, physical frailty and cognitive decline were related, and polypharmacy and a lack of joy in daily life were explanatory variables of frail status. CONCLUSIONS: We suggest that KCL is important for frail discrimination, and in order to prevent physical frailty, our community should take care of not only exercise and nutrition but also cognitive functioning and depressive tendencies. In particular, polypharmacy and the presence of fun in your life are possible to be related to frailty.

Sleep condition and cognitive decline in Japanese community-dwelling older people: Data from a 4-year longitudinal study.

This study examined whether sleep duration and excessive daytime sleepiness (EDS) are related to cognitive decline among community-dwelling older adults with intact cognition at baseline, using 4-year longitudinal data. A total of 3,151 community-dwelling older individuals aged ≥65 years were studied. They were assessed for cognitive function, including memory, attention, executive function and processing speed. Cognitive impairment was defined based on a score >1.5 standard deviations below the age- and education-specific mean. Cognitive decline was defined in one or more cognitive tests at follow-up. Self-reported sleep duration (short, ≤6.0 hr; medium, 6.1-8.9 hr; long, ≥9.0 hr) and EDS at first-wave examination were assessed and logistic regression analyses were used to examine the associations of sleep duration and EDS with cognitive status at second-wave examination. The incidence of cognitive decline differed significantly among the sleep-duration groups (short, 15.9%; medium, 11.9%; long, 20.1%; p = 0.001). The prevalence of having EDS was 13.1%, which was associated with a higher rate of cognitive decline than having no EDS (18.9% vs. 12.5%, p = 0.004). Long sleep duration compared with medium sleep duration (OR, 1.50; 95% CI, 1.05-2.13) and EDS (1.43; 1.01-2.03) independently impacted the incidence of cognitive decline. The results were similar after multiple imputations (long, 1.68, 1.12-2.52; EDS, 1.55, 1.05-2.29). In conclusion, our study revealed that both long sleep duration and EDS were independent risk factors associated with cognitive decline after 4 years among older adults.

Effects of Driving Skill Training on Safe Driving in Older Adults with Mild Cognitive Impairment.

BACKGROUND: Driving cessation is strongly associated with adverse health outcomes in the older adults. Although there were numerous documentations of driving rehabilitation in disabled adults, the effects of interventions on safe driving were not clear in older adults with cognitive impairment who had low driving skills. OBJECTIVE: This randomized controlled trial was designed to determine whether a safe driving skill program consisting of classroom and on-road training could enhance driving performance of older drivers with cognitive impairment in Japan. METHODS: A total of 160 community-living older drivers participated in the randomized controlled trial with blinded endpoint assessment. Participants randomized to intervention underwent 10 1-h classroom sessions and 10 1-h on-road sessions focused on common problem areas of older drivers. Controls received 1 classroom education. On-road driving performance was assessed by certified driving school instructors in a driving school. The participants carried out dynamic vision and cognitive performance tests. RESULTS: One hundred and forty-six (intervention group, n = 71) subjects completed the 3-month follow-up. Mean adherence to classroom-based vision training and driving simulator training and on-road training programs, including the 71 participants, was 99.0 ± 6.4 and 99.0 ± 7.2%, respectively. Regarding the safe driving skill score, there were group × time interactions (p < 0.01) indicating benefits of the intervention over time. Although there were no significant group × time interactions in cognitive tests, dynamic vision showed group × time interactions (p < 0.01). CONCLUSION: The driving skill program significantly improved safe driving performance in older adults with cognitive impairment who were at a potentially high risk of a car accident.

[Mail-based intervention for improvement of dietary habits among community-dwelling older adults living in heavy snowfall regions].

Objectives　The aim of this study was to investigate the effect of mail-based intervention using the TAKE10! Program to improve dietary habits in cases where direct intervention is not possible.Methods　Subjects aged 70-91 years (77.6±5.0) were randomly assigned to two groups: 72 in the intervention group and 71 in the control group. The intervention group received monthly mail, which included self-check sheets (TAKE10! Check sheet and TAKE10! Calendar) and a letter with feedback and comments for 5 months. The outcome measures were changes in the intake frequency of 10 food groups, Dietary Variety Score (DVS), and Food Frequency Score (FFS).Results　Compared to baseline, the post-intervention intake frequencies for 9 of 10 food groups, DVS, and FFS significantly increased in the intervention group. No significant differences were observed between baseline and post-intervention in the control group. In the subgroup analysis of the intervention group, post-intervention DVS and FFS of both subjects who cooked their own food and those who did not showed significant increases compared to baseline.Conclusion　The mail-based TAKE10! Program resulted in improved dietary habits and could be shared with families in addition to direct interventions and could also be used in regions with inadequate transportation systems or frequent poor weather conditions.

Behavioral protective factors of increased depressive symptoms in community-dwelling older adults: A prospective cohort study.

BACKGROUND: It remains unclear what kinds of behavior prevent the development of geriatric depression. This study aimed to elucidate behavioral predictors of increased depressive symptoms in older adults focusing on gender differences. METHODS: A total of 3106 community-dwelling older people aged older than or equal to 65 years without depressive symptoms at baseline participated. The 15-item Geriatric Depression Scale was used to assess depressive symptoms with a score of 6 or more at baseline and 15 month follow-up. Behavioral status was investigated by using dichotomous questions about the aspects of physical, cognitive, and social activities. Each category included 3 specific items. Demographic data and other potential confounding factors were also assessed. RESULTS: In the 15 month follow-up survey, 239 participants (7.7%) reported increased depressive symptoms. Multiple logistic regression analysis indicated that engagement in light physical exercise (odds ratio = 0.74, 95%, CI = 0.56-0.98), taking enrichment lessons (0.62, 0.46-0.85), using a personal computer (0.68, 0.48-0.97), participation in events at the community center (0.54, 0.40-0.72), and attending a community meeting (0.69, 0.52-0.92) were independently associated with lower risk of increased depressive symptoms. In a separate analysis for each gender, significant odds ratios of using a personal computer were observed in men, whereas significant odds ratios of light physical exercise, participation in events at the community center, and attending a community meeting were observed in women. CONCLUSIONS: Light physical exercise, taking lessons, usage of a computer, and participation in community events showed protective effects against depressive symptoms. However, the significance of each behavioral factor may vary according to gender.

Impact of fear of falling and fall history on disability incidence among older adults: Prospective cohort study.

OBJECTIVE: Fear of falling (FOF) is a major health problem for older adults, present not just in fallers, but also nonfallers. This study examined the impact of FOF and fall history on disability incidence among community-dwelling older adults from a prospective cohort study. METHODS: A total of 5104 older adults living in community settings participated in baseline assessment and were followed up for about 4 years (median 52 mo, range 49-55 mo). At baseline, participants were assessed the presence of FOF and their fall history, and divided into 4 groups: Fall (-) FOF (-), Fall (+) FOF (-), Fall (-) FOF (+), and Fall (+) FOF (+). Disability incidence was defined as national long-term care insurance certification for personal support or care. RESULTS: During the follow-up period, 429 participants (9.9%) were newly certified as having a disability and needing personal support for long-term care insurance. Fall (-) FOF (+) group and Fall (+) FOF (+) group showed a significantly higher risk of disability incidence than Fall (-) FOF (-) group even after adjusting for covariates (Fall (-) FOF (+): hazard ratio 1.28, 95% confidence interval, 1.01-1.62, Fall (+) FOF (+): hazard ratio 1.44, 95% confidence interval, 1.05-1.98). CONCLUSIONS: Fear of falling could be a simple and useful predictor of disability incidence in community-dwelling older adults. Identifying and decreasing fall risk factors may prevent fall-related injuries, but excessive FOF may be associated with increased risk of disability incidence.

Associations of Near-Miss Traffic Incidents with Attention and Executive Function among Older Japanese Drivers.

BACKGROUND: Attention and executive function may play an important role in ensuring safe driving as they involve paying attention to complex information and making an instantaneous judgment during driving. We hypothesized that poor performance in attention and executive function may increase the risk of near-miss incidents among older drivers. OBJECTIVE: The aim of this study was to examine associations of current experience of near-miss traffic incidents with attention and executive function among older Japanese drivers. METHODS: The study included 3,421 general older drivers (mean age: 71.7 ± 4.9 years; 56.3% men) with a valid driver's license who were currently driving at least once per week and who had participated in a community-based cohort study between February 2015 and August 2016. The participants were asked about their experiences of near-miss traffic incidents in 10 situations that had almost happened during driving in the previous year. RESULTS: Of the 3,421 older drivers, 1,840 (53.8%) had experienced near-miss incidents during driving in the previous year at least once. Male sex (OR 1.46, 95% CI 1.27-1.69) and high driving frequency (OR 1.11, 95% CI 1.07-1.15) were significantly associated with the current experience of near-miss traffic incidents when the overall data were analyzed. In young-old drivers aged 65-74 years, poor performance in attention as assessed by the Trail Making Test-part A (OR 1.45, 95% CI 1.05-2.00) was significantly associated with near-miss traffic incidents. CONCLUSION: Male sex, high driving frequency, and poor performance in attention (in young-old drivers) were associated with near-miss traffic incidents. Improvement in attention may play a role in decreasing the risk of traffic accidents among older drivers.

Subjective Memory Complaints are Associated with Incident Dementia in Cognitively Intact Older People, but Not in Those with Cognitive Impairment: A 24-Month Prospective Cohort Study.

OBJECTIVE: Although subjective memory complaints (SMCs) are considered a risk factor for incident dementia in older people, the effect might differ based on cognitive function. The aim of the present study was to investigate whether the effect of SMCs on the incidence of dementia in older people differed based on cognitive function. DESIGN: A 24-month follow-up cohort study. SETTING: Japanese community. PARTICIPANTS: Prospective, longitudinal data for incident dementia were collected for 3,672 participants (mean age: 71.7 years; 46.5% men) for up to 24 months. MEASUREMENTS: Baseline measurements included covariates for incident dementia, SMCs, and cognitive function. Associations between SMCs, cognitive impairment, and incident dementia were examined using Cox proportional hazards models. RESULTS: Incidences of dementia in the cognitively intact without SMC, cognitively intact with SMC, cognitive impairment without SMC, and cognitive impairment with SMC groups were 0.3%, 1.8%, 3.4%, and 4.8%, respectively. In the cognitively intact participants, SMCs were associated with a significantly higher risk of dementia (hazard ratio [HR]: 4.95, 95% confidence interval [CI]: 1.52-16.11, p = 0.008). Incident dementia with cognitive impairment was not significantly different based on SMC presence (p = 0.527). Participants with cognitive impairment in multiple domains had a significantly higher risk of incident dementia (HR: 2.07, 95% CI: 1.01-4.24, p = 0.046) CONCLUSION: SMCs were related with dementia in cognitively intact older people, but not in those with cognitive impairment.Multiple domains of cognitive impairment were associated with a higher risk of incident dementia.

Prospective associations between sedentary behaviour and incident depressive symptoms in older people: a 15-month longitudinal cohort study.

OBJECTIVE: This study aimed to investigate whether sitting time, as a form of sedentary behaviour, is related to incident depressive symptoms in older people. METHODS: This study included 3503 participants (mean age 71.7 years, 50.1% female) from the 'Obu Study of Health Promotion for the Elderly' cohort study. At baseline and then 15 months later, the participants reported their status of depressive symptoms using the 15-item Geriatric Depression Scale. During the baseline assessment, the participants were also asked about their sedentary behaviour on weekdays over the past 7 days and, from there, categorized into three groups (<240, 240-480, ≥480 min/day). Demographic data and the other health behaviours were also assessed at the baseline. RESULTS: Cross-sectional analysis revealed that 437 participants (12.0%) had depressive symptoms. In a prospective analysis, the logistic regression model revealed that the odds ratio for depressive symptom incidence was higher in participants who, at baseline, spent 480 min or more per day sitting (1.636; 95% confidence interval [CI] 1.015 to 2.636, p = 0.043), and in those who spent 240-480 min (1.605; 95% CI 1.085 to 2.375, p = 0.018) in comparison with those who spent less than 240 min. CONCLUSIONS: Sedentary behaviour significantly affects the risk of incident depressive symptoms. Further research is needed to develop an intervention strategy to manage depressive symptoms, as the second most common cause of burden of disease among older adults. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of exercise on brain activity during walking in older adults: a randomized controlled trial.

BACKGROUND: Physical activity may preserve neuronal plasticity, increase synapse formation, and cause the release of hormonal factors that promote neurogenesis and neuronal function. Previous studies have reported enhanced neurocognitive function following exercise training. However, the specific cortical regions activated during exercise training remain largely undefined. In this study, we quantitatively and objectively evaluated the effects of exercise on brain activity during walking in healthy older adults. METHODS: A total of 24 elderly women (75-83 years old) were randomly allocated to either an intervention group or a control group. Those in the intervention group attended 3 months of biweekly 90-min sessions focused on aerobic exercise, strength training, and physical therapy. We monitored changes in regional cerebral glucose metabolism during walking in both groups using positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG). RESULTS: All subjects completed the 3-month experiment and the adherence to the exercise program was 100%. Compared with the control group, the intervention group showed a significantly greater step length in the right foot after 3 months of physical activity. The FDG-PET assessment revealed a significant post-intervention increase in regional glucose metabolism in the left posterior entorhinal cortex, left superior temporal gyrus, and right superior temporopolar area in the intervention group. Interestingly, the control group showed a relative increase in regional glucose metabolism in the left premotor and supplemental motor areas, left and right somatosensory association cortex, and right primary visual cortex after the 3-month period. We found no significant differences in FDG uptake between the intervention and control groups before vs. after the intervention. CONCLUSION: Exercise training increased activity in specific brain regions, such as the precuneus and entorhinal cortices, which play an important role in episodic and spatial memory. Further investigation is required to confirm whether alterations in glucose metabolism within these regions during walking directly promote physical and cognitive performance. TRIAL REGISTRATION: UMIN-CTR ( UMIN000021829 ). Retrospectively registered 10 April 2016.