Link among apolipoprotein E E4, gait, and cognition in neurodegenerative diseases: ONDRI study.

INTRODUCTION: Apolipoprotein E E4 allele (APOE E4) and slow gait are independently associated with cognitive impairment and dementia. However, it is unknown whether their coexistence is associated with poorer cognitive performance and its underlying mechanism in neurodegenerative diseases. METHODS: Gait speed, APOE E4, cognition, and neuroimaging were assessed in 480 older adults with neurodegeneration. Participants were grouped by APOE E4 presence and slow gait. Mediation analyses were conducted to determine if brain structures could explain the link between these factors and cognitive performance. RESULTS: APOE E4 carriers with slow gait had the lowest global cognitive performance and smaller gray matter volumes compared to non-APOE E4 carriers with normal gait. Coexistence of APOE E4 and slow gait best predicted global and domain-specific poorer cognitive performances, mediated by smaller gray matter volume. DISCUSSION: Gait slowness in APOE E4 carriers with neurodegenerative diseases may indicate extensive gray matter changes associated with poor cognition. HIGHLIGHTS: APOE E4 and slow gait are risk factors for cognitive decline in neurodegenerative diseases. Slow gait and smaller gray matter volumes are associated, independently of APOE E4. Worse cognition in APOE E4 carriers with slow gait is explained by smaller GM volume. Gait slowness in APOE E4 carriers indicates poorer cognition-related brain changes.

[A Case of Consciousness Disorder Due to Hyperammonemia Induced by Modified FOLFOX6 for Multiple Liver Metastasis from Rectal Cancer].

A 74-year-old man underwent laparoscopic-assisted high anterior resection with D3 lymph node dissection for rectal cancer, which was simultaneously accompanied by multiple liver metastases. The patient received mFOLFOX6 therapy for liver metastases 1 month after the surgery. Anorexia, nausea, and vomiting appeared on the second day of treatment. On the third day of treatment, impaired consciousness(JCS Ⅱ-20)and flapping tremors appeared. Blood tests revealed hyperammonemia, and the patient was diagnosed with impaired consciousness due to hyperammonemia, which was inferred to be caused by 5-fluorouracil(5-FU). Intravenous infusion and branched-chain amino acids were administered, and the patient recovered. The underlying disease of renal dysfunction, constipation, and dehydration due to chemotherapy might have induced the hyperammonemia. It is important to note that hyperammonemia can lead to a disturbance of consciousness during chemotherapy including 5-FU.

Influence of education and subjective financial status on dietary habits among young, middle-aged, and older adults in Japan: a cross-sectional study.

BACKGROUND: Research has suggested an association between lower socioeconomic status (SES) and unhealthy dietary habits. However, differences in the effects of different SES indicators and age remain unclear. The current study addressed this research gap by investigating the relationship between SES and unhealthy dietary habits, specifically focusing on educational attainment and subjective financial status (SFS) among varied age groups. METHODS: Data were derived from a mail survey of 8,464 people living in a suburb of Tokyo, Japan. Participants were classified into three age groups (20-39 years: young adults; 40-64 years: middle-aged adults; and 65-97 years: older adults). SES was assessed based on individual educational attainment and SFS. Unhealthy dietary habits were defined as skipping breakfast and a low frequency of balanced meal consumption. Participants were asked how often they ate breakfast, and those who did not respond "every day" were categorized as "breakfast skippers." Low frequency of balanced meal consumption was defined as eating a meal that included a staple meal, main dish, and side dishes at least twice a day for less than five days per week. Poisson regression analyses with robust variance adjusted for potential covariates were used to determine the interactive effects of educational attainment and SFS on unhealthy dietary habits. RESULTS: Individuals with lower educational attainment across all age groups skipped breakfast more frequently compared to those with higher educational attainment. For older adults, poor SFS was associated with skipping breakfast. Young adults with poor SFS and middle-aged adults with lower educational attainment tended to eat less balanced meals. In addition, an interaction effect was found in older adults, where those with lower education despite good SFS and those with poor SFS despite higher education were at a greater risk of falling into unhealthy diet. CONCLUSIONS: The findings suggested that different SES indicators affect healthy dietary habits in different generations, and therefore, health policies should consider the potential influence of different SES on promoting healthier dietary habits.

Examining health risk behaviors of self-employed and employed workers in Japan: a cross-sectional study.

OBJECTIVES: Self-employed workers have a higher risk for adverse health outcomes than employed workers. However, the differences in health risk behaviors by employment status are largely unknown. This study examined differences in health risk behaviors between self-employed and employed (permanent/non-permanent) workers by sex and age (20-59 years, 60-79 years). STUDY DESIGN: This was a cross-sectional study involving community-dwelling adults living in urban cities in Japan. METHODS: In 2019, we conducted a mail survey in Wako city, Saitama, and Fuchu city, Tokyo. In total, 30,315 adults aged ≥18 years were randomly selected, and 14,185 completed the survey (response rate: 46.8%). The participants for analysis were 8538 workers. Health risk behaviors included physical inactivity (<150 min/wk of moderate-to-vigorous physical activity), prolonged sitting (>480 min/d), high-frequency drinking (≥3 d/wk), tobacco use (current smoker), and overweight (body mass index ≥ 25 kg/m2). We also calculated the total number of health risk behaviors. RESULTS: Self-employed workers had more health risk behaviors than permanent and non-permanent employees, with this difference more significant among younger males. In younger males, compared with self-employment, permanent employment was associated with less tobacco use, and non-permanent employment was associated with less physical inactivity, prolonged sitting, high-frequency drinking, and overweight. In younger females, non-permanent employment was associated with less prolonged sitting and overweight than self-employment. In older males and females, the prevalence of physical inactivity was lower in non-permanent employed than in self-employed workers. CONCLUSIONS: Promoting health behaviors among self-employed may be beneficial for reducing health inequalities between self-employed and employed workers.

Association of Eating Alone With Depression Among Older Adults Living Alone: Role of Poor Social Networks.

OBJECTIVES: Eating alone is associated with an increased risk of depression symptoms. This association may be confounded by poor social networks. The present study aimed to determine the role of poor social networks in the association of eating alone with depression symptoms, focusing on cohabitation status. METHODS: Seven hundred and ten community-dwelling older adults were categorized according to their eating style and social network size, evaluated using an abbreviated version of the Lubben Social Network Scale, with poor social network size (defined as the lowest quartile). Living arrangements and depression symptoms, detected using the Zung Self-Rating Depression Scale, were also assessed. RESULTS: A mixed-design two-way analysis of covariance (eating style and social network size factors) for the depression scale score, adjusted by covariates, yielded significant effects of social network size and eating style without interaction. Greater depression scores were observed in eating alone and poor social network size. Analysis of participants living with others showed the same results. However, among older adults living alone, only a significant main effect of social network size was observed; poor social network size resulted in greater depression scores irrespective of eating style. CONCLUSIONS: Poor social network size, and not eating alone, was associated with greater depression symptoms among older adults living alone, whereas both factors may increase depression symptoms among older adults living with others. Poor social network size may show a stronger influence on depression than eating alone in older adults living alone; thus, social network size is an important health indicator.

Older assistant workers in intermediate care facilities, and their influence on the physical and mental burden of elderly care staff.

BACKGROUND: As there is a shortage of care staff in elderly care homes, seniors are expected to work as assistants to help the care staff. This study examined the influence of older assistant workers in intermediate elderly care facilities on care staff, specifically focusing on emotional exhaustion which is a sign of burnout. These facilities provide long-term nursing and supportive care to older residents. METHODS: Data from a mail survey of intermediate elderly care facilities with older assistant workers were analyzed. Care staff were asked about the advantages and disadvantages of introducing older assistant workers in elderly care work, and their degree of emotional exhaustion. We also assessed work self-evaluations of older assistant workers, including the benefits of the work, and physical and mental burdens. RESULTS: A significantly large number of care staff reported improvements in workload with the employment of older assistant workers. Intermediate elderly care facilities enrolling more older assistant workers showed lower mean emotional exhaustion among care staff, independent of possible covariates. While older assistant workers felt that their work contributed to helping both care users and staff, they also reported a mental burden. CONCLUSIONS: Our results suggest that older assistant workers can play a significant role in reducing the physical and mental burden of intermediate elderly care facility staff. Thus, employing older assistant workers can be an effective approach to addressing shortages of care staff in elderly care homes.

A combined stepping and visual tracking task predicts cognitive decline in older adults better than gait or visual tracking tasks alone: a prospective study.

BACKGROUND: It is unclear whether motor-cognitive dual tasks predict cognitive decline better than either motor or cognitive tasks alone. AIMS: To examine the utility of the novel motor-cognitive dual-task test [Stepping Trail Making Test (S-TMT)], as a predictor of cognitive decline, and compare its predictive performance with single motor or cognitive tests. METHODS: This 2-year population-based prospective study included 626 adults aged ≥ 70 years from Takashimadaira, Itabashi, Tokyo. The S-TMT measured the time taken to step on 16 numbers in order. Gait speed and TMT-A were assessed with standardized methods as single motor and cognitive tasks, respectively. A decline in the Mini-Mental State Examination score by ≥ 3 points over 2 years was defined as a significant cognitive decline. RESULTS: Over 2 years, 97 (15.5%) experienced cognitive decline. After adjusting for confounders, binary logistic regression models showed no significant associations between gait speed, TMT-A time tertiles, and risk of cognitive decline, but participants in the longest tertile of S-TMT time were more likely to develop cognitive decline than those of the shortest tertile (odds ratio 2.14; 95% confidence interval 1.17-3.90). Only the addition of the S-TMT time to the covariates model significantly improved the reclassification indices for predicting cognitive decline (net reclassification improvement: 0.31, P < 0.01; integrated discrimination improvement: 0.01, P = 0.02). DISCUSSION AND CONCLUSION: Only the S-TMT was significantly associated with cognitive decline and improved reclassification indices, indicating that it is more useful for predicting cognitive decline than individual gait speed or visual tracking tests alone.

[Information tools commonly used during a natural disaster among information and communication technology device users].

Objective　During a natural disaster, accessing appropriate information is essential to reduce damage to health. Information and community technology (ICT) devices can help in obtaining information. This study aimed to identify the characteristics of information tools commonly used by ICT device users during a natural disaster, and identify associations between sociodemographic factors and Internet-based information tools.Methods　In 2019, 21,300 adults aged 18 years and above living in Fuchu city, Tokyo, were enrolled in our survey. Participants were asked which ICT devices (computer, smartphone, tablet, or mobile phone) they used. Those who used at least one device were classified as ICT device users. To evaluate the information tools commonly used during a natural disaster, participants were asked to select information resources they would use from a list provided (television, radio, Internet search, alert mail, administrative radio system, local government website, neighborhood, family, and friends). We classified Internet search, alert mail, and local government website as Internet-based tools. A Poisson regression model with robust variance was used to assess sex and age differences among ICT device users and clarify associations between sociodemographic factors and the use of Internet-based information tools.Results　The respondents were 9,201 adults (response rate: 43.2%). Among the ICT device users, more than 95% were below 70 years. Moreover, 66.7% of women and 70.6% of men were 80 years or above. More than 80% preferred television to get information during a natural disaster. Over 70% of women below 60 years and men below 70 years preferred to use an Internet search, compared with 7.8% of women aged 80 years or above. Those who selected Internet search were more likely to be women, have a high household income and high educational attainment, be widowed/divorced/single, and be less likely to live alone or be older adults (especially older women). Participants who selected alert mail were more likely to be women and have high educational attainment, and less likely to be widowed/divorced/single and older adults. Those who selected government websites were more likely to be women, have high educational attainment and be widowed/divorced/single, and less likely to live alone, be widowed/divorced/single, and be older adults (especially older women).Conclusion　There were differences by sex and age in information tools selected for use during a natural disaster among ICT device users. Sociodemographic factors were associated with Internet-based tools, and use differed by type of information tool.

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.

An Epidemiological Study of the Risk Factors of Bicycle-Related Falls Among Japanese Older Adults.

BACKGROUND: Considering the rate of growth of the older population in several countries, accidental falls in older cyclists are expected to increase. However, the prevalence and correlates of bicycle-related falls (BR-falls) are unknown. The aim of the present study was to explore the characteristics of BR-falls, focusing on the risk factors. METHODS: Seven-hundred and ninety-one older adults participated in a comprehensive baseline assessment that included questions on bicycle use, BR-falls, lifestyle, and physical and cognitive evaluations. A cyclist was defined as a person who cycled at least a few times per month. The incidence of BR-falls in participants who did not report BR-falls at baseline was again ascertained 3 years later. Logistic regression analyses examined the predictors of BR-falls incidence. RESULTS: At baseline, 395 older adults were cyclists and 45 (11.4%) of them had experienced BR-falls. Adjusted regression analysis showed that slower gait velocity, shorter one-leg standing time, and experience of falls (ie, non-BR-falls) were associated with BR-falls. Among the 214 cyclists who did not report BR-falls at baseline and who participated in both baseline and follow-up assessments, 35 (16.4%) cyclists experienced BR-falls during the 3-year follow-up. Adjusted regression analysis revealed that higher body mass index and non-BR-falls were predictors of future incidence of BR-falls, independent of physical function. CONCLUSIONS: Our results showed that experience of falls, irrespective of bicycling, is an independent correlate and risk factor of BR-falls. This suggests that experience of falls and BR-falls may share the same risk factors.

Co-existence of social isolation and homebound status increase the risk of all-cause mortality.

ABSTRACTBackground:Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality. METHODS: The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained. RESULTS: In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04-4.63). CONCLUSION: Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.

Preventive effects of an intergenerational program on age-related hippocampal atrophy in older adults: The REPRINTS study.

OBJECTIVES: A growing body of literature indicates that social engagements, such as intergenerational programs, are effective strategies to improve a range of cognitive abilities. The present study examined whether the intergenerational program-REPRINTS-prevents age-related hippocampal atrophy. METHODS: After comprehensive baseline assessment, participants were allowed to decide whether to participate in the REPRINTS intervention or in the control group, which required only completion of assessments. REPRINTS participants engaged in group activities that involved reading picture books to children at kindergarten and elementary schools, once every 1 to 2 weeks. A follow-up assessment was conducted after 6 years. Two MRI scans were performed, one immediately after baseline assessment and the other after 6 years. Volumes of the hippocampus, thalamus, and caudate nucleus were derived from automated segmentation. The analysis included 17 REPRINTS and 42 control-group participants. RESULTS: There was no significant difference in any variable of participants' characteristics at baseline between the REPRINTS and control groups. Hippocampal volume significantly declined in the control group but was maintained in the REPRINTS group. No significant differences between groups in thalamus or caudate nucleus volume were observed. Although cognitive function was unaffected by the program, greater decreases in hippocampal volume were significantly correlated with greater decreases in cognitive performance scores. CONCLUSIONS: Our results suggest that the REPRINTS intergenerational program has protective effects on age-related hippocampal atrophy in older adults. These changes precede improvements in cognitive performance, suggesting the validity of the concept of brain plasticity in later life following social engagement.

Observational Evidence of the Association Between Handgrip Strength, Hand Dexterity, and Cognitive Performance in Community-Dwelling Older Adults: A Systematic Review.

BACKGROUND: Deterioration of hand motor function is a possible risk factor of cognitive impairment in older adults. Despite a growing body of research, a lack of clarity exists regarding the relationships. This review offers a synthesis of existing observational studies evaluating the associations of handgrip strength and hand dexterity with cognitive performance in community-dwelling older adults. METHODS: PubMed, PsycINFO, and ScienceDirect were systematically searched (search dates: 1990-2016), and relevant articles were cross-checked for related and relevant publications. RESULTS: Twenty-two observational studies assessed the association of handgrip strength or hand dexterity with cognitive performance; none evaluated handgrip strength and hand dexterity together. Handgrip strength was associated with global cognition, mostly assessed using the Mini-Mental State Examination, cross-sectionally and longitudinally. Also, one cross-sectional and three longitudinal studies found an association with cognitive domains, such as language, memory, visuospatial ability, working memory, and processing speed. Hand dexterity was only assessed cross-sectionally in four studies. These studies found an association with cognitive domains, such as executive function. CONCLUSIONS: Although handgrip strength was associated with cognitive performance, it is unclear which variable at baseline affects the other in the long-term. Cross-sectional studies indicate an association between hand dexterity and cognitive performance, yet longitudinal studies are needed to elucidate this association. The interaction effects of both decreased grip strength and hand dexterity on cognitive performance is still unclear; therefore, future studies will need to consider the interaction of the three variables cross-sectionally and longitudinally.

Association between number of institutions with coronary computed tomography angiography and regional mortality ratio of acute myocardial infarction: a nationwide ecological study using a spatial Bayesian model.

BACKGROUND: Coronary computed tomography angiography (CTA) has demonstrated high diagnostic accuracy for detection of coronary artery stenosis, and healthcare providers can detect coronary artery disease in earlier stages before it develops into more serious clinical conditions such as acute myocardial infarction (AMI). We hypothesized that the mortality ratio of AMI in regions with a higher density of coronary CTA is lower than that in regions with a lower density of coronary CTA. METHODS: This ecological and cross-sectional study using secondary data targeted all secondary medical service areas (SMSAs) in Japan (n = 349). We obtained the numbers of cardiologists, institutions with coronary CTA, and institutions with a cardiac catheterization laboratory (CCL) as medical resources, socioeconomic factors, lifestyle factors, exercise habit factors, and AMI mortality data from a Japanese national database. We evaluated the association between the number of these medical resources and the standardized mortality ratio (SMR) of AMI in each SMSA using a hierarchical Bayesian model accounting for spatial autocorrelation (i.e., a conditional autoregressive model). We assumed a Poisson distribution for the observed number of AMI-related deaths and set the expected number of AMI-related deaths as the offset variable. RESULTS: The number of institutions with coronary CTA was negatively and significantly associated with the SMR of AMI (relative risk [RR] 0.900; 95% credible interval [CI] 0.848-0.953), while the SMR in each SMSA was not significantly associated with the number of either cardiologists (RR 0.997; 95% CI 0.988-1.004) or institutions with a CCL (RR 1.026; 95% CI 0.963-1.096). CONCLUSIONS: We observed a significant association between the number of institutions with coronary CTA and the SMR of AMI. Effective allocation of coronary CTA in each region is recommended, and it would be important to clarify the standing position of coronary CTA in regional networking for AMI treatment in the future.

Effects of aging on serum levels of lipid molecular species as determined by lipidomics analysis in Japanese men and women.

BACKGROUND: Aging is known to be associated with increased risk of lipid disorders related to the development of type 2 diabetes. Recent evidence revealed that change of lipid molecule species in blood is associated with the risk of type 2 diabetes. However, changes in lipid molecular species induced by aging are still unknown. We assessed the effects of age on the serum levels of lipid molecular species as determined by lipidomics analysis. METHODS: Serum samples were collected from ten elderly men (71.7 ± 0.5 years old) and women (70.2 ± 1.0 years old), ten young men (23.9 ± 0.4 years old), and women (23.9 ± 0.7 years old). Serum levels of lipid molecular species were determined by liquid chromatography mass spectrometry-based lipidomics analysis. RESULTS: Our mass spectrometry analysis revealed increases in the levels of multiple triacylglycerol molecular species in the serum of elderly men and women. Moreover, serum levels of total ester-linked phosphatidylcholine (PC) and phosphatidylethanolamine (PE) were increased by aging. In contrast, serum levels of specific ether-linked PC and PE molecular species were lower in elderly individuals than in young individuals. CONCLUSIONS: Our finding indicates that specific lipid molecular species, such as ether- and ester- linked phospholipids, may be selectively altered by aging.

Correction to: Hand dexterity, not handgrip strength, is associated with executive function in Japanese community-dwelling older adults: a cross-sectional study.

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Hand dexterity, not handgrip strength, is associated with executive function in Japanese community-dwelling older adults: a cross-sectional study.

BACKGROUND: An association between handgrip strength, hand dexterity and global cognition is suggested; however, it is unclear whether both hand motor functions are associated with executive function, which is important for performing daily activities. Understanding this association will help identify motor risk factors for impairment of executive function in late adulthood. We aim to investigate the relationship of handgrip strength and hand dexterity with executive function in physically and mentally healthy community-dwelling older adults. METHODS: Three hundred and twenty-six older adults (287 women, mean age ± SD, 70.1 ± 5.6) underwent handgrip strength and hand dexterity tests using a hand dynamometer and the Purdue Pegboard Test (PPT), respectively. Executive function was evaluated with the Trail Making Test (TMT)-A, TMT-B and Digit symbol; global cognition was assessed with the Mini-Mental State Examination (MMSE). RESULTS: Age-group differences showed that the younger groups (60-64, 65-69 and 70-74) had a significant better PPT and executive function performance than the oldest group (75 and older), whereas no significant age differences were observed for handgrip strength. Multiple regression analysis adjusted for potential covariates, including MMSE scores, showed that TMT-A, TMT-B, and Digit symbol were significantly associated with PPT scores; however, no significant association was observed between executive function variables and handgrip strength. CONCLUSIONS: Hand dexterity is vulnerable to the effects of aging and, contrary to handgrip strength, it strongly associates with executive function, independent of global cognition. Our results suggest that assessing hand dexterity may help identify individuals at higher risk of impairment of executive function among high-functioning older adults.

Head-to-head comparison of prasugrel versus ticagrelor in patients undergoing percutaneous coronary intervention: A meta-analysis of randomized controlled trials.

OBJECTIVES: We sought to compare the efficacy and safety of prasugrel and ticagrelor in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). BACKGROUND: Evidence from randomized head-to-head comparison between prasugrel and ticagrelor is rare regarding clinical endpoints. METHODS: PubMed, the Cochrane Library, and Web of Science were queried with the terms "prasugrel," "ticagrelor," and "randomized." Relevant randomized controlled trials (RCTs) or the same terms were also surveyed using clinicaltrials.gov, escardio.org, pcronline.org, and tctmd.com. The clinical endpoints were death, myocardial infarction (MI), stroke, and stent thrombosis (ST) for efficacy, and any bleeding for safety. RESULTS: A total number of 2068 patients in 12 RCTs, whose longest follow-up period was 6 months, was included in this study. The risks of death (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.46-1.62, P = 0.647), MI (OR: 1.61, 95%CI: 0.71-3.62, P = 0.252), stroke (OR: 1.45, 95%CI: 0.25-8.36, P = 0.680), and ST (OR: 0.76, 95%CI: 0.20-2.81, P = 0.677) were similar between prasugrel and ticagrelor, respectively. While the incidence of bleeding according to the Bleeding Academic Research Consortium definitions was also comparable (OR: 0.83, 95%CI: 0.45-1.52, P = 0.539), that according to the Thrombolysis in Myocardial Infarction criteria was lower in prasugrel than ticagrelor (OR: 0.49, 95%CI: 0.24-0.97, P = 0.042). CONCLUSIONS: Although the efficacy was similar between prasugrel and ticagrelor, prasugrel may be associated with a lower risk of bleeding compared with ticagrelor during short- to mid-term follow-up period after PCI. Further studies are warranted in a larger patient population during longer-term follow up to validate these findings.

Neural basis for the relationship between frequency of going outdoors and depressive mood in older adults.

OBJECTIVE: Low frequency of going outdoors (e.g. being homebound) is associated with depressive mood; however, the underlying neural mechanism of this association is unclear. We therefore investigated the neural substrate involved in the relationship between frequency of going outdoors and depressive mood using positron emission tomography (PET), focusing on the frontal lobe and the limbic system. METHODS: One hundred fifty-eight community-dwelling older adults aged 65-85 years underwent PET with 18 F-fluorodeoxyglucose to evaluate regional cerebral metabolic rates of glucose normalized in reference to cerebellar glucose metabolic value (normalized-rCMRglc) in six regions of interest. We also assessed depressive mood, frequency of going outdoors, and potential covariates. Depressive mood was assessed using the Geriatric Depression Scale (GDS). RESULTS: The proportion of participants who reported low frequency of going outdoors (LG, every 2-3 days or less) was 36.1%. The LG group showed significantly higher GDS scores than those who reported high (once a day or more) frequency of going outdoors. A multiple linear regression analysis adjusted for potential covariates showed higher GDS scores were associated with lower normalized-rCMRglc in the ventrolateral prefrontal and orbitofrontal cortices. Adjusting for frequency of going outdoors, the association between GDS score and normalized-rCMRglc in the orbitofrontal cortex was attenuated. CONCLUSIONS: Our results suggest that the orbitofrontal cortex may mediate the relationship between low frequency of going outdoors and depressive mood among community-dwelling older adults. These findings may help disentangle the role of going outdoors in regulating brain function to improve and/or maintain mental health among community-dwelling older adults. Copyright © 2016 John Wiley & Sons, Ltd.

Self-estimation of physical ability in stepping over an obstacle is not mediated by visual height perception: a comparison between young and older adults.

Older adults tend to overestimate their step-over ability. However, it is unclear as to whether this is caused by inaccurate self-estimation of physical ability or inaccurate perception of height. We, therefore, measured both visual height perception ability and self-estimation of step-over ability among young and older adults. Forty-seven older and 16 young adults performed a height perception test (HPT) and a step-over test (SOT). Participants visually judged the height of vertical bars from distances of 7 and 1 m away in the HPT, then self-estimated and, subsequently, actually performed a step-over action in the SOT. The results showed no significant difference between young and older adults in visual height perception. In the SOT, young adults tended to underestimate their step-over ability, whereas older adults either overestimated their abilities or underestimated them to a lesser extent than did the young adults. Moreover, visual height perception was not correlated with the self-estimation of step-over ability in both young and older adults. These results suggest that the self-overestimation of step-over ability which appeared in some healthy older adults may not be caused by the nature of visual height perception, but by other factor(s), such as the likely age-related nature of self-estimation of physical ability, per se.