Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 43 , Issue 1
Showing 1-29 articles out of 29 articles from the selected issue
  • Tatsuro Kaminaga
    2006 Volume 43 Issue 1 Pages 1-6
    Published: January 25, 2006
    Released: March 02, 2011
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    fMRI (functional MRI) is a major tool to study the location of sites in the human brain. It has a time resolution of several seconds and spatial resolution on the order of 1mm and is superior to other tools for studying functional sites in the human brain in area recognition inside the brain. Simultaneous use with electroencephalography and near-infrared spectroscopy improves the time resolution. To plan and perform fMRI studies, and to interpret the resulting data, various skills are required. These include knowledge of the task design and processing the fMRI data, mainly with statistical parametric mapping. In addition, it is desirable for the result to be verified by another method such as positron emission tomography. To protect the safety of the subject, it is extremely important to know the contraindications of exposing the subject to a strong magnetic field. Many epoch making results have been reported in the field of human brain mapping using fMRI and this method continues to provide excellent results if it is performed carefully by a team of professionals in various fields.
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  • Osamu Kawakami, Yuichiro Kato, Toshiki Ota
    2006 Volume 43 Issue 1 Pages 7-18
    Published: January 25, 2006
    Released: March 02, 2011
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  • Katsunori Kondo
    2006 Volume 43 Issue 1 Pages 19-26
    Published: January 25, 2006
    Released: March 02, 2011
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  • Hajime Orimo
    2006 Volume 43 Issue 1 Pages 27-34
    Published: January 25, 2006
    Released: March 02, 2011
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    Over the past 10 years (1992-2002) the physical activity of healthy elderly (over 65) has been more youthful by 7.5 years in men and 10 years in women. Functional independence in elderly diabetic patients (over 65) has been more youthful by 15 years. pathological examination revealed that the cerebral arteries have been more youthful by 20 years in men and 10 years in women during the past 14 years (1986-2000). Based on these data, the current definition of elderly (65 year over) should be changed to those over 75 years. Changing the social system (retirement, pension, medical care etc.) to harmonize with the coming aging society is a matter of great urgency.
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  • Tatsuo Suda
    2006 Volume 43 Issue 1 Pages 35-38
    Published: January 25, 2006
    Released: March 02, 2011
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  • Hiroshi Hagino, Hiroshi Katagiri
    2006 Volume 43 Issue 1 Pages 39-41
    Published: January 25, 2006
    Released: March 02, 2011
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  • Takayuki Hosoi
    2006 Volume 43 Issue 1 Pages 42-44
    Published: January 25, 2006
    Released: March 02, 2011
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  • Masataka Shiraki
    2006 Volume 43 Issue 1 Pages 45-47
    Published: January 25, 2006
    Released: March 02, 2011
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    Recent progress in osteoporosis treatment has realized prevention of osteoporotic fractures. However, there is no guideline regarding which agent should be used in an individual patient. In this report, we investigated the effectiveness of several drugs for osteoporosis in a head-to-head comparative study. A total of 776 osteoporotic patients were treated with alendronate (ALN, n=197), etidronate (EHDP, n=199), alfacalcidol (VD3, n=221) and vitamin K2 (K2, n=159). The control group (No, n=266) was followed without treatment. We followed their lumbar bone mineral density (LBMD), bone turnover markers (DPD or NTX or BAP) and presence or absence of incident vertebral fractures for more than 3 years. The mean age was 70 years old. The increase in LBMD after the treatment was highest in ALN treated group (8%) followed by EHDP (6%), VD3 (1-0%) and K2 (-2%). For the change in bone turnover marker after the treatment, ALN and EHDP treated groups showed significant decrease in bone resorption markers but not the VD3 and K2 treated groups. ALN group exhibited more powerful inhibition of fracture rate (Odds ratio 0.305 versus the control, p<0.01) than the other groups (Odds ratios 0.604-0.668 versus the control, p<0.05). ALN treatment has achieved a wide range effectiveness regardless of fracture risk. On the other hand, EHDP showed significant inhibition of fracture in low risk osteoporosis. VD3 or K2 treated groups did not inhibit new fracture occurrence in low risk osteoporosis but did so in high risk osteoporosis suggesting that those agents may improve bone quality.
    In conclusion, ALN is thought to be the first line drug in terms of fracture prevention in osteoporosis and the other drugs should be given to the patients who could not recieve ALN.
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  • Shigeto Morimoto, Shoshi Takamoto
    2006 Volume 43 Issue 1 Pages 48-51
    Published: January 25, 2006
    Released: March 02, 2011
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  • Yuji Hanawa
    2006 Volume 43 Issue 1 Pages 52-54
    Published: January 25, 2006
    Released: March 02, 2011
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  • Kunimitsu Moriya
    2006 Volume 43 Issue 1 Pages 55-57
    Published: January 25, 2006
    Released: March 02, 2011
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  • Momoko Yamazaki
    2006 Volume 43 Issue 1 Pages 58-61
    Published: January 25, 2006
    Released: March 02, 2011
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    In Japan there is a serious problem that we will have to face and handle, which is the super aging of society around 2010. According to the Universal Model of the WHO, ICF (International Classification of Functioning, Disability and Health) addresses, aging is one of such disabilities (underline). Since we all become old, we have to consider the impact of this new concept and deal with it in this aging society. Therefore it is important to clarify what a quality welfare service is. I believe the quality of welfare service is based on the understanding of human needs. In other words, a high quality of welfare services will match needs of both providers and recipients.
    At this point, I define two services, offered and required. I collected, classified and analyzed the data from this institution using technological methods. Summarizing the data, I created three tables. Then I examined them with Maslow's need-hierarchy-theory. I got another figure of possibility α for improvement. As the result of my study it should be designed to fulfill the desire and/or needs of who continue rehabilitation process to achieve their ultimate goal of independence and self-realization.
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  • Tomotaka Sobue
    2006 Volume 43 Issue 1 Pages 62-64
    Published: January 25, 2006
    Released: March 02, 2011
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  • Kenji Toba
    2006 Volume 43 Issue 1 Pages 65-67
    Published: January 25, 2006
    Released: March 02, 2011
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  • Kenichi Sugihara
    2006 Volume 43 Issue 1 Pages 68-70
    Published: January 25, 2006
    Released: March 02, 2011
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  • Tsuneharu Miki
    2006 Volume 43 Issue 1 Pages 71-73
    Published: January 25, 2006
    Released: March 02, 2011
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  • Motoo Tsushima
    2006 Volume 43 Issue 1 Pages 74-77
    Published: January 25, 2006
    Released: March 02, 2011
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  • Satoshi Inoue
    2006 Volume 43 Issue 1 Pages 78-80
    Published: January 25, 2006
    Released: March 02, 2011
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  • Shiro Kamakura
    2006 Volume 43 Issue 1 Pages 81-83
    Published: January 25, 2006
    Released: March 02, 2011
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  • Masao Nagata
    2006 Volume 43 Issue 1 Pages 84-86
    Published: January 25, 2006
    Released: March 02, 2011
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    Diabetes Mellitus is thought as the presymptomatic stage to cause various vascular diseases. From the point of view that diabetes is already a disease, this paper discusses the prevention of the manifestation of diabetes in the elderly. STOP-NIDDM study demonstrated that acarbose, an α-glucosidase inhibitor, reduced the onset of diabetes in impaired glucose tolerance (IGT) subjects by 24%. On the other hand, the Diabetes Prevention Program (DPP) study for IGT subjects revealed that intensive life style intervention prevented diabetes most powerfully by 58% and metformin treatment also reduced by 31%. Furthermore, HOPE, LIFE, and SCOPE studies against hypertension showed that ACI or ARB reduced diabetes by 20-32%, and the WOSCOT study that pravastatin, a HMG-CoA reductase inhibitor, reduced diabetes by 30%. These accumulated results suggest that the most suitable strategy to prevent diabetes in the elderly is intensive life style intervention, and in cases incapable of exercise and diet therapy, acarbose or metformin are recommended for IGT. When associated with hypertension and/or hyperlipidemia, the subjects have to receive ACI or ARB and statins to prevent diabetes.
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  • Hiroyuki Umegaki
    2006 Volume 43 Issue 1 Pages 87-88
    Published: January 25, 2006
    Released: March 02, 2011
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  • Ken Shinmura
    2006 Volume 43 Issue 1 Pages 89-91
    Published: January 25, 2006
    Released: March 02, 2011
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    Overeating and obesity are major health problems even in the elderly since they lead to the metabolic syndrome, resulting in an increase in cardiovascular disease. The development of novel nutritional therapeutics for the purpose of promoting health and controlling ageing process aims at the self-helping elderly. Caloric restriction (CR) has been widely investigated as a powerful method that can prevent and reverse senescent changes. CR might counteract the deleterious aspects of metabolic syndrome and may prolong lifespan even in humans. However, we should keep in mind that several fundamental issues about CR still remain unsolved. In addition, malnutrition and nutritional troubles are emerging problems in the elderly in care. Thus, we emphasize that nutritional intervention aiming at ageing control should be established and be developed as a custom-made therapeutics for the elderly, who show great individual variation.
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  • Megumi Ueno, Sachio Kawai, Tairai Mino, Hiroshi Kamoshita
    2006 Volume 43 Issue 1 Pages 92-101
    Published: January 25, 2006
    Released: March 02, 2011
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    Background: Fall-related factors and individual characteristics of the elderly who have had fall are necessary to develop practical fall prevention programs, and life support management. However, no nation-wide meta-analysis of the fall-related factors of elderly has been performed in Japan.
    Objectives: To conduct a meta-analysis concerning fall-related factors among the house-dwelling elderly in Japan.
    Data sources: Japana Centra Revuo Medicina, version 3 (systematic literature search system for Japanese literature), and Pub Med (a service of the National Library of Medicine) from January 1994 to December 2003.
    Methods: Study search terms included the following: retrograde case-control, prospective cohort, and retrospective cohort study with falls. Search terms included older adults (60 years and over), falls and humans. Thirty-two fall-related factors were meta-analyzed.
    Results: Among 32 fall-related factors, only nine factors were statistically proven to be related to falls. These factors were female gender, age over 70 years old, fall experience, past history of cerebrovascular disease, grip strength, knee extensor strength, one foot standing time with eyes open, one foot standing time with eyes closed, and skinfold thickness (female). Eleven factors: presence of a spouse, past medical history of hypertension, complaints of dizziness, numbness of the extremities, 10 meter maximum walking velocity, tendency to stumble, use of supportive equipment, standing postural sway, sitting trunk flexion, skinfold thickness (male), and body mass index, were not statistically proven to be related to falls.
    Conclusions: More studies are necessary to determine the efficacy of fall-related factors among the Japanese elderly.
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  • Toru Seki, Shuichi Awata, Yayoi Koizumi, Shigeo Kinomura, Yasuyuki Tak ...
    2006 Volume 43 Issue 1 Pages 102-107
    Published: January 25, 2006
    Released: March 02, 2011
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    Aim: We conducted a community-based study to verify relationships between cerebrovascular lesions (CVL) on magnetic resonance imaging and depressive symptoms (DS) in elderly individuals, and the validity of Krishnan's MRI-defined vascular depression (MRI-VD).
    Methods: MRI was performed in 196 community-dwelling elderly individuals (mean age, 72.3±1.7 years; range, 70-75 years) with a Mini Mental State (MMS) score of 22 or more who participated in the comprehensive geriatric assessment. The DS (+) group consisted of 41 subjects with Geriatric Depression Scale (GDS) score of 15 or more. The DS (-) group consisted of 141 subjects with a GDS score of 9 or less. Hyperintensities of deep white matter and subcortical gray matter were scored according to the modified Fazekas criteria. The CVL score was defined as the higher of the two scores, and 3 grades were defined as scores of 0, 1, or 2 or more. According to Krishnan's MRI-VD, a CVL score of 2 or more was defined as CVL (+). Logistic regression analyses were used to test associations between CVL and DS, and univariate analyses were used to examine differences in clinical features between CVL (+) and CVL (-) within the DS (+) group.
    Results: Logistic regression analysis adjusting for age, sex, cognitive function, educational level, instrumental activities of daily life (IADL) and subjective healthiness, CVL scores of 1 and 2 or more displayed significant associations with DS compared with a score of 0. However, no significant differences in DS were found between CVL (+) and CVL (-). Within the DS (+) group, no significant differences were noted between CVL (+) and CVL (-) in MMS, IADL, subjective healthiness, sleeping symptoms, alcohol-related problem or suicidal ideation.
    Conclusion: CVL was associated with DS independent of various confounders. However, clarification of clinical profiles is required to define MRI-VD as an independent clinical entity.
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  • Junko Okuno, Shigeo Tomura, Hisako Yanagi
    2006 Volume 43 Issue 1 Pages 108-116
    Published: January 25, 2006
    Released: March 02, 2011
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    Aim: The number of users of long-term care insurance has been increasing rapidly since it started in 2000. The number of those who want to enter the long-term care insurance facilities has increased. Although the basic philosophy of long-term care insurance is independence support and self-decision, to enter a facility or home return from facilities is likely to be decided by family caregivers, not by the elderly themselves. Moreover, the number of elderly who return home from welfare facilities is decreasing. We investigated the intension of caregivers who are willing to accept the institutionalized elderly at home and analyzed the factors affecting the acceptance of caregivers.
    Methods: Subjects were elderly who were in long-term care insurance facility in June 2004, and their caregivers. The study was conducted between June 2004 and September 2004 in Ibaraki Prefecture in Japan. A face-to-face interview based on a questionnaire was conducted for the institutionalized elderly and by the mail for the caregivers.
    Results: The caregivers of 34.6% of the elderly who hoped to return home intended to accept them home. There were differences between the plans of the elderly and caregivers. The risk factors (OR, 95%CI) to make the intention of the caregivers to accept the institutionalized elderly home difficult were level of cooperation with other family members to take care of elderly (OR 15.37, 2.05-115.24), dementia behavior disturbance category with more than one (OR 8.34, 1.02-68.05), time spending in bed of a day (OR 1.31, 1.01-1.71), few knowledge of long-term care insurance system of caregivers (OR 3.65, 0.81-16.38).
    Conclusion: It has been suggested that more physical activities in the facility, establishment of a care-system for the demented elderly living in the community and an educational campaign by the long-term care insurance system are necessary to increase the willingness of caregivers to accept home return of institutionalized elderly.
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  • Yasuyoshi Asakawa, Ryutaro Takahashi, Fumio Endo
    2006 Volume 43 Issue 1 Pages 117-121
    Published: January 25, 2006
    Released: March 02, 2011
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    Aim: Fall prevention programs for community-dwelling elderly people are carried out as part of disability-postponing programs in Japanese municipalities. This study examined how to design a fall prevention program for community health fair based on the characteristics of fall prevention strategies adopted by community-dwelling elderly women before attending community fall prevention programs.
    Methods: One hundred and four community-dwelling elderly women (71.7±6.3 years old) who were attending community fall prevention programs for the first time were asked about their strategies for fall prevention. Age, regular attendance at outpatient programs, the Tokyo Metropolitan Institute of Gerontology Index, and Timed Up&Go were determined as factors related to whether or not the women had strategies for fall prevention.
    Results: Sixty-four participants had their own strategies for fall prevention. Multiple logistic regression analysis showed that age (OR=1.10, 95%CI: 1.00-1.21) and regular attendance at outpatient programs (OR=4.77, 95%CI: 1.75-12.98) were significantly related to having fall prevention strategies. Timed Up&Go (OR=1.42, 95%CI: 0.95-2.13) had a weak relationship to having such strategies (P=0.085). The most common strategy was behavior such as lifting the toe when walking (n=38, 59.4%), followed by doing regular exercise (n=16, 25.0%). Few of the participants modified their environment (n=2, 3.1%).
    Conclusion: Community fall prevention programs for community-dwelling elderly women can motivate participants to develop interdisciplinary and comprehensive practices for fall prevention.
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  • Tokihisa Nagai, Tomoko Kido, Miwako Kido, Michiya Igase, Katsuhiko Koh ...
    2006 Volume 43 Issue 1 Pages 122-125
    Published: January 25, 2006
    Released: March 02, 2011
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    An 89-years-old woman had anorexia for at least 1 month, and had been given symptomatic treatment at a nearby hospital. She was admitted to our hospital on August 22, 2003, for thorough examination and appropriate treatment for lack of spontaneity and appetite loss. On admission, laboratory data revealed hyponatremia (125mEq/L) and hypoaldosteronism (0.7ng/mL). Since hyponatremia did not improve by intravenous drip with saline, we identified the major cause of her complaint as hypoaldosteronism. She was treated with fludrocortisone (0.05mg/day) and her condition improved immediately. Although she was discharged at that time, her condition shortly deteriorated. She was referred to our hospital on February 10, 2004 for medical treatment. On admission, inadequate oral intake, lack of spontaneity and weakness in her lower legs were noted. The plasma Na concentration was 127mEq/L. Nasogastric tube feeding was started to prevent aspiration pneumonia because of her dysphagia. Fludrocortisone was given (0.2mg/day), and she was able to swallow food without nasal feeding tube during the second month of therapy. Laboratory data including plasma natrium concentration were normal. Also she could perform bed-to-wheelchair transfer independently. This is a rare case of a critically ill elderly patient with hyponatremia caused by hypoaldosteronism possibly due to mineral corticoid-responsive hyponatremia of the elderly.
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  • Kenji Kamogawa, Kayo Tominaga, Kensho Okamoto, Bungo Okuda
    2006 Volume 43 Issue 1 Pages 126-131
    Published: January 25, 2006
    Released: March 02, 2011
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    We report 6 patients with Cheiro-oral syndrome (COS), with special reference to clinical features and responsible lesions. The time intervals from the onset of symptoms to arrival in our department were less than 24 hours in 3 patients, 2 days in 2, and 5 days in 1. All patients had subjective sensory disturbance involving the unilateral hand and ipsilateral perioral regions, and 4 patients presented with objective sensory disturbance. The body parts of tingling sensation tended to be larger than those of superficial sensory disturbance. Three patients developed motor disturbance including hemiparesis with or without ataxia, clumsiness of fine finger movements, and dysarthria. Magnetic resonance imaging revealed fresh infarctions around the thalamus, including lacunar infarctions in 5 patients and branch atheromatous disease in 1 patient. The lesion sites responsible for COS were ventral posterolateral (VPL) and ventral posteromedial (VPM) nuclei in the thalamus in 4 patients, thalamic pulvinar nucleus and medial geniculate body in 1, thalamic ventroposterior region-internal capsule-corona radiata in 1. Three patients had asymptomatic brain infarctions. Risk factors were hyperlipidemia, hypertension, diabetes mellitus, smoking, arteriosclerosis of the carotid artery, and polycythemia. In the convalescent stage, 5 patients suffered from residual sensory-motor disturbance, whereas 1 patient recovered from COS. COS has been attributed mainly to small infarctions in the thalamic ventroposterior nuclei. However, it is suggested that damage to ascending sensory fibers projecting to the thalamic VPL and VPM nuclei can cause COS. Because initial symptoms of COS are apt to be overlooked, early diagnosis and treatment are necessary to avoid residual sensory-motor disturbance.
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  • 2006 Volume 43 Issue 1 Pages 132-134
    Published: January 25, 2006
    Released: March 02, 2011
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