Aim: The purpose of this study was to investigate the effect of balance exercise considering cognitive function on Functional Reach Test (FRT) and Body Sway (BS) for the frail elderly. Methods: We enrolled 23 frail elderly (4men and 19women, mean age 81.5±4.8SD) who had given approval for participation in the study. They were divided into two groups at random: the balance exercise group (the control group) and the cognitive group (balance exercise considering cognitive function; task difficulty, internal observation). Postural balance exercise continued for 4 weeks, one session being 5 minutes, two or three times weekly. The control and intervention subjects were tested before the exercise, at the end of the trial, and 4 weeks after the exercise. Results: There was no change on walking speed in both groups. At the post-exercise stage, the cognitive subjects showed improved FRT and BS. In contrast there were not many significant improvements in the controls. At 4 weeks after the exercise, BS of the cognitive subjects showed continued improvements. Conclusion: These findings indicate that balance exercise considering cognitive function can improve standing posture balance in the frail elderly. The result showing continued improvements suggested that task difficulty in need of attention and judgment, and internal observation have an influence on the process of motor learning.
Aim: Purple urine bag syndrome is a condition in which the urinary catheter bag turns purple. A tryptophan-indigo hypothesis has been proposed as the mechanism of PUBS, in which bacterial decomposition of tryptophan in gut associated with chronic constipation, bacterial overgrowth in the urinary tract and alkaline urine causes production of indigo and discoloration. We considered that further investigation of cases was needed. Methods: We investigated 6 cases exhibiting PUBS (3 males and 3 females). Results: All cases had chronic constipation. Oral ingestion was impossible in one case. PUBS disappeared after antibiotic treatment (3 cases) or spontaneously (one case). Alkaline urine and indicanuria were not found in all cases that showed the disappearance of PUBS. In bacterial culture of urine during the exhibition of PUBS, Enterococcus faecalis was isolated together with Morganella morganii (3 cases) and Pseudomonas aeruginosa (one case). Single infections by Klebsiella pneumoniae or Citrobacter species were also found. After disappearance of PUBS, infected bacterial species changed but no cases showed sterile urine. Urine and blood α-amino-n-butyric acid levels reduced after the disappearance of PUBS whereas tryptophan levels did not show related changes. In one case, blood protein concentration increased after the spontaneous disappearance of PUBS. Indicanuria and alkalization of urine from urinary catheter bag were more intense than of fresh urine. Conclusions: The present results generally support the 'Tryptophan-indigo hypothesis'. Furthermore, it was suggested that additional factors associated with the occurrence of PUBS are an environment that facilitates specific bacterial growth in a hospital as well as abnormal metabolism relating to α-amino-n-butyric acid and reduced protein synthesis in patients.
Aim: Few studies have reported the influence of declining labial closure force on ADL among frail elderly persons. We therefore investigated to elucidate the relationships among labial closure force, ADL and cognitive function in frail elderly persons. Methods: The subjects were 92 frail elderly persons. Labial closure forces were examined using "Lip De Cum". The ADL and cognitive status of the subjects were evaluated using the ADL20 scale and HDS-R respectively. Furthermore, the symptoms related to dysphagia and salivation were evaluated by a patient-reported outcome. Results: The labial closure force was significantly related to total score and each sub-score of the ADL20 scale, and it was also related to HDS-R score. Furthermore, the labial closure force was significantly associated with salivation and 5 symptoms related to dysphagia as follows: weight loss, episodes of pyrexia, difficulties in swallowing, food falling from the mouth, sensation of food being stuck in the esophagus. Conclusion: Labial closure force among frail elderly persons correlated with ADL and cognitive function. These findings suggest that declining labial closure force is closely related with decreasing comprehensive physical and mental activities.
Aim: Fall prevention is important for elderly people to maintain their functional independence. We made a longitudinal fall-risk assessment using our "Fall-predicting score" of women who are 60 years or older and who exercised regularly. Methods: We sent "fall-predicting questionnaires" to 632 elderly women aged 60 years or older (mean 65.0±4.3), members of "Miishima gymnastics program", and asked about their fall history of falling in the past year in 2004 and 2005. We performed a logistic regression analysis to determine the future risk factor of falling in 2005. Results: The number of people who fell was 134 (21.2%) in 2004 and 121 (19.1%) in 2005. The number of people who fell decreased in the seventh decade, but increased in the eighth decade, and members for 6-10 years showed most decreased fall rates. Logistic regression analysis revealed that age, falls in 2004, "tripping", "cannot squeeze a towel", and "walk steep slope around the house" were significant independent risk factors of "falls in 2005". Logistic regression analysis of non-fallers in 2004 showed that age and "tripping" were the significant independent risk factors of "falls in 2005", and the analysis of people who fell in 2004 showed that age, "tripping", "cannot squeeze a towel", "walk steep slope around the house", and "taking more than 5 medicines" were significant independent risk factors for falls in 2005. Conclusions: In regular exercising elderly women, exercise appears to prevent falls in people in the seventh decade and in the members of 6-10 years. Age, past history of falls, and fall-predicting questionnaire were important risk predictors of future falls.
Aim: The purpose of this study was to evaluate whether the Telephone Interview for Cognitive Status in Japanese (TICS-J) is accepted among community-dwelling elderly, to examine the correlations among gender, age or the duration of education and the TICS-J, as well as to grasp the subjects with probable cognitive impairment. Methods: A total of 12,059 community-dwelling elderly were invited to join the cognitive screening by the TICS-J, among which 3,482 responded, of these we were actually able to measure 2,620 and found out the educational back ground of the 2,431. They counted 1,186 men (age 72.3±5.7 (mean±SD) years old, duration of education 11.4±2.9 years) and 1,245 women (72.4±5.8, 10.3±2.2). The TICS-J was administered according to the TICS manual. The TICS-J consisted of orientation concerning name, time and place, counting backward from 20 to 1, remembering a word list, 7 serial subtractions, naming of verbal descriptions, repetition, recent memory, praxis and opposites. The subjects were divided into two groups by the duration of education (less than 11 years, or 11 years or more), or four groups by age (65-69, 70-74, 75-79 and 80 years old or more). Results: There were no significant differences of total TICS-J scores between men and women, 34.3±3.5 and 34.4±3.6, respectively. The mean total score of the high education group (35.3±3.0) was significantly higher than that of the low education group (33.3±3.8). Moreover, the averages of the total scores decreased according to age increase. The number of the subjects who showed the total TICS-J scores below the cut-off point of 33 was 564 (23.2%). Conclusions: There was no difference between men and women with the average total score of the TICS-J, however, there were correlations between ages and extent of education and their average total scores. The TICS-J is useful to assess the cognitive function of the community-dwelling elderly.
Aim: The present study examined the association of pain coping strategy with pain and activity restriction among middle-aged and elderly women with the knee pain. Methods: The participants were 134 female community residents (62.1±8.2 years) with knee pain. The pain and activity restriction were assessed with the Japanese Knee Osteoarthritis Measure (JKOM). The pain coping strategy was evaluated using the Japanese short version of the Coping Strategy Questionnaire (CSQ). A theoretical model was developed to explain the relationships among age, pain, activity restriction, and pain coping strategy. This model was then tested using structural equation modeling (SEM). Results: The overall fit index was adequate for the final model (GFI=.980, AGFI=.946, CFI=.995, RMSEA=.022). SEM indicated that increasing age had a significant association with increasing pain, and indirect influence on progressive activity restriction. Also, aggravating pain was significantly associated with adopting more "praying or hoping", "catastrophizing", and "increasing pain behavior" as pain coping strategy, and indirectly affected progress in activity restriction. Conclusions: The results indicate that reducing the use of maladaptive coping strategy would be important to promote the ability of pain self-management among middle-aged and elderly women with knee pain. The present study suggests that it would be necessary to incorporate the cognitive-behavioral approaches in order to modify the use of maladaptive coping strategy in existing therapeutic exercise intervention for knee pain.
A 64-year old woman visited our outpatient clinic with chronic headache on August 30th, 2005. She had been sufferring from migraine from her 30's. Although sumatriptan improved her symptoms, migraine attacks had occurred every other day recently. At presentation, her headache was moderate in intensity and lasted about four hours. Daily activity worsened her pulsating headache associated with nausea and vomiting. She diagnosed with migraine without aura, which met the diagnostic criterion for migraine by International Classification of Headache Disorders. Lomerizine was administered as a prophylactic agent, however it did not reduce the frequency of migraine attacks. Accordingly, lomerizine was withdrawn from November 2005. Her blood pressure gradually increased during the course, and amlodipine, 2.5 mg/day, was started for her hypertension May 2007. After starting amlodipine, she noticed a reduction in migraine attacks, only two times a month in August 2007. Assessment with the HIT-6 questionnaire showed great improvement in her QOL score for daily life. Although the underlying mechanisms have not been elucidated, amlodipine was effective in reducing migraine attacks in this patient. The findings in this case may suggest that amlodipine administration might be a useful strategy to control migraine attack.