As a purpose of the long term care insurance in Japan, which was inaugurated in 2000, the achievement of "self-support" of aged people was stressed, which means, the prevention of fragility and senility. This system incorporated the new prevention service of "yo-shien" since its beginning. After 5 years experience since 2000, this preventive service was not always found to be effective. Therefore a new procedure of rehabilitation was introduced in 2006, mainly to strengthen the impaired muscle strength to achieve self-support. This new service was evaluated after few years experience and found to be effective in preventing the aggravation of disability and in suppressing the total cost of insurance, compared with control group. To prevent the fragility and senility of aged people, this preventive procedure in the long term care insurance will be effective.
Causes of falling are multi-factorial. Although it is not easy to identify specific causes of falling, it is necessary to detect the significant causes of falling in each individual. In particular, use of medications and indoor hazards are important factors. We need to give instructions to families who live together with older persons how to avoid dangers of falling. Exercise has been proven to provide beneficial effects to prevent falling, however it is necessary to consider exactly what and how much exercise one should prescribe to elderly individual who are at high risk of falling. In other words, it is important to give best approach to prevent falling after considering the status of the elderly.
Methods: Comprehensive questionnaires encompassing physical, psychological, and social aspects were administered by interview to 56 elderly outpatients with diabetes mellitus. Life satisfaction was assessed using the Life Satisfaction Index K (LSIK) . We also assessed the emotional and instrumental social support provided by the families living along with the participants or living separately from the participants. The Index of Social Interaction (18 items) was used to assess the social relationships and the environmental social resources, which were classified into 5 domains: 1) independence, 2) social curiosity, 3) relationships with other people, 4) participation in the community, and 5) feelings of safety. Results: In a univariate analysis, the presence of diabetic neuropathy and pain in the lower back or knee joints were associated with low LSIK scores. Community participation, social curiosity, relationships with other people, and instrumental support from families living together with the participants positively correlated with high LSIK scores. The LSIK scores of the leaders of the diabetes patient group were higher than the scores of those who only participated in the diabetes patient group. In a multiple linear regression analysis, community participation, instrumental support from families living along with the participants, and the absence of neuropathy were independently associated with high LSIK scores. Conclusion: Community participation is an important factor associated with life satisfaction in elderly people with diabetes mellitus.
Aim: Mild cognitive impairment (MCI) is considered to refer to a transitional zone between normal cognitive function and dementia. It comprises a heterogenous condition with a variety of clinical outcomes. The purpose of this study was to determine whether combined analysis of brain imaging studies, including MRI and single photon emission computed tomography (SPECT) , and assessment of awareness of memory deficits is useful in predicting Alzheimer disease (AD) in subjects with MCI. Methods: Thirty-nine patients with amnestic MCI [21 patients who had developed AD (MCI/AD) and 18 patients who did not develop AD (MCI/MCI) during a 2.5 to 3-year follow-up] and 19 patients with early AD were included in the study. The entorhinal cortex z-score in each patient was calculated using voxel-based morphometry with 3D T1-weighted MRI (software: VSRAD) . SPECT data were analyzed by the three-dimensional stereotactic surface projection method and posterior cortical hypoperfusion was qualitatively assessed. Awareness of memory deficits was evaluated with a standardized memory questionnaire system based on the Everyday Memory Checklist (EMC) . The discrepancy between these scores (caregiver rating-patient rating) was analyzed. Results: The MCI/AD group showed a tendency toward higher z-scores in the entorhinal cortex on MRI scan, a significantly higher frequency of posterior hypoperfusion on SPECT scan, and significantly more impaired awareness of memory deficits than in the MCI/MCI group. These findings were more severe and more frequent in the AD group than in the MCI/AD and MCI/MCI groups. A combined study of MRI, SPECT, and awareness of memory deficits yielded a higher level of discrimination between MCI/AD and MCI/MCI group results than in each separate study. Conclusion: A combined study of brain imagings (MRI and SPECT) and an assessment of awareness of memory deficits may improve the prediction of the development of AD in subjects with amnestic MCI.
Aim: The aim of this study was to examine the practical value of measurement of lower limb loading force to predict independent transfer ability in elderly patients with impairments. Methods: The subjects were 83 elderly patients with impairments (34 men and 49 women aged 79.9±6.1 [mean±SD]) . Their level of independent transfer ability was classified into 3 groups based on Functional Independence Measure (FIM) scores. The lower limb loading force was measured in both lower limbs at the same time, and converted to body weight ratio as a percentage. We compared it with the level of independent transfer ability as a factor in a one-way analysis of variance and multiple comparison test, and examined it with independent and non-independent transfer ability using a receiver operating characteristic (ROC) curve. Results: A statistically significant effect was found in the level of independent transfer ability, and also in transfer ability among all groups. On examining the ROC curve, the area under the curve was 0.84, and a cut-off value of 52.6% had a strong sensitivity for independence (77%) and specificity (81%). With in that cut-off value, the positive predictive value was 71%, the negative predictive value was 86%, and the accuracy of diagnosis was 80%. Conclusion: This study suggests that the lower limb loading force in elderly patients with impairments reflects closely the level of transfer ability, and independent or non-independent transfer ability can be accurately predicted.
A 72-year-old woman was admitted to a local hospital with general fatigue, ptosis and dysarthria. Her anti-AchR antibody titer was high, so myasthenia gravis was diagnosed. She was given a cholinesterase inhibitor, but her symptoms did not improve. CT and MRI scans revealed a mass in the anterior mediastinum infiltrating the superior vena cava (SVC) and the right atrium (RA) . The diagnosis was an invasive thymoma extending into the SVC and the RA. Moreover, there was a mass in the right middle lobe of her lung, which was suspected to be the result of metastasis of the thymoma. She was transferred to our hospital for medication and surgery for the invasive thymoma. Urgent surgery was performed without preoperative therapy, because the tumor was nearly obstructing her tricuspid valve. An expanded thymomectomy and a right middle lobectomy were performed. As the tumor had infiltrated into the SVC, the SVC was replaced with an artificial graft. The clinicopathological diagnosis of thymoma (Masaoka Stage IVb) was given. The patient had a myasthenic crisis for several weeks after surgery, so her breathing was controlled by an artificial respirator. Her symptoms improved after treatment with steroids, tacrolimus and a cholinesterase inhibitor. Although major surgery was required to prevent tumor embolism, the patient survived. Careful observation is necessary to detect signs of relapse of invasive thymoma.