In sarcopenia, muscle volume and strength decrease with ageing, disturbing activity of daily life in the elderly. We investigated risk factors of sarcopenia including life-style, nutrition intake and past history in randomly selected community living population aged 40 years and over. The subjects were 1,783 men and 1,825 women. They were followed up 10 years and repeatedly measured, we made a total of 14,010 measurements. Smoking, lack of exercise, shortage of energy, protein, branched-chain amino acid intake, and low self-rated health were risk factors of sarcopenia determined by muscle volume in dual-energy x-ray absorptiometry (DXA). Risk factors of sarcopenia determined by physical performance were also investigated in subjects aged 65 years or over. Smoking increased risk of sarcopenia, and intakes of total energy, vitamin D, protein and branched-chain amino acid significantly decreased risk of sarcopenia. However, physical activity was not related to incidence of sarcopenia.
Objective: To investigate the effectiveness of exercise alone in improving frailty, and exercise with nutritional supplementation in improving sarcopenia. Methods: Frailty: 131 community-dwelling elderly people over 75 years of age were randomly assigned to either the exercise group (n=66) or the control group (n=65). The exercise group was provided with a 60-minute comprehensive exercise program twice a week for 3 months. Sarcopenia: 155 community-dwelling elderly people over 75 years of age were randomly assigned to the exercise + amino acid group (n=39), exercise group (n=39), amino acid group (n=39) or control group (n=38). The exercise intervention included a comprehensive training program for 60 minutes, provided twice a week for 3 months. The amino acid group ingested a leucine-rich essential amino acid supplementation (6 g/day) for 3 months. Results: Frailty: in comparison to the non-frail elderly, muscle mass, bone mineral density, knee extension strength, and walking speed were significantly lower in the frail elderly; however, pain, fall rate, and osteoporosis history were greater in the frail elderly. The exercise intervention significantly improved bone mineral content and grip strength. Sarcopenia: appendicular skeletal muscle mass and walking speed were significantly improved by exercise or amino acid supplementation. However, muscle strength improved significantly only in the exercise + amino acid intervention. Conclusion: In the frail elderly, exercise was effective in enhancing bone mineral content and muscle strength; however, in order to increase leg muscle mass and strength in sarcopenic elderly, both exercise and amino acid supplementation may be necessary.
Aim: The clinical guidelines for idiopathic normal pressure hydrocephalus (iNPH) in Japan recommend cerebrospinal fluid (CSF) drainage. The positive response rate of the diagnostic CSF drainage is not very high because brain MRI findings of Alzheimer disease (AD) are similar to those of iNPH. Therefore, we sought to determine simple, quantitative indexes of head MRI to differentiate iNPH from AD and to predict positive response of the CSF drainage in possible iNPH. Methods: Eighteen patients with the clinical criteria of possible iNPH who had undergone diagnostic CSF drainage were evaluated. Nineteen patients with the clinical criteria of probable AD were used as controls. VSRAD, Evans index, and previously reported indicators were measured on brain MRI in all patients. These parameters were compared between AD and iNPH, and between iNPH responders and non-responders. Results: VSRAD, Evans index, bifrontal index, width and height of the temporal horn, and the maximum height of the Sylvian fissure were higher in iNPH than AD. The cutoff value of the bifrontal index, width and height of the temporal horn, and maximum height of the Sylvian fissure were 0.31, 6.0 mm, 3.13 mm, and 7.6 mm, respectively. The minimum thickness of the medial temporal lobe was higher in the CSF drainage responders than the non-responders. The cutoff value of the minimum thickness of the medial temporal lobe was 11.0 mm. Conclusions: Our results suggest that simple image indexes of brain MRI could distinguish iNPH from AD and predict positive response to CSF drainage in iNPH.
Aim: It is important to promote self-efficacy for exercise for developing exercise habit. The purpose of this study was to investigate factors influenced by self-efficacy for exercise among community-dwelling elderly men in urban areas. Methods: The subjects were 69 elderly men (mean age of 74.2±2.0 SD) who had given approval for participation in the study. We examined the following factors: family situation, history of falls, frequency of going out, stage model of a change, self-efficacy for exercise, fall efficacy scale (FES), geriatric depression scale (GDS), subjective health, functional ability and motor function (5 m walking time, chair stand test-5times). Analysis of variance was used to assess a stage model of a change differences in self-efficacy for exercise and other measures. Correlation analysis and multiple regression analysis were performed to determine the relationships between self-efficacy for exercise and other measures. Results: We found that self-efficacy of exercise, FES, GDS (p<0.01) and CST (p<0.05) vary depending on the stage model of change. Self-efficacy for exercise was found to correlate with psychological factors and functional ability (|r|=0.47-0.67). Multiple regression analysis revealed that the independent factors related to self-efficacy for exercise were FES and GDS. Conclusion: FES and GDS were found to be significant and independent predictors of self-efficacy for exercise in community-dwelling elderly men in urban areas. We should consider not only the approach based on behavioral science but also mental support for depression and fear of falling to promote exercise self-efficacy.
Aim: Bedridden elderly persons requiring care need special body-weight measurement implements, and body-weighting assumes more difficult if they live at their own homes. Therefore, we tried to design a new weight-estimation formulae using various anthropometric variables. Method: The subjects were 33 male and 132 female elderly inpatients certified to be at care level 4 or 5. The body composition included height, body weight, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, calf circumference, and waist circumference. Results: We studied the correlation between the body weight and each anthropometric variable and age. In men, the highest correlation with body weight was shown by waist circumference (r=0.891, p<0.0001), followed by age (r=0.779, p<0.0001) and calf circumference (r=0.614, p<0.0001). The variables that showed the highest correlation with body weight in women were waist circumference (r=0.806, p<0.0001), followed by triceps skinfold thickness (r=0.723, p<0.0001) and arm circumference (r=0.662, p<0.0001). The weight estimation formulae were obtained by multiple regression analysis. Formulae for men: body weight=0.660×waist circumference (cm)+0.702×calf circumference (cm)+0.096×age (years)-26.917 (R2=0.862, p<0.001); formulae for women: body weight=0.315×waist circumference (cm)+0.684×arm circumference (cm)+0.183×height (cm)-28.788 (R2=0.836, p<0.001). Conclusion: We successfully developed gender-specific weight-estimation formulae with high coefficients of determination. The results suggest that waist circumference, which is an index of visceral fat, is an effective anthropometric variable to estimate the body weight of bedridden elderly patients requiring care.
Aim: The purpose of this study was to evaluate whether physical activities reduce the risk of cognitive decline in community-dwelling elderly. We investigated correlations between cognitive functions at baseline and physical activities, correlations between cognitive functions at baseline and cognitive decline over 4 years, as well as correlations between physical activity at baseline and cognitive decline over 4 years. Methods: At baseline, 2,431 community-dwelling elderly completed the cognitive screening by telephone (TICS-J), and answered the questionnaires about physical activities. Of these, 1,040 subjects again completed the TICS-J over 4 years. Physical activities contained moving ability, walking frequency, walking speed, the exercise frequency. Results: At baseline, 870 elderly (age 75.87±4.96 (mean±SD) years, duration of education 11.05±2.41) showed normal cognitive functions and 170 (79.19±6.22, 9.61±2.23) showed cognitive impairment. The total TICS-J score was significantly higher in cognitive normal subjects compared with that of cognitive impaired subjects (36.02±1.89, 30.19±2.25, respectively, p<0.001). Logistic regression analyses showed that moving ability significantly reduced the risk of cognitive impairment in an unadjusted model, and walking speed also reduced the risk of cognitive impairment at baseline even in an adjusted model. Cognitive function at baseline might be a predictor of cognitive function over 4 years. The longitudinal study revealed that walking speed and exercise frequency significantly correlate with maintenance of cognitive function over 4 years. Conclusions: This study provides that physical activities, especially walking speed have significant correlation with cognitive function.
Aim: To investigate the relationship between depression and fall risk in the elderly. Methods: Residents of a village in Kumamoto Prefecture, Japan (563 people), aged ≥65 years were given a self-administered questionnaire survey between June and July 2010. To evaluate depression status and fall risk, the Geriatric Depression Scale -Short Form and the Simple Screening Test for Risk of Falls were administered. Adjustment factors assessed were age, sex, medical history for diseases associated with falls, usage of hypnotics, and cognitive dysfunction. We examined the relationship between depression and fall risk using multiple logistic regression analysis. Given that some degree of correlation was expected among adjustment factors in the model, we constructed a model that introduced the adjustment factors stepwise to confirm the robustness of the model and any effect of multicollinearity. Results: Overall (n=395), after excluding data from participants with significant cognitive disturbance or severe physical problems from among valid responders, a significant relationship was found between depression and fall risk in all models. The odds ratio was 2.28 (95% confidence interval: 1.31-3.96) in the final model, controlling for all adjustment factors. Conclusion: Our findings suggest a significant relationship between depression and fall risk in the elderly. This relationship implies that the improvement of depression could be an effective measure to decrease fall risk in the elderly.
Aim: To identify the effect of aging on urinary bladder function, the maximal volume, post-voiding residual of the urinary bladder, mean urine flow rate, and urine volume were examined during micturition after drinking water (500-700 ml). Methods: Bladder volume, post-voiding residual, mean urine flow rate, and urine volume during micturition were measured in young (22±3 yr, n=12) and elderly women (64±3 yr, n=6). Results: The maximal urinary bladder volume was not significantly different (P>0.05) between young and elderly women (576±158 vs. 505±119 ml). In contrast, post-voiding residual volume was greater (88±52 ml, P<0.05) in elderly than in 34±40 ml in young women. Accordingly, urine volume was decreased to 418±155 ml in elderly compared to the volume in young women (556±141 ml). Although mean urine flow rate of 16 ml/s was equivalent between young and elderly women, the time period necessary for voiding was 27±6 s in elderly women, shorter (p<0.05) than the period for 43±24 s in young women. Conclusion: It is suggested that contraction of the urinary bladder in elderly women is not so sustained as in young women, causing a greater post-voiding residual volume of the urinary bladder.
Aim: Malnutrition is common in the hospitalized elderly with hip fractures and has been linked to poorer recovery and increased complications. Hence, the aim of this study is to investigate whether nutrition support team (NST) intervention has a beneficial effect on rehabilitation outcome in the elderly, especially in the oldest-old patients with hip fracture using the Functional Independence Measure (FIM). Method: Patients were classified into two groups before and after NST intervention, and we evaluated FIM gain, FIM efficacy, and discharge outcomes. Every item was compared in low-ADL patients with an FIM of 54 or less on admission. Results: The numbers of patients were 18 in the non-NST and 22 in the NST group. Although nutritional indicators on admission showed no significant difference in the groups, FIM gain and FIM efficacy were significantly higher (p<0.01) and walking ability at discharge was better in the NST group (p<0.05). In low-ADL patients, the same results were confirmed. Conclusion: Although the malnourished patients often have a poor prognosis, there was a significant improvement in rehabilitation effect and discharge outcome in the NST group. Thus, these results suggest the effectiveness of multidisciplinary NST intervention. Moreover, even in elderly patients with low ADL on admission, significant effect of rehabilitation can be expected by appropriate nutritional management.
A 67-year-old man started to show symptoms of dementia and developed convulsions accompanied by presyncope. Since an old cerebral infarction was found, he was given a diagnosis of symptomatic epilepsy, treated with antiepileptics. Dementia progressed rapidly, resulting in admission to a dementia ward. There were no physical abnormalities, and only slight elevations of LDH and CRP were noted. He suddenly developed a fever between 38°C and 39°C. Only the serum concentration of soluble IL-2 receptor was elevated at 6,430 U/L. Although a malignant tumor of the lymphatic system was suspected, there was no swelling noted in the superficial lymph nodes. The patient suddenly developed hypoxemia, thrombocytopenia, and an increase in fibrin degradation products. Pulmonary thromboembolism was suspected, but contrast-enhanced chest CT did not reveal any abnormalities. Bone marrow aspiration did not detect any infiltrations of lymphoid cells but was suggestive of hemophagocytic syndrome. After that, a new cerebral infarction occurred. Based on the course, intravascular lymphoma, which causes microvascular occlusions in various organs, was considered probable. Prednisolone was administered at a dose of 60 mg daily and skin biopsy was scheduled. However, the patient experienced a sudden deterioration and died. In autopsy, immunostain with CD20 showed that the arteriolae, capillaries, and venulae of thoracic and abdominal organs were filled with cells of large B-cell lymphoma. The presence of similar cerebrovascular lesions was not confirmed, but can reasonably be speculated. Thus, the present case suggests that it is necessary to consider intravascular lymphoma when dementia rapidly progresses for unknown reasons.