DGBI (disorders of gut-brain interaction) is an important disease with dysmotility of the gastrointestinal tract, and we review the latest findings and our novel approach to the pathological evaluation of DGBI. For diseases of the esophagus, we have developed a nasal endoscopic ultrasonographic method for evaluation of motility, which allows assessment of esophageal wall distensibility disorders. For DGBI of the small intestine, we developed an ileus tube-based motion evaluation method and applied it clinically to differentiate between chronic idiopathic pseudo-obstruction and adhesive bowel obstruction. In the case of chronic constipation, he described the evaluation of the condition and treatment strategy using extracorporeal ultrasound, as well as a new treatment approach for hypoesthesia of the rectum. These innovative diagnostic and evaluation methods are expected to contribute to the elucidation of the pathophysiology of DGBI, promote personalized medicine, and improve the quality of life of patients.

　Sleep Apnea Syndrome (SAS) is a condition characterized by repeated pauses in breathing during sleep, leading to a state of hypoxia in the body. Common symptoms include daytime sleepiness, fatigue, and frequent nighttime urination. The syndrome is also associated with an increased risk of cardiovascular diseases such as hypertension, heart failure, and arrhythmias. The causes are broadly classified into Obstructive Sleep Apnea Syndrome (OSAS), which is primarily due to upper airway obstruction, and Central Sleep Apnea Syndrome (CSAS), which results from abnormalities in the respirator y center. Diagnostic tests are generally divided into simple screening tests and comprehensive polysomnography, depending on the parameters measured. Treatment depends on the severity of apnea and the patient’s overall condition. It includes lifestyle modifications such as smoking cessation, reducing alcohol intake, and weight loss if overweight. Discontinuing or reducing benzodiazepines may also effective. Oral appliances, positional therapy, and surgical interventions can also be beneficial. For patients with an apnea-hypopnea index (AHI) of 20 events per hour or greater, CPAP (Continuous Positive Airway Pressure) is the first-line therapy. However, adherence can be poor, and for those unable to tolerate CPAP, hypoglossal nerve stimulation (HNS) has recently attracted attention as an alternative treatment, now covered by health insurance in Japan.

　Over the past two decades, the management of Alzheimer’s disease has undergone significant changes, including the development of tests to quantify the disease state and the advent of antibody therapies. Looking ahead, it is anticipated that dementia treatment strategies combining the following approaches will become more widespread, with the aim of delaying onset: ① Intervention targeting risk factors ② Early detection of mild cognitive impairment and early treatment with antibody therapies ③ Treatment using symptomatic improvement drugs.

　Diabetes increases susceptibility to frailty and sarcopenia, and frailty/sarcopenia are risk factors for diabetes onset in the elderly. Risk factors for frailty development in diabetes include elevated HbA1c, hypoglycemia, cardiovascular risk factors, macrovascular disease, and abdominal obesity. Furthermore, diabetic patients are prone to sarcopenic obesity, which has a higher risk of frailty, cardiovascular disease, and mortality. The mechanisms underlying the development of frailty and sarcopenia include insulin resistance, atherosclerosis, white matter lesions in the brain, inflammation, oxidative stress, and mitochondrial dysfunction. In our longitudinal study of outpatients at the Frailty Clinic, we identified the following risk factors for incident frailty: (1) Alteration of white matter integrity in the anterior thalamic radiations on brain MRI, (2) Elevated serum GDF15 levels and high red blood cell distribution width (RDW), (3) Low speed of ground reaction force during sit-to-stand movement, and (4) DASC-8 category II or higher.

　Dietary therapy for the prevention of frailty, and sarcopenia involves consuming an adequate amount of energy, protein, and vitamins, and the prevention from malnutrition. Exercise therapy includes aerobic exercise, resistance training, and multi-component exercise. Drug therapy involves the following key points: (1) Treatment that minimizes the risk of hypoglycemia, (2) Drug selection and dose adjustment based on renal function assessment, (3) Simplification of treatment to address poor medication adherence, and (4) Prevention of cardiovascular disease and chronic kidney disease (CKD) using SGLT2 inhibitors or GLP-1 receptor agonists. Glycemic control targets for older patients with diabetes are categorized into three groups based on cognitive function and ADLs using the DASC-8, and determined considering the presence of drugs of hypoglycemia risk. This categorization can also guide treatment decisions for older adults with diabetes. The Comprehensive Geriatric Assessment (CGA) should be conducted by the evaluation of the DASC-8, frailty/sarcopenia, nutrition, psychological status, medications, and social factors. Implementing frailty prevention, treatment simplification, and social interventions from Category II after the CGA, as well as the prevention of hypoglycemia and the reduction of cardiovascular disease/CKD risk using SGLT2 inhibitors and GLP-1 receptor agonists, constitutes individualized treatment for older adults with diabetes.

　Background: Cognitive decline increases with aging and olfactory dysfunction is often an early symptom of such impairment.

　Objective: We examined the relationship among cognitive function, olfactory function, and blood pressure (BP).

　Methods: The participants were 44 consecutive volunteers aged ≥ 60 years or older (age 71.0 ± 5.6 years) in the present study. We performed the Odor Stick Identification Test for the Japan (OSIT-J) as the olfactory test. Cognitive function was assessed using the Revised Hasegawa's Dementia Scale, the Trail Making Test (TMT-B), and the N-back task (1-back task). The systolic BP (SBP), diastolic BP (DBP), and brachial-ankle pulse wave velocity (baPWV) were measured.

　Results: Completion time on the TMT-B was significantly correlated with the OSIT-J score. The ％ correct on the 1-back task was significantly correlated with SBP and baPWV. Multiple regression analysis revealed that the OSIT-J score was a significant factor for completion time on the TMT-B, and SBP was a significant factor of the ％ correct on the 1-back task.

　Conclusion: Assessment of olfactory function and BP may provide an important information for early detection of cognitive decline in the older population.