Prevalence and associated factors of locomotive syndrome in young Japanese adults: a cross-sectional study.

BACKGROUND: The onset of locomotive syndrome (LS) precedes that of frailty. Therefore, the first step in extending healthy life expectancy is to implement measures against LS in young adults. The aim of this study was to investigate the prevalence of LS and its associated factors in young adults for early detection and prevention of LS. METHODS: The participants of this study comprised 413 university students specializing in health sciences (192 males and 221 females) with an average age of 19.1 ± 1.2 years. All participants voluntarily participated in the study and reported no serious health problems. The presence or absence of LS was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale. Additionally, musculoskeletal assessment (one-leg standing, squatting, shoulder elevation, and standing forward bend), body composition analysis (weight, body mass index, body fat mass, body fat percentage, skeletal muscle mass index (SMI), and phase angle), handgrip strength test, physical activity assessment, and nutritional assessment were conducted. Sex-stratified analyses were performed, comparing groups with and without LS. Factors associated with LS were explored using binomial logistic regression. RESULTS: Of the 413 young adults studied, 86 individuals (20.8%) were found to have LS. When stratified by sex, LS was observed to have a considerably higher prevalence in females (55, 24.9%) than in males (31, 16.1%). In males, the notable differences between the groups with and without LS were observed in one-leg standing and phase angle, whereas in females, differences were identified in body fat mass, body fat percentage, SMI, musculoskeletal pain, and handgrip strength. Two types of binomial logistic regression analysis revealed that the inability to perform one-leg standing was associated with LS in males, while the presence of musculoskeletal pain and a high body fat percentage were identified as factors associated with LS in females. CONCLUSIONS: One in five young adults were found to have LS in this study, underscoring the necessity for early intervention and LS health education. Furthermore, effective management of musculoskeletal pain is also crucial.

Neck circumference is a highly reliable anthropometric measure in older adults requiring long-term care.

The reliability of neck circumference measurement as an assessment tool for older adults requiring long-term care remains unknown. This study aimed to evaluate the reliability of neck circumference measurement in older adults requiring long-term care, and the effect of edema on measurement error. Two physical therapists measured the neck circumference. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were performed to examine the reliability of neck circumference measurement. Correlation analysis was used to evaluate the relationship between edema values (extracellular water/total body water) and neck circumference measurement difference. For inter-rater reliability of neck circumference measurement, the overall ICC (2,1) was 0.98. The upper and lower limits of the difference between examiners ranged from -0.9 to 1.2 cm. There was no association between edema values and neck circumference measurement error. Thus, measurement of the neck circumference in older adults requiring long-term care is a reliable assessment tool, with a low error rate, even in older adults with edema.

Minimal Detectable Changes in the Five Times Sit-to-Stand Test in Older Japanese Adults with Sarcopenia Requiring Long-Term Care.

Background and Objectives: Although the importance of sarcopenia control has been suggested, there are no minimal detectable change (MDC) studies of older adults with sarcopenia, to our knowledge, and the criteria for determining the effectiveness of interventions are unknown. The purpose of this study was to calculate the MDC in the five times sit-to-stand test (FTSST) in older Japanese adults with sarcopenia and use it as an index to determine the effectiveness of future interventions. Materials and Methods: This was a cross-sectional study conducted in January and February 2023. The participants of this study were older Japanese adults using daycare rehabilitation. Thirty-eight participants performed the FTSST twice a week. Grip strength, walking speed, and skeletal muscle mass were measured to determine the presence of sarcopenia. The diagnosis of sarcopenia was defined as low skeletal muscle mass and low muscle strength and/or low physical function, based on the Asian Working Group for Sarcopenia 2019 diagnostic criteria. Participants were further classified as sarcopenic or non-sarcopenic. Intraclass correlation coefficients (ICCs) and MDCs were calculated for the overall, sarcopenia, and non-sarcopenia groups using the two FTSST measures. The average and difference of the two variables were used to calculate the MDC. Results: Overall, the ICC (1,1) was 0.94, MDC was 2.87 s, and MDC% was 23.3%. The sarcopenia group had an ICC (1,1) of 0.93, MDC of 3.12 s, and MDC% of 24.0%. The non-sarcopenia group had an ICC (1,1) of 0.95, MDC of 2.25 s, and MDC% of 19.2%. Conclusions: Despite the limitation of the data being only from this study population, we found that a change of ≥3.12 s or ≥24.0% in the FTSST of older adults with sarcopenia was clinically meaningful and may help to determine the effectiveness of sarcopenia treatment. The improvement or decline in older Japanese adults with sarcopenia should be determined by changes in the FTSST over a longer period of time than that for other conditions.

Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care.

AIM: Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care. METHODS: The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs. RESULTS: Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001). CONCLUSIONS: Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumference is suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.

Effect of bihemispheric transcranial direct current stimulation on distal upper limb function and corticospinal tract excitability in a patient with subacute stroke: a case study.

Introduction: Activation of the unaffected hemisphere contributes to motor function recovery post stroke in patients with severe upper limb motor paralysis. Transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation to increase the excitability of motor-related areas. tDCS has been reported to improve upper limb motor function; nonetheless, its effects on corticospinal tract excitability and muscle activity patterns during upper limb exercise remain unclear. Additionally, it is unclear whether simultaneously applied bihemispheric tDCS is more effective than anodal tDCS, which stimulates only one hemisphere. This study examined the effects of bihemispheric tDCS training on corticospinal tract excitability and muscle activity patterns during upper limb movements in a patient with subacute stroke. Methods: In this single-case retrospective study, the Fugl-Meyer Assessment, Box and Block Test, electromyography, and intermuscular coherence measurement were performed. Intermuscular coherence was calculated at 15-30 Hz, which reflects corticospinal tract excitability. Results: The results indicated that bihemispheric tDCS improved the Fugl-Meyer Assessment, Box and Block Test, co-contraction, and intermuscular coherence results, as compared with anodal tDCS. Discussion: These results reveal that upper limb training with bihemispheric tDCS improves corticospinal tract excitability and muscle activity patterns in patients with subacute stroke.

Characteristics of falls and their fear in older adults requiring long-term care.

[Purpose] Older adults requiring long-term care have a higher rate of falls than older adults who do not. This study aimed to examine the relationship between falls and fear of falling and their characteristics from the perspective of older adults requiring long-term care based on a sub-item in the Modified Falls Efficacy Scale. [Participants and Methods] This study included 51 older adults who were certified as needing long-term care. Fear of falling was measured using the Modified Falls Efficacy Scale. The Modified Falls Efficacy Scale and basic information, such as cognitive function, history of falls, level of care required, and age, were collected and analyzed based on the fall or non-fall groups. [Results] The fall and non-fall groups had 27 and 24 participants, respectively. Comparisons between the groups showed significant differences in the Modified Falls Efficacy Scale scores. Binomial logistic regression analysis results showed that "crossing the street (pedestrian crossing)" was significantly associated with falls (odds ratio=0.75). [Conclusion] In this study, falls were associated with fear of falling; specifically, among the Modified Falls Efficacy Scale items, "crossing the street (pedestrian crossing)" was significantly associated with falls.

Sarcopenia with Depression Presents a More Severe Disability Than Only Sarcopenia among Japanese Older Adults in Need of Long-Term Care.

Background and objectives: The combination of depression and sarcopenia, a condition prevalent worldwide, may cause dis-tinct problems that should not be underestimated. However, to the best of our knowledge, no reports have investigated the combined effects of depression and sarcopenia. In this study, we compared physical function, nutritional status, and daily functioning among older adults with only depression (OD), those with only sarcopenia (OS), and those with sarcopenia with depression (SD) to examine the effects of the combination of depression and sarcopenia. Materials and Methods: The participants were 186 communi-ty-dwelling older individuals who required support or care. The participants were classified into four groups based on the presence or absence of sarcopenia and depression: Control, OD, OS, and SD. The following parameters were evaluated in the four groups: grip strength, walking speed, skeletal muscle mass index (SMI), Mini Nutritional Assessment Short-Form (MNA-sf), and long-term care certification level. In addition, univariate and multivariate analyses of the survey results were performed to identify risk factors leading from OS to SD. Results: We found that 31.2% of older participants who needed support or nursing care had SD, which had more pronounced adverse effects on grip strength, walking speed, SMI, MNA-sf, and level of nursing care than OD or OS. Furthermore, multivariate analysis of SD vs. OS showed that decreased grip strength and worsening MNA-sf were independent risk factors. Conclusions: SD is common among older individuals living in the community. Patients with SD require support and care, and the condition has a greater impact on physical function, nutritional status, and decline in life function compared to OD and OS. Therefore, it is desirable to elucidate the process leading to SD and investigate the risk factors and prognosis. It is expected that sarcopenia with depression will be investigated worldwide in the future.

Leg skeletal muscle mass asymmetry is independently associated with gait speed in older adults requiring long-term care.

AIM: Decreased gait speed in older adults has been associated with incident disability, cognitive impairment, institutionalization, falls, deterioration in level of care, and mortality. Gait speed has been reported to be related to leg asymmetry. However, the relationship between gait speed and leg skeletal muscle mass asymmetry in older adults requiring long-term care has not been clarified. In this study, we examined the association between gait speed and leg skeletal muscle mass asymmetry and the cutoff values of leg skeletal muscle mass asymmetry that may affect gait speed. METHODS: The asymmetry index of leg skeletal muscle mass was measured in 230 older adults under the Japanese long-term care insurance system using bioelectrical impedance analysis. This cross-sectional study used multiple regression analysis and receiver operating characteristic (ROC) curve analysis to determine the relationship between gait speed and the asymmetry index of leg skeletal muscle mass. RESULTS: Multiple regression analysis revealed that the asymmetry index of leg skeletal muscle mass (ß = -0.19, P = 0.002, R2 = 0.261) was independently and significantly associated with gait speed. Furthermore, ROC analysis showed that the cutoff value of the asymmetry index of leg skeletal muscle mass that identified reduced gait speed (<1.0 m/s) was 3.02% (Area under the curve = 0.62, sensitivity 47.3%, specificity 81.0%, P = 0.014). CONCLUSIONS: The asymmetry index of leg skeletal muscle mass was associated with gait speed in older adults requiring long-term care. Future assessment and interventions directed towards symmetry of leg skeletal muscle mass may help to improve gait speed in older adults. Geriatr Gerontol Int 2023; 23: 371-375.

Indicators predicting the development and improvement of sarcopenia in older adults requiring long-term care.

[Purpose] This study aimed to identify factors associated with sarcopenia development and improvement among older adults requiring long-term care. [Participants and Methods] This prospective observational study included 118 older adults requiring long-term care in a single facility. Sarcopenia was assessed according to the 2019 diagnostic criteria of the Asian Working Group for Sarcopenia at baseline and after 6 months. Nutritional status was measured using calf circumference and the Mini Nutritional Assessment-Short Form to examine the association between sarcopenia onset and improvement. [Results] Risk of malnutrition and lower calf circumference at baseline were significantly associated with sarcopenia development. The study also showed that a non-risk of malnutrition, higher calf circumference, and higher skeletal muscle mass index were significantly associated with improved sarcopenia. [Conclusion] The Mini Nutritional Assessment-Short Form and calf circumference were able to predict sarcopenia development and improvement in older adults requiring long-term care.

Patterns of Changes in Respiratory Muscle Strength over 1 Year in Non-Sarcopenia, Sarcopenia, and Severe Sarcopenia.

In this prospective longitudinal cohort study, we explored the characteristics of older people with lower respiratory muscle strength, according to sarcopenia severity, over the course of 1 year. The maximum expiratory pressure (MEP), grip strength, walking speed, and skeletal muscle mass index of 58 participants (28 men, 30 women; mean age, 76.9 ± 7.7 years) were measured at baseline and at the 1-year follow-up. Participants were classified into a decreased MEP group (n = 29; MEP decreased by ≥10% after 1 year) and a non-decreased MEP group (n = 29; MEP decreased by <10%). Sarcopenia status in the mild direction at baseline was significantly associated with MEP decline after one year. Repeated two-way analysis of variance showed significant main effects of measurement time (p < 0.001) and severity of sarcopenia (p = 0.026), as well as a significant interaction effect (p = 0.006). Surprisingly, MEP decreased significantly in the non-sarcopenia and sarcopenia groups, but not in the severe sarcopenia group. Thus, individuals without sarcopenia and those with moderate sarcopenia at baseline are predisposed to MEP decline and should be closely monitored for signs of such decline and associated adverse events.

Assessing nutritional status in older adults requiring long-term care: Interchangeability of bioelectrical impedance analysis and manual methods for upper arm anthropometric measurements.

AIM: In older adults, arm circumference and arm muscle circumference are common nutritional assessment tools. Bioelectrical impedance analysis devices can automatically measure arm circumference and arm muscle circumference. However, the interchangeability of the measurements made by bioelectrical impedance analysis with the actual manual measurements has not been clarified. This study examined the interchangeability of these two measurements and their relationship with sarcopenia. METHODS: The interchangeability between bioelectrical impedance analysis and manual arm circumference and arm muscle circumference measurements was calculated using Bland-Altman analysis in 112 older adults certified to require long-term care in the Japanese system. Furthermore, multivariate analysis was used to investigate the association between arm circumference and arm muscle circumference obtained using the bioelectrical impedance analysis method and sarcopenia. RESULTS: The bioelectrical impedance analysis and manual methods were interchangeable, with a percentage error of <15% (arm circumference 13.54% and arm muscle circumference 13.54%) for the upper arm anthropometric measurement. In multivariate analysis, decreased arm muscle circumference was significantly associated with sarcopenia risk. CONCLUSIONS: Values obtained using the bioelectrical impedance analysis method were interchangeable with the values obtained using manual measurement. This shows that upper arm anthropometric measurement using bioelectrical impedance analysis might be useful as a nutritional assessment tool for older adults requiring long-term care. Geriatr Gerontol Int 2022; 22: 938-942.

Neck circumference may predict sarcopenia in Japanese older adults requiring long-term care.

Several studies have established the advantage of using anthropometric measurements as indicators of sarcopenia. Nevertheless, no study has explored the association between sarcopenia and neck circumference. In this cross-sectional study, we examined the data of 90 older adults requiring long-term care to evaluate this association and establish cut-off points for individuals at risk of sarcopenia as defined by the Asian Working Group for Sarcopenia (AWGS) 2019. A significant association was found between sarcopenia and neck circumference using binomial logistic regression and receiver operating characteristic analyses. The optimal cut-off value for neck circumference associated with increased risk for sarcopenia among older adults was 32.8 cm for females and 38.0 cm for males. Given the potential of declining neck circumference as an anthropometric marker of sarcopenia, it has clinical applications in screening for sarcopenia in older adults requiring long-term care.

Features of older community-dwelling adults with osteosarcopenia requiring support or care.

[Purpose] This study aimed to investigate the problems associated with osteosarcopenia and its effect on physical performance, nutritional status, and support or care required by older community-dwelling adults. [Participants and Methods] This study investigated 141 older community-dwelling adults requiring support or care using an ambulatory rehabilitation service. The patients were divided into a control, osteopenia only, sarcopenia only, and osteosarcopenia group. We investigated the associations of each condition with the baseline information, grip strength, gait speed, Mini Nutritional Assessment-Short Form score, and support or care level required. [Results] The osteosarcopenia group consisted of 43.3% of the total study participants. Osteosarcopenia was more closely associated with body mass index, support or care level, grip strength, gait speed, skeletal muscle mass index, and Mini Nutritional Assessment-Short Form score than osteopenia or sarcopenia alone. [Conclusion] Osteosarcopenia is highly prevalent in older community-dwelling adults requiring support or care, which may suggest a greater effect on physical performance, nutritional status, and support or care required than that exerted by osteopenia or sarcopenia alone.

Maximum Phonation Time is a Useful Assessment for Older Adults Requiring Long-term Care/support.

OBJECTIVE: The maximum phonation time (MPT) is used to assess simple respiratory functions and can be performed anywhere without special instruments. We investigated the association between MPT and respiration, considering the future utilization of simple respiratory assessments during home-based physical therapy. METHOD: This cross-sectional study included 140 older adults enrolled in Japanese long-term care insurance (77 men, 63 women; mean age, 77.9±8.0 years). The participants performed the MPT, followed by spirometry. We analyzed the MPT of the three age groups, relative reliability of the MPT values, and the association between MPT and respiratory function. RESULTS: We found that the MPT of older men requiring long-term care or support was related to age. The intraclass correlation coefficient of MPT was >0.8 for all groups. Only forced vital capacity was associated with MPT in the partial correlation and multiple regression analyses. CONCLUSION: MPT could be an alternative assessment of respiratory function in home-based physical therapy for older adults requiring long-term care or support.

[An improved driving ability after attention function training for safe driving via use of a day rehabilitation service in a patient with cerebral infarction].

In recent years, the assessment of and support for the safety of driving for people with higher brain dysfunction to allow them to resume car driving have become issues to be addressed in Japan. It is difficult to determine whether or not people with higher brain dysfunction may safely resume car driving; in addition, methods of supporting this resumption have not been established. To support people with higher brain dysfunction and allow them to live at home in areas where public means of transportation may be insufficient, initiatives promoting the resumption of car driving are necessary in healthcare sectors, including day rehabilitation facilities. We provided support to a patient with an attention disorder due to left thalamic infarction, with the aim of achieving sufficient independence to drive a car, in a day rehabilitation facility. We herein report this case from the perspective of a speech-language-hearing therapist. The patient was a right-handed man in his 60s who had higher brain dysfunction with attention disorder as the main symptom. No marked motor paralysis of the extremities was observed. Use of a day rehabilitation service was started approximately two months after the onset of symptoms. Rehabilitation and support aimed at the resumption of car driving were provided approximately one month after the start of the day rehabilitation service use. To determine whether or not the patient was fit to drive a car, higher brain function tests for the intellectual function, attention function, and frontal function, as well as a theoretical evaluation based on the Stroke Drivers' Screening Assessment Japanese Version (J-SDSA) and monitoring of daily behaviors were performed. In addition, after the patient was given permission from an attending physician to drive a car on the condition that the patient did not drive fast and the patient's wife always accompanied him while driving, a safety assessment was also performed. As a result, approximately 10 months later, the J-SDSA theoretical evaluation score showed a passing grade, in contrast to the failing grade he had previously earned. Furthermore, errors in performing household activities due to a decreased attention function became unremarkable with respect to daily behaviors; therefore, we determined, together with the attending physician, that the patient now had sufficient independence to drive a car. In our day rehabilitation facility, the number of requests for advice on car driving from people with higher brain dysfunction living in the community had been increasing. Multisectoral assessments, training, and instruction should be continued in collaboration with attending physicians, other facilities located within the community, and driving schools in order to support people with higher brain dysfunction and help them once again be able to drive a car.

Sarcopenia is not associated with inspiratory muscle strength but with expiratory muscle strength among older adults requiring long-term care/support.

BACKGROUND: Recently, the concept of respiratory sarcopenia has been advocated, but evidence is lacking regarding which respiratory parameters are appropriate indicators. Therefore, we investigated the association between sarcopenia, respiratory function, and respiratory muscle strength to identify the most appropriate parameters for respiratory sarcopenia. METHODS: We included 124 older adults (67 men, 57 women; average age 77.2 ± 8.3 years) requiring long-term care/support who underwent Day Care for rehabilitation. Handgrip strength, usual gait speed, and skeletal muscle mass were measured using bioelectrical impedance analysis. Participants were then diagnosed with sarcopenia using the algorithm of the Asian Working Group for Sarcopenia 2019. Parameters of respiratory function (forced vital capacity, forced expiratory volume in one second [FEV1.0], FEV1.0%, and peak expiratory flow rate) and respiratory muscle strength (maximal expiratory pressure [MEP] and maximal inspiratory pressure) were also measured according to American Thoracic Society guidelines. Respiratory parameters significantly related to sarcopenia were identified using binomial logistic regression and receiver operating characteristic analyses. RESULTS: Seventy-seven participants were classified as having sarcopenia. Binomial logistic regression analysis showed that MEP was the only respiratory parameter significantly associated with sarcopenia. The cut-off MEP value for predicting sarcopenia was 47.0 cmH20 for men and 40.9 cmH20 for women. CONCLUSIONS: The most appropriate parameter for assessing respiratory sarcopenia may be MEP, which is an indicator of expiratory muscle strength, rather than FVC, MIP, or PEFR, as suggested in previous studies. Measuring MEP is simpler than measuring respiratory function parameters. Moreover, it is expected to have clinical applications such as respiratory sarcopenia screening.

[A patient with mesenteric lymphoma who developed amyotrophic lateral sclerosis and sepsis].

We treated a patient with mesenteric lymphoma who concomitantly developed amyotrophic lateral sclerosis (ALS). The patient died of urinary tract infection nine months after the onset of ALS. We herein report the changes in the patient's condition and the sequence of events until death from the viewpoint of a physiotherapist. The patient was a 69-year-old woman who developed mesenteric lymphoma in September of X year and perceived weakness in the toes in November of X year. She showed signs of upper and lower motor neuron disorders, and electrophysiologic testing revealed denervation in three areas of the spinal cord. In March of X+1 year, she was diagnosed with definite ALS based on the Awaji criteria. In April of X+1 year, she began to receive continuous home healthcare, specifically outpatient rehabilitation. No remarkable bulbar palsy was observed soon after the initiation of rehabilitation; however, manual muscle testing revealed strengths in the lower and upper limbs of 1 and 3-5, respectively, indicating muscle weakness and muscle atrophy. She developed exacerbation of neurological symptoms in the upper limbs, bulbar palsy, and respiratory muscle paralysis during rehabilitation. The ALS Functional Rating Scale-Revised indicated a decreased tendency to X [please define X]. In July of X+1 year, the mesenteric lymphoma had enlarged, resulting in the development of ureteric obstruction and ultimately causing hydronephrosis. Urinary tract infection and sepsis were diagnosed, and she was hospitalized. Although her fever temporarily subsided following ceftriaxone administration, she ultimately died due to a systemic inflammatory response syndrome three days after hospitalization. The mean period between the ALS onset and death is reportedly 40.6±33.1 months. The rate of ALS progression differs among individuals. Malignant tumors and paraneoplastic neurological syndrome may be involved in rapidly worsening neurological symptoms. Patients who concomitantly develop motor neuron disorders and malignant tumors are likely to have a higher risk of developing serious conditions associated with the exacerbation of neurological symptoms and complications. Our patient had several diseases that affected her survival prognosis; however, the sharing of information regarding her condition among healthcare professionals may have been insufficient. The primary physician responsible for treating each disease should cooperate with physiotherapists and other paramedical staff who have frequent opportunities to talk to patients in daily clinical practice. In geriatric patients in particular, such an environment is essential.