The neural substrate of gait and executive function relationship in elderly women: A PET study.

AIM: Understanding the relationship between age-related gait impairment, such as slow gait, and executive functioning in seniors may help identify individuals at higher risk of mobility decline, falls, and progression to dementia at earlier stages. We aim to identify brain regions concomitantly associated with poor gait and executive functioning in a cohort of well-functioning elderly women. METHODS: In total, 149 well-functioning women aged 70.1 ± 6.2 years underwent FDG-PET to evaluate regional cerebral metabolic rates of glucose normalized in reference to cerebellar glucose metabolic value (normalized-rCMRglc) in 16 brain areas. We assessed gait speed, step length and cadence under usual and fast conditions. Executive function was assessed using Trail-Making-Tests (TMT) A and B. RESULTS: Adjusted multiple regression analyses for potential covariates showed that TMT-B and ΔTMT (TMT B-A) were associated with gait speed and cadence at fast condition. Lower normalized-rCMRglc in the posterior cingulate and primary sensorimotor cortices were associated with longer TMT-B and ΔTMT times (i.e., lower executive function) as well as with slower gait speed and lower cadence at fast condition. Slower gait speed and lower cadence at fast condition were also associated with lower normalized-rCMRglc in the occipital and parietal cortices. There were no other significant associations. CONCLUSIONS: In healthy elderly women without impending disability or cognitive impairment, reduced glucose metabolism in the posterior cingulate and primary sensorimotor cortices were associated with both lower gait performance and executive functioning. Our results suggest that gait control and executive functions might share the same neural substrate. Geriatr Gerontol Int 2017; 17: 1873-1880.

Neural basis for the relationship between frequency of going outdoors and depressive mood in older adults.

OBJECTIVE: Low frequency of going outdoors (e.g. being homebound) is associated with depressive mood; however, the underlying neural mechanism of this association is unclear. We therefore investigated the neural substrate involved in the relationship between frequency of going outdoors and depressive mood using positron emission tomography (PET), focusing on the frontal lobe and the limbic system. METHODS: One hundred fifty-eight community-dwelling older adults aged 65-85 years underwent PET with 18 F-fluorodeoxyglucose to evaluate regional cerebral metabolic rates of glucose normalized in reference to cerebellar glucose metabolic value (normalized-rCMRglc) in six regions of interest. We also assessed depressive mood, frequency of going outdoors, and potential covariates. Depressive mood was assessed using the Geriatric Depression Scale (GDS). RESULTS: The proportion of participants who reported low frequency of going outdoors (LG, every 2-3 days or less) was 36.1%. The LG group showed significantly higher GDS scores than those who reported high (once a day or more) frequency of going outdoors. A multiple linear regression analysis adjusted for potential covariates showed higher GDS scores were associated with lower normalized-rCMRglc in the ventrolateral prefrontal and orbitofrontal cortices. Adjusting for frequency of going outdoors, the association between GDS score and normalized-rCMRglc in the orbitofrontal cortex was attenuated. CONCLUSIONS: Our results suggest that the orbitofrontal cortex may mediate the relationship between low frequency of going outdoors and depressive mood among community-dwelling older adults. These findings may help disentangle the role of going outdoors in regulating brain function to improve and/or maintain mental health among community-dwelling older adults. Copyright © 2016 John Wiley & Sons, Ltd.

The effect of intergenerational programs on the mental health of elderly adults.

OBJECTIVES: The aim of this study was to clarify the effect of an intergenerational program on elderly persons' symptoms of depressive mood and in improving their sense of coherence, which is an element for successful coping with stressors. METHOD: We evaluated an intervention research project (Research of Productivity by Intergenerational Sympathy [REPRINTS]), in which volunteers >65 years old read picture books to children in a school setting. The intervention group (REPRINTS) was recruited through intensive weekly training seminars for three months. The no-contact control group members were also recreated to participate in health checks and surveys for data collection purposes. Eventually, 26 participants in the intervention group and 54 in the control group were included for data analysis. RESULTS: The age or gender was not significantly different between the intervention and control groups. A two-way repeated-measures ANOVA shows a time × group significant interaction effects. Analyses of the simple main effects showed that sense of meaningfulness significantly increased for members of the intervention group at all terms, with no changes in the control group over time. Multiple mediation analysis revealed that participation in the intergenerational program was associated with a sense of manageability which was also significantly related to depressive mood. CONCLUSION: Intergenerational programs could serve as key health promoters among elderly people by decreasing the risk of social isolation and loneliness due to the greater sense of meaningfulness. However, given our limited sample size, generalizability was restricted and studies with larger cohorts are required to further validate our findings.

Cognitive intervention through a training program for picture book reading in community-dwelling older adults: a randomized controlled trial.

BACKGROUND: Non-pharmacological interventions are expected to be important strategies for reducing the age-adjusted prevalence of senile dementia, considering that complete medical treatment for cognitive decline has not yet been developed. From the viewpoint of long-term continuity of activity, it is necessary to develop various cognitive stimulating programs. The aim of this study is to examine the effectiveness of a cognitive intervention through a training program for picture book reading for community-dwelling older adults. METHODS: Fifty-eight Japanese older participants were divided into the intervention and control groups using simple randomization (n =29 vs 29). In the intervention group, participants took part in a program aimed at learning and mastering methods of picture book reading as a form of cognitive training intervention. The control group listened to lectures about elderly health maintenance. Cognitive tests were conducted individually before and after the programs. RESULTS: The rate of memory retention, computed by dividing Logical Memory delayed recall by immediate recall, showed a significant interaction (p < .05) in analysis of covariance. Simple main effects showed that the rate of memory retention of the intervention group improved after the program completion (p < .05). In the participants with mild cognitive impairment (MCI) examined by Japanese version of the Montreal Cognitive Assessment (MoCA-J) (n =14 vs 15), significant interactions were seen in Trail Making Test-A (p < .01), Trail Making Test-B (p < .05), Kana pick-out test (p < .05) and the Mini-Mental State Examination (p < .05). CONCLUSIONS: The intervention effect was found in delayed verbal memory. This program is also effective for improving attention and executive function in those with MCI. The short-term interventional findings suggest that this program might contribute to preventing a decline in memory and executive function. TRIAL REGISTRATION UMIN-CTR: UMIN000014712 (Date of ICMJE and WHO compliant trial information disclosure: 30 July 2014).

Regional cerebral glucose metabolism and gait speed in healthy community-dwelling older women.

BACKGROUND: The objective of this study was to investigate the relationship between normalized regional cerebral metabolic rates of glucose (normalized-rCMRglc) and gait function in physically and mentally high-functioning older women. METHODS: One hundred eighty-two community-dwelling older women (mean age [SD], 69.4 [6.6] years) without disability in instrumental activities of daily living and without mobility limitations underwent positron emission tomography with 18F-fluorodeoxyglucose at rest to assess brain activity associated with gait function. We measured normalized-rCMRglc in 16 regions of interest. Within 6 months of the positron emission tomography with 18F-fluorodeoxyglucose scan, gait speed, step length, and step frequency both at comfortable and maximum paces were measured as indices of gait function. Associations between normalized-rCMRglc and gait indices were examined with multiple linear regression analyses adjusted for demographic characteristics, including age, height, body weight, blood pressure, past illness, and education. RESULTS: Slower maximum gait speed even in the range of individual difference was associated with lower normalized-rCMRglc in the prefrontal, posterior cingulate, and parietal cortices. Lower step frequency at the maximum pace was also associated with lower normalized-rCMRglc in these regions. However, there was no significant association between step length at the maximum pace and normalized-rCMRglc or between all gait variables at a comfortable pace and normalized-rCMRglc. CONCLUSIONS: The normalized-rCMRglc values in specific regions were associated with individual differences in gait function, even in healthy older women. These regions of the cerebrum could play an important role in gait control. Understanding the cerebral glucose metabolism in these brain regions may enable early detection of mobility limitation.

[Social concern and the present state of intergenerational programs. An analysis of newspaper articles and a survey of organizations].

OBJECTIVES: The objectives of this study were (1) to clarify changes in social concern in intergenerational programs and (2) to determine the current state of and issues affecting intergenerational programs. METHODS: Articles including the words "intergenerational programs" were selected from 3 major Japanese newspapers (Asahi Shimbun, Yomiuri Shimbun, and Mainichi Shimbun) using an online database (399 articles). Content analysis was conducted to check changes in the number and content of articles. A total of 56 cases of intergenerational programs were selected, and a questionnaire survey was conducted with the responsible organization. The problems were classified using cluster analysis. RESULTS: Content analysis revealed that the number of articles relating to this topic increased towards the end of the 1990s, which corresponds with a change in social policy. The questionnaire survey revealed that most of the intergenerational programs were either annual or periodic activities. Furthermore, it was shown that the 4 main issues facing current intergenerational programs were the intergenerational gap, operating problems, activity selection, and lack of participants. CONCLUSION: In summary, social concern regarding the intergenerational programs has increased. However, most intergenerational programs were infrequent and quite time-intensive. Furthermore, the 4 issues mentioned above must be addressed in order to create programs that have wide-ranging benefits for each community. Resolving the problem of compartmentalized administration and appointing local coordinators is necessary to solve these problems.

"Moving Forward": Success from a Physiotherapist's Point of View.

PURPOSE: The purpose of this study was to capture the meaning of professional success to experienced physiotherapists practising in the Greater Toronto Area (GTA). METHODS: Using a qualitative, phenomenological approach, 10 physiotherapists from the GTA each participated in a 60-minute, semistructured, face-to-face interview. Interviews were transcribed verbatim and analyzed using the vanKaam method, modified by Moustakas. RESULTS: Participants described success as "moving forward," a dynamic and evolving experience that extends throughout an entire career. Study participants identified three markers of professional success: positive patient outcome, career advancement, and advancement of the physiotherapy profession. The experience of moving forward toward success applied to all of these markers and was driven by making choices. Choices made throughout a career were influenced by mentorship and self-reflection. CONCLUSIONS: The physiotherapists in this study described different indicators of success than have been described by other health care or corporate professionals in the literature. Success in the physiotherapy profession is experienced as a circular rather than linear process. Physiotherapists, professional organizations, and employers have a role in fostering professional success. We suggest the introduction of mentorship and self-reflection programmes early in one's career, focusing on the three markers of success: patient outcomes, career advancement, and advancement of the profession.