Effect of Simultaneous Dual-Task Training on Regional Cerebral Blood Flow in Older Adults with Amnestic Mild Cognitive Impairment.

BACKGROUND: No previous study has examined the effect of dual-task training using changes in regional cerebral blood flow (rCBF) using single-photon emission computed tomography (SPECT) as an outcome. OBJECTIVE: This study aimed to examine the effects of simultaneous dual-task training of exercise and cognitive tasks on rCBF using SPECT in older adults with amnestic mild cognitive impairment (aMCI). METHODS: In this non-randomized control trial, 40 older adults with aMCI participated from May 2016 to April 2018. Outpatients in the intervention group (n = 22) underwent 24 sessions (12 months) of dualtask training twice a month for 60 mins per session. Participants in the control group (n = 18) continued to have regular outpatient visits. The primary outcome was rCBF at baseline and after 12 months, which was compared in each group using the two-sample t-test. The secondary outcomes were the rate of reversion and conversion from aMCI after 12 months. RESULTS: Of the 22 participants in the intervention group, six dropped out; therefore, 16 were included in the analysis. The intervention group showed more significant increases in rCBF in multiple regions, including the bilateral frontal lobes, compared with the control group. However, the rates of reversion or conversion from mild cognitive impairment (MCI) were not significantly different. CONCLUSION: Dual-task training for older adults with aMCI increased rCBF in the frontal gyrus but did not promote reversion from MCI to normal cognition. Future intervention studies, such as follow-up examinations after the intervention, are warranted to consider long-term prognosis.

The Relationship between Sarcopenia and Respiratory Muscle Weakness in Community-Dwelling Older Adults.

An association between respiratory muscle weakness and sarcopenia may provide a clue to the mechanism of sarcopenia development. We aimed to clarify this relationship among community-dwelling older adults. In total, 117 community-dwelling older adults were assessed and classified into 4 groups: robust, respiratory muscle weakness, sarcopenia, and respiratory sarcopenia. The respiratory sarcopenia group (12%) had a significantly higher percentage of males and had lower BMI, skeletal muscle index, skeletal muscle mass, phase angle, and oral function than the robust group (32.5%). All physical functions were significantly lower. The respiratory muscle weakness group (54.7%) had a significantly lower BMI and slower walking speed, compared with the robust group. The sarcopenia group (0.8%) was excluded from the analysis. The percent maximum inspiratory pressure was significantly lower in both the respiratory muscle weakness and respiratory sarcopenia groups, compared with the robust group. Almost all participants with sarcopenia showed respiratory muscle weakness. In addition, approximately 50% had respiratory muscle weakness, even in the absence of systemic sarcopenia, suggesting that respiratory muscle weakness may be the precursor of sarcopenia. The values indicating physical function and skeletal muscle mass in the respiratory muscle weakness group were between those in the robust and the respiratory sarcopenia groups.

Examination of Rehabilitation Intensity According to Severity of Acute Stroke: A Retrospective Study.

OBJECTIVES: To investigate the intensity and effectiveness of rehabilitation in acute stroke patients according to the severity of functional impairments in them. MATERIALS AND METHODS: This retrospective cohort study included 294 patients with acute hemispheric stroke admitted to three acute-care hospitals who subsequently underwent an inpatient rehabilitation program. Stroke severity was classified according to neurological deficits and trunk dysfunction. The following data were obtained from medical records: age, sex, stroke type, lesion side, hospitalization duration, initial functional status determined using the National Institutes of Health Stroke Scale, rehabilitation start date, first day out of bed after admission, total treatment duration, total number of treatment sessions, rehabilitation implementation rate between start of rehabilitation and discharge, trunk control test and Barthel Index score on the first day out of bed after admission and discharge, and post-discharge outcomes. Hierarchical cluster analysis was performed with clusters categorized using the National Institutes of Health Stroke Scale and trunk control test scores. Variables were compared using the Kruskal-Wallis test, and Dunn's nonparametric comparison test was performed for post-hoc analysis to determine differences between clusters. RESULTS: The National Institutes of Health Stroke Scale and trunk control test showed a significant correlation (r = -0.816, p < 0.01) using which cluster analysis identified three clusters. Rehabilitation showed a ceiling effect in patients with mild stroke and a floor effect in patients with severe stroke. CONCLUSION: These results may guide the determination of rehabilitation intensity with reference to the severity of neurological deficits and trunk dysfunction.

Characteristics of Regional Cerebral Blood Flow in Alzheimer Disease and Amnestic Mild Cognitive Impairment by Single-Photon Emission Computerized Tomography: A Cross-Sectional Study.

INTRODUCTION: The regional cerebral blood flow (rCBF) distribution can affect brain functioning, leading to amnestic mild cognitive impairment (aMCI) and mild Alzheimer disease (AD). This study aimed to clarify the detailed characteristics of rCBF distribution in patients with mild AD and aMCI. METHODS: This cross-sectional study from April 2015 to March 2018 included 103 older adults (mean age 78.9 years; 60% females), out of a total of 302 adults, and categorized them into 3 groups according to cognitive symptoms. The normal control (NC), aMCI, and mild AD groups included 20, 50, and 33 participants, respectively. The primary outcome was rCBF, which was compared among the 3 groups using a 2-sample t test without correction for multiple comparisons. RESULTS: In the aMCI group, the rCBF decreased in the bilateral parietal and left frontal association cortex and the bilateral premotor cortex (p < 0.01) but increased in the bilateral cerebellum (p < 0.01). In the mild AD group, the rCBF decreased in the bilateral parietal and occipital association cortex, the bilateral premotor cortex, the left temporal and frontal association cortex, and the left limbic lobe (p < 0.01). Conversely, the rCBF increased in some parts of the cerebellum, the bilateral frontal and temporal association cortex, the left occipital association cortex, and the right premotor cortex (p < 0.01). CONCLUSION: Based on the analysis of the values obtained, it was inferred that the rCBF undergoes reduction and elevation in aMCI and AD patients.

Factors Influencing Sitting Ability During the Acute Post-Stroke Phase: A Multicenter Prospective Cohort Study in Japan.

OBJECTIVES: Sitting ability during the acute phase after stroke is a useful indicator of functional outcomes; however, factors that affect this ability have not been evaluated. Therefore, this study aimed to identify and evaluate factors that affect sitting ability in the acute phase after stroke. MATERIALS AND METHODS: This multicenter prospective cohort study included hemispheric stroke patients who underwent an inpatient rehabilitation program after acute stroke from five acute care hospitals. The effect of age, sex, lesion side, etiology, consciousness disorder, stroke and dementia history, stroke-related complications, National Institutes of Health Stroke Scale score, hemiparalysis, turn-over movement from the supine position and sit-up movement, and Scale for Contraversive Pushing on the "remain sitting" item in the revised version of the Ability of Basic Movement Scale at the time of acute hospital discharge were investigated. Factors affecting sitting ability were identified using binomial logistic regression analysis. RESULTS: We included 293 stroke patients. Age (odds ratio: 0.943, 95% confidence interval: 0.910-0.977, p=0.001), National Institutes of Health Stroke Scale score (odds ratio: 0.862, 95% confidence interval: 0.811-0.916, p<0.001), and Scale for Contraversive Pushing score (odds ratio: 0.543, 95% confidence interval: 0.419-0.705, p<0.001) were identified as independent predictors of sitting ability at the time of hospital discharge (median; 23.0 days). CONCLUSIONS: Older patients and those with high Scale for Contraversive Pushing and National Institutes of Health Stroke Scale scores experienced difficulties in regaining sitting ability. These results may guide physical therapy for patients with impaired sitting ability due to hemispheric stroke.

Relationship between tongue muscle quality and swallowing speed in community-dwelling older women.

OBJECTIVE: The aim of this study was to investigate the relationship between tongue muscle quality index, which was represented as tongue muscle pressure divided by tongue muscle mass, and swallowing speed in community-dwelling older women. METHODS: The inclusion criteria for this cross-sectional study were that participants be community-dwelling older women aged 65 years and above without dysphagia. The exclusion criteria were stroke and Parkinson's disease that directly cause dysphagia. We measured tongue muscle thickness and maximum tongue pressure and the tongue muscle quality index, which was defined as the maximum tongue pressure divided by tongue muscle thickness. We investigated swallowing speed via a 100 ml water swallowing test. To assess the relationship between tongue muscle characteristics and swallowing speed, we performed stepwise multiple regression analysis. RESULTS: Ninety-three participants were enrolled in this study (mean age: 84.2 ± 4.7 years). A stepwise multiple regression analysis showed that age (ß = - 0.292, p < 0.01) and tongue muscle quality index (ß = 0.267, p < 0.01) were related to swallowing speed. CONCLUSION: We found that tongue muscle quality index was related to swallowing speed in community-dwelling older women. According to our findings, it is possible that the tongue muscle quality index is a useful parameter for assessing swallowing speed in older women without dysphagia.

Impact of unilateral spatial neglect with or without other cognitive impairments on independent gait recovery in stroke survivors.

OBJECTIVE: To investigate the impact of unilateral spatial neglect with or without other cognitive impairments on recovery of independent gait in stroke survivors. DESIGN: A prospective cohort study. SUBJECTS: Ninety-four stroke survivors in an inpatient rehabilitation ward. METHODS: The presence of unilateral spatial neglect was assessed by the visuospatial perception score of the Stroke Impairment Assessment Set, and other cognitive impairments were assessed by Mini-Mental State Examination. Participants were categorized into 3 groups: group 1, unilateral spatial neglect with other cognitive impairments; group 2, unilateral spatial neglect without other cognitive impairments; and group 3, non-unilateral spatial neglect. The outcome was the walking score of the Functional Independence Measure (FIM) at discharge (score ≥ 6 or ≤ 5). RESULTS: Multivariate logistic regression analysis (reference, group 3) showed that the presence of unilateral spatial neglect with other cognitive impairments (group 1) had a significant association with dependence of gait (p = 0.003), and the odds ratio (95% confidence interval) was 5.55 (1.19-23.04). In contrast, there was no significant relationship between the presence of unilateral spatial neglect without other cognitive impairments (group 2) and dependence of gait (p = 0.207). CONCLUSION: The presence of unilateral spatial neglect without other cognitive impairments is not a significant factor for regaining independent gait. In contrast, unilateral spatial neglect becomes a strong negative factor when combined with other cognitive impairments.

Relationship between characteristics of skeletal muscle and oral function in community-dwelling older women.

PURPOSE: To examine the relationship between oral function and sarcopenia staging, including dynapenia and presarcopenia, in community-dwelling older adults. METHODS: A cross-sectional study was performed in community-dwelling older women aged 65 years and above. We measured oral muscle strength using maximum tongue pressure, oral muscle performance using oral diadochokinesis, and subjective swallowing difficulties using the Eating Assessment Tool. We measured skeletal muscle mass and function and other variables. All participants were divided into 4 groups (normal, presarcopenia, dynapenia, and sarcopenia) using an algorithm that operationally defines sarcopenia staging by skeletal muscle characteristics. A general linear model was used to analyze differences in oral function among the 4 groups. RESULTS: A total of 245 participants were enrolled (median age [IQR], 81.0 [75.0-85.0]). The proportion of normal participants and those with presarcopenia, dynapenia, and sarcopenia was 48.6% (n = 119), 9.4% (n = 23), 30.2% (n = 74), and 11.8% (n = 29), respectively. The sarcopenia and dynapenia groups had significantly lower maximum tongue pressure and oral diadochokinesis than the normal group. In the multivariate analysis, after adjusting for age, maximum tongue pressure and oral diadochokinesis were found to be significantly lower in the sarcopenia and dynapenia groups than in the normal group. CONCLUSIONS: In this study, participants with sarcopenia and dynapenia showed low oral function, and similar trends were indicated for oral function and skeletal muscle according to progression of sarcopenia staging. Future research should clarify the characteristics of swallowing-related muscles, including muscle mass, strength, and performance at each sarcopenia stage.