Effects of computerized cognitive training on biomarker responses in older adults with mild cognitive impairment: A scoping review.

Background and Aims: Mild cognitive impairment (MCI) is a widespread condition in older individuals, posing significant risk of dementia. However, limited research has been conducted to explore effective interventions and clarify their impact at the neural level. Therefore, this study aimed to investigate the effects of computerized cognitive training (CCT) and explore the associated neural mechanisms in preventing dementia in older individuals with MCI, with a view to inform future intervention efforts. Methods: We reviewed the effects of CCT on biomarker outcomes in older adults with MCI. The search was conducted for studies published between 2010 and May 10, 2023, using three search engines: PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature. The inclusion criteria were as follows: studies that involved participants diagnosed with MCI, included CCT, included quantitative assessment of biomarker results, and conducted randomized controlled trials. Results: Sixteen studies that used biomarkers, including magnetic resonance imaging, electroencephalography (EEG), functional near-infrared spectroscopy (fNIRS), and blood or salivary biomarkers, were extracted. The results showed that CCT caused changes in structure and function within the main brain network, including the default mode network, and decreased both theta rhythm activity on EEG and prefrontal activity on fNIRS, with improvement in cognitive function. Furthermore, CCT combined with physical exercise showed more significant structural and functional changes in extensive brain regions compared with CCT alone. Virtual reality-based cognitive training improved not only executive function but also instrumental activities of daily living. Conclusion: CCT causes functional and structural changes in extensive brain regions and improves cognitive function in older adults with MCI. Our findings highlight the potential of individualized intervention methods and biomarker assessment according to the specific causes of MCI. Future research should aim to optimize these personalized therapeutic strategies to maximize the benefits of CCT in older adults with MCI.

Detecting differences in limb load asymmetry during walking between older adult fallers and non-fallers using in-shoe sensors.

BACKGROUND: Previous studies have reported that clinical walk tests could not detect differences between fallers and non-fallers in older adults. With advancements in wearable technology, it may be possible to assess differences in loading parameters in clinical settings using portable data collection methods. RESEARCH QUESTION: The purpose of this study was to determine if wearable sensors (loadsol®) are reliable for assessing asymmetry of contact time, peak force, loading rate (LR), and impulse in older adults and determine if the insole can detect differences in these parameters between fallers and non-fallers during walking. METHODS: Fifty-five older adults (74.1 ± 6.1 years) walked at their maximum speed on a flat floor. Force data were collected from insoles (100 Hz) during a 10-m walk test. To assess reliability, an intraclass correlation coefficient [ICC(2,k)] was generated for each asymmetry variable. To determine differences between fallers and non-fallers, analysis of covariance (ANCOVA; covariate: body mass index) was completed for each variable. RESULTS: The ICC of peak force asymmetry (PFA) was 0.942, but other ICCs were less than 0.75. The ANCOVA results indicate that the loadsol® can detect differences in PFA between fallers and non-fallers. The PFA was significantly greater in fallers than in non-fallers. SIGNIFICANCE: The ability to collect force data while walking using loadsol® has the potential to broaden the research questions investigated, explore clinical applications, and increase generalizability.

Simple and Objective Evaluation Items for the Prognosis and Mortality of Delirium in Real-World Clinical Practice: A Preliminary Retrospective Study.

Objective: Identifying factors associated with poor outcomes in patients with delirium is important for predicting prognosis. This retrospective study developed an easy and objective cognitive function measurement scale that can predict the prognosis and mortality related to delirium. Methods: Fifty-five patients aged ≥65 years and diagnosed with delirium were included. Objective data regarding attention and orientation related to time and place were extracted from their medical records during the first consultation, and in total, six points were evaluated. The patients were categorized into high and low cognitive function (LCF) groups. The severity at the first visit and 1-week post-treatment was evaluated using the Clinical Global Impressions-Severity scale. Outcomes (survival or death) at 6 months from the initial visit were evaluated by reviewing medical records. Results: Although the Clinical Global Impressions-Severity score at the first visit was not significantly different between the two groups, 1 week after treatment, it was significantly lower in the high cognitive function (HCF) group than in the LCF group. Regarding the outcome (survival or death) after 6 months, the LCF group had significantly higher mortality than the HCF group. A multivariate logistic regression analysis revealed the same result (OR = 17.049, 95% CI = 2.415-120.373, p = 0.004). Conclusion: A simple cognitive assessment of attention and orientation may help predict unfavorable outcomes, including mortality, in patients with delirium.

Age-stroke related dysfunction interaction associated with home discharge of stroke inpatients in the rehabilitation ward.

The purpose of this study was to investigate whether interactions exist among cognitive and physical functions and activities of daily living (ADL) associated with home discharge of stroke patients in the rehabilitation ward. The subjects were 231 patients with a first stroke. Age, gender, affected side, the stroke impairment assessment set, ADL and discharge destination were collected from the medical record. Using a decision tree, a combination of variables that might have an interaction effect associated with home discharge was extracted. The existence of an interaction between the extracted variables was confirmed by logistic regression analysis. A combination of total score of the stroke impairment assessment set (≤27 points) and age (>76.5 years) at admission was extracted from the decision tree. As a result of the logistic regression analysis, this interaction term was significantly associated with home discharge. The findings of the present study suggest that there is an interaction between age and stroke-related dysfunction related to home discharge. Stroke patients aged over 76.5 years with the stroke impairment assessment set score of 27 or less at admission to the rehabilitation ward may need rehabilitation program considering the difficulty of home discharge.

Seaweed consumption and the risk of prostate cancer: the Miyagi cohort study.

Some laboratory studies have shown that fucoidan, which is contained in seaweed extract, has inhibitory effects on the invasion and angiogenesis of tumor cells; however, the association between seaweed consumption and prostate cancer incidence remains unclear. The purpose of the present study was to examine the association between seaweed consumption and the risk of prostate cancer incidence in the Japanese population. Data from 19 311 men in the Miyagi Cohort Study who were 40-64 years old at baseline in 1990 were examined. Seaweed consumption was assessed at baseline using a self-administered food frequency questionnaire. The participants were divided into three categories based on seaweed consumption at baseline. During 24.5 years of follow-up, we identified 815 incident cases of prostate cancer. Multivariate analysis showed that seaweed consumption was not associated with prostate cancer incidence. The multivariate hazard ratios and 95% confidence intervals for prostate cancer incidence in the highest tertile versus the other tertiles were 0.76 (0.60-0.96) and 0.78 (0.61-0.99) ( P -trend = 0.15). Furthermore, the null association was independent of whether their clinical stage was localized or advanced. In this population-based prospective cohort study conducted in Japan, we found no significant association between seaweed consumption and the incidence of prostate cancer.

Effect of social participation on the association between frailty and disability.

OBJECTIVES: To examine whether social participation affects the association between frailty and disability. METHODS: A baseline survey conducted from December 1 to 15, 2006, included 11,992 participants who were classified based on the Kihon Checklist into three categories and based on the number of activities in which they socially participated into four categories. The study outcome, incident functional disability, was defined as in Long-Term Care Insurance certification. A Cox proportional hazards model was used to calculate hazard ratios (HRs) for incident functional disability according to frailty and social participation categories. Combination analysis was performed between the nine groups using the above-mentioned Cox proportional hazards model. RESULTS: During the 13-year follow-up (107,170 person-years), 5,732 incident cases of functional disability were certified. Compared with the robust group, the other groups had significantly higher incident functional disability. However, the HRs for those participating in social activities were lower than that for those not participating in any activity [1.52 (pre-frail + none group); 1.31 (pre-frail + one activity group); 1.42 (pre-frail + two activities group); 1.37 (pre-frail + three activities group); 2.35 (frail + none group); 1.87 (frail + one activity group); 1.85 (frail + two activities group); and 1.71 (frail + three activities group)]. CONCLUSIONS: The risk of functional disability for those participating in social activities was lower than that for those not participating in any activity, irrespective of being pre-frail or frail. Comprehensive social systems for disability prevention need to focus on social participation in frail older adults.

Preventive Effects of Group Cognitive Behavioral Therapy in First-Year University Students at Risk for Depression: A Non-Randomized Controlled Trial.

High scores on Harm Avoidance (HA) on Cloniger's Temperament and Character Inventory (TCI) have been identified as a risk factor for depression. Group cognitive-behavioral therapy (GCBT) has been found effective in preventing depression and improving depressive symptoms among university students. However, no randomized controlled trials of GCBT have been conducted with university students with high HA. Although we initiated a randomized controlled trial in this study, some participants submitted incomplete questionnaires at baseline interfering with assured randomization; therefore, we report this study as a non-randomized controlled trial. We evaluated whether a GCBT intervention would be effective at reducing HA and, thereby, preventing depression in university students with high HA. We performed final analysis of data on 59 participants in the intervention group and 60 in a control group. We used scores on the Beck Depression Inventory-II (BDI-II) as the primary outcome measure and analysis of covariance to assess group differences on mean BDI-II change scores before the intervention and at six months and one year after the intervention. The intervention group had lower BDI-II scores than the control group at six months after the intervention. GCBT may have facilitated cognitive modification in individuals with high HA, or GCBT may have fostered mutual modeling by group participants. Thus, GCBT may contribute to reducing depressive symptoms in university students with high HA, and associated risk for developing depression.

How Long Would You Like to Live? A 25-year Prospective Observation of the Association Between Desired Longevity and Mortality.

BACKGROUND: Desired longevity represents how strongly people esteem possible extensions of their own lifetime. The association between desired longevity and mortality risk has been reported in only one prospective study, which examined a small sample of older participants. We aimed to examine the hypothesis that desired longevity at middle-age predicted long-term survival. METHODS: In the prospective cohort study, residents aged 40-64 years were asked how long they would like to live and asked to choose one from three options: longer than, as long as, or shorter than the life expectancy. We used Cox proportional hazards model to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality according to the three groups for desired longevity, treating the "longer than" group as the reference. We conducted mediation analysis to investigate the mechanism for the association between desired longevity and mortality. RESULTS: We recruited 39,902 residents to the study. Risk of all-cause mortality was significantly higher in the "shorter than" group (HR 1.12; 95% CI, 1.04-1.21). The association was independent of sex, age, marital status, education, medical history, and health status. Regarding cause of death, mortality risk of cancer (HR 1.14; 95% CI, 1.00-1.29) and suicide (HR 2.15; 95% CI, 1.37-3.38) were also higher in the "shorter than" group. The unhealthy lifestyle mediated this association with all-cause mortality by 30.4%. CONCLUSION: Shorter desired longevity was significantly associated with an increased risk of all-cause mortality, and mortality from cancer and suicide. Lifestyle behaviors particularly mediated this association.

Similarities in cardiometabolic risk factors among random male-female pairs: a large observational study in Japan.

BACKGROUND: Previous observational studies have shown similarities in cardiometabolic risk factors between spouses. It is still possible that this result reflects the age similarity of spouses rather than environmental factors of spouses (e.g. cohabitation effect). To clarify the importance of mate cardiometabolic risk factors for similarity of environmental factors, it is necessary to examine whether they are observed in random male-female pairs while maintaining the age of the spousal pairs. This study aimed to determine whether the similarities found between spousal pairs for cardiometabolic risks were also observed between random male-female pairs. METHODS: This cross-sectional study included 5,391 spouse pairs from Japan; data were obtained from a large biobank study. For pairings, women of the same age were randomly shuffled to create new male-female pairs of the same age as that of the original spouse pairs. Similarities in cardiometabolic risk factors between the random male-female pairs were analysed using Pearson's correlation or age-adjusted logistic regression analyses. RESULTS: The mean ages of the men and women were 63.2 and 60.4 years, respectively. Almost all cardiometabolic risk factors similarities were not noted in cardiometabolic risk factors, including the continuous risk factors (anthropometric traits, blood pressure, glycated haemoglobin level, and lipid traits); lifestyle habits (smoking, drinking, and physical activity); or diseases (hypertension, type 2 diabetes mellitus, and metabolic syndrome) between the random male-female pairs. The age-adjusted correlation coefficients ranged from - 0.007 for body mass index to 0.071 for total cholesterol. The age-adjusted odds ratio (95% confidence interval) for current drinkers was 0.94 (0.81 - 1.09); hypertension, 1.07 (0.93 - 1.23); and type 2 diabetes mellitus, 1.08 (0.77 - 1.50). CONCLUSION: In this study, few similarities in cardiometabolic risk factors were noted among the random male-female pairs. As spouse pairs may share environmental factors, intervention strategies targeting lifestyle habits and preventing lifestyle-related diseases may be effective.

Dairy intake and incident functional disability among older Japanese adults: the Ohsaki Cohort 2006 Study.

PURPOSE: Previous studies have investigated the association between dairy intake and functional disability, but their results were inconsistent. Our study aimed to investigate whether dairy intake may protect against incident functional disability among Japanese older adults. METHODS: We conducted a longitudinal analysis of dairy intake with incident functional disability in a prospective cohort study of 11,911 Japanese individuals aged ≥ 65 years who were followed up for 8.2 years on average. Data on milk, yogurt, and cheese intake were collected using a validated food frequency questionnaire. Total dairy intake was the sum of the daily intake of milk, yogurt, and cheese, which was sex-specifically categorized in quintiles. Data on functional disability were retrieved from the public Long-term Care Insurance database. The Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CIs) for incident functional disability. RESULTS: During 97,234 person-years of follow-up, 4874 persons (40.9%) were ascertained as having functional disability. Our study suggested a null association between total dairy intake and incident risk of functional disability; compared to Q1 (the lowest quintile) group, the multivariable-adjusted HRs (95%CIs) were 0.96 (0.88-1.05) for Q2, 0.93 (0.85-1.02) for Q3, 0.93 (0.85-1.02) for Q4, and 1.01 (0.92-1.10) for Q5 (p-trend = 0.840). We did not find any associations between milk, yogurt, or cheese intake and incident risk of functional disability. CONCLUSION: We found no evidence showing that dairy intake was associated with functional disability among Japanese older adults.

Time spent walking and disability-free survival in older Japanese: The Ohsaki Cohort 2006 Study.

The extent to which long disability-free survival (DFS) time can be extended according to the amount of time spent walking has not been investigated. The aim of this study was to examine the association between time spent walking per day and DFS time in older adults. We conducted a cohort study of 14 342 disability-free individuals (aged ≥ 65 years) living in Ohsaki City, Japan. The amount of time spent walking per day (<0.5 h, 0.5-1 h, ≥1 h) by each individual in 2006 was assessed by a self-reported questionnaire. Data on 11-year incident functional disability were retrieved from the public Long-Term Care Insurance database. After estimating the multivariable-adjusted hazard ratios (HRs) of the composite outcome (incident functional disability or death), the multivariable-adjusted 50th percentile differences (50th PDs; difference in the period until the first 50% of the composite outcome occurred) were estimated according to time spent walking. Among 114 764 person-years, the composite outcome occurred in 7761 persons (67.6 per 1000 person-years). The HRs (95% confidence intervals) of the composite outcome were 1.00 (reference) for <0.5 h, 0.84 (0.79, 0.88) for 0.5-1 h, and 0.78 (0.74, 0.83) for ≥1 h (p-trend < 0.001). The 50th PDs (95% confidence intervals) of DFS time were 238 (155, 322) days longer for 0.5-1 h and 360 (265, 454) days longer for ≥1 h, in comparison with <0.5 h. The results suggest that longer time spent walking per day contributes to longer DFS time.

Association Between Social Participation and Disability-free Life Expectancy in Japanese Older People: The Ohsaki Cohort 2006 Study.

BACKGROUND: Although social participation has been reported to be associated with significantly lower risks of mortality and disability, to our knowledge, no study has estimated its impact on disability-free life expectancy (DFLE). Therefore, this study aimed to investigate the association between social participation and DFLE in community-dwelling older people. METHODS: We analyzed 11-year follow-up data from a cohort study of 11,982 Japanese older adults (age ≥65 years) in 2006. We collected information on the number of social participations using a questionnaire. Using this information, we categorized the participants into four groups. DFLE was defined as the average number of years a person could expect to live without disability. The multistate life table method using a Markov model was employed for calculating DFLE. RESULTS: The results revealed that DFLE according to the number of social participations was 17.8 years (95% confidence interval [CI], 17.3-18.2) for no activities, 20.9 (95% CI, 20.4-21.5) for one activity, 21.5 (95% CI, 20.9-22.0) for two activities, and 22.7 (95% CI, 22.1-23.2) for three activities in men, and 21.8 (95% CI, 21.5-22.2), 25.1 (95% CI, 24.6-25.6), 25.3 (95% CI, 24.7-25.9), and 26.7 years (95% CI, 26.1-27.4), respectively, in women. This difference in DFLE did not change after the participants were stratified for smoking, body mass index, physical activity, and depression. CONCLUSION: Social participation is associated with longer DFLE among Japanese older people; therefore, encouraging social participation at the population level could increase life-years lived in good health.

Impact of Sensory Impairment on Improvement of Upper-limb Function in Patients under 75 Years of Age with Subacute Stroke: A Preliminary Study.

OBJECTIVES: The aim of this study was to investigate whether an interaction exists between sensory impairment and age with respect to the recovery of upper-limb function in patients with subacute stroke. METHODS: This retrospective observational study included 83 patients recovering from subacute stroke in a rehabilitation hospital ward. The recovery of upper-limb function in four groups classified by age and sensory impairment were compared using analysis of covariance. Furthermore, multiple regression analysis was performed with recovery of upper-limb function as the dependent variable and with binarized sensory impairment and binarized age and their interaction term as the independent variables. RESULTS: The estimated marginal means of upper-limb recovery were significantly higher in the non-late elderly (≤74 years) without sensory impairment group than in the other three groups. No significant differences were observed among the following three groups: the non-late elderly with sensory impairment, the late elderly (≥75 years) without sensory impairment, and the late elderly with sensory impairment. In multiple regression analysis, the interaction term between sensory impairment and age was significantly associated with improvement in upper-limb function (ß=0.16, P <0.05). Age alone was significant, but sensory impairment alone was not significant. CONCLUSIONS: Sensory impairment in patients with subacute stroke affects the recovery of upper-limb function as a result of age interactions.

A Cross-Sectional Study on the Characteristics of Physical Activity in Pre-Frail Older Adults.

This cross-sectional study aimed to characterize the physical activity (PA) of older adults with pre-frail status by examining sedentary behavior (SB) and PA using triaxial accelerometer data, with non-frail older adults as the control group. In this study, we divided the study participants into older adults who regularly participated in self-initiated citizen group exercise activities and those who did not. Data were collected between September and December 2017. We analyzed data from 256 older adults (women: 86.3%) aged ≥65 years. The interaction effect of participation status (participation and non-participation group) and frailty status (pre-frail and non-frail group) for moderate-to-vigorous PA (F = 9.178, p = 0.003) and daily mean number of steps (F = 9.351, p = 0.002) was significant. For the participation group, there was no difference between pre-frail older adults and non-frail older adults regarding length of SB and PA time, indicating that PA level was maintained in the participating pre-frail older adults. In contrast, moderate-to-vigorous PA and daily mean number of steps were low in pre-frail older adults who did not participate in the activities. The opportunity to participate in self-initiated group exercise activities and other PAs in the community may help pre-frail older adults maintain their PA.

The association between psychological distress and risk of incident functional disability in elderly survivors after the Great East Japan Earthquake: The mediating effect of lifestyle and bodily pain.

BACKGROUND: We previously reported that psychological distress was associated with an increased risk of functional disability. However, the mechanism of the association remains unclear. Our aim was to estimate the mediating effect of lifestyle and bodily pain on the association among elderly survivors after the Great East Japan Earthquake. METHODS: The study population comprised 1037 residents aged ≥ 65 years. The baseline surveys (exposure and mediators) were conducted in 2011. We classified participants into three categories according to their Kessler 6 score (low: 0-9, moderate: 10-12, and high: 13-24) and defined functional disability as certification for long-term care insurance in Japan. The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident functional disability according to Kessler 6 categories and explored the mediating effects of lifestyle and bodily pain on the association. RESULTS: During approximately 8 years of follow-up, we documented 271 incident cases of functional disability. Compared with those in the low distress group, the multivariate adjusted HR for incident functional disability was 1.95 (95% CI 1.21-3.13) for those in the high distress group. Time spent walking, going out, and bodily pain significantly mediated the association between psychological distress and incident functional disability by 10.2%, 10.5%, and 10.3% for the high distress group, respectively. LIMITATIONS: We did not consider unmeasured confounders and use of appropriate medication. CONCLUSIONS: The evaluation and treatment of bodily pain as well as promotion of active lifestyle would be important for preventing disability among disaster survivors.

Subgroup characteristics of the association between volunteering and the risk of functional disability among older Japanese people: The Tsurugaya project.

BACKGROUND AND OBJECTIVE: Although it has been well known that volunteering is associated with a significantly decreased risk of incident disability among older people, it remains unanswered which subgroups of older people the above association is most remarkable. We aimed to identify such subgroups by conducting subgroup analyses for age, sex, chronic medical condition, and socio-demographic factors. METHODS: Participants were 826 Japanese community-dwelling people aged ≥70 years who lived in Tsurugaya, Sendai. Volunteering status was assessed with a baseline survey conducted in 2003. Incident functional disability was defined as the first certification of Long-term Care Insurance until 2017. The Cox proportional hazard model was used to estimate the multivariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident functional disability. Subgroup analyses were conducted according to sex, age, medical history, marital status, and educational level. RESULTS: The association between current volunteering and the risk of incident functional disability was not significant (HR 0.77, 95% CI 0.56-1.06) compared to non-volunteers. In the subgroup analysis, the association between current volunteering and the risk of incident functional disability was significant among participants who were women (HR 0.52, 95% CI 0.30-0.91), those who were aged 75 years or over (HR 0.57, 95% CI 0.36-0.91), and those living without a spouse (HR 0.47, 95% CI 0.24-0.91). CONCLUSION: The association between volunteering and a decreased risk of incident functional disability was remarkable among vulnerable groups such as women, those aged 75 years or over, those living without a spouse.

Interactions of Cognitive and Physical Functions Associated with Toilet Independence in Stroke Patients.

OBJECTIVES: The purpose of this study was to clarify the interaction among cognitive and physical functions associated with toilet independence in stroke patients. MATERIALS AND METHODS: We retrospectively examined 125 stroke patients. We performed decision tree analysis to detect the interaction associated with toilet independent using assessment of motor function on the affected side, muscle strength on unaffected side, trunk function, neglect, motivation, and cognitive function. The interactions detected via decision tree confirmed the existence and influence using logistic regression. RESULTS: The verticality test of the Stroke Impairment Assessment Set (3 or ≤2 points) was selected at the first level, and the Revised Hasegawa's dementia scale (≥19 or ≤18 points) and age (≥70 or ≤69 y) were selected at the second level of decision tree. Interaction terms created by these factors were significantly associated with toilet independence after adjusting for the independent influence of each factor using logistic regression. CONCLUSIONS: Our results show an interaction of trunk and cognitive functions or trunk function and age associated with toilet independence. The probability of toilet independence dramatically changes if two factors of each interaction were satisfied in stroke patients.

Relationship Between Oral Health and Fractures in Community-Dwelling Older Japanese Adults.

OBJECTIVE: To investigate the relationship between poor oral health and the incidence of fall-related fractures in older Japanese individuals. DESIGN: A 9-year prospective cohort study. SETTING AND PARTICIPANTS: Participants comprised 937 community-dwelling older Japanese adults aged 70 years or older. They all lived in the Tsurugaya district, a suburban area of Sendai city, and underwent comprehensive geriatric assessment, including an oral examination, in a public facility. MEASUREMENTS: The exposure variables were related to oral health status (posterior occlusal support, number of remaining teeth, and occlusal force). The outcome measure was the incidence of fall-related fractures, which was determined by National Health Insurance data. Analyzed covariates included age, sex, medical history, smoking, alcohol drinking, educational level, depressive symptoms, cognitive impairment, physical function, body mass index, and history of falls. Statistical relationships were examined by calculating hazard ratios (HRs) at 95% confidence intervals (CIs) using the Cox proportional hazard model. RESULTS: In the multivariate analysis, the HRs of fall-related fractures were significantly higher in those with unilateral posterior occlusal support (HR, 2.72; 95% CI, 1.13-6.55) and no posterior occlusal support (HR, 2.58; 95% CI, 1.29-5.15) than in those with bilateral posterior occlusal support. The HRs (95% CIs) of fall-related fractures in individuals with 10-19 and 1-9 teeth and edentulous individuals were 1.77 (0.81-3.89), 2.67 (1.24-5.75), and 2.31 (1.01-5.28), respectively, compared to those with ≥20 teeth. CONCLUSIONS AND IMPLICATIONS: Poor oral health status is a risk factor for the incidence of fall-related fractures in community-dwelling older Japanese individuals. The findings suggest that attention should be focused on oral health status to further understand the risk of fall-related fractures among community-dwelling older adults.

Changes in a specific dietary pattern and incident dementia: A prospective cohort study.

BACKGROUND & AIMS: Previous studies have reported that the Japanese diet is associated with a lower risk of dementia; however, whether changes in adherence to the Japanese diet affects incident dementia remains unknown. We aimed to evaluate the association between long-term changes in adherence to the Japanese diet and risk of incident dementia among older Japanese individuals. METHODS: We collected dietary information from community-dwelling older individuals living in Ohsaki city, Japan using a validated 39-item food frequency questionnaire in 1994 and 2006. Adherence to the Japanese diet was assessed using the 8-item Japanese Diet Index (JDI8) score (range: 0 to 8 points). Changes in adherence to the Japanese diet were defined as changes in the JDI8 score from 1994 to 2006. Next, the participants were classified into five groups: great decrease, moderate decrease, no changes [ref.], moderate increase, or great increase. Then, 3146 Japanese adults aged ≥65 years in 2006 were followed-up for 5.7 years. Incident dementia was retrieved from the long-term care insurance database. The Cox proportional hazards model was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident dementia. RESULTS: During 14,336 person-years of follow up, 231 cases of dementia were ascertained. Compared with no changes in the JDI8 score, the multivariable-adjusted HRs (95%CIs) were 1.72 (1.13, 2.62) for great decrease, 1.10 (0.73, 1.66) for moderate decrease, 0.82 (0.54, 1.25) for moderate increase, and 0.62 (0.38, 1.02) for great increase (p-trend <0.0001). CONCLUSIONS: An increase in adherence to the Japanese diet was associated with a reduced risk of incident dementia, whereas a decrease in adherence was associated with an elevated risk among older Japanese individuals.

Effect of a financial incentive (shopping point) on increasing the number of daily walking steps among community-dwelling adults in Japan: a randomised controlled trial.

OBJECTIVE: The aim of this study was to investigate the effect of a financial incentive on the number of daily walking steps among community-dwelling adults in Japan. STUDY DESIGN: Two-arm, parallel-group randomised controlled trial. SETTING/PARTICIPANTS: We recruited physically inactive community-dwelling adults from Sendai city, Japan. Eligible participants were randomly allocated to an intervention or a wait list control group. Pedometers were used to assess the mean number of daily steps in three periods: baseline (weeks 1-3), intervention (weeks 4-6) and follow-up (weeks 7-9). INTERVENTION: The intervention group was offered a financial incentive (shopping points) to meet the target number of increased daily steps in the intervention period. MAIN OUTCOME MEASURES: The primary outcome was an increase in the mean number of daily steps in the intervention and follow-up periods compared with baseline. RESULTS: Seventy-two participants (69.4% women; mean age, 61.2±16.2 years; mean number of daily steps at baseline, 6364±2804) were randomised to the intervention (n=36) and control groups (n=36). During the intervention period, the increase in mean daily steps was significantly higher in the intervention group (1650, 95% CI=1182 to 2119) than in the control group (514, 95% CI=136 to 891; p<0.001). However, the difference between groups was not significant at follow-up after the incentives were removed (p=0.311). In addition, compared with controls, a significantly higher proportion of participants in the intervention group showed an increase in mean daily steps of ≥1000 (69.4% vs 30.6%, respectively; OR=5.17, 95% CI=1.89 to 14.08). There were no adverse effects from the intervention. CONCLUSIONS: The present results suggest that financial incentives are effective in promoting short-term increases in physical activity. TRIAL REGISTRATION NUMBER: UMIN000033276.