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Tomioka K.,Nara Medical University | Ikeda H.,Red Cross | Morikawa M.,Sakai City Mental Health Center | Iwamoto J.,Yokkaichi Nursing and Medical Care University | And 3 more authors.
Quality of Life Research | Year: 2013

Purpose: Little is known about the usefulness of the Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) and a single question (SQ) in assessing hearing impairment (HI) and the impact of HI on quality of life (QOL). The objective of this study was to examine the reliability, validity, and associations with QOL measures (i.e.; subjective well-being, depressive symptoms, subjective loneliness, and physical functioning) of the HHIE-S and the SQ in the elderly community. Methods: A self-report questionnaire including HHIE-S, SQ, Philadelphia Geriatric Center Morale Scale, Geriatric Depression Scale, UCLA Loneliness Scale, and the Tokyo Metropolitan Institute of Gerontology Index of Competence was administered to community elderly (781 males and 950 females). Among them, 97 males and 100 females also responded voluntarily to a request for test-retest and auditory tests. The criterion validity was tested by using pure-tone averages. Results: Regarding the reliability of HHIE-S, Cronbach's alpha coefficient was 0.91, Spearman-Brown coefficient was 0.90, and intra-class correlation coefficient was 0.85. Regarding the test-retest reliability of SQ, kappa coefficient was 0.65. HHIE-S had significantly lower sensitivity in identifying >25-dB HI, but significantly higher specificity for the detection of >40-dB HI than SQ. HHIE-S had stronger associations with QOL measures than did SQ. Conclusions: HHIE-S had high reliability, while SQ had insufficient reliability. HHIE-S was more specific in detecting HI and more sensitive in assessing the impact of HI on QOL than SQ. HHIE-S is a more effective instrument for assessing HI and QOL research than SQ in the elderly community. © 2012 Springer Science+Business Media B.V.


Okamoto N.,Nara Medical University | Tomioka K.,Nara Medical University | Saeki K.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | And 3 more authors.
Journal of the American Geriatrics Society | Year: 2012

Objectives To investigate the relationship between swallowing problems and the number of remaining teeth in healthy elderly people. Design Cross-sectional. Setting Nara, Japan. Participants Three thousand six hundred sixty-three male and female volunteers aged 65 and older who were living independently were analyzed. Measurements Swallowing problems were defined operationally using a questionnaire and the 30-mL water swallow test. Data were collected on the number of remaining teeth, maximum bite force, occlusal status, presence or absence of oral dryness, and medical history. Results The prevalence of swallowing problems was 15.1% (n = 554) in this population. A positive correlation was observed between the number of remaining teeth and maximum bite force. The number of remaining teeth was categorized according to tertiles. Multiple logistic regression analysis revealed that the adjusted odds ratios for 0 to 13 or 14 to 24 remaining teeth to 25 to 32 remaining teeth for swallowing problems were 2.04 (95% confidence interval (CI) = 1.60-2.60) and 1.31 (95% CI = 1.02-1.70), respectively. Significant increases in these odds ratios were found in a trend test (P <.001). Conclusion Tooth loss is associated with swallowing problems. Having fewer teeth inhibits masticatory ability, which disturbs the execution of smooth swallowing. Preventive measures against tooth loss at a younger age may be effective at reducing the risk of laryngeal penetration and aspiration at an older age. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.


Okamoto N.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | Morikawa M.,Nara Medical University | Okamoto K.,Nara Kasuga Hospital | And 9 more authors.
Brain Research | Year: 2010

It has been reported that tooth loss is associated with Alzheimer's disease (AD) and dementia. The purpose of this study was to investigate the association between tooth loss and mild memory impairment (MMI) among the elderly. We examined 3,061 community residents aged 65 years or older who had a score of 24 or more on the Mini-Mental State Examination. The subjects were divided according to their score for the three-word delayed recall test into control (score: 3 or 2) and MMI (score: 1 or 0) subjects. The subjects underwent a dental examination, an interview to determine their medical history, a self-administered questionnaire (inclusive of higher-level functional capacity, drinking and smoking habits, and frequency of going out), and a 10-m walking test. Fewer remaining teeth, going out once a week or less frequently, and a slow walking speed on a 10-m walking test were found at a significantly higher prevalence in the MMI group (n = 101) than in the control group (n = 2,960), after adjustment for sex, age, and the level of education. Multiple logistic regression analysis using these items revealed that the odds ratio of 0-10 remaining teeth for MMI was 1.71 (95% CI 1.05-2.78), compared to individuals with 22-32 remaining teeth. A significant increase was also found in a trend test to examine the increasing odds ratios of 22-32, 11-21, and 0-10 remaining teeth. We consider that tooth loss is associated with MMI later in life. © 2010 Elsevier B.V.


Kouda K.,Kinki University | Iki M.,Kinki University | Fujita Y.,Kinki University | Tamaki J.,Kinki University | And 8 more authors.
Bone | Year: 2011

There are no data concerning a relationship between alcohol and bone status from a large-scale community-based study of elderly Japanese men. The baseline survey for the Fujiwara-kyo Osteoporosis Risk in Men Study was performed in 2174 male participants during the period from 2007 to 2008 in Nara Prefecture, Japan. Among them 1665 fitted the following inclusion criteria: (a) age ≤65years, (b) no diseases or drug therapy that could affect bone mineral density (BMD). We analyzed 1421 men with complete information about alcohol intake. We found that alcohol intake and BMD were positively correlated after adjustment for age, body mass index, natto intake, milk intake, smoking, physical activity, education, marital status, and hypertension. Adjusted total hip BMD of men with alcohol intake >39g/day was 0.90g/cm 2 and that of abstainers was 0.85g/cm 2. With regard to bone turnover markers, alcohol intake was inversely associated with serum levels of osteocalcin and tartrate-resistant acid phosphatase isoenzyme 5b. A two-piece linear regression model revealed a positive relationship between alcohol intake and crude mean BMD for the total hip in those with alcohol intake of less than 55g/day. In contrast, alcohol intake and BMD in those with an alcohol intake of 55g/day or more was inversely correlated. The present large-scale study of elderly Japanese men revealed that although an alcohol intake of <55g/day was positively correlated to BMD, alcohol intake of ≤55g/day was inversely correlated to BMD. © 2011 Elsevier Inc.


PubMed | Tenri University, Sakai City Mental Health Center, Nara Medical University and Osaka Electro-Communication University
Type: Journal Article | Journal: Geriatrics & gerontology international | Year: 2015

The present study investigated whether physical performance and musculoskeletal pain (MSP) are associated with self-perceived hearing handicap (HH) among high-functioning older adults.We analyzed a total of 3982 community-dwelling high-functioning older adults (age 65years and older). HH was assessed using the Hearing Handicap Inventory for Elderly-Screening. Self-reported hearing impairment (HI) was evaluated using a single question. We measured handgrip strength, walking speed (WS) and standing balance for assessments of physical performance. The severity of MSP assessed by interviews took into account its duration, limitation of daily activity and frequency.The prevalence of HH and HI in our sample was 22.2% and 28.1%, respectively. After adjusting for other two physical performance measures, MSP, sex, age, education, marital status, risk factors for hearing loss, instrumental activity of daily living, depression, cognitive function and self-reported HI, the odds ratios for HH in the second fastest, the second slowest, and the slowest WS quartile were 1.14 (95% CI=0.81-1.58), 1.29 (95% CI=0.92-1.79), and 1.58 (95% CI=1.11-2.23), respectively, compared with the fastest WS quartile. A significant dose-response relationship was found between slower WS and HH (P for trend=0.01). No significant association with HH was found in handgrip strength, standing balance and MSP.WS is associated with self-perceived HH in high-functioning older adults. The present study suggests that exercise programs to improve walking ability might be effective in preventing HH of self-sustainable older adults.


Okamoto N.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | Morikawa M.,Nara Medical University | Okamoto K.,Nara Kasuga Hospital | And 8 more authors.
Behavioral and Brain Functions | Year: 2010

Background: This cross-sectional study investigated the relationship between the number of remaining teeth to mild memory impairment (MMI), which is a preclinical stage of dementia, and to cognitive impairment.Methods: The subjects were aged 65 years or older and were grouped according to their score for the Mini-Mental State Examination (MMSE), the three-word delayed recall test in the MMSE, and the Geriatric Depression Scale into the control group (n = 3,696), the MMI group (n = 121), and the low MMSE score (23 or lower) group (n = 214). We collected data on the number of remaining teeth, the length of the edentulous period, health-related lifestyle, medical history, blood pressure, height, and body weight. Fasting venous blood samples were also obtained.Results: Multiple logistic regression analysis, adjusted for depressive symptoms, age, sex, length of education, and other explanatory variables, revealed that the odds ratios of 0-10 remaining teeth to 22-32 remaining teeth were 1.679 (95% CI 1.073-2.627) for MMI and 2.177 (95% CI 1.510-3.140) for a low MMSE score. A significant relationship was also found between the length of the edentulous period and the risk of a low MMSE score (odds ratio 3.102, 95% CI 1.432-6.720) (15 years or more/less than 15 years).Conclusions: Our findings suggest that tooth loss is associated with cognitive function. © 2010 Okamoto et al; licensee BioMed Central Ltd.


Morikawa M.,Sakai City Mental Health Center | Morikawa M.,Nara Medical University | Kiuchi K.,Nara Medical University | Taoka T.,Nara Medical University | And 3 more authors.
Psychogeriatrics | Year: 2010

Background: Neuroimaging studies show increased diffusivity and decreased anisotropy in Alzheimer's disease (AD) patients by diffusion tensor imaging (DTI). Previous reports have analyzed a correlation with cognitive function and DTI parameters, but their results are inconsistent. A reason for this might be a region of interest (ROI) method, used to calculate parameters for DTI, because this method has various usages of how to place a ROI and includes summations of values for various neuronal fiber tracts, resulting in contamination of unintended fibers. To improve the instability with ROI placement, a tractography-based method might be useful. Our coworker reported decreased fractional anisotropy (FA) and increased apparent diffusion coefficient (ADC) of uncinate fasciculus (UF) in patients with AD by tractography. To confirm whether DTI parameter values are related to severity of cognitive function in patients with AD, we measured mean diffusion anisotropy and diffusivity of coregistered voxels along the tracking lines (i.e. tract of interest) of UF. Methods: The subjects were 30 patients with probable AD (NINCDSADRDA criteria). Assessment of cognitive function was carried out according to the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-cognitive component-Japanese version (ADAS-Jcog). A 1.5-T clinical magnetic resonance unit was used to obtain diffusion tensor images. Diffusion tensors were computed and fiber-tract maps were created using 'dTV II' DTI software developed by Masutani et al. We measured mean FA and ADC values along the bilateral UF. Results: FA values were positively correlated with MMSE score (r = 0.67) and were negatively correlated with ADAS-Jcog score (r = -0.62), while ADC values were negatively correlated with MMSE score (r = -0.58) and were positively correlated with ADAS-Jcog score (r = 0.59). Conclusion: FA and ADC values might reflect the severity of cognitive dysfunction. The tract-of-interest method might be a useful tool for objectively evaluating DTI parameters in AD. © 2010 The Authors Journal compilation © 2010 Japanese Psychogeriatric Society.


Kiuchi K.,Nara Medical University | Morikawa M.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | Taoka T.,Nara Medical University | And 11 more authors.
Journal of Psychiatric Research | Year: 2011

Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are different types of dementia. However, their clinical symptoms partially overlap and differential diagnosis is occasionally difficult. There is need for additional diagnostic criteria to reliably differentiate between these two conditions. Meanwhile, several imaging studies have showed inconsistent results between DLB and AD. The aim of this study was to use a tractography-based analysis to elucidate white matter alterations in subjects with DLB compared to those with AD and to controls. An understanding of the white matter connectivity differences between AD, DLB and controls will be helpful for differential diagnosis and an understanding of the pathophysiology. Twenty-six subjects with DLB, 26 with AD and 26 controls underwent magnetic resonance diffusion tensor imaging and neuropsychological assessment. Diffusion tensors were computed and fiber-tract maps were created using "dTV II" software. We measured mean fractional anisotropy (FA) values along the uncinate fasciculus (UNC), the inferior occipitofrontal fasciculus (IOFF) and the inferior longitudinal fasciculus (ILF). Both subjects with DLB and AD had lower FA values for the bilateral UNC than controls. Subjects with DLB exhibited significantly lower FA values on both sides of the IOFF and the left side of the ILF than those of controls. Although there were no significant differences between subjects with DLB and AD for any measurements, those with DLB exhibited lower FA values especially in visual-related white matter. These different changes in white matter tracts among groups could be helpful for differential diagnosis and an understanding of the pathophysiology. © 2011 Elsevier Ltd.


Nezu S.,Nara Medical University | Okamoto N.,Nara Medical University | Morikawa M.,Sakai City Mental Health Center | Saeki K.,Nara Medical University | And 5 more authors.
Journal of Epidemiology | Year: 2014

Background: Very few studies have investigated the association between diabetes and impaired health-related quality of life (HRQOL) in older adults, independent of chronic conditions and geriatric syndromes. Methods: We conducted a self-administered questionnaire survey and structured interviews with 3946 people aged 65 years or older to obtain medical histories of diabetes, chronic conditions, and geriatric syndromes. Blood tests were performed to measure glycated hemoglobin (HbA1c) and plasma glucose levels. HRQOL was evaluated using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), and multiple logistic regression analysis was used to calculate adjusted odds ratios and 95% CIs for low HRQOL. Results: A total of 3521 participants had not received a physician diagnosis of diabetes. Of these, 2345 participants with an HbA1c less than 5.7% were defined as the referent group. As compared with the referent group, 1029 participants with an HbA1c of at least 5.7% but less than 6.5% showed no significant decrease in QOL on the SF-36 physical, mental, and role component summaries, after adjustment for chronic conditions, geriatric syndromes, and other potential confounders. However, 572 patients who had received a physician diagnosis of diabetes and/or had an HbA1c of 6.5% or higher had a significantly higher adjusted odds ratio (1.48; 95% CI, 1.18-1.84) for the low physical component summary. No significant differences in relation to glycemic control, treatment regimen, or diabetes duration were found in any of the 3 component summaries among the 425 participants who were undergoing diabetes treatment. Conclusions: Older Japanese adults with diabetes had decreased physical QOL, independent of chronic conditions and geriatric syndromes. © 2014 Satoko Nezu et al.


Kitamura S.,Nara Medical University | Kiuchi K.,Nara Medical University | Taoka T.,Nara Medical University | Hashimoto K.,Nara Medical University | And 6 more authors.
Brain Research | Year: 2013

Alzheimer's disease (AD) classically presents with gray matter atrophy, as well as feature significant white matter abnormalities. Previous evidence indicates the overall burden of these pathological changes continues to advance as the disease progresses. The aim of this study was to investigate whether pathological alterations of white matter tracts correlate with the course of AD disease progression. 35 AD patients and 29 normal controls were recruited to the study and administered baseline magnetic resonance diffusion tensor imaging (DTI) acquisition and a cognitive function assessment at the time of initial evaluation. Subjects were re-evaluated with secondary DTI scan and cognitive function assessment at intervals of about 1.5 years on average. For the DTI acquired scans, we calculated diffusion tensor parameters, fractional anisotropy (FA), apparent diffusion coefficient (ADC), radial diffusivity (DR), and axial diffusivity (DA) along with the uncinate fasciculus (UNC), the inferior longitudinal fasciculus (ILF), and the inferior occipitofrontal fasciculus (IOFF). Compared to baseline, a significant mean FA reduction of the bilateral UNC, as well as a significant mean DR increase of the left UNC, was evident in AD patients at follow-up. Compared with normal controls, AD patients exhibited significant diffusion parameter abnormalities in their UNC, ILF, and IOFF. Taken together, these results indicate that progressive pathological white matter alterations can be quantified using the DTI parameters utilized here and may prove to be a useful biological marker for monitoring the pathophysiological course of AD. © 2013 Elsevier B.V.

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