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To establish age- and sex-specific population reference values for tongue pressure (TP) in community-dwelling Japanese older adults.For this analysis, we pooled four population-based studies on community-dwelling adults aged ≥65 years that measured TP using a JMS tongue pressure measuring device. We calculated the means and deciles of TP per 5-year age group for each sex. We also estimated age trends in TP for men and women.In total, 5,083 individuals (2,150 men and 2,933 women, with a mean [standard deviation] age of 75.2 [6.5] years) were included in the present analysis. In male participants, the mean (standard deviation) TPs for ages 65-69, 70-74, 75-79, 80-84, and ≥85 years were 34.0 (8.4), 32.2 (8.1), 30.8 (8.3), 28.4 (8.9), and 24.4 (8.2) kPa, respectively. In female participants, the corresponding values were 31.5 (7.1), 30.5 (7.5), 29.6 (7.3), 28.4 (8.0), and 26.4 (7.6) kPa, respectively. For both sexes, there were significant declining trends in TP with advanced age. In addition, the interaction between age and sex had a significant effect on TP (regression coefficient [95% confidence interval] = -0.18 [-0.25 to -0.11] when age was modeled as a continuous variable and sex was modeled as a categorical variable [coded as 0=women, 1=men]).This study determined age- and sex-specific reference values for TP, presented as means and deciles, in community-dwelling Japanese older adults aged ≥65 years. This study also demonstrated sex differences in age-related declines in TP.

In this study, we examine the relationship between developmental insufficiency of mastoid air cells and abnormal morphology of the paranasal sinuses in patients with chronic otitis media (COM) and acquired middle ear cholesteatoma (AMEC) using precise image assessment, in order to evaluate whether the anatomical features of paranasal sinuses has any impact on the pathogenesis in COM and AMEC.A total of 127 patients, including 45 COM patients and 82 AMEC patients, were enrolled for this study. The existence of nasal septal deviation, the existence of paranasal sinus opacification, the modified Lund-Mackay score, the diameters of the paranasal sinuses, the Vidic classification, mastoid development, and cranial size were assessed by CT examination. A further 76 adult patients who underwent high-resolution CT imaging of their skull bone for other diseases were enrolled as the control.The AMEC group showed a significantly shorter sphenoid length (P 0.01) and lower Vidic classification score (P 0.01) compared to the control group in this study. In addition, we observed that patients with AMEC had less pneumatization of the mastoid air cells compared to the control individuals, and that the sphenoid length of the poor MC score group was significantly shorter than that of the good MC score group.Our results suggested that the developmental deficiency in sphenoid length caused by long-standing pediatric rhinosinusitis might indicate the potential of chronic middle ear inflammation in childhood and impact the pneumatization of mastoid air cells. Therefore, chronic rhinosinusitis during the childhood and adolescence might play a role in the pathophysiology of AMEC.

AIM Although a series of policies have been adapted to deliver an early diagnosis of dementia, many people living with dementia remain undetected and undiagnosed. The aim of this study is to investigate the characteristics of undetected dementia in community-dwelling older people in Metropolitan Tokyo. METHODS We conducted a three-step survey. First, the questionnaires were mailed, in total, to 7614 residents aged ≥70 years in one area in Tokyo, and 5430 were retrieved. Secondly, 2020 individuals attended the face-to-face survey, including Mini-Mental State Exam (MMSE). Thirdly, 198 of 335 individuals who scored

Objectives We selected assessment items that can be used to evaluate the physical, mental, and social functions of community-dwelling older people comprehensively and easily, and examined whether these items could predict a future transition to the requirement for nursing care and dementia.Methods We conducted a self-administered mail survey of 4,439 community-dwelling older people, who were not certified as requiring nursing care in 2011. The items for the survey were shortlisted out of a total of 54 items that were selected by referring to existing scales, and the evaluation items were determined by pass rate and factor analysis. The cut-off point of the total scores was estimated by ROC analysis using the certification of requiring long-term care (support level 1 or higher) and level of independence in the daily lives of older people with dementia (independence level I or higher) in 2014 as external criteria. The predictive validity was examined by binomial logistic regression analysis using the cut-off point of the total score and the score of the sub-domains as explanatory variables, and the requirement of nursing care and independence level of dementia in 2014 as objective variables.Results A factor analysis of 1,810 subjects with no deficiencies in the 54 items identified 24 items in five domains (mental health, walking function, Instrumental Activities of Daily Living (IADL), cognitive function, and social support). During the ROC analysis, the cut-off point of the total score was estimated to be 20/21 points (nursing care: AUC 0.75, sensitivity 0.77, specificity, 0.56; dementia: AUC 0.75; sensitivity 0.79, specificity 0.55). The binomial logistic regression analysis showed that persons with a total score of less than 20 points in 2011 were significantly more likely to be certified as requiring nursing care (odds ratio 2.57, 95%CI 1.69-3.92, P0.01) or show a decline in their independence level of dementia (odds ratio 3.12, 95%CI 1.83-5.32, P0.01) in 2014. The scores of mental health, walking function, and IADL were significantly associated with certification of requiring nursing care, while walking function and cognitive function were significantly associated with dementia.Conclusion We believe that the selected items in this study can successfully predict a transition to needing nursing care and dementia in the future. In the sub-domains, the results suggested an association with physical and mental function, as has been previously reported, but little association with social function.

We recently reported that subjects with a higher olfactory identification threshold for rose odor declined more in attentional ability in the elderly. This study focuses on discrimination ability and olfactory identification threshold in twelve elderly subjects living in a community (age: 80.9 ± 1.6). Olfactory function was assessed by the rose odor identification threshold. We assessed the discrimination ability by distinguishing 5 similar odor pairs. Our results showed that the subjects with a higher olfactory identification threshold (≥ 5) declined more in discrimination ability (14% ± 14%, p = 0.03) compared to those with a lower threshold (≤ 4) (averaged value set at 100%). As discrimination ability is related to the basal forebrain cholinergic system, our results suggest that olfactory impairment links to the decline in cognitive function relating the cholinergic system.

IntroductionPopulation aging is likely to increase the number of people with dementia living in urban areas. The Trail Making Test (TMT) is widely used as a cognitive task to measure attention and executive function among older adults. Normative data from a sample of community-dwelling older adults are required to evaluate the executive function of this population. The purpose of this study was to examine the Trail Making Test completion rate and completion time among urban community-dwelling older adults in Japan.MethodsA survey was conducted at a local venue or during a home visit (n = 1,966). Cognitive tests were conducted as a part of the survey, and TMT Parts A (TMT-A) and B (TMT-B) were completed after the completion of the Japanese version of the Mini-Mental State Examination (MMSE-J). Testers recorded TMT completion status, completion time, and the number of errors observed.ResultsIn the TMT-A, 1,913 (99.5%) participants understood the instructions, and 1,904 (99.1%) participants completed the task within the time limit of 240 s. In the TMT-B, 1,839 (95.9%) participants understood the instructions, and 1,584 (82.6%) participants completed the task within the time limit of 300 s. The completion rate of TMT-B was 90.2 and 41.8% for participants with an MMSE-J score of >23 points and ≦23 points, respectively. Results of multiple regression analyses showed that age, education, and the MMSE-J score were associated with completion time in both TMTs.ConclusionIn both TMTs, completion time was associated with age, education, and general cognitive function. However, not all participants completed the TMT-B, and the completion rate was relatively low among participants with low MMSE-J scores. These findings may help interpret future TMT assessments.

BackgroundEffective strategies to develop dementia-friendly communities (DFCs) are needed in aging societies. We aimed to propose a strategy to develop DFCs from a Japanese perspective and to evaluate an intervention program that adopted the strategy.MethodsThis study implemented a multi-level intervention that emphasized nurturing community social capital in a large apartment complex in the Tokyo metropolitan area in 2017. We offered an inclusive café that was open for extended hours as a place to socialize and a center for activities that included monthly public lectures. Individual consultation on daily life issues was also available for free at the café. Postal surveys were sent out to all older residents aged 70 years and older in 2016 and 2019. With a one-group pre-test and post-test design, we assessed changes in the proportion of older residents who had social interaction with friends and those who were confident about living in the community, even if they were living with dementia.ResultsTotals of 2633 and 2696 residents completed the pre and post-intervention surveys, respectively. The mean age of the pre-intervention respondents was 77.4 years; 45.7% lived alone and 7.7% reported living with impaired cognitive function. The proportion of men who had regular social interaction and were confident about living in their community with dementia increased significantly from 38.8 to 44.5% (p = 0.0080) and from 34.1 to 38.3% (p = 0.045), respectively. Similar significant increases were observed in the subgroup of men living with impaired cognitive function, but not in the same subgroup for women.ConclusionsThe intervention benefitted male residents who were less likely to be involved in the community’s web of social networks at baseline. A strategy to create DFCs that emphasizes nurturing community social capital can form a foundation for DFCs.Trial registrationThis study was retrospectively registered in the University hospital Medical Information Network (UMIN) Clinical Trial Registry (registry number:UMIN000038193, date of registration: Oct 3, 2019).

Aim Building community social capital is important for socially inclusive societies, leading to dementia-friendly communities. However, quantitative evidence is currently lacking regarding the effectiveness of dementia-friendly communities, including the association with community social capital. The current study examined the ecological relationship between social capital and the proportion of people with cognitive decline. Methods Data were obtained from population-based, cross-sectional surveys (mail-in questionnaire survey and home-interview survey) of community-dwelling older adults aged ≥65 years, living in 17 district areas in Machida City, Tokyo, Japan. Social capital included social networks (neighborly ties) and social support (emotional support and instrumental support). Cognitive function was assessed using the Mini-Mental State Examination, Japanese version (with a cut-off of 23/24). The proportions of people with high social capital and cognitive decline (Mini-Mental State Examination, Japanese version ≤23) were calculated for residential districts and used in the analysis. Results The district-level social capital indicators were positively and moderately correlated with the proportion of people with cognitive decline. After adjusting for the aging rate, educational level and population density of the district, an ordinal logistic regression analysis showed that higher proportions of people with strong neighborly ties and people with strong instrumental support were significantly associated with a higher proportion of people with cognitive decline. This trend was stronger among women than men. Conclusions People can continue to live in communities with high social capital, even if they are experiencing cognitive decline. Although this study was preliminary, it provided empirical evidence for the benefits of promoting dementia-friendly communities. Geriatr Gerontol Int 2019; 19: 950-955.

We conducted surveys in older people at a venue and in home-visits, and compared cognitive and health status between the two groups to assess their cognitive and everyday functioning.Among 7,614 persons aged 70 years and older living in an urban area, 5,430 responded to a mail survey for sociodemographic characteristics and self-rated questionnaires including the Geriatric Depression Scale-short form (GDS-15). Of these, 1,360 agreed to attend a venue survey, and 693 agreed to take a home-visit survey. Trained nurses examined participants' blood pressure, medical history, and daily functions using the dementia assessment sheet for community-based integrated care system (DASC-21), and tested their cognitive function using the Mini-Mental State Examination (MMSE).Of 2,053 participants, 2,020 (venue: 1,352; home-visit: 668) completed the MMSE. Median MMSE scores for the venue and home-visit groups were 28 and 26 points, respectively, with 130/1,352 (9.6%) and 205/668 (30.7%) participants below the traditional 23/24 cutoff score. The home-visit group had lower mobility, lower frequency of going out, poorer mental health, and lower independence in instrumental daily activities. Notably, 39.9% and 43.7% of the venue and home-visit groups lived alone, respectively.In this sample of urban older people, the rate of cognitive decline detected using the MMSE was three times higher in the home-visit group than in the venue group. Home-visit participants were more likely to have difficulty in physical, cognitive, and everyday functioning, suggesting they have a greater need for daily living support to continue living in the community.

This study investigated the relationship between olfaction and cognitive function in 12 elderly people (age: 80.9 ± 1.6) living in the community. Olfactory function was assessed by the identification threshold for rose odor. Four cognitive measures consisting general cognitive ability assessed by Mini-Mental State Examination (MMSE), its sub-domains, and attentional ability assessed by drawing a line to connect the numbers consecutively (trail-making test part A; TMT-A), were assessed. Subjects with a higher olfactory threshold (≥ 5) declined more in the performance speed of TMT-A (73% ± 7%, p = 0.05) compared with those subjects with a lower threshold (≤ 4) (averaged value was set at 100%). Other cognitive statuses assessed by MMSE tended to decline in subjects with higher thresholds. Because attentional function relates to the basal forebrain cholinergic system, our results suggest that olfactory impairment links to the decline in cognitive function, particularly of attention-relating cholinergic function.

Variants in the EYA4 gene are known to lead to autosomal dominant non-syndromic hereditary hearing loss, DFNA10. To date, 30 variants have been shown to be responsible for hearing loss in a diverse set of nationalities. To better understand the clinical characteristics and prevalence of DFNA10, we performed genetic screening for EYA4 mutations in a large cohort of Japanese hearing loss patients. We selected 1,336 autosomal dominant hearing loss patients among 7,408 unrelated Japanese hearing loss probands and performed targeted genome enrichment and massively parallel sequencing of 68 target genes for all patients. Clinical information of cases with mutations in EYA4 was gathered and analyzed from medical charts. Eleven novel EYA4 variants (three frameshift variants, three missense variants, two nonsense variants, one splicing variant, and two single-copy number losses) and two previously reported variants were found in 12 probands (0.90%) among the 1,336 autosomal dominant hearing loss families. The audiometric configuration of truncating variants tends to deteriorate for all frequencies, whereas that of non-truncating variants tends to show high-frequency hearing loss, suggesting a new correlation between genotype and phenotype in DFNA10. The rate of hearing loss progression caused by EYA4 variants was considered to be 0.63 dB/year, as found in this study and previous reports.

Variants of the LOXHD1 gene, which are expressed in hair cells of the cochlea and vestibule, have been reported to cause a progressive form of autosomal recessive non-syndromic hereditary hearing loss, DFNB77. In this study, genetic screening was conducted on 8074 Japanese hearing loss patients utilizing massively parallel DNA sequencing to identify individuals with LOXHD1 variants and to assess their phenotypes. A total of 28 affected individuals and 21 LOXHD1 variants were identified, among which 13 were novel variants. A recurrent variant c.4212 + 1G &gt, A, only reported in Japanese patients, was detected in 18 individuals. Haplotype analysis implied that this variation occurred in a mutational hot spot, and that multiple ancestors of Japanese population had this variation. Patients with LOXHD1 variations mostly showed early onset hearing loss and presented different progression rates. We speculated that the varying severities and progression rates of hearing loss are the result of environmental and/or other genetic factors. No accompanying symptoms, including vestibular dysfunction, with hearing loss were detected in this study. Few studies have reported the clinical features of LOXHD1-gene associated hearing loss, and this study is by far the largest study focused on the evaluation of this gene.

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.

Aim Polypharmacy is a serious medical problem among older adults. Polypharmacy can cause adverse drug reactions and is associated with frailty. Several drugs, particularly psychotropic medications, can cause cognitive impairment. Recent research also suggests that polypharmacy can cause cognitive impairment. We investigated the prevalence of polypharmacy, and examined the association between polypharmacy and cognitive impairment in a large sample of community-dwelling older adults in Japan. Methods A questionnaire covering sociodemographic variables was sent to all residents aged ≥65 years in an urban residential district of Tokyo, Japan (n = 7682). Next, 3000 individuals were randomly selected as study participants. A trained nurse and researcher interviewed participants in their own homes to obtain information about cognitive status, prescribed medications, and current medical history. Cognitive status was assessed using the Mini-Mental State Examination. Polypharmacy was defined as treatment with six or more prescribed medications. Results Of the 1270 respondents who completed an interview, 1152 were included in the analysis of medications. The prevalence of polypharmacy was 28.0% (n = 323). When the older adults in the medications analysis were stratified by Mini-Mental State Examination scores, polypharmacy was present in 48.3% of those scoring

Objectives The Mini-Mental State Examination (MMSE) is widely used as a cognitive screening test for older adults; however, cognitive performance can be affected by age, education, and sample selection bias, including time and place. The aims of this study were to examine the distribution of scores on the Japanese version of the MMSE in an urban community sample and to provide normative data for older Japanese adults. Methods A questionnaire survey was conducted on all residents aged 65 years and older living in an urban district in Tokyo (N = 7682). From among this population, 3000 residents were randomly selected to receive visits from trained nurses and to have their health status checked and their cognitive function examined using the MMSE. Results Of the 2786 eligible residents, the MMSE was administered to 1341 (47%) and successfully completed by 1319 (mean age, 74.4 ± 6.4 years; mean years of formal education, 12.6 ± 2.9). The median score was 28. A total of 143 residents (10.8%) had scores below the traditional 23/24 cutoff point. Younger age and higher education were associated with better performance. Greater variation was seen among the oldest and least educated residents, especially among women. Conclusion The results of this study confirm that age and education affect MMSE scores. To ensure the effective use of the MMSE, it is recommended to examine scores corresponding to age and education. The normative data presented are expected to be useful for assessing MMSE scores in older individuals both in and out of the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd.

Social engagement activities can help older adults maintain mental and physical functioning levels. This study examined the long-term effects of the intergenerational picture-book reading program "REPRINTS" (Research of Productivity by Intergenerational Sympathy) on older adults.After baseline assessment, participants were allowed to decide which condition they wanted to participate in: the REPRINTS intervention or control group involving only assessments. REPRINTS participants participated in group activities that involved playing a hand game and reading picture books to children at kindergartens, elementary schools, and public childcare centers, once every one-two weeks. A follow-up assessment, which focused on functional capacity (i.e., instrumental activities of daily living, intellectual activity, and social function), was conducted after seven years. The analysis included responses from 62 REPRINTS (mean age [SD]=66.2 [5.7]) and 100 control-group participants (mean age [SD]=68.0 [4.7]).A logistic regression analysis examining intervention effects revealed that control-group participants were more likely to reduce intellectual activity and interactions with children compared to REPRINTS participants (p=.013 and .003, respectively). Furthermore, the REPRINTS group maintained greater functional reach compared to the control group (p.001). However, the REPRINTS group was likely to stay indoors more often, compared to the control group (p=.045).The present study indicates that the REPRINTS intergenerational program has long-term, positive effects that help maintain and promote intellectual activity, physical functioning, and intergenerational exchange, although the effect of the increasing amount of physical activity is unclear.

Aim To investigate the prevalence and associated factors of cognitive frailty and cognitive frailty-related falls in community-dwelling older people. Methods A total of 25 out of 1192 community-dwelling older people aged >70 years with cognitive frailty participated in the present cross-sectional study. Cognitive function was assessed using the Mini-Mental State Examination. Physical function measures included calf circumference, Timed Up and Go (TUG) and usual walking speed. Interviews were carried out to assess Council on Nutrition Appetite Questionnaire (CNAQ); chronic diseases including hypertension, diabetes and falls; as well as physical frailty, defined as having three of five criteria: muscle weakness, slowness, exhaustion, low activity and weight loss. Results The prevalence of cognitive frailty was 2.1%. Participants with cognitive frailty had significantly reduced Mini-Mental State Examination and calf circumference; and higher instrumental activities of daily living disability and falls. Old age (OR 1.151, 95% CI 1.053-1.257), fall history (OR 3.577, 95% CI 1.381-9.263), having four or more chronic diseases (OR 7.419, 95% CI 2.117-26.005) and slower TUG (OR 1.234, 95% CI 1.041-1.462) were significantly associated with cognitive frailty, whereas greater calf circumference (OR 0.748, 95% CI 0.625-0.895) and CNAQ (OR 0.736, 95% CI 0.628-0.8631) had protective effects. Old age (OR 1.132, 95% CI 1.002-1.280), hospitalization (OR 10.090, 95% CI 2.554-39.854), having four or more chronic diseases (OR 5.120, 95% CI 1.113-23.557) and slower TUG (OR 1.394, 95% CI 1.167-1.665) were significantly associated with cognitive frailty-related falls, whereas CNAQ (OR 0.704, 0.571-0.868) had protective effects. Conclusions Age, chronic disease, TUG and CNAQ were significantly associated with cognitive frailty and cognitive frailty-related falls. The TUG and CNAQ have the greatest potential for improvement by intervention or lifestyle change. Further research is necessary to determine the efficacy of positive changes in these factors for symptomatic improvements. Geriatr Gerontol Int 2019; 19: 647-653.

BACKGROUND We confirmed the safety of postoperative bio-chemoradiotherapy using cetuximab and docetaxel in a small number of patients with cis-platinum–intolerant core high-risk head and neck cancer. OBJECTIVE To assess treatment efficacy, we planned a phase 2 study of postoperative bio-chemoradiotherapy for patients with cis-platinum–intolerant core high-risk head and neck cancer and will compare the results to those of previously collected radiotherapy data. METHODS Patients who underwent definitive surgery for oral cavity, laryngeal, oropharyngeal, or hypopharyngeal advanced cancer, whose postoperative pathological results indicated core high risk for recurrence (eg, positive margin in the primary site or extranodal extension) and who were cis-platinum–intolerant, will undergo postoperative bio-chemoradiotherapy. The primary end point is 2-year disease-free survival. RESULTS The expected 2-year disease-free survival is set at 55%, and the calculated sample size is 35 patients, according to a statistical analysis based on previous reports. CONCLUSIONS This treatment method is expected to improve the survival rate of patients with severe head and neck cancer. CLINICALTRIAL UMIN Clinical Trials Registry UMIN000031835; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000036355 (Archived by WebCite at http://www.webcitation.org/71fejVjMr)

A series of our studies on the development of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) were reviewed. Study 1: to examine the distribution of scores and internal reliability of DASC-21, trained nurses and researchers visited the homes of 1341 participants aged 65 years and older and living in the community. The nurses interviewed the participants and, when possible, their family members, to complete the DASC-21. Then, the Mini-Mental State Examination was carried out to select the participants of study 2. Study 2: to examine the concurrent and discriminant validity, experienced psychiatrists and psychologists, who were blind to the findings of study 1, visited the homes of 131 subjects who were selected from the participants of study 1 and completed the Clinical Dementia Rating (CDR), the Mini-Mental State Examination and the Frontal Assessment Battery (FAB). Cronbach's coefficient alpha of the DASC-21 was 0.808-0.950. Scores of the DASC-21 significantly correlated with CDR total and box scores, Mini-Mental State Examination and Frontal Assessment Battery. In an analysis of variance, CDR had the main effect on the score of the DASC-21. Receiver operating characteristic analysis showed that the DASC-21 had sufficient discriminatory ability between dementia (CDR1+) and non-dementia (CDR0 or CDR0.5; area under the curve = 0.804-0.895). When using a cut-off point of 30/31, sensitivity was 83.3-94.1% and specificity was 77.3-86.4%. The DASC-21 has sufficient reliability and validity as a tool to evaluate impairments in daily functioning and in cognitive functions, to detect dementia, and to assess the severity of dementia in the community.

Compelling evidence supporting the benefits of social engagement in older adults has been increasingly discussed. However, knowledge regarding an intergenerational program is limited. Herein, we provide a targeted review of intergenerational programs by focusing on our novel interventional program, Research on Productivity through Intergenerational Sympathy. The Research on Productivity through Intergenerational Sympathy program is an intergenerational picture-book reading program launched in 2004. Participants were involved a 3-month intensive weekly training seminar comprising classes about book selection, reading techniques and basic knowledge of children's school life. Subsequently, they participated in group activities that involved playing a hand game, and reading picture books to children at kindergartens, elementary schools and public childcare centers, once every 1-2 weeks. The Research on Productivity through Intergenerational Sympathy program has shown improvement of physical and psychological functioning of older adults and healthy upbringing of children. Similarly, Experience Corps - designed to train and place volunteers in participating elementary schools for an academic year during which time they assist teachers - also showed positive effects for older adults' health status and the psychological/academic success of young children in the USA. Health promotion efforts for older adults must support social policy for the creation of meaningful service programs for older adults on a large social scale. As such, an intergenerational program based on the concept of social capital, defined as "features of social organization, such as trust, norms and networks, that can improve the efficacy of society by facilitating coordinated actions," is an effective and sustainable program for health promotion among older adults.

PURPOSE The present study aims to develop a self-administered dementia checklist to enable community-residing older adults to realize their declining functions and start using necessary services. A previous study confirmed the factorial validity and internal reliability of the checklist. The present study examined its concurrent validity and discriminant validity. METHODS The authors conducted a 3-step study (a self-administered survey including the checklist, interviews by nurses, and interviews by doctors and psychologists) of 7,682 community-residing individuals who were over 65 years of age. The authors calculated Spearman's correlation coefficients between the scores of the checklist and the results of a psychological test to examine the concurrent validity. They also compared the average total scores of the checklist between groups with different Clinical Dementia Rating (CDR) scores to examine discriminant validity and conducted a receiver operating characteristic analysis to examine the discriminative power for dementia. RESULTS The authors analyzed the data of 131 respondents who completed all 3 steps. The checklist scores were significantly correlated with the respondents' Mini-Mental State Examination and Frontal Assessment Battery scores. The checklist also significantly discriminated the patients with dementia (CDR = 1+) from those without dementia (CDR = 0 or 0.5). The optimal cut-off point for the two groups was 17/18 (sensitivity, 72.0%; specificity, 69.2%; positive predictive value, 69.2%; negative predictive value, 72.0%). CONCLUSION This study confirmed the concurrent validity and discriminant validity of the self-administered dementia checklist. However, due to its insufficient discriminative power as a screening tool for older people with declining cognitive functions, the checklist is only recommended as an educational and public awareness tool.

Background An association between handgrip strength, hand dexterity and global cognition is suggested; however, it is unclear whether both hand motor functions are associated with executive function, which is important for performing daily activities. Understanding this association will help identify motor risk factors for impairment of executive function in late adulthood. We aim to investigate the relationship of handgrip strength and hand dexterity with executive function in physically and mentally healthy community-dwelling older adults. Methods Three hundred and twenty-six older adults (287 women, mean age ± SD, 70.1 ± 5.6) underwent handgrip strength and hand dexterity tests using a hand dynamometer and the Purdue Pegboard Test (PPT), respectively. Executive function was evaluated with the Trail Making Test (TMT)-A, TMT-B and Digit symbol; global cognition was assessed with the Mini-Mental State Examination (MMSE). Results Age-group differences showed that the younger groups (60–64, 65–69 and 70–74) had a significant better PPT and executive function performance than the oldest group (75 and older), whereas no significant age differences were observed for handgrip strength. Multiple regression analysis adjusted for potential covariates, including MMSE scores, showed that TMT-A, TMT-B, and Digit symbol were significantly associated with PPT scores; however, no significant association was observed between executive function variables and handgrip strength. Conclusions Hand dexterity is vulnerable to the effects of aging and, contrary to handgrip strength, it strongly associates with executive function, independent of global cognition. Our results suggest that assessing hand dexterity may help identify individuals at higher risk of impairment of executive function among high-functioning older adults.

AIM The aim of this study was to develop a self-administered dementia checklist (SDC), in order to help community-residing older adults realize their declining functions and encourage them to begin using necessary services, and to examine its factorial validity and internal reliability. METHODS A panel of dementia clinical experts developed a questionnaire according to pre-selected items and conducted a self-administered survey with community-residing people aged 65 + (n=2,483). The team developed a scale through an exploratory factor analysis and item response theory (IRT) analysis (Study 1). Using this scale, they conducted a self-administered survey with community-residing people aged 65 + (n=5,199), conducted another exploratory factor analysis, and developed a 10-item scale. A confirmatory factor analysis was subsequently conducted and reliability coefficients were computed. RESULTS The exploratory factor analysis of the proposed 37 items extracted 5 factors: Factor 1 was named "subjective decline in daily living functioning," and Factor 2 was "subjective cognitive decline" in the early stage of dementia. The team developed a 20-item scale by selecting 10 items from each factor which had high factor loadings and high slope values in the IRT analysis (Study 1). After the exploratory factor analysis of the 20-item scale, they developed a 10-item scale by selecting 5 items from each factor which had strong associations. The confirmatory factor analysis verified the 2-factor model. The Cronbach α coefficients for the subscales of Factors 1 and 2 were 0.935 and 0.834, respectively, and 0.908 for the overall 10-item scale. CONCLUSION The authors developed a 10-item SDC with 2 factors and confirmed its factorial validity and internal reliability.

It is known that cochlear implantation for deaf patients with eosinophilic otitis media (EOM) is safe and can provide good speech perception. However, the best timing of implant surgery in patients with EOM is not yet known. The aim of this case report is to suggest the appropriate timing of the surgery in EOM patients with deaf. Cochlear implantation was indicated in two patients with EOM. One underwent cochlear implantation in the absence of any ear discharge. In the other case, implant surgery was delayed for three years due to persistent ear discharge. No complications related to implant device or skin flap were observed in either case. The speech recognition score after implantation was good in the first case and poor in the second case. Perioperative complications were manageable even in the patient with persistent ear discharge. However, the delay in implant surgery due to the persistent ear discharge resulted in a poor speech recognition score. Early implantation should be considered even in EOM patients with ear discharge, although the presence of active middle ear inflammation is regarded as one of the contraindications for implantation according to the current Japanese guidelines.

The preservation of residual hearing after conventional cochlear implantation (CI) is frequently observed when atraumatic soft surgery is adopted. The purpose of this study was to elucidate the predictive factors for residual hearing preservation after atraumatic CI.This study included 46 patients who underwent CI based on an atraumatic technique using a standard-length flexible electrode implant through a round window approach.Cochlear volume was measured using magnetic resonance imaging (MRI). Cochlear duct length (CDL) was taken as the length of the scala media measured using computed tomography (CT). The association between residual hearing preservation and cochlear volume/CDL was then examined.Cochlear volume and CDL were significantly larger in patients with complete hearing preservation than in those with hearing loss. Multivariate logistic regression analysis revealed that cochlear volume was a significant predictive factor for residual hearing preservation.Residual hearing preservation after conventional CI was observed in patients with a larger cochlear volume and longer CDL. Cochlear volume could be a predictive factor for residual hearing preservation after conventional CI.

Understanding of the underlying mechanisms of Fear of Falling (FoF) could help to expand potential treatments. Given the nature of motor performance, the decline in the planning stage of motor execution may be associated with an expression of FoF. The aim of this study was to assess the planning/prediction accuracy in motor execution in people with FoF using gait-related motor imagery (MI). Cross-sectional case/control study. Three health centers in Japan. Two hundred and eighty-three community-dwelling older adults were recruited and stratified by presence of FoF as FoF group (n=178) or non-FoF group (n=107). Participants were tested for both imagery and execution tasks of a Timed Up and Go (TUG) test. The participants were first asked to imagine the trial (iTUG) and estimate the time it would take, and then perform the actual trial (aTUG). The difference between iTUG and aTUG (Δ TUG) was calculated. The FoF group was significantly slower in aTUG, but iTUG duration was almost identical between the two groups, resulting in significant overestimation in the FoF group. The adjusted logistic regression analysis showed that increased Δ TUG (i.e., tendency to overestimate) was significantly associated with FoF (OR = 1.05; 95% CI = 1.02–1.10). Low frequency of going outdoors was also associated with FoF (OR 2.95; 95% CI: 1.16–7.44). Older adults with FoF overestimate their TUG performance, reflecting impairment in motor planning. Overestimation of physical capabilities can be an additional explanation of the high risk of falls in this population.

A central issue in recent psycholinguistic research is whether phonological planning units in word production are language-specific. Evidence from some Indo-European language speakers contrasts with recent studies of native Chinese and Japanese speakers, who did not exploit word-onset phonemes in the word-form preparation paradigm. In the present study, we first replicated our earlier finding that no preparation effect for word-onset phonemes occurred when target responses were learned from commonly used Japanese orthographies, including kanji and kana. We then asked participants to learn target responses presented in romanized Japanese, known as romaji, and found a significant phoneme preparation effect. However, we failed to find a similar effect for auditory presentations of the target responses during the learning phase. These results suggest that Japanese speakers, who do not essentially base their speech planning on phonemes, can prepare phonemic segments in special circumstances in which the orthographic representation of romanized Japanese is first activated.

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. Language: en

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.We evaluated an intervention research project (Research of Productivity by Intergenerational Sympathy [REPRINTS]), in which volunteers65 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.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.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.

The purpose of the study is to review our experience with concurrent chemoradiotherapy (CCRT) for patients with advanced resectable squamous cell carcinoma (SCC) of the hypopharynx and to evaluate the factors affecting survival and larynx preservation. Retrospective study. The records of 102 patients with Stage III or IV resectable SCC of the hypopharynx treated with CCRT between January 1998 and August 2010 were reviewed. Of the 102 patients, 62 were treated with high-dose regimens including cisplatin, 5-fluorouracil, methotrexate, leucovorin or docetaxel, cisplatin, and 5-fluorouracil. The remaining 40 were treated with low-dose regimens including carboplatin and uracil-tegafur, weekly docetaxel, or S-1. Radiotherapy was delivered 5 days a week using a single daily fraction of 1.8–2.0 Gray (Gy), to a total dose of 64.8–70.2 Gy. Overall survival (OS), disease-specific survival (DSS), and DSS with larynx preservation were estimated using Kaplan–Meier methods. The log-rank test and Cox proportional hazards regression were used to identify significant prognostic factors for OS, DSS, and DSS with larynx preservation. The 5-year OS and DSS for all patients treated with CCRT were 51.3 and 64.3 %, respectively. The 5-year DSS with larynx preservation was 55.5 %. On multivariate analysis, the content of chemotherapy was a significant predictor of OS and DSS for patients undergoing CCRT; N stage was a significant prognostic factor for DSS and larynx preservation. The treatment method including the indication for CCRT may be determined by the contents of the chemotherapy and the N stages of SCC of the hypopharynx.

BACKGROUND: Concurrent chemoradiotherapy (CCRT) is used to treat advanced head and neck cancer. The accuracy of evaluating lymph nodes metastases following CCRT is important for subsequent therapy. PATIENTS AND METHODS: Patients were divided into two groups according to the nodal status, the complete response (CR) and the non-CR groups, as determined by imaging and fine-needle aspiration cytology (FNAC) performed 4-8 weeks after the CCRT, and the findings were compared with the status 6 months after the treatment completion. RESULTS: The sensitivity, the specificity, positive predictive value, negative predictive value and accuracy of each evaluation method were as follows: 66.7%, 73.5%, 26.7%, 93.8% and 72.5%, respectively, for computer tomography (CT) and magnetic resonance imaging (MRI); 91.7%, 69.9%, 30.6%, 98.3% and 72.6% for ultrasonography (US) ; 50.0%, 96.4%, 66.7%, 93.0% and 90.5% for fluorodeoxyglucose-positron emission tomography (FDG-PET) or PET-CT; and 68.4%, 96.1%, 81.3%, 92.5% and 90.6% for FNAC. CONCLUSION: To evaluate the response of lymph node(s) treated by CCRT, US is useful as a positive screening tool and FDG-PET and PET-CT as negative screening tools. FNAC is useful in evaluating suspicious lymph nodes in both positive and negative cases.