Involvement in Decision-Making for Daily Care and Cognitive Decline among Older Adults Who Need Care in Japan

Effective decision-making regarding daily care for older adults with needs could reduce the risk of dementia by preventing loss of motivation and improving care quality. However, empirical studies are scarce, particularly in non-Western countries with different socio-cultural backgrounds. By using 2-year longitudinal data of older Japanese adults aged 65 years and above who were receiving care at home, as well as of their family caregivers, we examined the association of involvement in decision-making with the onset of cognitive decline among older Japanese adults requiring care. The analysis included 219 cases of individuals with normal cognition and no missing variables at baseline and responded to the follow-up survey. An MMSE score of 23 or lower at follow-up was defined as the onset of cognitive decline. The level of involvement in decision-making was assessed by one item and dichotomized (not involved/involved). The covariates were age, gender, education, MMSE score, eligibility level for long-term care, and others at baseline. At baseline, 67.1% were 75 years or older, 58.9% were female, and 91.8% responded being “involved” in the decision-making. The incidence of cognitive decline at follow-up was 30.6%. The multivariable logistic regression analysis showed that involvement in decision-making (OR=0.298 [95% CI: 0.10-0.88], p=0.029) was negatively and significantly associated with the onset of cognitive decline. Our findings show the importance of involvement in the decision-making for daily care to reduce the risk of subsequent cognitive decline in older adults requiring care, even in a culture of familism.

Association between intra-individual changes in social network diversity and global cognition in older adults: Does closeness to network members make a difference?

OBJECTIVE

Although qualitative aspects of interpersonal networks, such as diversity or closeness, can protect the health of older adults, their association with cognitive health remains unclear. This study examined the concurrent and time-lagged association between intra-individual changes in global cognition and social network diversity, while considering emotional closeness.

METHODS

In this 10-year study, we obtained six-wave, biennial data from the National Institute for Longevity Sciences, Longitudinal Study of Aging. Data from 808 community-dwelling, cognitively intact adults aged 65 or older at baseline were analyzed. Global cognition was assessed using the Mini-Mental State Examination (MMSE). Social network diversity scores were assessed using a social convoy model, comprising three closeness levels: inner (closest), middle (second closest), and outer (least close).

RESULTS

The mean age of the respondents was 72.0 ± 4.4 years at baseline, and 50.1% were male. A fixed-effects model showed that intra-individual change in total (coefficients, B: 0.10; standard error [SE]: 0.05; p = .042) and inner (B: 0.25; SE: 0.07; p < .001) social network diversity was significantly associated with MMSE score decline, even after adjusting for covariates. Yet, in time-lagged models, diversity and MMSE score changes were not significantly associated during the subsequent two years.

CONCLUSION

Older adults' global cognition declined when the diversity of their closest social network decreased. This may be a promising marker for early cognitive decline in older adults. Indeed, their closest networks are relatively unlikely to decline as part of normal aging or diseases except dementia.

Early tumor response assessment may avoid serious immune-related adverse events in nivolumab and ipilimumab combination therapy for stage IV melanoma

Nivolumab and ipilimumab combination therapy is one of the most promising treatments for patients with melanoma. However, this combination therapy is highly toxic and causes serious adverse events (SAEs) in more than half of the patients.

Successful Aging in East Asia: Comparison Among China, Korea, and Japan

OBJECTIVES

Heterogeneity in successful aging has been found across countries. Yet, comparable evidence is sparse except in North America and Europe. Extending prior research, this study examined the prevalence and correlates of successful aging in East Asia: China, Korea, and Japan.

METHOD

We used harmonized data sets from national surveys. A total of 6,479 participants (aged between 65 and 75) were analyzed. Using Rowe and Kahn's (1987, 1997) model, successful aging was defined as having no major diseases, no difficulty performing activities of daily living, obtaining a median or higher score on tests of cognitive function, and being actively engaged.

RESULTS

The average prevalence of successful agers was 17.6%. There were variations in the global and specific measures of successful aging within and across countries, even after controlling for individual sociodemographic factors (age, gender, and education). The odds of aging successfully were highest in Japan and lowest in China, especially in the rural areas. Being younger and males were associated with a higher likelihood of successful agers in both global and specific measures.

DISCUSSION

This study observed heterogeneity in successful aging in East Asia. To identify policy implications, future research should explore potential societal factors influencing individuals' opportunities for successful aging.

Pre-operative endovascular coil embolisation for chronic pulmonary aspergillosis

OBJECTIVE: To retrospectively evaluate the clinical outcomes of pre-operative endovascular coil embolisation (ECE) for chronic pulmonary aspergillosis (CPA).METHODS: We evaluated surgical patients with CPA between November 2016 and April 2020. Pre-operative ECE for CPA with severe adhesions was selectively performed to reduce intra-operative blood loss. ECE procedures, operative procedures, intra-operative blood loss and complications were evaluated.RESULTS: Twenty-eight patients (21 males and 7 females; median age: 55 years) were included in the study. Of the 28 patients, 8 (28.6%) underwent pre-operative ECE. Technical success rate in pre-operative ECE was 100%. The median time required for ECE procedures was 123 min. The median number of vessels embolised per procedure was 2.5. The median period between embolisation and surgery was 5 days. Major complications were observed in three patients (10.7%). There were no significant differences between patients with and without pre-operative ECE in operative time (284 vs. 365 min, respectively, P = 0.7602) and intra-operative blood loss (294 vs. 228 mL, respectively, P = 0.8987).CONCLUSIONS: Pre-operative ECE for CPA appears to be feasible and safe; however, its role in reducing intra-operative blood loss needs further investigation.

Metallization of Quantum Material GaTa4Se8 at High Pressure

Pressure is a unique thermodynamic variable to explore the phase competitions and novel phases inaccessible at ambient conditions. The resistive switching material GaTa₄Se₈ displays several quantum phases under pressure, such as a J_eff = 3/2 Mott insulator, a correlated quantum magnetic metal, and d-wave topological superconductivity, which has recently drawn considerable interest. Using high-pressure Raman spectroscopy, X-ray diffraction, extended X-ray absorption, transport measurements, and theoretical calculations, we reveal a complex phase diagram for GaTa₄Se₈ at pressures exceeding 50 GPa. In this previously unattained pressure regime, GaTa₄Se₈ ranges from a Mott insulator to a metallic phase and exhibits superconducting phases. In contrast to previous studies, we unveil a hidden correlation between the structural distortion and band gap prior to the insulator-to-metal transition, and the metallic phase shows superconductivity with structural and magnetic properties that are distinctive from the lower-pressure phase. These discoveries highlight that GaTa₄Se₈ is a unique material to probe novel quantum phases from a structural, metallicity, magnetism, and superconductivity perspective.

Effects of H3 and H4 histones acetylation and bindings of CREB binding protein and p300 at the promoter on hepatic expression of gamma-glutamyltransferase gene in a streptozotocin-induced moderate hypoinsulinemic rat model

Gamma-glutamyltransferase (GGT), a marker of liver disease, has been shown to be associated with increased risk of diabetes and relative insulin secretion deficiency. However, the mechanism of hepatic Ggt regulation has not been explored fully. In this study, we made a concerted effort to understand the mechanism by investigating the effects of acetylation of histones H3 and H4, and bindings of histone acetyltransferases, CREB binding protein (CBP) and p300, at the Ggt promoter on the regulation of the expression of Ggt gene in the livers of streptozotocin (STZ)-induced moderate hypoinsulinemia rat model. The rats treated with STZ showed remarkably higher serum GGT level and hepatic Ggt/GGT expression than the untreated control rats. Furthermore, the acetylation of histones H3 and H4, and the binding of CBP not p300 at the Ggt promoter regions were significantly higher in the livers of STZ rats than those of the control rats. These results suggest that an enhanced hepatic expression of Ggt is associated with increased acetylation of histones H3 and H4 and CBP binding at the Ggt promoter in STZ-induced moderate hypoinsulinemic rats.

Life Satisfaction during the Transition to Widowhood among Japanese Older Adults

INTRODUCTION

The loss of a spouse is among the most stressful life events. Whilst grief and mourning vary across cultures, most longitudinal studies have been conducted in Western societies. Adding to prior research, this study examines the role of resources available prior to spousal bereavement and changes therein for trajectories of well-being in an Eastern society, namely, Japan.

METHODS

Data were derived from a nationally representative panel survey of Japanese older adults aged 60 years and above. We used data from married participants at baseline who experienced spousal loss during the 19-year follow-up period (N = 481). Well-being was indexed as life satisfaction.

RESULTS

The multiphase growth model revealed that life satisfaction typically deteriorated surrounding spousal loss and remained stable 1 year after the event. Compared with individuals coresiding with a child before and after loss, those who did not continuously coreside with a child showed lower levels of postloss life satisfaction, but better recovery. Perceiving better financial status prior to loss was related to higher levels of preloss life satisfaction and, conversely, lower levels after loss. Changes in resources were not associated with life satisfaction following widowhood.

DISCUSSION

Our results show that spousal bereavement has, on average, an initial negative impact on well-being with substantial individual differences in recovery 1 year later. When designing interventions to promote adaptation after spousal loss, it is important to consider the bereaved individual's cultural background and preloss resources.

Quenchable amorphous glass-like material from VF3

The quite simple but relatively stable VF3-type compounds are known to be of major interest due to their building blocks - octahedra that are extremely important in perovskites as well. Here, we show that the VF6 octahedron in VF3 varies over a fairly wide pressure range (0-50 GPa), maintaining undisturbed rhombohedral crystal symmetry. Half of this pressure, VF6 rotates easily while the other undergoes strong uniaxial deformation in a "super-dense" condition. The congested sphere packing ultimately does not endure and drives the material to amorphize. We observed that the amorphous state could be quenched and acquire a transparent glass-like appearance when unloaded to ambient conditions. Dramatic, pressure-induced changes are clarified by phonon dispersion curves with the imaginary phonon mode, the so-called phonon soft mode, which indicates the structural instability. The distortion of the VF6 octahedra is attributed to the distinctive amorphization that could be further searched for throughout the whole almost identical VF3-type series providing metal trifluorides of various amorphous species.

Left atrial strain and outcome in heart failure with preserved ejection fraction

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial (LA) function is impaired in heart failure with preserved ejection fraction (HFpEF). However, the association between LA longitudinal strain and heart failure (HF) events in patients with HFpEF is still unknown. We evaluated whether LA strain measurements would be useful to predict hospitalizations for worsening HF in this study.

Methods

This study included 121 patients (Male 73, Female 48) with HFpEF who had echocardiogram at our institute (Age = 76 ± 14y, Left ventricular ejection fraction; LVEF = 63 ± 8%). Patients with atrial fibrillation were excluded. LA longitudinal strain was measured by speckle-tracking echocardiography, using TOMTEC imaging system. The endpoints were hospitalizations for worsening HF.

Results

During follow-up period of 319 ± 269 days, 33 patients (27%) experienced hospitalizations for worsening HF. LA strain was markedly lower in patients with HF events at 11.3 ± 5.6, whereas LA strain was higher at 20.3 ± 10.1 in patients without HF events. Kaplan-Meier analysis demonstrated a significant separation of survival curves stratified by median value of LA strain (Figure).

Conclusions

LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization, and LA strain measurements would be useful to predict HF events.

Abstract Figure

Occupational Complexity and Late-Life Global Cognition: The SONIC Study

Studies have reported that work exposure to cognitively demanding environments predicted the level of late-life cognitive abilities. To date, whether or not such a relationship between work complexity and cognitive function is maintained in very old adults remains unknown. In the present study, we examined how the associations between lifetime work’s complexity and global cognition vary by age groups (70s, 80s, and 90s). To this end, we used data from 2754 Japanese community-dwelling participants in the SONIC Project. Specifically, we tested multiple group path models comparing the models based on differences in age and gender. The effects of work complexities on global cognition were found for male septuagenarians and octogenarians, having controlled for the variables related to education. The relationships between them were marginally significant for male nonagenarians. Based on the analysis, we discuss the maintenance of cognitive reserve and implications for cognitive and physical health in very old ages.

Early- to Late-Life Environmental Factors and Late-Life Global Cognition: The SONIC study

Life environment across the life course—such as engagement in late-life leisure activity (LA), primary occupation, and early-life education—have been reported to be associated with better late-life cognitive outcomes. However, few studies have included all these factors from the past to the present due to the time-consuming procedure to measure all factors. This study examined (1) whether late-life LA is associated with better late-life cognition, after considering other life environments and (2) whether occupation, education, and childhood intelligence quotient have indirect effects on the late-life cognition through late-life LA. We used baseline data from the groups of 70- and 80-year-olds in the SONIC study (N = 1721 ). Global cognition was measured using the Montreal Cognitive Assessment. As for LA, participants were asked for yes/no answers to questions regarding their engagement in 158 activities. A latent factor representing LA was used in the analyses. We retrospectively evaluated the complexity of work with data, people, and things. As early-life environments, education and language and arithmetic abilities during elementary school were included in the analyses. Age and gender were controlled. A structural equation model showed that late-life LA was significantly associated with higher global cognition, even after controlling for all past factors (RMSEA = .050, GFI = .973, AGFI = .947). Sobel tests showed significant indirect effects of occupation, education, and childhood abilities on cognitive function. Results were robust across age and gender. It is suggested that engagement in LA explains individual differences in late-life cognitive function.

The Psychometric Properties of the Montreal Cognitive Assessment (MoCA)

Abstract. The Montreal Cognitive Assessment (MoCA) is a test assessing global cognition in older adults which is often used by researchers and clinicians worldwide, although some of its psychometric properties have yet to be established. We focus on three fundamental aspects: the factorial structure of the MoCA, its general factor saturation, and the measurement invariance of the test. We administered the MoCA to a large sample of Japanese older adults clustered in three cohorts (69–71-year-olds, 79–81-year-olds, and 89–91-year-olds; N = 2,408). Our results show that the test has an overall stable hierarchical factorial structure with a general factor at its apex and satisfactory general-factor saturation. We also found measurement invariance across participants of different ages, educational levels, economic status, and sex. This comprehensive investigation thus supports the idea that the MoCA is a valid tool to assess global cognition in older adults of different socioeconomic status and age ranges.

Evaluation of epithelial and mesenchymal cell markers in canine urinary bladder transitional cell carcinoma

Canine transitional cell carcinoma (cTCC) is the most common malignant tumour in the urinary bladder: it is highly invasive and exhibits metastatic characteristics. Inflammation is also strongly related to cTCC. Epithelial tumours often exhibit a mesenchymal cell phenotype during tumour invasion and metastasis owing to epithelial-mesenchymal transition (EMT), which is often induced in chronic inflammation. The aim of this retrospective study was to investigate the expression of epithelial and mesenchymal cell markers in tumour cells and to evaluate its relationship with prognosis of cTCC. In this study, 29 dogs with cTCC who underwent surgical treatment were enrolled. Clinical parameters were reviewed using medical records. Tissue expression of epithelial and mesenchymal markers was evaluated by immunohistochemical analysis. The association between the expression of mesenchymal cell markers and clinical parameters, including prognosis, was statistically examined. In five normal bladder tissues used as controls, no expression of mesenchymal markers was observed, except for one tissue that expressed fibronectin. Conversely, epithelial tumour cells expressed vimentin and fibronectin in 23/29 and 19/28 cTCC tissues, respectively. Regarding clinical parameters, vimentin score in Miniature Dachshunds was significantly higher than those in other dog breeds (P < 0.001). Multivariate survival analyses revealed that age>12 years was related to shorter progression-free survival (P = 0.02). Higher vimentin score, lower fibronectin score, and advanced clinical T stage were significantly correlated with shorter median survival time (P < 0.05). The results of this study indicate that vimentin expression was associated with cTCC progression. Further studies are needed to examine the incidence and relevance of EMT in cTCC.

Dietary diversity is associated with longitudinal changes in hippocampal volume among Japanese community dwellers

BACKGROUND/OBJECTIVES

Dietary habits are known to affect health, including the rate of brain ageing and susceptibility to diseases. This study examines the longitudinal relationship between dietary diversity and hippocampal volume, which is a key structure of memory processing and is known to be impaired in dementia.

SUBJECTS/METHODS

Subjects were aged 40-89 years (n = 1683, men: 50.6%) and participated in a 2-year follow-up study of the National Institute for Longevity Sciences-Longitudinal Study of Aging. Dietary intake was calculated from 3-day dietary records, and dietary diversity was determined using the Quantitative Index for Dietary Diversity at baseline. Longitudinal changes in hippocampal and total grey matter volumes were estimated by T1-weighted brain magnetic resonance imaging and FreeSurfer software. Estimated mean brain volume change in relation to dietary diversity score quintiles was assessed by the general linear model, adjusted for age, sex, education, smoking status, alcohol intake, physical activity, and comorbidities.

RESULTS

The mean (± standard deviation) % decreases in hippocampal and total grey matter volume during the 2-year follow-up were 1.00% (±2.27%) and 0.78% (±1.83%), respectively. Multivariate-adjusted decreases in total grey matter volume were associated with dietary diversity score (p = 0.065, p for trend = 0.017), and the % decrease in hippocampal volume was more strongly associated with the dietary diversity score: the estimated mean (± standard error) values were 1.31% (±0.12%), 1.07% (±0.12%), 0.98% (±0.12%), 0.81% (±0.12%), and 0.85% (±0.12%), according to dietary diversity quintiles in ascending order (p = 0.030, p for trend = 0.003).

CONCLUSIONS

Among community dwellers, increased dietary diversity may be a new nutritional strategy to prevent hippocampal atrophy.

Exploratory open-label clinical study to determine the S-588410 cancer peptide vaccine-induced tumor-infiltrating lymphocytes and changes in the tumor microenvironment in esophageal cancer patients

Cancer vaccines induce cancer-specific T-cells capable of eradicating cancer cells. The impact of cancer peptide vaccines (CPV) on the tumor microenvironment (TME) remains unclear. S-588410 is a CPV comprising five human leukocyte antigen (HLA)-A*24:02-restricted peptides derived from five cancer testis antigens, DEPDC1, MPHOSPH1, URLC10, CDCA1 and KOC1, which are overexpressed in esophageal cancer. This exploratory study investigated the immunologic mechanism of action of subcutaneous S-588410 emulsified with MONTANIDE ISA51VG adjuvant (median: 5 doses) by analyzing the expression of immune-related molecules, cytotoxic T-lymphocyte (CTL) response and T-lymphocytes bearing peptide-specific T-cell receptor (TCR) sequencing in tumor tissue or blood samples from 15 participants with HLA-A*24:02-positive esophageal cancer. Densities of CD8+, CD8+ Granzyme B+, CD8+ programmed death-1-positive (PD-1+) and programmed death-ligand 1-positive (PD-L1+) cells were higher in post- versus pre-vaccination tumor tissue. CTL response was induced in all patients for at least one of five peptides. The same sequences of peptide-specific TCRs were identified in post-vaccination T-lymphocytes derived from both tumor tissue and blood, suggesting that functional peptide-specific CTLs infiltrate tumor tissue after vaccination. Twelve (80%) participants had treatment-related adverse events (AEs). Injection site reaction was the most frequently reported AE (grade 1, n = 1; grade 2, n = 11). In conclusion, S-588410 induces a tumor immune response in esophageal cancer. Induction of CD8+ PD-1+ tumor-infiltrating lymphocytes and PD-L1 expression in the TME by vaccination suggests S-588410 in combination with anti-PD-(L)1 antibodies may offer a clinically useful therapy.Trial registration UMIN-CTR registration identifier: UMIN000023324.

Association between dexamethasone treatment and alterations in serum concentrations of trace metals

Previously, a significant elevation in the serum levels of iron (Fe) was observed within a few days after the initiation of cisplatin (CDDP)-based chemotherapy. To clarify the underlying mechanisms, the serum concentration of hepcidin, a negative regulator of Fe release, was determined in the clinical samples obtained from six patients with cancer. The result showed that the serum concentration of hepcidin in patients receiving CDDP-based chemotherapy was significantly increased after 4-6 days of treatment, in comparison to the baseline level, suggesting that aforementioned excessive systemic Fe was not explained by the change of serum hepcidin level. All these patients received antiemetic premedication. We next evaluated of the effects of Pt-containing drugs and prophylactic antiemetic dexamethasone medication on the serum concentration of trace metals in mice, and on the hepatic and renal concentration of trace metals. The serum concentrations of Fe, Cu, and Zn in the CDDP-treated and oxaliplatin-treated mice were not significantly altered in comparison to those of the vehicle-treated control group. The serum concentrations of Fe, Cu, and Zn were increased after 24 h of dexamethasone treatment, compared to those of the control group (P < 0.05). The hepatic concentration of Mn was significantly reduced, whereas those of Fe and Cu inclined to diminish. The present findings suggest that dexamethasone can partly contribute to the changes in the serum concentrations of trace metals during anticancer chemotherapy.

Caregiving centenarians: Cross-national comparison in Caregiver-Burden between the United States and Japan

Background and Objectives: The personal distress associated with caring for a family member has been well documented; however, questions about the burden of caregiving for centenarians and cross-national differences in the caregiving context, remain unanswered.Research Design and Methods: This study includes reports by caregivers of 538 near-centenarians and centenarians in the U.S. and Japan: 234 from the Georgia Centenarian Study and 304 from the Tokyo Centenarian Study. Basic descriptive and multivariate regression analyses were conducted. Mean levels of caregiver burden and near-centenarian and centenarians' characteristics (as predictors) for caregiver burden were compared between the U.S. and Japan. The near-centenarian and centenarians' functional capacity and personality were assessed as predictors.Results: Differential predictive patterns in caregiver burden were found in the two groups. In the U.S., near-centenarian and centenarians' agreeableness and conscientiousness were negatively associated with caregiver burden; whereas the near-centenarian and centenarians' neuroticism and number of diseases were positively associated with caregiver burden. In Japan, the near-centenarian and centenarians' activities of daily living, openness, and agreeableness were negatively associated with caregiving burden. Interaction effects between functional capacity and personality, on caregiver burden were observed only in the U.S. In the U.S., higher levels of agreeableness and openness significantly changed the level of caregiver burden associated with vision problems and a greater number of diseases.Discussion and Implications: Cross-national comparative predictors of caregiving burden between the two countries emphasized that caring for centenarians should be understood in the caregiving context, as well as the social context.

Stability and change in well-being among middle-aged and older Japanese

Prior evidence suggests that subjective well-being (SWB) remains relatively stable across adulthood. However, longitudinal evidence is sparse except in Western societies such as North America and Western Europe. We examined age-related changes in SWB (life satisfaction, positive affect, and negative affect) among middle-aged and older Japanese. We applied multilevel growth models to 14-year seven-wave longitudinal data of a dynamic cohort study. A total of 3,890 participants aged 40–81 at first assessment were included in the analysis. The longitudinal results demonstrated differential trajectories of SWB. Life satisfaction exhibited an accelerated increase in middle age but decreased and leveled off in old age. Positive affect increased in midlife and declined in late life. Negative affect remained stable in middle age but increased in old age. Demographics, health, and methodological correlates did not fully account for age-related changes in SWB. Of note, increases in negative affect in old age remained evident even after controlling for the correlates. In conclusion, life satisfaction was stable across adulthood, which was not the case with positive and negative affect. We discussed the possible mechanisms in these observed trajectories of SWB, in particular, negative affect in late life.

Fructose metabolism as a common evolutionary pathway of survival associated with climate change, food shortage and droughts

Mass extinctions occur frequently in natural history. While studies of animals that became extinct can be informative, it is the survivors that provide clues for mechanisms of adaptation when conditions are adverse. Here, we describe a survival pathway used by many species as a means for providing adequate fuel and water, while also providing protection from a decrease in oxygen availability. Fructose, whether supplied in the diet (primarily fruits and honey), or endogenously (via activation of the polyol pathway), preferentially shifts the organism towards the storing of fuel (fat, glycogen) that can be used to provide energy and water at a later date. Fructose causes sodium retention and raises blood pressure and likely helped survival in the setting of dehydration or salt deprivation. By shifting energy production from the mitochondria to glycolysis, fructose reduced oxygen demands to aid survival in situations where oxygen availability is low. The actions of fructose are driven in part by vasopressin and the generation of uric acid. Twice in history, mutations occurred during periods of mass extinction that enhanced the activity of fructose to generate fat, with the first being a mutation in vitamin C metabolism during the Cretaceous-Paleogene extinction (65 million years ago) and the second being a mutation in uricase that occurred during the Middle Miocene disruption (12-14 million years ago). Today, the excessive intake of fructose due to the availability of refined sugar and high-fructose corn syrup is driving 'burden of life style' diseases, including obesity, diabetes and high blood pressure.