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Ruggiero C, Baroni M, Xenos D, Parretti L, Macchione IG, Bubba V, Laudisio A, Pedone C, Ferracci M, Magierski R, Boccardi V, Antonelli-Incalzi R, Mecocci P. Dementia, osteoporosis and fragility fractures: Intricate epidemiological relationships, plausible biological connections, and twisted clinical practices. Ageing Res Rev 2024; 93:102130. [PMID: 38030092 DOI: 10.1016/j.arr.2023.102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Dementia, osteoporosis, and fragility fractures are chronic diseases, often co-existing in older adults. These conditions pose severe morbidity, long-term disability, and mortality, with relevant socioeconomic implications. While in the research arena, the discussion remains on whether dementia is the cause or the consequence of fragility fractures, healthcare professionals need a better understanding of the interplay between such conditions from epidemiological and physiological standpoints. With this review, we summarized the available literature surrounding the relationship between cognitive impairment, dementia, and both low bone mineral density (BMD) and fragility fractures. Given the strength of the bi-directional associations and their impact on the quality of life, we shed light on the biological connections between brain and bone systems, presenting the main mediators, including gut microbioma, and pathological pathways leading to the dysregulation of bone and brain metabolism. Ultimately, we synthesized the evidence about the impact of available pharmacological treatments for the prevention of fragility fractures on cognitive functions and individuals' outcomes when dementia coexists. Vice versa, the effects of symptomatic treatments for dementia on the risk of falls and fragility fractures are explored. Combining evidence alongside clinical practice, we discuss challenges and opportunities related to the management of older adults affected by cognitive impairment or dementia and at high risk for fragility fracture prevention, which leads to not only an improvement in patient health-related outcomes and survival but also a reduction in healthcare cost and socio-economic burden.
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Affiliation(s)
- C Ruggiero
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy.
| | - M Baroni
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - D Xenos
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - L Parretti
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - I G Macchione
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - V Bubba
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - A Laudisio
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - C Pedone
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - M Ferracci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Magierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - V Boccardi
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Antonelli-Incalzi
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - P Mecocci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
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Li CL, Stanaway FF, Chang HY, Chen MC, Tsai YH. Joint predictability of physical frailty/pre-frailty and subjective memory complaints on mortality risk among cognitively unimpaired older adults. Eur J Ageing 2023; 20:17. [PMID: 37199786 DOI: 10.1007/s10433-023-00765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 05/19/2023] Open
Abstract
The aim of the present study was to investigate how frailty/pre-frailty in combination with subjective memory complaints predicts all-cause mortality in community dwelling cognitively unimpaired older adults. There were 1904 community-dwelling cognitively unimpaired persons aged 65 years or older who participated in the 2013 Taiwan National Health Interview Survey with a 5-year follow-up. Frailty was determined based on the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMC). In this study, 11.9% of participants had both frailty/pre-frailty and SMC. A total of 239 deaths were recorded after 9009.5 person-years of follow-up. After adjustment for other factors, compared with participants who were physically robust with no SMC, participants who reported either SMC alone (HR = 0.88, 95% CI = 0.60-1.27) or were frail/pre-frail alone (HR = 1.32, 95% CI = 0.90-1.92) had no significantly increased mortality risk. However, coexisting frailty/pre-frailty and SMC was associated with a significantly increased hazard ratio for mortality of 1.48 (95% CI = [1.02-2.16]). Our results highlight the high prevalence of co-occurring frailty/pre-frailty and SMC and that this co-occurrence is associated with an increased risk of mortality among cognitively unimpaired older adults.
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Affiliation(s)
- Chia-Lin Li
- Department of Health Care Management, College of Management, Chang Gung University, 259 Wen-Hwa 1St Road, Kwei-Shan, Tao-Yuan, 33302, Taiwan.
| | - Fiona F Stanaway
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Maoli, Taiwan
| | - Min-Chi Chen
- Department of Public Health, Biostatistics Consulting Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsuan Tsai
- Department of Health Care Management, College of Management, Chang Gung University, 259 Wen-Hwa 1St Road, Kwei-Shan, Tao-Yuan, 33302, Taiwan
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Rostami-Moez M, Masoumi SZ, Otogara M, Farahani F, Alimohammadi S, Oshvandi K. Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study. J Menopausal Med 2023; 29:1-20. [PMID: 37160298 PMCID: PMC10183767 DOI: 10.6118/jmm.22033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/19/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
Menopause is one the most crucial stages in a female's life. Identifying the education gaps regarding menopause is important, thus this study aims to explain the health-related needs of females during menopause. Scopus, PubMed, Scientific Information Database, and Web of Science databases were searched for the available observational (cohort, case-control, and cross-sectional), systematic review, meta-analysis, and clinical trial studies (2007-2021) using keywords, such as 'Educational Needs Assessment,' 'Assessment of Healthcare Needs,' 'menopause,' 'climacteric,' 'premenopause,' and 'postmenopause.' A total of 180 out of 5,705 papers were evaluated after considering the inclusion and exclusion criteria. The educational needs of females during menopause in the reviewed studies include osteoporosis, oral and dental problems, metabolic disorders, cardiovascular diseases, hypertension, lung diseases, infectious diseases, musculoskeletal problems, urinary problems, breast cancer, defecation problems, genital disorders, special diseases such as eye diseases and hypothyroidism and hormone therapy, mental disorders, cognitive function, sleep disorders, sexual disorders, physical activity, supplement consumption, public health issues, health education, fall, and nutrition. The study results reveal that females during postmenopause require training, counseling, and support in all aspects to get through this challenging time, and providing these services, infrastructure, appropriate policy, and the use and support of the medical team's capacity are all required.
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Affiliation(s)
- Masoumeh Rostami-Moez
- Research Center for Health Sciences, Education Development Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyedeh Zahra Masoumi
- Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Marzieh Otogara
- Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farhad Farahani
- Department of Ear, Nose and Throat, School of Medicine, Hearing Disorder Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shohreh Alimohammadi
- Department of Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
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Li CL, Chang HY, Tsai YH. Sarcopenia Screened with SARC-F and Subjective Memory Complaints Are Independently Associated with Increased Risk of Incident Dementia among Cognitively Unimpaired Older Adults. J Nutr Health Aging 2023; 27:940-945. [PMID: 37997713 DOI: 10.1007/s12603-023-2006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES The main aim of this study was to examine the association of sarcopenia and subjective memory complaints with the incidence of dementia in a population-based cohort of cognitively unimpaired older adults. DESIGN Three-year longitudinal study. SETTINGS AND PARTICIPANTS A total of 2163 community-dwelling persons aged 65 years or older who participated in the National Health Interview Survey in Taiwan, 2017. MEASUREMENTS Sarcopenia was determined based on SARC-F, a self-reported symptom-based questionnaire that includes five components: strength, assistance walking, rise from a chair, climb stairs, and falls. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMCs). The incidence of dementia was determined by data linkage to the Taiwan National Health Insurance claims database from 2018 to 2020. RESULTS Among the 2163 participants without dementia at baseline, 135 had incident dementia during the 3-year follow-up, giving a crude incidence rate of 6.2% (135/2163). Compared to participants free from sarcopenia and SMCs, the adjusted hazard ratio for incident dementia was 1.83 (95% confidence interval [CI]: 1.23-2.72) for SMCs alone, 2.40 (95% CI: 1.17-4.93) for sarcopenia alone, and 2.49 (95% CI: 1.21-5.11) for coexisting SMCs and sarcopenia. CONCLUSIONS Our results indicate that sarcopenia screened with SARC-F and SMCs independently predict the cognitively unimpaired older adults at risk of incident dementia. Our findings highlight the importance of screening not only for cognitive but also muscle deficits to identify those at increased risk of incident dementia.
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Affiliation(s)
- C-L Li
- Chia-Lin Li, PhD., Department of Health Care Management, College of Management, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan, Tel: +886-3-2118800 ext. 5666, E-mail:
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Abstract
OBJECTIVES While there is a large body of research on falls and their consequences in older adults, little is known about how older adults remember them. We addressed this gap by inviting older adults to remember falls and control memories. METHODS We analyzed specificity of memories and invited participants to rate emotional valence, mental time travel, visual imagery, importance, and rehearsal, as experienced during retrieval. RESULTS Although analysis demonstrated no significant differences between memories of falls and control memories regarding specificity, participants rated memories of falls as more negative than control memories. Furthermore, they rated memories of falls as triggering higher mental time travel, higher visual imagery, higher importance, and higher rehearsal than control memories. CONCLUSIONS The negative emotional valence of memories of falls, as well as their ability to trigger significant levels of mental time travel, visual imagery, importance, and rehearsal, demonstrate how these memories are different from other memories in older adults. CLINICAL IMPLICATIONS The findings demonstrate how falls can modulate memory of personal events in older adults.
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Affiliation(s)
- Karim Gallouj
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Emin Altintas
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Laboratoire PSITEC, Psychologie: Interactions Temps Émotions Cognition, Université Lille Nord de France, Lille, France
| | - Mohamad El Haj
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
- Laboratoire de Psychologie des Pays de la Loire (LPPL - EA 4638), Nantes Université, Univ Angers, Nantes, France
- Institut Universitaire de France, Paris, France
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Smith L, Oh H, Jacob L, López-Sánchez GF, Veronese N, Soysal P, Shin JI, Schuch F, Tully MA, Butler L, Barnett Y, Koyanagi A. Sleep problems and subjective cognitive complaints among middle-aged and older adults in 45 low- and middle-income countries. Aging Clin Exp Res 2022; 34:1285-1293. [PMID: 34985716 DOI: 10.1007/s40520-021-02052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, a small body of evidence suggests that sleep problems are positively associated with subjective cognitive complaints (SCC). However, no studies on this topic exist from low- and middle-income countries (LMICs). Thus, we investigated the association between sleep problems and SCC in a large sample of middle-age and older adults from 45 LMICs. METHODS Cross-sectional, predominantly nationally representative, community-based data were analyzed from the World Health Survey. Sleep problems (such as difficulties falling asleep, waking up frequently during the night or waking up too early in the morning) in the last 30 days were self-reported. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Multivariable linear regression was conducted to explore the association between sleep problems (exposure) and SCC (outcome). RESULTS Data on 60,228 adults aged ≥ 50 years were analyzed [mean (SD) age 61.4 (9.9) years; 53.9% females]. After adjustment for potential confounders, compared to those without sleep problems, the mean SCC score for the multivariable model was 13.32 (95% CI 12.01, 14.63), 19.46 (95% CI 17.95, 20.98), 24.17 (95% CI 22.02, 26.33), and 31.39 (95% CI 28.13, 34.65) points higher for mild, moderate, severe, and extreme sleep problems, respectively. Similar results were found for analyses stratified by age and country-income level. CONCLUSION Sleep problems were positively associated in a dose-response manner with SCC among middle-aged and older adults in multiple LMICs. Addressing sleep problems may aid in the prevention of SCC and ultimately dementia, pending future longitudinal research.
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Affiliation(s)
- Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-le-Bretonneux, France
| | - Guillermo F López-Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, 30100, Espinardo, Murcia, Spain.
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), Fatih, 34093, İstanbul, Turkey
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Mark A Tully
- School of Health Sciences, Institute of Mental Health Sciences, Ulster University, Newtownabbey, BT37 0QB, Northern Ireland, UK
| | - Laurie Butler
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Yvonne Barnett
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain
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Fallaci IV, Fabrício DDM, Alexandre TDS, Chagas MHN. Association between falls and cognitive performance among community-dwelling older people: a cross-sectional study. SAO PAULO MED J 2022; 140:422-429. [PMID: 35507999 PMCID: PMC9671243 DOI: 10.1590/1516-3180.2021.0180.r1.15092021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/15/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Falls among older people have a negative impact on health and therefore constitute a public health problem. Cognitive decline can also accompany the aging process, and both conditions lead to significant increases in morbidity and mortality in this population. OBJECTIVE To analyze the cognitive performance of older people, classified as non-fallers, sporadic fallers and recurrent fallers, and investigate the relationship between falls and cognition. DESIGN AND SETTING Cross-sectional study conducted in the interior of the state of São Paulo, Brazil. METHODS Evaluations on 230 older people were conducted. They were divided into three groups: non-fallers, sporadic fallers (one fall) and recurrent fallers (two or more falls). The Mini-Mental State Examination, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Brief Cognitive Screening Battery (BCSB), Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) similarities subtest and digit span test were applied. RESULTS In multinomial logistic regression, being a recurrent faller was significantly associated with lower scores in the CERAD word list (odds ratio, OR = 0.92; 95% confidence interval, CI, 0.86-0.98; P = 0.01), in CERAD constructive praxis (OR = 0.88; 95% CI, 0.79-0.98; P = 0.02), in BCSB figure list memory (OR = 0.94; 95% CI, 0.89-0.99; P = 0.02) and in verbal fluency (OR = 0.89; 95% CI, 0.81-0.97; P = 0.01). Recurrent fallers also had lower scores in these same tests, compared with sporadic fallers. CONCLUSION Cognitive impairment, especially in the domains of memory and executive functioning, can influence occurrences of recurrent falls.
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Affiliation(s)
- Isabella Vittoria Fallaci
- BSc. Gerontologist, Department of Gerontology, Research Group on Mental Health, Cognition and Aging, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | - Daiene de Morais Fabrício
- MSc. Gerontologist and Doctoral Student, Department of Gerontology, Research Group on Mental Health, Cognition and Aging, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | - Tiago da Silva Alexandre
- PhD. Physiotherapist and Associate Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil.
| | - Marcos Hortes Nisihara Chagas
- MD, PhD. Psychiatrist and Associate Professor, Department of Gerontology, Research Group on Mental Health, Cognition and Aging, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil; Associate Professor, Department of Gerontology, Universidade Federal de São Carlos (UFSCar), São Carlos (SP), Brazil; and Technical Director, Medical Residency Program on Psychiatry, Instituto Bairral de Psiquiatria, Itapira (SP), Brazil.
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Sex Differences in Modifiable Fall Risk Factors. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bouldin ED, Taylor CA, Knapp KA, Miyawaki CE, Mercado NR, Wooten KG, McGuire LC. Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life. Int Psychogeriatr 2021; 33:689-702. [PMID: 32883384 PMCID: PMC8630807 DOI: 10.1017/s1041610220001635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). DESIGN Cross-sectional. SETTING US - 50 states, District of Columbia, and Puerto Rico. PARTICIPANTS Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). MEASUREMENTS We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. RESULTS In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. CONCLUSIONS Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.
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Affiliation(s)
- Erin D Bouldin
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Christopher A Taylor
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kenneth A Knapp
- Department of Public Health, New York Medical College, Valhalla, NY, USA
| | | | - Nicholas R Mercado
- Department of Medicine, Donald and Barbara Zucker School of Medicine, Hofstra University/Northwell, Hempstead, NY, USA
- School of Health Professions and Human Services, Hofstra University, Hempstead, NY, USA
- Division of Medical Ethics, Northwell Health, New York, NY, USA
| | - Karen G Wooten
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa C McGuire
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Koyanagi A, Smith L, Shin JI, Oh H, Kostev K, Jacob L, Abduljabbar AS, Haro JM. Multimorbidity and Subjective Cognitive Complaints: Findings from 48 Low- and Middle-Income Countries of the World Health Survey 2002-2004. J Alzheimers Dis 2021; 81:1737-1747. [PMID: 33998540 DOI: 10.3233/jad-201592] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Data on the association between multimorbidity and subjective cognitive complaints (SCC) are lacking from low- and middle-income countries (LMICs). OBJECTIVE To assess the association between multimorbidity and SCC among adults from 48 LMICs. METHODS Cross-sectional, community-based data were analyzed from the World Health Survey 2002-2004. Ten chronic conditions (angina, arthritis, asthma, chronic back pain, depression, diabetes, edentulism, hearing problems, tuberculosis, visual impairment) were assessed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Multivariable linear regression and mediation analyses were conducted to explore the associations. RESULTS A total of 224,842 individuals aged≥18 years [mean (SD) age 38.3 (16.0) years; 49.3% males] constituted the final sample. Compared to no chronic conditions, the mean SCC score was higher by 7.13 (95% CI = 6.57-7.69), 14.84 (95% CI = 13.91-15.77), 21.10 (95% CI = 19.49-22.70), 27.48 (95% CI = 25.20-29.76), and 33.99 (95% CI = 31.45-36.53) points for 1, 2, 3, 4, and≥5 chronic conditions. Estimates by sex and age groups (18-44, 45-64,≥65 years) were similar. Nearly 30% of the association between multimorbidity (i.e.,≥2 chronic conditions) and SCC was explained by psychological factors (i.e., perceived stress, sleep problems, anxiety symptoms). CONCLUSION Multimorbidity is associated with SCC among adults in LMICs. Future studies should investigate whether addressing psychological factors in people with multimorbidity can improve cognitive function, and whether screening for SCC in individuals with multimorbidity can be a useful tool to identify individuals at particularly high risk for future cognitive decline.
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Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Karel Kostev
- Philipps University of Marburg, Marburg, Germany
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | | | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, Barcelona, Spain.,King Saud University, Riyadh, Saudi Arabia
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Krivanek TJ, Gale SA, McFeeley BM, Nicastri CM, Daffner KR. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis 2021; 81:871-920. [PMID: 33935078 PMCID: PMC8293659 DOI: 10.3233/jad-201462] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
A decade has passed since we published a comprehensive review in this journal addressing the topic of promoting successful cognitive aging, making this a good time to take stock of the field. Because there have been limited large-scale, randomized controlled trials, especially following individuals from middle age to late life, some experts have questioned whether recommendations can be legitimately offered about reducing the risk of cognitive decline and dementia. Despite uncertainties, clinicians often need to at least make provisional recommendations to patients based on the highest quality data available. Converging lines of evidence from epidemiological/cohort studies, animal/basic science studies, human proof-of-concept studies, and human intervention studies can provide guidance, highlighting strategies for enhancing cognitive reserve and preventing loss of cognitive capacity. Many of the suggestions made in 2010 have been supported by additional research. Importantly, there is a growing consensus among major health organizations about recommendations to mitigate cognitive decline and promote healthy cognitive aging. Regular physical activity and treatment of cardiovascular risk factors have been supported by all of these organizations. Most organizations have also embraced cognitively stimulating activities, a heart-healthy diet, smoking cessation, and countering metabolic syndrome. Other behaviors like regular social engagement, limiting alcohol use, stress management, getting adequate sleep, avoiding anticholinergic medications, addressing sensory deficits, and protecting the brain against physical and toxic damage also have been endorsed, although less consistently. In this update, we review the evidence for each of these recommendations and offer practical advice about behavior-change techniques to help patients adopt brain-healthy behaviors.
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Affiliation(s)
- Taylor J. Krivanek
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Seth A. Gale
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Brittany M. McFeeley
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Casey M. Nicastri
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
| | - Kirk R. Daffner
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Hale Building for Transformative Medicine, Boston, MA, USA
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Kang DW, Wang SM, Um YH, Na HR, Kim NY, Han K, Lee CU, Lim HK. Differential Risk of Incident Fractures Depending on Intensity and Frequency of Physical Activity According to Cognitive Status: A Nationwide Longitudinal Study. Front Med (Lausanne) 2020; 7:572466. [PMID: 33364244 PMCID: PMC7753209 DOI: 10.3389/fmed.2020.572466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Previous studies have demonstrated an increased risk of fractures in subjects with various degrees of cognitive impairments. Recently, there has been growing recognition of the vital effect of physical activity (PA) on delay and prevention of fractures in older adults. Objectives: This study aimed to evaluate the optimal intensity and frequency of PA needed to prevent fractures in cognitively preserved older adults (CP), participants with subjective cognitive decline (SCD), and dementia patients using a large-scale nationwide cohort study. Methods: Data from a nationwide health screening program for individuals at the transitional age of 66 years were used in this study. A total of 968,240 subjects was enrolled, followed from 2007 to 2014, and classified as CP (n = 759,874), SCD (n = 195,365), or dementia group (n = 13,001). Adjusted hazard ratios (aHRs) by demographic and known risk factors for fractures were evaluated to identify the impact of various frequency and intensity PA on the occurrence of hip, vertebral, and limb fractures. Results: In CP participants, the most noticeable reduction of hip and vertebral fracture risk was shown in those performing vigorous-intensity PA at least three times per week. In the SCD group, the risk decrement in hip and vertebral fractures was most prominent in subjects who performed multiple-intensity PAs at least three times a week regardless of intensity. In the dementia group, only high-frequency walking and high-frequency & multiple-intensity PA decreased the risk of hip fractures compared with absence of PA. Conclusion: These findings suggest a role for various PA intensity and frequency levels to prevent hip and vertebral fractures according to cognitive status. Further study is needed to validate the effects of PA intensity and frequency proposed in this study on fractures according to cognitive status.
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Affiliation(s)
- Dong Woo Kang
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sheng-Min Wang
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yoo Hyun Um
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Hae-Ran Na
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Nak-Young Kim
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Chang Uk Lee
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Kook Lim
- Department of Psychiatry, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Um YH, Wang SM, Han KD, Kim NY, Kang DW, Na HR, Lee CU, Lim HK. Differential Impact of Cigarette Smoking on Fracture Risks in Subjective Cognitive Decline and Dementia: A Nationwide Longitudinal Study. Psychiatry Investig 2020; 17:786-795. [PMID: 32750761 PMCID: PMC7449844 DOI: 10.30773/pi.2020.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We aimed to explore the differential impact of cigarette smoking on fracture risks in SCD and dementia. METHODS A nationwide population-based cohort study design was used. Out of all the people aged 66 (n=1,555,103) who went through the National Screening Program from 2009-2014, 968,240 participants with eligible data were included in the study. Time-to-event was calculated as the duration between the NSPTA and fracture incidence. Cox proportional-hazard regression analyses were conducted to evaluate the risk of fractures. RESULTS Increased risk of all [adjusted hazard ratio (aHR)=1.184; 95% confidence interval (CI)=1.184, 1.093-1.283], hip (aHR=1.518; 95% CI=1.168-4.972), vertebral (aHR=1.235; 95% CI=1.101-1.386) fractures were increased in current smokers with more than 20 or more pack years (≥20 py) of SCD group, after adjusting for all relevant confounding factors. In dementia group, however, current smokers ≥20 py were at reduced risk of hip fractures (aHR=0.249; 95% CI=0.089-0.97). CONCLUSION There was a disparate influence of cigarette smoking on the fracture risks in SCD and dementia group. Further studies are warranted to explicate this phenomenon, and personalized preventive measures according to one's cognitive status are imperative, since risk factors of fractures can exert disparate influence on patients at different stage of cognitive trajectory.
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Affiliation(s)
- Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nak-Young Kim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Woo Kang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae-Ran Na
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Carr S, Pichora-Fuller MK, Li KZ, Phillips N, Campos JL. Multisensory, Multi-Tasking Performance of Older Adults With and Without Subjective Cognitive Decline. Multisens Res 2019; 32:797-829. [DOI: 10.1163/22134808-20191426] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022]
Abstract
Abstract
As the population ages, it is increasingly important to detect non-normative cognitive declines as early as possible. Measures of combined sensory–motor–cognitive functioning may be early markers for identifying individuals who are at increased risk of developing dementia. Further, older adults experiencing subjective cognitive decline (SCD) may have elevated risk of dementia compared to those without SCD. Tasks involving complex, multisensory interactions reflective of everyday challenges may be particularly sensitive to subjectively perceived, pre-clinical declines. In the current study, older adults with and without SCD were asked to simultaneously perform a standing balance task and a listening task under increasingly challenging sensory/cognitive/motor conditions using a dual-task paradigm in a realistic, immersive virtual environment. It was hypothesized that, compared to older adults without SCD, those with SCD would exhibit greater decrements in postural control and listening response accuracy as sensory/motor/cognitive loads increased. However, counter to predictions, older adults with SCD demonstrated greater reductions in postural sway under more challenging dual-task conditions than those without SCD. Across both groups, poorer postural task performance was associated with poorer cognitive function and speech-in-noise thresholds measured with standard baseline tests. Poorer listening task performance was associated with poorer global cognitive function, poorer mobility, and poorer speech-in-noise detection. Overall, the results provide additional support for the growing evidence demonstrating associations between sensory, motor, and cognitive functioning and contribute to an evolving consideration of how best to categorize and characterize SCD in a way that guides strategies for screening, assessment, and intervention.
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Affiliation(s)
- Sophie Carr
- 1KITE—Toronto Rehabilitation Institute, University Health Network, Canada
- 2Department of Psychology, University of Toronto, Canada
| | - M. Kathleen Pichora-Fuller
- 2Department of Psychology, University of Toronto, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
| | - Karen Z. H. Li
- 3Department of Psychology, Concordia University, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
| | - Natalie Phillips
- 3Department of Psychology, Concordia University, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
| | - Jennifer L. Campos
- 1KITE—Toronto Rehabilitation Institute, University Health Network, Canada
- 2Department of Psychology, University of Toronto, Canada
- 4Centre for Research in Human Development, Concordia University, Canada
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Sharma A, Hoover DR, Shi Q, Holman S, Plankey MW, Tien PC, Weber KM, Floris-Moore M, Bolivar HH, Vance DE, Golub ET, Holstad MM, Yin MT. Longitudinal study of falls among HIV-infected and uninfected women: the role of cognition. Antivir Ther 2019; 23:179-190. [PMID: 28933703 DOI: 10.3851/imp3195] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although fracture rates are higher in HIV+ than HIV- women, whether HIV infection increases risk of falls is unclear. We determined the longitudinal occurrence and risk factors for falls in the Women's Interagency HIV Study (WIHS), and explored associations with cognitive complaints. METHODS Recent (prior 6 months) self-reported falls were collected in 1,816 (1,250 HIV+; 566 HIV-) women over 24 months. Generalized estimating equation models using stepwise selection determined odds of any fall (versus none). RESULTS HIV+ women were older than HIV- women (median 49 versus 47 years; P=0.0004), more likely to report neuropathy (20% versus 16%; P=0.023), and had greater central nervous system (CNS) medication use. At least one fall was reported in 41% HIV+ versus 42% HIV- women, including ≥2 falls in 25% HIV+ and 24% HIV- (overall P=0.30). Cognitive complaints were associated with falls among HIV+ (odds ratio [OR] 2.38; 95% CI 1.83, 3.09) and HIV- women (OR 3.43; 95% CI 2.37, 4.97); in adjusted models, cognitive complaints remained significant only in HIV- women (adjusted [aOR] 2.26; 95% CI 1.46, 3.48). Factors associated with any fall in adjusted analyses included: depressive symptoms and neuropathy (both HIV+ and HIV-); age, marijuana use, multiple CNS medications, and HCV infection (HIV+ only); and cognitive complaints, quality of life, hypertension and obesity (HIV- only). CONCLUSIONS Middle-aged HIV+ and HIV- women had similar fall rates. Among HIV+ women, factors affecting cognition such as age, depressive symptoms, marijuana use and multiple CNS medications were important predictors of falls, however, cognitive complaints were not.
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Affiliation(s)
- Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ, USA
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY, USA
| | - Susan Holman
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Phyllis C Tien
- Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen M Weber
- Department of Medicine, Cook County Health and Hospitals System/Hektoen Institute of Medicine, Chicago, IL, USA
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Hector H Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL, USA
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Michael T Yin
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Spano G, O Caffò A, Bosco A. Cognitive functioning, subjective memory complaints and risky behaviour predict minor home injuries in elderly. Aging Clin Exp Res 2018; 30:985-991. [PMID: 29181769 DOI: 10.1007/s40520-017-0858-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/10/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Home accidents are one of the major causes of death, particularly in older people, young children and women. AIMS The first aim of this study was to explore the role of subjective memory complaints, cognitive functioning and risky behaviour as predictors of home injuries occurred in a year in a sample of healthy Italian older adults. The second aim was to investigate the role of risky behaviour as a mediator in the relationship between subjective and objective cognitive functioning and home injuries. METHODS One hundred thirty-three community-dwelling older people from southern Italy were administered a battery of tests to evaluate cognitive functioning, subjective memory complaints, and risky behaviour during home activities. Risky behaviour was evaluated using the Domestic Behaviour Questionnaire, created specifically for this purpose. The number of home injuries was recorded for a year throughout monthly telephone interviews. A path analysis was performed to test the following model: cognitive functioning and subjective memory complaints directly influence risky behaviour and number of accidents over a year; risky behaviour mediates the impact of cognitive functioning and subjective memory on number of accidents over a year. RESULTS Path analysis confirmed the model tested except the role of risky behaviour as a mediator between cognitive functioning and home accidents. DISCUSSION Risky behaviour could represent a further risk factor in cognitively intact older adults with subjective memory complaints. CONCLUSIONS The assessment of both cognition and behaviour in elderly can make a valuable contribution in preventing home accidents in elderly.
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Affiliation(s)
- Giuseppina Spano
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari "Aldo Moro", Via Crisanzio 42, 70122, Bari, Italy.
| | - Alessandro O Caffò
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari "Aldo Moro", Via Crisanzio 42, 70122, Bari, Italy
| | - Andrea Bosco
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari "Aldo Moro", Via Crisanzio 42, 70122, Bari, Italy
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Shirooka H, Nishiguchi S, Fukutani N, Tashiro Y, Nozaki Y, Aoyama T. Subjective cognitive decline and fall risk in community-dwelling older adults with or without objective cognitive decline. Aging Clin Exp Res 2018; 30:457-462. [PMID: 28726038 DOI: 10.1007/s40520-017-0799-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The association between subjective cognitive decline and falls has not been clearly determined. AIMS Our aim was to explore the effect of subjective cognitive decline on falls in community-dwelling older adults with or without objective cognitive decline. METHODS We included 470 older adults (mean age 73.6 ± 5.2; 329 women) living in the community and obtained data on fall history directly from the participants. Subjective cognitive decline was assessed using a self-administered question. Objective cognitive function was measured using the Mini-Mental State Examination. Statistical analyses were carried out separately for participants with objective cognitive decline and those without. RESULTS A multiple logistic regression analysis showed that, among participants without objective cognitive decline, subjective cognitive decline was positively associated with falls [OR 1.91; 95% confidence interval (CI) 1.17-3.12; p = 0.01). Conversely, among participants with objective cognitive decline, subjective cognitive decline was negatively associated with falls (OR 0.07; 95% CI 0.01-0.85, p = 0.04). DISCUSSION The result suggests that the objective-subjective disparity may affect falls in community-dwelling older adults. CONCLUSIONS The presence of subjective cognitive decline was significantly positively associated with falls among cognitively intact older adults. However, among their cognitively impaired peers, the absence of subjective cognitive decline was positively associated with falls.
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Affiliation(s)
- Hidehiko Shirooka
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
- Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
| | - Shu Nishiguchi
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Naoto Fukutani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuto Tashiro
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuma Nozaki
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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