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Kamizato C, Osawa A, Maeshima S, Kagaya H, Arai H. Activity level by clinical severity and sex differences in patients with Alzheimer disease and mild cognitive impairment. Psychogeriatrics 2023; 23:815-820. [PMID: 37487570 DOI: 10.1111/psyg.13001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND To determine how to maintain activity in persons with dementia and mild cognitive impairment, we examined the daily activity level by different degrees of clinical severity and sex differences in patients with Alzheimer's disease and mild cognitive impairment. METHODS This study included 92 patients with Alzheimer's disease and 33 patients with mild cognitive impairment who visited our rehabilitation department. The Frenchay Activities Index was used to assess the level of activity. RESULTS Women had high Frenchay Activities Index scores for household activities, such as meal preparation, washing clothes, and light housework, whereas men had high Frenchay Activities Index scores for social occasions and walking outside. Although activity decreased with the severity of dementia in women, there was no difference in men. Additionally, a negative correlation was observed between the number of people living together and activity in women. CONCLUSIONS To maintain and improve activities in persons with Alzheimer's disease and mild cognitive impairment, it is important to suggest activities that fit the lifestyle of the individual and family caregivers and to provide lifestyle instructions that consider sex differences.
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Affiliation(s)
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Hitoshi Kagaya
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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2
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Inomoto A, Deguchi J, Fukuda R, Yotsumoto T, Toyonaga T. Gender-specific factors associated with the Japanese version of the trail making test among Japanese workers. J Phys Ther Sci 2023; 35:547-552. [PMID: 37405185 PMCID: PMC10315210 DOI: 10.1589/jpts.35.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 07/06/2023] Open
Abstract
[Purpose] The Trail Making Test is a valuable tool for predicting the transition from mild cognitive impairment to dementia. This cross-sectional study aimed to investigate gender-specific factors associated with the Trail Making Test using body composition and motor function among Japanese workers. [Participants and Methods] Demographic data, body composition, motor function, and cognitive and attentional functions (Trail Making Test, Part B) were analyzed among 627 workers who underwent health assessments during the 2019 fiscal year. After conducting univariate analysis, multiple regression analysis was performed. [Results] The presence of metabolic syndrome risk factors was found to significantly prolonged the performance time of the Trail Making Test-B in male workers. In addition, low fat-free mass and the 30-second chair stand test also significantly prolonged the performance time of the Trail Making Test-B in male workers. Among female workers, the presence of metabolic syndrome risk factors affected the performance time of the Trail Making Test-B. Therefore, MetS risk factors affect the performance times of the Trail Making Test-B in both male and female workers. [Conclusion] As male and female workers exhibit different body composition and motor function items in the Trail Making Test-B, gender differences should be considered when formulating measures to prevent cognitive and attentional decline.
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Affiliation(s)
- Atsushi Inomoto
- Faculty of Rehabilitation, Kyushu Nutrition Welfare
University: 1-5-1 Kuzuharatakamatsu, Kokuraminami-ku, Kitakyushu, Fukuoka 800-0298,
Japan
| | - Junko Deguchi
- Kyushu Rosai Hospital Research Center for the Promotion of
Health and Employment Support, Japan
| | - Rika Fukuda
- Kyushu Rosai Hospital Research Center for the Promotion of
Health and Employment Support, Japan
| | - Takamichi Yotsumoto
- Faculty of Rehabilitation, Kyushu Nutrition Welfare
University: 1-5-1 Kuzuharatakamatsu, Kokuraminami-ku, Kitakyushu, Fukuoka 800-0298,
Japan
| | - Toshihiro Toyonaga
- (Previous affiliation) Kyushu Rosai Hospital Research
Center for the Promotion of Health and Employment Support, Japan
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3
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Nagano S, Kamimura N, Sota S, Takahashi H, Suganuma N, Kazui H. Predictors of probable attention deficit hyperactivity disorder in elderly patients with mild cognitive impairment visiting a memory clinic. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e104. [PMID: 38868147 PMCID: PMC11114295 DOI: 10.1002/pcn5.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/14/2024]
Abstract
Aim Characteristics of attention deficit hyperactivity disorder (ADHD) that persist into old age are often confused with symptoms of mild cognitive impairment (MCI), and the actual rate of probable ADHD in people with MCI is unknown. This study estimated the proportion of MCI patients with probable ADHD and investigated the factors to identify MCI patients with probable ADHD. Methods We recruited 36 elderly patients (11 males, 25 females, mean age 72.4 ± 7.6 years) who met the MCI criteria. The MCI patients were classified as those with [MCI/ADHD (+)] and without [MCI/ADHD (-)] probable ADHD, according to the Wender Utah Rating Scale scores. The autism features, inattention, and hyperactivity features during childhood and current periods, estimated intelligence quotient, and demographic data were compared between the groups. Multiple logistic regression analysis was performed to identify factors of MCI/ADHD (+) patients. Results Nine (25.0%) and 27 patients were added into the MCI/ADHD (+) and MCI/ADHD (-) groups, respectively. The MCI/ADHD (+) group mostly comprised men, those who visited the clinic at a younger age, had more years of schooling, and had strong autism spectrum disorder tendencies. Multiple logistic regression analysis indicated male sex and current hyperactivity as significant predictors of probable ADHD in MCI patients. Conclusion A quarter of the patients with MCI had probable ADHD. Male sex and hyperactivity at the time of MCI diagnosis might help in predicting probable ADHD in MCI patients. However, these results were obtained from a single-center, small-case study and should be confirmed via longitudinal studies with a large number of cases.
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Affiliation(s)
- Shiho Nagano
- Department of Neuropsychiatry, Kochi Medical SchoolKochi UniversityKochiJapan
- Department of PsychiatryKochi Health Sciences CenterKochiJapan
- Kochi Gillberg Neuropsychiatry CentreKochiJapan
| | - Naoto Kamimura
- Department of Neuropsychiatry, Kochi Medical SchoolKochi UniversityKochiJapan
- Medical School BranchKochi University Health Service CenterKochiJapan
| | - Satoko Sota
- Department of Neuropsychiatry, Kochi Medical SchoolKochi UniversityKochiJapan
- Kochi Gillberg Neuropsychiatry CentreKochiJapan
| | - Hidetoshi Takahashi
- Department of Neuropsychiatry, Kochi Medical SchoolKochi UniversityKochiJapan
- Kochi Gillberg Neuropsychiatry CentreKochiJapan
- Department of Child and Adolescent Psychiatry, Kochi Medical SchoolKochi UniversityKochiJapan
| | - Narufumi Suganuma
- Kochi Gillberg Neuropsychiatry CentreKochiJapan
- Department of Environmental Medicine, Kochi Medical SchoolKochi UniversityKochiJapan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical SchoolKochi UniversityKochiJapan
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Hirakawa A, Sato H, Hanazawa R, Suzuki K. Estimating the longitudinal trajectory of cognitive function measurement using short-term data with different disease stages: Application in Alzheimer's disease. Stat Med 2022; 41:4200-4214. [PMID: 35749990 DOI: 10.1002/sim.9504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/05/2022]
Abstract
Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by a gradual decline in cognitive function over a few decades. The Mini-Mental State Examination (MMSE) is a widely used measure for evaluating global cognitive functioning. Characterizing the longitudinal trajectory of the MMSE in the population of interest is important to detect AD onset for preventive intervention. In this study, we formulate a new class of longitudinal trajectory modeling for MMSE from short-term individual data based on an ordinary differential equation. The proposed method models the relationship between individual decline speed of MMSE and the average MMSE using the fractional polynomial function model and subsequently estimates the longitudinal trajectory of MMSE by solving the ordinary differential equation for the estimated model. The appropriate model for trajectory estimation is selected based on the proposed criterion for quantifying the goodness of trajectory fit. The accuracy of the trajectory estimation of the proposed method was demonstrated via simulation studies. The proposed method was successfully applied to MMSE data from the Japanese Alzheimer's Disease Neuroimaging Initiative study.
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Affiliation(s)
- Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Sato
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Keisuke Suzuki
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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Sakatani K, Oyama K, Hu L, Warisawa S. Estimation of Human Cerebral Atrophy Based on Systemic Metabolic Status Using Machine Learning. Front Neurol 2022; 13:869915. [PMID: 35585840 PMCID: PMC9109818 DOI: 10.3389/fneur.2022.869915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/05/2022] [Indexed: 12/22/2022] Open
Abstract
BackgroundBased on the assumption that systemic metabolic disorders affect cognitive function, we have developed a deep neural network (DNN) model that can estimate cognitive function based on basic blood test data that do not contain dementia-specific biomarkers. In this study, we used the same DNN model to assess whether basic blood data can be used to estimate cerebral atrophy.MethodsWe used data from 1,310 subjects (58.32 ± 12.91years old) enrolled in the Brain Doc Bank. The average Mini Mental State Examination score was 28.6 ± 1.9. The degree of cerebral atrophy was determined using the MRI-based index (GM-BHQ). First, we evaluated the correlations between the subjects' age, blood data, and GM-BHQ. Next, we developed DNN models to assess the GM-BHQ: one used subjects' age and blood data, while the other used only blood data for input items.ResultsThere was a negative correlation between age and GM-BHQ scores (r = -0.71). The subjects' age was positively correlated with blood urea nitrogen (BUN) (r = 0.40), alkaline phosphatase (ALP) (r = 0.22), glucose (GLU) (r = 0.22), and negative correlations with red blood cell counts (RBC) (r = −0.29) and platelet counts (PLT) (r = −0.26). GM-BHQ correlated with BUN (r = −0.30), GLU (r = −0.26), PLT (r = 0.26), and ALP (r = 0.22). The GM-BHQ estimated by the DNN model with subject age exhibited a positive correlation with the ground truth GM-BHQ (r = 0.70). Furthermore, even if the DNN model without subject age was used, the estimated GM-BHQ showed a significant positive correlation with ground truth GM-BHQ (r = 0.58). Age was the most important variable for estimating GM-BHQ.DiscussionAging had the greatest effect on cerebral atrophy. Aging also affects various organs, such as the kidney, and causes changes in systemic metabolic status, which may contribute to cerebral atrophy and cognitive impairment. The DNN model may serve as a new screening test for dementia using basic blood tests for health examinations. Finally, the blood data reflect systemic metabolic disorders in each subject—this method may thus contribute to personalized care.
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Affiliation(s)
- Kaoru Sakatani
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
- *Correspondence: Kaoru Sakatani
| | - Katsunori Oyama
- Department of Computer Science, College of Engineering, Nihon University, Koriyama, Japan
| | - Lizhen Hu
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Shin'ichi Warisawa
- Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
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Lin SF, Fan YC, Kuo TT, Pan WH, Bai CH. Quality of life and cognitive assessment in healthy older Asian people with early and moderate chronic kidney disease: The NAHSIT 2013–2016 and validation study. PLoS One 2022; 17:e0264915. [PMID: 35271629 PMCID: PMC8912208 DOI: 10.1371/journal.pone.0264915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Taiwan has the highest prevalence of chronic kidney disease (CKD). Impaired cognition and quality of life are significant phenomena in the late stages of CKD. We sought to obtain an overview and the attributable effect of impaired glomerular filtration on multiple domains in cognition and dimensions of quality of life for community-based healthy older adults in Taiwan. Methods The study was derived from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013–2016, a nationwide cross-sectional study conducted to sample healthy, community-based older adults aged ≥65 years in Taiwan. Participants were categorized into four CKD groups: CKD stage 1, stage 2, stages 3a and 3b, and stages 4–5. The Mini-Mental State Examination (MMSE) and the QoL questionnaire derived from the 12-item Short Form Health Survey (SF-12) were measured. Generalized linear mixed models (GLMMs) and principal component regressions were employed for the analysis and validation, respectively. Results Participants with moderate CKD (stages 3a and 3b) showed deficits in global MMSE, domain orientation to time, calculation, complex commands, and role-physical and vitality in QoL questionnaires. In GLMMs, impaired eGFR per 30 mL/min/1.73 m² was associated with lower global MMSE scores (β = -0.807, standard error [SE] = 0.235, P = 0.0007), domain orientation to time (β = -0.155, SE = 0.047, P = 0.0011), calculation (β = -0.338, SE = 0.109, P = 0.0020), complex commands (β = -0.156, SE = 0.079, P = 0.0494), and role-physical (β = -2.219, SE = 0.779, P = 0.0046) dimensions of QoL. Conclusions Elderly Han Chinese adults with moderately impaired renal filtration could manifest cognitive deficits in orientation to time, calculation, and impaired quality of life in physical role functioning.
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Affiliation(s)
- Sheng-Feng Lin
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yen-Chun Fan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Tung Kuo
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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Kelly DM, Rothwell PM. Disentangling the Relationship Between Chronic Kidney Disease and Cognitive Disorders. Front Neurol 2022; 13:830064. [PMID: 35280286 PMCID: PMC8914950 DOI: 10.3389/fneur.2022.830064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) is a rapidly rising global health burden that affects nearly 40% of older adults. Epidemiologic data suggest that individuals at all stages of chronic kidney disease (CKD) have a higher risk of developing cognitive disorders and dementia, and thus represent a vulnerable population. It is currently unknown to what extent this risk may be attributable to a clustering of traditional risk factors such as hypertension and diabetes mellitus leading to a high prevalence of both symptomatic and subclinical ischaemic cerebrovascular lesions, or whether other potential mechanisms, including direct neuronal injury by uraemic toxins or dialysis-specific factors could also be involved. These knowledge gaps may lead to suboptimal prevention and treatment strategies being implemented in this group. In this review, we explore the mechanisms of susceptibility and risk in the relationship between CKD and cognitive disorders.
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Affiliation(s)
- Dearbhla M. Kelly
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter M. Rothwell
- Wolfson Center for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
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Nascimento CQD, Barros-Neto JA, Vieira NFL, Menezes-Filho JA, Neves SJF, Lima SO. Selenium concentrations in elderly people with Alzheimer's disease: a cross-sectional study with control group. Rev Bras Enferm 2021; 74Suppl 2:e20200984. [PMID: 34231781 DOI: 10.1590/0034-7167-2020-0984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/26/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate possible differences in plasma and erythrocyte concentrations of selenium among elderly with and without a diagnosis of Alzheimer's disease (AD). METHODS Cross-sectional study, performed with an elderly group with Alzheimer's disease, diagnosed by a geriatric doctor, and compared to an elderly group without the disease, equaling gender, education, and age. Atomic absorption spectrophotometry determined plasma and erythrocyte concentrations of total selenium (Set). RESULTS The mean age was 74.41±7.1 years in the Alzheimer's disease group and 71.46±5.1 years among the control group. The Alzheimer's disease group presented lower plasma concentrations (mean of 45.29±14.51 µg/dL vs. 55.14±14.01 µg/dL; p=0.004), and erythrocyte Set (median of 56.36 µg/L vs. 76.96 µg/L; p<0.001). The logistic regression model indicated an association between erythrocyte Set concentrations and diagnosis of Alzheimer's disease (p=0.028). CONCLUSION Elderly with Alzheimer's disease present lower selenium concentrations in the evaluated organic compartments.
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Bloomberg M, Dugravot A, Dumurgier J, Kivimaki M, Fayosse A, Steptoe A, Britton A, Singh-Manoux A, Sabia S. Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies. Lancet Public Health 2021; 6:e106-e115. [PMID: 33516287 PMCID: PMC8141610 DOI: 10.1016/s2468-2667(20)30258-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have shown an excess risk of Alzheimer's disease and related dementias among women. Education is thought to have a causal association with dementia onset. We aimed to investigate the role of education in influencing sex differences in cognitive ageing. METHODS We analysed data from two prospective cohort studies in the UK; the English Longitudinal Study of Ageing (ELSA) and the Whitehall II study, to assess sex differences in cognitive performance and cognitive decline by birth cohort (birth year 1930-38, 1939-45, or 1946-55), before and after adjustment for education, and by high and low education level. Memory was assessed using immediate recall, for which data were available from all waves of the ELSA (2002-14) and Whitehall II (1997-2015) studies. Fluency was assessed using a semantic fluency test based on an animal naming task, with data available from all waves of the Whitehall II study and waves one to five (2002-10) and wave seven (2014) of the ELSA study. Cognitive scores were standardised separately in each study based on the mean and SD of the corresponding test among participants aged 50-59 years with secondary education. FINDINGS 15 924 participants were included from the two studies. In pooled analyses, women had better memory scores than men in all birth cohorts, irrespective of adjustment for education (eg, at age 60 years, birth cohort 1930-38, mean difference between sexes [male scores minus female scores] -0·25 SDs [95% CI -0·32 to -0·19] after adjustment for education), and in both education level groups. Memory decline was faster in men than in women (at age 60 years, birth cohort 1946-55, mean difference in 13-year change -0·15 SDs [-0·20 to -0·09]; after adjustment for education -0·14 SDs [-0·20 to -0·08]). Men had better fluency scores than women in earlier birth cohorts and in the low education group (at age 60 years, birth cohort 1930-38, mean difference 0·20 SDs [95% CI 0·05 to 0·36]); but women had better fluency scores than men in later birth cohorts and in the high education group (at age 60 years, birth cohort 1946-55, mean difference -0·17 SDs [-0·24 to -0·10]). No sex differences were observed for fluency decline. INTERPRETATION Our findings suggest that decreasing disparities between sexes in education, due to secular increases in educational opportunities, could attenuate sex differences in dementia risk and cognitive decline in the future. FUNDING National Institute on Aging, National Institutes of Health; UK Medical Research Council; British Heart Foundation; and National Institute for Health Research.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Aline Dugravot
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Julien Dumurgier
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France; Cognitive Neurology Centre, Saint-Louis Lariboisière Fernand-Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aurore Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Annie Britton
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK; Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, London, UK; Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
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Disabilities of the arms, pinch strength, and mild cognitive impairment in patients with coronary artery disease. J Cardiol 2020; 77:300-306. [PMID: 33121796 DOI: 10.1016/j.jjcc.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We aimed to examine the relationship between the difficulty of activity using the arms and mild cognitive impairment (MCI), the relationship between the difficulty of activity using the arms and manual function, and cognitive function in patients with coronary artery disease (CAD). METHODS We conducted a cross-sectional study of 263 non-dementia patients who met the study criteria from 2328 CAD patients. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). The difficulty of activity using the arms was evaluated using the Disability of the Arm, Shoulder, Disability of the Arm, Shoulder and Hand and Hand (DASH) questionnaire. Manual function was evaluated by pinch strength and handgrip strength. RESULTS Age (odds ratio, 1.10), three-fingered pinch strength (odds ratio, 0.69), and DASH score (odds ratio, 1.03) were independently associated with MCI in the multivariable logistic regression analysis. Hemoglobin (β=-0.15), handgrip strength (β=-0.37), and MoCA-J score (β=-0.15) were independently associated with DASH score (Model 1: p<0.001, adjusted R2=0.33); hemoglobin (β=-0.17), eGFR (β=-0.14), three-fingered pinch strength (β=-0.25), and MoCA-J score (β=-0.14) were independently associated with DASH score in the multivariate regression analysis (Model 2: p<0.001, adjusted R2=0.31). CONCLUSIONS The difficulty of activity using the arms was independently associated with manual and cognitive function and MCI in CAD patients.
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Ishihara K, Izawa KP, Kitamura M, Ogawa M, Shimogai T, Kanejima Y, Morisawa T, Shimizu I. Gait speed, life-space mobility and mild cognitive impairment in patients with coronary artery disease. Heart Vessels 2020; 36:147-154. [PMID: 32770346 DOI: 10.1007/s00380-020-01677-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
Slow gait speed and restricted life-space mobility predict cognitive decline and dementia in healthy older adults, yet the relation between gait speed or life-space mobility and cognitive function remains poorly understood in patients with coronary artery disease (CAD). We, therefore, examined the following relations: that between gait speed and cognitive function, and mild cognitive impairment (MCI) and that between life-space mobility and cognitive function, and MCI. We conducted a cross-sectional study of 240 non-dementia patients who met the study criteria from 2132 consecutive CAD patients. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Gait speed was measured to perform gait trials at the patients' usual walking pace, and life-space mobility was evaluated using the Life-Space Assessment (LSA). We investigated the relation between gait speed or life-space mobility and cognitive function by Pearson correlation analysis, whereas multivariable logistic regression analysis was conducted for detecting MCI. Gait speed and LSA scores were positively associated with the MoCA-J score (r = 0.54, p < 0.001 and r = 0.44, p < 0.001, respectively), and both were independently associated with MCI in the multivariable logistic regression analysis (odds ratio 0.007, p < 0.001, and odds ratio 0.98, p = 0.038, respectively). Cognitive impairment can be easily detected by assessment of gait speed and life-space mobility. Interventions to improve gait speed and life-space mobility may lead to the improvement of cognitive function and MCI in patients with CAD.
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Affiliation(s)
- Kodai Ishihara
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama, 700-0804, Japan.,Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan. .,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Department of Physical Therapy, Fukuoka Wajiro Professional Training College, 1-13 Wajirooka 2-chome, Higashi-ku, Fukuoka, 811-0213, Japan
| | - Masato Ogawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Department of Rehabilitation Medicine, Kobe University Hospital, 5-2 Kusunokicho 7-chome, Chuo-ku, Kobe, 650-0017, Japan
| | - Takayuki Shimogai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe, 650-0047, Japan
| | - Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Cardiovascular Stroke Renal Project (CRP), 10-2 Tomogaoka 7-chome, Suma-ku, Kobe, 654-0142, Japan.,Department of Rehabilitation, Kobe City Medical Center General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe, 650-0047, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ikki Shimizu
- Department of Diabetes, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama, 700-0804, Japan
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12
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Sato K, Mano T, Ihara R, Suzuki K, Tomita N, Arai H, Ishii K, Senda M, Ito K, Ikeuchi T, Kuwano R, Matsuda H, Iwatsubo T, Toda T, Iwata A. Lower Serum Calcium as a Potentially Associated Factor for Conversion of Mild Cognitive Impairment to Early Alzheimer's Disease in the Japanese Alzheimer's Disease Neuroimaging Initiative. J Alzheimers Dis 2020; 68:777-788. [PMID: 30814351 DOI: 10.3233/jad-181115] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Effect of serum calcium level to the incidence of mild cognitive impairment (MCI) conversion to early Alzheimer's disease (AD) remains uncertain. OBJECTIVE To investigate association between baseline serum calcium and the MCI conversion in the Japanese Alzheimer's Disease Neuroimaging Initiative (J-ADNI) study cohort. METHODS In this sub-analysis of J-ADNI study, we reviewed data from MCI participants at baseline regarding their conversion to early AD during the 3 years of observation period and assessed the associated factors including serum calcium level. In addition, we compared our results from the J-ADNI study with the corresponding results from the North American (NA)-ADNI. RESULTS Of 234 eligible MCI participants from the J-ADNI cohort, 121 (51.7%) converted to AD during the first 36 months of observation. Using univariate analysis, being female, having shorter years of education, and lower serum calcium level were correlated with increased risk of MCI-to-AD conversion exclusively in J-ADNI cohort. The lower corrected serum calcium level remained as one of conversion-associated factors in the J-ADNI cohort even after adjustment for multiple confounding variables, although this was not observed in the NA-ADNI cohort. CONCLUSION Our findings suggest that lower serum calcium may be associated with an increased risk of MCI conversion to AD in Japanese cohorts. The reason for this correlation remains unclear and further external validation using other Asian cohorts is needed. It would be interesting for future AD studies to obtain serum calcium levels and other related factors, such as vitamin D levels, culture-specific dietary or medication information.
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Affiliation(s)
- Kenichiro Sato
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuo Mano
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryoko Ihara
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazushi Suzuki
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoki Tomita
- Department of Geriatrics and Gerontology, Division of Brain Science, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
| | - Hiroyuki Arai
- Department of Geriatrics and Gerontology, Division of Brain Science, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Sendai, Japan
| | - Kenji Ishii
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Michio Senda
- Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Kengo Ito
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | | | - Hiroshi Matsuda
- National Center for Neurology and Psychiatry, Kodaira, Japan
| | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan.,Department of Neuropathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Atsushi Iwata
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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13
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Ishihara K, Izawa KP, Kitamura M, Shimogai T, Kanejima Y, Morisawa T, Shimizu I. Serum concentration of dihomo-γ-linolenic acid is associated with cognitive function and mild cognitive impairment in coronary artery disease patients. Prostaglandins Leukot Essent Fatty Acids 2020; 158:102038. [PMID: 31767440 DOI: 10.1016/j.plefa.2019.102038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The relation between levels of n-6 polyunsaturated fatty acids (PUFAs) and cognitive function and mild cognitive impairment (MCI) in patients with coronary artery disease (CAD) is unclear. The purpose of the present study was to examine the associations between levels of n-6 PUFAs and cognitive function and MCI in patients with CAD. METHODS We conducted a cross-sectional study of 129 patients with CAD but without probable dementia. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). We classified patients into the normal cognitive group and MCI group and compared their clinical characteristics and serum levels of PUFAs. The relation between these levels and cognitive function and MCI was clarified with Pearson correlation analysis and logistic regression analysis. RESULTS The serum levels of dihomo-γ-linolenic acid (DGLA) in the CAD patients with MCI were significantly lower than those in the patients with normal cognitive function (p= 0.04). The serum levels of DGLA were positively associated with the MoCA-J score (r= 0.24, p= 0.005) and significantly associated with MCI in the univariate logistic regression analysis (odds ratio, 0.97; p= 0.035). However, in the multivariate logistic regression analysis, only age was significantly associated with MCI (odds ratio, 1.11; p < 0.001). CONCLUSIONS The serum levels of DGLA were associated with cognitive function and MCI in patients with CAD. Although not an independent predictor, DGLA might be one useful marker with which to identify early cognitive decline in these patients.
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Affiliation(s)
- Kodai Ishihara
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama 700-0804, Japan; Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan; Cardiovascular Stroke Renal Project (CRP), 10‑2 Tomogaoka 7‑chome, Suma‑ku, Kobe 654‑0142, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan; Cardiovascular Stroke Renal Project (CRP), 10‑2 Tomogaoka 7‑chome, Suma‑ku, Kobe 654‑0142, Japan.
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan; Cardiovascular Stroke Renal Project (CRP), 10‑2 Tomogaoka 7‑chome, Suma‑ku, Kobe 654‑0142, Japan; Department of Physical Therapy, Kokura Rehabilitation College, 2-10 Kuzuharahigashi 2-chome, Kokuraminami-ku, Kitakyushu 800-0206, Japan
| | - Takayuki Shimogai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan; Cardiovascular Stroke Renal Project (CRP), 10‑2 Tomogaoka 7‑chome, Suma‑ku, Kobe 654‑0142, Japan; Department of Rehabilitation, Kobe City General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe 650-0047, Japan
| | - Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan; Cardiovascular Stroke Renal Project (CRP), 10‑2 Tomogaoka 7‑chome, Suma‑ku, Kobe 654‑0142, Japan; Department of Rehabilitation, Kobe City General Hospital, 1-1 Minatojimaminamicho 2-chome, Chuo-ku, Kobe 650-0047, Japan
| | - Tomoyuki Morisawa
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 1-1 Hongo 2-chome, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Ikki Shimizu
- Department of Diabetes, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama 700-0804, Japan
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14
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Ishihara K, Izawa KP, Kitamura M, Ogawa M, Shimogai T, Kanejima Y, Morisawa T, Shimizu I. Relation of Poor Nutritional Status to Mild Cognitive Impairment in Patients with Coronary Artery Disease. J Nutr Health Aging 2020; 24:1080-1086. [PMID: 33244564 DOI: 10.1007/s12603-020-1428-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Nutritional status affects cerebral circulation and cognitive function. More attention needs to be paid to nutritional status in coronary artery disease (CAD) patients, yet the relation between nutritional status or dietary intake (DI) and cognitive function or mild cognitive impairment (MCI) in CAD patients remain unclear. Thus, we examined the following relations: 1) that between nutritional status and cognitive function, and MCI and 2) that between DI and cognitive function, and MCI. DESIGN, SETTING, AND PARTICIPANTS We conducted a cross-sectional study of 208 patients with CAD but without dementia. MEASUREMENTS MCI was estimated with the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Nutritional status was assessed by the Geriatric Nutritional Risk Index (GNRI), and DI was assessed by total energy intake per day. We investigated the relation between nutritional status or DI and cognitive function by Pearson correlation analysis, and that between nutritional status or DI and MCI by multivariable logistic regression analysis. RESULTS The GNRI and DI were positively associated with the MoCA-J score (r = 0.23, p < 0.001, and r = 0.24, p < 0.001, respectively), and both were independently associated with MCI in the multivariable logistic regression analysis (odds ratio, 0.96; p = 0.045, and odds ratio, 0.998; p = 0.020, respectively). CONCLUSIONS Poor nutritional status and low DI were found to be significantly associated with cognitive function and MCI in CAD patients. Our findings regarding nutritional status and DI might be useful for clinicians to prevent or intervene in the early cognitive decline of inpatients with CAD.
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Affiliation(s)
- K Ishihara
- Kazuhiro P. Izawa, Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma-ku, Kobe 654-0142, Japan, Tel: +81-78-796-4566; E-mail:
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15
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Links between Cognitive Status and Trace Element Levels in Hair for an Environmentally Exposed Population: A Case Study in the Surroundings of the Estarreja Industrial Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224560. [PMID: 31752166 PMCID: PMC6888438 DOI: 10.3390/ijerph16224560] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
In the present study, trace elements (TE) levels were evaluated in scalp hair along the continuum from healthy subjects (HS) to patients suffering from subjective memory concerns (SMC), and/or mild cognitive impairment (MCI), and those with already installed dementia (DEM) in order to: (i) assess the effects of environmental and lifestyle factors on TE concentrations and (ii) evaluate the analyzed elements as possible diagnostic biomarkers for the disease. The study involved 79 mainly permanent residents, >55 years old, from the city of Estarreja (northern Portugal), a former industrial area. The health status of the participants was assessed by means of a complete socio-demographic questionnaire and through cognitive screening tests, namely the Mini-Mental State Examination (MMSE). The test scores were categorized and used in the statistical analysis. Hair samples were collected and analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) ICP-MS for selected TE. Dementia appears to be associated with higher age, the female gender, lower education level, and longer residence time in the study area. In addition, most of the participants diagnosed with dementia frequently consume home-grown foodstuffs, some irrigated with contaminated well water. The calculation of the TE enrichment factors of soil samples collected in kitchen gardens/small farms in the vicinity of the Estarreja Chemical Complex (ECC) reinforces the degree of Hg soil contamination in the area, due to anthropogenic sources that can be a source for the population Hg exposure route among others. Mercury levels in hair differed significantly between the four individual groups (HS, SMC, MCI, and DEM), increasing from healthy to dementia participants. Improved diagnostic results can be obtained using hair TE signatures coupled with MMSE scores. This strategy may prove useful for predictive diagnosis in population screening for cognitive impairment.
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Sato K, Mano T, Matsuda H, Senda M, Ihara R, Suzuki K, Arai H, Ishii K, Ito K, Ikeuchi T, Kuwano R, Toda T, Iwatsubo T, Iwata A. Visualizing modules of coordinated structural brain atrophy during the course of conversion to Alzheimer's disease by applying methodology from gene co-expression analysis. NEUROIMAGE-CLINICAL 2019; 24:101957. [PMID: 31400633 PMCID: PMC6700430 DOI: 10.1016/j.nicl.2019.101957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/02/2019] [Accepted: 07/20/2019] [Indexed: 12/28/2022]
Abstract
Objective We aimed to identify modularized structural atrophy of brain regions with a high degree of connectivity and its longitudinal changes associated with the progression of Alzheimer's disease (AD) using weighted gene co-expression network analysis (WGCNA), which is an unsupervised hierarchical clustering method originally used in genetic analysis. Methods We included participants with late mild cognitive impairment (MCI) at baseline from the Japanese Alzheimer's Disease Neuroimaging Initiative (J-ADNI) study. We imputed normalized and Z-transformed structural volume or cortical thickness data of 164 parcellated brain regions/structures based on the calculations of the FreeSurfer software. We applied the WGCNA to extract modules with highly interconnected structural atrophic patterns and examined the correlation between the identified modules and clinical AD progression. Results We included 204 participants from the baseline dataset, and performed a follow-up with 100 in the 36-month dataset of MCI cohort participants from the J-ADNI. In the univariate correlation or variable importance analysis, baseline atrophy in temporal lobe regions/structures significantly predicted clinical AD progression. In the WGCNA consensus analysis, co-atrophy modules associated with MCI conversion were first distributed in the temporal lobe and subsequently extended to adjacent parietal cortical regions in the following 36 months. Conclusions We identified coordinated modules of brain atrophy and demonstrated their longitudinal extension along with the clinical course of AD progression using WGCNA, which showed a good correspondence with previous pathological studies of the tau propagation theory. Our results suggest the potential applicability of this methodology, originating from genetic analyses, for the surrogate visualization of the underlying pathological progression in neurodegenerative diseases not limited to AD. Applying origin-of-genetic unsupervised clustering to structural MRI from J-ADNI. We identified highly-interconnected modules associated with AD progression. Extension of co-atrophy modules corresponded with tau propagation theory in AD. This method has potential for visualizing underlying pathological progression. Application to other neurodegenerative diseases not limited to AD is expected.
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Affiliation(s)
- Kenichiro Sato
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan.
| | - Tatsuo Mano
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Hiroshi Matsuda
- National Center for Neurology and Psychiatry, Kodaira, Japan
| | - Michio Senda
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryoko Ihara
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan; Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazushi Suzuki
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan; Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyuki Arai
- Department of Geriatrics & Gerontology, Division of Brain Science, Institute of Development, Aging and Cancer (IDAC), Tohoku University, Japan
| | - Kenji Ishii
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kengo Ito
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | | | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan
| | - Takeshi Iwatsubo
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan; Department of Neuropathology, Graduate School of Medicine, University of Tokyo, Japan
| | - Atsushi Iwata
- Department of Neurology, Graduate School of Medicine, University of Tokyo, Japan.
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