Akihiko Kitamura

Associated factors for frailty development according to age group remain unclear. To identify frailty score trajectories among community-dwelling older Jap

Background: Few studies have examined the state of oral function in older adults with sarcopenia. We assessed the oral functions of community‐dwelling older adults with sarcopenia from multiple perspectives to clarify their potentially low oral function.Methods: A total of 1517 (86.2%; 990 women, 527 men; mean age 76.1 ± 7.6 years) participants were included in this study. Grip strength, gait speed and skeletal muscle mass index were assessed, and sarcopenia was evaluated according to the criteria of the Asian Working Group for Sarcopenia 2019. The degree of tongue coating, oral moisture, occlusal force, tongue–lip motor function, tongue pressure, masticatory function and swallowing function were assessed. The criteria for oral hypofunction (a disease that is a combination of multiple low oral functions) were used to assess oral function. Statistical analyses were performed using Kolmogorov–Smirnov test, unpaired t‐test, Mann–Whitney U test, χ² test, and univariate and multivariable logistic regression analyses, with each oral function as the dependent variable and sarcopenia as one of the independent variables. The significance level was set at P < 0.05.Results: The prevalence rates of sarcopenia and severe sarcopenia were 14.2% and 3.8%, respectively. The prevalence of oral hypofunction was 39.9%. Compared with the robust group, the sarcopenia and severe sarcopenia groups tended to have a higher frequency of the following components (all P < 0.01): low occlusal force, low tongue–lip motor function, low tongue pressure, low masticatory function, low swallowing function and oral hypofunction. Univariate logistic regression analysis showed that sarcopenia was associated with low occlusal force, low tongue–lip motor function, low tongue pressure, low masticatory function, low swallowing function and oral hypofunction. The odds ratios and 95% confidence intervals of sarcopenia for each oral function were 2.62 [2.00, 3.43], 2.21 [1.69, 2.89], 3.66 [2.79, 4.81], 3.23 [2.46, 4.25], 1.66 [1.26, 2.20] and 3.59 [2.72, 4.72], respectively. Multivariable logistic regression analysis showed that sarcopenia was associated with low occlusal force (1.63 [1.10, 2.40]), low tongue pressure (2.28 [1.65, 3.15]), low masticatory function, (1.94 [1.27, 2.97]), low swallowing function (1.64 [1.17, 2.28]) and oral hypofunction (2.17 [1.52, 3.09]).Conclusions: This study demonstrated that multiple aspects of oral function were low among community‐dwelling older adults with sarcopenia. The potential decline in oral functions in older adults with sarcopenia may have been overlooked until now. This study indicates the need for dental perspectives in intervening with older adults with sarcopenia and the need to encourage them to see dental professionals.

Aim: To examine the relationship between the number of present and functional teeth at baseline and future incidence of loss of independence.Methods: Participants were community‐dwelling older individuals who participated in a comprehensive geriatric health examination conducted in Kusatsu town, Japan, between 2009 and 2015. The primary endpoint was the incidence of loss of independence among participants, defined as the first certification of long‐term care insurance in Japan. The numbers of present and functional teeth at baseline were determined via an oral examination. Demographics, clinical variables (e.g., history of chronic diseases and psychosocial factors), blood nutritional markers, physical functions, and perceived masticatory function were assessed.Results: This study included 1121 individuals, and 205 individuals suffered from loss of independence during the follow‐up period. Kaplan–Meier estimates of loss of independence for participants with smaller numbers of present and functional teeth were significantly greater than for those with larger numbers of teeth. Cox proportional hazard analyses indicated that a smaller number of present teeth was not a significant risk factor after adjusting for demographic characteristics. However, the number of functional teeth was a significant risk factor after the adjustment (hazard ratio: 1.975 [1.168–3.340]). Additionally, higher hazard ratios were observed in other adjusted models, but they were not statistically significant.Conclusions: The number of functional teeth may be more closely related to the future incidence of loss of independence than the number of present teeth. This novel finding suggests that prosthodontic rehabilitation for tooth loss possibly prevents the future incidence of this life‐event. Geriatr Gerontol Int 2022; 22: 1032–1039.

Aim: Community settings often need simple screening, rather than detailed tests, to identify cognitive impairment. This study aimed to develop models to screen older adults with cognitive impairment.Methods: This study used data from the Integrated Research Initiative for Living Well with Dementia Cohort Study and included 5830 older adults. Individuals were considered cognitively impaired if their Mini‐Mental State Examination score was less than 24. Three screening models were developed: the simple model (age, sex, and education), the base model comprising 13 candidate variables available in the questionnaire, and the enhanced model, where grip strength and gait speed were added to the base model. We performed binary logistic regression analysis with stepwise backward elimination (P < 0.1 for retention in the model) to develop each model. Then, we calculated integer scores from coefficients to develop score‐based models. The area under the receiver operating characteristic curve (AUC) was used to evaluate discrimination.Results: Participants with cognitive impairment accounted for 4.0% (n = 233) of the total. The score‐based simple model comprised three variables (AUC = 0.72, sensitivity: 72%, specificity: 61%). The score‐based base model included nine variables (AUC = 0.76, sensitivity: 70%, specificity: 67%). The score‐based enhanced model comprised eight variables, including grip strength and gait speed (AUC = 0.79, sensitivity: 73%, specificity: 70%).Conclusions: This study developed three screening models with acceptable discriminant validity for cognitive impairment. These models comprised simple questionnaire‐based items and common physical performance measurements. These models could enable screening of older adults suspected of cognitive impairment without the need to conduct cognitive tests in community settings. Geriatr Gerontol Int 2022; 22: 292–297.

Nutritional epidemiology has shown the importance of protein intake for maintaining brain function in the elderly population. Mild cognitive impairment (MCI) may be associated with malnutrition, especially protein intake. We explored blood-based biomarkers linking protein nutritional status with MCI in a multicenter study. In total, 219 individuals with MCI (79.5 ± 5.7 year) from 10 institutions and 220 individuals who were cognitively normal (CN, 76.3 ± 6.6 year) in four different cities in Japan were recruited. They were divided into the training (120 MCI and 120 CN) and validation (99 MCI and 100 CN) groups. A model involving concentrations of PFAAs and albumin to discriminate MCI from CN individuals was constructed by multivariate logistic regression analysis in the training dataset, and the performance was evaluated in the validation dataset. The concentrations of some essential amino acids and albumin were significantly lower in MCI group than CN group. An index incorporating albumin and PFAA discriminated MCI from CN participants with the AUC of 0.705 (95% CI: 0.632–0.778), and the sensitivities at specificities of 90% and 60% were 25.3% and 76.8%, respectively. No significant association with BMI or APOE status was observed. This cross-sectional study suggests that the biomarker changes in MCI group may be associated with protein nutrition.

Objective The present study investigated associations between occupation, job stress, and salivary cortisol levels after psychological tasks. Methods We examined 766 (273 men and 493 women) healthy employed Japanese participants aged 21 to 68 years (mean age = 46.4 years, standard deviation = 8.5) with three types of occupation: manager, teacher, and general worker. The Brief Job Stress Questionnaire was used to evaluate participants’ job stress levels, including job demand, job control, support from supervisors, and support from coworkers. Salivary cortisol levels were measured at pre-session, post-stressful tasks, and post-relaxation. All samples were assayed using an enzyme-linked immunosorbent assay test. Natural log transformation was applied before statistical analyses. A multiple regression analysis and a repeated measures analysis of covariance were conducted to test associations between occupation and salivary cortisol levels, adjusting for confounding factors. Statistical analyses were conducted separately for men and women. Results Among both men and women, general workers had higher cortisol levels than managers throughout the experimental session (men 0.6 μg/dL and 0.4 μg/dL, respectively; women 0.5 μg/dL and 0.4 μg/dL, respectively). Job control was positively associated with cortisol levels measured in all sessions, after adjusting for confounding factors (standardized beta 0.15, 0.21, and 0.18 for pre-session, post-stressful-tasks, and post-relaxation, respectively, all p < 0.05). Men with low support from coworkers had higher cortisol levels than those with high support through the sessions (0.6 μg/dL and 0.4 μg/dL, respectively). Conclusion Socioeconomic disparity according to occupational status was related to cortisol levels in Japanese workers. Support from coworkers may be effective for reducing cortisol secretion in men.