Nagato Kuriyama

Objectives: To examine the associations of anticholinergic agents and β3‐adrenergic receptor agonists (β3‐agonists) prescribed for overactive bladder (OAB) with worsening long‐term care needs, incident dementia, and frailty among older women. Subjects/Patients and Methods: This retrospective cohort study used the Shizuoka Kokuho Database, a population‐based administrative claims database in Japan. Women aged 65–84 years who newly initiated anticholinergic agents or β3‐agonists for OAB between 2012 and 2024 and had prescription records consistent with continuous treatment for at least 1 year were included. Follow‐up began 12 months after treatment initiation. Stabilized inverse probability of treatment weighting (sIPTW) was used to balance baseline covariates between groups. Primary outcomes were worsening long‐term care needs and incident dementia; the secondary outcome was changes in the electronic Frailty Index (eFI). Time‐to‐event outcomes were analyzed using sIPTW‐weighted Cox proportional hazards models. Results: The cohort comprised 1 605 anticholinergic and 2 189 β3‐agonist users. After sIPTW, baseline covariates were well‐balanced. No significant difference was observed in worsening long‐term care needs (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.87–1.22). Anticholinergic use was associated with a higher risk of claims‐defined incident dementia compared with β3‐agonist use (HR, 1.49; 95% CI, 1.04–2.13). Median eFI did not differ significantly between the groups during 5 years of follow‐up. Conclusion: Among older women with OAB, anticholinergic use was associated with an increased risk of claims‐defined incident dementia but not with worsening long‐term care needs or frailty compared with β3‐agonists. Residual confounding and differential dementia ascertainment cannot be excluded.

Objectives: While smoking is a well-established risk factor for various cardiovascular diseases, its association with intracerebral haemorrhage (ICH) remains controversial. Cerebral microbleeds (CMBs) are markers of haemorrhage-prone small vessel disease, but ICH can also occur without detectable CMBs. Therefore, we investigated the association between smoking and ICH according to CMB status. Design: Single-centre retrospective case-control study. Setting: A tertiary stroke centre in Osaka, Japan (2017–2021). Participants: 487 patients with ICH as their first stroke (female sex 41.5%) and 322 controls with non-stroke neurological conditions (female sex 47.5%) were included. Patients with missing CMB evaluation or smoking status data were excluded. Primary and secondary outcome measures: The primary outcome was ICH status, analysed according to CMB status, with current smoking as the primary exposure. Secondary analyses evaluated the association between smoking cessation duration and the odds of ICH, using current smoking as the reference. Results: Patients with ICH (median age, 70.0 years; presence of CMBs, 53.6%) and controls (median age, 71.0 years; presence of CMBs, 13.4%) were analysed. Among individuals without CMBs, current smoking was more frequently observed in patients with ICH than in controls (25.7% vs 14.0%, p10 years) was associated with lower odds of ICH than current smoking (aOR 0.31, 95% CI 0.14 to 0.67, p=0.003), whereas short-term cessation (≤10 years) showed no significant difference. Among individuals with CMBs, no significant association was observed between smoking status and ICH. Conclusions: Current smoking was associated with higher odds of ICH among individuals without CMBs, whereas long-term cessation was associated with lower odds. These findings suggest that the absence of CMBs should not be interpreted as the absence of modifiable ICH risk, highlighting the clinical relevance of smoking history in this population. Trial registration number: NCT02251665 .

Background/Objectives: Low masticatory function has been proposed as a risk factor for sarcopenia. This study investigated its potential association with body composition and physical performance in community-dwelling older adults. Methods: Participants included adults aged ≥65 years (643 men; 797 women) who volunteered for a longitudinal cohort study. Masticatory function was objectively assessed using gummy jelly and subjectively evaluated via a structured questionnaire. The skeletal muscle mass, body mass index, waist circumference, handgrip strength, gait speed, and five-time chair-stand test were assessed. Results: Objectively measured masticatory function was classified as low (12.6%), moderate (38.0%), or high (49.4%). In men, masticatory function was significantly associated with skeletal muscle mass index (low, moderate, and high: 7.4, 7.7, and 7.7 kg/m²; p = 0.005), handgrip strength (31.8, 34.2, and 35.5 kg; p < 0.001), and gait speed (1.3, 1.4, and 1.4 m/s; p = 0.003). In women, low masticatory function was linked to a higher body mass index (22.9, 22.0, and 21.9 kg/m²; p = 0.028) and waist circumference (82.9, 80.8, and 80.4 cm; p = 0.041). Moreover, these significant associations persisted after adjusting for covariates. Discrepancies were observed between objective and subjective measures of masticatory function, with approximately 40% of participants showing low objective masticatory function, perceiving their chewing ability as normal. Subjective masticatory function exhibited no significant associations with anthropometric measures or sarcopenia components. Conclusions: In men, objectively measured low masticatory function was associated with reduced skeletal muscle mass and poor physical performance; in women, it was linked to higher body mass index.

To investigate the current epidemiology, clinical profile, and treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) using a nationwide survey in Japan. We conducted a nationwide survey using an epidemiologic method established in 2021. Questionnaire sheets were sent to the hospital departments of neurology and pediatric neurology throughout Japan. A primary questionnaire was used to determine the number of patients and their prevalence, and a second questionnaire was used to collect detailed clinical information. The primary survey showed that the estimated number of patients with CIDP was 4,180, with a prevalence of 3.3 per 100,000 persons. In the secondary survey, detailed clinical data were available for 1,257 patients. The male-to-female ratio was 1.5:1, and the median age at onset was 52 years. Typical CIDP was the most frequent subtype (52%), followed by distal (17%) and multifocal/focal CIDP (17%). Initial treatments included immunoglobulin therapy (72%), corticosteroids (15%), and others (13%). Among patients with CIDP, 78% had a progressive/relapsing course, 14% did not respond to first-line treatments, and 18% could not walk independently at the last visit. Among the subtypes, typical CIDP had the most severe disability before treatment (44% of patients could not walk independently). However, they showed a more favorable response to treatment than those with distal or multifocal CIDP. In the subgroup analyses, logistic regression analyses showed that younger age at onset, no muscle atrophy, and abnormal median-normal sural sensory nerve responses were associated with a higher probability of independent walking. Our study represents the largest cohort study on CIDP to demonstrate the current epidemiologic and clinical status of CIDP in Japan. Clinical subtypes seem to be associated with different treatment responses and outcomes; therefore, an appropriate treatment strategy according to the pathophysiology of each subtype is required to improve the prognosis of CIDP.

There are many reports on the risk of falls in older adults but none regarding the risk among middle-aged people. We aimed to determine fall risk factors among middle-aged women. The participants comprised 1421 women aged 40 to 64 years; anthropometric and other measurements were obtained, and lifestyle factors were examined using a self-administered questionnaire. The participants were categorized into two groups (No-fall and Fall/Almost-fall) based on their questionnaire responses. The No-fall and Fall/Almost-fall groups comprised 1114 and 307 participants, respectively. Body mass index, abdominal circumference measurements, and prevalence of dyslipidemia were significantly higher in the Fall/Almost-fall group. Additionally, those in the Fall/Almost-fall group had a shorter two-step test, experienced difficulty performing the 40 cm single-leg sit-to-stand test, and had higher 25-question Geriatric Locomotive Function Scale (GLFS-25) scores than those in the No-fall group. The results of the adjusted logistic regression analysis indicated that physical activity, higher GLFS-25 scores, and sedentary time of more than seven hours were all risk factors for falling or almost falling. Longer sedentary time is a new risk factor for falls among middle-aged women. It is necessary for people to be concerned with their sedentary behavior, such as by reducing or interrupting continuous sedentary time.

The polyunsaturated fatty acid (PUFA) elongase, ELOVL5, is upregulated in breast cancer (BC) vs. adjacent normal tissue. We performed a comprehensive lipid metabolomic analysis of serum using high-resolution accurate mass spectrometry from two case-control studies that included non-BC, BC subjects pre-surgery, and BC subjects one-month post-surgery to determine if the metabolic signatures of over-active fatty acid elongation and other lipid changes could be detected in BC vs. non-BC subjects: study 1 (n = 48: non-BC, n = 69: pre-surgery BC); study 2 (blinded validation: n = 121: non-BC, n = 62: pre-surgery BC, n = 31: one month post-surgery). The ratio of the ELOVL5 precursor, linoleic acid (18:2) to a non-ELOVL5 precursor, oleic acid (18:1) was evaluated in multiple lipid pools (phosphatidylethanolamine (PtdEtn), phosphatidylcholine (PtdCho), lyso-PtdCho, and free fatty acids). This ratio was lower in pre-surgery BC subjects in all pools in both studies (p < 0.001). At one-month post-surgery, the 18:2/18:1 ratios increased vs. pre-surgery and were no longer different from non-BC subjects (p > 0.05 expect for lyso-PtdCho). In contrast to the elongation biomarkers, docosahexaenoic acid (22:6n-3) containing ethanolamine plasmalogen (EtnPls) species were observed to be further decreased in BC subjects one-month post-surgery vs. pre-surgery levels (p < 0.001). These results are consistent with the hypothesis that ELOVL5 is upregulated in BC tissue, which would result in the selective depletion of 18:2 vs. 18:1 containing lipid species. Surgical removal of the tumor removes the overactive ELOVL5 effect on serum lipids. In contrast, the low EtnPls levels do not appear to be caused by BC tumor activity and may be pre-existent and a possible risk factor for BC. These results indicate that it may be possible to screen for both breast cancer risk and breast cancer activity using a simple blood test.

Purpose Deep white matter lesions (DWMLs), T2 high-intensity areas in the subcortical white matter on magnetic resonance imaging (MRI), are a clinical phenotype of cerebral small vessel disease. Factors such as age and hypertension have been reported to significantly contribute to the presence and severity of DWMLs in cross-sectional studies. We herein report a 10-year longitudinal study on DWMLs in elderly Japanese subjects to reveal the clinical variables contributing to the progression of DWMLs. Methods A total of 469 Japanese subjects were invited to participate in the study. Of the participants at baseline, 259 subjects completed the revisit MRI study 10 years later. In those 259 subjects, we evaluated the correlation between the progression of DWMLs and clinical variables, such as the gender, age, and overt vascular risk factors. To clarify the role of hypertension, 200 subjects with grade 1 DWMLs at baseline were categorized into three groups according to their status of hypertension and its treatment. Results Of the 200 subjects with grade 1 DWMLs, 47 subjects (23.5%) showed progression of DWMLs (progression group). In the progression group, the percentage of subjects with hypertension and the systolic blood pressure values were higher than in the non-progression group. In addition, subjects ≥ 60 years old at baseline tended to show deterioration of DWMLs in the group with hypertension without antihypertensive treatment. Conclusion The results of this 10-year longitudinal study imply a positive correlation between long-standing hypertension and the progression of DWMLs.

The relationship between Helicobacter pylori infection and/or gastric disorders and chronic kidney disease (CKD) has not been elucidated. We investigated the relationship between Helicobacter pylori and/or atrophic gastritis (AG) and chronic kidney disease. In total, 3560 participants (1127 men and 2433 women) were eligible for this cross-sectional study. We divided participants into four study groups: with/without Helicobacter pylori infection and with/without AG. The HP (+) AG (−) group demonstrated a significant association with CKD compared with the HP (−) AG (−) group (adjusted odds ratio, 1.443; 95% confidence interval, 1.047–1.989). In contrast, the HP (+) AG (+) group showed significantly lower adjusted odds of CKD than the HP (−) AG (−) group (adjusted odds ratio, 0.608; 95% confidence interval, 0.402–0.920). H. pylori infection without AG might be associated with CKD in these participants. Conversely, the HP (+) AG (+) group had lower odds of CKD. Uncovering an association between gastric and renal conditions could lead to development of new treatment strategies.