鈴村 彰太

ABSTRACT Aim This study aimed to estimate the relationship between finger function and cognitive function in patients with Alzheimer's disease (AD). Methods Patients diagnosed with AD at the Outpatient Center for Comprehensive Care and Research on Memory Disorder of the National Center for Geriatrics and Gerontology underwent a 15‐s bimanual alternating tapping task to measure finger movements. After finger movement measurements, we classified the severity of AD into mild and moderate and compared the finger movements. The Mann–Whitney U test and effect size were used to compare parameter values between the two groups (mild and moderate AD), and the calculated p values were corrected using the Bonferroni method. The Spearman rank correlation coefficient was calculated to determine the association between finger parameters and cognitive function (Mini‐Mental Examination [MMSE]). Results Data from 163 patients with AD were analyzed. When comparing finger parameters between the mild AD (64 individuals) and moderate AD (99 individuals) groups, the moderate AD group demonstrated fewer taps (p = 0.005; r = 0.22) and a longer interval between taps with the thumb and index finger (p = 0.007; r = 0.21) than the mild AD group. The correlation between the MMSE score and finger function was weakly positive for the number of taps and weakly negative for the average of tapping interval. Conclusions These parameters reflect the decline in finger function associated with the advanced stages of dementia and may help assess the severity of AD. Additionally, these findings may have clinical utility in assessing the severity of AD, potentially enhancing diagnostic accuracy for differentiating stages of AD.

<p>Purpose Detailed reports of the assessments used in rehabilitation wards are lacking. This study aimed to examine the common evaluations used in rehabilitation wards and discuss the necessary assessments for treatment plans and patient management. Methods We conducted a comprehensive literature search of PubMed, Web of Science, MEDLINE, and Ichushi Web for articles published between June 2013 and June 2023. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO. Data extraction and blind selection were performed, and a consensus was reached among experts in case of conflicts. Results We identified 220 studies, 31 meeting the inclusion criteria post-screening. The Functional Independence Measure was the most used assessment (96.8%), followed by grip strength (32.3%) and the 10-m walk test (9.7%). Other assessments included the Stroke Impairment Assessment Set, Short Physical Performance Battery, and Timed Up and Go Test. Although fall-related incidents are frequent, significantly affecting patient outcomes in rehabilitation units, balance assessments were underutilized. Conclusions Although the FIM is an extensively used assessment in rehabilitation wards, balance assessments critical for fall prevention are significantly underused. Therefore, these assessment tools should be evaluated in future research and clinical practice.</p>

Background: Because dementia is a long-term condition, the appropriate involvement of health-care professionals is considered important. However, little is known about the factors associated with changes in family caregiver burden. Objective: To clarify changes in family caregiver burden and associated factors during follow-up at a memory clinic. Methods: A retrospective cohort study was conducted, enrolling 495 pairs of patients with dementia or mild cognitive impairment and their family caregivers. A total of 120 pairs completed the second evaluation. The caregiver burden was assessed using the Zarit Burden Interview (ZBI). Data at the initial visit and after an average follow-up of about 2 years were compared and analyzed. Results: At initial visit, the patients’ mean age, Mini-Mental State Examination (MMSE) and ZBI scores were 78.6±5.6 years, 23.3±3.5, and 22.6±16.7, respectively. At follow-up, MMSE scores decreased (21.4±4.5, p &lt; 0.001), but ZBI scores remained similar (22.5±13.6). When the difference in ZBI scores between the two time points was defined as ΔZBI, and the related factors were analyzed by multiple regression analysis, ZBI scores at the initial visit, start of psychotropic drug, and decrease of neuropsychiatric symptoms were identified as significant factors (p &lt; 0.001, p = 0.003, p &lt; 0.001, respectively). A significant negative correlation was found between ZBI scores at the initial visit and ΔZBI (r = –0.588, p &lt; 0.001). Conclusions: These findings suggest the importance of assessing changes in the burden experienced by family caregivers during the disease follow-up.

BACKGROUND: Home-based rehabilitation involves professional rehabilitation care and guidance offered by physical, occupational, and speech therapists to patients in their homes to help them recuperate in a familiar living environment. The effects on the patient's motor function and activities of daily living (ADLs), and caregiver burden for community-dwelling patients are well-documented; however, little is known about the immediate benefits in patients discharged from the hospital. Therefore, we examined the effects of continuous home-based rehabilitation immediately after discharge to patients who received intensive rehabilitation during hospitalization. METHODS: We retrospectively reviewed 150 patients [mean (standard deviation, SD) = 81 (9) years] discharged from the convalescent rehabilitation and community-based integrated care wards undergoing tailored home-based rehabilitation for 6 months (provided by physical or occupational therapists: 1-2 sessions of 40-60 min each per week). The outcome measures at baseline and after 3 and 6 months were compared. RESULTS: The participants included in this study had orthopedic (n = 76), cerebrovascular (n = 50), neuromuscular (n = 11), cardiovascular (n = 5), respiratory (n = 3), cancer (n = 3) and other diseases (n = 2). The mean (SD) time from discharge to the start of rehabilitation was 4 (4) days. One-way analysis of variance and post-hoc comparisons showed significant improvements at 3 months from baseline in grip strength (p = 0.002), 5-repetition sit-to-stand test (p < 0.001), Standing test for Imbalance and Disequilibrium test (p = 0.025), Functional Independence Measure (p < 0.001), modified Frenchay Activities Index (p < 0.001). Additionally, a statistically significant improvement was observed in the Japanese Zarit Caregiver Burden Interview score at 6 months from baseline (p < 0.001). CONCLUSIONS: Home-based rehabilitation improves motor function, ADLs, and instrumental ADLs even after intensive inpatient rehabilitation and decreases the burden of the caregiver in the long term. Hence, tailored home-based rehabilitation should be continuously implemented after the completion of intensive inpatient rehabilitation.