田崎 史江

Chronic pain may impede occupational participation in older adults, but links among mobility, social networks, cognitive function, and pain-related factors remain unclear. To examine the relationships among these factors in relation to occupational participation in community-dwelling older Japanese adults. In this cross-sectional study, 130 adults more than 60 answered questions about occupational participation, mobility, social networks, cognitive function, and pain. Exploratory factor analysis was used to extract latent variables representing key constructs. These were incorporated into structural equation modeling to examine their associations with occupational participation. Latent factors combining mobility and social networks (standardized coefficient: 0.75), and cognitive functions (0.35), were directly and positively associated with occupational participation, while pain-related factors were strongly negatively correlated with mobility/social networks (-0.79, -0.73) but showed no direct association with participation. Interventions addressing both physical and social function and pain-related barriers may support occupational participation in older adults.

BACKGROUND: Cognitive and physical function both typically decline with age. Kyphosis is backward curvature of the spine that is especially commonly seen in older adults. This study seeks to clarify the suspected relationship between kyphosis posture and cognitive function in community-dwelling older adults. METHODS: This cross-sectional study included 301 community-dwelling individuals aged ≥ 60 years in Japan. The kyphosis index (KI) was determined according to a previously-reported method, cognitive function was evaluated using ACE-III, and physical functions were measured by handgrip strength, gait speed, and 2-step test. Multiple linear regression analysis was applied to identify factors affecting the KI, and we used a simple mediation analysis to clarify factors mediating the relationship between the KI and cognitive function using PROCESS Macro- Model 4 for SPSS and bootstrap method. Indirect effects were tested using bootstrapped confidence intervals (CI). RESULTS: In multiple linear regression analysis, gait speed (β = -0.188, p = 0.0007), 2-step value (β = －0.227, p < 0.0001) and language domain score (β = －0.136, p = 0.0160) were significantly associated with KI after adjustment for sex, age, education, body mass index and osteoporosis. Mediation analysis revealed a relationship between KI and language score; gait speed (indirect effect: −0.019, 95% CI: −0.039 to − 0.005) and 2-step value (indirect effect: −0.026, 95% CI: −0.051 to − 0.007) in complete mediation and grip strength (indirect effect: −0.014, 95% CI: −0.036 to − 0.001) in partial mediation. CONCLUSIONS: This study highlights worsening of kyphosis results to be related to decline in language ability by physical function. TRIAL REGISTRATION: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-025-06098-y.

For individuals undergoing psychiatric rehabilitation, there is an urgent need to establish an objective biomarker of brain activity without invasive or behavioral restrictions. To investigate an objective index for potential psychiatric rehabilitation assessment and intervention strategies in the future, we tried to detect the “Berger effect”, the alpha EEG reactivity to eyes opening, and to verify the suitability of a sheet-type electroencephalography (EEG) device, HARU-1. We measured EEG of 20 healthy young to middle-aged subjects using HARU-1 from the forehead area during resting closed-eye and open-eye conditions. Fast Fourier transform and time-frequency analysis were then performed on the data from all subjects in the resting closed-eye and resting open-eye conditions. Statistical analysis found that the reference electrode derivation method showed a significant increase in alpha waves and a significant decrease in beta and gamma waves in the three forehead channels of Fp1, Fp2 and AFz during the resting closed eye condition compared to the resting open eye condition. In the bipolar derivation method, all Fp1-AFz, Fp2-Fp1 and AFz-Fp2 showed a significant decrease in the β and γ bands at approximately 13–50 Hz. These results demonstrated that HARU-1 accurately measured the “Berger effect” in the forehead region, suggesting that HARU-1 may be useful in detecting objective biomarkers of brain activity during psychiatric rehabilitation.

【目的】地域在住高齢者のプレフレイル有症と食欲低下の関連性を調査すること。【方法】地域在住高齢者204名（男：53名，女：151名，年齢：74.1±6.6歳）を対象に，身体的フレイル，食欲，食習慣，高齢者のうつの評価を行い，ロバスト群と身体的プレフレイル群の2群に分け，単変量解析を行った。有意差を認めた項目には多変量解析を行った。なお，有意水準は5%とした。【結果】ロバスト群が99名（48.5%），身体的プレフレイル群が105名（51.5%）であり，単変量解析の2群比較では食欲低下，うつ傾向，注意機能に有意差を認め，多変量解析ではプレフレイルの独立関連因子として食欲低下のオッズ比：3.703, うつ傾向のオッズ比：0.246を認めた。【結論】プレフレイル有症群は食欲低下，うつ傾向が独立関連因子であることが示唆された。低栄養状態の改善を図る場合には，食欲低下を考慮する必要性があると考えられた。

In occupational therapy, crafts and groups are used as therapeutic tools, but their electrophysiological effects have not been well described. This study aimed to investigate the effects of group crafting on the physiological synchrony (PS) of dyadic heartbeats and on the autonomic activity and electroencephalogram (EEG) of individuals. In this cross-sectional study, individuals' EEG and dyadic electrocardiogram (ECG) were measured during the task in a variety of conditions. The three conditions were alone, parallel, nonparallel. Autonomic activity from the subjects' ECG, PS from the dyadic ECG, and current source density from exact Low Resolution Brain Electromagnetic Tomography (eLORETA) from subjects' EEG were analyzed. Measurements from 30 healthy young adults showed that the parallel condition significantly increased subjects' parasympathetic activity and dyadic PS. Parallel condition and frontal midline theta influenced parasympathetic activity, whereas parasympathetic activity was not associated with PS. Dyadic lag value were correlated with frontal delta, beta, and gamma activity. The results suggest that crafting in parallel groups increases parasympathetic activity and PS through different mechanisms, despite the absence of direct interaction. They also explain the electrophysiological evidence for the use of crafts and groups in psychiatric occupational therapy, such as increased relaxation and PS.

【はじめに、目的】 慢性痛 (CP)患者の身体活動量の低下は機能障害や能力障害の増悪に関連しているため，身体活動量増大のための運動プログラムが勧告されている．しかし，身体活動量が低下しているCP保有者の原因は十分に明らかにされていない．そこで本研究は， CPを有する地域在住高齢者のうち身体活動量低下の関連因子を抽出するとともに，分析に人工知能分析を加えてその精度を検証した． 【方法】 対象は70歳以上でCPがあり，ADLが自立している者89名 (77.4 ±5.0歳)である．CPは国際疼痛学会の定義を引用し，3ヶ月以上継続する痛みを有する者をCPありとした．身体活動量の評価には国際標準化身体活動質問紙環境尺度日本語短縮版 (IPAQ-SF)を用いた．また，参加者の測定データから，CPの関連因子である年齢，性別，BMI，The Central Sensitization Inventory-9 (CSI-9)，Tampa Scale for Kinesiophobia Japanese version (TSK-11)，握力，歩行速度，Athens Insomnia Scale，変形性関節症の既往や転倒経験を分析に用いた．分析のため， IPAQ-SFの結果から，低身体活動群と中等度あるいは高強度活動群の2群に分け群間比較し，有意差あるいは有意な傾向のある変数を独立変数として階層性ロジスティック回帰分析を (LR)実施した．人工知能を用いた分析は多層パーセプトロン分析 (MLP)を用いた．各変数はLRと同様の変数を用い重要度分析を実施した．LRとMLPの精度の比較は，正解率，受信者動作特性曲線から算出する曲線下面積 (AUC)，感度，F1スコアを用いた． 【結果】 LRの結果，CPの低身体活動は転倒経験 (オッズ比5.98)が有意に関連していた．一方，MLPの結果，CPの身体活動量低下の関連因子として，重要度が高いものとしてBMI，転倒経験, CSI-9，TSK-11が順に抽出された．LRとMLPの精度の比較では，正解率 (81.8% VS 84.6%)，AUC (0.75 VS 0.89), 感度 (0.67 VS 0.87), 特異度(0.84 VS 0.78)，F-1 score (0.79 VS 0.87) であっ た． 【考察】 CPを有する地域在住高齢者の身体活動低下に関連する因子は転倒経験であった．よって，身体活動レベルを改善させるために転倒予防の種々の方策が重要であると考えられた．また人工知能による分析はLRよりも予測モデルの精度が優れていた．今後の研究は，より良好な精度を有するモデルを構築するため複数の解析を並行して実施することが有用であると考えられた． 【倫理的配慮】 本研究は大阪河﨑リハビリテーション大学倫理審査委員会から承認(OKRU30-A016)されており，参加者には書面にてインフォームドコンセントを実施した．

【はじめに、目的】 近年、スマートフォンに搭載されたセンサーを活用した健康管 理アプリが活用されつつある。簡便に医療記録を残せるアプリや活動量などライフログデータを記録できるものまで多岐に渡る。地域在住高齢者ではスマートフォン普及率の増加とともに、健康管理アプリの使用者も増加しているが、フレイル予防や対策の一助となっているか十分に明らかではない。そのため、健康管理アプリ使用と地域在住高齢者の半数が該当するプレフレイルとの関連性について横断的調査することとした。 【方法】 ヘルスチェック事業に参加した、地域在住高齢者207名 (女性 153名、男性54名)、平均年齢75.5±5.6歳を対象とした。除外基準は64歳未満の者、重度サルコペニア該当者、フレイル該当者、データ欠損者とした。 調査項目は、調査票にて健康管理アプリ使用の有無、デジタル機器などの使用数、ロコモ25、主観的健康観、有償の仕事の有無、抑うつ状態 (GDS: Geriatric Depression Scale-15)、独居の有無、社会とのつながりを自記式にて記録した。実測調査は歩行速度、握力、四肢骨格筋量、一日の服薬数とした。サルコペニア、プレフレイルの判定はそれぞれ国内で推奨される定義に基づき実施した。 統計学的検討は健康管理アプリ使用の有無にて2群に分け、アプリ使用群と非使用群として調査項目を単変量解析し、有意差を認めた項目をアプリ使用の有無を従属変数とした強制投入法によるロジスティック回帰分析を行い、独立関連因子を検討した。なお、有意水準は5％未満とした。 【結果】 調査項目に不備のあった32名を除く、178名が解析対象となった。健康管理アプリ使用群は26名 (14.6%)、非使用群は152名 (85.4%)であった。単変量解析で2群間に差を認めた項目はプレフレイル該当率、デジタル機器などの使用数であった。 次に、年齢、性で調整した強制投入法によるロジスティック回帰分析の結果、プレフレイルはオッズ比0.34 (95%信頼区間 0.13-0.95)、デジタル機器などの使用数はオッズ比21.3 (95%信頼区間5.8-77.7)、と有意な独立関連因子であることが示唆された。 【結論】 地域在住高齢者のうち、健康管理アプリ使用群はデジタル機器などの使用数が多く、プレフレイル該当率が有意に少ないことが示唆された。 【倫理的配慮】 本研究は大阪河﨑リハビリテーション大学研究倫理委員会の承認 (承認番号：OKRU-RA0005)を得て実施している。また、参加者はヘルシンキ宣言に基づき口頭および書面にて説明を行 い、同意を得て実施している。

BACKGROUND: Chronic inflammation is a factor in the pathogenesis of sarcopenia, which is characterized by low muscle mass and reduced strength. Complement C3 is important in the management of the immune network system. This study seeks to determine the relationship between serum C3 levels and body composition and sarcopenia-related status in community-dwelling older adults. METHODS: Study participants were 269 older adults living in rural Japan. A bioelectrical impedance analysis device was used to measure body composition parameters including body mass index (BMI), body fat percentage, waist-hip-ratio, and appendicular skeletal muscle mass index (SMI). Muscle function was measured by handgrip strength and 6-m walking speed. The correlation coefficients for C3 level and measurements were calculated using Pearson correlation analysis. Participants were categorized into normal, pre-sarcopenia, dynapenia, or sarcopenia groups. Sarcopenia was defined according to 2019 Asian Working Group for Sarcopenia definition, dynapenia was defined as low muscle function without low muscle mass, and pre-sarcopenia was defined as the presence of low muscle mass only. The C3 threshold score for sarcopenia status was evaluated by receiver operating characteristic curve (ROC) analysis. RESULTS: Significant positive correlations were found between C3 and BMI, body fat percentage, and waist-hip ratio in both sexes, and further positive correlations with SMI were found in women. The relationship with body fat percentage was particularly strong. Body composition measurements (BMI, body fat percentage, and waist- hip ratio) and C3 levels were lowest in the sarcopenia group compared with the others. ROC analysis showed that the significant threshold of C3 for discriminating between the normal and sarcopenia groups was 105 mg/dL. Multiple logistic regression analysis showed that participants with C3 < 105 mg/dL had an odds ratio of 3.27 (95% confidence interval, 1.49-7.18) for sarcopenia adjusted by sex, age and body fat percentage. CONCLUSION: C3 levels are suggested to be related to body composition and pathophysiological functions of sarcopenia. C3 is expected to become a useful biomarker for sarcopenia, for predicting the onset of the disease and for predicting the effectiveness of interventions.

Employment of the elderly is gaining importance in Japan's super-aging society. However, investigating the role of employment on the health of the elderly population during the coronavirus disease 2019 (COVID-19) pandemic, wherein they were susceptible, is necessary. We aimed to investigate whether the presence or absence of employment affected motor and cognitive functions in the elderly during the COVID-19 pandemic. The study involved 144 individuals aged ≥ 65 years who participated in the medical examination project from August to September 2021. The participants were divided into employed and non-employed groups. The motor function was evaluated by determining the walking speed, skeletal muscle mass, 2-step test, and bone density. Cognitive function was evaluated using the Mini Mental State Examination and Trail Making Test-A/B (TMT-A/B). For statistical examination, univariate analysis and logistic regression analysis were performed using significantly differential variables. Out of the 144 participants, 33 (22.9%) and 111 (77.1%) were in the employed and non-employed groups, respectively. TMT-A had an odds ratio of 0.96 (95% confidence interval 0.94-0.99) and was an independent factor in the employed group. In conclusion, the attention function was significantly higher in the employed group.

BACKGROUND: Serum transthyretin (TTR) level has suggested association with mild cognitive impairment (MCI) and dementia. To clarify its usefulness as a biomarker of change in cognitive function in older individuals with normal cognitive function (NC) as a phenotype, we investigated the relationship between cognitive scores and TTR levels. We also investigated the involvement of TTR in the transition from NC to MCI. METHODS: Cognitive function was evaluated using Addenbrooke's Cognitive Examination-Revised (ACE-R). A cross-sectional study was conducted in community-dwelling older people (n = 211) with NC, MCI, or dementia according to ACE-R scores. A 32-month longitudinal study was then conducted (n = 29). RESULTS: Mean TTR levels did not differ between the NC, MCI and dementia groups. Linear regression analysis showed a significant relationship in people with NC between TTR and ACE-R (β = -0.192; p < 0.001). Multiple regression analysis adjusted for stepwise procedure-selected covariates showed that TTR was significantly associated with ACE-R in people with NC (β = -0.130; p = 0.014). Furthermore, multiple regression analysis showed significant association between TTR level and memory (β = -0.584; p = 0.002) and with language (β = -0.743; p = 0.031) in people with NC. In the longitudinal study, mean TTR level at baseline in women with MCI was significantly higher than that in women with NC (p = 0.044). CONCLUSIONS: Serum TTR level is suggested to be associated with cognitive scores in people with NC and to be an indicator of progression from NC to MCI.

INTRODUCTION: The therapeutic structure of occupational therapy (OT) includes groups. Although the presence of others is expected to be relaxing due to the social buffering effect and the tend and befriend theory, it has not been sufficiently validated in accordance with the therapeutic structure of OT. The aim of this study was to investigate the electrophysiological evidence for the effectiveness of parallel groups and states of concentration on craft activities used in OT. METHODS: Thirty healthy young adults were used as controls to measure EEG and autonomic activity during craft activities in three conditions: alone, parallel, and nonparallel. EEG was analyzed using exact low-resolution electromagnetic tomography, and autonomic activity was analyzed using Lorenz plot analysis. RESULTS: Parasympathetic activity was significantly higher in the parallel condition than in the alone condition. A significant negative correlation was found between current source density and parasympathetic activity in the region centered on the right insular cortex in the α1 band, and functional connectivity in regions including the anterior cingulate cortex and insular cortex was associated with autonomic activity. CONCLUSION: Craft activities that occurred during frontal midline theta rhythm also increased parasympathetic activity. The results suggest that the parallel groups used in OT and the intensive state of craft activities induce a social buffering effect that increases parasympathetic activity despite the absence of physical contact or social support. This provides evidence for the effectiveness of the therapeutic structure of occupational activities and groups in OT.

Hallux valgus, a frequently seen foot deformity, requires early detection to prevent it from becoming more severe. It is a medical economic problem, so a means of quickly distinguishing it would be helpful. We designed and investigated the accuracy of an early version of a tool for screening hallux valgus using machine learning. The tool would ascertain whether patients had hallux valgus by analyzing pictures of their feet. In this study, 507 images of feet were used for machine learning. Image preprocessing was conducted using the comparatively simple pattern A (rescaling, angle adjustment, and trimming) and slightly more complicated pattern B (same, plus vertical flip, binary formatting, and edge emphasis). This study used the VGG16 convolutional neural network. Pattern B machine learning was more accurate than pattern A. In our early model, Pattern A achieved 0.62 for accuracy, 0.56 for precision, 0.94 for recall, and 0.71 for F1 score. As for Pattern B, the scores were 0.79, 0.77, 0.96, and 0.86, respectively. Machine learning was sufficiently accurate to distinguish foot images between feet with hallux valgus and normal feet. With further refinement, this tool could be used for the easy screening of hallux valgus.

BACKGROUND: Soy peptide, when consumed as a functional food, has been reported to improve cognitive function. This study aimed to verify the combined effect of soy peptide supplementation and exercise on cognitive function among community-dwelling older adults in Japan. METHODS: In this population-based, non-blinded randomized controlled trial, 72 community-dwelling older adults who were independent in activities of daily living were randomly assigned to an "exercise plus nutrition" program (Ex + Nt group, n = 36) or an exercise program (Ex group, n = 36). For 3 months, both groups participated in an exercise and cognitive training regimen once per week, with the Ex + Nt group receiving soy supplementation once per week. Pre- and post-intervention measurements included grip strength, gait speed, skeletal muscle mass index, and scores on Addenbrooke's Cognitive Examination-Revised, trail-making test A, and the Geriatric Depression Scale. Participant enrollment for this study started in January 2019 and ended in April 2019. RESULTS: Exercise training increased the skeletal muscle mass index by 2.0% and 3.0% in the Ex + Nt and Ex groups, respectively. The Ex + Nt group exhibited a significant 0.3-point increase in the memory score. CONCLUSION: A 3-month exercise program combined with soy peptide supplementation may be effective in improving both motor and memory function in community-dwelling older adults.

Older people with chronic pain are at higher risk of developing sarcopenia. Central sensitization (CS) has been implicated in chronic pain among community-dwelling older adults. However, a relationship between CS and chronic pain with sarcopenia has not been established. This cross-sectional study aimed to clarify the relationship between chronic pain with sarcopenia or presarcopenia and CS among community-dwelling older adults. We assessed chronic pain and sarcopenia in 104 older adults participating in community health checks. We defined sarcopenia using the Asian Working Group for Sarcopenia (AWGS) consensus recommendations based on the following outcomes: low muscle mass, low muscle strength, and slow gait speed. Pain-related assessments included pain intensity, the Pain Catastrophizing Scale, the CS Inventory-9, the pressure pain threshold, the Tampa Scale of Kinesiophobia-11, and the EuroQol 5-dimension 5-level (EQ5D-5L). Chronic pain was defined by related symptoms within the month prior to the health check that had continued for ≥ 3 months and corresponded to a numerical rating scale score of ≥ 1 at the site of maximum pain. The prevalence of chronic pain was 43.3%. In addition, the prevalence of chronic pain with sarcopenia or presarcopenia was 29.8%. A logistic regression analysis revealed that the pressure pain threshold (odds ratio: 0.82, 95% CI: 0.95-1.02) and the EQ5D-5L (odds ratio: 0.58, 95% CI: 0.36-0.76) were significantly associated with the presence of chronic pain with sarcopenia or presarcopenia. Chronic pain with sarcopenia or presarcopenia was affected by central sensitization. Therefore, CS should be evaluated in the elderly.