田崎 史江

【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.

BACKGROUND: Locomotive syndrome (LS) is a condition in which mobility decreases, and it is known as a risk factor for elderly persons needing care in connection with sarcopenia and frailty. Prevention or delay of the onset of these diseases is important for preventing the need for care, and identification of biomarkers as indicators for appropriate intervention is useful. The present study aimed to clarify whether the serum insulin-like growth factor 1 (IGF-1) level, which has been reported to be related to sarcopenia and frailty, is related to LS. METHODS: The study participants were 133 elderly people living in a rural area in Japan. LS was assessed using Locomo-25, which is a self-administered questionnaire, and LS was defined as a Locomo-25 score ≥ 7 points. Serum IGF-1 and albumin levels were measured. A self-completed medical history questionnaire was used. RESULTS: On multiple linear regression analysis, age, IGF-1, osteoporosis, and osteoarthritis were significantly associated with the Locomo-25 score. The receiver-operating characteristic curve analysis of the IGF-1 level showed a threshold value of 82.0 ng/mL for discriminating non-LS and LS. The logistic regression analysis adjusted for osteoporosis, osteoarthritis, and the propensity score estimated from sex, age, and BMI showed that the odds ratio (OR) of the IGF-1 level for LS was 1.019 (95% confidence interval [CI], 1.002-1.039; p = 0.027), and the OR of IGF-1 ≤ 82 ng/mL for LS was 2.275 (95% CI 0.993-5.324; p = 0.052). CONCLUSIONS: The present findings suggest that osteoporosis and osteoarthritis were associated with early LS, and a decrease of the serum IGF-1 level was a significant independent factor for early LS.

The fruit of Prunus mume (ume, also known as Japanese apricot) has been used as a functional food in Japan since ancient times. We previously reported that ume stimulates the differentiation of preosteoblastic cells. Osteocalcin (OCN) is secreted by osteoblasts, and there is known association with glucolipid metabolism and cognitive function. This study sought to clarify the relationship between ume extracts and OCN production both in vitro and in vivo. Alkaline phosphatase activity and OCN level in the ethyl acetate extracts of ume-treated extracts were significantly increased in preosteoblast MC3T3-E1 cells compared with the control group. In human study, serum OCN level was significantly higher in the high ume intake group than in the low intake group in community-dwelling participants over 60 years old. These results suggest that ume has the potential to upregulated OCN production both in vitro and in vivo.

[This corrects the article DOI: 10.1371/journal.pone.0236111.].

BACKGROUND: Understanding the physical and mental changes in community-dwelling elderly people is very important during the coronavirus disease 2019 (COVID-19) pandemic when considering preventive measures. The purpose of this study was to clarify the changes of physical function and anxiety for activities of daily living in community-dwelling older adults, focusing on locomotor function during the COVID-19 pandemic. METHODS: The study participants were 127 older people who participated in successive surveys, in the summers of 2019 and again in 2020, after the state of emergency. The Locomo 25 questionnaire, Geriatric Depression Scale-15 (GDS-15) questionnaire, medical history, and number of people living together were self-reported. The Locomo 25 covers six aspects of physical pain, movement-related difficulty, usual care, daily activity, social activities, and anxiety. RESULTS: The paired samples t-test revealed that Locomo 25 total scores in 2020 were significantly higher than those in 2019. The GDS-15 score showed no significant difference. The comparison of scores for each item of the Locomo 25 revealed significantly higher scores in 2020 on Q21 ('difficult to perform sports activity', P = 0.0021), Q22 ('restricted from meeting own friends', P < 0.001), Q23 ('restricted from joining social activities', P < 0.001), Q24 ('anxious about falling in own house', P = 0.0023), and Q25 ('anxious about being unable to walk in the future', P = 0.0016). CONCLUSIONS: About 2 months after declaration of the first state of emergency due to the COVID-19 pandemic in Japan, social activity was severely restricted. Older adults showed almost no changes in body pain and locomotive disabilities, but increases in their anxieties about walking ability and falling were remarkable.