No abstract

Thigh Qc sarcopenia and visceral obesity are associated with postural instability in middle-aged to elderly subjects. These findings suggest that age-related, site-specific fat and muscle mass alterations are associated with functional impairment.

Background/Aim: Lower body weight in later life has been shown to be associated with dementia. However, abdominal fat distribution under conditions of mild cognitive impairment (MCI) and the possible involvement of leptin and adiponectin in MCI have not been fully investigated. Methods: We analyzed 517 middle-aged-to-elderly community-dwelling persons. Abdominal subcutaneous fat and visceral fat areas were determined using computed tomography, and plasma leptin and adiponectin concentrations were measured in fasting samples. MCI was assessed using the Japanese version of the MCI screening method. Results: In men, the abdominal subcutaneous fat area was significantly lower in participants with MCI than in those with normal cognitive function [median (interquartile range): 107.4 (85.9, 133.1) cm² vs. 136.4 (93.1, 161.4) cm²; p = 0.002]. Logistic regression analyses with confounding factors including age and abdominal subcutaneous fat area showed that a 10 mg/l increase in plasma adiponectin had a protective effect against the development of MCI in men (odds ratio: 0.46; 95% CI: 0.20–0.97; p = 0.041). In contrast, MCI was not found to be associated with abdominal fat area or adipose-derived hormones in women. Conclusion: Reduced amounts of subcutaneous fat and low levels of plasma adiponectin were found to be associated with MCI in men.

Postprandial BP decline is an overlooked risk marker for asymptomatic lacunar infarction in community residents.

These findings indicate that the SBP2, an estimate of central SBP, is significantly associated with the presence of SVD in an apparently healthy general population.

Background/Aims: Mobility impairment in older adults has been suggested to be a marker of subclinical structural and functional brain abnormalities. We investigated a possible association between static postural instability and brain abnormalities and cognitive decline. Methods: The study subjects were 390 community residents without definitive dementia (67 ± 7 years old) and 21 patients with Alzheimer’s disease (AD). Brain atrophy was measured by MRI. Results: The mobility of the posturography-measured center of gravity (COG) was positively associated with the temporal horn area (THA; r = 0.260; p < 0.001). Subjects who could not stand on one leg for >40 s (n = 102) showed a significantly larger THA (22 ± 18 vs. 14 ± 11 × 10^–2 cm²; p < 0.001). Multiple regression analysis identified COG path length (β = 0.118; p = 0.032) and one-leg standing time (β = 0.176; p = 0.001) as independent determinants of THA. Mild cognitive impairment (MCI) subjects (n = 61) had a significantly enlarged THA compared to that of normal cognitive subjects (22 ± 16 vs. 16 ± 13 × 10^–2 cm²; p = 0.002). AD patients showed a more enlarged THA (78 ± 55 × 10^–2 cm²). Subjects with cognitive decline showed a significantly shorter one-leg standing time (normal: 50 ± 17 s; MCI: 42 ± 21 s; AD: 18 ± 20s; p < 0.001). Conclusion: Reduced postural stability was an independent marker of brain atrophy and pathological cognitive decline in the elderly.

Mild cognitive impairment (MCI), a syndrome characteristic of the transition phase between normal cognitive function and dementia, has been shown to carry the risk of progression to dementia. Dysregulation of blood pressure (BP) is thought to be an indicator of cerebrovascular damage, including cognitive impairment. Here, we investigated the possible association of circadian BP variation with MCI in community-dwelling persons exhibiting no definitive dementia. Our study enrolled 144 persons (68 ± 7 years). Nocturnal BP profile was defined as dipper, with a 10-19% drop in nocturnal systolic BP; extreme dipper, X20% drop; non-dipper, 0-10% drop; and riser, any increase in nocturnal BP. MCI was assessed using the MCI screen, a cross-validated, staff-administered battery of tests. Subjects with MCI (n¼38) were significantly older (74±6, 67±6 years, Po0.001) and had higher frequency of apolipoprotein E e4 allele (36.8, 18.9%, P¼0.018). Although the ambulatory measured BP and the percent changes in nocturnal systolic BP (À10 ± 12% and À12 ± 8%, respectively; P¼0.291) did not differ between MCI subjects and normal controls, frequency of MCI was significantly higher in the extreme dippers (32.0%), non-dippers (30.0%) and risers (50.0%) than in dippers (13.2%, P¼0.018). Multiple logistic regression analysis identified a blunted nocturnal BP decline, non-dipping or increase in nocturnal BP and extreme drop in BP as potent determinants of MCI (odds ratio 3.062, P¼0.039), after adjustment for possible confounding factors, including apolipoprotein E e4 genotype. Abnormal nocturnal BP profile was found to be a strong indicator of MCI in otherwise apparently healthy community-dwelling elderly persons. Keywords: ambulatory blood pressure monitoring; mild cognitive impairment; nocturnal blood pressure INTRODUCTION Mild cognitive impairment (MCI) is a syndrome defined as cognitive decline greater than expected for an individual's age and education level that does not notably interfere with activities of daily life. 1 MCI is classified into four subtypes: amnestic MCI involving only memory impairment (single domain) or memory impairment along with deficits in another cognitive domain such as language function, visuospatial skills, or executive function (multiple domain) and non-amnestic MCI involving discrete cognitive impairments in single or multiple domains other than memory function. 2 MCI prevalence has been estimated to be between 6 and 10% based on community assessments, 3 a frequency about four times that of dementia. MCI also exhibits Alzheimer-type dementia-like neuropathology on autopsy, and at least half of those diagnosed with MCI, in particular amnestic MCI subtype, eventually progress into Alzheimer-type dementia (AD) with a smaller percentage progression to other forms of dementia,

Background and Purpose-Asymptomatic cerebral small-vessel disease (cSVD) in elderly individuals are potent risk factors for stroke. In addition to common clinical risk factors, postural instability has been postulated to be associated with cSVD in older frail patients. Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVD further, namely periventricular hyperintensity, lacunar infarction, and microbleeds, as well as cognitive function, in a middle-aged to elderly general population (n=1387). Methods-Postural instability was assessed based on one-leg standing time (OLST) and posturography findings. cSVD was evaluated by brain magnetic resonance imaging. Mild cognitive impairment was assessed using a computer-based questionnaire, and carotid intima-media thickness as an index of atherosclerosis was measured via ultrasonography. Results-Frequency of short OLST, in particular <20 s, increased linearly with severity of cSVD (lacunar infarction lesion: none, 9.7%; 1, 16.0%; >2, 34.5%; microbleeds lesion: none, 10.1%; 1, 15.3%; >2, 30.0%; periventricular hyperintensity grade: 0, 5.7%; 1, 11.5%; >2, 23.7%). The association of short OLST with lacunar infarction and microbleeds but not periventricular hyperintensity remained significant even after adjustment for possible covariates (lacunar infarction, P=0.009; microbleeds, P=0.003; periventricular hyperintensity, P=0.601). In contrast, no significant association was found between posturographic parameters and cSVD, whereas these parameters were linearly associated with OLST. Short OLST was also significantly associated with reduced cognitive function independent of covariates, including cSVD (P=0.002). Conclusions-Postural instability was found to be associated with early pathological changes in the brain and functional decline, even in apparently healthy subjects. Correspondence to Yasuharu Tabara, PhD, Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Shogoinkawaracho 53, Sakyoku, Kyoto 606-8507, Japan. E-mail tabara@genome.med.kyoto-u.ac.jp © 2014 American Heart Association, Inc. 16 has examined the association between lacunar infarction and postural instability, and no data are available on the association between microbleeds and postural instability, despite individuals with lacunar infarction and PVH being frequently complicated with microbleeds. 17Here, we conducted a cross-sectional study to understand the possible link between postural instability and asymptomatic cSVDs further-namely, PVH, lacunar infarction, and microbleeds-in a middle-aged to elderly general population. As we previously showed that individuals with mild cognitive impairment, particularly those with Alzheimer disease, were prone to instability while standing on 1 leg, 18 we attempted to gather more evidence in the present study. Methods Study SubjectsThe study subjects were 1387 apparently healthy middle-aged to elderly individuals who were consecutive participants in the medical checkup program a...