Cognitive Impairment and Disability in Older Japanese Adults

Shimada, Hiroyuki; Makizako, Hyuma; Doi, Takehiko; Tsutsumimoto, Kota; Lee, Sangyoon; Suzuki, Takao

doi:10.1371/journal.pone.0158720

Cited by 71 publications

(86 citation statements)

References 40 publications

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“…For cognitive function variables, the average MMSE score (26.1) was similar to that of a previous study (25.6), which used a home‐visit survey with all older adults living in one city with an adequate response rate (92.3%). The prevalences of mild (14.1%) and global cognitive impairment (13.8%) were not remarkably different from a previous study (17.4% for mild cognitive impairment, 13.9% for global cognitive impairment) . Additionally, no significant associations were observed for the distance to the screening site with MMSE scores and the incidence of such cognitive impairments.…”

Section: Discussioncontrasting

confidence: 75%

“…The prevalences of mild (14.1%) and global cognitive impairment (13.8%) were not remarkably different from a previous study (17.4% for mild cognitive impairment, 13.9% for global cognitive impairment). 29 Additionally, no significant associations were observed for the distance to the screening site with MMSE scores and the incidence of such cognitive impairments. However, Harada et al suggested that subjective cognitive impairments indirectly influence screening participation mediated by motivational factors.…”

Section: Discussionmentioning

confidence: 94%

“…The NCGG‐FAT is a multidimensional neurocognitive functional assessment tool using a tablet personal computer. Following the definition of Shimada et al , participants’ status of mild cognitive impairment (MMSE score of 24–30, objective cognitive impairment in the NCGG‐FAT) and global cognitive impairment (MMSE score of 21–23) were evaluated …”

Section: Methodsmentioning

confidence: 99%

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Distance to screening site and older adults’ participation in cognitive impairment screening

Harada

Lee

Shimada

et al. 2017

Geriatrics Gerontology Int

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Aim: To develop intervention strategies that promote screening for cognitive impairment, it is essential to identify the modifiable predictors for participation in screening. The present study aimed to examine whether a shorter distance to the screening site predicted participation in screening for cognitive impairment, and whether interactive effects of the distance and psychological factors on the participation would be observed among community-dwelling older adults. Methods:The study used a prospective design. After a baseline questionnaire survey, participation in screening for cognitive impairment was followed for 6 months (n = 9616). The distance to the screening site was measured by road distance from each residential address and categorized into four groups (<1 km, 1-1.99 km, 2-2.99 km, ≥3 km). The questionnaire measured psychological factors (behavioral intention and perceived benefits of screening), driving status and demographic factors.Results: A logistic regression analysis showed that compared with the <1 km group, the 2-2.99 km (adjusted odds ratio 0.62, P = 0.040) and ≥3 km (adjusted odds ratio 0.54, P = 0.015) groups did not participate in screening after adjusting for psychological and demographic factors, and driving status. The interaction of the distances and psychological factors on participation were not significant. Conclusions:The distance to the screening site predicted participation in cognitive impairment screening among older adults regardless of their psychological status. This finding shows that improving access to screening sites would be effective for promoting screening for cognitive impairments among both low and highly motivated older adults. Geriatr Gerontol Int 2017; ••: ••-••.

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

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Distance to screening site and older adults’ participation in cognitive impairment screening

Harada

Lee

Shimada

et al. 2017

Geriatrics Gerontology Int

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“…One strength of the current study is that we used data from full‐mouth assessments of periodontal status involving examinations of six sites on all teeth, allowing us to define periodontitis by two commonly used case definitions as well as calculate PISA. Another distinction is that our outcome includes MCI, which has attracted attention because of its increasing prevalence and association with a high risk of dementia and disabilities …”

Section: Discussionmentioning

confidence: 99%

Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5‐year cohort study

Iwasaki

Kimura

Ogawa

et al. 2018

J of Periodontal Research

105

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Background and Objectives Identification of modifiable factors for mild cognitive impairment (MCI) is important since individuals with MCI are at a high risk of dementia and disability. Previous studies have suggested a potential association between periodontitis and cognitive impairment, but the results remain inconclusive. We designed a 5‐year longitudinal study to explore the association between MCI and periodontitis and periodontal inflammation in older adults. Methods This study included 179 community‐dwelling dentate individuals (62 men and 117 women, average age: 80.1 years). A full‐mouth periodontal examination at six sites per tooth was performed at baseline. Case definitions provided by the European Workshop in Periodontology Group C (EWP definition) and the Centers for Disease Control/American Academy of Periodontology (CDC/AAP definition) were used to define severe periodontitis. Additionally, the periodontal inflamed surface area (PISA), reflecting the amount of inflamed periodontal tissue, was calculated using clinical periodontal parameters. Follow‐up cognitive examinations for MCI diagnosis were performed by neurologists 1, 2, 3, and 5 years after baseline. Odds ratios (ORs) for MCI according to the presence of periodontitis and periodontal inflammation at baseline were calculated using multilevel mixed‐effects logistic regression. Results At baseline, 56.4% and 27.4% of the participants had severe periodontitis by the EWP and CDC/AAP definitions, respectively. After adjusting for follow‐up period and other baseline health characteristics (age, sex, smoking status, educational level, physical activity level, obesity, depression, and diabetes), severe periodontitis by either definition was significantly associated with MCI (for the EWP definition: adjusted OR = 3.58, 95% confidence interval [CI] = 1.45‐8.87; for the CDC/AAP definition: adjusted OR = 2.61, 95% CI = 1.08‐6.28). Periodontal inflammation assessed by PISA was also significantly associated with a higher OR for MCI (adjusted OR = 1.05, 95% CI = 1.01‐1.10, per 10‐mm2 increase in PISA). Conclusion Severe periodontitis and periodontal inflammation were associated with incident MCI among older community‐dwelling men and women.

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“…This method was validated against an HRS substudy of Alzheimer disease and dementia that used an extended neuropsychological assessment as well as expert clinician adjudication to obtain gold standard diagnoses of normal cognition, CIND, and dementia. In the validation study, the 27-point scale classified individuals as normal cognition (scores, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and CIND (scores, 7-11). Scores lower than 7 indicated dementia, and these individuals were, therefore, excluded from the present study.…”

Section: Operationalization Of Physical Frailty and Cognitive Impairmentmentioning

confidence: 99%

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

Aliberti

Cenzer

Smith

et al. 2018

J American Geriatrics Society

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BACKGROUND: Physical frailty is a powerful tool for identifying nondisabled individuals at high-risk of adverse outcomes. The extension to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear. OBJECTIVES: To estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over eight years. DESIGN: Prospective cohort study. SETTING: The Health and Retirement Study (HRS). PARTICIPANTS: 7,338 community-dwelling people aged ≥65 years without dementia and ADL dependence at baseline (2006–2008). Follow-up assessments occurred every 2 years until 2014. MEASUREMENTS: The five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression and smoking status. RESULTS: The prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no-deficit=14% [reference group]; only-CIND=26%, sub-hazard ratio [sHR]=1.5, 95% confidence interval [CI]=1.3–1.8; only-frail=33%, sHR=1.7, 95%CI 1.4–2.0; both-deficits=46%, sHR=2.0, 95%CI=1.6–2.6) and death (no-deficit=21%; only-CIND=41%, HR=1.6, 95%CI=1.4–1.9; only-frail=56%, HR=2.2, 95%CI=1.7–2.7; both-deficits=66%, HR=2.6, 95%CI=2.0–3.3) over eight-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell’s C 0.74 vs 0.71; P<0.001) and death (Harrell’s C 0.70 vs 0.67; P<0.001). CONCLUSION: Physical frailty and CIND are independent predictors of incident disability and death. Since together physical frailty and CIND identify vulnerable older adults better, risk assessment among older adults should include both physical and cognitive elements.

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Cognitive Impairment and Disability in Older Japanese Adults

Cited by 71 publications

References 40 publications

Distance to screening site and older adults’ participation in cognitive impairment screening

Distance to screening site and older adults’ participation in cognitive impairment screening

Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5‐year cohort study

Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition

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