Postural Instability Is Associated with Brain Atrophy and Cognitive Impairment in the Elderly: The J-SHIPP Study

Okada

O’Hara

et al. 2015

Stroke

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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...

Section: Study Subjectsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Association of Postural Instability With Asymptomatic Cerebrovascular Damage and Cognitive Decline

Okada

O’Hara

et al. 2015

Stroke

Self Cite

“…This check-up program is specifically designed to evaluate aging-related disorders, including atherosclerosis, cardiovascular disease, physical function, and mild cognitive impairment 15,16) . Participants who had a history of symptomatic cardiovascular disease, who had been diagnosed with type 2 diabetes (fasting plasma glucose ≥ 126 mg/mL, or summarized in Table 1.…”

Section: Study Subjectsmentioning

confidence: 99%

Liver Enzyme and Adipocytokine Profiles are Synergistically Associated with Insulin Resistance: the J-SHIPP Study

Uetani

Igase

et al. 2012

JAT

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Aim: Alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) are associated with insulin resistance and arteriosclerotic disease. Since adiposity raises liver enzyme levels and causes insulin resistance, adipocytokines are thought to underlie the relationship between liver enzymes and insulin resistance. To clarify this hypothesis, we conducted a cross-sectional epidemiological study in a Japanese general population. Methods: The study subjects were 903 middle-aged to elderly persons. Plasma levels of adiponectin and leptin were measured, while other clinical parameters were obtained from personal health records of medical check-ups. Conclusion: Plasma levels of ALT and GGT were independent determinants of insulin resistance only in subjects with a worsened adipocytokine profile. Use of liver enzyme levels as a marker of insulin resistance requires stratification by adipocytokine profile.

“…Of the 543 participants who completed the MCI screener, we analyzed the 524 who agreed with the study aims and protocols, gave written consent to all procedures, and had no history of symptomatic cardiovascular events including stroke, transient ischemic attack, coronary heart disease or congestive heart failure. This cross-sectional investigation was carried out as part of the Shimanami Health Promoting Program (J-SHIPP study), a longitudinal study evaluating factors related to cardiovascular disease, dementia and death [22] . This series of studies was approved by the ethics committee of the Ehime University Graduate School of Medicine.…”

Section: Participantsmentioning

confidence: 99%

Abdominal Fat, Adipose-Derived Hormones and Mild Cognitive Impairment: The J-SHIPP Study

Kamogawa¹,

Kohara²,

Dement Geriatr Cogn Disord

et al. 2010

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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.