Publications by authors named "Ryota Sakurai"

90 Publications

Motor Imagery Deficits in High-Functioning Older Adults and its Impact on Fear of Falling and Falls.

J Gerontol A Biol Sci Med Sci 2021 Mar 8. Epub 2021 Mar 8.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, Japan.

Background: Older adults at risk of falling or who have fear of falling (FoF) present a discrepancy between "imagined" and "performed" actions. Using the gait-related motor imagery (MI) paradigm, we investigated whether prediction accuracy in motor execution is associated with the onset of FoF and with prospective falls among older adults with FoF.

Methods: A cohort of 184 community-dwelling older adults was tested for imaginary and executed Timed Up and Go (TUG) tests at a fast pace at baseline. They were first asked to imagine performing TUG and estimate the time taken to complete it (iTUG), and then, to perform the actual trial (aTUG); the difference between the two times was calculated. Prospective falls were monitored between baseline and 2-year follow-up of FoF assessment.

Results: At follow-up, 27 of 85 participants without FoF at baseline (31.8%) had developed FoF. Twenty-seven of 99 participants (27.2%) with FoF at baseline experienced falls. A significantly shorter iTUG duration, when compared with aTUG, was observed in those who developed FoF or experienced multiple prospective falls, indicating overestimation of their TUG performance. The adjusted logistic regression model showed that a greater ΔTUG (i.e., tendency to overestimate) at baseline was associated with an increased risk of new-onset FoF among those without FoF at baseline and multiple prospective falls among those with FoF at baseline.

Conclusions: Deficits in MI (i.e., overestimation of physical capabilities), reflecting impairment in motor planning, could provide an additional explanation of the high risk of FoF and recurrent falls among people with FoF.
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http://dx.doi.org/10.1093/gerona/glab073DOI Listing
March 2021

Who is mentally healthy? Mental health profiles of Japanese social networking service users with a focus on LINE, Facebook, Twitter, and Instagram.

PLoS One 2021 3;16(3):e0246090. Epub 2021 Mar 3.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Background: Both negative and positive associations between social networking service (SNS) usage and mental health have been suggested by previous studies; however, their differences by type of SNS and age remain unclear. We addressed this issue based on the frequency of traditional communication such as face-to-face and non-face-to-face communication (e.g., phone, email, and letters).

Methods: In total, 8,576 individuals participated, including 2,543 aged 18-39, 3,048 aged 40-64, and 2,985 aged over 65 years. They were asked to indicate their frequency of SNS usage, both for posting and checking, of LINE (a popular message application in Japan), Facebook, Twitter, and Instagram, with frequent usage defined as posting or checking more than a few times a week. To determine mental health status, WHO-5 (i.e., well-being), K6 (i.e., distress symptoms), and feelings of loneliness were assessed. Multiple and logistic regression analyses were adjusted for the frequency of traditional communication. To avoid type 1 error, a Bonferroni correction of p ≤ 0.002 was applied in the regression models (p = 0.05/18, a number of regression models).

Results: The most frequently used SNS across the three age groups was LINE; frequent usage (both posting and checking) among older adults was independently associated with better well-being. Frequent posting on Facebook was associated with better well-being in middle-aged adults. Young adults who frequently checked on Instagram showed a tendency toward better well-being and lower distress symptoms. On the contrary, frequent usage of Twitter was associated with distress symptoms or feelings of loneliness across all three age groups.

Conclusions: We found generational and SNS-type-dependent negative and positive associations between SNS use and mental health, indicating the possible influences of SNS use and the importance of non-SNS communication.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246090PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928453PMC
March 2021

Social Contact with Family and Non-Family Members Differentially Affects Physical Activity: A Parallel Latent Growth Curve Modeling Approach.

Int J Environ Res Public Health 2021 Feb 26;18(5). Epub 2021 Feb 26.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan.

Background: Social contact leads to an increased likelihood of engaging in physical activity (PA). However, the influence of social contact on PA would be different depending on the social contact source. This study aimed to identify the association of changes in social contact with family and non-family members with the change in PA using a parallel latent growth curve modeling.

Methods: Participants were randomly selected from among residents in the study area age ≥ 20 years ( = 7000). We conducted mail surveys in 2014, 2016, and 2019. The 1365 participants completed all surveys. PA was assessed with validated single-item physical activity measure. Social contact was assessed by summing frequencies of face-to-face and non-face-to-face contacts with family/relatives not living with the participant and friends/neighbors. Parallel latent growth curve modeling was used to assess the cross-sectional, prospective, and parallel associations of social contact with PA change.

Results: There was a positive cross-sectional association between contact with friends/neighbors and PA, whereas prospective and parallel associations between contact with family/relatives and PA.

Conclusion: Contacting friends/neighbors did not predict the change in PA, and a high frequency of contact with family/relatives at baseline and increasing contact with family/relatives was associated with increased PA over 5-year.
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http://dx.doi.org/10.3390/ijerph18052313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956539PMC
February 2021

Oral frailty and gait performance in community-dwelling older adults: findings from the Takashimadaira study.

J Prosthodont Res 2021 Feb 22. Epub 2021 Feb 22.

Tokyo Metropolitan Institute of Gerontology, Tokyo.

Purpose: This cross-sectional study compared gait performance between community-dwelling older adults with and without accumulated deficits in oral health, defined as oral frailty.

Methods: A total of 1,082 individuals (439 men and 643 women; mean age, 77.1 years) from the Takashimadaira study were included in the current analysis. Based on a multifaceted oral health assessment, oral frailty was defined as having three or more of the following six components: (i) fewer teeth, (ii) low masticatory performance, (iii) low articulatory oral motor skills, (iv) low tongue pressure, (v) difficulties in eating, and (vi) swallowing. Eight gait parameters were assessed using an electronic walkway. Gait characteristics comparison between groups with and without oral frailty was performed using multiple linear regression models. Models were adjusted for age, sex, educational status, income, smoking, drinking, physical activity level, height, body mass index, comorbidities, and the presence of chronic pain.

Results: Oral frailty was observed in 227 (21.0%) participants. After adjusting for potential confounders, the participants with oral frailty had slower gait speed, shorter stride and step length, wider step width, and longer double support duration as well as higher variability of stride length and step length.

Conclusions: Oral frailty was associated with poor gait performance among community-dwelling older adults.
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http://dx.doi.org/10.2186/jpr.JPR_D_20_00129DOI Listing
February 2021

Differences in the association between white matter hyperintensities and gait performance among older adults with and without cognitive impairment.

Geriatr Gerontol Int 2021 Mar 25;21(3):313-320. Epub 2021 Jan 25.

Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Aim: Gait impairment implies subtle cognitive impairment (CI) and is associated with severity of white matter hyperintensities (WMHs). However, cognitive differences in such an association are not yet fully understood. This study examined the association between WMHs and gait performance among three cognitively different older groups.

Methods: Gait performance and WMHs were assessed in 150 community-dwelling older adults, comprising 53 with CI (Mini-Mental State Examination [MMSE] score <24), 63 with mild CI (MMSE score ≥24 and Montreal Cognitive Assessment [MoCA] score <25), and 34 who were cognitively normal or preserved (MMSE ≥24 and MoCA score ≥25). Gait velocity and variability were assessed on a 5-m electronic walkway. Furthermore, WMH volume was derived by automated segmentation using 1.5 T magnetic resonance imaging.

Results: Adjusted multiple regression analyses showed that greater WMHs were associated with slower gait velocity and greater temporal (stride time) and spatial (stride and step lengths) variabilities among older adults with CI. In contrast, WMH was only associated with spatial variability in older adults with mild CI and in cognitively normal or preserved older adults.

Conclusions: Our findings suggest that gait variability measures are more sensitive to subtle underlying neurological pathologies including WMHs in older adults. The cognitive-dependent differences found in the association between WMHs and gait performance suggests that the level of cognitive function interferes with the association between WMH and gait performance. Geriatr Gerontol Int 2021; ••: ••-••.
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http://dx.doi.org/10.1111/ggi.14132DOI Listing
March 2021

MMSE Cutoff Discriminates Hippocampal Atrophy: Neural Evidence for the Cutoff of 24 Points.

J Am Geriatr Soc 2021 Mar 8;69(3):839-841. Epub 2021 Jan 8.

Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

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http://dx.doi.org/10.1111/jgs.17010DOI Listing
March 2021

Changes in self-estimated step-over ability among older adults: A 3-year follow-up study.

J Gerontol B Psychol Sci Soc Sci 2020 Dec 6. Epub 2020 Dec 6.

Health Promotion Science, Tokyo Metropolitan University, Minami-Osawa, Hachioji-shi, Tokyo, Japan.

Objectives: There is a growing body of literature examining age-related overestimation of one's own physical ability, which is a potential risk of falls in older adults, but it is unclear what leads them to overestimate. This study aimed to examine 3-year longitudinal changes in self-estimated step-over ability, along with one key risk factor: low frequency of going outdoors (FG), which is a measure of poor daily physical activity.

Method: This cohort study included 116 community-dwelling older adults who participated in baseline and 3-year follow-up assessments. The step-over test was used to measure both the self-estimated step-over bar height (EH) and the actual bar height (AH). Low FG was defined as going outdoors either every few days or less at baseline.

Results: The number of participants who overestimated their step-over ability (EH>AH) significantly increased from 10.3% to 22.4% over the study period. AH was significantly lower at follow-up than at baseline in both participants with low and high FGs. Conversely, among participants with low FG, EH was significantly higher at follow-up than at baseline, resulting in increased self-estimation error toward overestimation. Regression model showed that low FG was independently associated with increased error in estimation (i.e., tendency to overestimate) at follow-up.

Discussion: The present study indicated that self-overestimated physical ability in older adults is not only due to decreased physical ability but also due to increased self-estimation of one's ability as a function of low FG. Active lifestyle may be critical for maintaining accurate estimations of one's own physical ability.
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http://dx.doi.org/10.1093/geronb/gbaa219DOI Listing
December 2020

Influence of co-existing social isolation and homebound status on medical care utilization and expenditure among older adults in Japan.

Arch Gerontol Geriatr 2021 Mar-Apr;93:104286. Epub 2020 Oct 22.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan. Electronic address:

Objective: To examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults.

Methods: Postal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model).

Results: Almost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303-0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338-3.470).

Discussion: Older adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions.
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http://dx.doi.org/10.1016/j.archger.2020.104286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578670PMC
February 2021

A combined stepping and visual tracking task predicts cognitive decline in older adults better than gait or visual tracking tasks alone: a prospective study.

Aging Clin Exp Res 2020 Sep 23. Epub 2020 Sep 23.

Graduate School of Nutrition and Health Science, Kagawa Nutrition University, Sakato, Japan.

Background: It is unclear whether motor-cognitive dual tasks predict cognitive decline better than either motor or cognitive tasks alone.

Aims: To examine the utility of the novel motor-cognitive dual-task test [Stepping Trail Making Test (S-TMT)], as a predictor of cognitive decline, and compare its predictive performance with single motor or cognitive tests.

Methods: This 2-year population-based prospective study included 626 adults aged ≥ 70 years from Takashimadaira, Itabashi, Tokyo. The S-TMT measured the time taken to step on 16 numbers in order. Gait speed and TMT-A were assessed with standardized methods as single motor and cognitive tasks, respectively. A decline in the Mini-Mental State Examination score by ≥ 3 points over 2 years was defined as a significant cognitive decline.

Results: Over 2 years, 97 (15.5%) experienced cognitive decline. After adjusting for confounders, binary logistic regression models showed no significant associations between gait speed, TMT-A time tertiles, and risk of cognitive decline, but participants in the longest tertile of S-TMT time were more likely to develop cognitive decline than those of the shortest tertile (odds ratio 2.14; 95% confidence interval 1.17-3.90). Only the addition of the S-TMT time to the covariates model significantly improved the reclassification indices for predicting cognitive decline (net reclassification improvement: 0.31, P < 0.01; integrated discrimination improvement: 0.01, P = 0.02).

Discussion And Conclusion: Only the S-TMT was significantly associated with cognitive decline and improved reclassification indices, indicating that it is more useful for predicting cognitive decline than individual gait speed or visual tracking tests alone.
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http://dx.doi.org/10.1007/s40520-020-01714-wDOI Listing
September 2020

A Stepping Trail Making Test as an Indicator of Cognitive Impairment in Older Adults.

J Clin Med 2020 Sep 2;9(9). Epub 2020 Sep 2.

Graduate School of Nutrition and Health Science, Kagawa Nutrition University, Saitama 350-0288, Japan.

This study aimed to examine the concurrent validity of a novel motor-cognitive dual-task test, the Stepping Trail Making Test (S-TMT), as an indicator of cognitive impairment (CI), and compare its screening performance to that of motor or cognitive tests alone. This was a population-based cross-sectional study including 965 Japanese adults aged ≥ 70 years. To measure the time taken to perform the S-TMT, the participants were instructed to step on 16 numbers in sequence as quickly and accurately as possible. Motor and cognitive functions were assessed by gait speed and TMT part A (TMT-A), respectively. Participants were classified into CI (< 24 points), mild CI (MCI, 24-27 points), and intact cognition (> 27 points) categories based on their Mini-Mental State Examination score. Binary logistic regression models showed that the addition of the S-TMT to the covariates model gave the highest discrimination index (c-statistics), and significantly improved reclassification indices (net reclassification improvement and integrated discrimination improvement) for screening both CI and MCI compared to those of gait speed or TMT-A alone. These results show that S-TMT has a concurrent validity as a dual-task test for screening CI and MCI and better discrimination and reclassification performance than motor or cognitive tests alone in older adults.
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http://dx.doi.org/10.3390/jcm9092835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563673PMC
September 2020

Comparison of microscopic illumination between a three-dimensional heads-up system and eyepiece in cataract surgery.

Eur J Ophthalmol 2020 Jun 8:1120672120929962. Epub 2020 Jun 8.

Department of Ophthalmology, Fujita Health University, Toyoake, Japan.

Introduction: The ability to reduce illumination levels is generally accepted as one of the main benefits of a three-dimensional heads-up system (3D system: Ngenuity®; Alcon, CA, USA). Some studies have focused on illumination reduction in vitreoretinal procedures; however, information regarding illumination reduction in cataract surgery has not been published.

Purpose: This study aimed to compare the illumination of the operational field with a 3D system and a standard microscope eyepiece during cataract surgery.

Subject And Methods: We retrospectively evaluated 91 eyes of 84 consecutive patients who were undergoing cataract surgery at our hospital. We used the 3D system and the eyepiece on alternative days. We determined the minimum light intensity required for safe surgery using the foot switch of the microscope (OMS800; Topcon, Tokyo, Japan). Illuminance on the ocular surface and the minimum illuminance required for the operation were calculated from the minimum light intensity.

Results: The 3D system was used in 45 eyes (3D group), and the eyepiece was used in 46 eyes (eyepiece group). The values of minimum illuminance in the 3D group were significantly lower than those in the eyepiece group (3D: 5500 ± 2000 lux, eyepiece: 11,900 ± 1800 lux; p < 0.001*). In addition, the illuminance of the operational field was reduced by 60.4% on average using the 3D system.

Conclusion: With real-time digital processing and automated brightness control, the 3D system reduced ocular surface illumination by 50% or more. Hence, the 3D system may contribute to reducing the risk of retinal phototoxicity and patient photophobia.
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http://dx.doi.org/10.1177/1120672120929962DOI Listing
June 2020

Association of Eating Alone With Depression Among Older Adults Living Alone: Role of Poor Social Networks.

J Epidemiol 2021 Apr 18;31(4):297-300. Epub 2020 Apr 18.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.

Objectives: Eating alone is associated with an increased risk of depression symptoms. This association may be confounded by poor social networks. The present study aimed to determine the role of poor social networks in the association of eating alone with depression symptoms, focusing on cohabitation status.

Methods: Seven hundred and ten community-dwelling older adults were categorized according to their eating style and social network size, evaluated using an abbreviated version of the Lubben Social Network Scale, with poor social network size (defined as the lowest quartile). Living arrangements and depression symptoms, detected using the Zung Self-Rating Depression Scale, were also assessed.

Results: A mixed-design two-way analysis of covariance (eating style and social network size factors) for the depression scale score, adjusted by covariates, yielded significant effects of social network size and eating style without interaction. Greater depression scores were observed in eating alone and poor social network size. Analysis of participants living with others showed the same results. However, among older adults living alone, only a significant main effect of social network size was observed; poor social network size resulted in greater depression scores irrespective of eating style.

Conclusions: Poor social network size, and not eating alone, was associated with greater depression symptoms among older adults living alone, whereas both factors may increase depression symptoms among older adults living with others. Poor social network size may show a stronger influence on depression than eating alone in older adults living alone; thus, social network size is an important health indicator.
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http://dx.doi.org/10.2188/jea.JE20190217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940972PMC
April 2021

Reliability and construct validity of a novel motor-cognitive dual-task test: A Stepping Trail Making Test.

Geriatr Gerontol Int 2020 Apr 16;20(4):291-296. Epub 2020 Feb 16.

Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Aim: This study aimed to examine the reliability and construct validity of the Stepping Trail Making Test (S-TMT) in community-dwelling older adults.

Methods: This study comprised a cross-sectional study based on a population sample. Participants comprised 1224 community-dwelling older Japanese women aged 65-81 years without functional disability, dementia, depression, Parkinson's disease, or cognitive and visual impairments. The S-TMT measured the time taken to step on a sequence of numbers (1-16) positioned on a mat (1 m ). Participants were instructed to step as quickly and accurately as possible. Motor functions were assessed by walking speed and knee extensor strength tests, while cognitive functions were assessed by the Symbol Digit Substitution Task (SDST) test, verbal and logical memory test, and TMT-A and -B.

Results: As a result of test-retest reliability over 6 months, the intraclass correlation coefficients of the S-TMT was 0.82 (95% confidence interval, 0.68-0.90). An adjusted multiple regression model indicated that the S-TMT was significantly associated with walking speed for motor function, and associated with the SDST, TMT-A and TMT-B for cognitive functions (P < 0.001).

Conclusions: These results suggest that the S-TMT is a reliable dual-task test comprising mobility for motor function and a visual-dependent execution function for cognitive function in older women. Geriatr Gerontol Int 2020; 20: 291-296.
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http://dx.doi.org/10.1111/ggi.13878DOI Listing
April 2020

Overlap Between Apolipoprotein Eε4 Allele and Slowing Gait Results in Cognitive Impairment.

Front Aging Neurosci 2019 13;11:247. Epub 2019 Sep 13.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

: Although apolipoprotein E polymorphism ε4 allele (ApoE4) and slow gait are well-known risk factors for cognitive impairment, examination of their combined effect on cognitive function is lacking. Our objective was to elucidate whether a combination of ApoE4 phenotyping and slow gait resulted in greater cognitive impairment. : Overall, 1,085 community-dwelling older adults, either ApoE4 carriers ( = 167, 15.4%) or non-ApoE4 carriers, were included from the "Takashimadaira study." Gait speed was assessed with an electronic walkway and slow gait was defined as <1 m/s. Cognitive performance was also assessed using the Mini-Mental State Exam (MMSE) and the Trail Making Test (TMT)-A and -B. A two-way analysis of covariance (ANCOVA; ApoE and gait velocity factors) adjusted for covariates was performed for each analysis. : Gait and cognitive performances were similar for ApoE4 and non-ApoE4 carriers. A two-way ANCOVA of the MMSE showed a significant interaction between the two factors. ApoE4 carriers with slow gait had lower MMSE scores than ApoE4 carriers without slow gait and non-ApoE4 carriers with slow gait. Also, a significant main effect of gait velocity on TMT-A was observed, indicating that slow gait is associated with lower scores irrespective of the presence of ApoE4. There was no main effect or interaction observed on the TMT-B. : Our results suggest that the concurrent presence of at least one copy of ApoE4 and slow gait can define a subgroup with the lowest cognition. Elucidating the mechanisms underlying these associations may point out modifiable factors in populations at risk of dementia.
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http://dx.doi.org/10.3389/fnagi.2019.00247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753959PMC
September 2019

Effects of Computerized Guideline-Oriented Clinical Decision Support System on Antithrombotic Therapy in Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Stud Health Technol Inform 2019 Aug;264:768-772

Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

A systematic review and meta-analysis was conducted to investigate the effects of computerized guideline-oriented clinical decision support system (CDSS) on antithrombotic therapy in patients with atrial fibrillation. PubMed, the Cochrane Library, and Web of Science were queried. Four studies were included in this meta-analysis. The proportion of appropriate antithrombotic therapy in accordance with clinical guidelines was significantly higher in the CDSS group than in the control group (risk ratio (RR): 1.03, 95% confidence interval (CI): 1.01 to 1.04, P = 0.004). Although the incidence of thromboembolic events was similar between the two groups (RR: 1.12, 95% CI: 0.88 to 1.42, P = 0.357), the incidence of major bleeding tended to be lower in the CDSS group compared with the control group (RR: 0.79, 95% CI: 0.61 to 1.01, P = 0.063). Computerized guideline-oriented CDSS may be effective for appropriate antithrombotic therapy as compared with control in patients with atrial fibrillation.
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http://dx.doi.org/10.3233/SHTI190327DOI Listing
August 2019

Reference values of gait parameters measured with a plantar pressure platform in community-dwelling older Japanese adults.

Clin Interv Aging 2019 12;14:1265-1276. Epub 2019 Jul 12.

Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan.

Background: Gait measures such as gait speed, stride length, step width, and stance duration change with advanced age and are associated with adverse health outcomes among older adults. The stride-to-stride variabilities of gait measures are also related to falls and cognitive decline in older adults; however, reference values of these gait parameters in older Japanese adults do not exist. This study aimed to determine the reference values of gait parameters as measured by a plantar pressure platform in community-dwelling older Japanese adults.

Methods: Community-dwelling adults (N=1,212) who were independent in basic activities of daily living and aged 70-96 years (491 men, 721 women) completed the gait performance measurement in a geriatric health assessment. We assessed 10 gait performance measures with a plantar pressure platform system (P-WALK, BTS Bioengineering) and calculated means and coefficient of variations (CVs) of the gait measures as well as quintiles for those gait parameters per age group among men and women.

Results: Mean (SDs) of gait speed, stride length, step width, and stance durations were 1.26 (0.24) meters per second (m/s), 121.9 (19.8) cm, 24.0 (3.2) cm, and 552.4 (60.4) milliseconds (ms), respectively, in men, and 1.27 (0.21) m/s, 115.7 (16.3) cm, 17.9 (2.8) cm, and 517.6 (59.8) ms, respectively, in women. Mean of CVs (SD) of stride length, step width, and single-stance duration were 2.76 (1.35), 12.06 (3.98), and 5.74 (2.66), respectively, in men and 2.69 (1.24), 15.65 (4.53), and 5.77 (2.40), respectively, in women. Gait parameters (except CVs of step width) declined significantly with age regardless of gender (< 0.01 for trends).

Conclusion: This study determined age group dependent gait parameter reference values, presented as means with quintile ranges, in community-dwelling older Japanese adults. These reference values may be useful metrics for gait assessment in the elderly.
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http://dx.doi.org/10.2147/CIA.S213216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636431PMC
November 2019

Poor Social Network, Not Living Alone, Is Associated With Incidence of Adverse Health Outcomes in Older Adults.

J Am Med Dir Assoc 2019 11 15;20(11):1438-1443. Epub 2019 Apr 15.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Objective: Although it has been suggested that living alone is a "social risk factor" for adverse health outcomes, poor social network may confound the association. This study aimed to examine whether the interactive effects of living alone and poor social network contribute to adverse health outcomes.

Design: A 4-year prospective observational study.

Setting And Participants: Four hundred community-dwelling older adults living in Itabashi ward, an urban community in Tokyo. They participated in a health checkup (held in 2015 and 2017) and completed all the assessments.

Methods: Participants were classified into 4 groups according to their living arrangements (living alone or not living alone) and social network size, which was assessed using an abbreviated version of the Lubben Social Network Scale-6. Poor social network was defined as the lowest quartile (4th quartile) of the Lubben Social Network Scale-6 score. Adverse health outcomes including disabilities, depressive symptoms, and physical and cognitive functions were measured.

Results: Multiple and logistic regression models, adjusted for covariates such as financial status and educational level, showed that living alone and having a poor social network at baseline were significantly associated with increased depression symptoms, reduced grip strength, and disabilities of intellectual activity and social role at follow-up. Furthermore, older adults who did not live alone but had poor social networks showed significantly higher odds of subsequent homebound status and disability in activities of daily living.

Conclusions And Implications: We found that living alone among older adults is not always a social risk factor for health, and adverse health outcomes among older adults living alone may be confounded by poor social network. Our results also suggest that the effect of poor social network on health status may exceed the effects of living alone. Health professionals must, thus, pay attention to poor social network among older adults.
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http://dx.doi.org/10.1016/j.jamda.2019.02.021DOI Listing
November 2019

Is unwilling volunteering protective for functional decline? The interactive effects of volunteer willingness and engagement on health in a 3-year longitudinal study of Japanese older adults.

Geriatr Gerontol Int 2019 Jul 16;19(7):673-678. Epub 2019 Apr 16.

Institute for Gerontology, J. F. Oberlin University, Tokyo, Japan.

Aim: The present study explored the interactive effects of willingness to volunteer and actual volunteer engagement on the maintenance of functional health among older Japanese adults, using data from a 3-year longitudinal study.

Methods: We used data from the 3-year longitudinal Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (1997). We examined 676 older adults aged >65 years from the rural Nangai District who were independent in their basic activities of daily living (BADL). A follow-up study was carried out in 2000. We categorized participants into four groups: "willing volunteers," "unwilling volunteers," "willing non-volunteers" and "unwilling non-volunteers." Logistic regression analyses were carried out to evaluate the interactive effects of willingness to volunteer and actual engagement in volunteering at baseline on BADL decline over a 3-year period.

Results: During the follow-up period, 6.6% of willing volunteers, 17.4% of unwilling volunteers, 16.3% of willing non-volunteers and 21.0% of unwilling non-volunteers experienced a decline in BADL. Unwilling volunteers (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.29-6.43) and both non-volunteer groups (willing: OR 2.70, 95% CI 1.28-5.72; unwilling: OR 2.48, 95% CI 1.32-4.64) had significantly higher odds of BADL decline than did willing volunteers. When unwilling non-volunteer was set as the reference, the OR of unwilling volunteers became 1.16 (95% CI 0.55-2.49), suggesting that unwilling volunteers had a similar odds of BADL decline as non-volunteers.

Conclusion: Volunteer activity is effective for preventing BADL decline only for those who willingly engage. Geriatr Gerontol Int 2019; 19: 673-678.
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http://dx.doi.org/10.1111/ggi.13667DOI Listing
July 2019

Characteristics for gait parameters of community-dwelling elderly Japanese with lower cognitive function.

PLoS One 2019 27;14(3):e0212646. Epub 2019 Mar 27.

Research on Social and Human Science, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Objectives: Recent studies reported that several gait parameters were associated with lower cognitive function or cognitive decline, however, known gait parameters were limited and no study has used large-scale data. We identified the characteristics for gait parameters of community-dwelling elderly Japanese with lower cognitive function.

Methods: 1,240 community-dwelling adults (mean [SD] age, 77.2 [4.8] years; women, 59.4%) aged 70 or older participated in geriatric health assessments in 2016. We measured comprehensive gait parameters using resistive pressure platform. Cognition was assessed by Mini-Mental State Examination (MMSE).

Results: There are possible correlations between gait measures (gait speed, stride length, step length, step width, average foot pressure, double support duration, and single support duration) and CVs (CV of stride length, step length, average foot pressure, and single support duration) with MMSE score, respectively. After adjustment for important confounders, multiple regression models showed that gait speed (β = .080, p = 0.006), stride length (β = .123, p<0.001), step length (β = .123, p<0.001), average foot pressure (β = .060, p = 0.040), double support duration (β = -.082, p = 0.004), single support duration (β = .086, p = 0.003), CV of stride length (β = -.091, p<0.001), CV of step length (β = -.090, p<0.001), and CV of single support duration (β = -.058, p = 0.037) had significant association with MMSE score, respectively.

Conclusions: Our findings suggest that person with lower cognitive function tend to have unsteady gait such as erratic length and time of one step, in addition to decreasing the vertical displacement of the center of gravity and slower speed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212646PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436685PMC
November 2019

An Epidemiological Study of the Risk Factors of Bicycle-Related Falls Among Japanese Older Adults.

J Epidemiol 2019 Dec 8;29(12):487-490. Epub 2018 Dec 8.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.

Background: Considering the rate of growth of the older population in several countries, accidental falls in older cyclists are expected to increase. However, the prevalence and correlates of bicycle-related falls (BR-falls) are unknown. The aim of the present study was to explore the characteristics of BR-falls, focusing on the risk factors.

Methods: Seven-hundred and ninety-one older adults participated in a comprehensive baseline assessment that included questions on bicycle use, BR-falls, lifestyle, and physical and cognitive evaluations. A cyclist was defined as a person who cycled at least a few times per month. The incidence of BR-falls in participants who did not report BR-falls at baseline was again ascertained 3 years later. Logistic regression analyses examined the predictors of BR-falls incidence.

Results: At baseline, 395 older adults were cyclists and 45 (11.4%) of them had experienced BR-falls. Adjusted regression analysis showed that slower gait velocity, shorter one-leg standing time, and experience of falls (ie, non-BR-falls) were associated with BR-falls. Among the 214 cyclists who did not report BR-falls at baseline and who participated in both baseline and follow-up assessments, 35 (16.4%) cyclists experienced BR-falls during the 3-year follow-up. Adjusted regression analysis revealed that higher body mass index and non-BR-falls were predictors of future incidence of BR-falls, independent of physical function.

Conclusions: Our results showed that experience of falls, irrespective of bicycling, is an independent correlate and risk factor of BR-falls. This suggests that experience of falls and BR-falls may share the same risk factors.
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http://dx.doi.org/10.2188/jea.JE20180162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859081PMC
December 2019

Correction to: Hand dexterity, not handgrip strength, is associated with executive function in Japanese community-dwelling older adults: a cross-sectional study.

BMC Geriatr 2018 09 11;18(1):210. Epub 2018 Sep 11.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.

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http://dx.doi.org/10.1186/s12877-018-0907-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134789PMC
September 2018

Hand dexterity, not handgrip strength, is associated with executive function in Japanese community-dwelling older adults: a cross-sectional study.

BMC Geriatr 2018 08 24;18(1):192. Epub 2018 Aug 24.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.

Background: An association between handgrip strength, hand dexterity and global cognition is suggested; however, it is unclear whether both hand motor functions are associated with executive function, which is important for performing daily activities. Understanding this association will help identify motor risk factors for impairment of executive function in late adulthood. We aim to investigate the relationship of handgrip strength and hand dexterity with executive function in physically and mentally healthy community-dwelling older adults.

Methods: Three hundred and twenty-six older adults (287 women, mean age ± SD, 70.1 ± 5.6) underwent handgrip strength and hand dexterity tests using a hand dynamometer and the Purdue Pegboard Test (PPT), respectively. Executive function was evaluated with the Trail Making Test (TMT)-A, TMT-B and Digit symbol; global cognition was assessed with the Mini-Mental State Examination (MMSE).

Results: Age-group differences showed that the younger groups (60-64, 65-69 and 70-74) had a significant better PPT and executive function performance than the oldest group (75 and older), whereas no significant age differences were observed for handgrip strength. Multiple regression analysis adjusted for potential covariates, including MMSE scores, showed that TMT-A, TMT-B, and Digit symbol were significantly associated with PPT scores; however, no significant association was observed between executive function variables and handgrip strength.

Conclusions: Hand dexterity is vulnerable to the effects of aging and, contrary to handgrip strength, it strongly associates with executive function, independent of global cognition. Our results suggest that assessing hand dexterity may help identify individuals at higher risk of impairment of executive function among high-functioning older adults.
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http://dx.doi.org/10.1186/s12877-018-0880-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109297PMC
August 2018

Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA).

J Gerontol A Biol Sci Med Sci 2019 05;74(6):897-909

Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.

Background: A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions.

Methods: Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects.

Results: From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the "Core-battery" of tests. The expert panel also recommended a "Minimum-battery" of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B.

Conclusions: A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.
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http://dx.doi.org/10.1093/gerona/gly148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521916PMC
May 2019

Co-existence of social isolation and homebound status increase the risk of all-cause mortality.

Int Psychogeriatr 2019 05 19;31(5):703-711. Epub 2018 Jul 19.

Research Team for Social Participation and Community Health,Tokyo Metropolitan Institute of Gerontology,Tokyo,Japan.

ABSTRACTBackground:Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality.

Methods: The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained.

Results: In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04-4.63).

Conclusion: Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.
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http://dx.doi.org/10.1017/S1041610218001047DOI Listing
May 2019

Effects of aging on serum levels of lipid molecular species as determined by lipidomics analysis in Japanese men and women.

Lipids Health Dis 2018 Jun 6;17(1):135. Epub 2018 Jun 6.

Faculty of Sports Science, Waseda University, Tokorozawa, Saitama, Japan.

Background: Aging is known to be associated with increased risk of lipid disorders related to the development of type 2 diabetes. Recent evidence revealed that change of lipid molecule species in blood is associated with the risk of type 2 diabetes. However, changes in lipid molecular species induced by aging are still unknown. We assessed the effects of age on the serum levels of lipid molecular species as determined by lipidomics analysis.

Methods: Serum samples were collected from ten elderly men (71.7 ± 0.5 years old) and women (70.2 ± 1.0 years old), ten young men (23.9 ± 0.4 years old), and women (23.9 ± 0.7 years old). Serum levels of lipid molecular species were determined by liquid chromatography mass spectrometry-based lipidomics analysis.

Results: Our mass spectrometry analysis revealed increases in the levels of multiple triacylglycerol molecular species in the serum of elderly men and women. Moreover, serum levels of total ester-linked phosphatidylcholine (PC) and phosphatidylethanolamine (PE) were increased by aging. In contrast, serum levels of specific ether-linked PC and PE molecular species were lower in elderly individuals than in young individuals.

Conclusions: Our finding indicates that specific lipid molecular species, such as ether- and ester- linked phospholipids, may be selectively altered by aging.
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http://dx.doi.org/10.1186/s12944-018-0785-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991438PMC
June 2018

Association between number of institutions with coronary computed tomography angiography and regional mortality ratio of acute myocardial infarction: a nationwide ecological study using a spatial Bayesian model.

Int J Health Geogr 2018 05 21;17(1):13. Epub 2018 May 21.

Department of Biomedical Informatics, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.

Background: Coronary computed tomography angiography (CTA) has demonstrated high diagnostic accuracy for detection of coronary artery stenosis, and healthcare providers can detect coronary artery disease in earlier stages before it develops into more serious clinical conditions such as acute myocardial infarction (AMI). We hypothesized that the mortality ratio of AMI in regions with a higher density of coronary CTA is lower than that in regions with a lower density of coronary CTA.

Methods: This ecological and cross-sectional study using secondary data targeted all secondary medical service areas (SMSAs) in Japan (n = 349). We obtained the numbers of cardiologists, institutions with coronary CTA, and institutions with a cardiac catheterization laboratory (CCL) as medical resources, socioeconomic factors, lifestyle factors, exercise habit factors, and AMI mortality data from a Japanese national database. We evaluated the association between the number of these medical resources and the standardized mortality ratio (SMR) of AMI in each SMSA using a hierarchical Bayesian model accounting for spatial autocorrelation (i.e., a conditional autoregressive model). We assumed a Poisson distribution for the observed number of AMI-related deaths and set the expected number of AMI-related deaths as the offset variable.

Results: The number of institutions with coronary CTA was negatively and significantly associated with the SMR of AMI (relative risk [RR] 0.900; 95% credible interval [CI] 0.848-0.953), while the SMR in each SMSA was not significantly associated with the number of either cardiologists (RR 0.997; 95% CI 0.988-1.004) or institutions with a CCL (RR 1.026; 95% CI 0.963-1.096).

Conclusions: We observed a significant association between the number of institutions with coronary CTA and the SMR of AMI. Effective allocation of coronary CTA in each region is recommended, and it would be important to clarify the standing position of coronary CTA in regional networking for AMI treatment in the future.
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http://dx.doi.org/10.1186/s12942-018-0133-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963166PMC
May 2018

Entorhinal Cortex Volume Is Associated With Dual-Task Gait Cost Among Older Adults With MCI: Results From the Gait and Brain Study.

J Gerontol A Biol Sci Med Sci 2019 04;74(5):698-704

Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada.

Background: Low dual-task gait performance (the slowing of gait speed while performing a demanding cognitive task) is associated with low cognitive performance and an increased risk of progression to dementia in older adults with mild cognitive impairment. However, the reason for this remains unclear. This study aimed to examine the relationship between dual-task cost and regional brain volume, focusing on the hippocampus, parahippocampal gyrus, entorhinal cortex, and motor and lateral frontal cortices in older adults with mild cognitive impairment.

Methods: Forty older adults with mild cognitive impairment from the "Gait and Brain Study" were included in this study. Gait velocity was measured during single-task (ie, walking alone) and dual-task (ie, counting backwards, subtracting serial sevens, and naming animals, in addition to walking) conditions, using an electronic walkway. Regional brain volumes were derived by automated segmentation, using 3T magnetic resonance imaging.

Results: Partial rank correlation analyses demonstrated that a smaller volume of the left entorhinal cortex was associated with higher dual-task costs in counting backwards and subtracting serial sevens conditions. Subsequent logistic regression analyses demonstrated that a smaller volume of the left entorhinal cortex was independently associated with higher dual-task cost (slowing down >20% when performing cognitive task) in these two conditions. There were no other significant associations.

Conclusions: Our results show that lower dual-task gait performance is associated with volume reduction in the entorhinal cortex. Cognitive and motor dysfunction in older adults with mild cognitive impairment may reflect a shared pathogenic mechanism, and dual-task-related gait changes might be a surrogate motor marker for Alzheimer's disease pathology.
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http://dx.doi.org/10.1093/gerona/gly084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477635PMC
April 2019

Observational Evidence of the Association Between Handgrip Strength, Hand Dexterity, and Cognitive Performance in Community-Dwelling Older Adults: A Systematic Review.

J Epidemiol 2018 09 10;28(9):373-381. Epub 2018 Mar 10.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.

Background: Deterioration of hand motor function is a possible risk factor of cognitive impairment in older adults. Despite a growing body of research, a lack of clarity exists regarding the relationships. This review offers a synthesis of existing observational studies evaluating the associations of handgrip strength and hand dexterity with cognitive performance in community-dwelling older adults.

Methods: PubMed, PsycINFO, and ScienceDirect were systematically searched (search dates: 1990-2016), and relevant articles were cross-checked for related and relevant publications.

Results: Twenty-two observational studies assessed the association of handgrip strength or hand dexterity with cognitive performance; none evaluated handgrip strength and hand dexterity together. Handgrip strength was associated with global cognition, mostly assessed using the Mini-Mental State Examination, cross-sectionally and longitudinally. Also, one cross-sectional and three longitudinal studies found an association with cognitive domains, such as language, memory, visuospatial ability, working memory, and processing speed. Hand dexterity was only assessed cross-sectionally in four studies. These studies found an association with cognitive domains, such as executive function.

Conclusions: Although handgrip strength was associated with cognitive performance, it is unclear which variable at baseline affects the other in the long-term. Cross-sectional studies indicate an association between hand dexterity and cognitive performance, yet longitudinal studies are needed to elucidate this association. The interaction effects of both decreased grip strength and hand dexterity on cognitive performance is still unclear; therefore, future studies will need to consider the interaction of the three variables cross-sectionally and longitudinally.
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http://dx.doi.org/10.2188/jea.JE20170041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6111109PMC
September 2018

Effects of Computerized Guideline-Oriented Clinical Decision Support System on Glycemic Control in Diabetic Patients: A Systematic Review and Meta-Analysis.

Stud Health Technol Inform 2017 ;245:1376

Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

In a meta-analysis of 4 trials, computerized guideline-oriented clinical decision support system (CDSS) for healthcare providers showed a similar change in glycated hemoglobin (HbA1C) from baseline to follow up (weighted mean difference (95% confidence interval (CI)): -0.29 (-0.74, 0.16), p = 0.212), but a reduced proportion of patients with HbA1C ≥ 7.0% at follow up (odds ratio (95%CI)): 0.85 (0.74, 0.97), p = 0.014) compared with the control group, suggesting the need for the development of multifaceted computerized CDSS.
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June 2018