Development of a screening tool for risk of locomotive syndrome in the elderly: the 25-question Geriatric Locomotive Function Scale

White Matter Microstructure Alterations in Older Adults With Dyslipidemia Associated With Cognitive and Locomotor Dysfunction Evaluated Using Neurite Orientation Dispersion and Density Imaging

INTRODUCTION

Diffusion tensor imaging (DTI) studies have shown white matter (WM) microstructural alterations in individuals with dyslipidemia; however, DTI indices are not specific to WM pathology. However, neurite orientation dispersion and density imaging (NODDI) provides more specific measurements of WM microstructure. This study aimed to evaluate dyslipidemia-related WM microstructure alterations and their association with cognitive and motor functions using NODDI.

METHODS

The DTI and NODDI metrics were analyzed through tract-based spatial statistics between 24 older adults with dyslipidemia (low-density lipoprotein ≥140 mg/dL, high-density lipoprotein <40 mg/dL, and triglyceride ≥150 mg/dL, or under treatment) and 18 healthy control participants (HCs). Partial correlation tests were performed between diffusion magnetic resonance imaging measures and lipid profiles, cognitive, or locomotor scores in the dyslipidemia and HC groups separately. WM volumetry between HCs and dyslipidemia groups was also assessed. Age, gender, intracranial volume, and years of education were included as covariates in all analyses. A false discovery rate-corrected P value of <0.05 was considered statistically significant.

RESULTS

Individuals with dyslipidemia exhibited a notably reduced neurite density index (NDI) in several WM areas, including the posterior and superior corona radiata, the body, the genu, and the splenium of the corpus callosum, as well as the bilateral anterior and posterior internal capsule, compared with HCs. In the dyslipidemia group, lower NDI was significantly correlated with lower scores on the stand-up test and the Japanese version of the Montreal Cognitive Assessment. No significant differences were found in DTI metrics or WM volumes between dyslipidemia individuals and HCs.

CONCLUSION

Our findings suggest that NODDI can serve as a biomarker for assessing WM microstructural alterations in older adults with dyslipidemia. Particularly, NODDI indicates a lower intra-axonal volume, which may suggest axonal loss associated with dyslipidemia, and correlates with cognitive and locomotor function decline.

Whether a polyethylene terephthalate bottle cap can be opened could serve as a common indicator for locomotive syndrome, frailty and sarcopenia

AIM

This study aimed to develop an easy-to-use assessment that can be carried out anywhere by investigating the association between the ability to open a polyethylene terephthalate (PET) bottle cap and locomotive syndrome (LS), frailty and sarcopenia, and the screening ability of this method.

METHODS

This cross-sectional study was carried out between July 2022 and February 2024, analyzing 341 community-dwelling Japanese older adults (mean age 80.0 ± 6.9 years). We used odds ratios (OR) and their 95% confidence intervals (CI) to assess the association between the ability to open a PET bottle cap and LS, frailty and sarcopenia, as well as the screening ability of this method. LS was evaluated using the stand-up and two-step tests and Geriatric Locomotive Function Scale-5; frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria; and sarcopenia was evaluated using grip strength, walking speed and skeletal muscle mass index.

RESULTS

After adjusting for age, sex and body mass index, the binary logistic regression analysis showed that the inability to open a PET bottle cap was associated with LS stages 2 and 3 (OR 2.72, 95% CI 1.46-5.07), frailty according to the Japanese version of the Cardiovascular Health Study criteria (OR 3.38, 95% CI 1.23-9.24) and sarcopenia (OR 3.61, 95% CI 1.67-7.79). The receiver operating characteristic curve analysis showed moderate screening ability for LS, frailty and sarcopenia, with a positive predictive value of 97.4% for LS, and 93.9% for pre-frailty and frailty.

CONCLUSIONS

Notably, the positive predictive value was high for LS, and pre-frailty/frailty using the PET bottle method. The PET bottle method is "simple" and requires just "one action," and it holds promise for practical social implementation as a comprehensive assessment of LS (stages 2 and 3), frailty and sarcopenia. Geriatr Gerontol Int 2025; ••: ••-••.

Short-term resting-state electroencephalography fast activity is associated with cognitive decline in older adults: A population-based cross-sectional pilot study

Electroencephalography (EEG) slowing may help detect and prognosticate mild cognitive impairment (MCI). Whether slowed EEG activity is helpful for non-invasive MCI detection in a health checkup remains uncertain. This cross-sectional secondary study assessed the hypothesis that frontal EEG slowing in short-term resting-state is associated with MCI-suspicious participants over 65 in the Iwaki Health Promotion Project 2022. Participants who underwent the MCI screen test were matched by propensity score to minimize confounding (age and educational history) between the non-cognitive impairment (NCI, n = 14) and suspected-MCI (sMCI, n = 14) groups. The matched sMCI group had increased EEG β power, decreased δ power, θ/β power ratio (TBR), and frontal α asymmetry. No significant differences were found in imaginary coherence and debiased weighted phase lag index (dwPLI) between the groups. Spearman's correlation showed a negative correlation between the MCI screen performance and β power and positive correlations between the performance and δ power, TBR, or α-γ dwPLI. Contrary to the hypothesis and previous findings, these results suggest that fast frontal EEG activity is negatively associated with cognitive performance in older adults. EEG measurements in health checkups may be useful for screening cognitive impairments that are less likely due to neurodegeneration.

The prevalence and correlation of cancer-related fatigue and locomotive syndrome in geriatric cancer patients

OBJECTIVE

To explore the relationship between cancer-related fatigue (CRF) and locomotive syndrome (LS) among Chinese older adults with cancer.

METHODS

This study was a cross-sectional survey. Staged random sampling method was employed to enroll 500 geriatric cancer patients from the Oncology Center of Jiangnan University Hospital in Wuxi, Jiangsu Province, China. Data were collected using General Information Questionnaire, Cancer Fatigue Scale and the Geriatric Locomotive Function Scale. χ2 test, Logistic regression analysis and Spearman analysis were utilized to analyze the data.

RESULTS

A total of 466 geriatric cancer patients were enrolled in this survey. The occurrence of CRF was 43.8%, and the occurrence of LS was 30.9%. LS were risk factors for the occurrence of CRF in geriatric cancer patients. Advanced old age, fear of falling, comorbid with chronic diseases and CRF were risk factors for LS. CRF was positively associated with LS (r = 0.446, P < 0.001).

CONCLUSION

Our findings indicate a potential link between CRF and LS. By addressing LS from various aspects, including controlling the number of complications due to advanced old age and other factors, as well as spreading proper fall-related knowledge and controlling the awareness of fear of falling, healthcare professionals can indirectly alleviate CRF symptoms and improve the overall quality of life for these patients.

Decreased Lower Limb Phase Angle in Older People Is an Indicator of Standing and Gait Function, Regardless of Age

Background/Objectives: The phase angle (PhA), as measured using bioelectrical impedance analysis (BIA), indicates muscle mass and quality. However, its relationship with age-related muscle changes and motor function and effective BIA assessment/intervention sites remains unclear. Herein, we evaluated age-related changes in PhA, explored the relationship between PhA and muscle mass, and identified effective sites for BIA. Methods: We included 131 healthy community-dwelling adults divided into older (≥65 years) and control (≤65 years) groups. PhA and muscle mass were measured using BIA with a device determining electrical resistance by transmitting a weak alternating current <90 μA. Motor function was measured using ground reaction force index, gait function, and grip strength. The relationships between muscle mass, PhA, and motor function were analyzed. Results: All values, excluding upper limb muscle mass, were lower in the older group, as were the rates of change in muscle mass and PhA in the lower limbs vs. the upper limbs. Lower limb PhA showed negative and positive correlations with the Timed Up and Go test and standing function, respectively; it was significantly associated with all motor functions. Conclusions: Regardless of age, muscle mass and PhA measured by BIA were high and low in the lower limbs, respectively, and lower limb PhA was related to walking and standing function. The decrease in lower limb muscle mass and PhA may accelerate with age. Given global population aging, easy-to-assess lower limb PhA linked to the movements necessary for independent living may be an effective site for assessment and intervention in clinical practice.

Association between mobility decline and health literacy in older Japanese adults: Onjuku study

Decline in mobility is a global issue that must be addressed in rapidly aging societies. We aimed to clarify the association between locomotive syndrome (LS), a condition of decreased mobility and health literacy (HL) in community-dwelling Japanese adults aged ≥ 40 years. A descriptive survey was conducted in Onjuku Town, Japan, between 2019 and 2023. The participants performed LS risk tests, including the two-step test, stand-up tests and 25-question geriatric locomotive function scale, to assess mobility. They completed the 14-item health literacy scale to quantify the total HL and functional, communicative and critical HL subscales. Other participant characteristics, such as chronic diseases, bodily pain and physical activity, were also surveyed. The association between LS and HL was assessed using univariate and multivariate logistic regression analyses, adjusted for participant characteristics. We analyzed 492 participants with a median age of 71 years. The total HL score decreased as the LS stage increased, with 56, 54 and 51 points in stages 0, 1 and ≥ 2, respectively (p = 0.004). In the logistic regression analysis, a high total HL score was significantly associated with reduced odds of stage ≥ 2 LS (adjusted odds ratio, 0.95; p < 0.001). Furthermore, functional HL score had an independent association with stage ≥ 2 LS (adjusted odds ratio, 0.88; p = 0.009). Our results suggest that clinicians should provide HL education in addition to known preventive measures, such as promoting physical activity, as a holistic approach to decreased mobility.

Prevalence of locomotive syndrome and associated factors in patients receiving hemodialysis

Muscle strength and joint and nervous system functions decline with age and in patients undergoing hemodialysis. The Japanese Orthopaedic Association has defined locomotive syndrome (LoS) as a musculoskeletal disorder primarily caused by aging. Therefore, this study aimed to investigate the prevalence of LoS and identify factors associated with its development in patients undergoing hemodialysis. Patients receiving outpatient hemodialysis at Kurume University Hospital were categorized into LoS and non-LoS groups using the cutoff value of 25-question Geriatric Locomotive Function Scale (GLFS-25). We analyzed differences in malnutrition, biochemical examinations, and Kt/V (a measure of dialysis adequacy) between the 2 groups using Wilcoxon rank-sum tests. Additionally, we evaluated factors that correlated with GLFS-25 through pairwise correlations. Multivariate analysis was performed to determine the independent factors associated with LoS. Nineteen patients were included. The median GLFS-25 score was 18. The LoS group (n = 11) had a significantly higher age (P = .0056) and chloride levels than the non-LoS group (n = 8) (P = .0175). Furthermore, the Nutritional Risk Index for Japanese Hemodialysis patients, creatinine levels, and Kt/V were significantly lower in the LoS group than in the non-LoS group (P = .0156, .0026, and .0163, respectively). The GLFS-25 showed significant correlations with age, total protein levels, C-reactive protein, chloride, creatinine, Nutritional Risk Index for Japanese Hemodialysis patients, and Kt/V (with correlation coefficients of -0.6133, -0.4779, 0.4738, 0.5381, -0.7923, 0.6508, and 0.5747, respectively). Multivariate analysis identified life-space assessment (odds ratio [OR], 3.06; 95% confidence interval [CI], -676 to 674; P < .0001) and age (OR, 31.29; 95% CI, -2061 to 2067; P = .0007) as risk factors for LoS. Age and physical activity were found to be associated with the development of LoS in patients with end-stage renal disease undergoing outpatient hemodialysis at our hospital. This emphasizes the importance of implementing preventative measures for LoS, especially for older and less physically active patients.

Association between restricted outings and geriatric locomotive function scale score in the general elderly population during the COVID-19 pandemic

BACKGROUND

Restrictions in daily activities due to coronavirus infection countermeasures reduced opportunities for physical activity and social participation in people of all ages. This study investigated the associations of restricted outings on locomotive function during the COVID-19 pandemic using a cohort of middle-aged and elderly community-dwelling residents.

METHODS

Registered citizens of 50-89 years old were targeted for this investigation. We established 8 groups based on age (50's, 60's, 70's, and 80's) and gender (male and female) after random sampling from the basic resident registry of Obuse town in 2014. All participants were surveyed by a 25-question geriatric locomotive function scale (GLFS-25) at the time of checkup before the COVID-19 pandemic. Then, in 2021 and 2022 after government restrictions on outings were lifted for COVID-19 pandemic, all participants were mailed questionnaires including the GLFS-25. A total of 296 (143 male and 153 female) participants who responded at least once were included. We evaluated the changes in opportunities to go out between pre- and post-pandemic time points and the impact on GLFS-25 scores.

RESULTS

In total, 128 (43.2%) respondents had fewer opportunities to go out than the previous year. Pre- and post-pandemic GLFS-25 scores in the decreased outing (+) group were significantly worse than in the decreased outing (-) group (both p < 0.01). The final multivariate model revealed GLFS-25 score worsening beta coefficient of 0.27 for age (+10 years), 3.97 for male, 4.54 for decreased outings, and 4.46 for spinal canal stenosis.

CONCLUSIONS

In this randomly sampled Japanese cohort based on a resident registry, restricted outings during the COVID-19 pandemic was a significant independent factor associated with lower locomotive function.

Factors associated with discrepancies in disease activity as assessed by SDAI and RAPID3 in patients with rheumatoid arthritis: Data from a multicentre observational study (T-FLAG)

OBJECTIVES

The present study aimed to examine discrepancies between assessments based on Routine Assessment of Patient Index Data 3 (RAPID3) and Simple Disease Activity Index (SDAI) in rheumatoid arthritis (RA) patients with controlled disease activity.

METHODS

Data from 464 RA patients in SDAI remission or low disease activity (REM/LDA) were analysed. Patient-reported outcome (PRO) measures, including Health Assessment Questionnaire Disability Index (HAQ-DI), 25-question Geriatric Locomotive Function Scale (GLFS-25), and Kihon checklist (KCL), were assessed. Logistic regression models were used to identify factors associated with RAPID3 moderate or high disease activity (MDA/HDA). Cutoff values of RAPID3 MDA/HDA for each PRO evaluation item were determined using receiver operating characteristic curve analysis.

RESULTS

Among RA patients in SDAI REM/LDA, 84.9% were in RAPID3 REM/LDA. Multivariable analysis revealed that HAQ-DI, GLFS-25, and KCL were independently associated with RAPID3 MDA/HDA. Subdomain analysis of KCL revealed that activities of daily living, physical function, cognitive function, and depressive mood were significantly associated with RAPID3 MDA/HDA. Cutoff values for HAQ-DI and KCL were 0.38 and 8, respectively.

CONCLUSIONS

In RA patients with controlled disease activity, discrepancies between RAPID3 and SDAI assessments were observed, with factors such as HAQ-DI, GLFS-25, and KCL being independently associated with RAPID3 MDA/HDA.

A Preliminary Survey of Rheumatologists on the Management of Late-onset Rheumatoid Arthritis in Japan

Objective We investigated the current perspectives regarding the management of late-onset rheumatoid arthritis (LORA) among rheumatologists in clinical practice. Methods This study was performed in October 2021, and included 65 rheumatologists certified by the Japan College of Rheumatology, who were administered questionnaires (including multiple choice and descriptive formulae) regarding the management of LORA. We aggregated and analyzed the responses. Results All 65 rheumatologists responded to the survey; 47 (72%) answered that >50% of newly diagnosed patients were aged ≥65 years, 42 (65%) answered that achievement of remission or low disease activity was the treatment goal, and 40 (62%) considered patient safety to be the highest priority. Most rheumatologists are concerned about the management of conditions other than RA, such as comorbidities, financial constraints, and life circumstances that interfere with standard or recommended treatment implementation. Conclusion This preliminary survey highlighted various rheumatologists' perspectives regarding the management of LORA.

Assessing Locomotive Syndrome Through Instrumented Five-Time Sit-to-Stand Test and Machine Learning

Locomotive syndrome (LS) refers to a condition where individuals face challenges in performing activities of daily living. Early detection of such deterioration is crucial to reduce the need for nursing care. The Geriatric Locomotive Function Scale (GLFS-25), a 25-question assessment, has been proposed for categorizing individuals into different stages of LS. However, its subjectivity has prompted interest in technology-based quantitative assessments. In this study, we utilized machine learning and an instrumented five-time sit-to-stand test (FTSTS) to assess LS stages. Younger and older participants were recruited, with older individuals classified into LS stages 0-2 based on their GLFS-25 scores. Equipped with a single inertial measurement unit at the pelvis level, participants performed the FTSTS. Using acceleration data, 144 features were extracted, and seven distinct machine learning models were developed using the features. Remarkably, the multilayer perceptron (MLP) model demonstrated superior performance. Following data augmentation and principal component analysis (PCA), the MLP+PCA model achieved an accuracy of 0.9, a precision of 0.92, a recall of 0.9, and an F1 score of 0.91. This underscores the efficacy of the approach for LS assessment. This study lays the foundation for the future development of a remote LS assessment system using commonplace devices like smartphones.

How global spine sagittal alignment and spinal degeneration affect locomotive syndrome risk in the elderly

BACKGROUND

The aim of this study was to delineate the features of the locomotive syndrome (LS) risk stage in the elderly population, encompassing global spine sagittal alignment, visible spinal degenerative changes on plain radiographs, muscle strength, physical capabilities, and low back pain (LBP).

METHODS

The study enrolled 232 subjects, evaluated using plain radiographs. The evaluation included measurements of lumbar lordosis (LLA), thoracic kyphosis (TKA), spinal inclination (SIA) angles, and sagittal vertical axis. Assessments included lumbar osteophyte formation (LOF) and lumbar disc height (LDH) to examine spinal degenerative changes. LS evaluation used the locomotive syndrome risk test based on LS risk criteria, classifying participants into no risk, stage 1 LS, and stage 2 LS groups. Using a visual analogue scale (VAS), we investigated the prevalence of low back pain (LBP) and assessed physical performances across these groups.

RESULTS

There were 132 participants with no LS risk, 71 with stage 1 LS risk, and 29 with stage 2 LS risk. As LS risk increased, LBP prevalence and VAS scores rose, physical abilities, and back muscle strength decreased. TKA showed no variation across groups, while LLA decreased with advancing LS risk stage. Except for L1-L2 and L5-S1, lumbar disc height (LDH) decreased with higher LS risk stages. LOF occurrence increased notably with higher LS risk stages. Spinal inclination angle (SIA) significantly increased with advancing LS risk stages.

CONCLUSION

Participants diagnosed with LS exhibited an increased incidence of spinal degeneration, reduced LLA, and global spinal imbalance characterized by anterior spinal inclination.

Current status and risk determinants of locomotive syndrome in geriatric cancer survivors in China-a single-center cross-sectional survey

Objective

To assess the prevalence and risk determinants of locomotive syndrome (LS) in geriatric cancer survivors in China. To generate evidence-based insights for the clinical prevention and intervention strategies concerning LS in this vulnerable population, emphasizing the need for integrated public health initiatives focused on maintaining mobility among geriatric cancer survivors.

Methods

Six hundred geriatric cancer survivors were recruited at a hospital in China. A demographic questionnaire, the International Physical Activity Questionnaire-Short (IPAQ-S), and the Geriatric Locomotive Function Scale (GLFS-25) were administered. Survivors were stratified into three physical activity level (PAL) groups via IPAQ-S scores: low, medium, and high. LS was operationally defined via GLFS-25 scores, with cut-offs established for LS-1, LS-2, and LS-3. Elevated GLFS-25 scores signified deteriorated motor function (MF) and increased severity of LS. Data analysis was done to investigate the risk determinants to the occurrence and exacerbation of LS among geriatric cancer survivors.

Results

Of the 524 geriatric cancer survivors who completed the study, 292 (55.7%) were diagnosed with LS, including 152 (29%) categorized under LS-1, 52 (9.9%) under LS-2, and 88 (16.8%) under LS-3. Univariate analysis indicated that variations in exercise habits, prior occupational type, presence of tumor metastasis or recurrence, visual impairments, somatosensory abnormalities, and PAL were significantly associated with differing occurrences and severities of LS (p < 0.05). Ordinal logistic regression revealed that prior occupational type (OR = 0.466), tumor metastasis (OR = 0.404), tumor recurrence (OR = 0.341), and PAL (medium: OR = 7.178; high: OR = 1.984) were independent risk determinants modulating both the occurrence and severity of LS in cancer survivors (p < 0.05).

Conclusion

The occurrence of LS is notably elevated among geriatric cancer survivors in China, indicating a significant public health concern. Individuals who were previously engaged in non-physically demanding occupations and those with histories of tumor metastasis or recurrence, coupled with reduced PAL, demonstrate a heightened susceptibility and severities to LS. Early identification of these risk determinants is imperative for mitigating the onset and progression of LS. Comprehensive public health strategies, including regular screening programs, targeted physical rehabilitation initiatives, and community-based interventions, are essential to mitigate the onset and progression of LS in this vulnerable population, ultimately reducing its broader impact on aging-related health outcomes.

Association between gut microbiota and locomotive syndrome risk in healthy Japanese adults: a cross-sectional study

This cross-sectional study examined the association between gut microbiota composition and locomotive syndrome in 568 healthy Japanese adults (36.8% male, median age 58.5 years) using data from the Kanagawa "ME-BYO" Prospective Cohort Study. Locomotive syndrome was assessed using the 5-question Geriatric Locomotive Function Scale (GLFS-5). Linear discriminant analysis effect size showed an enrichment of Actinobacteria and depletion of Firmicutes in GLFS-5 positive individuals. Classification tree analysis identified three terminal nodes as GLFS-5 positive, with one node involving Holdemania. Participants aged ≥70.0 and <78.0 years who did not consume probiotic foods and had ≥0.04% relative abundance of Holdemania were classified as at risk for locomotive syndrome. Our findings suggest a potential association between gut microbiota, particularly higher Holdemania abundance, and locomotive syndrome in older adults. This study provides insights into the complex relationship between gut microbiome composition and musculoskeletal health in aging populations. However, the cross-sectional design limits causal inference.

Relationship Between the 25-Question Geriatric Locomotive Function Scale and Falls: A One-Year Longitudinal Observational Study of 1,173 Healthy Community-Dwelling Residents Aged 65 and Older

Introduction This study aimed to explore the relationship between the 25-question Geriatric Locomotive Function Scale (GLFS-25) score (i.e., total score and domain scores) and falls (i.e., history with or without falls and frequency of falls). Methodology We conducted a one-year longitudinal observational study involving 1,173 healthy community-dwelling residents aged ≥65 years who attended a basic health checkup in Minami-Aizu Town and Tadami Town, Fukushima, Japan, from 2016 to 2017. The following clinical information was collected: age, sex, body mass index, smoking status, alcohol consumption, living situation, metabolic syndrome, physical activity, and GLFS-25 score during the participants' health check in 2016. The GLFS-25 measures various domains, including body pain, movement-related difficulties, usual care, social activities, and anxiety. Participants were diagnosed with locomotive syndrome (LS) based on their GLFS-25 total scores: Non-LS (0-6 points), LS-1 (7-15 points), LS-2 (16-23 points), and LS-3 (24-100 points). We assessed the annual occurrence of falls during the participants' health check in 2017 and the monthly frequency of falls. Student's t-test, Mann-Whitney's U test, and Fisher's exact test were performed to compare parameters between fallers and non-fallers. To examine the association between the annual occurrence of falls and the diagnosis of LS, a multivariate logistic regression analysis was performed to calculate adjusted odds ratios (ORs), controlled based on the clinical information. To assess the association between the monthly frequency of falls and GLFS-25 scores, a multivariate regression analysis was performed to calculate the adjusted standardized partial regression coefficient (β), controlled based on the clinical information. Results Fallers were significantly older (p < 0.001), had a higher body mass index (p = 0.034), and had higher GLFS-25 total scores (p < 0.001) than non-fallers. In the multiple logistic regression analysis, falls were significantly associated with LS-1 or more (OR = 2.32, p < 0.001), LS-2 or more (OR = 2.72, p < 0.001), and LS-3 or more (OR = 2.99, p < 0.001). Furthermore, the annual occurrence of falls was significantly associated with GLFS-25 body pain (OR = 1.94, p = 0.012) and anxiety scores (OR = 2.09, p = 0.021). In the multiple regression analysis, the monthly frequency of falls was significantly associated with the GLFS-25 total score (β = 0.29, p < 0.001). The monthly frequency of falls was also significantly associated with GLFS-25 domain scores, including body pain score (β = 0.23, p < 0.001), movement-related difficulty score (β = 0.21, p < 0.001), usual care score (β = 0.18, p < 0.001), social activity score (β = 0.26, p < 0.001), and anxiety score (β = 0.22, p < 0.001). Conclusion Our findings emphasize the importance of fall prevention in individuals with LS-1 and suggest that the GLFS-25 total score may predict recurrent falls. Our study first provides valuable evidence regarding the relationship between the GLFS-25 (total score and domain scores) and falls. The monthly frequency of falls was correlated with the total GLFS-25 score and all GLFS-25 domain scores. However, the annual occurrence of falls was found to have no correlation with anything other than the GLFS-25 domain scores regarding physical pain and anxiety. Therefore, further investigations are needed.

Association of visceral fat area with early-stage locomotive syndrome across various age groups: a cross-sectional study

The association between visceral fat area (VFA) and locomotive syndrome (LS) has been extensively studied in the older population; however, the association between VFA and early-stage LS (stage 1 [LS1]) remains unclear. In this cross-sectional study, we investigated this association across different age groups. The study involved 1,236 (524 male and 712 female) participants (aged 20-85 years). Multiple regression analysis adjusted for sex, body mass index, skeletal muscle mass index, T-score, exercise habits, smoking status, and alcohol consumption revealed a significant association between LS1 and VFA across all VFA quartiles. The adjusted odds ratio OR for quartiles 2, 3, and 4 was 1.84, 2.68, and 4.12, respectively. The association between LS1 and VFA across the age groups-high VFA (> 73 cm2) and non-older (< 65 years) (OR, 1.87; 95% CI, 1.28-2.72; p = 0.001), low VFA (≤ 73 cm2) and older (≥ 65 years) (OR, 3.16; 95% CI, 1.94-5.14; p < 0.001), and high VFA and older groups (OR, 6.43; 95% CI, 3.98-10.4; p < 0.001)-was significantly stronger than that in the low VFA and non-older group. In summary, our findings suggest that managing VFA through diet and exercise is crucial for preventing LS1 across all age groups.

Spatiotemporal gait characteristics post-total hip arthroplasty and its impact on locomotive syndrome: a before-after comparative study in hip osteoarthritis patients

Background

Understanding the gait pattern of patients eligible for total hip arthroplasty (THA) due to hip osteoarthritis (OA) offers valuable information for improving locomotive syndrome (LS). This study aims to measure the gait patterns of THA-eligible patients using an optical motion capture system and to analyze these patterns using principal component analysis (PCA). Additionally, this study examines the relationship between THA-induced gait patterns and LS.

Methods

This before-after study included 237 patients who underwent unilateral primary THA due to hip OA. The primary outcome measures were spatiotemporal gait parameters. Secondary outcome measures included three LS risk tests: a stand-up test, a two-step test, a 25-question Geriatric Locomotive Function Scale (GLFS-25), and total clinical decision limits stages. PCA was performed using 16 spatiotemporal gait parameters collected before and three months after THA. Principal components (PC) were selected to achieve a cumulative contribution rate of 90% (0.9) or higher. Each summarized PC was compared using a paired t-test before and three months after THA. Furthermore, multiple regression analysis was conducted to determine how changes in each PC between before and three months after THA related to changes in the four LS evaluation items.

Results

PCA identified three principal components (PC1, PC2, PC3) that accounted for a cumulative contribution rate of 0.910 using 16 spatiotemporal gait parameters. When comparing before and three months after THA for all three PCs, significant differences were observed in each PC (p < 0.001), with overall walking ability and stance phase being higher three months after THA than before THA, while the asymmetry of support time was lower three months after THA. The results of multiple regression analysis revealed that PC1, PC2, and PC3 were the most influential factors in total clinical decision limits stage. For each LS risk test, the factors related to the stand-up test were identified as PC1, PC2, and PC3, while the factors related to the two-step test were identified as PC1 and PC2. The factors related to the GLFS-25 were also identified as PC1 and PC2.

Conclusions

The most important findings of this study indicate that the three PCs represent over 90% of the 16 spatiotemporal gait parameters, which are associated with total clinical decision limits stage and LS risk tests. The present results suggest that PC1 represents overall walking ability, PC2 represents the stance phase, and PC3 represents asymmetry of support time. Gait pattern characteristics, such as overall walking ability, stance phase, and asymmetry of support time, were clearly defined by these PCs. Regarding the relationship between PC and LS, all three PCs are related to total clinical decision limits stage. In addition, PC1 and PC2 related to all three LS risk tests, and PC3 related only to the stand-up test.

Association of the 25-question Geriatric Locomotive Function Scale with all-cause mortality in older adults: The Nagahama study

BACKGROUNDS

Locomotive syndrome is a condition in which a person is at risk of requiring nursing care due to musculoskeletal disorders. The 25-question Geriatric Locomotive Function Scale (GLFS-25) was developed to determine the severity of locomotive syndrome. In this study, we aimed to determine the prognostic significance of the GLFS-25 for all-cause mortality.

METHODS

The study participants consisted of 3,447 community residents aged ≥65 years. All-cause mortality was determined using residential registry records. Skeletal muscle mass assessed via bioimpedance methods was considered in the analysis as a confounding factor.

RESULTS

During a mean follow-up period of 3,236 days (30,566 person-years), 288 cases of all-cause mortality occurred. When participants were categorized by the GLFS-25 score [grade 1: <7 points (n = 1,948); grade 2: ≥7 to <16 points (n = 894); grade 3: ≥16 points (n = 605)], their survival probability decreased linearly with increasing grade (log-rank test P = 0.014). In a Cox proportional hazards model adjusted for confounding factors, including low skeletal muscle mass, GLFS-25 grade 3 was identified as an independent risk factor for all-cause mortality (hazard ratio: 1.60; P = 0.007) in the subpopulation aged ≥70 years but not in the overall population (P = 0.062). The hazard ratio for all-cause mortality with GLFS-25 grade 3 and low skeletal muscle mass combined was 2.66 (P < 0.001).

CONCLUSION

The GLFS-25 is independently associated with all-cause mortality in older adults. Using this questionnaire to assess locomotive syndrome could be useful for identifying individuals at risk.

Simple Mobility Tests Predict Use of Assistive Devices in Older Adults

BACKGROUND

Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members.

PURPOSE/OBJECTIVES

The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals.

METHODS

Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use.

RESULTS

80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers ( P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048).

DISCUSSION

Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD.

CONCLUSIONS

If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.

Efficacy of exercise with the hybrid assistive limb lumbar type on physical function in mobility-limited older adults: A 5-week randomized controlled trial

BACKGROUND

Sarcopenia and frailty often worsen in older adults because of declines in activities of daily living and social connections that are associated with chronic diseases and traumatic injuries such as falls and fractures. Exercise intervention for sarcopenia can take >3 months to improve muscle mass, muscle strength, and walking speed. Thus, a specialized intervention system for shorter periods of time is needed. In this study, we aimed to evaluate the short-term efficacy of an exercise program using the wearable cyborg Hybrid Assistive Limb (HAL) lumbar type in physical function in mobility-limited older adults who do not require transition to long-term care.

METHODS

This randomized, single-blind, parallel-group study involved 79 community-dwelling older adults with physical frailty or locomotive syndrome assigned to an intervention group (n = 40) with the HAL lumbar type exercise program or a control group (n = 39) without the exercise program. The intervention group underwent trunk training (including trunk and hip flexion, standing and sitting from a single sitting position, and squats) and gait training (treadmill and parallel bars) twice a week for 5 weeks while wearing the HAL lumbar type. The 10-m usual and maximum walking speeds, Timed Up and Go test results, 5-times chair-standing test results, 5-question Geriatric Locomotive Function Scale (GLFS-5) scores, body-fat percentage, and muscle mass were measured before and after the intervention and analyzed using the intention-to-treat method.

RESULTS

The intervention (23 % male; mean age, 74.7 ± 4.7 years) and control (21 % male; mean age, 75.1 ± 4.1 years) groups did not differ significantly in baseline characteristics. Seventy-seven participants completed the program; two withdrew for personal reasons. The mean difference (standard error) between the groups for the primary outcome (usual walking speed) was 0.35 (0.04) m/s; the time-by-group interaction was significant (p < 0.001). Secondary outcomes (maximum walking speed, Timed Up and Go test results, 5-times chair-standing test results, and GLFS-5 scores) significantly improved in the intervention group. Body composition was unchanged in both groups.

CONCLUSIONS

A 5-week exercise program using the HAL lumbar type is a promising option for community-dwelling older adults with limited mobility who do not require nursing care, resulting in clinically meaningful improvements in most physical functions within a short period.

Are Middle-Aged and Older Adult Users of Physical Activity Monitoring Systems More Physically Active and at a Lower Risk of Locomotive Syndrome? A Cross-Sectional Web-Based Online Survey

BACKGROUND

Physical inactivity is a risk factor for locomotive syndromes and functional limitations in middle-aged and older adults. Therefore, strategies to promote physical activity should be considered. This study investigated whether users of physical activity monitors were more physically active and exhibited a lower risk of locomotive syndrome, compared with non-users.

METHODS

We analyzed data from 742 Japanese adults aged 60-79 years. The participants were surveyed for their use of physical activity monitors in their daily lives. We also assessed the prevalence of locomotive syndrome.

RESULTS

We observed significantly higher physical activity levels in users compared with non-users. Moreover, the use of a physical activity monitor was significantly associated with decreased odds of locomotive syndrome (adjusted odds ratio [aOR]=0.48). Significantly lower risk of locomotive syndrome were observed in individuals who had used a monitor for >2 years (aOR=0.42) or had set a personal step goal (aOR=0.32).

CONCLUSION

Physical activity monitoring may increase engagement in physical activity-associated behavior. Therefore, monitoring could serve as a useful tool to promote physical health in middle-aged and older adults.

The relationship between locomotive syndrome and depression in young Chinese college students

OBJECTIVES

This study investigates the relationship between locomotive syndrome (LS) and mental disorder (depression) in young Chinese college students.

METHODS

Our study population (n = 165; mean age of 19.82 ±1.90 years) comprises college student residents at Tsinghua University in Beijing, China. Three screening methods were used to evaluate LS: 25-question Geriatric Locomotive Function Scale (GLFS-25), a two-step test, and a stand-up test. Depression was screened by the Chinese version of the Zung Self-Rating Depression Scale (ZSDS).

RESULTS

The prevalence of LS and depression was 20.1% and 30.9%, respectively. The LS group had lower grip strength and higher ZSDS scores than the non-LS group.

CONCLUSION

Young Chinese college students have a relatively high prevalence of LS, and LS and GLFS-25 scores were significantly related to depression. The present results suggest that management strategies for LS should consider depressive symptoms among young adults.

The correlation of gait and muscle activation characteristics with locomotion dysfunction grade in elderly individuals

Objective

To investigate the differences and regularity of gait and muscle activation characteristics parameters in the Locomotion Dysfunction Grade (LDG) scale assessment in elderly individuals, and analyse the correlation between objective parameters and scale grading. Thus, to propose a novel detection mode for elderly individuals, which combined the LDG scale with objective detection. It can not only provide quantitative data for intelligent evaluation and rehabilitation, but also provided more accurate reference for the classification of care levels in elderly care policies.

Methods

Elderly individuals (n = 159) who underwent gait analysis and sEMG at the Chinese Rehabilitation Research Center from January 2019 to September 2023 were included. According to the LDG scale, the elderly individuals were divided into four groups, namely, the LDG4, LDG5, LDG6 groups and the healthy control group. Four indicators, namely, spatiotemporal, kinematic, dynamic gait parameters and muscle activation characteristics data, were collected. Changes in these characteristics of elderly individuals with lower extremity motor dysfunction were evaluated and analysed statistically.

Results

The spatiotemporal gait parameters were significantly lower in the LDG4, LDG5, LDG6 groups than in the healthy control group. The double support phase was positively correlated with the LDG, while the swing phase, step length and velocity were negatively correlated (P < 0.05). The movement angles of both hips, knees and ankles were significantly limited and negatively correlated with the LDG (P < 0.05). Compared with those in the healthy control group, the centre of pressure (COP) path length were greater, and the average COP velocity was significantly lower (P < 0.05) in the LDG4, LDG5, LDG6 groups. The regularity of muscle activation clearly changed. The root mean square of the gastrocnemius medialis was positively correlated with LDG (P < 0.05), while the tibialis anterior showed no regularity.

Conclusion

As the LDG increased, the differences in spatiotemporal, kinematic and dynamic gait parameters between elderly individuals with motor dysfunction and the healthy individuals gradually increased. The muscle activation characteristics parameters showed an abnormal activation pattern. These parameters were correlated with the LDG, providing a more comprehensive and objective assessment of lower extremity motor function in elderly individuals, improve assessment accuracy, and help accurate rehabilitation.

Identifying factors associated with locomotive syndrome using machine learning methods: The third survey of the research on osteoarthritis/osteoporosis against disability study

AIM

To identify factors associated with locomotive syndrome (LS) using medical questionnaire data and machine learning.

METHODS

A total of 1575 participants underwent the LS risk tests from the third survey of the research on osteoarthritis/osteoporosis against disability study (ROAD) study. LS was defined as stage 1 or higher based on clinical decision limits of the Japanese Orthopaedic Association. A total of 1335 items of medical questionnaire data came from this study. The number of medical questionnaire items was reduced from 1335 to 331 in data cleaning. From the 331 items, identify factors associated with LS use by light gradient boosting machine-based recursive feature elimination with cross-validation. The performance of each set was evaluated using an average of seven performance metrics, including 95% confidence intervals, using a bootstrapping method. The smallest set of items is determined with the highest average of receiver operating characteristic area under the curve (ROC-AUC) under 20 items as association factors of LS. Additionally, the performance of the selected items was compared with the LS risk tests and Loco-check.

RESULTS

The nine items have the best average ROC-AUC under 20 items. The nine items show an average ROC-AUC of 0.858 (95% confidence interval 0.816-0.898). Age and back pain during walking were strongly associated with the prevalence of LS. The ROC-AUC of nine items is higher than that of existing questionnaire-based LS assessments, including the 25-question Geriatric Locomotor Scale and Loco-check.

CONCLUSIONS

The identified nine items could aid early LS detection, enhancing understanding and prevention. Geriatr Gerontol Int 2024; 24: 806-813.

Relationship between quantitative physical activity and deterioration of locomotive function: a cross-sectional study using baseline data from a cohort

BACKGROUND

In aged society, health policies aimed at extending healthy life expectancy are critical. Maintaining physical activity is essential to prevent the deterioration of body functions. Therefore, it is important to understand the physical activity levels of the target age group and to know the content and intensity of the required physical activity quantitatively. Especially we focused the role of non-exercise activity thermogenesis and sedentary time, which are emphasized more than the introduction of exercise in cases of obesity or diabetes.

METHODS

A total of 193 patients from 25 institutions were included. Participants underwent a locomotive syndrome risk test (stand-up test, 2-step test, and Geriatric Locomotive Function Scale-25 questionnaire) and were classified into three stages. Physical activity was quantitatively monitored for one week with 3-axial accelerometer. Physical activity was classified into three categories; (1) Sedentary behavior (0 ∼ ≤ 1.5 metabolic equivalents (METs)), (2) Light physical activity (LPA:1.6 ∼ 2.9 METs), and (3) Moderate to vigorous physical activity (MVPA: ≥3 METs). We investigated the relationship between physical activity, including the number of steps, and the stages after gender- and age- adjustment. We also investigated the relationship between social isolation using Lubben's Social Network Scale (LSNS), as social isolation would lead to fewer opportunities to go out and less outdoor walking.

RESULTS

Comparison among the three stages showed significant difference for age (p = 0.007) and Body Mass Index (p < 0.001). After gender-and age-adjustment, there was a significant relation with a decrease in the number of steps (p = 0.002) and with MVPA. However, no relation was observed in sedentary time and LPA. LSNS did not show any statistically significant difference. Moderate to high-intensity physical activity and the number of steps is required for musculoskeletal disorders. The walking, not sedentary time, was associated to the locomotive stages, and this finding indicated the importance of lower extremity exercise.

CONCLUSIONS

Adjusting for age and gender, the number of steps and moderate to vigorous activity levels were necessary to prevent worsening, and there was no effect of sedentary behavior. Merely reducing sedentary time may be inadequate for locomotive disorders. It is necessary to engage in work or exercise that moves lower extremities more actively.

Locomotive syndrome and depressive symptoms: A cross-sectional study in middle-aged women

OBJECTIVE

Evidence for an association between locomotive syndrome (LS) and depression is lacking in middle-aged women. This study aimed to investigate the relationship between LS severity and depressive symptoms in community-dwelling middle-aged women.

METHODS

This cross-sectional study included 1520 middle-aged women (mean age 52 ± 6 years). LS severity was evaluated using the 25-question Geriatric Locomotive Function Scale questionnaire and motor function test. Depressive symptoms were assessed using the Zung self-rating depression scale. Multiple logistic regression analyses were performed to determine the association between depressive symptoms and LS severity, adjusting for potential confounding factors.

RESULTS

LS severity, as evaluated through both questionnaires and motor function tests, was significantly associated with depressive symptoms (self-rating depression scale  ≥ 40 points) in middle-aged women. The relationship between LS and depressive symptoms was only significant when assessed through the 25-question Geriatric Locomotive Function Scale questionnaire rather than the motor function tests. Additionally, a stepwise association was observed between pain severity, as assessed by the 25-question Geriatric Locomotive Function Scale, and the prevalence of depressive symptoms.

CONCLUSIONS

LS severity is significantly associated with depressive symptoms in community-dwelling middle-aged women, suggesting the need for additional mental status assessment in participants with LS and concurrent pain.

Implications of the diagnosis of locomotive syndrome stage 3 for long-term care

Objectives

Locomotive syndrome stage 3 (LS3), which has been established recently, may imply a greater need for care than LS stage 0 (LS0), LS stage 1 (LS1), and LS stage 2 (LS2). The relationship between LS3 and long-term care in Japan is unclear. Therefore, this study aimed to examine this relationship.

Methods

A total of 531 patients (314 women and 217 men; mean age, 75 years) who were not classified as requiring long-term care and underwent musculoskeletal examinations in 2012 were grouped according to their LS stage. Group L comprised patients with LS3 and Group N comprised those with LS0, LS1, and LS2. We compared these groups according to their epidemiology results and long-term care requirements from 2013 to 2018.

Results

Fifty-nine patients (11.1%) were diagnosed with LS3. Group L comprised more patients (50.8%) who required long-term care than Group N (17.8%) (P < 0.001). Group L also comprised more patients with vertebral fractures and knee osteoarthritis than Group N (33.9% vs 19.5% [P = 0.011] and 78% vs 56.4% [P < 0.001], respectively). A Cox proportional hazards model and Kaplan-Meier analysis revealed a significant difference in the need for nursing care between Groups L and N (log-rank test, P < 0.001; hazard ratio, 2.236; 95% confidence interval, 1.451-3.447).

Conclusions

Between 2012 and 2018, 50% of patients with LS3 required nursing care. Therefore, LS3 is a high-risk condition that necessitates interventions. Approaches to vertebral fractures and osteoarthritis of the knee could be key.

Reliability and validity tests of the Chinese version of the Geriatric Locomotive Function Scale (GLFS-25) in tumor survivors

Objective

To evaluate the reliability and validity of the Chinese-translated Geriatric Locomotive Function Scale (GLFS-25) for the assessment of locomotive syndrome (LS) in individuals surviving malignancies.

Methods

393 tumor survivors at a general hospital in China were recruited. The Chinese version of GLFS-25 was utilized to conduct a cross-sectional survey to ascertain the tool's efficacy in measuring LS in this cohort. The scale's validity was examined through content, structural and discriminant validity assessments, while its reliability was investigated by determining the internal consistency (via Cronbach's α coefficient) and test-retest reliability (via intragroup correlation coefficient, ICC).

Results

The Chinese-adapted GLFS-25 demonstrated a robust scale-level content validity index of 0.94, while item-level content validity indices ranged from 0.83 to 1.00 across individual items. The suitability of the scale for structural validity assessment was confirmed via exploratory factor analysis, yielding a Kaiser-Meyer-Olkin measure of 0.930 and a significant Bartlett's test of sphericity (χ2 = 3217.714, df = 300, P < 0.001). Subsequent confirmatory factor analysis (CFA) extracted four distinct factors: Social Activity Engagement, Daily Living Ability, Pain Experience and Physical Mobility. These factors accounted for 72.668 % of the variance, indicating substantial construct validity for measuring LS among this population. CFA supported the model's fit with the following indices: χ2/df = 1.559, RMSEA = 0.077, GFI = 0.924, CFI = 0.941, NFI = 0.919, and TLI = 0.933. The factor loadings for the four factors ranged from 0.771 to 0.931, indicating the items corresponding to the four factors effectively represented the constructs they were designed to measure. The correlation coefficients among the four factors were between 0.306 and 0.469, all lower than the square roots of the respective AVEs (0.838-0.867). This suggests a moderate correlation among the four factors and a distinct differentiation between them, indicating the Chinese version of the GLFS-25 exhibits strong discriminant validity in Chinese tumor survivors. Reliability testing revealed a high Cronbach's α coefficient for the overall scale at 0.961, with the subscales yielding coefficients of 0.751, 0.836, 0.930, and 0.952. The overall ICC was determined to be 0.935, with subscale ICCs ranging from 0.857 to 0.941, reinforcing the scale's reliability in this context.

Conclusions

The Chinese version of the GLFS-25 exhibits strong reliability and validity for the assessment of LS in tumor survivors. It may serve as a diagnostic tool for LS, contributing to the prevention and management of musculoskeletal disorders and enhancing the prognosis for this patient population.

Prevalence and associated factors of locomotive syndrome in young Japanese adults: a cross-sectional study

BACKGROUND

The onset of locomotive syndrome (LS) precedes that of frailty. Therefore, the first step in extending healthy life expectancy is to implement measures against LS in young adults. The aim of this study was to investigate the prevalence of LS and its associated factors in young adults for early detection and prevention of LS.

METHODS

The participants of this study comprised 413 university students specializing in health sciences (192 males and 221 females) with an average age of 19.1 ± 1.2 years. All participants voluntarily participated in the study and reported no serious health problems. The presence or absence of LS was evaluated using the stand-up test, two-step test, and the 25-question Geriatric Locomotive Function Scale. Additionally, musculoskeletal assessment (one-leg standing, squatting, shoulder elevation, and standing forward bend), body composition analysis (weight, body mass index, body fat mass, body fat percentage, skeletal muscle mass index (SMI), and phase angle), handgrip strength test, physical activity assessment, and nutritional assessment were conducted. Sex-stratified analyses were performed, comparing groups with and without LS. Factors associated with LS were explored using binomial logistic regression.

RESULTS

Of the 413 young adults studied, 86 individuals (20.8%) were found to have LS. When stratified by sex, LS was observed to have a considerably higher prevalence in females (55, 24.9%) than in males (31, 16.1%). In males, the notable differences between the groups with and without LS were observed in one-leg standing and phase angle, whereas in females, differences were identified in body fat mass, body fat percentage, SMI, musculoskeletal pain, and handgrip strength. Two types of binomial logistic regression analysis revealed that the inability to perform one-leg standing was associated with LS in males, while the presence of musculoskeletal pain and a high body fat percentage were identified as factors associated with LS in females.

CONCLUSIONS

One in five young adults were found to have LS in this study, underscoring the necessity for early intervention and LS health education. Furthermore, effective management of musculoskeletal pain is also crucial.

Estimation of cognitive impairment in chronic pain patients and characteristics of estimated mild cognitive impairment

Background

Patients with chronic pain suffer from psychological effects such as anxiety due to the pain itself. Pain can not only impair activities of daily living (ADL) and quality of life (QOL), but also impair cognitive function. Therefore, in this study, we aimed to estimate the cognitive function of chronic pain patients using a deep neural network (DNN) model that has already been implemented in society. We investigated the characteristics of patients presumed to have mild cognitive impairment (MCI) and, at the same time, verified the relationship with the questionnaire commonly used in chronic pain research, which is administered by 43 university affiliated hospitals and medical institutions participating in the chronic pain research group of the Ministry of Health, Labor and Welfare in Japan (assessment batteries).

Method

The study included 114 outpatients from a multidisciplinary pain clinic, and we estimated their Mini-Mental State Examination (MMSE) scores based on age and basic blood test data (23 items). Furthermore, we classified the estimated MMSE scores of chronic pain patients into two groups based on a cutoff score of 27, which indicates MCI, and compared the blood data and assessment batteries. Additionally, we used a control group of 252 healthy adults aged 45 years or older who visited a dementia prevention outpatient clinic for comparison with the MMSE scores of chronic pain patients.

Result

The MMSE scores in chronic pain patients were below the cutoff for MCI. When classified into two groups based on the estimated MMSE score of 27 points, WBC, RBC, Hb, Hct, PLT, UA, BUN, creatinine, Triglyceride, and γ-GT were significantly higher in the blood data. In the MCI group, PDAS values were significantly lower. Furthermore, only in the non-MCI group, a significant correlation was found between the estimated MMSE value and BPI, PDAS, and Locomo. The estimated MMSE scores were significantly lower in chronic pain patients than in healthy adults (p = 0.04).

Conclusion

Patients with chronic pain may exhibit cognitive impairment due to systemic metabolic disturbances. This suggests that chronic pain affects activities of daily living, resulting in systemic metabolic disorders.

Risk factors for progression of the severity of locomotive syndrome: A two-year longitudinal observational study

BACKGROUND

The risk factors for progression of severity of locomotive syndrome (LS) remain unclear.

METHODS

We conducted a longitudinal observational study of 1148 community-dwelling residents (median age, 68.0 years old; 548 males, 600 females) from 2016 to 2018. LS was assessed by the 25-question Geriatric Locomotive Function Scale (GLFS-25), and total scores of ≤6 points, 7-15 points, 16-23 points, and ≥24 points were diagnosed as non-LS, LS-1, LS-2, and LS-3, respectively. If the LS severity in 2018 was higher than in 2016, the case was defined as progression of LS severity; otherwise, it was defined as non-progressive LS. We compared the age, gender, body mass index, smoking status, alcohol consumption, living situation, car use, chronic musculoskeletal pain, comorbidities, metabolic syndrome, physical activity, and LS severity in 2016 between the progression and non-progression groups. Furthermore, a multivariate logistic regression analysis was performed to elucidate the risk factors for progression of LS severity.

RESULTS

Participants in the progression group had a significantly older age, a lower rate of car use, a higher rate of low back pain, a higher rate of hip pain, a higher rate of knee pain, a higher GLFS-25 total score, and a higher rate of LS-2 than those in the non-progression group. The multivariate logistic regression analysis revealed that older age, female gender, higher body mass index (≥25.0 kg/m2), presence of low back pain, and presence of hip pain were risk factors for the progression of LS within two years.

CONCLUSIONS

To prevent the progression of LS severity, related prophylaxis strategies should be implemented, especially for individuals with the above-mentioned characteristics. Further longitudinal studies with a longer observation period are necessary.

Temporal validation of a clinical prediction rule for distinguishing locomotive syndromes in community-dwelling older adults: A cross-sectional study from the DETECt-L study

Objectives

Clinical prediction rules are used to discriminate patients with locomotive syndrome and may enable early detection. This study aimed to validate the clinical predictive rules for locomotive syndrome in community-dwelling older adults.

Methods

We assessed the clinical prediction rules for locomotive syndrome in a cross-sectional setting. The age, sex, and body mass index of participants were recorded. Five physical function tests-grip strength, single-leg standing time, timed up-and-go test, and preferred and maximum walking speeds-were measured as predictive factors. Three previously developed clinical prediction models for determining the severity of locomotive syndrome were assessed using a decision tree analysis. To assess validity, the sensitivity, specificity, likelihood ratio, and post-test probability of the clinical prediction rules were calculated using receiver operating characteristic curve analysis for each model.

Results

Overall, 280 older adults were included (240 women; mean age, 74.8 ± 5.2 years), and 232 (82.9%), 68 (24.3%), and 28 (10.0%) participants had locomotive syndrome stages ≥ 1, ≥ 2, and = 3, respectively. The areas under the receiver operating characteristics curves were 0.701, 0.709, and 0.603, in models 1, 2, and 3, respectively. The accuracies of models 1 and 2 were moderate.

Conclusions

These findings indicate that the models are reliable for community-dwelling older adults.

Oral sodium hyaluronate relieves knee discomfort: A 12‑week double‑blinded, placebo‑controlled study

Sodium hyaluronate (SH) is a high molecular-weight polysaccharide composed of repeating polymeric disaccharides of D-glucuronic acid and N-acetyl-D-glucosamine. SH is present in every connective tissue and organ, with synovial fluid having the highest concentration of SH in the body. The effectiveness of oral SH on gonarthrosis is known; although, its influence on the knees of healthy individuals is not. However, as severe diseases may require surgery, it is better to take care of healthy knees before the onset of gonarthrosis. Therefore, the present study investigated the functionality of SH on the knee of healthy individuals. The present study was a randomized double-blind, placebo-controlled trial in which healthy adults (mean age: Placebo group, 61.50±1.59; SH group, 58.50±1.81), rated as grade ≤1 based on the Kellgren-Lawrence classification, were administered 111 mg/day SH for 12 weeks. The evaluation of visual analog scales were performed to assess the discomfort in the knees of the participants and were conducted at baseline, and then 6 and 12 weeks after the start of SH ingestion. Additionally, a locomotive syndrome risk test quantifying the mobility of the participants, a one-leg standing time with eyes open test evaluating the strength of the leg muscle as well as the ability to balance by measuring the time to stand on one leg and a blood test (interleukin-10, aspartate aminotransferase, alanine transaminase, γ-glutamyl transferase, lactate dehydrogenase, creatine kinase and C-reactive protein) were performed at baseline and then 12 weeks after the start of SH ingestion. A significant suppression of knee symptoms were demonstrated in the SH group compared with the placebo group in terms of the total visual analog scale scores for pain, stiffness and discomfort for the 31 healthy adult subjects. Significant suppression of symptoms was also demonstrated in the placebo group in terms of discomfort in the knees when descending stairs and pain in the knees after walking for a longer distance or duration than normal. No significant differences between the two groups were demonstrated in the locomotive syndrome risk test, one-leg standing time with eyes open test and the blood test. The results of the present study suggest the possibility that oral SH may help to maintain a healthy condition of the knees. The study protocol was registered with the University Hospital Medical Information Network Clinical Trial Registry in advance (registration no. UMIN000045980, November 4, 2021).

Impact of Skeletal Muscle Mass on Physical Function and Locomotive Syndrome of Pre- and Postoperative Adult Spinal Deformity

Background: The purpose of this study is to identify the relationship between locomotive syndrome (LS) status, physical performance and limb and trunk skeletal muscle mass before and after surgery in adult spinal surgery (ASD) patients. Methods: A retrospective observational investigation of 63 consecutive patients with ASD who underwent spinal surgery was conducted. The total skeletal muscle mass of the arms and legs was considered a measure of the total appendicular skeletal muscle mass measured with whole-body dual-energy X-ray absorptiometry. All data pertaining to the physical performance tests and LS were collected preoperatively with follow-up one year postoperatively. Results: Gait speed, the one-leg standing test and the stand-up test were significantly improved one year after surgery compared to preoperative measurements. The lower extremity skeletal muscle mass predominantly influences physical function improvement including gait stride, one-leg standing and the stand-up test after ASD surgery. Conclusions: This study is the first to show that assessing lower extremity muscles prior to ASD surgery is useful in predicting postoperative recovery.

Development of patient-reported outcome for adult spinal deformity: validation study

Adult spinal deformity (ASD) is a complex condition that combines scoliosis, kyphosis, pain, and postoperative range of motion limitation. The lack of a scale that can successfully capture this complex condition is a clinical challenge. We aimed to develop a disease-specific scale for ASD. The study included 106 patients (mean age; 68 years, 89 women) with ASD. We selected 29 questions that could be useful in assessing ASD and asked the patients to answer them. The factor analysis found two factors: the main symptom and the collateral symptom. The main symptom consisted of 10 questions and assessed activity of daily living (ADL), pain, and appearance. The collateral symptom consisted of five questions to assess ADL due to range of motion limitation. Cronbach's alpha was 0.90 and 0.84, respectively. The Spearman's correlation coefficient between the change of main symptom and satisfaction was 0.48 (p < 0.001). The effect size of Cohen's d for comparison between preoperative and postoperative scores was 1.09 in the main symptom and 0.65 in the collateral symptom. In conclusion, we have developed a validated disease-specific scale for ASD that can simultaneously evaluate the benefits and limitations of ASD surgery with enough responsiveness in clinical practice.

Relationship between physical activity and locomotive syndrome among young and middle-aged Japanese workers

OBJECTIVES

This study aimed to examine the relationship between physical activity (PA) and locomotive syndrome (LS) among young and middle-aged Japanese workers.

METHODS

This cross-sectional study included 335 participants from a company in Kumamoto, Japan. LS was evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS-25); a GLFS-25 score ≥7 was defined as LS. Weekly PA was measured using the International Physical Activity Questionnaire. Work-related PA (time spent sitting, standing, walking, and strenuous work per day) and sedentary breaks were measured using a Work-related Physical Activity Questionnaire. Screen usage (television [TV], smartphones, tablets, and personal computers) during leisure time was recorded. The association between PA and LS was examined using a multivariate logistic regression analysis adjusted for age, sex, body mass index, history of musculoskeletal disorders, cancer, stroke, occupation, employment type, work time, shift system, employment status, and body pain.

RESULTS

A total of 149 participants had LS. Fewer sedentary breaks during work (>70-minute intervals, odds ratio [OR] = 2.96; prolonged sitting, OR = 4.12) and longer TV viewing time (≥180 minutes, OR = 3.02) were significantly associated with LS. In contrast, moderate PA (OR = 0.75) was significantly associated with a lower risk of LS.

CONCLUSIONS

Fewer sedentary breaks during work and longer TV viewing time could increase the risk of LS in young and middle-aged Japanese workers.

Association between frailty and locomotive syndrome in elderly patients with lumbar spinal stenosis: A retrospective longitudinal analysis

AIMS

With the aging society worldwide, lumbar spinal stenosis (LSS) has become common, and its incidence has been increasing worldwide. Frailty and locomotive syndrome significantly overlap as disorders in older people. The current study aimed to validate the association between frailty and locomotive syndrome in patients with LSS. In particular, the involvement of frailty in locomotive syndrome following surgery was examined.

METHODS

We retrospectively reviewed the time-course data of consecutive patients aged ≥65 years who underwent lumbar spinal surgery for LSS. The locomotive syndrome stages were determined using the 25-Question Geriatric Locomotive Function Scale: stage 0, score ≤6; stage 1, score ≥7; stage 2, score ≥16; and Stage 3, score ≥24. Robust, pre-frailty, and frailty were defined as a modified frailty index-11 score of 0, <0.21, and >0.21, respectively.

RESULTS

This study included 234 patients. All patients except one were diagnosed with locomotive syndrome preoperatively. Approximately 24.8% of participants were diagnosed with frailty. LSS surgery improved locomotive syndrome regardless of frailty severity. Meanwhile, multivariable analysis indicated that frailty could significantly inhibit improvement in locomotive syndrome after surgery in old patients with LSS (estimated relative risk: 0.6; 95% confidence interval: 0.4-0.9).

CONCLUSIONS

This study first assessed the association between locomotive syndrome and frailty in patients with LSS. Locomotive syndrome could be managed effectively with surgery regardless of frailty severity in old patients with LSS. However, our findings emphasize the need to screen for frailty preoperatively in this patient group. Geriatr Gerontol Int 2024; 24: 116-122.

Locomotive syndrome affects the acquisition of long-term care insurance system certification

BACKGROUND

Locomotive syndrome is closely related to the state of long-term care. This study aimed to longitudinally evaluate long-term care certification occurrence in locomotive syndrome using data from the Miyagawa study.

METHODS

The study included 470 individuals (168 males, 302 females; mean age, 70.7 years) with no long-term care certification at the time of participation in the study. Locomotive syndrome was classified into three stages (stages 1-3) according to the 25-question Geriatric Locomotive Function Scale. Analysis was performed with long-term care certification occurrence as the endpoint and locomotive syndrome stage as the explanatory variable.

RESULTS

The median observation period was 6.3 years, and long-term care certification occurred in 69 (34.2%) and 30 (11.2%) of the participants in the locomotive syndrome and no-locomotive syndrome groups, respectively. Independent risk factors of long-term care certification occurrence were locomotive syndrome stage-3 (hazard ratio: 2.27) in the total number of studies, and locomotive syndrome stages 2 (hazard ratio: 2.49) and 3 (hazard ratio: 2.79) in females. Locomotive syndrome stage-3 was an independent risk factor in long-term care certification occurrence due to musculoskeletal disorders (hazard ratio: 3.89).

CONCLUSIONS

The higher the locomotive syndrome stage, especially in females, the higher the risk of long-term care certification occurrence.

Associations of Lower-Limb Phase Angle with Locomotion and Motor Function in Japanese Community-Dwelling Older Adults

Whole-body phase angle (PhA) is associated with motor function and geriatric diseases. However, it was unclear which parts of the upper- or lower-limb PhA were involved. This study investigated the differences in the PhA of the upper and lower extremities and their relationships with frailty, locomotive syndrome indices, and motor function in community-dwelling older adult participants. This study was a cross-sectional observational study. In 69 community-dwelling older adults, the PhA at each measurement site (whole body, upper limbs, and lower limbs), motor function, Kihon Checklist (KCL), and 25-Geriatric Locomotive Function Scale (GLFS-25) were measured. This study examined differences in each PhA and its relationship with motor function and geriatric diseases. Multiple regression analysis was performed using GLFS-25 as the dependent variable and sex and lower-limb PhA as independent variables. In this cohort (mean age: 72.3 ± 5.7 years; 18 males and 51 females), lower-limb PhA was significantly lower than upper-limb PhA. Unlike other PhAs, lower-limb PhA was related to grip strength, TUG, F/w, and GLFS-25. Multiple regression analysis showed that the lower-limb PhA was independently related to GLFS-25. Cellular health of the lower extremity is associated with gait, standing function, and indicators of locomotive syndrome.

Relationship among Osteoporosis, Sarcopenia, Locomotive Syndrome, and Spinal Kyphosis in Older Individuals Living in a Local Mountain Area

STUDY DESIGN

Cross-sectional cohort study.

PURPOSE

This study investigated the relationship among osteoporosis, sarcopenia, locomotive syndrome, and spinal kyphosis in older individuals living in a mountain area.

OVERVIEW OF LITERATURE

Kyphosis greatly reduces the quality of life of older individuals. Osteoporosis and sarcopenia are kyphosiscausing factors.

METHODS

This cross-sectional study included 361 individuals aged ≥65 years (mean age, 75.0 years) living in a local mountain area and underwent medical check-ups from 2014 to 2018. The survey items included kyphosis index, body mass index, back pain prevalence, back pain Visual Analog Scale score, Oswestry Disability Index, walking speed, grip strength, skeletal mass index, osteoporosis (% young adult mean [YAM]), LOCOMO 5 score, and presence of sarcopenia (Asian Working Group for Sarcopenia). The participants were divided into the N (kyphosis index: <12; n=229, 63.4%), M (kyphosis index: 12-15; n=99, 27.4%), and K (kyphosis index: ≥15; n=33, 9.2%) groups. p -values of <0.05 were considered statistically significant. An association factor of kyphosis (kyphosis index: ≥15) was investigated with logistic regression analysis.

RESULTS

Age and LOCOMO 5 scores were significantly higher (p <0.05) and %YAM and walking speed were significantly lower (p <0.05) in the K group than in the M and N groups. Other survey items showed significant differences. Only %YAM (odds ratio, 0.20; 95% confidence interval, 0.04-0.96) was an independent factor associated with a kyphosis index of ≥15.

CONCLUSIONS

Decreased muscle mass and muscle strength would be related to kyphosis; however, no such relations were noted. Bone loss was significantly related to kyphosis. Osteoporosis-induced decrease in vertebral body height is present in the background. Sarcopenia and locomotive syndrome were not related to kyphosis, whereas decreased bone density was independently associated with kyphosis in older individuals living in a mountain area.

A machine learning-based scoring system and ten factors associated with hip fracture occurrence in the elderly

Hip fractures are fragility fractures frequently seen in persons over 80-years-old. Although various factors, including decreased bone mineral density and a history of falls, are reported as hip fracture risks, few large-scale studies have confirmed their relevance to individuals older than 80, and tools to assess contributions of various risks to fracture development and the degree of risk are lacking. We recruited 1395 fresh hip fracture patients and 1075 controls without hip fractures and comprehensively evaluated various reported risk factors and their association with hip fracture development. We initially constructed a predictive model using Extreme Gradient Boosting (XGBoost), a machine learning algorithm, incorporating all 40 variables and evaluated the model's performance using the area under the receiver operating characteristic curve (AUC), yielding a value of 0.87. We also employed SHapley Additive exPlanation (SHAP) values to evaluate each feature importance and ranked the top 20. We then used a stepwise selection method to determine key factors sequentially until the AUC reached a plateau nearly equal to that of all variables and identified the top 10 sufficient to evaluate hip fracture risk. For each, we determined the cutoff value for hip fracture occurrence and calculated scores of each variable based on the respective feature importance. Individual scores were: serum 25(OH)D levels (<10 ng/ml, score 7), femoral neck T-score (<-3, score 5), Barthel index score (<100, score 3), maximal handgrip strength (<18 kg, score 3), GLFS-25 score (≥24, score 2), number of falls in previous 12 months (≥3, score 2), serum IGF-1 levels (<50 ng/ml, score 2), cups of tea/day (≥5, score -2), use of anti-osteoporosis drugs (yes, score -2), and BMI (<18.5 kg/m2, score 1). Using these scores, we performed receiver operating characteristic (ROC) analysis and the resultant optimal cutoff value was 7, with a specificity of 0.78, sensitivity of 0.75, and AUC of 0.85. These ten factors and the scoring system may represent tools useful to predict hip fracture.

Feasibility and applicability of locomotive syndrome risk test in elderly patients who underwent total knee arthroplasty

OBJECTIVES

The concept of locomotive syndrome (LS) and its evaluation method, the LS risk test, have been applied in an integrated manner to capture the decline in mobility resulting from musculoskeletal disorders. The purpose of this study was to evaluate the impact of total knee arthroplasty (TKA) in the elderly with knee osteoarthritis, a common disorder found in LS.

METHODS

A total of 111 patients were registered prior to TKA and postoperatively followed up for 1 year. Three components of the LS risk test (the two-step test, stand-up test, and Geriatric Locomotive Function Scale-25) were assessed pre- and postoperatively.

RESULTS

After surgery, all three components of the test showed significant improvements from the baseline. The ratio of Stage 3 LS patients (progressed stage of decrease in mobility) reduced from 82.3% to 33.9% postoperatively. There was no significant difference in the degree of change in the scores between the younger (60-74 years) and older (≥75 years) age groups.

CONCLUSIONS

We found that TKA has a major impact in preventing the progression of LS in patients with knee osteoarthritis. The LS risk test is a feasible tool for the longitudinal evaluation of patients with musculoskeletal diseases of varying severity and with multiple symptoms.

Statistical model of trajectories of reduced mobility in older people with locomotive disorders: a prospective cohort study with group-based trajectory model

BACKGROUND

Today we experience "Super-aged society", and a drastic increase in the number of older people needing assistance is an urgent matter for everyone from medical and socio-economical standpoints. Locomotive organ dysfunction due to musculoskeletal disorders is one of the main problems in these patients. Although the concepts of frailty and sarcopenia have been proposed for functional decline, pain remains the main and non-negligible complaint in these of such disorders. This prospective cohort study aimed to observe the changes of reduced mobility in patients with locomotive disorders and to determine the risk factors for functional deterioration of those patients using statistical modeling.

METHODS

A cohort of older adults with locomotive disorders who were followed up every 6 months for up to 18 months was organized. Pain, physical findings related to the lower extremities, locomotive function in performing daily tasks, and Geriatric Locomotive Function Scale-25 (GLFS-25) score were collected to predict the progress of deterioration. Group-based trajectory analysis was used to identify subgroups of changes of GLFS-25 scores, and multinomial logistic regression analysis was performed to investigate potential predictors of the GLFS-25 trajectories.

RESULTS

Overall, 314 participants aged between 65 and 93 years were included. The participants were treated with various combinations of orthopedic conservative treatments on an outpatient basis. The in-group trajectory model analysis revealed a clear differentiation between the four groups. The mild and severe groups generally maintained their GLFD-25 scores, while the moderate group included a fluctuating group and a no change group.　This study showed that comorbidity of osteoporosis was related to GLFS-25 score over 18 months. Age was a weak factor to be moderate or severe group, but gender was not. In addition, the number of pain locations, number of weak muscles, one-leg standing time, grip strength and BMI significantly contributed to the change in GLFS-25 score.

CONCLUSIONS

This study proposes an effective statistical model to monitor locomotive functions and related findings. Pain and comorbid osteoporosis are significant factors that related to functional deterioration of activities. In addition, the study shows a patient group recovers from the progression and their possible contributing factors.

Impact of spinal surgery on locomotive syndrome in patients with lumbar spinal stenosis in clinical decision limit stage 3: a retrospective study

BACKGROUND

Locomotive syndrome (LS) is characterized by reduced mobility. Clinical decision limit (CDL) stage 3 in LS indicates physical frailty. Lumbar spinal canal stenosis (LSS) is one of the causes of LS, for which lumbar surgery is considered to improve the CDL stage. This study aimed to investigate the efficacy of lumbar surgery and independent factors for improving the CDL stage in patients with LSS.

METHODS

This retrospective study was conducted at the Department of Orthopaedic Surgery at our University Hospital. A total of 157 patients aged ≥ 65 years with LSS underwent lumbar surgery. The 25-Question Geriatric Locomotive Function scale (GLFS-25) was used to test for LS, and the Timed Up and Go test (TUG) was used to evaluate functional ability. Lower limb pain was evaluated using a visual analog scale. Patients with at least one improvement in the CDL stage following lumbar surgery were included in the improvement group. Differences in lower limb pain intensity between the groups were evaluated using the Wilcoxon rank-sum test. The Spearman's rank correlation coefficient was used to determine correlations between Δ lower limb pain and Δ GLFS-25. Logistic regression analysis was used to identify factors associated with improvement in LS.

RESULTS

The proportion of patients with improved CDL stage was 45.1% (improvement/non-improvement: 32/39). Δ Lower limb pain was significantly reduced in the improvement group compared with that in the non-improvement group (51.0 [36.3-71.0] vs 40.0 [4.0-53.5]; p = 0.0107). Δ GLFS-25 was significantly correlated with Δ lower limb pain (r = 0.3774, p = 0.0031). Multiple logistic regression analysis revealed that TUG and age were significantly associated with improvement in LS (odds ratio, 1.22; 95% confidence interval: 1.07-1.47).

CONCLUSIONS

Lumbar surgery effectively improved the CDL stage in patients with LSS. In addition, TUG was an independent factor associated with improvement in the CDL.

Relationship between oral frailty and locomotive syndrome in working-age individuals: a cross-sectional survey of workers in Japan

BACKGROUND

Although the relationship between oral and physical frailty in older adults has been investigated, few studies have focused on the working-age population. This study examined the relationships of the number of remaining teeth and masticatory ability, i.e., signs of oral frailty, with locomotive syndrome (LS) in the working-age population.

METHODS

The number of remaining teeth, masticatory ability, and presence of LS in 501 participants from four companies were examined. The relationships between the number of remaining teeth groups (≥ 20 teeth or ≤ 19 teeth) and LS and between the masticatory ability groups (high or low) and LS were examined. A binomial logistic regression analysis was conducted using LS from the stand-up test as the objective variable and the two subgroups based on the number of remaining teeth and potential crossover factors as covariates.

RESULTS

The analysis included 495 participants (354 males and 141 females; median age, 43 years). The median number of remaining teeth among the participants was 28, and 10 participants (2.0%) had ≤ 19 teeth. The mean masticatory ability values were 39.9 for males and 37.7 for females, and 31 participants (6.3%) had low masticatory ability. In the stand-up test, those with ≤ 19 teeth had a higher LS rate than those with ≥ 20 teeth. The odds ratio for LS in the group with ≤ 19 remaining teeth was 5.99, and the confidence interval was 1.44-24.95.

CONCLUSIONS

The results confirmed signs of oral frailty in the working-age population. Further, the number of remaining teeth possibly affects standing movement. Thus, oral frailty is associated with LS in the working-age population.

Influence of CurQfen®-curcumin on cognitive impairment: a randomized, double-blinded, placebo-controlled, 3-arm, 3-sequence comparative study

Background

Although curcumin is a blood-brain-barrier permeable molecule with the ability to bind and segregate β-amyloid plaques and neurofibrillary tangles of hyperphosphorylated tau proteins, its poor oral bioavailability, rapid biotransformation to inactive metabolites, fast elimination from the systemic circulation, and hence the poor neuronal uptake has been limiting its clinical efficacy under neurodegenerative conditions.

Objective

We hypothesized that the highly bioavailable CurQfen-curcumin (CGM), which has been shown to possess significant blood-brain-barrier permeability and brain bioavailability, would ameliorate dementia in neurodegenerative conditions.

Methods

In the present double-blinded placebo-controlled 3-arm 3-sequence comparative study, 48 subjects characterized with moderate dementia due to the onset of Alzheimer's disease were randomized into three groups (N = 16/group) and supplemented with 400 mg × 2/day of either placebo (MCC), unformulated standard curcumin complex with 95% purity (USC), or CGM as a sachet for six months. The relative changes in cognitive and locomotor functions and biochemical markers were compared.

Results

Supplementation with CGM produced significant (P < 0.05) improvement in the Mini-Mental State Examination (MMSE) and the Geriatric Locomotive Function Scale (GLFS) scores in both intra- and inter-group comparison by 2 × 2 repeated measures (RM) ANOVA. Further, analysis of the serum levels of specific biomarkers (BDNF, Aβ42, tau protein, IL-6, and TNF-α) also revealed a significant (P < 0.05) improvement among CGM subjects as compared to placebo and the USC groups.

Conclusion

Supplementation with CGM as sachet was found to offer significant delay in the progress of Alzheimer's disease, as evident from the improvements in locomotive and cognitive functions related to dementia.

Clinical trial registration

http://ctri.nic.in, identifier: CTRI/2018/03/012410.

Does locomotive syndrome severity predict future fragility fractures in community-dwelling women with osteoporosis?

OBJECTIVES

We investigated whether the locomotive syndrome (LS) severity affects future fragility fractures in osteoporosis patients.

METHODS

In this retrospective cohort study, 315 women with osteoporosis (mean follow-up period, 2.8 years) were reviewed, of whom 244 were included in the analysis. At baseline, we obtained medical information, bone mineral density of the lumbar spine and femoral neck, and sagittal vertical axis. Additionally, LS risk was assessed using the two-step test, stand-up test, and 25-question geriatric locomotive function scale scores. The LS risk test results were used to classify LS severity, which was rated on a 4-point scale from stage 0 (robust) to 3 (worsening). Cox proportional hazards regression analysis was used to determine the association of the severity with future fragility fracture.

RESULTS

Fragility fractures occurred in 37 of 315 participants (11.8%). This study showed that sagittal vertical axis (hazard ratio = 1.014; 95% confidence interval, 1.005-1.023; p value = 0.003) and LS severity (hazard ratio =1.748; 95% confidence interval, 1.133-2.699; p = 0.012) were independent risk factors for incidence of fragility fracture.

CONCLUSIONS

This study revealed the LS severity to predicted fragility fractures. We suggested that the progression of LS associated with osteoporosis increases the fracture risk.

Association of sarcopenia, pre-sarcopenia, and dynapenia with the onset and progression of locomotive syndrome in Japanese older adults: a cross-sectional study

BACKGROUND

Sarcopenia commonly occurs in older adults with motor disorders requiring long-term care, and the clinical features of sarcopenia are associated with locomotive syndrome. Dynapenia is the age-related loss of muscle strength. However, the association of sarcopenia and dynapenia with the onset and progression of locomotive syndrome in older adults remains unknown. The current study aimed to determine the association of sarcopenia, pre-sarcopenia, and dynapenia with the onset and progression of locomotive syndrome in Japanese older adults.

METHODS

This study included older females (n = 264, 73.9 ± 5.8 years) and males (n = 92, 76.3 ± 6.1 years). Sarcopenia was defined as low muscle function and mass; pre-sarcopenia was defined as low muscle mass with normal muscle function; and dynapenia was defined as low muscle function without low muscle mass. Locomotive syndrome (stage 0-2) severity was determined using the stand-up test, the two-step test, and the 25-question geriatric locomotive function scale. Logistic regression analysis was performed to determine the relationship between sarcopenia category and locomotive syndrome stages.

RESULTS

Age (1.208, 95% confidence interval (CI) 1.124-1.298), sex (2.455, 95% CI 1.241-4.856), and BMI (1.211, 95% CI 1.077-1.361) were significant variables for determining locomotive syndrome stage ≥ 1, whereas pre-sarcopenia (0.543, 95% CI 0.331-0.891) and sarcopenia (1.664, 95% CI 1.005-2.755) were significant variables for determining locomotive syndrome stage 2.

CONCLUSIONS

Only sarcopenia was associated with locomotive syndrome progression, while low muscle mass or low muscle function was not associated with locomotive syndrome. Gaining muscle mass accompanied by an increased muscle function for older adults is warranted to prevent locomotive syndrome progression in the super-aged society.