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      Frontal Lobe Function and Risk of Hip Fracture in Patient With Alzheimer Disease : An Analysis of Linked Data

      research-article
      , MD, , MD, PhD, , PhD, , MD, DrPH, , MD, PhD, , MD, , MD, PhD, , MD, PhD, , MD, PhD, , PhD, , MD, PhD, , MD, PhD, , MD, , MD, PhD
      Medicine
      Wolters Kluwer Health

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          Abstract

          To determine the association between frontal lobe function and risk of hip fracture in patients with Alzheimer disease (AD).

          Retrospective cohort study using multicenter hospital-based dementia registry and national health insurance claim data was done. Participants who had available data of neuropsychological test, national health insurance claim, and other covariates were included. A total of 1660 patients with AD were included based on Stroop Test results. A total of 1563 patients with AD were included based on the Controlled Oral Word Association Test (COWAT) results. Hip fracture was measured by validated identification criteria using national health insurance claim data. Frontal lobe function was measured by Stroop Test and COWAT at baseline.

          After adjusting for potential covariates, including cognitive function in other domains (language, verbal and nonverbal memory, and attention), the Cox proportional hazard regression analysis revealed that risk of a hip fracture was decreased with a hazard ratio (HR) of 0.98 per one point of increase in the Stroop Test (adjusted HR = 0.98, 95% confidence interval [CI]: 0.97–1.00) and 0.93 per one point increase in COWAT (adjusted HR = 0.93, 95% CI: 0.88–0.99).

          The risk of hip fracture in AD patients was associated with baseline frontal lobe function. The result of this research presents evidence of association between frontal lobe function and risk of hip fracture in patients with AD.

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          Most cited references46

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          Acute moderate exercise elicits increased dorsolateral prefrontal activation and improves cognitive performance with Stroop test.

          A growing number of human studies have reported the beneficial influences of acute as well as chronic exercise on cognitive functions. However, neuroimaging investigations into the neural substrates of the effects of acute exercise have yet to be performed. Using multichannel functional near-infrared spectroscopy (fNIRS), we sought cortical activation related to changes in the Stroop interference test, elicited by an acute bout of moderate exercise, in healthy volunteers (N=20). The compactness and portability of fNIRS allowed on-site cortical examination in a laboratory with a cycle ergometer, enabling strict control of the exercise intensity of each subject by assessing their peak oxygen intake (VO2peak). We defined moderate exercise intensity as 50% of a subject's peak oxygen uptake (50%VO2peak). An acute bout of moderate exercise caused significant improvement of cognitive performance reflecting Stroop interference as measured by reaction time. Consistent with previous functional neuroimaging studies, we detected brain activation due to Stroop interference (incongruent minus neutral) in the lateral prefrontal cortices in both hemispheres. This Stroop-interference-related activation was significantly enhanced in the left dorsolateral prefrontal cortex due to the acute bout of moderate exercise. The enhanced activation significantly coincided with the improved cognitive performance. This suggests that the left dorsolateral prefrontal cortex is likely the neural substrate for the improved Stroop performance elicited by an acute bout of moderate exercise. fNIRS, which allows physiological monitoring and functional neuroimaging to be combined, proved to be an effective tool for examining the cognitive effects of exercise. 2009 Elsevier Inc. All rights reserved.
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            Risk adjustment in outcome assessment: the Charlson comorbidity index.

            To measure the burden of comorbid diseases using the MED-ECHO database (Quebec), the so-called Charlson index was adapted to International Classification of Disease (ICD-9) codes. The resulting comorbidity index was applied to the study of inpatient death in a group of 62,456 patients having one of the following conditions: ischemic heart disease, congestive heart failure, stroke, or bacterial pneumonia. Multiple logistic regression was used to relate inpatient death to its predictors, including gender, principal diagnosis, age, and the comorbidity index. Various transformations of the comorbidity score were performed, and their effect on predictive accuracy was assessed. The comorbidity index was constantly and strongly associated with death. When gender, age, comorbidity and the principal diagnoses were taken into account, the area under the receiver-operating curve was 0.83. Therefore, the Charlson Index is a useful approach to risk adjustment in outcomes research from administrative databases.
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              The Relationship between Executive Function and Falls and Gait Abnormalities in Older Adults: A Systematic Review

              Background/Objectives: Older adults with dementia have at least a twofold increased risk of falls. Multi-factorial interventions have failed to demonstrate a reduction in falls in this group. Improved understanding of specific cognitive factors and their relationship to gait, balance and falls is required. Methods: Systematic searches of Medline, Embase, PsycInfo, and CINAHL databases from inception to April 2011 were conducted to identify prospective studies in older adults examining executive function and its relationship with falls, balance and gait abnormalities. Two independent reviewers extracted data on study populations, executive function measures and study outcomes. Results: Of 8,985 abstracts identified, 14 studies met inclusion criteria. Eleven studies examined executive function and falls. The remaining studies examined executive function and gait speed decline. Nine studies examining executive function and falls found a relationship between poor executive function and increased fall risk. All 3 studies examining executive function and gait found an association between poor executive function and declines in gait speed. Impaired executive function was associated with more serious falling patterns. Conclusions: Executive function was associated with falls and gait speed slowing in older adults. Future research should consider executive dysfunction as a training target for fall prevention, or as a factor mediating the failure of conventional fall prevention interventions.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                November 2015
                13 November 2015
                : 94
                : 45
                : e1918
                Affiliations
                From the Department of Psychiatry, Ajou University School of Medicine, Suwon (HWR, CHH, KJC, YKC, KYL, JSN, SJS); Health Administration, Department of Management & Administration, Backseok Arts University, Seoul (SJL); Department of Preventive Medicine and Public Health, Ajou University School of Medicine (YL); Institute on Aging, Ajou University Medical Center, Suwon (HWR, CHH, YL, KJC, SJS); Department of Psychiatry, CHA University College of Medicine, Gangnam Medical Center and CHAUM Life Center (KSL); Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul (BHO); Department of Neurology, Inha University School of Medicine, Incheon (SHC); Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul (SYK); and Health Insurance Police Research Institute, National Health Insurance Service, Seoul, Republic of Korea (JHB).
                Author notes
                Correspondence: Sang Joon Son, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 443-721, Republic of Korea (e-mail: sjsonpsy@ 123456ajou.ac.kr ).
                Article
                01918
                10.1097/MD.0000000000001918
                4912253
                26559259
                cbe04b9c-b438-4dac-b43d-132f13716fd9
                Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 6 July 2015
                : 30 September 2015
                : 5 October 2015
                Categories
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                Research Article
                Observational Study
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