Healthy Elderly Persons Research Articles

Effects of Cognitive Task During Unstable Walking on the Frontal Cerebral Blood Flow in Elderly Retirement Home Residents Leading an Independent Daily Life.

This study aimed to examine the effects of cognitive tasks during walking with perturbation on the cerebral blood flow. The subjects were a total of 20 persons, consisting of 12 healthy adults aged 21-47 years (adult group) and 8 retirement home residents aged 67-85 years who led an independent daily life and could walk independently (elderly group). Oxyhemoglobin was measured using wireless functional near-infrared spectroscopy (fNIRS). An analysis was conducted using the Wilcoxon rank sum test to compare the variation of oxyhemoglobin between walking with perturbation (WP) and walking with perturbation and cognitive tasks (WPC) in each group. In addition, we compared the variation of oxyhemoglobin between groups by analysis of covariance adjusting for the value of WP. In the adult group, the left and right oxyhemoglobin significantly increased under WPC (p=0.0122, 0.0015, respectively). On the other hand, in the elderly group, the right and left oxyhemoglobin did not significantly change under WPC. These results suggest that the effect of a cognitive task during unstable walking conditions differs between healthy adults and elderly persons, and that this may be important when considering postural control strategies, especially in the elderly.

Vascular risk factors and fMRI activation in a prodromal dementia population

AbstractBackgroundVascular risk factors (VRF) are associated with an increased risk of developing dementia (1). Functional magnetic resonance imaging (fMRI) demonstrates the ability to detect early changes in neuronal activation before cognitive changes are clinically measurable (2). We investigate whether the number of VRF in cognitively healthy persons with a minimum of two VRF present was associated with a change in neuronal activation in the brain measured with task‐based fMRI.Methods56 cognitively healthy, defined by Mini‐Mental State Exam (MMSE) and clinical dementia rating (CDR), elderly persons completed an fMRI examination with task‐based fMRI and N‐Back paradigm to access Working Memory (WM). Vascular risk factors included in the study were stable coronary artery disease or cerebrovascular disease according to MRI criteria, hypercholesterolemia, hypertension, diabetes mellitus and overweight (3).We analyzed the fMRI data at a single time point using the FMRIB Software Library (FSL v6.0; Analysis Group, Oxford, UK).ResultsThe mean age was 68.4 (± 5.4) years. The number of VRF present were VRF2 (n = 21), VRF3 (n = 25) and VRF4 (n = 10). The median MMSE were: VRF2: 29 (IQR 29 ‐ 30), VRF3: 30 (IQR 28.8 ‐ 30) and VRF4: 29.5 (IQR 28.3 ‐ 30). A low number of VRF (VRF2) revealed higher neuronal activation than the groups with a higher number of VRF (VRF3 and VRF4). The regional activated clusters in the VRF2 group showed activation in the superior parietal lobule, visual cortex, premotor cortex, Broca’s area and anterior intra‐parietal sulcus.ConclusionOur results show that a lower neuronal activation measured with fMRI is associated with a higher number of VRF. We suggest further studies to assess whether altered neuronal activation measured by fMRI in cognitively healthy elderly persons with VRFs can be associated with a higher risk of developing cognitive decline and dementia.1. O'Brien JT, Thomas A. Vascular dementia. The Lancet. 2015;386(10004):1698‐706.2. Chen J, Glover G. Functional Magnetic Resonance Imaging Methods. Neuropsychology Review. 2015;25(3):289‐313.3. Khalifa K, Bergland AK, Soennesyn H, Oppedal K, Oesterhus R, Dalen I, et al. Effects of Purified Anthocyanins in People at Risk for Dementia: Study Protocol for a Phase II Randomized Controlled Trial. Front Neurol. 2020;11:916.

Vascular risk factors and fMRI activation in a prodromal dementia population

AbstractBackgroundVascular risk factors (VRF) are associated with an increased risk of developing dementia (1). Functional magnetic resonance imaging (fMRI) demonstrates the ability to detect early changes in neuronal activation before cognitive changes are clinically measurable (2). We investigate whether the number of VRF in cognitively healthy persons with a minimum of two VRF present was associated with a change in neuronal activation in the brain measured with task‐based fMRI.Method56 cognitively healthy, defined by Mini‐Mental State Exam (MMSE) and clinical dementia rating (CDR), elderly persons completed an fMRI examination with task‐based fMRI and N‐Back paradigm to access Working Memory (WM). Vascular risk factors included in the study were stable coronary artery disease or cerebrovascular disease according to MRI criteria, hypercholesterolemia, hypertension, diabetes mellitus and overweight (3). We analyzed the fMRI data at a single time point using the FMRIB Software Library (FSL v6.0; Analysis Group, Oxford, UK).ResultThe mean age was 68.4 (± 5.4) years. The number of VRF present were VRF2 (n = 21), VRF3 (n = 25) and VRF4 (n = 10). The median MMSE were: VRF2: 29 (IQR 29 ‐ 30), VRF3: 30 (IQR 28.8 ‐ 30) and VRF4: 29.5 (IQR 28.3 ‐ 30). A low number of VRF (VRF2) revealed higher neuronal activation than the groups with a higher number of VRF (VRF3 and VRF4). The regional activated clusters in the VRF2 group showed activation in the superior parietal lobule, visual cortex, premotor cortex, Broca’s area and anterior intra‐parietal sulcus.ConclusionOur results show that a lower neuronal activation measured with fMRI is associated with a higher number of VRF. We suggest further studies to assess whether altered neuronal activation measured by fMRI in cognitively healthy elderly persons with VRFs can be associated with a higher risk of developing cognitive decline and dementia. • O'Brien JT, Thomas A. Vascular dementia. The Lancet. 2015;386(10004):1698‐706. • Chen J, Glover G. Functional Magnetic Resonance Imaging Methods. Neuropsychology Review. 2015;25(3):289‐313. • Khalifa K, Bergland AK, Soennesyn H, Oppedal K, Oesterhus R, Dalen I, et al. Effects of Purified Anthocyanins in People at Risk for Dementia: Study Protocol for a Phase II Randomized Controlled Trial. Front Neurol. 2020;11:916.

Cardiovascular risk in elderly persons without established atherosclerotic cardiovascular disease

Abstract Introduction Age is the dominant driver of atherosclerotic cardiovascular disease (ASCVD) risk, and the estimated 10-year ASCVD risk of almost all individuals ≥70 years exceeds conventional risk thresholds. Treatment of risk factors should be considered taking ASCVD risk modifiers, including frailty, lifetime treatment benefit, comorbidities, polypharmacy, socio-economic status, and patient preferences into account. Aim Because of problems with risk prediction in the elderly most ASCVD risk scores do not function well, so there is limited ability to quantify ASCVD risk in persons 70 years of age or older. Therefore, we sought out to estimate ASCVD risk in apparently healthy elderly persons. Methods We enrolled 253 apparently healthy elderly persons ≥70 years without established ASCVD. The Systemic Coronary Risk Estimation 2 - Older Persons (SCORE2-OP) score was used to estimate the 10-year risk of ASCVD. A 10-year risk ≥15% was generally considered ‘very high risk’, and 7.5% to <15% was considered ‘high risk’. Based on age study population was divided into four groups: (1) 70–74 years (N=61), (2) 75–79 years (N=73), 80–84 (N=76), and (4) 85-89 years (N=43). Results The median 10-year ASCVD risk in the entire cohort was 23% (17%–32%). There was no person with low ASCVD risk (<7.5%). 41 out of 253 persons (16.2%) were high-risk and 212 (83.8%) were very high-risk. The number of persons at very high risk of ASCVD increased dramatically with age. Roughly, almost all persons aged ≥75 years were deemed very high risk (Table 1). Multimorbidity defined as the presence of two or more chronic conditions and polypharmacy defined as the use of at least 5 medications were highly prevalent in all four study groups. Hypertension was the most prevalent condition – roughly eight in 10 persons had hypertension. The rate of overweight/obese patients was higher in younger persons. This fact was further reflected by the body composition of study participants and the rate of malnutrition (Table 1). Age ≥75 years was highly predictive for identifying persons at very high risk for ASCVD with a C-statistics of 0.92 (positive predictive value 99%, negative predictive value 53%; P<0.001) (Figure 1). Conclusions Older people without established ASCVD are a heterogeneous group. Most of them were found to be at very high risk of ASCVD. Age and high blood pressure were the dominant drivers of that risk. In addition, ASCVD risk modifiers such as multimorbidity, polypharmacy, and malnutrition were highly prevalent. These findings have important clinical and public health and individualized decisions regarding preventative and therapeutic strategies for elderly persons are needed.Table 1Baseline characteristicsFigure 1.ROC analysis

Brain activity in healthy elderly persons when presented with swallowing-related videos: A functional magnetic resonance imaging study

ObjectiveFunctional training is necessary for swallowing rehabilitation; however, there is a risk of aspiration. Indirect swallowing training involving mirror neuron activity may be useful for swallowing recovery, as there is no risk of aspiration. MethodsThis study investigated the activity of mirror neurons in the cerebral cortex (Brodmann areas 6, 40, and 44) while healthy elderly adults (eight men and seven women; average age, 66.4 years) watched swallowing-related videos. Functional magnetic resonance imaging was used to examine the presence or absence of mirror neuron activity during the presentation of four types of swallowing-related videos. ResultsThe strongest brain activity was observed during the chewing/swallowing fluoroscopic video, and female participants showed increased activity compared with male participants. Some activity was observed for all four video types; however, the highest intensity occurred during the masticatory swallowing fluoroscopy video. ConclusionsSince there was mirror neuron activity while participants watched the videos, it is possible that it mimics swallowing and can therefore be used for safe, indirect swallowing training during rehabilitation.

Safety and performance of oropharyngeal muscle strength training in the treatment of post-stroke dysphagia during oral feeding: protocol for a systematic review and meta-analysis

IntroductionDysphagia is a common functional disorder after stroke. Most patients post-stroke are incapable of oral feeding, which often leads to complications such as malnutrition, aspiration pneumonia and dehydration that seriously...

Effects of H-Reflex Onset Latency on Gait in Elderly and Hemiplegic Individuals.

Background and Objectives: The Hoffmann’s reflex (H-reflex) is important in electrodiagnostic testing because it improves sensitivity and specificity in diagnosing radiculopathies. Although quantitative electromyography (EMG) measurements for H-reflex amplitudes during the gait cycle have been performed in both hemiplegic and healthy individuals, research on the H-wave latency in these individuals during the gait cycle is lacking. Materials and Methods: The H-reflex latency of the soleus muscle was investigated in hemiplegic stroke patients and healthy elderly persons in this observational analytical study. Two groups of individuals participated in this study: healthy adults (n = 25) and stroke patients with hemiplegia (n = 25) were compared. An MP150 with Ag-Ag/Cl electrodes was utilized to record and analyse electromyography measurements. All individuals could walk independently indoors. Stimuli were administered to elicit the H-reflex in the four gait phases as the participant walked. Results: Stroke patients had a significantly shorter latency than did healthy patients in the mid-swing, mid-stance, and toe-off phases of the gait cycle; heel-strike latency did not significantly differ. Conclusions: These results can be used as diagnostic data to help account for patient characteristics or measure the recovery extent for treatment planning and gait training in hemiplegic individuals.

Elderly People Activity Recognition in Smart Grid Monitoring Environment

Elderly people activity recognition has become a vital necessity in many countries, because most of the elderly people live alone and are vulnerable. Thus, more research to advance in the monitoring systems used to recognize the activities of elderly people is required. Many researchers have proposed different monitoring systems for activity recognition using wired and wireless wearable sensing devices. However, the activity classification accuracy achieved so far should be improved to meet the challenges of more precise activity monitoring. Our study proposes a smart Human Activity Recognition system architecture utilizing an open source dataset generated by wireless, batteryless sensors used by 14 healthy aged persons and unsupervised and supervised machine learning algorithms. In this paper, we also propose using a smart grid for checking regularly the wearable sensing device operational status to address the well-known reliability challenges of these devices, such as wireless charging and data trustworthiness. As the data from the sensing device is very noisy, we employ the K-means++ clustering to identify outliers and use advanced ensemble classification techniques, such as the stacking classifier for which a meta model built using the random forest algorithm gave better results than all other base models considered. We also employ a bagging classifier, which is an ensemble meta-estimator fitting the prediction outputs of the base classifiers and aggregating them to produce the ensemble output. The best classification accuracy of 99.81 was achieved by the stacking classifier in training and 99.78% in testing, respectively. Comparisons for finding the best model were conducted using the recall, F1 score, and precision values.

The Correlation between a New Online Cognitive Test (the Brain Assessment) and Widely Used In-Person Neuropsychological Tests

Introduction: There are several problems with standard in-person neuropsychological assessments, such as habituation, necessity of human resources, and difficulty of in-person assessment under societal conditions during the outbreak of coronavirus disease 2019. Thus, we developed an online cognitive test (the Brain Assessment [BA]). In this study, we investigated the correlation between the results of the BA and those of established neuropsychological tests. Participants and Methods: Seventy-seven elderly persons (mean 71.3 ± 5.1 years old; range 65–86; male:female = 45:32) were recruited through the internet. Correlations were evaluated between the BA and the following widely used neuropsychological tests: the mini-mental state examination (MMSE), the Raven’s colored progressive matrices (RCPM), the logical memory I and II of the Rivermead Behavioral Memory Test, the word fluency (WF) test, and the Trail-Making TestA/B. Results: We found moderate correlations between the total cognitive score of the BA and the total score of the MMSE (r = 0.433, p < 0.001), as well as between the total BA score and the total RCPM score (r = 0.582, p < 0.001) and time to complete the RCPM (r = 0.455, p < 0.001). Moderate correlations were also observed between the cognitive score of the memory of words BA subtest and the LM-I (r = 0.518, p < 0.001), the mental rotation subtest and figure drawing (r = 0.404, p < 0.001), the logical reasoning subtest and total RCPM score (r = 0.491, p < 0.001), and the memory of numbers and words subtests and WF (memory of numbers and total WF: r = 0.456, p < 0.001; memory of words and total WF: r = 0.571, p < 0.001). Discussion: We found that the BA showed moderate correlations between established neuropsychological tests for intellect, memory, visuospatial function, and frontal function. The MMSE and the RCPM reflect Spearman’s s-factor and g-factor, respectively, and thus the BA also covered both factors. Conclusion: The BA is a useful tool for assessing the cognitive function of generally healthy elderly persons.

COVID-19 lockdowns’ effects on the quality of life, perceived health and well-being of healthy elderly individuals: A longitudinal comparison of pre-lockdown and lockdown states of well-being

Purpose. The concept of lockdown in relation to COVID-19 is thought to have an indirect impact on the quality of life and well-being of the elderly due to its consequences on the physical, psychological, and cognitive health of individuals. However, previous published studies on this subject are limited in terms of methodological approach used, including the absence of pre-confinement status and the type of experimental design, which is often cross-sectional. The present study proposes a longitudinal design with pre-confinement measures. It assesses changes in quality of life, perceived health, and well-being by comparing the period before lockdown (T1 = December 2019), three months after the start of the first lockdown (T2 = June 2020), and during the second lockdown (T3 = January 2021) due to COVID-19. Materials and Methods. This study is conducted with a group of 72 healthy elderly persons. They completed an electronic (online) survey assessing personal factors, activities, and participation as well as responding to the EuroQol-5D and Warwick-Edinburgh Mental Well-being Scale. Results. A decrease in quality of life, perceived health and well-being was observed between T1 and T2 and between T1 and T3, but no difference was reported between the two lockdown periods. The variables associated with these changes included energy level, level of happiness, physical activity, change in medical condition, memory difficulties, level of perceived isolation and age. Conclusion. This study will help to target variables that may have a deleterious effect on older adults for consideration in future confinement settings and for preventive purposes.

Reference Ranges of Iron Profiles in Apparently Healthy Elderly in Sokoto, Nigeria

Background: Iron is an important micronutrient in the body, lead to anaemia, frailty and cognitive disorders in the elderly when deficient.&#x0D; Aim: This study was aimed to determine reference values of iron profile in apparently healthy elderly persons in Sokoto and compared with the local reference values.&#x0D; Study Design: This was a comparative study&#x0D; Duration of Study: The study lasted for a period of one year between January to December, 2020.&#x0D; Methodology: This was a comparative study involving 105 apparently healthy elderly persons aged 60 years and above in Sokoto metropolis. Serum iron and total-iron binding capacity (TIBC) were determined using Iron Ferrozine method. Serum ferritin, Serum transferrin (Tf) and Serum Transferrin Receptors (sTfR) were assayed using enzyme-linked immunosorbent assay (ELISA). Transferrin Saturation (TS) and Serum Transferrin Receptors ferritin log (sTfR/FL) was calculated. Data were expressed as percentiles, mean and standard deviation and analysed using t-test and one way ANOVA.&#x0D; Results: The study established reference ranges of Serum iron,TIBC, Serum ferritin, Tf, sTfR, TS and sTfR/FL was calculated. in Sokoto. The study showed that iron and ferritin have high reference ranges than the local values in Sokoto. The local values for TIBC, ferritin, sTfR, TS and sTfR/FL were not available. Mean Ferritin (µg/L), sTfR (ng/L) and sTfR/Fl the test subjects were significantly higher in males than females in Sokoto (p=0.026), (p= 0.001), (p=0.044) and (p= 0.003) respectively. Iron, ferritin and TS increased as the BMI was increasing (p=&lt;0.001).&#x0D; Conclusion: In conclusion, normal reference values obtained in this study notably vary with the local reference ranges used in the Sokoto metropolis. There is a need for each locality to have separate reference ranges for the elderly for their proper diagnosis and management of iron related disorders.

Elderly Muslim Wellbeing: Family Support, Participation in Religious Activities, and Happiness

Aims: The aim of this study was to examine the effect of family support and participation in religious activities on the happiness of elderly muslims. Background: An increase in the number of older age people should be balanced with the increased quality of their life. The quality of life is influenced by internal factors such as self-quality, as well as external factors such as family support and religious activities. Objective: The objective of this research was to identify differences in the level of happiness of elderly muslims based on several factors: Work, health, salary, Islamic study, and marriage. Methods: Three hundred and ten elderly muslims (133 male, 177 female) participated in this study. Respondents were selected by simple random sampling of the elderly muslim population in seven districts in Central Java province, Indonesia. Results: The results showed 1) there was a correlation between family support and participation in religious activities and the happiness of elderly Muslims, 2) a healthy elderly person has a higher level of happiness than a sick elderly person; elderly who partake in Islamic studies one to two times a week have higher happiness than the elderly who do not; the retired elderly have the highest happiness compared to the elderly who still work and the elderly who do not (the lowest level of happiness), and there was no difference in the level of happiness in terms of salary and marriage. Conclusion: Family support and participation in religious activities are the main predictors of subjective well-being in the muslim elderly. In addition, there are other predictors such as health and participation in Islamic studies.

Some Haematological Parameters of the Elderly in Sokoto, Nigeria

The assessment of haematological parameters is very necessary because, they are important proxy indicators useful in the assessment of immune status, therapeutic purposes and monitoring of disease progression and treatment outcome for proper patient management. This study was aimed at determining some haematological parameters in apparently healthy elderly persons living in Sokoto, Nigeria. This was a cross-sectional study involving a total of 105 apparently healthy elderly persons living in Sokoto. Elderly persons aged 60years and above were recruited for the study. Full blood counts (FBC) were determined using five part haematological analyser by Mindray, Germany. Data were analysed using Statistical Package of Social Sciences (SPSS) version 25. Haematological parameters showed distinct differences with some local reference ranges. This study found out that the values of WBC, Lymphocyte, Neutrophil, Eosinophil, Monocyte, RDW-CV, Platelet Count, MPV, PDW and Plateletcrit were within the normal range in according to reference ranges used in Sokoto. While the values of RBC, HCT, MCHC, MCH and MCV were lower based on reference values used in Sokoto. However, RDW-CV was raised. There were statistical significant increases in mean values of Hb, HCT and MCV among male than females in Sokoto metropolis (p&lt;0.05). There was statistical significant increases in mean values of PLT count among females than males in (p&lt;0.05). There were statistical differences in mean values of Neutrophil, RBC, HCT, PLT and PCT among different age groups in Sokoto metropolis (p&lt;0.05). There were statistical differences in mean values of WBC, Lymphocyte, Neutrophil, Eosinophil, RDW-CV, PLT, PDW and PCT among different groups of BMI in Sokoto metropolis (p&lt;0.05). It was observed that monocyte increased significantly with BMI from normal weight to obesity (p&lt;0.05). In conclusion, this study established a baseline data for FBC in elderly in Sokoto. Some of the parameters under study vary with local reference range. Elderly have lower haemoglobin and HCT. There is age, gender and BMI variation in the parameters studied. There is need to establish a different reference ranges for elderly in a given location for proper understanding and management of elderly population in our society.

Alzheimer Disease Pathogenesis: The Role of Autoimmunity.

In addition to deposits of amyloid β (Aβ) plaques and neurofibrillary tangles, growing evidence demonstrates that complex and multifaceted biological processes can arise during Alzheimer disease (AD) pathogenesis. The recent failures of clinical trials based on the amyloid hypothesis and the presence of Aβ plaques in cognitively healthy elderly persons without AD point toward a need to explore novel pathobiological mechanisms of AD. In the search for alternative AD mechanisms, numerous genome-wide association studies and mechanistic discoveries suggest a potential immunologic component of the disease. However, new experimental tools are needed to uncover these immunogenic components. The current methods, such as ELISAs or protein microarrays, have limitations of low throughput and/or sensitivity and specificity. In this article, we briefly discuss evidence of potential autoimmune contributions to AD pathobiology, describe the current methods for identifying autoantibodies in patient fluids, and outline our own efforts to develop new techniques for novel autoantibody biomarker discovery. Uncovering the putative autoimmune components of AD may be crucial in paving the way to new concepts for pathogenesis, diagnosis, and therapy. In addition to deposits of amyloid β plaques and neurofibrillary tangles, growing evidence demonstrates that complex and multifaceted biological processes can arise during Alzheimer disease (AD) pathogenesis. Numerous research directions, including genome-wide association, clinical correlation, and mechanistic studies, have pointed to a potential autoimmunologic contribution to AD pathology. We present research suggesting the association between autoimmunity and AD and demonstrate the need for new laboratory techniques to further characterize potential brain antigen-specific autoantibodies. Uncovering the putative autoimmune components of AD may be crucial in paving the way to new concepts for pathogenesis, diagnosis, and therapy.

Comparison of sleep-wake rhythms in elderly persons with intellectual disabilities and the general population

BackgroundSleep problems are common in people with intellectual disabilities (ID), but the knowledge on the natural course of sleep-wake rhythms and sleep problems in elderly persons with ID is limited. In the current study, objectively measured sleep-wake rhythms and the prevalence and severity of sleep problems of elderly persons with ID was compared to that of healthy elderly persons from a large representative sample from the general population. MethodsActigraphy data of 501 elderly persons with ID (age 62.02 ± 8.02 years, 48% female) from the Healthy Ageing and Intellectual Disabilities study was compared to the data of 1734 elderly persons from the general population (age 62.24 ± 9.34 years, 53% female) from the Rotterdam Study. Main outcome variables were Interdaily stability (IS) and Intradaily variablitiy (IV), total sleep time (TST), Waking after sleep onset (WASO), Short sleep (TST<6 h), Night waking (WASO >90 min). ResultsElderly persons with ID had less stable sleep wake rhythms than elderly persons from the general population (IS = 0.70 ± 0.17, vs 0.80 ± 0.10 z = −8.00). Their sleep-wake rhythm was also more fragmented (IV = 0.56 ± 0.26 vs 0.42 ± 0.13 respectively, z = 8.00). Elderly persons with ID slept on average 60.09 min longer than elderly persons from the general population, and lay awake 48.28 min longer after sleep onset. Short sleep in elderly persons with ID was less prevalent (20.7% vs 30.2%) but more severe (TST in Short sleep; 5.13 ± 0.80 h vs 5.39 ± 0.50 h, z = −2.76) then in elderly persons from the general population. Night waking was more prevalent (63.0% vs 17.7%) and more severe in elderly persons with ID (WASO in Night waking; 150.39 ± 54.72 min vs 111.60 ± 17.95 min, z = 7.06). ConclusionThe differences in sleep-wake rhythms, prevalence and severity of sleep problems between elderly persons with and without ID are marked and possibly explained by medical, psychiatric conditions and lifestyle in elderly persons with ID. Better understanding of sleep in elderly with ID is needed to improve the quality of sleep in this population and to diminish health problems related to a disruption of sleep.

Pediatric Speech Audiometry Web Application for Hearing Detection in the Home Environment

This paper describes the development of the speech audiometry application for pediatric patients in Slovak language and experiences obtained during testing with healthy children, hearing-impaired children, and elderly persons. The first motivation behind the presented work was to reduce the stress and fear of the children, who must undergo postoperative audiometry, but over time, we changed our direction to the simple game-like mobile application for the detection of possible hearing problems of children in the home environment. Conditioned play audiometry principles were adopted to create a speech audiometry application, where children help the virtual robot Thomas assign words to pictures; this can be described as a speech recognition test. Several game scenarios together with the setting condition issues were created, tested, and discussed. First experiences show a positive influence on the children’s mood and motivation.

Effect of Neuromuscular Electrical Stimulation on Masseter Muscle Thickness and Maximal Bite Force among Healthy Community-Dwelling Persons Aged 65 Years and Older: A Randomized, Double Blind, Placebo-Controlled Study

Aim: This study investigated the effect of neuromuscular electrical stimulation (NMES) on masseter muscle thickness and maximal bite force among healthy community-dwelling elderly persons older than 65 years. Materials and methods: A total of 40 participants were randomly assigned to the experimental and placebo groups. In the experimental group, NMES was applied to both masseter muscles, and electrical signals were gradually increased until the participants felt a grabbing sensation (range 6.0–7.5 mA) in the masseter muscle. The placebo group, in contrast, underwent NMES in the same manner and procedure as the experimental group with less electrical intensity (0.5 mA). All interventions were administered five times a week for six weeks, 20 min per day. The outcomes were masseter muscle thickness assessed using ultrasound and maximal bite force using a bite force meter. The level of significance was set as p < 0.05. Results: The experimental group showed a significant increase in both masseter muscle thickness and maximal bite force as compared with the placebo group (p = 0.002 and 0.019, respectively). Moreover, the degree of change in the masseter muscle thickness and maximal bite force significantly increased in the experimental and placebo groups (p < 0.001, both). Conclusions: This study demonstrated that NMES could be an effective modality for increasing masseter muscle thickness and maximal bite force in healthy older adults.

The SENIEUR protocol and the efficacy of hepatitis B vaccination in healthy elderly persons by age, gender, and vaccine route

BackgroundReduced response to hepatitis B vaccines is associated with aging, confounding and comorbid conditions, as well as inadvertent subcutaneous (SC) inoculation. We hypothesized that the antibody and T cell-mediated immune responses (T-CMI) of elderly adults to a vaccine intended for intramuscular (IM) administration would be attenuated when deposited into SC fat, independent of confounding conditions.ResultsFifty-two healthy, community dwelling elderly adults (65–82 years), seronegative for HBV, were enrolled in the SENIEUR protocol as a strictly healthy population. These seniors were randomized to receive a licensed alum-adjuvanted recombinant HBV vaccine either SC or IM, with the inoculum site verified by imaging. The response rates, defined as hepatitis B surface antibodies (HBsAb) ≥10 IU/L, were significantly lower in the elderly than in young adults, a group of 12, healthy, 21–34-year-old volunteers. Moreover, elderly participants who received the vaccine IM were significantly more likely to be responders than those immunized SC (54% versus 16%, p = 0.008). The low seroconversion rate in the IM group progressively declined with increasing age, and responders had significantly lower HBsAb titers and limited isotype responses. Moreover, T-CMI (proliferation and cytokine production) were significantly reduced in both percentage of responders and intensity of the response for both Th1 and Th2 subsets in the elderly.ConclusionsOur data demonstrate the blunted immunogenicity of SC inoculation as measured by peak titers and response rates. Further, the qualitative and quantitative deficits in B- and T-CMI responses to primary alum adjuvanted protein antigens persisted even in strictly healthy elderly populations with verified IM placement compared to younger populations.Clinical trial registrationClinicalTrials.gov, NCT04162223. Registered 14 November 2019. Retrospectively registered.

Relationship between displacement of the masseter muscle during biting and masseter muscle quality and bite force in healthy elderly persons.

Although age-related changes in muscle quality influence muscle strength, the relationship between masseter muscle (MM) quality and maximum biting force (MBF) has never been studied. The aims of the study were to verify the relationship among MM quality, MBF, and the displacement of the MM while biting forcefully (MMD) and to clarify the age-related decline in MBF in healthy elderly persons. Seventy-four healthy community-dwelling individuals (mean age, >65years) from Tokyo metropolis were recruited. The thickness (index of muscle quantity), echo intensity (index of muscle quality) and displacement of the MM while biting forcefully (MMT, MMEI and MMD, respectively) were measured by ultrasonography. MBF was measured using a pressure-sensitive sheet. Independent predictors of MBF and MMD were determined using multivariate linear regression analyses adjusted for age, sex and the number of present teeth. MBF was significantly correlated with the number of teeth (β=0.577, P<.001) and MMD (β=0.302, P=.015), but not with MMT (β=0.019, P=.868) or MMEI (β=0.054 P=.703). MMD was significantly correlated with MMEI (β=-0.606, P<.001), but not with MMT (β=0.048, P=.681) or the number of teeth (β=0.065, P=.613). MMEI was associated with MMD, an index of MBF, regardless of tooth number. The age-related quality change in the MM might cause a decrease in its contraction, resulting in age-related decline in MBF.

Age-related changes in standing ability on a foam surface based on the center-of-mass acceleration of each body segment.

[Purpose] The purpose of this study was to elucidate the age-related changes in the stability of the quiet standing posture based on the acceleration of the center of mass of each body segment under deteriorated somatosensory conditions. [Participants and Methods] The participants in this study were 18 healthy elderly persons and 11 healthy young adults. A foam surface was placed on the force plate for load-bearing onto the somatosensory system. The participants maintained a quiet position on the force plate under two conditions: a firm surface and a foam surface. The accelerations of the head, thorax, pelvis, and whole body center of mass when quiet standing in two conditions were measured by a motion capture system. In the statistical analysis, regarding the center of mass of each body segment, the interactions were examined by performing a two-way analysis of variance using age and surface condition as factors. [Results] A two-way analysis of variance detected an interaction between age and surface factors for anteroposterior acceleration at the center of mass of the head. For other body segments, interactions between the two factors were not detected. [Conclusion] The results of anteroposterior acceleration at the center of mass of the head suggest that under conditions of deteriorated somatosensory function in the lower limbs, minute anteroposterior position adjustment of the head is an essential characteristic of the standing posture control mechanism in the elderly.