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COGNITIVE AND FUNCTIONAL STATUS OF THE JAPANESE OLDEST OLD

1997; Wiley; Volume: 45; Issue: 3 Linguagem: Inglês

10.1111/j.1532-5415.1997.tb00963.x

1532-5415

Kozo Matsubayashi, Kiyohito Okumiya, Tomoko Wada, Yasushi Osaki, Yoshinori Doi, Toshio Ozawa,

Technology and Human Factors in Education and Health

To the Editor: We read with interest the article of Dr. Corey-Bloom and colleagues that concluded that advancing age is accompanied by a decrease in cognitive function, but is not accompanied by functional impairment, in normal American subjects.1 Although they assessed many kinds of cognitive function, they assessed functional status using only Pfeffer Disability Scale. We tried to verify their results in normal Japanese oldest old, assessing neurobehavioral functions and activities of daily living (ADL) as well as cognitive functions. Subjects were the 383 clinically normal Japanese aged 65 years or more living in Kahoku, a rural Japanese town in which 32% of the population was 65 years or older in 1995.2 We assessed cognitive function using three tests (Mini-Mental State Examination, Hasegawa Dementia Scale Revised,3 Kohs block design test) and assessed functional status of these older subjects using four tests of quantitative neurobehavioral function and eight items of ADL. Namely, we measured stability of gait and posture by Up & Go test4 and Functional Reach5 and measured discriminative finger movement by Button Score and Visuospatial Cognitive Performance Score.6 We also evaluated eight ADL items (walking, ascending and descending stairs, feeding, dressing, toileting, bathing, grooming, and taking medicine) as to the help needed, and rated them from 3 to 0, with score 3 = completely independent, score 2 = need some help, score 1 = need help much, and scores 0 = completely dependent).2 Forty-one subjects whose MMSE scores were less than 23 were excluded. In accordance with Dr Corey-Bloom's criteria, the 342 clinically normal older adults (44% of eligible older population in this town) in this study were classified into two groups: 44 subjects who were 85 years of age or older (mean age 87.2 ± 2.4) and 298 subjects aged 65 to 84 years (mean age 77.2 ± 4.1). Table 1 shows the comparison of scores of cognitive and neurobehavioral function tests and ADL scores between two groups. Our data showed complete agreement with Dr Corey-Bloom's results in that mean score in each of cognitive function tests was significantly lower in the oldest old than in the younger old. However, contrary to their results, functional abilities such as neurobehavioral function tests and ADL scores in our study were also significantly lower in the oldest old than in the younger old. Because the differences in functional status between two groups in our study were significant but small, the discrepancy between Dr Corey-Bloom's study and ours might be attributable to the differences in cohort characaterisitcs or cultural environment. However, the differences in scores in cognitive function tests between two groups in Dr Corey-Bloom's study were also significant but small. If Dr Corey-Bloom and colleagues had introduced functional assessment in addition to the Pfeifer Disability Scale, their conclusion would have been more acceptable. In conclusion, our data indicate that advancing age in clinically normal subjects, at least those living in Kahoku in Japan, is accompanied not only by a decrease in cognitive function but also by functional impairment.