We read with great interest the recent study by Seya et al. [1] regarding the association between sit-to-stand (STS) biomechanics and Locomotive Syndrome (LS) severity. The authors are to be commended for identifying that the rate of force development (RFD/w), rather than maximal strength (F/w), acts as the sole independent predictor of LS stage (OR: 0.84, p = 0.002). This finding aligns with the “dynapenia” hypothesis, suggesting that deficits in rapid neural drive often precede the loss of absolute muscle mass in middle-aged and older adults.
Two methodological points warrant further discussion to contextualize these findings for clinical application.
First, regarding the use of the zaRitz BM-220 system (80 Hz), while laboratory-based assessments of early RFD (e.g., 0–50 ms) typically employ sampling frequencies ≥ 1000 Hz to capture the steep slope of neural discharge [2], device-based STS systems are designed to balance precision with clinical feasibility. Consequently, the reported RFD values likely reflect a functional average rather than the maximal explosive capacity seen in high-frequency settings. Recognizing this distinction is important when comparing these clinical findings with physiological literature, suggesting that future validation studies may be needed to confirm sensitivity to subtle post-intervention changes.
Second, identifying RFD as a biomarker highlights a critical opportunity for intervention design. Traditional power training—essential for improving RFD—often involves high-velocity movements that generate significant eccentric braking forces. For patients with LS, who may have comorbidities such as osteoporosis or osteoarthritis, this presents a safety challenge. In this context, “concentric-only” resistance strategies offer a viable solution. Our previous randomized controlled trial demonstrated that hydraulic resistance training, which eliminates eccentric load, significantly improved contractile RFD (0–200 ms) by approximately 27% in patients with musculoskeletal comorbidities [3]. Unlike weight-based isotonic training, hydraulic mechanisms allow patients to exert maximal acceleration without the risk of impact during the deceleration phase.
Seya et al. have successfully established the diagnostic necessity of RFD. One potential next step for the geriatric rehabilitation community may be the exploration of intervention protocols—such as hydraulic or pneumatic power training—that can safely target this specific neuromuscular deficit while minimizing injury risk in vulnerable populations.
The authors have nothing to report.
The authors have nothing to report.
The authors have nothing to report.
The authors have nothing to report.
The authors declare no conflicts of interest.
Data sharing is not applicable to this article as no new data were created or analyzed in this study.
Functional recovery after a hip fracture is closely related to nutrition; however, the factors with the strongest influence on early postoperative mobility remain unclear. We aimed to investigate whether preoperative muscle quality (intramuscular adipose tissue content [IMAC]) and phase angle (PhA) are associated with short-term (2-week) functional recovery, and to compare their associations with those of muscle mass.
We retrospectively reviewed 87 patients with hip fractures who could walk before their injury and divided them into two groups: Group A (n = 43), individuals without a decline in walking ability at discharge compared with pre-fracture status, and Group B (n = 44), individuals whose walking ability declined postoperatively. All participants underwent bioelectrical impedance analysis and computed tomography on admission. PhA, psoas muscle index (PMI), and IMAC were measured, and the ΔFIM (difference between admission and two postoperative weeks) was calculated. Between-group comparisons and Spearman's correlation analyses were performed.
PhA was significantly higher in Group A (4.3° ± 0.9°) than in Group B (3.6° ± 0.7°; p < 0.0005). IMAC was significantly lower in Group A (−0.2 ± 0.4) than in Group B (0.4 ± 0.3; p < 0.0005). Δ walking score was significantly correlated with IMAC (ρ = −0.399; p = 0.000139) and PhA (ρ = 0.275; p = 0.01). In multivariate logistic regression, IMAC was the only variable independently associated with walking recovery (p = 0.049). Furthermore, ΔFIM correlated positively with PhA (ρ = 0.24; p < 0.05), while IMAC showed no significant correlation with ΔFIM.
Preoperative IMAC and PhA may be useful indicators of short-term postoperative functional recovery, with IMAC showing a particularly strong association with ambulation recovery. These findings highlight the clinical relevance of muscle quality and nutritional assessment, although the evaluation at only two postoperative weeks represents a limitation.
The COVID-19 pandemic disrupted end-of-life (EOL) care for patients with incurable non-communicable diseases. This study evaluated the overall quality of EOL care and achievement of a good death in Japan during the pandemic, particularly focusing on hospital deaths.
Questionnaires were mailed to 26 969 bereaved family members of patients aged ≥ 20 years who died in 2021 from the 10 leading causes of death in Japan. Causes were grouped into six categories: cancer, cardiovascular disease, renal failure, respiratory diseases, neurocognitive disorders, and senility. Outcomes were (1) perceived quality of EOL care, measured with the Care Evaluation Scale (CES), and (2) achievement of a good death, measured with the Good Death Inventory (GDI).
We received 10 890 responses (50.9%); 3619 hospital deaths were analyzed. Perceived quality of EOL care was generally high during the pandemic (73.3%–92.9%). Within CES, “family care” was lowest across diseases, yet 73.3%–78.6% perceived care as good quality. For the GDI item “being free from physical distress,” achievement was 37.6% in cancer and 65.8% in senility. After adjusting for age and sex, achievement of a good death did not vary by disease, except for pathophysiology-related symptom items (e.g., pain and cognitive function).
During the pandemic, “family care” was rated lower, yet it became especially important under visiting restrictions. Approximately one in three people dying of senility experienced pain, indicating a need for closer attention from caregivers. Within good-death outcomes, person-centered items did not vary by disease—an encouraging finding in universal EOL care.
To elucidate the pathophysiological mechanisms between neurocognition and neuropsychiatric sub-symptoms in Alzheimer's disease (AD), the present cross-sectional study compared severity of each subitem in a neuropsychiatric symptom (NPS) scale among four neurocognitive groups classified based on the pattern of executive and general cognitive function.
Of 546 consecutive outpatients who visited Memory Clinic at Jikei University Kashiwa Hospital, we selected 160 with AD and classified them into four neurocognitive groups based on score in the MMSE (Mini-Mental State Examination: ≥ 21 point was general cognitive preserved) or FAB (Frontal Assessment Battery: ≥ 13 was executive cognitive preserved): BPC (both cognitive preserved); GCP (general cognitive preserved); ECP (executive cognitive preserved); NCP (neither cognitive preserved). We compared the severity of each subitem of the Behavioral Pathology in Alzheimer's Disease (Behave-AD) scale among the four groups.
Among seven subitems of Behave-AD, the scores for diurnal rhythm disturbances and anxieties/phobias differed significantly among the four groups. The score for diurnal rhythm disturbances was significantly higher in GCP than BCP, and the score for anxiety/phobias was significantly higher in ECP than BCP. However, no significant difference was shown between each cognitive group and the NCP.
The general cognitive preservation without executive preservation may be relevant to the diurnal rhythm disturbances by self-correction for own behavior, and the executive preservation without general cognition preservation may contribute to the transient anxiety as emotional reaction. Such dissociative relations between executive and general neurocognition may be relevant to specific neuropsychiatric sub-symptoms emergence or severity in AD.
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