title: Impaired Higher-Level Functional Capacity as a Predictor of Stroke in Community-Dwelling Older Adults: The Ohasama Study.
abstract: OBJECTIVE
  Functional capacity is a predictor, as well as a consequence, of stroke. However, little research has been done to examine whether higher-level functional capacity above basic activities of daily living is a predictor of stroke.
  
  
  METHODS
  We followed 1493 Japanese community-dwelling adults aged ≥60 years (mean age, 70.1 years) who were independent in basic activities of daily living and had no history of stroke. Baseline data were collected using a self-administered questionnaire. Higher-level functional capacity was measured using the total score and 3 subscales (instrumental activities of daily living, intellectual activity, and social role) derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Adjusted hazard ratios and 95% confidence intervals were calculated by the Cox proportional hazards model.
  
  
  RESULTS
  During a mean follow-up of 10.4 years, 191 participants developed a first stroke. Impaired higher-level functional capacity based on total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.15-2.33). Among the 3 subscales, only intellectual activity was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.21-2.22). Social role was significantly associated with stroke only among those aged ≥75 years (hazard ratio, 1.78; 95% confidence interval, 1.07-2.98).
  
  
  CONCLUSIONS
  Impaired higher-level functional capacity, especially in the domain of intellectual activity, was a predictor of stroke, even among community-dwelling older adults with independent basic activities of daily living at baseline. Monitoring of higher-level functional capacity might be useful to detect those at higher risk of developing stroke in the future.
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan. mkeiko-tky@umin.ac.jp.
authors.forename: Keiko
authors.initials: K
authors.lastname: Murakami
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Tsubota-Utsugi
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Ishiguro
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Matsuda
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Kanno
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Yasui
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Murakami
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.affiliation: From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003071:Cognition; D015444:Exercise; D005260:Female; D006801:Humans; D057187:Independent Living; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012919:Social Behavior; D020521:Stroke / Q000453:epidemiology*
keywords: elderly; functional capacity impairment; instrumental activities of daily living; intellectual activity; social role; stroke