Association Between Frequency of Social Contact and Brain Atrophy in Community-Dwelling Older People Without Dementia: The JPSC-AD Study.


Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
12 09 2023
Historique:
received: 28 12 2022
accepted: 16 05 2023
medline: 13 9 2023
pubmed: 13 7 2023
entrez: 12 7 2023
Statut: ppublish

Résumé

Epidemiologic evidence has shown that social isolation, a low frequency of social contact with others, is associated with the risk of dementia and late-life depressive symptoms. Therefore, we hypothesized that low frequency of social contact may be involved in brain atrophy, and depressive symptoms may play some role in this relationship. We aimed to evaluate the association between low frequency of social contact and the volumes of various brain regions and to assess the extent to which depressive symptoms mediate these relationships from a large population-based multisite cohort study. Dementia-free community-dwelling Japanese aged 65 years or older underwent brain MRI scans and a comprehensive health examination. Frequency of contact with noncohabiting relatives and friends was determined by asking a single question with 4 categories: everyday, several times a week, several times a month, and seldom. Total and regional brain volumes, intracranial volume (ICV), and white matter lesion volume were estimated using FreeSurfer software. The associations between frequency of social contact and brain volumes per ICV were examined using analyses of covariance. Mediation analyses were conducted to calculate the proportion of the associations explained by depressive symptoms. We included 8,896 participants. The multivariable-adjusted mean of the total brain volume in the group with the lowest frequency of social contact was significantly lower compared with that in the group with the highest frequency of social contact (67.3% vs 67.8%), with a significant increasing trend across the groups ( Lower frequency of social contact was associated with decreased total and cognitive function-related regional brain volumes. In addition, depressive symptoms partially explained the association in community-dwelling older people without dementia in Japan.

Sections du résumé

BACKGROUND AND OBJECTIVES
Epidemiologic evidence has shown that social isolation, a low frequency of social contact with others, is associated with the risk of dementia and late-life depressive symptoms. Therefore, we hypothesized that low frequency of social contact may be involved in brain atrophy, and depressive symptoms may play some role in this relationship. We aimed to evaluate the association between low frequency of social contact and the volumes of various brain regions and to assess the extent to which depressive symptoms mediate these relationships from a large population-based multisite cohort study.
METHODS
Dementia-free community-dwelling Japanese aged 65 years or older underwent brain MRI scans and a comprehensive health examination. Frequency of contact with noncohabiting relatives and friends was determined by asking a single question with 4 categories: everyday, several times a week, several times a month, and seldom. Total and regional brain volumes, intracranial volume (ICV), and white matter lesion volume were estimated using FreeSurfer software. The associations between frequency of social contact and brain volumes per ICV were examined using analyses of covariance. Mediation analyses were conducted to calculate the proportion of the associations explained by depressive symptoms.
RESULTS
We included 8,896 participants. The multivariable-adjusted mean of the total brain volume in the group with the lowest frequency of social contact was significantly lower compared with that in the group with the highest frequency of social contact (67.3% vs 67.8%), with a significant increasing trend across the groups (
DISCUSSION
Lower frequency of social contact was associated with decreased total and cognitive function-related regional brain volumes. In addition, depressive symptoms partially explained the association in community-dwelling older people without dementia in Japan.

Identifiants

pubmed: 37438128
pii: WNL.0000000000207602
doi: 10.1212/WNL.0000000000207602
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1108-e1117

Investigateurs

Masato Akiyama (M)
Koichi Murashita (K)
Tatsuya Mikami (T)
Songee Jung (S)
Mina Misawa (M)
Naoki Ishizuka (N)
Hiroshi Akasaka (H)
Yasuo Terayama (Y)
Hisashi Yonezawa (H)
Junko Takahashi (J)
Moeko Noguchi-Shinohara (M)
Kazuo Iwasa (K)
Shutaro Shibata (S)
Sohshi Yuki-Nozaki (S)
Masahito Yamada (M)
Shogyoku Bun (S)
Hidehito Niimura (H)
Ryo Shikimoto (R)
Hisashi Kida (H)
Yasuyo Fukada (Y)
Hisanori Kowa (H)
Toshiya Nakano (T)
Kenji Wada (K)
Masafumi Kishi (M)
Tomoki Ozaki (T)
Ayumi Tachibana (A)
Yuta Yoshino (Y)
Shu-Ichi Ueno (SI)
Tomohisa Ishikawa (T)
Seiji Yuki (S)
Ryuji Fukuhara (R)
Asuka Koyama (A)
Mamoru Hashimoto (M)
Manabu Ikeda (M)
Yoshihiro Kokubo (Y)
Kazuhiro Uchida (K)
Midori Esaki (M)
Benjamin Thyreau (B)
Koji Yonemoto (K)
Hisako Yoshida (H)
Kaori Muto (K)
Yusuke Inoue (Y)
Izen Ri (I)
Yukihide Momozawa (Y)
Chikashi Terao (C)
Michiaki Kubo (M)
Yutaka Kiyohara (Y)

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2023 American Academy of Neurology.

Auteurs

Naoki Hirabayashi (N)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Takanori Honda (T)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Jun Hata (J)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Yoshihiko Furuta (Y)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Mao Shibata (M)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Tomoyuki Ohara (T)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Yasuko Tatewaki (Y)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Yasuyuki Taki (Y)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Shigeyuki Nakaji (S)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Tetsuya Maeda (T)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Kenjiro Ono (K)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Masaru Mimura (M)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Kenji Nakashima (K)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Jun-Ichi Iga (JI)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Minoru Takebayashi (M)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.

Toshiharu Ninomiya (T)

From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan. t.ninomiya.a47@m.kyushu-u.ac.jp.

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