Convergence of TMS Sites and Lesion Locations Associated With Nicotine Addiction Improvement on a Common Brain Circuit.

With the advent of a super-aged society, it is imperative to extend life expectancy. Intervention before the onset of care dependency is therefore crucial. This necessitates comprehensive prevention actions with attention to nutrition (diet, oral function), physical activity (exercise, etc.), and social participation (employment, leisure activities, etc.) []. For many older people, declining oral function leads to physical frailty, dependency on care, and increased mortality risk [, ]. Among oral functions, swallowing is essential for daily living. Dysphagia not only reduces quality of life, it is strongly associated with aspiration pneumonia in older adults, and this can lead to prolonged hospital stays, worsening of other diseases, and increased mortality risk []. Preventing dysphagia is therefore a critical challenge in improving the health of older adults. ‘Oral frailty’ refers to a state where there is overlap of multiple ‘minor declines’ in various oral functions, and this increases the risk of oral functional decline []. However, this remains a condition that is amenable to improvement. Among community-dwelling older individuals in Japan, for example, both oral frailty/oral function decline and dysphagia are observed at relatively high frequencies. Oral frailty reportedly affects approximately 22–30% of people [, ], and dysphagia affects around 20% []. Among community-dwelling independent older individuals, the presence of dysphagia has been shown to be associated with disease clusters such as tooth loss, oral dryness, Care Dependency Scale scores, malnutrition, dementia, neurological disorders, and cerebrovascular disease/hemiplegia [, ]. Evidence is accumulating on the relationship between physical/motor function (grip strength, standing up) and oral function [–]. Previous studies have reported associations between performance on the standing up test and oral diadochokinesis []. Furthermore, grip strength, single-leg stance, and the Timed Up & Go test have also been associated with tongue movement and oral diadochokinesis []. There are also reported associations between grip strength, walking speed, and occlusal force, tongue-lip movement, masticatory function, and swallowing function []. A strong relationship is thus suggested to exist between motor function and oral function. Meanwhile, habitual exercise has been shown to be effective in maintaining physical ability in older adults []. However, many studies use walking ability (speed, Timed Up & Go time, walking speed) as a proxy indicator for ‘habit’ [–], and there are few reports on the relationship between genuine ‘exercise habit’ and oral function [–]. In this study, we focus on the exercise habits of community-dwelling older adults, to clarify the relationship with oral function, particularly swallowing-related symptoms, through a cross-sectional study, and then further to clarify the change of swallowing-related symptoms before and after an exercise program.