Упражнения для улучшения осанки
Упражнения для исправления осанки: как перестать сутулиться и ...
Руки можно вытянуть вдоль туловища или собрать в замок за спиной (под корпусом). Необходимо постепенно поднимать таз — тело от коленей до ...
выявить
В 2022 году японским ученым удалось <anchor>выявить</anchor>, что нарушения осанки могут привести и к ухудшению когнитивных функций. Другие исследования показали, что правильная осанка улучшает эмоциональный фон человека, уменьшает усталость и даже снижает уровень депрессии и тревожности. Кроме того, красивая ровная спина дарит внутреннее чувство уверенности в себе.
Detection of cognitive decline by spinal posture assessment in health exams of the general older population | Scientific Reports
Detection of cognitive decline by spinal posture assessment in health exams of the general older population \| Scientific Reports

[Skip to main content](#content)

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain
the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in
Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles
and JavaScript.

Advertisement

[![Scientific Reports](https://media.springernature.com/full/nature-cms/uploads/product/srep/header-d3c533c187c710c1bedbd8e293815d5f.svg)](/srep)

- [View all journals](https://www.nature.com/siteindex)
- [Search](#search-menu)
- [Log in](https://idp.nature.com/auth/personal/springernature?redirect_uri=https://www.nature.com/articles/s41598-022-12605-7)

- [Explore content](#explore)
- [About the journal](#about-the-journal)
- [Publish with us](#publish-with-us)

- [Sign up for alerts](https://idp.nature.com/auth/personal/springernature?redirect_uri=https%3A%2F%2Fwww.nature.com%2Fmy-account%2Falerts%2Fsubscribe-journal%3Flist-id%3D288%26journal-link%3Dhttps%253A%252F%252Fwww.nature.com%252Fsrep%252F)
- [RSS feed](https://www.nature.com/srep.rss)

1. [nature](/)
2. [scientific reports](/srep)
3. [articles](/srep/articles?type=article)
4. article

Detection of cognitive decline by spinal posture assessment in health exams of the general older population


[Download PDF](/articles/s41598-022-12605-7.pdf)

[Download PDF](/articles/s41598-022-12605-7.pdf)

- Article
- [Open access](https://www.springernature.com/gp/open-research/about/the-fundamentals-of-open-access-and-open-research)
- Published: 19 May 2022

# Detection of cognitive decline by spinal posture assessment in health exams of the general older population

- [Hikaru Nishimura](#auth-Hikaru-Nishimura-Aff1) [1](#Aff1),
- [Shota Ikegami](#auth-Shota-Ikegami-Aff2) [2](#Aff2),
- [Masashi Uehara](#auth-Masashi-Uehara-Aff2) [2](#Aff2),
- [Jun Takahashi](#auth-Jun-Takahashi-Aff2) [2](#Aff2),
- [Ryosuke Tokida](#auth-Ryosuke-Tokida-Aff1) [1](#Aff1) &
- …
- [Hiroyuki Kato](#auth-Hiroyuki-Kato-Aff2) [2](#Aff2)

Show authors

[_Scientific Reports_](/srep) **volume 12**, Article number: 8460 (2022)
[Cite this article](#citeas)

- 9428 Accesses

- 4 Citations

- 179 Altmetric

- [Metrics details](/articles/s41598-022-12605-7/metrics)


### Subjects

- [Epidemiology](/subjects/epidemiology)
- [Neurological disorders](/subjects/neurological-disorders)
- [Orthopaedics](/subjects/orthopaedics)
- [Public health](/subjects/public-health)

## Abstract

The recent increase in the older adult population has led to a higher prevalence of cognitive impairment, which is often overlooked in routine health examinations. Citizens aged 50–89 years were targeted for this cohort survey by random sampling from the resident registry of a cooperating town in 2014. A total of 411 participants (202 male and 209 female) were enrolled. We analyzed the distribution of cognitive function test scores as determined by Montreal Cognitive Assessment and Mini-Mental State Examination tests in each age (50’s, 60’s, 70’s and 80’s) and sex group to examine whether cognitive decline could be detected by sagittal spinal balance measurement based on a radiological approach. Sagittal spinal balance was quantitatively measured as sagittal vertical axis (SVA). We observed significant associations for higher age and/or SVA anteriorization with lower cognitive function. In males, spinal balance anteriorization was associated with cognitive decline independently of age, with combinations of age and SVA also making valid cognitive decline determinations; male cases of SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all more likely to have cognitive decline than cases below those values. For females, cognitive decline was more likely in cases of SVA ≥ 70 mm, regardless of age. Thus, spinal balance anteriorization can be regarded as an easily visible indicator of latent cognitive decline in community-dwelling older people.

### Similar content being viewed by others

![](https://media.springernature.com/w215h120/springer-static/image/art%3A10.1038%2Fs41598-024-64706-0/MediaObjects/41598_2024_64706_Fig1_HTML.png)

### [Osteoporosis, spinal degenerative disorders, and their association with low back pain, activities of daily living, and physical performance in a general population](https://www.nature.com/articles/s41598-024-64706-0?fromPaywallRec=false)

ArticleOpen access09 July 2024

![](https://media.springernature.com/w215h120/springer-static/image/art%3A10.1038%2Fs41598-023-39044-2/MediaObjects/41598_2023_39044_Fig1_HTML.png)

### [Pelvic compensation accompanying spinal malalignment and back pain-related factors in a general population: the Wakayama spine study](https://www.nature.com/articles/s41598-023-39044-2?fromPaywallRec=false)

ArticleOpen access22 July 2023

![](https://media.springernature.com/w215h120/springer-static/image/art%3A10.1038%2Fs41598-023-40470-5/MediaObjects/41598_2023_40470_Fig1_HTML.png)

### [Differences in spinal posture and mobility between adults with obesity and normal weight individuals](https://www.nature.com/articles/s41598-023-40470-5?fromPaywallRec=false)

ArticleOpen access17 August 2023

## Introduction

The recent rise in disability rates among older people has become increasingly alarming in consideration of caregiver costs and associated impairments in quality of life (QOL)[1](/articles/s41598-022-12605-7#ref-CR1 "Freedman, V. A. et al. Resolving inconsistencies in trends in old-age disability: Report from a technical working group. Demography 41(3), 417–441 (2004)."). As cognitive function diminishes with age, mild cognitive impairment (MCI) is a transitional condition between cognitive decline during the normal aging process and very early dementia. Although the definition of MCI continues to change, the current consensus includes self- or informant-reported cognitive complaints, objective cognitive impairment, preserved independence in functional abilities, and no dementia[2](#ref-CR2 "Petersen, R. C. Mild cognitive impairment as a diagnostic entity. J. Intern. Med. 256(3), 183–194 (2004)."), [3](#ref-CR3 "Petersen, R. C. et al. Mild cognitive impairment: A concept in evolution. J. Intern. Med. 275(3), 214–228 (2014)."), [4](#ref-CR4 "Petersen, R. C. Mild cognitive impairment. Continuum 22(2), 404–418 (2016)."), [5](/articles/s41598-022-12605-7#ref-CR5 "Dunne, R. A. et al. Mild cognitive impairment: the Manchester consensus. Age Ageing. 50(1), 72–80 (2021)."). MCI often causes problems with memory, language, thinking, and judgment but does not comprise dementia; thus, some cases of MCI do not deteriorate further. In individuals over the age of 70 years, 14% have sufficient cognitive impairment to warrant a diagnosis of dementia[6](/articles/s41598-022-12605-7#ref-CR6 "Plassman, B. L. et al. Prevalence of dementia in the United States: The aging, demographics, and memory study. Neuroepidemiology 29(1–2), 125–132 (2007)."). Gait slowing is also common among patients with this condition[7](#ref-CR7 "Buchman, A. S. et al. Physical activity and motor decline in older persons. Muscle Nerve 35(3), 354–362 (2007)."), [8](#ref-CR8 "Verghese, J. et al. Abnormality of gait as a predictor of non-Alzheimer’s dementia. N. Engl. J. Med. 347(22), 1761–1768 (2002)."), [9](/articles/s41598-022-12605-7#ref-CR9 "Waite, L. M. et al. Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. J. Neurol. Sci. 229–230, 89–93 (2005)."). MCI rarely has a critical impact on daily life but is nonetheless a pre-disease condition with a very high probability of progressing to dementia. Several reports have shown that activities of daily living (ADL) and instrumental ADL (IADL) are already adversely affected at the MCI stage[10](/articles/s41598-022-12605-7#ref-CR10 "Ahn, I. S. et al. Impairment of instrumental activities of daily living in patients with mild cognitive impairment. Psychiatry Invest. 6(3), 180–184 (2009)."), [11](/articles/s41598-022-12605-7#ref-CR11 "Eshkoor, S. A. et al. Mild cognitive impairment and its management in older people. Clin. Interv. Aging 10, 687–693 (2015).").

It is widely recognized that sagittal spinal balance deteriorates with age[12](/articles/s41598-022-12605-7#ref-CR12 "Oe, S. et al. The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine 40(19), 1487–1497 (2015)."), [13](/articles/s41598-022-12605-7#ref-CR13 "Asai, Y. et al. Sagittal spino-pelvic alignment in adults: The Wakayama Spine Study. PLoS ONE 12(6), e0178697 (2017)."), which may hinder standing and walking in advanced cases[14](/articles/s41598-022-12605-7#ref-CR14 "Dubousset, J. Three-dimensional analysis of the scoliotic deformity. In Pediatric Spine: Principles and Practice (ed. Weinstein, S. L.) (Raven Press, New York, NY, 1994)."). Sagittal spinal alignment correlates strongly with health-related QOL, with severe spinal imbalance known to impair QOL results[15](/articles/s41598-022-12605-7#ref-CR15 "Glassman, S. D. et al. The impact of positive sagittal balance in adult spinal deformity. Spine 30(18), 2024–2029 (2005)."). Indeed, sagittal spinal balance is an important barometer of health status in seniors. Whereas severe spinal imbalances accompanied by changes in spinal alignment are now recognized as adult spinal deformity (ASD), minor or moderate changes in alignment are often considered a natural process of aging.

Although spinal alignment change and cognitive deterioration are individually acknowledged as age-related phenomena, no studies have examined for associations between those factors. Various events of age-related decline occur simultaneously or in tandem, with each not completely independent of the others. This concept has been introduced using the term "frailty" as a way of understanding the changes in health in older people[16](/articles/s41598-022-12605-7#ref-CR16 "Fried, L. P. et al. Frailty in older adults: Evidence for a phenotype. J. Gerontol. Med. Sci. 56A, M146–M156 (2001)."). We maintain that spinal imbalance is not just a problem in itself, but rather one of the manifestations of several potential frailties in older adults.

For the construction of a new population study of Japanese community-dwelling older people, eligible candidates were randomly sampled from the basic resident registry of a cooperating town in an inland rural area to minimize selection bias and obtain a cohort more representative of the general population. This epidemiological study of comprehensive locomotive health in older people was coined “the Obuse study”, bearing the name of the collaborating local government.

The hypothesis of the current study is that diminished cognitive function is detectable by the degree of spinal balance anteriorization. As such, this investigation aimed to determine whether cognitive deterioration could be detected by spinal posture assessment in the general older population using the Obuse study cohort.

## Results

Among the participants, the mean ± standard deviation distribution of male and female sagittal vertical axis (SVA) measurements was 22 ± 41 mm and 22 ± 46 mm, respectively. The SVA values for each age group are shown in Table [1](/articles/s41598-022-12605-7#Tab1). For both sexes, a moderate positive correlation was seen for age and SVA (Fig. [1](/articles/s41598-022-12605-7#Fig1)). Larger SVAs of ≥ 50 mm were more frequent in older age groups.

**Table 1 Spinal alignment parameter findings, cognitive function test scores, and prevalence rates of cognitive impairment.**

[Full size table](/articles/s41598-022-12605-7/tables/1)

**Figure 1**

[![figure 1](//media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41598-022-12605-7/MediaObjects/41598_2022_12605_Fig1_HTML.png)](/articles/s41598-022-12605-7/figures/1)

Distributions of sagittal vertical axis with age. _r_ denotes Pearson’s correlation coefficient between sagittal vertical axis and age. _SVA_ sagittal vertical axis.

[Full size image](/articles/s41598-022-12605-7/figures/1)

SVA was significantly associated with physical QOL scores. The Physical Component Summary (PCS) score of the SF-8 Health Survey was evaluated in groups of SVA < 50 mm (balanced), SVA 50–100 mm (mildly anteriorized), and SVA > 100 mm (severely anteriorized). In males, the mean ± standard deviation PCS scores were 49 ± 7, 44 ± 9, and 41 ± 10 in the balanced, mildly anteriorized, and severely anteriorized groups, respectively. These scores were 49 ± 6, 42 ± 8, and 36 ± 11, respectively, in females. In males, PCS scores were significantly lower in the mildly and severely anteriorized groups than in the balanced group ( _p_ < 0.01 and _p_ = 0.01 for balanced vs. mildly anteriorized and balanced vs. severely anteriorized, respectively, Tukey–Kramer multi-comparison method). In females, a significant difference was detected among all groups ( _p_ < 0.01, _p_ < 0.01, and _p_ = 0.01 for balanced vs. mildly anteriorized, balanced vs. severely anteriorized, and mildly anteriorized vs. severely anteriorized, respectively). Larger SVA values tended to display lower PCS scores. On the other hand, no significant relationships were observed between SVA and SF-8 Mental Component Summary (MCS) scores.

Cognitive function test scores tended to decrease with age for both genders (Table [1](/articles/s41598-022-12605-7#Tab1)). Mean Montreal Cognitive Assessment (MoCA) scores were the normal limit of 26 points in males and females in their 60's, with cognitive decline indicated in the 70's and 80's age groups. The prevalence rate of cognitive decline in males and females in their 50's was 28% and 15%, respectively, which increased by decade to more than half of participants in their 70's and over 80% of participants in their 80's. The individual testing methods did not differ significantly between genders (mean score: 25 points for both sexes for MoCA \[ _p_ = 0.47\] and 28 points for both sexes for Mini-Mental State Examination \[MMSE\] \[ _p_ = 0.89\]).

Table [2](/articles/s41598-022-12605-7#Tab2) demonstrates how age and SVA are associated with cognitive decline based on MoCA score, with additional analysis on the relationship between cognitive decline and worsening spinal alignment and links to frailty. In males, older age and greater SVA were both significantly and independently associated with cognitive decline. In univariate analysis, employment in the tertiary sector of economy was associated with decreased cognitive decline, although significance was lost in multivariate analysis. In females, age, SVA, osteoporosis, and subjective fatigue were associated with cognitive decline in univariate analysis, with a negative association for employment in the tertiary sector of economy. In multivariate analysis, age alone remained significantly associated with cognitive decline.

**Table 2 Univariate and multivariate analyses on the association of cognitive impairment with age, spinal balance, and other candidate factors.**

[Full size table](/articles/s41598-022-12605-7/tables/2)

Figure [2](/articles/s41598-022-12605-7#Fig2) presents the receiver operating characteristic (ROC) curves of cognitive decline prediction based on age and SVA scores. For males, the area under the ROC curve (AUC) for age alone, SVA alone, and the combination of age and SVA all exceeded 0.7, indicating relatively good cognitive decline prediction. In particular, the predictive ability of combined age and SVA was high, with the lower limit of the 95% confidence interval of the AUC exceeding 0.7. For females, the AUC for age, but not SVA was over 0.7 for cognitive decline prediction. Combining age and SVA did not raise the predictive value above that of age alone.

**Figure 2**

[![figure 2](//media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41598-022-12605-7/MediaObjects/41598_2022_12605_Fig2_HTML.png)](/articles/s41598-022-12605-7/figures/2)

Receiver operating characteristic curves of cognitive decline prediction based on age and/or sagittal vertical axis. _SVA_ sagittal vertical axis.

[Full size image](/articles/s41598-022-12605-7/figures/2)

Table [3](/articles/s41598-022-12605-7#Tab3) shows the positive likelihood ratios for cognitive decline determination for each cutoff combination of age and SVA. For males, several combinations could make valid cognitive decline determinations. Cases with SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all more likely to have cognitive decline than those below those values. Females with SVA ≥ 70 mm were also more likely to have cognitive decline, regardless of age.

**Table 3 Positive likelihood ratio matrix for mild cognitive impairment prediction.**

[Full size table](/articles/s41598-022-12605-7/tables/3)

## Discussion

In the present cohort study of over 400 participants randomly selected from a rural Japanese town registry, the prevalence rate of cognitive decline reached more than half among participants in their 70's and over 80% among those in their 80's. We observed that cognitive decline could be reliably detected by combining age and the degree of spinal imbalance. Males with SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all likely to have cognitive decline. Females with SVA ≥ 70 mm were also likely to have cognitive decline irrespectively of age. The combination of age and spinal balance were able to detect latent cognitive decline based on five–tenfold likelihood contrasts. In contrast, it could not rule out cognitive decline at any age and spinal balance, nor could it reveal any value as a gatekeeper measurement.

Impaired walking, standing, and standing balance have been related to elevated SVA[17](/articles/s41598-022-12605-7#ref-CR17 "Tokida, R. et al. Association between sagittal spinal alignment and physical function in the Japanese general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. J. Bone Joint Surg. Am. 101, 1698–1706 (2019)."), and previous studies showed SVA to be correlated with balance ability[18](/articles/s41598-022-12605-7#ref-CR18 "Ishikawa, Y. et al. Spinal sagittal contour affecting falls: Cut-off value of the lumbar spine for falls. Gait Posture. 38(2), 260–263 (2013)."), [19](/articles/s41598-022-12605-7#ref-CR19 "Imagama, S. et al. Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males. Eur. Spine J. 22(6), 1346–1353 (2013)."). Diminished walking, standing, and balance have been associated with poor cognitive function in older people as well[20](/articles/s41598-022-12605-7#ref-CR20 "Ikegami, S. et al. Physical performance reflects cognitive function, fall risk, and quality of life in community dwelling older people. Sci. Rep. 9, 12242 (2019)."). Therefore, we hypothesized that spinal imbalance might not only indicate poor motor function, but also reduced cognitive ability.

ASD and frailty are closely and interactively related[21](/articles/s41598-022-12605-7#ref-CR21 "Bakhsheshian, J. et al. Impact of poor mental health in adult spinal deformity patients with poor physical function: A retrospective analysis with a 2-year follow-up. J. Neurosurg. Spine. 26(1), 116–124 (2017)."). Patients with ASD cannot exercise muscular strength sufficiently and often exhibit symptoms of intermittent claudication due to back pain[22](/articles/s41598-022-12605-7#ref-CR22 "Matsuyama, Y. Surgical treatment for adult spinal deformity: Conceptual approach and surgical strategy. Spine Surg. Relat. Res. 1(2), 56–60 (2017)."). Pressure on the abdomen may also cause losses in appetite and weight and contribute to frailty. Frailty is a pre-disease condition comprehensively summarizing the symptoms accompanying aging and includes the concept of a decline in social activity due to mental and physical changes. Although frailty is reversible, the patient’s ASD may deteriorate permanently in severe cases.

On the other hand, spinal alignment changes less severe than those in ASD are not included in frailty. Such alterations tend to be regarded as a natural consequence of age. However, cognitive decline with spinal alignment changes may be a factor contributing to frailty through mental and social decline. On report found an association between severe kyphosis patients and diminished health-related QOL[23](/articles/s41598-022-12605-7#ref-CR23 "Furuto, J. & Yuki, M. Health-related QOL and self-efficacy for activities of daily living in elderly residents of mountainous areas with kyphosis: A one-year longitudinal study. Japan. J. Geriatr. 51(1), 60–68 (2014)."). Although it remains difficult to prove a direct causal relationship between postural changes and cognitive decline, our results demonstrate that spinal anteriorization and cognitive decline are correlated phenomena occurring simultaneously with age. Thus, when visible appearance changes in posture occur, appropriate diagnostic measures are advised in consideration of the possibility of cognitive impairment to help prevent frailty, dementia, and bedridden status.

Considerable research has been conducted on the relationship between motor and cognitive function, including the Obuse study[20](/articles/s41598-022-12605-7#ref-CR20 "Ikegami, S. et al. Physical performance reflects cognitive function, fall risk, and quality of life in community dwelling older people. Sci. Rep. 9, 12242 (2019)."). When muscle weakness, decreased walking ability, and other forms of physical function deterioration are present, a risk of AD and dementia may exist[24](#ref-CR24 "Aggarwal, N. T. et al. Motor dysfunction in mild cognitive impairment and the risk of incident Alzheimer disease. Arch. Neurol. 63(12), 1763–1769 (2006)."), [25](#ref-CR25 "Boyle, P. A. et al. Association of muscle strength with the risk of Alzheimer disease and the rate of cognitive decline in community-dwelling older persons. Arch. Neurol. 66(11), 1339–1344 (2009)."), [26](#ref-CR26 "Buchman, A. S. et al. Grip strength and the risk of incident Alzheimer’s disease. Neuroepidemiology 29(1–2), 66–73 (2007)."), [27](/articles/s41598-022-12605-7#ref-CR27 "Hooghiemstra, A. M. et al. Gait speed and grip strength reflect cognitive impairment and are modestly related to incident cognitive decline in memory clinic patients with subjective cognitive decline and mild cognitive impairment: findings from the 4C study. J. Gerontol. A Biol. Sci. Med. Sci. 72(6), 846–854 (2017)."). In addition, cognitive function deterioration was identified as a risk factor for physical function decline[28](/articles/s41598-022-12605-7#ref-CR28 "Mielke, M. M. et al. Assessing the temporal relationship between cognition and gait: Slow gait predicts cognitive decline in the Mayo Clinic Study of Aging. J. Gerontol. A Biol. Sci. Med. Sci. 68(8), 929–937 (2013)."). In the broad sense of the term, cognitive frailty is a condition in which physical and cognitive decline coexist. Cognitive frailty is a high-risk disorder that has gained attention in recent years[29](/articles/s41598-022-12605-7#ref-CR29 "Sugimoto, T. et al. Epidemiological and clinical significance of cognitive frailty: A mini review. Ageing Res. Rev. 44, 1–7 (2018)."). Nara et al. described that a MoCA cut-off score of 23 might be useful to predict cognitive function at a potentially reversible stage with exercise training in community-dwelling Japanese older adults with cognitive decline[30](/articles/s41598-022-12605-7#ref-CR30 "Nara, M. et al. Japanese version of the Montreal Cognitive Assessment cut-off score to clarify improvement of mild cognitive impairment after exercise training in community-dwelling older adults. Geriatr. Gerontol. Int. 18(6), 833–838 (2018)."). Of the 411 subjects in the present study, there were 119 (29%) who scored < 26 points and ≥ 23 points for MoCA. If cognitive decline can improve with appropriate intervention in this population, it may be desirable to adopt a variety of approaches to such a condition. The mild deterioration of cognitive function is a difficult parameter to notice among the age-related changes that lead to frailty. Just as osteoporosis has been under-detected in the older population, cognitive deterioration may suffer from this problem as well. Testing that requires special equipment or additional time, even that with good detection capability, may be limited as an exam method in the older population. We herein propose a method to detect cognitive decline based on SVA, a representative radiological indicator of spinal balance anteriorization that may incidentally be obtained in other examinations. However, a more intuitive method for noticing spinal posture changes may be more efficient in revealing latent cognitive decline.

The limitations of the current investigation include a cross-sectional design and the possibility of selection bias. First, since this was a cross-sectional study, the causal relationship between sagittal spinal balance and cognitive function could not be established. Cognitive function is influenced by numerous direct factors which include genetic, health, and environmental sources. Due to the multifactorial nature of cognitive function, the present study investigating indirect factor (i.e., sagittal spinal alignment) associations should have ideally considered more possible confounders. However, it was not possible to completely account for the myriad of relevant factors, especially potential ones, and longitudinal studies using this investigation as a prelude are being planned. Furthermore, sagittal spinal alignment is also considerably influenced by numerous factors, such as age, lifestyle, disability of physical activities, osteoporosis, degenerative joint disease, spinal disease including lumbar stenosis and degenerative sagittal imbalance, and pain; even in the same person, sagittal spinal alignment may change daily according to his or her physical condition. As this study merely presents correlations, longitudinal research is necessary to exclude the effects of relevant confounders and address the basis of the association, including causal relationships. Longitudinal studies will also help reveal which of spinal balance anteriorization or cognitive decline occurs first. Second, since this was a non-compulsory survey, the proportion of randomly sampled people who ultimately participated in the survey was less than half, implying incomplete selection bias elimination. Nevertheless, the Obuse study cohort closely resembled the average Japanese population due to its distinctive survey design. In order to maintain ADL, IADL, and QOL in older people, it will be necessary to monitor for signs of impending cognitive impairment that may lead to frailty and dementia. Our results showed that the anteriorization of spinal balance existed at the onset of cognitive impairment. Accordingly, greater attention is warranted to changes in posture among community-dwelling older people. Lastly, potential human error in the measurement of radiographic angles is an important limitation that must be mentioned. Advanced evaluation techniques, such as the use of machine learning, are being considered to improve the accuracy and reliability of measurements for future work.

In conclusion, spinal balance anteriorization was significantly associated with cognitive function decline in Japanese older adults. Cognitive decline could be reliably detected by combining age and the degree of spinal imbalance. Males with SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years are likely to have cognitive decline, while females with SVA ≥ 70 mm at any age are likely to harbor this condition. Such visible clues as the anteriorization of spinal balance can help to more easily monitor for signs of impending cognitive impairment, which may lead to dementia and frailty.

## Methods

This study was approved by the investigational review board of Shinshu University Hospital (approval number: 2792) and performed in accordance with the Declaration of Helsinki and the STROBE Statement. All participants provided written informed consent for study participation.

### Construction of cohort classified by sex and age group

The participant group in this study was the Obuse study cohort based on a basic municipal resident registry. The construction procedure of the cohort is described in a previous report[31](/articles/s41598-022-12605-7#ref-CR31 "Uehara, M. et al. Sagittal spinal alignment deviation in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. Spine J. 19(2), 349–356 (2019)."). Briefly, we randomly sampled 1,297 individuals from 5352 people aged between 50 and 89 years in the basic resident registry of Obuse town in 2014. After providing written consent, 415 participants were enrolled in the Obuse study. A total of 411 participants (202 male and 209 female) were included after the exclusion of 4 candidates, which included 2 candidates unable to participate in radiological assessments, 1 candidate already diagnosed as having dementia, and 1 candidate with a postural disorder due to Parkinson's disease. Table [4](/articles/s41598-022-12605-7#Tab4) summarizes the characteristics of each group. The primary employment sector was related to the agricultural industry, the secondary sector was manufacturing, and the tertiary sector was the service industry. The regional characteristics of the cooperating town included rural and urban areas, with high levels of employment in the agricultural and service industries. Thus, the participants were mainly employed in the primary and tertiary sectors, with relatively few in the secondary sector. The proportion of unemployment increased with age, especially since the general retirement age in Japan is 60–65 years old.

**Table 4 Characteristics of the study cohort.**

[Full size table](/articles/s41598-022-12605-7/tables/4)

### Measurements of spinal alignment

All participants underwent whole-spine lateral radiography in a standing position (fists on clavicles position) for the measurement of SVA as a parameter of sub-cervical total spinal alignment (Fig. [3](/articles/s41598-022-12605-7#Fig3)). SVA was measured as the distance from the plumb line from the center of C7 to the posterior edge of the upper sacral endplate surface. The averaged values of 2 spine surgeons (M.U. and S.I.) and a trained staff member (R.T. or H.N.) were calculated for the analysis. Inter-rater reliability was high at 0.95.

**Figure 3**

[![figure 3](//media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41598-022-12605-7/MediaObjects/41598_2022_12605_Fig3_HTML.png)](/articles/s41598-022-12605-7/figures/3)

Sagittal vertical axis as a radiological parameter representing sagittal spinal balance. ( **a**) SVA is the distance from the plumb line from the center of C7 to the posterior edge of the upper sacral endplate surface; ( **b**) SVA = 0 mm, which is in sagittal balance; ( **c**) SVA = 70 mm, which represents sagittal balance anteriorization; ( **d**) SVA = 95 mm, which is highly anteriorized and indicates sagittal imbalance. _SVA_ sagittal vertical axis.

[Full size image](/articles/s41598-022-12605-7/figures/3)

### Cognitive function testing

We employed 2 tests to evaluate cognitive function: MoCA and MMSE. As a tool to determine the existence of MCI, the 30-point MoCA provides higher a sensitivity and specificity than does the 30-point MMSE, another representative cognitive function evaluation method[32](/articles/s41598-022-12605-7#ref-CR32 "Nasreddine, Z. S. et al. The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 53(4), 695–699 (2005)."), [33](/articles/s41598-022-12605-7#ref-CR33 "Fujiwara, Y. et al. Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr. Gerontol. Int. 10(3), 225–232 (2010)."). Participants with ≥ 26 points for MoCA were considered normal (sensitivity: ≥ 94%, specificity: ≤ 60%)[34](/articles/s41598-022-12605-7#ref-CR34 "Davis, D. H. et al. Montreal Cognitive assessment for the diagnosis of Alzheimer’s disease and other dementias. Cochrane Database Syst. Rev. 10, CD010775 (2015)."), with those scoring ≤ 25 points as having cognitive impairment[32](/articles/s41598-022-12605-7#ref-CR32 "Nasreddine, Z. S. et al. The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. J. Am. Geriatr. Soc. 53(4), 695–699 (2005)."). Similarly for MMSE, a score of < 24 points was judged as suspected dementia[35](/articles/s41598-022-12605-7#ref-CR35 "Folstein, M. F., Folstein, S. E. & McHugh, P. R. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12(3), 189–198 (1975)."), [36](/articles/s41598-022-12605-7#ref-CR36 "Tsoi, K. K. et al. Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Intern. Med. 175(9), 1450–1458 (2015)."). The Japanese version of both questionnaires was used. The cognitive impairment measured in this epidemiological study was defined solely by screening test (MoCA and MMSE) scores. For analysis, we regarded the presence of cognitive decline as a MoCA score of < 26 points. In order to precisely define cognitive impairment, including MCI, as a disease requiring treatment, however, further comprehensive examination and exclusion of other conditions are required[37](/articles/s41598-022-12605-7#ref-CR37 "Arevalo-Rodriguez, I. et al. Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 3, CD010783 (2015).").

### Health-related QOL assessments and other interview information

SF-8 Health Survey measures were determined for all participants for health-related QOL evaluation. Results were calculated and expressed as 2 summary scores: PCS and MCS. Information related to frailty was also collected via interviews, including that on osteoporosis, spine and joint disease, weight loss within 6 months, subjective fatigue, and degree of low back pain (visual analogue scale of 0–100 mm).

### Statistical analyses

The relationship between age and SVA was assessed by Pearson’s correlation coefficient for each gender. The mean and standard deviation of the cognitive function test scores for each age and sex group were calculated along with the prevalence of cognitive impairment. Calculated cognitive function testing results between genders were assessed using Welch’s _t_-test. In the evaluation of the impact of age and SVA on cognitive decline, we employed univariate and multivariate logistic analyses with the presence of cognitive decline as the response variable and age and SVA as the explanatory variables. In addition to age and spinal alignment, BMI and information obtained from interviews (history of osteoporosis, spinal disease, arthritis, degree of low back pain, weight loss within 6 months, subjective fatigue, and job category) were included in the analyses as candidate factors. Candidate factors with _p_-values of < 0.1 in univariate analysis were included in subsequent multivariate analysis.

ROC analysis was performed to assess the power of cognitive decline detection by age and/or SVA. In AUC calculations, a value of ≥ 0.7 was considered a sufficient curve pattern for reliable prediction. Afterwards, matrices of positive likelihood ratios were constructed for combinations of age and SVA, whereby a positive likelihood ratio of ≥ 5.0 was considered useful for a suspected diagnosis and a ratio of ≥ 10.0 being considered a confident diagnosis. Positive likelihood ratios of < 5.0 were interpreted as having no screening value.

Statistical analyses were carried out using the statistical package R, version 3.6.2 (available at: [http://www.r-project.org](http://www.r-project.org)). The level of significance was set at _p_ < 0.05.

## References

01. Freedman, V. A. _et al._ Resolving inconsistencies in trends in old-age disability: Report from a technical working group. _Demography_ **41**(3), 417–441 (2004).

    [Article](https://doi.org/10.1353%2Fdem.2004.0022) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Resolving%20inconsistencies%20in%20trends%20in%20old-age%20disability%3A%20Report%20from%20a%20technical%20working%20group&journal=Demography&doi=10.1353%2Fdem.2004.0022&volume=41&issue=3&pages=417-441&publication_year=2004&author=Freedman%2CVA)

02. Petersen, R. C. Mild cognitive impairment as a diagnostic entity. _J. Intern. Med._ **256**(3), 183–194 (2004).

    [Article](https://doi.org/10.1111%2Fj.1365-2796.2004.01388.x) [CAS](/articles/cas-redirect/1:STN:280:DC%2BD2cvhvFCkug%3D%3D) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Mild%20cognitive%20impairment%20as%20a%20diagnostic%20entity&journal=J.%20Intern.%20Med.&doi=10.1111%2Fj.1365-2796.2004.01388.x&volume=256&issue=3&pages=183-194&publication_year=2004&author=Petersen%2CRC)

03. Petersen, R. C. _et al._ Mild cognitive impairment: A concept in evolution. _J. Intern. Med._ **275**(3), 214–228 (2014).

    [Article](https://doi.org/10.1111%2Fjoim.12190) [CAS](/articles/cas-redirect/1:STN:280:DC%2BC2crhsFaqtA%3D%3D) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Mild%20cognitive%20impairment%3A%20A%20concept%20in%20evolution&journal=J.%20Intern.%20Med.&doi=10.1111%2Fjoim.12190&volume=275&issue=3&pages=214-228&publication_year=2014&author=Petersen%2CRC)

04. Petersen, R. C. Mild cognitive impairment. _Continuum_ **22**(2), 404–418 (2016).

    [PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=27042901) [PubMed Central](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390929) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Mild%20cognitive%20impairment&journal=Continuum&volume=22&issue=2&pages=404-418&publication_year=2016&author=Petersen%2CRC)

05. Dunne, R. A. _et al._ Mild cognitive impairment: the Manchester consensus. _Age Ageing._ **50**(1), 72–80 (2021).

    [Article](https://doi.org/10.1093%2Fageing%2Fafaa228) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Mild%20cognitive%20impairment%3A%20the%20Manchester%20consensus&journal=Age%20Ageing.&doi=10.1093%2Fageing%2Fafaa228&volume=50&issue=1&pages=72-80&publication_year=2021&author=Dunne%2CRA)

06. Plassman, B. L. _et al._ Prevalence of dementia in the United States: The aging, demographics, and memory study. _Neuroepidemiology_ **29**(1–2), 125–132 (2007).

    [Article](https://doi.org/10.1159%2F000109998) [CAS](/articles/cas-redirect/1:STN:280:DC%2BD2sjgs1ymuw%3D%3D) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Prevalence%20of%20dementia%20in%20the%20United%20States%3A%20The%20aging%2C%20demographics%2C%20and%20memory%20study&journal=Neuroepidemiology&doi=10.1159%2F000109998&volume=29&issue=1%E2%80%932&pages=125-132&publication_year=2007&author=Plassman%2CBL)

07. Buchman, A. S. _et al._ Physical activity and motor decline in older persons. _Muscle Nerve_ **35**(3), 354–362 (2007).

    [Article](https://doi.org/10.1002%2Fmus.20702) [CAS](/articles/cas-redirect/1:STN:280:DC%2BD2s7gtVKjtA%3D%3D) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Physical%20activity%20and%20motor%20decline%20in%20older%20persons&journal=Muscle%20Nerve&doi=10.1002%2Fmus.20702&volume=35&issue=3&pages=354-362&publication_year=2007&author=Buchman%2CAS)

08. Verghese, J. _et al._ Abnormality of gait as a predictor of non-Alzheimer’s dementia. _N. Engl. J. Med._ **347**(22), 1761–1768 (2002).

    [Article](https://doi.org/10.1056%2FNEJMoa020441) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Abnormality%20of%20gait%20as%20a%20predictor%20of%20non-Alzheimer%27s%20dementia&journal=N.%20Engl.%20J.%20Med.&doi=10.1056%2FNEJMoa020441&volume=347&issue=22&pages=1761-1768&publication_year=2002&author=Verghese%2CJ)

09. Waite, L. M. _et al._ Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. _J. Neurol. Sci._ **229–230**, 89–93 (2005).

    [Article](https://doi.org/10.1016%2Fj.jns.2004.11.009) [ADS](http://adsabs.harvard.edu/cgi-bin/nph-data_query?link_type=ABSTRACT&bibcode=2005ApSS..251...89W) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Gait%20slowing%20as%20a%20predictor%20of%20incident%20dementia%3A%206-year%20longitudinal%20data%20from%20the%20Sydney%20Older%20Persons%20Study&journal=J.%20Neurol.%20Sci.&doi=10.1016%2Fj.jns.2004.11.009&volume=229%E2%80%93230&pages=89-93&publication_year=2005&author=Waite%2CLM)

10. Ahn, I. S. _et al._ Impairment of instrumental activities of daily living in patients with mild cognitive impairment. _Psychiatry Invest._ **6**(3), 180–184 (2009).

    [Article](https://doi.org/10.4306%2Fpi.2009.6.3.180) [MathSciNet](http://www.ams.org/mathscinet-getitem?mr=2495648) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Impairment%20of%20instrumental%20activities%20of%20daily%20living%20in%20patients%20with%20mild%20cognitive%20impairment&journal=Psychiatry%20Invest.&doi=10.4306%2Fpi.2009.6.3.180&volume=6&issue=3&pages=180-184&publication_year=2009&author=Ahn%2CIS)

11. Eshkoor, S. A. _et al._ Mild cognitive impairment and its management in older people. _Clin. Interv. Aging_ **10**, 687–693 (2015).

    [Article](https://doi.org/10.2147%2FCIA.S73922) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Mild%20cognitive%20impairment%20and%20its%20management%20in%20older%20people&journal=Clin.%20Interv.%20Aging&doi=10.2147%2FCIA.S73922&volume=10&pages=687-693&publication_year=2015&author=Eshkoor%2CSA)

12. Oe, S. _et al._ The influence of age and sex on cervical spinal alignment among volunteers aged over 50. _Spine_ **40**(19), 1487–1497 (2015).

    [Article](https://doi.org/10.1097%2FBRS.0000000000001071) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=The%20influence%20of%20age%20and%20sex%20on%20cervical%20spinal%20alignment%20among%20volunteers%20aged%20over%2050&journal=Spine&doi=10.1097%2FBRS.0000000000001071&volume=40&issue=19&pages=1487-1497&publication_year=2015&author=Oe%2CS)

13. Asai, Y. _et al._ Sagittal spino-pelvic alignment in adults: The Wakayama Spine Study. _PLoS ONE_ **12**(6), e0178697 (2017).

    [Article](https://doi.org/10.1371%2Fjournal.pone.0178697) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Sagittal%20spino-pelvic%20alignment%20in%20adults%3A%20The%20Wakayama%20Spine%20Study&journal=PLoS%20ONE&doi=10.1371%2Fjournal.pone.0178697&volume=12&issue=6&publication_year=2017&author=Asai%2CY)

14. Dubousset, J. Three-dimensional analysis of the scoliotic deformity. In _Pediatric Spine: Principles and Practice_ (ed. Weinstein, S. L.) (Raven Press, New York, NY, 1994).

    [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Three-dimensional%20analysis%20of%20the%20scoliotic%20deformity&publication_year=1994&author=Dubousset%2CJ)

15. Glassman, S. D. _et al._ The impact of positive sagittal balance in adult spinal deformity. _Spine_ **30**(18), 2024–2029 (2005).

    [Article](https://doi.org/10.1097%2F01.brs.0000179086.30449.96) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=The%20impact%20of%20positive%20sagittal%20balance%20in%20adult%20spinal%20deformity&journal=Spine&doi=10.1097%2F01.brs.0000179086.30449.96&volume=30&issue=18&pages=2024-2029&publication_year=2005&author=Glassman%2CSD)

16. Fried, L. P. _et al._ Frailty in older adults: Evidence for a phenotype. _J. Gerontol. Med. Sci._ **56A**, M146–M156 (2001).

    [Article](https://doi.org/10.1093%2Fgerona%2F56.3.M146) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Frailty%20in%20older%20adults%3A%20Evidence%20for%20a%20phenotype&journal=J.%20Gerontol.%20Med.%20Sci.&doi=10.1093%2Fgerona%2F56.3.M146&volume=56A&pages=M146-M156&publication_year=2001&author=Fried%2CLP)

17. Tokida, R. _et al._ Association between sagittal spinal alignment and physical function in the Japanese general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. _J. Bone Joint Surg. Am._ **101**, 1698–1706 (2019).

    [Article](https://doi.org/10.2106%2FJBJS.18.01384) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Association%20between%20sagittal%20spinal%20alignment%20and%20physical%20function%20in%20the%20Japanese%20general%20elderly%20population%3A%20A%20Japanese%20cohort%20survey%20randomly%20sampled%20from%20a%20basic%20resident%20registry&journal=J.%20Bone%20Joint%20Surg.%20Am.&doi=10.2106%2FJBJS.18.01384&volume=101&pages=1698-1706&publication_year=2019&author=Tokida%2CR)

18. Ishikawa, Y. _et al._ Spinal sagittal contour affecting falls: Cut-off value of the lumbar spine for falls. _Gait Posture._ **38**(2), 260–263 (2013).

    [Article](https://doi.org/10.1016%2Fj.gaitpost.2012.11.024) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Spinal%20sagittal%20contour%20affecting%20falls%3A%20Cut-off%20value%20of%20the%20lumbar%20spine%20for%20falls&journal=Gait%20Posture.&doi=10.1016%2Fj.gaitpost.2012.11.024&volume=38&issue=2&pages=260-263&publication_year=2013&author=Ishikawa%2CY)

19. Imagama, S. _et al._ Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males. _Eur. Spine J._ **22**(6), 1346–1353 (2013).

    [Article](https://link.springer.com/doi/10.1007/s00586-013-2721-9) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Influence%20of%20spinal%20sagittal%20alignment%2C%20body%20balance%2C%20muscle%20strength%2C%20and%20physical%20ability%20on%20falling%20of%20middle-aged%20and%20elderly%20males&journal=Eur.%20Spine%20J.&doi=10.1007%2Fs00586-013-2721-9&volume=22&issue=6&pages=1346-1353&publication_year=2013&author=Imagama%2CS)

20. Ikegami, S. _et al._ Physical performance reflects cognitive function, fall risk, and quality of life in community dwelling older people. _Sci. Rep._ **9**, 12242 (2019).

    [Article](https://doi.org/10.1038%2Fs41598-019-48793-y) [ADS](http://adsabs.harvard.edu/cgi-bin/nph-data_query?link_type=ABSTRACT&bibcode=2019NatSR...912242I) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Physical%20performance%20reflects%20cognitive%20function%2C%20fall%20risk%2C%20and%20quality%20of%20life%20in%20community%20dwelling%20older%20people&journal=Sci.%20Rep.&doi=10.1038%2Fs41598-019-48793-y&volume=9&publication_year=2019&author=Ikegami%2CS)

21. Bakhsheshian, J. _et al._ Impact of poor mental health in adult spinal deformity patients with poor physical function: A retrospective analysis with a 2-year follow-up. _J. Neurosurg. Spine._ **26**(1), 116–124 (2017).

    [Article](https://doi.org/10.3171%2F2016.5.SPINE151428) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Impact%20of%20poor%20mental%20health%20in%20adult%20spinal%20deformity%20patients%20with%20poor%20physical%20function%3A%20A%20retrospective%20analysis%20with%20a%202-year%20follow-up&journal=J.%20Neurosurg.%20Spine.&doi=10.3171%2F2016.5.SPINE151428&volume=26&issue=1&pages=116-124&publication_year=2017&author=Bakhsheshian%2CJ)

22. Matsuyama, Y. Surgical treatment for adult spinal deformity: Conceptual approach and surgical strategy. _Spine Surg. Relat. Res._ **1**(2), 56–60 (2017).

    [Article](https://doi.org/10.22603%2Fssrr.1.2016-0036) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Surgical%20treatment%20for%20adult%20spinal%20deformity%3A%20Conceptual%20approach%20and%20surgical%20strategy&journal=Spine%20Surg.%20Relat.%20Res.&doi=10.22603%2Fssrr.1.2016-0036&volume=1&issue=2&pages=56-60&publication_year=2017&author=Matsuyama%2CY)

23. Furuto, J. & Yuki, M. Health-related QOL and self-efficacy for activities of daily living in elderly residents of mountainous areas with kyphosis: A one-year longitudinal study. _Japan. J. Geriatr._ **51**(1), 60–68 (2014).

    [Article](https://doi.org/10.3143%2Fgeriatrics.51.60) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Health-related%20QOL%20and%20self-efficacy%20for%20activities%20of%20daily%20living%20in%20elderly%20residents%20of%20mountainous%20areas%20with%20kyphosis%3A%20A%20one-year%20longitudinal%20study&journal=Japan.%20J.%20Geriatr.&doi=10.3143%2Fgeriatrics.51.60&volume=51&issue=1&pages=60-68&publication_year=2014&author=Furuto%2CJ&author=Yuki%2CM)

24. Aggarwal, N. T. _et al._ Motor dysfunction in mild cognitive impairment and the risk of incident Alzheimer disease. _Arch. Neurol._ **63**(12), 1763–1769 (2006).

    [Article](https://doi.org/10.1001%2Farchneur.63.12.1763) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Motor%20dysfunction%20in%20mild%20cognitive%20impairment%20and%20the%20risk%20of%20incident%20Alzheimer%20disease&journal=Arch.%20Neurol.&doi=10.1001%2Farchneur.63.12.1763&volume=63&issue=12&pages=1763-1769&publication_year=2006&author=Aggarwal%2CNT)

25. Boyle, P. A. _et al._ Association of muscle strength with the risk of Alzheimer disease and the rate of cognitive decline in community-dwelling older persons. _Arch. Neurol._ **66**(11), 1339–1344 (2009).

    [Article](https://doi.org/10.1001%2Farchneurol.2009.240) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Association%20of%20muscle%20strength%20with%20the%20risk%20of%20Alzheimer%20disease%20and%20the%20rate%20of%20cognitive%20decline%20in%20community-dwelling%20older%20persons&journal=Arch.%20Neurol.&doi=10.1001%2Farchneurol.2009.240&volume=66&issue=11&pages=1339-1344&publication_year=2009&author=Boyle%2CPA)

26. Buchman, A. S. _et al._ Grip strength and the risk of incident Alzheimer’s disease. _Neuroepidemiology_ **29**(1–2), 66–73 (2007).

    [Article](https://doi.org/10.1159%2F000109498) [MathSciNet](http://www.ams.org/mathscinet-getitem?mr=2333166) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Grip%20strength%20and%20the%20risk%20of%20incident%20Alzheimer%27s%20disease&journal=Neuroepidemiology&doi=10.1159%2F000109498&volume=29&issue=1%E2%80%932&pages=66-73&publication_year=2007&author=Buchman%2CAS)

27. Hooghiemstra, A. M. _et al._ Gait speed and grip strength reflect cognitive impairment and are modestly related to incident cognitive decline in memory clinic patients with subjective cognitive decline and mild cognitive impairment: findings from the 4C study. _J. Gerontol. A Biol. Sci. Med. Sci._ **72**(6), 846–854 (2017).

    [Article](https://doi.org/10.1093%2Fgerona%2Fglx003) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Gait%20speed%20and%20grip%20strength%20reflect%20cognitive%20impairment%20and%20are%20modestly%20related%20to%20incident%20cognitive%20decline%20in%20memory%20clinic%20patients%20with%20subjective%20cognitive%20decline%20and%20mild%20cognitive%20impairment%3A%20findings%20from%20the%204C%20study&journal=J.%20Gerontol.%20A%20Biol.%20Sci.%20Med.%20Sci.&doi=10.1093%2Fgerona%2Fglx003&volume=72&issue=6&pages=846-854&publication_year=2017&author=Hooghiemstra%2CAM)

28. Mielke, M. M. _et al._ Assessing the temporal relationship between cognition and gait: Slow gait predicts cognitive decline in the Mayo Clinic Study of Aging. _J. Gerontol. A Biol. Sci. Med. Sci._ **68**(8), 929–937 (2013).

    [Article](https://doi.org/10.1093%2Fgerona%2Fgls256) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Assessing%20the%20temporal%20relationship%20between%20cognition%20and%20gait%3A%20Slow%20gait%20predicts%20cognitive%20decline%20in%20the%20Mayo%20Clinic%20Study%20of%20Aging&journal=J.%20Gerontol.%20A%20Biol.%20Sci.%20Med.%20Sci.&doi=10.1093%2Fgerona%2Fgls256&volume=68&issue=8&pages=929-937&publication_year=2013&author=Mielke%2CMM)

29. Sugimoto, T. _et al._ Epidemiological and clinical significance of cognitive frailty: A mini review. _Ageing Res. Rev._ **44**, 1–7 (2018).

    [Article](https://doi.org/10.1016%2Fj.arr.2018.03.002) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Epidemiological%20and%20clinical%20significance%20of%20cognitive%20frailty%3A%20A%20mini%20review&journal=Ageing%20Res.%20Rev.&doi=10.1016%2Fj.arr.2018.03.002&volume=44&pages=1-7&publication_year=2018&author=Sugimoto%2CT)

30. Nara, M. _et al._ Japanese version of the Montreal Cognitive Assessment cut-off score to clarify improvement of mild cognitive impairment after exercise training in community-dwelling older adults. _Geriatr. Gerontol. Int._ **18**(6), 833–838 (2018).

    [Article](https://doi.org/10.1111%2Fggi.13253) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Japanese%20version%20of%20the%20Montreal%20Cognitive%20Assessment%20cut-off%20score%20to%20clarify%20improvement%20of%20mild%20cognitive%20impairment%20after%20exercise%20training%20in%20community-dwelling%20older%20adults&journal=Geriatr.%20Gerontol.%20Int.&doi=10.1111%2Fggi.13253&volume=18&issue=6&pages=833-838&publication_year=2018&author=Nara%2CM)

31. Uehara, M. _et al._ Sagittal spinal alignment deviation in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. _Spine J._ **19**(2), 349–356 (2019).

    [Article](https://doi.org/10.1016%2Fj.spinee.2018.06.346) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Sagittal%20spinal%20alignment%20deviation%20in%20the%20general%20elderly%20population%3A%20A%20Japanese%20cohort%20survey%20randomly%20sampled%20from%20a%20basic%20resident%20registry&journal=Spine%20J.&doi=10.1016%2Fj.spinee.2018.06.346&volume=19&issue=2&pages=349-356&publication_year=2019&author=Uehara%2CM)

32. Nasreddine, Z. S. _et al._ The montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. _J. Am. Geriatr. Soc._ **53**(4), 695–699 (2005).

    [Article](https://doi.org/10.1111%2Fj.1532-5415.2005.53221.x) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=The%20montreal%20cognitive%20assessment%2C%20MoCA%3A%20A%20brief%20screening%20tool%20for%20mild%20cognitive%20impairment&journal=J.%20Am.%20Geriatr.%20Soc.&doi=10.1111%2Fj.1532-5415.2005.53221.x&volume=53&issue=4&pages=695-699&publication_year=2005&author=Nasreddine%2CZS)

33. Fujiwara, Y. _et al._ Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment. _Geriatr. Gerontol. Int._ **10**(3), 225–232 (2010).

    [Article](https://doi.org/10.1111%2Fj.1447-0594.2010.00585.x) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Brief%20screening%20tool%20for%20mild%20cognitive%20impairment%20in%20older%20Japanese%3A%20Validation%20of%20the%20Japanese%20version%20of%20the%20Montreal%20Cognitive%20Assessment&journal=Geriatr.%20Gerontol.%20Int.&doi=10.1111%2Fj.1447-0594.2010.00585.x&volume=10&issue=3&pages=225-232&publication_year=2010&author=Fujiwara%2CY)

34. Davis, D. H. _et al._ Montreal Cognitive assessment for the diagnosis of Alzheimer’s disease and other dementias. _Cochrane Database Syst. Rev._ **10**, CD010775 (2015).

    [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Montreal%20Cognitive%20assessment%20for%20the%20diagnosis%20of%20Alzheimer%27s%20disease%20and%20other%20dementias&journal=Cochrane%20Database%20Syst.%20Rev.&volume=10&publication_year=2015&author=Davis%2CDH)

35. Folstein, M. F., Folstein, S. E. & McHugh, P. R. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. _J. Psychiatr. Res._ **12**(3), 189–198 (1975).

    [Article](https://doi.org/10.1016%2F0022-3956%2875%2990026-6) [CAS](/articles/cas-redirect/1:STN:280:DyaE28%2FntFKjtw%3D%3D) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=%22Mini-mental%20state%22%3A%20A%20practical%20method%20for%20grading%20the%20cognitive%20state%20of%20patients%20for%20the%20clinician&journal=J.%20Psychiatr.%20Res.&doi=10.1016%2F0022-3956%2875%2990026-6&volume=12&issue=3&pages=189-198&publication_year=1975&author=Folstein%2CMF&author=Folstein%2CSE&author=McHugh%2CPR)

36. Tsoi, K. K. _et al._ Cognitive tests to detect dementia: A systematic review and meta-analysis. _JAMA Intern. Med._ **175**(9), 1450–1458 (2015).

    [Article](https://doi.org/10.1001%2Fjamainternmed.2015.2152) [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Cognitive%20tests%20to%20detect%20dementia%3A%20A%20systematic%20review%20and%20meta-analysis&journal=JAMA%20Intern.%20Med.&doi=10.1001%2Fjamainternmed.2015.2152&volume=175&issue=9&pages=1450-1458&publication_year=2015&author=Tsoi%2CKK)

37. Arevalo-Rodriguez, I. _et al._ Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). _Cochrane Database Syst Rev._ **3**, CD010783 (2015).

    [Google Scholar](http://scholar.google.com/scholar_lookup?&title=Mini-Mental%20State%20Examination%20%28MMSE%29%20for%20the%20detection%20of%20Alzheimer%27s%20disease%20and%20other%20dementias%20in%20people%20with%20mild%20cognitive%20impairment%20%28MCI%29&journal=Cochrane%20Database%20Syst%20Rev.&volume=3&publication_year=2015&author=Arevalo-Rodriguez%2CI)


[Download references](https://citation-needed.springer.com/v2/references/10.1038/s41598-022-12605-7?format=refman&flavour=references)

## Acknowledgements

We thank Dr. Noriko Sakai of the Department of Orthopaedic Surgery at New Life Hospital, Dr. Hironobu Sato of the Obuse Town Institute for Community Health Promotion, Prof. Takashi Igarashi of the Center for Clinical Research at Shinshu University Hospital, and the Obuse town office for sample selection in this study. This work was supported by a grant from the Japan Orthopaedics and Traumatology Research Foundation, Inc. \[no. 339\], Shinshu Public Utility Foundation for Promotion of Medical Sciences, Research Funding from the Japanese Society for Musculoskeletal Medicine, the Promotion Project of Education, Research, and Medical Care from Shinshu University Hospital, and The Nakatomi Foundation. None of the above funding sources had any role in the design, execution, analysis, interpretation of data, or writing of the study.

## Author information

### Authors and Affiliations

1. Rehabilitation Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

Hikaru Nishimura & Ryosuke Tokida

2. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

Shota Ikegami, Masashi Uehara, Jun Takahashi & Hiroyuki Kato


Authors

1. Hikaru Nishimura


[View author publications](/search?author=Hikaru%20Nishimura)





You can also search for this author in
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Hikaru%20Nishimura) [Google Scholar](http://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Hikaru%20Nishimura%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en)

2. Shota Ikegami


[View author publications](/search?author=Shota%20Ikegami)





You can also search for this author in
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Shota%20Ikegami) [Google Scholar](http://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Shota%20Ikegami%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en)

3. Masashi Uehara


[View author publications](/search?author=Masashi%20Uehara)





You can also search for this author in
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Masashi%20Uehara) [Google Scholar](http://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Masashi%20Uehara%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en)

4. Jun Takahashi


[View author publications](/search?author=Jun%20Takahashi)





You can also search for this author in
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Jun%20Takahashi) [Google Scholar](http://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Jun%20Takahashi%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en)

5. Ryosuke Tokida


[View author publications](/search?author=Ryosuke%20Tokida)





You can also search for this author in
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Ryosuke%20Tokida) [Google Scholar](http://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Ryosuke%20Tokida%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en)

6. Hiroyuki Kato


[View author publications](/search?author=Hiroyuki%20Kato)





You can also search for this author in
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=search&term=Hiroyuki%20Kato) [Google Scholar](http://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Hiroyuki%20Kato%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en)


### Contributions

H.N. and S.I. analyzed the data and wrote the main manuscript text. M.U. and R.T. performed the experiments. S.I. made the figures. J.T. and H.K. initiated the study and supervised all aspects of the work. All authors reviewed and approved the manuscript.

### Corresponding author

Correspondence to
[Shota Ikegami](mailto:sh.ikegami@gmail.com).

## Ethics declarations

### Competing interests

The authors declare no competing interests.

## Additional information

### Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

## Rights and permissions

**Open Access** This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/).

[Reprints and permissions](https://s100.copyright.com/AppDispatchServlet?title=Detection%20of%20cognitive%20decline%20by%20spinal%20posture%20assessment%20in%20health%20exams%20of%20the%20general%20older%20population&author=Hikaru%20Nishimura%20et%20al&contentID=10.1038%2Fs41598-022-12605-7&copyright=The%20Author%28s%29&publication=2045-2322&publicationDate=2022-05-19&publisherName=SpringerNature&orderBeanReset=true&oa=CC%20BY)

## About this article

[![Check for updates. Verify currency and authenticity via CrossMark](data:image/svg+xml;base64,<svg height="81" width="57" xmlns="http://www.w3.org/2000/svg"><g fill="none" fill-rule="evenodd"><path d="m17.35 35.45 21.3-14.2v-17.03h-21.3" fill="#989898"/><path d="m38.65 35.45-21.3-14.2v-17.03h21.3" fill="#747474"/><path d="m28 .5c-12.98 0-23.5 10.52-23.5 23.5s10.52 23.5 23.5 23.5 23.5-10.52 23.5-23.5c0-6.23-2.48-12.21-6.88-16.62-4.41-4.4-10.39-6.88-16.62-6.88zm0 41.25c-9.8 0-17.75-7.95-17.75-17.75s7.95-17.75 17.75-17.75 17.75 7.95 17.75 17.75c0 4.71-1.87 9.22-5.2 12.55s-7.84 5.2-12.55 5.2z" fill="#535353"/><path d="m41 36c-5.81 6.23-15.23 7.45-22.43 2.9-7.21-4.55-10.16-13.57-7.03-21.5l-4.92-3.11c-4.95 10.7-1.19 23.42 8.78 29.71 9.97 6.3 23.07 4.22 30.6-4.86z" fill="#9c9c9c"/><path d="m.2 58.45c0-.75.11-1.42.33-2.01s.52-1.09.91-1.5c.38-.41.83-.73 1.34-.94.51-.22 1.06-.32 1.65-.32.56 0 1.06.11 1.51.35.44.23.81.5 1.1.81l-.91 1.01c-.24-.24-.49-.42-.75-.56-.27-.13-.58-.2-.93-.2-.39 0-.73.08-1.05.23-.31.16-.58.37-.81.66-.23.28-.41.63-.53 1.04-.13.41-.19.88-.19 1.39 0 1.04.23 1.86.68 2.46.45.59 1.06.88 1.84.88.41 0 .77-.07 1.07-.23s.59-.39.85-.68l.91 1c-.38.43-.8.76-1.28.99-.47.22-1 .34-1.58.34-.59 0-1.13-.1-1.64-.31-.5-.2-.94-.51-1.31-.91-.38-.4-.67-.9-.88-1.48-.22-.59-.33-1.26-.33-2.02zm8.4-5.33h1.61v2.54l-.05 1.33c.29-.27.61-.51.96-.72s.76-.31 1.24-.31c.73 0 1.27.23 1.61.71.33.47.5 1.14.5 2.02v4.31h-1.61v-4.1c0-.57-.08-.97-.25-1.21-.17-.23-.45-.35-.83-.35-.3 0-.56.08-.79.22-.23.15-.49.36-.78.64v4.8h-1.61zm7.37 6.45c0-.56.09-1.06.26-1.51.18-.45.42-.83.71-1.14.29-.3.63-.54 1.01-.71.39-.17.78-.25 1.18-.25.47 0 .88.08 1.23.24.36.16.65.38.89.67s.42.63.54 1.03c.12.41.18.84.18 1.32 0 .32-.02.57-.07.76h-4.36c.07.62.29 1.1.65 1.44.36.33.82.5 1.38.5.29 0 .57-.04.83-.13s.51-.21.76-.37l.55 1.01c-.33.21-.69.39-1.09.53-.41.14-.83.21-1.26.21-.48 0-.92-.08-1.34-.25-.41-.16-.76-.4-1.07-.7-.31-.31-.55-.69-.72-1.13-.18-.44-.26-.95-.26-1.52zm4.6-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.07.45-.31.29-.5.73-.58 1.3zm2.5.62c0-.57.09-1.08.28-1.53.18-.44.43-.82.75-1.13s.69-.54 1.1-.71c.42-.16.85-.24 1.31-.24.45 0 .84.08 1.17.23s.61.34.85.57l-.77 1.02c-.19-.16-.38-.28-.56-.37-.19-.09-.39-.14-.61-.14-.56 0-1.01.21-1.35.63-.35.41-.52.97-.52 1.67 0 .69.17 1.24.51 1.66.34.41.78.62 1.32.62.28 0 .54-.06.78-.17.24-.12.45-.26.64-.42l.67 1.03c-.33.29-.69.51-1.08.65-.39.15-.78.23-1.18.23-.46 0-.9-.08-1.31-.24-.4-.16-.75-.39-1.05-.7s-.53-.69-.7-1.13c-.17-.45-.25-.96-.25-1.53zm6.91-6.45h1.58v6.17h.05l2.54-3.16h1.77l-2.35 2.8 2.59 4.07h-1.75l-1.77-2.98-1.08 1.23v1.75h-1.58zm13.69 1.27c-.25-.11-.5-.17-.75-.17-.58 0-.87.39-.87 1.16v.75h1.34v1.27h-1.34v5.6h-1.61v-5.6h-.92v-1.2l.92-.07v-.72c0-.35.04-.68.13-.98.08-.31.21-.57.4-.79s.42-.39.71-.51c.28-.12.63-.18 1.04-.18.24 0 .48.02.69.07.22.05.41.1.57.17zm.48 5.18c0-.57.09-1.08.27-1.53.17-.44.41-.82.72-1.13.3-.31.65-.54 1.04-.71.39-.16.8-.24 1.23-.24s.84.08 1.24.24c.4.17.74.4 1.04.71s.54.69.72 1.13c.19.45.28.96.28 1.53s-.09 1.08-.28 1.53c-.18.44-.42.82-.72 1.13s-.64.54-1.04.7-.81.24-1.24.24-.84-.08-1.23-.24-.74-.39-1.04-.7c-.31-.31-.55-.69-.72-1.13-.18-.45-.27-.96-.27-1.53zm1.65 0c0 .69.14 1.24.43 1.66.28.41.68.62 1.18.62.51 0 .9-.21 1.19-.62.29-.42.44-.97.44-1.66 0-.7-.15-1.26-.44-1.67-.29-.42-.68-.63-1.19-.63-.5 0-.9.21-1.18.63-.29.41-.43.97-.43 1.67zm6.48-3.44h1.33l.12 1.21h.05c.24-.44.54-.79.88-1.02.35-.24.7-.36 1.07-.36.32 0 .59.05.78.14l-.28 1.4-.33-.09c-.11-.01-.23-.02-.38-.02-.27 0-.56.1-.86.31s-.55.58-.77 1.1v4.2h-1.61zm-47.87 15h1.61v4.1c0 .57.08.97.25 1.2.17.24.44.35.81.35.3 0 .57-.07.8-.22.22-.15.47-.39.73-.73v-4.7h1.61v6.87h-1.32l-.12-1.01h-.04c-.3.36-.63.64-.98.86-.35.21-.76.32-1.24.32-.73 0-1.27-.24-1.61-.71-.33-.47-.5-1.14-.5-2.02zm9.46 7.43v2.16h-1.61v-9.59h1.33l.12.72h.05c.29-.24.61-.45.97-.63.35-.17.72-.26 1.1-.26.43 0 .81.08 1.15.24.33.17.61.4.84.71.24.31.41.68.53 1.11.13.42.19.91.19 1.44 0 .59-.09 1.11-.25 1.57-.16.47-.38.85-.65 1.16-.27.32-.58.56-.94.73-.35.16-.72.25-1.1.25-.3 0-.6-.07-.9-.2s-.59-.31-.87-.56zm0-2.3c.26.22.5.37.73.45.24.09.46.13.66.13.46 0 .84-.2 1.15-.6.31-.39.46-.98.46-1.77 0-.69-.12-1.22-.35-1.61-.23-.38-.61-.57-1.13-.57-.49 0-.99.26-1.52.77zm5.87-1.69c0-.56.08-1.06.25-1.51.16-.45.37-.83.65-1.14.27-.3.58-.54.93-.71s.71-.25 1.08-.25c.39 0 .73.07 1 .2.27.14.54.32.81.55l-.06-1.1v-2.49h1.61v9.88h-1.33l-.11-.74h-.06c-.25.25-.54.46-.88.64-.33.18-.69.27-1.06.27-.87 0-1.56-.32-2.07-.95s-.76-1.51-.76-2.65zm1.67-.01c0 .74.13 1.31.4 1.7.26.38.65.58 1.15.58.51 0 .99-.26 1.44-.77v-3.21c-.24-.21-.48-.36-.7-.45-.23-.08-.46-.12-.7-.12-.45 0-.82.19-1.13.59-.31.39-.46.95-.46 1.68zm6.35 1.59c0-.73.32-1.3.97-1.71.64-.4 1.67-.68 3.08-.84 0-.17-.02-.34-.07-.51-.05-.16-.12-.3-.22-.43s-.22-.22-.38-.3c-.15-.06-.34-.1-.58-.1-.34 0-.68.07-1 .2s-.63.29-.93.47l-.59-1.08c.39-.24.81-.45 1.28-.63.47-.17.99-.26 1.54-.26.86 0 1.51.25 1.93.76s.63 1.25.63 2.21v4.07h-1.32l-.12-.76h-.05c-.3.27-.63.48-.98.66s-.73.27-1.14.27c-.61 0-1.1-.19-1.48-.56-.38-.36-.57-.85-.57-1.46zm1.57-.12c0 .3.09.53.27.67.19.14.42.21.71.21.28 0 .54-.07.77-.2s.48-.31.73-.56v-1.54c-.47.06-.86.13-1.18.23-.31.09-.57.19-.76.31s-.33.25-.41.4c-.09.15-.13.31-.13.48zm6.29-3.63h-.98v-1.2l1.06-.07.2-1.88h1.34v1.88h1.75v1.27h-1.75v3.28c0 .8.32 1.2.97 1.2.12 0 .24-.01.37-.04.12-.03.24-.07.34-.11l.28 1.19c-.19.06-.4.12-.64.17-.23.05-.49.08-.76.08-.4 0-.74-.06-1.02-.18-.27-.13-.49-.3-.67-.52-.17-.21-.3-.48-.37-.78-.08-.3-.12-.64-.12-1.01zm4.36 2.17c0-.56.09-1.06.27-1.51s.41-.83.71-1.14c.29-.3.63-.54 1.01-.71.39-.17.78-.25 1.18-.25.47 0 .88.08 1.23.24.36.16.65.38.89.67s.42.63.54 1.03c.12.41.18.84.18 1.32 0 .32-.02.57-.07.76h-4.37c.08.62.29 1.1.65 1.44.36.33.82.5 1.38.5.3 0 .58-.04.84-.13.25-.09.51-.21.76-.37l.54 1.01c-.32.21-.69.39-1.09.53s-.82.21-1.26.21c-.47 0-.92-.08-1.33-.25-.41-.16-.77-.4-1.08-.7-.3-.31-.54-.69-.72-1.13-.17-.44-.26-.95-.26-1.52zm4.61-.62c0-.55-.11-.98-.34-1.28-.23-.31-.58-.47-1.06-.47-.41 0-.77.15-1.08.45-.31.29-.5.73-.57 1.3zm3.01 2.23c.31.24.61.43.92.57.3.13.63.2.98.2.38 0 .65-.08.83-.23s.27-.35.27-.6c0-.14-.05-.26-.13-.37-.08-.1-.2-.2-.34-.28-.14-.09-.29-.16-.47-.23l-.53-.22c-.23-.09-.46-.18-.69-.3-.23-.11-.44-.24-.62-.4s-.33-.35-.45-.55c-.12-.21-.18-.46-.18-.75 0-.61.23-1.1.68-1.49.44-.38 1.06-.57 1.83-.57.48 0 .91.08 1.29.25s.71.36.99.57l-.74.98c-.24-.17-.49-.32-.73-.42-.25-.11-.51-.16-.78-.16-.35 0-.6.07-.76.21-.17.15-.25.33-.25.54 0 .14.04.26.12.36s.18.18.31.26c.14.07.29.14.46.21l.54.19c.23.09.47.18.7.29s.44.24.64.4c.19.16.34.35.46.58.11.23.17.5.17.82 0 .3-.06.58-.17.83-.12.26-.29.48-.51.68-.23.19-.51.34-.84.45-.34.11-.72.17-1.15.17-.48 0-.95-.09-1.41-.27-.46-.19-.86-.41-1.2-.68z" fill="#535353"/></g></svg>)](https://crossmark.crossref.org/dialog/?doi=10.1038/s41598-022-12605-7)

### Cite this article

Nishimura, H., Ikegami, S., Uehara, M. _et al._ Detection of cognitive decline by spinal posture assessment in health exams of the general older population.
_Sci Rep_ **12**, 8460 (2022). https://doi.org/10.1038/s41598-022-12605-7

[Download citation](https://citation-needed.springer.com/v2/references/10.1038/s41598-022-12605-7?format=refman&flavour=citation)

- Received: 31 August 2021

- Accepted: 12 May 2022

- Published: 19 May 2022

- DOI: https://doi.org/10.1038/s41598-022-12605-7


### Share this article

Anyone you share the following link with will be able to read this content:

Get shareable link

Sorry, a shareable link is not currently available for this article.

Copy to clipboard

Provided by the Springer Nature SharedIt content-sharing initiative


## This article is cited by

- ### [Male–female disparity in clinical features and significance of mild vertebral fractures in community-dwelling residents aged 50 and over](https://doi.org/10.1038/s41598-024-56379-6)



  - Shota Ikegami
  - Masashi Uehara
  - Jun Takahashi

_Scientific Reports_ (2024)

- ### [Relationships between indices of cognitive reserve and cognitive impairment in patients with multiple sclerosis](https://doi.org/10.1007/s12144-024-05629-x)



  - Zeinab Hajian
  - Shokoufeh Mousavi
  - Mahmoud Reza Shahsavari

_Current Psychology_ (2024)

## Comments

By submitting a comment you agree to abide by our [Terms](/info/tandc.html) and [Community Guidelines](/info/community-guidelines.html). If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.

[Download PDF](/articles/s41598-022-12605-7.pdf)

Advertisement

## Explore content

- [Research articles](/srep/research-articles)
- [News & Comment](/srep/news-and-comment)
- [Collections](/srep/collections)
- [Subjects](/srep/browse-subjects)

- [Follow us on Facebook](https://www.facebook.com/scientificreports)
- [Follow us on Twitter](https://twitter.com/SciReports)
- [Sign up for alerts](https://www.nature.com/my-account/alerts/subscribe-journal?list-id=288)
- [RSS feed](https://www.nature.com/srep.rss)

## About the journal

- [About Scientific Reports](/srep/about)
- [Contact](/srep/contact)
- [Journal policies](/srep/journal-policies)
- [Guide to referees](/srep/guide-to-referees)
- [Calls for Papers](/srep/calls-for-papers)
- [Editor's Choice](/srep/editorschoice)
- [Journal highlights](/srep/highlights)
- [Open Access Fees and Funding](/srep/open-access)

## Publish with us

- [For authors](/srep/author-instructions)
- [Language editing services](https://authorservices.springernature.com/go/sn/?utm_source=For+Authors&utm_medium=Website_Nature&utm_campaign=Platform+Experimentation+2022&utm_id=PE2022)
- [Submit manuscript](https://author-welcome.nature.com/41598)

## Search

Search articles by subject, keyword or author

Show results fromAll journalsThis journal

Search

[Advanced search](/search/advanced)

### Quick links

- [Explore articles by subject](/subjects)
- [Find a job](/naturecareers)
- [Guide to authors](/authors/index.html)
- [Editorial policies](/authors/editorial_policies/)

Scientific Reports ( _Sci Rep_)
ISSN2045-2322 (online)


## nature.com sitemap

### About Nature Portfolio

- [About us](https://www.nature.com/npg_/company_info/index.html)
- [Press releases](https://www.nature.com/npg_/press_room/press_releases.html)
- [Press office](https://press.nature.com/)
- [Contact us](https://support.nature.com/support/home)

### Discover content

- [Journals A-Z](https://www.nature.com/siteindex)
- [Articles by subject](https://www.nature.com/subjects)
- [protocols.io](https://www.protocols.io/)
- [Nature Index](https://www.natureindex.com/)

### Publishing policies

- [Nature portfolio policies](https://www.nature.com/authors/editorial_policies)
- [Open access](https://www.nature.com/nature-research/open-access)

### Author & Researcher services

- [Reprints & permissions](https://www.nature.com/reprints)
- [Research data](https://www.springernature.com/gp/authors/research-data)
- [Language editing](https://authorservices.springernature.com/language-editing/)
- [Scientific editing](https://authorservices.springernature.com/scientific-editing/)
- [Nature Masterclasses](https://masterclasses.nature.com/)
- [Research Solutions](https://solutions.springernature.com/)

### Libraries & institutions

- [Librarian service & tools](https://www.springernature.com/gp/librarians/tools-services)
- [Librarian portal](https://www.springernature.com/gp/librarians/manage-your-account/librarianportal)
- [Open research](https://www.nature.com/openresearch/about-open-access/information-for-institutions)
- [Recommend to library](https://www.springernature.com/gp/librarians/recommend-to-your-library)

### Advertising & partnerships

- [Advertising](https://partnerships.nature.com/product/digital-advertising/)
- [Partnerships & Services](https://partnerships.nature.com/)
- [Media kits](https://partnerships.nature.com/media-kits/)
- [Branded\
content](https://partnerships.nature.com/product/branded-content-native-advertising/)

### Professional development

- [Nature Careers](https://www.nature.com/naturecareers/)
- [Nature\
Conferences](https://conferences.nature.com)

### Regional websites

- [Nature Africa](https://www.nature.com/natafrica)
- [Nature China](http://www.naturechina.com)
- [Nature India](https://www.nature.com/nindia)
- [Nature Italy](https://www.nature.com/natitaly)
- [Nature Japan](https://www.natureasia.com/ja-jp)
- [Nature Middle East](https://www.nature.com/nmiddleeast)

- [Privacy\
Policy](https://www.nature.com/info/privacy)
- [Use\
of cookies](https://www.nature.com/info/cookies)
- Your privacy choices/Manage cookies

- [Legal\
notice](https://www.nature.com/info/legal-notice)
- [Accessibility\
statement](https://www.nature.com/info/accessibility-statement)
- [Terms & Conditions](https://www.nature.com/info/terms-and-conditions)
- [Your US state privacy rights](https://www.springernature.com/ccpa)

[![Springer Nature](/static/images/logos/sn-logo-white-ea63208b81.svg)](https://www.springernature.com/)

© 2024 Springer Nature Limited

Close bannerClose

![Nature Briefing](/static/images/logos/nature-briefing-logo-n150-white-d81c9da3ec.svg)

Sign up for the _Nature Briefing_ newsletter — what matters in science, free to your inbox daily.

Email address

Sign up

I agree my information will be processed in accordance with the _Nature_ and Springer Nature Limited [Privacy Policy](https://www.nature.com/info/privacy).

Close bannerClose

Get the most important science stories of the day, free in your inbox. [Sign up for Nature Briefing](https://www.nature.com/briefing/signup/?brieferEntryPoint=MainBriefingBanner)

![](/u9a747xs/article/s41598-022-12605-7)