Examination of the cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline during the COVID-19 pandemic

Minoru Kouzuki; Shota Furukawa; Keisuke Mitani; Katsuya Urakami

doi:10.1371/journal.pone.0248446

Peer Review History

Original SubmissionMarch 2, 2021
1 Sep 2021 Decision Letter - Ghulam Md Ashraf, Editor PONE-D-21-06873 Impact of the COVID-19 pandemic on cognitive function in Japanese community-dwelling older adults in a class for preventing cognitive decline PLOS ONE Dear Dr. Kouzuki, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 15th November 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ghulam Md Ashraf, Ph.D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. 2. For this observational study, please avoid causal-sounding language (such as 'impact' or 'effect') when reporting associations, including in the title. 3. Thank you for stating the following in the Competing Interests/Financial Disclosure* (delete as necessary) section: “I have read the journal's policy and the authors of this manuscript have the following competing interests: MK, SF, and KM have no conflicts of interest to declare. KU owns a patent on the Touch Panel-type Dementia Assessment Scale and receives royalties from Nihon Kohden Corporation (Tokyo, Japan).” We note that one or more of the authors are employed by a commercial company: Touch Panel-type Dementia Assessment Scale & Nihon Kohden Corporation (Tokyo, Japan) a. Please provide an amended Funding Statement declaring this commercial affiliation, as well as a statement regarding the Role of Funders in your study. If the funding organization did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of authors' salaries and/or research materials, please review your statements relating to the author contributions, and ensure you have specifically and accurately indicated the role(s) that these authors had in your study. You can update author roles in the Author Contributions section of the online submission form. Please also include the following statement within your amended Funding Statement. “The funder provided support in the form of salaries for authors [insert relevant initials], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.” If your commercial affiliation did play a role in your study, please state and explain this role within your updated Funding Statement. b. Please also provide an updated Competing Interests Statement declaring this commercial affiliation along with any other relevant declarations relating to employment, consultancy, patents, products in development, or marketed products, etc. Within your Competing Interests Statement, please confirm that this commercial affiliation does not alter your adherence to all PLOS ONE policies on sharing data and materials by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests) . If this adherence statement is not accurate and there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include both an updated Funding Statement and Competing Interests Statement in your cover letter. We will change the online submission form on your behalf. 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a fairly well written manuscript. The COVID pandemic is pretty recent and any study performed with reference to the same will add value to the knowledge. The authors of current manuscript did the same. They investigated the effect of suspension of classes that were being held for elderly individuals for preventing cognitive decline. I have only minor issues- 1. The opening statement of the manuscript, the first line of the manuscript reads incorrect. Use of too many 'ands' in the statement. Also, what is 'thoughts on cognitive function'? Kindly modify the statement, it reads very vague. 2. Authors have not mentioned age of the individuals in the abstract and age and number of patients recruited in th MM section. They only mention it finally in the result section. KIndly add this information in other two sections. 3. Format of Table-1 can be improved. Kindly make it concise. Reviewer #2: This title seems better "Impact of the COVID19 pandemic on cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline". In lines 43-44, “Participation in the class leads to the formation of a community”. It would be helpful to specify or briefly mention/explain the class structure. Also in line 52> specify or briefly mention/explain the class structure At many places In the intro and other sections “the class(es)” can be changed to ‘this(these) class(es)’’ after having briefly mentioned what those classes are at the beginning. In line 86, delete “not”. I didn’t not understand this line (112-113) “The exclusion criteria were subjects who declined the use of their data”. From Table 1 & 2, I couldn’t get the clear idea as to what the observed cognitive parameters were before and/or after the class suspension. I am also concerned about the small sample size of cognitive decline group. I was also wondering if three months (early March to end May) is good enough time window to assess the dementia related symptoms. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** Zeeshan Banday [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0248446.r001
Revision 1
8 Sep 2021 Author Response Responses to the Journal Requirements 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: Thank you for this reminder. We have checked PLOS ONE's style requirements. We made some corrections in the arrangement of contents within a cell in Tables 1, 2, and S2. 2. For this observational study, please avoid causal-sounding language (such as 'impact' or 'effect') when reporting associations, including in the title. Response: As you suggested, we have revised the title and some parts of the text as much as possible. 3. Thank you for stating the following in the Competing Interests/Financial Disclosure* (delete as necessary) section: “I have read the journal's policy and the authors of this manuscript have the following competing interests: MK, SF, and KM have no conflicts of interest to declare. KU owns a patent on the Touch Panel-type Dementia Assessment Scale and receives royalties from Nihon Kohden Corporation (Tokyo, Japan).” We note that one or more of the authors are employed by a commercial company: Touch Panel-type Dementia Assessment Scale & Nihon Kohden Corporation (Tokyo, Japan) a. Please provide an amended Funding Statement declaring this commercial affiliation, as well as a statement regarding the Role of Funders in your study. If the funding organization did not play a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of authors' salaries and/or research materials, please review your statements relating to the author contributions, and ensure you have specifically and accurately indicated the role(s) that these authors had in your study. You can update author roles in the Author Contributions section of the online submission form. Please also include the following statement within your amended Funding Statement. “The funder provided support in the form of salaries for authors [insert relevant initials], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.” If your commercial affiliation did play a role in your study, please state and explain this role within your updated Funding Statement. Response: The Touch Panel-type Dementia Assessment Scale (TDAS) is the name of the cognitive function test, and Nihon Kohden Corporation is the company that sells TDAS. KU receives royalties from Nihon Kohden Corporation, but is not employed. In addition, this study did not use any royalties and was not funded by Nihon Kohden Corporation. This study was independently planned and carried out by researchers who were not employed by a commercial company, and Nihon Kohden Corporation had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Therefore, there are no changes to the Funding Statement as the following: “The authors received no specific funding for this work.” b. Please also provide an updated Competing Interests Statement declaring this commercial affiliation along with any other relevant declarations relating to employment, consultancy, patents, products in development, or marketed products, etc. Within your Competing Interests Statement, please confirm that this commercial affiliation does not alter your adherence to all PLOS ONE policies on sharing data and materials by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If this adherence statement is not accurate and there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include both an updated Funding Statement and Competing Interests Statement in your cover letter. We will change the online submission form on your behalf. Response: Within our Competing Interests Statement, we added, "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” Please refer to the following: “MK, SF, and KM have no conflicts of interest to declare. KU owns a patent on the Touch Panel-type Dementia Assessment Scale and receives royalties from the Nihon Kohden Corporation (Tokyo, Japan). This does not alter our adherence to PLOS ONE policies on sharing data and materials.” 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: We checked the reference list and no retracted articles were included. However, some errors in the reference list were revised. Responses to the comments of Reviewer 1 1. The opening statement of the manuscript, the first line of the manuscript reads incorrect. Use of too many 'ands' in the statement. Also, what is 'thoughts on cognitive function'? Kindly modify the statement, it reads very vague. Response: We apologize for the lack of clarity. We have revised the text in the opening part of the Abstract. 2. Authors have not mentioned age of the individuals in the abstract and age and number of patients recruited in the MM section. They only mention it finally in the result section. Kindly add this information in other two sections. Response: We appreciate this valuable suggestion. We have added information on the age of the individuals in the Abstract, as well as the age and number of participants recruited in the Methods/Study participants section. In addition, we have revised the Results/Participant characteristics section to avoid duplication of text. 3. Format of Table-1 can be improved. Kindly make it concise. Response: Thank you for your comment. We have tried to make the format of Table 1 as concise as possible. In addition, we have changed the sex description format in Table 2. Responses to the comments of Reviewer 2 1. This title seems better "Impact of the COVID19 pandemic on cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline". Response: Thank you for your comment. However, the Journal Requirements pointed out to avoid causal-sounding language (such as 'impact' or 'effect') when reporting associations. Therefore, we considered the following title and short title as alternatives: Title: Examination of the cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline during the COVID-19 pandemic Short title: Examination of cognitive function of Japanese older adults during the COVID-19 pandemic 2. In lines 43-44, “Participation in the class leads to the formation of a community”. It would be helpful to specify or briefly mention/explain the class structure. Also in line 52> specify or briefly mention/explain the class structure. Response: We appreciate this valuable suggestion. We have changed the text related to the class to improve its coherence. Specifically, we added a description of the class structure on line 38 and corrected the text on lines 44 and 54. 3. At many places In the intro and other sections “the class(es)” can be changed to ‘this(these) class(es)’’ after having briefly mentioned what those classes are at the beginning. Response: We agree with your recommendation. We already explained the class at the beginning of the introduction and Methods/Study participants; thus, we changed some from “the class(es)” to “this(these) class(es)” as advised. 4. In line 86, delete “not”. Response: Thank you for this comment. We have revised the sentences accordingly in line 89. 5. I didn’t not understand this line (112-113) “The exclusion criteria were subjects who declined the use of their data”. Response: We apologize for the lack of clarity. In this study, all information pertaining to the study was disclosed in advance on the homepage of the Tottori University website and the notice board of the Houki town hall to ensure that participants were given the opportunity to decline participation (opt-out approach). Therefore, the exclusion criteria meant that participants who declined the use of their data were excluded. This was the item that we described in the application form for ethics review (the research proposal); thus, we have included it in the text as well. We have added an explanation of the exclusion criteria to improve its coherence. 6. From Table 1 & 2, I couldn’t get the clear idea as to what the observed cognitive parameters were before and/or after the class suspension. Response: As we wrote in the Methods section, cognitive function was evaluated using only TDAS. However, we found the description difficult to understand; thus, we have revised the text of the Methods/Data Collection and added annotations for the decline and non-decline groups in Table 2. 7. I am also concerned about the small sample size of cognitive decline group. I was also wondering if three months (early March to end May) is good enough time window to assess the dementia related symptoms. Response: Thank you for this very important comment. As the reviewer has pointed out, we also considered the small sample size of the cognitive decline group as a limitation of our study (described as the third limitation in the Discussion section). Unfortunately, we were unable to collect any additional data. We have added a little description about the sample size; thus, the reader should pay attention to the interpretation of the results. Regarding the time window, three months may be a short period, but because daily life has changed significantly due to COVID-19, we performed this study because we believe that even class suspension of three months would have a negative effect on cognitive function. In fact, a study has been reported that in a study investigating the effects of about two months of COVID-19 lockdown in Italy, telephone interviews with caregivers of 31 subjects with MCI revealed a worsening of cognition in 41.9% of individuals (ref 30: Baschi R, et al. Front Psychiatry. 2020; 11: 590134.). Corrections other than reviewer comments Some errors in Table 2, abbreviation notation (lines 48 and 125), typographical errors (lines 156 and 287), and reference lists (lines 399, 404, 410, 428, 441, 443, 463, 467, and 511) have been corrected. However, these changes did not affect the interpretation of the results. We apologize for the lack of confirmation. Attachments Attachment Submitted filename: Rubuttal_letter.docx https://doi.org/10.1371/journal.pone.0248446.r002
5 Oct 2021 Decision Letter - Ghulam Md Ashraf, Editor PONE-D-21-06873R1Examination of the cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline during the COVID-19 pandemicPLOS ONE Dear Dr. Kouzuki, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by 25th October 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ghulam Md Ashraf, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): The authors are advised to address minor concerns raised by the reviewer. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: In the revised manuscript “By participating in this class…” in line 44 now becomes incoherent. It has to be preceded with a sentence explaining what ‘this class’ actually is. Now that the authors have changed the structure of this sentence-in the process made it more complex ‘this’ in the sentence may be changed to ‘the’ OR better simplify this sentence. In my previous review, I had asked the authors to change ‘the class(es) to this (these) class(es) at certain places giving readers a clear reference as to what those classes are, which the authors have actually done. In the revised manuscript, however, I noticed that the authors have made these changes at many other places where it was not required at all (e.g in line 65). The authors must fix such inconsistencies before the manuscript can be accepted for publication. Lines 116-118 are contradictory. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes:** Zeeshan Z. Banday [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0248446.r003
Revision 2
25 Oct 2021 Author Response Responses to the Journal Requirements 1. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: We checked the reference list, and no retracted articles were included. However, the details of reference 40 were revised. Responses to the comments of Reviewer 2 In the revised manuscript “By participating in this class…” in line 44 now becomes incoherent. It has to be preceded with a sentence explaining what ‘this class’ actually is. Now that the authors have changed the structure of this sentence-in the process made it more complex ‘this’ in the sentence may be changed to ‘the’ OR better simplify this sentence. Response: Thank you for your comment. We have revised the sentences in lines 44-47. In my previous review, I had asked the authors to change ‘the class(es) to this (these) class(es) at certain places giving readers a clear reference as to what those classes are, which the authors have actually done. In the revised manuscript, however, I noticed that the authors have made these changes at many other places where it was not required at all (e.g in line 65). The authors must fix such inconsistencies before the manuscript can be accepted for publication. Response: We apologize because we did not understand your intentions correctly. We changed some from “this class” to “the class” as you have pointed out. If the correction is incorrect, please let me know in detail. Lines 116-118 are contradictory. Response: We completely agree with you. We have revised the sentences in lines 116-118. Attachments Attachment Submitted filename: Rubuttal_letter2.docx https://doi.org/10.1371/journal.pone.0248446.r004
29 Nov 2021 Decision Letter - Ghulam Md Ashraf, Editor Examination of the cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline during the COVID-19 pandemic PONE-D-21-06873R2 Dear Dr. Kouzuki, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ghulam Md Ashraf, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: I do not have any further comments. Much of the comments have been addressed by the authors. Thanks to the authors! ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: Yes:** Zeeshan Z. Banday https://doi.org/10.1371/journal.pone.0248446.r005
Formally Accepted
3 Dec 2021 Acceptance Letter - Ghulam Md Ashraf, Editor PONE-D-21-06873R2 Examination of the cognitive function of Japanese community-dwelling older adults in a class for preventing cognitive decline during the COVID-19 pandemic Dear Dr. Kouzuki: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Ghulam Md Ashraf Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0248446.r006

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