Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: A cross-sectional study

Kazushige Koyama; Kanichiro Wada; Gentaro Kumagai; Hitoshi Kudo; Sunao Tanaka; Toru Asari; Songee Jung; Masataka Ando; Yasuyuki Ishibashi

doi:10.1371/journal.pone.0258852

Peer Review History

Original SubmissionApril 9, 2021
26 Jul 2021 Decision Letter - Masaki Mogi, Editor PONE-D-21-11408 Associations between symptoms and quality of life in lumbar degenerative disease and cognitive dysfunction in a Japanese community: a cross-sectional study PLOS ONE Dear Dr. Wada, 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 Aug 27 2021 11:59PM. 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. 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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 Additional Editor Comments (if provided): #1. How about the use of analgesic drugs or other drugs such as pregabalin, anti-depressant, or benzodiazepines? #2. Did the authors check MMSE just one time? Sometimes, MMSE score maybe changed. #3. How about the depression scores in these subjects? If there are not such data, it is better to describe them in Study Limitation. [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. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The paper is interesting but I have some suggestions that may help to improve its quality. - The title needs to be rethought, as it is not entirely clear regarding the content of the paper . - Regarding the introduction, it would be positive to include a brief explanation about the "super-aging society". - In the introduction it is used the acronym ADL without its explanation. - Regarding the diagnosis of LSS, which were the questions included in the self-administered questionnaire? It would be necessary to expand the information in this section. - It would be easierfor the reader not using so many abbreviations. It is confusing and difficult to fully understand the paper in its current form. - I would recommend to rewrite the Discussion section, as it repaets the main findings of the study but no proper discussion takes place. ****** 6. 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Revision 1
16 Sep 2021 Author Response 24th August, 2021 Masaki Mogi Academic Editor PLOS ONE Dear Dr. Mogi: We wish to re-submit the attached manuscript titled “Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: a cross-sectional study” as a Research Article. The manuscript ID is PONE-D-21-11408. We would like to change the title from “Associations between symptoms and quality of life in lumbar degenerative disease and cognitive dysfunction in a Japanese community: a cross-sectional study” to the above new title. The manuscript has been rechecked and appropriate changes have been made in accordance with the reviewers’ suggestions. The responses to their comments have been prepared and are given below. For convenience, modified parts in the manuscript are in red-colored font. We thank you and the reviewers for your thoughtful suggestions and insights, which have enriched the manuscript and produced a better and more balanced account of the research. We hope that the revised manuscript is now suitable for publication in your journal. Sincerely, Kanichiro Wada Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine Zaifu-cho, Hirosaki, Aomori 036-8562, Japan Department of Social Health, Hirosaki University Graduate School of Medicine Zaifu-cho, Hirosaki, Aomori 036-8562, Japan E-mail: wadak39@hirosaki-u.ac.jp Tel: +81-172-39-5083 Fax: +81-36-3826 Editor and reviewer comments and replies Comment 1 from editor How about the use of analgesic drugs or other drugs such as pregabalin, anti-depressant, or benzodiazepines? Reply 1 to editor We thank the editor for providing advice on the current study, thereby improving the manuscript. The percentage of participants who used sleeping pills, analgesic drugs, and psychotropic drugs were 8.3% (28/336), 7.4% (25/336), and 1.5% (5/336). However, we did not have detailed drug information, such as the drug names, in this study. Analgesic drugs or other drugs would mask their symptoms, and we might underestimate cognitive impairment and/or lumbar degenerative disease. Thus, we have described the effect of the absence of drug information on the relationship between cognitive function and lumbar degenerative disease as a limitation of this study (page 22, lines 303-306). Comment 2 from editor Did the authors check MMSE just one time? Sometimes, MMSE score maybe changed. Reply 2 to editor Thank you for pointing out an important issue of our evaluations. We checked MMSE just one time in this study. As you mentioned, MMSE score may be changed by mental and physical conditions of individuals, and we have described this in the study limitations (page 22, line 306-307). Comment 3 from editor How about the depression scores in these subjects? Reply 3 to editor We appreciate the editor’s comment and agree that it is necessary to evaluate depression scores in this study. We have evaluated depression using The Center for Epidemiologic Studies Depression Scale and set a cut-off point at 16 points or greater. We have repeated the statistical analysis and revised the material and method section (page 8, lines 124-128), results, and tables (table 1 to 4). Comment 4 from reviewer The title needs to be rethought, as it is not entirely clear regarding the content of the paper. Reply 4 to reviewer Thank you for your valuable advice to improve the title of our study. We have changed the title to “Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: a cross-sectional study.” Comment 5 from reviewer Regarding the introduction, it would be positive to include a brief explanation about the "super-aging society". Reply 5 to reviewer Thank you for your valuable comment. “Super-aging society” means that the proportion of older adults whose age is >65 years old is over 21%. In Japan, the proportion of older adults is 26%. Accordingly, we have explained “super-aging society” in the introduction (page 3, lines 33-34). Comment 6 from reviewer In the introduction it is used the acronym ADL without its explanation. Reply 6 to reviewer We thank you for pointing out our insufficient description. We have spelled out ADL accordingly (activities of daily living) (page 3, line 48). Comment 7 from reviewer Regarding the diagnosis of LSS, which were the questions included in the self-administered questionnaire? It would be necessary to expand the information in this section. Reply 7 to reviewer Thank you for pointing out the lack of explanation about the questionnaire. We diagnosed LSS using a simple single sheet, self-administered, self-reported history questionnaire. It consisted of 15 questions associated with buttock and lower limb numbness or pain, and intermitted-claudication. Each question is scored from -1 to 5 points. We totaled the points of all questions and diagnosed LSS when the score was 13 points or greater. The sensitivity and specificity were 92.7% and 84.7% for diagnosing LSS in patients with lower limb symptoms due to LSS, arteriosclerosis obliterans, diabetes, or peripheral nerve diseases. These explanations have been added to the materials and methods (pages 5-6, lines 80-86). Comment 8 from reviewer It would be easier for the reader not using so many abbreviations. It is confusing and difficult to fully understand the paper in its current form. Reply 8 to reviewer We agree with your comment regarding not using too many abbreviations in this study. We used abbreviations; lumbar degenerative disease (LDD), lumbar spinal canal stenosis (LSS), mild cognitive impairment (MCI), quality of life (QOL), Japanese Orthopedic Association Back-Pain Evaluation Questionnaire (JOABPEQ), Mini Mental State Examination (MMSE), activities of daily living (ADL), visual analog scale (VAS), Kellgren-Lawrence grading (KL), diabetes (DM), and confidence interval (CI). We have reduced the number of abbreviations, other than the important key words in this study; LSS, MCI, QOL, JOABPEQ, MMSE, VAS and CI. We have reworded “LDD symptom” to “lumbar degenerative disease symptom.” Comment 9 from reviewer I would recommend to rewrite the Discussion section, as it repeats the main findings of the study but no proper discussion takes place. Reply 9 to reviewer We thank you for your valuable comment for improving the discussion of this study. We repeated the main findings of the study in the first paragraph, as well as in the middle of the second and third paragraphs and the conclusion; thus, we have deleted the first paragraph, which was the summary of the result. In the first paragraph, we discussed the prevalence of MCI and LSS combined. The comorbidity rate of MCI and LSS was not high (2.1%; however, the rate of MCI in participants with LSS　and the rate of LSS in participants with MCI were high (41%, 9.7%). According to a previous study, the risk factors of LSS presence, such as age or diabetes or low ankle-brachial index values, were similar to the risk factors of cognitive impairment. We have included this discussion in the first paragraph (pages 17-19, lines 220-257). In the second paragraph, we discussed that LSS presence and QOL decline due to low back pain were associated with MCI or MMSE summary score. It is clear that pain is related to cognitive impairment in the previous study. We suggested that a combination of LSS symptoms, such as pain or numbness of buttock or lower limbs or intermittent claudication, were related to cognitive impairment as with the previous study. It is clear that physical dysfunction associates with cognitive impairment. We suggest that physical dysfunction (limitation in range of lumbar motion) due to low back pain caused QOL decline and cognitive impairment. Several reports showed a causal relationship between pain or physical dysfunction and cognitive impairment; however, whether the intervention of pain or physical dysfunction improves cognitive impairment remains unclear. We have added that longitudinal study should be continued to clarify the causal relationship between lumbar degenerative disease and cognitive impairment (pages 19-21, lines 258-295). Attachments Attachment Submitted filename: Editor reviewer replies_revision.docx https://doi.org/10.1371/journal.pone.0258852.r002
7 Oct 2021 Decision Letter - Masaki Mogi, Editor Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: a cross-sectional study PONE-D-21-11408R1 Dear Dr. Wada, 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, Masaki Mogi Academic Editor PLOS ONE Additional Editor Comments (optional): No further comment. 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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 ****** 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 ****** 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) ****** 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 https://doi.org/10.1371/journal.pone.0258852.r003
Formally Accepted
11 Oct 2021 Acceptance Letter - Masaki Mogi, Editor PONE-D-21-11408R1 Association between mild cognitive impairment and lumbar degenerative disease in a Japanese community: a cross-sectional study Dear Dr. Wada: 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. Masaki Mogi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0258852.r004

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