{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:56:33Z","timestamp":1792626993739,"version":"4.5.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,5,27]],"date-time":"2023-05-27T00:00:00Z","timestamp":1685145600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP20ek0109482h0001"],"award-info":[{"award-number":["JP20ek0109482h0001"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Inher Metab Disea"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Wilson disease (WD) is a congenital copper metabolism disorder with various manifestations and can be treated with oral medication. This study examined the factors related to decline in activities of daily living (ADL) in patients with WD as research in this area remains limited. We enrolled 308 patients with WD, including patients who participated in a national survey and those who sought cares at the Department of Pediatrics, Toho University Ohashi Medical Center, from 2016 to 2017. We analyzed the association between ADL decline and factors including age at diagnosis, period from diagnosis to survey, hepatic symptoms, neurological signs, and psychiatric presentation at diagnosis. The relative risks (RRs) for ADL decline were estimated for each factor using multivariate modified Poisson regression analysis. Overall, 97 out of 308 (31.5%) patients experienced ADL decline. After adjusting for explanatory variables, regression analysis revealed that factors significantly associated with ADL decline were a period of \u226520\u2009years from diagnosis to survey (adjusted RR\u2009=\u20092.34, 95% confidence interval [CI]: 1.47\u20133.74), hepatic symptoms with splenomegaly (adjusted RR\u2009=\u20092.57, 95% CI: 1.26\u20135.24), mild neurological signs (adjusted RR\u2009=\u20093.20, 95% CI: 1.96\u20135.23), and severe neurological signs (adjusted RR\u2009=\u20093.63, 95% CI: 2.28\u20135.77). Neurological signs, hepatic symptoms with splenomegaly, and a period of 20\u2009years from diagnosis to survey are associated with ADL decline. Thus, careful assessment of patients for these factors is necessary, and these findings may guide future efforts to improve patient prognosis.<\/jats:p>","DOI":"10.1002\/jimd.12634","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T14:04:33Z","timestamp":1684505073000},"page":"735-743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors affecting activities of daily living among patients with Wilson disease"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6429-5325","authenticated-orcid":false,"given":"Ayumi","family":"Amemiya","sequence":"first","affiliation":[{"name":"Department of Pediatrics Toho University Graduate School of Medicine  Tokyo Japan"},{"name":"Department of Pediatrics Toho University Ohashi Medical Center  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2323-1640","authenticated-orcid":false,"given":"Keiko","family":"Asakura","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, School of Medicine Toho University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6813-9223","authenticated-orcid":false,"given":"Yuji","family":"Nishiwaki","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, School of Medicine Toho University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4189-1519","authenticated-orcid":false,"given":"Norikazu","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Toho University Ohashi Medical Center  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(07)60196\u20102"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2019.01.20"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00716470"},{"key":"e_1_2_10_5_1","first-page":"25","volume-title":"Neonatal and Perinatal Screening, the Asian Pacific Perspective","author":"Aoki T","year":"1996"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442\u2010200x.1999.01093.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109343(56)90066\u20103"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(72)90845\u20108"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.13812"},{"issue":"167","key":"e_1_2_10_10_1","first-page":"441","article-title":"Coper chelation in patients with Wilson's disease. 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