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Objectives: To investigate dysfunction in fine motor skills in a cohort of older Italian adults, identifying their prevalence and usefulness as indicators and predictors of cognitive impairment. Design: Population‐based longitudinal study with mean follow‐up of 4.4 years. Setting: Community. Participants: Older men and women enrolled in the Progetto Veneto Anziani (Pro.V.A.) (N = 2,361); 1,243 subjects who were cognitively intact at baseline were selected for longitudinal analyses. Measurements: Fine motor skills were assessed by measuring the time needed to successfully complete two functional tasks: putting on a shirt and a manual dexterity task. Cognitive impairment was defined as a Mini‐Mental State Examination (MMSE) score less than 24. Results: On simple correlation, baseline MMSE score was significantly associated with the manual dexterity task (correlation coefficient (r) = −0.25, P < .001) and time needed to put on a shirt (r = −0.29, P < .001). Over the study period, changes in time needed to perform the fine motor tasks were significantly associated with changes in MMSE (putting on a shirt: β = 0.083, P = .003; manual dexterity task: β = 0.098, P < .001). Logistic regression analyses confirmed that worse results on tasks were associated with cognitive impairment at baseline (odds ratio (OR) = 2.47, 95% confidence interval (CI) = 1.74–3.50, for the fourth quartile of time needed to put on a shirt; OR = 1.98, 95% CI = 1.42–2.76, for the fourth manual dexterity task quartile) and greater risk of cognitive impairment developing during follow‐up (OR = 4.38, 95% CI = 2.46–7.80, for the fourth quartile of time needed to put on a shirt; OR = 2.20, 95% CI = 1.30–3.72, for the fourth manual dexterity task quartile). Conclusions: Difficulties with fine motor skills are common in older adults, and assessing them may help to identify early signs of dementia, subjects at high risk to develop cognitive decline, and individuals who can be referred to specialists. [ABSTRACT FROM AUTHOR]

Background: The identification of novel rehabilitative impairments that are risk factors for mobility limitations may improve their prevention and treatment among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults.Methods: We conducted a 1-year prospective cohort study of community-dwelling older adults (N = 99) aged 67 years and older who did not have mobility limitations (Short Physical Performance Battery score > 9) at baseline. Participants performed antiphase coordination of the right and left ankles or shoulders while paced by an auditory metronome. Using multivariable logistic regression, we determined odds ratios (ORs) for mobility limitations at 1-year follow-up as a function of coordination variability and asymmetry.Results: After adjusting for age, sex, body mass index, Mini-Mental State Examination score, number of chronic conditions, and baseline Short Physical Performance Battery score, ORs were significant for developing mobility limitations based on a 1 SD difference in the variability of ankle (OR = 1.88; 95% confidence interval [CI]: 1.16-3.05) and shoulder (OR = 1.96; 95% CI: 1.17-3.29) coordination. ORs were significant for asymmetry of shoulder (OR = 2.11; 95% CI: 1.25-3.57), but not ankle (OR = 0.95; 95% CI: 0.59-1.55) coordination. Similar results were found in unadjusted analyses.Conclusions: The results support our hypothesis that impaired interlimb ankle and shoulder coordination are risk factors for the development of mobility limitations. Future work is needed to further examine the peripheral and central mechanisms underlying this relationship and to test whether enhancing coordination alters mobility limitations. [ABSTRACT FROM AUTHOR]

Background: Prior studies suggest being overweight may be protective against poor functional outcomes in older adults.Methods: Body mass index (BMI, kg/m2) was measured over 25 years across five visits (1987-2011) among Atherosclerosis Risk in Communities Study participants (baseline Visit 1 n = 15,720, aged 45-64 years). Gait speed was measured at Visit 5 ("late-life", aged ≥65 years, n = 6,229). BMI trajectories were examined using clinical cutpoints and continuous mixed models to estimate effects of patterns of BMI change on gait speed, adjusting for demographics and comorbidities.Results: Mid-life BMI (baseline visit; 55% women; 27% black) was associated with late-life gait speed 25 years later; gait speeds were 94.3, 89.6, and 82.1 cm/s for participants with baseline normal BMI (<25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30) (p < .001). In longitudinal analyses, late-life gait speeds were 96.9, 88.8, and 81.3 cm/s for participants who maintained normal, overweight, and obese weight status, respectively, across 25 years (p < .01). Increasing BMI over 25 years was associated with poorer late-life gait speeds; a 1%/year BMI increase for a participant with a baseline BMI of 22.5 (final BMI 28.5) was associated with a 4.6-cm/s (95% confidence interval: -7.0, -1.8) slower late-life gait speed than a participant who maintained a baseline BMI of 22.5.Conclusion: Being overweight in older age was not protective of mobility function. Maintaining a normal BMI in mid- and late-life may help preserve late-life mobility. [ABSTRACT FROM AUTHOR]

The article offers information on various hyperkinetic movement disorders, its causes and treatment among adults. It presents dystonia as the most common type of hyperkinetic movement disorders and sees drugs as the major cause of almost movement disorders. Meanwhile, botulinum toxin injections as one of the medicinal drugs that can control movement disorders especially dystonic tremor. Other movement disorders discussed include myoclonus, chorea, and dyskinesia.

Summary: Restless legs syndrome is a sleep and movement disorder that affects 5–15% of the general population, with an increased prevalence among the elderly population. It not only affects quality of life but also increases risk of mortality among older adults. The diagnosis is based on clinical symptoms of the patient by four minimal essential criteria. Restless legs syndrome can be divided into primary or secondary causes. Examination should be performed to rule out potentially treatable illnesses, such as iron deficiency, renal failure or peripheral neuropathy, especially among elderly patients. The initial approach to restless legs syndrome should be nonpharmacologic management, such as good sleep hygiene, regular exercise, cognitive behavioral therapy and avoidance of certain aggravating drugs. An algorithm based on scientific evidence and expert opinion was developed for guidance of treatment. Combination or change of medication can be applied to resistant or difficult cases. Since elderly patients are prone to treatment-related side effects, the best strategy is to start medication cautiously and at the lowest recommended dosage. [Copyright &y& Elsevier]

The article reports that advances in miniature-sensor technology have contributed to the development of wearable systems that physicians could use in order to observe motor behavior in patients with Parkinson's disease. In this article the researchers have sought to determine whether accelerometer data could aid physicians in predicting the severity of tremors, bradykinesia, and dyskinesia, identifying distinct movement patterns that record walking once stimulation has stopped, and estimating the rate of change in the severity of the tremor, bradykinesia, and dyskinesia.

This article presents a clinical review of Parkinson's disease. The author explains how the disease often presents with signs of bradykinesia and hypokinesia and tremors at rest. The symptoms can often be confused for other types of tremors and the diagnosis of Parkinson's can be difficult. Most experts in Great Britain use the Parkinson's Disease Society's Brain Bank diagnostic criteria. Often a single photon emission computer tomography (SPECT) is useful to separate Parkinson's from essential tremor. Suggestions are offered on early stage treatment and the treatment of motor complications.

Objectives: To compare the prevalence, severity, and type of gait and balance disorders in Alzheimer's disease (AD), vascular dementia (VaD), Parkinson's disease with dementia (PDD), dementia with Lewy bodies (DLB), Parkinson's disease without dementia (PD), and age-matched controls. Design: Cross-sectional. Setting: Secondary care clinics in geriatric psychiatry, neurology, and geriatrics. Participants: Two hundred forty-five participants aged 65 and older (AD, n=40; VaD, n=39; PDD, n=46; DLB, n=32; PD, n=46; and controls, n=42). Measurements: Prevalence and severity of gait and balance disorders were assessed using the Tinetti gait and balance scale. The types of gait disorders in each diagnostic group were classified using the Nutt et al. classification. Results: Gait and balance disorders were more common with PDD (93%), VaD (79%), and DLB (75%) than with PD (43%) and AD (25%) and in controls (7%). The risk of gait and balance disorder was higher in the non-Alzheimer's dementia groups (VaD, PDD, and DLB) than in the AD group (odds ratio=15 (95% confidence interval=6–37). If a gait disorder was present in mild dementia (Cambridge Examination for Mental Disorders of the Elderly cognitive subsection score >65), this was diagnostic of non-Alzheimer's dementia, with sensitivity of 78% and specificity of 100%. Non-Alzheimer's dementia groups had worse Tinetti gait and balance scores than the AD group (all P<.001). The types of gait disorders discriminated between non-Alzheimer's dementias. Conclusion: The findings support the idea that gait and balance assessment may augment the diagnostic evaluation of dementia. [ABSTRACT FROM AUTHOR]

A 2½-month-old girl presented with feeding difficulties of 8 weeks’ duration. She cried, vomited, arched, and became rigid during every feeding. She was suspected of having gastroesophageal reflux disease. Dystonia and developmental delay became apparent at age 8 months. Nasogastric tube feeding and gastrostomy with Nissen’s fundoplication were performed at age 7 and 12 months, respectively. She was treated with baclofen, trihexyphenidyl, and antireflux therapy, without benefit. She became severely developmentally delayed with marked head lag, dystonia, and rigidity. Levodopa therapy was initiated at age 21 months. She manifested dramatic improvement over the next year. Dystonia, rigidity, and retching disappeared soon after treatment. She experienced good catch-up in development. She exhibited poor head control and an inability to reach out at age 21 months, but bottom shuffling was observed at age 26 months, and walking and speaking three-word sentences at age 2 years and 10 months. Pertinent issues relating to signs, pathophysiology, genetics, and biochemical defects are discussed briefly. [Copyright &y& Elsevier]

The article presents a case study of a elderly gentleman with a medical history of ataxic gait and was admitted to a hospital due to further worsening of his gait and suffered multiple falls due to poor balance. The patient underwent a magnetic resonance imaging which showed a mild cerebellar atrophy and an autosomal recressive hereditary spastic paraplegia due to SPG-7 mutation. The article also discusses the importance of SPG-7 gene to hereditary spastic paraplegia (ARHSP).

IMotor complications like dyskinesias and fluctuations pose a major challenge in the medical management of Parkinson's disease. This study evaluated various motor complications and the factors contributing to their occurrence. Two hundred ninety three consecutive subjects (230 males and 63 females) with a mean age of 53.41(SD 11.24) years were recruited over a 2 year period. All patients were interviewed for information regarding clinical features, complications of disease and treatment details by neurologists. The predictive factors of dyskinesias and on-off phenomenon were ascertained using univariate and multi-variate (binomial logistic regression) analysis. Dyskinesias were reported in 57 patients (19.6%) and on- off phenomenon in 100 (34.2%) patients. The main type of dyskinesia observed was peak-dose (improvement-dyskinesia-improvement) dyskinesia. The important factors contributing to dyskinesias after multivariate analysis were young age of onset (< 40 years), presence of wearing-off and freezing episodes (ORs of 2.33,19.12 and 3.41 respectively), while tremor-dominant phenotype was associated with a lower risk of dyskinesias (OR 0.45). Cumulative dose of levodopa and/or dopa-agonist also showed significant association when considered along with the age of onset (OR 2.45). The factors associated with occurrence of on-off phenomenon were UPDRS motor score , freezing episodes, levodopa use (as opposed to dopa agonists), cumulative dose of levodopa and initial response to levodopa (OR 2.92, 3.00, 13.24, 2.91 and 0.28 respectively). This study helps to understand clinical features associated with motor complications; the recognition of which may have therapeutic and prognostic implications. [ABSTRACT FROM AUTHOR]

Discusses research being done on the diagnosis and treatment of restless legs syndrome (RLS) in older people in the U.S. Reference to a study by Richard P. Allen, published in a 2005 issue of the "Archive of Internal Medicine" journal; Percentage of the population over 60 years old who would sleep and function better in the daytime if RLS was correctly diagnosed and treated; Definition of medically-significant RLS.