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Background: Low muscle strength is a powerful predictor of negative health‐related events and a key component of sarcopenia. The lack of normative values for muscle strength across ages hampers the practical appraisal of this parameter. The aim of the present study was to produce normative values for upper and lower extremity muscle strength across a wide spectrum of ages, in a large sample of community‐dwellers recruited in the Longevity check‐up (Lookup) 7+ project. Methods: Lookup 7+ is an ongoing project that started in June 2015 and conducted in unconventional settings (i.e. exhibitions, malls, and health promotion campaigns) across Italy with the aim of fostering the adoption of healthy lifestyles in the general population. Candidate participants are eligible for enrolment if they are 18+ years and provide written informed consent. Upper and lower extremity muscle strength is assessed by handgrip strength and five‐repetition chair‐stand [5 × sit‐to‐stand (STS)] tests, respectively. Cross‐sectional centile and normative values for handgrip strength and 5 × STS tests from age 18 to 80+ years were generated for the two genders. Smoothed normative curves for the two tests were constructed for men and women using the lambda‐mu‐sigma method. Results: From 1 June 2015 to 30 May 2019, 11 448 participants were enrolled. The mean age of participants was 55.6 years (standard deviation: 11.5 years; range: 18–98 years), and 6382 (56%) were women. Normative values for handgrip strength and the 5 × STS test, both absolute and normalized by body mass index, were obtained for men and women, stratified by age groups. Values of upper and lower extremity muscle strength across ages identified three periods in life: an increase to peak in young age and early adulthood (18–24 years), preservation through midlife (25–44 years), and a decline from midlife onwards (45+ years). Conclusions: Our study established age‐specific and gender‐specific percentile reference values for handgrip strength and the 5 × STS test. The normative curves generated can be used to interpret the assessment of muscle strength in everyday practice for the early detection of individuals with or at risk of sarcopenia. [ABSTRACT FROM AUTHOR]

Objectives: The Trail Making Test (TMT) is widely used to assess psychomotor speed and attentional set-shifting. Since the regression-based norms and equivalent scores (ESs) for the TMT Italian version trace back to more than 20 years ago, we aimed at providing updated normative data for basic (Part A and Part B) and derived (Score B-A and Score B/A) TMT scores collected in a larger sample with an extended age range.Methods: Three hundred fifty-five Italian volunteers stratified for sex (166 men), age decades (age range 20-90 years), and educational level (from primary school to university) completed the TMT and the Montreal Cognitive Assessment (MoCA).Results: Multiple linear regression analyses revealed that age and educational level significantly influenced performances on basic and derived TMT scores except for B/A, which was associated only with the educational level. From the derived linear equations, correction grids for basic and derived TMT raw scores were developed. Inferential cutoff scores, estimated using a non-parametric technique, and ES were computed. Basic and derived TMT scores showed a good test-retest reliability (all rs ≥ 0.50); Part B (rs = - 0.48, p < 0.001) and Score B-A (rs = - 0.49, p < 0.001) were moderately associated with MoCA total score.Conclusions: This study confirms the association of basic and derived TMT raw scores with sociodemographic variables and provides updated correction grids and ES for assessing the attentional/executive functions in clinical and research fields. [ABSTRACT FROM AUTHOR]

• Disused railways represent a heritage that can be recovered as greenways. • A decision support system is applied to the design of a regional greenway. • The Greenway Suitability Index is designed to prioritize the rail to trail recover. • Scenario analysis is adopted to consider stakeholders' preferences. • The system steers participatory decisions regarding recovery policy and funding. Since the 1960s, a significant percentage of railway networks have been closed all over the world. This represents a heritage that can be used to provide new features to local communities with regard to sustainable development and landscape regeneration processes. Disused railways can be converted into greenways which are only dedicated to not motorized users and people with reduced mobility. Greenways can also be utilized for leisure, tourism and commuting. The growing interest and social demand for greenways face an obstacle in the form of scarce public funds. Accordingly, decision-makers and land-use planners need to assess the potential benefits and costs for local communities as well as the attractiveness for users. In this paper, we aim to provide a transferable working tool able to support decision-making and land-use planning processes related to the conversion of disused railway lines into greenways in mixed urban-rural contexts. We tested the developed methodology in Piedmont (Italy), a region with almost 600 km of abandoned railway lines and over 200 disused stations. We used a Geographic Information System (GIS) to carry out the spatial data analysis and an analytic hierarchy process (AHP) for integrating the preferences of stakeholders. We defined the Greenway Suitability Index (GSI), a synthetic global index able to take into account and synthetize the characteristics and current conditions of the disused railway networks and the territorial and social contexts ("Natural elements," "Historical-Cultural resources," "Traditional food and local wine," "Landscape or Scenery," "Accessibility," and "Population"). Decision-makers can use the GSI to prioritize and concentrate the investments on the sections with the highest score. We defined four scenarios based on the desired prevalent use of the future greenways - namely, touristic versus recreational/daily travel. We then calculated the GSI for each of them in order to verify how the priorities can change in relation to the objectives. The successful application demonstrated that the methodology can be used to calculate a sort of "priority score" considering the stakeholder's preferences and allowing for the land-use decision-makers to concentrate their investments in a hierarchal way. [ABSTRACT FROM AUTHOR]

Objective: To examine the usefulness of specific neurocognitive tests for predicting the crash involvement in ultra-octogenarian population., Methods: A total of 800 subjects (mean age 82.4 + 3.1 years) underwent a battery of neuropsychological tests. Global intellectual functioning was assessed using the Mini Mental State Examination, mental flexibility and information processing speed were assessed using the Trail Making Test parts A and B (TMT-A and TMT-B), long-term memory was evaluated with the short story, and visuo-spatial skills were tested with Clock Drawing Test. One year after this evaluation, 343 (43%) participants have been interviewed by a telephone call to know if they were currently driving and if they had a car crash during this period., Results: Two hundred ninety-seven subjects had their driving license renewed and completed the follow-up 1 year after. Data shows that less than 11% of this group had a car crash during the first year of observation (Crash Involved). Older subjects involved in a car crash showed significant worse performances on TMT-B (TMT-B pathological Crash Involved vs. Noncrash Involved 47% vs. 27%; p = 0.02) and on short story (short story pathological Crash Involved vs. Noncrash Involved 19% vs. 5%; p = 0.02)., Conclusions: Trail Making test B and short story have been demonstrated to provide a predictive value of driving performance of older people. Therefore, we suggest that a simple and standardized battery of neuropsychological tests, lasting about 30 min and administered by an experienced staff, is a good diagnostic instrument for risk prevention of driving activity of older drivers., (Copyright © 2012 John Wiley & Sons, Ltd.)

Objective: The objective was to examine whether preexisting cognitive function rather than cognitive decline associated with intraoperative procedures may predict change in behavioral functional capacity in patients 1 year after cardiac surgery., Method: Forty-five patients completed a cognitive evaluation, including the Trail Making Test part B (TMT-B) for attention and psychomotor speed, the Memory with 10-s interference for working memory, the Digit Span test for short-term memory and the Instrumental Activities of Daily Living (IADLs) questionnaire for behavioral functional capacity, before surgery and 1 year after cardiac surgery., Results: Sixteen patients (36%) exhibited cognitive decline after cardiac surgery. Preoperative scores on TMT-B significantly predicted change in behavioral functional capacity as measured by IADLs (beta = 0.371, P < .05), whereas the postoperative cognitive decline and intraoperative variables were unrelated to residualized change scores in IADLs (all Ps > .08)., Conclusions: Preexisting cognitive dysfunctions as assessed by TMT-B can be a marker of preoperative brain dysfunction, which, in turn, in addition to brain damage caused by cardiac surgery procedures, may further predispose patients to poor behavioral functional capacity and outcome 1 year after surgery. Impaired cognitive functions before surgery should be considered when evaluating the effects of cardiac surgery procedures on long-term behavioral functional status of patients., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Recent data have suggested few differences in the cognitive effects of antipsychotic medications. However, assessment of such effects can be complex, due to a number of factors. Clozapine has previously shown greater clinical and lesser cognitive benefits than other atypicals. This study compared the cognitive benefits of clozapine and ziprasidone in schizophrenia patients (n=130) with a history of either failure to respond to or intolerance of previous adequate antipsychotic treatments., Methods: Patients were randomized (double-blind) to either clozapine or ziprasidone in a single country (Italy), multi-site trial. The cognitive assessments examined episodic memory (RAVLT), executive functioning (Stroop test), and processing speed (Trail-making test (TMT) Parts A and B)., Results: Analyses found statistically significant within-group improvements for ziprasidone in learning and delayed recall on the RAVLT and on TMT Parts A and B. Clozapine-treated patients improved on the RAVLT, but not on the TMT. A composite cognitive score improved from baseline in both groups, but the improvements were significantly larger in the ziprasidone group (p=.029)., Implications: These results indicated that cognitive functioning improved following treatment with ziprasidone in patients with a history of either treatment resistance or intolerance, and that the effects are comparable or greater than those observed with clozapine. One interpretation of these findings is that clozapine treatment interferes with the performance benefits associated with practice.

Objectives: To study the association between performance on psychological tests of executive function and performance on lower extremity tasks with different attentional demands in a large sample of nondemented, older adults., Design: Cross-sectional study., Setting: Community-based., Participants: Nine hundred twenty-six persons aged 65 and older, without dementia, stroke, parkinsonism, visual impairment, or current treatment with neuroleptics, enrolled in a large epidemiological study., Measurements: Trail Making Test (TMT) parts A and B and two performance-based measures of lower extremity function that require different executive/attentional-demanding skills: walking speed on a 4-m course at usual pace and walking speed on a 7-m obstacle course at fast pace. A difference score (Delta TMT), obtained by subtracting time to perform part A from time to perform part B of the TMT, was used as an indicator of executive function. Based on Delta TMT, subjects were divided into poor performance, intermediate performance, and good performance., Results: After adjustment, no association between Delta TMT and 4-m course usual-pace walking speed was found. Participants with poor Delta TMT and with intermediate Delta TMT performance were more likely to be in the lowest tertile for 7-m obstacle course walking speed., Conclusion: In nondemented older persons, executive function is independently associated with tasks of lower extremity function that require high attentional demand.

Objectives: To evaluate the association between insulin resistance (IR) and executive dysfunction in a large, population-based study of older persons without diabetes mellitus (DM) or dementia., Design: Cross-sectional study., Setting: Outpatient clinic in Greve in Chianti and Bagno a Ripoli, Italy., Participants: A total of 597 subjects aged 65 to 93 without DM or dementia., Measurements: Anthropometric measurements; plasma fasting levels of glucose, insulin, cholesterol (total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol), and insulin-like growth factor-1 (IGF-1); homeostasis model assessment (HOMA) to estimate degree of IR; Trail Making Test (TMT) A; TMT-B; TMT-B minus TMT-A (DIFF B-A); and Mini-Mental State Examination (MMSE)., Results: IR (HOMA) was associated with longer TMT-B (correlation coefficient (r)=0.11; P=.006) and DIFF B-A times (r=0.10; P=.022). Subjects in the upper tertile of IR were older and had longer TMT-B and DIFF B-A than participants in the lowest tertile. After adjusting for age, sex, and years of formal education, IR was significantly correlated with TMT-A, TMT-B, and DIFF B-A. After adjusting for age, sex, education, body mass index, waist:hip girth ratio, HDL-C, triglycerides, IGF-1, hypertension, drug intake, and physical activity, the results did not significantly change. After introducing MMSE score into the model, IR continued to be an independent determinant of TMT-A (beta=11.005; P=.021), TMT-B (beta=28.379; P<.001), and DIFF B-A (beta=17.374; P=.011)., Conclusion: IR is independently associated with frontal cortex function evidenced by poor TMT times in older persons without DM or dementia.