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Background: Tic disorders belong to the broad spectrum of pediatric and adult movement disorders. The wide variability in clinical presentations, applied assessment tools, and treatments are poorly understood. Objectives: To map practices and knowledge base of movement disorder clinicians concerning clinical features, pathophysiology, and treatment approaches in tic disorders. Methods: A 33-item survey was developed by the Tic Disorders and Tourette syndrome Study Group members of the Movement Disorder Society. The survey was distributed to the complete society membership and included responses from 346 members, 314 of whom reported treating tic disorders. Results: Approximately one third of survey respondents (35%) frequently evaluated patients with tics. The data revealed widespread use of existing guidelines (about 70%) and screening for comorbid disorders (>90%). The most common investigations used to rule out secondary causes of tics were imaging (92%), laboratory tests (66%) and neurophysiology (38%). Functional tics were the second most common tic etiology following primary tics. Only 27% of respondents reported confidence in knowledge about tic pathogenesis. Top rated interventions to treat tics were psychoeducation, cognitive behavioral intervention for tics (CBIT) and treatment for neuropsychiatric comorbidities. Antipsychotics were ranked as the most effective pharmacologic tic intervention. Conclusions: The majority of movement disorders specialists do not frequently encounter tics. There was sparse knowledge about tic pathophysiology. Psychoeducation, CBIT, the treatment of neuropsychiatric comorbidities and use of antipsychotics emerged as the most common interventions to treat tics. These results provide insight into what will be needed to improve the diagnosis and treatment of tic disorders. [ABSTRACT FROM AUTHOR]

Background and purpose: Reliable and valid assessment tools are needed to evaluate and predict physical function in older hospitalised patients. The purpose of this study was to determine the reliability and validity of the Norwegian‐language version of the Elderly Mobility Scale (EMS‐N) for use with geriatric patients. Methods: Fifty patients admitted to a medical ward in a hospital in Norway were included. The inclusion criteria were acute hospital admission because of medical issues, age ≥65 years and referred to a physiotherapist for a physical function review. The original version of the Elderly Mobility Scale (EMS) was translated from English to Norwegian before initiating this study. EMS‐N was tested for internal consistency, test–retest reliability and criterion validity by using the short physical performance battery (SPPB) as the gold standard. Internal consistency was measured by Cronbach's alpha. Test–retest reliability was estimated by linear weighted kappa and the intra‐class correlation coefficient (ICC). Results: The mean age of participants was 82 (range 65–95). The main admission diagnoses were acute functional decline (64%, n = 32) or acute infection (26%, n = 13). Internal consistency was estimated at 0.88. Test–retest reliability: six of the seven EMS‐N items showed very good consistency, and the last item showed good consistency, ICC was estimated at 0.99. The standard error of measurement (SEM) reflected the absolute reliability, calculated at 0.52. The minimal detectable change (MDC) was calculated with 95 and 90% confidence intervals at 1.44 and 1.21, respectively. Criterion validity was calculated by a correlation analysis of the EMS‐N and the SPPB. The rho value was estimated as 0.75, which corresponds to a high correlation and indicated good criterion validity. Discussion: EMS‐N exhibited good internal consistency and good to very good test–retest reliability and criterion validity. EMS can safely be used as an assessment tool for hospitalised geriatric patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study. DESIGN: Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years. SETTING: LIFE was a multicenter eight‐site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD. PARTICIPANTS: Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment. MEASUREMENTS: Self‐reported fatigue was assessed using the modified trait version of the Exercise‐Induced Feelings Inventory, a six‐question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual‐paced 400‐m walk every 6 months. We defined incident MMD as the inability to walk 400‐m at follow‐up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates. RESULTS: Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD =.71; 95% confidence interval [CI] =.57‐.90; P =.004) and PMMD (HR =.60; 95% CI =.44‐.82; P =.001). For those with lower baseline fatigue, no group differences in MMD (P =.36) or PMMD (P =.82) were found. Results of baseline fatigue by intervention interaction was MMD (P =.18) and PMMD (P =.05). CONCLUSION: A long‐term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue. J Am Geriatr Soc 68:619–624, 2020 [ABSTRACT FROM AUTHOR]

Background: In the immediate period following stroke, sitting balance is one of the most important predictors of functional recovery at discharge after rehabilitation. Thus, sitting balance determines the content of the early phase of stroke rehabilitation and an appropriate measurement tool is important.Research Question: The aim of this study is to investigate the concurrent validity of center of pressure (CoP) excursions of patients seated on a force plate, as well as to examine the daily variability of trunk control after stroke.Methods: Twenty stroke patients at an inpatient rehabilitation clinic underwent two assessment sessions, on average eight hours apart. Each session comprised two trials: quiet sitting for 30 s; extended reaching in forward, backward, left and right directions. The Trunk Impairment Scale (TIS) was measured during the first session. CoP excursions were measured to determine the outcomes of sway area and sway velocity during stable sitting and the maximal excursions in frontal and sagittal planes during the reaching tasks.Results: High Spearman's correlations (0.72, 0.79) were found between the TIS and the frontal and sagittal excursions. However, only low correlations between the TIS and the sway area and sway velocity were observed. Within sessions, all CoP outcomes showed high ICCs (0.73-1.00). Between sessions, high ICCs (0.86-0.93) were found except for sway velocity (ICC 0.51). Sway velocity increased significantly between sessions.Significance: Frontal and sagittal CoP excursions during reaching tasks appear to be valid measurement parameters to evaluate trunk control in patients after stroke. Only small variability was observed and no significant differences between consecutive days. [ABSTRACT FROM AUTHOR]

Background: Abnormalities in gait kinetics in patients with Parkinson's disease (PD) who have suffer from gait impairment have been noted using a conventional inverse dynamic analysis derived by marker-based motion capture system and force plate, which are typically mounted in the laboratory floor. Despite the high accuracy of this approach in tracking markers' trajectories and acquiring ground reaction forces (GRFs), its dependence on laboratory-mounted equipment restricts its potential use in wider variety of clinical applications.Research Question: Would a full-body musculoskeletal model driven by a single depth sensor data only produce comparable gait kinetic parameters, including GRFs and lower extremity joints moments, for elderly participants, both healthy and those diagnosed with PD?Methods: Nine patients diagnosed with PD and 11 healthy age-matched control participants performed three over-ground gait trials. Full-body kinematic data were collected using a depth sensor and a musculoskeletal model have been constructed using AnyBody musculoskeletal modeling system to predict the three-dimensional GRFs and lower extremity joint moments. Predicted kinetic parameters for both PD and control groups were compared during the braking and propulsive phases of the gait cycle. In addition, ensemble curve analysis with 90% confidence intervals were constructed to compare between group differences across the stance phase of the gait cycle.Results: The findings of this study showed that the PD exhibited a significantly lower braking peak vertical GRF and propulsion peak horizontal GRF while no significant between-group differences were found in peak lower extremity joint moments. However, the PD showed significant alterations in lower extremity joint moments during the early and late phases of stance, which indicate a difference in ambulation strategy.Significance: The proposed method adopting full-body musculoskeletal model driven by a depth sensor data proves that it has the potential to be a portable and cost-effective gait analysis tool in the clinical setting. [ABSTRACT FROM AUTHOR]

Background: In addition to motor deficits, Parkinson's disease (PD) may cause perceptual impairments. The role of perceptual impairments in sensorimotor function is unclear, and has typically been studied in single-joint motions.Research Question: We hypothesized that perception of whole-body motion is impaired in PD and contributes to balance impairments. We tested (1) whether directional acuity to whole body perturbations during standing was worse in people with PD compared to neurotypical older adults (NOA), and (2) whether balance ability, as assessed by the MiniBESTest, was associated with poor directional acuity in either group.Methods: Participants were exposed to pairs of support-surface translation perturbations in a two-alternative forced choice testing paradigm developed previously in a young healthy population. The first perturbation of each pair that was to be judged by participants was directly backward, and the second perturbation deviated from the left or right from the backward direction by 1°-44°. Participants reported whether the perturbations in each pair were in the "same" or "different" direction. Judgements from 24 to 67 perturbation pairs were used to calculate directional acuity thresholds corresponding to "just-noticeable differences" in perturbation direction. Linear mixed models determined associations between directional thresholds and clinical variables including MDS-UPDRS-III score, age, and MiniBESTest score.Results: 20 PD (64 ± 7 y, 12 male, ≥12 h since last intake of antiparkinsonian medications) and 12 NOA (64 ± 8, 6 male) were assessed. Directional thresholds were higher (worse) among PD participants (17.6 ± 5.9° vs. 12.8 ± 3.3°, P < 0.01). Linear mixed models further showed that higher thresholds were associated with MDS-UPDRS-III score (P < 0.01), and were associated with poorer balance ability among PD participants (P < 0.01), but not among NOA participants (P = 0.40).Significance: Perception of whole-body motion is impaired in PD and may contribute to impaired balance and falls. [ABSTRACT FROM AUTHOR]

Objectives: To examine baseline characteristics and change in gait speed and Short Physical Performance Battery (SPPB) scores in participants medically suspended (MS) from a physical activity intervention (PA). Design: Randomized controlled trial. Setting: University and community centers. Participants: Sedentary older adults (N = 213) randomized to PA in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P). Measurements: MS was defined as missing 3 consecutive PA sessions in adoption and transition phases or 2 wk in maintenance phase because of a health event. Results: In all, 122 participants completed PA without MS (NMS subgroup), 48 participants underwent MS and resumed PA (SR subgroup), and 43 participants underwent MS and did not complete PA (SNR subgroup). At baseline, SNR walked slower (p = .03), took more prescribed medications (p = .02), and had lower SPPB scores than NMS and SR (p = .02). Changes from baseline to Month 12 SPPB scores were affected by suspension status, adjusted mean (SE) SPPB change: SNR 0.0957 (0.3184), SR 0.9413 (0.3063), NMS 1.0720 (0.1871); p = .03. Conclusions: MS participants unable to return to complete the PA in a trial of mobility-limited sedentary older adults had slower walking speeds, lower SPPB scores, and a higher number of prescribed medications at baseline. Change in SPPB scores at 12 months was related to suspension status. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether older golfers have better static and dynamic balance control than older but nongolfing healthy adults. Methods: Eleven golfers and 12 control participants (all male; 66.2 ± 6.8 and 71.3 ± 6.6 yr old, respectively) were recruited. Duration of static single-leg stance was timed. Control of body sway was assessed in single-leg stance during forward and backward platform perturbations. The lunge distance normalized with respect to each participant's height was used to compare the 2 groups in a forward-lunge test. Results: Golfers maintained significantly longer duration in static single-leg stance. They achieved less anteroposterior body sway in perturbed single-leg stance and lunged significantly farther than did control participants. Conclusions: The better static and dynamic balance control exhibited by older golfers possibly reflects the effects of weight transfers from repeated golf swings during weight shift from 2-leg to predominantly 1-leg stance and from walking on uneven fairways. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: To assess whether gait speed under complex conditions predicts long‐term risk for mobility disability as well as or better than usual‐pace gait speed. DESIGN: Longitudinal cohort study. SETTING/PARTICIPANTS: Subsample of Health Aging and Body Composition study with follow‐up from 2002 to 2003 to 2010 to 2011, including 337 community‐dwelling adults (mean age = 78.5 years, 50.7% female, 26.1% black). MEASUREMENTS: Associations of gait speed measured under usual‐pace, fast‐pace, dual‐task, and narrow‐path conditions with mobility disability, defined by any self‐reported difficulty walking ¼ mile assessed annually, were tested by Cox proportional hazard models adjusted for demographic and health characteristics. Models were fitted for each walking condition, and R2 statistics were used to compare predictive value across models. Models were repeated for persistent mobility disability, defined as at least two consecutive years of mobility disability. RESULTS: Mobility disability occurred in 204 (60.5%) participants over the 8‐year follow‐up. There was a lower hazard of developing mobility disability with faster gait speed under all conditions. Hazard ratios, confidence intervals, and R2 of gait speed predicting mobility disability were similar across all four walking conditions (R2 range = 0.22‐0.27), but were strongest for dual‐task gait speed (hazard ratio [95% confidence interval], R2 of fully adjusted models = 0.81 [0.75‐0.88], 0.27). Results were comparable for persistent mobility disability (R2 range = 0.26‐0.28). CONCLUSION: Slower gait speed under both usual‐pace and complex conditions may be a clinical indicator of future risk of mobility disability. These results support the call for increased use of gait speed measures in routine geriatric care. J Am Geriatr Soc 67:2072–2076, 2019 [ABSTRACT FROM AUTHOR]

Non-ketotic hyperglycaemic hemichorea is a rare syndrome characterized by a triad of hemichorea, hyperglycemia, and peculiar imaging abnormalities. Regression of symptoms is typically associated with normalisation of serum glucose levels and plasma osmolality. An 85 year-old female was admitted to the neurology clinic with left-sided involuntary movements. Magnetic resonance imaging of brain demonstrated hyperintensity on T1 weighted images. She was treated with clonazepam (12. 5 mg/ day) for symptomatic therapy. Hyperglycaemia was controlled using a combined therapy with insulin aspart and insülin glargine. The patient showed prompt improvement in her involuntary movements in a day. Acute or subacute onset of unilateral involuntary movements should suggest non-ketotic hyperglycaemic hemichorea, the recognition of which may result in prompt control of the symptoms by normalization of blood glucose. [ABSTRACT FROM AUTHOR]

The number of mobility scooter users is growing, a trend that is likely to continue in the context of the ageing society. Despite this, very little is known about their use, and the issues users are likely to encounter. This research draws upon a review of UK newspaper articles to explore the prevalence of articles relating to scooters, and ascertain the themes within them in order to begin to form theories about the use of scooters, and areas where further knowledge is required. It shows that the number of articles has been steadily increasing over time, and identifies a number of main themes relating to mobility scooter use. These included safety, theft and a range of ownership and use issues. There is a strong division of opinion, with users having very positive feelings about scooters and members of the public and professionals having more negative ones. In conclusion, additional research is needed to understand the issues scooter users experience, in particular in relation to safety, in order to ensure their potential to facilitate continued mobility is realised. In turn, this could lead to well-being benefits for the individual, and wider benefits for the public sector and the population more generally. [ABSTRACT FROM AUTHOR]

Abstract: Summary: In a community-dwelling elderly cohort (Korean Urban Rural Elderly), low peak jump power was associated with elevated odds of dysmobility syndrome and its components, independent of age and comorbidities. Jump power measurement improved discrimination of individuals with dysmobility syndrome when added to conventional risk factors.Introduction: Dysmobility syndrome was proposed to encompass the risks affecting musculoskeletal outcomes. Jump power measurement is a safe, reproducible high-intensity test for physical function in elderly. However, the relationship between jump power and dysmobility syndrome remains unknown.Methods: A total of 1369 subjects (mean 71.6 years; women, 66%) were analyzed from a community-based cohort. Dysmobility syndrome was defined as the presence of ≥ 3 factors among falls in the preceding year, low lean mass, high fat mass, osteoporosis, low grip strength, and low timed get-up-and-go (TUG) performance. Subjects were grouped into tertiles of jump power relative to weight based on sex-stratified cutoffs (32.4 and 27.6 W/kg in men; 23.9 and 19.9 W/kg in women) or into the failed-to-jump group.Results: The prevalence of dysmobility syndrome was 20% overall, increasing from the highest (T1) to lowest (T3) jump power tertile (1, 11, 15% in men; 11, 16, 39% in women) and the failed-to-jump group (39% in men; 48% in women). Low jump power or failed-to-jump was associated with elevated odds of dysmobility syndrome (T3 vs. T1, adjusted odds ratio [aOR] 4.35, p < 0.001; failed-to-jump vs. T1, aOR 7.60, p < 0.001) and its components including falls, low lean mass, high fat mass, and poor TUG performance but not osteoporosis after adjustment for covariates. Jump power modestly discriminated dysmobility syndrome (area under the curve [AUC], 0.71, p < 0.001), which improved discriminatory performance when added to conventional risk factors (AUC, from 0.75 to 0.79, p < 0.001).Conclusions: Low peak jump power was associated with elevated odds of dysmobility syndrome and its components, independent of age and comorbidities. [ABSTRACT FROM AUTHOR]

Background: An important decision with accelerometry is the threshold in counts per minute (CPM) used to define moderate to vigorous physical activity (MVPA). We explore the ability of different thresholds to track changes in MVPA due to a physical activity (PA) intervention among older adults with compromised function: 760 CPM, 1,041 CPM, and an individualized threshold. We also evaluate the ability of change in accelerometry and self-reported PA to attenuate treatment effects on major mobility disability (MMD).Methods: Data from a week of hip worn accelerometers and self-reported PA data (30-day recall) were examined from baseline, 6-, 12-, and 24-months of follow-up on 1,528 older adults. Participants were randomized to either PA or Health Education (HE). MMD was objectively defined by loss of ability to walk 400 m during the follow-up.Results: The three thresholds yielded similar and higher levels of MVPA for PA than HE (p < .001), however, this difference was significantly attenuated in participants with lower levels of physical function. Self-reported PA that captured both walking and strength training totally attenuated the intervention effect for MMD, an 18% reduction to a 3% increase. Accelerometer CPMs showed less attenuation of the intervention effect.Conclusions: Accelerometry assessment within the LIFE study was not sensitive to change in level in physical activity for older adults with very low levels of physical function. A combination of self-report and objective measures are recommended for use in physical activity intervention studies of the elderly; limitations of accelerometry deserve closer attention. [ABSTRACT FROM AUTHOR]

Background: The Two-Step test is one of three official tests authorized by the Japanese Orthopedic Association to evaluate the risk of locomotive syndrome (a condition of reduced mobility caused by an impairment of the locomotive organs). It has been reported that the Two-Step test score has a good correlation with one's walking ability; however, its association with the gait pattern of older people during normal walking is still unknown. Therefore, this study aims to clarify the associations between the gait patterns of older people observed during normal walking and their Two-Step test scores.Methods: We analyzed the whole waveforms obtained from the lower-extremity joint angles and joint moments of 26 older people in various stages of locomotive syndrome using principal component analysis (PCA). The PCA was conducted using a 260 × 2424 input matrix constructed from the participants' time-normalized pelvic and right-lower-limb-joint angles along three axes (ten trials of 26 participants, 101 time points, 4 angles, 3 axes, and 2 variable types per trial).Results: The Pearson product-moment correlation coefficient between the scores of the principal component vectors (PCVs) and the scores of the Two-Step test revealed that only one PCV (PCV 2) among the 61 obtained relevant PCVs is significantly related to the score of the Two-Step test.Conclusions: We therefore concluded that the joint angles and joint moments related to PCV 2-ankle plantar-flexion, ankle plantar-flexor moments during the late stance phase, ranges of motion and moments on the hip, knee, and ankle joints in the sagittal plane during the entire stance phase-are the motions associated with the Two-Step test. [ABSTRACT FROM AUTHOR]

Objectives: To examine the potential contribution of severity of lumbopelvic pain (LPP) in well‐functioning older adults to poorer walking efficiency, lack of endurance, slower gait speed, and decline in these mobility parameters over 1 to 5 years. Design: Longitudinal analysis of Baltimore Longitudinal Study of Aging data. Setting: National Institute on Aging, Clinical Research Unit, Baltimore, Maryland. Participants: Well‐functioning men and women aged 60 to 89 (N=878). Measurements: An interviewer‐administered questionnaire was used to ascertain reported presence and severity of back and hip pain in the preceding 12 months and reported walking ability, including ease of walking a mile. Certified examiners assessed usual gait speed, the energetic cost of walking (oxygen consumption, mL per kg/m), and time taken to walk 400 m as quickly as possible. Covariates included sex, age, age‐squared, race, height, weight, exercise, and smoking. Results: Overall, 31.4% had mild LPP, and 15.7% had moderate to severe LPP. In adjusted analyses, reported walking ability (p<.001), endurance walk performance (p=.007), and energetic cost of walking (p=.049) were worse with increasing LPP severity. Usual gait speed did not vary according to LPP (p=.31). Longitudinally, over an average 2.3 years, persons with new or sustained LPP had worse follow‐up level, greater mean decline, and higher likelihood of meaningful decline in reported walking ability than persons free of LPP or whose LPP resolved. Walking performance did not differ according to LPP follow‐up status. Conclusion: LPP was common in well‐functioning older adults and was associated with greater energetic cost of walking and poorer perceived and observed walking endurance. The longitudinal effect of LPP is unclear, but worsening perception of walking ability and its contribution to future mobility loss warrants further attention. [ABSTRACT FROM AUTHOR]

Mobility impairment in older persons is associated with brain white matter hyperintensities (WMH), a common finding in magnetic resonance images and one established imaging biomarker of small vessel disease. The contribution of possible microstructural abnormalities within normal-appearing white matter (NAWM) to mobility, however, remains unclear. We used diffusion tensor imaging (DTI) measures, i.e. fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), to assess microstructural changes within supratentorial NAWM and WMH sub-compartments, and to investigate their association with changes in mobility performance, i.e. Tinetti assessment and the 2.5-meters walk time test. We analyzed baseline (N = 86, age ≥75 years) and 4-year (N = 41) follow-up data. Results from cross-sectional analysis on baseline data showed significant correlation between WMH volume and NAWM-FA (r = -0.33, p = 0.002), NAWM-AD (r = 0.32, p = 0.003) and NAWM-RD (r = 0.39, p = 0.0002). Our longitudinal analysis showed that after 4-years, FA and AD decreased and RD increased within NAWM. In regional tract-based analysis decrease in NAWM-FA and increase in NAWM-RD within the genu of the corpus callosum correlated with slower walk time independent of age, gender and WMH burden. In conclusion, global DTI indices of microstructural integrity indicate that significant changes occur in the supratentorial NAWM over four years. The observed changes likely reflect white matter deterioration resulting from aging as well as accrual of cerebrovascular injury associated with small vessel disease. The observed association between mobility scores and regional measures of NAWM microstructural integrity within the corpus callosum suggests that subtle changes within this structure may contribute to mobility impairment. [ABSTRACT FROM AUTHOR]

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 More and more elderly problems come to our life and the elderly health care become more important. Elderly people with lower extremities weakness usually use walkers to assist in walking. Although the commercial standard walkers (N-type) can improve elderly people's walking ability, users sometimes take risk of falling when using the standard walkers to perform sit-to-stand (STS). The purpose of this study is to design an additional armrest which can be attached to a standard walker for users performing STS more easily and evaluate it with clinical assessments and a body worn sensor. Methods The combination of the walker and the new armrest design are referred to as a better type (B-type). Clinical assessments and a motion analysis were performed on 34 elderly people (age, 83 ± 6 y/o) with a Five Times Sit-to-Stand Test (FTSST), a satisfaction survey and an inertial measurement unit (IMU) attached to the trunk to measure the acceleration data when using B-type and N-type during STS. Results The FTSST result shows that the B-type can reduce about 5 s spending time of elderly people during STS and 63.7% of subjects were more satisfied on the B-type than the N-type. According to the IMU, the result reveals that the B-type can provide subjects higher peak–peak anterio-posterior acceleration, peak flexion acceleration and peak extension acceleration during STS. Conclusion There is a better assistance during STS when using our new armrests design combined with the commercial product which could provide larger acceleration to perform sit-to-stand. [ABSTRACT FROM AUTHOR]

Cutaneous mechanoreceptors in the anterior lower leg and foot dorsum provide important information about contact with objects and movement at the knee and ankle. This cutaneous feedback contributes to static and dynamic balance control. We conducted experiment 1 to determine the effects of ageing on anterior lower leg cutaneous feedback. We measured light touch (monofilament) perceptual thresholds (MPT) at seven skin sites across the anterior lower leg and foot dorsum in 12 young (5 male, aged 21–28) and 13 older adults (8 male, aged 73–92). Results showed that older adults had ~ 5.5 × higher MPTs across these skin sites. We conducted experiment 2 to probe how different cutaneous mechanoreceptor subtypes are affected by ageing through measures of vibrotactile perceptual threshold (VPT) at 3, 15, and 40 Hz at six skin sites across the anterior lower leg and foot dorsum in 10 young (5 male, aged 21–26) and 10 older adults (3 male, aged 75–85). In this group, we also assessed functional balance using the timed-up-and-go (TUG) and functional reach test (FRT). Older adults demonstrated significantly higher VPTs overall, and this effect was largest at 40 Hz – a frequency primarily transmitted by fast adapting cutaneous afferents. Furthermore, higher thresholds at each frequency tended to correlate with poorer performance on the TUG within the older adult group (3 Hz: r = 0.550; 15 Hz: r = 0.689; 40 Hz: r = 0.663). These results suggest ageing influences cutaneous feedback from regions of the lower leg that provide important information about movement and contact. [ABSTRACT FROM AUTHOR]

Background: A robotic exoskeleton device is an intelligent system designed to improve gait performance and quality of life for the wearer. Robotic technology has developed rapidly in recent years, and several robot-assisted gait devices were developed to enhance gait function and activities of daily living in elderly adults and patients with gait disorders. In this study, we investigated the effects of the Gait-enhancing Mechatronic System (GEMS), a new wearable robotic hip-assist device developed by Samsung Electronics Co, Ltd., Korea, on gait performance and foot pressure distribution in elderly adults.Methods: Thirty elderly adults who had no neurological or musculoskeletal abnormalities affecting gait participated in this study. A three-dimensional (3D) motion capture system, surface electromyography and the F-Scan system were used to collect data on spatiotemporal gait parameters, muscle activity and foot pressure distribution under three conditions: free gait without robot assistance (FG), robot-assisted gait with zero torque (RAG-Z) and robot-assisted gait (RAG).Results: We found increased gait speed, cadence, stride length and single support time in the RAG condition. Reduced rectus femoris and medial gastrocnemius muscle activity throughout the terminal stance phase and reduced effort of the medial gastrocnemius muscle throughout the pre-swing phase were also observed in the RAG condition. In addition, walking with the assistance of GEMS resulted in a significant increase in foot pressure distribution, specifically in maximum force and peak pressure of the total foot, medial masks, anterior masks and posterior masks.Conclusion: The results of the present study reveal that GEMS may present an alternative way of restoring age-related changes in gait such as gait instability with muscle weakness, reduced step force and lower foot pressure in elderly adults. In addition, GEMS improved gait performance by improving push-off power and walking speed and reducing muscle activity in the lower extremities.Trial Registration: NCT02843828 . [ABSTRACT FROM AUTHOR]

Background Mild parkinsonian signs ( MPS) are frequent in the elderly population and associated with the presence of risk markers for Parkinson's disease ( PD). Both MPS and non-motor signs may be present in prodromal PD and may significantly impair quality of life ( Qo L). Objective To disentangle the contribution of motor impairment and extra-motor manifestations to QoL in subjects with MPS (n=63), manifest PD (n=69), disorders with motor symptoms due to non-neurodegenerative diseases (n=213) and healthy controls (n=258). Methods Subjects with MPS, healthy controls, disease controls (patients with motor impairment due to, eg, arthrosis and spondylosis), and PD patients (total n=603) were selected from a large epidemiological longitudinal study, the EPIPARK cohort. Motor function was determined using the UPDRSIII protocol, and information on depressive symptoms, anxiety, sleep, and QoL was assessed via rating scales and data were analyzed. Results Depressive symptoms, anxiety, and sleep problems were equally frequent in the MPS group and controls. Health-related QoL was slightly reduced in the MPS group. Motor impairment and its extent was comparable between the MPS group and disease controls ( UPDRSIII 5-6 points). Higher motor dysfunction was associated with lower QoL. Depressive symptoms, but not anxiety and daytime sleepiness, was significant predictors of general QoL, independent of motor function. Conclusions Quality of life is slightly decreased in an elderly population with MPS. QoL is associated with severity of motor impairment but also with non-motor aspects, ie, depressive symptoms. Follow-up studies in large cohorts are warranted to determine the natural course of MPS and its impact on QoL. [ABSTRACT FROM AUTHOR]

Background: Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be adaptive in and postpone the decline in life-space mobility. However, this has not been studied. This study examined whether changes in life-space mobility over a 2-year period differ between people who at baseline report no walking difficulty and no task modification, those who report no walking difficulty but task modification, and those who report walking difficulty.Methods: Community-dwelling people aged 75-90 years were interviewed face-to-face at baseline (N = 848), and over phone one (n = 816) and two (n = 761) years later. Life-space mobility was assessed annually with the Life-Space Assessment (range 0-120, higher scores indicate better life-space mobility). Self-reported ability to walk 2 km was assessed at baseline and categorized into "no difficulty," "no difficulty but task modifications" (reduced frequency, given up walking, walking slower or resting during walking) and "difficulty." The analyses were adjusted for age, gender, number of chronic conditions, cognitive impairment, lower extremity performance and education.Results: The life-space mobility score was highest and remained stable over 2-years among those with no walking difficulties at baseline and lowest and showing a steady decline among those with walking difficulties. Those with task modifications formed the middle group. They showed no marked changes in life-space mobility during the first year, but significant decline during the second year.Conclusion: Task modifications in walking may help community-dwelling older people to postpone life-space mobility decline. [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]

Background: The purpose of health and social policies is to encourage older people more longevity, remain free of disability and experience quality of life while living in their homes. The aim of this study was to describe the characteristics of 473 patients diagnosed with motor impairment in primary care, the objectives of home-based rehabilitation and its functional impact.Methods: This prospective observational study was conducted in the Almería Health District. The analysed variables included age, gender, secondary diagnosis, Barthel Index (BI), physiotherapeutic objectives and techniques, and number of sessions.Results: The sample had a mean age of 83 years, and 59% were women. The assessed conditions with a high prevalence included osteoarticular pathology (55%), Alzheimer's disease (15.1%), cardiovascular disease (13.7%) and stroke (6.5%). The techniques applied mainly consisted of functional exercises (57.1%), caregiver education (13.8%), and technical assistance (5.7%). There were statistically significant differences (t = -15.79; p < 0.001) between initial (X = 34.8) and final BI (X = 48.1), with an improvement of 13.4 points in patients' functional capacity (95% confidence interval [CI]: -15.0 to -11.7). An equation was constructed to predict patients' final BI as a function of the initial BI using a multiple linear regression model. The regression model explained 78% of the variance in patients with motor impairment.Conclusions: Important improvements were obtained in terms of functional capacity with a mean of ten sessions of physiotherapy. Lower patient age was correlated with higher initial and final functional capacities in primary care. This study aimed to present a useful starting point for decision making among management and health administration regarding this population group by approaching the process from the reality of practice and in relation to the rehabilitation provided.Trial Registration: ClinicalTrials.gov identifier: NCT02715245 ; Date of registration: 18 January 2016. [ABSTRACT FROM AUTHOR]

Background: Physical activity plays a pivotal role in the development of disability and may modify the negative effect of vascular risk factors on progression of both cardio and cerebrovascular disorders. The aim of this study was to evaluate the activity level in people with age-related white matter changes as identified on magnetic resonance imaging (MRI) in relation to motor performance, cognition and perceived health.Methods: Data came from the first year follow up of one participating centers of the LADIS study. Fifty one subjects were first enrolled in the study. Complete first year follow up data was available for 41 subjects. Information on comorbidity, physical activity level, physical function, cognition, level of white matter changes and perceived health was collected. Physical activity level was classified with a yes or no question and with the Frenchay Activities Index (FAI).Results: Only 36% of the subjects in this study were physically active according to the yes/no question. 27.5% of the subjects were active according to the FAI score which evaluates the everyday activities. Being active discriminated subjects with better physical function. Subjects active according to the FAI score had a higher cognitive level (p ≤ 0.01), lower comorbidity (p = 0.02) and performed better on all motor function tasks as assessed by walking speed (p ≤ 0.01) and the Short Physical Performance battery (SPPB) (p ≤ 0.01).Conclusions: Being physically active seems to be a long term protective factor. In our study, the majority of subjects with Age Related White Mattter Changes (ARWMC) with no or mild Instrumental Activity of Daily Living (IADL) disability did not attain recommended level of activity at first year follow up. Whether or not increasing physical activity may slow down cognitive decline and lessen development of disability in physically inactive subjects with manifest ARWC remains to be studied.Trial Registration: not applicable. [ABSTRACT FROM AUTHOR]

In the literature pertaining to supporting rehabilitation for elderly people, methods such as robot suits and belts has been proposed, however the method to be used casually by individuals is not provided sufficiently. In this research, we propose a rehabilitation robot that allows elderly people to perform rehabilitation individually. Specifically, the robot provides adaptive motion according to the stride of a person, based on the estimation of stride length by a statistical method. We develop a prototype of a rehabilitation robot that assists the movement of people, based on the estimation of the stride. To evaluate performance, we evaluate the ratio of recall and relevance rate of the proposed rehabilitation robot, with the proposed method that based on the estimation of stride length. The result shows that the effectiveness of estimation. [ABSTRACT FROM AUTHOR]

Objective: The advent of second-generation antipsychotics (SGAs) in the 1990s brought optimism that neuroleptic-induced tardive dyskinesia (TD) may become relegated to history. Whether or not this is the case remains inconclusive, and this review aims to compare the risk of TD in older adults treated with first-generation antipsychotics (FGAs) versus SGAs.Methods: Relevant papers were sourced via a range of electronic databases, with a date range from 1957 to January 2015. Included studies used both a validated rating scale and research diagnostic criteria to report on the prevalence or incidence of TD in older adults exposed to antipsychotic medications.Results: For FGAs, the prevalence estimate was 53% (95% confidence interval [CI] [39.0, 68.4]) for mild TD and 38% (95% CI [25.9, 50.3]) for probable TD. Incidence estimates for probable TD with FGAs were 23% (95% CI [15.3, 30.6]) at 1 year, 42% (95% CI [24.8, 58.4]) at 2 years and 57% (95% CI [45.3, 69.1]) at 3 years. For SGAs, the incidence estimates at 1 year were 7% (95% CI [4.4, 10.2]) for probable TD and 3% (95% CI [1.5, 4.2]) for persistent TD.Conclusions: The risk of probable TD is more than three times lower in older adults receiving SGAs in comparison with FGAs after 1 year of treatment (23% vs 7%). The risk of persistent TD at 1 year with SGAs is particularly low. Evidence is lacking in regard to the longer-term risk of TD with SGAs, although the rates associated with the prolonged use of FGAs are high. Caution is therefore still required, particularly with the protracted use of both FGAs and SGAs. [ABSTRACT FROM AUTHOR]

The alien hand syndrome (AHS) is a fascinating movement disorder. Patients with AHS experience one of their limbs as alien, which acts autonomously and performs meaningful movements without being guided by the intention of the patient. Here, we report a case of a 74-years old lady diagnosed with an atypical Parkinson syndrome by possible corticobasal degeneration. The patient stated that she could not control her right hand and that she felt like this hand had her own life. We tested the patient for ownership illusions of the hands and general tactile processing. Results revealed that when blindfolded, the patient recognized touch to her alien hand only if it was presented separated from touch to the other hand (bilateral asynchronous touch). Delivering touch synchronously to both the alien and the healthy hand resulted in failure of recognizing touch to the alien hand (bilateral synchronous touch). Thus, AHS here co-existed with right-sided tactile extinction and is one of only very few cases in which the alien hand was felt on the right side. We discuss the results in the light of recent research on AHS. [ABSTRACT FROM AUTHOR]

Objectives: The response time (RT) to kinesthetic perception has been used as a proprioceptive measurement, for example, in older individuals. However, the RT cannot provide information on impairments at specific stages of the respective sensorimotor processing. In the present study, electroencephalographic (EEG) signals were recorded during passive ankle movement with and without an associated perceptual task of movement detection. The main purpose was to analyze differences between young and older adults both in terms of RT and cortical responses. Putative differences in the latter were expected to point to changes in the processing associated with neural pathways or cortical regions in the older subjects. Methods: The EEG activity of nineteen older (OA, 65-76 years) and 19 young adults (YA, 21-32 years) was recorded during passive ankle movement, without motor voluntary response (NVR, sensory condition), and during a condition with voluntary motor response (VR, with measurement of the RT). Event-related potentials (ERP) and beta event-related desynchronization/synchronization (ERD/ERS) were recorded and analyzed in both experimental conditions. Results: The RT in OA was larger than in YA (P < 0.0001). EEG analyses showed that the N1 amplitude was larger in the VR than in the NVR condition (P = 0.006), whereas no difference for latency was obtained between conditions (P = 0.376). Comparisons between the groups revealed attenuated (P = 0.019) and delayed (P = 0.001) N1 in the OA group, irrespective of the condition (no interaction group vs condition). Only OA showed correlations between RT and N1, with significant correlation for both amplitude (r = 0.603, P = 0.006) and latency (r = 0.703, P = 0.001). The ERD/ERS analyses revealed a task-dependent group effect: in NVR, significant differences were obtained only for the ERS amplitude, which was attenuated in OA (P = 0.003). In VR, larger (P = 0.004) and delayed (P = 0.003) ERD and attenuated (P = 0.029) and delayed (P = 0.017) ERS peaks were observed in the older group. Conclusions: The results suggest that a larger response time to proprioceptive stimuli in older adults is associated with a weaker and delayed proprioceptive afferent inflow to the cortex. In this scenario, older adults would need a higher cognitive effort (larger ERD) to process the sensory inputs when attempting to properly perform a sensorimotor task. Significance: ERP and ERD/ERS measurements during kinesthetic assessment provide new insights on identification of the origin of sensorimotor slowing in older adults. [ABSTRACT FROM AUTHOR]

Objective: All previous studies using TMS to assess short-interval intracortical inhibition (SICI) in older adults have used a conventional coil orientation, which produces posterior-to-anterior (PA) current flow in the motor cortex. However, no studies have examined SICI in older adults by reversing the coil to induce anterior-to-posterior (AP) current flow, which is considered more sensitive at detecting SICI. Therefore, we investigated age-related changes in SICI using both PA and AP TMS across different conditioning stimulus intensities and muscle activation states. Methods: In 22 young and 20 older adults, SICI was assessed using PA and AP coil orientations, across a range of conditioning stimulus intensities (70-90% active motor threshold), and whilst participants kept their first dorsal interosseous (FDI) muscle either relaxed or active (2 N force). Results: There were no age-related differences in SICI using conventional PA TMS in resting or active FDI muscle. However, SICI was increased in elderly participants when assessed with reverse coil AP TMS in resting FDI. Conclusions: Coil orientation is a key factor to consider when assessing age-related differences in SICI. Significance: Reverse coil AP TMS can reveal age-related changes in SICI, which were previously not evident with conventional PA TMS. This may have implications for the assessment of SICI in some clinical populations that may show subtle differences in SICI circuitry. [ABSTRACT FROM AUTHOR]

Some of the neurodegenerative processes in healthy aging, including changes in structural and biochemical properties of the brain, are argued to affect cortical inhibitory functions. Age-related deficits in the ability to control cerebral inhibition may explain wide range of motor and cognitive deficits that healthy older adults experience in daily life such as impaired coordination skills and declines in attention, concentration, and learning abilities. Importantly, evidence from many studies suggests that impaired inhibitory control in advancing age can be delayed or even alleviated by aerobic exercise training. Findings from a recent study by Duchesne and colleagues (2015) may provide insights into this process. First, observations from Duchesne et al. indicated that aerobic exercise training program improved cognitive inhibitory functioning in both patients with Parkinson's disease (PD) and matched older controls. Second, Duchesne et al. showed that cognitive inhibition and motor skills were highly correlated both pre- and post-exercise in PD but not in controls. Based on the aforementioned findings we highlight possible mechanisms that may play a role in the interactions between cognitive and motor inhibitory functions in healthy elderly that could benefit from aerobic exercise training: specifically, the brain neurotransmission systems and the frontal-basal ganglia network. In conclusion, we raise two fundamental questions which are yet to be addressed: (1) the extent to which different brain neurotransmitter systems are affected by aerobic exercise training; (2) the extent to which neurotransmitter levels prior to the onset of intervention may facilitate (or impede) training-induced neuroplasticity in the aging brain. [ABSTRACT FROM AUTHOR]

Background. Mobility is an essential aspect of everyday life and enables autonomy and participation. Although many risk factors for mobility loss have been previously described, their relative importance and independent contributions to the long-term risk of losing mobility have not been well defined. Methods. This study is based on 1,013 men and women aged >65 years enrolled in 1998-2000 and followed for 9 years through 2007-2008 in the population-based InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) study. We considered 44 different measures assessed at baseline to explore six subsystems: (i) central nervous system, (ii) peripheral nervous system, (iii) muscles, (iv) bone and joints, (v) energy production and delivery, and (vi) perceptual system.The outcome was incident mobility loss defined as self-report of inability to walk 400 m or climb and descend 10 steps without help from another person. Random survival forest analysis was used to rank the candidate predictors by their importance. Results. The most important physiological markers predicting mobility loss that emerged from the random survival forest modeling were older age among women (81-95 vs 65-68 years, hazard ratio [HR] 9.60 [95% CI 3.35, 27.50]), weaker ankle dorsiflexion strength (lowest vs highest quintile, HR 5.25 [95% CI 2.35, 11.72]), low hip flexion range of motion (lowest vs highest quintile, HR 2.30 [95% CI 1.20, 4.41]), presence of primitive reflexes (yes vs no, HR 1.47 [95% CI 1.03, 2.09]), and tremor (yes vs no, HR 1.91 [95% CI 1.18, 3.07]). Conclusion. Prevention of mobility loss with aging should focus on prevention and treatment of neuromuscular impairments. [ABSTRACT FROM AUTHOR]

Background. The assessment of mobility is essential to both aging research and clinical geriatric practice. A newly developed self-report measure of mobility, the mobility assessment tool-short form (MAT-sf), uses video animations as an innovative method to improve measurement accuracy/ precision.The primary aim of the current study was to evaluate whether MAT-sf scores can be used to identify risk for major mobility disability (MMD). Methods. This article is based on data collected from the Lifestyle Interventions and Independence for Elders study and involved 1,574 older adults between the ages of 70-89. The MAT-sf was administered at baseline; MMD, operationalized as failure to complete the 400-m walk < 15 minutes, was evaluated at 6-month intervals across a period of 42 months.The outcome of interest was the first occurrence of MMD or incident MMD. Results. After controlling for age, sex, clinic site, and treatment arm, baseline MAT-sf scores were found to be effective in identifying risk for MMD (p< .0001). Partitioning the MAT-sf into four groups revealed that persons with scores <40, 40-49, 50-59, and 60+ had failure rates across 42 months of follow-up of 66%, 52%, 35%, and 22%, respectively. Conclusions. The MAT-sf is a quick and efficient way of identifying older adults at risk for MMD. It could be used to clinically identify older adults that are in need of intervention for MMD and provides a simple means for monitoring the status of patients' mobility, an important dimension of functional health. [ABSTRACT FROM AUTHOR]

Objective: To establish the cutoff time for the one-leg standing (OLS) test (with eyes open) to use when screening elderly people for locomotive syndrome. Methods: Patients visiting orthopedic clinics and healthy volunteers, all ≥65 years old, were recruited. Participants were asked to complete the 25-question Geriatric Locomotive Function Scale (GLFS-25) and then underwent the OLS test. Using the previously determined GLFS-25 cutoff value, participants were divided into two groups: the locomotive and the non-locomotive syndrome groups (GLFS-25 scores of ≥16 and <16, respectively). Conventional receiver operating characteristic curve (ROC) analysis was used to calculate the optimal cutoff time for the OLS. Results: Data from 880 individuals (261 men, 619 women; mean age (SD), 77 (6) years; range 65-96 years) were analyzed; 497 were in the locomotive syndrome group and 383 were in the non-locomotive syndrome group. A significant difference was seen between each group mean for individual average (IA) OLS times (IA-OLS: the average of the OLS times obtained for both legs of an individual). According to ROC analysis without age adjustment, when the IA-OLS time was ~9 s, the sum of the sensitivity and specificity of the test was highest. However, because of a statistically significant difference in IA-OLS time among the three age groups (aged ≤70, aged >70 and ≤75, and aged >75), we determined the optimal cutoff value for IA-OLS time for each of the three age groups using ROC analysis. According to additional ROC analysis, the optimal cutoff for IA-OLS time was 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons for locomotive syndrome. Conclusions: We propose using a GLFS-25 score of 16 and/or a cutoff for the IA-OLS time of 19 s for individuals aged ≤70, 10 s for individuals aged >70 and ≤75, and 6 s for individuals aged >75 when screening elderly persons to determine who should receive medical intervention or undergoing training programs. [ABSTRACT FROM AUTHOR]

Social activity and health correlate in old age, but less is known about what explains this association. The aim of this study was to investigate whether mobility, cognitive functioning, and depressive symptoms mediate the association between social activity and mortality risk, or whether they alternatively should be considered as prerequisites for social activity in older Finnish men and women. In 1988, 406 men and 775 women aged 65-84 years took part in face-to-face interviews about their health, socioeconomic status, and social activities. Confirmatory factor analyses were used to form latent variables describing collective and productive social activity. Latent variable models were used to investigate the possible pathways among social activity, mobility, cognitive functioning, depressive symptoms, and mortality risk. In the 21-year follow-up, 89 % of men and 81 % of women had died. Collective and productive social activity correlated with a lower risk for mortality among men and women. Part of the association between social activity and mortality was mediated by mobility. Cognitive functioning and depressive symptoms were not mediators in the association. Instead, good cognitive functioning and having less depressive symptoms were prerequisites for participating in collective social activity among men and women. Among men, good cognitive functioning, and among women, good cognitive functioning and having less depressive symptoms were prerequisites for productive social activity. The health-enhancing influences of social activity may be partly explained by better mobility among persons who are socially active. Moreover, social activity may maintain mobility and thus decreases mortality risk, as many social activities also include physical activity. Better cognitive functioning and having less depressive symptoms should be considered as prerequisites for participating in social activities. [ABSTRACT FROM AUTHOR]

Abstract: Background: Short-term (<1year) calorie restriction (CR) has been reported to decrease physical activity and metabolic rate in humans and non-human primate models; however, studies examining the very long-term (>10year) effect of CR on these parameters are lacking. Objective: The objective of this study was to examine metabolic and behavioral adaptations to long-term CR longitudinally in rhesus macaques. Design: Eighteen (10 male, 8 female) control (C) and 24 (14 male, 10 female) age matched CR rhesus monkeys between 19.6 and 31.9years old were examined after 13 and 18years of moderate adult-onset CR. Energy expenditure (EE) was examined by doubly labeled water (DLW; TEE) and respiratory chamber (24h EE). Physical activity was assessed both by metabolic equivalent (MET) in a respiratory chamber and by an accelerometer. Metabolic cost of movements during 24h was also calculated. Age and fat-free mass were included as covariates. Results: Adjusted total and 24h EE were not different between C and CR. Sleeping metabolic rate was significantly lower, and physical activity level was higher in CR than in C independent from the CR-induced changes in body composition. The duration of physical activity above 1.6 METs was significantly higher in CR than in C, and CR had significantly higher accelerometer activity counts than C. Metabolic cost of movements during 24h was significantly lower in CR than in C. The accelerometer activity counts were significantly decreased after seven years in C animals, but not in CR animals. Conclusions: The results suggest that long-term CR decreases basal metabolic rate, but maintains higher physical activity with lower metabolic cost of movements compared with C. [Copyright &y& Elsevier]

The issue of falls is a significant health concern in geriatric medicine and a major contributor to morbidity and mortality in those over 65 years of age. Gait and balance problems are responsible for up to a quarter of falls in the elderly. It is unclear whether dual-task assessments, which have become increasingly popular in recent years, have any added benefit over single-task assessments in predicting falls. A previous systematic review that included manuscripts published prior to 2006 could not reach a conclusion due to a lack of available data. Therefore, a systematic review was performed on all dual-task material published from 2006 to 2011 with a focus on fall prediction. The review included all studies published between 2006-2011 and available through PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials databases that satisfied inclusion and exclusion criteria utilised by the previous systematic review. A total of sixteen articles met the inclusion criteria and were analysed for qualitative and quantitative results. A majority of the studies demonstrated that poor performance during dual-task assessments was associated with a higher risk of falls in the elderly. Only three of the 16 articles provided statistical data for comparison of single- and dual-task assessments. These studies provided insufficient data to demonstrate whether dual-task tests were superior to single-task tests in predicting falls in the elderly. Further head-to-head studies are required to determine whether dual-task assessments are superior to single-task assessments in their ability to predict future falls in the elderly. [ABSTRACT FROM AUTHOR]

Background: Rasagiline, an MAO-B inhibitor, is indicated for the treatment of Parkinson's disease (PD). In this post hoc analysis, the efficacy, safety and tolerability of rasagiline as an adjunct to levodopa were compared with placebo in elderly (≥70 years) and younger (<70 years) patients with PD. Methods: Data were pooled from the Parkinson's Rasagiline: Efficacy and Safety on the Treatment of 'OFF' and Lasting effect in Adjunct therapy with Rasagiline Given Once daily randomized, double-blind, placebo-controlled trials with the primary efficacy end-point being the reduction from baseline in daily OFF time. Secondary efficacy end-points included scores for Clinical Global Improvement (CGI)-Examiner during ON time, Unified Parkinson's Disease Rating Scale (UPDRS)-ADL during OFF time, UPDRS-Motor during ON time and total daily ON time with and without troublesome dyskinesia. Tolerability was evaluated from adverse events (AEs) in the two age groups. Results: Rasagiline decreased daily OFF time versus placebo ( P < 0.01) and improved CGI-Examiner score ( P = 0.001) and UPDRS-Motor ON score ( P < 0.05). Changes in UPDRS-ADL OFF score and total daily ON time without dyskinesia also favoured rasagiline but were not significant. Between-group comparisons (≥70 vs. <70 years) showed that efficacy was unaffected by age for all end-points ( P > 0.1), and rasagiline was well tolerated amongst both groups of patients with a comparable incidence of total and dopaminergic AEs ( P > 0.1). Conclusions: Adjunct rasagiline is efficacious and well tolerated in elderly non-demented patients (≥70 years) with moderate to advanced PD. Confirmation of the efficacy and safety of rasagiline in the elderly patient subgroup is especially relevant because of the increasing number of elderly patients with PD. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether separate physical tests of the lower extremities, that assess movement speed and postural control, were associated with cognitive impairment in older community-dwelling subjects. Subjects and methods: In this population-based, cross-sectional, cohort study, the following items were assessed: walking speed, walking 2 × 15 m, Timed Up and Go (TUG) at self-selected and fast speeds, one-leg standing, and performance in step- and five chair-stand tests. The study comprised 2115 subjects, aged 60-93 years, with values adjusted for demographics, health-related factors, and comorbidity. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE), and cognitive impairment was defined by the three-word delayed recall task of the MMSE. Subjects who scored 0/3 on the three-word delayed recall task were defined as cases (n = 328), those who scored 1/3 were defined as intermediates (n = 457), and the others as controls (n = 1330). Results: Physical tests performed rapidly were significantly associated with cognitive impairment; this was the case in increased time of five chair stands (P = 0.009, odds ratio [OR] = 1.03), TUG (P , 0.001, OR = 1.11) and walking 2 × 15 m (P , 0.001, OR = 1.05). Inability to stand on one leg for 10 seconds was associated with increased risk of being a case (P , 0.001, OR = 1.78), compared to those able to stand for 30 seconds or longer. More steps during the step test (P , 0.001, OR = 0.95) and higher fast walking speed (P , 0.001, OR = 0.51) were associated with lower risk of being a case. Conclusion: Slower movements and reduced postural control were related to an increased risk of being cognitively impaired. All tests that were performed rapidly were able to separate cases from controls. These findings suggest that physical tests that are related to lower extremity and postural control, emphasizing velocity, might be useful in investigating relationships between physical and cognitive function; furthermore, they can be used to complement cognitive impairment diagnoses [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the coordination between posture and movement in pathological aging (frailty) in comparison with normal aging, with the hypothesis that in pathological aging, postural control evolves towards a more reactive mode for which the perturbation induced by the movement is not anticipated and leads to delayed and late postural adjustments. Methods: Elderly subjects performed rapid focal arm-raising movements towards a target, from an upright standing position in two stimuli conditions: simple reaction time and choice reaction time (CRT). Hand and center of pressure (CoP) kinematics were compared between a control group and a frail group of the same age. Results: In frail individuals, the entire movement was impaired and slowed down. In addition, postural adjustments that classically precede and accompany the focal arm movement were delayed and reduced, especially in the CRT condition in which the motor prediction is more limited. Finally, a correlation between the time to CoP maximal velocity and the timed up- and-go score was observed. Conclusion: In these patients, it was concluded that the control of the CoP displacement evolved from a proactive mode in which the perturbation associated with the arm movement is anticipated toward a more reactive mode in which the perturbation is compensated by late and delayed adjustments. [ABSTRACT FROM AUTHOR]

Subcortical vascular dementia is a clinical entity, widespread, even challenging to diagnose and correctly treat. Patients with this diagnosis are old, frail, often with concomitant pathologies, and therefore, with many drugs in therapy. We tried to diagnose and follow up for three years more than 600 patients. Study subjects were men and women, not bedridden, aged 68-94 years, outpatients, recruited from June, 1st 2007 to June, 1st 2010. We examined them clinically, neurologically, with specific consideration on drug therapies. Our aim has been to define gait and imbalance problem, if eventually coexistent with the pathology of white matter and/or with the worsening of the deterioration. Drug intake interference has been detected and considered. [ABSTRACT FROM AUTHOR]

Men and women exhibit different gait patterns during customary walking and may respond differently to joint diseases. The present paper aims to identify gait patterns associated with knee-OA separately in men and women. Participants included 144 men and 124 women aged 60 years and older enrolled in the Baltimore Longitudinal Study of Aging (BLSA) who underwent gait testing at a self-selected speed. Both men and women with knee-OA had lower ankle propulsion mechanical work expenditure (MWE; P < .001 for both) and higher hip generative MWE (P < .001) compared to non-OA controls. Women with knee-OA had a higher BMI (P = .008), slower gait speed (P = .049), and higher knee frontal-plane absorbing MWE (P = .007) than women without knee-OA. These differences were not observed in men. Understanding sex-specific differences in gait adaptation to knee-OA may inform the development of appropriate strategies for early detection and intervention for knee-OA in men and women. [ABSTRACT FROM AUTHOR]

Background: Falls in the elderly is nowadays a major concern because of their consequences on elderly general health and moral states. Moreover, the aging of the population and the increasing life expectancy make the prediction of falls more and more important. The analysis presented in this article makes a first step in this direction providing a way to analyze gait and classify hospitalized elderly fallers and non-faller. This tool, based on an accelerometer network and signal processing, gives objective informations about the gait and does not need any special gait laboratory as optical analysis do. The tool is also simple to use by a non expert and can therefore be widely used on a large set of patients. Method: A population of 20 hospitalized elderlies was asked to execute several classical clinical tests evaluating their risk of falling. They were also asked if they experienced any fall in the last 12 months. The accelerations of the limbs were recorded during the clinical tests with an accelerometer network distributed on the body. A total of 67 features were extracted from the accelerometric signal recorded during a simple 25 m walking test at comfort speed. A feature selection algorithm was used to select those able to classify subjects at risk and not at risk for several classification algorithms types. Results: The results showed that several classification algorithms were able to discriminate people from the two groups of interest: fallers and non-fallers hospitalized elderlies. The classification performances of the used algorithms were compared. Moreover a subset of the 67 features was considered to be significantly different between the two groups using a t-test. Conclusions: This study gives a method to classify a population of hospitalized elderlies in two groups: at risk of falling or not at risk based on accelerometric data. This is a first step to design a risk of falling assessment system that could be used to provide the right treatment as soon as possible before the fall and its consequences. This tool could also be used to evaluate the risk several times during the revalidation procedure. [ABSTRACT FROM AUTHOR]

Our objective was to develop and validate a new brain-computer interface (BCI) system suitable for long-term independent home use by people with severe motor disabilities. The BCI was used by a 51-year-old male with ALS who could no longer use conventional assistive devices. Caregivers learned to place the electrode cap, add electrode gel, and turn on the BCI. After calibration, the system allowed the user to communicate via EEG. Re-calibration was performed remotely (via the internet), and BCI accuracy assessed in periodic tests. Reports of BCI usefulness by the user and the family were also recorded. Results showed that BCI accuracy remained at 83% ( r = −.07, n.s.) for over 2.5 years (1.4% expected by chance). The BCI user and his family state that the BCI had restored his independence in social interactions and at work. He uses the BCI to run his NIH-funded research laboratory and to communicate via e-mail with family, friends, and colleagues. In addition to this first user, several other similarly disabled people are now using the BCI in their daily lives. In conclusion, long-term independent home use of this BCI system is practical for severely disabled people, and can contribute significantly to quality of life and productivity. [ABSTRACT FROM AUTHOR]

Objectives: Psychosocial stressors faced by patients with fragile X-associated tremor/ataxia syndrome (FXTAS) and their caregivers have not been systematically explored. FXTAS is a neurodegenerative disease occurring in approximately 45% of elderly male carriers and 8-16% of female carriers of the fragile X mental retardation one premutation. This study investigated the subjective needs of patients with FXTAS and their family caregivers, by utilizing Q-sort methodology. Method: Patients with FXTAS and their caregivers seen during January 2005 to June 2007 participated. The Q-sort was composed of 17 (eight formal and nine informal) items, designed to explore emotional, informational, and instrumental needs of patients with FXTAS and their caregivers. Item scores were generated from 1 = least important to 7 = most important. Analysis included descriptive statistics for all the demographic and outcome variables. Generalized estimating equations were used to identify which of the need domains were perceived as most important by the participants. Results: A total of 24 patients (79% men, mean age 65.6 ± 6.4 years) with FXTAS and 18 caregivers (11% men, mean age 63.6 ± 6.2 years) completed the Q-sort. Both patients and caregivers rated informational needs as most important, followed by emotional and, finally, by instrumental needs. Participants lacked many important resources, in particular those addressing instrumental needs. Conclusion: Providers should be educated and able to provide timely information and referrals to formal services, as well as to informal resources, including the National Fragile X Foundation online support network (www.fragilex.org). [ABSTRACT FROM AUTHOR]

The article discusses research conducted to investigate the contributions that gait mechanics and gait characteristics make to the energy cost of walking in older adults with impaired mobility. Researchers evaluated 50 older adults with slow and variable gait. They found that hip extension, trunk flexion and step width were factors related to the energy costs of walking. They concluded that other factors not studied in the research may also explain greater energy cost and that a closer evaluation of hip extension, step width and cadence during physical therapy gait assessments may help physical therapists to recognize factors that lead to greater energy costs in older adults.