Search Results (28)

The Timed Up and Go (TUG) test is a widely used clinical tool for assessing mobility and fall risk in older adults and individuals with neurological or musculoskeletal conditions. While it provides a quick measure of functional independence, traditional stopwatch-based timing offers only a single completion time and fails to reveal which movement phases contribute to impairment. This study presents a smartphone-based system that automatically segments the TUG test into distinct phases, delivering objective and low-cost biomarkers of lower-limb performance. This approach enables clinicians to identify phase-specific impairments in populations such as individuals with Parkinson’s disease, and older adults, supporting precise diagnosis, personalized rehabilitation, and continuous monitoring of mobility decline and neuroplastic recovery. Our method combines adaptive preprocessing of accelerometer and gyroscope signals with supervised learning models (Random Forest, Support Vector Machine (SVM), and XGBoost) using statistical features to achieve continuous phase detection and maintain robustness against slow or irregular gait, accommodating individual variability. A threshold-based turn detection strategy captures both sharp and gradual rotations. Validation against video ground truth using group K-fold cross-validation demonstrated strong and consistent performance: start and end points were detected in 100% of trials. The mean absolute error for total time was 0.42 s (95% CI: 0.36–0.48 s). The average error across phases (stand, walk, turn) was less than 0.35 s, and macro F₁ scores exceeded 0.85 for all models, with the SVM achieving the highest score of 0.882. Combining accelerometer and gyroscope features improved macro F1 by up to 12%. Statistical tests (McNemar, Bowker) confirmed significant differences between models, and calibration metrics indicated reliable probabilistic outputs (ROC-AUC > 0.96, Brier score < 0.08). These findings show that a single smartphone can deliver accurate, interpretable, and phase-aware TUG analysis without complex multi-sensor setups, enabling practical and scalable mobility assessment for clinical use. Full article

Background: Euthanasia and physician-assisted suicide (EPAS) are highly contentious topics with significant medical, legal, and cultural implications. Previous research suggests that various sociodemographic, health, and psychosocial factors determine attitudes toward EPAS. This study set out to identify psychosocial predictors of support for EPAS. We hypothesized that perceived control, self-efficacy, and social support would each predict support for EPAS after controlling for sociodemographic and health-related variables. Methods: For this study, we recruited 446 Jewish Israeli adults who were 82.32 years of age on average (SD = 5.99; range 65–101 years). Participants completed a battery of questionnaires including a series of vignettes featuring hypothetical family members with a terminal illness (i.e., cancer, dementia, Parkinson’s disease). We performed a three-step hierarchical regression equation, controlling for demographic factors (age, gender, education, relationship status, economic status, and religiosity) as well as perceived and relative physical health. Results: As hypothesized, both self-efficacy and (the absence of) social support predicted support for EPAS; perceived control did not. Religiosity was the strongest predictor of opposition to EPAS. Fully 31% of variance in support for EPAS was predicted by this regression model. Conclusion: Support for EPAS does not appear to reflect a pervasive need for control over all aspects of life (i.e., perceived control) but a more specific need for personal autonomy (i.e., self-efficacy). Longitudinal research is required over multiple points of data collection to ascertain how change in social support affects support for EPAS in late life. Policy makers should embrace these findings when formulating end-of-life care policies, ensuring that both social support and personal autonomy are prioritized in the care of older adults. Full article

Background: Neurodegenerative diseases cause both progressive motor and cognitive impairments for which no curative treatments exist. Virtual reality (VR)-based rehabilitation has emerged as a promising strategy to enhance physical rehabilitation by offering immersive, engaging, and personalized environments. Methods: A systematic review was conducted following the PRISMA guidelines, examining studies published between 2020 and 2025 in the Web of Science and Scopus. Twelve studies met the inclusion criteria, focusing on VR-based physical rehabilitation in individuals with neurodegenerative diseases. Results: Most studies reported significant improvements in balance, gait, postural control, and motor function. Some studies also found benefits in processing speed, executive function, emotional well-being, and activities of daily living. Across different levels of immersion, VR interventions showed high usability and were well tolerated, even among older adults. However, methodological limitations, such as small sample sizes, a lack of control groups, and short intervention durations, were prevalent. Conclusions: VR has demonstrated to be an effective and well-tolerated tool for the rehabilitation of individuals with neurodegenerative diseases such as Parkinson’s disease and multiple sclerosis. However, the confirmation of its clinical efficacy and long-term impact necessitates the execution of randomized controlled trials with larger samples and extended follow-up periods. Full article

Background/Objectives: Aging and a sedentary lifestyle aggravate hypokinetic diseases, compromising the functional capacity of older adults. Thus, the prescription of physical exercise (PE) through mobile applications (MA) has emerged as a remote and personalized alternative. However, there are still gaps in the effectiveness of prescribing physical exercise via mobile apps for older people. This study aimed to analyze the effects of prescribing PE through MAs on the health of older adults. Materials and Methods: This systematic review included studies with older people (≥60 years) that used MAs to prescribe PE, published between 2014 and 2024, in Portuguese or English. The search strategy used the descriptors “older adults,” “physical exercise,” “mobile applications,” and “health,” combined with Boolean operators. The screening followed previously defined eligibility criteria regarding population, intervention, outcomes, and study design. Two independent reviewers extracted data, mediated by a third party in case of disagreement; they screened and extracted data from the PubMed and VHL/Medline databases from 2004 to 2024. Risk of bias was assessed according to levels of evidence, and the results were categorized. Results: Of the 2298 publications initially identified, 7 studies were eligible for this review, totaling 748 participants, predominantly female. The studies included prospective and observational clinical trials with older people suffering from Parkinson’s disease, cardiovascular disease, sarcopenia, and breast cancer. The findings showed favorable effects on adherence to the program (6 studies; n = 654), an increase in PE (5 studies; n = 502), and improvements in functional capacity (4 studies; n = 389), perceived quality of life (5 studies; n = 481), and muscle strength (3 studies; n = 298). Conclusions: The prescription of MA-mediated PE showed positive effects on the health of older people, indicating its viability as a complementary strategy in clinical practice or public health. Full article

This narrative review examines the effects of caffeine on brain health in older adults, with particular attention to its potential for dependence—an often-overlooked issue in geriatric care. Caffeine acts on central adenosine, dopamine, and glutamate systems, producing both stimulating and rewarding effects that can foster tolerance and habitual use. Age-related pharmacokinetic and pharmacodynamic changes prolong caffeine’s half-life and increase physiological sensitivity in the elderly. While moderate consumption may enhance alertness, attention, and possibly offer neuroprotective effects—especially in Parkinson’s disease and Lewy body dementia—excessive or prolonged use may lead to anxiety, sleep disturbances, and cognitive or motor impairment. Chronic exposure induces neuroadaptive changes, such as adenosine receptor down-regulation, resulting in tolerance and withdrawal symptoms, including headache, irritability, and fatigue. These symptoms, often mistaken for typical aging complaints, may reflect a substance use disorder yet remain under-recognized due to caffeine’s cultural acceptance. The review explores caffeine’s mixed role in neurological disorders, being beneficial in some and potentially harmful in others, such as restless legs syndrome and frontotemporal dementia. Given the variability in individual responses and the underestimated risk of dependence, personalized caffeine intake guidelines are warranted. Future research should focus on the long-term cognitive effects and the clinical significance of caffeine use disorder in older populations. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) and Parkinson’s disease (PD) are two highly prevalent chronic conditions that often coexist in older adults. Their interaction may influence clinical outcomes, particularly during external stressors such as the COVID-19 pandemic. This study aimed to assess the prevalence and temporal trends of PD among hospitalized patients with T2DM in Spain (2017–2023), evaluate sex-based differences in clinical characteristics and outcomes, examine the impact of the COVID-19 pandemic, and identify predictors of PD diagnosis and in-hospital mortality (IHM). Methods: We conducted a retrospective, nationwide study using the Spanish National Hospital Discharge Database (RAE-CMBD). Adults aged ≥40 years hospitalized with T2DM were included. PD cases were identified using ICD-10 codes. Joinpoint regression assessed temporal trends, and multivariable logistic regression identified factors associated with PD and IHM. Results: Among 5.1 million T2DM-related hospitalizations, 107,931 (2.41%) involved PD. PD prevalence increased over time, particularly among women. Men accounted for most PD cases and were younger than their female counterparts. Depression and anxiety were more frequent in women and associated with PD in both sexes. IHM peaked at 14.6% in 2020, coinciding with the COVID-19 outbreak. Predictors of IHM included older age, higher comorbidity burden, dementia, and COVID-19 diagnosis. Conclusions: The coexistence of PD and T2DM in hospitalized patients is associated with clinical complexity and increased mortality. Personalized, multidisciplinary care is essential to address sex-specific patterns, psychiatric comorbidities, and vulnerability to systemic stressors. Full article

Background/Objectives: Parkinson’s disease (PD) and benign paroxysmal positional vertigo (BPPV) are both prevalent in the geriatric population. While dizziness is a common non-motor symptom in PD, the relationship between PD and incident BPPV remains unclear. Limited data suggest potential shared mechanisms, including mitochondrial dysfunction and oxidative stress, but large-scale epidemiological evidence is lacking. This investigation focused on assessing the incidence of BPPV in patients with PD compared to matched controls using a nationwide cohort. Methods: Data from the Korean National Health Insurance Service–Health Screening Cohort were used to perform a retrospective cohort analysis. We identified 8232 newly diagnosed PD patients and matched them 1:4 with 32,928 controls based on age, sex, income, and residential region. Stratified Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident BPPV. Subgroup and Kaplan–Meier analyses were also performed. Results: Over 220,151 person-years of follow-up revealed a lower incidence of BPPV in the PD group relative to the control group (4.98 vs. 5.95 per 1000 person-years); the corresponding adjusted HR was 0.77 (95% CI: 0.66–0.90; p = 0.001), indicating a 23% reduced risk. The inverse association remained consistent across most subgroups, including older adults and rural residents. Kaplan–Meier analysis further illustrated a significant decline in the cumulative incidence of BPPV in PD patients (p = 0.007). Conclusions: PD may contribute to a lower incidence of BPPV, which could be explained by reduced mobility, altered vestibular function, or diagnostic challenges. Clinicians should consider BPPV in PD patients presenting with dizziness. Full article

Diabetes mellitus (DM) and neurodegenerative diseases/disturbances are worldwide health problems. The most common chronic conditions diagnosed in persons 60 years and older are type 2 diabetes mellitus (T2DM) and cognitive impairment. It was found that diabetes mellitus is a major risk for cognitive decline, dementia, Parkinson’s disease (PD), Alzheimer’s disease (AD), Huntington’s disease (HD), amyotrophic lateral sclerosis (ALS) and other neurodegenerative disorders. Different mechanisms of associations between these diseases and diabetes mellitus have been suggested. For example, it is postulated that an impaired intracellular insulin signaling pathway, together with hyperglycemia and hyperinsulinemia, may cause pathological changes, such as dysfunction of the mitochondria, oxidative stress inflammatory responses, etc. The association between diabetes mellitus and neurodegenerative diseases, as well as the mechanisms of these associations, needs further investigation. The aim of this review is to describe the associations between diabetes mellitus, especially type 1 (T1DM) and type 2 diabetes mellitus, and selected neurodegenerative diseases, i.e., Alzheimer’s disease, Parkinson’s disease, Huntington’s disease and amyotrophic lateral sclerosis. Suggested mechanisms of these associations are also described. Full article

Chronic kidney disease (CKD) is strongly associated with dementia. However, its independent association with Alzheimer’s or Parkinson’s disease remains unclear. This study investigated the prospective association of patients with CKD aged ≥55 years with an increased risk of Alzheimer’s or Parkinson’s disease. We conducted a retrospective cohort analysis using a national cohort sample of approximately one million patients. Primary outcome indicators measured included incidence of all-cause dementia, Alzheimer’s disease, and Parkinson’s disease events using person-years at risk. The hazard ratio was adjusted using the Cox proportional hazards model. We included 952 patients without CKD and 476 with CKD over 55 years using propensity score matching. The CKD group exhibited higher incidences of all-cause dementia, Parkinson’s disease, and Alzheimer’s disease than the non-CKD group. Furthermore, the CKD group had an elevated risk of all-cause dementia and a significantly increased risk of Parkinson’s disease, especially among older women. Notably, the risk of Parkinson’s disease was higher within the first 3 years of CKD diagnosis. These findings emphasize the link between CKD in mid- and late-life individuals and a higher incidence of all-cause dementia and Parkinson’s disease rather than Alzheimer’s disease. Full article

Gait abnormalities are common in the elderly and individuals diagnosed with Parkinson’s, often leading to reduced mobility and increased fall risk. Monitoring and assessing gait patterns in these populations play a crucial role in understanding disease progression, early detection of motor impairments, and developing personalized rehabilitation strategies. In particular, by identifying gait irregularities at an early stage, healthcare professionals can implement timely interventions and personalized therapeutic approaches, potentially delaying the onset of severe motor symptoms and improving overall patient outcomes. In this paper, we studied older adults affected by chronic diseases and/or Parkinson’s disease by monitoring their gait due to wearable devices that can accurately detect a person’s movements. In our study, about 50 people were involved in the trial (20 with Parkinson’s disease and 30 people with chronic diseases) who have worn our device for at least 6 months. During the experimentation, each device collected 25 samples from the accelerometer sensor for each second. By analyzing those data, we propose a metric for the “gait quality” based on the measure of entropy obtained by applying the Fourier transform. Full article

Introduction: The aim of the present study was to analyze the influence of different music genres, three modulated noises and a pink noise on the heart rate (HR) and to compare between young healthy adults (YA), elderly healthy adults was (EA) and patients with Parkinson’s disease (PD). Furthermore, a sound condition comparison for each group was conducted. Methods: A total of 77 subjects (41m/36w) were divided into healthy adults aged 20–35 years (YA) and 55–76 years (EA) as well as adults diagnosed with Parkinson’s disease (42–76 years) (PD). The “Polar OH1”, an optical pulse sensor, determined the heart rate. All test persons used identical wireless headphones (Bose QC35). The music genres were classical, relaxation and heavy metal with different speeds (bpm) while the three modulated noises were equivalent to these three music styles. To exclude visual information, everyone wore a blindfold. Significance was set at 5%. Results: When comparing experimental conditions within a subject group, there was a significant difference (p ≤ 0.001). between the different measurement mostly in group YA but barely noticeable in group EA. Subject group PD had no significant condition differences. For each sound condition the median HR was higher in YA than in EA (p ≤ 0.001–0.05). Conclusion: The heart rate was not affected by wearing headphones with or without the noise canceling mode. While listening to the music or the tones, younger people have a higher HR variability than older people which may, thus, make them more sensitive to the conditions studied. It can be assumed that the listening to music has no systematic influence on decreasing or increasing the HR. Full article

This paper describes the second part of the PASSO (Parkinson smart sensory cues for older users) project, which designs and tests an innovative haptic biofeedback system based on a wireless body sensor network using a smartphone and different smartwatches specifically designed to rehabilitate postural disturbances in persons with Parkinson’s disease. According to the scientific literature on the use of smart devices to transmit sensory cues, vibrotactile feedback (particularly on the trunk) seems promising for improving people’s gait and posture performance; they have been used in different environments and are well accepted by users. In the PASSO project, we designed and developed a wearable device and a related system to transmit vibrations to a person’s body to improve posture and combat impairments like Pisa syndrome and camptocormia. Specifically, this paper describes the methodologies and strategies used to design, develop, and test wearable prototypes and the mHealth system. The results allowed a multidisciplinary comparison among the solutions, which led to prototypes with a high degree of usability, wearability, accessibility, and effectiveness. This mHealth system is now being used in pilot trials with subjects with Parkinson’s disease to verify its feasibility among patients. Full article

The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact global health regarding both morbidity and mortality. Although SARS-CoV-2 primarily causes acute respiratory distress syndrome (ARDS), the virus interacts with and influences other organs and tissues, including blood vessel endothelium, heart, gastrointestinal tract, and brain. We are learning much about the pathophysiology of SARS-CoV-2 infection; however, we are just beginning to study and understand the long-term and chronic health consequences. Since the pandemic’s beginning in late 2019, older adults, those with pre-existing illnesses, or both, have an increased risk of contracting COVID-19 and developing severe COVID-19. Furthermore, older adults are also more likely to develop the neurodegenerative disorder Parkinson’s disease (PD), with advanced age as the most significant risk factor. Thus, does SARS-CoV-2 potentially influence, promote, or accelerate the development of PD in older adults? Our initial focus was aimed at understanding SARS-CoV-2 pathophysiology and the connection to neurodegenerative disorders. We then completed a literature review to assess the relationship between PD and COVID-19. We described potential molecular and cellular pathways that indicate dopaminergic neurons are susceptible, both directly and indirectly, to SARS-CoV-2 infection. We concluded that under certain pathological circumstances, in vulnerable persons-with-Parkinson’s disease (PwP), SARS-CoV-2 acts as a neurodegenerative enhancer to potentially support the development or progression of PD and its related motor and non-motor symptoms. Full article

Financial abilities (FA) are a multi-dimensional domain comprising a wide range of conceptual, pragmatical, and judgmental skills ranging from basic abilities, such as bill payment, to high level abilities, such as financial decision-making (FDM). Preserved FDM abilities include the capacity to recognize fraud attempts, and they are fundamental for a person’s independence. Previous studies have reported decreased FDM in older adults and in patients with mild cognitive impairment (MCI), who consequently become more susceptible to fraud attempts. However, FDM has scarcely been investigated in other neurological populations, and it is unclear whether FDM may be predicted by more basic FA. The aim of the present study was to investigate FDM across patients with MCI, Parkinson’s disease (PD), or stroke, as well as healthy controls (HC), and to explore to what extent FDM could be inferred by other FA. We collected FDM and FA performances using the NADL-F short battery. Performances in the NADL-F short subtests were compared among groups. Additionally, the relationship between the scores at the FDM subtest and the performance obtained in other financial subtests of the NADL-F short were investigated for each group of participants. MCI patients performed worse than HC in FDM and in several FA domains. Conversely, FDM was relatively preserved in our sample of PD and stroke patients. In HC, FDM was associated with numeracy and financial knowledge applied to everyday situations, whereas this was true with some basic FA in both MCI and PD patients. No significant association was observed in stroke patients. Our results suggest that FDM is a complex ability, only partially inferable from other FA. Full article

During aging, many physiological systems spontaneously change independent of the presence of chronic diseases. The reward system is not an exception and its dysfunction generally includes a reduction in dopamine and glutamate activities and the loss of neurons of the ventral tegmental area (VTA). These impairments are even more pronounced in older persons who have neurodegenerative diseases and/or are affected by cognitive and motoric frailty. All these changes may result in the occurrence of cognitive and motoric frailty and accelerated progression of neurodegenerative diseases, such as Alzheimer’s and Parkinson’s diseases. In particular, the loss of neurons in VTA may determine an acceleration of depressive symptoms and cognitive and motor frailty trajectory, producing an increased risk of disability and mortality. Thus, we hypothesize the existence of a loop between reward system dysfunction, depression, and neurodegenerative diseases in older persons. Longitudinal studies are needed to evaluate the determinant role of the reward system in the onset of motoric-cognitive risk syndrome. Full article