Activities Of Daily Living Scale Research Articles

The Evaluation of Frailty in the Elderly and Affecting Biopsychosocial Factors: A Cross-Sectional Observational Study.

We aimed to evaluate the frequency of frailty and the affecting factors in people living in our society over 65 yr old. Our descriptive and cross-sectional study included 261 individuals aged 65 and over who applied to Ankara Training and Research Hospital family practice centers and district polyclinics from 1 Jan to 1 Feb 2020. The participants were asked to complete a sociodemographic data form, FRAIL Scale, Katz Daily Living Activities Scale, Lawton&Brody Instrumental Activities of Daily Living Scale and Geriatric Depression Scale Short Form. According to the FRAIL Scale results: 35 people were found to be frail (13.4%), 115 to be pre-frail (44.1%). No frailty was observed in 111 people (42.5%). While the mean score of the Katz Activities of Daily Living Scale was found to be 5.65±0.71, the mean score of the Lawton&Brody Instrumental Activities of Daily Living Scale was found to be 6.65±1.69. In the geriatric depression evaluation, mild, medium or severe depression was detected in 87 participants (33.2%). As the level of frailty increased, the Geriatric Depression Scale score climbed significantly (P<0.001). In frail individuals, Lawton&Brody Scale scores were significantly lower (P<0.001). In our study: a correlation was found between frailty and female gender, being single, low income, low educational level, obesity, polypharmacy and decreased physical activity. Additionally, as the number of children increase frailty in women increases therewithal. Elderly people had high frailty. Polypharmacy, depression and reduced physical activity were the more frequent in frail elderly. In frail females, the number of children was significantly higher.

Retrospective Study of 157 Patients with Otosclerosis to Evaluate Association Between Carhart Notch on the Preoperative Bone-Conduction Audiogram and Postoperative Hearing and Balance Evaluated by the Vestibular Disorders Activities of Daily Living Scale.

BACKGROUND A Carhart notch in the pure tone audiogram can be an indicator of stapes fixation in otosclerosis. This retrospective study of 157 patients with otosclerosis aimed to evaluate the association between the presence of a Carhart notch on the preoperative bone-conduction audiogram and postoperative hearing and balance evaluated by the Vestibular Disorders Activities of Daily Living scale. MATERIAL AND METHODS Patients with suspected otosclerosis based on medical history and audiometric tests were considered. The analysis included 157 consecutive patients who underwent surgery in the years 2016 to 2019, in whom the diagnosis of otosclerosis was confirmed during surgery. Carhart notch was defined as an impairment in the bone conduction threshold of ≥7.5 dB for 2000 Hz frequencies above the mean thresholds at higher and lower adjacent frequencies. The Vestibular Disorders Activities of Daily Living subjective scale was used in the preoperative period and 4 and 12 months after surgery. RESULTS The preoperative presence of Carhart notch and progressive sensorineural hearing loss were statistically significantly correlated with more common onset of tinnitus and then dizziness (P=0.006). Preoperative vertigo was observed in patients who had Carhart notch observed in the preoperative audiometric test. This vertigo more commonly coexisted with profound sensorineural hearing loss and minor or no improvement in average values of bone conduction after surgery (P=0.002). CONCLUSIONS Preoperative Carhart notch on audiogram and the severity of sensorineural hearing loss were associated with tinnitus and vertigo. However, preoperative Carhart notch was not associated with persistent postoperative tinnitus in patients with cochlear otosclerosis.

An evaluation of the usefulness of Comprehensive Geriatric Assessment in patients after a fracture within the proximal femoral epiphysis while staying at a nursing home – a pilot study

IntroductionThe aim of this study was to evaluate the usefulness of Comprehensive Geriatric Assessment (CGA) in patients after a fracture within the proximal femoral epiphysis, staying at a nursing home (NH).MethodsThe study was conducted at a NH centre on 15 people after a fracture within the proximal femoral epiphysis (mean aged 76.9 ± 10.8). The CGA assessment was performed twice: before and after a 12 week stay at the centre. Physiotherapy was carried out five times a week for one hour (Monday to Friday).ResultsThe analysis showed a significant improvement in the Activities of Daily Living scale (ADL). In the case of the physical condition of the patients, the physiotherapy led to significant improvements, predominantly in the gait and balance of the patients. Significant correlations, at the start and end of the study, were found between the ADL and Tinetti scale.ConclusionsThere was a significant relationship found between the functional status and physical health of the patients undergoing physiotherapy staying at the NH. The systematic 3-month physiotherapy significantly improved the functional and physical condition of elderly patients. CGA can be a tool for evaluating the efficacy of the rehabilitation process of elderly patients staying at a NH. The results are a pilot study, but confirm that CGA can and should be routinely used in geriatric centres in Poland.

A Study on the Effect of Traditional Chinese Exercise Combined With Rhythm Training on the Intervention of Older Adults With Mild Cognitive Impairment.

To examine the effect of combination exercise program on cognitive function of older adults with mild cognitive impairment (MCI), and identify biomarkers associated with improvement of cognitive functions. Subjects were 42 older adults (ages, 60-80years) with MCI. The subjects were randomly classified to traditional Chinese exercise combined with rhythm training group (TCE + RTG, n = 14), walking group (WG, n = 14), and control group (CG, n = 14), according to their level of MMSE scores. These groups exercised for 60minutes at 1 session, 3 sessions a week for 12weeks. The intervention program was conducted under multitask conditions to stimulate attention and memory, and the control group attended 3 education classes. Measurements were administered before, after the 6-week, and after the 12-week intervention period; Measurements: The Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Symbol Digit Modalities Test (SDMT), Activities of Daily Living Scale (ADL), and the 17-item Hamilton Depression Scale (HAMD-17), along with the brain-derived neurotrophic factor (BDNF). A repeated-measures analysis of variance was used to examine differences among the 3 groups and between the 3 testing times (pre-test vs middle-test vs post-test). (1) The TCE + RTG showed significant improvement in the MMSE, MoCA, SDMT, and ADL scale test results (P < .01) and HAMD-17 scale test results (P < .05). The WG also showed significant improvement in the MMSE, MoCA, and HAMD-17 scale test results (P < .05) and the ADL scale test results (P < .01). While there was no significant change in the CG after the intervention. (2) The TCE + RTG and WG showed positive improvement in peripheral blood BDNF levels, while the CG showed a decrease in these test results. There were significant differences between the TCE + RTG and CG before and after the intervention. The results suggested that a TCE + RT is beneficial for improving memory and maintaining general cognitive function and peripheral blood BDNF levels in older adults with MCI. Peripheral blood BDNF levels may predict improvement of cognitive functions in older adults with MCI. Further studies are required to determine the positive effects of TCE + RT on cognitive function in older adults with MCI. Trial Registration: ChiCTR2200058545, Registered 10 April 2022.

Predictors of depression among the elderly persons with disabilities in Indonesia.

Depression is a major mental problem in the elderly, particularly those with disability. This study's aim was to identify variables that predict depression in the elderly with disabilities. This cross-sectional study was conducted in Gunungkidul Regency and Yogyakarta City from April to June 2021. The study participants were community-dwelling elderly aged 60 years and above with disabilities, who could communicate verbally without any apparent cognitive impairment. Data was collected by interviewing participants using structured questionnaire on following sections: Demographic characteristics, Mini-Mental State Examination (MMSE), Washington Group Short Set (WG-SS), Barthel Index of activities of daily living (ADL), Lawton Instrumental ADL (IADL) Scale, and Geriatric Depression Scale-30 (GDS-30). Multivariate linear regression analysis applied to identify variables significantly correlated with depression. Multinomial logistic regression analysis performed to obtain the odds ratio (OR). Study included 115 elderly persons with disabilities. Most of them had mobility impairment. Higher independence in ADL and being married were related with lower risk of depression, whereas increased age at disability increased the risk of depression (P = 0.001). The elderly who had greater independence with daily activities were less likely to have depression (OR = 0.639 for mild depression and OR = 0.589 for severe depression). Those who were not married were more likely to have mild depression (OR = 3.203) and severe depression (OR = 29.119). compared to the married elderly. Age at acquiring disability was associated with higher risk for mild depression (OR = 1.025) and severe depression (OR = 1.053). Higher independence in ADL and being married were related with lower risk of depression, whereas increased age at disability increased the risk of depression (P = 0.001). Independence in the ADL, being married, and being disabled as a young adult are negative predictors of depression in the elderly with disability.

Possible association between cerebral white matter atrophy and impaired performance of activities of daily living in patients with Parkinson's disease.

The contribution of brain abnormalities in patients with Parkinson's disease (PD) to impaired functional status remains uncertain. Our study assessed whether global and regional brain structural abnormalities are associated with impaired performance of activities of daily living (ADL) in PD patients. A retrospective analysis was conducted of 46 patients with PD, recruited prospectively from a movement disorder clinic. Motor impairment and disability were assessed using the Hoehn and Yahr (H-Y) scale and Unified Parkinson's Disease Rating Scale Part III (UPDRS-III). Cognitive status was evaluated with Montreal Cognitive Assessment (MoCA). The performance of ADL was indexed by the sum score of the Physical Self-Maintenance Scale (PSMS) and Lawton Instrumental ADL scale. Brain magnetic resonance imaging (MRI) was performed to assess white matter hyperintensities and medial temporal lobe atrophy (MTLA). Global brain atrophy, indexed by the relative grey matter volume (RGM), relative white matter volume (RWM) and average cortical thickness of the whole brain, was quantified by voxel-based morphometry (VBM). The ADL score (where higher scores indicate poorer performance) negatively correlated with RWM (where greater volume indicates less severe atrophy; r = -0.41, p = 0.004) and RGM (where greater volume indicates less severe atrophy; r = -0.43, p = 0.003) but not with the average cortical thickness ( r = -0.16, p = 0.29). With ADL score as the dependent variable in a linear regression model, H-Y stage and RWM significantly correlated with the ADL score after adjusting for age and MoCA score, and together accounted for 51% of the variance therein. RGM was not significantly correlated with the ADL score after adjusting for age and MoCA score. Cerebral white matter atrophy may be associated with the performance of ADL in patients with PD, indicating an important role of white matter impairment in their functional status.

Factors influencing the prevalence of frailty in older adults with fractures: the association of nutritional status with frailty.

To investigate the association between frailty, malnutrition, comorbid medical conditions and activities of daily living (ADL) in older adult patients with fractures, and to analyse the influential factors of frailty. The FRAIL scale including five components: fatigue, resistance, ambulation, illness, and loss of weight, was used to evaluate frailty. Participants were divided into frailty, pre-frailty and non-frailty groups. The ADL was assessed using the Barthel Index, while the nutrition risk screening tool, NRS-2002, was used to assess the nutritional risk, and the Global Leadership Initiative on Malnutrition diagnostic criteria were used to diagnose the nutritional status. Statistical analysis was performed using univariate and multivariate logistic regression to determine the factors associated with frailty. A total of 166 patients were included in the study, and the incidences of frailty, pre-frailty and non-frailty were 39.2%, 33.1% and 27.7%, respectively. The severe dependence rate (ADL scale of <40) in the frailty, pre-frailty and non-frailty groups was 49.2%, 20.0% and 6.52%, respectively. The prevalence of nutritional risk was 33.7% (56/166), including 56.9% (31/65) in the frailty group and 32.7% (18/55) in the pre-frailty group. Of the 166 patients, 45 (27.1%) were diagnosed with malnutrition, including 47.7% (31/65) in the frailty group and 23.6% (13/55) in the pre-frailty group. Frailty in older adult patients with fractures is widespread, and the prevalence of malnutrition is high. The occurrence of frailty may be related to an advanced age, increased medical comorbidity and impairment in ADL.

Association of Frailty With Health-Related Quality of Life in Liver Transplant Recipients

Frailty has been recognized as a risk factor for mortality after liver transplant (LT) but little is known of its association with functional status and health-related quality of life (HRQL), termed global functional health, in LT recipients. To evaluate the association between pre-LT and post-LT frailty with post-LT global functional health. This prospective cohort study was conducted at 8 US LT centers and included adults who underwent LT from October 2016 to February 2020. Frail was defined by a pre-LT Liver Frailty Index (LFI) score of 4.5 or greater. Global functional health at 1 year after LT, assessed using surveys (Short Form-36 [SF-36; summarized by physical component scores (PFC) and mental component summary scores (MCS)], Instrumental Activities of Daily Living scale) and performance-based tests (LFI, Fried Frailty Phenotype, and Short Physical Performance Battery). Of 358 LT recipients (median [IQR] age, 60 [53-65] years; 115 women [32%]; 25 [7%] Asian/Pacific Islander, 21 [6%] Black, 54 [15%] Hispanic White, and 243 [68%] non-Hispanic White individuals), 68 (19%) had frailty pre-LT. At 1 year post-LT, the median (IQR) PCS was lower in recipients who had frailty vs those without frailty pre-LT (42 [31-53] vs 50 [38-56]; P = .002), but the median MCS was similar. In multivariable regression, pre-LT frailty was associated with a -5.3-unit lower post-LT PCS (P < .001), but not MCS. The proportion who had difficulty with 1 or more Instrumental Activities of Daily Living (21% vs 10%) or who were unemployed/receiving disability (38% vs 29%) was higher in recipients with vs without frailty. In a subgroup of 210 recipients with LFI assessments 1 year post-LT, 13% had frailty at 1 year post-LT. Recipients who had frailty post-LT reported lower adjusted SF-36-PCS scores (coefficient, -11.4; P < .001) but not SF-36-MCS scores. Recipients of LT who had frailty vs those without frailty 1 year post-LT also had worse median (IQR) Fried Frailty Phenotype scores (1 [1-2] vs 1 [0-1]) and higher rates of functional impairment by a Short Physical Performance Battery of 9 or less (42% vs 20%; P = .01). In this cohort study, pre-LT frailty was associated with worse global functional health 1 year after LT. The presence of frailty after LT was also associated with worse HRQL in physical, but not mental, subdomains. These data suggest that interventions and therapeutics that target frailty that are administered before and/or early post-LT may help to improve the health and well-being of LT recipients.

A pilot study of a 12-week community-based boxing program for Parkinson’s disease

IntroductionCommunity-based exercise programs for Parkinson’s disease (PD) have gained popularity. Our understanding of such programs on non-motor features is limited. We characterized the effect of a 12-week community-based boxing exercise program on motor and non-motor symptoms in people with Parkinson’s disease (PwPD). MethodsIn this prospective observational study, PwPD underwent a 12-week community-based boxing program (2 sessions per week, for a total of 24 sessions). The following assessments were performed by a movement disorders neurologist at baseline and after completion of the program: MDS-Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS III) in a modified version since assessments were performed virtually due to COVID-19 pandemic, MDS Non-Motor Rating Scale (MDS-NMS), Hamilton Depression Rating Scale (HDRS), Lilli Apathy Rating Scale (LARS), Parkinson’s Disease Questionaire-39 (PDQ-39), and Schwab and England Activities of Daily Living scale (SE-ADL). Pre- and post-assessments were compared using Wilcoxon signed rank test; only participants who completed the program and both assessments were analyzed. ResultsA total of 14 PwPD agreed to be a part of the study and completed assessments. All participants were ambulatory and functionally independent at baseline. Total non-motor feature severity (MDS-NMS, p = 0.0031), depression (HDRS, p = 0.015), and motor features (MDS-UPDRS PART 3 modified, p = 0.023) all improved significantly after the intervention. Scales on apathy (LARS, p = 0.29), Parkinson’s disease-specific health related quality (PDQ-39, p = 0.093), and activities of daily living (SE-ADL, p = 0.32) did not demonstrate significant change. ConclusionPwPD who participated in a community-based, pilot boxing program showed improvements in motor exam and non-motor symptoms.

Quality of life in elderly people with type 2 diabetes using EQ-5D-5L tool: a case control study

BackgroundAccording to the World Health Organization (WHO), quality of life is “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns. Researchers have conceptualized quality of life on many levels, and there are multiple views on how it should be defined and measured. Chronic diseases like diabetes mellitus are known to compromise the HRQoL. Type 2 diabetes mellitus (DM) is a chronic metabolic disease known to affect HRQoL adversely. Two types of tools have been developed to measure HRQoL. Generic tools are general purpose measures used to assess HRQoL of communities and also for comparison between populations. The EQ-5D-5L consists of two pages—the EQ-5D-5L descriptive system and the EQ visual analog scale (EQ VAS). The descriptive system comprises the five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression).ObjectivesAssess of quality of life in elderly patients of type 2 diabetes mellitus as well as determine effects of factors related to diabetes and diabetic control on the quality of life of type 2 diabetes.Methods- Population of study and disease condition:◦ A total of 60 participants were enrolled in this study, and all of the participants were among the geriatric group of people (age ≥ 60 years old).◦ Thirty of them self-reported to have diabetes mellitus type 2, while the other 30 subjects were a control group (self-reported no to have diabetes mellitus).◦ All participants were subjected to careful history taking, full clinical examination, in addition to laboratory investigation in the form of HBA1C.◦ All participants had to fill in self-reported questionnaire which is used as a tool for the assessment of HRQOL named EQ-5D-5L (some patients were illiterate so the questionnaire was interviewed to them).◦ All participants underwent interview questionnaires of the following HRQOL scales: geriatrics depression scale, ADL (activities of daily living scale), and IADL (instrumental activities of daily living scale).ResultsEQ-5D-5L score is significantly higher in diabetic patients than non-diabetics (p value < 0.001).EQ VAS score is significantly lower in diabetic patients than non-diabetics (p value < 0.001).ADL (activities of daily living) functional assessment impairment is higher in diabetics than non-diabetics (p value < 0.001). IADL (independence in activities of daily living) functional assessment impairment is higher in diabetics than non-diabetics (p value < 0.001).Visual prop is impaired in diabetics more than non-diabetics (p value < 0.001).Pain severity is mainly affected in diabetics more than non-diabetics.ConclusionType 2 diabetes mellitus in elderly patients affects their health-related quality of life and their daily activities.In our study, the HRQOL of uncontrolled diabetic patients were more negatively affected than that of the controlled diabetic patients.Moreover, some of our diabetic patients were found to suffer from cognitive disorders (insomnia and depression) as a complication of diabetes.We also found that the EQ-5D-5L of diabetic patients with comorbidities was higher than those without comorbidities and EQ-VAS was lower in comorbid diabetic patients.

Acupuncture May Be a Potential Complementary Therapy for Alzheimer's Disease: A Network Meta-Analysis.

With Alzheimer's disease (AD) becoming a worldwide problem, traditional Chinese medicine (TCM), especially acupuncture, stands out as a complementary therapy because of its feature-"treatment based on syndrome differentiation". This systematic review and network meta-analysis (NMA) confirms the complement effect of acupuncture and explores the best combination of therapy for AD based on the total effect and activity of daily living scale (ADL). We searched relevant randomized controlled trials (RCTs) that applied acupuncture for treating AD. 58 studies with 4334 patients were included in accordance with PRISMA guidelines. The results showed that for the total effect, the order of probability for the effect: acupuncture + western medicine > acupuncture + herbal medicine > acupuncture > acupuncture + western medicine + herbal medicine. For the ADL score, the order of probability for the effect: acupuncture + western medicine > acupuncture > acupuncture + western medicine + herbal medicine > acupuncture + herbal medicine. The combination of acupuncture and medicine has a better clinical effect than acupuncture only in a way. Acupuncture + western medicine has an obvious and exact improvement in the curative effect from both total effect and ADL score, but further higher quality studies, which can detail the classification of these interventions, are still needed to verify it.

Effect of butylphthalide in patients with vascular cognitive impairment

Purpose: To study the effects of butylphthalide in patients with vascular cognitive impairment. &#x0D; Method: Sixty patients with vascular cognitive impairment were randomly divided into control group and butylphthalide (NBP) group (n = 30). Control group received blood pressure control, blood sugar control, and lipid-lowering therapies, while NBP group received butylphthalide capsules (200 mg, thrice daily). Treatments in both groups lasted for 14 days. Thereafter, Hasegawa Dementia Scale (HDS), Mini-Mental State Examination (MMSE), Activities of Daily Living Scale (ADL), and event-related potential (P300) were used to evaluate the effects of butylphthalide treatment. &#x0D; Result: Following 14 days of treatment, HDS, MMSE and ADL scores of NBP group were significantly higher than those of the control group (p &lt; 0.05). The P300 latency of NBP group was shorter than that of control group, while P300 amplitude was higher than that of control group (p &lt; 0.05). &#x0D; Conclusion: Butylphthalide treatment achieves higher scores of HDS, MMSE and ADL scores, but shorter P300 latency. These results provided good evidence of the effectiveness of butylphthalide therapy in the management of vascular cognitive impairment. However, further clinical trials are recommended prior to application in clinical practice.

Application of Exploratory Factor Analysis and Item Response Theory to Validate NHANES ADL Scale in Patients Reporting Rheumatoid Arthritis.

Background: Several instruments are used for measuring functional limitations among rheumatoid arthritis (RA) patients. However, these instruments are incongruously assessed for their psychometric properties. The National Health and Nutritional Examination Survey (NHANES) uses a generic questionnaire to assess the activities of daily living (ADL) to measure functional limitations among its participants. The psychometric properties of the NHANES-ADL scale were evaluated using a patient examination and survey data. Methods: NHANES-ADL scale was assessed for its internal consistency and factor structure. Scale reliability was assessed with Cronbach's alpha reliability coefficient. Principal component analysis with Promax rotation was used to obtain factor structure. Confirmatory factory analysis was used to calculate fit indices. The graded item response theory model was used to estimate item discrimination, difficulty, and test information. Results: Our sample included 1132 individuals with RA. Exploratory factor analyses of 19-item NHANES ADL scale produced one factor solution and accounted for 35% of variance. The Cronbach alpha of this scale was 0.92. The results of graded item response model indicated items performing well discriminating high and low level of functional ability. A higher slope (α) reflected stronger ability of items to discriminate across the continuum. Conclusions: The NHANES ADL scale showed good reliability, single dimensionality, and validity in RA patients. Studies should explore its test-retest reliability and its ability to reliably measure functional change over time in the future.

VP.41 Congenital myasthenic syndrome: natural history of an Italian cohort of patients

Congenital myasthenic syndromes (CMS) are genetic diseases characterized by impairment of the structure or function of the neuromuscular junction. CMS natural history has been poorly investigated and has not been clarified yet. Aim of this study is to longitudinally assess the disease course of CMS in an Italian cohort of patients. We included genetically defined CMS, followed in three Italian neuromuscular centres. Patients were evaluated at baseline and then once per year, with a minimum follow-up of 2 years. Neurological examination included the Myasthenia Gravis–specific Activities of Daily Living scale (MG-ADL), the MG-composite scale (MGC), time to get up from the floor and from a chair, upper and lower limbs fatigability (Mingazzini I and II manoeuvres). A total of 40 patients, including 16 males and 24 females, were enrolled. The most common mutated gene was CHRNE (n=17 pts), followed by DOK7 (n=5 pts) and GFPT1 (n= 4 pts). Mean age at first evaluation was 39.2 ± 15.2 years (range=10-71) and mean follow-up period was 2.1 ± 0.5 years (range=2-3). Mean MG-ADL and MGC scores at baseline were 5.3 ± 3.6 and 10.5 ± 6.8, respectively, with a significant improvement during the follow-up period (p-value=0.0000 for MG-ADL; p-value=0.0037 for MGC) mainly related to treatment modifications. Good concordance was found between MG-ADL and MGC across the 2-year period. Conversely, no significant changes of upper and lower limb fatigability or timed tests were reported between baseline and following visits. Our preliminary data suggest no overall disease progression over a 2-year period in CMS patients.

Characteristics Scanning of Brain Structure and Function Changes in Patients with Different Degrees of Alzheimer's Disease.

Through the case control study on structural magnetic resonance imaging (sMRI) scanning, MR spectrum (MRS), and neuropsychological assessment of the intracranial structures of Alzheimer's disease (AD), patients of different degrees (early, middle, and late), the early clinical features, imaging features, and neuropsychological characteristics of patients with AD were analyzed to provide help for the early diagnosis of AD. The data of MR scanning of the brain, bilateral MRS scan of the hippocampus, thyroid function and other laboratory indicators, and neuropsychological evaluation analysis were collected in 50 patients who had been diagnosed with AD. According to CDR, 50 patients were divided into the early AD group and the middle and advanced AD group, with 23 patients in the early AD group and 27 patients in the middle and advanced AD group. Retrospective study was conducted to analyze the general conditions, medial temporal lobe atrophy (MTA) grading, and the metabolic changes of bilateral MRS in the hippocampus of patients in both groups, so did the mini-mental state examination (MMSE), activities of daily living scale (ADL), and other neuropsychological assessment results. Moreover, the comparative analysis was carried out. The results showed that the MTA grade of medial temporal atrophy increased with the progressive severity of the disease in both groups. A statistical test was conducted on the reduction of hippocampal volume in the two groups, and the P was less than 0.05. Therefore, the MTA scale was of great value in the diagnosis and staging of early AD. However, when the diagnosis of early AD was treated by MTA visual evaluation alone, there was 23.8% false negative diagnosis. If the judgment of early AD only depended on the metabolic changes of hippocampus MRS or MR scanning of intracranial structures, it was likely to cause false negative diagnosis. Therefore, the combination of MRS analysis and MR scanning of intracranial structures was favorable for the early diagnosis and treatment of AD. Combined with neuropsychological assessment, AD patients were staged more effectively, which greatly improved the accuracy of AD diagnosis in the early stage.

Activities of daily living and its influencing factors for older people with type 2 diabetes mellitus in urban communities of Fuzhou, China.

BackgroundType 2 diabetes mellitus (T2DM) is an independent risk factor for functional limitations among the older population. The predicted increase in T2DM cases combined with the ongoing rapidly aging population may further burden the already overloaded healthcare system and aggravate the loss of economic self-sufficiency. This study aimed to investigate the activities of daily living (ADL) and its influencing factors on older people with T2DM, and to provide implications for the development and improvement of community nursing services in the context rapidly aging population in China.MethodsFrom March 2019 to June 2020, we conducted a cross-sectional questionnaire survey among older T2DM patients in Fuzhou, using a multi-stage cluster sampling approach. Functional status was measured by the Lawton ADL scale. Stata “nptrend” test was used to examine the trend of ordinal variables on ADL. Non-conditional logistic regression was used to identify factors affecting ADL limitations.ResultsA total of 2016 questionnaires were received, with a response rate of 96%. 12.4% of participants suffered from varying degrees of functional impairment. ADL limitations increased with age. More comorbidities were associated with a greater risk of developing functional limitations in ADLs. the following sub-groups were more likely to suffer from ADL impairment: those aged 70 and over years (OR = 1.99, 95%CI 1.77–2.56), living in an aged care house or with spouse/children (OR = 2.31, 95%CI 1.25–4.26), low monthly income (OR = 1.49, 95%CI 1.28–1.64), without health insurance (OR = 1.82, 95%CI 1.40–2.40), tight family expenses (OR = 1.95, 95%CI 1.42–2.69), having stroke (OR = 6.70, 95%CI 2.22–20.23) or malignant tumor (OR = 4.45, 95%CI 1.27–15.53), irregular eating habit (OR = 2.55, 95%CI 2.23–2.92), smoking (OR = 1.40, 95%CI 1.22–1.60), sedentary lifestyle (OR = 2.04, 95%CI 1.46–2.85), lack of physical exercise (OR = 1.35, 95%CI 1.19–1.53), sleeping difficulty (OR = 1.25, 95%CI 1.10–1.42), and lack of family support (OR = 1.19, 95%CI 1.10–1.29).ConclusionOlder adults (≥70 years) with T2DM had a high prevalence of functional limitations across a range of daily living tasks, which not only affect individual life of quality but also present a huge burden on the family, health services system, and the whole society. Identified factors associated with ADL limitations may provide useful information for targeted nursing practice and health promotion.

Piloting of the virtual telecare technology ‘Addison Care’ to promote self-management in persons with chronic diseases in a community setting: protocol for a mixed-methods user experience, user engagement and usability pilot study

IntroductionChronic diseases in older adults are one of the major epidemiological challenges of current times and leading cause of disability, poor quality of life, high healthcare costs and death. Self-management...

Integrative medicine in treating post-stroke depression: Study protocol for a multicenter, prospective, randomized, controlled trial.

BackgroundPost-stroke depression (PSD) is one of the most common neuropsychiatric diseases in patients with stroke, and it can increase the disability rate, mortality, and recurrence rate of stroke. Currently, many clinical studies have indicated that traditional Chinese medicine (TCM), such as acupuncture and herbs, Western medicine, rehabilitation, repeated transcranial magnetic stimulation, and other treatment methods, are effective in treating PSD. However, no study has formulated a comprehensive treatment plan that integrates TCM, Western medicine, and rehabilitation for PSD. Thus, this trial aims to assess the efficacy and safety of integrative medicine for treating PSD.MethodsThis multicenter, prospective, randomized, controlled study aims to form a set of effective clinical treatment schemes that integrate TCM, Western medicine, and rehabilitation for PSD. A total of 202 participants recruited from four centers will be randomized into either the integrative medicine or standard care group. Standard care—basic treatment, general nursing care, and exercise therapy—will be provided to all participants. The integrative medicine group will also receive acupuncture, Chinese herbs, and repeated transcranial magnetic stimulation (rTMS). Participants will receive acupuncture and rTMS treatments five times per week for 4 weeks and will be administered Chinese herbs, basic treatment, general nursing care, and exercise therapy for 4 weeks. The primary outcomes include the Hamilton Depression Scale (HAMD), Self-Rating Depression Scale (SDS), and Activity of Daily Living Scale (ADL). And the secondary outcomes include the Montreal Cognitive Assessment Scale, the Fugl-Meyer Assessment (FMA) Scale, and the Pittsburgh Sleep Quality Index (PSQI). All outcome measures will be evaluated at baseline, week 4 (the end of the treatment courses), and week 8 (the end of follow-up). Safety assessments will be performed throughout the study.DiscussionThis study is expected to verify the efficacy and safety of integrative medicine for treating PSD, providing an evidence-based clinical reference for the future development of a standardized scheme.Clinical trial registrationClinicalTrials.gov, identifier: NCT05187975

Clinical efficacy of idebenone in stroke patients with mild cognitive impairment, and its effect on regional homogeneity of resting-state functional magnetic resonance imaging of the brain

Purpose: To evaluate the clinical efficacy of Idebenone in stroke patients with mild cognitive impairment, and its effect on regional homogeneity (ReHo) of resting-state functional magnetic resonance imaging (rs-fMRI) of the brain.&#x0D; Methods: One hundred and twenty stroke patients with mild cognitive impairment who were admitted to the Department of Neurology of the China Rehabilitation Research Center Beijing Boai Hospital from January 2018 to January 2020 were enrolled in this study. The patients were randomly divided into control group and study group. Control group was treated with nimodipine, while the study group received a combination of nimodipine and idebenone.&#x0D; Results: Clinical efficacy was higher in the study group than in the control group (p &lt; 0.05). Scores on Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), and activity of daily living scale (ADL) were significantly elevated (p &lt; 0.05) in both groups after treatment, but scores for MoCA and ADL were significantly higher in the study group than in the control group (p &lt; 0.05). After 6 months of treatment, there were significantly more patients with improved clinical dementia rating (CDR)in the study group than in the control group (p &lt; 0.05).&#x0D; Conclusion: The use of idebenone and nimodipine for treatment of stroke patients with cognitive dysfunction leads to significant improvement in clinical outcomes, and enhancement of cognitive function and quality of life, due to improved brain function in the precuneus. However, the mechanism involved in the combination therapy-induced enhancement of cognitive function requires further investigation.&#x0D; Keywords: Stroke; Cognitive dysfunction; Resting-state functional magnetic resonance imaging of brain; Regional homogeneity; Quality of life

A systematic review of the efficacy of donepezil hydrochloride combined with nimodipine on treating vascular dementia.

Background:Vascular dementia (VaD) is a comprehensive syndrome related to the damage of cognitive function and various cerebral vascular illnesses. VaD is also generally recognized as the second most common type of dementia after Alzheimer disease, contributing to 30% of the dementia population in Asia and developing countries. The ability of donepezil hydrochloride and nimodipine had been respectively proven in improving cognitive function in vascular dementia. However, whether the combined application of both drugs contribute to better efficacy remains as a research hotspot. Studies had shown definite satisfactory result with such combination, however evidence-based evaluation of the efficacy is still lacking. Therefore, meta-analysis is employed in this study to evaluate the efficacy and safety of using donepezil hydrochloride combined with nimodipine in treating VaD to provide references for clinical treatments. The efficacy of donepezil hydrochloride combined with nimodipine on treating vascular dementia is systematically reviewed to provide evidence-based references for clinical applications.Methods:Both Chinese and English databases were searched from the start till August, 2020 for any RCT regarding the combined use of the 2 drugs in treating vascular dementia. Two investigators would later evaluate and screened out research and data based on an improved Jaded scale. Software Rev Man 5.3.0 was employed to carry out meta-analysis on clinical effificacy, mini-mental state examination (MMSE) ratings, activity of daily living (ADL) ratings, and clinical dementia scale (CDR) ratings.Results:Donepezil hydrochloride combined with nimodipine had demonstrated satisfactory efficacy on the treatment of vascular dementia. Improvements were namely spotted on MMSE scale, ADL scale, and CDR scale, with the utmost efficacy by 12 weeks after intervention.Conclusions:Donepezil hydrochloride combined with nimodipine had good efficacy in the treatment of patients with vascular dementia, mainly in terms of improving the Simple MMSE scores, the ability to use daily living scale (ADL) scores and the CDR, and the best results were obtained after 12 weeks of intervention. Such conclusion should be cautiously evaluated.