Quality of life, grip strength, health indicators, and clinical risk in older adults: A cross-sectional study.

Prevalence and factors influencing reversible cognitive frailty among older adults in elderly care facilities in Northeast China: A cross-sectional survey.

Neuroprotective effects of Tongxinluo capsule in acute ischemic stroke: A systematic review and meta-analysis.

Activities of daily living, physical activity, and care situation in chronic critical illness survivors one year after disease onset: A prospective cohort study.

Low intrinsic capacity, delirium, and urinary incontinence are associated with poor trajectories of activities of daily living in older patients after discharge.

Hypoxic ischemic encephalopathy (HIE) is a severe brain injury that can lead to death and long-term disability. HIE can be treated with therapeutic hypothermia, and various adjuvant treatments (such as melatonin) are also utilized. Adjuvant therapies are not recommended outside clinical trials, and therapeutic hypothermia is not universally available. This study aimed to investigate the effects of Edaravone on improving levels of consciousness, hemodynamic stability, and short-term clinical outcomes of adult patients with severe HIE. To the best of our knowledge, this study is the first randomized clinical trial investigating the effects of Edaravone in adult patients with severe HIE. A double-blind clinical trial enrolled 72 severe HIE patients (aged > 18) within 24 h of onset who were diagnosed clinically and radiologically. Patients were randomized to Edaravone group (n = 20) and non-Edaravone group (n = 52). Measured parameters included level of consciousness, vital signs, Barthel index, and patient outcome (death or discharge). Statistical analysis was performed using SPSS version 27, with a significance level of P < 0.05. In short-term assessment of the patient's level of consciousness, the Edaravone group showed significant improvement in the Glasgow Coma Scale (GCS) post-intervention (p = 0.001). While the Edaravone group and non-Edaravone group showed no significant difference in outcome (p = 0.863) and Barthel score for discharged patients (P = 0.557). Vital signs showed significant differences between groups in temperature (P = 0.002). In the comparison of comorbidities between the Edaravone and non-Edaravone groups, only coronary artery bypass grafting was significantly different (P = 0.021). Edaravone improved the short-term level of consciousness in severe HIE adult patients, but there was no significant effect on outcome and level of independence in performing activities of daily living. Further investigation into Edaravone's effectiveness is warranted, particularly in patients with milder forms of HIE, as well as longer follow-up periods.

The optimal timing of cranioplasty (CP) after craniectomy remains uncertain. We aimed to evaluate and compare functional outcomes and complication rates associated with early and late CP after craniectomy. We systematically searched PubMed, Scopus, and Web of Science through June 2025. Fifty-five studies (n = 8602 patients) met inclusion criteria, comparing at least 2 distinct CP timing categories. Functional outcomes included Barthel Index (BI), functional independence measure, and modified motor assessment and enhancement scale. Patients were categorized as having undergone ultra-early CP (30-45 days), intermediate CP (45-70 days), early CP (80-100 days), or delayed CP (120-180 days). Early CP significantly improved functional outcomes in BI absolute scores, BI gain scores, absolute functional independence measure scores, and absolute modified motor assessment and enhancement scale scores compared with delayed CP. Ultra-early CP demonstrated the greatest benefit in absolute BI scores and significantly reduced bone flap resorption risk. No significant differences were found in rates of complications. Implant material (autologous vs prosthetic) and traumatic etiology did not significantly affect these outcomes. Earlier CP after craniectomy-particularly within 100 days-was associated with improved functional recovery without a significant increase in complications. Although bone flap resorption appeared lower with ultra-early timing, other adverse events such as infection, hydrocephalus, and hematoma did not vary meaningfully across timing windows. These findings suggest that, in carefully selected patients, earlier reconstruction may offer neurological benefits. Because timing was not randomized and may reflect clinical stability and treatment selection, these findings reflect associations and do not establish causality. Further studies are needed.

ABSTRACT Objective As neuropsychological tests insufficiently reflect impairments in activities of daily living (ADL), behavioral observation using Moss Attention Rating Scale (MARS) is necessary. Although MARS scores are associated with ADL independence, their longitudinal relationship remains unclear. This study aimed to investigate whether changes in MARS scores over time are associated with ADL independence in patients with mild-to-moderate acute stroke who could undergo neuropsychological tests. Methods This single-center, prospective longitudinal cohort study included 60 patients (median age: 73.5 years) hospitalized for acute stroke for ≥14 days. The median interval from stroke onset to initial evaluation was 3 days. The primary outcome was ADL independence, measured using the Barthel Index (BI) at 2 weeks. Results Multiple regression analysis identified MARS as a significant predictor of BI at 2 weeks. Neuropsychological tests revealed floor effects, whereas MARS did not. Receiver operating characteristic curves demonstrated strong discriminative ability of MARS for predicting BI ≥ 60 (area under the curve: 0.96 [baseline], 0.93 [1 week]). Conclusions MARS is more effective than conventional neuropsychological tests for assessing attention-related ADL independence, particularly in early stroke rehabilitation. Clinical trial registration UMIN000055922

Geriatric patients are faced with ongoing care needs after hospitalization. This study evaluated the prevalence of sarcopenia and malnutrition at admission and related clinical characteristics in geriatric inpatients of a transitional care program. A cross-sectional study and a longitudinal observational study were conducted among geriatric inpatients in a retirement home. Sarcopenia was assessed using the Sarcopenia Definitions and Outcomes Consortium criteria, and nutritional status via the Mini Nutrition Assessment. Patient- and clinician-reported outcome measures, including the Barthel Index, EQ-5D-5L, NPRS, HAQ-DI, 10m walking test and Timed Up and Go test were collected at admission and discharge (mean stay: 39 ± 22 days). In addition, a 3-month post-discharge follow-up telephone interview was conducted. Out of 72 geriatric rehabilitation inpatients (mean age: 84 ± 7 years, 83% female), the prevalence of sarcopenia was 80.6%, while 81.2% of patients were malnourished or at risk of malnutrition upon admission. Sarcopenic patients showed reduced health-related quality of life (EQ-5D-5L; p < .05, d = 0.61), greater hand-grip strength asymmetry (68.6%; p < .05), and a trend to have a lower functional ability to perform activities of daily living (HAQ-DI; p = .06). The transitional care program improved quality of life, care needs, and mobility (all p < .001), independently of sarcopenia or malnutrition status. This study showed a high prevalence of sarcopenia and malnutrition in geriatric transitional care inpatients. Despite improvements in function and quality of life, persistent sarcopenia underscores the need for ongoing, individualized interventions such as progressive resistance training combined with nutritional support.

To compare the prognostic value of somatosensory evoked potentials and motor evoked potentials for upper limb functional recovery in patients with subacute stroke. Retrospective observational analysis. A total of 111 inpatients with subacute stroke who underwent upper limb somatosensory evoked potentials and motor evoked potentials testing within 1 week of admission and completed a standardized rehabilitation programme. Somatosensory evoked potentials and motor evoked potentials were categorized as non-responsive, abnormal, or normal. Discharge outcomes included the Fugl-Meyer Assessment for upper limb, Box and Block Test, Functional Independence Measure, and Korean version of the modified Barthel Index. Mixed-effects models were applied to examine associations between somatosensory evoked potentials or motor evoked potentials status and discharge outcomes, adjusting for baseline score and admission duration, with patient ID as a random intercept. Effect sizes were calculated using Cohen's f 2. Normal somatosensory evoked potentials were associated with higher Functional Independence Measure and Korean version of the modified Barthel Index scores than non-responsive somatosensory evoked potentials, while abnormal somatosensory evoked potentials showed non-significant trends. For motor evoked potentials, the normal group showed higher Box and Block Test scores, and both abnormal and normal groups had higher Korean modified Barthel Index scores than non-responsive. Admission somatosensory evoked potentials and motor evoked potentials provide complementary prognostic information in subacute stroke rehabilitation.

Activities of daily living (ADL) are an important outcome of surgery for elderly patients. As life expectancy increases, interest in minimally invasive surgery (MIS) is increasing. However, there is limited evidence regarding the effect of MIS on ADL, especially in the very elderly patients (≥ 80years). A total of 1009 consecutive patients (80-99years) undergoing elective surgery for gastrointestinal and hepatobiliary-pancreatic tumors between 2010 and 2025 were enrolled. Propensity score matching (PSM, 1:1) was performed in 869 patients after excluding those with benign tumors or missing data. A comparison was made between MIS (laparoscopic/robotic, n = 284) and open surgery (n = 284). The primary outcome was postoperative ADL decline. Severe postoperative ADL decline was defined as a decline of ≥ 30 points in the Barthel Index total score. Postoperative ADL decline was observed in 128 patients (14.7%) in the entire cohort. After PSM, postoperative ADL decline occurred in 17.3% and 19.4% of patients in the open and MIS groups, respectively (P = 0.59). Severe postoperative ADL decline was lower in the MIS than in the open groups (5.7% vs. 9.5%, P = 0.11). The 90-day readmission rate was also lower in the MIS groups (16.6% vs. 22.3%, P = 0.11). Intraoperative blood loss, ICU and hospital length of stay, and severe postoperative complications were significantly better in the MIS group. In high-risk or frail subgroups, such as those with poor performance status, care needs, and severe complications, MIS consistently demonstrated lower rates of severe postoperative ADL decline compared with open surgery. Compared with open surgery, MIS reduced the incidence of severe postoperative ADL decline and 90-day readmission. Subgroup analysis indicated that this trend was strongest in high-risk or frail patients. These results suggest that MIS may help maintain postoperative independence and prevent functional frailty in the very elderly patients.

BackgroundPostoperative delirium (POD) is a common complication in elderly surgical patients associated with adverse outcomes. However, the relationship between low preoperative Barthel Index (BI) and POD remains unclear.PurposeThis study investigated the correlation between preoperative BI and POD incidence in elderly patients undergoing non-cardiac surgery.Patients and MethodsThis prospective cohort study enrolled 298 patients (≥65 years) undergoing elective non-cardiac surgery under general anesthesia. Preoperative BI assessed activities of daily living (ADL) within 24 hours before surgery. POD was screened twice daily until postoperative day 7 or discharge using the 3-Minute Diagnostic Interview for Confusion Assessment Method–defined Delirium (3D-CAM). Univariate and multivariate logistic regression analyzed associations between BI and POD. Restricted cubic spline (RCS) and two-piecewise linear regression explored non-linearity and identified inflection points. Findings were validated using inverse probability of treatment weighting (IPTW), and BI’s incremental predictive value was evaluated by receiver operating characteristic (ROC) curve analysis.ResultsPOD incidence was 25.8% (77/298). Multivariate analysis showed lower preoperative BI (OR=0.956, 95% CI: 0.940–0.973, p<0.001), lower BMI (OR=0.860, 95% CI: 0.757–0.977, p=0.020), and advanced age (OR=1.174, 95% CI: 1.102–1.250, p<0.001) independently associated with POD. RCS revealed a nonlinear relationship with inflection at BI=75. Patients with BI<75 had significantly higher POD risk than those with BI≥75 (OR=4.615, 95% CI: 2.377–8.963, p<0.001), robust after IPTW adjustment (42.9% vs 14.5%; adjusted OR=4.445, 95% CI: 2.564–7.707, p<0.001). This association was pronounced in patients with fewer comorbidities, shorter anesthesia duration, and shorter preoperative stays. Incorporating the BI score significantly improved the discrimination of the predictive model for POD.ConclusionPreoperative ADL impairment (BI<75) independently predicts POD in elderly non-cardiac surgery patients. Preoperative BI assessment is recommended for perioperative risk stratification, identifying low-BI patients as targets for preventive interventions.

Purpose Survivors of critical illness often acquire significant physical, cognitive, and psychological burdens following their intensive care unit (ICU) stay, termed “post-intensive care syndrome” (PICS). Screening for PICS is generally not performed outside of research settings largely due to lack of a simple assessment tool and time constraints. Methods This was a prospective cohort study at a single academic medical center in the USA. We included adults (18 years or older) who spent greater than 48 h in any ICU within the medical center. Following transfer out of the ICU and at 3 months, psychological, cognitive, and physical functioning were assessed using the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Montreal Cognitive Assessment-blind, and Barthel Index. We compared these validated questionnaires to a brief, 15-item PICS screening tool (5 questions/domain) that was developed by our multidisciplinary study team and administered to study participants after ICU discharge to general care. The primary objectives of this study were to assess the ability of validated screening tools administered at ICU discharge to predict PICS at 3 months and develop a novel screening tool for identifying patients at risk of PICS. Major Findings 191 participants completed the initial questionnaire, and 109 (56%) completed the 3-month follow-up. PICS tool scores were compared to 3-month follow-up data from validated questionnaires to evaluate predictive performance. Overall, the screening tool weakly-to-moderately correlated with continuous outcomes of the validated measures at 3-month follow-up. When evaluating sensitivity and specificity for individual domains, the screening tool had an area under curve of &gt;0.7 for all three domains, indicating moderate-to-good sensitivity and specificity. Conclusions We developed a brief PICS screening tool that is feasible to use without prior training that modestly predicted the development of PICS following ICU stay.

Functional impairment as predictors of renal outcomes and mortality in elderly patients: a retrospective cohort study.

Background: The process and dynamics of post-stroke recovery can vary considerably across patient subgroups. However, few studies have explored long-term functional recovery profiles (an essential outcome indicator), particularly in relation to patients' quality of life, and caregiver burden. This study aimed to identify distinct 12-month trajectories of functional recovery among stroke survivors, and to examine their associations with sociodemographic and clinical factors, as well as patient-reported outcomes. Methods: The study involved 225 patients with acute ischemic stroke, assessed at admission (T0), discharge (T1), and at 3 (T2) and 12 months (T3) post-discharge. Informal caregivers participated at T2 (n = 126) and T3 (n = 118). Functional status was measured using the modified Barthel Index, quality of life using the Stroke-Specific Quality of Life scale, and caregiver burden with the Caregiver Burden Scale. Latent growth mixture modelling (LGMM) was applied to identify recovery trajectories. Associations with sociodemographic and clinical variables, quality of life, and caregiver burden were analysed using ANOVA and χ2 tests. Results: Three recovery trajectory classes were identified: Class 1 (moderate upward, 20.4%), Class 2 (low-stable, 4.9%), and Class 3 (high-functioning stable, 74.7%). Class 3 patients were younger, less impaired at baseline, and more frequently diagnosed with lacunar strokes. Class 2 comprised older, more impaired individuals and had the lowest proportion of males. Class 1 represented intermediate baseline profiles with gradual functional improvement over time. Patient-reported outcomes differed significantly between classes (p < 0.001): Class 3 had the highest quality of life and lowest caregiver burden whilst Class 2 consistently reported the poorest quality of life. Conclusions: This study demonstrates significant heterogeneity in post-stroke functional recovery and its associations with clinical, sociodemographic, and patient-reported outcomes. Identifying recovery trajectories may support more personalised stroke care and rehabilitation planning.

Introduction: Stroke survivors in low-resource settings often rely on family caregivers to provide essential daily care after hospital discharge. However, many caregivers lack the necessary knowledge, skills, and confidence to perform safe and effective home-based care. Virtual Reality (VR) offers an immersive, interactive, and practical training method that may enhance caregiver preparedness and is associated with improved patient outcomes during post-stroke recovery. This study evaluated the effectiveness of a VR-based caregiver training program on functional, psychological, physiological, and cognitive outcomes among stroke survivors. Methods: A quasi-experimental pre–post design was conducted with 60 caregiver–patient pairs recruited from a community health center in South Sumatra. Participants were assigned to either a VR-based training group or a control group receiving standard discharge education. The intervention consisted of five immersive VR modules simulating stroke-care scenarios, including hygiene, feeding, transfer techniques, positioning, suctioning, and range of motion exercises. Outcome measures included systolic blood pressure, functional independence (Barthel Index), anxiety and depression (HADS), and cognitive status (MoCA). Results: Patients whose caregivers received VR-based training demonstrated significant improvements in patient outcomes compared with the control group. The intervention group showed greater reductions in systolic blood pressure (p = 0.021), increased functional independence (p = 0.041), reduced anxiety (p = 0.017) and depression (p = 0.011), and enhanced cognitive function (p = 0.032). Effect sizes ranged from moderate to large, indicating clinically meaningful improvements. Conclusion: VR-based caregiver training is a feasible, low-cost, and effective strategy associated with improved patient outcomes following caregiver training. Its immersive design provides experiential learning that may support caregiving activities in community health settings with limited resources.

IntroductionCorticospinal tract lesion load (CST-LL) is a biomarker used for studying motor outcomes after stroke. However, the optimal method for calculating this metric is unknown.MethodsThis is a cross-sectional study of a large ischemic stroke cohort from the ENIGMA Stroke Recovery Consortium (n = 221; mean age = 59.8 years, 56% male) to compare 4 lesion load metrics across 3 CST templates. We then validate these findings in another large, independent stroke cohort (n = 125; mean age = 64.6 years, 54% male).ResultsResults indicate that variance in behavioral outcome was best explained using the maximum weighted cross-sectional overlap between lesion and the CST (Max-WLL), and when using an age-appropriate normative CST template (generated from the HCP Aging study). This was true both when the outcome was motor impairment, measured using the Fugl-Meyer Upper Extremity scale (FMUE, relative explained variance (REV) = 58.9%), and when it was global function, measured using the Barthel Index (BI, REV = 60%). In the validation cohort, FMUE results were replicated (REV = 47.6%).ConclusionThe findings indicate that Max-WLL, which represents the proportion of transected CST fibers, most accurately captures CST injury as it relates to motor and functional outcomes after stroke. Additionally, results suggest the importance of an age-appropriate template, a key consideration given that stroke is largely a disease of the elderly. Together, these findings provide an independently validated tool to optimize future research examining CST injury after stroke.

Background Post-stroke spasticity is a frequent complication of stroke. Early interventions aimed at positioning the limb in a reflex-inhibiting posture may help reduce the severity of spasticity. Purpose This trial aimed to evaluate the efficacy of the supinated forearm, extended fingers and elbow and an abducted and externally rotated shoulder, with the wrist in neutral position (SEA posture), in preventing the severity of upper limb spasticity in acute stroke patients with flaccid weakness. Methods In this prospective, single-centre, randomised, open-label controlled trial with blinded outcome assessment, 76 acute stroke patients aged 18–80 years presenting within 72 hours with flaccid upper limb weakness were enrolled. Patients were randomised 1:1 to receive either the SEA posture intervention using a splint for at least 210 minutes daily plus conventional physiotherapy ( n = 38) or conventional physiotherapy alone ( n = 38). The primary outcome was spasticity measured by the Modified Ashworth Scale (MAS) at three and six months. Secondary outcomes included the Modified Rankin Scale (mRS) and the Barthel Index. Results After six months, 66 patients completed follow-up (34 intervention, 32 control). Groups were comparable at baseline. The intervention group showed significantly lower spasticity scores at the elbow, forearm, wrist and fingers at both three and six months ( p &lt; .05). Barthel Index scores were significantly better in the intervention group, while mRS scores did not differ between the groups. No adverse effects related to splinting were noted. Conclusion Early application of the SEA posture reduces the severity of upper limb spasticity after acute stroke and improves functional independence.

Background/Objectives: Stroke frequently leads to balance deficits. Vestibular physical therapy (VPT) may enhance postural control through neuroplastic mechanisms. Virtual reality (VR) can provide ecologically valid environments for rehabilitation, increasing patient engagement. Methods: In this randomized feasibility study, nine individuals with chronic stroke were randomized to either a Real visuo-vestibular rehabilitation group (n = 6) or a Sham VR group (n = 3) to explore the feasibility of the protocol and randomization procedures rather than to compare clinical efficacy. Both groups were trained in immersive VR environments for 12 sessions. The Real group experienced visuo-vestibular stimuli requiring sensorimotor integration; the Sham group trained in the same environments without such stimuli. Feasibility was assessed through attendance, participation (Pittsburgh Rehabilitation Participation Scale, PRPS), and user satisfaction (USEQ). Safety and acceptability were monitored through adverse event reporting. Secondary exploratory outcomes included measures of balance-the Mini Balance Evaluation Systems Test (MiniBESTest), the Berg Balance Scale (BBS), and the Performance-Oriented Mobility Assessment (POMA)-as well as functional independence (Barthel Index), health-related quality of life (Stroke-Specific Quality of Life Scale, SSQoL), and a set of spatiotemporal and gait quality parameters derived from inertial measurement unit (IMU) data collected during the 10-Meter Walk Test and the Figure of 8 Walk Test. Results: All participants completed the protocol without adverse events. Participation, as measured by the PRPS, remained consistently high across sessions (mean ≥5.7/6), while USEQ scores indicated excellent user satisfaction (mean ≥28/30). Exploratory analyses revealed improvements in MiniBESTest and BBS scores for the Real group. Instrumental measures derived from IMUs demonstrated improvements across groups. Conclusions: Exploratory outcomes suggested positive trends in balance improvements, and the integration of clinical scales with wearable sensors proved feasible and informative.

Based on anonymized inpatient service data from 2023 using the InEK-DatenBrowser (according to § 21 KHEntgG), the correlation between restrictions in the activities of daily living - measured with the Barthel Index - and the assigned level of care was examined. The aim was to demonstrate that the Barthel Index can be used as a practical tool for assessing the need for care in everyday medical practice. The results show that a lower Barthel Index is significantly associated with a higher level of care. Using ordinal logistic regression analyses (OR for level of care>1 are between 1.40 and 14.52) and the Kendall correlation test (τ=0.32; p<0.001; Cohen's d=1.10) we were able to demonstrate a statistically significant correlation. Thus, the Barthel Index can be used as an indicator for care needs - especially in cases where no formal level of care has yet been assigned. These findings can support medical decision-making and contribute to more needs-based care. Additionally, they could potentially ease physicians' daily routines by enabling the early identification of a need for long-term care.