Non-pharmacological Interventions Research Articles

Disparities by Socioeconomic Status and Diagnosis of Dementia in the Prescribing of Antipsychotics in a Real-World Data Population Over 60 Years of Age.

Antipsychotics are widely used in the elderly due to the high prevalence of neuropsychiatric associated with dementia. To analyze potential disparities in antipsychotic use in the general population of Gipuzkoa by socioeconomic status (SES) and diagnosis of Alzheimer's disease and related dementia (ADRD) adjusting for somatic and psychiatric comorbidities, age, and sex. A retrospective observational study was carried out in all the 221,777 individuals over 60 years of age (Gipuzkoa, Spain) to collect diagnosis of ADRD, the Charlson Comorbidity Index, and psychiatric comorbidities considering all primary, outpatient, emergency and inpatient care episodes and first- and second-generation antipsychotics, and sociodemographic variables, namely, age, sex, SES and living in a nursing home. Logistic regression was used for multivariate statisticalanalysis. Use of any antipsychotic was greater in women, individuals over 80 years old, living in a nursing home, with a diagnosis of dementia, somatic and psychiatric comorbidities, and low SES. Quetiapine was the most used drug. The likelihood of any antipsychotic use was significantly associated with low SES (odds ratio [OR]: 1.60; confidence interval [CI]: 1.52-1.68), age over 80 years (OR: 1.56; CI: 1.47-1.65), institutionalization (OR: 12.61; CI: 11.64-13.65), diagnosis of dementia (OR: 10.18; CI: 9.55-10.85) and the comorbidities of depression (OR: 3.79; CI: 3.58-4.01) and psychosis (OR: 4.96; CI: 4.64-5.30). The greater levels of antipsychotic use and institutionalization in people of low SES indicate inequity in the management of neuropsychiatric symptoms. Increasing the offer of non-pharmacological treatments in the health system might help reduce inequity.

Review on Alzheimer’s disease

The treatment of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD) is crucial for individuals with the condition. Cholinesterase inhibitors (CIs) and memantine, used for cognitive symptoms, may have some effect on BPSD, but additional drugs may be needed as BPSD worsens. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, and others are effective antidepressants for comorbid depression in AD. Limited evidence supports their use for treating depression, agitation, and psychosis in AD, but recent trials showed no benefit and increased risks. Non-pharmacological interventions such as psycho social approaches and alternative therapies are important. A comprehensive approach combining medication and non-pharmacological interventions, along with close monitoring, is essential for managing BPSD and improving quality of life for individuals with AD and their caregivers.

How to undertake a pain assessment for -patients with acute post-operative pain.

Acute post-operative pain is common among patients in secondary care settings, and the alleviation of this pain is a principal responsibility for all healthcare professionals, including nurses. To achieve this, it is essential to regularly undertake comprehensive pain assessments, using validated pain assessment tools, for all patients who have undergone a surgical procedure. Inadequate pain assessment may lead to ineffective or inappropriate pain management, which can adversely affect the patient's recovery and increase their risk of developing chronic pain. •Pain is a subjective experience and therefore requires individualised, comprehensive assessment and management interventions. •The assessment process for patients with acute pain is fundamental to understanding the patient's current status, informing differential diagnoses regarding the underlying cause of the pain, providing appropriate treatment and monitoring, and evaluating the effectiveness of treatment. •Pain assessment should not be undertaken as a one-off care activity; it should be completed whenever a patient reports pain and repeated following pharmacological and/or non-pharmacological interventions. REFLECTIVE ACTIVITY: 'How to' articles can help you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: •How this article might improve your practice when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. •How you could use this information to educate nursing students or colleagues on the appropriate actions to take when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain.

PENERAPAN LATIHAN PILATES UNTUK MENGURANGI NYERI MENSTRUASI PADA REMAJA PUTRI

Dysmenorrhea is a disorder of menstrual blood flow or menstrual pain that, if not promptly addressed, can affect an individual's mental and physical functions, necessitating non-pharmacological interventions. One such non-pharmacological therapy is Pilates exercises, which relax contracted muscles and stimulate the hypothalamus to produce endorphins, a natural pain reliever that reduces pain. This community service activity aims to reduce menstrual pain in adolescent girls through Pilates exercise classes held in Dusun Luksongo, Tugurejo Village, Ngasem District, Kediri Regency. The program involves 10 adolescent girls as participants. The methods used include socialization, education, and training in Pilates techniques by a competent instructor. The training includes practical guidance on safe and effective Pilates techniques to reduce menstrual pain and enhance the well-being of the adolescent girls. The results of the service show that out of 10 adolescent girls who participated in the program, 8 girls (80%) reported a decrease in menstrual pain after attending the Pilates sessions, while 2 girls (20%) reported the pain remained the same. No participants reported an increase in pain. These results indicate that the Pilates exercise classes have a significant impact on reducing menstrual pain in adolescent girls, which is an important factor for their well-being. Therefore, the Pilates exercise class program can be considered effective in reducing menstrual pain and improving the physical and psychological health of adolescent girls, as well as strengthening their role in maintaining their own health.

Impact of Preoperative Gum Chewing on Postoperative Anti-Emetic Use in Robot-Assisted Laparoscopic Surgery for Benign Ovarian Masses: A Prospective, Single-Blinded Randomized Controlled Trial.

Background and Objectives: Postoperative nausea and vomiting (PONV) is a common issue for females undergoing gynecological surgeries, including those assisted by robotic systems. Despite available prophylactic measures, the incidence of PONV remains high, negatively impacting recovery and increasing healthcare costs. This study evaluates whether preoperative gum chewing reduces the need for anti-emetic drugs in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. Materials and Methods: This prospective, single-blinded, randomized controlled trial enrolled 92 adult females scheduled for robot-assisted laparoscopic surgery to treat benign ovarian mass. Following exclusions, the remaining participants were randomly assigned to either a gum-chewing group or a no-gum-chewing group. The gum-chewing group chewed sugar-free gum for 15 min in the holding area before surgery. The primary outcome measured was the need for anti-emetics to control PONV during the first hour in the post-anesthesia care unit (PACU). Secondary outcomes included the number of anti-emetic requests. No preemptive anti-emetics were administered during surgery. Results: Out of the initial 92 patients, 88 were included in the final analysis, with 44 in each group. The incidence of PONV requiring anti-emetics in the PACU was significantly lower in the gum-chewing group (79.5%) compared to the no-gum-chewing group (95.5%). Additionally, the number of anti-emetic requests was higher in the no-gum-chewing group. No postoperative complications such as tooth or jaw pain/injury or gastric content regurgitation were reported. Conclusions: Preoperative gum chewing for 15 min immediately before surgery significantly reduced the incidence of PONV in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. This simple, non-pharmacological intervention improved patient comfort and reduced the need for anti-emetic medications without any adverse effects. Further studies are needed to confirm these findings and to develop guidelines for incorporating preoperative gum chewing into clinical practice.

Impact of pole dancing on mental wellbeing and sexual self-concept: Protocol for a systematic review and meta-analysis.

Despite the recognized psychological benefits of traditional dance forms, the impact of newer forms, such as pole dancing, on mental well-being and sexual self-concept remains underexplored. This protocol outlines a systematic review and meta-analysis aimed at elucidating the effects of pole dancing, a burgeoning non-pharmacological intervention, on these dimensions of mental health. This systematic review was registered in the PROSPERO. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocol to accomplish the systematic review protocol. This review will systematically search electronic databases, including PubMed, Embase, Web of Science, Medline, and CNKI, for randomized controlled trials (RCTs) assessing the impact of pole dancing on mental well-being and sexual self-concept. Two independent evaluators will screen the literature, extract data, and evaluate study quality and bias. Data synthesis will utilize Stata 14.0 and Revman 5.4, employing random-effects models. The Grading of Recommendations, Development, and Evaluation (GRADE) system will appraise evidence reliability, with subgroup analysis exploring heterogeneity sources. Publication bias will be assessed through funnel plots and Egger's regression tests. This review aims to fill the gap in the current literature by providing a comprehensive evaluation of pole dancing's psychological effects. It is anticipated that this systematic review and meta-analysis will offer valuable insights for health policy and practice, advocating for the inclusion of pole dancing in mental health and sexual well-being interventions. Systematic review registration: PROSPERO CRD42024529369.

Fibromyalgia: A Review of the Pathophysiological Mechanisms and Multidisciplinary Treatment Strategies.

Fibromyalgia is a syndrome characterized by chronic widespread musculoskeletal pain, which may or may not be associated with muscle or joint stiffness, accompanied by other symptoms such as fatigue, sleep disturbances, anxiety, and depression. It is a highly prevalent condition globally, being considered the third most common musculoskeletal disorder, following lower back pain and osteoarthritis. It is more prevalent in women than in men, and although it can occur at any age, it is more common between the ages of thirty and thirty-five. Although the pathophysiology and etiopathogenesis remain largely unknown, three underlying processes in fibromyalgia have been investigated. These include central sensitization, associated with an increase in the release of both excitatory and inhibitory neurotransmitters; peripheral sensitization, involving alterations in peripheral nociceptor signaling; and inflammatory and immune mechanisms that develop concurrently with the aforementioned processes. Furthermore, it has been determined that genetic, endocrine, psychological, and sleep disorders may influence the development of this pathology. The accurate diagnosis of fibromyalgia remains challenging as it lacks specific diagnostic biomarkers, which are still under investigation. Nonetheless, diagnostic approaches to the condition have evolved based on the use of scales and questionnaires for pain identification. The complexity associated with this pathology makes it difficult to establish a single effective treatment. Therefore, treatment is multidisciplinary, involving both pharmacological and non-pharmacological interventions aimed at alleviating symptoms. The non-pharmacological treatments outlined in this review are primarily related to physiotherapy interventions. The effectiveness of physical exercise, both on land and in water, as well as the application of electrotherapy combined with transcranial therapy and manual therapy has been highlighted. All of these interventions aim to improve the quality of life of patients highly affected by fibromyalgia.

Evaluating research waste and traits among randomized controlled trials of scars over the past 20years: a cross-sectional study.

To analyze the changes in the characteristics of randomized controlled trials (RCTs) in the field of scarring over the last two decades, unveil the components of research waste (RW) within these RCTs, and identify targets for improvement. A search was conducted on ClinicalTrials.gov for RCTs registered from January 2000 to December 2023, using "scar" as the keyword. The search was carried out in January 2024. 391 RCTs were included in this analysis. The global registration of RCTs in scarring has exhibited a consistent increase annually, with the proportion in Asia gradually rising, while the shares in North America and Europe have demonstrated a declining trend. In the analysis of RW, 232 RCTs were included, of which 96 (41.4%) have been published. Among the published RCTs, 56 (58.3%) were evaluated to have sufficient reporting, while 47 RCTs (48.9%) were identified as having avoidable design flaws. Ultimately, 183 RCTs (78.9%) exhibited at least one form of RW. Multicenter design (OR: 3.324, 95%CI: 1.385-7.975, P = 0.018), non-pharmacological interventions (OR: 2.61, 95%CI: 1.253-5.435, P = 0.010), the absence of external funding (OR: 0.325, 95%CI: 0.144-0.732, P = 0.031), and participant numbers exceeding 50 (OR: 3.269, 95%CI: 1.573-6.794, P = 0.002) were identified as independent protective factors against waste. This study delineates the changes in the characteristics of scar RCTs globally over the past two decades, uncovering a substantial burden of RW in scarring research. It provides an evidential reference for more rational planning of future scar-related RCTs and for minimizing RW.

Diagnosis and management of sarcopenia

Background: Sarcopenia refers to the progressive and generalized loss of skeletal muscle mass, strength, and function and is associated with falls, fractures, hospitalization, and even mortality. Owing to rapid population aging, the prevalence of sarcopenia is expected to increase, and this condition is increasingly gaining attention as an important topic in research and clinical settings. This review focuses on the diagnosis, pathophysiology, and management of sarcopenia.Current Concepts: Diagnosis of sarcopenia can be confirmed based on low muscle mass accompanied by low muscle strength, or low physical performance. The European Working Group on Sarcopenia in Older People and the Asian Working Group for Sarcopenia guidelines are commonly used in clinical practice. Intrinsic factors associated with skeletal muscles, such as inflammation, anabolic resistance, mitochondria, and neuromuscular junctions, combined with extrinsic factors associated with the systemic environment, including decreased endocrine function, malnutrition, and immobilization all play a role in impaired muscle anabolism, muscle atrophy, and weakness. Currently, the Food and Drug Administration has not approved any specific medications for treatment of sarcopenia. Therefore, non-pharmacological interventions such as aerobic, resistance, and combined exercise and appropriate nutrition (protein and essential amino acids) are important for prevention and treatment of sarcopenia.Discussion and Conclusion: Sarcopenia is a manageable target for improvement of overall health outcomes. Exercise and nutrition are essential components of nonpharmacological management of sarcopenia. Future studies are needed to identify early diagnostic biomarkers and pharmacologic targets and to develop consistent pre-emptive management strategies and sensitive measures to predict effectiveness of sarcopenia management and treatment response.

Cumulative sucrose exposure for repeated procedural pain in preterm neonates and neurodevelopment at 18 months of corrected age: a prospective observational longitudinal study

IntroductionOral sucrose is repeatedly administered to neonates in the neonatal intensive care unit (NICU) to treat pain from commonly performed procedures; however, there is limited evidence on its long-term cumulative...

Evaluating research waste and traits among randomized controlled trials of scars over the past 20years: a cross-sectional study.

To analyze the changes in the characteristics of randomized controlled trials (RCTs) in the field of scarring over the last two decades, unveil the components of research waste (RW) within these RCTs, and identify targets for improvement. A search was conducted on ClinicalTrials.gov for RCTs registered from January 2000 to December 2023, using "scar" as the keyword. The search was carried out in January 2024. 391 RCTs were included in this analysis. The global registration of RCTs in scarring has exhibited a consistent increase annually, with the proportion in Asia gradually rising, while the shares in North America and Europe have demonstrated a declining trend. In the analysis of RW, 232 RCTs were included, of which 96 (41.4%) have been published. Among the published RCTs, 56 (58.3%) were evaluated to have sufficient reporting, while 47 RCTs (48.9%) were identified as having avoidable design flaws. Ultimately, 183 RCTs (78.9%) exhibited at least one form of RW. Multicenter design (OR: 3.324, 95%CI: 1.385-7.975, P = 0.018), non-pharmacological interventions (OR: 2.61, 95%CI: 1.253-5.435, P = 0.010), the absence of external funding (OR: 0.325, 95%CI: 0.144-0.732, P = 0.031), and participant numbers exceeding 50 (OR: 3.269, 95%CI: 1.573-6.794, P = 0.002) were identified as independent protective factors against waste. This study delineates the changes in the characteristics of scar RCTs globally over the past two decades, uncovering a substantial burden of RW in scarring research. It provides an evidential reference for more rational planning of future scar-related RCTs and for minimizing RW.

Cold atmospheric plasma inactivates Aspergillus flavus and Fusarium keratoplasticum biofilms and conidia in vitro.

Introduction. Aspergillus flavus and Fusarium keratoplasticum are common causative pathogens of fungal keratitis (FK), a severe corneal disease associated with significant morbidity and vision loss. Escalating incidence of antifungal resistance to available antifungal drugs poses a major challenge to FK treatment. Cold atmospheric plasma (CAP) is a pioneering nonpharmacologic antimicrobial intervention that has demonstrated potential as a broad-spectrum antifungal treatment.Gap statement. Previous research highlights biofilm-associated resistance as a critical barrier to effective FK treatment. Although CAP has shown promise against various fungal infections, its efficacy against biofilm and conidial forms of FK pathogens remains inadequately explored.Aim. This study aims to investigate the antifungal efficacy of CAP against clinical fungal keratitis isolates of A. flavus and F. keratoplasticum in vitro.Methodology. Power parameters (22-27 kVpp, 300-400 Hz and 20-80 mA) of a dielectric barrier discharge CAP device were optimized for inactivation of A. flavus biofilms. Optimal applied voltage and total current were applied to F. keratoplasticum biofilms and conidial suspensions of A. flavus and F. keratoplasticum. The antifungal effect of CAP treatment was investigated by evaluating fungal viability through means of metabolic activity, c.f.u. enumeration (c.f.u. ml-1) and biofilm formation.Results. For both fungal species, CAP exhibited strong time-dependent inactivation, achieving greater than 80 % reduction in metabolic activity and c.f.u. ml-1 within 300 s or less, and complete inhibition after 600 s of treatment.Conclusion. Our findings indicate that CAP is a promising broad-spectrum antifungal intervention. CAP treatment effectively reduces fungal viability in both biofilm and conidial suspension cultures of A. flavus and F. keratoplasticum, suggesting its potential as an alternative treatment strategy for fungal keratitis.

Low-intensity transcranial focused ultrasound suppresses pain by modulating pain-processing brain circuits

AbstractThere is an urgent and unmet clinical need to develop nonpharmacological interventions for chronic pain management because of the critical side effects of opioids. Low-intensity transcranial focused ultrasound (tFUS) is an emerging noninvasive neuromodulation technology with high spatial specificity and deep brain penetration. Here, we developed a tightly focused 128-element ultrasound transducer to specifically target small mouse brains using dynamic focus steering. We demonstrate that tFUS stimulation at pain-processing brain circuits can significantly alter pain-associated behaviors in mouse models in vivo. Our findings indicate that a single-session focused ultrasound stimulation to the primary somatosensory cortex (S1) significantly attenuates heat pain sensitivity in wild-type mice and modulates heat and mechanical hyperalgesia in a humanized mouse model of chronic pain in sickle cell disease. Results further revealed a sustained behavioral change associated with heat hypersensitivity by targeting deeper cortical structures (eg, insula) and multisession focused ultrasound stimulation to S1 and insula. Analyses of brain electrical rhythms through electroencephalography demonstrated a significant change in noxious heat hypersensitive- and chronic hyperalgesia–associated neural signals after focused ultrasound treatment. Validation of efficacy was carried out through control experiments, tuning ultrasound parameters, adjusting interexperiment intervals, and investigating effects on age, gender, and genotype in a head-fixed awake model. Importantly, tFUS was found to be safe, causing no adverse effects on motor function or the brain’s neuropathology. In conclusion, the validated proof-of-principle experimental evidence demonstrates the translational potential of novel focused ultrasound neuromodulation for next-generation pain treatment without adverse effects.

Reduced Blood Glucose Levels in Diabetic Patients After Using a Combination of Progressive Muscle Relaxation (Pro-Mure) and Slow Deep Breathing Exercises (SD-Bex)

Background: One of the causes of diabetes mellitus is a person's lifestyle, namely their level of physical inactivity. So, to avoid complications, persons with diabetes mellitus require both pharmaceutical and non-pharmacological treatments to lower blood glucose values. Finding out if people with diabetes mellitus might reduce their blood glucose levels by combining a technique that involved slow deep breathing and progressive muscular relaxation was the primary goal of the research. Methods: This study is quasi-experimental because it uses a control group design with pre- and post-tests. The number of respondents is 34, and the method of sampling is purposive sampling. Twenty to twenty-five minutes of a combination of progressive muscle relaxation (Pro-Mure) and slow deep breathing exercises (SD-Bex) were administered to the experimental group, while the control group received the usual course of intervention. Values of blood glucose levels were the dependent variable. With a p-value of less than 0.05, the study used the Wilcoxon Signed Rank Test to compare outcomes before and after treatment and the Mann-Whitney test to compare the experimental group to the control group. Results: We found that the intervention group's blood glucose value was 0.001 and the control group's was 0.025. A p-value of 0.001 was found on the value of blood glucose levels between the experimental group and the control group as a result of the study utilising the Mann-Whitney test. Conclusion: Those suffering from diabetes mellitus can find relief from their symptoms by combining the techniques of Progressive Muscle Relaxation with Slow Deep Breathing. Additionally, the method is simple to apply.

Moving Beyond Medication: Harnessing the Power of Physical Therapy and Dance Therapy in Parkinson's Disease Management

Introduction Parkinson's disease (PD) poses significant challenges due to its complex array of motor and non-motor symptoms, impacting patients' quality of life. While traditional pharmacological treatments focus on motor symptoms, non-pharmacological interventions, including physical and dance therapy, offer alternative approaches. Aim of the Study This study aims to evaluate the therapeutic potential of physical and dance therapy, including tango, in managing motor symptoms and improving overall well-being in individuals with PD. It seeks to compare these interventions with traditional treatments and explore their efficacy. State of Knowledge Parkinson's disease management involves a combination of pharmacological and non-pharmacological approaches. Traditional treatments target motor symptoms but have limitations. Non-pharmacological interventions, such as deep brain stimulation and physical therapy, complement traditional treatments. Dance therapy, including tango, shows promise in improving motor function and quality of life. Conclusions Physical and dance therapy, including tango, offer promising avenues for managing motor symptoms and enhancing quality of life in PD patients. While traditional treatments remain essential, non-pharmacological interventions provide valuable alternatives. Further research is needed to refine intervention parameters and compare their effectiveness comprehensively. Overall, these therapies present holistic approaches to PD management, addressing both motor and non-motor symptoms for improved patient outcomes.

Treatment of chronic kidney disease in older populations.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Bridging the gap: facilitating the use of rheumatology research results in clinical practice with hybrid implementation effectiveness studies

The implementation of proven effective pharmacological and non-pharmacological interventions into routine rheumatology practice is a lengthy and complex process. Bridging this gap between research and practice is crucial. Hybrid implementation...

Cognition and Activity of Daily Living Function in people with Parkinson's disease.

The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.

Treatment of chronic kidney disease in older populations.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Cognition and Activity of Daily Living Function in people with Parkinson's disease.

The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.