Prospective cohort study. Determine whether epigenetic age (EA), calculated via DNA methylation analysis, is associated with early postoperative complications in adult spinal deformity (ASD) surgery. ASD is increasingly prevalent in the aging population, with postoperative complication rates ranging from 37% to 71%. While chronological age (CA) and frailty scores are known predictors of poor outcomes, they may not fully capture biological vulnerability. EA, derived from DNA methylation patterns, may better reflect a patient's physiological reserve and stress response capacity. Thirty patients undergoing ASD surgery were prospectively enrolled and provided peripheral blood samples on the day of surgery. DNA methylation of peripheral blood mononuclear cells (PBMCs) was analyzed using the Illumina EPIC v2.0 array. EA was computed using the Horvath DNAmAge algorithm. Associations between EA, CA, and the Edmonton Frailty Index (EFI) with postoperative complications at 30 days were assessed using appropriate parametric and non-parametric statistical tests. Differentially methylated positions (DMPs) were identified between complication and non-complication group. Of the 30 enrolled patients (mean CA: 68.4y, 21 female), 14 (47%) experienced postoperative complications. Sixty-three DMPs were found between the two groups, with 35 hypomethylated and 28 hypermethylated CpG sites in the complication group. Genes affected were linked to immune response, including LRBA and NFACT2. Regulators of EGFR and WNT pathways were also differentially methylated. Patients with EA greater than CA were significantly more likely to experience complications (86% vs. 14%, P=0.038). The difference between EA and CA was greater in the complication group (5.07 vs. 0.87y, P=0.029). No significant differences were found in mean CA, EA, or EFI alone between the groups. Postoperative complications in ASD patients were associated with epigenetic alterations and elevated EA relative to CA. These findings suggest EA may be a novel biomarker for preoperative risk stratification in ASD surgery.

Cartilage and osteochondral disorders pose an increasing clinical, economic, and social challenge. With an aging population, there is a need to develop innovative, nonsurgical strategies for treating defects, fractures, and other osteochondral disorders. Bone implants require surgical intervention, carry a risk of complications, are expensive, and do not always provide comfort to the patient. Alternatively, stimulation of bone regeneration using synthetic peptides is a promising and less invasive option in the treatment of trauma, orthopedics, craniofacial surgery, and dentistry. In the present study, we evaluated the biological effects of two peptides: the novel peptide UG27 and CDP4 derived from the protein Cpne7 (Copine 7), on the activity of adipose tissue-derived mesenchymal stem cells. Using labeling, differentiation, and imaging methods, we demonstrated the effect of UG27 on viability, biomineralization, extracellular matrix, and calcium salt growth in osteocytes. The peptides were immunologically safe and stimulated cell migration without showing any cytotoxic effects. The peptide, UG27, has an active connection with the biomaterial and is a promising compound in bone injury therapies.

Introduction: There is a high prevalence of vitamin deficiency in our healthy population; however, age-related cognitive decline is an emerging global health concern, especially with an aging population and rising cases of dementia. Many trials have been performed to assess the improvement in cognitive functions of people, especially those of older age, by daily multivitamin supplementation. Studies have shown that daily multivitamin intake significantly improves memory in older adults and reduces the risk of cognitive decline. Methods: A comprehensive search was conducted across PubMed, Embase, and Google Scholar databases from 2003 to 2023. Studies were included based on predefined PICO criteria, focusing on older adults with cognitive decline receiving multivitamin supplementation compared to placebo, with cognitive improvement as the outcome. Nineteen studies meeting the inclusion criteria, comprising randomized trials, reviews, cohort, and cross-sectional designs, were analyzed. Results: The findings reveal mixed outcomes. Multivitamin supplementation was associated with cognitive improvements, particularly in memory, global cognition, and attention, mainly in individuals with baseline deficiencies or mild cognitive impairment. B-complex vitamins and antioxidant-rich formulas showed the most promising effects. However, in well-nourished or healthy populations, results were often neutral. Variability in study design, supplement composition, assessment tools, and duration were key contributors to these inconsistencies. Conclusion: The use of multivitamins shows potential cognitive benefits in specific subgroups, particularly the elderly with nutritional deficiencies or early cognitive decline. However, universal cognitive enhancement cannot be concluded. Personalized, targeted supplementation guided by nutritional status may represent the future of cognitive health strategies.

BackgroundCognitive decline and incident dementia in ageing populations have been linked to brain parenchymal injury and the ALPS index (ALPS-I).ObjectiveThis investigation aimed to elucidate whether the baseline ALPS-I could predict incident dementia and cognitive decline in this population.MethodsIn total, 973 dementia-free participants from the Shunyi Study (mean age, 57 years; 37% male) received MRI between 2013 and 2016 to quantify the ALPS-I. The longitudinal relationships between the ALPS-I and cognitive deterioration in various cognitive areas were evaluated via linear mixed models. Cox proportional hazard models were utilized to explore the link between the index and incident dementia. Mediation assessments were carried out to identify the potential mediating effects of brain parenchymal injury on the link between the ALPS-I and cognition.ResultsThe baseline ALPS-I predicted longitudinal changes in global cognition (Montreal Cognitive Assessment), language (verbal fluency test), visuospatial perception (block design subtest of Wechsler intelligence scale), and executive function (Trail Making Test). A lower score was markedly associated with a higher incident dementia risk. Mediation analysis revealed that fractional anisotropy mediated the associations between the ALPS-I and executive function (mediation effect: 21.9%) and visuospatial perception (mediation effect: 68.8%). The white matter hyperintensity fraction was found to mediate the link between the ALPS-I and global cognition (mediation effect: 55.0%).ConclusionsThis longitudinal evidence supports a link between the ALPS-I and cognitive degeneration. Furthermore, the link is mediated by subcortical parenchymal injury.

Objective . To determine and assess the impact of changes in the age structure on the level and dynamics of mortality among women of working age in the Republic of Belarus in 1990–2019. Materials and methods . The study materials were data on the number and composition of living and deceased women of working age (hereinafter referred to as WWA) by five-year age groups in 1990–2019. To assess and analyze the studied indicators, linear and piecewise linear regression models of crude and standardized mortality rates by the method of direct standardization according to the age structure standard of WWA in 1990 were used. Based on the differences in the rates of annual mortality increase over the study period, expressed in %, a periodization of mortality dynamics in 1990–2019 of the studied population stratum was formed. Results . A decrease in the number and aging of the female population of working age was established for the period 1990-2019, characterized by a decrease in the share of the younger (15-29 years) and an increase in the share of the middle (30-49 years) and older (50-64 years) age groups in the age structure. The change in the age structure factor did not affect the annual growth rate (hereinafter referred to as AGR) of WWA mortality in the periods of the mortality dynamics model, but led to an overestimation of mortality rates in 1990-1993 by up to 0.2‰. Since 2010, the overestimating effect on the WWA mortality rate has continued and by 2019 it amounted to 0.55‰, p<0.05. Conclusion . The crude mortality rate of the female employable population, due to the ongoing transformation of its age structure, cannot serve as a target indicator in developing programs aimed at maintaining and strengthening the health of the employable population. When studying the level and dynamics of mortality of the age stratum of the female employable population, it is necessary to take into account the influence of the age structure factor on the indicators and dynamics of mortality.

Gastric cancer ranks as the fifth most prevalent malignancy and the fifth leading cause of cancer-related mortality worldwide, with stomach adenocarcinoma (STAD) being the predominant pathological type. Despite a decline in STAD incidence in recent years, factors such as an aging population may contribute to an increase in future cases. Current clinical management of STAD primarily involves surgical resection, radiation, chemotherapy, and emerging immune checkpoint blockade (ICB) therapies. However, the limited efficacy of ICB monotherapy in most patients with STAD highlights the need for novel therapeutic targets. This study investigated the role of versican (VCAN) in STAD. Comprehensive analysis of multiple databases revealed significantly higher VCAN expression in STAD tissues compared to normal tissues, correlating with poor patient prognosis. Single-cell analysis further identified VCAN as predominantly secreted by cancer-associated fibroblasts (CAFs), especially the pan-pCAF subtype. CAFs with elevated VCAN levels promoted the proliferation, migration, and invasion of high-stemness adenocarcinoma cells via the MDK-NCL and MIF-CD74-CD44 signaling pathways, while also enhancing immune evasion and self-renewal. These results position VCAN as a potential new therapeutic target for STAD.

Population aging is driving the need for unobtrusive, continuous monitoring solutions in residential care environments. Radio-frequency (RF)-based technologies such as Ultra-Wideband (UWB) and millimeter-wave (mmWave) radar are particularly attractive for providing detailed information on presence and movement while preserving privacy. Building on a UWB–mmWave localization system deployed in a senior living residence, this paper focuses on the data-processing methodology for extracting quantitative mobility indicators from long-term indoor monitoring data. The system combines a device-free mmWave radar setup in bedrooms and bathrooms with a tag-based UWB positioning system in common areas. For mmWave data, an adaptive short-term average/long-term average (STA/LTA) detector operating on an aggregated, normalized radar energy signal is used to classify micro- and macromovements into bedroom occupancy and non-sedentary activity episodes. For UWB data, a partially constrained Kalman filter with a nearly constant velocity dynamics model and floor-plan information yields smoothed trajectories, from which daily gait- and mobility-related metrics are derived. The approach is illustrated using one-day samples from three users as a proof of concept. The proposed methodology provides individualized indicators of bedroom occupancy, sedentary behavior, and mobility in shared spaces, supporting the feasibility of combined UWB and mmWave radar sensing for longitudinal routine analysis in real-world elderly care environments.

ABSTRACT In November 2017, Guangzhou implemented a self-paid two-dose varicella vaccination program. This study evaluated the program’s impact on varicella incidence trends across the general population and specific age groups. An interrupted time-series analysis was conducted using surveillance data from January 2011 to December 2024. The pre-intervention period spanned 2011–2017, and the post-intervention period 2018–2024. Seasonal-trend decomposition and segmented regression were employed to analyze changes in level and trend of varicella incidence. A total of 225,497 varicella cases were reported between 2011 and 2024. The annual incidence rate decreased by 28.1% from the pre-intervention to post-intervention period, from 126.80 to 91.14 per 100,000 population. Prior to intervention, there was no evidence of a monthly change in varicella incidence (0.3%; t = 2.27, P = .294). Significant upward trends were observed among 10–14-y-olds and ≥20-y-olds (0.6% monthly increase, both P < .01). Post-intervention, a significant monthly decrease of 1.8% was observed overall (t = -9.956, P < .001). The most pronounced reduction occurred in 4–6-y-olds (3.8% monthly decrease), followed by 7–9-y-olds (3.0%), 0–3-y-olds (2.3%), 10–14-y-olds (1.9%), ≥20-y-olds (1.1%), and 15–19-y-olds (0.5%). Varicella incidence exhibited consistent seasonal variation, with a primary peak occurring from October to January. The two-dose varicella vaccination program was associated with a significant reduction in varicella incidence across all age groups in Guangzhou, demonstrating both direct protection among vaccinated children and indirect herd effects in older populations. These findings support incorporating the two-dose varicella vaccine into routine national immunization programs.

Given the global demographic shifts and rapid digitalization, digital engagement has emerged as a critical determinant of healthy aging. While previous research has linked digital engagement to cognitive outcomes, the underlying mechanisms remain underexplored among Chinese older adults. This study aimed to analyze the relationships between digital engagement and cognitive function among older adults in China through a moderated mediation model guided by the technological reserve hypothesis, with digital health literacy (DHL) and social support as mediators and living arrangements as a moderator. We conducted a cross-sectional questionnaire survey using stratified multistage sampling from June to November 2024, including 8123 participants aged 55 years and older. Digital engagement, defined as older adults' use of contemporary digital technologies to support routine daily activities, autonomy, independence, and social inclusion, was assessed using a multidimensional questionnaire. The Chinese eHealth Literacy Scale, the 3-item short version of the Perceived Social Support Scale, and the Mini-Cog test were used to assess DHL, social support, and cognitive function. Guided by a directed acyclic graph based on the technological reserve hypothesis, mediation and moderated mediation analyses were performed using the PROCESS macro in SPSS (IBM Corp) with 5000 bootstrap resamples. Digital engagement was positively associated with cognitive function among older adults (β=0.241, 95% CI 0.216-0.265). This association was partially mediated by DHL (β=0.059, 95% CI 0.049-0.069) and social support (β=0.012, 95% CI 0.008-0.016), with the combined indirect effects accounting for 29.5% of the total effect (β=0.071, 95% CI 0.061-0.082). Additionally, living arrangements significantly moderated the associations between digital engagement and cognitive function (β=0.109, 95% CI 0.052-0.166), digital engagement and DHL (β=0.063, 95% CI 0.014-0.112), and digital engagement and social support (β=0.151, 95% CI 0.089-0.212). These effects were stronger among older adults living alone. This study contributes to the understanding of cognitive aging in the digital environment from the perspective of the technological reserve hypothesis and digital engagement. Digital engagement influenced cognitive function via DHL and social support, and these associations of digital engagement with cognitive function, DHL, and social support were stronger among older adults living alone. Digital health interventions and public health policies should target both DHL and social support among older populations and prioritize older adults living alone.

Abstract The shrinkage of working age population at ages between 15 and 59 after 2010 will end the era of the high-speed economic growth in China. By revealing annual growth rate of potential output to drop to 7.2 percent in 2011-2015 and 6.1 percent in 2016-2020, the purpose of this paper is to draw policy implications of such slowdown. First, the government should not seek a growth rate above potential rate if they do not intend to see distortions in the economy such as macroeconomic instability, overcapacity, deviation from comparative advantage, and protection of inefficient firms. Second, the potential growth rate can be strengthened through institutions building and reorientation of public policy in various areas in order to spur labor mobility and productivity improvement.

Retraction: Regional impact of aging population on carbon dioxide emissions in China: Evidence from panel threshold regression (PTR)

Background: Dementia is an increasing public health challenge in Mexico, yet recent national data on mortality patterns remain limited. This study examines temporal trends in dementia-related mortality and its sociodemographic and ecological characteristics among adults aged ≥65 years from 2017 to 2023. Methods: National mortality records from the General Directorate of Health Information were analyzed. Annual dementia-related mortality rates were calculated based on mid-year population estimates from CONAPO. Trends were assessed with regression analysis, including population offsets, and individual- and state-level characteristics were evaluated. Results: Between 2017 and 2023, dementia-related deaths increased from 761 to 1425, corresponding to an observed rise from 7.9 to 14.6 deaths per 100,000 inhabitants aged ≥65 years. Period trend indicated an average annual expected increase of 18.6% in dementia related mortality. A transient decline occurred in 2020–2021, coinciding with the COVID-19 pandemic. At the individual level, higher education was associated with greater odds of dementia certification, whereas Indigenous ethnicity appeared protective, which may reflect patterns consistent with diagnostic and reporting disparities. Higher state-level life expectancy correlated with higher dementia mortality, while greater population aging was inversely associated. Conclusions: Dementia-related mortality in Mexico shows a sustained upward trend with regional heterogeneity and apparent inequities in diagnosis and reporting. Strengthening mortality surveillance, improving certification quality, and integrating dementia indicators into national non-communicable disease registries are essential to guide equitable policy responses.

Background With the accelerating global population aging, age-related cognitive decline has become a significant health concern for the older adults. The limited efficacy and common side effects of pharmacological interventions have made the exploration of safe non-pharmacological strategies an urgent need. Plant active substances have drawn much attention due to their multi-target neuroprotective properties, there is a lack of systematic comparative research on cognitive function in healthy older adults. Objective To assess the effects of plant active substances on various domains of cognitive function in healthy older adults through a network meta-analysis (NMA). Methods Comprehensive searches were conducted in Embase, PubMed, Cochrane Library, and Web of Science (up to 31 December 2024). Primary outcomes included learning and memory, complex attention, executive function, language, and perceptual-motor skills. NMA was performed using Stata 15.1, with cumulative ranking curve area (SUCRA) for intervention ranking; consistency and publication bias were examined. Results After screening, 25 eligible studies with 1861 healthy older adults, evaluating 10 plant active substances, were included. Specifically, 23 studies included learning and memory functions, 18 studies included complex attention, 16 studies included executive functions, 4 studies included language functions, and 3 studies included perceptual-motor functions. The research results showed that based on the SUCRA values, raisins (95.1%) and tart cherry (89.5%) were the most likely to be the best intervention for improving learning and memory functions. The bacopa monnieri compound (91.3%), curcumin (89.3%), and tart cherry (88.9%) ranked in the top three in the executive function domain. Bacopa monnieri compound (93%) and raisin (80.7%) ranked in the language function category. Guarana (90.3%) had the highest probability in the perceptual-motor domain. The intervention effects on complex attention functions were generally limited. Conclusion The NMA results indicate that in terms of learning and memory functions, raisin and tart cherry ranked higher; in terms of executive functions, the bacopa monnieri compound demonstrated a relatively better intervention effect, providing an important basis for non-drug interventions for cognitive health in the healthy older adults. Future research should focus on long-term safety, dosage optimization, and synergistic mechanisms to promote functional food development. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CDR420251032046.

Generative artificial intelligence (genAI) is a potentially important new technology, but its impact on the economy depends on the speed and intensity of adoption. This paper reports results from a series of nationally representative U.S. surveys of genAI use at work and at home. As of late 2024, 45% of the U.S. population age 18–64 uses genAI. Among employed respondents, 27% used genAI for work at least once in the previous week: 10% used it every workday and 17% on some but not all workdays. Relative to each technology’s first mass-market product launch, work adoption of genAI has been faster than the personal computer (PC), and overall adoption has outpaced both PCs and the internet by an even wider margin. Between 1% and 7% of all work hours are currently assisted by genAI, and respondents report time savings equivalent to 1.4% of total work hours. Potential productivity gains vary widely by industry, and firm climate and policies play an important role in adoption patterns. This paper was accepted by Alfonso Gambardello, business strategy. Funding: This work was supported by the Walmart Foundation [Grant 252882]. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2025.02523 .

Introduction As the global population ages at an unprecedented rate, rapid shifts in demographics and evolving family structures have placed increasing pressure on countries to ensure the health and well-being of an aging population. Intergenerational programs have emerged as a potential solution in improving the physical, social, and psychological outcomes of older adults. While research has primarily focused on intergenerational relationships within care facilities, familial context, or participants of intergenerational programs, few studies have examined these relationships in broader community settings. This study aimed to understand and compare the experiences, facilitators, barriers, and perceptions of older adults who have participated in intergenerational programs before with those who have not. Methods A qualitative descriptive approach with semi-structured interviews was conducted with 15 older adults who participated in intergenerational programs and 10 older adults who did not participate in intergenerational programs via purposive sampling. Data were analyzed thematically using inductive coding. Results The themes were organized into three themes: (1) perceptions of young adults and intergenerational relationships, (2) perception of generation gap and navigating intergenerational relationships, and (3) facilitators and barriers of intergenerational relationships and programs. A key finding was that participation in intergenerational programs fostered positive impressions of young adults, but older adults’ preference for casual interactions over deeper intergenerational relationships limited the sustainability and quality of the relationships. Conclusion In conclusion, the study highlighted how older adults’ experiences and perceptions with intergenerational relationships and programs are shaped by both contact and motivation. Results indicated that contact alone may be insufficient, highlighting the need for a shift in mindset to view intergenerational relationships and programs as meaningful and rewarding.

This study examined whether different levels of cognitive impairment influence postural control (PC) in physically independent older women, using complementary time domain and time-frequency analyses. Understanding these associations may help identify early markers of cognitive vulnerability and guide preventive strategies aimed at reducing fall risk in aging. A cross-sectional sample of 129 women aged ≥ 60 years (mean age 69), physically independent and not engaged in structured exercise for at least three months, was categorized into three groups according to Montreal Cognitive Assessment (MoCA) scores: normal cognition (NC), mild cognitive impairment (MCI), and advanced cognitive impairment (ACI). PC was assessed through time domain variables, mean sway velocity (anteroposterior and mediolateral) and the area of the center of pressure (A-COP), and through time-frequency parameters categorized into low (0.05-0.5Hz; visual-vestibular contribution), medium (0.5-1.5Hz; cerebellar modulation), and high (1.5-10Hz; proprioceptive contribution) frequency bands. Confirmatory analyses for the primary conditions (BSEO and BIUS) were performed using ANCOVA adjusted for age, body mass index (BMI), Charlson Comorbidity Index (CCI), and Falls Efficacy Scale (FES) scores. Exploratory outcomes were analyzed with one-way ANOVA, followed by Sidak-adjusted post hoc tests. Effect sizes were estimated using partial eta squared. Time domain analyses showed that women with better cognitive performance demonstrated better postural control, reflected by lower sway velocity, particularly in the BSEO and BIUS conditions. Exploratory analyses also identified group differences in the BIVR condition. Although the time-frequency analyses did not reveal statistically significant differences between groups, the descriptive patterns suggested that lower-frequency components were more evident during less demanding tasks, whereas medium and high frequency components appeared more prominent in more challenging conditions. Effect-size estimates supported the clinical relevance of time domain differences between cognitive groups. Cognitive status influences postural control in physically independent older women. Time domain measures, particularly sway velocity, were sensitive to poorer balance among those with cognitive impairment, while time-frequency parameters did not differentiate cognitive groups. These findings highlight the importance of incorporating cognitive screening into balance assessment and fall-prevention strategies in aging populations.

Prospective multicenter cohort study. To comprehensively evaluate the impact of diabetes mellitus (DM) on surgical outcomes, perioperative complications, and patient-reported outcomes in patients undergoing surgery for degenerative cervical myelopathy (DCM). Both DM and DCM are age-related conditions, and their coexistence has become increasingly common with the aging population. DM is associated with microvascular and metabolic disturbances that may impair neurological recovery and wound healing. Previous studies have yielded inconsistent results, largely due to small sample sizes, retrospective designs, and inadequate adjustment for confounders. A total of 875 patients with DCM, including 200 with DM, were prospectively enrolled across ten high volume centers in Japan. Clinical outcomes, including the JOA score, SF 36, Neuropathic Pain Symptom Inventory, and JOA Cervical Myelopathy Evaluation Questionnaire, were evaluated before surgery and at two years after surgery. Perioperative complications were recorded within 30 days after surgery. Clinical and surgical outcomes were analyzed using multivariable statistical models adjusting for demographic and surgical confounders, and the association between preoperative HbA1c and outcomes was examined within the diabetic cohort. Patients with DM were older and had higher BMI than those without DM. After statistical adjustment, DM was not associated with significant differences in postoperative neurological recovery, quality of life, pain, or perioperative complications. Within the diabetic cohort, higher HbA1c levels were modestly associated with smaller improvements in JOA scores (β=-0.111, P=0.045), but no significant correlations were found with other outcomes or complication rates. DM did not adversely affect surgical or patient-reported outcomes in patients with DCM when perioperative glycemic control was appropriately maintained. These findings suggest that well-managed DM should not be considered a contraindication to surgical treatment for DCM and provide reassurance for clinicians and patients in shared decision-making.

Risk Analysis Index Outperforms the Modified Frailty Index in Predicting Outcomes in Thyroidectomy and Parathyroidectomy.

Objective – To investigate public policies aimed at promoting health and well-being among older adults, specifically physical exercise, in the small town of Centenário do Sul, Paraná, Brazil. Methodology – To this end, an exploratory qualitative study was conducted, using simple observation and structured interviews with older adults residing in Centenário do Sul, Paraná, Brazil. Originality/Relevance – The study stands out for focusing on the interface between population aging, public policies, and the everyday use of preventive health urban facilities in a small town—an empirical setting that remains underexplored compared with analyses concentrated in metropolitan centers. It is also relevant to policy formulation, as it shows that the mere provision of infrastructure does not, in itself, ensure adherence or changes in habits. Results – The findings indicate that the outdoor gyms have not been used by older adults living in the neighborhoods where they were installed; that older adults do not conceive physical exercise as a means of promoting health; and that there are no municipal management actions that contribute to building a new perspective on physical exercise in old age. Theoretical/Methodological Contributions – The research contributes by linking the discussion of aging to the production/use of urban space and to the effectiveness of public policies in non-metropolitan contexts, highlighting socio-territorial dimensions (location, accessibility, meanings attributed to the equipment, routines, and sociability networks) that condition policy outcomes. Methodologically, it demonstrates the value of combining simple observation and structured interviews to capture the mismatch between institutional provision (equipment) and social appropriation (use, meaning, and practices). Social and Environmental Contributions – The findings provide support for improving municipal policies on health and well-being in later life, indicating the need for integrated actions (health education, professional follow-up, regular groups, community engagement strategies, and the participation of older adults in the design of initiatives). Indirectly, they reinforce the role of public spaces and open areas in promoting health, social interaction, and the appreciation of the urban environment, fostering the qualified appropriation of outdoor facilities and the everyday activation of collective spaces.

Neurological disorders affect approximately 3.4 billion people worldwide and are the leading cause of disability. We conducted this study to explore global neurorehabilitation requirements and project trends from 2022 to 2036. The data on health conditions that may benefit from neurorehabilitation were sourced from the World Health Organization Rehabilitation Need Estimator. Prevalence and years lived with disability (YLDs) of neurorehabilitation needs were analyzed overall and by sex, age, region, country, and health condition. Estimated annual percentage changes (EAPCs) were calculated to quantify trends in age-standardized rates. A decomposition analysis was conducted to identify drivers of changes in neurorehabilitation needs. Projections of neurorehabilitation needs were made until 2036 using Bayesian age-period-cohort analysis (BAPC). Globally, in 2021, neurological disorders requiring rehabilitation affected 225.38 million (95% UI 215.84-235.21) individuals, contributing to 52.35 million (95% UI 37.57-67.46) YLDs. The age-standardized prevalence rate (ASPR) and YLD rate (ASYR) were 2,758.37 (95% UI 2,644.02-2,878.23) and 640.5 (95% UI 459.39-824.44) per 100,000 persons, respectively. From 1990 to 2021, neurorehabilitation needs increased significantly, with prevalent cases and YLDs rising by 97.5% and 96.4%, respectively. This trend was reflected in a significant annual increase in both ASPR and ASYR, with an EAPC of 0.17 (95% CI 0.15-0.19) and 0.13 (95% CI 0.11-0.15), respectively, and is expected to continue increasing by 2036. Furthermore, decomposition analysis identified population growth and aging as the primary drivers of this increase. Most neurorehabilitation needs occur in low- and middle-income countries (LMICs). From 2021 to 2036, the highest contributors to the global need for neurorehabilitation will remain stroke, cerebral palsy, and Alzheimer's disease and dementia. Our findings reveal a large and escalating global burden of neurological disorders requiring rehabilitation, driven by demographic aging and population growth. It is essential to expand rehabilitation services and integrate them into primary healthcare systems, particularly in LMICs.