Motoric Cognitive Risk Syndrome: Could It Be Defined Through Increased Five-Times-Sit-to-Stand Test Time, Rather Than Slow Walking Speed?

Background: Slow walking speed, time to perform the five-times-sit-to-stand (FTSS) test and motoric cognitive risk syndrome (MCR; defined as slow gait speed combined with subjective cognitive complaint) have been separately used to screen older individuals at risk of cognitive decline. This study seeks to (1) compare the characteristics of older individuals with MCR, as defined through slow walking speed and/or increased FTSS time; and (2) examine the relationship between MCR and its motor components as well as amnestic (a-MCI) and non-amnestic (na-MCI) Mild Cognitive Impairment. Methods: A total of 633, individuals free of dementia, were selected from the cross-sectional "Gait and Alzheimer Interactions Tracking" study. Slow gait speed and increased FTSS time were used as criteria for the definition of MCR. Participants were separated into five groups, according to MCR status: MCR as defined by (1) slow gait speed exclusively (MCRs); (2) increased FTSS time exclusively (MCRf); (3) slow gait speed and increased FTSS time (MCRsaf); (4) MCR; irrespective of the mobility test used (MCRsof); and (5) the absence of MCR. Cognitive status (i.e., a-MCI, na-MCI, cognitively healthy) was also determined. Results: The prevalence of MCRs was higher, when compared to the prevalence of MCRf (12.0% versus 6.2% with P ≤ 0.001). There existed infrequent overlap (2.4%) between individuals exhibiting MCRs and MCRf, and frequent overlap between individuals exhibiting MCRs and na-MCI (up to 50%). a-MCI and na-MCI were negatively [odd ratios (OR) ≤ 0.17 with P ≤ 0.019] and positively (OR ≥ 2.41 with P ≤ 0.019) related to MCRs, respectively. Conclusion: Individuals with MCRf are distinct from those with MCRs. MCRf status does not relate to MCI status in the same way that MCRs does. MCRs is related negatively to a-MCI and positively to na-MCI. These results suggest that FTTS cannot be used to define MCR when the goal is to predict the risk of cognitive decline, such as future dementia

Age effect on the prediction of risk of prolonged length hospital stay in older patients visiting the emergency department: results from a large prospective geriatric cohort study.

With the rapid growth of elderly patients visiting the Emergency Department (ED), it is expected that there will be even more hospitalisations following ED visits in the future. The aim of this study was to examine the age effect on the performance criteria of the 10-item brief geriatric assessment (BGA) for the prolonged length of hospital stay (LHS) using artificial neural networks (ANNs) analysis. Based on an observational prospective cohort study, 1117 older patients (i.e., aged ≥ 65 years) ED users were admitted to acute care wards in a University Hospital (France) were recruited. The 10-items of BGA were recorded during the ED visit and prior to discharge to acute care wards. The top third of LHS (i.e., ≥ 13 days) defined the prolonged LHS. Analysis was successively performed on participants categorized in 4 age groups: aged ≥ 70, ≥ 75, ≥ 80 and ≥ 85 years. Performance criteria of 10-item BGA for the prolonged LHS were sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic curve [AUROC]). The ANNs analysis method was conducted using the modified multilayer perceptron (MLP). Values of criteria performance were high (sensitivity> 89%, specificity≥ 96%, PPV > 87%, NPV > 96%, LR+ > 22; LR- ≤ 0.1 and AUROC> 93), regardless of the age group. Age effect on the performance criteria of the 10-item BGA for the prediction of prolonged LHS using MLP was minimal with a good balance between criteria, suggesting that this tool may be used as a screening as well as a predictive tool for prolonged LHS

Update of EULAR recommendations for the treatment of systemic sclerosis

The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis and gastrointestinal involvement. Compared with the 2009 recommendations, the 2016 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressive SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc

Changes in gait variability with anti-dementia drugs: a systematic review and meta-analysis.

Studies have examined the effects of anti-dementia drugs on gait performance. No structured critical evaluation of these studies has been done so far. The objectives of this study were (1) to perform a qualitative analysis of all published studies on changes in stride time variability (STV) with anti-dementia drugs among patients with Alzheimer disease through a systematic review, and (2) to quantitatively synthesize anti-dementia drug-related changes in STV. An English and French MEDLINE search was conducted on November 2013, with no limit of date, using the Medical Subject Headings term "pharmaceutical preparations" combined with "delirium", "dementia", "amnestic", "cognitive disorders" AND "gait" OR "gait disorders, neurologic" OR "gait apraxia". Fixed-effects meta-analyses were performed to compare STV before and after the use of anti-dementia drugs, and to compare the final STV among participants in intervention and control groups. Of the 110 originally identified abstracts, four studies (i.e., one assessing galantamine, one donepezil, one memantine, and one memantine and acetylcholinesterase inhibitors) were included in the qualitative review, and three studies in the quantitative synthesis. Results were mixed, as two studies showed significant between-visit improvements (i.e., decrease in mean value) in STV, while one study did not, and the last one reported mixed results. In the meta-analysis, there was no difference between intervention and control groups (summary mean difference of final STV = -0.38 % [95 % confidence interval -1.14 to 0.37]) and no before-after difference in the intervention group (summary mean difference of STV = 0.66 [95 % confidence interval -0.17 to 1.49]). Our findings showed inconclusive effects of anti-dementia drugs on STV

Prediction of in-hospital mortality with the 6-item Brief Geriatric Assessment tool: An observational prospective cohort study.

The 6-item Brief Geriatric Assessment (BGA) is a screening tool to identify frail inpatients who are at risk of adverse health events. Its predictive value for in-hospital mortality has not been examined yet. This study examined whether the BGA is able to predict in-hospital mortality in older patients. A total of 1082 participants were included in this observational prospective cohort study. At their admission to the medical wards of Angers University Hospital (France), all inpatients aged ≥65 years were screened with the BGA. Its 6 items are: age ≥85 years, male gender, polypharmacy (i.e., ≥5 drugs per day), non-use of home-help services, history of falls in the previous 6 months, and temporal disorientation (i.e., inability to give the month and/or year). Three levels (low, intermediate and high) of risk of adverse health events had previously been identified, based on different combinations of BGA items. Patients were separated into 2 groups using the occurrence of in-hospital death. The length of stay was calculated as the number of days in hospital using the hospital registry. The use of psychoactive drugs and the reason for admission were used as covariates. Older inpatients who died were more frequently admitted for an acute organ failure (P < 0.001). Cox regression models showed that a priori intermediate risk (HR = 1.89, P < .001) and high risk (HR = 2.34, P < .001) risk levels predicted in-hospital mortality. Kaplan-Meier survival curves confirmed that inpatients at high risk (P = .047) and those at intermediate risk (P = .013) died earlier than patients at low risk. Combinations of items on the BGA successfully predicted the risk of in-hospital mortality in this sample of older inpatients

Motor imagery of gait in non-demented older community-dwellers: performance depends on serum 25-hydroxyvitamin D concentrations.

Hypovitaminosis D has been associated with poorer physical and cognitive performances in older adults. The objectives of this study were (1) to measure and compare the time to perform (pTUG) and to imagine (iTUG) the Timed "Up & Go" test (TUG) test, and the time difference between these two performances (i.e., TUG delta time) in non-demented community-dwelling older adults with and without lower serum 25-hydroxyvitamin D (25OHD) concentrations and (2) to examine the association between the TUG delta time and serum 25OHD concentrations. Durations of pTUG, iTUG and TUG delta time, and serum 25OHD concentrations (severe insufficiency <10 ng/mL; moderate insufficiency: 10-30 ng/mL; normal status >30 ng/mL) were measured in 359 non-demented participants (mean age 70.4 ± 4.8 years; 40.7 % women). Participants with severe 25OHD insufficiency (15.6 %) had higher TUG delta time compared to those with moderate insufficiency (P = 0.010) and normal status (P = 0.048). TUG delta time was negatively associated with serum 25OHD concentrations (P < 0.010). Accurate motor imagery of gait was explained in part by serum 25OHD concentrations, increased discrepancy between pTUG and iTUG being associated with lower serum 25OHD concentrations

Respective and combined effects of impairments in sensorimotor systems and cognition on gait performance: a population-based cross-sectional study.

Respective and combined effects of impairments in sensorimotor systems and cognition on gait performance have not been fully studied. This study aims to describe the respective effects of impairments in muscle strength, distance vision, lower-limb proprioception and cognition on the Timed Up & Go (TUG) scores (i.e., performed TUG [pTUG], imagined TUG [iTUG] and the time difference between these two tests [delta TUG]) in older community-dwellers; and to examine their combined effects on TUG scores. Based on a cross-sectional design, 1792 community-dwellers (70.2 ± 4.8 years; 53.6% female) were recruited. Gait performance was assessed using pTUG, iTUG and delta TUG. Participants were divided into healthy individuals and 15 subgroups of individuals according to the presence of impairment in one or more subsystems involved in gait control (i.e., muscle strength and/or distance vision and/or lower-limb proprioception and/or cognition [episodic memory and executive performance]). Impairment in muscle strength, distance vision and lower-limb proprioception was defined as being in the lowest tertile of performance. Impairment in cognition was defined as abnormal episodic memory and executive tests. A total of 191 (10.7%) exhibited impairment in muscle strength, 188 (10.5%) in distance vision, 302 (16.9%) in lower-limb proprioception, and 42 (2.3%) in cognition. Linear regressions showed that cognitive impairment as well as dual combinations of impairments were associated with increased pTUG (P<0.02). Impairment in lower-limb proprioception was associated with decreased iTUG (P=0.015). All combinations of impairments, except those including muscle strength and the combinations of the 4 subsystems, were associated with increased delta TUG (P<0.04). Cognitive integrity is central for efficient gait control and stability, whereas lower-limb proprioception seems to be central for gait imagery