Clinical assessment of gait and functional mobility in Italian healthy and cognitively impaired older persons using wearable inertial sensors

Aim The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status. Methods This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke’s Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back. Results Individualswithcognitiveimpairmentsexhibitapeculiargaitpattern,characterizedbysignificantreductionofspeed (− 34% vs. healthy individuals), stride length (− 28%), cadence (− 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman’s rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time). Conclusion The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals

Functional mobility in older women with and without motoric cognitive risk syndrome: a quantitative assessment using wearable inertial sensors

Background. The Motoric Cognitive Risk (MCR) syndrome is defined in non-demented older adults by cognitive complaints and slow gait. Individuals with MCR are at higher risk of dementia and other poor clinical outcomes, such as falls. However, no data are available as regards functional mobility alterations associated with MCR. The main purpose of the present study is to quantitatively investigate such an aspect using the instrumented Timed-Up-and-Go (iTUG) test carried out using a wearable inertial measurement unit (IMU). Methods. Fifty-one women aged over 65 years underwent a geriatric and neuropsychologic assessment (which included the Mini Mental State Examination, MMSE and Addenbrooke’s Cognitive Examination Revised, ACE-R), instrumented gait analysis and iTUG performed using an IMU located on the lower back. Based on subjective cognitive complaints and slow gait, they were assigned either to the MCR (n = 24) or non-MCR (n = 27) group. IMU data allowed calculation of overall and sub-phases iTUG times. Results. Women with MCR were characterized by a significantly higher body mass and body mass index, lower normalized handgrip strength, and similar values of MMSE compared to non-MCRs. A trend was observed in terms of lower overall and sub-domain ACE-R score. They also performed iTUG at a significantly slower speed (22.4 s vs 14.1 of the non-MCR group, p < 0.001) and exhibited increased sub-phase times (29 to 31% higher with respect to non-MCRs). Conclusions. The findings of the present study suggest that the MCR syndrome impairs functional mobility, probably due reduced muscular strength and coordination, fear of falling and increased instability. The instrumental evaluation of functional mobility appears useful in the management of women with MCR, particularly in monitoring the progression of the motor impairments, verifying the effectiveness of interventions targeted in alleviating the impact on daily life of mobility limitations associated with MCR and in defining tailored rehabilitation programs

The Impact of SARS-CoV-2 (COVID-19) and its Lockdown Measures on the Mental and Functional Health of Older Individuals

The effect of the COVID-19 on the physical and mental health of Italian older individuals displaying signs of cognitive deterioration has not been deeply investigated. This longi- tudinal study examined the impact of COVID-19 lockdown measures on the psychologi- cal well-being and motor efficiency of a sample of Italian community-dwellers with and without cognitive decline. Forty-seven participants underwent instrumental gait analysis performed in ecological setting using wearable sensors, and completed a battery of tasks assessing cognitive functioning and psychological well-being, before and after the full lockdown due to the COVID-19 spreading. A series of Multivariate Analyses of Variance (MANOVAs) documented that the superior gait performance of the cognitively healthy participants exhibited before the COVID-19 spread, vanished when they were tested at the end of the lockdown period. Moreover, before the outbreak of the COVID-19, cognitively healthy participants and those with signs of cognitive decline reported similar levels of psychological well-being, whereas, after the lockdown, the former group reported better coping, emotional competencies, and general well-being than the participants displaying signs of cognitive decline. In conclusion, the full COVID-19 outbreak had a significant impact on the mental and motor functioning of older individuals with and without signs of cognitive deterioration living in Italy

Las estrategias turísticas de las grandes intervenciones urbanas

Peer Reviewe

Las estrategias turísticas de las grandes intervenciones urbanas

Peer Reviewe

Monoolein-based cubosomes affect lipid profile in HeLa cells

Monoolein-based cubosomes are promising drug delivery nanocarriers for theranostic purposes. Nevertheless, a small amount of research has been undertaken to investigate the impact of these biocompatible nanoparticles on cell lipid profile. The purpose of the present investigation was to explore changes in lipid components occurring in human carcinoma HeLa cells when exposed to short-term treatments (2 and 4h) with monoolein-based cubosomes stabilized by Pluronic F108 (MO/PF108). A combination of TLC and reversed-phase HPLC with DAD and ELSD detection was performed to analyze cell total fatty acid profile and levels of phospholipids, free cholesterol, triacylglycerols, and cholesteryl esters. The treatments with MO/PF108 cubosomes, at non-cytotoxic concentration (83μg/mL of MO), affected HeLa fatty acid profile, and a significant increase in the level of oleic acid 18:1 n-9 was observed in treated cells after lipid component saponification. Nanoparticle uptake modulated HeLa cell lipid composition, inducing a remarkable incorporation of oleic acid in the phospholipid and triacylglycerol fractions, whereas no changes were observed in the cellular levels of free cholesterol and cholesteryl oleate. Moreover, cell-based fluorescent measurements of intracellular membranes and lipid droplet content were assessed on cubosome-treated cells with an alternative technique using Nile red staining. A significant increase in the amount of the intracellular membranes and mostly in the cytoplasmic lipid droplets was detected, confirming that monoolein-based cubosome treatment influences the synthesis of intracellular membranes and accumulation of lipid droplets

Elderly subjects with type 2 diabetes show altered tissue electrical properties

Objective: The aim of the present research was to show the characteristics of body composition in a sample of elderly subjects with type 2 diabetes compared with healthy controls matched by age and body mass index (BMI) by bioelectrical impedance vector analysis. Methods: The sample consisted of 144 free-living patients (84 women and 60 men) with type 2 diabetes 60 to 84 y old and 209 age-matched controls (116 women and 93 men). Anthropometric measurements (weight; height; upper arm, hip, waist, and calf circumferences; biceps; triceps; and subscapular and suprailiac skinfolds) were taken. Blood samples for the assessment of plasma glucose and glycated hemoglobin were collected. The BMI, upper arm muscular area, and waist-to-hip ratio were calculated. Bioelectrical impedance vector analysis was applied. The analysis was performed in the entire diabetic sample and the healthy BMI-matched groups. Results: Compared with healthy subjects, patients had greater weight (P < 0.01 in women), higher BMI (P < 0.01 in women), smaller muscular area (P < 0.01 in men), and thicker skinfolds (P < 0.01 in women and men). Female and male patients showed larger phase angles (P < 0.01). Moreover, female patients showed a shorter vector length and lower resistance (P < 0.01) and male patients showed a higher reactance (P < 0.01). The BMI-matched analysis confirmed that patients were characterized by larger phase angles. Conclusions: Older patients with type 2 diabetes were characterized by peculiar anthropometric and bioelectrical patterns, which can be related to their smaller appendicular muscular area and lower extracellular/intracellular water ratio

Motor proficiency as a correlate of coping in late adult lifespan. An exploratory study

Background and Objectives: A body of studies suggests that coping resources may represent a protective factor against functional and cognitive losses associated with advanced ageing. This study intended to examine the contributions of global cognition, functional mobility, and muscular strength on self-reported coping strategies in late adulthood. Methods: One hundred and thirty-seven community-based older individuals (Mage = 77.2 years, SD = 5.8 years, age range: 63–92 years), 48 males and 89 females with and without signs of cognitive decline completed a battery of tools assessing global cognitive function, problem-focused coping, muscular strength (assessed by handgrip strength, HGS) and functional mobility (assessed using the instrumented Timed-Up-and-Go test). Results: Signi!cant associations were found between problem-focused coping, global cognitive function, HGS, functional mobility parameters, age, and education. Moreover, when the e"ects of education and gender were controlled for, HGS, functional mobility, and global cognitive function scores accounted for 44% of the variance in coping. Conclusions: In clinical practice, the use of functional mobility and muscular strength measures to screen the physical health of older individuals should be encouraged

Executive and Motor Functions in Older Individuals with Cognitive Impairment

Background: A current research trend is the examination of the interplay between cognitive functioning, higher-order processes, and motor efficiency in late adulthood. However, the association between motor and cognitive functions when cognitive decline occurs has not been extensively explored. This study investigated whether gait features, functional mobility, and handgrip strength were associated with executive functions in older people with mild cognitive impairment (MCI) or dementia. Methods: 127 older participants (Mage = 77.9 years, SD = 5.8 years) who had received a diagnosis of MCI and dementia voluntarily took part in the study. A battery of tests assessing global cognitive function, executive functions, muscular strength, functional mobility, and spatio-temporal parameters of gait was completed by the participants. Results: Statistically significant correlations were obtained between global cognitive function, executive functions, and motor efficiency measures. Moreover, a series of regression analyses showed that 8–13% of the variance of several motor pa- rameters was predicted by several executive functions. Additionally, walking, functional mobility, and global cognitive function predicted 53–71% of the variance relative to the occurrence of demen- tia. In conclusion, motor functioning is closely related to cognitive functioning in late adulthood. Conclusions: The assessment of muscular strength and functional mobility should be promoted in clinical settings

Smoothness of Gait in Healthy and Cognitively Impaired Individuals: A Study on Italian Elderly Using Wearable Inertial Sensor

The main purpose of the present study was to compare the smoothness of gait in older adults with and without cognitive impairments, using the harmonic ratio (HR), a metric derived from trunk accelerations. Ninety older adults aged over 65 (age: 78.9 ± 4.8 years; 62% female) underwent instrumental gait analysis, performed using a wearable inertial sensor and cognitive assessment with the Mini Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination Revised (ACE-R). They were stratified into three groups based on their MMSE performance: healthy controls (HC), early and advanced cognitive decline (ECD, ACD). The spatio- temporal and smoothness of gait parameters, the latter expressed through HR in anteroposterior (AP), vertical (V) and mediolateral (ML) directions, were derived from trunk acceleration data. The existence of a relationship between gait parameters and degree of cognitive impairment was also explored. The results show that individuals with ECD and ACD exhibited significantly slower speed and shorter stride length, as well as reduced values of HR in the AP and V directions compared to HC, while no significant differences were found between ECD and ACD in any of the investigated parameters. Gait speed, stride length and HR in all directions were found to be moderately correlated with both MMSE and ACE-R scores. Such findings suggest that, in addition to the known changes in gait speed and stride length, important reductions in smoothness of gait are likely to occur in older adults, owing to early/prodromal stages of cognitive impairment. Given the peculiar nature of these metrics, which refers to overall body stability during gait, the calculation of HR may result in being useful in improving the characterization of gait patterns in older adults with cognitive impairments