JMIR Aging最新文献

Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app-based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain.

Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults.

Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7%; White:n=106, 86.2%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates.

Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence (ß=-.20, P=.37, 95% CI -.65 to -.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance (ß=-.20, P=.02, 95% CI -.02 to -.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=-1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance.

Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia.

Background: Due to the progressive nature of dementia, concerns about nursing home residents' safety are frequently raised. Surveillance technology, enabling visual and auditory monitoring, is often seen as a solution for ensuring safe and efficient care. However, tailoring surveillance technology to individual needs is challenging due to the complex and dynamic care environment involving multiple formal and informal stakeholders, each with unique perspectives.

Objective: This study aimed to explore the scientific literature on the perspectives and values of stakeholders involved in applying surveillance technology for people with dementia in nursing homes.

Methods: We conducted a scoping review and systematically searched five scientific databases. We identified 31 articles published between 2005 and 2024. Stakeholder characteristics were extracted and synthesized according to Schwartz' theory of basic human values.

Results: Twelve stakeholder groups were identified, with nursing staff, residents and informal caregivers being the most frequently mentioned. Among stakeholder groups close to residents, values related to benevolence, security, conformity and tradition were most commonly addressed. Further, values such as self-direction, power and achievement seemed important to most stakeholder groups.

Conclusions: Several stakeholder groups emphasized the importance of being and feeling involved in the application of surveillance technologies. Additionally, they acknowledged the necessity of paying attention to stakeholders' perspectives and values. Across these stakeholder groups, values related to benevolence, security, and self-direction were represented although various stakeholders assigned different meanings to these values. Awareness of stakeholders' perspectives demands a willingness to acknowledge each other's values and bridge differences.

Clinicaltrial:

Background: The utility of aging metrics that incorporate cognitive and physical function is not fully understood.

Objective: We aim to compare the predictive capacities of 3 distinct aging metrics-motoric cognitive risk syndrome (MCR), physio-cognitive decline syndrome (PCDS), and cognitive frailty (CF)-for incident dementia and all-cause mortality among community-dwelling older adults.

Methods: We used longitudinal data from waves 10-15 of the Health and Retirement Study. Cox proportional hazards regression analysis was employed to evaluate the effects of MCR, PCDS, and CF on incident all-cause dementia and mortality, controlling for socioeconomic and lifestyle factors, as well as medical comorbidities. Discrimination analysis was conducted to assess and compare the predictive accuracy of the 3 aging metrics.

Results: A total of 2367 older individuals aged 65 years and older, with no baseline prevalence of dementia or disability, were ultimately included. The prevalence rates of MCR, PCDS, and CF were 5.4%, 6.3%, and 1.3%, respectively. Over a decade-long follow-up period, 341 cases of dementia and 573 deaths were recorded. All 3 metrics were predictive of incident all-cause dementia and mortality when adjusting for multiple confounders, with variations in the strength of their associations (incident dementia: MCR odds ratio [OR] 1.90, 95% CI 1.30-2.78; CF 5.06, 95% CI 2.87-8.92; PCDS 3.35, 95% CI 2.44-4.58; mortality: MCR 1.60, 95% CI 1.17-2.19; CF 3.26, 95% CI 1.99-5.33; and PCDS 1.58, 95% CI 1.17-2.13). The C-index indicated that PCDS and MCR had the highest discriminatory accuracy for all-cause dementia and mortality, respectively.

Conclusions: Despite the inherent differences among the aging metrics that integrate cognitive and physical functions, they consistently identified risks of dementia and mortality. This underscores the importance of implementing targeted preventive strategies and intervention programs based on these metrics to enhance the overall quality of life and reduce premature deaths in aging populations.

Background: The prevalence of stroke is high in both males and females, and it rises with age. Stroke often leads to sensor and motor issues, such as hemiparesis affecting one side of the body. Poststroke patients require torso stabilization exercises, but maintaining proper posture can be challenging due to their condition.

Objective: Our goal was to develop the Postural SmartVest, an affordable wearable technology that leverages a smartphone's built-in accelerometer to monitor sagittal and frontal plane changes while providing visual, tactile, and auditory feedback to guide patients in achieving their best-at-the-time posture during rehabilitation.

Methods: To design the Postural SmartVest, we conducted brainstorming sessions, therapist interviews, gathered requirements, and developed the first prototype. We used this initial prototype in a feasibility study with individuals without hemiparesis (n=40, average age 28.4). They used the prototype during 1-hour seated sessions. Their feedback led to a second prototype, which we used in a pilot study with a poststroke patient. After adjustments and a kinematic assessment using the Vicon Gait Plug-in system, the third version became the Postural SmartVest. We assessed the Postural SmartVest in a within-subject experiment with poststroke patients (n=40, average age 57.1) and therapists (n=20, average age 31.3) during rehabilitation sessions. Participants engaged in daily activities, including walking and upper limb exercises, without and with app feedback.

Results: The Postural SmartVest comprises a modified off-the-shelf athletic lightweight compression tank top with a transparent pocket designed to hold a smartphone running a customizable Android app securely. This app continuously monitors sagittal and frontal plane changes using the built-in accelerometer sensor, providing multisensory feedback through audio, vibration, and color changes. Patients reported high ratings for weight, comfort, dimensions, effectiveness, ease of use, stability, durability, and ease of adjustment. Therapists noted a positive impact on rehabilitation sessions and expressed their willingness to recommend it. A 2-tailed t-test showed a significant difference (P<.001) between the number of the best-at-the-time posture positions patients could maintain in 2 stages, without feedback (mean 13.1, SD 7.12) and with feedback (mean 4.2, SD 3.97), demonstrating the effectiveness of the solution in improving posture awareness.

Conclusions: The Postural SmartVest aids therapists during poststroke rehabilitation sessions and assists patients in improving their posture during these sessions.

Background: Serum levels of silent information regulator 6 (SIRT6), a key biomarker of aging, were identified as a predictor of coronary artery disease (CAD), but whether SIRT6 can distinguish severity of coronary artery lesions in older adult patients is unknown.

Objectives: This study developed a nomogram to demonstrate the functionality of SIRT6 in assessing severity of coronary artery atherosclerosis.

Methods: Patients aged 60 years and older with angina pectoris were screened for this single-center clinical study between October 1, 2022, and March 31, 2023. Serum specimens of eligible patients were collected for SIRT6 detection by enzyme-linked immunosorbent assay. Clinical data and putative predictors, including 29 physiological characteristics, biochemical parameters, carotid artery ultrasonographic results, and complete coronary angiography findings, were evaluated, with CAD diagnosis as the primary outcome. The nomogram was derived from the Extreme Gradient Boosting (XGBoost) model, with logistic regression for variable selection. Model performance was assessed by examining discrimination, calibration, and clinical use separately. A 10-fold cross-validation technique was used to compare all models. The models' performance was further evaluated on the internal validation set to ensure that the obtained results were not due to overoptimization.

Results: Eligible patients (n=222) were divided into 2 cohorts: the development cohort (n=178) and the validation cohort (n=44). Serum SIRT6 levels were identified as both an independent risk factor and a predictor for CAD in older adults. The area under the receiver operating characteristic curve (AUROC) was 0.725 (95% CI 0.653-0.797). The optimal cutoff value of SIRT6 for predicting CAD was 546.384 pg/mL. Predictors included in this nomogram were serum SIRT6 levels, triglyceride glucose (TyG) index, and apolipoprotein B. The model achieved an AUROC of 0.956 (95% CI 0.928-0.983) in the development cohort. Similarly, in the internal validation cohort, the AUROC was 0.913 (95% CI 0.828-0.999). All models demonstrated satisfactory calibration, with predicted outcomes closely aligning with actual results.

Conclusions: SIRT6 shows promise in predicting CAD, with enhanced predictive abilities when combined with the TyG index. In clinical settings, monitoring fluctuations in SIRT6 and TyG may offer valuable insights for early CAD detection. The nomogram for CAD outcome prediction in older adult patients with angina pectoris may aid in clinical trial design and personalized clinical decision-making, particularly in institutions where SIRT6 is being explored as a biomarker for aging or cardiovascular health.

Background: Parkinson disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms. Recently, dance has started to be considered an effective intervention for people with PD. Several findings in the literature emphasize the necessity for deeper exploration into the synergistic impacts of dance therapy and exergaming for PD management. Moreover, socially engaging robotic platforms equipped with advanced interaction and perception features offer potential for monitoring patients' posture and enhancing workout routines with tailored cues.

Objective: This paper presents the results of the Social Robotics for Active and Healthy Ageing (SI-Robotics) project, aimed at designing an innovative rehabilitation program targeted at seniors affected by (early-stage) PD. This study therefore aims to assess the usefulness of a dance-based rehabilitation program enriched by artificial intelligence-based exergames and contextual robotic assistance in improving motor function, balance, gait, and quality of life in patients with PD. The acceptability of the system is also investigated.

Methods: The study is designed as a technical feasibility pilot to test the SI-Robotics system. For this study, 20 patients with PD were recruited. A total of 16 Irish dance-based rehabilitation sessions of 50 minutes were conducted (2 sessions per week, for 8 wks), involving 2 patients at a time. The designed rehabilitation session involves three main actors: (1) a therapist, (2) a patient, and (3) a socially interacting robot. To stimulate engagement, sessions were organized in the shape of exergames where an avatar shows patients the movements they should perform to correctly carry out a dance-based rehabilitation exercise.

Results: Statistical analysis reveals a significant difference on the Performance-Oriented Mobility Assessment scale, both on balance and gait aspects, together with improvements in Short Physical Performance Battery, Unified Parkinson Disease Rating Scale-III, and Timed Up and Go test, underlying the usefulness of the rehabilitation intervention on the motor symptoms of PD. The analysis of the Unified Theory of Acceptance and Use of Technology subscales provided valuable insights into users' perceptions and interactions with the system.

Conclusions: This research underscores the promise of merging dance therapy with interactive exergaming on a robotic platform as an innovative strategy to enhance motor function, balance, gait, and overall quality of life for patients grappling with PD.

Background: Telomere length (TL) is a marker of cellular health and aging. Physical exercise has been associated with longer telomeres and, therefore, healthier aging. However, results supporting such effects vary across studies. Our aim was to synthesize existing evidence on the effect of different modalities and durations of physical exercise on TL.

Objective: The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a virtual reality physical activity platform in a community organization.

Methods: We performed an umbrella review and meta-analysis. Data sources included PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We selected systematic reviews and meta-analyses of randomized and nonrandomized controlled clinical trials evaluating the effect of physical exercise on TL.

Results: Our literature search retrieved 12 eligible systematic reviews, 5 of which included meta-analyses. We identified 22 distinct primary studies to estimate the overall effect size of physical exercise on TL. The overall effect size was 0.28 (95% CI 0.118-0.439), with a heterogeneity test value Q of 43.08 (P=.003) and I² coefficient of 51%. The number of weeks of intervention explained part of this heterogeneity (Q_B=8.25; P=.004), with higher effect sizes found in studies with an intervention of less than 30 weeks. Exercise modality explained additional heterogeneity within this subgroup (Q_B=10.28, P=.02). The effect sizes were small for aerobic exercise and endurance training, and moderate for high-intensity interval training.

Conclusions: Our umbrella review and meta-analysis detected a small-moderate positive effect of physical exercise on TL, which seems to be influenced by the duration and type of physical exercise. High quality studies looking into the impact of standardized, evidence-based physical exercise programs on TL are still warranted.