Pub Date : 2025-10-08DOI: 10.1016/j.archger.2025.106050
Wei-Chen Chen , Yea-Ru Yang , Ching-Ya Chiu , Ray-Yau Wang
Objective
Dual-task walking (DTW) performance is commonly reduced in older adults and is associated with a higher risk of falls. While dual-task deficits have been documented, it remains unclear how different task prioritization strategies during training influence DTW outcomes. This study compared effects of posture-first (PF), supraposture-first (SF), and conventional training on DTW performance in older adults.
Methods
A three-arm randomized, single-blind controlled study was conducted. Thirty-nine community-dwelling older adults were randomly assigned to PF, SF, or control groups to receive 12-session of cognitive-motor dual-task training with distinct task prioritization instructions. Cognitive and motor DTW performance, Trail Making Test Part B, Berg Balance Scale, single-task walking performance, and secondary task performance were assessed pre- and post-intervention.
Results
The PF group showed significant improvements in both cognitive and motor DTW performance, including speed (cognitive: p = 0.001, motor: p = 0.008), cadence (p < 0.001), and dual-task cost (DTC-speed) (p < 0.001). Compared to the SF and control groups, the PF group showed greater improvements in stride length (p = 0.009 vs. SF; p = 0.001 vs. control) and DTC (p = 0.025 vs. SF; p = 0.005 vs. control) during cognitive DTW. During motor DTW, improvements in speed (p = 0.008), cadence (p = 0.016), and DTC (p = 0.049) were also greater than in the SF group.
Conclusions
Posture-first strategy during training enhances cognitive and motor DTW performance more effectively than other approaches. These findings support its implementation to improve functional mobility and dual-task coordination in older adults.
目的：老年人双任务行走（DTW）的表现通常会下降，并且与摔倒的风险增加有关。虽然双任务缺陷已被记录在案，但尚不清楚训练期间不同的任务优先级策略如何影响DTW结果。本研究比较了姿势优先（PF）、上姿势优先（SF）和常规训练对老年人DTW表现的影响。方法采用三组随机、单盲对照研究。39名居住在社区的老年人被随机分配到PF组、SF组或对照组，接受12次认知-运动双任务训练，并根据不同的任务优先级指示进行训练。评估干预前后的认知和运动DTW表现、造径测试B部分、Berg平衡量表、单任务步行表现和次要任务表现。结果PF组在认知和运动DTW表现上均有显著改善，包括速度（认知：p = 0.001，运动：p = 0.008）、节奏（p < 0.001）和双任务成本（DTC-speed） （p < 0.001）。与SF组和对照组相比，PF组在认知DTW期间步幅（p = 0.009 vs SF; p = 0.001 vs对照组）和DTC （p = 0.025 vs SF; p = 0.005 vs对照组）有更大的改善。在运动DTW期间，速度（p = 0.008），节奏（p = 0.016）和DTC （p = 0.049）的改善也大于SF组。结论在训练过程中，姿势优先策略比其他方法更能提高认知和运动能力。这些发现支持其实施，以改善老年人的功能流动性和双任务协调。
{"title":"Effects of dual-task prioritization training on dual-task walking in older people: A single-blinded randomized controlled trial","authors":"Wei-Chen Chen , Yea-Ru Yang , Ching-Ya Chiu , Ray-Yau Wang","doi":"10.1016/j.archger.2025.106050","DOIUrl":"10.1016/j.archger.2025.106050","url":null,"abstract":"<div><h3>Objective</h3><div>Dual-task walking (DTW) performance is commonly reduced in older adults and is associated with a higher risk of falls. While dual-task deficits have been documented, it remains unclear how different task prioritization strategies during training influence DTW outcomes. This study compared effects of posture-first (PF), supraposture-first (SF), and conventional training on DTW performance in older adults.</div></div><div><h3>Methods</h3><div>A three-arm randomized, single-blind controlled study was conducted. Thirty-nine community-dwelling older adults were randomly assigned to PF, SF, or control groups to receive 12-session of cognitive-motor dual-task training with distinct task prioritization instructions. Cognitive and motor DTW performance, Trail Making Test Part B, Berg Balance Scale, single-task walking performance, and secondary task performance were assessed pre- and post-intervention.</div></div><div><h3>Results</h3><div>The PF group showed significant improvements in both cognitive and motor DTW performance, including speed (cognitive: <em>p</em> = 0.001, motor: <em>p</em> = 0.008), cadence (<em>p</em> < 0.001), and dual-task cost (DTC-speed) (<em>p</em> < 0.001). Compared to the SF and control groups, the PF group showed greater improvements in stride length (<em>p</em> = 0.009 vs. SF; <em>p</em> = 0.001 vs. control) and DTC (<em>p</em> = 0.025 vs. SF; <em>p</em> = 0.005 vs. control) during cognitive DTW. During motor DTW, improvements in speed (<em>p</em> = 0.008), cadence (<em>p</em> = 0.016), and DTC (<em>p</em> = 0.049) were also greater than in the SF group.</div></div><div><h3>Conclusions</h3><div>Posture-first strategy during training enhances cognitive and motor DTW performance more effectively than other approaches. These findings support its implementation to improve functional mobility and dual-task coordination in older adults.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106050"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: To investigate the causal relationships between chronic kidney disease (CKD) and sarcopenia using cohort data and Mendelian randomization (MR), and to further assess the mediating roles of physical activity and sedentary behavior using two-step MR.
Methods
: Data from 5648 participants in the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. A linear mixed-effects model was used to evaluate the relationship between CKD and sarcopenia. Two-sample MR was then utilized to assess the causality of the observed association. Additionally, we applied a two-step MR to evaluate the mediating role of physical activities in the pathway from CKD to sarcopenia.
Results
: Chronic kidney disease demonstrated a persistent and statistically significant association with elevated sarcopenia risk throughout the entire study period (P < 0.01). Similarly, lower estimated glomerular filtration rate (eGFR) showed a significant positive association with increased sarcopenia risk (P = 0.017). MR analysis further indicates a causal relationship between CKD and sarcopenia (Low hand grip strength: OR[95 %CI] = 0.920[0.874 to 0.969], P < 0.01) (Appendicular lean mass: β[95 %CI] = -0.028[-0.053 to -0.004], P = 0.024). Mediation analysis showed that sedentary behavior (mediation proportion = 3.050 %) and physical activity (mediation proportion = 2.869 %) had mediating effects.
Conclusions
: CKD is an independent risk factor for sarcopenia, with a clear temporal association. Mendelian randomization studies confirm this link and identify sedentary behavior and physical activity as mediators. These results underscore the need for early screening and individualized intervention strategies in CKD patients to prevent sarcopenia.
{"title":"Association between chronic kidney disease and sarcopenia: a national cohort study and two-step Mendelian randomization analysis","authors":"Hongji Wang , Ying Zhou , Chen Chen , Lihai Zhang , Gongzi Zhang","doi":"10.1016/j.archger.2025.106051","DOIUrl":"10.1016/j.archger.2025.106051","url":null,"abstract":"<div><h3>Objective</h3><div><strong>:</strong> To investigate the causal relationships between chronic kidney disease (CKD) and sarcopenia using cohort data and Mendelian randomization (MR), and to further assess the mediating roles of physical activity and sedentary behavior using two-step MR.</div></div><div><h3>Methods</h3><div><strong>:</strong> Data from 5648 participants in the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. A linear mixed-effects model was used to evaluate the relationship between CKD and sarcopenia. Two-sample MR was then utilized to assess the causality of the observed association. Additionally, we applied a two-step MR to evaluate the mediating role of physical activities in the pathway from CKD to sarcopenia.</div></div><div><h3>Results</h3><div><strong>:</strong> Chronic kidney disease demonstrated a persistent and statistically significant association with elevated sarcopenia risk throughout the entire study period (<em>P</em> < 0.01). Similarly, lower estimated glomerular filtration rate (eGFR) showed a significant positive association with increased sarcopenia risk (<em>P</em> = 0.017). MR analysis further indicates a causal relationship between CKD and sarcopenia (Low hand grip strength: OR[95 %CI] = 0.920[0.874 to 0.969], <em>P</em> < 0.01) (Appendicular lean mass: β[95 %CI] = -0.028[-0.053 to -0.004], <em>P</em> = 0.024). Mediation analysis showed that sedentary behavior (mediation proportion = 3.050 %) and physical activity (mediation proportion = 2.869 %) had mediating effects.</div></div><div><h3>Conclusions</h3><div><strong>:</strong> CKD is an independent risk factor for sarcopenia, with a clear temporal association. Mendelian randomization studies confirm this link and identify sedentary behavior and physical activity as mediators. These results underscore the need for early screening and individualized intervention strategies in CKD patients to prevent sarcopenia.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106051"},"PeriodicalIF":3.8,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.archger.2025.106049
Tasmin Alanna Rookes , Rachael Frost , Louise Marston , Megan Armstrong , Yolanda Barrado-Martin , Kate Walters
Background
Health promotion activities for people with mild cognitive impairment (MCI) may improve their overall health and prevent progression to dementia. We need to understand the best approaches to behaviour change in this population.
Aim
To summarise the types of health promotion interventions and current clinical effectiveness evidence for physical and cognitive functioning outcomes in people with MCI.
Design
State-of-the art review
Method
Medline was searched in April 2025, for systematic reviews synthesising randomised controlled trials testing effectiveness of health promotion interventions in older adults with MCI, published since 2015. Abstracts, titles, and full texts were single screened and, for eligible reviews, the characteristics, intervention type, primary outcome, and evidence for people with MCI, were extracted. Key messages were narratively synthesised across reviews, grouping by type of intervention and outcome measure.
Results
From 1776 titles and abstracts, 57 systematic reviews were eligible. Regular moderate intensity multicomponent physical exercise and memory-focussed cognitive training interventions had the strongest evidence base for improving cognitive functioning. However, combining physical exercise and cognitive training was more beneficial for cognitive domains and physical functioning, in comparison to doing them individually. The evidence for nutrition interventions was mixed. One review of psychological interventions showed improvements for wellbeing.
Conclusion
There is evidence that health promotion interventions can support people with MCI and dementia to improve or maintain their cognitive function, through multicomponent physical activity combined with cognitive training. More evidence is needed for nutritional recommendations, psychological interventions, and social inclusion interventions.
{"title":"Evidence for health promotion interventions to improve cognitive and physical functioning outcomes in older adults with MCI: A state-of-the-art review","authors":"Tasmin Alanna Rookes , Rachael Frost , Louise Marston , Megan Armstrong , Yolanda Barrado-Martin , Kate Walters","doi":"10.1016/j.archger.2025.106049","DOIUrl":"10.1016/j.archger.2025.106049","url":null,"abstract":"<div><h3>Background</h3><div>Health promotion activities for people with mild cognitive impairment (MCI) may improve their overall health and prevent progression to dementia. We need to understand the best approaches to behaviour change in this population.</div></div><div><h3>Aim</h3><div>To summarise the types of health promotion interventions and current clinical effectiveness evidence for physical and cognitive functioning outcomes in people with MCI.</div></div><div><h3>Design</h3><div>State-of-the art review</div></div><div><h3>Method</h3><div>Medline was searched in April 2025, for systematic reviews synthesising randomised controlled trials testing effectiveness of health promotion interventions in older adults with MCI, published since 2015. Abstracts, titles, and full texts were single screened and, for eligible reviews, the characteristics, intervention type, primary outcome, and evidence for people with MCI, were extracted. Key messages were narratively synthesised across reviews, grouping by type of intervention and outcome measure.</div></div><div><h3>Results</h3><div>From 1776 titles and abstracts, 57 systematic reviews were eligible. Regular moderate intensity multicomponent physical exercise and memory-focussed cognitive training interventions had the strongest evidence base for improving cognitive functioning. However, combining physical exercise and cognitive training was more beneficial for cognitive domains and physical functioning, in comparison to doing them individually. The evidence for nutrition interventions was mixed. One review of psychological interventions showed improvements for wellbeing.</div></div><div><h3>Conclusion</h3><div>There is evidence that health promotion interventions can support people with MCI and dementia to improve or maintain their cognitive function, through multicomponent physical activity combined with cognitive training. More evidence is needed for nutritional recommendations, psychological interventions, and social inclusion interventions.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106049"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.archger.2025.106046
Wenxiu Niu , Jingjing Zhang , Xuhong Lan , Yuhan Sha , Xiaomeng Han , Jijun Qiao , Fei Zheng , Lu Liu , Fangli Ma , Li Yao , Zhigang Zhang
Background
Numerous studies have identified a correlation between sleep disorders and delirium; however, the causal relationship remains ambiguous. This bidirectional two-sample Mendelian randomization (MR) study, combined with colocalization and enrichment analyses, aims to investigate the potential causal relationship between sleep-associated phenotypes and delirium.
Methods
We performed a two-sample bidirectional Mendelian randomization analysis using 10 gene variants associated with sleep phenotypes to investigate the causal relationship between sleep disorders and delirium. Five methods for MR Analysis. Moreover, sensitivity analyses were conducted to assess the robustness of our findings. Enrichment and colocalization analyses were conducted to uncover the genetic mechanisms linking sleep phenotypes and delirium.
Results
The IVW method showed that insomnia positively correlates with delirium (OR = 2.523, 95 % CI: 1.048–6.079, P = 0.039). Morning person is causally negatively associated with delirium (OR = 0.869, 95 % CI: 0.774–0.977, P = 0.018). Conversely, delirium is negatively associated with daytime napping (OR = 0.987, 95 % CI: 0.984–0.990, P < 0.001), insomnia (OR = 0.985, 95 % CI: 0.981–0.989, P < 0.001), snoring (OR = 0.991, 95 % CI: 0.985–0.997, P = 0.002), and single item chronotype (beta = -0.161, 95 % CI:0.241–0.081, P = 0.002). Insomnia-related genes are enriched in neuro-metabolic and epigenetic pathways, while Morning person is linked to circadian rhythm regulation. A morning person shares genetic signals with delirium at the rs2398144 locus on chromosome 16 (PPH4 > 0.5).
Conclusions
Our findings provide evidence for a potential causal relationship between sleep disorders and delirium.These findings may support better prevention and management of delirium in older adults.
背景：许多研究已经确定了睡眠障碍和谵妄之间的相关性；然而，因果关系仍然模糊不清。这项双向双样本孟德尔随机化（MR）研究，结合共定位和富集分析，旨在探讨睡眠相关表型与谵妄之间的潜在因果关系。方法：采用10个与睡眠表型相关的基因变异进行双样本双向孟德尔随机化分析，探讨睡眠障碍与谵妄之间的因果关系。磁共振分析的五种方法。此外，还进行了敏感性分析，以评估我们研究结果的稳健性。富集和共定位分析揭示了连接睡眠表型和谵妄的遗传机制。结果：IVW方法显示失眠与谵妄呈正相关（OR = 2.523, 95% CI: 1.048 ~ 6.079, P = 0.039）。早起的人与谵妄呈负相关（OR = 0.869, 95% CI: 0.774-0.977, P = 0.018）。相反，谵妄与白天午睡（OR = 0.987, 95% CI: 0.984-0.990, P < 0.001）、失眠（OR = 0.985, 95% CI: 0.981-0.989, P < 0.001）、打鼾（OR = 0.991, 95% CI: 0.985-0.997, P = 0.002）和单项睡眠类型（β = -0.161, 95% CI:0.241-0.081, P = 0.002）负相关。与失眠相关的基因在神经代谢和表观遗传途径中富集，而早起的人则与昼夜节律调节有关。早起的人在16号染色体上的rs2398144位点（PPH4 > 0.5）与谵妄共享遗传信号。结论：我们的发现为睡眠障碍和谵妄之间潜在的因果关系提供了证据。这些发现可能支持更好地预防和管理老年人谵妄。
{"title":"Causal association between sleep disorders and delirium: A bidirectional mendelian randomization analysis for clinical practice","authors":"Wenxiu Niu , Jingjing Zhang , Xuhong Lan , Yuhan Sha , Xiaomeng Han , Jijun Qiao , Fei Zheng , Lu Liu , Fangli Ma , Li Yao , Zhigang Zhang","doi":"10.1016/j.archger.2025.106046","DOIUrl":"10.1016/j.archger.2025.106046","url":null,"abstract":"<div><h3>Background</h3><div>Numerous studies have identified a correlation between sleep disorders and delirium; however, the causal relationship remains ambiguous. This bidirectional two-sample Mendelian randomization (MR) study, combined with colocalization and enrichment analyses, aims to investigate the potential causal relationship between sleep-associated phenotypes and delirium.</div></div><div><h3>Methods</h3><div>We performed a two-sample bidirectional Mendelian randomization analysis using 10 gene variants associated with sleep phenotypes to investigate the causal relationship between sleep disorders and delirium. Five methods for MR Analysis. Moreover, sensitivity analyses were conducted to assess the robustness of our findings. Enrichment and colocalization analyses were conducted to uncover the genetic mechanisms linking sleep phenotypes and delirium.</div></div><div><h3>Results</h3><div>The IVW method showed that insomnia positively correlates with delirium (OR = 2.523, 95 % CI: 1.048–6.079, <em>P</em> = 0.039). Morning person is causally negatively associated with delirium (OR = 0.869, 95 % CI: 0.774–0.977, <em>P</em> = 0.018). Conversely, delirium is negatively associated with daytime napping (OR = 0.987, 95 % CI: 0.984–0.990, <em>P</em> < 0.001), insomnia (OR = 0.985, 95 % CI: 0.981–0.989, <em>P</em> < 0.001), snoring (OR = 0.991, 95 % CI: 0.985–0.997, <em>P</em> = 0.002), and single item chronotype (beta = -0.161, 95 % CI:0.241–0.081, <em>P</em> = 0.002). Insomnia-related genes are enriched in neuro-metabolic and epigenetic pathways, while Morning person is linked to circadian rhythm regulation. A morning person shares genetic signals with delirium at the rs2398144 locus on chromosome 16 (PPH4 > 0.5).</div></div><div><h3>Conclusions</h3><div>Our findings provide evidence for a potential causal relationship between sleep disorders and delirium.These findings may support better prevention and management of delirium in older adults.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"141 ","pages":"Article 106046"},"PeriodicalIF":3.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.archger.2025.106048
Jing Hu, Ling Xu
Agitation impacts 50 - 80 % of elderly dementia patients, imposing burdens on caregivers and healthcare systems. Pharmacological treatments are limited, whereas non-pharmacological music therapy (MT) holds promise. This study sought to evaluate MT's efficacy in alleviating agitation. A thorough search across multiple databases was carried out, incorporating 14 studies (10 RCTs, 4 pre-post trials; n = 847). Meta-analysis demonstrated that MT significantly reduced agitation with a moderate effect size (d = 0.42). Subgroup analyses yielded consistent findings. Heterogeneity was low, and publication bias was negligible. MT effectively mitigated agitation in dementia patients despite heterogeneity in aspects like music duration and genre, underscoring its generalizability, particularly in resource-constrained areas and households lacking professional nursing support. It offers evidence for integrating MT into patient care. The review was registered on PROSPERO (CRD420251033860).
{"title":"The impact of music therapy on agitation in elderly patients with dementia: A systematic review and meta-analysis","authors":"Jing Hu, Ling Xu","doi":"10.1016/j.archger.2025.106048","DOIUrl":"10.1016/j.archger.2025.106048","url":null,"abstract":"<div><div>Agitation impacts 50 - 80 % of elderly dementia patients, imposing burdens on caregivers and healthcare systems. Pharmacological treatments are limited, whereas non-pharmacological music therapy (MT) holds promise. This study sought to evaluate MT's efficacy in alleviating agitation. A thorough search across multiple databases was carried out, incorporating 14 studies (10 RCTs, 4 pre-post trials; <em>n</em> = 847). Meta-analysis demonstrated that MT significantly reduced agitation with a moderate effect size (<em>d</em> = 0.42). Subgroup analyses yielded consistent findings. Heterogeneity was low, and publication bias was negligible. MT effectively mitigated agitation in dementia patients despite heterogeneity in aspects like music duration and genre, underscoring its generalizability, particularly in resource-constrained areas and households lacking professional nursing support. It offers evidence for integrating MT into patient care. The review was registered on PROSPERO (CRD420251033860).</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106048"},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-29DOI: 10.1016/j.archger.2025.106047
Yingtian Wang , Haining Qi , Xinru Hu , Qian Yu , Manshu Yu , Fan Yang , Xirui Qiu , Fangyi Chen , Ye Ding , Meng Jiang , Xiaoxiao Wang , Li Liu , Wei Wang
Objectives
To investigate the joint effects and interactions of psychological resilience (PR) and activities of daily living (ADL) on cognitive impairment and all-cause mortality.
Methods
Chinese older adults were recruited from the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazards regression and log-binomial regression were employed to estimate the associations between exposures and all-cause mortality and cognitive impairment (defined as MMSE score <18 or self-reported dementia). Interactions were test on the basis of multivariable regressions.
Results
Compared to participants with normal ADL and high PR (Group 1), participants with limited ADL and high PR (Group 3, HR = 2.105; 95 % CI: 1.656, 2.676) and those with limited ADL and low PR (Group 4, HR = 3.076; 95 % CI: 2.436, 3.884) showed significantly increased risks of all-cause mortality. Moreover, the synergistic interactions between ADL and PR for all-cause mortality were evidenced by relative excess risk due to interaction (RERI = 0.824; 95 % CI: 0.363, 1.286), attributable proportion due to interaction (AP = 0.268; 95 % CI: 0.121, 0.415) and synergy index (SI = 1.659; 95 % CI: 1.134, 2.426). Regarding cognitive impairment, compared to Group 1, Group 3 (RR = 1.662; 95 % CI: 1.073, 2.576) and Group 4 (RR = 2.138; 95 % CI: 1.399, 3.8) exhibited increased risks. Additionally, subgroup analysis showed additive interaction for cognitive impairment was significant only in males.
Conclusions
Limited ADL and low PR jointly increase the risks of cognitive impairment and all-cause mortality in Chinese older adults, with a synergistic additive interaction observed for all-cause mortality.
{"title":"The interaction between activities of daily living and psychological resilience on all-cause mortality and cognitive impairment among Chinese older adults: A cohort study based on CLHLS","authors":"Yingtian Wang , Haining Qi , Xinru Hu , Qian Yu , Manshu Yu , Fan Yang , Xirui Qiu , Fangyi Chen , Ye Ding , Meng Jiang , Xiaoxiao Wang , Li Liu , Wei Wang","doi":"10.1016/j.archger.2025.106047","DOIUrl":"10.1016/j.archger.2025.106047","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the joint effects and interactions of psychological resilience (PR) and activities of daily living (ADL) on cognitive impairment and all-cause mortality.</div></div><div><h3>Methods</h3><div>Chinese older adults were recruited from the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazards regression and log-binomial regression were employed to estimate the associations between exposures and all-cause mortality and cognitive impairment (defined as MMSE score <18 or self-reported dementia). Interactions were test on the basis of multivariable regressions.</div></div><div><h3>Results</h3><div>Compared to participants with normal ADL and high PR (Group 1), participants with limited ADL and high PR (Group 3, HR = 2.105; 95 % CI: 1.656, 2.676) and those with limited ADL and low PR (Group 4, HR = 3.076; 95 % CI: 2.436, 3.884) showed significantly increased risks of all-cause mortality. Moreover, the synergistic interactions between ADL and PR for all-cause mortality were evidenced by relative excess risk due to interaction (RERI = 0.824; 95 % CI: 0.363, 1.286), attributable proportion due to interaction (AP = 0.268; 95 % CI: 0.121, 0.415) and synergy index (SI = 1.659; 95 % CI: 1.134, 2.426). Regarding cognitive impairment, compared to Group 1, Group 3 (RR = 1.662; 95 % CI: 1.073, 2.576) and Group 4 (RR = 2.138; 95 % CI: 1.399, 3.8) exhibited increased risks. Additionally, subgroup analysis showed additive interaction for cognitive impairment was significant only in males.</div></div><div><h3>Conclusions</h3><div>Limited ADL and low PR jointly increase the risks of cognitive impairment and all-cause mortality in Chinese older adults, with a synergistic additive interaction observed for all-cause mortality.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106047"},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Persistent inflammation is a key factor in the development of chronic pain, as diet can modulate inflammation, it may influence the risk of chronic pain risk. Pro-inflammatory dietary patterns—characterized by higher Dietary Inflammatory Index (DII) scores, indicating dietary patterns that promote systemic inflammation—may be particularly relevant. The impact of diet on inflammation and pain may vary by individual factors such as sex, age, and psychological status. This study examined this association with a particular focus on sex differences.
Methods
This cross-sectional study used baseline data from the Itabashi Longitudinal Study on Aging, a cohort of community-dwelling older adults in Tokyo. The DII was derived from dietary data collected via a self-administered diet survey. Binary logistic regression analysis was performed with sex and DII quartile interaction terms as exposure variables and chronic pain (pain lasting ≥three months) as outcome, adjusted for age, overweight, educational level, and smoking status.
Results
Using men in the lowest DII quartile as the reference group, women had significantly higher odds ratios (OR) for chronic pain across all DII quartiles (first, OR: 1.69, 95% CI: 1.16–2.46; second, OR: 1.84, 95% CI: 1.27–2.67; third, OR: 1.64, 95% CI: 1.12–2.40; and fourth, OR: 2.51, 95% CI: 1.73–3.66).
Conclusions
Our findings suggest that the association between a pro-inflammatory diet, as reflected by higher DII scores, and chronic pain may differ by sex and that systemic inflammation may be involved. These findings underscore the need for sex-specific dietary strategies to manage chronic pain.
{"title":"Association between pro-inflammatory dietary patterns and chronic pain in community-dwelling older adults: A cross-sectional study","authors":"Junji Nishimoto , Naoki Deguchi , Sho Hatanaka , Takashi Shida , Takahisa Ohta , Narumi Kojima , Maki Shirobe , Keiko Motokawa , Hirohiko Hirano , Tsuyoshi Okamura , Shuichi Awata , Hiroyuki Sasai","doi":"10.1016/j.archger.2025.106035","DOIUrl":"10.1016/j.archger.2025.106035","url":null,"abstract":"<div><h3>Background</h3><div>Persistent inflammation is a key factor in the development of chronic pain, as diet can modulate inflammation, it may influence the risk of chronic pain risk. Pro-inflammatory dietary patterns—characterized by higher Dietary Inflammatory Index (DII) scores, indicating dietary patterns that promote systemic inflammation—may be particularly relevant. The impact of diet on inflammation and pain may vary by individual factors such as sex, age, and psychological status. This study examined this association with a particular focus on sex differences.</div></div><div><h3>Methods</h3><div>This cross-sectional study used baseline data from the Itabashi Longitudinal Study on Aging, a cohort of community-dwelling older adults in Tokyo. The DII was derived from dietary data collected via a self-administered diet survey. Binary logistic regression analysis was performed with sex and DII quartile interaction terms as exposure variables and chronic pain (pain lasting ≥three months) as outcome, adjusted for age, overweight, educational level, and smoking status.</div></div><div><h3>Results</h3><div>Using men in the lowest DII quartile as the reference group, women had significantly higher odds ratios (OR) for chronic pain across all DII quartiles (first, OR: 1.69, 95% CI: 1.16–2.46; second, OR: 1.84, 95% CI: 1.27–2.67; third, OR: 1.64, 95% CI: 1.12–2.40; and fourth, OR: 2.51, 95% CI: 1.73–3.66).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that the association between a pro-inflammatory diet, as reflected by higher DII scores, and chronic pain may differ by sex and that systemic inflammation may be involved. These findings underscore the need for sex-specific dietary strategies to manage chronic pain.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106035"},"PeriodicalIF":3.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.archger.2025.106034
Juan Gu , Yufei Qiu , Jiali Liu , Yake Yue , Mengjie Tong , Lijuan Zeng , Yiqing Yu , Fen Yang
Objective
This study aimed to explore the prevalence and influencing factors of digital smart devices (DSDs) use among older adults from a global perspective.
Methods
Systematic searches were conducted on four databases including Pubmed, Cochrane Library, Web of Science, and Embase from January 1, 2011 to April 16, 2025. Two researchers performed a thorough literature search, gathered data, and independently evaluated the quality of the articles. Subgroups, sensitivity, and meta-regression analyses were performed to address heterogeneity. Publication bias was evaluated using funnel plots and Egger’s test.
Results
After screening 36,405 articles, we included 39 studies encompassing 528,721 participants. The pooled prevalence of DSDs use among older adults was 0.47 (95 % CI: 0.39-0.54; p < 0.001). A higher educational attainment (OR = 2.00; 95 % CI: 1.14-3.51; p < 0.05) and a more positive attitude (OR = 2.37; 95 % CI: 1.16-4.83; p < 0.05) were associated with a significantly increased likelihood of DSDs use among older adults. However, a higher age (OR = 0.85; 95 % CI: 0.73-0.99; p < 0.05) was associated with a significantly reduced use of DSDs among older adults. A total of 13 other factors for DSDs use were identified through qualitative synthesis.
Conclusion
The prevalence of DSDs use among older adults is moderate and influenced by multiple factors, including age, education and attitude towards use
目的从全球角度探讨老年人数字智能设备（dsd）的使用情况及其影响因素。方法系统检索2011年1月1日至2025年4月16日Pubmed、Cochrane Library、Web of Science、Embase 4个数据库。两位研究人员进行了彻底的文献检索，收集了数据，并独立评估了文章的质量。进行亚组、敏感性和元回归分析以解决异质性。采用漏斗图和Egger检验评价发表偏倚。在筛选了36,405篇文章后，我们纳入了39项研究，涉及528,721名参与者。老年人使用dsd的总患病率为0.47 （95% CI: 0.39-0.54; p < 0.001）。较高的教育程度（OR = 2.00; 95% CI: 1.14-3.51; p < 0.05）和更积极的态度（OR = 2.37; 95% CI: 1.16-4.83; p < 0.05）与老年人使用dsd的可能性显著增加相关。然而，较高的年龄（OR = 0.85; 95% CI: 0.73-0.99; p < 0.05）与老年人使用dsd的显著减少相关。通过定性综合，共确定了13个影响dsd使用的其他因素。结论老年人dsd的使用程度适中，受年龄、文化程度和使用态度等多种因素的影响
{"title":"Prevalence and influencing factors of digital smart devices use among older adults: a systematic review and meta-analysis","authors":"Juan Gu , Yufei Qiu , Jiali Liu , Yake Yue , Mengjie Tong , Lijuan Zeng , Yiqing Yu , Fen Yang","doi":"10.1016/j.archger.2025.106034","DOIUrl":"10.1016/j.archger.2025.106034","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to explore the prevalence and influencing factors of digital smart devices (DSDs) use among older adults from a global perspective.</div></div><div><h3>Methods</h3><div>Systematic searches were conducted on four databases including Pubmed, Cochrane Library, Web of Science, and Embase from January 1, 2011 to April 16, 2025. Two researchers performed a thorough literature search, gathered data, and independently evaluated the quality of the articles. Subgroups, sensitivity, and meta-regression analyses were performed to address heterogeneity. Publication bias was evaluated using funnel plots and Egger’s test.</div></div><div><h3>Results</h3><div>After screening 36,405 articles, we included 39 studies encompassing 528,721 participants. The pooled prevalence of DSDs use among older adults was 0.47 (95 % CI: 0.39-0.54; <em>p</em> < 0.001). A higher educational attainment (OR = 2.00; 95 % CI: 1.14-3.51; <em>p</em> < 0.05) and a more positive attitude (OR = 2.37; 95 % CI: 1.16-4.83; <em>p</em> < 0.05) were associated with a significantly increased likelihood of DSDs use among older adults. However, a higher age (OR = 0.85; 95 % CI: 0.73-0.99; <em>p</em> < 0.05) was associated with a significantly reduced use of DSDs among older adults. A total of 13 other factors for DSDs use were identified through qualitative synthesis.</div></div><div><h3>Conclusion</h3><div>The prevalence of DSDs use among older adults is moderate and influenced by multiple factors, including age, education and attitude towards use</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106034"},"PeriodicalIF":3.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.archger.2025.106031
Li Feng Tan , Alicia Le How , Xin Xiang Lee , Benjamin Y.Q. Tan , Yee Wei Lim , Leonard Lee , Shuna S. Khoo , Lile Jia , Reshma A Merchant , on behalf of the Health District at Queenstown
Background
Intrinsic capacity (IC) is central to the World Health Organization’s life course approach to healthy ageing. Population-level data across the lifespan remain limited. This study aimed to assess the prevalence of IC deficits and to identify sociodemographic, clinical, and lifestyle factors associated with these deficits in a nationally representative community cohort in Singapore.
Methods
Cross-sectional survey of adults aged ≥21 years in the Queenstown Study. IC was assessed using a modified WHO ICOPE Step 1 screening approach. Sociodemographic and health data were collected.
Results
Among 4274 participants, 29.2 % had ≥1 IC deficit; prevalence rose stepwise with age from 10.3 % (20–39 years) to 19.1 % (40–59), 45.0 % (60–79) and 74.5 % (≥80 years). Locomotion (16.8 %) and sensory (11.4 %) deficits were most common. In multivariable analysis, IC deficits were associated with older age (OR 1.05 per year, 95 % CI 1.04–1.06, p < 0.001), female sex (OR 1.19, 95 % CI 1.01–1.40, p = 0.037), underweight (OR 1.61, 95 % CI 1.18–2.20, p = 0.003), and obesity (OR 1.36, 95 % CI 1.07–1.71, p = 0.011), frailty (OR 10.94, 95 % CI 3.57–48.14, p < 0.001), impaired instrumental ADLs (OR 3.93, 95 % CI 2.11–7.84, p < 0.001), low handgrip strength (OR 1.68, 95 % CI 1.43–1.97, p < 0.001), diabetes (OR 1.45, 95 % CI 1.12–1.87, p = 0.004), and social isolation (OR 1.23, 95 % CI 1.04–1.45, p = 0.014). Higher quality of life was protective (OR 0.84, 95 % CI 0.80–0.89, p < 0.001).
Conclusion
IC deficits were prevalent even in midlife and linked to modifiable factors. These findings support the need for early, multidomain interventions to preserve function and promote healthy ageing across adulthood.
内在能力（IC）是世界卫生组织健康老龄化的生命过程方法的核心。整个生命周期的人口数据仍然有限。本研究旨在评估新加坡具有全国代表性的社区队列中IC缺陷的患病率，并确定与这些缺陷相关的社会人口统计学、临床和生活方式因素。方法对Queenstown研究中年龄≥21岁的成年人进行横断面调查。使用改进的WHO ICOPE第1步筛查方法评估IC。收集了社会人口和健康数据。结果4274名受试者中，29.2%存在≥1个IC缺陷；随着年龄的增长，患病率从10.3%（20-39岁）逐渐上升到19.1%（40-59岁）、45.0%（60-79岁）和74.5%（≥80岁）。运动障碍（16.8%）和感觉障碍（11.4%）最为常见。在多变量分析中,IC赤字与老年有关(或每年1.05,95%可信区间1.04 - -1.06,p & lt; 0.001),女性性(或1.19,95%可信区间1.01 - -1.40,p = 0.037),体重不足(或1.61,95%可信区间1.18 - -2.20,p = 0.003),和肥胖(或1.36,95%可信区间1.07 - -1.71,p = 0.011),虚弱(或10.94,95%可信区间3.57 - -48.14,p & lt; 0.001),仪器ADLs受损(或3.93,95%可信区间2.11 - -7.84,p & lt; 0.001),低握力(或1.68,95%可信区间1.43 - -1.97,p & lt; 0.001)、糖尿病(或1.45,95% CI 1.12-1.87, p = 0.004)和社会孤立（OR 1.23, 95% CI 1.04-1.45, p = 0.014）。较高的生活质量具有保护作用（OR 0.84, 95% CI 0.80-0.89, p < 0.001）。结论：即使在中年人中，视力缺陷也很普遍，并与可改变的因素有关。这些发现支持早期多领域干预的必要性，以保持功能并促进整个成年期的健康老龄化。
{"title":"Intrinsic capacity deficits across the lifespan in a nationally representative community cohort: findings from the Queenstown study","authors":"Li Feng Tan , Alicia Le How , Xin Xiang Lee , Benjamin Y.Q. Tan , Yee Wei Lim , Leonard Lee , Shuna S. Khoo , Lile Jia , Reshma A Merchant , on behalf of the Health District at Queenstown","doi":"10.1016/j.archger.2025.106031","DOIUrl":"10.1016/j.archger.2025.106031","url":null,"abstract":"<div><h3>Background</h3><div>Intrinsic capacity (IC) is central to the World Health Organization’s life course approach to healthy ageing. Population-level data across the lifespan remain limited. This study aimed to assess the prevalence of IC deficits and to identify sociodemographic, clinical, and lifestyle factors associated with these deficits in a nationally representative community cohort in Singapore.</div></div><div><h3>Methods</h3><div>Cross-sectional survey of adults aged ≥21 years in the Queenstown Study. IC was assessed using a modified WHO ICOPE Step 1 screening approach. Sociodemographic and health data were collected.</div></div><div><h3>Results</h3><div>Among 4274 participants, 29.2 % had ≥1 IC deficit; prevalence rose stepwise with age from 10.3 % (20–39 years) to 19.1 % (40–59), 45.0 % (60–79) and 74.5 % (≥80 years). Locomotion (16.8 %) and sensory (11.4 %) deficits were most common. In multivariable analysis, IC deficits were associated with older age (OR 1.05 per year, 95 % CI 1.04–1.06, <em>p</em> < 0.001), female sex (OR 1.19, 95 % CI 1.01–1.40, <em>p</em> = 0.037), underweight (OR 1.61, 95 % CI 1.18–2.20, <em>p</em> = 0.003), and obesity (OR 1.36, 95 % CI 1.07–1.71, <em>p</em> = 0.011), frailty (OR 10.94, 95 % CI 3.57–48.14, <em>p</em> < 0.001), impaired instrumental ADLs (OR 3.93, 95 % CI 2.11–7.84, <em>p</em> < 0.001), low handgrip strength (OR 1.68, 95 % CI 1.43–1.97, <em>p</em> < 0.001), diabetes (OR 1.45, 95 % CI 1.12–1.87, <em>p</em> = 0.004), and social isolation (OR 1.23, 95 % CI 1.04–1.45, <em>p</em> = 0.014). Higher quality of life was protective (OR 0.84, 95 % CI 0.80–0.89, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>IC deficits were prevalent even in midlife and linked to modifiable factors. These findings support the need for early, multidomain interventions to preserve function and promote healthy ageing across adulthood.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106031"},"PeriodicalIF":3.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.archger.2025.106033
Fei Wang , Xiang Shang , Weiran Li , Meixia Wang , Fei Li
Background
With China's aging population, cognitive impairment has become a pressing public health issue. Rural older adults face disproportionately higher risks, yet remain underrepresented in predictive modeling studies. This study aimed to develop and externally validate a nomogram to estimate cognitive impairment risk among rural older adults in China.
Methods
Data were obtained from 2228 rural participants aged ≥60 years in the 2011 China Health and Retirement Longitudinal Study (CHARLS), randomly assigned to training and internal validation cohorts. An additional 1854 rural participants from the 2013 CHARLS wave served as an external validation set. Feature selection was conducted using the least absolute shrinkage and selection operator (LASSO), followed by multivariable logistic regression to identify independent predictors. A nomogram was constructed, with model performance evaluated through ROC curves, calibration plots, and decision curve analysis (DCA).
Results
Six predictors—age, education, alcohol consumption, systolic blood pressure, handgrip strength, and depressive symptoms—were included in the final nomogram. The model achieved AUCs of 0.849 (training), 0.852 (internal validation), and 0.806 (external validation), indicating strong discriminative ability. Calibration showed good agreement between predicted and observed outcomes. DCA demonstrated favorable clinical utility across all cohorts.
Conclusion
The nomogram exhibited strong predictive performance and generalizability, offering a cost-effective and practical tool for early identification of cognitive impairment in underserved rural populations in China.
{"title":"Time-stratified modeling of cognitive impairment risk in rural aging populations: Nomogram development (2011) and external validation (2013) using CHARLS","authors":"Fei Wang , Xiang Shang , Weiran Li , Meixia Wang , Fei Li","doi":"10.1016/j.archger.2025.106033","DOIUrl":"10.1016/j.archger.2025.106033","url":null,"abstract":"<div><h3>Background</h3><div>With China's aging population, cognitive impairment has become a pressing public health issue. Rural older adults face disproportionately higher risks, yet remain underrepresented in predictive modeling studies. This study aimed to develop and externally validate a nomogram to estimate cognitive impairment risk among rural older adults in China.</div></div><div><h3>Methods</h3><div>Data were obtained from 2228 rural participants aged ≥60 years in the 2011 China Health and Retirement Longitudinal Study (CHARLS), randomly assigned to training and internal validation cohorts. An additional 1854 rural participants from the 2013 CHARLS wave served as an external validation set. Feature selection was conducted using the least absolute shrinkage and selection operator (LASSO), followed by multivariable logistic regression to identify independent predictors. A nomogram was constructed, with model performance evaluated through ROC curves, calibration plots, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>Six predictors—age, education, alcohol consumption, systolic blood pressure, handgrip strength, and depressive symptoms—were included in the final nomogram. The model achieved AUCs of 0.849 (training), 0.852 (internal validation), and 0.806 (external validation), indicating strong discriminative ability. Calibration showed good agreement between predicted and observed outcomes. DCA demonstrated favorable clinical utility across all cohorts.</div></div><div><h3>Conclusion</h3><div>The nomogram exhibited strong predictive performance and generalizability, offering a cost-effective and practical tool for early identification of cognitive impairment in underserved rural populations in China.</div></div>","PeriodicalId":8306,"journal":{"name":"Archives of gerontology and geriatrics","volume":"140 ","pages":"Article 106033"},"PeriodicalIF":3.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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