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Regenerative therapies are increasingly integrated into modern rehabilitation medicine. Extracorporeal shock wave therapy (ESWT) represents a central modality within this framework, extending beyond symptom control toward enabling functional recovery across disciplines including occupational medicine, geriatrics, and oncology. In addition, its potential socioeconomic impact is of growing relevance. This work comprises a narrative synthesis integrating concepts of regenerative medicine, rehabilitation, prehabilitation, prevention, and health economics, with a focus on ESWT as a mechanotherapeutic intervention. Rehabilitation is based on a biopsychosocial model targeting body functions, activities, and participation. By reducing pain, modulating inflammation, and promoting tissue regeneration, ESWT acts as a biological "enabler" thereby, facilitating active rehabilitation strategies. In oncological settings, ESWT may support the management of treatment-related functional impairments. In occupational medicine and geriatrics, it contributes to maintaining ability to work and independence. From a socioeconomic perspective, ESWT may reduce healthcare utilization, prevent chronicity, shorten the duration of rehabilitation, and facilitate return to work, thereby lowering indirect costs. While evidence for primary prevention is lacking, ESWT is relevant in tertiary and quaternary prevention. Extracorporeal shock wave therapy represents a key component of regenerative rehabilitation strategies. Its function-oriented and potentially cost-effective application enhances mobility, participation, and quality of life, particularly in ageing and multimorbid populations. HINTERGRUND: Regenerative Therapien werden zunehmend in die moderne Rehabilitationsmedizin integriert. Die extrakorporale Stoßwellentherapie (ESWT) stellte eine zentrale Modalität in diesem Rahmen dar, sie erstreckt sich über die reine Symptomkontrolle hinaus auf die Ermöglichung der funktionellen Genesung über verschiedene Fachgebiete hinweg einschließlich Arbeitsmedizin, Geriatrie und Onkologie. Außerdem ist ihr Potenzial für sozioökonomische Auswirkungen von zunehmender Relevanz. Die vorliegende Arbeit umfasst eine narrative Synthese integrativer Konzepte der regenerativen Medizin, Rehabilitation, Prähabilitation, Prävention und Gesundheitsökonomie; der Fokus liegt dabei auf der ESWT als einer mechanotherapeutischen Intervention. Rehabilitation basiert auf einem biopsychosozialen Modell, das auf Körperfunktionen, Aktivitäten und Teilhabe abzielt. Durch Schmerzlinderung, Beeinflussung von Entzündungsprozessen und Förderung der Geweberegeneration wirkt die ESWT wie ein biologischer „Wegbereiter“, der so aktive Rehabilitationsstrategien erleichtert. In onkologischen Zusammenhängen kann die ESWT die Behandlung therapiebedingter funktioneller Beeinträchtigungen unterstützen. In der Arbeitsmedizin und der Geriatrie trägt sie zur Erhaltung der Arbeitsfähigkeit und Unabhängigkeit bei. Aus sozioökonomischer Sicht kann die ESWT die Inanspruchnahme des Gesundheitswesens vermindern, einer Chronifizierung vorbeugen, die Dauer der Rehabilitation verkürzen und die Rückkehr ins Berufsleben erleichtern und somit die indirekten Kosten senken. Es fehlt zwar noch Evidenz für die Primärprävention, aber in der Tertiär- und Quartärprävention ist die ESWT relevant. Die ESWT stellt eine Schlüsselkomponente der regenerativen Rehabilitationsstrategien dar. Ihre funktionsorientierte und potenziell kostengünstige Anwendung fördert die Mobilität, Teilhabe und Lebensqualität, insbesondere in alternden und multimorbiden Populationen.
Chronic insomnia disorder (INS) is particularly prevalent in older adults and females. Sex- and age-related differences in neurophysiological markers of sleep quality (sleep spindles and slow-wave activity [SWA]) may underlie differential vulnerability to INS. This study investigated the effects of sex and chronic insomnia disorder on spindle and SWA beyond aging, to better understand the mechanistic differences contributing to the higher prevalence of INS in females. After a habituation night, one night of sleep assessed with polysomnography was analyzed in 222 adults (aged 18-82) including 119 INS (71% female) and 103 healthy sleepers (HS; 61% female). Spindle density, slow oscillation (SO) density, relative sigma power and SWA were derived during NREM sleep. Age, group, sex, and group-by-sex interactions were examined, with age as a covariate. Age, INS, and sex each contributed uniquely to NREM oscillatory activity. INS primarily reduced spindle and SO density, while sex accounted for differences in SWA. While SWA was higher in females overall, sex differences were not significant within the INS or HS groups. Female INS reported highest rates of insomnia severity as well as lower sigma power than males in the INS group. Spindle and SO density deficits were also present in female INS relative to female HS, as well as male INS relative to male HS. The combination of reduced sigma power in females with chronic insomnia disorder relative to their male counterparts, as well as less spindle and SO density compared to female healthy sleepers may contribute to greater insomnia severity in females.
The rapid expansion of plasma proteomic data and protein quantitative trait loci (pQTLs) provides an opportunity to identify genes that confer disease risk through their effect on plasma protein abundance. We conducted an Alzheimer's disease (AD) proteome-wide association study (PWAS) integrating publicly available plasma cis-pQTL data (1348 European American and 1385 African American genetically determined protein models) with AD dementia GWAS summary statistics. Whereas the African American PWAS identified one candidate [apolipoprotein E (APOE)] and multiple suggestive genes, the European American PWAS identified 18 genes with putative causal relationships with AD through cis regulation of plasma protein abundance. Thirteen of these candidate genes were additionally supported by colocalization and complementary causal-inference analyses such as summary data-based Mendelian randomization. Four of these proteins were not previously detected in AD GWAS [complement decay-accelerating factor (CD55), leukocyte immunoglobulin-like receptor B1 (LILRB1), scavenger receptor class A member 5 (SCARA5), and signal regulatory protein alpha (SIRPA)]. A subset of candidate gene-associated proteins was associated with 8- and 20-year dementia risk, markers of AD pathology, and a CSF proteomic signature enriched for immune and metabolic processes. Putative causal proteins were enriched for adaptive (lymphocyte-mediated) immunity and, compared with GWAS candidates, showed less enrichment for synaptic and amyloid regulatory processes. LILRB1 and SIRPA, two immunoregulatory proteins not previously implicated in AD GWAS, showed the strongest mechanistic link to AD in the European American PWAS. These results shed additional light on AD etiology and enable the prioritization of potential AD therapeutic targets in peripheral circulation.
Acute kidney injury (AKI) is a frequent condition among patients presenting to the emergency department (ED). Obstructive AKI constitutes a urological emergency requiring rapid diagnosis and intervention. The objective of this study was to derive and internally validate a predictive model of obstructive AKI in ED. We conducted a retrospective derivation and internal validation cohort study. Adult patients presenting to the EDs of Toulouse University Hospital with AKI of any Kidney Disease: Improving Global Outcomes (KDIGO) stage between 1 July and 31 December 2019 were eligible. Included patients were randomly assigned in a 2:1 ratio to a derivation cohort (DC) and an internal validation cohort (VC). The primary outcome was obstructive AKI, defined as hydronephrosis identified on imaging and requiring either urological intervention or Foley catheter insertion. A risk stratification decision tree was developed (Kidney Injury Tree For Identification of obSTructive Origin (KIT-FISTO) model). The prevalence of obstructive AKI was 9% in the DC (64/727) and 7% in the VC (27/364). Patients presenting with lumbar, flank or hypogastric pain were classified as 'high risk' in each cohort, with a corresponding obstructive AKI risk of 55% (95% CI 45% to 64%) and 54% (95% CI 39% to 69%), respectively. Patients without pain but with a history of urinary tract surgery, abdominal cancer, a solitary functional kidney or prostatic hyperplasia were classified as 'moderate risk', with obstructive AKI risks of 4% (95% CI 1% to 10%) and 2% (95% CI 0% to 12%), respectively. All remaining patients (>70%) were classified as 'low risk', with an observed obstructive AKI risk of 0% (95% CI 0% to 1%). 'Low risk' classification had a sensitivity of 98% (95% CI 92% to 100%) and 96% (95% CI 81% to 100%), respectively. The KIT-FISTO was derived and internally validated to predict obstructive AKI in ED, but requires external and prospective validation before implementation.
Guidelines recommend fluoroquinolones or cotrimoxazole for urinary tract infections in men (UTIm), but safety data in frail older patients remain limited. The aim of this study was to compare the tolerability of these antibiotics in UTIm patients over age 75 years. This multicenter retrospective study included patients age ≥75 years who were hospitalized for UTIm in 8 hospitals and treated with oral fluoroquinolone or cotrimoxazole. Adverse events (AEs) during hospitalization were compared. Among 228 patients (median age, 85 years), 131 (57.4%) received fluoroquinolones and 97 (42.6%) cotrimoxazole. Baseline characteristics were similar. AEs occurred in 29.7% of fluoroquinolone-treated patients vs 48.5% treated with cotrimoxazole (P = .006), leading to treatment discontinuation in 2.3% vs 11.3% (P = .009). Acute kidney injury was observed in 7.2% vs 29.4% (P < .001), metabolic disorders in 7.6% vs 18.6% (P = .023). Other AEs and mortality did not differ significantly. Cotrimoxazole was associated with a doubled risk of AEs (adjusted odds ratio, 2.10; 95% CI, 1.18-3.74; P = .01). These results suggest a better safety profile of fluoroquinolones than cotrimoxazole in the treatment of UTI in older men. These results need to be confirmed in a prospective design.
Fluid assessment in geriatric inpatients is challenging, as clinical signs are often unreliable. Inferior vena cava (IVC) ultrasound provides a rapid, noninvasive estimation of intravascular volume. Teleguided point-of-care ultrasound (POCUS) allows examiners without prior ultrasound experience to perform scans under real-time supervision. This study aimed to evaluate the feasibility, accuracy, efficiency, and user satisfaction of remote-guided IVC ultrasound performed by medical students and nurses without prior ultrasound experience in a geriatric inpatient setting. This prospective feasibility study was conducted between February and March 2025 in a geriatric inpatient ward at a German tertiary care hospital. Thirty hospitalized geriatric patients were recruited using a pragmatic convenience sampling approach on predefined study days. Each patient underwent 2 IVC ultrasound examinations (n=60) using a handheld device with TeleGuidance; one was performed by a medical student and one by a nurse. All scans were remotely supervised by an ultrasound-experienced cardiologist, who subsequently performed a third, independent IVC scan on each patient, serving as the reference standard. Examiners were 2 final-year medical students and 2 nurses, all without ultrasound experience, each performing 15 scans. Primary outcomes were technical feasibility (successful teleguidance connection), accuracy of IVC diameter measurement (≥80% within +2 mm to -2 mm), and examination duration (≤10 minutes). The secondary outcome was user satisfaction (≥75 on a 0-100 numeric rating scale). Connectivity and remote supervision were consistently stable, enabling completion of all scans (feasibility 100%). IVC visualization was successful in 90% (27/30) of cases. Accuracy was achieved in 80% (48/60; 95% CI 67-88) of scans. Mean duration was 3.3 (SD 2.0) minutes. Mean user satisfaction was 89%, with all ratings ≥85%. Telemedicine-guided IVC ultrasound was feasible and well accepted in this geriatric inpatient setting. Nonexpert examiners were able to obtain clinically usable measurements under remote supervision within a few minutes after minimal training. These findings suggest that teleguided POCUS is a promising approach to support task sharing in geriatric care. Further studies are needed to confirm these results and to evaluate integration into clinical practice. German Clinical Trials Register DRKS00035821; https://www.drks.de/search/de/trial/DRKS00035821/details.
Mobile geriatric teams visit patients in their homes to provide multidisciplinary expertise to an aging population. The work of specialized geriatric nurse coordinators is central to these teams but remains little known. We sought to describe the specific features of geriatric home assessments conducted by our nurse coordinators in practice, analyze them, and contextualize them within the literature to raise awareness of them.
Total intracranial volume (TIV) is a major confounding factor in neuroimaging studies, particularly when studying sex differences in the brain. Different methods have been proposed to adjust for this effect; however, their impact has not been directly studied and compared. Furthermore, when studying cortical metrics at the vertex level, the choice of smoothing level can impact analysis outcomes which can in turn impact the degree of TIV-based biases and the effectiveness of the correction methods. In this study, we sought to evaluate the impact of four most commonly used adjustment methods in the literature on the estimations of neuroanatomical sex differences. These methods included the proportions method, the residuals method, the power-corrected proportions method, and adding TIV as a covariate in a regression analysis. Leveraging data from the UK Biobank, we employed a matching approach to devise a gold standard as reference for comparing TIV correction methods. To achieve this, we matched the male and female participants based on age and TIV to remove the impact of TIV differences between sexes. We further modeled aging trajectories at the regional level, vertexwise using data with different smoothing levels, and voxelwise, using raw and adjusted values, and compared the obtained estimates against the gold standard. We found that across different metrics, adding TIV as a covariate was the best-performing method for removing the effect of TIV, in terms of the correlation between the estimates of the different subsamples and the gold standard as well as the degree of estimation bias. Furthermore, we showed that the commonly used smoothing of the morphometric measures can result in biased estimation of sex differences in these measures. Finally, we showed that while small in effect size, there still remains some neuroanatomically specific uncorrected effects for all adjustment methods.
Cognitive impairment is an important comorbidity of chronic heart failure (CHF) and may be associated with major complications. Despite ongoing advances in research and clinical management, early identification and prevention of cognitive impairment remain challenging. This study aims to provide a comprehensive description of the cognitive profile of participants with CHF using baseline data from the Effects of Individualized Cognitive Training on Cognition in Heart Failure (SYNAPSE) trial. A total of 53 participants with CHF (aged, mean [ ± standard deviation] 68.58 ± 9.26 years; 54.7% men; 64% with heart failure with reduced ejection fraction, with a left ventricular ejection fraction of 32.43%) were approached and agreed to participate in the SYNAPSE trial. They underwent a remote baseline neuropsychological assessment of global cognition, working and short-term memory, episodic memory, executive functioning, and abstraction ability. Scores were computed in standardized z-scores that consider age, sex, and education, based on normative data. A total of 68% of participants had impairment (-1.5 standard deviations from the population norms) in at least one cognitive domain. Episodic memory and executive functioning were mainly affected. Among those with no impairment, 26% of participants presented scores that fell within the low average range of the population (-0.66 standard deviations). No cognitive differences were observed between men and women, or between different CHF phenotypes. The results underline the importance of neuropsychological assessment in CHF patients. Mild cognitive impairment in CHF patients is prevalent, but even more patients are susceptible to subclinical cognitive weakness. Prevention and treatment of these deficits are of major importance for optimal disease management. NCT05223426. Les troubles cognitifs constituent une comorbidité importante de l'insuffisance cardiaque chronique et peuvent être associés à des complications majeures. Malgré les progrès continus de la recherche et de la prise en charge clinique, le dépistage précoce et la prévention de ces troubles cognitifs restent difficiles. Cette étude vise à fournir une description complète du profil cognitif des participants atteints d'insuffisance cardiaque chronique à partir des données de base de l'essai SYNAPSE. Cinquante-trois participants atteints d'insuffisance cardiaque chronique (âge [± écart-type médian] 68,58 ± 9,26; 54,7 % d'hommes; 64 % avec insuffisance cardiaque à fraction d'éjection réduite avec une fraction d'éjection du ventricule gauche de 32,43 %) ont été approchés et ont accepté de participer à l'essai SYNAPSE. Ils ont participé à une évaluation neuropsychologique à distance de leur cognition globale, de leur mémoire de travail et à court terme, de leur mémoire épisodique, de leurs fonctions exécutives et de leur capacité d'abstraction. Les scores ont été calculés sous forme de scores z standardisés tenant compte de l'âge, du sexe et du niveau d'éducation, sur la base de données normatives. Soixante-huit pour cent des participants présentaient une déficience (-1,5 écart-type par rapport aux normes populationnelles) dans au moins un domaine cognitif. La mémoire épisodique et les fonctions exécutives étaient principalement affectées. Parmi les participants ne présentant aucun trouble, 26 % ont obtenu des scores se situant dans la moyenne basse de la population (-0,66 écart-type). Aucune différence cognitive n'a été observée entre les hommes et les femmes, ni entre les différents phénotypes d'insuffisance cardiaque chronique. Les résultats soulignent l'importance de l'évaluation neuropsychologique chez les patients atteints d'insuffisance cardiaque chronique. Les troubles cognitifs légers sont fréquents chez les patients atteints d'insuffisance cardiaque chronique, mais un nombre encore plus important de patients sont susceptibles de présenter une faiblesse cognitive sublinique. La prévention et le traitement de ces déficits sont d'une importance capitale pour une prise en charge optimale de la maladie. NCT05223426.
Females consistently demonstrate greater tau Positron Emission Tomography (PET) tracer signal. Although interpreted as reflecting greater Alzheimer disease (AD) pathology, it's unclear whether differences arise from biological mechanisms or methodological factors. Microtubule binding region tau species containing residue 243 (MTBR-tau243) in cerebrospinal fluid (CSF) is a biomarker of aggregated tau but avoids PET limitations such as off-target binding. Comparing tau-PET and CSF MTBR-tau243, including sex interactions, can help elucidate the origin of sex differences in tau. Conduct a cross-sectional analysis of CSF MTBR-tau243 and tau-PET by sex in the Swedish BioFINDER-2 (BioFINDER-2) Study and Charles F. and Joanne Knight Alzheimer Disease Research Center (Knight-ADRC). Participants had CSF MTBR-tau243, tau-PET, and Aβ status defined by the CSF Aβ42/40 ratio. Tau-PET was measured using [18F]Flortaucipir (Knight-ADRC, N = 219) and [18F]RO948 (BioFINDER-2, N = 446). We tested the interaction between sex and CSF MTBR-tau243 on tau-PET burden in a temporal meta region-of-interest (ROI) across all participants and in Aβ-positive participants. In both cohorts, CSF MTBR-tau243 was associated with tau-PET temporal meta-ROI burden (BioFINDER-2: β = 1.1, p = < 0.0001 and Knight-ADRC: β = 0.7, p = < 0.0001), and this association did not differ by sex (BioFINDER-2 β = 0.04, p = 0.6 and Knight-ADRC: β = 0.009, p = 0.9). Among Aβ-positive subgroups, results remained consistent for the main effect (BioFINDER-2: β = 1.1, p = < 0.0001 and Knight-ADRC: β = 0.7, p = < 0.0001) and interaction (BioFINDER-2: β = 0.04, p = 0.7 and Knight-ADRC: β = 0.06, p = 0.6). The lack of sex moderating the association between tau-PET and CSF MTBR-tau243 indicates that higher tau-PET signal in females reflects greater susceptibility to tau pathology rather than a methodological artifact.
Older adults living with type 2 diabetes represent a particularly vulnerable population. We investigated which continuous glucose monitoring (CGM)-derived targets are associated with all-cause mortality in this population. HYPOAGE is prospective multicenter study including 141 insulin-treated older adults living with type 2 diabetes aged 75 and older, under insulin therapy for at least 6 months. All participants underwent standardized geriatric and diabetic assessments and wore an ambulatory blinded CGM (FreeStyle Libre Pro®) for 28 consecutive days. In this ancillary study, multivariable cox regressions were performed to identify factors associated with mortality after adjustment for age, sex, HbA1c, kidney function, geriatric status, and metformin use. At baseline, participants were 81.5 years old on average. After a median follow-up of 44 months, 58 of 141 patients had died. In adjusted model, higher percentages of level 1 time below range (TBR), level 2 TBR and glycemic variability assessed by the coefficient of variation (CV) were independently associated with an increased mortality risk (hazard ratio [95% CI] 1.51 [1.11; 2.06], 1.25 [1.02; 1.53], and 1.76 [1.21; 2.56] for an interquartile range (IQR)% increase of each parameter, respectively). When recommended CGM targets were considered, only glycemic variability (CV ≤ 36%), remained significantly associated with a lower risk of mortality (hazard ratio 0.57 [0.32; 0.99]), whereas TIR > 50% and TBR ≤ 1% were not. Among insulin-treated older adults living with type 2 diabetes, glycemic variability was independently associated with all-cause mortality, highlighting its potential relevance for clinical management in geriatric diabetes care.
Cognitive impairment can affect up to 50% of patients with chronic heart failure (CHF) and is associated with reduced treatment adherence, high mortality rates, and poor quality of life. Nonpharmacologic strategies, including cognitive intervention and physical exercise training, may help enhance cognition in patients with CHF. Recent studies in dementia prevention have shown that combining cognitive and exercise interventions could have synergistic effects on cognition, but scientific evidence for the benefits in CHF patients is lacking. Moreover, how men and women with heart failure may differ in their response to nonpharmacologic interventions is also unknown. This randomized controlled trial will investigate the effects of combining cognitive and exercise training, on cognition and cerebral blood flow regulation in men and women with CHF. To achieve this, 216 participants (50% female) with stable CHF regardless of etiology and left ventricular ejection fraction will be randomized to 1 of the 3 following arms: 1. combined cognitive and exercise training; 2. exercise training alone; 3. usual medical care with standard cardiovascular rehabilitation. The first 2 groups will engage in a 6-month intervention, whereas those in group 3 will take part in a standard 3-month cardiac rehabilitation program. The primary endpoint will be changes in cognitive performance from baseline to 6 months based on 4 cognitive composite scores (global cognitive functioning, memory, executive functions, processing speed). Secondary outcomes will include changes in cerebral blood flow regulation (neurovascular coupling, pulsatility, and autoregulation). Tertiary outcomes will include cardiorespiratory fitness, physical functioning, and quality of life. NCT04970888. Les troubles cognitifs peuvent toucher jusqu'à 50 % des patients atteints d'insuffisance cardiaque chronique (ICC) et sont associés à une observance thérapeutique réduite, à des taux de mortalité élevés et à une mauvaise qualité de vie. Des stratégies non pharmacologiques, incluant des interventions cognitives et des programmes d'entraînement physique, pourraient contribuer à améliorer les fonctions cognitives chez les patients atteints d'ICC. Des études récentes sur la prévention de la démence ont montré que la combinaison d'interventions cognitives et d'exercices physiques pourrait avoir des effets synergiques sur les fonctions cognitives, mais les preuves scientifiques des bénéfices chez les patients atteints d'ICC restent insuffisantes. De plus, on ignore également dans quelle mesure les hommes et les femmes atteints d'IC peuvent réagir différemment aux interventions non pharmacologiques. Cet essai contrôlé randomisé étudiera les effets de la combinaison d'un entraînement cognitif et physique sur les fonctions cognitives et la régulation du flux sanguin cérébral chez les hommes et les femmes atteints d'ICC. Pour ce faire, 216 participants (dont 50 % de femmes) présentant une ICC stable, indépendamment de l'étiologie et de la fraction d'éjection ventriculaire gauche, seront randomisés dans l'un des trois groupes suivants : 1. Entraînement cognitif et physique combiné; 2. Entraînement physique seul; 3. Soins médicaux habituels avec réadaptation cardiovasculaire standard. Les deux premiers groupes participeront à une intervention de 6 mois, tandis que ceux du groupe 3 participeront à un programme standard de réadaptation cardiaque de 3 mois. Le critère d'évaluation principal sera l'évolution des performances cognitives entre le début de l'étude et le sixième mois, sur la base de quatre scores cognitifs composites (fonction cognitive globale, mémoire, fonctions exécutives, vitesse de traitement). Les critères d'évaluation secondaires comprendront les changements dans la régulation du flux sanguin cérébral (couplage neurovasculaire, pulsatilité et autorégulation). Les critères d'évaluation tertiaires comprendront la capacité cardiorespiratoire, la fonction physique et la qualité de vie. NCT04970888.
Mounting evidence shows sex-based differences in sleep experiences and outcomes, including the prevalence of insomnia disorder. However, the impact of biological sex on brain oscillations during sleep remains poorly understood, especially in the context of insomnia disorder. This is a notable gap, given that neurophysiological aspects of sleep are associated with brain health and overall sleep quality. We systematically reviewed and meta-analysed data from studies reporting spindle and slow wave activity in adults with and without insomnia disorder. We conducted systematic searches in PubMed, Embase, Scopus, and PsycInfo. Risk of bias was evaluated using the Newcastle Ottawa and the PEDro scales. Forty-three studies met our inclusion criteria, with thirteen studies of normal sleepers (N = 668) reporting sufficient data for random-effects meta-analyses. Compared with males, female normal sleepers had higher spindle density, sigma and delta power. Most studies recruited individuals with primary insomnia, and data pooling for insomnia and mixed groups was not possible due to insufficient statistical reporting. Moreover, group-by-sex interactions were limited, inconsistent, and varied across studies and sample characteristics. Further research is needed to explore sex-specific differences in sleep microarchitecture and their role in normal sleep and the manifestation of insomnia disorder.
Subjective cognitive decline (SCD) may represent the earliest observable stage of Alzheimer's disease (AD), yet identifying individuals at risk of progressing remains challenging. Cognitive dispersion, or intra-individual variability (IIV-D), may serve as a sensitive early marker. This study examined IIV-D across diagnostic groups, focusing on SCD and amnestic mild cognitive impairment (aMCI) progressors (SCD-p, aMCI-p; progressing to a more advanced disease stage) versus non-progressors (SCD-np, aMCI-np; not progressing to a more advanced stage). We expected greater IIV-D across groups (AD > aMCI > SCD > controls) and in progressors. A total of 308 participants aged 65-94 (67 healthy controls [HC], 126 SCD, 79 aMCI, 36 AD) from the Consortium for the Early Identification of Alzheimer's Disease - Quebec (CIMA-Q) were included. SCD and aMCI participants were followed for up to eight years (34 SCD-p, 92 SCD-np; 29 aMCI-p, 50 aMCI-np). Analyses of covariance assessed baseline across- and verbal memory within-domain IIV-D, maximum discrepancy (MD), and domain-specific deviation. IIV-D increased with disease severity (HC = SCD < aMCI < AD). Among SCD participants, progressors showed greater episodic memory deviation than non-progressors, primarily driven by poorer Logical Memory delayed recall. In aMCI, progressors showed higher IIV-D across all indices (across- and within-domain, IIV-D and MD), with domain-specific differences limited to episodic memory. These findings indicate that IIV-D measures distinguish aMCI progressors from non-progressors, although they do not appear to enhance predictive accuracy for progression to AD and may not yet be a reliable marker at the SCD stage.
Chronic kidney disease (CKD) prevalence increases with age and is frequently associated with geriatric syndromes. These situations may require close collaboration between nephrologists and geriatricians. However, in France, little is known about the current state of such collaborations or the training needs expressed by geriatricians regarding nephrological care for older adults. To identify nephrogeriatric collaborations and geriatricians' wishes for training in this field, a questionnaire was developed by the Action Group in Nephrology of Older Persons (Granpa) of the Société française de gériatrie et gérontologie (SFGG) and was disseminated through its constitutive societies between March and May 2025. Among 252 geriatricians, 89% reported having access to a nephrologist and 37% identified someone to refer to for nephrogeriatric questions. Geriatricians reported referring to nephrologists more frequently than the reverse. The most frequent need of geriatricians was the discussion of care plan for stages 4/5 CKD without prior follow-up. The most frequent reason for referral to geriatricians by nephrologists was neurocognitive disorders, delirium and then shared decision about dialysis. Geriatricians with previous advanced training in nephrology were more frequently involved in shared decision-making process about dialysis. Training in nephrology was desired by 75% of geriatricians, in particular on metabolic, bone and cardiovascular complications of CKD (60%), non-stage 5 CKD (46%) and drug management in renal failure (38%). This survey highlights frequent nephro-geriatric collaborations in France, but also a significant need for geriatrician training, particularly on CKD care.
Chronic spinal pain is associated with fragmented sleep, yet the neurophysiological mechanisms linking the two remain unclear. Given their role in sensory gating and sleep stability, sleep spindles may represent a key mechanism connecting chronic spinal pain and sleep fragmentation. This study examined whether pain intensity over the past 4 weeks was associated with sleep spindle density and related characteristics in individuals with chronic low back or neck pain and chronic insomnia disorder. Data from 120 participants, classified by self-reported pain severity (mild, moderate, severe), were compared on spindle density derived from C4-A1A2 and F4-A1A2 EEG channels. No significant group differences were found in spindle density (respectively, C4: p = 0.372 and F4: p = 0.744). Regression analyses adjusted for age, sex and medication use showed that pain intensity did not significantly predict spindle density (p > 0.05). However, exploratory regression models revealed small but statistically significant associations between pain intensity and both spindle power (p = 0.047) and amplitude (p = 0.038) on the C4 channel. These findings suggest that while spindle density does not vary meaningfully with pain intensity in this clinical population, alterations in spindle power and amplitude may reflect pain-related modulation of thalamocortical activity. This highlights the complexity of pain-sleep interactions in the presence of chronic spinal pain and insomnia. More nuanced, temporally resolved assessments of pain are needed to clarify the dynamic interactions between chronic pain, insomnia, and sleep microarchitecture.