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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.
The International Psychogeriatric Association (IPA) developed a consensus syndromic definition of agitation in neurocognitive disorders. To facilitate adoption of the IPA criteria, we systematically reviewed validated measures of agitation and evaluated alignment with IPA criteria. This review was pre-registered on PROSPERO (CRD42023429494). We searched MEDLINE, EMBASE, and PsycINFO from inception to June 30, 2023 (updated September 9, 2025) using search clusters for 1) neurocognitive disorders; 2) agitation; and 3) psychometric outcomes. Title/abstract screening identified validation studies of agitation scales in neurocognitive disorder samples (e.g., mild cognitive impairment, dementia). Full texts were then reviewed to extract agitation scales. Scale instructions, items, and response fields for each scale were evaluated for alignment with IPA agitation criteria by at least three independent reviewers. We retrieved 2,477 unique search records, of which 2,231 were excluded at title/abstract screening. From the 240 full-text articles, 41 unique agitation scales were identified and evaluated. Across all scales, physical aggression was the most common agitation domain assessed, followed by verbal aggression, and excessive motor activity. The Neuropsychiatric Inventory - Nursing Home demonstrated the greatest combination of IPA agitation domain coverage and alignment. The Cohen-Mansfield Agitation Inventory had a lower-than-expected efficiency score for alignment. The most common reason for low alignment was failing to capture persistence and distress. Numerous agitation scales have been validated in populations with neurocognitive disorders. Few align strongly with the IPA agitation criteria. We provide a comprehensive list of information about validated agitation scales, scale characteristics, and alignment with IPA agitation criteria.
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 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.
This study tested the effect of a new memory training programme to facilitate memory retrieval. The programme improved memory performance in older adults, and its benefits generalised to social problem-solving abilities. Because social problem-solving was not directly trained, these results indicate transfer, highlighting the programme's potential for cognitive training interventions targeting older adults' cognitive health.Trial registration: ClinicalTrials.gov identifier: NCT06110234.
Trapeziometacarpal osteoarthritis (TMO) is among the most prevalent forms of upper extremity osteoarthritis. It is frequently associated with significant levels of pain and disability, particularly among ageing women. The typical care pathway for TMO relies on non-surgical approaches for up to 2 years, before surgery is considered. One of the most common non-surgical approaches is an intra-articular cortisone injection. However, these are not universally recommended due to their safety profile and unclear efficacy compared with saline injections. Recent evidence suggests that saline might be non-inferior to cortisone, but this remains to be clarified. This pilot trial aims to assess the feasibility of a trial examining the non-inferiority of saline compared with cortisone injections for TMO. This trial will recruit 40 adults with a diagnosis of TMO and a prescription for a cortisone injection from the Centre hospitalier de l'Université de Montréal (CHUM), Canada. Participants will be randomised to receive either an intra-articular injection of 0.9% sodium chloride (experimental arm, n=20) or triamcinolone acetonide (standard of care, n=20) under fluoroscopic guidance at the Radiology Department or under ultrasound guidance at the Physiatry Clinic. Opaque syringes will be used to blind participants and physicians. Feasibility outcomes, collected at all time points, will include recruitment rates, follow-up completion rates and blinding indices. Preliminary efficacy outcomes, collected at baseline and at 1 day, 1 month, 3 months and 6 months post-injection, will include pain intensity (0-10 scales), hand function (QuickDASH 11-items), cumulative analgesic consumption scores, concurrent interventions, adverse events and number of participants receiving a second injection or an arthroplasty. Descriptive statistics will be used to present feasibility outcomes. Preliminary data on the effectiveness of saline and cortisone injections will inform the design of a large-scale study for formal hypothesis testing. The trial was approved by the CHUM Human Research Ethics Board (2025-11815). The research output will be presented at conferences and published in a peer-reviewed journal. NCT06401317.
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.
Influenza infection can represent a key factor for functional decline and loss of independence among older adults. In France, over 600,000 seniors live in social institutions, including nursing homes (NH). Yet, real-world data on the place of influenza hospitalization in care pathway before institutionalization are scarce in France. This study described the care pathway of older adults hospitalized for influenza-like illness (ILI) before NH admission. A retrospective observational study based on the French National Health System (SNDS) was conducted. All patients aged ≥ 65 years who were admitted to a NH between the start of the 2018-2019 epidemic season and up to eight months after were identified. Those hospitalized for ILI within six months prior to institutionalization were included and followed for six months prior to and up to three months after NH admission. Demographic and clinical characteristics of patients were described. State sequence analysis (SSA) was used to identify clusters of patients based on healthcare events (e.g. hospitalizations, rehabilitation, and deaths) during follow-up. Among 119,869 NH admissions, 1,239 (1.1%) had prior ILI hospitalization. About 70% of patients had received influenza vaccination. Median age was 88 years; 64.6% were women; over 90% had at least one comorbidity, notably hypertension (75%) and neurodegenerative disorders (31.3%). After ILI-hospitalization, 31.2% of patients were transferred to rehabilitation before NH admission, and 8.4% were admitted directly to NH. SSA identified five patient clusters differing in vaccination rates, comorbidities and healthcare utilization. Cluster 1 and Cluster 2 were generally healthier and admitted to NH immediately after discharge (median 20.5-22.5 days). Cluster 3-5 had more comorbidities and were more frequently transferred to rehabilitation after discharge and before NH admission. The total cost to the French health insurance for these patients exceeded €20 million. Rehabilitation accounted for €9.6 million, ILI hospitalizations €6.0 million, and other hospitalizations (including cardiorespiratory) €4.3 million. This study explored the place of influenza in the care pathway of French older adults admitted to NH after ILI hospitalization. Findings underscore the important place of rehabilitation care following ILI hospitalization, specifically among adults with multiple comorbidities, highlighting the need for improving vaccination coverage among frail older adults to mitigate post‑ILI care burden.
Videogames provide a promising framework to understand brain activity in a rich, engaging, and active environment, in contrast to mostly passive tasks currently dominating the field, such as image viewing. Analyzing videogames neuroimaging data is, however, challenging, and relies on time-intensive manual annotations of game events, based on somewhat arbitrary rules. Here, we introduce an innovative approach using Artificial Neural networks (ANN) and brain encoding techniques to generate activation maps associated with videogame behavior using functional magnetic resonance imaging (fMRI). As individual behavior is highly variable across subjects in complex environments, we hypothesized that ANNs need to account for subject-specific behavior to capture brain dynamics properly. In this study, we used data collected while subjects played Shinobi III: Return of the Ninja Master (an action-platformer released by Sega in 1993), an action-platformer videogame. Using imitation learning, we trained an ANN to play the game while closely replicating the unique gameplay style of individual participants. We found that hidden layers of our imitation learning model successfully encoded task-relevant neural representations, and predicted individual brain dynamics with higher accuracy than models trained on other subjects' gameplay. Individual-specific models also outperformed several baselines to predict brain activity, such as pixel inputs, or button presses. The highest correlations between layer activations and brain signals were observed in biologically plausible brain areas, that is, somatosensory, attention, and visual networks. This work thus demonstrates that subject-specific imitation models can be trained from scratch and improve brain encoding in an active naturalistic task. Our framework builds on a commercial videogame of unprecedented complexity in the fMRI brain encoding literature. We used a flexible game emulator that supports a broad range of commercial videogames, opening new naturalistic interactive environments for cognitive neuroscience.
Polypharmacy is increasingly common across all age groups and is often associated with the use of potentially inappropriate medications (PIMs), where harms may outweigh benefits, contributing to increased adverse drug events, reduced quality of life, and rising health care costs. However, existing deprescribing guidelines and PIM criteria, such as the Beers Criteria and STOPP/START (Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert to Right Treatment), primarily target older adults, overlooking the risks faced by younger populations. This study aims to develop an international consensus-based list of PIMs for adults aged 18 to 65 years through a modified Delphi process, addressing a critical gap in medication safety and deprescribing guidance. A 14-member international steering committee developed a preliminary list of candidate PIMs through a literature review and expert input. An international, interdisciplinary Delphi panel of 30 to 40 participants will evaluate this list across 3 survey rounds. Panelists will rate the relevance of potential PIMs using predefined criteria, including the balance of benefits and harms, patient preferences, and the availability of alternatives. Consensus will be defined as a median rating of ≥4 (for inclusion) or ≤2 (for exclusion) on a 5-point Likert scale (1=not relevant to 5=extremely relevant), with an IQR width of ≤1 and at least 70% directional agreement. Items not meeting thresholds will be carried forward to subsequent rounds for reconsideration. Quantitative analyses will summarize ratings and agreement levels, while qualitative free-text responses will undergo content analysis to provide context and capture nuanced perspectives. The process will yield a prioritized list of PIMs for adults aged 18 to 65 years. Panel recruitment was completed between September and October 2025, with 36 participants. Three rounds of data collection were completed between October 2025 and January 2026. Interim analyses were conducted to inform structured feedback between rounds. Final data analysis is ongoing, and consensus results are expected to be reported in late 2026. This Delphi process will yield a consensus-based list of PIMs for adults aged 18 to 65 years, informing the development of an international guideline to support safer prescribing practices and to expand deprescribing efforts beyond geriatric care.
Overtreatment of localized prostate cancer in older patients remains a problem in healthcare. The reasons for this are manifold and range from overdiagnosis to problematic incentives in the healthcare system. However, another reason could also lie in the current nomenclature of the disease, which narrows clinical significance down to biological parameters of the disease and neglects key patient-specific dimensions such as life expectancy. A new definition, in which clinical significance is established solely through the patient context, is proposed for discussion here. According to this definition, localized prostate cancer would be clinically significant, respectively clinically relevant, if its malignancy-associated risk is highly likely to lead to morbidity or mortality within the patient's individual life expectancy without treatment. This approach would clearly counteract the structural imbalance whereby tumors whose malignant potential could not or would hardly manifest within a patient's remaining life expectancy are no longer considered significant. Accordingly, this could significantly sharpen the quality of indications for performing diagnostic and therapeutic procedures and thus have the potential to limit both overdiagnosis and overtreatment. This would be particularly important in the light of demographic trends. Die Übertherapie des lokalisierten Prostatakarzinoms im Alter stellt auch heute noch ein persistierendes Gesundheitsversorgungsproblem dar. Die Gründe hierfür sind vielfältig und reichen von der Überdiagnose bis hin zu Fehlanreizen im Gesundheitsweisen. Ein weiterer Grund könnte allerdings auch in der aktuellen Nomenklatur der Erkrankung liegen, welche klinische Signifikanz auf biologische Parameter der Erkrankung einengt und zentrale patientenspezifische Dimensionen wie beispielsweise die Restlebenserwartung vernachlässigt. Eine neue Definition, bei welcher klinische Signifikanz erst durch den Patientenbezug hergestellt wird, soll hier zur Diskussion gestellt werden. Gemäß dieser wäre ein lokalisiertes Prostatakarzinom dann klinisch signifikant und behandlungsrelevant, wenn sein malignitätsassoziiertes Risiko innerhalb der individuellen Restlebenserwartung des Patienten ohne Therapie mit hoher Wahrscheinlichkeit zu Morbidität oder Mortalität führt. Diese Herangehensweise würde dem strukturellen Missverhältnis, dass Tumoren, deren malignes Potenzial sich nicht oder kaum noch in dem verbleibenden Lebenshorizonts eines Patienten entfalten könnte, klar entgegenwirken – und zwar indem diese eben als klinisch nicht signifikant, respektive, klinisch nicht relevant bezeichnet werden würden. Entsprechend könnte dies Indikationsqualität zur Durchführung diagnostischer und therapeutischer Schritte ganz klar schärfen und damit das Potenzial haben, sowohl Überdiagnostik als auch Übertherapie einzuschränken. Gerade vor dem Hintergrund der demographischen Entwicklung wäre dies ein wichtiges Ziel.
Adiponectin dysregulation has been implicated in Alzheimer's disease (AD), but the respective roles of total and high-molecular-weight (HMW) adiponectin, as well as central versus peripheral mechanisms, remain unclear. We aimed to investigate the association between biomarker-confirmed AD and plasma total adiponectin, HMW/total adiponectin ratio, and CSF/plasma adiponectin ratio, used as an indirect marker of central-peripheral distribution. We also assessed correlations with CSF amyloid and tau biomarkers. In this monocentric cross-sectional study, 134 participants (90 AD, 44 controls) from a tertiary memory clinic were included. Plasma and CSF total adiponectin were measured by ELISA, and plasma HMW adiponectin by chemiluminescent immunoassay. Associations were analyzed using multivariate linear regression adjusted for age, sex, body mass index, and APOE ε4 carriership. Plasma total and HMW adiponectin levels were higher in AD than in controls (p < 0.05 and p < 0.005, respectively), but the association was no longer significant after adjustment. The HMW/total ratio was higher in AD (0.50 vs. 0.43, p = 0.02), whereas the CSF/plasma ratio did not differ between groups (p = 0.69). No correlations were found between adiponectin (plasma total and HMW, and CSF total) and CSF amyloid or tau biomarkers. Although adiponectin levels were elevated in biomarker-confirmed AD, this association was largely driven by age, sex, and BMI. Overall, adiponectin appears to reflect systemic metabolic and nutritional status rather than AD-specific pathophysiology.
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.
It has been demonstrated that cognitive training can improve working memory task performance in older adults; however, less is known about the associated brain changes. This study examines how brain activation changes in older adults as a function of working memory training improvement and how this relationship is influenced by task load and training phase. Participants were 58 cognitively healthy older and 28 younger adults from the Attentional Control Training for Older People (ACTOP) study. Older participants completed either working memory training or an active control condition (inhibition training) and received fMRI scans while completing an N-back task at low (1-back) and high (2-back) load before training (PRE), after 6 (MID) and 12 (POST) training sessions. Younger participants served as an age comparison for brain activation. Working memory training improvement was associated with an early (PRE to MID) decrease in activity in frontoparietal regions during the 1-back condition, followed by a late-phase (MID to POST) increase in activity in the frontal lobe during the 2-back condition. There were no significant associations in the control group. Furthermore, there was a significant difference in load-related activation (2>1 back) between older and younger adults at PRE, which was no longer observed at POST within the medial and left hemisphere, suggesting that training restores older adults' load-related modulation of activation to more youthlike levels. These results suggest that working memory training gain in older adults is associated with more efficient brain activation for low-load tasks and a greater ability to recruit neural resources as tasks become more demanding.
In healthcare, socially assistive robots are increasingly used for logistical, assistive, and psychosocial purposes, raising ethical, social, and organizational questions. In these contexts, professionals' acceptability varies by use case, perceived risk, and care setting. Understanding how healthcare professionals evaluate these technologies is essential for anticipating their large-scale integration into health systems and its implications for workforce organization and equity of access. This cross-sectional survey in France examined healthcare professionals' perceptions of socially assistive robots, focusing on perceived usefulness, acceptability, and implementation-related factors. A self-administered 48-item questionnaire covered sociodemographic characteristics, knowledge of robots, perceived usefulness across use cases, importance of implementation factors, and acceptability and intention to use. Data were analyzed using descriptive statistics, non-parametric tests, and principal component analysis with hierarchical clustering to identify attitudinal profiles. A total of 148 healthcare professionals participated, 77% reporting prior knowledge of robots. Perceived usefulness was generally high, particularly for physical tasks and recreational support, while therapeutic mediation and feeding were rated lower. Ethical, organizational, and regulatory factors were rated as very important, and acceptability was higher for general use than for personal clinical practice. Cluster analysis identified three attitudinal profiles characterized by low, moderate, and high acceptability. Healthcare professionals expressed generally favorable but selective attitudes toward socially assistive robots, mainly valuing logistical and organizational support and remaining more cautious about therapeutic and psychosocial uses. Acceptability appeared conditional and context-dependent, linked to perceived usefulness, safeguards, and prior knowledge rather than professional or sociodemographic characteristics. These findings highlight the need for public-health and implementation strategies combining clear ethical and legal frameworks, training, and context-specific integration, and the relevance of longitudinal mixed-method studies to examine how attitudes and adoption evolve with real-world use.