Alice Margherita Ornago

Background: Gait speed (GS) has been suggested as a predictor of incident dementia in old age. However, the mechanisms underlying this body–mind connection remain unclear, and it is still unknown whether trajectories of GS decline differ according to levels of blood biomarkers related to Alzheimer's disease ( AD ). This study aims to investigate the association between levels of seven blood biomarkers related to AD and long‐term GS changes in dementia‐free older adults living in the community. Methods: The present study included 1665 community‐dwelling adults ≥ 60 years, followed for 15 years, drawn from the Swedish National study on Aging and Care in Kungsholmen (SNAC‐K). GS (m·s ⁻¹ ) was assessed at baseline and at five subsequent follow‐up time points. Blood biomarkers, including serum amyloid‐ β 42 to amyloid‐ β 40 ratio (A β 42/40), phosphorylated Tau181 ( p ‐Tau181) and Tau217 ( p ‐Tau217), total Tau ( t ‐Tau), neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP), were collected from peripheral venous blood samples at baseline. Linear mixed‐effects models were implemented to investigate the association between blood biomarkers and GS changes over time. Results: After adjusting for potential confounders, participants in the highest quartile of p ‐Tau181 (Model I; 4th quartile β : −0.008, 95% CI: −0.013; −0.003), p ‐Tau217 (Model I; 4th quartile β : −0.010, 95% CI: −0.015; −0.005), NfL (Model I; 4th quartile β : −0.013, 95% CI: −0.019; −0.006) and GFAP (Model I; 4th quartile β : −0.007, 95% CI: −0.013; −0.002) exhibited a steeper decline in GS over time, as compared with those in the lowest quartile. Notably, participants in these highest quartiles developed mobility limitations (GS < 0.8 m·s ⁻¹ ), on average, 2.3 to 6.0 years earlier. Of note, only the association between NfL and GS changes over time persisted after further adjusting for time‐varying global cognition. Conclusions: Higher blood biomarker levels of AD are associated with accelerated trajectories of GS decline and earlier onset of mobility limitations. Consequently, a faster decline in GS may reflect underlying neurodegeneration and indicate changes in brain health.

Frailty is increasingly recognized as a major determinant of surgical risk in older adults; however, its prognostic significance in the context of elective neurosurgery remains unclear. This study investigated the prevalence of frailty, the concordance between three validated frailty instruments, and their association with postoperative complications. A prospective cohort study was conducted at a tertiary neurosurgical center from November 2021 to November 2024. Patients aged ≥ 65 years undergoing elective cranial or spinal surgery were included. Preoperative frailty was assessed using the Clinical Frailty Scale (CFS), the Comprehensive Geriatric Assessment Frailty Index (CGA-FI), and the Fried’s Frailty Phenotype (FFP) criteria. Postoperative complications—including infectious, cardiovascular, neurological, haemorrhagic events, delirium, and in-hospital death—were systematically recorded. Associations with frailty were examined using multivariable logistic regression adjusted for covariates. Among 181 patients (mean age, 74.1 [SD] 6.1 years), frailty prevalence ranged from 23.8% (CGA-FI) to 44.2% (FFP). Agreement between instruments was variable, with substantial concordance between CFS and CGA-FI (κ = 0.65) and only moderate concordance with FFP. Postoperative complications occurred in 47 (25.9%) patients. Frailty defined by CFS (adjusted odds ratio [aOR], 2.73; 95% CI, 1.05–7.42) and CGA-FI (aOR, 3.78; 95% CI, 1.34–11.1) was independently associated with increased risk of complications. In conclusion, frailty as assessed by the CFS and CGA-FI, is a strong determinant of postoperative risk in older adults undergoing elective neurosurgery. Incorporating frailty assessment into routine neurosurgical pathways may improve perioperative risk stratification and guide clinical decision-making.

Aging is accompanied by the progressive accumulation of biological deficits, which increases susceptibility to developing multiple chronic diseases (that is, multimorbidity). The biological underpinnings of multimorbidity remain poorly understood. Here we analyzed 54 blood biomarkers reflecting inflammatory, vascular, metabolic and neurodegenerative processes in 2,247 individuals aged 60 and over from the Swedish National Study on Aging and Care in Kungsholmen. Multimorbidity was assessed using three measures: baseline total disease count, baseline multimorbidity patterns identified through latent class analysis and 15-year rate of disease accumulation. Associations between baseline biomarkers and multimorbidity measures were examined using least absolute shrinkage and selection operator regression. Growth differentiation factor 15, hemoglobin A1c, cystatin C, leptin and insulin were consistently and positively associated with all multimorbidity measures. Additional biomarkers demonstrated specific associations with distinct multimorbidity patterns. Moreover, faster disease accumulation was directly associated with gamma-glutamyl transferase and inversely with albumin. Longitudinal results were externally validated in 522 participants from the Baltimore Longitudinal Study of Aging, with comparable predictive accuracy. Our findings suggest that multiple biological processes contribute to multimorbidity through shared and distinct mechanisms. Metabolic disturbances emerged as a key driver of multimorbidity. If confirmed, these processes could represent targets for interventions to mitigate disease accumulation.

Background: Type 2 diabetes mellitus (T2DM) is a common chronic disease in older adults and a leading cause of death and disability worldwide. While recent diabetes guidelines introduce the Comprehensive Geriatric Assessment (CGA) as a key tool for managing diabetes treatments, evidence of its effectiveness in delaying functional impairment and achieving patient-reported outcomes (PROs) remains lacking. This article describes the protocol of a randomized parallel-group controlled trial aimed at evaluating the effect of a CGA-guided plan of care on physical performance changes over time as compared with a usual-care group. Methods: Three centers will participate in this study, each recruiting 60 older adults with T2DM from their outpatient clinics. Eligible patients will be randomized into either the usual-care or intervention group in a 1:1 allocation ratio. All patients will receive standard care according to current diabetes guidelines and undergo CGA. For the intervention group, the CGA will guide a multidimensional intervention. Follow-up visits will be scheduled at 6 and 12 months. The primary outcome will be the change in physical performance at the end of the follow-up, as assessed by the Short Physical Performance Battery score, with a comparison between the control and intervention groups. Discussion: From this study, we will contribute to the growing evidence of the impact of CGA on the assessment and management of older patients with T2DM and its complications. Results will be disseminated through a peer-reviewed journal and presentations at conferences. Final results will be shared with a broader audience through collaborations with patients with diabetes and their caregiver association at local and national levels. The findings will inform the extent to which a CGA-driven care plan may significantly reduce functional impairment and improve patient and caregiver satisfaction. Trial registration: ClinicalTrials.gov ID: NCT06842459 – registered February 24, 2025 – retrospectively registered.

Purpose: Delirium, a common medical emergency among hospitalized patients, requires effective detection and management protocols. This study aims to evaluate the delirium point prevalence and its management across Italian hospitals, categorized by delirium literacy levels. Additionally, it seeks to identify prevailing barriers and future priorities in delirium practice and research. Methods: We analyzed data from World Delirium Awareness Day (WDAD) on March 15th, 2023, collected by participating clinicians in Italian hospitals. High delirium literacy (HL) was determined based on the use of validated delirium assessment tools and the presence of a written protocol for delirium management. Conversely, low delirium literacy (LL) was determined by meeting only one or neither of these criteria. Results: Fifty-eight hospital wards participated in the survey, with 25 (43.1%) classified as HL. The overall reported point prevalence of delirium was found to be approximately 10%. Notably, the reported prevalence was twice as high in the HL group compared to the LL group. Despite minimal differences compared to the other group, the HL group demonstrated greater adherence to appropriate delirium management strategies, encompassing both non-pharmacological and pharmacological strategies. Critical gaps in delirium care emerged, including suboptimal management practices, barriers to implementing evidence-based strategies, and insufficient awareness and training among professionals. Conclusion: The study highlights the suboptimal identification and management of delirium among Italian hospitals, emphasizing the necessity of enhancing awareness and implementing evidence-based strategies. Addressing these shortcomings is crucial for optimizing delirium care, improving patient outcomes, and mitigating the burden of delirium in hospital settings.