Aurelia Romila

Introduction and Objective: Monitoring short-term changes in functional and neuromotor performance among older adults during a two-week hospital stay remains challenging in everyday geriatric practice. In this context, the present exploratory observational study aims at investigating the potential of the Clock Drawing Test, evaluated by means of quantitative geometric and kinematic parameters, as a method for capturing short-term fluctuations in visuomotor performance in routine multimodal inpatient care. The aim of the study is not to identify the isolated causal effects of single pharmacological or physical interventions, but to formulate hypotheses on the evolution of graphomotor trajectories within the framework of the usual clinical management. Methods: We conducted a prospective observational study involving 90 older adults hospitalized with chronic medical comorbidities and receiving multimodal inpatient care, including pharmacological treatments and physical rehabilitation techniques such as kinesiotherapy and TECAR therapy. Participants were classified into three diagnostic groups according to their cognitive status: no cognitive impairment (n = 40), mild cognitive impairment (n = 25), and dementia (n = 25). Results of the Clock Drawing Test performed at admission (T0) were compared with those performed at discharge (T14), focusing on contour integrity, numeral spacing, hand placement precision, and digital kinematic parameters. As the primary longitudinal outcome, paired T0 and T14 drawings were compared to evaluate short-term visuomotor changes. As a secondary exploratory analysis, baseline (T0) cognitive status classification was evaluated using Random Forest and Multilayer Perceptron models through participant-level 5-fold stratified cross-validation to determine how baseline neurocognitive and vascular profiles frame short-term graphomotor trajectories. Additionally, a binary (two-way) classification experiment (no cognitive impairment, n = 40, vs. cognitive impairment combining MCI and dementia, n = 50) was conducted, and the Structural Similarity Index (SSIM) was employed to objectively quantify whole-image morphological differences between CDT images obtained at admission (T0) and discharge (T14) using a standardized clock as ground truth. Results: Across the 90 complete pairs, significant Time × Regimen Cluster interactions were observed (p < 0.001). In Cluster 1 (multimodal physical and neurotrophic rehabilitation, n = 55), discharge evaluations showed significant improvements in contour closure gap (from 9.12 ± 2.45 mm to 1.78 ± 0.64 mm, p < 0.001), angular hand placement error (from 27.9° ± 6.8° to 4.1° ± 1.9°, p < 0.001), air-to-paper time ratio (from 1.84 ± 0.42 to 1.36 ± 0.31, p < 0.001), and Z-axis pressure stability (p < 0.001), whereas conceptual time-representation errors remained unchanged. Conversely, the small exploratory Cluster 2 subgroup that was treated with central nervous system depressants for acute inpatient insomnia or agitation showed a decline in graphomotor parameters (contour gap 2.15 ± 0.70 mm to 7.85 ± 2.30 mm, p = 0.016). This pattern could be a marker of either the pharmacodynamic sedation or the underlying acute neuropsychiatric conditions that warranted treatment. Conversely, Cluster 3 (standard medical maintenance, n = 27) remained stable (p > 0.20). For the secondary baseline classification task, the regularized Random Forest and Multilayer Perceptron models achieved promising internal cross-validation (out-of-fold) balanced accuracies of 86.00% and 88.13%, respectively. When reformulated as a two-way classification task (no impairment vs. MCI + dementia), out-of-fold overall accuracies increased to 92.22% (balanced accuracy 92.00%) for Random Forest and 94.44% (balanced accuracy 94.25%) for Multilayer Perceptron. Across 83 paired image sets, mean SSIM between T0 and T14 was 0.7494 ± 0.1016, while mean SSIM relative to the ground-truth clock changed from 0.7527 ± 0.0609 at T0 to 0.7352 ± 0.0687 at T14 (p < 0.001). Conclusions: Quantitative geometric and kinematic CDT parameters captured short-term changes in visuomotor execution over a 14-day hospitalization, while conceptual clock-drawing deficits remained associated with baseline diagnostic status in this exploratory observational cohort. Confounding by indication, practice effects and relief of pain or fatigue may also contribute to the observed trajectories in non-randomized multimodal care. Controlled trials and external multi-center validation cohorts are needed to confirm broader model generalizability and establish the independent effects of specific therapies.

Frailty is a dynamic state of reduced reserve whose expression reflects clinical, functional, cognitive, psychological, social, and environmental factors. This structured narrative review examines its conceptual models, determinants, consequences, multidimensional assessment, holistic interventions, and coordination across hospital, community, and home care. The literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Embase up to September 2026, supplemented by World Health Organization (WHO) documents, Google Scholar, and citation tracking. Physical phenotype, deficit-accumulation, multidimensional, judgement-based, and electronic approaches address different clinical questions and should not be treated as interchangeable. Brief case finding is most useful when it leads to assessment of modifiable contributors and a care plan aligned with the older person’s goals. Evidence most consistently supports progressive multicomponent exercise; nutritional support, medication review, falls prevention, and cognitive or social interventions should target identified needs. Hospital geriatric care, structured discharge, community follow-up, and home-based services require coordination, shared information, and reassessment, although evidence for particular models remains heterogeneous. Under-recognition, fragmented services, limited multidisciplinary capacity, caregiver burden, and unequal access constrain implementation. Frailty care is best understood as a longitudinal, person-centred process. Future research should test clinically meaningful outcomes, reproducible pathways, and equity in digital and non-digital delivery.

Background/Objectives: Periodontitis is sustained by dysbiotic biofilms and dysregulated host responses, providing pharmacological targets for antimicrobial, host-modulating, phytochemical, regenerative, and locally delivered interventions. This scoping review mapped bioactive heterocyclic compounds investigated in periodontitis according to the structural family, pharmacological target, periodontal compartment, therapeutic maturity, selected periodontal–systemic interfaces, and a secondary geriatric cerebrovascular context. Methods: PubMed, Scopus, and the Web of Science Core Collection were searched for the principal review on 30 July 2026. Companion publications were linked at the study level, and design-specific appraisal was applied when sufficient methodological information was available. A separate cerebrovascular extension was searched on 6 August 2026 and analyzed independently of the principal evidence denominator. Results: The principal evidence map comprised 715 independent studies represented by 804 canonical eligible reports. Nitroimidazole-containing regimens formed the largest structural family (283 studies; 39.6%), followed by melatonin and indole-related agents (83; 11.6%), macrolides (77; 10.8%), berberine and isoquinoline-related compounds (29; 4.1%), and quinolones or fluoroquinolones (28; 3.9%). Human clinical evidence was concentrated mainly in established antimicrobial regimens, whereas many host-modulating, phytochemical, regenerative, signaling, and delivery-based approaches remained predominantly translational or preclinical. The detailed clinical subset comprised 48 human studies, including six core comparative studies; heterogeneity in population, regimen, treatment background, follow-up, outcome definition, and analysis unit precluded a clinically meaningful pooled estimate. Prespecified systemic interfaces included diabetes (35 studies), cardiovascular disease (13), and rheumatoid arthritis (2). The separate cerebrovascular component comprised 30 studies addressing the oral health burden, microbial and inflammatory associations, oral care interventions, and treatment safety considerations in older adults with ischemic stroke. Conclusions: The evidence supports compound- and formulation-specific interpretation rather than class-wide therapeutic recommendations. Clinical translation should integrate structural and mechanistic plausibility with periodontal target-site exposure, pharmacokinetic–pharmacodynamic evidence, clinically meaningful benefit, safety, and antimicrobial stewardship. The cerebrovascular evidence supports oral care integration and safety surveillance but does not establish causal periodontal effects on stroke, reperfusion outcomes, or thrombolysis eligibility.

Monoclonal antibody-based therapies are widely used in chronic immune-mediated diseases, but their periodontal effects, dentoalveolar safety signals, and exposure characteristics remain incompletely characterized. This scoping review mapped periodontal clinical outcomes, biomarkers, microbiological and imaging findings, dentoalveolar safety, administration, treatment exposure, and pharmaceutical-context reporting. PubMed, Scopus, and Web of Science were searched in July 2026 without publication-year or language restrictions. Twenty-one reports representing 20 studies or cohort families were included. Evidence mainly concerned rheumatoid arthritis and therapies targeting tumor necrosis factor, interleukin-6 receptor, and cluster of differentiation 20. Evidence for interleukin-17A inhibition was insufficient and derived from one confounded five-patient case series. Tocilizumab showed the most consistent reductions in gingival inflammation and bleeding on probing, while structural changes were smaller and inconsistent. Tumor necrosis factor-directed findings were heterogeneous. Small rituximab studies showed favorable clinical or biomarker signals, whereas pharmacovigilance identified infectious and destructive dentoalveolar signals. Exposure reporting was incomplete, and no included periodontal study evaluated formulation stability, storage, cold-chain integrity, or handling deviations. This review integrates treatment-effect evidence, safety signals, and exposure variables across antibody targets and identifies a pharmaceutical–periodontal reporting gap requiring prospective investigation.

Monoclonal antibody-based therapies are widely used in chronic immune-mediated diseases, yet periodontal effects, dentoalveolar safety signals and exposure characteristics remain incompletely characterized. This scoping review mapped periodontal outcomes, safety signals, administration, exposure and pharmaceutical-context reporting in adults. PubMed, Scopus and Web of Science were searched in July 2026 without publication-year or language restrictions. Sources were selected using Population, Concept and Context criteria, appraised with design-specific Joanna Briggs Institute tools and synthesized by therapeutic target. Of 1154 records, 21 reports representing 20 studies or cohort families were included. Evidence concentrated on rheumatoid arthritis and therapies targeting tumour necrosis factor, interleukin-6 receptor, cluster of differentiation 20, or interleukin-17A. Tocilizumab showed the most consistent reductions in gingival inflammation and bleeding on probing, whereas structural changes were smaller and inconsistent. Tumour necrosis factor-directed findings were heterogeneous; small rituximab studies showed favourable clinical or biomarker signals, while pharmacovigilance contained infectious and destructive dentoalveolar signals. Intravenous and subcutaneous administration were represented, but exposure reporting was incomplete. No included periodontal study evaluated formulation stability, storage, cold-chain integrity, or handling deviations. Risk-based periodontal surveillance may accompany therapy, but validated protocols cannot be defined. The identified gap concerns integrating pharmaceutical-context variables into periodontal research, not monoclonal-antibody stability research generally.