Geriatrics

Persistent instrumental ADL impairment flags early Alzheimer pathology and high dementia risk

In 1000 dementia-free ADNI participants (mean age ~73, 63% with MCI), persistent impairment in three IADLs was closely linked to CSF Alzheimer biomarkers. Persistent, but not transient, difficulty with preparing a hot drink, cooking a balanced meal, and shopping alone tracked lower Aβ42 and higher p-tau181. APOE-ε4 carriage was more frequent with persistent impairment, aligning functional decline with genetic and biofluid evidence of Alzheimer pathology. Persistent impairment conferred a 6.66-fold higher dementia incidence versus no impairment; transient impairment showed only modest risk elevation. 1

Mobility-Fit boosts arm strength and quality of life in long-term care residents

This cluster RCT in 20 long-term care facilities randomized 146 residents (median age 86) to 12 weeks of Mobility-Fit or usual-care exercise. Mobility-Fit added tailored upper-limb and core resistance, balance, and agility training three times weekly, versus lower-limb–focused usual care. Compared with control, Mobility-Fit produced greater improvements in elbow extension strength and in EQ-5D utility and visual analogue quality-of-life scores. Both groups improved lower-limb strength, mobility, and questionnaire-based fall risk, reflecting benefits of structured physical activity. 2

Plasma p-tau217 data show Alzheimer pathology is common in community-dwelling elders

In a Norwegian population cohort of 11,486 adults ≥58, plasma p-tau217 was used as a surrogate for Alzheimer neuropathological change. Estimated Alzheimer pathology prevalence rose from <8% at ages 58–69.9 to 65.2% in those over 90 years. Among adults ≥70, 10% had preclinical Alzheimer disease, 10.4% prodromal disease, and 9.8% Alzheimer dementia based on clinical and biomarker status. Pathology was present in 60% of dementia, 32.6% of MCI, and 23.5% of cognitively unimpaired participants ≥70. 3