Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study.

BACKGROUND: The Neutrophil-to-lymphocyte ratio (NLR) is a marker of poor prognosis in hospitalized older patients with different diseases, but there is still no consensus on the optimal cut-off value to identify older patients at high-risk of in-hospital mortality. Therefore, in this study we aimed at both validating NLR as a predictor of death in older hospitalized patients and assess whether the presence of specific acute diseases can modify its predictive value. METHODS: This prospective cohort study included 5034 hospitalizations of older patients admitted to acute care units in the context of the ReportAge study. NLR measured at admission was considered as the exposure variable, while in-hospital mortality was the outcome of the study. ROC curves with Youden's method and restricted cubic splines were used to identify the optimal NLR cut-off of increased risk. Cox proportional hazard models, stratified analyses, and Kaplan-Meier survival curves were used to analyse the association between NLR and in-hospital mortality. RESULTS: Both continuous and categorical NLR value (cut-off ≥ 7.95) predicted mortality in bivariate and multivariate prognostic models with a good predictive accuracy. The magnitude of this association was even higher in patients without sepsis, congestive heart failure, and pneumonia, and those with higher eGFR, albumin, and hemoglobin (p < 0.001). A negative multiplicative interaction was found between NLR and eGFR < 45 (p = 0.001). CONCLUSIONS: NLR at admission is a readily available and cost-effective biomarker that could improve identification of geriatric patients at high risk of death during hospital stay independent of admitting diagnosis, kidney function and hemoglobin levels.

Efficacy and safety of reperfusion treatments in middle-old and oldest-old stroke patients.

INTRODUCTION: Intravenous thrombolysis (IT) and mechanical thrombectomy (MT) have significantly changed the clinical outcome of acute ischaemic stroke (AIS). Concerns about possible complications often reduce the use of these treatment options for older patients, preferentially managed with antiplatelet therapy (AT). Aim of this study was to evaluate, in a population of middle-old (75-84 years) and oldest-old (≥ 85 years) subjects, the efficacy and safety of different treatments for AIS (IT, IT + MT, MT or AT), mortality and incidence of serious complications. PATIENTS AND METHODS: All patients aged over 75 years admitted for AIS in two Stroke Units were enrolled. The physician in each case considered all treatment options and chose the best approach. NIHSS and modified Rankin Scale (mRS) were obtained and differences between admission and discharge scores, defined as delta(NIHSS) and delta(mRS), were calculated. The relationship between delta(NIHSS), delta(mRS) and type of procedure was analysed with a GLM/Multivariate model. Differences in mortality and incidence of serious complications were analysed with the chi-square test. RESULTS: A total of 273 patients, mean age 84.07 (± 5.47) years, were included. The Delta(NIHSS) was significantly lower in patients treated with AT than in those treated with IT and MT (p < 0.009 and p < 0.005, respectively). Haemorrhagic infarction occurrence was significantly lower (p < 0.0001) among patients treated with AT (10.6%) or IT (16.7%) compared to MT (34.9%) or MT + IT (37.0%). No significant difference was observed for in-hospital mortality. Age did not influence the outcome. CONCLUSIONS: Our results suggest that IT and AT are effective and relatively safe approaches in middle-aged and older patients.

"The Community That Takes Care of Itself": A Feasibility Study to Support Families Caring for a Loved One With Alzheimer Disease.

This pilot project was aimed at supporting those families caring at home for loved ones suffering from Alzheimer dementia. Fourteen dyads of "caregivers-loved ones with dementia" were recruited and assigned either to the experimental group (n = 7) or to the control group (n = 7). The experimental group attended a training course, an Alzheimer Café, a self-help group for caregivers, and the support from a volunteer and professional nurse in-home visits, while the control group's dyads attended a standard intervention. To investigate the effects of this integrated and interprofessional model of care, caregivers completed the Caregiver Burden Inventory and 2 ad hoc structured questions to evaluate whether quality of life of the dyads was changed. Moreover, the caregivers of the experimental group completed the Self-Assessment Single Questionnaire, version 6 (Q-UAV6). Only caregivers of the experimental group reported a significant reduction in burden and an improved quality of life of the dyad. They also showed a greater acceptance of the disease, became experts in the care of their loved ones, and improved their relationship. The creation of a service integration network of professionals, volunteers, and families has been shown to be useful in supporting those families caring at home for loved ones suffering from Alzheimer dementia.

Rehabilitation of older people with Parkinson's disease: an innovative protocol for RCT study to evaluate the potential of robotic-based technologies.

BACKGROUND: Parkinson's disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson's disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson's disease, designed to improve the gait and to reduce the risk of falling. METHODS: This study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale - International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. DISCUSSION: The final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term. TRIAL REGISTRATION: NCT04087031, registration date September 12, 2019.

Spiritual well-being associated with personality traits and quality of life in family caregivers of cancer patients.

PURPOSE: This study focuses on the spiritual well-being (SWB) of the family caregivers of cancer patients, examining the relationship with personality traits and quality of life (QoL) in palliative and curative care settings. METHODS: All participants (n = 199) underwent the following self-report questionnaires: the Structural Analysis of Social Behavior (SASB)-Form A, the SWB Index, and the Medical Outcomes Study Short Form (SF-36). SWB scores were dichotomized at a cutoff corresponding to the 75th percentile. STATISTICAL ANALYSIS: Student's t test or by χ squared tests to compare high and low SWB and multivariate linear regression to estimate relations between SWB, SASB clusters (Cl), and QoL dimensions. RESULTS: Caregivers with high SWB reported significantly better scores than low SWB caregivers in the following SF-36 subscales: bodily pain (p = 0.035), vitality (p < 0.001), social activities (p < 0.001), mental health subscales (p < 0.001), and standardized mental component (p < 0.001) in the SASB Cl2 (p < 0.005), SASB Cl7 (p = 0.007), and SASB Cl8 (p < 0.001). Multivariate linear regression was performed with vitality, standardized mental component, SASB Cl2, SASB Cl7, and SASB Cl8. Greater SWB is associated with greater vitality (p < 0.001), mental standardized component (p < 0.001), and SASB Cl2 (p < 0.001), but lower SASB Cl7 (p < 0.05) and SASB Cl8 (p < 0.05); palliative care is associated with greater SASB Cl8 (p < 0.05) and lower standardized mental component compared with the caregivers in active care. CONCLUSIONS: This study points out that caregivers who experience low SWB have a poorer QoL and more problematic intrapsychic aspects of personality, such as low self-acceptance of their own emotions, are self-refusing and unable to be in contact with their own feelings. This suggests that spirituality could be a source of strength and a potential avenue for therapeutic intervention.

Usage and Usability of a Web-based Program for Family Caregivers of Older People in Three European Countries: A Mixed-Methods Evaluation.

InformCare is a European Web platform that supports informal caregivers of older people by providing access to online information and professional and peer support. The aim of this study was to assess the usage and usability of a psychosocial Web-based program carried out in three European countries (Italy, Sweden, and Germany). A mixed-methods sequential explanatory design was adopted, comprising baseline and postintervention assessments, as well as combined thematic content analysis of results and focus group findings. A convenience sample of 118 caregivers was enrolled, of whom 94 used the services offered by the program at least once. The subsamples in the three countries used the platform in different ways, with a predominance of passive strategies (eg, seeking information and reading other people's comments) for Italian caregivers, and more active usage by Swedish and German caregivers. The usability assessment showed that the platform was perceived well by Italian and German caregivers, whereas technical problems affected the Swedish sample's experiences. Focus group data highlighted user satisfaction with the online support and reliability of the environment. Recommendations for practitioners are to ensure digital training for caregivers who have lower confidence in use of the Internet, to involve different healthcare professionals in the provision of professional support, and to adequately manage online community building.

Autonomic nervous system imbalance during aging contributes to impair endogenous anti-inflammaging strategies.

Inflammaging refers to the age-related low grade, sterile, chronic, systemic, and long-lasting subclinical, proinflammatory status, currently recognized as the main risk factor for development and progression of the most common age-related diseases (ARDs). Extensive investigations were focused on a plethora of proinflammatory stimuli that can fuel inflammaging, underestimating and partly neglecting important endogenous anti-inflammaging mechanisms that could play a crucial role in such age-related proinflammatory state. Studies on autonomic nervous system (ANS) functions during aging highlighted an imbalance toward an overactive sympathetic nervous system (SNS) tone, promoting proinflammatory conditions, and a diminished parasympathetic nervous system (PNS) activity, playing anti-inflammatory effects mediated by the so called cholinergic anti-inflammatory pathway (CAP). At the molecular level, CAP is characterized by signals communicated via the vagus nerve (with the possible involvement of the splenic nerves) through acetylcholine release to downregulate the inflammatory actions of macrophages, key players of inflammaging. Notably, decreased vagal function and increased burden of activated/senescent macrophages (macrophaging) probably precede the development of several age-related risk factors and diseases, while increased vagal function and reduced macrophaging could be associated with relevant reduction of risk profiles. Hypothalamic-pituitary-adrenal axis (HPA axis) is another pathway related to ANS promoting some anti-inflammatory response mainly through increased cortisol levels. In this perspective review, we highlighted that CAP and HPA, representing broadly "anti-inflammaging" mechanisms, have a reduced efficacy and lose effectiveness in aged people, a phenomenon that could contribute to fuel inflammaging. In this framework, strategies aimed to re-balance PNS/SNS activities could be explored to modulate systemic inflammaging especially at an early subclinical stage, thus increasing the chances to reach the extreme limit of human lifespan in healthy status.

A study protocol for identifying aging trajectories toward chronic neurodegenerative diseases by means of Marche regional administrative databases - TREND project.

Background: People are living longer but an increasing number of older people experience chronicity and disability in the latest years of their life. The Marche region is one of the Italian regions where people live the longest lives; therefore, the number of people with age-related chronic diseases is expected to be at least similar, if not higher, compared to the rest of Italy. The identification of the aging trajectories is of huge interest in the arena of public health. Administrative healthcare databases represent valuable reservoirs for reconstructing the trajectories of aging. Here, we present the protocol for a study (TREND project) aimed to integrate existing administrative databases into a Marche regional dataset in order to estimate the prevalence and incidence rates of age-related neurodegenerative diseases (ND), with a specific focus on Parkinsonism and Dementia. Methods: The TREND Project is a retrospective cross-sectional study. The source population includes permanent residents in the Marche region aged 40 years and older. A minimal dataset has been built up linking data on drug prescriptions, outpatient services, and diagnosis for hospital admission, from 2014 to 2021 in the Marche Region. Data on clinical outcomes (re-hospitalization, mortality, comorbidities), and therapeutic approaches (drugs and medicines) have been integrated with state-of-the-art statistical methods to define patients into different risk clusters and to analyze the aging trend by assessing the Comorbidity Index (CI) as a proxy for chronicity. Discussion: Our research contributes to the integration of existing administrative databases on ND to create a Marche regional ND database, support regional health policy, and better understand patients' needs and their aging trajectories. This approach could be implemented also at the National level. Moreover, by linking different administrative data sources, this study sheds light on important issues related to ND, such as early-onset dementia; ethical aspects such as anticipated wills; problems of dementia in patients still in the job market, etc. The results of this study will contribute to the successful implementation of integrated care for patients affected by ND at regional or national levels.

Social robotics to support older people with dementia: a study protocol with Paro seal robot in an Italian Alzheimer's day center.

Introduction: The aging of the population and the high incidence of those over 80 lead to an inevitable increase in chronic degenerative diseases, such as dementia, resulting in increased morbidity and disability. Treatment of people with dementia involves both pharmacological and non-pharmacological interventions. In particular, robot-assisted therapy is a potentially useful treatment for dementia as it has the advantage of improving mood, encouraging social interaction and communication. The overall objective of the study is to evaluate the improvement in patient-perceived quality of life following the use of the Paro robot integrated with usual care in the older people with dementia. Methods and analysis: For this study, 20 patients with dementia are recruited and divided into Experimental Group (EG) and Control Group (CG). Twenty-four session of intervention are conducted, divided into 2 sessions per week, for 12 weeks. The therapy sessions last 20 min. The Experimental Group will receive a social robotic intervention with Paro combined with usual care; the Control Group will receive only the traditional therapy, consisting of cognitive stimulation (reality orientation therapy, cognitive training) and occupational activities (painting workshops, cooking workshops, garden therapy, music therapy, etc.). Paro is a seal-shaped robot designed to have a calming effect and elicit emotional responses in patients in hospitals, nursing homes, and retirement homes. Assessment will be performed at the baseline, at the end of intervention and 3 months after the end of intervention. During these phases, several scales will be administered to the patients, such as Quality of Life-Alzheimer's Disease, Addenbrooke's Cognitive Examination, the Rating Anxiety In Dementia scale and the Cornell Scale for Depression in Dementia, Quebec User Evaluation of Satisfaction, Neuropsychiatric Inventory, the Technology Acceptance Model. Discussions: The final goals of the present study are to evaluate the improvement in patient-perceived quality of life following the use of the Paro robot integrated with usual care in the older people with dementia. Ethics and dissemination: The study was approved by the Ethic Committee of the Istituto Nazionale Ricovero e Cura Anziani, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS INRCA) during the session of 12 April 2022. It was recorded in ClinicalTrials.gov on 23 November 2022 on the number NCT05626205. The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings.

Radiomics and Artificial Intelligence for the Diagnosis and Monitoring of Alzheimer's Disease: A Systematic Review of Studies in the Field.

The use of radiomics and artificial intelligence applied for the diagnosis and monitoring of Alzheimer's disease has developed in recent years. However, this approach is not yet completely applicable in clinical practice. The aim of this paper is to provide a systematic analysis of the studies that have included the use of radiomics from different imaging techniques and artificial intelligence for the diagnosis and monitoring of Alzheimer's disease in order to improve the clinical outcomes and quality of life of older patients. A systematic review of the literature was conducted in February 2023, analyzing manuscripts and articles of the last 5 years from the PubMed, Scopus and Embase databases. All studies concerning discrimination among Alzheimer's disease, Mild Cognitive Impairment and healthy older people performing radiomics analysis through machine and deep learning were included. A total of 15 papers were included. The results showed a very good performance of this approach in the differentiating Alzheimer's disease patients-both at the dementia and pre-dementia phases of the disease-from healthy older people. In summary, radiomics and AI can be valuable tools for diagnosing and monitoring the progression of Alzheimer's disease, potentially leading to earlier and more accurate diagnosis and treatment. However, the results reported by this review should be read with great caution, keeping in mind that imaging alone is not enough to identify dementia due to Alzheimer's.

Dementia, stroke, age, use of medical devices and antipsychotic drugs may increase the risk of nosocomial infections among elderly patients hospitalized at Neurology Clinics.

Healthcare-acquired infections (HCAI) represent a major health problem worldwide. Stroke and dementia are considered risk factors for HCAI. Preliminary data suggest that use of antipsychotic drugs also increase the risk for HCAI. Here, we performed a retrospective study aimed at investigating the major risk and protective factors for HCAI in a cohort of elderly subjects hospitalized at an Italian tertiary Neurology Clinics. We included all patients with age ≥ 65 years hospitalized at Neurology Clinics of National Institute on Ageing, Ancona, Italy from 1st January 2018 to 31st December 2021. For each patient, the following data were collected: age, sex, use of medical devices, comorbidities, use of antipsychotic medications, development of HCAI. We included 1543 patients (41.4% males; median age 85 years [80-89]). According to multivariable analysis, age, stroke, duration of urinary catheter placement (for all p < 0.001) and midline placement (p = 0.035) resulted to be risk factors for HCAI, Diabetes resulted to be a protective factor for pneumonia (p = 0.041), while dementia and nasogastric tube were risks factor for this condition (p = 0.022 and p < 0.001, respectively). Urinary catheter was a risk factor for urinary tract infections (p < 0.001). Duration of placement of vascular catheters and use of antipsychotic drugs resulted to significantly increase the risk for bloodstream infections. Stroke, age and use of medical devices were confirmed to be risk factors for HCAI. Antipsychotic drugs resulted to increase risk for bloodstream infections. Further prospective studies will be needed to confirm these findings.

Results of the Italian RESILIEN-T Pilot Study: A Mobile Health Tool to Support Older People with Mild Cognitive Impairment.

(1) Background: The RESILIEN-T system addresses the need for innovative solutions to support self-management in older people with Mild Cognitive Impairment (MCI). Despite the increasing prevalence of dementia and MCI, there is a lack of tailored solutions for these individuals. The RESILIEN-T system aims to empower and engage people with cognitive decline by providing a modular platform for self-management and coaching services. (2) Methods: Italian data collected for the RESILIEN-T project involved 62 older participants randomly assigned to the intervention or control group. Data were collected through questionnaires and user interactions with the system over a three-month period. (3) Results: Quantitative outcomes showed no significant differences between the intervention and control groups, except for an improvement in perceived memory capability in the intervention group. The usability assessment indicated a high level of acceptance of the RESILIEN-T system. (4) Discussions: Although no significant improvements were observed in most quantitative measures, the high user engagement and acceptance suggest the potential effectiveness of the RESILIEN-T system. Future improvements could involve integrating smart objects and interactive virtual agents. Overall, RESILIEN-T represents a promising step toward empowering individuals with cognitive impairment in their self-management and decision-making processes.

Nitric oxide synthase expression in rat anorectal tissue after sacral neuromodulation.

BACKGROUND: Sacral neuromodulation is becoming established as a valid treatment option for patients with anorectal disorders. Nevertheless, despite its efficacy, little is known regarding its mechanism of action. The purpose of this study was to evaluate whether chronic sacral neuromodulation is able to influence the expression of nitric oxide synthetase (NOS) in the anorectum of rats. MATERIALS AND METHODS: Twenty-six female Sprague-Dawley rats were divided into three groups; normal control rats (n = 6); sham treatment (n =10) and group in whom, electrical sacral neuromodulation was performed (n = 10). Bilateral electrode wires were placed in the S1 and electrical stimulation was performed for 14 d. At the end of the procedures the rats were sacrificed, proctectomy was performed, and anorectal specimens were sent to the laboratory for immunostaining with n-NOS and i-NOS. RESULTS: In the anal and rectal specimens, n-NOS and i-NOS expression was significantly increased in epithelial and muscle cells after neuromodulation of the anus and rectum of the animals. CONCLUSION: Our results showed that this model can be applied in further experimental studies to better understand the mechanism of action of sacral neuromodulation in anorectal disorders.

Design and Development of a Scale for Evaluating the Acceptance of Social Robotics for Older People: The Robot Era Inventory.

Introduction: Nowadays, several robots have been developed to provide not only companionship to older adults, but also to cooperate with them during health and lifestyle activities. Despite the undeniable wealth of socially assistive robots (SARs), there is an increasing need to customize the tools used for measuring their acceptance in real-life applications. Methods: Within the Robot-Era project, a scale was developed to understand the degree of acceptance of the robotic platform. A preliminary test with 21 participants was performed to assess the statistical validity of the Robot-Era Inventory (REI) scales. Results: Based on the criteria observed in the literature, 41 items were developed and grouped in different scales (perceived robot personality, human-robot interaction, perceived benefit, ease of use, and perceived usefulness). The reliability of the Robot-Era Inventory scale was analyzed with Cronbach's alpha, with a mean value of 0.79 (range = 0.61-0.91). Furthermore, the preliminary validity of this scale has been tested by using the correlation analysis with a gold standard, the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Discussion: The Robot-Era Inventory represents a useful tool that can be easily personalized and included in the assessment of any SARs that cooperate with older people in real environment applications.

A Psychosocial Intervention for Supporting Informal Caregivers of Older People With Alzheimer Disease: Protocol for the InnFamiglia Randomized Controlled Trial.

BACKGROUND: Dementia is a neurodegenerative syndrome characterized by impaired cognitive functions associated with psychological and behavioral disorders. The informal caregiver has a central role in the life of the person with dementia. Committing a large part of the day to caring for the assisted person inevitably has an effect on the caregiver's life. OBJECTIVE: The aim of this study is to analyze the impact of a psychosocial intervention dedicated to a group of informal caregivers of patients with Alzheimer disease. The intervention will be guided by a trained psychologist who will facilitate the participants' expression of their emotional states, as compared to a traditional self-help group. METHODS: The intervention described in this paper was designed and developed for the project INNovazione sociale e tecnologica per le FAMIGLIE che assistono malati affetti da Alzheimer (InnFamiglia). The study is designed as a randomized controlled trial (RCT). The RCT includes an experimental group, in which the participants will undertake the psychosocial intervention, and a control group, where participants will receive support according to traditional self-help methodology. Interventions for both groups will last 4 months and will be comprised of 16 sessions. RESULTS: Participant recruitment, enrollment, and data collection began in 2021. Enrollment continued until September 2022, at which time the last group began the intervention. Data collection will be completed by December 2022, and data analysis will be completed by March 2023. The study findings will be published in peer-reviewed scientific journals and will be presented at scientific meetings. Summaries of the results will also be made available to investigators for dissemination within their clinics. CONCLUSIONS: We hypothesize that the experimental group will be more effective in managing caregiver burden and coping strategies and that this will improve the perception of well-being, anxiety, and depression among caregivers. Our study aims to compare two groups receiving different interventions: a self-help group and a psychosocial group with elements of emotional support. This study may also give us more information about the most appropriate ways to support and help caregivers of people with dementia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37496.

Cognitive Digital Intervention for Older Patients with Parkinson's Disease during COVID-19: A Mixed-Method Pilot Study.

Mild cognitive impairment is frequent among people with Parkinson's disease. Cognitive training seems effective for cognitive status and for mitigating anxiety and depression. With the COVID-19 outbreak, such therapeutic interventions were delivered online. This longitudinal mixed-method study was aimed at evaluating the effectiveness of an online cognitive treatment, carried out during COVID times and based on Parkinson's-Adapted Cognitive Stimulation Therapy, on cognitive domains and mood of 18 older people with Parkinson's disease. After screening, the cognitive status and mood were assessed three times by Addenbrooke's Cognitive Examination-Revised scale and the Geriatric Depression Scale-Short Form. At the follow-up, patients were also interviewed for understanding their experience with the technology. Such treatment was effective on the participants' cognitive functions, but not on their mood. Despite some initial problems with the technology, the online intervention was experienced as a way of not being 'left behind', staying in contact with others, and being safe during the lockdown. This suggests that online cognitive treatment can be adopted to integrate face-to-face interventions by increasing their efficacy, accessibility, and long-term outcomes. Suggestions for future research are given.

Social Robotics and Dementia: Results from the eWare Project in Supporting Older People and Their Informal Caregivers.

The aim of this paper is to describe the results collected with the Italian study conducted within eWare project, aimed at supporting the autonomy and health of the older people affected by dementia and their informal caregivers, through the use of an innovative system based on a social robot and a sensorized environmental infrastructure. Nine dyads of older participants with their caregivers were enrolled in testing the system for 6 months. The results show a positive impact of the system in supporting the achievement of personal goals of the participants, as well as in supporting the quality of life of the informal caregivers. Nevertheless, the impact of the system in reducing the caregivers' burden needs to be deeply investigated. This research highlights the potential of the eWare system but modifications will have to be made, especially on the interactivity capabilities, in order to meet the peculiar needs and wishes of older people with dementia and to favor the long-term use of the system.

Acceptability and Preliminary Results of Technology-Assisted Balance Training in Parkinson's Disease.

(1) Background: Parkinson's Disease (PD) is one of the most common causes of disability among older individuals. The advanced stages of PD are usually characterized by postural instability and, as a consequence, falls. Those are among the main factors that determine the quality of life, as well as the morbidity and mortality of a person with PD. In the field of PD rehabilitation, robotics is also rapidly gaining ground. As a primary aim, we evaluate the acceptability of the technology integrated intervention, using the Psychosocial Impact of Assistive Devices Scale (PIADS), in order to analyze the attitude of the participants towards the Tymo® system. As a secondary outcome, we assess the result of the rehabilitation treatment integrated with the Tymo® system on several patient's features. (2) Methods: We studied a population of 16 patients with Parkinson's Disease. Each recruited subject completed 10 treatment sessions, organized as two training sessions per week, for 5 weeks. The intervention included 30 min of traditional therapy and 20 min of technological treatment with a robotic system. PIADS is composed of three subscales (Competence subscale, Adaptability subscale, Self-esteem subscale) ranging from -3 to +3, reflecting, respectively, a negative or positive feeling towards the device. (3) Results: The Competence subscale, measuring feelings of competence and usefulness, obtained a score of 1.24 (SD = 0.78). The score of Adaptability subscale, indicating a willingness to try out new things and to take risks, was 1.83 (SD = 0.65). Finally, the Self-esteem subscale, indicating feelings of emotional health and happiness, reached a score of 1.31 (SD = 0.72). Moreover, statistical analysis reveals a significant effect on balance performance after intervention. (4) Conclusions: This feasibility study represents a starting point in the use of technology in the rehabilitation pathway of patients affected by Parkinson's Disease. In fact, our results suggest that a standard therapy combined with an innovative treatment using Tymo® may be accepted by PD patients, which may benefit especially from preserving balance.