Factors Associated with Dual-Fluency Walk Speed Improvement after Rehabilitation in Older Patients.

Walk speed measured under dual-task conditions (neurocognitive tasks) could reflect patient performance in real-life. Rehabilitation programs are effective in increasing walk speed, but few studies have evaluated the associations between geriatric factors and rehabilitation efficacy under dual-task conditions. Our objective was to investigate the association between geriatric factors and an increase in dual-task walk speed (threshold of 0.1 m/s), after a multidisciplinary rehabilitation program. We performed a retrospective cohort study that included patients aged 75 years and over, who underwent a complete rehabilitation program and who had a neurocognitive assessment at baseline. The primary outcome was the increase in the dual-task (fluency verbal task) walking speed between pre- and post-rehabilitation assessments. In this study, 145 patients were included, with a mean age of 83.6 years old. After rehabilitation, dual-task walk speed increase in 62 (43%) patients. In multivariate analysis, the following factors were associated with an increase in dual-task walk speed: IADL (OR 2.50, 95% CI [1.26; 4.94], p = 0.009), vitamin D level (OR 0.83, 95% CI [0.72; 0.95], p = 0.008), severe sarcopenia (OR 0.00, 95% CI [0.00; 0.32], p = 0.016), depression (OR 15.85, 95% CI [1.32; 190.40], p = 0.029), number of drugs (OR 1.41, 95% CI [1.04; 1.92], p = 0.027), initial dual-fluency walk speed (OR 0.92, 95% CI [0.86; 0.98], p = 0.014) and time interval between initial and final assessments (OR 0.98, 95% CI [0.96; 1.00], p = 0.06). Identifying patients that are less resilient to rehabilitation may promote a centered-patient approach for an individualized and optimized rehabilitation care.

Multimorbidity and epilepsia in the elderly.

Epilepsia is a frequent disease in the elderly. Most of the time seizures are the consequence of another or other comorbidities and they are generally partial. Causal pathologies are either cerebral or general. The most common is the stroke, especially if it is haemorrhagic. If the seizure is delayed in relation to stroke, it defines vascular epilepsy and is an indication for long-term antiepileptic therapy. Neurodegenerative diseases, primarily Alzheimer's disease, are associated with epilepsy, but the pathophysiological links between the two are poorly understood. The clinical presentation of seizures is often atypical and the existence of memory disorders complicates the diagnosis because they make it difficult to reconstruct the anamnesis. Cranial trauma and tumours are the other classic brain causes of epilepsy. The general causes include metabolic and hydroelectrolytic disorders (especially hypoglycaemia and hyponatremia), drugs (either by their toxicity or by a withdrawal syndrome), and uraemic encephalopathy of renal failure. Finally, alcohol is a common cause not to be neglected, including among institutionalised patients.