Introduction:Subjective Cognitive Decline (SCD) is a heterogeneous at-risk condition along the Alzheimer's disease continuum, characterized by cognitive complaints despite preserved neuropsychological performance. Cognitive reserve (CR) may help explain individual differences in resilience to early cognitive and psychological vulnerability. This exploratory cross-sectional study examined whether global and domain-specific CR-education, occupational activity, and leisure time - were associated with differences in cognitive and psychological functioning in individuals with SCD. Methods:Fifty-one older adults with SCD underwent a comprehensive neuropsychological assessment and self-report measures of subjective complaints, depressive symptoms, and anxiety. Non-parametric analyses compared performance across low, medium, and high CR levels. Results:Cognitive performance was globally preserved, while depressive symptoms were clinically relevant in a substantial proportion of participants. Selective CR-related differences emerged: higher global CR was associated with better visuospatial-constructive performance; lower leisure-time CR was associated with faster performance on attentional and executive tasks; and occupational CR showed a non-monotonic association with depressive symptoms, with lower scores in the medium CR group. No differences emerged in other cognitive domains. Discussion:These findings support a multidimensional and domain-specific conceptualization of CR in SCD and highlight the clinical value of integrating CR into early cognitive aging assessment.

Background: This pilot study investigated the potential effects of an individualized home-based cognitive training program delivered through the Neurotablet® in individuals with Mild Cognitive Impairment (MCI). Methods: Fourteen outpatients were assigned to the experimental group (n = 7) or to the waiting-list control group (n = 7). Standardized neuropsychological and psychological measures were collected at baseline and follow-up. Outpatients of the experimental group completed an eight-week personalized home-based digital rehabilitation protocol targeting multiple cognitive domains. Longitudinal changes in standardized outcomes were analyzed using generalized linear mixed models. In addition, individual MCI trajectories were examined qualitatively by comparing MCI subtype between baseline and follow-up, whereas training performance was analyzed using within-participant linear regression models. Results: Standardized neuropsychological outcomes remained overall stable over time, with no significant differences between groups. By contrast, analyses of training performance revealed heterogeneous patterns across participants, with significant session-related changes emerging in some individuals. In particular, some tasks showed reductions in reaction times across sessions, suggesting changes in task efficiency with repeated practice. These findings highlight the heterogeneity of cognitive trajectories in MCI and suggest that individualized digital training may be associated with measurable changes in task performance, even in the absence of detectable changes in standardized neuropsychological measures. Conclusions: Despite the presence of limitations, digital cognitive interventions may offer a feasible approach to support the delivery of individualized cognitive rehabilitation in individuals reporting cognitive complaints. Further studies with larger samples, more detailed monitoring of training variables and engagement are needed to better clarify the potential cognitive impact of such interventions.

This paper provides a comprehensive overview of dementia in internal medicine hospital settings, highlighting its clinical detection, key red flags and frailty factors, as well as intervention perspectives. Dementia, a multifactorial neurocognitive syndrome represents a major global health challenge due to its rising prevalence, significant socioeconomic burden, and frequent comorbidity with chronic diseases. The paper underscores the importance of early identification and management of dementia in hospitalized older adults, emphasizing the heterogeneity of presentations including delirium, acute cognitive deterioration, and previously undiagnosed cases. It outlines biological, psychological, and social factors influencing dementia progression and frailty, advocating for holistic, biopsychosocial approaches.Clinical red flags and diagnostic pathways tailored for non-specialist hospital settings are discussed, alongside the role of biomarkers and neuroimaging in differential diagnosis. The paper details common neuropsychiatric symptoms of dementia and the challenges they pose for patient care. It stresses the need for dementia-friendly hospital models through environmental adaptation, staff training, and caregiver integration. Interventions addressing both formal healthcare workers and informal caregivers are reviewed too. Pharmacological treatments are considered with caution due to mixed efficacy and safety concerns, highlighting the growing role of novel anti-amyloid therapies under evaluation.Non-pharmacological cognitive and motor rehabilitation interventions are recognized as promising yet underutilized strategies. The paper advocates for integrated, person-centered dementia care models spanning hospital and community to improve outcomes and optimize resource use. The overarching message promotes early detection, multidimensional management, and systemic healthcare planning to meet the complex needs of this vulnerable population.

Background/Objectives: Diabetic neuropathy (DN), a common complication of type 2 diabetes mellitus, manifests as peripheral nerve dysfunction with symptoms such as fatigue. Although exercise effectively reduces fatigue in neuropathy patients, precise detection methods are crucial to elucidate the role of rehabilitation. Accordingly, this study aimed to evaluate fatigue in DN patients using a multimodal approach (clinical and instrumental) and to compare the efficacy of aerobic versus resistance training on fatigue parameters. Methods: Eligible DN inpatients admitted for rehabilitation at the Neuromotor Rehabilitation Unit of the IRCCS ICS Maugeri Institute of Montescano (PV) were enrolled. Inclusion criteria included age between 65 and 85 years and confirmation via the Michigan Neuropathy Screening Instrument (anamnestic section: ≥7; clinical section: ≥2.5). Patients with confounding orthopedic, neurologic, or unstable cardiopulmonary/diabetic conditions were excluded. Overall, 36 participants were randomized into two groups: 17 underwent aerobic training (treadmill), while 19 received resistance training (elastic bands), both as supplements to a standard rehabilitation program. Assessments at baseline and post-training comprised clinical measures (Borg CR10 scale, Functional Independence Measure (FIM) total and subitems, Six-Minute Walk Test (6MWT), fasting blood glucose) and instrumental evaluations (sEMG of the tibialis anterior muscle to analyze conduction velocity intercept, slope, and changes). Results: All patients completed the protocol without dropout or adverse events. Both groups demonstrated significant improvements in FIM scores and post-exercise perceived exertion over time. Instrumental sEMG analysis confirmed a physiological fatigue trend manifested as conduction velocity reduction, yet revealed no significant differences between groups. Conclusions: Multimodal assessment provides an effective means to characterize fatigue in DN patients. Both aerobic and resistance modalities enhance functional independence and fatigue perception. Its early identification enables clinicians to tailor rehabilitation strategies to overcome exercise barriers.

BACKGROUND:Over the last decades, neuromotor rehabilitation programs have integrated multidisciplinary approaches with the implementation of emerging technology (e.g., robotics and virtual reality - VR), to effectively target recovery complexity. While this strategy supported patient's physical improvement, little evidence has been reported regarding the widespread effects on non-motor rehabilitation outcomes. METHODS:A prospective, two-arm, non-randomized study design was adopted to provide pilot feasibility evidence on the multi-domain impact of personalized technology-enhanced neuromotor rehabilitation from convenience sub-samples of patients with stroke, Parkinson's Disease (PD), and osteoarthritis (OA). Technological intervention consisted of the integrated use of robot-assisted and/or VR-based exercises, individualized based on patient's diagnosis and rehabilitation goals. Study outcomes included patient's functional status (autonomy in ADLs, risk of falls), cognition (attention and executive functions, memory, verbal fluency), physical and mental health-related quality of life (HRQoL), and psychological status (anxiety and depression symptoms, and well-being) and were compared to patients participating in standard training only. Rehabilitation experience and technology psychosocial impact were also evaluated. Intra- and intergroup comparisons along with general linear models were statistically tested within each sub-sample considered independently over three timepoints (baseline, post-intervention, 6-month follow-up). RESULTS:At post-intervention, significant multi-domain intra-group improvements were observed within each sub-sample. Between-group differences were found on ADLs autonomy (stroke and PD; p < .05), executive functions (stroke; p < .01), anxiety and depression (OA and PD, respectively; p < .05), and well-being (stroke and OA; p < .05). Interaction effects (time x group) were significant only on well-being variables in stroke (p = .01) and OA (p = .02), evidencing wider short-term effects of technology-enhanced programs compared to standard training. At 6-month, significant time effects indicating sustained improvements over the three timepoints were estimated on HRQoL within each sub-sample (p < .05) and, additionally, on anxiety and depression in stroke (p = .02) and OA (p < .001). Interaction effects emerged only on physical HRQoL in OA (p = .02), along with significant between-group differences on HRQoL and anxiety and depression in OA (p < .05) and PD (p = .01), respectively. CONCLUSION:Further full-scale trials are warranted to confirm the longitudinal trends observed in this pilot study and to further investigate the potential multi-domain benefits of multidisciplinary and technology-integrated recovery approaches across different clinical populations. TRIAL REGISTRATION:ClinicalTrials.gov ID: NCT05399043.

Objective: Robot-assisted therapy (RAT) has shown promise in post-stroke motor recovery. However, its effects on non-motor outcomes remain unclear. This systematic review evaluated RAT impact on post-stroke quality of life (QoL), cognition, and psychosocial functioning. Methods: Following PRISMA guidelines, electronic searches were performed from Web of Science, PubMed, Cochrane Library, CINAHL, Embase, and PsycINFO. Risk of bias was assessed using NIH Quality Assessment Tools. Data on study design, participants, intervention characteristics, outcomes, and results were extracted and synthetized descriptively. Results: A total of 90 studies met the inclusion criteria. Considerable heterogeneity was found in participants’ characteristics, intervention duration (2–52 weeks), and dosage (20–240 min/session). Most studies reported significant RAT effects on QoL (emotional, physical, cognitive, social subdomains), cognition (attention, executive functions, memory, language, visuo-spatial abilities, intelligence), and psychosocial outcomes (anxiety, depression, self-efficacy, fear of falling, motivation, coping). Some studies also showed greater improvements compared with conventional training controls. Longitudinal effects were generally absent, except for QoL variations observed up to 12 months. Cognitive and psychological factors were also identified as moderators/predictors of RAT response. Conclusion: Despite variability across studies, findings suggest RAT may have a broad impact beyond motor recovery. Future large-scale, standardized, longitudinal trials are recommended to confirm these results.

Background and objectives: This study examines how sociodemographic, clinical, and psychological factors within the patient–caregiver dyad affect caregiver burden and health-related quality of life (HRQoL) in cognitive impairment. By comparing baseline data with a 1-year follow-up, the research aims to identify key predictors of caregiver burden and well-being. Methods: A longitudinal observational study was conducted in an Italian rehabilitation hospital, recruiting 132 outpatients and their caregivers at baseline, categorized as (a) Mild Cognitive Impairment (MCI, n = 33); (b) dementia (DEM, n = 58); (c) healthy subjects (No-CI, n = 41). One year after baseline assessment (T0), patients were contacted and invited for an in-person follow-up re-evaluation (T1). Most attrition was related to the COVID-19 pandemic. Statistical analyses included non-parametric tests for group comparisons and stepwise multiple linear regression to identify predictors of burden, adjusting for confounders (e.g., age, gender, education, employment, co-residence). Results: A total of 51 subjects (age: 80.0 ± 6.1) and 34 caregivers (age: 58.8 ± 15.9) were evaluated. Patients were balanced by gender (53% males); most were retired (96%), married (62.7%), and cared for by sons (47%) or wife–husband (47%). Caregivers (females: 85%) were married (68.3%) and active workers (46.4%). Over one year, 17 No-CI subjects developed MCI or DEM; 15 MCI patients progressed to DEM. Caregiver HRQoL negatively correlated with distress and burden in MCI and DEM groups. Patient cognitive status, functional abilities, neuropsychiatric symptoms, and gender predicted caregiver burden, emphasizing the interplay between clinical and demographic factors. Conclusions: It is essential to monitor psychosocial factors in both the patient and the caregiver to develop effective prevention and support strategies.

Parkinson's disease (PD) and multiple sclerosis (MS) are two chronic neurological diseases (CNDs) that have a high demand for early and continuous rehabilitation. However, accessing professional care remains a challenge, making it a key priority to identify sustainable solutions for ensuring early rehabilitation availability. Objective: The FIT4TeleNEURO pragmatic trial proposes to investigate, in real-life care settings, the superiority in terms of the effectiveness of early rehabilitation intervention with harmonized, mix-model telerehabilitation (TR) protocols (TR single approach, task-oriented-TRsA; TR combined approach, task-oriented and impairment-oriented-TRcA) compared to conventional management (control treatment, CeT) in people with PD and MS. Design, and Methods: This multicenter, randomized, three-treatment arm pragmatic trial will involve 300 patients with CNDs (PD, N = 150; MS, N = 150). Each participant will be randomized (1:1:1) to the experimental groups (20 sessions of TRsA or TRcA according to a mix-model-3 asynchronous + 1 synchronous session/week) or the control group (20 sessions of CeT). Primary and secondary outcome measures will be obtained at the baseline (T0), post-intervention (T1, 5 weeks after baseline), and follow-up (T2, 3 months after the end of the treatment). A multidimensional evaluation (cognitive, motor, and quality of life domains) will be conducted at each time point of assessment (T0; T1; T2). The primary outcome measures will be the assessment of change (T0 vs. T1 vs. T2) in static and dynamic balance, measured using the Mini-Balance Evaluation Systems Test. Usability and acceptability assessment will be also investigated. Expected Results: Implementing TR protocols will enable a more targeted and efficient response to the growing demand for rehabilitation in the early stages of CNDs. Both the TRsA and TRcA approaches are expected to be more effective than CeT, with the combined approach likely providing greater benefits in secondary outcome measures. Finally, the acceptability of the asynchronous modality could open the door to scalable solutions, such as digital therapeutics.

PURPOSEThe implementation of Technology-Assisted Rehabilitation (TAR) introduces both challenges and opportunities to enhance patient-therapist interactions. However, the therapist's perspective on TAR often remains understudied. This study aims to address this gap by investigating therapist perceptions of Robot-Assisted Gait Training (RAGT) by developing a specific questionnaire.METHODSThe study is a real-life observational and multicentric pilot study. First, a multidisciplinary board was created to develop the questionnaire. Second, an observational pilot study was conducted, where the questionnaire was administered to therapists involved in RAGT working with a lower-limb robotic device for gait disorders.RESULTSThirty-two questionnaires were collected. Results indicate favourable perceptions among therapists in terms of device's usefulness, ease of use and safety. However, despite the overall positive response trend, therapist engagement showed more variability.CONCLUSIONSThe findings underscore the need of reconceptualizing therapist contribution in TAR, for optimal integration into clinical practice and to improve patient-therapist-device interaction.

Background: Lower limb amputation (LLA), due to non-traumatic causes such as vascular diseases and diabetes, significantly impacts patients’ physical, psychological, and social well-being. While multidisciplinary rehabilitation programs commonly address physical and functional recovery, psychological and subjective experiences related to limb loss remain less explored. Thus, this preliminary study aimed to investigate the psychological and behavioral adaptation processes in patients undergoing rehabilitation following lower limb amputation. Methods: A preliminary observational study with a mixed-method approach based on quantitative and qualitative data triangulation was conducted. This approach involves integrating multiple data sources and methodologies—in this case, quantitative psychometric measures and qualitative interviews via the prospective of amputees and those who use prostheses—to enhance the validity and depth of the research findings. Results: Fourteen inpatient amputees and fourteen inpatient prosthesis users (years: 66.6 ± 2.5 for amputee and 61.5 ± 1.9 for prosthesis users, male amputees: 85.7%, male prosthesis users: 100%) of a research hospital in the North of Italy were assessed using validated psychometric tools (GAD-7, PHQ-9, PID-5-BF, BIS, ASonA) alongside semi-structured interviews analyzed through the Interpretive Description approach. Key themes highlighted illness acceptance, prosthesis adaptation, body image, medication and behavioral adherence, anxiety, depression, quality of life, denial, optimism, and social support. Overall, anxiety–depressive symptomatology tended to decrease with the prosthesis, and pharmacological and behavioral adherence improved, as did the disease acceptance. Body image was fairly preserved in all patients despite some fears of others’ judgment with respect to the prosthesis. Interestingly, there was poor agreement between quantitative and qualitative data in both the amputee’ and prosthesis users’ groups: while the former returned a partial and neutral picture, a more multifaceted picture emerged from the interviews collected. Conclusions: These findings underline the importance of integrating quantitative psychometric evaluations with qualitative methods to comprehensively understand patients’ adaptive experiences. Such combined insights are essential to inform tailored psychological interventions throughout the rehabilitation journey.

Background: Executive dysfunction may be an early marker of neurodegenerative disorders, even if it is difficult to detect objectively. Subjective cognitive decline (SCD) may reflect subtle deficits in executive functions (EFs); however, SCD is also strongly influenced by affective factors such as depression. Whether depressive symptoms alter the link between EFs and SCD remains unclear. The present study tested whether depressive symptoms moderate the association between executive functioning and SCD. Methods: In this cross-sectional study, 65 outpatients completed a comprehensive assessment including executive functions (FAB), self-reported cognitive difficulties (CFI self-report), and depressive symptoms (PHQ-9). Descriptive statistics were performed, as well as a moderation analysis using PHQ-9 as moderator of the relationship between FAB and CFI self-report. Results: Participants (age: 69.28 ± 9.03) showed preserved EFs (FAB = 15.42, SD = 2.11), mild depressive symptoms (PHQ-9 = 6.57, SD = 5.02), and modest subjective difficulties (CFI = 4.87, SD = 2.57). The FAB main effect was positive but non-significant (β = 0.155, p = 0.266), while PHQ-9 was a significant positive predictor (β = 0.470, p ≤ 0.001). The interaction effect was significant (95% CI: [−0.166, −0.015], β = −0.343, p = 0.020). Specifically, simple slope analysis showed that at low levels of depression (−1 SD), better executive functioning was associated with higher SCD (β = 0.498, p = 0.039). Instead, the association was negative but non-significant at moderate (β = 0.155, p = 0.266) and high levels of depression (+1 SD) (β = −0.188, p = 0.229). Conclusions: In SCD, depressive symptoms are a stronger correlate of subjective cognitive difficulties than executive functions. Moreover, higher depression may modulate the executive functions–complaint link, reducing and potentially reversing it as symptom burden increases. Screening and treatment of depressive symptoms should be integrated into SCD assessment and care. Longitudinal and multicenter studies are needed to more deeply understand these preliminary results.

Background:Subjective Cognitive Decline (SCD) is increasingly recognized as a potential early indicator of neurodegenerative disorders, yet its heterogeneous nature and lack of standardized screening tools complicate early detection and clinical management. This study aimed to comprehensively characterize a clinical SCD population and provide a preliminary contribution to the validation of a novel multidimensional screening battery, called MASCoD (Multidimensional Assessment of Subjective Cognitive Decline). Methods:A total of 59 individuals (69.36 ± 8.66, female: 71,2%) with self-reported SCD without objective cognitive impairment was recruited within two Centers for Cognitive Disorders and Dementia (CCDDs) in Northern Italy. Participants underwent a comprehensive assessment, including neurological assessment, neuropsychological testing, psychological screening, and administration of MASCoD. Convergent validity was assessed using the Cognitive Function Instrument (CFI), and internal consistency was evaluated too. Correlations between MASCoD subscales, depressive and anxious symptoms, and cognitive performance were examined, alongside comparisons between short and long forms of anxiety and depression measures (GAD and PHQ). Results:The sample showed preserved cognitive performance across all domains, consistent with SCD diagnostic criteria. Mild depressive symptoms were present and significantly associated with SCD, explaining up to around 10% of the variance in SCD measures. MASCoD Section B demonstrated good internal consistency (KR-20 = 0.782) and the entire tool shows moderate-to-strong convergent validity with the CFI. Notably, comparisons between PHQ-2/GAD-2 and their full-length versions indicated the brief tools may underestimate affective symptoms in this population. Conclusion:This study offers a detailed clinical and cognitive profile of an older SCD population, emphasizing the psychological dimensions of subjective complaints which should be evaluated into routine cognitive screening to proposed targeted preventive and rehabilitation interventions. The preliminary validation of MASCoD supports its potential as a reliable and multidimensional screening tool for early SCD detection. However, limitations such as small sample size, cross-sectional design, and cultural specificity necessitate further validation studies.

Robotics and Virtual Reality (VR) have shown promise in rehabilitation programs, but more integrated technology evaluations are essential to promote patient engagement and outcomes. This study assessed technology experience of use, usability, and psychosocial impact in neuromotor rehabilitation, by accounting both patients' (n = 29) and their therapists' (n = 13) view. A mixed-method convergent parallel design with a nested triangulation protocol was adopted to analyze participants' perspectives and further identify agreements and discrepancies. Positive perceptions of technology experience of use, usability, and psychosocial impact were reported by patients along with significant correlations between technology use and perceived effectiveness. Therapists noted acceptable usability with some device-specific variations. From qualitative data, key themes were identified (i.e., "Learnability," "Engagement," "Implementation", "Barriers") and areas for improvement were highlighted for future deployment. Finally, triangulation showed broad agreement among participants. Findings emphasize the need for integrating different user perspective when evaluating rehabilitation technologies and underscore their potential to enhance rehabilitation outcomes.

The rehabilitation of patients with severe acquired brain injury (sABI) presents various challenges. There is still a lack of knowledge regarding the efficacy and timing of high-technology (HT) rehabilitation in this clinical population. This paper describes the rehabilitation of a 56-year-old Caucasian woman who developed sABI due to the spontaneous rupture of multiple left middle cerebral artery aneurysms. The focus is on the interconnection between cognitive resources and motor-cognitive abilities to implement HT rehabilitation as early as possible, aiming to maximize the restoration of both motor and cognitive deficits. Following the acute clinical phase, the patient underwent an intensive multidisciplinary rehabilitation, which is described in this paper. The main target was the superior limb training with HT using an upper limb exoskeleton and augmented feedback exercises. The rehabilitative exercises have been selected and timed according to the neuropsychological assessment. The patient showed progressive cognitive and upper limb motor recovery along the tailored rehabilitative path. This case study provides useful insights into the value of a customized motor-cognitive HT rehabilitative approach, allowing for the best possible functional outcome in a case of sABI.

Background. The management of Long COVID symptoms is necessary. This study proposes a screening tool for psycho-physical COVID-19 sequelae. Patients' experiences after COVID-19 are also described. Method. 84 COVID-19 patients (66.2 +/- 11.0 years old; 71.4% male) underwent a phone interview 1-2 years after the disease using the ad-hoc "Post-Acute Sequelae of COVID-19 Checklist (PASC-C)". It explores 30 physical, psychological, and cognitive symptoms clustered into 10 areas, with possible clinical recommendations in case of high severity scores (>50) of a symptom or the presence of two or more ones within the same area. Results. Overall, fatigue (69%), dyspnea (52.4%), memory disturbances (44%), joint- muscle pain (41.7%), vision/hearing loss (40.5%), anxiety (40.5%) persist one-two years after COVID-19 disease. Being a survivor was primarily defined in terms of being "lucky". Conclusions. PASC-C seems promising in monitoring psycho-physical sequelae of Long COVID and providing tailored suggestions to care for the patient over time.

Abstract Background The identification and staging of Alzheimer’s Disease (AD) represent a challenge, especially in the prodromal stage of Mild Cognitive Impairment (MCI), when cognitive changes can be subtle. Worldwide efforts were dedicated to select and harmonize available neuropsychological instruments. In Italy, the Italian Network of Neuroscience and Neuro-Rehabilitation has promoted the adaptation of the Uniform Data Set Neuropsychological Test Battery (I-UDSNB), collecting normative data from 433 healthy controls (HC). Here, we aimed to explore the ability of I-UDSNB to differentiate between a) MCI and HC, b) AD and HC, c) MCI and AD. Methods One hundred thirty-seven patients (65 MCI, 72 AD) diagnosed after clinical-neuropsychological assessment, and 137 HC were included. We compared the I-UDSNB scores between a) MCI and HC, b) AD and HC, c) MCI and AD, with t-tests. To identify the test(s) most capable of differentiating between groups, significant scores were entered in binary logistic and in stepwise regressions, and then in Receiver Operating Characteristic curve analyses. Results Two episodic memory tests (Craft Story and Five Words test) differentiated MCI from HC subjects; Five Words test, Semantic Fluency (vegetables), and TMT-part B differentiated AD from, respectively, HC and MCI. Conclusions Our findings indicate that the I-UDSNB is a suitable tool for the harmonized and concise assessment of patients with cognitive decline, showing high sensitivity and specificity for the diagnosis of MCI and AD.

BACKGROUND:The heightened risk of dementia resulting from multiple comorbid conditions calls for innovative strategies. Engaging in physical and cognitive activities emerges as a protective measure against cognitive decline. This protocol aims to discuss a multidomain intervention targeting individuals with dementias secondary to cerebrovascular or other medical diseases, emphasizing an often underrepresented demographic. METHODS:This study primary objectives are: a) to identify patients affected by Neurocognitive disorder due to vascular disease or multiple etiologies (screening and diagnostic phase) and b) to evaluate the effectiveness of distinct rehabilitation protocols (intervention phase): motor training alone, paper-based cognitive rehabilitation combined with motor training, digital-based cognitive rehabilitation coupled with motor training. DISCUSSION:Identifying cognitive impairment beyond rigid neurological contexts can facilitate timely and targeted interventions. This protocol strives to address the complex interplay of cognitive decline and comorbidities through a multidimensional approach, providing insights that can shape future interventions and enhancing overall well-being in this vulnerable population. TRIAL REGISTRATION:The study has been registered on July 13, 2023 with the ClinicalTrials.gov NCT05954741 registration number (https://classic.clinicaltrials.gov/ct2/show/NCT05954741).

The advent of computerized medical recording systems in healthcare facilities has made data retrieval tasks easier, compared to manual recording. Nevertheless, the potential of the information contained within medical records remains largely untapped, mostly due to the time and effort required to extract data from unstructured documents. Natural Language Processing (NLP) represents a promising solution to this challenge, as it enables the use of automated text-mining tools for clinical practitioners. In this work, we present the architecture of the Virtual Dementia Institute (IVD), a consortium of sixteen Italian hospitals, using the NLP Extraction and Management Tool (NEMT), a (semi-) automated end-to-end pipeline that extracts relevant information from clinical documents and stores it in a centralized REDCap database. After defining a common Case Report Form (CRF) across the IVD hospitals, we implemented NEMT, the core of which is a Question Answering Bot (QABot) based on a modern NLP model. This QABot is fine-tuned on thousands of examples from IVD centers. Detailed descriptions of the process to define a common minimum dataset, Inter-Annotator Agreement calculated on clinical documents, and NEMT results are provided. The best QABot performance show an Exact Match score (EM) of 78.1%, a F1-score of 84.7%, a Lenient Accuracy (LAcc) of 0.834, and a Mean Reciprocal Rank (MRR) of 0.810. EM and F1 scores outperform the same metrics obtained with ChatGPTv3.5 (68.9% and 52.5%, respectively). With NEMT the IVD has been able to populate a database that will contain data from thousands of Italian patients, all screened with the same procedure. NEMT represents an efficient tool that paves the way for medical information extraction and exploitation for new research studies.

The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, improving their performance in several activities. However, the subjective perception of the device has never been fully addressed, being a conditioning factor for its use. The aims of the study were: (a) to develop a questionnaire on patients’ personal experience with TAR and exergames in a real-world clinical setting; (b) to administer the questionnaire to a pilot group of neurologic patients to assess its feasibility and statistical properties. A self-administrable and close-ended questionnaire, Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q), designed by a multidisciplinary team, was developed in Italian through a Delphi procedure. An English translation has been developed with consensus, for understandability purposes. The ultimate version of the questionnaire was constituted of 10 questions (5 with multiple answers), totalling 29 items, exploring the patient’s performance and personal experience with TAR with Augmented Performance Feedback. TARPP-Q was then administered pre-post training in an observational, feasible, multi-centric study. The study involved in-patients aged between 18 and 85 with neurological diseases, admitted for rehabilitation with TAR (upper limb or gait). FIM scale was run to control functional performance. Forty-four patients were included in the study. All patients answered the TARPP-Q autonomously. There were no unaccounted answers. Exploratory factor analyses identified 4 factors: Positive attitude, Usability, Hindrance perception, and Distress. Internal consistency was measured at T0. The values of Cronbach’s alpha ranged from 0.72 (Distress) to 0.92 (Positive attitude). Functional Independence Measure (FIM®) scores and all TARPP-Q factors (Positive attitude, Usability, Hindrance perception, except for Distress (p = 0.11), significantly improved at the end of the treatment. A significant positive correlation between Positive attitude and Usability was also recorded. The TARPP-Q highlights the importance of patients’ personal experience with TAR and exergaming. Large-scale applications of this questionnaire may clarify the role of patients’ perception of training effectiveness, helping to customize devices and interventions.