INTRODUCTION:Automated cerebrospinal fluid (CSF) biomarker assays have largely replaced manual immunoassays for measuring amyloid pathology in CSF. We refitted and validated the ABIDE model, predicting progression from mild cognitive impairment (MCI) to dementia, with CSF measurements from the automated Elecsys platform. METHODS:We included 2413 MCI participants (998 [41%] amyloid-positive) from seven observational cohorts. Elecsys was used in 958 (40%) participants. The parameters of the previous ABIDE Cox model were re-estimated. Model discrimination and calibration were evaluated with leave-one-cohort-out cross-validation. RESULTS:During follow-up, 1034 (42%; 585 [58%] amyloid-positive) participants developed dementia. Discrimination was good with Harrell's C of 0.70 (95% confidence interval [CI]: 0.66-0.73). Calibration was good in the total population and amyloid-positive subgroup, with substantial predicted progression risks for all amyloid-positive participants. DISCUSSION:We refitted the ABIDE model, predicting MCI to dementia progression, with automated CSF measurements. The model was well calibrated in amyloid-positive patients and may support clinical discussions regarding ATTs.

Alzheimer’s disease (AD) represents one of the most complex and pressing challenges of modern medicine, particularly in the context of global population aging. Despite major advances in molecular biology, neuroimaging, and digital health, Alzheimer’s disease remains largely diagnosed at a symptomatic stage, when neurodegeneration is already advanced and therapeutic options are limited. Recent large-scale population studies using blood-based biomarkers reveal that biological Alzheimer’s disease pathology is far more prevalent than clinically diagnosed dementia, highlighting a long and actionable preclinical phase for prevention and early intervention. This chapter adopts a lifespan and longevity-medicine perspective, integrating classical pathophysiological mechanisms with emerging concepts in brain resilience, stress biology, intrinsic capacity, and preventive medicine. We review current and emerging diagnostic tools – including fluid, imaging, digital, and AI-supported biomarkers – key mechanisms of disease pathogenesis, and multimodal therapeutic strategies. Particular emphasis is placed on the transition from symptom-based diagnosis to biology-based staging, early intervention, and personalized, adaptive care pathways. We address the “digital health paradox,” emphasizing that effective deployment of digital biomarkers requires objective assessment of digital competence rather than reliance on patient self-report, given documented discrepancies in older populations. Finally, we propose a Seniors-Oriented Technology Acceptance Model (STAM) and co-creation strategies to support age-inclusive, ethically governed, and scalable clinical implementation. Together, these approaches aim to preserve brain healthspan, delay disease progression, and translate geroscience principles into routine clinical practice.

With increasing numbers of older adults worldwide, the following topics have become a priority: understanding and promoting aging in place, well-being, and technology adoption. We focused on how well-being is understood by old older adults, those aged between 75 to 84 years old. To them, the concept of aging at home starts to gain relevance alongside the need for receiving care and technology adoption. In our methodology, we have employed questionnaires (2022) and interviews (2024) across four countries: Romania, Portugal, Switzerland, and Denmark, with a total of 71 participants. Three major themes were identified for old older adults: a) with age, the relevance of physical and mental health fade, hence the importance of preserving their wellbeing, b) aging at home means independence and receiving support for this category and c) From the perspective of technology adoption, a second segmentation, based on functional capacity, within the general old older adults’ segmentation (74–85) is necessary. This segmentation based on the functional capacity shows 5 categories of old older adults who have different attitudes towards technology adoption. This study contributes to getting a better insight concerning old older adults’ perspectives on wellbeing and their technology adoption, comparative to the those aged 65 to 74. Enhancing support in care and designing age friendly cities which offer security and foster participation, are contributing factors to aging in place.

Automated cerebrospinal fluid (CSF) biomarker assays have largely replaced manual immunoassays for measuring amyloid pathology. Their relevance is increasing as amyloid-targeting therapies (ATTs) are becoming available for amyloid-positive mild cognitively impaired (MCI) individuals. Therefore, we refitted and validated the ABIDE model, predicting progression from MCI to dementia, with CSF measurements from the automated Elecsys platform. Additionally, we evaluated the performance in an amyloid-positive subpopulation, potentially eligible for ATTs. We combined data from MCI participants of seven single-centre and multicentre observational cohorts: Amsterdam Dementia Cohort ( n =648), Alzheimer's Disease Neuroimaging Initiative ( n =544), BioFINDER ( n =212), European Medical Information Framework for Alzheimer's Disease ( n =809), Lleida ( n =88), National Alzheimer's Coordinating Centre ( n =63), and Wisconsin Alzheimer's Disease Cohort ( n =9). Participants were included with MCI at baseline, a baseline Mini-Mental State Examination, either a magnetic resonance imaging hippocampal volume or CSF Aβ1-42 and pTau181 measurements, and at least six months of follow-up. Elecsys was used in 737 (31%) participants. A Cox model was used to predict time to dementia using the variables in the previous ABIDE model (Maurik et al. 2019). Model discrimination and calibration were evaluated with leave-one-cohort-out cross-validation. Calibration was assessed in the pooled cohort (PC) and amyloid-positive (APos) subgroup, stratified by predicted risk: PC/APos1 (P86). Of 2372 MCI participants (Table 1; 70±8yrs, 57%F; 41% amyloid-positive) with a median follow-up of 2.1yrs, 997 (42%; 563 [58%] amyloid-positive) developed dementia (IQR:1.3-3.2yrs). The refitted coefficients resemble the prior model, except for a larger effect of the Aβ1-42*pTau interaction (Table 2). Discrimination was similar to the prior ABIDE model, with Harrell's C of 0.70 (95%CI:0.69-0.71), and calibration was good in the pooled cohort, amyloid-positive subgroup (Figure 1), and across CSF assays. In the amyloid-positive subgroup, all four risk groups had a substantial progression risk with a median predicted progression time of 6.3yrs (95%CI:6.1-6.6) in APos1, 3.7yrs (95%CI:3.5-4.0) in APos2, 3.0yrs (95%CI:2.8-3.0) in APos3, and 2.0yrs (95%CI:2.0-2.1) in APos4. We updated the ABIDE model for predicting MCI to dementia progression with automated CSF measurements. The model was well calibrated in amyloid-positive patients and may support clinical discussions regarding the initiation of ATTs.

BackgroundThe association between lifestyle factors and Alzheimer's disease (AD) pathophysiology remains incompletely understood.ObjectiveThe aim of this study was to assess the association of alcohol consumption, smoking behavior, sleep quality and physical, cognitive, and social activity with cerebral amyloid pathology.MethodsFor this cross-sectional study, we selected participants from the Amyloid Biomarker Study data pooling initiative. We used generalized estimating equations to assess associations of dichotomized lifestyle measures with amyloid pathology.ResultsWe included 9171 participants with normal cognition (NC) and 2555 participants with mild cognitive impairment (MCI) from the Amyloid Biomarker Study. Of participants with NC, 58% were women, 34% were APOE ε4 carrier, and 27% had amyloid pathology. Of participants with MCI, 48% were women, 47% were APOE ε4 carrier, and 57% had amyloid pathology. In NC, cognitively active participants were less likely to have amyloid pathology (OR = 0.77, 95%CI 0.66-0.89, p < 0.001). In MCI, participants who had ever smoked or had sleep problems were less likely to have amyloid pathology (OR = 0.85, 95%CI 0.73-0.99, p = 0.029; OR = 0.62, 95%CI 0.45-0.86, p = 0.004).ConclusionsIn NC, cognitive activity was associated with a lower frequency of amyloid pathology. In MCI, favorable lifestyle behaviors were not associated with a lower frequency of amyloid pathology. The results of the current study contribute to the broader evidence base on lifestyle and AD by further characterizing the role of lifestyle behaviors in AD pathology across different clinical stages.

INTRODUCTION:Digital technology holds promise for addressing age-related challenges such as diminished physical and cognitive abilities, chronic conditions, and shifts in social connections. Individual proficiency in computer and internet skills influences technology adoption, correlated with advanced usage, positive attitudes, and self-efficacy. Despite extensive research on digital competence among younger demographics, there is a noticeable gap in inclusive design and research for older adults, with existing assessments often overlooking user ability diversity. The aim of this study is to evaluate the reliability of self-assessment as a method for measuring digital skills among older adults by comparing self-reported competence with objective assessments using the digital foundation skills framework. METHODS:A between-subjects design was used to explore the reliability of self-assessment in evaluating digital skills among older adults, comparing self-assessed and objective assessments using the digital foundation skills framework. This framework encompasses six domains and provides statements and practical examples for self-assessment and objective evaluation of digital competence. Data were collected from 51 Romanian adults over the age of 60 using an online survey for the subjective assessment and laboratory testing for the objective assessment. RESULTS:Significant disparities were found between self-assessed and actual performance in three domains: digital foundation skills, communicating, and problem-solving. However, older adults accurately assessed their performance in handling information and content, transacting, and being safe and legal online. CONCLUSION:Given the lack of a consistent pattern of overestimation or underestimation, objective assessment is recommended for precise digital competence evaluation.

Background and Objective: In the context of the rapidly aging global population, the older adult vulnerability poses a significant challenge for public health systems. Frailty, cognitive and nutritional status, depression, and grip strength are essential parameters for staging the vulnerability of older adults. The objective of this study is to identify a rapid but multidimensional geriatric assessment tool that can enhance the rehabilitation process for older adults, tailored to their specific needs. Materials and Methods: This pilot study examines the relationships between grip strength, nutritional status, frailty, depression, and cognition in a group of 80 older adults with a mean age of 69.6 years, 49 male and 31 female, using standardized geriatric scales and digital grip strength measurements. The study employed a digital dynamometer, a portable and reliable tool that facilitated quick and accurate grip strength measurements. Results: The analysis revealed significant correlations among the parameters. Greater grip strength was associated with better cognitive performance (r = 0.237, p = 0.034) and improved nutritional status (r = 0.267, p = 0.016), while it was inversely related to frailty (r = −0.313, p = 0.005). Nutritional status also played a key role, showing an inverse relationship with frailty (r = −0.333, p = 0.003) and depression levels (r = −0.248, p = 0.027). Furthermore, frailty and depression were strongly interconnected, with those experiencing higher frailty levels also displaying more severe depressive symptoms (r = 0.545, p < 0.001). Marital status was also relevant: married participants exhibited higher grip strength, lower frailty, and fewer depressive symptoms, suggesting that social support positively influences both physical and mental health in older adults. Conclusions: These findings not only emphasize the need for integrated care approaches that simultaneously address physical health, nutrition, and cognitive function, but also provide a foundation for the development of a rapid and multidimensional assessment protocol, which consists of using a digital dynamometer and four geriatric scales. Such a tool could play a crucial role in the early detection of frailty syndrome and guide the implementation of multidisciplinary, tailored therapeutic strategies aimed at preserving the autonomy and improving the quality of life of older adults.

As life expectancy continues to increase, improving the quality of life (QoL) for older adults becomes an important issue. This study investigated the impact of a two-week intensive rehabilitation program at the Techirghiol Balneal and Rehabilitation Sanatorium on older adults' QoL, focusing on physical and cognitive function. The study employed a comprehensive geriatric assessment to evaluate the progress of 156 patients over 65 from admission to discharge. We used the Scale for Identifying Fall Risk Factors (STRATIFY) scale to assess the risk of falling, the Visual Analogue Scale (VAS) to assess pain levels, and the Functional Independence Measure (FIM) to assess motor and cognitive abilities. The program included multiparametric evaluations and personalized treatment plans. Statistical analysis of these data led to the following results: The STRATIFY scale showed a significant improvement in patient functionality and a decrease in the risk of falling during hospitalization, with a mean difference in scores between admission and discharge ranging from 0.141 to 0.372, with a p-value of less than 0.001, confirming the clinical significance of this improvement. The VAS showed a significant reduction in pain or symptom intensity, reflected by a mean decrease of -3.141 between admission and discharge. The FIM recorded a mean increase of 1.436 in patients' motor capacity between admission and discharge, reflecting improved adaptation to daily activities, especially in the areas of self-care, sphincter control, transfer, and locomotion. Social participation and health status were positively influenced, demonstrating the benefits of short-term, intensive rehabilitation. The two-week rehabilitation program significantly improved the QoL of older adult patients. These outcomes suggested that active aging strategies could be effectively integrated into medical and institutional care frameworks, highlighting the necessity for policies that support older adults' involvement in economic and social contexts.

The global demographic shift toward an aging population necessitates a nuanced approach to developing and adopting assistive technologies tailored for older adults. This paper synthesizes key challenges, strategies, and recommendations identified in addressing the complex landscape of technology adoption and usage among aging populations. User-centric design and co-creation initiatives are vital for developing assistive technologies that meet the needs of older adults. These initiatives involve engaging older adults in activities like workshops, focus groups, and design sessions to gather feedback and refine technology solutions, ensuring they are accessible, intuitive, and effective. Challenges such as participant selection, cultural attitudes, and trust-building mechanisms are paramount in ensuring meaningful user involvement in technology development processes. Accurate assessment of older adults’ technological literacy is identified as critical for designing and implementing digital solutions. The unreliability of self-reported proficiency necessitates objective measures in assessments to counter potential biases and ensure accurate insights into user capabilities. The fragmented digital ecosystem and resulting digital divide among older adults pose significant barriers to technology adoption and usage. The role of caregivers in technology acceptance highlights the need for integrated models that encompass the caregiver perspective, reducing adoption barriers and fostering meaningful engagement with assistive technologies. Interdisciplinary collaboration and robust research standards are essential in advancing technology adoption and addressing societal inequalities. Prioritizing user-centric design, integrating caregivers into technology adoption models, and fostering collaborative efforts across disciplines can significantly improve technology acceptance and enhance the quality of life for older adults in an increasingly digital era.

Background Masitinib is an orally administered tyrosine kinase inhibitor that targets activated cells of the neuroimmune system (mast cells and microglia). Study AB09004 evaluated masitinib as an adjunct to cholinesterase inhibitor and/or memantine in patients with mild-to-moderate dementia due to probable Alzheimer’s disease (AD). Methods Study AB09004 was a randomized, double-blind, two parallel-group (four-arm), placebo-controlled trial. Patients aged ≥50 years, with clinical diagnosis of mild-to-moderate probable AD and a Mini-Mental State Examination (MMSE) score of 12–25 were randomized (1:1) to receive masitinib 4.5 mg/kg/day (administered orally as two intakes) or placebo. A second, independent parallel group (distinct for statistical analysis and control arm), randomized patients (2:1) to masitinib at an initial dose of 4.5 mg/kg/day for 12 weeks that was then titrated to 6.0 mg/kg/day, or equivalent placebo. Multiple primary outcomes (each tested at a significance level of 2.5%) were least-squares mean change from baseline to week 24 in the Alzheimer’s Disease Assessment Scale - cognitive subscale (ADAS-cog), or the Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory scale (ADCS-ADL). Safety for each masitinib dose level was compared against a pooled placebo population. Results Masitinib (4.5 mg/kg/day) ( n =182) showed significant benefit over placebo ( n =176) according to the primary endpoint of ADAS-cog, −1.46 (95% CI [−2.46, −0.45]) (representing an overall improvement in cognition) versus 0.69 (95% CI [−0.36, 1.75]) (representing increased cognitive deterioration), respectively, with a significant between-group difference of −2.15 (97.5% CI [−3.48, −0.81]); p <0.001. For the ADCS-ADL primary endpoint, the between-group difference was 1.82 (97.5% CI [−0.15, 3.79]); p =0.038 (i.e., 1.01 (95% CI [−0.48, 2.50]) (representing an overall functional improvement) versus −0.81 (95% CI [−2.36, 0.74]) (representing increased functional deterioration), respectively). Safety was consistent with masitinib’s known profile (maculo-papular rash, neutropenia, hypoalbuminemia). Efficacy results from the independent parallel group of titrated masitinib 6.0 mg/kg/day versus placebo ( n =186 and 91 patients, respectively) were inconclusive and no new safety signal was observed. Conclusions Masitinib (4.5 mg/kg/day) may benefit people with mild-to-moderate AD. A confirmatory study has been initiated to substantiate these data. Trial registration EudraCT: 2010-021218-50. ClinicalTrials.gov : NCT01872598

IMPORTANCE:Occupational therapists need dependable and accurate instruments for remote assessments and monitoring of hand functionality. These assessments monitor progress, evaluate interventions, and guide independence goals. OBJECTIVE:To assess the interinstrument reliability and concurrent validity of the Squegg® Smart Dynamometer and Hand Grip Trainer and the Jamar® Hydraulic Hand Dynamometer. DESIGN:Repeated-measures design. SETTING:Individual clinic in Bucharest, Romania. PARTICIPANTS:Forty middle-age and older adult volunteers, healthy and free from any neuromuscular, orthopedic dysfunction that affected hand strength. OUTCOMES AND MEASURES:Participants' maximal grip strength (MGS) for both their dominant and nondominant hands was measured with both devices. Participants with odd-numbered IDs were measured with the Squegg first and the Jamar second, and those with even-numbered IDs were measured in opposite sequence. RESULTS:Paired-samples t tests on overall mean MGS and mean MGS (three measures on each hand) showed no statistically significant differences between the two devices. Intraclass correlation analysis showed good to excellent interinstrument agreement. Pearson correlations between measurements across all participants, and hands, indicated strong agreement. CONCLUSIONS AND RELEVANCE:The Squegg shows promise for health care professionals, including occupational therapists, for grip strength assessment in clinical contexts. What This Article Adds: These results offer initial psychometric data for a new remote MGS measurement device. MGS is crucial for assessing the physical function of aging adults. Reliable measurements from such a device are vital for occupational therapists to guide treatment interventions and assess hand function's impact on daily activities.

The worldwide population is undergoing a fundamental change in its age structure, which challenges the health- and social-services system. The need to migrate towards a more person-centered and coordinated model of care that supports the optimization of abilities and capacities for older people has to be matched. In this sense, eHealth technologies can play a fundamental role. In this paper, through a questionnaire-based data collection using 30 primary (older people) and 32 secondary (informal caregivers) end-users, we share our vision on how to sustainably develop a product by optimizing the user experience and ensuring adoption. We hypothesized that a technology-based intervention can promote healthy ageing through informed and active user involvement at all stages of the care process. Both older adults and caregivers consider the use of a smartphone and smartwatch to be very important; in addition, the use of digital devices for healthcare can be helpful. Seniors care about self-monitoring health parameters through the use of wearable devices, regardless of their health status, and would like to be included in the process of making good health decisions, because they need to feel in control of their healthcare process. Digital solutions in health and care can support the well-being of older adults in many areas of their daily lives, both at home and in their communities, but only if such innovation is designed around the natural voice of the intended target.

In the context of global ageing, the acceptance and adoption of the new technologies by older adults has become a focus point in society at large, as the actual and optimal usage of technology can improve independence and general well-being in the late life. This research sheds light on the importance of accounting for the psychological well-being as a key determinant in technology acceptance and adoption of the older adults. We employed two surveys. The first, in 2019, asked 125 older adults from the countries of Romania, Slovenia and Cyprus. The second, in 2021, asked the opinions of 32 older adults and their formal and informal caregivers from Romania and Cyprus. We have found that the older adults who are psychologically well accept new technologies as long as they bring new information relevant to them, while also give them a sense of social integration and entertainment. Those who are psychologically not well accept new technologies based on the social influence of the formal and informal care-givers. The first group adopt new technologies as long as they are easy to be used, but the second group adopt new technologies as long as they give them a sense of social integration and companionship, decrease their loneliness, and, not last, if they are easy to be used. We bring new evidence for how the psychological unwellness, and not the socio-demographic characteristics such as age, education or income, is the key factor for the unequal use of the online resources - the second digital divide.