Clinical trials have demonstrated the efficacy of cholinesterase inhibitors (ChEI) in improving cognitive status and disability in subjects with mild to moderate Alzheimer's disease (AD). However, little is known about the effectiveness of ChEI in clinical practice, and no large clinical trials comparing different ChEI are available at present. Aim of this study was to evaluate safety and effectiveness of ChEI in a sample of elderly outpatients diagnosed with mild to moderate AD. We selected 407 subjects for ChEI treatment (donepezil, rivastigmine or galantamine). Their cognitive function was evaluated by means of the mini mental state examination (MMSE), and the global functional status was estimated by using the activities of daily living (ADL) and the instrumental activities of daily living (IADL) scales at baseline (T-0), then after 1 (T-1), 3 (T-2) and 9 months (T-3), respectively. T-3 follow-up was completed by 212 subjects. The patients were considered as responders (R), if the MMSE score at T-2 was unchanged or improved, if compared to that of To. In 35 patients (8.6%) treatment was withdrawn because of mostly gastrointestinal adverse events. Compared to the other drugs, donepezil was associated with a lower incidence of withdrawals due to adverse events. Subjects who completed T-3 follow-up (age 78 +/- 6 years, MMSE scores 18.8 +/- 3.9) showed an increase at T-2 of 0.7 +/- 2.7 (p = 0.001) and a decrease at T-3 of -0.6 +/- 3.4 (p = 0.008) in the MMSE scores, as compared to T-0. The ADL and IADL scores did not show significant changes at T-2; however, both decreased significantly at T-3. The patients R-at-T-2 showed a better cognitive and functional outcome at T-3, compared to the non-responders (NR-at-T-2), displaying values of MMSE R-at-T-2 0.4 +/- 3.1 vs. NR-at-T-2 -3.0 +/- 2.5,-p = 0.001, and ADL values of -0.3 +/- 1.2 vs. -0.7 +/- 1.3, p = 0.03, respectively. No significant difference was found in the changes of MMSE scores between donepezil and rivastigmine (galantamine was not included in the comparison due to the small number of treated subjects). In conclusion, in this sample of elderly subjects with mild to moderate AD, treated with ChEl, a small but significant decline in cognitive and functional status was observed after 9 months. Subjects who showed a good response to treatment after 3 months, had a better cognitive and functional outcome at 9 months. No significant difference in cognitive outcome was found between drugs, while donepezil was better tolerated.

Objective: To investigate retest reliability and concurrent validity of the fundamental measurements made of a posturographic protocol that employs quiet standing to quantify the severity and the nature of patients' postural disturbances. Study Design: Retrospective complete block design. Setting: Geriatric rehabilitation department. Participants: Thirty-six participants (age range, 67 to 86yrs) having normal, moderate, or severe levels of disequilibrium. Methods: Quiet standing was evaluated on three occasions using a three-dimensional motion analysis system and a force platform. Eight testing conditions, designed to vary task difficulty by controlling the contributions of vision, foot proprioception, and base-of-support width, were administered. Main Outcome Measures: Retest reliability of body sway, joint alignment, body position, and motor coordination indicators were evaluated by intraclass correlation coefficients (ICCs). Concurrent validity of protocol measures was evaluated by the prediction of disequilibrium from a stepwise linear discriminant analysis. Results: ICCs indicated high level of retest reliability for all variables but those of motor coordination, which was not influenced by testing conditions. Discriminant analysis resulted in a four-factor discriminator that included measures of body sway, position, alignment, and motor coordination. The derived linear discriminate function correctly classified 96% of the patients' level of disequilibrium. Conclusions: The posturographic protocol has the potential to be a useful tool for evaluating severity and nature of postural instability and the effects of pharmacologic and rehabilitative treatment. Results also indicate that combining direct body measurements with force-plate data has the potential to expose the underlying impairments that cause disequilibrium, determine their pathogenesis, and evaluate compensatory strategies.

The stride-cycle frequency of gait data is often estimated by taking the inverse of the average stride-cycle time (stride period) over several stride-cycles. We derive the density function of the stride-cycle frequency frequency (stride frequency) and describe some of its properties. We also show the conditions under which the inverse of the mean stride period is a `good' estimate of the mean stride frequency.

This study examined the inter-cycle and between-session reliability of EMG temporal patterns during walking in older adults. Twenty subjects, 50–78 years of age, walked at three speeds in two sessions. Burst duration and onset latency of the tibialis anterior, lateral gastrocnemius, vastus lateralis and biceps femoris muscles for ten gait cycles were calculated for each session. EMG patterns were consistent within and between sessions; however, slow walking generated more inter-cycle variability than self-selected or fast walking. Similar inter-cycle variability in both sessions suggests no practice effect. A single session using self-selected or fast walking may provide reliable EMG values in older adults.