Academic literature on the topic 'Gait disorders in old age'

Old age is normally associated with stereotypical structural and physiological changes in the brain that are caused by deterioration in elementary cognitive, sensory, and sensorimotor functions as well as increased susceptibility to stress. These changes are connected with gait impairment and falls, especially among patients with common neurological diseases. Even in the absence of history of falling or when there is no physical injury after a fall, many older people develop a fear of falling that leads to restricted mobility, reduced activity, depression, social isolation, worsened metabolic disease, and increasing risk of cardiovascular morbidity and mortality. Although links between cognitive decline and age-associated brain changes have been clarified, relationships between gait disorders and psychophysiological alterations in aging are less well understood. This review focuses on two crucial elements of aged individuals with gait disorders: characteristic comorbidities in the elderly and the psychophysiological effects of physical exercise in the elderly with gait disorder. We propose an integrated approach to studying elderly subjects with gait disorder before starting a program of motor rehabilitation with wearable robotic devices, in order to investigate the effectiveness and safety of the ambulatory training.

The effects of aging on lower trunk ( trunk–low-back joint–pelvis) coordination and energy transfer during locomotion has received little attention; consequently, there are scant biomechanical data available for comparison with patient populations whose upper body movements may be impaired by orthopaedic or neurologic disorders. To address this problem, we analyzed gait data from a cross-sectional sample of healthy adults ( n = 93) between 20 and 90 yr old ( n = 44 elderly, >50 yr old; n = 49 young, <50 yr old). Gait characteristics of elders were mostly typical: gait speed of elders (1.13 ± 0.20 m/s) was significantly ( P = 0.007) lower than gait speed of young subjects (1.20 ± 0.18 m/s). Although elders had less low-back (trunk relative to pelvis) range of motion (ROM; P = 0.013) during gait than young subjects, no age-related differences were detected in absolute trunk and pelvis ROM or peak pitch angles during gait. Despite similar upper body postures, there was a strong association between age and pelvis-trunk angular velocity phase angle ( r = 0.48, P < 0.001) with zero phase occurring at approximately 55 yr of age; young subjects lead with the pelvis while elderly subjects lead with the trunk. Age related changes in gait speed and low-back ROM were unable to explain the above findings. The trunk-leading strategy used by elders resulted in a sense reversal of the low-back joint power curve and increased ( P = 0.013) the mechanical energy expenditure required for eccentric control of the lower trunk musculature during stance phase of gait. These data suggest an age-related change in the control of lower trunk movements during gait that preserves upper body posture and walking speed but requires a leading trunk and higher mechanical energy demands of lower trunk musculature—two factors that may reduce the ability to recover from dynamic instabilities. The behavioral and motor control aspects of these findings may be important for understanding locomotor impairment compensations in aging humans and in quantifying falls risk.

Abstract Age-related gait dysfunction and balance disorders are a major cause of falls and injury in the elderly population. Epidemiological studies have shown that disturbances in gait coordination which manifest with age are associated with increased morbidity and mortality, impaired cognitive capacity, as well as reduced level of function and loss of independence. In geroscience, mice are the most frequently used model system to test efficiency of antiaging interventions. Despite the clinical importance of age-related gait abnormalities in older adults, the impact of aging on mouse gait coordination is not well documented in the literature. To characterize the effect of aging on mouse gait, we assessed gait function in young (3-month-old) and aged (24-month-old) freely moving C57BL/6 mice using the semiautomated, highly sensitive CatWalk XT system for quantitative assessment of footfall and motor performance. We found that aged mice exhibited significantly decreased cadence and increased stride time variability. Aging also tended to alter footfall patterns. In aged mice, speed, swing speed, stride length, duty cycle, base of support, terminal dual stance, the regularity index, and the gait symmetry index were unaltered. Thus, aging is associated with characteristic alterations in gait function in C57BL/6 mice, which could potentially be assessed as clinically relevant endpoints in geroscience studies testing the effects of antiaging interventions.

Purpose of the study — to form normative guidelines for the values of kinetic and kinematic parameters of gait in children aged 3–6 years without motor disorders. Materials and methods. Using video analysis to determine the normative range of the values of locomotor characteristics, the gait profile (Gait profile Score — GPS) was assessed in children aged 3–6 years (n=16) without movement disorders in the laboratory of biomechanics of the Ilizarov Centre. Kinematic parameters were recorded with Qualisys 7+ optical cameras (n=8), kinetic parameters were recorded using Kistler dynamometric platforms (n=6). The examination consisted of two tests: 1 — independent walking with the usual speed of movement on a 7-m track; 2 — carried out on the background of comfortable for the child accompaniment by an adult for 1 hand. Analysis of results was carried out by automated calculations of kinematics and kinetics values using descriptive statistics. The assessment of the normality of the distribution of the studied parameters was performed according to 12 univariate criteria. Results. It has been established that the main characteristics of locomotor activity in age-homogeneous groups of children aged 3–6 years obey the normal distribution function and, therefore, the normative range of functioning values can be determined by the rule of sigma deviations. The article presents selective values of kinematic and kinetic parameters of gait in children aged 3–6 years without movement disorders recommended as normative guidelines. Conclusions. For children 3–4 years old, examination conditions are acceptable both independently and with support by the hand. For children aged 5–6 years, the examination should include only independent walking, walking with support by the hand distorts the structure of the locomotor stereotype of the accompanying person, and therefore such a gait should be regarded as unnatural

Introduction: Huntington’s disease (HD) is a neurodegenerative disorder caused by CAG expansion repeats in the HTT gene. Usually, the symptoms start to manifest in mid-adulthood. In about 5% of cases, however, the signs begin before the age of 20 years. These cases are known as juvenile HD (JHD). Objective: Here we report a case series of JHD from Amazonas, a state where data are scarce due to the restricted access to specialized medical assistance for diagnosis and care. Case series: The patients were attended by neurologists specialized in movement disorders at Manaus. Two cases manifested the disease in childhood (6 and 7 years old) and two cases, in adolescence (12 and 16 years old). All cases showed dystonia and parkinsonism as predominant motor disorders. Moreover, signs of cognitive decline, depression, and psychosis were observed in all patients. Conversely, cerebellar signs, gait disturbances, seizures, and some psychiatric symptoms were variable among the cases. Expansion size varied from 66 to 84 to CAG repeats and the difference in age at onset between parent and child varied from 23 to 43 years. Conclusion: To our knowledge, these are the first clinical reports of JHD in northern Brazil. These cases illustrate the variability in clinical phenotypes and genetic features of JHD cases. Furthermore, they can contribute to the awareness of HD here, both by professionals and the public in general.

Background: Several studies have stated that frailty is associated with cognitive impairment. Based on various studies, cognition impairment has been considered as a component of frailty. Other authors have shown that physical frailty is associated with low cognitive performance. Dual task gait tests are used as a strong predictor of falls in either dementia or frailty. Consequently, it is important to investigate dual task walking tests in elderly populations including control robust oldest old, frail oldest old with mild cognitive impairment (MCI) and frail oldest old without MCI. Methods: Dual task walking tests were carried out to examine the association between frailty and cognitive impairment in a population with advanced age. Forty-one elderly men and women participated in this study. The subjects from control, frail with MCI and frail without MCI groups, completed the 5-meter walk test at their own gait velocity. Arithmetic and verbal dual task walking performance was also assessed. Kinematic data were acquired from a unique tri-axial inertial sensor. Results: The spatiotemporal and frequency parameters related to gait disorders did not show any significant differences between frail with and without MCI groups. Conclusions: The evaluation of these parameters extracted from the acceleration signals led us to conclude that these results expand the knowledge regarding the common conditions in frailty and MCI and may highlight the idea that the impairment in walking performance does not depend of frailty and cognitive status.

Background: Emphasis on early identification, prevention, and intervention of fall risk in elderly people is becoming increasingly important in the fields of physical therapy and rehabilitation.Methods: Various scales are currently used for assessment of balance and fall risk. We have selected, MiniBESTest and DGI for our present study. We compared scores of Mini-BESTest and DGI in 30 elderly subjects with mean age of 62.23±4.38yrs. These subjects included 17 completely normal individuals, whereas 13 subjects were having early clinical features of fall-related disorders. Example: Parkinsonism, vertigo and paresis.Results: The data indicated that Mini-BESTest is more superior than DGI to indicate the fall risk in normal elderly population. Similarly, in cases of paresis and Parkinsonism, results are indicating that Mini-BESTest is better suited than the DGI. But in cases of vertigo, the results indicate that DGI is more superior than Mini-BESTest.Conclusions: An interesting finding is that the DGI scale seems to be more superior in subjects having vertigo (Refer Table-4), which is to be verified by further studies in a larger sample. The point which justifies the above conclusion is that the DGI scale includes many items which test the vestibular apparatus.

IntroductionWe present the case of a woman with an 8 year history of slowly progressive cognitive dysfunction and gait disturbance, and a diagnosis of vanishing white matter disease (VWMD).CaseThe patient struggled at work as an accountant, her hand writing became illegible, she had difficulty judging distances when driving and she had developed gait instability, slowing and falls. Her past medical history was unremarkable save for premature menopause at 35. Examination showed marked cognitive impairment ACE-R 59/100 (attention and orientation – 13/18, memory – 16/26, fluency – 1/14, language – 21/26, visuospatial – 8/16), reduced dexterity of hands, left upper limb ataxia and high- level gait dysfunction. MRI brain showed leukodystrophy with frontal predominance. Relevant investigations – white cell enzymes, very long chain fatty acids, phytanic acid, CSF were normal. In view of the clinical and radiological features genetic testing with leukodystrophy panel was performed which revealed homozygous eukaryotic translation initiation factor B3 (EIF2B3) mutation (p.Ala87Val variant). Adult onset leukodystrophies are rare genetic metabolic disorders of the glial cells. The white matter (WM) degeneration causes disruption of distributed neural networks resulting in variable constellation of cognitive dysfunction, ataxia, pyramidal and extrapyramidal signs. The clinical and radiological phenotypes overlap and there are up to 60 genes that account for adult onset leukodystrophy, which makes diagnosis challenging. Vanishing white matter disease due to EIF2B gene mutation are a group of disorders that result from mutation of any of the EIF2B subunits (1 to 5). Two thirds have associated premature ovarian failure. MRI shows confluent WM T2 high signal, subcortical U Fibre sparing, periventricular WM rarefaction and cerebral atrophy. Management is symptomatic.ConclusionAdult onset VWMD is a rare and devastating condition. When evaluating these patients targeted gene testing guided by clinical and radiological phenotype is likely to provide the highest diagnostic yield. Establishing the diagnosis is important as it has implications on future generations.

Population aging is inextricably linked to an increase in the prevalence of dementia, which are one of the main causes of loss of autonomy in old age. However, early detection of cognitive decline is critical to proactively implementing interventions to slow the progression of cognitive decline and maintain the ability to live independently of outside help. Therefore, early detection of cognitive decline is one of the primary tasks of the general practitioner. The aim of the lecture is to present a low gait speed, frailty, neuropsychiatric symptoms, sleep disorders and hearing loss as biomarkers of high risk to development of dementia risk and suggest ways measuring these risk factors in primary health care.

Background: Aging is a stage of life that increases the risk of physical diseases, some of which are chronic and can affect different dimensions of life’s quality. Hydrotherapy is used to treat rheumatic, orthopedic and neurological disorders. It has been the subject of investigations regarding balance and gating recovery in elderly people. Objective: To evaluate the effect 8 weeks water cure program with aquatic devices on static balance and velocity of gait in elderly men.Methods: : Fifteen old men were chosen purposely by age mean and Std 58±6.5, length 167.12±7.35 cm, weight 75.64±7.64. . We used the Sharpened Romberg test (static balance with eyes open and close) and Timed Up & Go (for evaluating velocity of gait). we used a selected program in water with aquatic devices in 8 weeks. Water exercise session included of three parts warm up, main part of exercise, and cool down. we analyzed the achieved data by a correlated t-test at a meaningful level (p≤0.05).Results: Among the post-test and pre-test Romberg test ( p≤013) and the velocity of gait (p≤005) were recovered meaningfully after the program.Conclusions: The results showed that participating in an exercise in water program with aquatic devices on a regular basis can be considered as an effective and reliable method to increase balance, and it can promote quality and velocity of gait among these aged men.

Although footwear has been recognised as a risk factor for falls in older people, it remains unclear as to which features of shoes are beneficial or detrimental to balance. This project aimed to systematically investigate the effects of common shoe features, namely: an elevated heel, a soft sole, a hard sole, a flared sole, a bevelled heel, a high-collar and a tread sole, on balance and gait in older community-dwelling people. The experimental shoes were compared to standard shoes in three studies examining: (i) standing balance, leaning balance and stepping in 29 older people, (ii) centre of mass (COM)-base of support (BOS) margins, vertical and braking loading rates, and perceived shoe comfort and stability in 11 young and 15 older people walking on even and uneven surfaces, and (iii) temporal-spatial gait variables, pelvis acceleration, and gait termination in 10 young and 26 older people, on level, irregular and wet surfaces. Elevated heel shoes impaired overall performance in functional tests of balance and stepping. They were also perceived as lacking comfort and stability and led to a conservative walking pattern characterised by increased step width and double-support time, reduced braking and vertical loading rates and medio-lateral (ML) pelvis accelerations on various surfaces. Soft sole shoes increased lateral COM-BOS margin and step width, indicating reduced ML walking stability. When wearing these shoes, subjects had longer total stopping times and on the wet surface, smaller step lengths and shoe/floor angles at heel strike, suggesting a potential risk of slipping. When wearing high-collar shoes, subjects had better balance as demonstrated by small but significant increases in lateral COM-BOS margin, double-support time and step width, and decreases in ML pelvis accelerations on varying surfaces and in total stopping time on the wet surface. Shoes with hard, flared or tread soles or a bevelled heel did not affect balance. In conclusion, providing that they are fitted, have adequate fastening and perhaps a slip-resistant sole, shoes with a low square heel, a sole of medium hardness (shore A-40) and a high-collar provide the greatest stability for older people when walking on dry, wet and irregular surfaces.

Background: High blood pressure (BP) is the leading risk factor for disease and mortality worldwide. However, risks associated with high BP in very old age (≥ 80 or ≥ 85 years) are not entirely understood, as the majority of scientific studies have been performed with younger populations and existing scientific knowledge about very old individuals is sometimes contradictory. Results of previous studies of very old individuals suggest that the associations of BP with mortality and stroke differ with levels of physical and cognitive function. More studies that are representative of very old individuals, including individuals with multimorbidity, that are of adequate size, involve proper adjustment, and investigate non-linear associations, are needed to investigate these issues. Systolic blood pressure (SBP) decline is common among very old individuals and has been shown to precede adverse events. Previous studies have shown that SBP change is associated with baseline SBP, age, and health-related factors, but determinants of SBP change have not been investigated using comprehensive, multivariate models. The three main aims of this thesis were to investigate, in a sample of individuals aged ≥ 85 years, 1) determinants of SBP change, 2) the association of BP with mortality risk and whether this association differs with respect to gait speed and/or Mini-Mental State Examination (MMSE) score, and 3) the association of BP with stroke risk and whether this association differs with respect to the Barthel Activities of Daily Living (ADL) index and/or MMSE score. Methods: The studies conducted for this thesis were based on data from the population-based Umeå 85+/Gerontological regional database study, which provided cross-sectional and longitudinal data on socioeconomic factors, medical conditions, drug prescriptions, and health-related assessments from 2000 to 2015. Participants were aged 85, 90, and ≥ 95 years, and lived in Västerbotten, Sweden, and Österbotten/Pohjanmaa, Finland. Follow-up assessments were conducted after 5 years. Mortality data were collected after 2 and 5 years, and stroke data were collected after 5 years, from death certificates, medical records, population registers, and the inpatient diagnosis register. Comprehensive multivariate models were developed to investigate determinants of SBP change using multiple linear regression, and to investigate associations of mortality and stroke risks with BP using Cox proportional-hazard regression models. Results: Average (± standard deviation) baseline SBP was 146 ± 23 mm Hg, and average diastolic blood pressure (DBP) was 74 ± 11 mm Hg. Within 5 years, 61% of participants had died and 10% had had incident strokes. Among participants followed for 5 years, the average annual SBP decline was 2.6 ± 5.4 mm Hg. In a multivariate model, SBP decline was associated with later investigation year (p = .009), higher baseline SBP (p < .001), baseline antidepressant drug use (p = .011), incident acute myocardial infarction during follow-up (p = .003), use of a new diuretic drug during follow-up (p = .044), and declining Barthel ADL index scores during follow-up (p < .001). In an age- and sex-adjusted analysis of the total sample, mortality risk was decreased in higher (vs. lower) BP categories (SBP ≥ 165 vs. ≤ 125 mm Hg: hazard ratio [HR] .50, p < .001; DBP 70–74 vs. 75–80 mm Hg: HR 1.32, p = .031). In a comprehensively adjusted analysis of the total sample, SBP was not associated significantly with mortality risk. The associations of SBP with mortality in the gait speed < .5 m/s subcohort corresponded with those found in the total sample. In comprehensively adjusted analyses in the gait speed ≥ .5 m/s subcohort, mortality risk increased independently with higher (vs. lower) BP (SBP ≥ 165 vs. 126–139 mm Hg: HR 2.13, p = .048; DBP > 80 vs. 75–80 mm Hg: HR 1.76, p = .026). In comprehensively adjusted analyses in the MMSE score subcohorts, SBP was associated significantly with mortality risk only in the 0–10 MMSE score subcohort; high and low SBP categories were associated independently with increased mortality risk, compared with an intermediary SBP category (SBP ≥ 165 vs. 126–139 mm Hg; HR 4.54, p = .007; SBP ≤ 125 vs. 126–139 mm Hg: HR 2.23, p = .023). Higher BP was associated significantly with increased stroke risk in multivariate models (SBP per 10 mm Hg increment: HR 1.19, p < .001; DBP per 10 mm Hg increment: HR 1.26, p = .013). SBP was not associated with stroke risk in participants with SBP < 140 mm Hg. Interaction effects on the association with mortality were significant between SBP and gait speed (age- and sex-adjusted model: p = .031) but not between SBP and MMSE score. No interaction in the association with stroke was found between any BP measure and Barthel ADL index or MMSE score. Conclusion: The decline in BP in very old age may be explained by health-related factors. Low BP may be a risk marker for short life expectancy, due to morbidity, in the general very old population and among very old individuals with low gait speeds. High BP seems to be an independent risk factor for mortality only in certain groups, which may be distinguished by high gait speed or very severe cognitive impairment. High SBP and DBP seem to increase stroke risk in very old age. These findings may contribute to a better understanding of the risks of adverse outcomes in very old individuals with different BP levels, the importance of comorbidity for these risks, and the etiology of SBP change.
Bakgrund: Högt blodtryck är den största bidragande orsaken till sjukdom och död i världen. Man har ännu inte fastslagit om högt blodtryck ökar risken för sjukdom och död även i mycket hög ålder, vilket kan definieras som 80 år och äldre. Detta beror bland annat på att endast en liten andel av forskningen hittills har fokuserat på den här åldersgruppen. Mycket gamla människor skiljer sig från yngre på olika sätt som skulle kunna påverka riskerna med högt blodtryck. Till exempel är det vanligare med sjukdomar och att ha många samtidiga sjukdomstillstånd bland mycket gamla människor än i yngre åldersgrupper. Då andelen mycket gamla människor i befolkningen ökar kraftigt får dessa frågor allt större betydelse. Det är vanligt med sjunkande blodtryck i mycket hög ålder, något som verkar föregå sjukdom och död. Tidigare studier har funnit att sjunkande blodtryck skulle kunna bero på ökande sjuklighet, högre ålder och högre begynnelseblodtryck. Man vet ännu inte vilka enskilda faktorer som bäst förklarar blodtrycksförändringen i mycket hög ålder, oberoende av andra faktorer. Tidigare studier har visat att lägre blodtryck kan vara förenat med en ökad risk för tidig död bland mycket gamla människor. Det är oklart om risken för tidig död bättre kan förklaras av andra faktorer, s.k. störfaktorer. Störfaktorer kan till exempel vara sjukdomar som både påverkar blodtrycket och risken. Fynd från tidigare studier av personer som är minst 65 år tyder på att sambandet mellan blodtryck och död kan skilja sig mellan grupper med hög eller låg gånghastighet, vilket används som ett ungefärligt mått på hälso-tillståndet. Detta skulle även kunna ha betydelse för mycket gamla människor eftersom deras hälsotillstånd kan skilja sig mycket mellan individer. Man har också utrett huruvida sambandet mellan blodtryck och död skiljer sig mellan grupper med och utan kognitiv svikt, som till exempel kan bero på demenssjukdom, men inte kommit fram till entydiga resultat. Ett fåtal studier har utrett strokerisken med högt blodtryck i mycket hög ålder. På grund av motsägelsefulla resultat är det ännu oklart om högt blodtryck ökar risken för stroke bland mycket gamla människor. Man har sett tecken på att sambandet mellan blodtryck och strokerisk skulle kunna skilja sig mellan grupper av mycket gamla människor med och utan kognitiv svikt, samt mellan grupper med och utan hjälpbehov i dagliga aktiviteter. Dagliga aktiviteter innefattar bland annat att tvätta sig, klä sig, gå på toaletten, äta och resa sig från en stol. Frågeställningar: I den här avhandlingen undersöktes huvudsakligen tre frågeställningar. Den första var vilka faktorer som påverkar hur blodtrycks-nivåerna förändras över tid i mycket hög ålder. Den andra frågeställningen var om olika blodtrycksnivåer är förenade med ökad risk för tidig död i mycket hög ålder och huruvida risken skiljer sig mellan grupper av mycket gamla människor med olika gånghastighet eller olika grader av kognitiv svikt. Den tredje frågeställningen var om olika blodtrycksnivåer är förenade med ökad risk för stroke i mycket hög ålder och om risken skiljer sig mellan grupper av mycket gamla människor med och utan kognitiv svikt eller hjälpbehov i dagliga aktiviteter. Även skillnader mellan gånghastighets-grupper testades. Metod: Avhandlingen bygger på befolkningsmaterialet Umeå85+/Gerontologisk regional databas (GERDA). Umeå85+/GERDA innehåller information från individer i åldrarna 85, 90 och 95 år och äldre, boende i Västerbotten, Sverige och Österbotten/Pohjanmaa, Finland. Informationen är insamlad vart femte år under perioden 2000-2015. Umeå85+/GERDA innehåller information om socioekonomiska faktorer, sjukdomar och läkemedel. Informationen inhämtades med hjälp av ett standardiserat frågeformulär som deltagarna besvarade under ett hembesök, samt med hjälp av journaler, boendepersonal och anhöriga. Det gjordes även hälsorelaterade mätningar och tester under hembesöken, bl.a. av blodtryck och gånghastighet i vanlig takt. Skattningsskalorna Mini-Mental State Examination (MMSE) och Barthel Activities in daily living (ADL) index användes för att skatta kognitiv funktion respektive hjälpbehov i dagliga aktiviteter. Deltagarna delades in i två gånghastighetsgrupper. Personer med högre gånghastighet (minst 0,5 m/s) utgjorde en grupp. I den andra gruppen var personer med lägre gånghastighet (under 0,5 m/s) och de som inte klarade av att genomföra testet på grund av bestående begränsningar av gångfunktionen. Deltagarna grupperades också med avseende på olika grader av kognitiv svikt. Gruppindelningen baserades på MMSE-poäng; mycket svår kognitiv svikt (0-10 poäng), svår kognitiv svikt (11-17 poäng) och mild kognitiv svikt (18-23 poäng). Deltagare utan kognitiv svikt utgjorde en egen grupp (24-30 poäng). Deltagarna delades även in i grupper med och utan hjälpbehov i dagliga aktiviteter, baserat på Barthel ADL index (under 20 respektive 20). Blodtrycksförändring observerades över tiden mellan två Umeå85+/GERDA-insamlingar, vilket var 5 år. Dödsdatum och datum för stroke inhämtades från dödsbevis, befolkningsregister, journaler och sjukvårdens diagnoskodsregister i upp till 5 år. Frågeställningarna utreddes med hjälp av statistiska metoder, baserat på materialet från Umeå85+/GERDA. Sambanden prövades med avseende på störfaktorer och skillnader mellan grupper. Resultat: Förändringar av det systoliska blodtrycket undersöktes bland 297 deltagare. I genomsnitt sjönk blodtrycket med 2,6 mm Hg per år. För nästan två tredjedelar (62%) av deltagarna sjönk blodtrycket med minst 5 mm Hg på 5 år. Ungefär en fjärdedel (26%) hade minst 5 mm Hg stigande blodtryck på 5 år. Ett antal faktorer var förenade med förändring av det systoliska blodtrycket över 5 år, oberoende av varandra. Sjunkande systoliskt blodtryck var förenat med ett högre begynnelseblodtryck, senare undersökningsår, att ha antidepressiv behandling, att få en hjärtinfarkt, att påbörja läkemedels-behandling med diuretika eller få ökat hjälpbehov i dagliga aktiviteter. Man vet ännu inte vad som är orsak och verkan i dessa samband. Frågeställningen om olika blodtrycksnivåer är förenade med ökad risk för tidig död undersöktes i ett urval av 806 deltagare. Inom 5 år avled nästan två tredjedelar (61%) av deltagarna. Risken för tidig död var mindre bland deltagare med högre blodtryck, jämfört med dem som hade lägre blodtryck. Största skillnaden uppmättes mellan deltagare med minst 165 mm Hg i systoliskt blodtryck, där risken var halverad, jämfört med dem som hade 125 mm Hg eller lägre. Detta samband verkar bero på störfaktorer, främst sjukdomar, som både orsakar lågt blodtryck och den ökade risken för tidig död. Gånghastighetsgrupperna utgjordes av 312 deltagare med högre gånghastighet och 433 med lägre gånghastighet, varav 136 inte kunde genomföra mätningen på grund av bestående begränsning av gångfunktionen. Sambandet mellan blodtryck och risken att dö inom 5 år verkade skilja sig mellan gånghastighetsgrupperna. Gruppen med lägre gånghastighet uppvisade samma samband som hela urvalet och hade ökad risk för tidig död med lägre blodtryck. Även här verkade sambandet förklaras av störfaktorer. Personer med högre gånghastighet uppvisade ett annat samband, där högre systoliskt blodtryck på minst 165 mm Hg var förenat med en fördubblad risk för tidig död, jämfört med 126-139 mm Hg. Högre diastoliskt blodtryck på över 80 mm Hg var också förenat med ökad risk för tidig död, jämfört med 75-80 mm Hg. Sambandet berodde inte på störfaktorer. Grupperna med svår, måttlig och mild kognitiv svikt innehöll 118, 166 och 289 deltagare vardera. Gruppen utan kognitiv svikt innehöll 542 deltagare. Dessa grupper verkade också skilja sig något med avseende på sambandet mellan blodtryck och risken för tidig död, men skillnaderna var inte statistiskt säkerställda. Särskilt gruppen med mycket svår kognitiv svikt uppvisade ett annorlunda samband mellan systoliskt blodtryck och risken för tidig död, jämfört med övriga deltagare. Bland dessa deltagare var risken för tidig död mer än fyrdubblad med höga blodtryck på minst 165 mm Hg, jämfört med 126-139 mm Hg. De med blodtryck 125 mm Hg eller lägre hade dubbelt så hög risk för tidig död, jämfört med 126-139 mm Hg. Dessa samband var oberoende av störfaktorer. Frågeställningen om strokerisk med högt blodtryck utreddes i ett urval av 955 deltagare. Inom 5 år fick 94 deltagare en stroke, vilket motsvarar en av tio. Högre blodtryck var förenat med ökad risk för stroke, jämfört med lägre blodtryck. Risken att få en stroke inom 5 år var fördubblad bland deltagare med högt systolisk blodtryck på minst 160 mm Hg, jämfört med under 140 mm Hg, eller med höga diastoliska blodtryck på minst 90 mm Hg, jämfört med under 90 mm Hg. Sambanden var oberoende av en mängd andra riskfaktorer. Strokerisken med högt blodtryck verkade inte påverkas av gånghastigheten, den kognitiva nivån, eller hjälpbehovet i dagliga aktiviteter. Slutsatser: Blodtrycket verkar sjunka hos de flesta i mycket hög ålder. Sjunkande systoliskt blodtryck kan till stor del förklaras av högre begynnelseblodtryck, senare undersökningsår, att ha antidepressiv läkemedelsbehandling, att få en hjärtinfarkt, att påbörja läkemedels-behandling med diuretika eller få ökat hjälpbehov i dagliga aktiviteter. Lågt blodtryck verkar i mycket hög ålder vara ett tecken på olika underliggande sjukdomsprocesser, som ökar risken att dö inom 5 år. Detta samband verkar särskilt gälla personer med lägre gånghastighet, vilket kan vara ett tecken på sämre hälsa. Högt blodtryck verkar endast vara förenat med ökad risk för tidig död i särskilda grupper, som kan utmärkas av högre gånghastighet eller mycket svår kognitiv svikt. Även lågt systoliskt blodtryck kan vara förenat med ökad risk för tidig död bland personer med mycket svår kognitiv svikt. I dessa grupper kan sambandet vara oberoende av störfaktorer. Högre blodtryck verkar vara förenat med ökad risk för stroke i mycket hög ålder, oberoende av en mängd andra sjukdomstillstånd. Det finns sannolikt en gräns för hur lågt blodtryck som är gynnsamt med avseende på strokerisken, men det är ännu inte klarlagt var den gränsen går. Sambandet mellan högt blodtryck och strokerisk verkar inte skilja sig mellan grupper med olika hög gånghastighet, kognitiv nivå, eller hjälpbehov i dagliga aktiviteter. Dessa fynd kan bidra till en bättre förståelse för blodtrycksförändring, risker med högt och lågt blodtryck i mycket hög ålder samt hälsotillståndets betydelse för dessa risker.

Thesis (Ph. D.)--University of Oregon, 2008.
Typescript. Includes vita and abstract. Includes bibliographical references (leaves 88-96). Also available online in Scholars' Bank; and in ProQuest, free to University of Oregon users.

Community locomotion is threatened when older individuals are required to negotiate obstacles, which place considerable stress on the musculoskeletal system. The vulnerability of older adults during challenging locomotor tasks is further compromised by age-related strength decline and muscle atrophy. The first study in this investigation determined the relationship between the major muscle groups of the lower body and challenging locomotor tasks commonly found in the community environment of older adults. Twenty-nine females and sixteen males aged between 62 and 88 years old (68.2 ±6.5) were tested for the maximal voluntary contraction (MVC) strength of the knee extensors and 1-RM for the hip extensors, flexors, adductors, abductors, knee extensors and flexors and ankle plantar flexors. Temporal measurements of an obstacle course comprising four gait tasks set at three challenging levels were taken. The relationship between strength and the obstacle course dependent measures was explored using linear regression models. Significant associations (p≤0.05) between all the strength measures and the gait performances were found. The correlation values between strength and obstructed gait (r = 0.356-0.554) and the percentage of the variance explained by strength (R2 = 13%-31%), increased as a function of the challenging levels, especially for the stepping over and on and off conditions. While the difficulty of community older adults to negotiate obstacles cannot be attributed to a single causal pathway, the findings of the first study showed that strength is a critical requirement. That the magnitude of the association increased as a function of the challenging levels, suggests that interventions aimed at improving strength would potentially be effective in helping community older adults to negotiate environmental gait challenges. In view of the findings of the first study, a second investigation determined the effectiveness of a progressive resistance-training program on obstructed gait tasks measured under specific laboratory conditions and on an obstacle course mimicking a number of environmental challenges. The time courses of strength gains and neuromuscular mechanisms underpinning the exercise-induced strength improvements in community-dwelling older adults were also investigated. The obstructed gait conditions included stepping over an obstacle, on and off a raised surface, across an obstacle and foot targeting. Forty-three community-living adults with a mean age of 68 years (control =14 and experimental=29) completed a 24-week progressive resistance training program designed to improve strength and induce hypertrophy in the major muscles of the lower body. Specific laboratory gait kinetics and kinematics and temporal measures taken on the obstacle course were measured. Lean tissue mass and muscle activation of the lower body muscle groups were assessed. The MVC strength of the knee extensors and 1-RM of the hip extension, hip flexion, knee extension, knee flexion and ankle plantar flexion were measured. A 25% increase on the MVC of the knee extensors (p≤0.05) was reported in the training group. Gains ranging between 197% and 285% were recorded for the 1-RM exercises in the trained subjects with significant improvements found throughout the study (p≤0.05). The exercise-induced strength gains were mediated by hypertrophic and neural factors as shown by 8.7% and 27.7% increases (p≤0.05) in lean tissue mass and integrated electromyographic activity, respectively. Strength gains were accompanied by increases in crossing velocity, stride length and reductions in stride duration, stance and swing time for all gait tasks except for the foot targeting condition. Specific kinematic variables associated with safe obstacle traverse such as vertical obstacle heel clearance, limb flexion, horizontal foot placements prior to and at post obstacle crossing and landing velocities resulted in an improved crossing strategy in the experimental subjects. Significant increases in the vertical and anterior-posterior ground reaction forces accompanied the changes in the gait variables. While further long-term prospective studies of falls rates would be needed to confirm the benefits of lower limb enhanced strength, the findings of the present study provide conclusive evidence of significant improvements to gait efficiency associated with a systematic resistance-training program. It appears, however, that enhanced lower body strength has limited effects on gait tasks involving a dynamic balance component. In addition, due to the larger strength-induced increases in voluntary activation of the leg muscle compared to relatively smaller gains in lean tissue mass, neural adaptations appear to play a greater contributing role in explaining strength gains during the current resistance training protocol.

Falls and gait impairment in older populations present a major challenge to healthcare systems and reduce quality of later life. There is evidence that cognitive decline contributes to falls and gait impairment in older adults and may, therefore, serve as a marker for persons at risk. Intraindividual variability (IIV; trial-to-trial fluctuations in response time across a neurocognitive task) may have screening potential in this respect as this measure is thought to capture unique information about cognitive function not captured by other neuropsychological metrics. The present research, therefore, examined relationships between IIV, gait and falls in cognitively intact older adults. The extent to which relationships varied according to age and the demands placed on the individual when assessing IIV and gait, was also investigated. Finally, a mediational approach identified potential mechanisms underpinning these relationships. Systematic reviews of published research were followed by cross-sectional experimental studies and a longitudinal investigation. The findings provided mixed evidence of a link between IIV and falls. There was strong cross-sectional evidence that greater IIV was associated with poorer gait performance, and that this relationship strengthened with increasing age. Variability better predicted gait outcomes when gait was assessed under more demanding dual-task conditions, and when IIV measures were derived from tasks with higher executive demands. Tests of mediation suggested that processing speed underpinned relationships between IIV and less demanding single-task gait, whereas executive function played a greater role in more demanding gait conditions. Together, the outcomes suggest that IIV measures have potential as an early screening tool for gait impairment, and also falls. Importantly, general slowing accounts of cognitive ageing explained findings when IIV and gait were assessed under lower demand conditions, whereas frontal lobe/executive control perspectives provided a better account when demands were greater.

Background: Multiple sclerosis (MS) and Alzheimer disease (AD) are neurodegenerative diseases with distinct pathophysiology but similar burdens. Early cognitive impairment in MS is unusual but, due to disease modifying therapies (DMT) advancements and bigger life expectancy, its coexistence with AD has become more common. Objective: To report a coexistence case of MS and AD. Methods: Retrospective case report and literature review. Results: 58-year-old patient presented with work issues, behavioral changes, gait disturbance and unbalance. It was disclosed an impairment of attention span, multitasking, executive dysfunction, and loss of memory for recent events. A PET/CT showed hypometabolism in frontal lobes and CSF analysis disclosed oligoclonal bands and increased TAU protein levels. The patient was initially treated with donepezil, with poor response. A later brain MRI showed typical demyelinating MS lesions. The patient was treated with Natalizumab due to high lesion load and functional impairment. Conclusion: As MS patients live longer, it’s important to recognize age-related comorbidities such as AD. In our patient a poor relapse perception contributed for a late MS diagnosis. The evaluation with PET/CT and increased TAU levels in CSF highly suggests a coexistence with AD. There are no peer-reviewed studies regarding coexisting MS and AD. Further research is necessary to better understand the clinical, demographic, and neuropathological features of the coexistence of both diseases.

Introduction: Among more than 350 immunological deficiencies, 25% have neurological manifestations. Thus, Ataxia-telangiectasia stands out, being considered a combined immunodeficiency. In childhood, cerebellar motor findings and recurrent sinopulmonary infections, signaling early cerebellar degeneration and deficit in the combined immune response. It has an autosomal recessive inheritance pattern. Case report: She describes herself as a female patient, 9 years old, daughter of consanguineous parents and born in Sousa, Paraíba. In the child’s neuropsychomotor development, she sat down at 5 months, verbalized loose words at 12 months and started the process of ambulation at 13 months of life. While walking, the mother noticed strange walking and frequent hospitalizations due to recurrent pneumonia. From 7 years of age, there is worsening of gait and telangiectasias in the conjunctiva are evident. Subsequently, the molecular examination in order to demonstrate the possible mutation. Therefore, a mutation described as c.7913G> A (p.Trp2638 *) was found in homozygosity in exon 53 of the ATM gene. Findings: typical onset of early childhood when walking, swallowing problems with solid and liquid foods and the growth disorder. Regarding the immune system: low levels of immunoglobulins, but without lymphopenia and the worrying presence of adenomegaly, making it necessary to always pay attention to neoplasms such as leukemias and lymphomas. In disagreement, there are no: myoclonus, the highest IgM levels, cutaneous granulomas and bone deformities. Conclusions: The case presents aspects that are very consistent with the scientific findings consolidated in Ataxia-telangiectasia, but the late molecular diagnosis.

The article presents generalized data on the relationship between the types of old-age adaptation and emotional disorders as manifestations of the geriatric syndrome. The manifestations of aggression and depression are also considered. The purpose of the study is to identify a correlation between emotional disorders and types of adaptation to old age. The study involved 50 subjects without mental disorders aged between 60 to 80. Analysis of the data obtained showed that there is a correlation between the types of old-age adaptation and emotional manifestations in older people which can be considered as an important factor in the subjective feeling of an old person’s well-being. Also, aggressive and depressive manifestations are interconnected with destructive styles of social functioning. There is a statistically significant correlation between emotional disturbances and types of old-age adaptation.

Background: Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems. Objective: To assess possible associations between cognition, function status and frailty in a sample of oldest old with performance below cut off scores for dementia in the MMSE. Methods: Sociodemographic, cognitive, functional status and frailty data were obtained from 130 individuals.Frailty was defined by Fried’s frailty phenotype.Functional status was measured by the Functional Activities Questionnaire.The Cognitive Dementia Rating scale was applied to assess dementia severity. Results: In all,28% were male and 72% female,mean age of 82.4 years(SD=5.3).40% were illiterate and 94% had held jobs based on manual activity.In the sample 54.6% had functional impairment.Among participants with normal cognition and functional status,6.1% were frail,8.4% pre-frail and 7.6% robust,among those with impaired cognition and preserved functional status,13% were frail,6.9% pre-frail and 0.7% robust;among those with impaired cognition and functional status,30,7% were frail,19.2% pre-frail and 4.6% robust;and among those with preserved cognition and impaired functional status,0% were frail or robust and 2.3% pre-frail. Conclusion: Participants with impaired cognition and functional status included the largest number of frail and pre-frail participants. These results suggest that impaired cognition and functional status are associated with frailty among the oldest old.

a) Objectives: This study analyses the characteristics and prevalence of psychotic disorders in patients with substance use, that needed medical and psychiatric care in a Dual Pathology Department during a 3 years period. b) Background and aims: The strong comorbidity between substance use and psychotic disorders has been deeply studied in recent literature. The aim of this study is to analyse the characteristics of the psychotic episode (primary or drug-induced), the predominant substance of use and the age of onset of consumption, as well as some sociodemographic characteristics in these patients. c) Materials and methods After a bibliographic review of recent literature, we realize a descriptive study of psychotic disorders and substance use from a total of 531 hospitalized patients during a 3 years period, using SPSS for Windows 20.0 database for statistic results. d) Results: In this study we can observe a predominant percentage of males with an average age of 36 years old, around 50% psychotic disorders out of total number of patients with a predominant type of primary psychosis and a high prevalence of cocaine (18% of total patients), alcohol (16%) and cannabis (8%) use and also an early age of onset of problematic consumption (15 years old for alcohol, 16 years old for cannabis and 21 years old for cocaine). e) Conclusions: The result of this study approach the current literature data about psychotic disorders and substance use and underlines the importance of a correct and early diagnosis in patients with a serious mental illness.

Context: Huntington’s disease (HD) is a degenerative neurological disorder with autosomal dominant inheritance resulting from the loss of GABAergic neurons in the striatum. The prevalence of HD is 10.6 to 13.7 individuals per 100,000 in the Western population. Case report: DRO is a 57- year-old female admitted to a Long-Term Care Facility in 2018 due to the diagnosis of Huntington’s Disease (HD) four years ago. The patient presented right-side hemiplegia, choreic movements in the upper extremities, postural instability, dysarthria, visual hallucinations, behavioral changes, alert and communicative. During institutionalization, the occupational therapist, physical therapist and the speech therapist performed cognitive stimulation activities, motor physiotherapy with balance training, gait and muscle strengthening, interventions for dysarthria and dysphagia prevention. After a year, there was a disease progression with episodes of fall and deterioration of choreic movements, cognitive function and coordination; then, the physical therapist intensified motor rehabilitation and bracing in the left hand in the occupational therapy sessions due to the onset of deformities. In 2020, the patient reported stabilizing her clinical condition and continued the rehabilitation sessions. Conclusions: Physiotherapeutic interventions demonstrated improvement in muscle strength and gait in HD patients. However, the results are heterogeneous due to the morbidity and phenotypic variety of the disease. The response to occupational therapy and speech therapy lacks previous studies on this disease. Thus, the multidisciplinary therapeutic approach is indicated due to its importance in the patient’s overall assessment and prevention of comorbidities.

Introduction: Headache is a frequent neurological complaint among adolescents, reducing quality of life in this age group. This study aims to evaluate the prevalence of headache, its characteristics and association with sleep disorders in adolescents from the 2004 Pelotas Birth Cohort. Methods: Data from the perinatal and 15-year-old follow-up of the 2004 Birth Cohort were used to define the occurrence of headache and its characteristics (intensity, location and type). Sleep disorders were used as exposure and referred to frequency in the month prior to the interview, including: long sleep latency, insomnia and nightmares. Statistical analysis was performed calculating crude and adjusted prevalence ratios to assess the relationship between sleep disorders and headache. Results: The occurrence of headache was reported by 51.7% of the adolescents. More than a third of them reported severe or disabling pain. More than two thirds of adolescents with long sleep latency or insomnia classified their sleep as bad or very bad, and 64.6% of these reported headache. Adolescents with long sleep latency or insomnia ≥3 times/ week were 42% more likely to have headache than those who didn’t report difficulty falling asleep. Among adolescents who rated their sleep as bad and very bad, the probability of headache was 33% higher compared to those who rated sleep as very good. Conclusion: The prevalence of headache is high in adolescents and it’s associated with sleep disorders. Thus, sleep hygiene measures and clinical evaluation are essential to identify and treat these comorbidities, ensuring improvement of headache.

Background: The role of hippocampal connectivity for good memory performance is well known in persons with high educational level. However, it is understudied the role of hippocampal connectivity in illiterate populations. Objectives: To determine whether the hippocampal connectivity correlate with episodic memory in illiterate adults. Methods: Thirty-nine illiterate adults underwent resting state functional MRI and an episodic memory test (Free and Cued Selective Reminding Test). We correlated the hippocampal connectivity at rest with the free recall scores. Analyzes were corrected for head motion and physiological BOLD signal. Results: Participants were most female (66%) and black (79%) and the mean age was 49 years-old (±13.9). The mean score on free recall was 27.2 (±10.7) out of 48 points. We found a significant correlation between both hippocampi and the posterior cingulate and ventral medial prefrontal cortex. However, we did not find an association between the hippocampal connectivity and the memory scores. Conclusions: The lack of association with memory scores might be associated with low brain reserve in this group of individuals.

Background: Positrons emission tomography associated with computed tomography- PET/CT using the 18 F-fluorodeoxyglucose is a well-established exam for the medical evaluation of dementia, mainly helping in differential diagnosis to determine the specific type of dementia. Objectives: To describe the role of the PET/CT in the differential diagnosis of dementia in patients. Methods: a single-center, descriptive and records-based analysis of patients with Dementia evaluated in a clinic of Neurology at Recife and referred to PET/ CT due to diagnosis uncertainty, between 2020-2021. Results: 29 patients were included. The mean age was 65 years-old and 62% were female. Alzheimer’s dementia was the main diagnostic hypothesis (41.3%). PET/CT was suggestive of Alzheimer’s in 24%, Frontotemporal dementia in 21% and Lewy Bodies Dementia in 17% of patients. PET/CT results disagreed from clinical hypothesis in 21% o and in 10% it was inconclusive. In 38% it corroborated the clinical suspicion. Conclusions: in this sample the use of PET/CT FDG contributed to improve diagnostic accuracy in a significant subset of patients, mostly in the scenery of diagnostic uncertainty or atypical syndromes such as earlyonset dementias. A larger sample size and the continuation of this research will give us more information in the near future.

The paper presents the results of a study of the bioelectrical activity of the brain in 77 patients aged 2 to 18 years old with chronic cerebral ischemia, due to pathology of the main arteries of the brain, observed and operated in the Institute of Neurosurgery of N.N. Burdenko from 2012. The study showed the role of EEG in assessing the functional state of the brain in chil-dren with chronic cerebrovascular insufficiency of various etiopathogenesis in children, de-pending on the age of the child. Comparison of EEG data in extra- and intracranial cerebral vascular pathology was performed. Revealed more pronounced changes with steno-occlusive disorders in the intracranial arteries. EEG is dominated by slow forms of activity or their combination with acute potentials. Extracranial pathology led to the predominance of signs of irritation in the bioelectric picture of the brain: accelerated, pointed alpha rhythm, acute potentials, frequent fluctuations. Detailed clinical and neurophysiological examination using EEG served as a rationale for diagnosis, determination of treatment tactics and indications and contraindications for surgical intervention.

Review question / Objective: Is acupuncture a safe and effective therapy for constipation associated with Parkinson’s disease? Our aim is to assess the effectiveness and safety of acupuncture for constipation associated with PD and give guidance to future research direction. Condition being studied: Parkinson’s disease (PD) is a prevalent degenerative disease of nervous system characterized mainly by static tremor, bradykinesia, myotonia, postural gait disorders and other non-motor symptoms. According to variations on race, ethnicity, age and sex, the incidence of PD ranges from 8 to 20.5 per 100, 000 individuals annually. One global research shows that there were 6.1 million individuals suffer from PD in 2016 and will be 12 million patients around the world. According to several outcomes of case-control studies, the prevalence of constipation in PD varies from 28% to 61%. Constipation, as a common gastrointestinal disease which refers to the clinical presentation of reduced spontaneous complete bowel movement, dyschezia, feeling of incomplete defecation and outlet obstruction, is demonstrated to antedate the motor symptom and it's severity is related to the progression of PD. Acupuncture has been proved to act on the pathogenesis of constipation associated with PD. The proposed systematic review we're about to present is the first advanced evidence-based medical evidence in this area.

Review question / Objective: To investigate the prevalence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD) between regional and general anesthesia in older patients undergoing hip fracture surgery. Condition being studied: About 1.6 million people suffer hip fractures each year globally1. The risk of hip fracture-related postoperative mortality within 30 days approximately was 8.2% in December 2020, up 1.5% from December 2016. Across the world, the aging population is growing, and a significant number of elderly patients are undergoing various kinds of orthopedic surgeries. Age as an important independent high-risk factor is associated with perioperative neurocognitive disorders (PNDs), which not only increases the rate but also causes a serious economic and social burden. One previous study investigated that between 2012 and 2016, the absolute total number of hip fractures in people aged 55 and older increased by about 4 times due to an aging population12. In addition, Bhushan et al. reported that along with the increasing aging of society, the incidence rate of POCD is 5% to 56% in the elderly over 55 years old after surgery morbidity and mortality but also causes a serious economic and social burden.

Reticuloendotheliosis virus (REV) is an avian retrovirus that can cause immunosuppression, growth retardation and tumors. An attempt to define the extent of the economic damage to the poultry industry that it causes is discussed in this report. In addition to losses experienced by commercial laying flocks, reduced rates of hatchability and embryo developmental disorders were demonstrable due to vertical transmission of the virus. I. Eradication of REV In this project a comprehensive national program was applied for the eradication of REV from Israeli breeding stocks by the elimination of antibody-positive birds from the breeding program. The prevention of REV-infected breeders entering Israel was also implemented by serological examination of imported day-old chickens and turkeys for maternal antibody. At the same time commercial breeding flocks in Israel were surveyed routinely to measure the extent of environmental exposure to REV throughout Israel. II. Economic factors associated with vertical transmission on breeders and progeny It was observed that on some poultry farms exposure of breeding flocks to viral infection, if it occurs when the birds are immunocompetent, leads only to a seroconvertion event. In these flocks no differences were demonstrated between the performances of seronegative and seropositive birds. When the F1 generation was selected according to seronegativity of the parents, all the progeny were seronegative, indicating that tolerantly infected birds did not form a significant proportion of the parent flock. In sharp contrast, breeding flocks that became exposed to the virus about the point of lay or during the laying period, shed virus vertically for a brief period of time through the egg. Our epizootiological observations lead us to conclude that the progeny (laying pullets) becomes tolerantly infected and are immunosuppressed as they increase in age. Increased mortality and susceptibility to intercurrent diseases were recorded.

In Hungary, NEET Youth are faced with many problems: social exclusion; lack of opportunities (e.g., education, health, infrastructure, public transport, labour market conditions); low so-cio-economic status; and, a lack of relationships outside the enclosed settlements. In Hungary, the most frequent risk factors are: a socio-economically disadvantageous envi-ronment; low levels of education and schooling problems; lack of proper housing; financial problems; learning difficulties; dissatisfaction with the school; socio-emotional disorders; delinquency; health problems; homelessness; and, drug or alcohol abuse. NEET Youth are fa-cing with this multi-dimensional difficulties, regional disparities and a lack of proper services.The general employment statistics have been improving in Hungary since 2010. The emplo-yment rate of the 15-39-year-old population has increased from 53.0% to 62.5% between 2009 - 2019. The employment rate improved in every type of settlement/area. The improve-ment can be attributed to the community work in the marginalised regions micro-regions and settlements. The NEET rate shows a considerable improvement of nearly 40% between 2009 and 2019 in the urban environment for all age groups. A slight improvement can be detected in the towns and urban environment, which amounts to 25% for all age groups between 2009 and 2019. However special services and targeted programmes are required to make a diffe-rence for NEET Youth.