TY  - JOUR
A1  - Wiesmeier, Isabella K.
A1  - Dalin, Daniela
A1  - Wehrle, Anja
A1  - Granacher, Urs
A1  - Muehlbauer, Thomas
A1  - Dietterle, Jörg
A1  - Weiller, Cornelius
A1  - Gollhofer, Albert
A1  - Maurer, Christoph
T1  - Balance training enhances vestibular function and reduces overactive proprioceptive feedback in elderly
JF  - Frontiers in aging neuroscience
N2  - Objectives: Postural control in elderly people is impaired by degradations of sensory, motor, and higher-level adaptive mechanisms. Here, we characterize the effects of a progressive balance training programon these postural control impairments using a brain network model based on system identification techniques. Methods and Material: We analyzed postural control of 35 healthy elderly subjects and compared findings to data from 35 healthy young volunteers. Eighteen elderly subjects performed a 10 week balance training conducted twice per week. Balance training was carried out in static and dynamic movement states, on support surfaces with different elastic compliances, under different visual conditions and motor tasks. Postural control was characterized by spontaneous sway and postural reactions to pseudorandom anterior-posterior tilts of the support surface. Data were interpreted using a parameter identification procedure based on a brain network model. Conclusion: Balance training reduced overactive proprioceptive feedback and restored vestibular orientation in elderly. Based on the assumption of a linear deterioration of postural control across the life span, the training effect can be extrapolated as a juvenescence of 10 years. This study points to a considerable benefit of a continuous balance training in elderly, even without any sensorimotor deficits.
KW  - age
KW  - balance
KW  - vestibular
KW  - proprioception
KW  - training
Y1  - 2017
U6  - https://doi.org/10.3389/fnagi.2017.00273
SN  - 1663-4365
VL  - 9
PB  - Frontiers Research Foundation
CY  - Lausanne
ER  - 
TY  - JOUR
A1  - Herrmann, Matthias L.
A1  - Boden, Cindy
A1  - Maurer, Christoph
A1  - Kentischer, Felix
A1  - Mennig, Eva
A1  - Wagner, Sören
A1  - Conzelmann, Lars O.
A1  - Förstner, Bernd R.
A1  - Rapp, Michael A.
A1  - von Arnim, Christine A. F.
A1  - Denkinger, Michael
A1  - Eschweiler, Gerhard W.
A1  - Thomas, Christine
T1  - Anticholinergic drug exposure increases the risk of delirium in older patients undergoing elective surgery
JF  - Frontiers in medicine
N2  - IntroductionPostoperative delirium (POD) is a common and serious adverse event of surgery in older people. Because of its great impact on patients' safety and quality of life, identification of modifiable risk factors could be useful. Although preoperative medication intake is assumed to be an important modifiable risk factor, the impact of anticholinergic drugs on the occurrence of POD seems underestimated in elective surgery. The aim of this study was to investigate the association between preoperative anticholinergic burden and POD. We hypothesized that a high preoperative anticholinergic burden is an independent, potentially modifiable predisposing and precipitating factor of POD in older people. MethodsBetween November 2017 and April 2019, 1,470 patients of 70 years and older undergoing elective orthopedic, general, cardiac, or vascular surgery were recruited in the randomized, prospective, multicenter PAWEL trial. Anticholinergic burden of a sub-cohort of 899 patients, who did not receive a multimodal intervention for preventing POD, was assessed by two different tools at hospital admission: The established Anticholinergic Risk Scale (ARS) and the recently developed Anticholinergic Burden Score (ABS). POD was detected by confusion assessment method (CAM) and a validated post discharge medical record review. Logistic regression analyses were performed to evaluate the association between anticholinergic burden and POD. ResultsPOD was observed in 210 of 899 patients (23.4%). Both ARS and ABS were independently associated with POD. The association persisted after adjustment for relevant confounding factors such as age, sex, comorbidities, preoperative cognitive and physical status, number of prescribed drugs, surgery time, type of surgery and anesthesia, usage of heart-lung-machine, and treatment in intensive care unit. If a patient was taking one of the 56 drugs listed in the ABS, risk for POD was 2.7-fold higher (OR = 2.74, 95% CI = 1.55-4.94) and 1.5-fold higher per additional point on the ARS (OR = 1.54, 95% CI = 1.15-2.02). ConclusionPreoperative anticholinergic drug exposure measured by ARS or ABS was independently associated with POD in older patients undergoing elective surgery. Therefore, identification, discontinuation or substitution of anticholinergic medication prior to surgery may be a promising approach to reduce the risk of POD in older patients.
KW  - delirium
KW  - acute encephalopathy
KW  - surgery
KW  - anticholinergic
KW  - geriatric
KW  - postoperative
Y1  - 2022
U6  - https://doi.org/10.3389/fmed.2022.871229
SN  - 2296-858X
VL  - 9
PB  - Frontiers Media
CY  - Lausanne
ER  -