Motor and Perceptual Recovery in Adult Patients with Mild Intellectual Disability

Transcriptome Study in Sicilian Patients with Autism Spectrum Disorder

ASD is a complex condition primarily rooted in genetics, although influenced by environmental, prenatal, and perinatal risk factors, ultimately leading to genetic and epigenetic alterations. These mechanisms may manifest as inflammatory, oxidative stress, hypoxic, or ischemic damage. To elucidate potential variances in gene expression in ASD, a transcriptome analysis of peripheral blood mononuclear cells was conducted via RNA-seq on 12 ASD patients and 13 healthy controls, all of Sicilian ancestry to minimize environmental confounds. A total of 733 different statistically significant genes were identified between the two cohorts. Gene Set Enrichment Analysis (GSEA) and Gene Ontology (GO) terms were employed to explore the pathways influenced by differentially expressed mRNAs. GSEA revealed GO pathways strongly associated with ASD, namely the GO Biological Process term "Response to Oxygen-Containing Compound". Additionally, the GO Cellular Component pathway "Mitochondrion" stood out among other pathways, with differentially expressed genes predominantly affiliated with this specific pathway, implicating the involvement of different mitochondrial functions in ASD. Among the differentially expressed genes, FPR2 was particularly highlighted, belonging to three GO pathways. FPR2 can modulate pro-inflammatory responses, with its intracellular cascades triggering the activation of several kinases, thus suggesting its potential utility as a biomarker of pro-inflammatory processes in ASD.

Efficacy and safety of transcranial pulse stimulation in young adolescents with attention-deficit/hyperactivity disorder: a pilot, randomized, double-blind, sham-controlled trial

Background

This is the first study to evaluate the efficacy and safety of transcranial pulse stimulation (TPS) for the treatment of attention-deficit/hyperactivity disorder (ADHD) among young adolescents in Hong Kong.

Methods

This double-blind, randomized, sham-controlled trial included a TPS group and a sham TPS group, encompassing a total of 30 subjects aged 12-17 years who were diagnosed with ADHD. Baseline measurements SNAP-IV, ADHD RS-IV, CGI and executive functions (Stroop tests, Digit Span) and post-TPS evaluation were collected. Both groups were assessed at baseline, immediately after intervention, and at 1-month and 3-month follow-ups. Repeated-measures ANOVAs were used to analyze data.

Results

The TPS group exhibited a 30% reduction in the mean SNAP-IV score at postintervention that was maintained at 1- and 3-month follow-ups.

Conclusion

TPS is an effective and safe adjunct treatment for the clinical management of ADHD.

Clinical trial registration

ClinicalTrials.Gov, identifier NCT05422274.

Cognitive and functional evolution in older adults with and without intellectual disability using a multicomponent intervention: A prospective longitudinal study

BACKGROUND

The global population is experiencing accelerated biopsychosocial aging. Cognitive impairment is frequently associated with functional impairment in basic and instrumental daily living activities. To maintain optimal cognitive and functional functioning, health professionals recommend that older adults participate in cognitive training.

AIMS

This study examines the cognitive and functional evolution of older adults with and without Intellectual Disability and the factors associated with favourable evolution following the intervention of a multicomponent programme based on the human occupational model and the person-centred care model.

METHODS AND PROCEDURES

247 people participated. Descriptive and univariate analyses were performed to examine baseline data. The Wilcoxon paired samples test was used to compare cognitive and functional evolution one year after the intervention. Linear regression was used to detect factors predicting favourable evolution.

OUTCOMES AND RESULTS

Both populations improved cognitively. There was no change in basic activities of daily living. There was an improvement in instrumental activities of daily living in the group with Intellectual Disability. None of the variables collected was a predictor of greater improvement.

CONCLUSIONS AND IMPLICATIONS

This study demonstrated that older people with Intellectual Disability who have supports to cope with this life stage can improve their cognitive and functional abilities.

Exploratory genome-wide analyses of cortical inhibition, facilitation, and plasticity in late-life depression

Late-life depression (LLD) is a heterogenous mood disorder influenced by genetic factors. Cortical physiological processes such as cortical inhibition, facilitation, and plasticity may be markers of illness that are more strongly associated with genetic factors than the clinical phenotype. Thus, exploring the relationship between genetic factors and these physiological processes may help to characterize the biological mechanisms underlying LLD and improve diagnosis and treatment selection. Transcranial magnetic stimulation (TMS) combined with electromyography was used to measure short interval intracortical inhibition (SICI), cortical silent period (CSP), intracortical facilitation (ICF), and paired associative stimulation (PAS) in 79 participants with LLD. We used exploratory genome-wide association and gene-based analyses to assess for genetic correlations of these TMS measures. MARK4 (which encodes microtubule affinity-regulating kinase 4) and PPP1R37 (which encodes protein phosphatase 1 regulatory subunit 37) showed genome-wide significant association with SICI. EGFLAM (which encodes EGF-like fibronectin type III and laminin G domain) showed genome-wide significant association with CSP. No genes met genome-wide significant association with ICF or PAS. We observed genetic influences on cortical inhibition in older adults with LLD. Replication with larger sample sizes, exploration of clinical phenotype subgroups, and functional analysis of relevant genotypes is warranted to better characterize genetic influences on cortical physiology in LLD. This work is needed to determine whether cortical inhibition may serve as a biomarker to improve diagnostic precision and guide treatment selection in LLD.

Effectiveness and Electrophysiological Mechanisms of Focal Vibration on Upper Limb Motor Dysfunction in Patients with Subacute Stroke: A Randomized Controlled Trial

Upper limb motor dysfunction is a common complication after stroke, which has a negative impact on the daily life of patients. Focal vibration (FV) has been used to improve upper limb motor function in acute and chronic stroke patients, but its application in subacute stroke patients has not been extensively explored. Therefore, the purpose of this study was to explore the therapeutic effect of FV on upper limb motor function in subacute stroke patients and its underlying electrophysiological mechanism. Twenty-nine patients were enrolled and randomized into two groups: control group and vibration group. The control group were treated with conventional therapy including passive and active physical activity training, standing and sitting balance exercises, muscle strength training, hand extension and grasping exercises. The vibration group were given conventional rehabilitation and vibration therapy. A deep muscle stimulator (DMS) with a frequency of 60 Hz and an amplitude of 6 mm was used to provide vibration stimulation, which was sequentially applied along the biceps muscle to the flexor radialis of the affected limb for 10 minutes, once a day, and 6 times a week. Both groups received treatments for 4 consecutive weeks. In the vibration group, the motor evoked potential (MEP) latency and the somatosensory evoked potential (SEP) latency were significantly shortened (P<0.05) immediately after vibration and 30 minutes after vibration; the SEP amplitude and MEP amplitude were significantly increased (P<0.05) immediately after vibration and 30 minutes after vibration. The MEP latency (P=0.001) and SEP N20 latency (P=0.001) were shortened, and the MEP amplitude (P=0.011) and SEP N20 amplitude (P=0.017) were significantly increased after 4 weeks in the vibration group. After 4 consecutive weeks, the vibration group showed significant improvements in Modified Ashworth Scale (MAS) (P=0.037), Brunnstrom stage for upper extremity (BS-UE) (P=0.020), Fugl-Meyer assessment for upper extremity (FMA-UE) (P=0.029), Modified Barthel Index (MBI) (P=0.024), and SEP N20 (P=0.046) compared to the control group. The Brunnstrom stage for hand (BS-H) (P=0.451) did not show significant differences between the two groups. This study showed that FV was effective in improving upper limb motor function in subacute stroke patients. The underlying mechanism of FV may be that it enhances the efficacy of sensory pathways and induces plastic changes in the sensorimotor cortex.

Effects of a Physical Activity Program that Incorporates Exercises Targeting Balance, Strength, and Proprioception on Cognitive Functions and Physical Performance in Old Adults with Mild Cognitive Impairment

BACKGROUND

Aging often leads to cognitive function decline, sensory structure deterioration, and musculoskeletal system weakening. This impacts postural control during static and dynamic activities like walking, increasing the fall risk among the elderly. Older adults with mild cognitive impairment (MCI) face an elevated fall risk and cognitive decline, magnifying the public health concern.

OBJECTIVE

This study aimed to explore solutions by investigating the effects of a multi-component physical activity program on cognitive and motor functions in MCI patients.

METHODS

Twenty-three participants were enrolled in the study and assigned into two groups: an intervention group (n = 13; age = 85.7±5.5 years) and a control group (n = 9; age = 85±6.7 years). The study spanned two months, with participants engaging in three 60-minute weekly physical exercise sessions. The intervention focused on improving proprioception, muscle strength, and balance.

RESULTS

Results demonstrated significant enhancements in physical performance, fall risk reduction, and balance (p < 0.05). Various tests, including the timed up and go test, Unipedal Stance test, Tinetti test, Short Physical Performance Battery, and 6-minute walking test, indicated these improvements. Cognitive function was evaluated with the Mini-Mental State Examination, revealing non-significant progress (p > 0.05). Predictive models for outcomes were developed using linear regression analysis during the follow-up stage.

CONCLUSIONS

This study underscores the effectiveness of a multi-component physical activity program encompassing balance, proprioception, and muscle-strengthening exercises as a non-pharmaceutical approach in improving balance skills and playing a key role in mitigating the risk of falls among old adults with MCI.

"Mind" versus "Body" in Mild Cognitive Impairment Rehabilitation: Does a Multicomponent Physical Exercise Program Have a Dichotomous Effect on Cognitive Functions and Physical Performance?

In the relevant study by Boulares and colleagues, the importance of a multicomponent physical activity program in improving balance skills and leading to falling risk and fear reduction in older adults with mild cognitive impairment (MCI) is highlighted, despite the lack of cognitive effects. Given this apparent discrepancy between "body" and "mind" in MCI rehabilitation, the present commentary faces and discusses these findings within the existing literature and poses the question whether there were actually no cognitive results or if the program design and evaluation tool used were not sensitive enough to detect them, at least at this stage.

Effectiveness of an integrative medicine approach to improve cognitive dysfunction and dementia: An observational study

Despite the urgent need to control dementia, an effective treatment has yet to be developed. Along with the Korean government's policy of cooperation between conventional medicine (CM) and Korean medicine (KM), integrative medical services for dementia patients are being provided. This study aimed to compare the integrative medical clinic (IMC) for dementia used by Dongguk University Hospitals (DUH) with other service models and to review the characteristics and treatment outcomes of patients who had visited DUH over the past 5 years. Patients' electronic medical records from May 2015 to June 2020 were searched and their data were analyzed to evaluate the IMC's service model. Patient demographic and clinical characteristics, diagnostic tests, and treatment patterns for CM and KM were collected. The proportion of patients who did not show worsening cognitive function was described in detail. A strength of the DUH integrative medicine clinic is its ability to manage both KM and CM patients in the same space at the same time. Among the 82 patients who visited the clinic during our study period, 56 remained for data analysis after we excluded patients who met the exclusion criteria; nineteen patients had diagnoses of mild cognitive impairment. Among collaboration patterns, the first visit to the IMC had the highest proportion (55.4%). Among diagnosed tests in CM, laboratory tests and neuropsychological tests were used the most. In KM, a heart rate variability test was frequently used. The most common CM treatment prescribed was anticonvulsants, with 22 patients (39.2%) receiving donepezil, whereas the most frequent KM treatments were acupuncture (82.1%) and herbal medicine (78.6%). Twelve patients were followed up with the Mini-Mental State Examination, and 8 demonstrated either no worsening or improved cognition (baseline Mini-Mental State Examination range: 21-26). All 8 patients had mild cognitive impairment including 6 with amnestic, multidomain impairment. This study searched for a way to improve cognitive dysfunction and dementia using an integrative approach, and it shows promising results for mild cognitive impairment. However, more precisely designed follow-up studies are needed to address the present work's limitations of a retrospective study design and a small sample size.

The Effect of Repetitive Transcranial Magnetic Stimulation on Dysphagia After Stroke: A Systematic Review and Meta-Analysis

Objective: The primary purpose of our study is to systemically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on recovery of dysphagia after stroke.

Search Methods: We searched randomized controlled trials (RCTs) and non-RCTs published by PubMed, the Cochrane Library, ScienceDirect, MEDLINE, and Web of Science from inception until April 24, 2021. Language is limited to English. After screening and extracting the data, and evaluating the quality of the selected literature, we carried out the meta-analysis with software RevMan 5.3 and summarized available evidence from non-RCTs.

Results: Among 205 potentially relevant articles, 189 participants (from 10 RCTs) were recruited in the meta-analysis, and six non-RCTs were qualitatively described. The random-effects model analysis revealed a pooled effect size of SMD = 0.65 (95% CI = 0.04–1.26, p = 0.04), which indicated that rTMS therapy has a better effect than conventional therapy. However, the subgroup analysis showed that there was no significant difference between low-frequency and high-frequency groups. Even more surprisingly, there were no statistically significant differences between the two groups and the conventional training group in the subgroup analysis, but the combined effect was positive.

Conclusion: Our study suggests that rTMS might be effective in treating patients with dysphagia after stroke.

Procedural Learning through Action Observation: Preliminary Evidence from Virtual Gardening Activity in Intellectual Disability

Intellectual disability (ID) compromises intellectual and adaptive functioning. People with an ID show difficulty with procedural skills, with loss of autonomy in daily life. From an embodiment perspective, observation of action promotes motor skill learning. Among promising technologies, virtual reality (VR) offers the possibility of engaging the sensorimotor system, thus, improving cognitive functions and adaptive capacities. Indeed, VR can be used as sensorimotor feedback, which enhances procedural learning. In the present study, fourteen subjects with an ID underwent progressive steps training combined with VR aimed at learning gardening procedures. All participants were trained twice a week for fourteen weeks (total 28 sessions). Participants were first recorded while sowing zucchini, then they were asked to observe a virtual video which showed the correct procedure. Next, they were presented with their previous recordings, and they were asked to pay attention and to comment on the errors made. At the end of the treatment, the results showed that all participants were able to correctly garden in a real environment. Interestingly, action observation facilitated, not only procedural skills, but also specific cognitive abilities. This evidence emphasizes, for the first time, that action observation combined with VR improves procedural learning in ID.

Performance of (Instrumental) Activities of Daily Living and Physical Capacity in Spanish Adults with Intellectual Disabilities: A Cross-Sectional Pilot Study

Performance in basic and instrumental activities of daily living (ADL; IADL) is an essential indicator of daily functioning and health of people with intellectual disabilities (ID). The aims of this pilot study were to describe the profile of ADL and IADL performance in Spanish adults with ID, and to examine its association with functional physical skills. The Waisman Activities of Daily Living Scale for adolescents and adults with developmental disabilities (W-ADL) scale was administered to the caregivers of twenty adults with ID (mean age = 41.0, SD = 10.1; women = 75.0%). In addition, dynamic balance and maximum walking speed (MWS), lower-body strength, aerobic capacity and manual dexterity of participants were individualized assessed. The results showed that 40% of adults with ID were completely independent in ADL, but all participants reported activity limitations in at least one IADL. Dynamic balance and MWS, lower-body strength and manual dexterity showed significant and moderate-to-strong correlations with daily functioning (r = 0.495-0.814; p < 0.05). Linear regression analysis indicated that lower-body strength and manual dexterity significantly predicted activity performance in adults with ID (adjusted R2 = 0.816, p = 0.004-0.016). This study highlights the need to support the performance of both ADL and IADL and to promote physical fitness in Spanish community-based care centers for adults with ID.

Moderate Mocha Coffee Consumption Is Associated with Higher Cognitive and Mood Status in a Non-Demented Elderly Population with Subcortical Ischemic Vascular Disease

To date, interest in the role of coffee intake in the occurrence and course of age-related neurological and neuropsychiatric disorders has provided an inconclusive effect. Moreover, no study has evaluated mocha coffee consumption in subjects with mild vascular cognitive impairment and late-onset depression. We assessed the association between different quantities of mocha coffee intake over the last year and cognitive and mood performance in a homogeneous sample of 300 non-demented elderly Italian subjects with subcortical ischemic vascular disease. Mini Mental State Examination (MMSE), Stroop Colour-Word Interference Test (Stroop T), 17-items Hamilton Depression Rating Scalfe (HDRS), Activities of Daily Living (ADL), and Instrumental ADL were the outcome measures. MMSE, HDRS, and Stroop T were independently and significantly associated with coffee consumption, i.e., better scores with increasing intake. At the post-hoc analyses, it was found that the group with a moderate intake (two cups/day) had similar values compared to the heavy drinkers (≥three cups/day), with the exception of MMSE. Daily mocha coffee intake was associated with higher cognitive and mood status, with a significant dose-response association even with moderate consumption. This might have translational implications for the identification of modifiable factors for vascular dementia and geriatric depression.

Moderate Mocha Coffee Consumption Is Associated with Higher Cognitive and Mood Status in a Non-Demented Elderly Population with Subcortical Ischemic Vascular Disease

To date, interest in the role of coffee intake in the occurrence and course of age-related neurological and neuropsychiatric disorders has provided an inconclusive effect. Moreover, no study has evaluated mocha coffee consumption in subjects with mild vascular cognitive impairment and late-onset depression. We assessed the association between different quantities of mocha coffee intake over the last year and cognitive and mood performance in a homogeneous sample of 300 non-demented elderly Italian subjects with subcortical ischemic vascular disease. Mini Mental State Examination (MMSE), Stroop Colour-Word Interference Test (Stroop T), 17-items Hamilton Depression Rating Scalfe (HDRS), Activities of Daily Living (ADL), and Instrumental ADL were the outcome measures. MMSE, HDRS, and Stroop T were independently and significantly associated with coffee consumption, i.e., better scores with increasing intake. At the post-hoc analyses, it was found that the group with a moderate intake (two cups/day) had similar values compared to the heavy drinkers (≥three cups/day), with the exception of MMSE. Daily mocha coffee intake was associated with higher cognitive and mood status, with a significant dose-response association even with moderate consumption. This might have translational implications for the identification of modifiable factors for vascular dementia and geriatric depression.

Error-Related Cognitive Control and Behavioral Adaptation Mechanisms in the Context of Motor Functioning and Anxiety

Motor proficiency reflects the ability to perform precise and coordinated movements in different contexts. Previous research suggests that different profiles of motor proficiency may be associated with different cognitive functioning characteristics thus suggesting an interaction between cognitive and motor processes. The current study investigated this interaction in the general population of healthy adults with different profiles of motor proficiency by focusing on error-related cognitive control and behavioral adaptation mechanisms. In addition, the impact of these processes was assessed in terms of trait anxiety and worries. Forty healthy adults were divided into high and low motor proficiency groups based on an assessment of their motor skills. Using electroencephalography during a flanker task, error-related negativity (ERN) was measured as the neural indicator of cognitive control. Post-error slowing (PES) was measured to represent behavioral adaptation. Participants also completed an anxiety assessment questionnaire. Participants in the high motor proficiency group achieved better task accuracy and showed relatively enhanced cognitive control through increased ERN. Contrastingly, individuals in the lower motor proficiency group achieved poorer accuracy whilst showing some evidence of compensation through increased PES. Trait anxiety reflecting general worries was found to be correlated with motor functioning, but the study could not provide evidence that this was related to cognitive or behavioral control mechanisms. The interaction between cognitive and motor processes observed in this study is unique for healthy and sub-clinical populations and provides a baseline for the interpretation of similar investigations in individuals with motor disorders.

Biopsychosocial Predictors of Cognitive Impairment in the Elderly: A Case-control Study

Background:

Cognitive impairment is one of the most common diseases in the elderly. Several studies have already been conducted to identify related factors, but few have explored all the factors involved in the development of cognitive problems.

Objective:

The present study aimed to identify significant biopsychosocial predictors of cognitive impairment.

Methods::

This case-control study was conducted on 535 elderly people referred to Shafa Clinic in the city of Tehran in 2017. The biological factors including serum cholesterol, fasting blood sugar, systolic and diastolic blood pressure, vitamin D, vitamin B12, serum folate, serum homocysteine, height, and weight were measured. The psychological variable in this study was a history of depression that was extracted from the medical records. Social network and social support were measured by LSNS-6 and MOS-SSS questionnaires. The SPSS version 25 was used to analyze the data.

Results:

The mean age of the control group was 68.4 years (SD = 5.89) and of the case group was 71.5 years (SD = 7.37). The results of multiple logistic regression analysis showed age (AOR=1.05; CI:1.089-1.016, p≤0.05,), Secondary education (AOR=0.51; CI:0.266-0.990, p<0.05,), Tertiary education (AOR=0.41; CI:0.212-0.810, p<0.01,), hypertension (AOR=2.16; CI:3.671-1.266, p<0.01) homocysteine level (AOR=1.09; CI:1.147-1.045, p<0.001,), Hypothyroidism (AOR=0.43; CI: 0.226 0.820, p<0.001,), and depression (AOR=4.5; CI:7.163-2.822, p<0.001) to be significant predictors of cognitive impairment.

Conclusion:

Results of this study showed that low education level, high blood pressure, high level of homocysteine and depression likely increase the risk of cognitive impairment; also, it was implied that timely screening can identify people at risk. The novelty of the present study is that it used a combination of the biopsychosocial factors to predict unique predictors of cognitive impairment.

Adapted physical activity in community-dwelling adults with neurological disorders: design and outcomes of a fitness-center based program

Purpose: To describe and evaluate an adapted physical activity-based program (APA-program) designed for community-dwelling patients with neurological diseases in local fitness centers.Materials and methods: The APA-program consisted of individual and group activities supervised by an adapted physical activity (APA) instructor twice a week for 6 months. Clinical evaluations before and after the APA-program included strength tests on gym machines, the six-minute walk test (6MWT), the single-leg stance test, and the Short Form-36 (SF-36).Results: Between January 2017 and May 2019, 79 individuals participated in the APA-program (33 women, mean age 59 ± 14 years, 47 stroke, 13 multiple sclerosis, and 19 other neurological diseases). All physical outcomes improved significantly: upper body strength increased by 49%, lower body strength by 37%, 6MWT by 22%, single-leg stance time by 86%, and SF-36 Mental and Physical scores by 23%. Sixty-eight percent of participants completed the 6-month program and 83% of completers then purchased a one-year subscription in the fitness center.Conclusions: The 6-month APA-program improved participant's physical abilities and quality of life. More than half of participants decided to subscribe personally to the fitness center at the end of the program, supporting the development of community APA-programs for people with chronic neurological diseases, in collaboration with rehabilitation hospitals.Implications for rehabilitationA physical activity-based-program implemented in a fitness center is effective in improving physical fitness and quality of life in people suffering from neurological disorders such as stroke and multiple sclerosis.Close coordination between rehabilitation hospitals and local fitness centers, training by skilled adapted physical activity instructors and group activities are critical determinants of successful participation.

Acetyl-L-Carnitine in Dementia and Other Cognitive Disorders: A Critical Update

Several studies explored the effects of acetyl-L-carnitine (ALC) in dementia, suggesting a role in slowing down cognitive decline. Nevertheless, in 2003 a systematic review concluded there was insufficient evidence to recommend a clinical use, although a meta-analysis in the same year showed a significant advantage for ALC for clinical scales and psychometric tests. Since then, other studies have been published; however, a critical review is still lacking. We provide an update of the studies on ALC in primary and secondary dementia, highlighting the current limitations and translational implications. Overall, the role of ALC in dementia is still under debate. The underlying mechanisms may include restoring of cell membranes and synaptic functioning, enhancing cholinergic activity, promoting mitochondrial energy metabolism, protecting against toxins, and exerting neurotrophic effects. The effects of ALC on the gut-liver-brain axis seem to identify the category of patients in which the new insights contribute most to the mechanisms of action of ALC, likely being the liver metabolism and the improvement of hepatic detoxifying mechanisms the primary targets. In this framework, our research group has dealt with this topic, focusing on the ALC-related cross-talk mechanisms. Further studies with homogeneous sample and longitudinal assessment are needed before a systematic clinical application.

Acetyl-L-Carnitine in Dementia and Other Cognitive Disorders: A Critical Update

Several studies explored the effects of acetyl-L-carnitine (ALC) in dementia, suggesting a role in slowing down cognitive decline. Nevertheless, in 2003 a systematic review concluded there was insufficient evidence to recommend a clinical use, although a meta-analysis in the same year showed a significant advantage for ALC for clinical scales and psychometric tests. Since then, other studies have been published; however, a critical review is still lacking. We provide an update of the studies on ALC in primary and secondary dementia, highlighting the current limitations and translational implications. Overall, the role of ALC in dementia is still under debate. The underlying mechanisms may include restoring of cell membranes and synaptic functioning, enhancing cholinergic activity, promoting mitochondrial energy metabolism, protecting against toxins, and exerting neurotrophic effects. The effects of ALC on the gut-liver-brain axis seem to identify the category of patients in which the new insights contribute most to the mechanisms of action of ALC, likely being the liver metabolism and the improvement of hepatic detoxifying mechanisms the primary targets. In this framework, our research group has dealt with this topic, focusing on the ALC-related cross-talk mechanisms. Further studies with homogeneous sample and longitudinal assessment are needed before a systematic clinical application.

Motor activity and Becker's muscular dystrophy: lights and shadows

Becker's disease is an inherited muscular dystrophy caused by mutations in the gene coding for the dystrophin protein that leads to quantitative and/or qualitative protein dysfunction and consequent muscle degeneration. Studies in animal models demonstrate that, while eccentric or high-intensity training are deleterious for dystrophic muscles, low-intensity aerobic training may slowdown the disease process and progression. Based on these preclinical data, the available studies in patients with Becker's muscular dystrophy undergoing workout on a cycle ergometer or on a treadmill, at a heart rate ≤65% of their maximal oxygen uptake, showed that aerobic exercise counteracts physical deterioration and loss of functional abilities. These findings suggest an improvement of physical performance through an increase of muscle strength, fatigue resistance, and dexterity capacities, without substantial evidence of acceleration of muscular damage progression. Therefore, individually tailored mild-to-moderate intensity aerobic exercise should be considered as part of the management of these patients. However, further research is necessary to define specific and standardized guidelines for the prescription of type, intensity, frequency, and duration of motor activities. In this review, we provided a summary of the impact of physical activity both in animal models and in patients with Becker's muscular dystrophy, with the intent to identify trends and gaps in knowledge. The potential therapeutic implications and future research directions have been also highlighted.

Update on intensive motor training in spinocerebellar ataxia: time to move a step forward?

Some evidence suggests that high-intensity motor training slows down the severity of spinocerebellar ataxia. However, whether all patients might benefit from these activities, and by which activity, and the underlying mechanisms remain unclear. We provide an update on the effect and limitations of different training programmes in patients with spinocerebellar ataxias. Overall, data converge of the finding that intensive training is still based either on conventional rehabilitation protocols or whole-body controlled videogames ("exergames"). Notwithstanding the limitations, short-term improvement is observed, which tends to be lost once the training is stopped. Exergames and virtual reality can ameliorate balance, coordination, and walking abilities, whereas the efficacy of adapted physical activity, gym, and postural exercises depends on the disease duration and severity. In conclusion, although a disease-modifying effect has not been demonstrated, constant, individually tailored, high-intensity motor training might be effective in patients with degenerative ataxia, even in those with severe disease. These approaches may enhance the remaining cerebellar circuitries or plastically induce compensatory networks. Further research is required to identify predictors of training success, such as the type and severity of ataxia and the level of residual functioning.

Update on intensive motor training in spinocerebellar ataxia: time to move a step forward?

Some evidence suggests that high-intensity motor training slows down the severity of spinocerebellar ataxia. However, whether all patients might benefit from these activities, and by which activity, and the underlying mechanisms remain unclear. We provide an update on the effect and limitations of different training programmes in patients with spinocerebellar ataxias. Overall, data converge of the finding that intensive training is still based either on conventional rehabilitation protocols or whole-body controlled videogames ("exergames"). Notwithstanding the limitations, short-term improvement is observed, which tends to be lost once the training is stopped. Exergames and virtual reality can ameliorate balance, coordination, and walking abilities, whereas the efficacy of adapted physical activity, gym, and postural exercises depends on the disease duration and severity. In conclusion, although a disease-modifying effect has not been demonstrated, constant, individually tailored, high-intensity motor training might be effective in patients with degenerative ataxia, even in those with severe disease. These approaches may enhance the remaining cerebellar circuitries or plastically induce compensatory networks. Further research is required to identify predictors of training success, such as the type and severity of ataxia and the level of residual functioning.

Current and emerging therapies in Becker muscular dystrophy (BMD)

Becker muscular dystrophy (BMD) has onset usually in childhood, frequently by 11 years. BMD can present in several ways such as waddling gait, exercise related cramps with or without myoglobinuria. Rarely cardiomyopathy might be the presenting feature. The evolution is variable. BMD is caused by dystrophin deficiency due to inframe deletions, mutations or duplications in dystrophin gene (Xp21.2) We review here the evolution and current therapy presenting a personal series of cases followed for over two decades, with multifactorial treatment regimen. Early treatment includes steroid treatment that has been analized and personalized for each case. Early treatment of cardiomyopathy with ACE inhibitors is recommended and referral for cardiac transplantation is appropriate in severe cases. Management includes multidisciplinary care with physiotherapy to reduce joint contractures and prolong walking. BMD is slowly progressive with phenotypic variability. Despite childhood onset, independent walking is never lost before the third decade. Personalized medicine is required to tailor treatment to individual cases.