The patients received 1h per day auricular vagus nerve stimulation and individual rehabilitation procedures

These patients only received individual rehabilitation procedures

All patients received individual rehabilitation procedures tailored on their musculoskeletal degenerative disease.

Investigation of AVNT effect on cognitive frailty using the Montreal Cognitive Assessment (MoCA-B), Edmonton Frailty Scale, and Rapid Cognitive Screen Test (RCS). Every one of the test is measured in units of a scale.

For Montreal Cognitive Assessment - Basic (MoCA-B) the total Score is 30 points. A score ≥ 26 is generally considered within normal limits Scores < 26 may suggest mild cognitive impairment (MCI). < 20 may suggest moderate cognitive impairment. In this study, we calculated both the total MoCA-B score and separate domain-specific scores to identify domain-level changes more precisely.

The Rapid Cognitive Test is a brief screening instrument used to detect mild cognitive impairment and early dementia. Maximum score:10 ; ≤5: Suggestive of dementia For the Edmonton Frail Scale (EFS), the scoring system is: Total score range: 0-17; Higher scores indicate greater frailty. It was administered only at baseline (upon admission) as a reference measure of frailty status.

We used the Pittsburgh Sleep Quality Index (PSQI) to asses the quality of sleep.

Scoring - units per scale Total score range: 0-21 Score ≤ 5: Good sleep quality Score > 5: Poor sleep quality Higher scores indicate worse sleep quality. The PSQI evaluates 7 components: Subjective sleep quality, Sleep latency, Sleep duration, Habitual sleep efficiency, Sleep disturbances, Use of sleep medication, Daytime dysfunction.

In this study, both total PSQI score and component-level changes were analyzed.

We will assess quantitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α).

Reference Range and measurement unit

1. IL-6: Typically < 7 pg/mL Values > 7 pg/mL indicate elevated inflammatory activity
2. Tumor Necrosis Factor Alpha (TNF-α) Typically < 8 pg/mL
3. Quantitative C-reactive protein (CRP)

< 5 mg/L: Normal

5-10 mg/L: Mild inflammation

10 mg/L: Significant inflammation (acute or chronic)

4. Erythrocyte Sedimentation Rate (ESR) For men: < 20 mm/hour For women: < 30 mm/hour