[Nutritional deficiency and Alzheimer's disease: how to identify and prevent]. / Deficit nutrizionale e demenza di Alzheimer: come individuarlo e prevenirlo.

Weight loss is a very common problem for patients with Alzheimer's Disease (AD), whether they live at home or in long-term care facilities. At any rate it depends on an imbalance between energy expenditure and intake. Though in the initial phases of the illness, the weight loss might be caused by socio-environmental and psychological factors and reduced autonomy, in the following stages it depends on Adversive Feeding Behaviours (AFBs). The AFBs invariably lead to protein, fat and sugar deficits as well as a vitamin deficit which presents a positive correlation with the cognitive performance level and negatively affects the course of the disease. Thus it is important to identify AFBs (Blandford Scale) as soon as possible, especially when they can be treated. Furthermore it is very important to recognise weight loss immediately and identify a possible malnutrition state, using investigative methods which allow for follow-up monitoring (Mini Nutritional Assessment). Pharmacological therapy of cognitive deficit and AFBs together with possible contemporary conditions (depression) and intervention on the nutrition, will be useful to avoid a deficiency state and the consequent negative repercussion on the disease.

Aging and red blood cell membrane: a study of centenarians.

Successful aging, characterized by little or no loss in physiological functions, should be the usual aging process in centenarians. It is known that well-preserved physiological functions depend on the proper functioning of cell systems. In this article we focus on cell membrane integrity and study the red blood cell membrane to evaluate the effect of physiological aging in centenarians. Fifteen healthy, self-sufficient centenarians, mean age 103 years, were examined by assessing hemocytometric values and some relevant characteristics of the erythrocyte membrane, i.e., the cholesterol/phospholipid molar ratio, the distribution of phospholipid classes and their fatty acid composition, the integral and skeletal protein profiles. The centenarians showed a significant decrease in the red blood cell count (p < 0.0002), hemoglobin (p < 0.0002), and hematocrit (p < 0.0005). The red blood cell membrane showed a significantly increased cholesterol/phospholipid molar ratio (p < 0.01), with a concomitant increase in polyunsaturated fatty acids in phosphatidylcholine (p < 0.001) and, to a lesser extent, in phosphatidylethanolamine. The electrophoretic pattern of membrane proteins was qualitatively normal compared to controls but the densitometric analysis showed a significant increase in the integral protein band 4.2 (p < 0.05) and in the skeletal protein actin (p < 0.001). Extreme longevity seems to be associated with a substantial integrity of the erythrocyte membrane. Moreover, the evident increase in polyunsaturated fatty acids and in actin are likely to improve the membrane fluidity and to strengthen the membrane structure.

Power spectral analysis of heart rate in subjects over a hundred years old.

Altered autonomic regulation of cardiac function may contribute to the onset of cardiovascular disease and provide a substrate for malignant ventricular arrhythmias. This study was designed to assess cardiovascular neuroautonomic status in healthy subjects with short-term power spectral analysis of heart rate variability, including a group over 100 years of age, to identify a neuroautonomic pattern that could help to protect ultra-centenarians against cardiovascular disease. One hundred and twelve subjects (22 men and 90 women, age range 20 to 107 years) were subdivided into five age groups: <40 years (N=26, mean age 30.6+/-0.9); 41 to 60 years (N=27, mean age 51.9+/-1.2); 61 to 80 years (N=37, mean age 70.3+/-1.1); 81 to 100 (N=10, mean age 85.2+/-0.8) and older than 101 years (N=13, mean age: 103.6+/-0.6). Power spectral analysis with autoregressive algorithm provides two indexes of autonomic activity: a low-frequency component oscillating around 0.10 Hz, mainly reflecting sympathetic activity and a high-frequency component around 0.30 Hz, reflecting parasympathetic activity. Subjects 40 years of age or younger had significantly higher spectral high-frequency power values expressed in logarithmic form than the other age groups (P<0.05), the age group from 41 to 100 years had values similar to those of the other groups. However, the age group over 101 years had significantly higher values than the group from 81 to 100 years (P<0.05). Low-frequency spectral density expressed in logarithmic form and in normalized units decreased with age (P<0.0001). These data confirm an age-related decline in sympathetic activity. Compared with elderly subjects from 81 to 100 years of age ultra-centenarians have significantly higher spectral parasympathetic indexes. Parasympathetic predominance may be the neuroautonomic feature that helps to protect ultra-centenarians against cardiovascular disease.

Functional status and well-being of centenarians.

Data regarding a sample of 109 centenarians are presented, living in the region of central Italy. Physical and psychosocial variables were analyzed by a questionnaire based on a multidimensional conceptualization of health. Objective and laboratory data were collected and functional capacity was complemented by clinical diagnoses and judgements as well as by self-reported health problems and functional limitations. The results reveal that people can reach their maximum life span while maintaining good levels of functional capacity in spite of the chronological age. One major aspect of functional status in upper ranges of human life span is the everyday competence in the activities of daily living (ADL). In this regard, 26.6% of centenarians are classified as having no ADL-dependency (level A: 34.6% of males and 24.0% of females); the most frequent type of dependency was in bathing (65.1%; 46.2% of males, 71.1% of females) and in continence (45.9%; 50% of males, 44.6% of females). The Mini Mental State Examination (MMSE) showed a mean score of 19.86 +/- 5.93 (21.04 +/- 5.33 of males; 19.49 +/- 6.10 of females). The Geriatric Depression Scale (GDS) mean score was 8.22 +/- 4.89 (7.60 +/- 5.05 of males, 8.40 +/- 4.87 of females).

Autopsy study of very old hospitalized patients.

All autopsies (n = 63) performed over the period from January 1, 1989 to December 31, 1990 on patients older than 85 years who died at the Policlinico Umberto I of Rome were reviewed retrospectively. The purpose of the study was to determine the autopsy rate, to ascertain accordance between clinical and pathological diagnoses and to clarify problems in diagnosis and complications of geriatric management in our University Hospital. The autopsy rate was 12.1%. The diagnostic error was particularly high for pulmonary embolism. In 26% of cases both the causes of death and the major clinical diagnoses were confirmed.