Italian guidance on Dementia Day Care Centres: A position paper.

Dementia Day Care Centres (DDCCs) are defined as services providing care and rehabilitation to people with dementia associated with behavioural and psychological symptoms (BPSD) in a semi-residential setting. According to available evidence, DDCCs may decrease BPSD, depressive symptoms and caregiver burden. The present position paper reports a consensus of Italian experts of different disciplines regarding DDCCs and includes recommendations about architectural features, requirements of personnel, psychosocial interventions, management of psychoactive drug treatment, prevention and care of geriatric syndromes, and support to family caregivers. DDCCs architectural features should follow specific criteria and address specific needs of people with dementia, supporting independence, safety, and comfort. Staffing should be adequate in size and competence and should be able to implement psychosocial interventions, especially focused on BPSD. Individualized care plan should include prevention and treatment of geriatric syndromes, a targeted vaccination plan for infectious diseases including COVID-19, and adjustment of psychotropic drug treatment, all in cooperation with the general practitioner. Informal caregivers should be involved in the focus of intervention, with the aim of reducing assistance burden and promoting the adaptation to the ever-changing relationship with the patient.

Classification of facial peri-implant soft tissue dehiscence/deficiencies at single implant sites in the esthetic zone.

BACKGROUND: The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of peri-implant PSTD at a single implant site. METHODS: Four classes of PSTDs were discussed based on the position of the gingival margin of the implant-supported crown in relation to the homologous natural tooth. In addition, the bucco-lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae. RESULTS: Subsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prosthetic-surgical approach or soft tissue augmentation with a submerged healing) was also suggested. CONCLUSION: This paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol.

Non-carious cervical lesions associated with gingival recessions: a decision-making process.

BACKGROUND: A method to predetermine the maximum root coverage level (MRC) was recently demonstrated to be reliable in predicting the position of the soft tissue margin after root coverage surgery. The aim of the present study is to suggest a decision-making process for treating non-carious cervical lesions (NCCLs) associated with gingival recessions based upon the topographic relationship between the MRC and NCCL and to assess patient and independent-periodontist esthetic evaluations. METHODS: Five treatments were performed in 94 patients with NCCLs associated with a single gingival recession: 1) coronally advanced flap (CAF); 2) bilaminar procedure; 3) coronal odontoplasty plus restoration plus root odontoplasty plus CAF; 4) restoration plus CAF; and 5) restorative therapy. Clinical and esthetic evaluations made by the patient and an independent periodontist were done 1 year after treatments. RESULTS: The satisfaction of the patient and periodontist with esthetics was very high in all NCCL treatments and Miller Class gingival recessions. The patient satisfaction and evaluation of root coverage and the periodontist evaluation of root coverage were statistically correlated with color-match evaluations and not with the amount of root coverage clinically achieved in each patient. CONCLUSION: The proposed approaches provided good esthetic appearance and correct emergence profile for the great majority of NCCLs associated with gingival recessions.

Visual recognition memory in Alzheimer's disease: repetition-lag effects.

There is considerable evidence that visual recognition memory is largely affected by Alzheimer's disease (AD). Deficits might concern the forming, maintaining, and matching of the memory representation of the visual stimulus, especially when long interitem lags occur. The aim of the present study was to assess the effect of repetition lag on picture identification in mild- and moderate-AD patients, as well as in elderly controls. Participants underwent an old/new paradigm. To manipulate the temporal gradient, short and long lags were introduced between the first and second presentations. Pictures were presented at different levels of spatial filtering, following a coarse-to-fine order. This allowed for the measurement of the amount of physical information required for the identification of stimuli as a function of prior exposure and repetition lag. In the elderly, the magnitude of repetition priming did not differ as a function of interitem lag. Instead, repetition-lag effects interacted with dementia severity, and the capacity to retain memory traces for longer intervals worsened as the disease progresses. Current findings suggest that severe cortical degeneration may render AD patients unable to maintain their perceptual memories, and that dementia severity is a critical variable in the visual recognition memory assessment.

Category-specific visual identification of filtered objects in Alzheimer's disease.

The category-specific deficit in object identification as function of spatial frequency (SF) content and priming effect was investigated. Twenty-two patients with Alzheimer Disease (AD) and 24 control subjects performed an object identification task. The objects belonged to living and nonliving categories. In the study phase an episodic trace of objects was created. In the identification phase, each object was revealed in a sequence of frames wherein the object was represented by an increasingly less and less filtered image up to complete version. A recall phase followed immediately after the identification phase. While the priming was preserved in mild-AD but not in moderate-AD, no difference was observed in the recall task. Moreover, although patients showed a decline in performance for both categories compared to controls, this decline was more rapid for living things especially in patients with more severe disease. Present results indicate a semantic memory deficit along with a disruption of perceptual representation. Data were discussed referring to perceptual/functional, domain-specific knowledge, and prefrontal cortex (PFC) theories.

Comparative levels of DNA breaks and sensitivity to oxidative stress in aged and senescent human fibroblasts: a distinctive pattern for centenarians.

Basal and H(2)O(2)-induced DNA breaks as well as DNA repair activity and efficacy of the antioxygenic system were determined in human dermal fibroblasts explanted from either (i) young donors and passaged serially to reach replicative senescence or (ii) young, old and centenarian donors and shortly propagated in culture. These fibroblasts have been employed as an in vitro and ex vivo model, respectively, to evaluate comparatively DNA integrity during senescence (increasing population doubling levels) and aging (increasing donor age). Constitutive levels of DNA total strand breaks, as determined by the alkaline extraction procedure, changed moderately among the different cell lines, which exhibited, however, significant differences in the amount of either single or double strand breaks. The former decreased along with both aging and senescence; the latter augmented during senescence while being virtually steady during aging. Moreover, fibroblasts from centenarians showed to be less sensitive to H(2)O(2)-induced DNA damage than other ex vivo fibroblasts. This feature could not account for either increased DNA repair activity or higher efficacy of the antioxygenic system and pointed, instead, to an intrinsic nuclear stability which might be typical of centenarian fibroblasts and potentially functional to longevity.

Evaluation of non-pharmacological intervention on antisocial behavior in patients suffering from Alzheimer's disease in a day care center.

Psychosocial treatment was studied on improving socially non integrated behavior and in containing cognitive-behavioral degeneration in patients suffering from Alzheimer's disease. The hypothesis was that patients who do not maintain social relationships decline in their psycho-social and psycho-cognitive behavior more rapidly and that intervention helps to attain the above mentioned objectives (18 patients in day care center). All subjects had to perform the Cohen-Mansfield Agitation Inventory and the Cornell Depression Scale at the beginning of the study and were tested again after 1.5 years. The results of the group of Alzheimer patients showed a significant difference in the CMAI Scale (P<0.01) and sub-scales and in the Cornell Scale (0.014). In conclusion, the usefulness of the center is fundamental in encouraging the maintenance of significant relationships and helping patients adapt to their disease.