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.

Functional disability in early Alzheimer's disease - a validation study of the Italian version of the disability assessment for dementia scale.

AIM: To determine the applicability and psychometric properties of the Italian version of the Disability Assessment of Dementia scale (DAD-I) in a community-residing population with early-stage Alzheimer's disease (AD). METHODS: The DAD-I was administered to the primary caregivers of 159 patients (mean age +/- SD 77.1 +/- 5.2) with mild AD (mean Mini Mental State Examination, MMSE, +/- SD 23.1 +/- 2.2). RESULTS: The DAD-I showed excellent internal consistency reliability (Cronbach's alpha = 0.92) and good construct validity. The DAD-I score was not significantly associated with gender, education and presumed duration of the illness, and had a low negative correlation with age. The DAD-I score correlated moderately with the traditional Instrumental Activities of Daily Living and Activities of Daily Living scales, respectively, with r = 0.53 and r = 0.54 (p < 0.0001). Relatively low, but statistically significant correlations (r ranging between 0.21 and 0.31) with the MMSE were also found. CONCLUSION: The DAD-I was found to be a reliable and valid instrument to assess functional disability in community-dwelling Italian subjects with early-stage AD.

Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study.

BACKGROUND: Adults and older people with intellectual disabilities (ID) frequently receive anti-cholinergic drugs in chronic use, but no studies in Italy to date have investigated cumulative anticholinergic exposure and factors associated with high anticholinergic burden in this frail population. AIM: To probe the cumulative exposure to anticholinergics and the demographic, social and clinical factors associated with high exposure. METHODS: The 2012 updated version of the Anticholinergic Burden Score (ACB) was calculated for a multicentre sample of 276 adult and older people over 40 years with ID and associations with factors assessed. RESULTS: Overall, antipsychotics, antiepileptics, anxiolytics, and antidepressants were the most frequent classes contributing to the total ACB score. People living in residential care were more likely exposed to high anticholinergic burden (an ACB score of 3+): both community housing (odds ratio [OR] 4.63, 95%CI 1.08-19.95) and nursing home facility ([OR] 9.99, 95%CI 2.32-43.04). There was also a significant association between an ACB score of 3+ and reporting mental health conditions ([OR] 25.56, 95% CI 8.08-80.89) or a neurological disease ([OR] 4.14, 95%CI 1.32-12.94). Neither demographic characteristics (age and gender) nor other clinical conditions (somatic comorbidity, levels and typology of ID) were associated with higher anticholinergic load. A high burden of anticholinergic was significantly more frequent in laxative users (22.6% ACB3+ vs. 5.1% ACB 0) (p = 0.003). CONCLUSIONS: Psychotropics drugs were the highest contributors to the anticholinergic burden in adult and old age ID, especially in those people living in institutional settings with mental health and/or neurological conditions. High anticholinergic load has shown to be associated with the use of laxatives.

A Multicentre Italian Validation Study in Aging Adults with Down Syndrome and Other Forms of Intellectual Disabilities: Dementia Screening Questionnaire for Individuals with Intellectual Disabilities.

BACKGROUND: The USA National Task Group (NTG) guidelines advocate the use of an adapted version of Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) for dementia screening of individuals with Down syndrome (DS) and with other forms of ID (non-DS). OBJECTIVE: In order to meet these guidelines, this study verifies the psychometric properties of an Italian version of the original DSQIID in a population composed of adults aged 40 years and over with DS and non-DS ID. METHODS: Internal consistency, inter-rater and intra-rater reliabilities, structural validity, convergent validity and known group differences of DSQIID-I were assessed with 200 individuals with ID (mean of 55.2 years; range: 40-80 years) recruited from 15 different centers in Italy. Diagnosis of dementia was done according to IASSID diagnostic criteria and its degree of clinical certainty was defined according to Silverman et al.'s classification (2004). RESULTS: Cronbach's alpha for the DSQIID-I was 0.94. The ICCs for inter-rater and test-retest reliability were both 0.89. A Principal Component analysis revealed three domains, namely memory and confusion- related items, motor and functional disabilities, depression and apathy, which explained almost 40% of the overall variance. The total DSQIID-I score correlated significantly with DMR and differed significantly among those individuals (n = 34) with cognitive decline from those without (n = 166). Age, gender and severity of ID were unrelated to the DSQIID-I. CONCLUSION: The present study confirms the cross-cultural value of DSQIID which was proved to be a psychometrically valid and user-friendly observer-rated scale for dementia screening in adults with both DS and non-DS ID.

The traveling salesman problem as a new screening test in early Alzheimer's disease: an exploratory study. Visual problem-solving in AD.

BACKGROUND AND AIMS: In the clinical setting, brief general mental status tests tend to detect early-stage Alzheimer's disease (AD) less well than more specific cognitive tests. Some preliminary information was collected on the diagnostic accuracy of the Traveling Salesman Problem (TSP) compared with the Mini-Mental State Examination (MMSE) in recognizing early AD from normal aging. METHODS: Fifteen AD outpatients (mean +/- SD MMSE: 24.45 +/- 2.61) and 30 age- and education-matched controls were submitted in a single blind protocol to a paper-and-pencil visually-presented version of the TSP, containing a random array of 30 points (TSP30). The task consisted of drawing the shortest continuous path, passing through each point once and only once, and returning to the starting point. Path lengths for subjects' solutions were computed and compared with the optimal solution given by a specific evolutionary algorithm called GenD. RESULTS: TP30 discriminated significantly better between AD subjects and controls (ROC curve AUC = 0.976; 95% CI 0.94-1.01) compared with the MMSE corrected for age and education (ROC curve AUC = 0.877; 95% CI 0.74-1.005). A path length of 478.2354, taken as "cut-off point", classified correctly subjects with a sensitivity of 93.3% and a specificity of 99.3%, whereas a score corrected for age and education of 25.85 on the MMSE had a sensitivity of 73.3% and a specificity of 96.7%. CONCLUSIONS: The TSP seems to be particularly sensitive to early AD and independent of patient's age and educational level. The high diagnostic ability, simplicity, and independence of age and education make the TSP promising as a screening test for early AD.