Olfactory deficit and hippocampal volume loss for early diagnosis of Alzheimer disease: a pilot study.

BACKGROUND: The aim of this pilot study was to verify the role of olfactory test and volumetric magnetic resonance imaging measure of hippocampus to predict conversion from mild cognitive impairment to Alzheimer disease (AD). MATERIALS AND METHODS: Eighteen patients with amnesic mild cognitive impairment, broadly defined, were followed at 12 months. Hypothesized baseline predictors for follow-up conversion to AD were olfactory deficit and hippocampal volumes loss. RESULTS: In the 1-year follow-up, 5 patients converted to AD. The 2 clinical predictors olfactory test and hippocampal volume loss showed the same sensitivity of 92.3% but the olfactory test showed a higher specificity than the hippocampal volume loss (75% vs. 60%). CONCLUSIONS: Our findings suggest the potential utility of olfactory test and hippocampal volume loss for early detection of AD.

Depressive symptoms in older people with metabolic syndrome: is there a relationship with inflammation?

OBJECTIVE: To investigate if there is a higher prevalence of depressive symptoms in older people with metabolic syndrome (MetS) compared with those without and whether dedpressive symptoms are independently associated to MetS and its single components and to the inflammatory markers. METHODS: Physical parameters, standard blood analytes, high sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR) were assessed. Fifteen-item Geriatric Depression Scale and mini mental state examination (MMSE) were administered. RESULTS: One hundred thirty-three subjects were enrolled. MetS patients (57) exhibited higher prevalence of depressive symptoms (p < 0.0001), worse cognitive function (p < 0.0001), and higher levels of ESR and hsCRP were higher (p < 0.0001). The univariate analysis showed a linear strong correlation of depressive symptoms (p < 0.0001) with the MMSE score (r = -0.422), body mass index (r = 0.414), MetS (r = 0.582), number of MetS components (r = 0.663), fasting blood glucose (r = 0.565), ESR (r = 0.565), hsCRP (r = 0.745), central obesity (r = 0.269; p = 0.002), and high-density lipoprotein cholesterol (r = -0.241; p = 0.005). However, the multivariate analysis showed that only age (B = -0.093; p = 0.032), MetS (B = 1.446; p = 0.025), fasting blood glucose (B = 0.039; p = 0.005), and hsCRP (B = 7.649; p < 0.0001) were independently associated with depressive symptoms. CONCLUSIONS: MetS and inflammation are independently associated with depressive symptoms in older people. Inflammation may explain cognitive decline too. Further investigations are needed to better understand the direction of these associations and to determine whether these can be reversible.

[Well-being and physical activity in the frail elderly]. / Benessere ed attività fisica nell'anziano fragile.

Physical inactivity damage the elderly patients. The Authors stressed the concept about the very important role of daily, moderate, physical activity on self-sufficiency and mental health and the importance of the house-care for the efficiency and well-being of elderly patients.

[Geriatric telecare, a new model of assistance: a pilot study]. / Teleassistenza geriatrica continua. Nuovo modello di supporto all'anziano fragile: progetto pilota.

Aim of this pilot study was to evaluate the feasibility and explore the patients' acceptance of the -telecare model. The objective of this trial was to investigate the effects of a telecare system on elderly management at home. In a 24-months prospective study we enrolled all patients aged >65 years at risk of disability. During the two years of observation, each patient contact the TELECARE system. Telephone contact was followed by specific intervention and administration of a questionnaire evaluation. Over the 24 months we recorded 90,000 calls and 13,000 elderly were included in the telecare project. We analyzed the calls and the measures adopted. Our findings provide evidence of improved quality of life through clinical management at home from a telecare system. The use of this system had high adherence and was feasible for elderly patients and their family.

[Hepatic steato-fibrosis and non-alcoholic liver disease in elderly]. / Steato-fibrosi del fegato e malattia non-alcolica del fegato nel paziente anziano.

The critical role of the hepatic stellate cells in pathogenesis and evolution of hepatic fibrosis is stressed. The authors, also, illustrate the most recent acquisitions about morphological and bioumoral aspects of complex sinusoidal-Disse space-stellate cells and their importance for the risk of evolution towards non-alcoholic liver disease.

[Predictors of liver fibrosis in patients with non-alcoholic fatty liver disease. The role of metabolic syndrome, insulin-resistance and inflammation]. / Predittori di fibrosi epatica in pazienti con steatosi epatica non-alcolica. Il ruolo della sindrome metabolica, dell'insulino-resistenza e dell'infiammazione.

INTRODUCTION: NAFLD (non-alcoholic fatty liver disease) reaches an high prevalence in the general population, and it is closely related to metabolic syndrome (MetS). The entity of metabolic abnormalities and the chronic inflammation seem to play a main role in the development of liver fibrosis. The aim of our study is to determine whether subjects with NAFLD and MetS have higher liver fibrosis degree when compared with NAFLD subjects without MetS, and to investigate the relations between fibrosis, MetS and its single components and inflammation. MATERIALS AND METHODS: We considered 24 patients with NAFLD. Those who had viral- and alcohol- related liver disease were excluded. MetS was diagnosed according to NCEP ATP III criteria; inflammatory status was determined through C-reactive protein (PCR) assay. The peripheral insulin-resistance was assessed by calculating HOMA ir. Liver fibrosis was measured by transient elastography (Fibroscan®). RESULTS: Subjects with MetS had higher HOMA ir, PCR and Fibroscan® score (log value: 0.92±0.24 KPa vs 0.73±0.2 KPa; p=0.047). The linear correlation analysis showed that Fibroscan® score was related to MetS, number of MetS components, waist circumference, HOMA ir and PCR. However the multivariate regression analysis showed that only HOMA ir (B=0.077; 95%CI: -0.002- 0.157; p=0.05) and PCR (B=0.152; 95% CI: 0.006 - 0.299; p=0.006) were independent predictors of higher Fibroscan® score. CONCLUSION: MetS is associated to higher liver fibrosis degree in subjects with NAFLD. The insulin-resistance and inflammation seem to be the main determinants.

[Cardiac arrythmias in the elderly]. / Aritmie cardiache in età geriatrica.

The prescription of antiarrhythmic therapy in the elderly depends on the characteristics of clinical symptoms and on the potential morbidity and mortality. Some cardiac arrhythmias may cause bothersome symptoms but do not affect the long-term prognosis. However, other dysrhythmias with mild or no symptoms may be associated with a poor prognosis.

[Adapted physical activity: the role in secondary prevention of the osteoporosis]. / Attività motoria adattata nella prevenzione secondaria dell'osteoporosi.

An active lifestyle represents a significant factor in prevention of osteoporosis. Evidences on multifactorial etiology allowed to develop a plan for risk evaluation and for an integrated screening approach. Adapted physical activity plays a relevant role in secondary prevention, also when performed in swimming pools.

[Cirrhotic spontaneous bacterial peritonitis in the elderly]. / La peritonite batterica spontanea nell'anziano cirrotico.

The cirrhotic patients are at increased risk of infection greater than patients with other chronic diseases, due to differences in inflammatory and immune reactions. In cirrhotic patients with ascites, you must pay close attention to the prevention of complications such as hyponatremia, hepatorenal syndrome and spontaneous bacterial peritonitis SBP.The hospital mortality after an episode of SBP is 12-15% in the elderly, less than 10% in adults. Over 70% of patients with SBP belong to Class C Child-Pugh. Spontaneous bacterial peritonitis, the most common infection in cirrhosis, is characterized by a bacterial infection of ascites in the absence of conditions of intra-abdominal surgical relevance. After having described the pathogenesis, clinical and management of spontaneous bacterial peritonitis in elderly cirrhotic patients with ascites, the Authors stressed the most recent therapeutic measures and, particularly, the effectiveness of antibiotic treatment. An appropriate focus on the occurrence of complications is essential for life and survival of these patients.

[Vascular depression in the elderly. Does inflammation play a role?]. / La depressione vascolare nell'anziano. Quale ruolo per l'infiammazione?

Vascular depression in the elderly. Does inflammation play a role?Depression is the most common comorbidity in the elderly, and it is a major determinant of disability. The late-onset depression in highly associated to cardiovascular disease. Depressive symptoms may follow vascular brain damage, especially when mood regulating areas are affected. However depression is strongly associated to vascular disease even when there is no manifest brain damage. Recently great attention has been given to chronic inflammation, both related to depression and vascular disease. Both experimental and clinical evidence shows that a rise in the concentrations of proinflammatory cytokines and glucocorticoids in depressed patients is associated with defect in serotonergic function. Chronic inflammation may underlie many forms of depression associated with vascular disease and metabolic syndrome. The importance of the inflammation hypothesis of depression lies is that psychotropic drugs may have central anti-inflammatory action, and that new generation of central anti-inflammatory drugs may be useful in depression treatment.

[Prevalence of depression in a geriatric population with metabolic syndrome]. / Prevalenza della depressione in una popolazione geriatrica con sindrome metabolica.

Metabolic Syndrome (Metabolic Syndrome, MS) is associated with many other diseases in the elderly. We have studied a possible correlation between this disorder and depression in a Geriatric Centre. The study was conducted on a random sample of 30 geriatric patients, then divided into 2 groups according to clinical and instrumental diagnostic investigations: 15 patients affected MS according to the criteria of NCEP ATP III, and 15 controls without MS. Then it's administered the Geriatric Depression Scale (GDS). Elaboration of the results it appears statistically significant correlation (t=2.05, p=0.0495) between MS and depression in the elderly.

[Non-invasive ventilation in acute respiratory failure. A case report]. / Insufficienza respiratoria acuta trattata con ventilazione meccanica non invasiva.

This is a case of 89 years old patient suffering by chronic obstructive pulmonary disease and affected by acute respiratory failure characterized by hypoxemia and hipercapnia. It is interesting because, comparing oxygen therapy and non invasive ventilation, the best results were reached with the last technique, in an elder patient.

[Relationship between atrial fibrillation and other cardiovascular risk factors in Alzheimer's disease. New prevention opportunities]. / Fibrillazione atriale e fattori di rischio vascolari nella malattia di Alzheimer. Nuove opportunità di prevenzione.

Dementia is one of the most frequent neurological disorders in the elderly. Several vascular risk factors such as atrial fibrillation have been found to be associated with vascular dementia and Alzheimer's disease. Early interventions at reducing atrial fibrillation may have a strong impact on future incidence and prevalence of cognitive impairment.

[Adverse drug reactions: a common cause of hospitalization of the elderly]. / Reazioni avverse ai farmaci negli anziani.

Aging is associated with various physiological changes and multiple diseases which alter the pharmacological response to a drug in elderly patient. Moreover, elderly people are more sensitive to frequently used drugs like NSAIDs, benzodiazepines, opioids, etc. There is an urgent need to develop better preventive strategies to reduce the burden of adverse drug reactions.

Event related brain potentials in elderly patients with recently diagnosed isolated systolic hypertension.

OBJECTIVE: Isolated Systolic Hypertension (ISH) is a known risk factor for cognitive impairment, but the time of onset of neurocognitive changes relative to the onset of ISH has yet to be established. The purpose of this study was to investigate the relationship between systolic BP values and neurocognitive function in the early stages of ISH. METHODS: Twenty elderly patients with recently (< 2 years) diagnosed ISH and 10 elderly normotensive controls underwent Ambulatory Blood Pressure Monitoring (ABPM) and neurocognitive assessment, performed using the Mini Mental State Examination (MMSE), and the recording of ERPs with an odd ball acoustic paradigm. RESULTS: There were no significant differences in MMSE scores or in the P300 latency between ISH patients and controls. The N2 latency was significantly higher in ISH patients vs. controls (p<0.0001), and showed a significant association with both clinical and ambulatory systolic BP and pulse pressure values in the overall study population. CONCLUSIONS: These findings suggest the existence of early subclinical alterations in neurocognitive function in early ISH, detectable through ERPs. SIGNIFICANCE: Our findings underscore the ISH may constitute a threat to neurocognitive health in the elderly.

[Circadian rhythm of blood pressure: non-dipping pattern and cardiovascular risk]. / Ritmo circadiano della pressione arteriosa: "non-dipping pattern" e rischio cardiovascolare.

24h ambulatory blood pressure monitoring (ABPM) can easily detect the circadian blood pressure (BP) pattern: usually, systolic and diastolic blood pressure (BP) show a nocturnal fall. Nocturnal BP values do not however always decline in essential hypertension: the subjects who show a nocturnal BP fall of at least 10% are called dippers; in other subjects, called non-dippers, BP behaviour is characterized by a lack of or very limited nocturnal BP fall. Several studies have investigated the relationship between the lack of or reduction of nocturnal BP fall (non-dipping pattern) and cardiovascular risk, showing not only an increase of target-organ damage (heart, brain, kidney), but a greater frequency of cardiovascular events (stroke, myocardial infarction, etc.) also and higher cardiovascular mortality in non-dippers subjects, both hypertensives and normotensives. Therefore, a non-dipping pattern may be an additional risk factor. Thus, ABPM could be a useful method to evaluate the initial global cardiovascular risk in patients with hypertension, and an adequate antihypertensive therapy should aim not only at lowering high BP values, but also at re-establishing the physiological nocturnal BP fall.

Influence of cardiac-resynchronization therapy on heart rate and blood pressure variability: 1-year follow-up.

BACKGROUND: Several studies have shown that cardiac-resynchronization therapy (CRT) improves haemodynamic function, cardiac symptoms, and heart rate variability (HRV) and reduces the risk of mortality and sudden death in subjects with chronic heart failure (CHF). In subjects with CHF, power spectral values for the low-frequency (LF) component of RR variability < or =13 ms2, are associated with an increased risk of sudden death. AIMS AND METHODS: To assess whether spectral indexes obtained by power spectral analysis of HRV and systolic blood pressure (SBP) variability could predict malignant ventricular arrhythmias in patients with severe CHF treated with an implantable cardioverter-defibrillator (ICD) alone or with ICD+CRT. In addition, changes in non-invasive spectral indices using short-term power spectral analysis of HRV and SBP variability during controlled breathing in 15 patients with CHF treated with an ICD alone and 16 patients receiving ICD+CRT, were assessed pre-treatment and at 1 year. RESULTS: Arrhythmias necessitating an appropriate ICD shock were more frequent in subjects who had low LF power. CRT improved all spectral components, including LF power. CONCLUSIONS: Low LF power values predict an increased risk of malignant ventricular arrhythmias; after 1 year of CRT most non-spectral and spectral data, including LF power, improved. Whether these improvements lead to better long-term survival in patients with CHF remains unclear.

Cerebral perfusional effects of 1-year rivastigmine treatment in Alzheimer disease: a case report.

It is described the case of a 74-years-old woman with probable Alzheimer Disease who showed good clinical response to rivastigmine associated with relevant improvement of cerebral perfusion after 1 year of treatment. The single-photon emission computed tomography (SPECT) scan showed a significant improvement in cortical uptake of the tracer in temporo-parietal and frontal regions in comparison to the examination performed before the treatment.

Olfactory Dysfunction, Olfactory Bulb Volume and Alzheimer's Disease: Is There a Correlation? A Pilot Study1.

BACKGROUND: Olfactory dysfunction is present since the earliest stage of Alzheimer's disease (AD). In AD patients, the olfactory impairment has been correlated with atrophy of some structures of the olfactory system, but the role of the olfactory bulb remains unclear. OBJECTIVE: The aim of our work is to test if patients suffering from AD exhibit a statistically significant reduction of the average volume of the olfactory bulb (OBV) compared to healthy subjects. METHODS: 78 subjects were enrolled in the study and divided into three groups: 28 healthy elderly (22 females, 6 males, mean age 69.4 ± 9.2), 25 patients with mild cognitive impairment (MCI) amnestic type (14 females, 11 males, mean age 74.5 ± 7.5), and 25 mild AD patients (14 females, 11 males, mean age 73.7 ± 6.8). Every subject underwent an MRI study of the olfactory bulb and an olfactory assessment with the Sniffin' Stick Extended Test. RESULTS: The statistical analysis showed no correlation between the OBV and MCI or AD. Moreover, olfactory function and OBV were not correlated in any of the three groups. CONCLUSION: The reduction of OBV does not seem to represent an index of neuronal damage in the earliest stages of AD.

Raloxifene modulates interleukin-6 and tumor necrosis factor-alpha synthesis in vivo: results from a pilot clinical study.

Raloxifene (RAL), a selective estrogen receptor modulator, is indicated for the prevention and treatment of postmenopausal osteoporosis. RAL, by decreasing bone turnover, prevents bone loss and microarchitecture damage, reducing the incidence of osteoporotic fractures. Our previous in vitro data demonstrated that RAL modulates osteoclast activity by, at least in part, an IL-6- and TNF-alpha-dependent mechanism. In this study we evaluated the effects of RAL treatment (60 mg/d) on circulating levels of these cytokines in 14 postmenopausal women with osteoporosis. Lumbar bone density (determined by dual energy x-ray absorptiometry) and IL-6 and TNF-alpha levels were measured before and after 6 and 24 months of therapy. After 24 months, RAL increased bone density. IL-6 and TNF-alpha expression, elevated before treatment, significantly decreased (50% and 30%, respectively) after 6 months. This effect was sustained up to the end of the treatment (75% and 35%, respectively). Thus, our data show that RAL can modulate circulating levels of cytokines involved in osteoclastogenesis and bone resorption, suggesting that modulation of soluble factors could play a pivotal role in the mechanisms of the osteoprotective effect of RAL.