Aging and Adherence to the Mediterranean Diet: Relationship with Cardiometabolic Disorders and Polypharmacy.

OBJECTIVES: To investigate the association between adherence to the Mediterranean Diet (Med-Diet), cardiometabolic disorders and polypharmacy. DESIGN: Cross-sectional study. SETTING: Geriatrics outpatient clinic, Policlinico Umberto I, Sapienza University of Rome. PARTICIPANTS: 508 patients (219 male, 289 female) aged 50 to 89 who were evaluated for cardiovascular and metabolic disorders. METHODS AND MEASUREMENTS: Patients underwent a comprehensive medical assessment including medical history and the use of medications. Adherence to Med-Diet was assessed using the validated Med-Diet 14-item questionnaire; for the analysis, patients were divided in high (≥8) and medium-low (<8) adherence. Polypharmacy was defined as taking ≥5 medications. RESULTS: 476 patients completed the study. Mean age was 70.4 years; 58% female. Median Med-Diet score was 8 (interquartile range, 6-9). Patients with medium-low adherence had higher body mass index (p=0.029) and higher prevalence of arterial hypertension (p<0.001), previous coronary (p=0.002) and cerebrovascular events (p=0.011), diabetes, (p<0.001) and dyslipidemia (p=0.001) compared to those at high adherence. Med-Diet score decreased with the number of cardiometabolic disorders (p<0.001). The prevalence of polypharmacy was 39%. Consumption of olive oil (p=0.005), vegetables, (p<0.001), wine (p=0.017), legumes (p=0.028), fish (p=0.046) and nuts (p=0.045) were all inversely associated with the overall number of medications. In a multivariable regression model, medium-low adherence to Med-Diet was independently associated to polypharmacy (O.R.:1.859; 95% CI 1.142 to 3.025; p=0.013), after adjusting for possible confounding factors. CONCLUSION: Med-Diet was inversely associated with cardiometabolic disorders and with polypharmacy, suggesting that improved Med-Diet adherence might potentially delay the onset of age-related health deterioration and reduce the need of multiple medications.

Fall prevention in the young old using an exoskeleton human body posturizer: a randomized controlled trial.

BACKGROUND: Fall risk in elderly has been related with physical decline, low quality of life and reduced survival. AIM: To evaluate the impact of exoskeleton human body posturizer (HBP) on the fall risk in the elderly. METHODS: 150 subjects (mean age 64.85; 79 M/71 F) with mild fall risk were randomized into two groups: 75 for group treated with human body posturizer (HBP group) and 75 for physical training without HBP group (exercise group). The effects of interventions were assessed by differences in tests related to balance and falls. Medically eligible patients were screened with Tinetti balance and Gait evaluation scale, short physical performance battery and numeric pain rating scale to determine fall risk in elderly people. RESULTS: In the HBP group there was a significant improvement in short physical performance battery, Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk (p < 0.05). In the exercise group we observed only minimal variations in the test scores. DISCUSSION: The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain. CONCLUSION: The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients. Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly.

Hypovitaminosis D: which oral supplement therapy?

OBJECTIVES: the possible therapeutic role of vitamin D in different kind of diseases explains the growing interest in this vitamin due to its pleiotropic effects. This short report shows preliminary results of prevalence of hypovitaminosis D in a group of patients and proposes a oral supplement therapy effective in correcting hypovitaminosis in a short time, without side effects. METHODS: 243 patients (aged 26-93; 67 males) were enrolled at this study. We evaluated plasma levels of 25-hydroxyvitamin D [25(OH)D] with the following cut-off values: <10 ng/ml or <0-25 nmol/L (deficient), 10-30 ng/ml or 25-75 nmol/L 30-50 (insufficient) and > 30 ng/ml or > 50 nmol/L (normal). The first 73 patients with hypovitaminosis D received at baseline 25,000 IU (Cholecalciferol) per os twice a month (Tp.A). The next patients (Tp.B) at baseline received a loading dose of 50,000 IU once a week for 8 weeks, followed by a maintenance dose of 25,000 IU twice a month. RESULTS: hypovitaminosis D is a widespread condition (i.e., 82.3%) not only in elderly (75.6% of 75 patients aged <65 yrs and 86.5% of 168 subjects aged >65 yrs). Preliminary results at 6 months show that Tp.B is more effective in correcting hypovitaminosis D (baseline 14.4 ± 5.3 ng/ml; 24 wk 43.3 ± 14.7 ng/ml; p<0.0001). CONCLUSION: hypovitaminosis D is an important public health problem. We believe it is important to quickly achieve normal Vit. D plasma values in order to produce pleiotropic effects.

The treatment with ursodeoxycholic acid in elderly patients affected by NAFLD and metabolic syndrome: a case-control study.

AIMS: Evaluating the prevalence and the degree of steatosis in geriatric patients (65 to 85 years of age) with Metabolic Syndrome (defined by ATP III criteria); searching for metabolic factors which are predictive for the degree of steatosis; evaluating the efficacy of Ursodeoxycholic Acid (UDCA) for 6 months in the treatment of patients with NAFLD or NASH. MATERIALS AND METHODS: We studied 87 geriatric patients with Metabolic Syndrome. Steatosis was diagnosed and graded by laboratory assessment and ultrasonography, method based on the determination of liver/kidney ratio through grey-scale intensity, which was calculated as an index of the severity of the steatosis: it could oscilates from 0 (none) to 3 (severe). We randomized the geriatric patients into two groups: Ursodeoxycholic Acid (UDCA)-treated group (n=43 pz) and diet-treated group (1200 Kcal/die for female, 1500 Kcal/die for male) (n=44 pz), for a period of 6 months. BMI, principal symptoms, liver function, blood lipids, ultrasonography liver were evaluated respectively before and after treatment. RESULTS: The prevalence of steatosis was 100% (26 mild steatosis cases, 38 moderate cases and 23 severe cases) in our patients with Metabolic Syndrome. Of the 43 subjects assigned to receive 300-450 mg/d of UDCA and diet, the hepatic steatosis index decreased on the average, of the 75%. Serum AST, ALT and γ-GT decreased significantly at 3 months already (p<0.001). CONCLUSIONS: UDCA improves liver enzymes and ultrasonography immaging in geriatric patients with NAFLD or NASH. Unexpectedly, UDCA has resulted in beneficial effects on glycemic control and insulin sensitivity.

A self-administered questionnaire to screen the risk of dementia: a pilot study and the results of a comparison with the mini-mental state examination (MMSE).

Cognitive impairment is an age-related condition as the rate of cognitive decline rapidly increases with aging. The aim of this study was to screen the risk of cognitive decline in people over 60 years from 16 different Italian cities, by comparing the results of a self-administered questionnaire with the MMSE. We analyzed data from 203 persons aged 60 years and over, who voluntarily accepted to participate during the "Second Prevention Day for AD". A self-administered questionnaire, developed by clinicians of our Department of Aging, was distributed to all participants, in order to easily screen the risk of cognitive impairment. Then, all subjects underwent cognitive assessment by MMSE. We esteemed the risk of cognitive impairment of all participants basing on MMSE scores (no risk, mild and moderate risk) and we compared this assessment with the results obtained by the self-administered questionnaire. The comparison between the risk of cognitive impairment revealed by our questionnaire and the risk esteemed by MMSE resulted in a discrepancy in 43.96% of cases in no risk class. In mild risk group there was a discrepancy of results in 70.53% of subjects. In moderate risk class there was a discrepancy of results in 38.46% of individuals. Our questionnaire resulted to be accurate for the evaluation of patients with moderate risk of cognitive impairment. It showed a lower accuracy for the mild risk class, often overestimating the risk of cognitive decline.

Screening of frailty in elderly patients with disability by the means of Marigliano-Cacciafesta polypathology scale (MCPS) and Canadian Study of Health and Aging (CSHA) scales.

Frailty is an age-related condition, characterized by a decreased homeostatic reserve and increased vulnerability to stressful events, with high risk of adverse outcomes. The aim of this study was to compare the evaluation of the frailty by the means of the MCPS and the Rockwood criteria. We enrolled 98 patients (mean age ± standard deviation, m ± SD, 80.7 ± 7.0 years) and 20 controls (82.7 ± 3.4 ys), who attended our outpatient clinic for the evaluation of disability and the renewal of driving license, respectively. The multidisciplinary geriatric assessment (MGA) was performed including the administration of the following scales for frailty: MCPS scale (range 0-245), CSHA-Rules-Based Definition of Frailty (CSHA-RBDF) (range 0-3) and CSHA-Clinical Frailty Scale (CSHA-CFS) (range 0-7). The patients and controls showed MCPS=52.39 ± 11.36 and 4.6 ± 3.28, CSHA-RBDF=2.27 ± 0.62 and 0.10 ± 0.44, CSHA-CFS=6.22 ± 0.75 and 2.95 ± 0.51, respectively (p<0.000001). Frailty scores were higher in female than in male (p=0.065 for CSHA-RDBF and p<0.05 for CSHA-CFS). The MCPS scores were significantly related to both CSHA-RDBF (r=0.753, p<0.001) and CSHA-CFS scores (r=0.793, p<0.001). The frailty scales were significantly related to disability, cognitive impairment and polypathology. In conclusion, the frail patient may be a carrier of multiple chronic pathologies and/or of physical/cognitive decline. The frail patient has to be considered the elective geriatric patient, characterized by a continuous multidimensional care requirement. MCPS is an useful tool for the frailty screening and to set up a tailored program of geriatric rehabilitation, in order to prevent or reduce the development of frailty-related complications.

Atrial fibrillation (AF) and cognitive impairment in the elderly: a case-control study.

AF is able not only to increase the risk of cognitive decline due to acute cerebrovascular events, but also to reduce cardiac output, with the consequence of impaired cerebral perfusion. The aim of this study was to evaluate the association between AF, dementia and depression in patients with negative anamnesis for past strokes. Our sample included 26 patients with a diagnosis of AF (paroxystic, persistent, permanent) and 31 patients with sinus rhythm, enrolled as controls. All selected patients underwent a Multidimensional Geriatric Assessment in order to investigate cognitive and behavioral functions. Statistical analysis of results showed a greater frequency of latent cognitive impairment in patients with AF, even in the absence of memory disorders. As a matter of facts, AF patients showed Mini Mental State Examination (MMSE) scores significantly lower than those with sinus rhythm (p<0.05) and Geriatric Depression Scale (GDS) scores higher than those without AF, evidencing a greater risk of depression too (p<0.02). Results showed a statistically significant association between AF, depression and cognitive impairment in early stage. In conclusion, AF is not only associated with the risk of developing cognitive impairment, but it can also be considered as a risk factor for dementia and depression, even in the absence of medical history of past stroke.

Role of cardiovascular risk factors (CRF) in the patients with mild cognitive impairment (MCI).

Few therapeutic options are available nowadays to improve the prognosis of patients with Alzheimer's disease (AD). There are rather several evidences in literature that controlling vascular risk factors may be an effective intervention for modifying the course of this disease. The aim of our study was to investigate the role of CRF in 50 patients with MCI according to Petersens's criteria, and to evaluate their influence on cognitive and behavioral features of the disease and on the development of dementia. Statistical analysis of the data showed that the 60% of the patients with MCI and CRF developed dementia, while 40% maintained the same cognitive conditions at the end of the study. Only 32% of the subjects without cardiovascular comorbidities developed dementia. The results of the study suggest that CRF play a key role in cognitive decline of patients with MCI. Patients with MCI and CRF showed not only worse cognitive performances, but also behavioral disorders, depression and functional disability. Patients with CRF had higher conversion rate to AD than the other group, with a mean disease-free period 3 months shorter than the control group.

Self-administrated test based on the Marigliano-Cacciafesta Polypathological Scale (MCPS), as a screening tool for early identification of frailty in the elderly: a cohort study.

The aim of our study was to screen people of advanced age for "frailty", and illnesses, in order to prevent future disabilities through interventions made globally and individually to these patients. Applying the items such as those of the Marigliano-Cacciafesta Polypathological Scale (MCPS), we utilized a completely multi-dimensional evaluation. We have elaborated a series of simple and comprehensive questions enabling all participants to answer independently and easily. The results of the testing were successful. Within their limits, all the participants considered the test as a valuable instrument to assess their weaknesses. The test was especially efficient when it came to identifying problem areas in the psycho-physical state and frailty of elderly patients, as well as some loss of their own autonomy. These studies successfully tested a cohort of elderly people with similar symptoms.

New frontiers of cognitive rehabilitation in geriatric age: the Mozart Effect (ME).

The ME was described for the first time in 1993. Subsequently other studies with similar designs were performed. The present study, therefore, proposes: (i) to verify the existence of the benefits of exposure to music in elderly subjects with mild cognitive impairment (MCI), (ii) to explore whether it is possible to find any lasting improvement after training, conducted for a long period of time, with such musical pieces, in the measurable cognitive performances. The study we conducted showed that the ME is present in geriatric patients with MCI; the influence on spatial-temporal abilities remains constant in time if the stimulation is maintained. The continuation of our study will consist of increasing the number of individuals examined and in having them listen to music during the study of ECG rhythms and during the acquisition of cerebral functional magnetic resonance imaging (fMRI), and, at the same time, testing them by neuropsychometric methods.

A rare familiar case of hereditary bisalbuminemia and diabetic predisposition: a possible predictive link?

We present a case report of hereditary bisalbuminemia in an Italian family with three affected members. Bisalbuminemia represents a genetic variant of the albumin, it will then be permanent, or acquired and then be transient. It is characterized by the presence of two albumin bands in electrophoresis: the first band with the same mobility of the normal albumin, the second band with a fast variable or a slow variable. The double band of albumin was detected fortuitously on a routine analytical study of an adult woman who was referred to our laboratory with an increase of fasting glucose value, this originated the study of the rest of the members of the family. Finally, it is like the genetic peculiarity of this family core show a possible predictive link between bisalbuminemia on one hand and the predisposition to type II diabetes mellitus on the other hand. As a result of such high probability we are eager to continue further search at our medicine predictive centre.

Third degree of atrioventricular block: a rare geriatric complication that may cause sudden death. Remarks on two clinical cases.

Two clinical cases are reported that have in common the electrocardiographic detection of a third degree atrioventricular block (AVB), which occurred in the first case in a man of 78 years, hospitalized in our unit after an accidental fall with an ensuing head trauma, and in the second case, in a woman of 67 years, after cataract surgery on her left eye. The complete or third degree AVB is a bradyarrhythmia characterized by the absence of paroxystic or permanent atrioventricular conduction. Several studies conducted on subjects between the ages of 60 and 85 pointed out that the incidence of AVB-type bradyarrhythmias of a degree greater than the first is extremely rare, i.e., it is close to zero. It is, however, necessary to make an early diagnosis of the AVB, as in many cases it may complicate the patient's clinical progress and may often lead to sudden death. Clinical and experimental observations have shown that electrocardiographic alterations and arrhythmias are frequent complications of cerebral accidents such as head traumas, or of ophthalmic surgery. It is therefore necessary, especially in elderly patients in whom bradyarrhythmias are characterized by the presence of widespread histological alterations of the conduction system, to perform a 24-h monitoring of all adverse events that may lead to an AVB.

A possible role of atrial fibrillation as a risk factor for dementia.

Atrial fibrillation (AF), which is a very common disease among the elderly, is already well known as a risk factor for arterial thromboembolism and stroke. The attention of medical research is now focused on establishing a possible role of AF in the development of cognitive impairment in order to include this arrhythmia among risk factors for dementia. The aim of this work was to investigate the relationship between AF and various types of dementia, such as vascular dementia (VaD), Alzheimer's disease (AD) and mixed dementia (MD). The study consisted of 71 VaD, AD or MD patients, 31 males and 40 females. The sample has been divided in 2 groups according to the sex, and these two groups have been analyzed separately. In females, a statistically significant association was found between mini mental state examination (MMSE) and clinical dementia rating (CDR) scores and AF occurrence (r=-0.32; p<0.05; r=0.33; p<0.05). On the contrary, no significant linear correlation was found between AF and a lower activities if daily living (ADL) and instrumental activities if daily living (IADL) scores. In males, AF/MMSE, AF/CDR, AF/ADL and AF/IADL variables have not been found to be linearly related to each other. Unexpectedly, AF turned to be associated to AD more often than to VAD, becoming a possible risk factor for this neurodegenerative disease. Our results are supported by many studies in literature attributing a basic role of brain hypoperfusion in sporadic AD patho-genesis. More and more scientific data suggest that the already well known risk factors for AD could be considered just the top of an iceberg, providing powerful arguments for impaired cerebral perfusion as the primary trigger in the development of this disease. Moreover, the mildly favorable treatment response in patients with AD to therapy that improves cerebral blood flow is a consistent finding; the same cannot be said of antiamyloid treatments. This opens new possibilities to find an effective way to treat this dramatic pathology.

The treatment of hypertension with telmisartan in the sphere of circadian rhythm in metabolic syndrome in the elderly.

This study compares the efficacy of telmisartan with that of valsartan and ramipril in reducing blood pressure (BP) over 24 hrs in the elderly patients with metabolic syndrome (MS). This prospective and open label study analyzed a sample of 60 patients over 65 years of age with hypertension and with MS. At the beginning the BP was monitored by a 24-hr ambulatory blood pressure monitoring (AMBP). Following this, the 60 patients were divided into 3 groups of 20, to each of which was prescribed, respectively, telmisartan, valsartan and ramipril to take for 12 weeks. The drugs were to be taken at 9.00 a.m. Later on the doses were increased. After 12 weeks of therapy, BP was monitored by a 24-hr AMBP. The use of telmisartan caused a greater reduction of the BP in the final 4-6 hours of the period between the 1st administration of the drug and the next one, these last 4-6 hours being those when cardiovascular and cerebrovascular accidents are more frequent (between 6.00 and 10.00 a.m.). Comparing to valsartan and ramipril, telmisartan results in excellent pressure control during the last 4-6 hours between the 1st administration of the drug and the next one.

Impact of therapy with alpha-lipoic acid (ALA) on the oxidative stress in the controlled NIDDM: a possible preventive way against the organ dysfunction?

There is a growing evidence that excess generation of highly reactive free radicals, largely due to hyperglycemia, causes oxidative stress, which further exacerbates the development and progression of diabetes and its complications. The purpose of this study was to evaluate the impact of ALA on lipid profile, oxidative pattern and inflammation in patients with controlled non-insulin dependent diabetes mellitus (NIDDM). ALA, 400mg/day was investigated in NIDDM patients over a period of 4 weeks using a randomized, placebo-(PLA)-controlled study with two parallel groups. The marker of oxidative stress was the concentration of reactive oxygen metabolites, evaluated using a commercially available test, called d-ROMs test, and the biological antioxidant potential (BAP); besides, the lipid profile (total cholesterol=TC, high-density lipoprotein-cholesterol = HDL-C; low-density lipoprotein-cholesterol=LDL-C, and triglycerides=TG) and the C-reactive protein (CRP), marker of inflammation were measured at the beginning and at the end of the treatment. A total of 14 patients were randomly assigned to the two groups. ALA was safe and well tolerated in the only oral daily administration. The d-ROMs test (p=0.03) and HDL-C (p=0.04) showed a significant difference between the two groups. BAP (p=0.06) tended to be higher in the treated patients, while LDL-C (p=0.07) presented a moderate decline. There were no significant differences in TC (p=0.65), TG (p=0.78) and CRP (p=0.96) between the ALA and PLA groups. ALA therapy appears to reduce significantly d-ROMs and to improve HDL-C value, especially in men with metabolic syndrome treated with oral hypoglycemic drugs. These findings will be useful in patient selection in future clinical trials with ALA in long term studies.

Is there a relationship between high C-reactive protein (CRP) levels and dementia?

Inflammation is believed to play a pivotal role in dementia, but its role is still unclear. The aim of our study was to analyze the interplay among markers of inflammation, such as fibrinogen and high CRP levels, and dementia. First, we performed a cross-sectional study comparing markers of inflammation between 99 patients affected by dementia (mean age: 83.0+/-0.6 years) and 99 controls (mean age: 83.9+/-0.7 years). Then, we analyzed the relationship between inflammation and dementia in the same population composed by 34 Alzheimer's disease (AD) patients (mean age: 83.4+/-0.8 years), 64 vascular dementia (VaD) patients (mean age: 82.7+0.8 years) and 99 controls. Patients affected by dementia had higher CRP levels than controls (2.6+/-+/-0.2 vs. 0.7 + 0.1 p < 0.001, respectively). AD patients had higher CRP levels than VaD patients (4.2 + 0.6 vs. 1.7+/-0.2, p < 0.001, respectively). Stepwise multiple logistic regression analysis showed that dementia (odds ratio=OR=4.965, 95% confidence interval=Cl=1.402-13.23, p=0.004), fibrinogen (OR=1.011, Cl=1.007-1.015, p<0.001), and age (OR=1.158, Cl=1.063-1.261, p<0.001) are independently correlated with high levels of CRP. The study suggests that inflammation may have a pathogenetic role in AD.

The evaluation of the presence of comorbidity by the Marigliano-Cacciafesta polypathology scale (MCPS) and the cumulative illness rating scale (CIRS) in elderly subjects with disability.

Multiple factors associated with the frailty syndrome may be involved in the appearance of disability, including the presence of comorbidity. The CIRS is commonly used for the evaluation of comorbidity, consisting of two parts: the comorbidity index (CI) and the severity index (SI). A multidimensional scale, the MCPS, has been recently developed, predicting the risk to develop disability. Fifty-nine subjects were examined by a structured multidimensional geriatric assessment. The MCPS and CIRS was significantly correlated (r=0.410; p<0.01 with the CI; and r=0.443, p<0.001 with the SI). The patients were divided in two groups, according to the MCPS score. The mean activities of daily living (ADL) and instrumental activities of daily living (IADL), as well as the corrected mini-mental state examination (MMSE) score (+/-S.E.M.) were: 3.19+/-0.26; 0.28+/-0.04 and 24.00+/-1.14 in moderate-severe polypathology (n=21); 2.16+/-0.22; 0.13+/-0.02 and 21.23+/-0.72 in severe polypathology (n=38) (p<0.001, p<0.01 and p<0.05), respectively. The MCPS score was correlated with the main indices of disability. In conclusion, we found that the MCPS is a useful tool in order to quantify and classify the presence of comorbidity, with results significantly related to that obtained with the CIRS. The MCPS offers an important stratification of the patients on the base of a well-established classification, not supplied by the CIRS.

Exaggerated morning blood pressure surge and cardiovascular events. A 5-year longitudinal study in normotensive and well-controlled hypertensive elderly.

Cardiovascular events (CE) occur most frequently in the morning hours in hypertensive subjects. We studied the association between the morning blood pressure (BP) surge and CE in prognosis of 10 normotensive and 32 well-controlled hypertensive elderly, in whom ambulatory BP monitoring was performed and who were followed prospectively for 5 years. The morning surge (MS) of BP was calculated as mean systolic BP during 2h after awakening--mean systolic BP during 1h that included the lowest sleep BP. During an average of 60 months, five CE occurred. When the patients were divided into two groups according to MS, those in the top terzile (MS group; MS> or =34 mmHg, n=14) had a higher prevalence of CE (5 versus 0, p=0.001) during the follow-up period, than the others (non-MS group; MS<34 mmHg, n=28). The logistic regression analysis showed the MS sleep-trough surge as predictive variable of CE (odds ratio, OR=0.794, p=0.022). In conclusion, in older normotensives and well-controlled hypertensives, a higher BP MS is associated with vascular risk independently of clinical and ambulatory BP. Reduction of the MS could thus be a therapeutic target for preventing vascular events also in non-hypertensive patients.

The Marigliano-Cacciafesta polypathology scale (MCPS): a tool for predicting the risk of developing disability.

The purpose of the work was to verify whether our MCPS can be a tool for predicting the risk of developing disabilities. We considered 45 elderly subjects divided into three groups of 15 subjects each. Group 1 consisted of cases with a "moderate-severe" degree of polypathology, with no associated condition of disability evaluated by means of the activities of daily living (ADL). Group 2 contained cases with a "moderate" degree of polypathology (with no associated condition of ADL disability). The Group 3 was the control group with a "mild" degree of polypathology (with no disability associated with ADL). All subjects were re-evaluated after 6 and 12 months. Both Groups 1 and 2 of cases over time developed greater disabilities, compared to the control Group 3; in particular, the subjects with "moderate-severe" polypathology were more disabled after 12 months.

The Marigliano-Cacciafesta polypathological scale: a tool for assessing fragility.

The aim of our studies was to establish a standard method of assessment that allows an early identification of frailty in the elderly, i.e., to predict who are at risk of developing disabilities, in order to be able to intervene with preventive global and individualized measures. A new multidimensional scale called Marigliano-Cacciafesta polypathological scale (MCPS) was used on 180 elderly people, together with the Barthel index (BI), the global evaluation functional index (GEFI), the geriatric depression scale (GDS), the mini mental state examination (MMSE), the mini nutritional assessment (MNA), and the Tinetti test. A strongly significant statistical correlation was found between the MCPS and the nutritional state, mood level, motor functionality, level of disability and global functionality. As the fragile patients are at a risk to develop disabilities, we think that our scale can be a significant contribution to the multidimensional geriatric assessment (MGA), aimed at identifying and quantifying the parameter of fragility of each patient, an information which should be known, if we intend to introduce preventive measures.