Comparative study of the prevalence of dementia in two Sicilian communities with different psychosocial backgrounds.

The role of education and psychosocial environment as factors for the development of dementia is controversial. We carried out a comparative study on the prevalence of dementia among persons over 74 years of age in two Sicilian municipalities, Troina and S. Agata Militello, with different psychosocial backgrounds. A two-stage survey was performed for both samples. In stage 1 the Mine Mental Status Examination (previously validated for the cutoff score with 100% sensitivity and the highest specificity) was used to screen a 50% random sample of persons over 74 years of age. In those referred to stage 2, the diagnosis of dementia was made be a neurologist according to DSM-III R. Three hundred and sixty-five subjects were recruited in Troina and 408 in S. Agata Militello. The minimal estimates of dementia prevalence were 21.9% (21% men, 21.9% women) in Troina and 28.4% (26.6% men, 29.6% women) in S. Agata Militello. Although intrasample multiple logistic exact analysis (demented vs. unproven demented) indicated poor formal education and manual occupation at risk factors for dementia, and intersample comparison (Troina vs S. Agata Militello) showed that these variable were more frequent in Troina, we did not find a higher prevalence of dementia in this community. We discuss this apparently ambiguous result and suggest that psychosocial and cultural variables might be considered multiple interacting factors with different protective or predisposing roles for dementia. Higher or lower risk could than be the result of this complex interaction in different populations.

Home pharmacological therapy in an ultra-75 years old population in Troina (inner Sicily).

In a group of 365 subjects, 75 years old and ultra, living in Troina (Sicily), a study on prevalence of dementia has been carried out. In the questionnaire, used to collect information about subjects' health, one of the questions concerned the assumption of drugs. The interviewer transcribed the name of the drugs and then coded the related chemical-pharmacological classification, according to the 14 principal groups of the guide of the National Health Service. Up to 9 drugs, on a daily basis, were registered. The total amount of prescriptions was 889, equal to 2.4 per person, with a clear prevalence of the females. 26.1% of the sample did not take any drug. The mode of assumptions was 3 a day. The cardiovascular system is at the top of prescriptions, with 39% of the total, followed by the gastroenteric apparatus and metabolism (17.9%), the nervous system (16.7%), the haemopoietic system (8.4%), the musculo-skeletal system (6.2%), the respiratory apparatus (5.7%), and so on the others. For each principal group of drugs, those more represented are identified, obtaining other information about the practitioners' choices. Among the principal subgroups of cardiovascular system, it is worth mentioning anti-hypertensives, diuretics and antianginal, each of them with their own subgroups. In the gastroenteric apparatus and metabolism group, the latter comprises the drugs for the treatment of diabetes: oral hypoglicaemics and insulin. These drugs allow to identify 34 cases of diabetes: 29 NIDD and 5 IDD. Analogous evaluations for drugs of other groups and comparisons with a few data available in literature are carried out. Surveying the drugs used in a population is useful: (i) to evaluate the health state; (ii) to identify the dominant disease; (iii) to draw comparisons with other populations; (iiii) to follow the evolution of pharmacotherapy.

Prevalence of dementia among elderly people in Troina, Sicily.

We performed a two-stage survey on the prevalence of dementia among people aged over 74 in Troina, northern Sicily, Italy. During the first stage people were screened by the Mini Mental Status Examination (MMSE), previously validated in our population for the cut-off score with 100% sensitivity and the best specificity to diagnose dementia. During the second stage people scoring 19 or less at the MMSE test were invited to be examined by a neurologist who diagnosed dementia according to DSM-III R. Out of 365 subjects of the initial sample 347 were screened by MMSE test and 163 scored 19 or less. Of these, 135 were neurologically and neuropsychologically examined in the second stage, and 80 proved to be demented. The minimal estimate of prevalence of dementia in our sample was 21.9% (21.9% men, 21.8% women). The poor education and psychosocial life may be the underlying condition favoring dementia in this sample of elderly people.

Pravastatin reduces carotid intima-media thickness progression in an asymptomatic hypercholesterolemic mediterranean population: the Carotid Atherosclerosis Italian Ultrasound Study.

PURPOSE: The Carotid Atherosclerosis Italian Ultrasound Study (CAIUS) was performed to test the effects of lipid lowering on the progression of carotid intima-media thickness (IMT) in 305 asymptomatic patients from a Mediterranean country. PATIENTS AND METHODS: Eligibility included hypercholesterolemia (baseline means: low-density lipoprotein [LDL] = 4.68 mmol/L, high-density lipoprotein [HDL] = 1.37 mmol/L), and at least one 1.3 < IMT < 3.5 mm in the carotid arteries. Patients (mean age 55 years, 53% male) were assigned to pravastatin (40 mg/day, n = 151) or placebo (n not equal to 154). Ultrasound imaging was used to quantify IMT at baseline, and semiannually thereafter for up to 3 years. The mean of the 12 maximum IMTs (MMaxIMT), was calculated for each patient visit, and used to determine each patient's longitudinal progression slope. The intention-to-treat group difference in the MMaxIMT progression was chosen a priori as the primary end point. RESULTS: Five serious cardiovascular events (1 fatal myocardial infarction), and 7 drop-outs for cancer were registered. In the pravastatin group, LDL decreased -0.22 after 3 months versus -0.01 in the placebo group, and remained substantially unchanged afterward (-0.23 versus +0.01 at 36 months, respectively). Progression of the MMaxIMT was 0.009 +/- 0.0027 versus -0.0043 +/- 0.0028 mm/year (mean +/- SE, P < 0.0007) in the placebo and pravastatin groups, respectively. IMT progression slopes diverged after 6 months of treatment. CONCLUSIONS: Pravastatin stops the progression of carotid IMT in asymptomatic, moderately hypercholesterolemic men and women. This finding extends the beneficial effects of cholesterol lowering to the primary prevention of atherosclerosis in a population with relatively low cardiovascular event rates, and suggests that this benefit is mediated by specific morphological effects on early stages of plaque development.

Features and prevalence of diabetes mellitus in a rural population aged 80 and over of inner Sicily (Troina).

Forty cases of diabetes mellitus (15 males and 25 females) were investigated in an ultra-octogenarian rural population of inner Sicily (Troina). Age, gender, education, voluptuary habits, psychophysical conditions, occurrence of insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), body mass index (BMI), specific and non-specific therapy were evaluated. Psychophysical conditions of diabetics as well as their actual abilities of taking drugs have also been recorded and discussed.

Domiciliary therapy in an ultraoctogenarian population of inner Sicily--Troina.

Drug assumption was studied in a rural population of octogenarians and over, in inner Sicily. The study was performed by means of interviews applying a questionnaire on 326 subjects, 162 males and 164 females, representing 91% of the entire age-matched population. Sixty subjects (18.4%) did not take any kind of medications, while 266 (81.6%) did take drugs, ranging from 1 to 10 different kinds of medicines daily, altogether 1001 different drugs were mentioned. Distribution of drugs related to organs and apparatuses as well as pharmacological features revealed a wide use of cardiovascular medications (about 50%), followed by drugs acting on gastrointestinal (18.9%), nervous (9.4%), respiratory (8.3%), locomotor (6.8%) and urogenital (1.5%) systems, and the rest included hormones, vitamins, antibiotics, etc. The study of patients' abilities in recognizing and properly assuming medications revealed that 20.7% of patients could not act autonomously, they were requiring a continuous aid. However, the overall consumption of drugs was relatively moderate and well addressed to the existing pathologies.

[Diagnosis of nonobstructive hypertrophic cardiomyopathy in a patient with Down's syndrome]. / Rilievo di cardiomiopatia ipertrofica non ostruttiva in un paziente con sindrome di Down.

This report describes the case of a patient with nonobstructed hypertrophic cardiomyopathy and Down's syndrome (47,XY, +21) in a 31 year old patient. Diagnosis of hypertrophic cardiomyopathy was made subsequently to ECG and two dimensional echocardiography findings. Personal and familial anamnesis and physical examination were negative. Standard ECG revealed signs of left ventricular enlargement and secondary alterations of repolarization (negative and giant T waves in DI-DII-V3-V4-V5-V6). Two dimensional and Doppler echocardiography disclosed left ventricular walls hypertrophy, particularly of the ventricular septum, of apex, lateral and inferior walls with normal systolic and diastolic function's index. Any intracavitary gradients were sound and Holter ECG monitoring repeated three times, revealed normal cardiac findings. In the literature this association was never described. We can't claim familial genesis of hypertrophic cardiomyopathy because parents and brothers didn't present any cardiopathy. It's important to mark that anatomic alterations functional features didn't correspond in our case, as demonstrated by clinical and echo-Doppler findings.

[Hypothyroid myopathy in a young adult]. / Miopatia ipotiroidea in un giovane adulto.

We describe here the case of a young man admitted to our department for asthenia and diffuse myalgia. Because of persistently increasing aminotransferase levels over the preceding 2 years, he had undergone a number of diagnostic procedures to evaluate liver function. On admission to our department, the patient suffered from asthenia, myalgia, notable hair loss and sinus bradycardia. Laboratory examinations confirmed severe primary hypothyroidism with high serum levels of aminotransferase, aldolase and creatine-phosphokinase attributable to thyroprivic myopathy. The thyroid deficit was caused by autoimmune atrophic thyroiditis. Treated with levothyroxine, the patient recovered fully from his illness, his normal metabolic state was restored, and his serum aminotransferase level returned to normal.

[Bence-Jones proteinuria in multiple sclerosis: a possible indicator of disease activity]. / La proteinuria di Bence Jones nella sclerosi multipla: un possibile indicatore di attività della malattia.

The protein patterns of the serum, cerebrospinal fluid and urine from 32 patients with definite multiple sclerosis and 30 control patients with neurological non-demyelinating disorders were simultaneously analyzed by means of high-resolution agarose gel electrophoresis combined with immunofixation. About one-third (31%) of the patients with multiple sclerosis were found to excrete monoclonal free light chains of immunoglobulins, i.e., Bence Jones proteins, in the urine without any concurrent immunoproliferative disease. Bence Jones proteinuria, at concentration generally not exceeding 0.2 g/24 hours, was demonstrated exclusively in multiple sclerosis patients in a phase of active disease (44% of the cases) or in chronic progressive disease (25% of the cases). The results of the study suggest that the presence of Bence Jones protein in the urine from multiple sclerosis patients may be utilized as an indicator of disease activity.

Efficacy of ciprofibrate in primary type II and IV hyperlipidemia: the Italian multicenter study.

The 127 diet-resistant primary hyperlipidemic patients received 100 mg of ciprofibrate daily for 12 weeks. In the 63 patients with type IIa hyperlipidemia and 41 patients with type IIb hyperlipidemia, serum levels of total cholesterol, very-low-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, very-low-density lipoprotein triglycerides, and apolipoprotein (apo) B decreased significantly and levels of high-density lipoprotein cholesterol and apo A-I increased significantly. Similar changes occurred in the 23 type IV patients, except that high-density lipoprotein cholesterol levels increased significantly and apo B levels did not change. No clinically significant side effects or drug-related abnormal laboratory test results were noted. It is concluded that ciprofibrate is a safe and potent hypolipidemic agent.

Evaluation of a new antihypertensive agent ketanserin versus methyldopa in the treatment of essential hypertension in older patients: an international multicenter trial.

The serotonergic antagonist ketanserin (K) was compared to methyldopa (M) in a four-center international study in 119 hypertensive patients over 50 years of age. After a 4-week placebo run-in period, patients randomly received K (20-40 mg b.i.d.) or M (250-500 mg b.i.d.) for 3 months. The drugs were given in monotherapy for at least 1 month, then a diuretic could be added if blood pressure remained abnormally high. For the patients on monotherapy, active drug was replaced by placebo at the end of the 3-month period until the patients were hypertensive again. K and M had a similar effect on systolic blood pressure, but diastolic blood pressure was reduced significantly more by K than by M. Significantly more patients had their blood pressure normalized in the K group (75%) than in the M group (49%). The twice daily dosage schedule caused trough blood pressure control with both drugs. No rebound hypertension occurred at discontinuation of treatment. Monotherapy with K caused a decrease in heart rate (-5 beats/min) while M produced no change. Body weight decreased with K (-0.5 kg) and increased with M (+ 0.4 kg). No important hematological or biochemical changes were seen with either drug. Slightly fewer patients reported adverse reactions during K monotherapy (40%) than with M (45%). In the latter group mainly central side effects were observed. The data confirm K to be an effective first-line antihypertensive agent with a favorable side-effect profile.

'Senile' myeloma: a possible variant form of multiple myeloma.

Fifty-four patients were recognized as having multiple myeloma after the coincidental finding of a serum and/or urine M component on agarose gel electrophoresis during a survey for monoclonal gammopathies of a large random hospital population sample over 70 yr of age. Analysis of the presenting features and the clinical characteristics revealed that about two-thirds of the myeloma patients over 80 yr were asymptomatic at the time of the discovery of their monoclonal gammopathy. Follow-up studies and serial evaluations of changes in the myeloma cell mass without chemotherapy showed a subset of the older patients exhibiting a distinct pattern of slow tumor growth. The results of the study would suggest the possible existence of a variant form in the advanced age group of myeloma patients. This 'senile' type of myeloma would appear to be characterized primarily by non-specific presenting features, a fairly symptom-poor status, and a relatively protracted and benign course without chemotherapy.

[Platelet factor 3 and 4 in juvenile diabetes and in children of diabetic mothers]. / I fattori piastrinici 3 (PF3) e 4 (PF4) nel diabete giovanile e nei figli di madre diabetica.

We studied 91 children, distributed, as follows, in four groups: Group A, including 24 children (average age 11.4 +/- 0.7) with juvenile onset diabetes (duration less than 4 years), without any clinically apparent vascular disorder. Group B: 22 matched controls (average age 11.5 +/- 0.53). Group C: 25 newborns (average age 3.7 +/- 0.3) of diabetic mothers (B Group in P. White classification). Group D: 20 matched controls (average age 2.8 +/- 0.3). All were tested for total, HDL, LDL-cholesterol, triglycerides, fasting blood sugar, systolic and diastolic blood pressure. In all the subjects we performed: -- PF4 (by H.T.C.H., according O'Brien et al., 1975) on PPP and on PRP (300,000-350,000 platelets/microliters) after platelet aggregation with 4.0 10(-6)M epinephrine (Born's method). -- PF3 (b a Stypven time) on frozen-thawed (three times) PRP and on PRP after p.a. with 4.0 10(-6)M epinephrine. No statistically significant difference was noted in PF3 values between A-C groups and their respective control groups (B-D). PF4 was more represented on diabetic's PPP (group A), whilst no difference was noted after aggregation. This increase suggests in early juvenile onset diabetes, without any clinically apparent disease, an "in vivo" platelet activation, which may be important in thromboembolic disorders of diabetics.