Associations between conflictual relationships, psychopathology, and the use of psychotropic drugs among older people living in residential facilities.

BACKGROUND: Psychiatric symptoms and conflictual relationships (CR) may negatively affect the delivery of care in residential facilities (RF). This study aims to analyze neuropsychiatric symptoms, their correlations with CR among older people living in RF, and their associations with the prescription of psychotropic drugs. METHODS: A total of 1215 RF residents in five Italian regions were selected for this cross-sectional study. Psychiatric symptoms and CR were assessed with the Neuropsychiatric Inventory and the Resident Assessment Instrument, respectively. Associations between Neuropsychiatric Inventory items, CR, and the use of psychotropic drugs were tested via multiple logistic regressions. RESULTS: About half (52.7%) of the RF residents experienced one or more clinically relevant neuropsychiatric symptoms. At least one category of CR was reported for 223 residents (19%). Although reciprocal associations were found between different categories of CR, only conflictuality with other residents was associated with the use of antipsychotics (odds ratio (OR) = 2.12). Significant associations were found with irritability (with staff: OR = 2.35; with relatives: OR = 3.09), aberrant motor behaviour (with staff: OR = 2.02), and elation (with relatives: OR = 10.55). CONCLUSIONS: Neuropsychiatric symptoms and CR are common among RF residents and are reciprocally associated. Further research with longitudinal design is needed to better understand this relationship.

Elderly subjects with type 2 diabetes show altered tissue electrical properties.

OBJECTIVE: The aim of the present research was to show the characteristics of body composition in a sample of elderly subjects with type 2 diabetes compared with healthy controls matched by age and body mass index (BMI) by bioelectrical impedance vector analysis. METHODS: The sample consisted of 144 free-living patients (84 women and 60 men) with type 2 diabetes 60 to 84 y old and 209 age-matched controls (116 women and 93 men). Anthropometric measurements (weight; height; upper arm, hip, waist, and calf circumferences; biceps; triceps; and subscapular and suprailiac skinfolds) were taken. Blood samples for the assessment of plasma glucose and glycated hemoglobin were collected. The BMI, upper arm muscular area, and waist-to-hip ratio were calculated. Bioelectrical impedance vector analysis was applied. The analysis was performed in the entire diabetic sample and the healthy BMI-matched groups. RESULTS: Compared with healthy subjects, patients had greater weight (P < 0.01 in women), higher BMI (P < 0.01 in women), smaller muscular area (P < 0.01 in men), and thicker skinfolds (P < 0.01 in women and men). Female and male patients showed larger phase angles (P < 0.01). Moreover, female patients showed a shorter vector length and lower resistance (P < 0.01) and male patients showed a higher reactance (P < 0.01). The BMI-matched analysis confirmed that patients were characterized by larger phase angles. CONCLUSIONS: Older patients with type 2 diabetes were characterized by peculiar anthropometric and bioelectrical patterns, which can be related to their smaller appendicular muscular area and lower extracellular/intracellular water ratio.

Changes in cholesterol metabolism-related gene expression in peripheral blood mononuclear cells from Alzheimer patients.

BACKGROUND: Cholesterol homeostasis dysfunction has been reported to have role in the pathogenesis of Alzheimer disease (AD). Therefore, changes in cholesterol metabolism in blood components may help to develop new potential AD biomarkers. In this study changes in cholesterol metabolism-related gene expression genes were evaluated in peripheral blood mononuclear cells (PBMCs) from AD subjects, their first degree relatives (FDR) and two groups of age matched controls (C1 > 80 years, C2 < 60 years). The expression of three genes related to APP processing was also determined. RESULTS: Results showed significantly different behavior (P = 0.000) in the expression of all analyzed genes among the 4 groups. An inverse correlation emerged between the age of controls and the propensity of their PBMCs to express selected genes. Moreover, when gene expression was evaluated in PBMCs from AD patients and compared with that of PBMCs from healthy subjects of the same age, LDL-R and APP mRNAs were most abundant in AD as compared C1 whereas SREBP-2 and particularly nCEH were present at much lower mRNA levels in AD-PBMCs. This study describes for the first time a differential expression profile of cholesterol and APP related genes in PBMCs from AD patients and their FDR. CONCLUSIONS: We suggest that the expressions of cholesterol homeostasis and APP processing related genes in PBMC could be proposed as possible biomarkers to evaluate AD risk. In addition, gene expression in PBMC could be also used for diagnosis and development of therapeutic strategies as well as for personalized prediction in clinical outcome of AD.

Body composition variations in ageing.

Age-related physiological variations of body composition concern both the fat-free mass (FFM) and the fat mass (FM). These variations expose the elderly person to the risk of malnutrition and could lead to conditions of disability. This paper aims to review the current state of knowledge on body composition in the aged population. The pattern of qualitative variations in body composition in old age is fairly well defined. In adulthood, the physiological variation of body mass involves a first increasing phase followed by a decreasing trend. The reduction is due mainly to the loss of fat-free mass, especially muscle mass. Total body water and bone mass also decrease. Fat mass tends to decrease and the reduction seems to be due mainly to the loss of subcutaneous fat. The quantitative aspects of the age of onset, rate and intensity of the physiological variations are still not completely clear. This poor quantitative definition is due to the variable and multifactorial phenomenology of ageing, the heterogeneity of assessment techniques and sampling models, and the limited number of empirical observations in oldest-old individuals.

Accumulation of neutral lipids in peripheral blood mononuclear cells as a distinctive trait of Alzheimer patients and asymptomatic subjects at risk of disease.

BACKGROUND: Alzheimer's disease is the most common progressive neurodegenerative disease. In recent years, numerous progresses in the discovery of novel Alzheimer's disease molecular biomarkers in brain as well as in biological fluids have been made. Among them, those involving lipid metabolism are emerging as potential candidates. In particular, an accumulation of neutral lipids was recently found by us in skin fibroblasts from Alzheimer's disease patients. Therefore, with the aim to assess whether peripheral alterations in cholesterol homeostasis might be relevant in Alzheimer's disease development and progression, in the present study we analyzed lipid metabolism in plasma and peripheral blood mononuclear cells from Alzheimer's disease patients and from their first-degree relatives. METHODS: Blood samples were obtained from 93 patients with probable Alzheimer's disease and from 91 of their first-degree relatives. As controls we utilized 57, cognitively normal, over-65 year-old volunteers and 113 blood donors aged 21-66 years, respectively. Data are reported as mean +/- standard error. Statistical calculations were performed using the statistical analysis software Origin 8.0 version. Data analysis was done using the Student t-test and the Pearson test. RESULTS: Data reported here show high neutral lipid levels and increased ACAT-1 protein in about 85% of peripheral blood mononuclear cells freshly isolated (ex vivo) from patients with probable sporadic Alzheimer's disease compared to about 7% of cognitively normal age-matched controls. A significant reduction in high density lipoprotein-cholesterol levels in plasma from Alzheimer's disease blood samples was also observed. Additionally, correlation analyses reveal a negative correlation between high density lipoprotein-cholesterol and cognitive capacity, as determined by Mini Mental State Examination, as well as between high density lipoprotein-cholesterol and neutral lipid accumulation. We observed great variability in the neutral lipid-peripheral blood mononuclear cells data and in plasma lipid analysis of the subjects enrolled as Alzheimer's disease-first-degree relatives. However, about 30% of them tend to display a peripheral metabolic cholesterol pattern similar to that exhibited by Alzheimer's disease patients. CONCLUSION: We suggest that neutral lipid-peripheral blood mononuclear cells and plasma high density lipoprotein-cholesterol determinations might be of interest to outline a distinctive metabolic profile applying to both Alzheimer's disease patients and asymptomatic subjects at higher risk of disease.

Altered cholesterol ester cycle in skin fibroblasts from patients with Alzheimer's disease.

Intracellular cholesterol metabolism was reported to modulate amyloid-beta (Abeta) generation in Alzheimer's disease (AD). Results presented herein demonstrated that, like brain cells, cultured skin fibroblasts from AD patients contained more cholesterol esters than fibroblasts from healthy subjects. Particularly, Oil Red-O, Nile Red, and filipin staining highlighted higher levels of neutral lipids which responded to inhibitors of acyl-coenzyme A:cholesterol acyl-transferase (ACAT-1), associated with an increase in free cholesterol. ACAT-1 mRNA levels increased significantly in AD fibroblasts, whereas those of sterol regulatory element binding protein-2, neutral cholesterol ester hydrolase, and ATP-binding cassette transporter member 1 were markedly down-regulated. Instead, mRNA levels of low-density lipoprotein receptor, hydroxy-methyl-glutaryl-coenzyme A reductase, caveolin-1, and amyloid-beta protein precursor (AbetaPP) were virtually unchanged. Notably, mRNA levels of both beta-site AbetaPP-cleaving enzyme 1 (BACE1) and neprilysin were significantly down-regulated. An increase in Abeta(40) and Abeta(42) immunostaining and a decrease in BACE1 active form were also found in AD versus control fibroblasts. Altogether, these findings support the hypothesis that the derangement of cholesterol homeostasis is a systemic alteration involving central but also peripheral cells of AD patients, and point to cholesterol ester levels in AD fibroblasts as an additional metabolic hallmark useful in the laboratory and clinical practice.

Somatotype in elderly type 2 diabetes patients.

Somatotyping is a practical technique for the description of physique. Individuals with Type 2 diabetes are characterized by physical peculiarities, such as overweight, obesity and a central pattern of body fat distribution. Somatotype applications to diabetes are limited. The objective of this study is to describe the somatotype of elderly type 2 diabetes patients. The sample consisted of 110 patients with type 2 diabetes (45 men, mean age 69.4 +/- 7.0 years; 65 women, mean age 72.9 +/- 7.1 years). The pathological subjects were compared with a control group consisting of 280 healthy individuals (134 men, mean age 74.2 +/- 7.3 years; 146 women, mean age 74.9 +/- 7.4 years). The Heath-Carter somatotype was applied. Diabetic men and women (mean somatotype, respectively: 6.8-5.6-0.6 and 8.6-6.4-0.2) presented significantly higher values of endomorphy than the controls (p = 0.043 in men, p = 0.003 in women); men also had a lower mesomorphic component (p = 0.000). The somatotype method revealed physical peculiarities in type 2 diabetes patients. The marked endomorphy in the pathological individuals can be related to general fatness, which is a well known disease risk factor. The somatotype appears to be a suitable technique for the assessment of physique in type 2 diabetes patients.

Alzheimer's disease: case-control association study of polymorphisms in ACHE, CHAT, and BCHE genes in a Sardinian sample.

Alzheimer's disease (AD) is characterized by an extensive loss of cholinergic neurons, and their cortical projections, from the basal forebrain area. The resulting reduction in cholinergic activity is associated with decreased levels of the neurotransmitter acetylcholine (ACh), decreased activity of acetylcholinesterase (AChE), choline acetyltransferase (ChAT), and increased butyrylcholinesterase (BChE) activity. In the present study, we investigated whether the BCHE, ACHE, and CHAT genes were associated with AD and the possibility of a synergistic effect with APOE-epsilon4 in a Sardinian sample. AD patients (n = 158), exclusively of Sardinian ancestry, were recruited from the Division of Geriatrics Local Health Agency 8 and Unit of Clinical Pharmacology, Department of Neurosciences, University of Cagliari. Patients were diagnosed according to DSM-IV, and National Institute of Neurologic and Communicative Disorders and Stroke-AD and Related Disorders Association (NINCDS-ADRDA) criteria for possible or probable AD. Cognitive screening was performed by means of Mini-Mental State Examination (MMSE). Healthy controls (n = 118) of Sardinian ancestry were recruited from religious and sport associations. All patients and control subjects gave informed consent for participation in the study. Single nucleotide polymorphism (SNP) analysis was performed by PCR/RFLP or the TaqMan 5' exonuclease method. Our study confirms the association between APOE epsilon4 allele and AD (P < 0.000). No significant differences were observed in allele and genotype frequencies of BCHE, ACHE, and CHAT between AD and controls. Haplotype analysis of ACHE SNPs did not reveal a significant association between ACHE and AD. Our results suggest that the AChE, ChAT, and BChE polymorphisms do not constitute a major genetic risk factor for susceptibility to AD in a Sardinian population.

Residential facilities for older people in Italy: a five-region survey.

BACKGROUND AND AIMS: To survey all Residential Facilities (RFs) for older people (more than 50% residents over 65 years of age) in five Italian regions (Calabria, Sardinia, Sicily, Umbria, Veneto), and to evaluate their logistic and organizational characteristics and staff and resident features. METHODS: Structured interviews with RF managers; selected RFs operating in five regions. RESULTS: A total of 853 RFs were operating in the five regions, with an average of 198.0 beds per 10,000 older people - a rate showing marked regional variability. The number of RFs actually surveyed was 754 (88.4% of sample pool). The mean number of RF beds was 59.8 (+/-65.0; median: 34), and the great majority (96%) had 24-hour staff cover. A large proportion (29%) were managed by local municipal authorities, religious non-profit associations (approx. 24%) and other non-profit organizations (approx. 21%). In the RFs 24,456 workers were employed; the number of staff per facility also showed great variability. The mean number of workers directly involved in resident care was 27.8 (+/-39.0; range: 1-331); the median number of staff members was 14, and the resident/staff ratio was 2.1. These 754 RFs hosted 42,687 residents, with an average of 53.5 (+/-58.5) older people in each facility, and 3.2 residents below the age of 65. The mean age of the entire resident sample was 79.3 years (+/-5.2) and there was a high proportion of residents with neurological (including dementia), psychiatric and medical disorders. CONCLUSIONS: The five regions varied considerably in residential bed provision; many other RF characteristics, including staff/resident ratios, showed similar variability. Most RFs hosted older people with a variety of neurological, psychiatric and medical disorders. Future phases of the project will aim at shedding light on many other features in these institutions, which care for 2.1% of the older population in Italy and may serve even greater proportions of older people in the future.

Somatotype in Alzheimer's disease.

BACKGROUND: The clinical picture of Alzheimer's disease includes anthropometric and body composition variations. Somatotyping is a practical non-invasive method to assess body type. OBJECTIVE: The objective of this study was to describe the somatotype of a sample of Alzheimer's patients. METHODS: The sample consisted of 55 Alzheimer disease individuals in the mild-moderate stage (17 men, mean age = 76.9 +/- 7.2 years; 38 women, mean age = 79.6 +/- 6.4 years). The pathological subjects were compared with a control group consisting of 280 healthy individuals (134 men, mean age = 74.2 +/- 7.3 years; 146 women, mean age = 74.9 +/- 7.4 years). The Heath-Carter somatotype was applied. RESULTS: The Alzheimer patients (mean somatotype: 6.1-5.5-0.8 in men, 7.0-5.3-0.7 in women) are less mesomorphic and more ectomorphic than the controls (mean somatotype: 6.1-6.3-0.6 in men, 7.7-6.3-0.4 in women), the differences being significant in women (mesomorphy, p = 0.000; ectomorphy, p = 0.012). CONCLUSION: Alzheimer patients show peculiar somatometric characteristics. The somatotype technique could represent a suitable tool for the study and monitoring of physical variations.

The Caregiver Burden Inventory in evaluating the burden of caregivers of elderly demented patients: results from a multicenter study.

BACKGROUND AND AIMS: The burden perceived by caregivers of patients with dementia is a fundamental prognostic aspect in the history of the disease. The aim of this study was to demonstrate the internal consistency of the Caregiver Burden Inventory (CBI), a scale used to quantify burdens in different aspects of a caregiver's life, and the influence of patients' and caregivers' characteristics on its different dimensions. METHODS: In this cross-sectional study, 419 demented patients and their caregivers were evaluated in 16 geriatric centers in Italy. Cognitive status and behavioral disturbances were assessed by the Mini Mental State Examination (MMSE) and Neuropsychiatric Inventory (NPI), respectively. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were also evaluated. Comorbidity was assessed by the Cumulative Illness Rating Scale (CIRS). The severity of dementia was evaluated by the Clinical Dementia Rating (CDR) score. Caregiver distress due to the behavioral problems of the patient was assessed by the Neuropsychiatric Inventory-Distress, a subscale of the NPI which evaluates stress caused by each behavioral disturbance of the patient, and by the Brief Symptom Inventory which evaluates anxiety and depression. Burden was evaluated by the CBI. RESULTS: The CBI showed very high internal consistency (Cronbach's alpha value > 0.80). Factor analysis showed that the items clustered into four dimensions, and not five as originally proposed. Multiple regression analysis revealed that patients' behavioral disturbances and disability were the major predictors of the time-dependent burden; the psychophysical burden was explained mainly by caregiver anxiety and depression. CONCLUSIONS: The CBI proved to be an effective multidimensional tool for evaluating the impact of burden on many aspects of caregivers' lives.

[Residential facilities for the elderly in five Italian regions. The Progres-Anziani Project]. / Le strutture residenziali per anziani: una ricerca in cinque regioni italiane. Il progetto Progres-Anziani.

OBJECTIVE: To survey all Residential Facilities (RFs) for the elderly in five Italian Regions (Calabria, Sardinia, Sicily. Umbria and Veneto), and to evaluate their logistic and organizational characteristics, staff and residents' features. DESIGN: Structured interviews were conducted with RF managers. SETTING: All RFs operating in the five Italian Regions. RESULTS: In the five Regions there are 853 RFs with an average of 198.0 beds per 10000 elderly inhabitants; this rate shows a marked variability between different Regions. The mean number of beds in the RFs is 59.8 (median: 34). The large majority (96%) have a 24-hour staff cover. In terms of management, the RFs are handled by local municipalities (29%), religious non-profit associations (24%), and other non-profit organizations (21%). In the 754 RFs surveyed (91.1% of the sample) there were 24.456 workers employed, even the number of staff in each facility shows a great variability. The mean number of workers directly involved in residents' care is 27.8, and the ratio residents/staff is 2.1, which becomes lower (1.8) if we consider the ratio non-independent residents/staff. In the 754 RFs there were 42,687 residents, with an average of 53.5 elderly residents for each facility and 3.2 residents below the age of 65; the mean age of the resident sample was 79.3 years, and there is an high proportion of residents with neurological (including dementia), psychiatric or medical disorders. CONCLUSION: There is marked variability in the provision of residential places between different Regions; many other characteristics of RFs for the elderly, including staff/residents ratios, show a similar variability Most RFs host elderly with a variety of neurological, psychiatric and medical disorders. The future waves of the project will shed light on many features of these institutions, which care for 2.1% of the elderly population in Italy and may serve larger proportions of the elderly in the future.

Reversible Pisa syndrome (pleurothotonus) due to the cholinesterase inhibitor galantamine: case report.

We report on a case of reversible Pisa syndrome developed after treatment with galantamine in a patient with Alzheimer's disease without previous exposure to neuroleptic or other cholinesterase inhibitors. Complete and persistent resolution of the syndrome was achieved several weeks after botulinum toxin type-A injection.