Background
The training of mindfulness enhances the emotive and cognitive equilibrium and well-being in older adults. So some authors hypothesize it is an appropriate approach to cultivating these ...benefits and a good quality of life in Alzheimer’s patients (AD-P) at early stage and in their caregivers (Cg) (Dyad).
Aim
Our main hypothesis is that AD-P and Cg who completed the program of Mindfulness-Based Interventions (MBIs) training would experience improvements in well-being and mood and cognitive performance (AD-P: attention and memory).
Methods
The perspective randomized controlled will enroll the Dyad of 80 Alzheimer’s patients (age ≥ 60) and 80 caregivers (age > 18) who will be randomly assigned to 6 months MBI training in groups and to control group study. All outcome will be analyzed before intervention (baseline), after follow-up 1 (at the end of treatment), after 6 months (follow-up 2) and after 1 year (follow-up 3) from the end of treatment.
Discussion
AD-P-expected outcomes: (a) improvement of the quality of life (QoL-AD); (b) decrease of depression (BDI); (c) improvement of spiritual well-being (Facit SWB Index); (d) improvement of attention and good cognitive performance Rey Memory Test (MFIT); (e) decrease of neuropsychiatric symptoms. (NPI)-Cg-expected outcomes: (a) improvement of the quality of life (SF36); (b) decrease of the care burden (CBI); (c) decrease of depression (BDI); (d) improvement of self-awareness (FFMQ); (e) increase in spiritual-well-being (Facit SWB).
Conclusions
This study could provide a clues on multidisciplinary interventions as secondary prevention of Alzheimer’s dementia and on stress reduction in family caregivers.
Introduction In this study correlations between care burden, depression, and personality at intrapsychic level in caregivers of Alzheimer's disease patients were evaluated. Materials and methods ...Caregivers: n.40. Tests: Social-schedule; CBI; BDI; SASB-Structural-Analysis of Social Behaviours- Form-A- intrapsychic behaviours (8 Cluster); ECOG. Patients:MMSE. Statistical analysis: Chi-squared test; Anova one way F test; Pearson's R coefficient. Results Correlations: CBI-total and NPI(p < .001); CBI-total-ECOG (p = .042); CBI-total-BDI(p< .001); CBI- total-SASB-Cl7(p = .014); SASB-CL8(p<0.000); BDI and SASB-Cl 2 (p = .018), SASB-Cl 3 (p = .004), SASB-Cl7(p < .000), SASB-CL8 (p < .000). High CBI is correlated with high depression, neuropsychiatry symptoms, low cognitive patient's functions. Caregivers have the following intrapsychic behaviors: poor self-care, poor ability to take care of themselves; they exercise control over themselves and do not consider and/or ignore their basic needs at emotional and physical levels. These intrapsychic behaviours are indicators of depression (SASB Model) and are correlated with high care burden-CBI and high depression-CDQ. Discussion Care burden is closely related to the depression and individual personality (intrapsychic experience) of the caregiver. This may reveal a source of strength and may suggest areas of multidimensional and psychotherapeutic interventions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In patients with Alzheimer's disease (AD), synaptic plasticity seems to be involved in cognitive improvement induced by cognitive training. The platelet amyloid precursor protein (APP) ratio (APPr), ...i.e., the ratio between two APP isoforms, may be a useful peripheral biomarker to investigate synaptic plasticity pathways. This study evaluates the changes in neuropsychological/cognitive performance and APPr induced by cognitive training in AD patients participating in the "My Mind Project". Neuropsychological/cognitive variables and APPr were evaluated in the trained group (
= 28) before a two-month experimental protocol, immediately after its termination at follow-up 1 (FU1), after 6 months at follow-up 2 (FU2), and after 24 months at follow-up 3 (FU3). The control group (
= 31) received general psychoeducational training for two months. Some memory and attention parameters were significantly improved in trained vs. control patients at FU1 and FU2 compared to baseline (Δ values). At FU3, APPr and Mini Mental State Examination (MMSE) scores decreased in trained patients. Δ APPr correlated significantly with the Δ scores of (i) MMSE at FU1, (ii) the prose memory test at FU2, and (iii) Instrumental Activities of Daily Living (IADL), the semantic word fluency test, Clinical Dementia Rating (CDR), and the attentive matrices test at FU3. Our data demonstrate that the platelet APPr correlates with key clinical variables, thereby proving that it may be a reliable biomarker of brain function in AD patients.
Background
Mitochondrial DNA (mtDNA) mutations are considered as a possible primary cause of age-associated neurodegenerative disorders like Parkinson’s disease (PD).
Aims
To analyze, along the whole ...mtDNA sequence of PD patients, the presence of non-reference alleles compared to reference alleles, as defined in the revised Cambridge Reference Sequence (rCRS).
Methods
mtDNA was extracted from whole blood of PD and control groups, and was sequenced using a chip-based resequencing system.
Results
58 nucleotide positions (np) exhibited a different allelic distribution in the two groups; in 81% of them the non-reference alleles were over-represented in PD patients, similar to findings reported in patients with Alzheimer’s disease, albeit in reduced proportion. Closer analysis of the 58 np in PD group showed that they were characterized by low-level heteroplasmy, and that the nucleotide substitutions determined an amino acid change in 84% of cases.
Conclusions
These results suggest that mtDNA allelic changes are increased in PD and that age-related neurodegenerative diseases could share a common mechanism involving mtDNA.
Urinary incontinence is a chronic, age-related disorder, likely to increase in the future due to global population ageing. In Italy, as in most countries, older people with incontinence are often ...cared for by family caregivers, whose burden might be worsened by the perception of receiving an inadequate support, due to the lack of customized services. The aim of this study was to evaluate the impact of the absorbent products distribution method on family caregivers' perception of the support received.
The study compared the distribution of pads to homes and in pharmacy via a survey reaching 101 family caregivers of older people with incontinence living in two geographical areas of the Marche Region (Central Italy) with different distribution systems. The association between "Quality of perceived support" (the outcome variable) and two types of absorbent products delivery methods (i.e. pharmacy and home distribution) was analysed by means of a general linear model.
Findings show that family caregivers receiving pads at home (HODs) perceived a higher support than those gaining them at the pharmacy (PHADs) (respectively 68.1% vs 35%). The association between perceived support level and distribution system remained even after correction for confounding factors. 70.2% of PHADs reported "Poor well-being", versus only 53.7% of HODs. The latter are more satisfied with the type of products distribution and thus less inclined to experiment different systems for the supply of products for the urinary continence (e.g. by voucher). The results are virtually reversed among PHADs and the difference is statistically significant (p < 0.001).
When family caregivers feel supported by a more customized service delivery system, their perception of the care-related burden is mitigated. Thus, it is important to consider the needs of both family caregivers and cared for older people, and not only of the latter for designing a more suitable distribution of absorbent products. The best solution could be leaving end-users the freedom to choose how they want to get products (e.g. voucher or personal budget). This requires a reorganization of the current pads delivery systems adopted by the Marche and by other Italian Regional Health Systems.
This study aimed to investigate profiles of personality evaluated by temperament and character dimensions (TCI) in 638 adult and older adult patients (CP) who had recently been diagnosed with breast, ...colon, lung, and other kinds of cancer (female and male subjects were assessed). Tests: Temperament and Character Inventory (TCI). Statistical analysis: cluster K-means analysis for personality traits.
Two different personality profiles emerged: "Low self-determination and pessimism" (Profile 1) and "Self-determination and self-caring (medium)" (Profile 2). The following significant differences were observed in the TCI dimensions between the two profiles: Temperament-Novelty-Seeking (NS) (
< 0.001); Harm-Avoidance (HA) (
< 0.001); Reward-Dependence (RD) (
< 0.001); Persistence (PS) (
< 0.001); Character-Self-Directness (SD) (
< 0.001); Cooperativeness (C) (
> 0.001); Self-Transcendence (ST) (
< 0.001). No differences in the two profiles were found between adult and elderly patients. Profile 1 - "Low self-determination and pessimism": Patients with this profile present low resistance to frustration, poor search for novelty and solutions (NS), anxiety and pessimism (medium HA), high social attachment and dependence on the approval of others (medium-high RD), and low self-determination (PS) as temperament dimensions; and medium-low self-direction, low autonomy and ability to adapt (SD-medium-low), medium cooperativeness (C), and low self-transcendence (ST) as character dimensions. Profile 2 - "Self-determination and self-caring (medium)": Patients with this profile have resistance to frustration, ability to search for novelty and solutions (medium-NS), low anxiety and pessimism (HA), low social attachment and dependence on approval (medium-low-RD), and determination (medium-high PS) as dimensions of temperament; and autonomy and capacity for adaptation and self-direction (SD), capacity for cooperation (high-CO), and self-transcendence (medium-high-ST) as character dimensions.
Personality screening allows a better understanding of the difficulties of the individual patient and the planning of targeted psychotherapeutic interventions that promote quality of life and good adaptation to the disease course.
Objective
This study aimed to determine the most appropriate cognitive and cerebrospinal fluid (CSF) biomarker setting to distinguish frontotemporal dementia (FTD) from Alzheimer’s disease (AD).
...Method
Patients with FTD, those with AD, and those without dementia were enrolled in this study. CSF amyloid-ß 42 (Aß42), total (t)-tau, and phosphorylated (p)-tau concentrations were determined by enzyme-linked immunosorbent assays. Cognition was evaluated by the Mini-Mental State Examination (MMSE) and its domain scores. The associations of CSF biomarkers with cognitive measures were examined using regression models and the diagnostic value of CSF biomarkers was determined by receiver operating characteristics curves.
Results
CSF Aß42 levels were lower, whereas t-tau/Aß42 and p-tau/Aß42 ratios were higher in patients with AD compared with those with FTD. Some MMSE domain scores were different in FTD and AD, but they did not improve the ability to distinguish between the two pathologies. Poor temporal orientation scores were associated with low Aß42 levels only in patients with FTD. The p-tau/Aß42 ratio reached sufficient levels of sensitivity and specificity to discriminate FTD with primary progressive aphasia from AD.
Conclusions
The ratio of CSF p-tau/Aß42 is a sensitive and specific biomarker for discriminating patients with primary progressive aphasia from those with AD.
Background
Peripheral arterial disease (PAD) is frequent among older diabetic patients, but the evidence about endovascular revascularization is very limited.
Method
We retrospectively analyzed data ...collected from 120 diabetic patients consecutively admitted to a Diabetic Foot Clinic, including 64 patients aged 65–79 years and 56 patients aged 80 or more.
Results
Percutaneous transluminal angioplasty (PTA) was followed by technical success in 82.5% of older patients and 62.5% of oldest old ones (
p
= 0.05). No significant difference was observed in regards to complete re-epithelization (76.6 vs 76.8%,
p
= 0.820), recurrent stenosis (26.6 vs 19.6%,
p
= 0.371), intra- or post-procedure complications (21.9 vs 10.7%,
p
= 0.102), and amputations (12.5 vs 5.4%,
p
= 0.176).
Discussion
Our findings suggest that older and oldest old patients with diabetic foot and critical ischemia could be effectively and safely treated with PTA.
During the COVID-19 pandemic, reduced access to care services and fear of infection prompted families to increase home care for their older relatives with long-term care needs. This had negative ...effects on both members of the caring dyad, impacting their quality of life (QoL) and mental well-being. This study investigated the factors that influenced the mental well-being and QoL of 239 dyads, before and after the first pandemic wave in Italy.
Data were collected through a survey on the use of health and social care services and interventions by older care recipients living in the community and their family caregivers. Factors associated with deterioration of mental well-being and QoL in older care recipients (mean age 86.1 years old) and their family caregivers after the pandemic were studied.
The importance attached by family caregivers to the skills and training of healthcare professionals was a protective factor against the deterioration in the well-being of older care recipients. Similarly, the importance associated by family caregivers to the help received from healthcare professionals was a protective factor for QoL. Financial hardship of older care recipients was a risk factor for deterioration in caregivers' mental well-being, while support from other family members was a protective factor for QoL.
The presence of attentive healthcare professionals, a supportive family environment, and economic support can reduce the burden on both the caregiver and the older care recipient. These aspects need to be considered in any future emergency situation and when planning care services for community-dwelling older people.
Background
Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and ...PIMs in relation to readmission are distinctively lacking.
Aims
To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital.
Methods
Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models.
Results
After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48–4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46–1.56), STOPP (OR 1.60, 95% CI 0.85–3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57–1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55–5.34), STOPP (OR 2.64, 95% CI 1.43–4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51–5.21).
Discussion
Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs.
Conclusions
Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.
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