A prolonged preclinical phase of more than two decades before the onset of dementia suggested that initial brain changes of Alzheimer’s disease (AD) and the symptoms of advanced AD may represent a ...unique continuum. Given the very limited therapeutic value of drugs currently used in the treatment of AD and dementia, preventing or postponing the onset of AD and delaying or slowing its progression are becoming mandatory. Among possible reversible risk factors of dementia and AD, vascular, metabolic, and lifestyle-related factors were associated with the development of dementia and late-life cognitive disorders, opening new avenues for the prevention of these diseases. Among diet-associated factors, coffee is regularly consumed by millions of people around the world and owing to its caffeine content, it is the best known psychoactive stimulant resulting in heightened alertness and arousal and improvement of cognitive performance. Besides its short-term effect, some case-control and cross-sectional and longitudinal population-based studies evaluated the long-term effects on brain function and provided some evidence that coffee, tea, and caffeine consumption or higher plasma caffeine levels may be protective against cognitive impairment/decline and dementia. In particular, several cross-sectional and longitudinal population-based studies suggested a protective effect of coffee, tea, and caffeine use against late-life cognitive impairment/decline, although the association was not found in all cognitive domains investigated and there was a lack of a distinct dose-response association, with a stronger effect among women than men. The findings on the association of coffee, tea, and caffeine consumption or plasma caffeine levels with incident mild cognitive impairment and its progression to dementia were too limited to draw any conclusion. Furthermore, for dementia and AD prevention, some studies with baseline examination in midlife pointed to a lack of association, although other case-control and longitudinal population-based studies with briefer follow-up periods supported favourable effects of coffee, tea, and caffeine consumption against AD. Larger studies with longer follow-up periods should be encouraged, addressing other potential bias and confounding sources, so hopefully opening new ways for diet-related prevention of dementia and AD.
Objective
To evaluate whether the presence of pseudobulbar affect (PBA) in an early stage of the disease influences survival in a population‐based incident cohort of amyotrophic lateral sclerosis ...(ALS).
Methods
Incident ALS cases, diagnosed according to El Escorial criteria, were enrolled from a prospective population‐based registry in Puglia, Southern Italy. The Center for Neurologic Study‐Lability Scale (CNS‐LS), a self‐administered questionnaire, was used to evaluate PBA. Total scores range from 7 to 35. A score ≥13 was used to identify PBA. Cox proportional hazard models were used for survival analysis. The modified C‐statistic for censored survival data was used for models’ discrimination. RECursive Partitioning and AMalgamation (RECPAM) analysis was used to identify subgroups of patients with different patterns of risk, depending on baseline characteristics.
Results
We enrolled 94 sporadic ALS, median age of 64 years (range: 26‐80). At the censoring date, 65 of 94 (69.2%), 39 of 60 (65.0%), and 26 of 34 (76.5%) patients reached the outcome (tracheotomy/death), in the whole, non‐PBA and in the PBA groups, respectively. Kaplan‐Meier survival curves for the two subgroups were not significantly different (log‐rank test: 1.3, P = .25). The discrimination ability of a multivariable model with demographic and clinical variables of interest was not improved by adding PBA. In the RECPAM analysis, ALSFRSr and the total score of CNS‐LS scale (</≥10) were the most important variables for differentiating all risk categories.
Conclusions
These preliminary results underlie that the presence of PBA at entry negatively influences survival in a specific subgroup of patients with ALS characterized by less functional impairment.
Citizens in an ageing World population are at higher risk of cognitive impairment and dementia with considerable negative consequences for their autonomy and quality of life, that of those who care ...for them, and the sustainability of health and care systems. Thus, the need for strategies to avoid or delay the process of cognitive decline. Innovative ICT solutions should play a role in tertiary prevention of cognitive decline supporting active and healthy ageing and countering the cognitive decline in the elderly subjects. In this study, we tested whether a computerized cognitive training (CCT) with an application of serious games (computerized neuropsychological battery) may produce an improve of cognitive functions and beneficial enhancement of the resting state eyes-closed electroencephalographic (rsEEG) rhythms deranging typically in Alzheimer's disease (AD) patients. Ten AD patients were enrolled and completed the 15 daily CCT sessions. Standard neuropsychological testing and rsEEG recordings were performed before and after the CCT program. eLORETA estimated the rsEEG cortical sources. Statistical results (p <; 0.05) showed that the AD patients were characterized by increased performance scores (i.e. accuracy and reaction time) in the execution of the neuropsychological tasks after the CCT program. On the contrary, no statistical difference (p > 0.05) was observed in the rsEEG markers after the CCT program. These preliminary results suggest that the CCT program with this application of serious games may represent a useful and practical approach to slow down the cognitive decline in AD patients even if it has no effect on the cortical neural synchronization mechanisms of rsEEG, possibly because of the impaired integrity of the cholinergic system in these patients.
In the general population, cognitive impairment is associated with increased mortality, and higher levels of education are associated with lower risks for cognitive impairment and mortality. These ...associations are not well studied in patients receiving long-term hemodialysis and were the focus of the current investigation.
Prospective cohort study.
Adult hemodialysis patients treated in 20 Italian dialysis clinics.
Patients’ cognitive function across 5 domains (memory, attention, executive function, language, and perceptual-motor function), measured using a neuropsychological assessment comprising 10 tests; and patients’ self-reported years of education.
All-cause mortality.
Nested multivariable Cox regression models were used to examine associations of cognition (any domain impaired, number of domains impaired, and global function score from principal components analysis of unadjusted test scores) and education with mortality and whether there were interactions between them.
676 (70.6%) patients participated, with a median age of 70.9 years and including 38.8% women. Cognitive impairment was present in 79.4% (527/664; 95% CI, 76.3%-82.5%). During a median follow-up of 3.3 years (1,874 person-years), 206 deaths occurred. Compared to no cognitive impairment, adjusted HRs for mortality were 1.77 (95% CI, 1.07-2.93) for any impairment, 1.48 (95% CI, 0.82-2.68) for 1 domain impaired, 1.88 (95% CI, 1.01-3.53) for 2 domains, and 2.01 (95% CI, 1.14-3.55) for 3 to 5 domains. The adjusted HR was 0.68 (95% CI, 0.51-0.92) per standard deviation increase in global cognitive function score. Compared with primary or lower education, adjusted HRs were 0.79 (95% CI, 0.53-1.20) for lower secondary and 1.13 (95% CI, 0.80-1.59) for upper secondary or higher. The cognition-by-education interaction was not significant (P=0.7).
Potential selection bias from nonparticipation and missing data; no data for cognitive decline; associations with education were not adjusted for other socioeconomic factors.
Cognitive impairment is associated with premature mortality in hemodialysis patients. Education does not appear to be associated with mortality.
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Introduction Depression is a common disorder in late-life. Structured clinical interviews may be less efficient compared to self-administered questionnaires, but provide more accurate findings in ...terms of diagnosis. No population-based studies with both these depression assessment instruments have been ever performed. Objectives To estimate the GDS-30 accuracy for depression assessment against the gold standard Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID) in subjects 65+ years in a random sampling of the general population. Methods The sample was collected in a population-based study (GreatAGE) conducted among elderly residents in Castellana, Southeast Italy. It includes 597 participants (57.62% males, mean age 73 years). Depression was assessed through the GDS-30 and the SCID, both double-blinded administered respectively by a trained neuropsychologist and psychiatrist. The GDS-30 screening performances were analyzed using ROC curves. Results According to the gold standard SCID, the rate of depressive disorder was 10.22% (15.81% of women; 6.1% of men) while with GDS-30 instrument 12.06% of the residents met the depression cutoff. Only 36.1% of GDS cases were true positive. At the optimal cutoff score (> 5), GDS had 62% sensitivity and 81% specificity. Using a more conservative cutoff (> 9), the GDS-30 specificity reached 91% while sensitivity dropped to 43%. Conclusions These preliminary results from the first population-based study that compares GDS-30 and SCID showed that the GDS-30 identified adequate levels of screening accuracy (AUC 0.76) compatible with scores established in community settings. Funding PRIN2009E4RM4Z.
Introduction The prevalence of Anxiety Disorders (ADs) among the elderly (65 plus) varies across studies, because of differences in diagnostic criteria's definition and the heterogeneity of clinical ...presentation. Furthermore the comorbidity of anxiety with affective disorders is controversial. Objectives Estimate the prevalence of ADs in 65 years plus subjects in a random sampling of the general population and provide current estimates of comorbidity with affective disorders. Methods The sample was collected in the Great Age study, a population-based study conducted in a random sampling of the elderly residents in Castellana, South-East Italy. It includes 719 participants (56,33% males). Through the SCID-IVTR interview performed by a psychiatrist, ADs diagnosis and classification in subtypes (phobia, generalized anxiety disorder, OCD, panic disorder, post-traumatic stress disorder, adjustment disorder and AD nos) were assessed. Results The 30,25% of females and 15,30% of males were positive for any DSM-VI disorder. The ADs prevalence was 10,43% (14,97% of women; 6,91% of men; mean age at interview 72 years). Rates prevalence in 65-74 age stratum was 11,78%; 8,1% in 75-84 and 10,26% in the oldest age. The ADs were classified as phobia (1,49%), GAD (2,22%), OCD (0,28%), panic disorder (0,7%), PTSD (0,55%), adjustment disorder (1,67%) and AD nos (3,75%). 21,33% of the ADs had apparently new-onset (Late OnsetADs). Affective disorders occur in 25,33% of ADs. Conclusions The prevalence rates of ADs in late life tend to decline, but remain the most common psychiatric disorders, especially in women. Anxiety co-occurs with affective disorders in similar rate to Late OnsetADs. Founding: PRIN2009E4RM4Z
Fibromyalgia (FM), clinical condition characterized by several signs and symptoms such as widespread pain, trigger point, morning stiffness and extreme tiredness for scarce hours of sleep, is linked ...to several changes in several brain neurotransmitters, particularly serotonin and norepinephrine. Consequently, the Neural Vegetative System works more and so it generates an exaggerated muscular contraction, sweating and constriction of blood vessels. The aim of our study was to treat a selected group of female patients suffering from FM with duloxetine with physiotherapy. We used two clinical scales (VAS and FIQ) and an objective evaluation such as myometric. The analysis of the data Myoton used during any inspection showed a statistically significant reduction in the values of muscle tone in each district analyzed. This finding was also confirmed by the patients themselves who have experienced a significant welfare and less muscle tension in different locations, as evidenced by data obtained from the clinical scales used by us. In addition, our patients were thought to be satisfied with the improvements not only subjective, but also with the objective witnessed myometry, making them a share of the study and feeling constantly monitored for treatment aimed at a real reduction in muscle stiffness. In conclusion, our study demonstrates combined treatment duloxetine- physiotherapy effectively reduces a symptom often disabling and particularly troublesome in patients with FM as the exaggerated muscle contraction.
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