Archives of gerontology and geriatrics. Supplement最新文献

Patients affected by Alzheimer disease (AD) need an accurate diagnosis, to the extent allowing us to find the best therapy or polytherapy, in order to take under control their cognitive impairment. In our Alzheimer Evaluation Units (from the Italian name abbreviated: UVA), the patients undergo a multidimensional evaluation, which can address us towards a proper diagnosis and of other weakening, or even dementia-related diseases. The patients are also subject to neuropsychometric and neuropsychological evaluations, allowing a more focused analysis on cognitive impairments. Among the tests, we use the Rey auditory-verbal learning test (RAVLT), evaluating the patient's verbal memory. A list of 15 words is read to each patient. N the first part of the test, the clinician repeats 5 times such a list. the patient is hen asked, at the end of every repetition, to tell all words he/she remembers. This part is useful to evaluate the immediate recall (IR) ability. The score, i.e., the total number of recalled words, ranges from 0 to 75. After 15 minutes, the delayed recall (DR) ability is evaluated: the patient is newly asked to repeat as many words as he can recall from the list. The score for this part ranges from 0 to 15 minutes. The score is corrected of rage and education, with a cut-off of 28.5 for IR and 4.7 for DR. We made a survey with the purpose of deciding if there was a correlation between cognitive impairment and verbal memory lack, whose deficiency appears earlier in AD. To this aim, we selected several patients with AD, diagnosed during the period between September 2002 and February 2003. We only considered those patients whose AD was not associated with other weakening diseases, and whose clinical dementia rating scale (CDR) score was between 0.5-2.0. A sample of 35 individuals (11 men and 24 women) could be obtained. A meaningful correlation was observed between CDR and IR (r = -0.725, p < 0.01), as well as between CDR and DR (r = -0.470; p < 0.05). Such a result confirms the importance of evaluating immediate and long-term memories, for the early diagnosis of AD, because it is the only symptom of clinically not yet diagnosed dementia, as proven also by other studies.

Several studies have shown that cerebrovascular organ damage can related not only to average blood pressure (BP) levels, but also to BP variability. The aim of this study was to investigate the relationship between 24 hr BP variability and cognitive function in older hypertensives. Forty older, never treated hypertensives were submitted to 24 hr ambulatory BP monitoring (ABPM) and subdivided, according to the variability of the systolic BP (SBP), in two groups: 23 with higher (> PV) and 17 with lower (< PV) SBP variability, defined as the standard deviation (SD) of the mean 24 hr SBP values and as coefficient of variation (CV). They underwent a cognitive assessment by mini mental state examination (MMSE) and a recording of the brain event-related potentials (ERPs). ERPs record neuronal electric activity when the patients are submitted to frequent and rare acoustic stimuli and must recognize and count rare (target) stimuli. The two groups with statistically different 24 hr SBP variability, did not show significant differences in MMSE scores or in N2 and P300 ERP latencies, thus indicating a lack of difference in the cognitive ability between the two groups. Our results show that cognitive function is not related to 24 hr SBP variability in older hypertensives.

The study was aimed at identifying recovery possibility in elderly patients suffering from a first ever stroke and admitted to rehabilitation with concomitant high disability. From 1998 to 1999 one hundred elderly patients were entered consecutively into this study. Disability was measured by functional independence measure (FIM). The FIM value at admission had a median value 23, which indicated a very high post-stroke disability. At discharge the FIM median value was 33. After one year 41 patients were at home. Their median FIM value was 62.5. Thirty-one patients had died over the interval. The death was mainly due to a new stroke, cardiac diseases or acute pneumonia. Six patients were in a nursing home and 22 could not be studied at follow-up.

This controlled study evaluated various outcomes in a group of 127 chronically ill and frail elderly patients when discharged from a hospital ward, and cared at home, enrolled during 12 months starting from September 2001. The observation of patients is programmed to be of two years from enrollment, with a scheduled program of follow up at baseline,6, 12, and 24 months. Patients (of both sexes) were randomly assigned to one of two groups: (i) Control group (61 patients: mean age 85.2 years) having a usual home care program of assistance, guaranteed by the Social Health Care Service. (ii) Intervention group (66 patients: mean age 83.2 years), for whom the program of care mentioned above was integrated providing collaboration of a home care attendant. This was a lay-working person who has attended a specializing course about care of the elderly and of the very frail. The home attendance was provided for 4-10 hrs daily, according to a program established by a Geriatric Evaluation Unit. The team evaluated the patients at their home,deciding the amount of hours of attendance in the presence of the caregiver. The financial cost of the additional home care attendance was sponsored, totally or in part, according to the financial situation of the patient's family, by the "Fondazione del Monte di Bologna e di Ravenna". This report takes into consideration only few preliminary data, coming from the first 6 months of observation of all the patients included. The two groups were homogeneous when compared statistically at baseline. Data coming form laboratory and biological analysis will be available only at the end of the project as they are recorded in a blind methodology. A lower degree of mortality and of dropouts in the intervention group was observed,compared to the control group, already at 6 months. These outcomes can be considered favorable, and perhaps can be related to the various benefits gained by additional program of home attendance.

Sleep in elderly people shows progressive changes caused by general aging processes. Several alterations are described in medical literature: changes of sleep/wake rhythm and modifications both in sleep duration and in sleep architecture. The aim of our study was to evaluate sleep disturbances in elderly people, with and without cognitive impairment,through a sleep questionnaire. Our population included 1000 subjects, over 65 years of age, stratified by sex and age. The first 600 interviews were included in this report. All patients underwent a mini mental state examination (MMSE) and a questionnaire concerning excessive daytime sleepiness. In our total sample, we found a high prevalence of excessive daytime sleepiness, insomnia, nighttime awakenings, snoring, restlessness and periodic leg movements during sleep. Patients with cognitive dysfunctions showed less difficulty in falling asleep and fewer nighttime awakenings; they snored less frequently and were the only ones to present enuresis and to fall off the bed. Moreover, patients with cognitive impairment presented excessive daytime sleepiness with variable intensity and frequency. In conclusion, our results indicate significant differences in sleep disorders between healthy subjects and patients cognitively impaired. Besides, our subjective evaluation seems to be a useful method to perform an assessment of sleep disturbances in elderly people.

The role of the free radicals in aging has been in center of research for long years. It is assumed that with advancing age, damaging effects of oxygen free radicals might be accumulated in the organisms on all components, especially on the DNA and the mitochondria. In addition, because of the decreased efficiency of the antioxidant systems, the oxidative mechanisms prevail in numerous age-dependent diseases, such as the arterio -sclerosis, Parkinson and Alzheimer diseases. The present study was aimed at revealing an eventual correlation between the free radical levels and the psychophysical health state of an ultraoctagenarian East-Sicilian population living in institutes or at home. Our study population consisted of 125 ultraoctagenarian subjects, 62 of them were institutionalized and 63 living outside the institutes. The free radical effects were measured by using the free radical analytical system (FRAS) assessing the derivatives of reactive oxygen metabolites(D-ROMs). The results are expressed in units of Caratelli (U-CARR). The psycho-physical state of the subjects was estimated by means of the mini mental state examination(MMSE), geriatric depression scale (GDS), activities of daily living (ADL) and instrumental activities of daily living (IADL). The nutritional state and the physical activity of the subjects were evaluated through the mini nutritional assessment (MNA) and the physical performance test (PPT). All studied parameters underwent a correlation analysis of Pearson. Statistically significant negative correlation was found between the free radical levels and the cognitive performance (p < 0.0001), as well as the levels of autonomy and autosufficiency,the physical activity in the total population (p < 0.01). These correlations were even more expressed in the institutionalized subjects. Statistically significant positive correlation seems to exist between the free radical levels and the nutritional status (p < 0.001). These studies revealed some important differences between the institutionalized and noninstitutionalized population. The levels of oxygen free radicals were higher in the former group, indicating a stronger oxidative stress, influencing the psychophysical state of the elderly subjects. This may have negative consequences on the quality and duration of the life. It is difficult to define the exact role of free radicals in the determination of aging pattern,but they may be considered without any doubt as true "markers" of an enhanced oxidative stress, accompanying a non-successful aging process.

Aging of the world population risks to be accompanied by an increase of chronic health problems, and most particularly of mental health problems. To face these problems the organization of care and education in old age psychiatry is still quite low. If at inter -national level the body of knowledge and skills of the psychiatry of the elderly is today enough recognized it is very difficult to convince authorities at national and local level to recognize this discipline as a sub-specialty of psychiatry. Even when some resources exist at local level to support old people with mental disorders, very often these old persons do not look for care as consequence of the prevailing double stigma attached to mental disorders in general and to the end of life in particular. In order to promote changes of this situation, the World Health Organization (WHO) Collaborating Centre of Lausanne realized a WHO-World Psychiatric Association (WPA) consensus meeting and statement on how to reduce the stigma and the discrimination against old persons with mental disorders, as well it has realized a survey in Europe on this specific subject of stigma and discrimination against these old persons. As education is one of the most important components of the strategy to reduce stigma and discrimination, 3 recent developments were done to promote this. The first one is a survey conducted by the section of old age psychiatry of WPA. The second one is the consensus statement on education in psychiatry of the elderly jointly published by WHO and WPA, and finally was the recent publication of a skill -based objectives for the training in the discipline. These efforts will be completed by some actions to strengthen the impact of all these documents.

The objective of the study was to evaluate the so-called Kennard effect, i.e., the existence of a negative correlation between recovery and age. Thirty-eight elderly patients(median age 71 years, range 60-81) suffering from their first stroke were enrolled. The mean interval since the stroke was 15 days. Patients entered a 60-day rehabilitation pro -gram. Their functional condition was assessed by means of the functional independence measure (FIM). Only FIM values under 36 at admission were considered. Computerized tomographic (CT) or magnetic resonance imaging (MRI) scans were performed in all cases. The type of lesion was ischemic in 24 cases, hemorrhagic in 7 cases and 7 cases had more than one lesion. The patients' families were contacted after one year for a follow-up and all of them gave their consent. The survivors were examined again. The FIM score at discharge and the corresponding values at follow-up were statistically compared by means of Wilcoxon test (two-tailed). The FIM value at admission of the whole population had the median value of 27.5. None of these patients died during their stay at our rehabilitation center and their median FIM value at discharge was 34.5, a value still indicating high disability. After one year, 22 were still alive at home (57.9 %). Their FIM median value was 46. The difference was significant compared to discharge (Z = -3.228, p = 0.001). Three patients scored 85, 87 and 88, respectively, although none of them received rehabilitation treatment. In conclusion, our results indicate that restorative processes are still active in elderly patients, despite previous stroke and existing comorbidities. Some of the elderly patients of our group could approach to independence, although they displayed a very low FIM value at admission.

Twenty-eight subjects with chronic age-related disabilities living in the nursing home"Istituto di Riposo per la Vecchiaia" in Torino were assigned to a pet-therapy intervention group, consisting of 3/week sessions of almost one-hour visit for 6 weeks with a little cat, of to a control group undergoing usual activity programs. The purpose of this study was to evaluate the effects of pet-therapy on nursing home inpatients. There were no differences in demographic or clinical characteristics and in mean duration of institutionalization between the two groups. Results showed that patients with animal interaction had improved depressive symptoms and a significant decrease in blood pressure values. The pet-therapy programs are desirable components of the multidisciplinary treatment for frail elderly patients in long-term care.

Infectious agents have been suspected as contributing factors to dementia, especially in Alzheimer disease. We intended to test whether viral or bacterial seropositivity is associated with cognitive impairment among home-dwelling elderly. Viral burden (seropositivity for herpes simplex type 1 (HSVI), type 2 (HSV2), or cytomegalovirus (CMV), and bacterial burden (Chlamydia pneumoniae and Mycoplasma pneumoniae) were tested among 383 home-dwelling individuals with vascular disease (mainly coronary heart disease) in the ongoing DEBATE study (mean age 80 years). Mini-mental state examination (MMSE) and its changes were used to define cognitive impairment. At baseline, 0-1, 2, and 3 positive titers toward viruses were found in 48 (12.5 %), 229 (59.8 %), and 106 (27.7 %) individuals,respectively. MMSE points decreased with increasing viral burden (p = 0.03). At baseline,58 individuals (15.1 %) had cognitive impairment (MMSE < 24 points) which after adjustments was significantly associated with seropositivity for 3 viruses (risk ratio 2.5, 95%confidence interval 1.3 to 4.7). MMSE score decreased in 150 cases (43%) during 12-month follow-up. After adjustment for MMSE score at baseline and with 0-1 seropositivities as reference (1.0), the risk ratios were 1.8 (95 % confidence interval 0.9 to 3.6) and 2.3 (95% confidence interval 1.1 to 5.0) for 2 and 3 seropositivities, respectively. No significant associations were observed between bacterial burden and cognition. Viral burden of herpes virus and cytomegalovirus was associated with cognitive impairment in home-dwelling elderly. The association may offer a preventable cause of cognitive decline.