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Borroni B, Libri I, Rota M, Binetti G, Benussi L, Ghidoni R, Cotelli MS, Fostinelli S, Guerini F, Boffelli S, Magni E, Pengo M, Gennuso M, Bianchi M, Cossu B, Palomba V, Crucitti A, Bianchetti A, Logroscino G, Padovani A. Incidence of young-onset dementia in Italy: The Brescia register study. Alzheimers Dement (Amst) 2024; 16:e12544. [PMID: 38433744 PMCID: PMC10904882 DOI: 10.1002/dad2.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The goal of the present work was to assess the incidence of dementia with onset before the age of 65 years (i.e., young-onset dementia [YOD]) and define the frequencies of young-onset Alzheimer's disease (AD), frontotemporal lobar degeneration (FTLD), and dementia with Lewy bodies (DLB) in the general population. METHODS The study was conducted from January 1, 2019 to December 31, 2019 in Brescia province (population: 1,268,455). During the study period, all new YOD cases (incident YOD) were counted, and all patients' records reviewed. The incidence was standardized to the Italian general population in 2019. RESULTS A total of 29 YOD patients were diagnosed. The age-sex standardized incidence rate was 4.58 (95% confidence interval, 3.07-6.58) per 100,000 person-years. No difference in incidence rate between YOD due to AD or FTLD (P = 0.83) and between sexes (P = 0.81) was observed. YOD incidence increased with age, reaching its peak after 60 years. DISCUSSION Presenting neurodegenerative YOD phenotypes encompasses both AD and FTLD. Improved knowledge on YOD epidemiology is essential to adequately plan and organize health services.
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Affiliation(s)
- Barbara Borroni
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Department of Continuity of Care and FrialtyASST Spedali Civili BresciaBresciaItaly
| | - Ilenia Libri
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Matteo Rota
- Department of Molecular and Translational MedicineUniversity of BresciaBresciaItaly
| | - Giuliano Binetti
- Memory ClinicIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Luisa Benussi
- Molecular Markers LaboratoryIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Roberta Ghidoni
- Molecular Markers LaboratoryIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | | | - Silvia Fostinelli
- Memory ClinicIRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
| | - Fabio Guerini
- Medicine and Rehabilitative Unit, Sant'Anna InstituteBresciaItaly
| | | | | | - Marta Pengo
- Neurology Unit, “Città di Brescia” HospitalBresciaItaly
| | | | | | | | | | | | | | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging BrainDepartment of Clinical Research in NeurologyUniversity of Bari “Aldo Moro”Pia Fondazione Cardinale G. PanicoTricaseLecceItaly
- Department of Basic Medical SciencesNeuroscience and Sense OrgansUniversity of Bari “Aldo Moro”BariItaly
| | - Alessandro Padovani
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
- Department of Continuity of Care and FrialtyASST Spedali Civili BresciaBresciaItaly
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Bianchetti A, Ikeda M, Mateos R, Mondini S, Rabheru K, Serrati C, De Leo D. The NIA-AA revised clinical criteria for Alzheimer's disease: are they too advanced? Int Psychogeriatr 2023; 35:679-681. [PMID: 37753728 DOI: 10.1017/s1041610223000868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Angelo Bianchetti
- Department of Medicine and Rehabilitation, S. Anna Hospital, Brescia, Italy
| | - Manubu Ikeda
- Department of Psychiatry, Osaka University, Osaka, Japan
| | - Raimundo Mateos
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Kiran Rabheru
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Carlo Serrati
- Department of Neurology, San Martino Hospital, Genova, Italy
| | - Diego De Leo
- Department of Psychology, Primorska University, Primorska, Slovenia
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Ornago AM, Pinardi E, Zucchelli A, Trevisan C, Volterrani M, Cacciatore S, Ceolin C, Landi F, Trabucchi M, De Leo D, Bianchetti A, Bellelli G. Mental Health among Geriatric Healthcare Workers in Italy during the COVID-19 Pandemic: Results from a National Survey. J Nutr Health Aging 2023; 27:626-631. [PMID: 37702335 DOI: 10.1007/s12603-023-1958-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES This study aimed to investigate the psychological impact of the COVID-19 pandemic on healthcare workers (HCWs) in geriatric settings. DESIGN Online cross-sectional survey. SETTINGS AND PARTICIPANTS 394 geriatric HCWs in Italy. MEASUREMENTS The survey was developed by a multidisciplinary team and disseminated in April 2022 to the members of two geriatric scientific societies (Italian Society of Geriatrics and Gerontology and Italian Association of Psychogeriatrics). The survey examined the experiences related to the COVID-19 pandemic, as well as psychological burden and support. Work-related anxiety and distress related to the pandemic were studied using the SAVE-9 scale (Stress and Anxiety to Viral Epidemics). RESULTS Three hundred sixty-four participants (92.4%) changed their job activity during the pandemic and about half (50.9%) failed to cope with this change, 58 (14.7%) had increased work-related anxiety, and 39 (9.9%) work-related stress levels. Three hundred forty (86.3%) participants reported acute stress reaction symptoms, including irritability, depressed mood, headache, anxiety, and insomnia, and 262 (66.5%) required psychological support, mainly from friends/relatives (57.9%) and/or colleagues (32.5%). Furthermore, 342 participants (86.8%) recognized they would benefit from informal and formal psychological support in case of future similar emergencies. CONCLUSIONS This study highlights the high psychological burden experienced by geriatric HCWs in Italy during the COVID-19 pandemic and emphasizes the need for supportive interventions.
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Affiliation(s)
- A M Ornago
- Alice Margherita Ornago, School of Medicine and Surgery, University of Milano-Bicocca. Piazza dell'Ateneo Nuovo, 1, Milan, Italy, Tel: +39 3473192723, E-mail address: , ORCID: orcid.org/0009-0008-7927-793X
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Novelli A, Bianchetti A. Glutathione: pharmacological aspects and implications for clinical use. Geriatr Care 2022. [DOI: 10.4081/gc.2022.10390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Glutathione is a tripeptide found in many tissues which plays a pivotal role in critical physiological processes such as maintenance of redox balance, reduction of oxidative stress by enhancement of metabolic detoxification of both xenobiotic and endogenous compounds, and regulation of immune system function. Glutathione depletion is associated with many chronic degenerative diseases and loss of function with aging and altered glutathione metabolism has been implicated in central nervous system diseases, frailty and sarcopenia, infected state, chronic liver diseases, metabolic diseases, pulmonary and cardiovascular diseases. Therefore, the glutathione status may be an important biomarker and treatment target in various chronic, age-related diseases. Here we describe the main pharmacological aspects of glutathione, focusing on its synthesis and role in several vital functions including antioxidant defense, detoxification of xenobiotics and modulation of immune function and fibrogenesis and the clinical implications of its depletion and we discuss the different strategies for increasing glutathione cellular levels either by providing specific precursors and cofactors or directly administering the tripeptide.
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Delbon P, Buzzi EM, Maghin F, Bianchetti A, Conti A. COVID-19 vaccination in nursing homes: considerations on freedom to make decisions and legal protection measures. JGG 2022. [DOI: 10.36150/2499-6564-n496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sidoli C, Zambon A, Tassistro E, Rossi E, Mossello E, Inzitari M, Cherubini A, Marengoni A, Morandi A, Bellelli G, Tarasconi A, Sella M, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Porcella L, Nardiello I, Chimenti E, Zeni M, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, Pietrogrande L, Mosca M, Corazzin I, Rossi P, Nunziata V, D’Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell’Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Borghi C, Bianchetti A, Crucitti A, DiFrancesco V, Fontana G, Geriatria A, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cassadonte F, Vatrano M, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Seneci F, Fimognari F, Bambar V, Saitta A, Corica F, Braga M, Servi, Ettorre E, Camellini Bellelli CG, Annoni G, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Formilan M, Patrizia G, Santuar L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl’Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Alessandro M, Calogero P, Corvalli G, Di F, Pezzoni D, Platto C, D’Ambrosio V, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Bonetto M, Grasso M, Troisi E, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Faraci B, Bertoletti E, Vannucci M, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D’Amico F, Grippa A, Mazzone A, Cottino M, Vezzadini G, Avanzi S, Brambilla C, Orini S, Sgrilli F, Mello A, Lombardi Muti LE, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D’Amico F, D’Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Cortegiani A, Pistidda L, D’Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clin Exp Res 2022; 34:1827-1835. [PMID: 35396698 DOI: 10.1007/s40520-022-02099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
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Rozzini R, Bianchetti A, Alboni P, Baldasseroni S, Bo M, Boccanelli A, Desideri G, Marchionni N, Palazzo G, Terrosu P, Ungar A, Vetta F, Zito G. The older patient with cardiovascular disease: background and clinical implications of the comprehensive geriatric assessment (CGA). Minerva Med 2022; 113:609-615. [PMID: 35332761 DOI: 10.23736/s0026-4806.22.08086-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Principles and processes of Comprehensive Geriatric Assessment (CGA) are increasingly being applied to subspecialties and subspecialty conditions, including cardiovascular patients (i.e. infective endocarditis; considerations of surgery or transcatheter aortic valve replacement, TAVR, for patients with aortic stenosis; vascular surgery) and postoperative mortality risk. In cardiovascular field CGA has mainly the aim to define ideal management according to the different typology of older adult patients (eg, robust versus intermediate versus physical and cognitively disabled versus end-stage or dying), allowing physicians to select different therapeutic goals according to life expectancy; Aspect to be valued are by CGA are global health status and patient's decision-making capacity: CGA allows the individualized treatment definition and optimize the preprocedure condition.
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Affiliation(s)
- Renzo Rozzini
- SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy - .,Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy -
| | | | - Paolo Alboni
- SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy
| | | | - Mario Bo
- SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy
| | | | | | | | - Giuseppe Palazzo
- SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy
| | | | - Andrea Ungar
- SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy
| | - Francesco Vetta
- SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy
| | - Giovanni Zito
- SICGe Società Italiana di Cardiologia Geriatrica, Florence, Italy
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Zucchelli A, Manzoni F, Morandi A, Di Santo S, Rossi E, Valsecchi MG, Inzitari M, Cherubini A, Bo M, Mossello E, Marengoni A, Bellelli G, Tarasconi A, Sella M, Auriemma S, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Margola A, Porcella L, Nardiello I, Chimenti E, Zeni M, Giani A, Famularo S, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Ballestrero A, Minaglia C, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, De F, Pietrogrande L, De B, Mosca M, Corazzin I, Rossi P, Nunziata V, D‘Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell‘Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Bianchetti A, Crucitti A, Di Francesco V, Fontana G, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cannistrà U, Cassadonte F, Vatrano M, Cassandonte F, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Fimognari F, Bambara V, Saitta A, Corica F, Braga M, Ettorre E, Camellini C, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Patrizia G, Santuari L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl‘Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Calogero P, Corvalli G, Pezzoni D, Gentile S, Morandi A, Platto C, D‘Ambrosio V, Faraci B, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Confente S, Bonetto M, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Bertoletti E, Vannucci M, Tesi F, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D‘Amico F, Grippa A, Mazzone A, Riva E, Dell‘Acqua D, Cottino M, Vezzadini G, Avanzi S, Orini S, Sgrilli F, Mello A, Lombardi L, Muti E, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, De F, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D‘Amico F, D‘Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Scapigliati A, Cortegiani A, Vitale F, Pistidda L, D‘Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017. Aging Clin Exp Res 2022; 34:349-357. [PMID: 34417734 PMCID: PMC8847195 DOI: 10.1007/s40520-021-01950-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/31/2021] [Indexed: 01/22/2023]
Abstract
Introduction Delirium and sarcopenia are common, although underdiagnosed, geriatric
syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium. Methods The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses. Results A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]. Discussion and conclusion Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01950-8.
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Cuomo A, Bianchetti A, Cagnin A, De Berardis D, Di Fazio I, Antonelli Incalzi R, Marra C, Neviani F, Nicoletti F. Trazodone: a multifunctional antidepressant. Evaluation of its properties and real-world use. JGG 2021. [DOI: 10.36150/2499-6564-n320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Affiliation(s)
- Renzo Rozzini
- Director of the geriatrics department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Angelo Bianchetti
- Head of the medicine and rehabilitation department, Istituto Clinico Sant'Anna - Gruppo San Donato, Brescia, Italy
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11
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Rebora P, Rozzini R, Bianchetti A, Blangiardo P, Marchegiani A, Piazzoli A, Mazzeo F, Cesaroni G, Chizzoli A, Guerini F, Bonfanti P, Morandi A, Faraci B, Gentile S, Bna C, Savelli G, Citerio G, Valsecchi MG, Mazzola P, Bellelli G. Delirium in Patients with SARS-CoV-2 Infection: A Multicenter Study. J Am Geriatr Soc 2020; 69:293-299. [PMID: 33411332 PMCID: PMC7753490 DOI: 10.1111/jgs.16969] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN Multicenter observational cohort study. SETTINGS Acute medical units in four Italian hospitals. PARTICIPANTS A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.
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Affiliation(s)
- Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Renzo Rozzini
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna Hospital, Brescia, Italy
| | - Paolo Blangiardo
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Alice Marchegiani
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Andrea Piazzoli
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Francesca Mazzeo
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giulia Cesaroni
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Anita Chizzoli
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna Hospital, Brescia, Italy.,Department of Clinical and Experimental Sciences, Geriatric School, University of Brescia, Brescia, Italy
| | - Fabio Guerini
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna Hospital, Brescia, Italy
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.,Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy.,Parc Sanitari Pere Virgili and Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Bianca Faraci
- Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy
| | - Simona Gentile
- Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy
| | - Claudio Bna
- Department of Radiology and Medical Imaging, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giordano Savelli
- Department of Radiology and Medical Imaging, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
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Caratozzolo S, Zucchelli A, Turla M, Cotelli MS, Fascendini S, Zanni M, Bianchetti A, Psy MP, Rozzini R, Boffelli S, Cappuccio M, Psy FG, Psy CV, Bellandi D, Caminati C, Gentile S, Psy EL, Di Fazio I, Psy MZ, Vezzadini G, Psy CF, Psy MC, Psy RT, Psy SP, Scalvini A, Di Cesare M, Psy MG, Falanga L, Medici N, Palamini N, Psy EZ, Psy EG, Bellelli G, Marengoni A, Trabucchi M, Padovani A. The impact of COVID-19 on health status of home-dwelling elderly patients with dementia in East Lombardy, Italy: results from COVIDEM network. Aging Clin Exp Res 2020; 32:2133-2140. [PMID: 32918696 PMCID: PMC7486591 DOI: 10.1007/s40520-020-01676-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND COVID-19 outbreak has led to severe health burden in the elderly. Age, morbidity and dementia have been associated with adverse outcome. AIMS To evaluate the impact of COVID-19 on health status in home-dwelling patients. METHODS 848 home-dwelling outpatients with dementia contacted from April 27 to 30 and evaluated by a semi-structured interview to evaluate possible health complication due to COVID-19 from February 21 to April 30. Age, sex, education, clinical characteristics (including diagnosis of dementia) and flu vaccination history were obtained from previous medical records. Items regarding change in health status and outcome since the onset of the outbreak were collected. COVID-19 was diagnosed in patients who developed symptoms according to WHO criteria or tested positive at nasal/throat swab if hospitalized. Unplanned hospitalization, institutionalization and mortality were recorded. RESULTS Patients were 79.7 years old (SD 7.1) and 63.1% were females. Ninety-five (11.2%) patients developed COVID-19-like symptoms. Non COVID-19 and COVID-19 patients differed for frequency of diabetes (18.5% vs. 37.9%, p < 0.001), COPD (7.3% vs. 18.9%, p < 0.001), and previous flu vaccination (56.7% vs. 37.9%, p < 0.001). Diabetes and COPD were positively associated with COVID-19, whereas higher dementia severity and flu vaccination showed an inverse association. Among COVID-19 patients, 42 (44.2%) were hospitalized while 32 (33.7%) died. Non COVID-19 patients' hospitalization and mortality rate were 1.9% and 1.2%, respectively. COVID-19 and COPD were significantly associated with the rate of mortality. DISCUSSION/CONCLUSIONS A high proportion of adverse outcome related to COVID-19 was observed in home-dwelling elderly patients with dementia. Active monitoring though telehealth programs would be useful particularly for those at highest risk of developing COVID-19 and its adverse outcomes.
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Affiliation(s)
- Salvatore Caratozzolo
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alberto Zucchelli
- Unità Geriatria, Dipartimento Scienze Cliniche e Sperimentale, Università degli Studi di Brescia, Brescia, Italy
| | - Marinella Turla
- Neurology Unit, Azienda Socio-Sanitaria Territoriale della Valcamonica, Esine (Brescia), Italy
| | - Maria Sofia Cotelli
- Neurology Unit, Azienda Socio-Sanitaria Territoriale della Valcamonica, Esine (Brescia), Italy
| | - Sara Fascendini
- Centro di Eccellenza Alzheimer FERB Onlus, Ospedale Briolini di Gazzaniga, Gazzaniga (Bergamo), Italy
| | - Mara Zanni
- Centro di Eccellenza Alzheimer FERB Onlus, Ospedale Briolini di Gazzaniga, Gazzaniga (Bergamo), Italy
| | - Angelo Bianchetti
- Gruppo San Donato - Ospedale Sant'Anna Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | - Matteo Peli Psy
- Gruppo San Donato - Ospedale Sant'Anna Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | - Renzo Rozzini
- Unità di Cure Sub Acute, Dipartimento di Geriatria, Fondazione Poliambulanza di Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | - Stefano Boffelli
- Unità di Cure Sub Acute, Dipartimento di Geriatria, Fondazione Poliambulanza di Brescia, Brescia, Italy
- Gruppo di Ricerca Geriatrica, Brescia, Italy
| | | | | | - Chiara Vecchi Psy
- Coordinamento dei Caffè Alzheimer della Lombardia Orientale, Brescia, Italy
| | | | | | - Simona Gentile
- Fondazione Teresa Camplani - Casa di Cura Ancelle della Carità, Cremona, Italy
| | - Elena Lucchi Psy
- Fondazione Teresa Camplani - Casa di Cura Ancelle della Carità, Cremona, Italy
| | | | | | | | | | - Maura Cosseddu Psy
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Rosanna Turrone Psy
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Silvia Pelizzari Psy
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Andrea Scalvini
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Marco Di Cesare
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | | | - Lina Falanga
- Unità di Cure Sub Acute, Dipartimento di Geriatria, Fondazione Poliambulanza di Brescia, Brescia, Italy
| | | | | | | | - Eleonora Grossi Psy
- Fondazione Teresa Camplani - Casa di Cura Ancelle della Carità, Cremona, Italy
| | - Giuseppe Bellelli
- Dipartimento Medicina e Chirurgia, Clinica Geriatrica, Università Bicocca, Milan, Italy
| | - Alessandra Marengoni
- Unità Geriatria, Dipartimento Scienze Cliniche e Sperimentale, Università degli Studi di Brescia, Brescia, Italy
| | | | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, Center for Neurodegenerative Disorders, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.
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Bianchetti A, Ferrara N, Padovani A, Scarpini E, Trabucchi M, Maggi S. Timely Detection of Mild Cognitive Impairment in Italy: An Expert Opinion. J Alzheimers Dis 2020; 68:1401-1414. [PMID: 30958367 DOI: 10.3233/jad-181253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Mild cognitive impairment (MCI) generally evolves in a gradually progressive decline in memory and non-memory cognitive domains that may eventually decay to dementia. This process might be preventable by improving early detection of the MCI syndrome followed by proper and timely interventions. The aim of this work was providing helpful indications for a standardized early diagnosis of MCI, mainly focusing on the Italian elderly population. We reviewed here MCI epidemiology and classification, as well as the most recent advancements in early detection of the patient with MCI in the Italian scenario. Specialist centers in connection with general practitioners (GPs) have been established across the country and designated as Centers for Cognitive Disorders and Dementia (CDCD). CDCDs are dedicated to the diagnosis and management of patients for all forms of dementia across all the complex staging spectrum. New tools were made available by the advancements of imaging techniques and of the research on biomarkers, leading to novel approaches based on the combination of imaging and biomarker detection, to improve accuracy and effectiveness in the early diagnosis of MCI. Moreover, patient genotyping, alone or in combination with other techniques, was also revealed as a promising method in evaluating and preventing MCI progression. We recommend the introduction of all these novel tools in the diagnostic practice of the specialist centers and that further efforts and resources are spent into the research of the most effective techniques and biomarkers to be introduced as first-level tests into the practice of early diagnosis of MCI.
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Affiliation(s)
- Angelo Bianchetti
- Dipartimento di Medicina e Riabilitazione, Istituto Clinico S. Anna-Gruppo San Donato, Brescia, Italy.,Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy.,Italian Association of Psychogeriatrics (AIP), Brescia, Italy
| | - Nicola Ferrara
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy.,Italian Association of Psychogeriatrics (AIP), Brescia, Italy.,Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli "Federico II" Naples, Italy
| | - Alessandro Padovani
- Neurology Unit, Dipartimento Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy
| | - Elio Scarpini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Università di Milano, Centro Dino Ferrari, Milan, Italy
| | - Marco Trabucchi
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy.,Italian Association of Psychogeriatrics (AIP), Brescia, Italy.,University of "Tor Vergata", Rome, Italy
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Morandi A, Zambon A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Marengoni A, Bellelli G, Rispoli V, Malara A, Spadea F, Di Cello S, Ceravolo F, Fabiano F, Chiaradia G, Gabriele A, Lenino P, Andrea T, Settembrini V, Capomolla D, Citrino A, Scriva A, Bruno I, Secchi R, De Martino E, Muccinelli R, Lupi G, Paonessa P, Fabbri A, Passuti MT, Castellari S, Po A, Gaggioli G, Varesi M, Moneti P, Capurso S, Latini V, Ghidotti S, Riccardelli F, Macchi M, Rigo R, Claudio P, Angelo B, Flavio C, Benedetta B, Boffelli S, Cassinadri A, Franzoni S, Spazzini E, Andretto D, Tonini G, Andreani L, Coralli M, Balotta A, Cancelliere R, Ballardini G, Simoncelli M, Mancini A, Strazzacapa M, Fabio S, De Filippi F, Giudice C, Dentizzi C, Azzini M, Cazzadori M, Mastroeni V, Bertassello P, Claudia Benati HS, Nesta E, Tobaldini C, Guerini F, Elena T, Mombelloni P, Fontanini F, Gabriella L, Pizzorni C, Oliverio M, Del Grosso LL, Giavedoni C, Bidoli G, Mazzei B, Corsonello A, Fusco S, Vena S, De Vuono T, Maiuri G, Luca FF, Andrea A, Giovanni S, Rossella N, Castegnaro E, De Rosa S, Sechi RB, Benvenuti E, Del Lungo I, Giardini S, Giulietti C, Mauro DB, Eleonora B, Roberto F, Paolo B, DuranteMangoni E, Testoni M, Fabio DS, Loredana S, Valeria S, Fabiano M, Annabella DG, Salvatore DC, Martina P, Greco A, Grazia D, Daniele S, Gianluca R, Renzo G, Sergio M, Morena B, Vitali M, Marina P, Paolo DC, Irene F, Cristina S, Alessandra F, Orlandini F, La Regina M, Desirée A, Mirella F, Marco F, Mario B, Paola P, Giuliana B, Riccardo B, Michela T, Eleonora C, Padulo F, Cristina M, Dario R, Giancarla M, Guido R, Elena M, Prete C, Marileda N, Federica S, Igor B, Nicole B, Elena R, Paolillo C, Riccardi A, Claudia B, Barbara R, Francesca M, Silvia V, Chiara C, Ilaria DL, Oliver B, Mauro C, Eleonora M, Giuseppe P, Rosaria T, Maria C, Davide D, Stefania C, Marco C, Massimo P, Bertoletti E, Luca S, Martina DF, Paola V, Lia S, Sandro C, Valentina DS, Erminia B, Paola C, Romina R, Minisola S, D'Amico F, Luciano C, Pasquale A, Ilaria L, Francesca C, Guglielmo S, Marco E, Sara R, Paola A, Claudio A, Francesco R, Caronzolo F, Alessandro C, Simona M, Lara F, Paola R, Simonetta C, Antonella C, Generoso U, Fernando G, Giuliano C, Emanuela S, Grippa A, Mariolina S, Alessandro D, Chiara P, Giulia L, Alessandro G, Famularo S, Sandini M, Pinotti E, Gianotti L, Antonella B, Lombardo G, Giulia P, Sante G, Rossi A, Rubele S, Sant S, Marco V, Danila C, Fabio R, Bandirali MP, Nicoletta C, Pipicella T, Laura B, Paolo T, Luciano T, Leonello A, Margherita S, Stefania DN, Pierluigi DS, Laura R, Fabiana T, Giovanna C, Antonino S, Antonino A, Felice C, Giuseppe B, Danilo F, Giovanna DB, Francesco L, Salini S, Angela BM, De Filippi F, Giorgetta C, Francesco C, Giovanni G, Paola C, Gerardo B, Silvio R, Letizia S, Sabrina P, Davide B, Rosaria RM, Maria DA, Raffaele P, Valeria PG, Palmieri VO, Palasciano G, Belfiore A, Portincasa P, Carlo S, Vincenzo S, Alessia D, Valiani V, Carolina B, Tiziana C, Daniela L, Giuseppe M, Francesca C, Giordano C, Roberto S, Paola T, Ugo P, Federica R, Giacomo P, Castellano M, Anna G, Domenico C, Elisa C, Federica C, Antonietta CM, Luigi M, Fabio L, Salvatore B, Giuseppe M, Gelosa G, Viviana AT, Piras V, Giorgio B, Andrea C, Alessandra B, Coen D, Magliola R, Milanesio D, Muzzulini CL, Paolo F, Marinella T, Sofia CM, Marta B, March A, Siano P, Capo G, Napoletano R, Cecilia P, Mancini C, Del Buono C, De Bartolomeo G, Addolorata M, Carmen C, Roberto C, Nitti MT, Giovanni VA, Moschettini G, Franco M, Daniela R, D'Amico G, Mirella P, Endrizzi C, Trotta L, Ciarambino T, Orazio Z, Felici A, Emanuela T, Marta S, Thomas F, Giacomo T, Ignazio DF, Andrea B, Giuseppe O, Emanuela F, Serena A, Elena D, Pavan S, Anna C, Serena B, Erika N, Roberto S, Elena S, Manuela P, Francesca A, Angelo T, Piazzani F, Lunelli A, Dimori S, Margotta A, Soglia T, Postacchini D, Brunelli R, Santini S, Francavilla M, Macchiati I, Sorvillo F, Giuli C, Mecocci P, Longo A, Perticone F, Addesi D, Rosa PC, Bencardino G, Falbo T, Grillo N, Marco F, Mirella F, Fantò F, Isaia G, Pezzilli S, Bergamo D, Furno E, Rrodhe S, Lucarini S, Dijk B, Dall'Acqua F, Cappelletto F, Calvani D, Becheri D, Giuseppe M, Costanza M, Vito A, Francesca B, Magherini L, Novella M, Franca B, Lucia Gambardella PM, Valente C, Ilaria B, Alice F, Bo M, Porrino P, Ceci G, Giuliana B, Michela T, Eleonora C, Ettore E, Camellini C, Servello A, Grassi A, Rozzini R, Tironi S, Grassi MG, Troisi E, Carlo C, Simona Gabriella DS, Flaminia F, Federica R, Beatrice P, Sofia T, Gabutto A, Quazzo L, Rosatello A, Suraci D, Tagliabue B, Perrone C, Ferrara L, Castagna A, Tremolada ML, Giuseppe C, Stefano B, Davide O, Piano S, Serviddio G, Lo Buglio A, Gurrera T, Merlo V, Rovai C, Cotroneo AM, Carlucci R, Abbaldo A, Monzani F, Qasem AA, Bini G, Tafuto S, Galli G, Bruni AC, Mancuso G, Mancuso G, Calipari D, Giuseppe Massimiliano DL, Bernardini B, Corsini C, Michele C, Sara DF, Cagnin A, Fragiacomo F, Pompanin S, Piero A, Marco C, Zurlo A, Guerra G, Pala M, Menozzi L, Gatti CD, Magon S, Roberto M, Alfredo DG, Fabio F, Ruana T, Elisa M, Benedetta B, Christian M, Marco P, Massimo G, Di Francesco V, Faccioli S, Pellizzari L, Giorgia F, Barbagallo G, Lunardelli ML, Martini E, Ferrari E, Macchiarulo M, Corneli M, Bacci M, Battaglia G, Anastasio L, Lo Storto MS, Seresin C, Simonato M, Loreggian M, Cestonaro F, Durando M, Latella R, Mazzoleni M, Russo G, Ponte M, Valchera A, Salustri G, Petritola D, Costa A, Sinforiani E, Cotta MR, Piano S, Pizio RN, Cester A, Formilan M, Pietro B, Carbone P, Cazzaniga I, Appollonio I, Cereda D, Stabile A, Xhani R, Acampora R, Tremolizzo L, Federico P, Antonio C, Valerio P, Cesare B, Zhirajr M, Giovanni V, Maria A, Mariaelena S, Bottacchi E, Bucciantini E, Di Giovanni M, Franchi F, Lucchetti L, Mariani C, Grande G, Rapazzini P, Marco M, Romanelli G, Marengoni A, Franco N, Alessio M, Stefano B, Nicola L, Laura P, Nazario P, Carlo C, Chiara G, Soccorso P, Andrea S, Luca B, Francesca S, Roberto A, Marco F, Anna C, Francesco C, Anna C, Fugazza L, Guerrini C, De Paduanis G, Iallonardo L, Palumbo P, Zuliani G, Ortolani B, Capatti E, Soavi C, Bianchi L, Francesconi D, Miselli A, Gloria B, Tommaso R, Chiara P, Agata MM, Marco D, Luca M, Gianluca G, Suardi T, Mazzone A, Zaccarini C, Manuela R, Mirra G, Muti E, Bottura R, Gianpaolo M, Secreto P, Bisio E, Cecchettani M, Naldi T, Pallavicino A, Pugliese M, Iozzo RC, Grassi G, Michele B, Raffaella D, Fosca QT, Giorgio GC, Giovanni P, Ernesto C, Soccorso P, Mannironi A, Giorli E, Oberti S, Fierro B, Piccoli T, Giacalone F, Mandas A, Serchisu L, Costaggiu D, Pinna E, Orrù F, Mannai M, Cordioli Z, Pelizzari L, Turcato E, Arduini P, Cacace C, Chiloiro R, Cimino R, Ruberto C, Giovanni R, Pietro G, Laura G, Alberto C, Pietro G, Carmen R, Santo PD, Andriolli A, Burattin G, Rossi L, Andreolli Antonino CG, Giuseppe C, Tezza F, Maddalena P, Laura S, Crippa P, Aloisio P, Di Monda T, Malighetti A, Galbassini G, Salutis D, Ivaldi C, Russo AM, Bennati E, Pino E, Zavarise G, Pesci A, Suigo G, Faverio P, Andrea G, Sabrina P, Zanasi M, Moniello G, Rostagno C, Cartei A, Polidori G, Ungar A, Melis MR, Martellini E, Enrico M, Monica T, Antonella G, Giovanna L, Migliorini M, Caramelli F, Battiston B, Berardino M, Cavallo S, Alessandro M, Anna S, Lombardi B, D'Ippolito P, Furini A, Villani D, Clara R, Guarneri M, Paolucci S, Bassi A, Coiro P, De Angelis D, Morone G, Venturiero V, Palleschi L, Raganato P, Di Niro G, Rosa CA, Loredana B, Imoscopi A, Isaia G, Tibaldi V, Bottignole G G, Calvi E, Clementi C, Zanocchi M, Agosta L, Nortarelli A, Provenzano G, Mari D, Romano FY, Rosini F, Mansi M, Rossi S, Geriatria AR, Inzaghi L, Bonini G, Rossi P, Potena A, Lichii M, Candiani T, Grimaldi W, Bertani E, Alessandra P, Calogero P, Pinto D, Bernardi R, Nicolino F, Galetti C, Gianstefani A, Giulia C, Lorenzo M, Odetti P, Monacelli F, Prefumo M, Fiammetta M, Canepa M, Minaglia C, Paolisso G, Rizzo MR, Prestano R, Dalise AM, Barra D, Bosco LD, Asprinio V, Dallape L, Perina E, Incalzi RA, Bartoli IR, Pluderi A, Maina A, Pecoraro E, Sciarra M, Prudente A, Paola M, Francesca M, Manuel V, Luisella C, Maria PL, Tina S, Benini L, Levato F, Mhiuta V, Alius F, Davidoaia D, Giardini V, Garancini M, Bellamoli C, Terranova L, Bozzini C, Tosoni P, Provoli E, Cascone L, Dioli A, Ferrarin G, Gabutto A, Bucci A, Bua G, Fenu S, Bianchi G, Casella S, Romano V, Maurizio P, Mascherona I, Belotti G, Cavaliere S, Cuni E, Merciuc N, Oberti R, Veneziani S, Capoferri E, De Bernardi E, Colombo K, Bravi M, Nicoletta N, D'Arcangelo P, Montenegro N, Galli G, Montanari R, Lamanna P, Gasperini B, Isabella M, Stefania D, Gaia A, Filippo C, Palamà C, Di Emidio C, Scarpini E, Arighi A, Fumagalli G, Basilico P, De Amicis Margherita M, Marta M, Diletta M, D'Amico F, Granata A, Rostagno C, Ranalli C, Cammilli A, Cavallini MC, Tricca M, Natella D, Gabbani L, Tesi F, Martella L, Gurrera T, Imbrici R, Guerrini G, Scotuzzi AM, Sozzi F, Valenti L, Chiarello A, Monia M, Pilotto A, Prete C, Senesi B, Meta AC, Pendenza E, Monzani F, Pasqualetti G, Polini A, Tognini S, Ballino E, Cherubini A, Dell'Aquila G, Gasparrini PM, Marotti E, Migale M, Scrimieri A, Falsetti L, Salvi A, Toigo G, Ceschia G, Rosso A, Tongiorgi C, Scarpa C, Maurizio P, De Dominicis L, Pucci E, Renzi S, Cartechini E, Tomassini PF, Del Gobbo M, Ugenti F, Romeo P, Nardelli A, Lauretani F, Visioli S, Montanari I, Ermini F, Giordano A, Pigato G, Simeone E, Barbujani M, Giampieri M, Amoruso R, Piccinini M, Ferrari C, Gambetti C, Sfrappini M, Semeraro L, Striuli R, Mariani C, Pelliccioni G, Marinelli D, Fabi K, Rossi T, Pesallaccia M, Sabbatini D, Gobbi B, Cerqua R, Tagliani G, Schlauser E, Caser L, Caramello E, Sandigliano F, Rosso G, Ferrari A, Bendini C, Luisa DM, Casella M, Prampolini R, Scevola M, Vitale E, Roberto B, Carlo F, Sergio F, Alberto S, Daniela Z, Giulia B, Serena G, Michele B, Maugeri D, Sorace R, Anzaldi M, De Gesu R, Morrone G, Davolio F, Fabbo A, Palmieri M, Barbagallo G, Zoli M, Forti P, Pirazzoli L, Fabbri E, Terenzi L, Bergolari F, Wenter C, Ruffini I, Insam M, Abraham E, Kirchlechner C, Cucinotta D, Antonino L, Basile G, Grazia AM, Parise P, Boccali A, Amici S, Gambacorta M, Ferrari A, Lasagni A, Lovati R, Giovinazzo F, Kimak E, Zappa P, Medici F, Lo Castro M, Mauro F, De Luca A, Sancesario G, Martorana A, Scaricamazza B, Toniolo S, Di Lorenzo F, Liguori C, Lasco A, Basile G, Vita N, Giomi M, Dimori S, Forte F, Padovani A, Rozzini L, Ceraso A, Salvatore C, Padovani A, Cottino M, Vitali S, Marelli E, Tripi G, Miceli S, Urso G, Grioni G, Vezzadini G, Misaggi G, Forlani C, Avanzi S, Serena S, Claudia C, Marilena V, Alberto L, Diego G, Alessandro G, Iemolo F, Giordano A, Sanzaro E, D'Asta G, Proietto M, Carnemolla A, Razza G, Spadaro D, Bertolotti M, Mussi C, Neviani F, Roberto C, Valentina G, Linda M, Francesca V, Tarozzi A, Balestri F, Monica T, Mannarino G, Tesi F, Bigolari M, Natale A, Grassi S, Bottaro C, Stefanelli S, Bovone U, Tortorolo U, Quadri R, Leone G, Ponzetto M, Frasson P, Annoni G, Bellelli G, Bruni A, Confalonieri R, Corsi M, Moretti D, Teruzzi F, Umidi S, Mazzola P, Perego S, Persico I, Olivieri G, Bonfanti A, Hajnalka S, Galeazzi M, Massariello F, Anzuini A, Caffarra P, Barocco F, Spallazzi M, Paolo CG, Simonetta M, Andrea A, Chioatto P, Bortolamei S, Soattin L, Ruotolo G, Beneamino B, Pietro G, Giuseppe B, Carmen R, Castagna A, Bertazzoli M, Rota E, Adobati A, Scarpa A, Granziera S, Zuccher P, Fabbro AD, Zara D, Lo Nigro A, Franchetti L, Toniolo M, Marcuzzo C, Piano S, Rollone M, Guerriero F, Sgarlata C, Massè A, Berardino M, Cavallo S, Anna S, Zatti G, Piatti M, Graci J, Benati G, Boschi F, Biondi M, Fiumi N, Erika T, Locatelli SM, Mauri S, Beretta M, Margheritis L, Desideri G, Liberatore E, Carucci AC, Bonino P, Caput M, Antonietti MP, Polistena G, De la Pierre F, Mari M, Massignani P, Tombesi F, Selvaggio F, Verbo B, Bodoni P, Marchionni N, Mossello E, Cavallini MC, Sabatini T, Mussio E, Magni E, Bianchetti A, Crucitti A, Titoldini G, Cossu B, Fascendini S, Licini C, Tomasoni A, Calderazzo M, Daniela T, Valentina L, Ferrari A, Prampolini R, Melotti RM, Lilli A, Buda S, Adversi M, Noro G, Turco R, Ubezio MC, Mantovani AR, Viola MC, Serrati C, Pretta S, Infante M, Gentile S, Morandi A, D'Ambrosio V, Mazzanti P, Brambilla C, Sportelli S, Platto C, Faraci B, Quattrocchi D, Pernigotti LM, Pisu C, Sicuro F, Oliverio M, Del Grosso LL, Zagnoni P, Ghiglia S, Mosca M, Corazzin I, Deola M, Biagini CA, Bencini F, Cantini C, Tonon E, Pierinelli S, Onofrj M, Thomas A, Filomena B, Bonanni L, Gabriella C, Comi G, Magnani G, Santangelo R, Mazzeo S, Giuseppe M, Francesca C, Giordano C, Roberto S, Barbieri C, Giroldi L, Davolio F, Bandini F, Masina M, Malservisi S, Cicognani A, Ricca L, Ricca L, Piccininni M, Ferrari C, Gambetti C, Tassinari T, Brogi D, Sugo A, Alessandra F, Sonia M, Valerio V, Andrea UC, Enrico C, Vera RF, Assunta S, Gianmaria Z, Mauro P, Pietro B, Roberto M, Salvatore C, Barone A, Razzano M, Giuseppe I, Angela B, Francesco S, Valeria D, Federico G, Lucia P, Antonella V, Elisabetta DC, Cristina R, Nadia C, Maria S, Luciano A, Chiara C, Bini P, Pignata M, Enrico B, Maria V, Giovanni C, Giorgio C, Andrea T, Marco M, Anna C, Piera R, Alberto Z, Ceccon A, Magrin L, Marin S, Barbara S, Marco M, Laura G, Matteo M, Marco P, Caterina PM, Carla R, Federica G, Clara T, Melania C, Giampaolo B, Stefano G, Valeria G, Lucia M, Giovambattista D, Ester L, Cecilia CA, Maurizio T, Alessandra F, Vera RF, Nadia B, Grillo A, Arenare F, Tonino M, David K, Giorgio VP, Ubaldo B, Vincenzo S, Stefano M, Marino F, Busonera Flavio MT, Paolo A, Monica M, Francesco B. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia. J Am Med Dir Assoc 2020; 21:486-492.e7. [DOI: 10.1016/j.jamda.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
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Morandi A, Di Santo SG, Zambon A, Mazzone A, Cherubini A, Mossello E, Bo M, Marengoni A, Bianchetti A, Cappa S, Fimognari F, Antonelli Incalzi R, Gareri P, Perticone F, Campanini M, Penco I, Montorsi M, Di Bari M, Trabucchi M, Bellelli G. Delirium, Dementia, and In-Hospital Mortality: The Results From the Italian Delirium Day 2016, A National Multicenter Study. J Gerontol A Biol Sci Med Sci 2020; 74:910-916. [PMID: 29982365 DOI: 10.1093/gerona/gly154] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/26/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is little evidence about the prevalence of cognitive disorders and their effect on in-hospital mortality in large multicenter studies. The objectives of the 2016th edition of the "Italian Delirium Day," a large multicenter study on in-hospital older patients, were to assess (i) the point prevalence of cognitive impairment/no dementia, dementia, delirium, and delirium superimposed on dementia and (ii) the effect of these conditions on in-hospital mortality. METHODS This multicenter study and included 2,037 older patients (aged ≥65 years) admitted to acute medical and surgical wards across 205 acute hospitals. The four cognitive disorders groups were defined with a structured approach including the four AT and the presence of a documented diagnosis of dementia. The outcome measure was in-hospital mortality, as reported by the researchers involved in the study in each center. RESULTS The mean age was 81.17 ± 7.7 years. Overall, 893 patients (43.8%) had neither delirium nor dementia nor cognitive impairment, 483 (23.7%) had cognitive impairment/no dementia, 230 (11.3%) dementia alone, 187 (9.2%) delirium alone, and 244 (12.0%) delirium superimposed on dementia. Overall, 99 (4.8%) patients died. Participants with delirium alone (odds ratio 2.56; 95% confidence interval: 1.29-5.09) and those with delirium superimposed on dementia (odds ratio 2.60; 95% confidence interval: 1.39-4.85) had higher mortality risk compared with the reference group of patients with "no cognitive impairment." CONCLUSIONS Delirium and delirium superimposed on dementia were highly prevalent among older hospitalized patients and significantly increased in-hospital mortality. Clinicians should systematically assess these conditions and recognize them as markers of critical conditions and predictors of imminent death.
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Affiliation(s)
- Alessandro Morandi
- Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Cremona, Italy
| | - Simona G Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy
| | - Antonella Zambon
- School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica, Centro di ricerca per l'invecchiamento, IRCCS-INRCA, Ancona, Italy
| | - Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza - Molinette, Torino, Italy
| | | | - Angelo Bianchetti
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna, Brescia, Italy
| | - Stefano Cappa
- Italian Society of Neurology for Dementia (SINDEM), Roma, Italy
| | - Filippo Fimognari
- Italian Society of Hospital's and Community Geriatrics (SIGOT), Roma, Italy
| | - Raffaele Antonelli Incalzi
- Department of Geriatrics, Campus Bio-Medico University of Roma, Italy.,Italian Society of Gerontology and Geriatrics (SIGG), Roma, Italy
| | - Pietro Gareri
- Center for Cognitive Diseases and Dementias, Catanzaro, Italy.,Extrahospital Geriatric Association (AGE), Roma, Italy
| | | | - Mauro Campanini
- Federazione Italiana delle Associazioni Dirigenti Ospedalieri Internisti (FADOI), Società Italiana di Cure Palliative, Roma, Italy
| | | | - Marco Montorsi
- Department of General and Digestive Surgery, Humanitas University and Research Hospital, Roma, Italy.,Tor Vergata, Roma University, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Italy.,Geriatric Unit, San Gerardo Hospital, Monza, Italy
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Ferrara MC, Andreano A, Tassistro E, Rapazzini P, Zurlo A, Volpato S, Mussi C, Corsi M, Lunardelli ML, Martini E, Castoldi G, De Filippi F, Pizzonia M, Monacelli F, Barone A, Pilotto A, March A, Ungar A, Capelli R, Galmarini V, Franzoni S, Terragnoli F, Bianchetti A, Cazzulani I, Gandossi C, Valsecchi MG, Bellelli G. Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients. Aging Clin Exp Res 2020; 32:1245-1253. [PMID: 32026420 DOI: 10.1007/s40520-020-01488-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. METHODS The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. RESULTS The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80-90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23-62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators ("pre-surgical cognitive assessment", "bone protection prescription", "use of urinary catheter" and "start of physiotherapy"), moderate in two indicators ("surgery performed ≤ 48 h from fracture" and "discharge toward rehabilitation" and low in one ("absence of delirium on day following surgery"). Comparison with international studies suggests very different ways of providing care to HF Italian patients. CONCLUSIONS The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.
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Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, Bianchetti L, Trabucchi M. Clinical Presentation of COVID19 in Dementia Patients. J Nutr Health Aging 2020; 24:560-562. [PMID: 32510106 PMCID: PMC7227170 DOI: 10.1007/s12603-020-1389-1] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE No studies analyzing the role of dementia as a risk factor for mortality in patients affected by COVID-19. We assessed the prevalence, clinical presentation and outcomes of dementia among subjects hospitalized for COVID19 infection. DESIGN Retrospective study. SETTING COVID wards in Acute Hospital in Brescia province, Northern Italy. PARTICIPANTS We used data from 627 subjects admitted to Acute Medical wards with COVID 19 pneumonia. MEASUREMENTS Clinical records of each patients admitted to the hospital with a diagnosis of COVID19 infection were retrospectively analyzed. Diagnosis of dementia, modalities of onset of the COVID-19 infection, symptoms of presentation at the hospital and outcomes were recorded. RESULTS Dementia was diagnosed in 82 patients (13.1%). The mortality rate was 62.2% (51/82) among patients affected by dementia compared to 26.2% (143/545) in subjects without dementia (p<0.001, Chi-Squared test). In a logistic regression model age, and the diagnosis of dementia resulted independently associated with a higher mortality, and patients diagnosed with dementia presented an OR of 1.84 (95% CI: 1.09-3.13, p<0.05). Among patients diagnosed with dementia the most frequent symptoms of onset were delirium, especially in the hypoactive form, and worsening of the functional status. CONCLUSION The diagnosis of dementia, especially in the most advanced stages, represents an important risk factor for mortality in COVID-19 patients. The clinical presentation of COVID-19 in subjects with dementia is atypical, reducing early recognition of symptoms and hospitalization.
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Affiliation(s)
- A Bianchetti
- Angelo Bianchetti, MD. Department Medicine and Rehabilitation, Istituto Clinico S.Anna Hospital, via del Franzone 31, 25122 Brescia, Italy; e-mail: , https://orcid.org/0000-0002-2914-0627, phone: +390303197409 - fax: +390303198687
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Rozzini R, Bianchetti A, Mazzeo F, Cesaroni G, Bianchetti L, Trabucchi M. Delirium: Clinical Presentation and Outcomes in Older COVID-19 Patients. Front Psychiatry 2020; 11:586686. [PMID: 33262713 PMCID: PMC7688465 DOI: 10.3389/fpsyt.2020.586686] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
The aim of the study is to describe the clinical characteristics and outcomes of a series of older patients consecutively admitted into a non-ICU ward due to SARS-CoV-2 infection (14, males 11), developing delirium. Hypokinetic delirium with lethargy and confusion was observed in 43% of cases (6/14 patients). A total of eight patients exhibited hyperkinetic delirium and 50% of these patients (4/8) died. The overall mortality rate was 71% (10/14 patients). Among the four survivors we observed two different clinical patterns: two patients exhibited dementia and no ARDS (acute respiratory distress syndrome), while the remaining two patients exhibited ARDS and no dementia. The observed different clinical patterns of delirium (hypokinetic delirium; hyperkinetic delirium with or without dementia; hyperkinetic delirium with or without ARDS) identified patients with different prognosis: we believe these observations may have an impact on the management of older subjects with delirium due to COVID-19.
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Affiliation(s)
- Renzo Rozzini
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.,Associazione Italiana di Psicogeriatria, Brescia, Italy
| | - Angelo Bianchetti
- Associazione Italiana di Psicogeriatria, Brescia, Italy.,Medicine and Rehabilitation Department, Istituto Clinico S. Anna Hospital, Brescia, Italy
| | - Francesca Mazzeo
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giulia Cesaroni
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
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de Girolamo G, Bellelli G, Bianchetti A, Starace F, Zanetti O, Zarbo C, Micciolo R. Older People Living in Long-Term Care Facilities and Mortality Rates During the COVID-19 Pandemic in Italy: Preliminary Epidemiological Data and Lessons to Learn. Front Psychiatry 2020; 11:586524. [PMID: 33173526 PMCID: PMC7591767 DOI: 10.3389/fpsyt.2020.586524] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Long-Term Care Facilities (LTCF) in Italy have been particularly affected by the COVID-19 pandemic, especially in terms of mortality rates of older residents. However, it is still unclear the actual extent of this situation. The aim of this manuscript is to assess the extent of mortality rates of older adults in LTCF during the pandemic across different regions of Italy, compared to the previous years and to older general population not resident in LTCF. Methods: We extracted and analyzed data collected by three Italian institutions (i.e., Italian Statistician Institute ISTAT, Italian N.I.H, Milan Health Unit) about the number of deaths among older people living in the community and among LTCF residents during the pandemic and the previous years. We also compared the observed mortality rate among LTCF residents in each Italian Region with the corresponding expected number of deaths of the general older adult population to obtain an observed/expected ratio (O/E ratio). Results: During the pandemic, about 8.5% (N = 6,797) of Italian older adults residents in LTCF died. Findings resulting from the O/E ratio suggest that LTCF residents (in particular in the Lombardy Region) show higher mortality rates when compared to expected values of mortality rates among the older general population living in the community. Furthermore, we found that the risk of death among LTCF residents increased about 4 times during the pandemic when compared to the previous years. Conclusions: Mortality rates in LTCF were high during the pandemic, especially in Lombardy. Possible causes of higher mortality rates in LTCF and suggestions for specific targeted interventions are discussed.
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Affiliation(s)
- Giovanni de Girolamo
- Unit of Psychiatric Epidemiology and Evaluation (UOPEV), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy.,Head of the Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Angelo Bianchetti
- Department of Medicine and Rehabilitation, S. Anna Hospital, Brescia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Addiction, Local Health Authority of Modena, Modena, Italy
| | - Orazio Zanetti
- Operative Unit (UO) Alzheimer-Memory Clinic, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristina Zarbo
- Unit of Psychiatric Epidemiology and Evaluation (UOPEV), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Rocco Micciolo
- Department of Psychology and Cognitive Sciences, University of Trento, Trento, Italy
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20
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Boccardi M, Nicolosi V, Festari C, Bianchetti A, Cappa S, Chiasserini D, Falini A, Guerra UP, Nobili F, Padovani A, Sancesario G, Morbelli S, Parnetti L, Tiraboschi P, Muscio C, Perani D, Pizzini FB, Beltramello A, Salvini Porro G, Ciaccio M, Schillaci O, Trabucchi M, Tagliavini F, Frisoni GB. Italian consensus recommendations for a biomarker-based aetiological diagnosis in mild cognitive impairment patients. Eur J Neurol 2019; 27:475-483. [PMID: 31692118 DOI: 10.1111/ene.14117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Biomarkers support the aetiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and not very helpful in clinical practice. The aim was to develop a biomarker-based diagnostic algorithm for mild cognitive impairment patients, leveraging on knowledge from recognized national experts. METHODS With a Delphi procedure, experienced clinicians making variable use of biomarkers in clinical practice and representing five Italian scientific societies (neurology - Società Italiana di Neurologia per le Demenze; neuroradiology - Associazione Italiana di Neuroradiologia; biochemistry - Società Italiana di Biochimica Clinica; psychogeriatrics - Associazione Italiana di Psicogeriatria; nuclear medicine - Associazione Italiana di Medicina Nucleare) defined the theoretical framework, relevant literature, the diagnostic issues to be addressed and the diagnostic algorithm. An N-1 majority defined consensus achievement. RESULTS The panellists chose the 2011 National Institute on Aging and Alzheimer's Association diagnostic criteria as the reference theoretical framework and defined the algorithm in seven Delphi rounds. The algorithm includes baseline clinical and cognitive assessment, blood examination, and magnetic resonance imaging with exclusionary and inclusionary roles; dopamine transporter single-photon emission computed tomography (if no/unclear parkinsonism) or metaiodobenzylguanidine cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism (round VII, votes (yes-no-abstained): 3-1-1); 18 F-fluorodeoxyglucose positron emission tomography for suspected frontotemporal lobar degeneration and low diagnostic confidence of Alzheimer's disease (round VII, 4-0-1); cerebrospinal fluid for suspected Alzheimer's disease (round IV, 4-1-0); and amyloid positron emission tomography if cerebrospinal fluid was not possible/accepted (round V, 4-1-0) or inconclusive (round VI, 5-0-0). CONCLUSIONS These consensus recommendations can guide clinicians in the biomarker-based aetiological diagnosis of mild cognitive impairment, whilst guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.
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Affiliation(s)
- M Boccardi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
| | - V Nicolosi
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy
| | - C Festari
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Brescia, Brescia, Italy
| | - A Bianchetti
- Istituto Clinico S. Anna, Brescia, Italy.,Italian Psychogeriatric Association (AIP), Brescia, Italy
| | - S Cappa
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University Institute of Higher Studies, Pavia, Italy.,Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy
| | - D Chiasserini
- University of Perugia, Perugia, Italy.,Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy
| | - A Falini
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Italian Association of Neuroradiology (AINR), Milan, Italy
| | - U P Guerra
- Poliambulanza Foundation, Brescia, Italy.,Italian Association of Nuclear Medicine (AIMN), Bari, Italy
| | - F Nobili
- Italian Association of Nuclear Medicine (AIMN), Bari, Italy.,University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Padovani
- Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy.,Brescia University Hospital, Brescia, Italy
| | - G Sancesario
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,IRCCS Santa Lucia Foundation, Neuroimmunology Unit Via Ardeatina 354, Rome, Italy
| | - S Morbelli
- University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - L Parnetti
- Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | | | - C Muscio
- IRCCS 'Carlo Besta', Milan, Italy
| | - D Perani
- IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - A Beltramello
- Verona University Hospital, Verona, Italy.,IRCCS 'Sacro Cuore-Don Calabria', Negrar, Verona, Italy
| | | | - M Ciaccio
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy.,University of Palermo, Palermo, Italy
| | - O Schillaci
- University Tor Vergata, Rome, Italy.,IRCCS-Neuromed, Pozzilli, Italy
| | - M Trabucchi
- Italian Psychogeriatric Association (AIP), Brescia, Italy.,University Tor Vergata, Rome, Italy
| | | | - G B Frisoni
- IRCCS Istituto Centro S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.,University of Geneva, Geneva, Switzerland
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21
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Boccardi M, Nicolosi V, Festari C, Bianchetti A, Cappa SF, Chiasserini D, Falini A, Guerra UP, Nobili F, Padovani A, Sancesario GM, Morbelli S, Parnetti L, Tiraboschi P, Muscio C, Perani D, Pizzini FB, Beltramello A, Porro GS, Ciaccio M, Schillaci O, Trabucchi M, Tagliavini F, Frisoni GB. P1-238: ITALIAN CONSENSUS RECOMMENDATIONS FOR THE ETIOLOGICAL DIAGNOSIS IN MEMORY CLINICS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Sarcopenia is a major contributor to the risk of physical frailty, functional decline, poor health-related quality of life and premature death in older people. Sarcopenia can be considered a geriatric syndrome. The term sarcopenia indicates the loss of muscle mass that accompanies aging. Muscle mass declines with aging process with differences between subjects in relation to the presence of chronic diseases, to lifestyles habits (mainly diet and physical activity), to cognitive status. Sarcopenia in the elderly is associated with poor health outcomes, such as falls, disability, loss of independence, and mortality; however, it is potentially treatable if recognized and intervened early. The prevalence of sarcopenia rates between 5% and 13% in community-dwelling older people aged 65 years and over, and is higher in those 80 years and older (20-25%). The cause of sarcopenia is generally thought to be multifactorial, with environmental causes, disease triggers, inflammatory pathway activation, and a large number of cellular and biochemical abnormalities. Resistance training and amino acid supplementation are a recommended practice for the prevention of sarcopenia. The essential elements for the management of the sarcopenic patient are the recognition of a condition of frailty, an accurate multidimensional geriatric assessment, with attention to cognitive problems, mood, functional problems, living conditions, using standardized instruments. Combining exercise with some pharmacological compounds such as β- Hydroxy-β-methylbutyrate (HMB) and dietary supplements (including proteins, aminoacids and vitamin D) may exert a beneficial effect on older adults thus influencing the progress to sarcopenia. The recommended daily amount of protein is greater for older people. Vitamin D and leucine enrichment seems mandatory in order to improve muscle mass and lowerextremity function among sarcopenic older adults. There are some evidences that collagen peptides in this setting might be even superior to whey protein in promoting muscle growth and increasing the mobility.
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Bo M, Porrino P, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bianchetti A, Musicco M, Ferrari A, Ferrara N, Filippini C, Trabucchi M, Morandi A, Bellelli G. The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015". Aging Clin Exp Res 2019; 31:411-420. [PMID: 29858986 DOI: 10.1007/s40520-018-0974-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
BACKROUND Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. AIM This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. METHODS Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). RESULTS Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. DISCUSSION We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. CONCLUSION Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence.
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Affiliation(s)
- Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza, Molinette, Corso Bramante, 88, 10126, Torino, Italy
| | - Paola Porrino
- Section of Geriatrics, Città della Salute e della Scienza, Molinette, Corso Bramante, 88, 10126, Torino, Italy.
| | - Simona G Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Fondation S Lucia, Via Ardeatina, 306-354, 00179, Roma, Italy
| | - Andrea Mazzone
- Redaelli Geriatric Institute, Via Bartolomeo d'Alviano, 78, 20146, Milano, Italy
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Via della Montagnola, 81, 60127, Ancona, Italy
| | - Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and AziendaOspedaliero-UniversitariaCareggi, Largo Brambilla, 3a, 50134, Firenze, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, IstitutoClinico S. Anna, Via del Franzone, 31, 25127, Brescia, Italy
| | - Massimo Musicco
- Institute of Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, Segrate, 20090, Milano, Italy
- Italian Society of Neurology for Dementia (SINDEM), via del Rastrello, 7, 53100, Siena, Italy
| | - Alberto Ferrari
- Italian Society of Hospital and Community Geriatrics (SIGOT), Roma, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Corso Umberto I 40, 80138, Napoli, Italy
| | - Claudia Filippini
- Department of Surgical Sciences, University of Turin, Corso Bramante, 88, 10126, Torino, Italy
| | - Marco Trabucchi
- Geriatric Research Group, via Fratelli Lombardi, 2, 25121, Brescia, Italy
- Italian Psychogeriatric Association (AIP), Via Fratelli Lombardi, 2, 25121, Brescia, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Via Aselli, 14, 26100, Cremona, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milano, Italy
- Geriatric Unit, San Gerardo University Hospital, Via G. B. Pergolesi, 33, 20900, Monza, Italy
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Limongi F, Noale M, Bianchetti A, Ferrara N, Padovani A, Scarpini E, Trabucchi M, Maggi S. The instruments used by the Italian centres for cognitive disorders and dementia to diagnose mild cognitive impairment (MCI). Aging Clin Exp Res 2019; 31:101-107. [PMID: 30178442 DOI: 10.1007/s40520-018-1032-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022]
Abstract
AIMS The purpose of this study was to examine the tools used in Italy to diagnose mild cognitive impairment (MCI). METHODS In collaboration with the Luigi Amaducci Research Consortium, the Italian Network of Alzheimer Evaluation Units prepared a questionnaire to describe how MCI is diagnosed in the Italian Centres for cognitive disorders and dementia (CCDD). RESULTS Most of the ninety-two CCDDs participating in the survey were located in hospitals (54.7%); large percentages were coordinated by neurologists (50.8%) and geriatricians (44.6%). Almost all (98.5%) used the Mini Mental State Examination to diagnose MCI; the Clock Drawing Test was also frequently used (83.9%). Other neuropsychological, imaging and biomarker tests were utilized less frequently and a wide diversity in the instruments used was noted. CONCLUSIONS According to the results, diagnoses of MCI are based on a multitude of instruments, with major differences in the clinical assessment of geriatricians and neurologists. Standardized testing protocols, validated instruments and cut-off points need to be identified and adopted by the CCDDs for assessing MCI.
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Affiliation(s)
- Federica Limongi
- CNR, Neuroscience Institute, Aging Branch, Via Giustiniani 2, 35128, Padua, Italy
| | - Marianna Noale
- CNR, Neuroscience Institute, Aging Branch, Via Giustiniani 2, 35128, Padua, Italy.
| | - Angelo Bianchetti
- Dipartimento di Medicina e Riabilitazione, Istituto Clinico S.Anna-Gruppo San Donato, Brescia, Italy
- Società Italiana di Geriatria e Gerontologia (SIGG), Florence, Italy
- Associazione Italiana di Psicogeriatria (AIP), Brescia, Italy
| | - Nicola Ferrara
- Società Italiana di Geriatria e Gerontologia (SIGG), Florence, Italy
- Associazione Italiana di Psicogeriatria (AIP), Brescia, Italy
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Alessandro Padovani
- Neurology Unit, Dipartimento Scienze Cliniche e Sperimentali, Università degli Studi di Brescia, Brescia, Italy
| | - Elio Scarpini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Università di Milano, Centro Dino Ferrari, Milan, Italy
| | - Marco Trabucchi
- Società Italiana di Geriatria e Gerontologia (SIGG), Florence, Italy
- Associazione Italiana di Psicogeriatria (AIP), Brescia, Italy
- University of "Tor Vergata", Rome, Italy
| | - Stefania Maggi
- CNR, Neuroscience Institute, Aging Branch, Via Giustiniani 2, 35128, Padua, Italy
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Morichi V, Fedecostante M, Morandi A, Di Santo SG, Mazzone A, Mossello E, Bo M, Bianchetti A, Rozzini R, Zanetti E, Musicco M, Ferrari A, Ferrara N, Trabucchi M, Cherubini A, Bellelli G. A Point Prevalence Study of Delirium in Italian Nursing Homes. Dement Geriatr Cogn Disord 2018; 46:27-41. [PMID: 30092581 DOI: 10.1159/000490722] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/07/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Delirium is a common geriatric syndrome. Few studies have been conducted in nursing home (NH) residents. The aim of this project was to perform a point prevalence study of delirium in Italian NHs. METHODS Data collected in 71 NHs are presented. Inclusion criteria were age ≥65 years and native Italian speaker. Exclusion criteria were coma, aphasia, and end-of-life status. Sociodemographic and medical data were recorded. Delirium was assessed using the Assessment Test for Delirium and Cognitive Impairment (4-AT). Patients with a 4-AT score ≥4 were considered to have delirium. Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS). RESULTS A total of 1,454 patients were evaluated (mean age 84.4 ± 7.4 years, 70.2% female), of whom 535 (36.8%) had delirium. In multivariate logistic regression analysis, variables significantly associated with delirium were education (OR 0.94, 95% CI 0.91-0.97), dementia (OR 3.12, 95% CI 2.38-4.09), functional dependence (OR 6.13, 95% CI 3.08-12.19 for ADL score 0; OR 1.99, 95% CI 1.03-3.84 for ADL score 1-5), malnutrition (OR 4.87, 95% CI 2.68-8.84), antipsychotics (OR 2.40, 95% CI 1.81-3.18), and physical restraints (OR 2.48, 95% CI 1.71-3.59). CONCLUSION Delirium is common in older NH residents. Simple assessment tools might facilitate its recognition in this vulnerable population.
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Affiliation(s)
- Valeria Morichi
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Massimiliano Fedecostante
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Alessandro Morandi
- Geriatric Research Group, Brescia, Italy.,Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy
| | - Simona Gabriella Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation Santa Lucia, Rome, Italy
| | | | - Enrico Mossello
- Geriatric Medicine Research Unit, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna, Brescia, Italy
| | - Renzo Rozzini
- Department of Geriatric and Internal Medicine, Poliambulanza Hospital, Brescia, Italy
| | | | - Massimo Musicco
- Institute of Biomedical Technologies, National Research Council, Milan, Italy.,Italian Society of Neurology for Dementia (SINDEM), Siena, Italy
| | - Alberto Ferrari
- Geriatric Unit, Department of Neuromotor Physiology, ASMN Hospital, Reggio Emilia, Italy.,Italian Society of Hospital and Community Geriatrics (SIGOT), Rome, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.,Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese, Telese Terme, Italy.,Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Marco Trabucchi
- Geriatric Research Group, Brescia, Italy.,Tor Vergata, Rome University, Rome, Italy.,Italian Psychogeriatric Association (AIP), Brescia, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Giuseppe Bellelli
- Geriatric Research Group, Brescia, Italy.,Geriatric Unit, San Gerardo University Hospital, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Mossello E, Tesi F, Di Santo SG, Mazzone A, Torrini M, Cherubini A, Bo M, Musicco M, Bianchetti A, Ferrari A, Ferrara N, Trabucchi M, Morandi A, Bellelli G. Recognition of Delirium Features in Clinical Practice: Data from the "Delirium Day 2015" National Survey. J Am Geriatr Soc 2017; 66:302-308. [PMID: 29206286 DOI: 10.1111/jgs.15211] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Delirium is underrecognized in clinical practice. The primary aim of the present multicenter study was to compare the ability of nurses to identify delirium features with a standardized assessment. The secondary aim was to identify predictors of missed or incorrect identifications of delirium by nurses. DESIGN Point prevalence study in 120 wards across Italy. SETTING "Delirium Day 2015." PARTICIPANTS Inpatients aged 65 and older (N = 1,867). MEASUREMENTS Participants and nurses were asked specific questions to investigate their perceptions of the presence of delirium features (acute cognitive change, inattention, cognitive fluctuations, impaired arousal). Delirium was identified according to the results of the Assessment Test for Delirium and Cognitive Impairment (4AT), completed by a physician. Comorbidities including dementia, disability, drug treatments, and delirium motor subtype according to the Delirium Motor Subtype Scale were recorded. RESULTS Delirium was present in 429 subjects (23%) according to the 4AT. Cognitive fluctuations was the delirium feature that the nurses most often recognized. Nurses' perceptions of acute cognitive change, cognitive fluctuations, or impaired arousal had 84% sensitivity and 81% specificity for delirium. The nonmotor subtype of delirium was less likely to be recognized (80%) than the hyperactive (97%), mixed (92%), and hypoactive (90%) subtypes. Incorrect perception of delirium was more frequent in subjects with dementia (specificity 64%). CONCLUSIONS The delirium feature that nurses were best able to recognize was cognitive fluctuations. The nonmotor subtype was associated with a lower recognition rate. Routine observation and registration of delirium features by nurses in clinical practice might be helpful to increase formal diagnosis of delirium.
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Affiliation(s)
- Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Francesca Tesi
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Simona G Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy
| | | | - Monica Torrini
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS-INRCA, Ancona, Italy
| | - Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Massimo Musicco
- Institute of Biomedical Technologies, National Research Council, Segrate, Italy.,Italian Society of Neurology for Dementia, Siena, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna, Brescia, Italy
| | - Alberto Ferrari
- Geriatric Unit, Department of Neuromotor Physiology, ASMN Hospital, Reggio Emilia, Italy.,Italian Society of Hospital and Community Geriatrics, Roma, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.,Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese, Telese Terme, Italy.,Italian Society of Gerontology and Geriatrics, Firenze, Italy
| | - Marco Trabucchi
- Tor Vergata, Rome University, Roma, Italy.,Italian Psychogeriatric Association, Brescia, Italy.,Geriatric Research Group, Brescia, Italy
| | - Alessandro Morandi
- Geriatric Research Group, Brescia, Italy.,Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Cremona, Italy
| | - Giuseppe Bellelli
- Geriatric Research Group, Brescia, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,Geriatric Unit, San Gerardo University Hospital, Monza, Italy
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Morandi A, Di Santo SG, Cherubini A, Mossello E, Meagher D, Mazzone A, Bianchetti A, Ferrara N, Ferrari A, Musicco M, Trabucchi M, Bellelli G. Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study. Am J Geriatr Psychiatry 2017; 25:1064-1071. [PMID: 28579352 DOI: 10.1016/j.jagp.2017.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. METHODS This is a point prevalence study nested in the "Delirium Day 2015", which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. RESULTS Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). CONCLUSIONS The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium.
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Affiliation(s)
- Alessandro Morandi
- Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy; Geriatric Research Group, Italy.
| | - Simona G Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy
| | | | - Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - David Meagher
- Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Andrea Mazzone
- Department of Rehabilitation, Istituto Redaelli, Milano, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna, Brescia, Italy
| | | | | | - Massimo Musicco
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy
| | | | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy
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Almici C, Skert C, Bruno B, Bianchetti A, Verardi R, Di Palma A, Neva A, Braga S, Piccinelli G, Piovani G, Malagola M, Bernardi S, Giaccone L, Brunello L, Festuccia M, Baeten K, Russo D, Marini M. Circulating endothelial cell count: a reliable marker of endothelial damage in patients undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 2017; 52:1637-1642. [PMID: 28892085 DOI: 10.1038/bmt.2017.194] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Abstract
The physio-pathologic interrelationships between endothelium and GvHD have been better elucidated and have led to definition of the entity 'endothelial GvHD' as an essential early phase prior to the clinical presentation of acute GvHD. Using the CellSearch system, we analyzed circulating endothelial cells (CEC) in 90 allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients at the following time-points: T1 (pre-conditioning), T2 (pre-transplant), T3 (engraftment), T4 (onset of GvHD) and T5 (1 week after steroid treatment). Although CEC changes in allo-HSCT represent a dynamic phenomenon influenced by many variables (that is, conditioning, immunosuppressive treatments, engraftment syndrome and infections), we showed that CEC peaks were constantly seen at onset of acute GvHD and invariably returned to pre-transplant values after treatment response. Since we showed that CEC changes during allo-HSCT has rapid kinetics that may be easily missed if blood samples are drawn at pre-fixed time-points, we rather suggest an 'on demand' evaluation of CEC counts right at onset of GvHD clinical symptoms to possibly help differentiate GvHD from other non-endothelial complications. We confirm that CEC changes are a suitable biomarker to monitor endothelial damage in patients undergoing allo-transplantation and hold the potential to become a useful tool to support GvHD diagnosis (ClinicalTrials.gov NCT02064972).
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Affiliation(s)
- C Almici
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - C Skert
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - B Bruno
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - A Bianchetti
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - R Verardi
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - A Di Palma
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - A Neva
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - S Braga
- Department of Trasfusion Medicine, Laboratory for Stem Cells Manipulation and Cryopreservation, ASST Spedali Civili, Brescia, Italy
| | - G Piccinelli
- Department of Transfusion Medicine, ASST Spedali Civili, Brescia, Italy
| | - G Piovani
- Biology and Genetics Division, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - M Malagola
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - S Bernardi
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - L Giaccone
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - L Brunello
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Festuccia
- BMT Unit, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - K Baeten
- Global Scientific and Medical Affairs, Janssen Diagnostics, Beerse, Belgium
| | - D Russo
- Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - M Marini
- Department of Transfusion Medicine, ASST Spedali Civili, Brescia, Italy
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29
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Boccardi M, Altomare D, Ferrari C, Festari C, Guerra UP, Paghera B, Pizzocaro C, Lussignoli G, Geroldi C, Zanetti O, Cotelli MS, Turla M, Borroni B, Rozzini L, Mirabile D, Defanti C, Gennuso M, Prelle A, Gentile S, Morandi A, Vollaro S, Volta GD, Bianchetti A, Conti MZ, Cappuccio M, Carbone P, Bellandi D, Abruzzi L, Bettoni L, Villani D, Raimondi MC, Lanari A, Ciccone A, Facchi E, Di Fazio I, Rozzini R, Boffelli S, Manzoni L, Salvi GP, Cavaliere S, Belotti G, Avanzi S, Pasqualetti P, Muscio C, Padovani A, Frisoni GB. Assessment of the Incremental Diagnostic Value of Florbetapir F 18 Imaging in Patients With Cognitive Impairment. JAMA Neurol 2016; 73:1417-1424. [DOI: 10.1001/jamaneurol.2016.3751] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marina Boccardi
- LANVIE–Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland2Laboratory of Alzheimer’s Neuroimaging and Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Daniele Altomare
- Laboratory of Alzheimer’s Neuroimaging and Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy3Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Clarissa Ferrari
- Unit of Statistics, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristina Festari
- Laboratory of Alzheimer’s Neuroimaging and Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy3Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Ugo Paolo Guerra
- Department of Nuclear Medicine, Poliambulanza Foundation, Brescia, Italy
| | - Barbara Paghera
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Claudio Pizzocaro
- Department of Nuclear Medicine, Poliambulanza Foundation, Brescia, Italy
| | - Giulia Lussignoli
- Alzheimer’s Unit, Memory Clinic, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristina Geroldi
- Alzheimer’s Unit, Memory Clinic, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Orazio Zanetti
- Alzheimer’s Unit, Memory Clinic, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Marinella Turla
- Neurology Unit, Ospedale di Vallecamonica Esine, Brescia, Italy
| | - Barbara Borroni
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | - Luca Rozzini
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | - Dario Mirabile
- European Foundation Biomedical Research, Center of Excellence Alzheimer, Ospedale Briolini, Gazzaniga, Bergamo, Italy
| | - Carlo Defanti
- European Foundation Biomedical Research, Center of Excellence Alzheimer, Ospedale Briolini, Gazzaniga, Bergamo, Italy
| | | | | | - Simona Gentile
- Department of Rehabilitation, Fondazione Teresa Camplani, Casa di cura Ancelle della Carità, Cremona, Italy
| | - Alessandro Morandi
- Department of Rehabilitation, Fondazione Teresa Camplani, Casa di cura Ancelle della Carità, Cremona, Italy
| | - Stefano Vollaro
- Neurology Unit, Istituto Clinico Città di Brescia, Brescia, Italy
| | | | - Angelo Bianchetti
- Department of Medicine and Rehabilitation, Istituto Clinico Sant’Anna, Brescia, Italy
| | - Marta Zaffira Conti
- Hospice, Istituto Polifunzionale Sociosanitario Foundation Cardinal Giorgio Gusmini, Vertova, Bergamo, Italy
| | - Melania Cappuccio
- Hospice, Istituto Polifunzionale Sociosanitario Foundation Cardinal Giorgio Gusmini, Vertova, Bergamo, Italy
| | - Pasqualina Carbone
- Alzheimer Evaluation Unit, Istituto Ospedaliero di Sospiro Non-Profit Organization of Social Utility Foundation, Sospiro, Cremona, Italy
| | - Daniele Bellandi
- Alzheimer Evaluation Unit, Istituto Ospedaliero di Sospiro Non-Profit Organization of Social Utility Foundation, Sospiro, Cremona, Italy
| | - Luciano Abruzzi
- Neurology Unit, Istituti Ospedalieri di Cremona, Cremona, Italy
| | - Luigi Bettoni
- Neurology Unit, Istituti Ospedalieri di Cremona, Cremona, Italy
| | - Daniele Villani
- Alzheimer Evaluation Unit, Casa di Cura Figlie di S. Camillo, Cremona, Italy
| | | | | | | | - Emanuela Facchi
- Geriatric General Rehabilitation, Fondazione Richiedei, Palazzolo sull'Oglio, Brescia, Italy
| | - Ignazio Di Fazio
- Geriatric General Rehabilitation, Fondazione Richiedei, Palazzolo sull'Oglio, Brescia, Italy
| | - Renzo Rozzini
- Neurology Unit, Poliambulanza Foundation, Brescia, Italy
| | | | - Laura Manzoni
- Neuromotor and Cognitive Rehabilitation Center, Clinic Quarenghi, San Pellegrino Terme, Bergamo, Italy
| | - Giovanni Pietro Salvi
- Neuromotor and Cognitive Rehabilitation Center, Clinic Quarenghi, San Pellegrino Terme, Bergamo, Italy
| | - Sabina Cavaliere
- Alzheimer Evaluation Unit, Hospice Santa Maria Ausiliatrice Onlus Foundation, Bergamo, Italy
| | - Gloria Belotti
- Alzheimer Evaluation Unit, Hospice Santa Maria Ausiliatrice Onlus Foundation, Bergamo, Italy
| | - Stefano Avanzi
- Neuromotor Rehabilitation Medicine, Salvatore Maugeri Foundation Clinic of Work and Rehabilitation, Istituto di Ricovero e Cura a Carattere Scientifico, Castel Goffredo, Mantova, Italy
| | - Patrizio Pasqualetti
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
| | - Cristina Muscio
- Laboratory of Alzheimer’s Neuroimaging and Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy26Division of Neurology V–Neuropathology, Fondazione, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandro Padovani
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Brescia, Italy
| | - Giovanni B. Frisoni
- LANVIE–Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland2Laboratory of Alzheimer’s Neuroimaging and Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy27Memory Clinic, University Hospital of Geneva, Geneva, Switzerland
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Cattaneo A, Cattane N, Galluzzi S, Provasi S, Lopizzo N, Festari C, Ferrari C, Guerra UP, Paghera B, Muscio C, Bianchetti A, Volta GD, Turla M, Cotelli MS, Gennuso M, Prelle A, Zanetti O, Lussignoli G, Mirabile D, Bellandi D, Gentile S, Belotti G, Villani D, Harach T, Bolmont T, Padovani A, Boccardi M, Frisoni GB. Association of brain amyloidosis with pro-inflammatory gut bacterial taxa and peripheral inflammation markers in cognitively impaired elderly. Neurobiol Aging 2016; 49:60-68. [PMID: 27776263 DOI: 10.1016/j.neurobiolaging.2016.08.019] [Citation(s) in RCA: 755] [Impact Index Per Article: 94.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 12/14/2022]
Abstract
The pathway leading from amyloid-β deposition to cognitive impairment is believed to be a cornerstone of the pathogenesis of Alzheimer's disease (AD). However, what drives amyloid buildup in sporadic nongenetic cases of AD is still unknown. AD brains feature an inflammatory reaction around amyloid plaques, and a specific subset of the gut microbiota (GMB) may promote brain inflammation. We investigated the possible role of the GMB in AD pathogenesis by studying the association of brain amyloidosis with (1) GMB taxa with pro- and anti-inflammatory activity; and (2) peripheral inflammation in cognitively impaired patients. We measured the stool abundance of selected bacterial GMB taxa (Escherichia/Shigella, Pseudomonas aeruginosa, Eubacterium rectale, Eubacterium hallii, Faecalibacterium prausnitzii, and Bacteroides fragilis) and the blood expression levels of cytokines (pro-inflammatory cytokines: CXCL2, CXCL10, interleukin [IL]-1β, IL-6, IL-18, IL-8, inflammasome complex (NLRP3), tumor necrosis factor-alpha [TNF-α]; anti-inflammatory cytokines: IL-4, IL-10, IL-13) in cognitively impaired patients with (n = 40, Amy+) and with no brain amyloidosis (n = 33, Amy-) and also in a group of controls (n = 10, no brain amyloidosis and no cognitive impairment). Amy+ patients showed higher levels of pro-inflammatory cytokines (IL-6, CXCL2, NLRP3, and IL-1β) compared with both controls and with Amy- patients. A reduction of the anti-inflammatory cytokine IL-10 was observed in Amy+ versus Amy-. Amy+ showed lower abundance of E. rectale and higher abundance of Escherichia/Shigella compared with both healthy controls (fold change, FC = -9.6, p < 0.001 and FC = +12.8, p < 0.001, respectively) and to Amy- (FC = -7.7, p < 0.001 and FC = +7.4, p = 0.003). A positive correlation was observed between pro-inflammatory cytokines IL-1β, NLRP3, and CXCL2 with abundance of the inflammatory bacteria taxon Escherichia/Shigella (rho = 0.60, p < 0.001; rho = 0.57, p < 0.001; and rho = 0.30, p = 0.007, respectively) and a negative correlation with the anti-inflammatory E. rectale (rho = -0.48, p < 0.001; rho = -0.25, p = 0.024; rho = -0.49, p < 0.001). Our data indicate that an increase in the abundance of a pro-inflammatory GMB taxon, Escherichia/Shigella, and a reduction in the abundance of an anti-inflammatory taxon, E. rectale, are possibly associated with a peripheral inflammatory state in patients with cognitive impairment and brain amyloidosis. A possible causal relation between GMB-related inflammation and amyloidosis deserves further investigation.
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Affiliation(s)
- Annamaria Cattaneo
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy; King's College London, Institute of Psychiatry, London, UK.
| | - Nadia Cattane
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy
| | - Samantha Galluzzi
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Stefania Provasi
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy
| | - Nicola Lopizzo
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy
| | - Cristina Festari
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy
| | - Ugo Paolo Guerra
- Nuclear Medicine, Poliambulanza Foundation, Istituto Ospedaliero, Brescia, Italy
| | - Barbara Paghera
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Muscio
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy; European Foundation Biomedical Research (FERB), Center of Excellence Alzheimer, Ospedale Briolini, Gazzaniga, Bergamo, Italy
| | - Angelo Bianchetti
- Department of Medicine and Rehabilitation, Istituto Clinico Sant'Anna, Brescia, Italy
| | | | - Marinella Turla
- Neurology Unit, Ospedale di Vallecamonica Esine, Brescia, Italy
| | | | | | | | - Orazio Zanetti
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy
| | - Giulia Lussignoli
- Biological Psychiatry Laboratory, IRCCS Fatebenefratelli, Brescia, Italy
| | - Dario Mirabile
- European Foundation Biomedical Research (FERB), Center of Excellence Alzheimer, Ospedale Briolini, Gazzaniga, Bergamo, Italy
| | - Daniele Bellandi
- Alzheimer Evaluation Unit, Istituto Ospedaliero di Sospiro ONLUS Foundation, Cremona, Italy
| | - Simona Gentile
- Department of Rehabilitation, Casa di Cura Ancelle della Carità, Cremona, Italy
| | - Gloria Belotti
- Alzheimer Evaluation Unit, Hospice Santa Maria Ausiliatrice ONLUS Foundation, Bergamo, Italy
| | - Daniele Villani
- Alzheimer Evaluation Unit, Casa di Cura Figlie di S. Camillo, Cremona, Italy
| | - Taoufiq Harach
- Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
| | | | - Alessandro Padovani
- Neurology Unit, Department of Medical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marina Boccardi
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging and Alzheimer's Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals, Geneva, Switzerland; Memory Clinic, University Hospitals and University of Geneva, Geneva, Switzerland
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31
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Bellelli G, Morandi A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Bianchetti A, Rozzini R, Zanetti E, Musicco M, Ferrari A, Ferrara N, Trabucchi M. "Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med 2016; 14:106. [PMID: 27430902 PMCID: PMC4950237 DOI: 10.1186/s12916-016-0649-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/23/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. METHODS This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. RESULTS The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. CONCLUSIONS Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys.
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Affiliation(s)
- Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. .,Geriatric Unit, San Gerardo University Hospital, Monza, Italy. .,Geriatric Research Group, Brescia, Italy.
| | - Alessandro Morandi
- Geriatric Research Group, Brescia, Italy.,Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Cremona, Italy
| | - Simona G Di Santo
- Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, IRCCS Foundation S Lucia, Roma, Italy
| | | | | | - Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza - Molinette, Torino, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna, Brescia, Italy
| | - Renzo Rozzini
- Department of Geriatric and Internal Medicine, Poliambulanza Hospital, Brescia, Italy
| | | | - Massimo Musicco
- Institute of Biomedical Technologies, National Research Council, Segrate (Milan), Italy.,Italian Society of Neurology for Dementia (SINDEM), Siena, Italy
| | - Alberto Ferrari
- Geriatric Unit, Department of Neuromotor Physiology, ASMN Hospital, Reggio Emilia, Italy.,Italian Society of Hospital and Community Geriatrics (SIGOT), Roma, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.,Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Telese, Telese Terme (BN), Italy.,Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Marco Trabucchi
- Geriatric Research Group, Brescia, Italy.,Tor Vergata, Rome University, Rome, Italy.,Italian Psychogeriatric Association (AIP), Brescia, Italy
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Coccolini F, Corbella D, Finazzi P, Brambillasca P, Benigni A, Prussiani V, Ceresoli M, Manfredi R, Poiasina E, Bertoli P, Catena F, Bianchetti A, Bontempelli M, Lorini LF, Sonzogni V, Ansaloni L. Time course of cytokines, hemodynamic and metabolic parameters during hyperthermic intraperitoneal chemotherapy. Minerva Anestesiol 2015:R02Y9999N00A150087. [PMID: 26154446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Systemic response to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) causes the activation of endocrine, metabolic, hemodynamic and inflammatory processes. The aim of this work is to describe and analyze the time course of the inflammatory markers concentration during CRS+HIPEC in plasma and peritoneal fluids and the association with hemodynamic and metabolic parameters. MATERIAL AND METHODS Pre-, Intra- and Post-operative data were collected. Tumor necrosis factor (TNF), interleukine 6, procalcitonine (PCT), cancer antigen 125 (CA-125) in blood and in peritoneal fluids were evaluated. RESULTS Thirty-eight patients included, 29 (76.3%) female. Mean/median PCI: 9.2/5. Primary malignancy: 5 colo-rectal (13.2%), 5 gastric (13.2%), 23 ovarian (60.5%) and 5 others (13.2%). CCR 0-1 reached in all patients. Cardiac Index, Heart rate and Central Venous Pressure, increased during the procedure while Stroke Volume Variation showed a decrease. Mean Arterial Pressure and Superior Vena Cava Oxygenation were stable through the whole procedure. TNF and CA-125 were steady during the whole procedure; IL-6 had a relevant increase from baseline to start of perfusion (p<0.01); PCT had a steady increase at every time point. Peritoneal sampling showed a statistically significant increase (p<0.01) between start and end of the perfusion phase for all markers but TNF. Serum and peritoneal marker concentration were similar for TNF, PCT and CA-125. IL-6 showed a sharp difference. CONCLUSION The most significant variations are those of IL-6 and PCT. The cytokines level parallel the hemodynamic derangements. Treatment during HIPEC should mimic the established treatment during sepsis and septic shock.
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Affiliation(s)
- F Coccolini
- General surgery dept., Papa Giovanni XXIII Hospital, Bergamo, Italy -
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Conde AJ, Bianchetti A, Veiras FE, Federico A, Cabaleiro JM, Dufva M, Madrid RE, Fraigi L. A polymer chip-integrable piezoelectric micropump with low backpressure dependence. RSC Adv 2015. [DOI: 10.1039/c5ra08819d] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A polymer piezoelectric micropump fabricated with conventional machining methods that can be embedded in laminated microfluidic chips.
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Affiliation(s)
- A. J. Conde
- Centro de Micro y Nanoelectrónica del Bicentenario (CMNB)
- Instituto Nacional de Tecnología Industrial (INTI)
- San Martín
- Argentina
| | | | - F. E. Veiras
- Electrónica e Informática
- INTI
- San Martín
- Argentina
- Laboratorio de Sistemas Líquidos
| | - A. Federico
- Electrónica e Informática
- INTI
- San Martín
- Argentina
| | - J. M. Cabaleiro
- Laboratorio de Fluidodinámica
- FIUBA
- Argentina
- Laboratorio de Micro y Nanofluídica y Plasma
- UdeMM
| | - M. Dufva
- DTU Nanotech
- Technical University of Denmark
- Denmark
| | - R. E. Madrid
- Instituto Superior de Investigaciones Biológicas (INSIBIO-CONICET)
- Laboratorio de Medios e Interfases (LAMEIN)
- Dpto. de Bioingeniería FACET/UNT
- Argentina
| | - L. Fraigi
- Centro de Micro y Nanoelectrónica del Bicentenario (CMNB)
- Instituto Nacional de Tecnología Industrial (INTI)
- San Martín
- Argentina
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Alberici A, Archetti S, Pilotto A, Premi E, Cosseddu M, Bianchetti A, Semeraro F, Salvetti M, Muiesan ML, Padovani A, Borroni B. Results from a pilot study on amiodarone administration in monogenic frontotemporal dementia with granulin mutation. Neurol Sci 2014; 35:1215-9. [PMID: 24569924 DOI: 10.1007/s10072-014-1683-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/11/2014] [Indexed: 11/30/2022]
Abstract
Frontotemporal dementia (FTD) is one of the most important neurodegenerative conditions and Granulin (GRN) is one of the major genes associated to the disease. FTD-GRN patients are still orphan for any evidence-based target-therapy approach. Interestingly, it has been recently found that alkalizing agents rescued haploinsufficiency in cellular models expressing FTD-GRN mutations. We set up a pilot phase II clinical trial in five FTD patients with GRN Thr272s(g.1977_1980delCACT) mutation, to determine if amiodarone (200 mg/day) may (1) reverse progranulin deficiency and (2) delay disease progression. Each patient was scheduled for 7 study visits over 12 months period. We assessed GRN levels at baseline and after amiodarone administration during the treatment course. Somatic and neurologic examinations, along with cognitive and behavioral assessment were recorded as well. No significant effect on peripheral GRN levels was observed. In treated FTD, disease course did not differ when compared with a group of untreated FTD-GRN patients. This is the first trial targeting progranulin rescue in FTD-GRN patients using amiodarone. Despite the negative findings, it may be interesting to extend this attempt to a larger sample of subjects and to other alkalizing agents to restore granulin haploinsufficiency.
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Affiliation(s)
- A Alberici
- Department of Medical Sciences, Clinic of Neurology, Spedali Civili, University of Brescia, Piazzale Spedali Civili 1, 25100, Brescia, Italy,
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Rozzini R, Bianchetti A, Franzoni S, Zanetti O, Trabucchi M. Social, functional and health status influences on mortality: Consideration of a multidimensional inquiry in a large elderly population. J Cross Cult Gerontol 2014; 6:83-90. [PMID: 24390433 DOI: 10.1007/bf00117112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Health status, functional status, and social influences were analyzed as risk factors associated with mortality in 1201 elderly subjects (70-75 years old), living in the center of Brescia, Northern Italy, followed up for three years.Mortality was positively associated with degree of impairment in health status, functional status, and mental status as measured by cognitive function and mood depression. Among social conditions no relation was found between mortality and living alone, education, or income, while a significant inverse relationship has been found between mortality and activities. In defining risk factors of mortality in aged people not only health status and cognitive function have to be taken into account but also social activities; these latter may act as protective factors buffering the organism from the effects of noxious stimuli.
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Affiliation(s)
- R Rozzini
- Geriatric Research Group, Brescia, Italy
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Premi E, Gazzina S, Bozzali M, Archetti S, Alberici A, Cercignani M, Bianchetti A, Gasparotti R, Turla M, Caltagirone C, Padovani A, Borroni B. Cognitive reserve in granulin-related frontotemporal dementia: from preclinical to clinical stages. PLoS One 2013; 8:e74762. [PMID: 24040338 PMCID: PMC3767639 DOI: 10.1371/journal.pone.0074762] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/02/2013] [Indexed: 12/03/2022] Open
Abstract
Objective Consistent with the cognitive reserve hypothesis, higher education and occupation attainments may help persons with neurodegenerative dementias to better withstand neuropathology before developing cognitive impairment. We tested here the cognitive reserve hypothesis in patients with frontotemporal dementia (FTD), with or without pathogenetic granulin mutations (GRN+ and GRN-), and in presymptomatic GRN mutation carriers (aGRN+). Methods Education and occupation attainments were assessed and combined to define Reserve Index (RI) in 32 FTD patients, i.e. 12 GRN+ and 20 GRN-, and in 17 aGRN+. Changes in functional connectivity were estimated by resting state fMRI, focusing on the salience network (SN), executive network (EN) and bilateral frontoparietal networks (FPNs). Cognitive status was measured by FTD-modified Clinical Dementia Rating Scale. Results In FTD patients higher level of premorbid cognitive reserve was associated with reduced connectivity within the SN and the EN. EN was more involved in FTD patients without GRN mutations, while SN was more affected in GRN pathology. In aGRN+, cognitive reserve was associated with reduced SN. Conclusions This study suggests that cognitive reserve modulates functional connectivity in patients with FTD, even in monogenic disease. In GRN inherited FTD, cognitive reserve mechanisms operate even in presymptomatic to clinical stages.
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Affiliation(s)
- Enrico Premi
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Stefano Gazzina
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, Santa Lucia Foundation IRCCS, Rome, Italy
| | | | - Antonella Alberici
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Mara Cercignani
- Brighton and Sussex Medical School, Clinical Imaging Centre, University of Sussex, Brighton, United Kingdom
| | | | | | | | - Carlo Caltagirone
- Department of Neuroscience, University of Rome “Tor Vergata”, Rome, Italy
| | - Alessandro Padovani
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
- * E-mail:
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Bianchetti A, Trabucchi M. Slaying dementia dragons. J Am Geriatr Soc 2013; 61:1247-8. [PMID: 23855870 DOI: 10.1111/jgs.12351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bianchetti A, Rozzini R, Trabucchi M. [Heart disease and psychogeriatric issues: a complexity model]. G Ital Cardiol (Rome) 2013; 14:12-18. [PMID: 23612208 DOI: 10.1714/1261.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this paper, the most common clinical conditions characterized by cardiac problems and psychogeriatric diseases are discussed. In particular, the impact of depressive disorders and dementia on treatment strategies and on patient's short- and long-term outcome is analyzed.
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Magni E, Binetti G, Bianchetti A, Rozzini R, Trabucchi M. Mini-Mental State Examination: a normative study in Italian elderly population. Eur J Neurol 2011; 3:198-202. [DOI: 10.1111/j.1468-1331.1996.tb00423.x] [Citation(s) in RCA: 415] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Borroni B, Alberici A, Grassi M, Turla M, Zanetti O, Bianchetti A, Dalla Volta G, Rozzini R, Gilberti N, Bellelli G, Padovani A. Is frontotemporal lobar degeneration a rare disorder? Evidence from a preliminary study in Brescia county, Italy. J Alzheimers Dis 2010; 19:111-6. [PMID: 20061630 DOI: 10.3233/jad-2010-1208] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Frontotemporal Lobar Degeneration (FTLD) has always been considered a rare disorder, but only a few epidemiologic studies are available. The aim of the present work was to ascertain all FTLD patients in a Northern Italy area from January 2001 to December 2008, and to estimate the disease prevalence. On the census day, 213 FTD patients were still alive, resulting in an overall prevalence of 17.6 per 100,000 inhabitants. The prevalence of FTLD in patients aged 45-65 years was 22 per 100,000 inhabitants (95% CI=17-27). The prevalence of FTLD was the highest in patients aged 66-75 (78 per 100,000 inhabitants, 95% CI=56-100), and it was still high over 75 years (54 per 100,000 inhabitants, 95% CI=36-69). FTLD is a more common form of dementia than previously recognized. Our results claimed that FTLD is not only an early-onset disorder, but it is frequent in advanced age as well.
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Affiliation(s)
- Barbara Borroni
- Department of Neurology, University of Brescia, Brescia, Italy.
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Ranieri P, Bianchetti A, Badini I, Trabucchi M. Family and Emergency Decision Making in Noncompetent Very Old Patients. J Am Med Dir Assoc 2009; 10:363. [DOI: 10.1016/j.jamda.2009.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 03/19/2009] [Indexed: 10/20/2022]
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Bianchetti A, Ranieri P, Badini I, Scudellari R, Grigolo M, Trabucchi M. P4‐132: Hospital admission of demented patients: Clinical, functional characteristics and outcomes. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Angelo Bianchetti
- Istituto Clinico S. AnnaBresciaItaly
- Geriatric Research GroupBresciaItaly
| | - Piera Ranieri
- Istituto Clinico S. AnnaBresciaItaly
- Geriatric Research GroupBresciaItaly
| | - Ilaria Badini
- Istituto Clinico S. AnnaBresciaItaly
- Geriatric Research GroupBresciaItaly
| | - Roberta Scudellari
- Istituto Clinico S. AnnaBresciaItaly
- Geriatric Research GroupBresciaItaly
| | - Marta Grigolo
- Istituto Clinico S. AnnaBresciaItaly
- Geriatric Research GroupBresciaItaly
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Cornali C, Bianchetti A, Trabucchi M. End-Stage Nursing Home Residents with Dementia: Recognizing the Need for Palliative Care. J Am Med Dir Assoc 2008; 9:281-3. [DOI: 10.1016/j.jamda.2008.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 01/14/2008] [Indexed: 11/26/2022]
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Ranieri P, Bianchetti A, Margiotta A, Virgillo A, Clini EM, Trabucchi M. Predictors of 6-Month Mortality in Elderly Patients with Mild Chronic Obstructive Pulmonary Disease Discharged from a Medical Ward After Acute Nonacidotic Exacerbation. J Am Geriatr Soc 2008; 56:909-13. [DOI: 10.1111/j.1532-5415.2008.01683.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Assessment of personality changes in patients with dementia has received little systematic investigation, although caregivers report personality modifications in every phase of dementia. METHODS A group of 52 patients with probable Alzheimer's disease (AD) vs. a group of fifteen control subjects were selected for these personality tests before and after the manifestation of dementia using an Italian version of Brooks and McKinaly's Personality Inventory (PI). RESULTS After the onset of AD, a significant shift from positive to negative characteristics in PI was observed in 12 of 18 bipolar pairs of adjectives constituting the instrument and the total mean PI score decreased significantly (p < 0.001), indicating a substantial worsening of personality profile. In the control group however, evaluated before and after retirement, personality traits and total mean PI score did not show a significant change. The association of personality traits and total PI score with demographic, cognitive and functional characteristics of AD patients was calculated. CONCLUSION Personality changes have been depicted to be influenced by severity of cognitive, functional and behavioural complaints rather than age, sex, education and disease duration. These first applications of the Italian version of PI confirmed that personality modifications make a consistent aspect of the phenomenology of AD although in the negative direction. Further studies are needed to understand the nature of personality changes in dementia and the utility of PI to investigate these changes.
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Affiliation(s)
- E Talassi
- Department of Medicine, Istituto Clinico S. Anna, Hospital, Brescia, Italy
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Talassi E, Guerreschi M, Feriani M, Fedi V, Bianchetti A, Trabucchi M. Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): A case control study. Arch Gerontol Geriatr 2007; 44 Suppl 1:391-9. [PMID: 17317481 DOI: 10.1016/j.archger.2007.01.055] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Data support the evidence that neuropsychological rehabilitation is effective in Alzheimer disease (AD), to strengthen the pharmacological treatment to delay the progression of dementia. At moment, a few studies have examined the efficacy of non-pharmacological treatment in MCI. This is a controlled study that assesses the effectiveness of neuropsychological rehabilitation on cognitive and behavioral symptoms and functional status in a group of community-dwelling subjects with MCI and MD. Our results demonstrate that a systematic rehabilitation, that provides a computerized cognitive program training, produces an improvement in cognitive and affective status of patients with MCI and MD, while a rehabilitation program not providing a punctual stimulation of cognitive functions, does not have significant effects.
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Affiliation(s)
- E Talassi
- Istituto Clinico S. Anna Hospital, Brescia, Italy
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