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Okoye C, Arosio B, Carino S, Putrino L, Franchi R, Rogani S, Cesari M, Mari D, Vitale G, Malara A, Calsolaro V, Monzani F. The Free Triiodothyronine/Free Thyroxine Ratio Is Associated with Frailty in Older Adults: A Longitudinal Multisetting Study. Thyroid 2023; 33:169-176. [PMID: 36641642 DOI: 10.1089/thy.2022.0422] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Various models have been proposed to predict frailty, including those based on clinical criteria and phenotypes. However, a simple biomarker associated with frailty has been not yet identified. The aim of this study is to evaluate the relationship between free triiodothyronine (fT3)/free thyroxine (fT4) ratio value and the degree of frailty among three different cohorts of older individuals: (1) acutely ill hospitalized patients, (2) nursing-home (NH) residents, and (3) home-dwelling centenarians. Methods: We performed a secondary analysis of de-identified patient-level data from two prospective observational studies on acutely hospitalized older patients (Geriatric Acute Unit [GAU]), and home-dwelling centenarians (CENT), and a retrospective-prospective observational study on older NH residents. Demographic characteristics, along with a 30-items Frailty Index (FI) and serum thyrotropin, fT3 and fT4 measurements were obtained. Results: Six hundred fifteen individuals (aged 86.4 ± 8.9 years; 55.1% females) were included in the study, including 298 (48.5%) GAU, 250 (40.6%) NH, and 67 (10.9%) CENT. A significant inverse relationship between fT3/fT4 ratio and FI values was observed (ρs = -0.17 [confidence interval; CI: -0.092 to 0.252], p < 0.001), and this was confirmed by logistic multivariate analysis (β = -0.44, odds ratio [OR]: 0.64 [CI: 0.47-0.87], p < 0.001) (after adjustment for age, sex, and cohorts). Moreover, a progressively decreased mortality risk was associated with rising fT3/fT4 ratio (OR 0.60 [CI: 0.44-0.80] β = -0.51, p < 0.001]. Conclusions: The fT3/fT4 ratio value was inversely correlated with frailty degree and mortality risk in a large cohort of older individuals, including centenarians, regardless of their sex and clinical condition. fT3/fT4 ratio value could represent an easily measured independent biochemical marker of frailty degree in older people.
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Affiliation(s)
- Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, Interdepartmental Research Centre on Biology and Pathology of Aging, University of Pisa, Pisa, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Beatrice Arosio
- Geriatrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Riccardo Franchi
- Geriatrics Unit, Department of Clinical and Experimental Medicine, Interdepartmental Research Centre on Biology and Pathology of Aging, University of Pisa, Pisa, Italy
| | - Sara Rogani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, Interdepartmental Research Centre on Biology and Pathology of Aging, University of Pisa, Pisa, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Daniela Mari
- Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Vitale
- Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | | | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, Interdepartmental Research Centre on Biology and Pathology of Aging, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, Interdepartmental Research Centre on Biology and Pathology of Aging, University of Pisa, Pisa, Italy
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Okoye C, Calsolaro V, Calabrese AM, Zotti S, Fedecostante M, Volpato S, Fumagalli S, Cherubini A, Antonelli Incalzi R, Monzani F. Determinants of Cause-Specific Mortality and Loss of Independence in Older Patients following Hospitalization for COVID-19: The GeroCovid Outcomes Study. J Clin Med 2022; 11:jcm11195578. [PMID: 36233447 PMCID: PMC9571114 DOI: 10.3390/jcm11195578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Hospitalization for acute SARS-CoV-2 infection confers an almost five-fold higher risk of post-discharge, all-cause mortality compared to controls from the general population. A negative impact on the functional autonomy of older patients, especially in cases of severe disease and prolonged hospitalization, has been recently described. However, little is known about the determinants of cause-specific mortality and loss of independence (LOI) in the activities of daily living (ADL) following COVID-19 hospitalization. Thus, the current prospective, multicenter study is aimed at identifying the determinants of post-discharge cause-specific mortality and the loss of autonomy in at least one ADL function. Older patients hospitalized for a SARS-CoV-2 infection were consecutively enrolled in an e-Registry from 1 March 2020, until 31 December 2020. After at least six months from discharge, patients were extensively re-evaluated according to a common protocol at the outpatient clinic of eight tertiary care Italian hospitals. Of 193 patients [109 (56.4%) men, mean age 79.9 ± 9.1 years], 43 (22.3%) died during follow-up. The most common causes of death were cardiovascular diseases (46.0%), respiratory failure (26.5%), and gastrointestinal and genitourinary diseases (8.8% each). Pre-morbid ADLs qualified as an independent mortality risk factor [adjusted HR 0.77 (95%CI: 0.63–0.95)]. Of 132 patients, 28 (21.2%) lost their independence in at least one ADL. The adjusted risk of LOI declined with a lower frailty degree [aOR 0.03 (95%CI: 0.01–0.32)]. In conclusion, at long-term follow-up after hospitalization for acute SARS-CoV-2 infection, more than 40% of older patients died or experienced a loss of functional independence compared to their pre-morbid condition. Given its high prevalence, the loss of functional independence after hospitalization for COVID-19 could be reasonably included among the features of the “Long COVID-19 syndrome” of older patients.
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Affiliation(s)
- Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, 17165 Stockholm, Sweden
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
| | - Sonia Zotti
- Geriatrics Unit, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, 00128 Rome, Italy
| | - Massimiliano Fedecostante
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, 60124 Ancona, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Stefano Fumagalli
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence, 50121 Firenze, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, 60124 Ancona, Italy
| | - Raffaele Antonelli Incalzi
- Geriatrics Unit, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, 00128 Rome, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
- Correspondence:
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Okoye C, Niccolai F, Rogani S, Lemmi B, Peta U, Del Vecchio S, Morelli V, Caraccio N, Calsolaro V, Monzani F. Is non-thyroidal illness syndrome (NTIS) a clinical predictor of COVID-19 mortality in critically ill oldest old patients? J Endocrinol Invest 2022; 45:1689-1692. [PMID: 35545741 PMCID: PMC9094134 DOI: 10.1007/s40618-022-01806-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/16/2022] [Indexed: 12/01/2022]
Affiliation(s)
- C Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - F Niccolai
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - S Rogani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - B Lemmi
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - U Peta
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - S Del Vecchio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - V Morelli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - N Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
| | - V Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy.
| | - F Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56124, Pisa, Italy
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Mohamed MA, Zeng Z, Gennaro M, Lao-Kaim NP, Myers JFM, Calsolaro V, Femminella GD, Tyacke RJ, Martin-Bastida A, Gunn RN, Nutt DJ, Edison P, Piccini P, Roussakis AA. Astrogliosis in aging and Parkinson’s disease dementia: a new clinical study with 11C-BU99008 PET. Brain Commun 2022; 4:fcac199. [PMID: 36072646 PMCID: PMC9445175 DOI: 10.1093/braincomms/fcac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/20/2022] [Accepted: 08/16/2022] [Indexed: 11/14/2022] Open
Abstract
The role of astrogliosis in the pathology of brain aging and neurodegenerative diseases has recently drawn great attention. Imidazoline-2 binding sites represent a possible target to map the distribution of reactive astrocytes. In this study, we use 11C-BU99008, an imidazoline-2 binding sites-specific PET radioligand, to image reactive astrocytes in vivo in healthy controls and patients with established Parkinson’s disease dementia. Eighteen healthy controls (age: 45–78 years) and six patients with Parkinson’s disease dementia (age: 64–77 years) had one 11C-BU99008 PET-CT scan with arterial input function. All subjects underwent one 3 T MRI brain scan to facilitate the analysis of the PET data and to capture individual cerebral atrophy. Regional 11C-BU99008 volumes of distribution were calculated for each subject by the two-tissue compartmental modelling. Positive correlations between 11C-BU99008 volumes of distribution values and age were found for all tested regions across the brain within healthy controls (P < 0.05); furthermore, multiple regression indicated that aging affects 11C-BU99008 volumes of distribution values in a region-specific manner. Independent samples t-test indicated that there was no significant group difference in 11C-BU99008 volumes of distribution values between Parkinson’s disease dementia (n = 6; mean age = 71.97 ± 4.66 years) and older healthy controls (n = 9; mean age = 71.90 ± 5.51 years). Our data set shows that astrogliosis is common with aging in a region-specific manner. However, in this set-up, 11C-BU99008 PET cannot differentiate patients with Parkinson’s disease dementia from healthy controls of similar age.
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Affiliation(s)
- Mohamed A Mohamed
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Zhou Zeng
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Xiangya Hospital of Central South University , Changsha, Hunan , P.R. China
| | - Marta Gennaro
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Nicholas P Lao-Kaim
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Jim F M Myers
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Valeria Calsolaro
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Grazia Daniela Femminella
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Department of Translational Medical Sciences, University of Naples Federico II , Naples , Italy
| | - Robin J Tyacke
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Antonio Martin-Bastida
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
- Department of Neurology and Neurosciences, Clinica Universidad de Navarra , Pamplona-Madrid , Spain
| | - Roger N Gunn
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - David J Nutt
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Paul Edison
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
| | - Paola Piccini
- Department of Brain Sciences, Imperial College London, Hammersmith Hospital , London , UK
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Calsolaro V, Okoye C, Rogani S, Calabrese AM, Dell'Agnello U, Antognoli R, Guarino D, Monzani F. Different glomerular filtration rate estimating formula for prescribing DOACs in oldest patients: appropriate dosage and bleeding risk. Post hoc analysis of a prospective cohort. Aging Clin Exp Res 2022; 34:591-598. [PMID: 34661901 PMCID: PMC8894223 DOI: 10.1007/s40520-021-01986-w] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022]
Abstract
Background Direct oral anticoagulants (DOACs) pharmacokinetics depends on estimated glomerular filtration rate (eGFR), whose estimation is crucial for optimal risk/benefit balance. Aims To assess the concordance among different eGFR formulas and the potential impact on DOACs prescription appropriateness and bleeding risk in oldest hospitalized patients. Methods Post hoc analysis of a single-centre prospective cohort study. eGFR was calculated by creatinine-based (MDRD, CKD-EPICr, BIS1) and creatinine–cystatin-C-based (CKD-EPIComb and BIS2) formulas. Patients were stratified according to eGFR [severely depressed (SD) 15–29; moderately depressed (MD) 30–49; preserved/mildly depressed (PMD): ≥ 50 ml/min/1.73 m2]. Concordance between the different equations was assessed by Cohen’s kappa coefficient. Results Among AF patients, 841 (59.2% women, mean age 85.9 ± 6.5 years) received DOACs. By CKD-EPICr equation, 135 patients were allocated in the SD, 255 in the MD and 451 in the PMD group. The concordance was excellent only between BIS 2 and CKD-EPIComb and MDRD and CKD-EPICr, while was worse (from good to poor) between the other formulas. Indeed, by adding cystatin-C almost over 1/3 of the patients were reallocated to a worse eGFR class. Bleeding prevalence increased by 2–3% in patients with discordant eGFR between formulas, reallocated to a worse chronic kidney disease (CKD) stage, although without reaching statistical significance. CKD-EPIComb resulted the best predictor of bleeding events (AUROC 0.71, p = 0.03). Discussion This study highlights the variability in CKD staging according to different eGFR formulas, potentially determining inappropriate DOACs dosing. Although the cystatin-C derived CKDEPIComb equation is the most accurate for stratifying patients, BIS1 may represent a reliable alternative. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01986-w.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Sara Rogani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Umberto Dell'Agnello
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Daniela Guarino
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Okoye C, Calsolaro V, Niccolai F, Calabrese AM, Franchi R, Rogani S, Coppini G, Morelli V, Caraccio N, Monzani F. A Randomized, Open-Label Study to Assess Efficacy of Weekly Assumption of Cholecalciferol versus Calcifediol in Older Patients with Hypovitaminosis D. Geriatrics (Basel) 2022; 7:geriatrics7010013. [PMID: 35076537 PMCID: PMC8788272 DOI: 10.3390/geriatrics7010013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 12/16/2022] Open
Abstract
The aim of this single-center, open-label, randomized controlled study was to evaluate which formulation of vitamin D—between cholecalciferol and calcifediol—is most effective in the treatment of hypovitaminosis D in older adults. Demographic characteristics, clinical history, and comprehensive geriatric assessment were recorded at admission. Eligible patients were randomly assigned an equivalent vitamin D supplement, either with cholecalciferol or calcifediol, from the time of hospital admission to three months after discharge. Among the 140 older patients included (mean age 83 ± 6.6 years, 57.8% females), 69 received cholecalciferol and 71 received calcifediol. The mean plasma values of 25-hydroxyvitamin D3 (25OH-vitamin D3) found at the time of enrollment were 16.8 ± 9.9 ng/mL in patients receiving cholecalciferol and 18.8 ± 13.3 ng/mL in those treated with calcifediol (p = 0.31). At the three month follow-up, the mean concentration of 25OH-vitamin D3 was significantly higher in patients treated with calcifediol than in those receiving cholecalciferol (30.7 ± 8.4 vs. 45.4 ± 9.8 ng/mL, respectively; p < 0.001). Supplementation with either cholecalciferol or calcifediol effectively results in reaching the optimal circulating values of 25OH-vitamin D3 in older patients suffering from hypovitaminosis D. However, supplementation with calcifediol led to average circulating values of 25OH-vitamin D3 that were significantly higher (over 50%) than those obtained with cholecalciferol.
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Raza S, Calsolaro V, Buckley C, Gentleman S, Brooks DJ, Edison P. The relationship between flutriciclamide PET uptake and grey matter atrophy in mild cognitive impairment and Alzheimer’s disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.056113] [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: 11/07/2022]
Affiliation(s)
- Sanara Raza
- Imperial College London London United Kingdom
| | | | | | | | | | - Paul Edison
- Imperial College London London United Kingdom
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Calsolaro V, Matthews PM, Donat CK, Livingston NR, Femminella GD, Guedes SS, Myers J, Fan Z, Tyacke RJ, Venkataraman AV, Perneczky R, Gunn R, Rabiner EA, Gentleman S, Parker CA, Murphy PS, Wren PB, Hinz R, Sastre M, Nutt DJ, Edison P. Astrocyte reactivity with late-onset cognitive impairment assessed in vivo using 11C-BU99008 PET and its relationship with amyloid load. Mol Psychiatry 2021; 26:5848-5855. [PMID: 34267329 PMCID: PMC8758500 DOI: 10.1038/s41380-021-01193-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/16/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023]
Abstract
11C-BU99008 is a novel positron emission tomography (PET) tracer that enables selective imaging of astrocyte reactivity in vivo. To explore astrocyte reactivity associated with Alzheimer's disease, 11 older, cognitively impaired (CI) subjects and 9 age-matched healthy controls (HC) underwent 3T magnetic resonance imaging (MRI), 18F-florbetaben and 11C-BU99008 PET. The 8 amyloid (Aβ)-positive CI subjects had higher 11C-BU99008 uptake relative to HC across the whole brain, but particularly in frontal, temporal, medial temporal and occipital lobes. Biological parametric mapping demonstrated a positive voxel-wise neuroanatomical correlation between 11C-BU99008 and 18F-florbetaben. Autoradiography using 3H-BU99008 with post-mortem Alzheimer's brains confirmed through visual assessment that increased 3H-BU99008 binding localised with the astrocyte protein glial fibrillary acid protein and was not displaced by PiB or florbetaben. This proof-of-concept study provides direct evidence that 11C-BU99008 can measure in vivo astrocyte reactivity in people with late-life cognitive impairment and Alzheimer's disease. Our results confirm that increased astrocyte reactivity is found particularly in cortical regions with high Aβ load. Future studies now can explore how clinical expression of disease varies with astrocyte reactivity.
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Affiliation(s)
| | - Paul M Matthews
- Department of Brain Sciences, Imperial College London, London, UK
- UK Dementia Research Institute, Imperial College London, London, UK
| | - Cornelius K Donat
- Department of Brain Sciences, Imperial College London, London, UK
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | | | | | | | - Jim Myers
- Department of Brain Sciences, Imperial College London, London, UK
| | - Zhen Fan
- Department of Brain Sciences, Imperial College London, London, UK
| | - Robin J Tyacke
- Department of Brain Sciences, Imperial College London, London, UK
| | | | - Robert Perneczky
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- German Centre for Neurodegenerative Disorders (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London, UK
| | - Roger Gunn
- Department of Brain Sciences, Imperial College London, London, UK
- Invicro, London, UK
| | | | - Steve Gentleman
- Department of Brain Sciences, Imperial College London, London, UK
| | - Christine A Parker
- Department of Brain Sciences, Imperial College London, London, UK
- GlaxoSmithKline, Stevenage, UK
| | | | | | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Magdalena Sastre
- Department of Brain Sciences, Imperial College London, London, UK
| | - David J Nutt
- Department of Brain Sciences, Imperial College London, London, UK
| | - Paul Edison
- Department of Brain Sciences, Imperial College London, London, UK.
- Cardiff University, Cardiff, Wales, United Kingdom.
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Calsolaro V, Okoye C, Rogani S, Calabrese AM, Monzani F. Type of anticoagulation therapy in oldest old, frail people with atrial fibrillation: Prescription modification over time. Authors' Reply. Eur J Intern Med 2021; 89:113-114. [PMID: 34099369 DOI: 10.1016/j.ejim.2021.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Sara Rogani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
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Gareri P, Fumagalli S, Malara A, Mossello E, Trevisan C, Volpato S, Coin A, Calsolaro V, Bellelli G, Del Signore S, Zia G, Ranhoff AH, Incalzi RA. Management of Older Outpatients during the COVID-19 Pandemic: The GeroCovid Ambulatory Study. Gerontology 2021; 68:412-417. [PMID: 34182557 PMCID: PMC8339050 DOI: 10.1159/000516969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/01/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives The GeroCovid Study is a multi-setting, multinational, and multi-scope registry that includes the GeroCovid home and outpatients' care cohort. The present study aims to evaluate whether outpatient and home care services with remote monitoring and consultation could mitigate the impact of the COVID-19 pandemic on mental and affective status, perceived well-being, and personal capabilities of outpatients and home care patients with cognitive disorders. Methods Prospectively recorded patients in an electronic web registry provided by BlueCompanion Ltd. Up to October 31, 2020, the sample included 90 patients receiving regular care from the Center for Cognitive Disorders and Dementia in Catanzaro Lido, Italy. It was made of 52 ambulatory outpatients and 38 home care patients, mean age 83.3 ± 7.54 years. Participants underwent a multidimensional assessment at baseline (T0) and after 90 days (T1). For each patient, we administered the Mini-Mental State Examination (MMSE) for cognitive functions, the Activities of Daily Living (ADL) and Instrumental ADL (IADL) scales for functional capabilities, the Cumulative Illness Rating Scale (CIRS) for comorbidities and their impact on patients' health, the 5-items Geriatric Depression Scale (GDS) for mood, and the Euro Quality of Life (EuroQoL) for perceived quality of life. Contacts with both ambulatory and home care patients were managed in person or via telephone, preferably through video calls (WhatsApp or FaceTime). Results Contacts with patients were kept at T0 through telephone. At T1, visits were made in person for over 95% out of the cases. The ADL, IADL, CIRS, GDS, MMSE, and EuroQoL changed slightly between T0 and T1. Most of the patients were clinically stable over time on the majority of the scales explored, but behavioral changes were found in 24.4% of patients and anxiety and insomnia in 17.7% of patients. Conclusion Our study suggests that contacts through telephone and video consultations are likely associated with a health status preservation of the patients.
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Affiliation(s)
- Pietro Gareri
- CDCD Catanzaro Lido - ASP Catanzaro, Catanzaro, Italy
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence and SOD Geriatrics-UTIG, AOU Careggi, Florence, Italy
| | - Alba Malara
- Scientific Committee of National Association of Third Age Residences (ANASTE) Calabria, Lamezia Terme, Italy
| | - Enrico Mossello
- Department of Experimental and Clinical Medicine, University of Florence and SOD Geriatrics-UTIG, AOU Careggi, Florence, Italy
| | - Caterina Trevisan
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Alessandra Coin
- Department of Experimental and Clinical Medicine, University of Florence and SOD Geriatrics-UTIG, AOU Careggi, Florence, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca and Acute Geriatic Unit, San Gerardo Hospital, Monza, Italy
| | | | | | - Anette Hylen Ranhoff
- Department of Clinical Science, University of Bergen, Norway and Diakonhjemmet Hospital, Oslo, Norway
| | - Raffaele Antonelli Incalzi
- Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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Calabrese AM, Calsolaro V, Franchi R, Rogani S, Guarino D, Okoye C, Monzani F. Dabigatran-induced acute liver injury in older patients: case report and literature review. JGG 2021. [DOI: 10.36150/2499-6564-n345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Calsolaro V, Okoye C, Antognoli R, Dell'Agnello U, Calabrese AM, Monzani F. Long-term effectiveness and safety of anticoagulation therapy in oldest old, frail people with atrial fibrillation. Eur J Intern Med 2021; 86:91-97. [PMID: 33551290 DOI: 10.1016/j.ejim.2021.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Atrial Fibrillation (AF) represents a major cause of mortality and morbidity in older people; however, oldest-old frail patients are usually excluded from clinical trials. Aim of the study is to evaluate the impact of oral anticoagulation (OAC) therapy on long-term overall survival and clinically relevant bleedings in a large cohort of hospitalised frail, oldest-old patients with AF. PATIENTS AND METHODS Prospective, observational, cohort study, evaluating patients consecutively hospitalized for acute illnesses in our Geriatrics Unit (January 2013-July 2017). Participants were divided in two groups, AF and sinus rhythm (SR). Besides recording demographic characteristics and clinical history, comprehensive geriatric assessment (CGA) was obtained. RESULTS AF patients [1808/5093 (35.5%), 58.5% women] were older, with higher burden of comorbidity than those with SR. At discharge, HAS-BLED [OR 0.77 (95%CI 0.67-0.90), cognitive impairment [OR 0.92 (95%CI 0.90-0.95)], malnutrition [OR 0.74 (95%CI 0.57-0.97)] and CHA2DS2VASc [OR 1.33 (95%CI 1.20-1.47)] emerged as significant independent predictors of anticoagulant prescription. AF patients showed significantly reduced overall survival (OS) than those with SR (11.4 vs 19.4 months, p<.001). However, anticoagulated AF patients (75.2%) had three-times longer OS than those not anticoagulated (15.0 vs 5.6 months, p<.001), comparable to SR patients after adjustment for potential confounders [HR 1.04 (95%CI 0.99-1.10)]. ED readmittance risk for clinically relevant bleeding did not differ between AF patients receiving or not anticoagulation [HR 1.04 (95%CI 0.76-1.14)] CONCLUSION: anticoagulation therapy was associated with significant increase of long-term OS without increased risk of clinically relevant bleeding. CGA resulted an useful tool in OAC therapy decision-making.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Umberto Dell'Agnello
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, Pisa University Hospital, Italy.
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Femminella GD, Livingston NR, Raza S, van der Doef T, Frangou E, Love S, Busza G, Calsolaro V, Carver S, Holmes C, Ritchie CW, Lawrence RM, McFarlane B, Tadros G, Ridha BH, Bannister C, Walker Z, Archer H, Coulthard E, Underwood B, Prasanna A, Koranteng P, Karim S, Junaid K, McGuinness B, Passmore AP, Nilforooshan R, Macharouthu A, Donaldson A, Thacker S, Russell G, Malik N, Mate V, Knight L, Kshemendran S, Tan T, Holscher C, Harrison J, Brooks DJ, Ballard C, Edison P. Does insulin resistance influence neurodegeneration in non-diabetic Alzheimer's subjects? Alzheimers Res Ther 2021; 13:47. [PMID: 33597002 PMCID: PMC7890851 DOI: 10.1186/s13195-021-00784-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/14/2020] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
Background Type 2 diabetes is a risk factor for Alzheimer’s disease (AD), and AD brain shows impaired insulin signalling. The role of peripheral insulin resistance on AD aetiopathogenesis in non-diabetic patients is still debated. Here we evaluated the influence of insulin resistance on brain glucose metabolism, grey matter volume and white matter lesions (WMLs) in non-diabetic AD subjects. Methods In total, 130 non-diabetic AD subjects underwent MRI and [18F]FDG PET scans with arterial cannula insertion for radioactivity measurement. T1 Volumetric and FLAIR sequences were acquired on a 3-T MRI scanner. These subjects also had measurement of glucose and insulin levels after a 4-h fast on the same day of the scan. Insulin resistance was calculated by the updated homeostatic model assessment (HOMA2). For [18F]FDG analysis, cerebral glucose metabolic rate (rCMRGlc) parametric images were generated using spectral analysis with arterial plasma input function. Results In this non-diabetic AD population, HOMA2 was negatively associated with hippocampal rCMRGlc, along with total grey matter volumes. No significant correlation was observed between HOMA2, hippocampal volume and WMLs. Conclusions In non-diabetic AD, peripheral insulin resistance is independently associated with reduced hippocampal glucose metabolism and with lower grey matter volume, suggesting that peripheral insulin resistance might influence AD pathology by its action on cerebral glucose metabolism and on neurodegeneration. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00784-w.
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Affiliation(s)
- Grazia Daniela Femminella
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Nicholas R Livingston
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Sanara Raza
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Thalia van der Doef
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | | | | | - Gail Busza
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Valeria Calsolaro
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Stefan Carver
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | | | | | - Robert M Lawrence
- South West London and St George's Mental Health NHS Trust, London, UK
| | | | - George Tadros
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Basil H Ridha
- Brighton and Sussex University Hospital Trust, Brighton, UK
| | | | - Zuzana Walker
- Mental Health Unit, St. Margaret's Hospital, Epping, Essex, UK
| | | | | | - Ben Underwood
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Aparna Prasanna
- Black Country Partnership NHS Foundation Trust, Wolverhampton, UK
| | - Paul Koranteng
- Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Salman Karim
- Lancashire Care NHS Foundation Trust, Preston, UK
| | - Kehinde Junaid
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | | | | | | | | | - Simon Thacker
- Derbyshire Healthcare NHS Foundation Trust, Derby, UK
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Naghma Malik
- North West Boroughs Partnership NHS Foundation Trust, Warrington, UK
| | - Vandana Mate
- Cornwall Partnership NHS Foundation Trust, Redruth, UK
| | - Lucy Knight
- Somerset Partnership NHS Foundation Trust, South Petherton, UK
| | - Sajeev Kshemendran
- South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Shrewsbury, UK
| | - Tricia Tan
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Christian Holscher
- Research and Experimental Center, Henan University of Chinese Medicine, Zhengzhou, China
| | - John Harrison
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Paul Edison
- Division of Neurology, Neurology Imaging Unit, Department of Brain Sciences, Imperial College London, 1st Floor B Block, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK.
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Abstract
Dementia is a highly prevalent chronic disease among the older population, affecting more than 50 million people worldwide and representing a huge healthcare, social and economic burden. Dementia, and in particular Alzheimer's disease, prevalence is expected to raise within the next few years. Unfortunately, no disease-modifying therapies are available so far, despite a plethora of clinical trials targeting the hallmarks of Alzheimer's disease. Given these premises, it appears crucial to address not only the neuropathological correlates of the disease, but also the modifiable risk factors. Among them, evidence suggest a role of the endocrine system not only in the brain development, but also in the maintenance of its health, having neurotrophic, antioxidant and metabolic functions crucial for the cognitive abilities. This review focuses on the evidence evaluating the impact of the endocrine systems, in particular thyroid function, insulin resistance, parathyroid hormone, vitamin D and sexual hormones on cognitive status. Results from epidemiological, preclinical and some clinical studies demonstrated the link between thyroid, parathyroid hormone and vitamin D and cognitive status, between diabetes, and insulin resistance in particular, and dementia, between sexual and adrenal hormones, particularly estrogen variation at menopause, and cognitive decline. The growing interest on the modifiable risks factors of cognitive decline increased the knowledge about the complex interplay of endocrine systems and cognition, highlighting the need and the usefulness of a multidisciplinary approach to the prevention of a complex and devastating disease.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Marina Bottari
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giulia Coppini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Bianca Lemmi
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy -
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Abstract
Dementia is a highly prevalent chronic disease among the older population, affecting more than 50 million people worldwide and representing a huge healthcare, social and economic burden. Dementia, and in particular Alzheimer's disease, prevalence is expected to raise within the next few years. Unfortunately, no disease-modifying therapies are available so far, despite a plethora of clinical trials targeting the hallmarks of Alzheimer's disease. Given these premises, it appears crucial to address not only the neuropathological correlates of the disease, but also the modifiable risk factors. Among them, several evidences suggest a role of the endocrine system not only in the brain development, but also in the maintenance of its health, having neurotrophic, anti-oxidant and metabolic functions crucial for the cognitive abilities. This review focuses on the evidences evaluating the impact of the endocrine systems, in particular thyroid function, insulin resistance, parathyroid hormone, Vitamin D and sexual hormones on cognitive status. Results from epidemiological, preclinical and some clinical studies demonstrated the link between thyroid, parathyroid hormone and vitamin D and cognitive status, between diabetes, and insulin resistance in particular, and dementia, between sexual and adrenal hormones, particularly estrogen variation at menopause, and cognitive decline. The growing interest on the modifiable risks factors of cognitive decline increased the knowledge about the complex interplay of endocrine systems and cognition, highlighting the need and the usefulness of a multidisciplinary approach to the prevention of a complex and devastating disease.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Marina Bottari
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giulia Coppini
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Bianca Lemmi
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy -
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Paterni S, Okoye C, Calabrese AM, Niccolai F, Polini A, Caraccio N, Calsolaro V, Monzani F. Prognostic Value of Glycated Hemoglobin in Frail Older Diabetic Patients With Hip Fracture. Front Endocrinol (Lausanne) 2021; 12:770400. [PMID: 34867813 PMCID: PMC8637116 DOI: 10.3389/fendo.2021.770400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/22/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have shown increased risk of fracture in older patients with poor or strict glycemic control (glycated hemoglobin, HbA1c, ≥ 8% or < 6-7% respectively); however, these reports did not investigate the oldest-old population. Comprehensive geriatric assessment (CGA) and a patient-centered approach have been proven to improve the quality of care in the management of Type 2 Diabetes Mellitus (T2DM) in the older patients, but data regarding T2DM in patients with fragility fractures are still lacking. AIM To investigate the prognostic role of HbA1c and frailty level in older diabetic patients admitted for hip fracture. METHODS Prospective observational cohort study conducted on diabetic geriatric patients consecutively hospitalized for hip fracture in the orthogeriatric unit of a tertiary care hospital. Preoperative comprehensive geriatric assessment (CGA) was performed. Using the Clinical Frailty Scale (CFS), diabetic patients were categorized in robust (CFS < 5) and frail (CFS ≥ 5), and further stratified according to HbA1c values [Tertile 1 (T1) HbA1c < 48 mmol/mol, Tertile 2 (T2) 48-58 mmol/mol and Tertile 3 (T3) > 58 mmol/mol). Comparisons between continuous variables were performed with analysis of non-parametric test for independent samples, while relationships between categorical variables were assessed by chi-square test. Using logistic multivariate regression, we evaluated the determinants of 1-year all-cause mortality in diabetic older patients with hip fracture. RESULTS Among the 1319 older patients (mean age 82.8 ± 7.5 years, 75.9% females) hospitalized for hip fracture, 204 (15.5%) had a previous diagnosis of T2DM. T2DM patients showed an increased proportion of multiple concurrent fractures occurred during the accidental fall or syncope (12.7% vs 11.2%, p=0.02). One-year mortality after hip fracture surgery was significantly higher in T2DM as compared to not diabetic patients (21.2% vs 12.5%, p<0.001). No significant difference in mortality was found across HbA1c tertiles; however, frail diabetic patients in the second and third HbA1c tertiles showed higher mortality risk compared to the robust counterparts (26.9% vs 5%, p=0.001 for T2 and 43.5% vs 13.3%, p=<0.05 for T3), while no difference was observed among those in T1. CONCLUSIONS Frail patients with HbA1c ≥ 48 mmol/L showed an increased mortality risk as compared to robust counterparts. CFS represents an important tool to select diabetic subjects with higher likelihood of adverse outcome.
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Rogani S, Calsolaro V, Franchi R, Calabrese AM, Okoye C, Monzani F. Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review. BMC Geriatr 2020; 20:539. [PMID: 33353545 PMCID: PMC7755066 DOI: 10.1186/s12877-020-01963-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 10/01/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background In late December 2019, a cluster of pneumonia cases due to a novel betacoronavirus, SARS-CoV-2 was reported in China. The so-called COVID 19 is responsible not only for respiratory symptoms, from mild up to pneumonia and even acute respiratory distress syndrome, but also for extrapulmonary involvement. Cases presentation Here we present two cases of spontaneous muscle hematoma in patients with SARS-CoV-2 infection, both on therapeutic LMWH for atrial fibrillation: the first one was an 86-year-old Caucasian female with a history of hypertensive cardiomyopathy and the second one was an 81-year-old Caucasian male with a history of hypertension, diabetes and ischemic heart disease. Blood tests revealed a considerable drop of hemoglobin and alterations of coagulation system. In both cases, embolization of femoral artery was performed. A few other cases of bleeding manifestations are reported in literature, while a lot has been published about the hypercoagulability related to COVID-19. Conclusions Our reports and literature review highlight the need of active surveillance for possible hemorrhagic complications in patients with SARS-CoV-2 infection.
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Affiliation(s)
- Sara Rogani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Riccardo Franchi
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
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Linsalata G, Okoye C, Antognoli R, Guarino D, Ravenna V, Orsitto E, Calsolaro V, Monzani F. Pneumonia Lung Ultrasound Score (PLUS): A New Tool for Detecting Pneumonia in the Oldest Patients. J Am Geriatr Soc 2020; 68:2855-2862. [PMID: 33264442 DOI: 10.1111/jgs.16783] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/19/2020] [Revised: 07/08/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare the diagnostic accuracy of lung ultrasound (LUS) and standard chest X-ray (CXR) in older patients admitted to an acute-care geriatric ward for suspected acute pneumonia, and to develop an easy-to-use diagnostic tool, now called Pneumonia Lung Ultrasound Score (PLUS), for early risk stratification. DESIGN Prospective, single-center, cohort study. SETTING Acute-care geriatric ward of tertiary care center. PARTICIPANTS Individuals, aged 65 years and older, with suspected acute pneumonia. MEASUREMENTS Participants were stratified according to the Multidimensional Prognostic Index. All the patients underwent CXR and LUS, whereas chest computed tomography was performed in case of mismatch between LUS and CXR. Using logistic multivariate regression, we assessed the influence of age, sex, multimorbidity, cognitive impairment, and clinical biomarkers in the misdiagnosis of acute pneumonia. Finally, an easy-to-perform diagnostic tool based on the combination of biomarkers (brain natriuretic peptide, high-sensitivity C-reactive protein, and partial pressure arterial oxygen/fraction of inspired oxygen ratio) and LUS was realized. A receiver operating characteristic curve was used to verify the predictive accuracy of PLUS, CXR, and LUS in pneumonia diagnosis. RESULTS A total of 132 subjects (69% women; mean age = 85.3 ± 6.9 years) were enrolled in the study. Acute pneumonia was diagnosed in 94 of 132 cases. LUS showed higher diagnostic accuracy compared with CXR (0.91 (95% confidence interval (CI) = 0.85-0.93) vs 0.67 (95% CI = 0.58-0.75)) in detecting pneumonic consolidations. A higher degree of cognitive impairment was associated with both LUS and CXR pneumonia misdiagnosis (odds ratio = 1.30 (95% CI = 1.04-1.65)). PLUS showed higher predictive accuracy in the diagnosis of acute pneumonia compared with LUS (AUC = 0.92 (95% CI = 0.87-0.98) vs 0.86 (95% CI = 0.80-0.96); P = .029). CONCLUSIONS This study confirms the higher diagnostic accuracy of LUS compared with CXR for acute pneumonia in older adults. Nonetheless, the accuracy of PLUS, an easy-to-use, biomarker-derived diagnostic tool, was superior to LUS regardless of patients' degree of frailty.
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Affiliation(s)
- Giuseppe Linsalata
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Daniela Guarino
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Virginia Ravenna
- Emergency Radiology Unit, University Hospital of Pisa, Pisa, Italy
| | - Eugenio Orsitto
- Emergency Radiology Unit, University Hospital of Pisa, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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Calsolaro V, Hinz R, Femminella GD, Pasqualetti G, Buckley CJ, Gentleman S, Brooks DJ, Edison P. Microglial activation evaluated using flutriciclamide (
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F‐GE180) in subjects with cognitive impairment. Alzheimers Dement 2020. [DOI: 10.1002/alz.045465] [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: 11/10/2022]
Affiliation(s)
| | - Rainer Hinz
- University of Manchester Manchester United Kingdom
| | | | | | | | | | | | - Paul Edison
- Imperial College London London United Kingdom
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Calsolaro V, Antognoli R, Okoye C, Monzani F. The Use of Antipsychotic Drugs for Treating Behavioral Symptoms in Alzheimer's Disease. Front Pharmacol 2019; 10:1465. [PMID: 31920655 PMCID: PMC6915160 DOI: 10.3389/fphar.2019.01465] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
According to the World Alzheimer’s report, dementia was estimated to affect 50 million worldwide in 2018, number expected to increase to more than 150 million within 30 years. Alzheimer’s disease is the most common type of dementia, accounting on its own for 2/3 of all dementia cases. The initial signs and symptoms of Alzheimer’s disease relate to progressive cognitive decline, inexorably progressing until the loss of independence. Neuropsychiatric and behavioral symptoms may occur during the progression of the disease; around 20% of patients without any behavioral symptoms at the diagnosis will experience some of them within 2 years. Consequences are early institutionalization, lower quality of life, of both patients and carers, and more severe cognitive impairment. Treatment options for behavioral symptoms include pharmacological and non-pharmacological approaches. The latter are usually preferred, since antipsychotic therapy is not free from several, and often serious, adverse events. However, behavioral symptoms are not always controllable with non-pharmacological intervention. The psychotropic class of medication more frequently prescribed for behavioral symptoms are atypical antipsychotics; among them, risperidone is the only one licensed for the treatment of aggression, in Europe but not in the USA. On that regard, the use of antipsychotic drugs should be limited, due to the increased risk of mortality, stroke, hallucination, and higher risk of relapse after discontinuation. Some new agents are under evaluation, such as pimavanserin and lumateperone. In this review, we are evaluating the current available pharmacological options to treat behavioral symptoms as well as the forthcoming new agents.
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Affiliation(s)
- Valeria Calsolaro
- Neurology Imaging Unit, Imperial College London, London, United Kingdom.,Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Calsolaro V, Antognoli R, Pasqualetti G, Okoye C, Aquilini F, Cristofano M, Briani S, Monzani F. 30-Day Potentially Preventable Hospital Readmissions In Older Patients: Clinical Phenotype And Health Care Related Risk Factors. Clin Interv Aging 2019; 14:1851-1858. [PMID: 31806943 PMCID: PMC6842315 DOI: 10.2147/cia.s208572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/30/2019] [Accepted: 07/21/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose Early readmission rate has been regarded as an indicator of in-hospital and post-discharge quality of care. Evaluating the contributing factors is crucial to optimize the healthcare and target the intervention. In this study we evaluated the potential for preventing 30-day hospital readmission in a cohort of older patients and identified possible risk factors for readmission. Patients and methods Diagnosis-Related Group (DRG) codes of patients consecutively hospitalized for acute disease in the Geriatrics Unit of the University Hospital of Pisa within a 1-year window were recorded. All the patients had received a comprehensive geriatric assessment. Crossing and elaboration of the DRG codes was performed by the Potentially Preventable Readmission Grouping software (3M™ Corporation). DRG codes were classified as stand-alone admissions (SA), index admissions (IA) and potentially preventable readmissions (PPR) within a time window of 30 days after discharge. Results In total, 1263 SA and 171 IA were identified, with an overall PPR rate of 11.9%. Hospitalizations were significantly longer in IA and PPR than SA (p<0.05). The more frequent readmission causes were acute heart failure, pulmonary edema, sepsis, pneumonia and stroke. In acute heart failure a nonlinear U-shaped readmission trend (with nadir at 5 days of hospitalization) was observed while, in all the other DRG codes, the PPR rate increased with increasing length of hospitalization. Comprehensive geriatric assessment showed a significantly lower degree of disability and comorbidity in SA than IA patients. At stepwise regression analysis, a high degree of disability and comorbidity as well as the diagnosis of sepsis emerged as independent risk factors for PPR. Conclusion Addressing PPR is crucial, especially in older patients. The adequacy of treatment during hospitalization (especially in cases of sepsis) as well as the setting of a comprehensive discharge plan, accounting for comorbidity and disability of the patients, are essential to reduce PPR.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | | | | | - Silvia Briani
- Health Management Department, University Hospital of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
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22
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Sbrana A, Antognoli R, Pasqualetti G, Linsalata G, Okoye C, Calsolaro V, Paolieri F, Bloise F, Ricci S, Antonuzzo A, Monzani F. Effectiveness of Multi-Prognostic Index in older patients with advanced malignancies treated with immunotherapy. J Geriatr Oncol 2019; 11:503-507. [PMID: 31672558 DOI: 10.1016/j.jgo.2019.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/19/2019] [Revised: 09/07/2019] [Accepted: 09/30/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Older adults with cancer are less likely to be offered treatment for cost-benefit concern. The Multi-Prognostic Index (MPI) has been validated in various clinical settings for survival estimation. We aimed to evaluate MPI as a screening tool for older adults with cancer eligible to receive immunotherapy. PATIENTS AND METHODS Older adults with advanced or metastatic cancer, admitted to the Oncology Day Hospital of the University Hospital of Pisa from January 2017 to May 2018, eligible to receive immunotherapy were prospectively enrolled. In addition to routine oncological evaluation, each patient received a comprehensive geriatric assessment with MPI calculation. Overall survival (Cox-adjusted curve) was stratified by tertiles of MPI score. Drug toxicity was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (Version 4.03: June 14, 2010). RESULTS Seventy-nine patients [26.6% women, mean age (±SD) 74.0 ± 6.1 years] were enrolled with the following diagnosis: melanoma (51.9%), non-small cell lung cancer (25.3%), renal cell cancer (12.7%), urothelial cancer (8.9%) and Merkel cell carcinoma (1.2%). Median follow-up was 7 months (range 1-35). The patients' survival rate resulted progressively longer proceeding from the first to the third MPI tertile [HR 1.76 (0.49-6.31) Vs 2nd tertile, p < 0.05; HR 5.33 (1.68-16.89) Vs 3rd tertile, p < 0.01]. CONCLUSIONS MPI score is an effective tool for the stratification of older patients with cancer eligible for immunotherapy with checkpoint inhibitors. Further studies are required to achieve conclusive remarks on MPI usefulness in different underlying tumor types.
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Affiliation(s)
- Andrea Sbrana
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy.
| | - Giuseppe Linsalata
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
| | - Federico Paolieri
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Francesco Bloise
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Sergio Ricci
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy
| | - Andrea Antonuzzo
- Oncology Unit 1, Pisa University Hospital, via Roma 67, 56126 Pisa, Italy.
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa, via Savi 10, 56127 Pisa, Italy
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Calsolaro V, Antognoli R, Monzani F. Why are so few antipsychotic drugs licensed for Alzheimer's disease related behavioral and psychological symptoms? Expert Rev Neurother 2019; 19:1051-1053. [PMID: 31282774 DOI: 10.1080/14737175.2019.1641407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa , Pisa , Italy.,Neurology Imaging Unit, Imperial College , London , UK
| | - Rachele Antognoli
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa , Pisa , Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical & Experimental Medicine, University of Pisa , Pisa , Italy
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24
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Calsolaro V, Hampshire A, Femminella GD, Brooks DJ, Edison P. P4-325: RELATIONSHIP BETWEEN MICROGLIAL ACTIVATION MEASURED BY FLUTRICICLAMIDE AND MICROSTRUCTURAL ALTERATION IN ALZHEIMER'S DISEASE AND MILD COGNITIVE IMPAIRMENT SUBJECTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3995] [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: 11/30/2022]
Affiliation(s)
| | | | | | - David J. Brooks
- Imperial College London; London United Kingdom
- Newcastle University; Newcastle United Kingdom
- Aarhus University; Aarhus Denmark
| | - Paul Edison
- Imperial College London; London United Kingdom
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Femminella GD, Wang YT, van der Doef T, Frangou E, Love S, Calsolaro V, Carver S, Holmes C, Ritchie CW, Lawrence RM, McFarlane B, Tadros G, Ridha BH, Bannister C, Walker Z, Archer H, Coulthard E, Underwood B, Prasanna A, Koranteng P, Karim S, Junaid K, McGuinness B, Passmore AP, Nilforooshan R, Macharouthu A, Donaldson A, Thacker S, Russell G, Malik N, Mate V, Knight L, Kshemendran S, Harrison J, Ballard C, Brooks DJ, Edison P. P3-328: DOES INSULIN RESISTANCE INFLUENCE WHITE MATTER LESIONS IN NON-DIABETIC AD SUBJECTS? Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3360] [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: 10/25/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Clive Holmes
- University of Southampton; Southampton United Kingdom
| | | | - Robert M. Lawrence
- South West London and St George's Mental Health NHS Trust; London United Kingdom
| | - Brady McFarlane
- Southern Health NHS Foundation Trust; Southampton United Kingdom
| | - George Tadros
- Heart of England NHS Foundation Trust; Birmingham United Kingdom
| | - Basil H. Ridha
- Brighton and Sussex University Hospital Trust; Brighton United Kingdom
| | | | - Zuzana Walker
- Mental Health Unit; St. Margaret's Hospital; Epping Essex United Kingdom
| | | | | | - Ben Underwood
- Cambridgeshire and Peterborough NHS Foundation Trust; Cambridge United Kingdom
| | - Aparna Prasanna
- Black Country Partnership NHS Foundation Trust; Wolverhampton United Kingdom
| | - Paul Koranteng
- Northamptonshire Healthcare NHS Foundation Trust; Northampton United Kingdom
| | - Salman Karim
- Lancashire Care NHS Foundation Trust; Preston United Kingdom
| | - Kehinde Junaid
- Nottinghamshire Healthcare NHS Foundation Trust; Nottingham United Kingdom
| | | | | | - Ramin Nilforooshan
- Surrey and Borders Partnership NHS Foundation Trust; Chertsey United Kingdom
| | | | | | - Simon Thacker
- Derbyshire Healthcare NHS Foundation Trust; Derby United Kingdom
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust; Bradford United Kingdom
| | - Naghma Malik
- North West Boroughs Partnership NHS Foundation Trust; Warrington United Kingdom
| | - Vandana Mate
- Cornwall Partnership NHS Foundation Trust; Redruth United Kingdom
| | - Lucy Knight
- Somerset Partnership NHS Foundation Trust; South Petherton United Kingdom
| | - Sajeev Kshemendran
- South Staffordshire and Shropshire Healthcare NHS Foundation Trust; Shrewsbury United Kingdom
| | - John Harrison
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC; Vrije Universiteit Amsterdam; Amsterdam Netherlands
| | - Clive Ballard
- University of Exeter Medical School; Exeter United Kingdom
| | | | - Paul Edison
- Imperial College London; London United Kingdom
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Calsolaro V, Femminella GD, Buckley C, Turkheimer F, Gentleman S, Hinz R, Brooks DJ, Edison P. P2-400: MICROGLIAL ACTIVATION DETECTED BY NOVEL TSPO TRACER FLUTRICICLAMIDE ([11FGE180]) IN AD AND MCI SUBJECTS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.2807] [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: 11/26/2022]
Affiliation(s)
| | | | | | | | | | - Rainer Hinz
- University of Manchester; Manchester United Kingdom
| | - David J. Brooks
- Imperial College London; London United Kingdom
- Newcastle University; Newcastle United Kingdom
- Aarhus University; Aarhus Denmark
| | - Paul Edison
- Imperial College London; London United Kingdom
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Femminella GD, Dani M, Wood M, Fan Z, Calsolaro V, Atkinson R, Edginton T, Hinz R, Brooks DJ, Edison P. Microglial activation in early Alzheimer trajectory is associated with higher gray matter volume. Neurology 2019; 92:e1331-e1343. [PMID: 30796139 PMCID: PMC6511099 DOI: 10.1212/wnl.0000000000007133] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/14/2018] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate the influence of microglial activation in the early stages of Alzheimer's disease trajectory, we assessed the relationship between microglial activation and gray matter volume and hippocampal volume in patients with mild cognitive impairment (MCI). Methods In this study, 55 participants (37 with early stages of MCI and 18 controls) underwent [11C]PBR28 PET, a marker of microglial activation; volumetric MRI to evaluate gray matter and hippocampal volumes as well as clinical and neuropsychometric evaluation. [11C]PBR28 VT (volume of distribution) was calculated using arterial input function and Logan graphical analysis. Gray matter volume and hippocampal volumes were calculated from MRI for each participant. Statistical parametric mapping software was used to perform voxel-wise correlations and biological parametric mapping analysis. Amyloid status was assessed using [18F]flutemetamol PET. Results Higher [11C]PBR28 VT in different cortical areas correlated with higher gray matter volume in both amyloid-positive and -negative MCI. In addition, higher hippocampal volume correlated with higher cortical [11C]PBR28 Logan VT. Conclusions In this in vivo study, we have demonstrated that microglial activation quantified using [11C]PBR28 PET was associated with higher gray matter volume and higher hippocampal volume in patients with MCI. This might suggest that microglial activation may not always be associated with neuronal damage, and indeed it may have a beneficial effect in the early stages of the Alzheimer trajectory. While further longitudinal studies are necessary, these findings have significant implications on therapeutic strategies targeting microglial activation.
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Affiliation(s)
- Grazia Daniela Femminella
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Melanie Dani
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Melanie Wood
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Zhen Fan
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Valeria Calsolaro
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Rebecca Atkinson
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Trudi Edginton
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Rainer Hinz
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - David J Brooks
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark
| | - Paul Edison
- From the Department of Medicine (G.D.F., M.D., M.W., Z.F., V.C., R.A., D.J.B., P.E.), Imperial College London; Department of Psychology (T.E.), University of London, London; Wolfson Molecular Imaging Centre (R.H.), University of Manchester, UK; and Department of Nuclear Medicine (D.J.B.), Aarhus University, Denmark.
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Calsolaro V, Niccolai F, Pasqualetti G, Calabrese AM, Polini A, Okoye C, Magno S, Caraccio N, Monzani F. Overt and Subclinical Hypothyroidism in the Elderly: When to Treat? Front Endocrinol (Lausanne) 2019; 10:177. [PMID: 30967841 PMCID: PMC6438852 DOI: 10.3389/fendo.2019.00177] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 11/23/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022] Open
Abstract
Hypothyroidism is characterized by increased thyrotropin (TSH) levels and reduced free thyroid hormone fractions while, subclinical hypothyroidism (sHT) by elevated serum TSH in the face of normal thyroid hormones. The high frequency of hypothyroidism among the general population in Western Countries made levothyroxine (LT4) one of the 10 most prescribed drugs. However, circulating TSH has been demonstrated to increase with aging, regardless the existence of an actual thyroid disease. Thus, when confronting an increase in circulating TSH levels in the elderly, especially in the oldest old, it is important to carry an appropriate diagnostic path, comprehensive of clinical picture as well as laboratory and imaging techniques. In the current review, we summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with elevated TSH value, with special attention to the presence of frailty, comorbidities, and poly-therapy. The treatment of choice for hypothyroid patients is hormone replacement with LT4 but, it is important to consider multiple factors before commencing the therapy, from the age dependent TSH increase to the presence of an actual thyroid disease and comorbidities. When treatment is necessary, a tailored therapy should be chosen, considering poly-pharmacy and frailty. A careful follow-up and treatment re-assessment should be always considered to avoid the risk of over-treatment. It is important to stress the need of educating the patient for a correct administration of LT4, particularly when poly-therapy is in place, and the importance of a tailored therapeutic approach and follow-up, to avoid overtreatment.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Neurology Imaging Unit, Imperial College, London, United Kingdom
- *Correspondence: Valeria Calsolaro
| | - Filippo Niccolai
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessia Maria Calabrese
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Polini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Magno
- Obesity Center at the Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Femminella GD, Thayanandan T, Calsolaro V, Komici K, Rengo G, Corbi G, Ferrara N. Imaging and Molecular Mechanisms of Alzheimer's Disease: A Review. Int J Mol Sci 2018; 19:ijms19123702. [PMID: 30469491 PMCID: PMC6321449 DOI: 10.3390/ijms19123702] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 10/05/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
Alzheimer’s disease is the most common form of dementia and is a significant burden for affected patients, carers, and health systems. Great advances have been made in understanding its pathophysiology, to a point that we are moving from a purely clinical diagnosis to a biological one based on the use of biomarkers. Among those, imaging biomarkers are invaluable in Alzheimer’s, as they provide an in vivo window to the pathological processes occurring in Alzheimer’s brain. While some imaging techniques are still under evaluation in the research setting, some have reached widespread clinical use. In this review, we provide an overview of the most commonly used imaging biomarkers in Alzheimer’s disease, from molecular PET imaging to structural MRI, emphasising the concept that multimodal imaging would likely prove to be the optimal tool in the future of Alzheimer’s research and clinical practice.
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Affiliation(s)
| | - Tony Thayanandan
- Imperial Memory Unit, Charing Cross Hospital, Imperial College London, London W6 8RF, UK.
| | - Valeria Calsolaro
- Neurology Imaging Unit, Imperial College London, London W12 0NN, UK.
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy.
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy.
- Istituti Clinici Scientifici Maugeri SPA-Società Benefit, IRCCS, 82037 Telese Terme, Italy.
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy.
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy.
- Istituti Clinici Scientifici Maugeri SPA-Società Benefit, IRCCS, 82037 Telese Terme, Italy.
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30
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Calsolaro V, Niccolai F, Pasqualetti G, Tognini S, Magno S, Riccioni T, Bottari M, Caraccio N, Monzani F. Hypothyroidism in the Elderly: Who Should Be Treated and How? J Endocr Soc 2018; 3:146-158. [PMID: 30607373 PMCID: PMC6309133 DOI: 10.1210/js.2018-00207] [Citation(s) in RCA: 18] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022] Open
Abstract
Hypothyroidism is among the most frequent chronic diseases in the elderly, and levothyroxine (l-T4) is worldwide within the 10 drugs more prescribed in the general population. Hypothyroidism is defined by increased serum thyroid-stimulating hormone (TSH) values and reduced circulating free thyroid hormones, whereas subclinical hypothyroidism (sHT) is characterized by free hormone fractions within the normal ranges and has been divided into two classes, depending on circulating TSH levels (above or below 10 mIU/L). Given that during aging, a natural trend toward higher values of circulating TSH has been reported, it is necessary to verify carefully the diagnosis of sHT to tailor an appropriate follow-up and ad hoc therapy, avoiding unnecessary or excessive treatment. In the current review, we evaluate the state of the art on hypothyroidism in the elderly with special focus on the effect of sHT on cognition and the cardiovascular system function. We also summarize the recommendations for a correct diagnostic workup and therapeutic approach to older people with an elevated TSH value, with special attention to the presence of frailty, comorbidities, and poly therapy. In conclusion, personalized therapy is crucial in good clinical practice, and in the management of older patients with sHT, multiple factors must be considered, including age-dependent TSH cutoffs, thyroid autoimmunity, the burden of comorbidities, and the possible presence of frailty. l-T4 is the drug of choice for the treatment of hypothyroid older people, but the risk of overtreatment, potential adverse drug reactions, and patient compliance should always be considered and thyroid status periodically reassessed.
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Affiliation(s)
- Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Niccolai
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Tognini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Silvia Magno
- Obesity Center at the Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Riccioni
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marina Bottari
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Femminella GD, Fan Z, Frangou E, Love S, Calsolaro V, Holmes C, Ritchie CW, Lawrence RM, McFarlane B, Tadros G, Ridha BH, Bannister C, Walker Z, Archer H, Coulthard E, Underwood B, Prasanna A, Koranteng P, Karim S, Junaid K, McGuinness B, Passmore AP, Nilforooshan R, Macharouthu A, Donaldson A, Thacker S, Russell G, Malik N, Mate V, Knight L, Kshemendran S, Harrison J, Ballard C, Brooks DJ, Edison P. P3‐225: PERIPHERAL INSULIN RESISTANCE DOES NOT CORRELATE WITH CEREBRAL GLUCOSE METABOLIC RATE IN NON‐DIABETIC ALZHEIMER'S PATIENTS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1584] [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: 10/28/2022]
Affiliation(s)
| | - Zhen Fan
- Imperial College LondonLondonUnited Kingdom
| | | | | | | | - Clive Holmes
- University of SouthamptonSouthamptonUnited Kingdom
| | | | - Robert M. Lawrence
- South West London and St George's Mental Health National Health Service TrustLondonUnited Kingdom
| | - Brady McFarlane
- Southern Health, National Health Service Foundation TrustSouthamptonUnited Kingdom
| | - George Tadros
- Heart of England National Health Service Foundation TrustBirminghamUnited Kingdom
| | - Basil H. Ridha
- Dementia Research Centre, Institute of NeurologyUniversity College LondonLondonUnited Kingdom
| | | | - Zuzana Walker
- Mental Health UnitSt. Margaret's HospitalEppingEssexUnited Kingdom
| | - Hilary Archer
- North Bristol National Health Service TrustBristolUnited Kingdom
| | | | - Ben Underwood
- Cambridgeshire and Peterborough National Health Service Foundation TrustCambridgeUnited Kingdom
| | - Aparna Prasanna
- Black Country Partnership National Health Service Foundation TrustWolverhamptonUnited Kingdom
| | - Paul Koranteng
- Northamptonshire Healthcare National Health Service Foundation TrustNorthamptonUnited Kingdom
| | - Salman Karim
- Lancashire Care National Health Servuce Foundation TrustPrestonUnited Kingdom
| | - Kehinde Junaid
- Nottinghamshire Healthcare National Health Service Foundation TrustNottinghamUnited Kingdom
| | | | | | - Ramin Nilforooshan
- Surrey and Borders Partnership National Health Service Foundation TrustChertseyUnited Kingdom
| | | | | | - Simon Thacker
- Derbyshire Healthcare National Health Service Foundation TrustDerbyUnited Kingdom
| | - Gregor Russell
- Bradford District Care National Health Service Foundation TrustBradfordUnited Kingdom
| | - Naghma Malik
- North West Boroughs Partnership National Health Service Foundation TrustWarringtonUnited Kingdom
| | - Vandana Mate
- Cornwall Partnership National Health Service Foundation TrustRedruthUnited Kingdom
| | - Lucy Knight
- Somerset Partnership National Health Service Foundation TrustSouth PethertonUnited Kingdom
| | - Sajeev Kshemendran
- South Staffordshire and Shropshire Healthcare National Health Service Foundation TrustShrewsburyUnited Kingdom
| | - John Harrison
- Alzheimer CenterVU University Medical CenterAmsterdamNetherlands
| | - Clive Ballard
- University of Exeter Medical SchoolExeterUnited Kingdom
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Fan Z, Calsolaro V, Mayers J, Tyacke R, Venkataraman A, Femminella GD, Perneczky R, Gunn RN, Rabiner EA, McMahan Matthews P, Nutt D, Edison P. O5‐01‐05: RELATIONSHIP BETWEEN ASTROCYTE ACTIVATION USING [11C]BU99008 PET, GLUCOSE METABOLISM AND AMYLOID IN ALZHEIMER'S DISEASE: A DEMENTIA PLATFORM UK EXPERIMENTAL MEDICINE STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zhen Fan
- Imperial College LondonLondonUnited Kingdom
| | | | - Jim Mayers
- Imperial College LondonLondonUnited Kingdom
| | | | | | | | | | | | | | | | - David Nutt
- Imperial College LondonLondonUnited Kingdom
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Pasqualetti G, Calsolaro V, Bernardini S, Linsalata G, Bigazzi R, Caraccio N, Monzani F. Degree of Peripheral Thyroxin Deiodination, Frailty, and Long-Term Survival in Hospitalized Older Patients. J Clin Endocrinol Metab 2018; 103:1867-1876. [PMID: 29546287 DOI: 10.1210/jc.2017-02149] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Although the association between low free triiodothyronine (FT3) and poor outcome has been extensively reported in literature, the degree of peripheral thyroxin deiodination and its relationship with frailty and survival in hospitalized older patients has not yet been fully established. The aim of the current study was to evaluate the possible correlation between FT3/free thyroxine (FT4) ratio reduction, an indirect marker of thyroxin deiodination impairment, and frailty status and survival in hospitalized older patients. METHODS We consecutively enrolled older patients, hospitalized in the geriatrics ward of the University of Pisa. At admission, Multidimensional Geriatric Assessment (MGA) and Multi Prognostic Index (MPI), an indirect measure of frailty, were obtained from all the patients. Causes of hospitalization and prevalence of delirium were recorded. Blood samples for FT3, FT4, and thyrotropin value evaluation were drawn after an overnight fast. RESULTS A total of 643 patients (83.8 ± 7.4 years, 53% women) were studied. FT3 was inversely and strongly correlated, whereas FT4 was moderately positively correlated with MGA parameters, MPI score (P < 0.001 and P < 0.05, respectively), and survival (P < 0.001 and P = 0.09, respectively). FT3/FT4 ratio reduction was highly associated with worse MGA (P < 0.001) and MPI scores (P < 0.0001), even in patients without low FT3. The inclusion of FT3 in the final model of multivariate Cox regression confirmed the independent role of FT3/FT4 ratio in predicting survival (P = 0.005). CONCLUSION Overall, our study documented a strong association between FT3/FT4 ratio reduction, a surrogate marker of peripheral thyroxin deiodination, and frailty. Moreover, FT3/FT4 ratio value emerged as independent marker of survival, even in patients with normal FT3 values.
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Affiliation(s)
- Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Neurology Imaging Unit, Imperial College, London, United Kingdom
| | - Sara Bernardini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Linsalata
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Renato Bigazzi
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Calsolaro V, Pasqualetti G, Niccolai F, Caraccio N, Monzani F. Thyroid Disrupting Chemicals. Int J Mol Sci 2017; 18:ijms18122583. [PMID: 29194390 PMCID: PMC5751186 DOI: 10.3390/ijms18122583] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [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: 11/02/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 02/08/2023] Open
Abstract
Endocrine disruptor compounds are exogenous agents able to interfere with a gland function, exerting their action across different functional passages, from the synthesis to the metabolism and binding to receptors of the hormone produced. Several issues, such as different levels and time of exposure and different action across different ages as well as gender, make the study of endocrine disruptors still a challenge. The thyroid is very sensitive to the action of disruptors, and considering the importance of a correct thyroid function for physical and cognitive functioning, addressing this topic should be considered a priority. In this review, we examined the most recent studies, many of them concentrating on maternal and child exposure, conducted to assess the impact of industrial chemicals which showed an influence on thyroid function. So far, the number of studies conducted on that topic is not sufficient to provide solid conclusions and lead to homogeneous guidelines. The lack of uniformity is certainly due to differences in areas and populations examined, the different conditions of exposures and the remarkable inter-subject variability. Nonetheless, the European Commission for Health and Food Safety is implementing recommendations to ensure that substances identified as endocrine disruptors will be withdrawn from the market.
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Affiliation(s)
- Valeria Calsolaro
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa 56125, Italy.
- Neurology Imaging Unit, Imperial College, London W12 0NN, UK.
| | - Giuseppe Pasqualetti
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa 56125, Italy.
| | - Filippo Niccolai
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa 56125, Italy.
| | - Nadia Caraccio
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa 56125, Italy.
| | - Fabio Monzani
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa 56125, Italy.
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Calsolaro V, Fan Z, Daniela Femminella G, Veronese M, Pasqualetti G, Trigg W, Turkheimer F, Gentleman S, Brooks DJ, Hinz R, Edison P, Buckley CJ. [O3–09–06]: MICROGLIAL ACTIVATION IN ALZHEIMER's DISEASE DETECTED BY NOVEL THIRD GENERATION TRANSLOCATOR PROTEIN TRACER FLUTRICICLAMIDE ([18F]GE180). Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.355] [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: 10/18/2022]
Affiliation(s)
- Valeria Calsolaro
- Imperial College LondonLondonUnited Kingdom
- Kings College LondonLondonUnited Kingdom
- Newcastle UniversityNewcastleUnited Kingdom
- Aarhus UniversityAarhusDenmark
- University of ManchesterManchesterUnited Kingdom
| | - Zhen Fan
- Imperial College LondonLondonUnited Kingdom
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Daniela Femminella G, Dani M, Wood M, Fan Z, Calsolaro V, Mizoguchi R, Atkinson RA, Edginton T, Waldman A, Hinz R, Brooks DJ, Edison P. [O3–09–03]: MICROGLIAL ACTIVATION IS ASSOCIATED WITH HIGHER GREY MATTER DENSITY AND HIPPOCAMPAL VOLUME IN MCI SUBJECTS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Grazia Daniela Femminella
- Imperial College LondonLondonUnited Kingdom
- University of SussexBrightonUnited Kingdom
- University of WestminsterLondonUnited Kingdom
- University of ManchesterManchesterUnited Kingdom
- Aarhus UniversityAarhusDenmark
| | | | | | - Zhen Fan
- Imperial College LondonLondonUnited Kingdom
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Fan Z, Dani M, Daniela Femminella G, Calsolaro V, Veronese M, Turkheimer F, Brooks DJ, Gentleman S, Hinz R, Edison P. [P1–123]: STRATEGIES TO DEVELOP PARAMETRIC MAPS FOR TSPO PET TRACER [11C]‐PBR28 IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.190] [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: 11/25/2022]
Affiliation(s)
- Zhen Fan
- Imperial College LondonLondonUnited Kingdom
| | | | | | | | | | | | - David J. Brooks
- Imperial College LondonLondonUnited Kingdom
- Aarhus UniversityAarhusDenmark
| | | | - Rainer Hinz
- University of ManchesterManchesterUnited Kingdom
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38
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Pasqualetti G, Seghieri M, Santini E, Rossi C, Vitolo E, Giannini L, Malatesta MG, Calsolaro V, Monzani F, Solini A. P2X 7 Receptor and APOE Polymorphisms and Survival from Heart Failure: A Prospective Study in Frail Patients in a Geriatric Unit. Aging Dis 2017; 8:434-441. [PMID: 28840058 PMCID: PMC5524806 DOI: 10.14336/ad.2016.1202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/12/2016] [Accepted: 12/02/2016] [Indexed: 11/29/2022] Open
Abstract
Heart failure (HF) is one of the most frequent cause of hospitalization in elderly and often coexists with concurrent geriatric syndromes, like cognitive disturbances; various pathophysiological mechanisms are shared by HF and cognitive decline, notably a substrate of low-grade inflammation. We investigated whether SNPs in the purinergic receptor (P2X7R) and apolipoprotein (APO) E genes, both involved in a series of inflammatory responses, are associated to HF or cognitive impairment and are able to predict post-discharge mortality in the elderly. We prospectively analyzed 198 patients (age 85 ± 8 years, predominantly females) admitted to a Geriatric unit for acute HF, whose diagnosis was based on clinical signs, brain natriuretic peptide (BNP) values and ecocardiography in uncertain diagnosis (BNP values between 100 and 400 pg/mL); cognitive performance was assesed by Short Portable Mental Status Questionnaire (SPMSQ). In all the participants, SNPs rs208294 and rs3751143 for P2X7R gene and rs429558 and rs7412 for APOE gene were assessed. Information on all-cause mortality was adjudicated by medical records review 36 months after discharge. We found no relationship between P2X7R and APOE polymorphisms and 36-month post-discharge mortality; a better outcome for overall survival was observed in patients with BNP values below the median (281 pg/mL) (p=0.002) persisting after adjustment for renal function and age, and in those with cognitive impairment (p<0.001). Patients harboring APOE-ε4 genotype showed higher BNP concentrations than noncarriers (1289.9 ± 226.9 vs 580.5 ± 90.2 pg/mL respectively,p=0.004), whereas none of the studied SNPs were associated to impairment in cognitive performance. In conclusion, neither P2X7R or APOE genotype seem to predict long-term mortality in elderly patients. Interestingly, APOE-ε4 genotype was associated to higher BNP values, suggesting a putative interaction between genetic and biochemical markers in identifying people at risk for HF.
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Affiliation(s)
- Giuseppe Pasqualetti
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Marta Seghieri
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Eleonora Santini
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Chiara Rossi
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Edoardo Vitolo
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Livia Giannini
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | | | - Valeria Calsolaro
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Anna Solini
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
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Calsolaro V, Daniela Femminella G, Fan Z, Dani M, Kozlowski K, Aboagye E, Edison P. [P4–221]: EVALUATION OF CASPASE‐3 ACTIVATION IN AN ALZHEIMER's DISEASE POPULATION USING [
18
F]ICMT‐11 PET/CT. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2089] [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: 10/18/2022]
Affiliation(s)
| | | | - Zhen Fan
- Imperial College LondonLondonUnited Kingdom
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Edison P, Mayers J, Calsolaro V, Fan Z, Turton S, Venkataraman A, Daniela Femminella G, Perneczky R, Gunn RN, Rabiner EA, Matthews PM, Tyacke R, Nutt D. [P3–324]: DEMENTIA PLATFORM U.K. EXPERIMENTAL MEDICINE: HUMAN
IN VIVO
ASTROGLIAL ACTIVATION IN EARLY ALZHEIMER's DISEASE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1539] [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: 10/18/2022]
Affiliation(s)
| | - Jim Mayers
- Imperial College LondonLondonUnited Kingdom
| | | | - Zhen Fan
- Imperial College LondonLondonUnited Kingdom
| | | | | | | | - Robert Perneczky
- Imperial College LondonLondonUnited Kingdom
- West London Mental Health NHS TrustLondonUnited Kingdom
| | - Roger N. Gunn
- Imperial College LondonLondonUnited Kingdom
- IMANOVA Ltd.LondonUnited Kingdom
| | - Eugenii A. Rabiner
- IMANOVA Ltd.LondonUnited Kingdom
- King's College LondonLondonUnited Kingdom
| | | | | | - David Nutt
- Imperial College LondonLondonUnited Kingdom
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41
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Fan Z, Dani M, Daniela Femminella G, Calsolaro V, Veronese M, Turkheimer F, Gentleman S, Hinz R, Edison P. [P1–124]: REGIONAL KINETIC MODELLING APPLICATION FOR TSPO PET TRACER [11C]PBR28. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.191] [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: 10/18/2022]
Affiliation(s)
- Zhen Fan
- Imperial College LondonLondonUnited Kingdom
| | | | | | | | | | | | | | - Rainer Hinz
- University of ManchesterManchesterUnited Kingdom
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Pasqualetti G, Calsolaro V, Bini G, Dell’Agnello U, Tuccori M, Marino A, Capogrosso-Sansone A, Rafanelli M, Santini M, Orsitto E, Ungar A, Blandizzi C, Monzani F. Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope. Clin Interv Aging 2017; 12:687-695. [PMID: 28450779 PMCID: PMC5399985 DOI: 10.2147/cia.s127824] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65-105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17-1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27-0.58], 0.40 [0.24-0.68], 0.35 [0.14-0.82], and 0.31 [0.20-0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07-5.90] and 1.24 [1.07-1.44], respectively). Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50-0.84], 0.52 [0.30-0.89], 0.40 [0.20-0.77], and 0.26 [0.13-0.55]), respectively. These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.
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Affiliation(s)
| | | | | | | | - Marco Tuccori
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Alessandra Marino
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | | | - Martina Rafanelli
- Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence
| | - Massimo Santini
- Emergency Department, University Hospital of Pisa, Pisa, Italy
| | - Eugenio Orsitto
- Emergency Department, University Hospital of Pisa, Pisa, Italy
| | - Andrea Ungar
- Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence
| | - Corrado Blandizzi
- Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa
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43
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Calsolaro V, Edison P. Alterations in Glucose Metabolism in Alzheimer's Disease. ACTA ACUST UNITED AC 2017; 10:31-39. [PMID: 27306508 DOI: 10.2174/1872214810666160615102809] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most frequent type of dementia in people over 65 years of age; type 2 diabetes mellitus is a metabolic condition affecting 382 million of adults worldwide. Glucose is the main substrate for energy for the brain, which consumes 25% of the body's glucose. Glucose metabolism, evaluated using Positron Emission Tomography (PET) scanning using 18F-fluorodeoxyglucose ([18F]-FDG) is commonly used for diagnosis and follow up in AD. Epidemiological and pathophysiological studies showed a link between AD and diabetes, particularly in relation to insulin resistance. OBJECTIVE In this paper, we discuss how [18F] FDG is a marker of glucose metabolism, how insulin resistance is related to diabetes, the link between diabetes and AD, and how novel treatments for diabetes could be beneficial in the treatment of Alzheimer's disease. We also review few recent patents in the field, suggesting both diagnostic and therapeutic potential approaches. METHODS The electronic searches were performed in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases. We also manually searched abstract books and reviewed available recent patents on specific websites. RESULTS The impaired glucose metabolism in the brain of subject with AD is a widely recognised early feature of the disease; in vivo evaluation with PET is a useful diagnostic tool. The link between diabetes and neurodegeneration is widely recognized and offer a target for novel therapeutic strategies. CONCLUSIONS Early diagnosis and early therapeutic intervention are needed to approach this devastating disease. Important studies targeting different aspect of the disease are currently ongoing.
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Affiliation(s)
| | - Paul Edison
- Division of Brain Sciences, Department of Medicine, Imperial College London, Neurology Imaging Unit, Imperial College London, W12 0NN, UK.
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Pasqualetti G, Calsolaro V, Monzani F. Editorial (Thematic Issue: Endocrine Disorders and Cognitive Function in the Elderly). ACTA ACUST UNITED AC 2017; 10:2-3. [PMID: 27981913 DOI: 10.2174/187221481001161005181628] [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: 11/22/2022]
Affiliation(s)
| | | | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56 126 - Pisa, Pisa Italy.
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45
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Marino A, Capogrosso-Sansone A, Tuccori M, Bini G, Calsolaro V, Mantarro S, Convertino I, Pasqualetti G, Orsitto E, Santini M, Monzani F, Blandizzi C. Expected and actual adverse drug-drug interactions in elderly patients accessing the emergency department: data from the ANCESTRAL-ED study. Expert Opin Drug Saf 2017; 15:45-50. [PMID: 27875918 DOI: 10.1080/14740338.2016.1221400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 10/20/2022]
Abstract
OBJECTIVE This study was aimed at evaluating the frequency and describing the adverse drug-drug interactions (DDIs) recorded among elderly patients accessing the emergency department (ED). METHODS Patients aged ≥65 years, accessing the ED of Pisa University Hospital (Italy) from 1 January 2015 to 31 December 2015 within the ANCESTRAL-ED program, were included in this study. 'Expected' DDIs were assessed using Thomson Micromedex®. Each ED admission (discharge diagnosis) consistent with the signs and symptoms of an expected DDI for each patient was classified as an 'actual' DDI. RESULTS Throughout the study period, 3473 patients (3812 ED admissions, 58% females, mean age: 80.3) were recorded. The total number of expected DDIs was 12,578 (67 contraindicated; 3334 major; 8878 moderate; 299 minor) detected in 2147 (62%) patients. Overall 464 expected DDIs were found to be consistent with the ED admission in 194 patients (representing 9% of patients with expected DDIs). CONCLUSIONS More than one half of elderly patients admitted to ED presented at least one expected DDI at the time of ED presentation. However, 9% of the expected DDIs were identified as actual DDIs, based on the consistency of the expected event with the ED discharge diagnosis.
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Affiliation(s)
- A Marino
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - A Capogrosso-Sansone
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - M Tuccori
- b Unit of Adverse Drug Reaction Monitoring , University Hospital of Pisa , Pisa , Italy
| | - G Bini
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - V Calsolaro
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - S Mantarro
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - I Convertino
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - G Pasqualetti
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - E Orsitto
- d Emergency Department , University Hospital of Pisa , Pisa , Italy
| | - M Santini
- d Emergency Department , University Hospital of Pisa , Pisa , Italy
| | - F Monzani
- c Geriatric Unit, Department of Clinical and Experimental Medicine , University Hospital of Pisa , Pisa , Italy
| | - C Blandizzi
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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Calsolaro V, Ashraf A, Fan Z, Brooks DJ, Edison P. P4‐175: Increased [11C](R)PK11195‐PET and Attenuated Cerebral Glucose Metabolism: A Common Theme in Neurodegenerative Diseases? Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.2267] [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: 11/30/2022]
Affiliation(s)
| | | | - Zhen Fan
- Imperial College LondonLondonUnited Kingdom
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Fan Z, Calsolaro V, Atkinson RA, Femminella GD, Waldman A, Buckley C, Trigg W, Brooks DJ, Hinz R, Edison P. Flutriciclamide (18F-GE180) PET: First-in-Human PET Study of Novel Third-Generation In Vivo Marker of Human Translocator Protein. J Nucl Med 2016; 57:1753-1759. [DOI: 10.2967/jnumed.115.169078] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/10/2016] [Indexed: 12/27/2022] Open
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Pasqualetti G, Calsolaro V, Monzani F. Major adverse cardiovascular and cerebral events in hypothyroid patients undergoing percutaneous coronary intervention. J Thorac Dis 2016; 8:1042-4. [DOI: 10.21037/jtd.2016.04.11] [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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Calsolaro V, Edison P. Neuroinflammation in Alzheimer's disease: Current evidence and future directions. Alzheimers Dement 2016; 12:719-32. [DOI: 10.1016/j.jalz.2016.02.010] [Citation(s) in RCA: 738] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 02/14/2016] [Accepted: 02/25/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | - Paul Edison
- Neurology Imaging Unit; Imperial College London; UK
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Abstract
The use of multi drug regimens among the elderly population has increased tremendously over the last decade although the benefits of medications are always accompanied by potential harm, even when prescribed at recommended doses. The elderly populations are particularly at an increased risk of adverse drug reactions considering comorbidity, poly-therapy, physiological changes affecting the pharmacokinetics and pharmacodynamics of many drugs and, in some cases, poor compliance due to cognitive impairment and/or depression. In this setting, drug–drug interaction may represent a serious and even life-threatening clinical condition. Moreover, the inability to distinguish drug-induced symptoms from a definitive medical diagnosis often results in addition of yet another drug to treat the symptoms, which in turn increases drug–drug interactions. Cognitive enhancers, including acetylcholinesterase inhibitors and memantine, are the most widely prescribed agents for Alzheimer’s disease (AD) patients. Behavioral and psychological symptoms of dementia, including psychotic symptoms and behavioral disorders, represent noncognitive disturbances frequently observed in AD patients. Antipsychotic drugs are at high risk of adverse events, even at modest doses, and may interfere with the progression of cognitive impairment and interact with several drugs including anti-arrhythmics and acetylcholinesterase inhibitors. Other medications often used in AD patients are represented by anxiolytic, like benzodiazepine, or antidepressant agents. These agents also might interfere with other concomitant drugs through both pharmacokinetic and pharmacodynamic mechanisms. In this review we focus on the most frequent drug–drug interactions, potentially harmful, in AD patients with behavioral symptoms considering both physiological and pathological changes in AD patients, and potential pharmacodynamic/pharmacokinetic drug interaction mechanisms.
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Affiliation(s)
- Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Tognini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Polini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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