Cognitive Impairment and Age-Related Vision Disorders: Their Possible Relationship and the Evaluation of the Use of Aspirin and Statins in a 65 Years-and-Over Sardinian Population

Neurological disorders (Alzheimer’s disease, vascular and mixed dementia) and visual loss (cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy) are among the most common conditions that afflict people of at least 65 years of age. An increasing body of evidence is emerging, which demonstrates that memory and vision impairment are closely, significantly, and positively linked and that statins and aspirin may lessen the risk of developing age-related visual and neurological problems. However, clinical studies have produced contradictory results. Thus, the intent of the present study was to reliably establish whether a relationship exist between various types of dementia and age-related vision disorders, and to establish whether statins and aspirin may or may not have beneficial effects on these two types of disorders. We found that participants with dementia and/or vision problems were more likely to be depressed and displayed worse functional ability in basic and instrumental activities of daily living than controls. Mini mental state examination scores were significantly lower in patients with vision disorders compared to subjects without vision disorders. A closer association with macular degeneration was found in subjects with Alzheimer’s disease than in subjects without dementia or with vascular dementia, mixed dementia, or other types of age-related vision disorders. When we considered the associations between different types of dementia and vision disorders and the use of statins and aspirin, we found a significant positive association between Alzheimer’s disease and statins on their own or in combination with aspirin, indicating that these two drugs do not appear to reduce the risk of Alzheimer’s disease or improve its clinical evolution and may, on the contrary, favor its development. No significant association in statin use alone, aspirin use alone, or the combination of these was found in subjects without vision disorders but with dementia, and, similarly, none in subjects with vision disorders but without dementia. Overall, these results confirm the general impression so far; namely, that macular degeneration may contribute to cognitive disorders (Alzheimer’s disease in particular). In addition, they also suggest that, while statin and aspirin use may undoubtedly have some protective effects, they do not appear to be magic pills against the development of cognitive impairment or vision disorders in the elderly

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Utilizzo delle colture in vitro per la produzione di metaboliti secondari

Plant secondary metabolites are known to play a major role in the adaptation of plants to their environment. Production from spontaneous or cultivated plants is affected by environmental and physiological factors. Plant cell cultures have been suggested as a feasible technology for the production of plant derivedm etabolites. Few industrial lines having high production, have been obtained on the base of experimental studies

RBANS: un valido strumento di valutazione cognitiva in soggetti HIV-infetti in cART = RBANS: a valid tool for cognitive assessment of HIV-infected people on cART

Introduction. Combination Antiretroviral Therapy (cART) has dramatically modified prognosis of individuals with HIV infection, and also the HIV-Associated Neurocognitive Disorders (HAND) spectrum, with reduction of the most severe form of HAND, HIV-Associated Dementia (HAD), but with persistence of the milder forms (ANI: Asymptomatic Neurocognitive Impairment; MND: Mild Neurocognitive Disorder). Screening of HAND requires efficient tools. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a tool that is fast and easy to use, and which is able to assess different cognitive domains. Our purpose is to evaluate the utility of RBANS in screening HAND. Materials and methods. 95 HIV-infected patients (mean age 47.8 +/- 8.0, range 26-74 years; mean duration of infection 17.0 +/- 8.5, range 1-32 years) on cART, run by Internal Medicine, Allergology and Clinical Immunology, University of Cagliari, underwent neuropsychological assessment with MMSE, Clock Test and RBANS. Results obtained were compared with participants in the RBANS validation study for the Italian population (control group). Results. Mean scores in MMSE and Clock Test were 29.3 +/- 1.3 and 8.5 +/- 1.4, respectively, indicative of normal cognitive abilities. In RBANS evaluation, however, the total index score was significantly lower than the mean of the control group (84.9 +/- 13.6, P < 0.001), as were indices of immediate memory (82.4 +/- 14.1), language (91.2 +/- 10), attention (87.9 +/- 16.1) and delayed memory (87.3 +/- 17.6). Conclusions. Our results support the utility of RBANS for identification of HAND in HIV-infected people on cART

The Repeatable Battery for the Assessment of Neuropsychological Status as a screening strategy for HIV-Associated Neurocognitive Disorders

HIV-infected people are at risk for neurocognitive impairment (HIV-Associated Neurocognitive Disorders–HAND). To evaluate whether the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a widely used neurocognitive screening tool, could be a valid instrument for HAND identification, we evaluated 166 HIV-infected subjects. Our results showed that 96 (57.8%) HIV-infected scored RBANS Total Index Score &lt;85 (at least one SD below the normal), 12 (7.2%) of them scored RBANS Total Index Score &lt;70 (at least 2 SD below the normal, indicating a possible HIV-Associated Dementia). The more compromised areas were Immediate and Delayed Memory, and Attention. In the group with RBANS Total Index Score &lt;85, there were significantly lower scores of Mini Mental State Examination (P = 0.0008), Clock Drawing Test (P = 0.0015) and higher score of Geriatric Depression Scale (P = 0.02) compared to the RBANS Total Index Score ≥85 group. Using a stepwise logistic regression, considering RBANS Total Index Score as dependent variable, we found a positive interaction with tenofovir/emtricitabine assumption (P = 0.027), Clock Drawing Test (P = 0.0125) and educational level (P = 0.0054). Being the viro-immunological markers not capable of predicting cognitive decline in HIV-infected individuals, our data suggest that RBANS may be a valid tool for the early identification of HIV-related cognitive impairment

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

426noreservedObjective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 “Delirium Day” project. Setting and Participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P &lt;.001), visual impairment (24.2% vs 15.7%; P &lt;.01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2–2.1; P =.00] and in Model 2 (OR 1.4; CI 1.1–1.9; P =.02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6–1.2, P =.36; OR 1.1; CI 0.8–1.4; P =.42) or in Model 2 (OR 0.8, CI 0.6–1.2, P =.27; OR 1.1, CI 0.8–1.4, P =.63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.mixedMorandi A.; Inzitari M.; Udina C.; Gual N.; Mota M.; Tassistro E.; Andreano A.; Cherubini A.; Gentile S.; Mossello E.; Marengoni A.; Olive A.; Riba F.; Ruiz D.; de Jaime E.; Bellelli G.; Tarasconi A.; Sella M.; Auriemma S.; Paterno G.; Faggian G.; Lucarelli C.; De Grazia N.; Alberto C.; Margola A.; Porcella L.; Nardiello I.; Chimenti E.; Zeni M.; Giani A.; Famularo S.; Romairone E.; Minaglia C.; Ceccotti C.; Guerra G.; Mantovani G.; Monacelli F.; Candiani T.; Ballestrero A.; Santolini F.; Rosso M.; Bono V.; Sibilla S.; Dal Santo P.; Ceci M.; Barone P.; Schirinzi T.; Formenti A.; Nastasi G.; Isaia G.; Gonella D.; Battuello A.; Casson S.; Calvani D.; Boni F.; Ciaccio A.; Rosa R.; Sanna G.; Manfredini S.; Cortese L.; Rizzo M.; Prestano R.; Greco A.; Lauriola M.; Gelosa G.; Piras V.; Arena M.; Cosenza D.; Bellomo A.; LaMontagna M.; Gabbani L.; Lambertucci L.; Perego S.; Parati G.; Basile G.; Gallina V.; Pilone G.; Giudice C.; De F.; Pietrogrande L.; De B.; Mosca M.; Corazzin I.; Rossi P.; Nunziata V.; D'Amico F.; Grippa A.; Giardini S.; Barucci R.; Cossu A.; Fiorin L.; Distefano M.; Lunardelli M.; Brunori M.; Ruffini I.; Abraham E.; Varutti A.; Fabbro E.; Catalano A.; Martino G.; Leotta D.; Marchet A.; Dell'Aquila G.; Scrimieri A.; Davoli M.; Casella M.; Cartei A.; Polidori G.; Brischetto D.; Motta S.; Saponara R.; Perrone P.; Russo G.; Del D.; Car C.; Pirina T.; Franzoni S.; Cotroneo A.; Ghiggia F.; Volpi G.; Menichetti C.; Bo M.; Panico A.; Calogero P.; Corvalli G.; Mauri M.; Lupia E.; Manfredini R.; Fabbian F.; March A.; Pedrotti M.; Veronesi M.; Strocchi E.; Borghi C.; Bianchetti A.; Crucitti A.; DiFrancesco V.; Fontana G.; Bonanni L.; Barbone F.; Serrati C.; Ballardini G.; Simoncelli M.; Ceschia G.; Scarpa C.; Brugiolo R.; Fusco S.; Ciarambino T.; Biagini C.; Tonon E.; Porta M.; Venuti D.; DelSette M.; Poeta M.; Barbagallo G.; Trovato G.; Delitala A.; Arosio P.; Reggiani F.; Zuliani G.; Ortolani B.; Mussio E.; Girardi A.; Coin A.; Ruotolo G.; Castagna A.; Masina M.; Cimino R.; Pinciaroli A.; Tripodi G.; Cannistra U.; Cassadonte F.; Vatrano M.; Scaglione L.; Fogliacco P.; Muzzuilini C.; Romano F.; Padovani A.; Rozzini L.; Cagnin A.; Fragiacomo F.; Desideri G.; Liberatore E.; Bruni A.; Orsitto G.; Franco M.; Bonfrate L.; Bonetto M.; Pizio N.; Magnani G.; Cecchetti G.; Longo A.; Bubba V.; Marinan L.; Cotelli M.; Turla M.; Sessa M.; Abruzzi L.; Castoldi G.; LoVetere D.; Musacchio C.; Novello M.; Cavarape A.; Bini A.; Leonardi A.; Seneci F.; Grimaldi W.; Fimognari F.; Bambara V.; Saitta A.; Corica F.; Braga M.; Ettorre E.; Camellini C.; Bellelli G.; Annoni G.; Crescenzo A.; Noro G.; Turco R.; Ponzetto M.; Giuseppe L.; Mazzei B.; Maiuri G.; Costaggiu D.; Damato R.; Formilan M.; Patrizia G.; Gallucci M.; Paragona M.; Bini P.; Modica D.; Abati C.; Clerici M.; Barbera I.; NigroImperiale F.; Manni A.; Votino C.; Castiglioni C.; Di M.; Degl'Innocenti M.; Moscatelli G.; Guerini S.; Casini C.; Dini D.; D'Imporzano E.; DeNotariis S.; Bonometti F.; Paolillo C.; Riccardi A.; Tiozzo A.; DiBari M.; Vanni S.; Scarpa A.; Zara D.; Ranieri P.; Alessandro M.; Di F.; Pezzoni D.; Platto C.; D'Ambrosio V.; Ivaldi C.; Milia P.; DeSalvo F.; Solaro C.; Strazzacappa M.; Cazzadori M.; Confente S.; Grasso M.; Troisi E.; Guerini V.; Bernardini B.; Corsini C.; Boffelli S.; Filippi A.; Delpin K.; Faraci B.; Bertoletti E.; Vannucci M.; Tesi F.; Crippa P.; Malighetti A.; Bettini D.; Maltese F.; Abruzzese G.; Cosimo D.; Azzini M.; Colombo M.; Procino G.; Fascendini S.; Barocco F.; Del P.; Mazzone A.; Riva E.; Dell'Acqua D.; Cottino M.; Vezzadini G.; Avanzi S.; Brambilla C.; Orini S.; Sgrilli F.; Mello A.; Lombardi L.; Muti E.; Dijk B.; Fenu S.; Pes C.; Gareri P.; Passamonte M.; Rigo R.; Locusta L.; Caser L.; Rosso G.; Cesarini S.; Cozzi R.; Santini C.; Carbone P.; Cazzaniga I.; Lovati R.; Cantoni A.; Ranzani P.; Barra D.; Pompilio G.; Dimori S.; Cernesi S.; Ricco C.; Piazzolla F.; Capittini E.; Rota C.; Gottardi F.; Merla L.; Barelli A.; Millul A.; De G.; Morrone G.; Bigolari M.; Macchi M.; Zambon F.; Pizzorni C.; DiCasaleto G.; Menculini G.; Marcacci M.; Catanese G.; Sprini D.; DiCasalet T.; Bocci M.; Borga S.; Caironi P.; Cat C.; Cingolani E.; Avalli L.; Greco G.; Citerio G.; Gandini L.; Cornara G.; Lerda R.; Brazzi L.; Simeone F.; Caciorgna M.; Alampi D.; Francesconi S.; Beck E.; Antonini B.; Vettoretto K.; Meggiolaro M.; Garofalo E.; Notaro S.; Varutti R.; Bassi F.; Mistraletti G.; Marino A.; Rona R.; Rondelli E.; Riva I.; Scapigliati A.; Cortegiani A.; Vitale F.; Pistidda L.; D'Andrea R.; Querci L.; Gnesin P.; Todeschini M.; Lugano M.; Castelli G.; Ortolani M.; Cotoia A.; Maggiore S.; DiTizio L.; Graziani R.; Testa I.; Ferretti E.; Castioni C.; Lombardi F.; Caserta R.; Pasqua M.; Simoncini S.; Baccarini F.; Rispoli M.; Grossi F.; Cancelliere L.; Carnelli M.; Puccini F.; Biancofiore G.; Siniscalchi A.; Laici C.; Mossello E.; Torrini M.; Pasetti G.; Palmese S.; Oggioni R.; Mangani V.; Pini S.; Martelli M.; Rigo E.; Zuccala F.; Cherri A.; Spina R.; Calamai I.; Petrucci N.; Caicedo A.; Ferri F.; Gritti P.; Brienza N.; Fonnesu R.; Dessena M.; Fullin G.; Saggioro D.Morandi, A.; Inzitari, M.; Udina, C.; Gual, N.; Mota, M.; Tassistro, E.; Andreano, A.; Cherubini, A.; Gentile, S.; Mossello, E.; Marengoni, A.; Olive, A.; Riba, F.; Ruiz, D.; de Jaime, E.; Bellelli, G.; Tarasconi, A.; Sella, M.; Auriemma, S.; Paterno, G.; Faggian, G.; Lucarelli, C.; De Grazia, N.; Alberto, C.; Margola, A.; Porcella, L.; Nardiello, I.; Chimenti, E.; Zeni, M.; Giani, A.; Famularo, S.; Romairone, E.; Minaglia, C.; Ceccotti, C.; Guerra, G.; Mantovani, G.; Monacelli, F.; Candiani, T.; Ballestrero, A.; Santolini, F.; Rosso, M.; Bono, V.; Sibilla, S.; Dal Santo, P.; Ceci, M.; Barone, P.; Schirinzi, T.; Formenti, A.; Nastasi, G.; Isaia, G.; Gonella, D.; Battuello, A.; Casson, S.; Calvani, D.; Boni, F.; Ciaccio, A.; Rosa, R.; Sanna, G.; Manfredini, S.; Cortese, L.; Rizzo, M.; Prestano, R.; Greco, A.; Lauriola, M.; Gelosa, G.; Piras, V.; Arena, M.; Cosenza, D.; Bellomo, A.; Lamontagna, M.; Gabbani, L.; Lambertucci, L.; Perego, S.; Parati, G.; Basile, G.; Gallina, V.; Pilone, G.; Giudice, C.; De, F.; Pietrogrande, L.; De, B.; Mosca, M.; Corazzin, I.; Rossi, P.; Nunziata, V.; D'Amico, F.; Grippa, A.; Giardini, S.; Barucci, R.; Cossu, A.; Fiorin, L.; Distefano, M.; Lunardelli, M.; Brunori, M.; Ruffini, I.; Abraham, E.; Varutti, A.; Fabbro, E.; Catalano, A.; Martino, G.; Leotta, D.; Marchet, A.; Dell'Aquila, G.; Scrimieri, A.; Davoli, M.; Casella, M.; Cartei, A.; Polidori, G.; Brischetto, D.; Motta, S.; Saponara, R.; Perrone, P.; Russo, G.; Del, D.; Car, C.; Pirina, T.; Franzoni, S.; Cotroneo, A.; Ghiggia, F.; Volpi, G.; Menichetti, C.; Bo, M.; Panico, A.; Calogero, P.; Corvalli, G.; Mauri, M.; Lupia, E.; Manfredini, R.; Fabbian, F.; March, A.; Pedrotti, M.; Veronesi, M.; Strocchi, E.; Borghi, C.; Bianchetti, A.; Crucitti, A.; Difrancesco, V.; Fontana, G.; Bonanni, L.; Barbone, F.; Serrati, C.; Ballardini, G.; Simoncelli, M.; Ceschia, G.; Scarpa, C.; Brugiolo, R.; Fusco, S.; Ciarambino, T.; Biagini, C.; Tonon, E.; Porta, M.; Venuti, D.; Delsette, M.; Poeta, M.; Barbagallo, G.; Trovato, G.; Delitala, A.; Arosio, P.; Reggiani, F.; Zuliani, G.; Ortolani, B.; Mussio, E.; Girardi, A.; Coin, A.; Ruotolo, G.; Castagna, A.; Masina, M.; Cimino, R.; Pinciaroli, A.; Tripodi, G.; Cannistra, U.; Cassadonte, F.; Vatrano, M.; Scaglione, L.; Fogliacco, P.; Muzzuilini, C.; Romano, F.; Padovani, A.; Rozzini, L.; Cagnin, A.; Fragiacomo, F.; Desideri, G.; Liberatore, E.; Bruni, A.; Orsitto, G.; Franco, M.; Bonfrate, L.; Bonetto, M.; Pizio, N.; Magnani, G.; Cecchetti, G.; Longo, A.; Bubba, V.; Marinan, L.; Cotelli, M.; Turla, M.; Sessa, M.; Abruzzi, L.; Castoldi, G.; Lovetere, D.; Musacchio, C.; Novello, M.; Cavarape, A.; Bini, A.; Leonardi, A.; Seneci, F.; Grimaldi, W.; Fimognari, F.; Bambara, V.; Saitta, A.; Corica, F.; Braga, M.; Ettorre, E.; Camellini, C.; Bellelli, G.; Annoni, G.; Crescenzo, A.; Noro, G.; Turco, R.; Ponzetto, M.; Giuseppe, L.; Mazzei, B.; Maiuri, G.; Costaggiu, D.; Damato, R.; Formilan, M.; Patrizia, G.; Gallucci, M.; Paragona, M.; Bini, P.; Modica, D.; Abati, C.; Clerici, M.; Barbera, I.; Nigroimperiale, F.; Manni, A.; Votino, C.; Castiglioni, C.; Di, M.; Degl'Innocenti, M.; Moscatelli, G.; Guerini, S.; Casini, C.; Dini, D.; D'Imporzano, E.; Denotariis, S.; Bonometti, F.; Paolillo, C.; Riccardi, A.; Tiozzo, A.; Dibari, M.; Vanni, S.; Scarpa, A.; Zara, D.; Ranieri, P.; Alessandro, M.; Di, F.; Pezzoni, D.; Platto, C.; D'Ambrosio, V.; Ivaldi, C.; Milia, P.; Desalvo, F.; Solaro, C.; Strazzacappa, M.; Cazzadori, M.; Confente, S.; Grasso, M.; Troisi, E.; Guerini, V.; Bernardini, B.; Corsini, C.; Boffelli, S.; Filippi, A.; Delpin, K.; Faraci, B.; Bertoletti, E.; Vannucci, M.; Tesi, F.; Crippa, P.; Malighetti, A.; Bettini, D.; Maltese, F.; Abruzzese, G.; Cosimo, D.; Azzini, M.; Colombo, M.; Procino, G.; Fascendini, S.; Barocco, F.; Del, P.; Mazzone, A.; Riva, E.; Dell'Acqua, D.; Cottino, M.; Vezzadini, G.; Avanzi, S.; Brambilla, C.; Orini, S.; Sgrilli, F.; Mello, A.; Lombardi, L.; Muti, E.; Dijk, B.; Fenu, S.; Pes, C.; Gareri, P.; Passamonte, M.; Rigo, R.; Locusta, L.; Caser, L.; Rosso, G.; Cesarini, S.; Cozzi, R.; Santini, C.; Carbone, P.; Cazzaniga, I.; Lovati, R.; Cantoni, A.; Ranzani, P.; Barra, D.; Pompilio, G.; Dimori, S.; Cernesi, S.; Ricco, C.; Piazzolla, F.; Capittini, E.; Rota, C.; Gottardi, F.; Merla, L.; Barelli, A.; Millul, A.; De, G.; Morrone, G.; Bigolari, M.; Macchi, M.; Zambon, F.; Pizzorni, C.; Dicasaleto, G.; Menculini, G.; Marcacci, M.; Catanese, G.; Sprini, D.; Dicasalet, T.; Bocci, M.; Borga, S.; Caironi, P.; Cat, C.; Cingolani, E.; Avalli, L.; Greco, G.; Citerio, G.; Gandini, L.; Cornara, G.; Lerda, R.; Brazzi, L.; Simeone, F.; Caciorgna, M.; Alampi, D.; Francesconi, S.; Beck, E.; Antonini, B.; Vettoretto, K.; Meggiolaro, M.; Garofalo, E.; Notaro, S.; Varutti, R.; Bassi, F.; Mistraletti, G.; Marino, A.; Rona, R.; Rondelli, E.; Riva, I.; Scapigliati, A.; Cortegiani, A.; Vitale, F.; Pistidda, L.; D'Andrea, R.; Querci, L.; Gnesin, P.; Todeschini, M.; Lugano, M.; Castelli, G.; Ortolani, M.; Cotoia, A.; Maggiore, S.; Ditizio, L.; Graziani, R.; Testa, I.; Ferretti, E.; Castioni, C.; Lombardi, F.; Caserta, R.; Pasqua, M.; Simoncini, S.; Baccarini, F.; Rispoli, M.; Grossi, F.; Cancelliere, L.; Carnelli, M.; Puccini, F.; Biancofiore, G.; Siniscalchi, A.; Laici, C.; Mossello, E.; Torrini, M.; Pasetti, G.; Palmese, S.; Oggioni, R.; Mangani, V.; Pini, S.; Martelli, M.; Rigo, E.; Zuccala, F.; Cherri, A.; Spina, R.; Calamai, I.; Petrucci, N.; Caicedo, A.; Ferri, F.; Gritti, P.; Brienza, N.; Fonnesu, R.; Dessena, M.; Fullin, G.; Saggioro, D

The relationship between frailty and delirium: insights from the 2017 Delirium Day study.

Background: although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. Objective: to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients' 30-day survival. Design: observational study nested in the Delirium Day project, with 30-day follow-up. Setting: acute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy. Subjects: a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. Methods: a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. Results: overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45-1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41-1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27-2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33-2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28-2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. Conclusions: in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality