Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: A multicenter cohort observational study

Background: Decline of renal function is common in older persons and the prevalence of chronic kidney disease (CKD) is rising with ageing. CKD affects different outcomes relevant to older persons, additionally to morbidity and mortality which makes CKD a relevant health burden in this population. Still, accurate laboratory measurement of kidney function is under debate, since current creatinine-based equations have a certain degree of inaccuracy when used in the older population. The aims of the study are as follows: to assess kidney function in a cohort of 75+ older persons using existing methodologies for CKD screening; to investigate existing and innovative biomarkers of CKD in this cohort, and to align

Association between Cognitive Status and Physical Activity: Study Profile on Baseline Survey of the My Mind Project

Background: The incidence of people with dementia is expected to increase significantly in the coming years, but it seems that there is a relationship between an active lifestyle and cognitive decline. The present study aimed to compare the characteristics and engagement in the physical activity (PA) of three groups of Italian elderly with different cognitive statuses at baseline phase. Methods: Data were examined using the results from the “My Mind Project” on 305 community-dwelling Italians. The sample was comprised of 93 subjects with Alzheimer’s disease (AD), 109 with mild cognitive impairment (MCI) and 103 healthy elderly (HE). Results: Classification of subjects on the basis of Physical Activity Scale for the Elderly (PASE) score showed that 47% of HE performed the highest level of physical activity while 40% of AD performed the lowest level. MCI subjects were distributed quite homogeneously across the levels (p < 0.001). Physical activity such as walking and light sports was carried out mainly and more frequently by HE as compared to the others (p < 0.05). As regards functional status, AD presented worse conditions in basic and instrumental activities of daily living than the other groups (p < 0.001). Conclusions: Our results evidenced that subjects with cognitive decline had the tendency to engage in PA less than HE. In particular, age and education negatively affected engagement in PA

Malnutrition and Left Ventricular Systolic Function in Hospitalized Elderly Patients with and without Heart Failure

Heart failure (HF) is highly prevalent among older subjects and it is associated with poor prognosis. HF frequently coexists with malnutrition. Objectives of our work were to assess nutritional status of old inpatients with and without HF and to study the association of malnutrition markers with echocardiographic parameters of left ventricular function and geometry. We enrolled 165 patients (72 men, 93 women; mean age: 80±7 years) consecutively admitted to Cardiology ward of our geriatric research hospital. For all subjects we performed clinical examination, echocardiogram and laboratory tests. Nutritional status was assessed evaluating anthropometric and laboratory markers of malnutrition (BMI ≤ 24 kg/m2 and/or serum albumin ≤ 3.2 g/dL). We found high prevalence of HF (67.3%) and malnutrition (28.5%). Mean serum albumin and mean BMI were 3.6±0.5 g/dL and 25.8±5.2 kg/m2 respectively. T-Student tests showed lower values of serum albumin in patients with HF compared with patients without HF (3.5±0.6 g/dL vs 3.7±0.4 g/dL; p:0.043). Conversely BMI values were not significantly different. We found significant association between serum albumin and ejection fraction (EF) of left ventriculum (r:0.311; p:0.001). An independent correlation between EF and serum albumin was confirmed by multivariate analysis (β:0.301; p:0.027). Our study highlights that malnutrition is common among elderly inpatients with HF. Lower albumin was associated with worse systolic left ventricular function. Efforts should be made in the research setting to better understand the pathophysiology of malnutrition in HF and to identify useful management strategies for nutritional assessment and supplementation

Chronic care model and cost reduction in initial health: a new approach for satisfaction and improvement of chronicity

Nowadays, the number of elderly is growing, with consequent increase of chronic diseases. An effective approach to reduce the costs incurred is required. The Chronic Care Model has proven to be a good starting point for a better management of economic and human resources

Bacterial DNAemia in Alzheimer’s Disease and Mild Cognitive Impairment: Association with Cognitive Decline, Plasma BDNF Levels, and Inflammatory Response

Microbial dysbiosis (MD) provokes gut barrier alterations and bacterial translocation in the bloodstream. The increased blood bacterial DNA (BB-DNA) may promote peripheral- and neuro-inflammation, contributing to cognitive impairment. MD also influences brain-derived neurotrophic factor (BDNF) production, whose alterations contribute to the etiopathogenesis of Alzheimer’s disease (AD). The purpose of this study is to measure BB-DNA in healthy elderly controls (EC), and in patients with mild cognitive impairment (MCI) and AD to explore the effect on plasma BDNF levels (pBDNF), the inflammatory response, and the association with cognitive decline during a two-year follow-up. Baseline BB-DNA and pBDNF were significantly higher in MCI and AD than in EC. BB-DNA was positively correlated with pBDNF in AD, plasma Tumor necrosis factor-alpha (TNF-α), and Interleukin-10 (IL-10) levels in MCI. AD patients with BB-DNA values above the 50th percentile had lower baseline Mini-Mental State Examination (MMSE). After a two-year follow-up, AD patients with the highest BB-DNA tertile had a worse cognitive decline, while higher BB-DNA levels were associated with higher TNF-α and lower IL-10 in MCI. Our study demonstrates that, in early AD, the higher the BB-DNA levels, the higher the pBDNF levels, suggesting a defensive attempt; BB-DNA seems to play a role in the AD severity/progression; in MCI, higher BB-DNA may trigger an increased inflammatory response

Contribution of non-reference alleles in mtDNA of Alzheimer’s disease patients.

Many observations suggest that mutations of mitochondrial DNA (mtDNA) could be responsible for the neurodegenerative changes of Alzheimer's disease (AD). Here we examined the signal intensity of the four alleles of each mtDNA nucleotide position (np) in whole blood of AD patients and age-matched controls using MitoChip v2.0 array. Our analysis identified 270 significantly different nps which, with one exception, showed an increased contribution of non-reference alleles in AD patients. Principal component analysis (PCA) and cluster analysis showed that five of these nps could discriminate AD from control subjects with 80% of cases correctly classified. Our data support the hypothesis of mtDNA alterations as an important factor in the etiology of AD

Reversible Cognitive Frailty, Dementia, and All-Cause Mortality. The Italian Longitudinal Study on Aging

Objectives Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a \u201creversible\u201d cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role. Design Longitudinal population-based study with 3.5- and 7-year of median follow-up. Setting Eight Italian municipalities included in the Italian Longitudinal Study on Aging. Participants In 2150 older individuals from the Italian Longitudinal Study on Aging, we operationalized reversible cognitive frailty with the presence of physical frailty and pre-mild cognitive impairment subjective cognitive decline, diagnosed with a self-report measure based on item 14 of the Geriatric Depression Scale. Measurements Incidence of dementia, its subtypes, and all-cause mortality. Results Over a 3.5-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.02\u20135.18], particularly vascular dementia (VaD), and all-cause mortality (HR 1.74, 95% CI 1.07\u20132.83). Over a 7-year follow-up, participants with reversible cognitive frailty showed an increased risk of overall dementia (HR 2.12, 95% CI 1.12\u20134.03), particularly VaD, and all-cause mortality (HR 1.39, 95% CI 1.03\u20132.00). Vascular risk factors and depressive symptoms did not have any effect modifier on the relationship between reversible cognitive frailty and incident dementia and all-cause mortality. Conclusions A model of reversible cognitive frailty was a short- and long-term predictor of all-cause mortality and overall dementia, particularly VaD. The absence of vascular risk factors and depressive symptoms did not modify the predictive role of reversible cognitive frailty on these outcomes