Declino cognitivo e stress ossidativo

Introduction. The pathogenesis of Alzheimer disease (AD) and mild cognitive impairment (MCI) is largely unknown. Several evidence document an involvement of oxidative stress in the development of these two diseases. Materials and methods. We studied patients older than 65 years who came to our Alzheimer evaluation unit between January and December 2008. Patients underwent accurate history taking and complete clinical examination, nutritional evaluation, cognitive tests, functional status evaluation and a dosage of plasma isoprostane and total antioxidant status. Results. We studied 66 subjects with a median age of 77.14 years, 34 men (51.5%) and 32 women (48.5%). The mean concentration of isoprostane in the three groups were: 34.21 pg/ml in controls, 41.54 pg/ml in MCI and 31.84 pg/ml in patients with AD. For the Total Antioxidant Status the mean for the three groups were: controls 2.19 mmol/l, MCI 2.60 mmol/l and AD 3.40 mmol/l (p = 0.002 AD/controlli, 0.041 AD/MCI). Conclusions. Our results are in agreement with other studies showing a reduction of antioxidants enzymatic and non enzymatic defenses in serum of Alzheimer and mild cognitive impairment patients

Quetiapina: un farmaco sicuro? Studio osservazionale in pazienti dementi con BPSD

Introduction: Behavioural and Psychological Symptoms of Dementia (BPSD) often occur in patients with dementia leading to a complex clinical course and a more difficult management of these subjects. Although a standardized therapy for these symptoms is not available, typical and atypical antipsychotics drugs are actually used for the treatment of these disturbs. Previous studies have demonstrated efficacy and safeness of these drugs and only few cardiovascular adverse events have been reported in patient treated with antipsychotics than in controls. Aim: Aim of this work was to evaluate the occurrence of cardiovascular adverse events such as blood pressure reduction and/or ECG alterations (cardiac frequency, PQ, QTc) in dementia patients with BPSD treated with quetiapine. Methods: 30 patients, 23 women and 7 men, aged from 71 to 97 years (average 85.17 ± 6.006 SD) in who diagnosis of dementia and BPSD was performed. Patients were examined with MMSE (Mini Mental State Examination) to evaluate cognitive impairment, with ADL (Activity of Daily Living) and IADL (Instrumental Activity of Daily Living) in order to analyze respectively simple daily activities and complex ones. Moreover, NPI (Neuropsychiatric Inventory) and NPI-D (Neuropsychiatric Inventory-Distress) were performed to check frequency and severity of BPSD and the associated caregiver’s distress. Electrolytes values (Na, K) and orthostatic and clinostatic blood pressure values were measured and ECG (cardiac frequency, PQ, QTc) was performed in each patients at the beginning of the therapy with Quetiapine (T0), after six months (T1) and after one year of treatment (T2). Conclusions: Our study resulted in an increase of NPI and NPI-D scores which stands for an improvement of BPSD in our patients and for a reduction of caregiver’s stress. On the other side, a statistically significant decrease in ADL score was found during the treatment, while no other important modifications of the analyzed parameters occurred. We conclude that the treatment with quetiapine didn’t cause cardiovascular adverse events such as blood pressure changes, ECG parameters alterations and electrolytes values modifications

IL CONSENSO INFORMATO NELLA CURA DEL PAZIENTE CON FRATTURA DEL FEMORE

Informed consent is fundamental in the process of care, except in case of urgent, lifesaving treatments. In Italy, the legal sources are the Italian Constitution, the numerous judgments of the courts and the current \u201cCodice di Deontologia medica\u201d. In clinical practice, as in the case of the elderly patient with hip fracture, the physician may encounter problems if the patient is incompetent and without legal representation

Health care for older people in Italy: The U.L.I.S.S.E. Project (Un link informatico sui servizi sanitari esistenti per l'anziano - a computerized network on health care services for older people).

Objectives: The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy. Design: The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study. Setting: Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. Measurements: The patient\u2019s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results: The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented. Conclusions: Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system

Health care for older people in Italy: The U.L.I.S.S.E. Project (Un link informatico sui servizi sanitari esistenti per l'anziano - a computerized network on health care services for older people)

Objectives: The U.L.I.S.S.E. study is aimed at describing older patients who are cared for in hospitals, home care or nursing homes in Italy. Design: The U.L.I.S.S.E. study is an observational multicenter prospective 1-year study. Setting: Overall, 23 acute geriatric or internal medicine hospital units, 11 home care services and 31 nursing homes participated in the study. Measurements: The patient\u2019s evaluation was performed using comprehensive geriatric assessment instruments, i.e. the interRAI Minimum Data Set, while data on service characteristics were recorded using ad-hoc designed questionnaires. Results: The older subjects who are in need of acute and long term care in Italy have similar characteristics: their mean age is higher than 80 years, they have a high level of disability in ADL, an important multimorbidity, and are treated with several drugs. The prevalence of cognitive impairment is particularly high in nursing homes, where almost 70% of residents suffer from it and 40% have severe cognitive impairment. On the other hand, there is a shortage of health care services, which are heterogeneous and fragmented. Conclusions: Health care services for older people in Italy are currently inadequate to manage the complexity of the older patients. An important effort should be undertaken to create a more integrated health care system