The economic impact of moderate stage Alzheimer's disease in Italy: Evidence from the UP-TECH randomized trial

Background: There is consensus that dementia is the most burdensome disease for modern societies. Few cost-of-illness studies examined the complexity of Alzheimer's disease (AD) burden, considering at the same time health and social care, cash allowances, informal care, and out-of-pocket expenditure by families. Methods: This is a comprehensive cost-of-illness study based on the baseline data from a randomized controlled trial (UP-TECH) enrolling 438 patients with moderate AD and their primary caregiver living in the community. Results: The societal burden of AD, composed of public, patient, and informal care costs, was about �20,000/yr. Out of this, the cost borne by the public sector was �4,534/yr. The main driver of public cost was the national cash-for-care allowance (�2,324/yr), followed by drug prescriptions (�1,402/yr). Out-of-pocket expenditure predominantly concerned the cost of private care workers. The value of informal care peaked at �13,590/yr. Socioeconomic factors do not influence AD public cost, but do affect the level of out-of-pocket expenditure. Conclusion: The burden of AD reflects the structure of Italian welfare. The families predominantly manage AD patients. The public expenditure is mostly for drugs and cash-for-care benefits. From a State perspective in the short term, the advantage of these care arrangements is clear, compared to the cost of residential care. However, if caregivers are not adequately supported, savings may be soon offset by higher risk of caregiver morbidity and mortality produced by high burden and stress. The study has been registered on the website www.clinicaltrials.org (Trial Registration number: NCT01700556). Copyright � International Psychogeriatric Association 2015

Socioeconomic Predictors of the Employment of Migrant Care Workers by Italian Families Assisting Older Alzheimer's Disease Patients: Evidence from the Up-Tech Study

Background: The availability of family caregivers of older people is decreasing in Italy as the number of migrant care workers (MCWs) hired by families increases. There is little evidence on the influence of socioeconomic factors in the employment of MCWs. Method: We analyzed baseline data from 438 older people with moderate Alzheimer's disease (AD), and their family caregivers enrolled in the Up-Tech trial. We used bivariate analysis and multilevel regressions to investigate the association between independent variables - education, social class, and the availability of a care allowance - and three outcomes - employment of a MCW, hours of care provided by the primary family caregiver, and by the family network (primary and other family caregivers). Results: The availability of a care allowance and the educational level were independently associated with employing MCWs. A significant interaction between education and care allowance was found, suggesting that more educated families are more likely to spend the care allowance to hire a MCW. Discussion: Socioeconomic inequalities negatively influenced access both to private care and to care allowance, leading disadvantaged families to directly provide more assistance to AD patients. Care allowance entitlement needs to be reformed in Italy and in countries with similar long-term care and migration systems. � 2015 The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved

Cognitive Abilities of Musicians

Playing music may involve different cognitive domains, but previous studies of musicians and patients with brain lesions have reported inconsistent associations between music performances and other cognitive functions. Fine musical performance may be associated with high executive and control functions. 21 skilled musicians and 21 age- and education-matched healthy controls with no specific musical competence were compared on attentive, executive, linguistic, perceptual, praxic, memory, and theory of mind functions, using standardized neuropsychological tests. No differences between the musicians and controls, music composers and performers, or between soloists or orchestral players were observed. In musicians, there was no correlation between the test scores and amount of music education. Findings based on these musician group, carefully evaluated, suggest further exploration of associations of distinct components of music comprehension and expression to different cognitive functions and behavioral aspects

Can music therapy alleviate psychological, cognitive ad behavioral impairment in epilepsy?

It is well- known that the burden of epilepsy is provoked not only by the type and severity of the seizures and chronic pharmacological therapies, but also by an array of cognitive and psycho-behavioural problems that contribute in reducing quality of life and persist even after seizure control. Music activity and music therapy techniques showed significant effects on psychological, behavioral and cognitive aspects in many neurological disorders. Nevertheless, music therapy has been not applied in the field of epilepsy as a therapeutic-rehabilitative technique. The brain circuitry of music involves different neural systems in the temporal and frontal lobes, which are also implied in executive functions, language, memory and ToM. In our opinion the sharing of neural networks that support music processing and production and other cognitive functions suggest that music therapy may help to attenuate cognitive deficits, in particular those caused by epilepsy. The positive impact of music and music therapy on psychological well-being, interpersonal relationships, and quality of life could be also translated in epilepsy. We hope that, considering the above mentioned aspects, music therapy could be also included in rehabilitative programs in epilepsy, contributing to alleviate the psychological, behavioral and cognitive impairment. Evidence-based research projects using well-designed music therapy methods are needed to verify this hypothesis

Active music therapy improves cognition and behaviour in chronic vascular encephalopathy : a case report

Objectives: This study describes the effects of active music therapy (AMT) on cognition and behaviour in chronic vascular encephalopathy. Design: A single case study investigated different cognitive and psycho-behavioural changes after AMT. Setting: An adult patient with memory, attention, and verbal fluency deficits associated with Vascular Cognitive Impairment-No Dementia (VCI-ND) was treated. Intervention: A four-months AMT course was based on creative and interactive music playing. Sixteen sessions were conducted simultaneously to the pharmacological therapy. Main outcomes measures: Cognitive performances, mood, interpersonal interactions, and perceived abilities were assessed using standardized neuropsychological and psycho-behavioural measurements. Results: At baseline, the patient reported a tendency to feel tense, nervous, and angry and difficulties in memory and visuospatial performances, frequently accompanied by attention drops. The social network was a habitual component of the patient's life, but not a source of sharing of personal experiences, safety or comfort. Neuropsychological tests showed deficits in object and figure naming, verbal fluency, short and long-term verbal memory, short-term spatial memory, selective attention, and visuomotor coordination. After AMT, the cognitive profile significantly improved in attention, visuomotor coordination, and verbal and spatial memory. Such positive changes were confirmed at the three-months follow-up. An increase of the interpersonal interactions and consistent reduction of anxiety were also observed. Conclusions: In selected patients with VCI-ND, a well-structured AMT intervention added to standard therapy may contribute in determining a stable improvement of cognitive and psycho-behavioural aspects. Controlled studies are needed to confirm these promising results

Active music therapy improves cognition and behaviour in chronic vascular encephalopathy

OBJECTIVES: This study describes the effects of active music therapy (AMT) on cognition and behaviour in chronic vascular encephalopathy. DESIGN: A single case study investigated different cognitive and psycho-behavioural changes after AMT. SETTING: An adult patient with memory, attention, and verbal fluency deficits associated with Vascular Cognitive Impairment-No Dementia (VCI-ND) was treated. INTERVENTION: A four-months AMT course was based on creative and interactive music playing. Sixteen sessions were conducted simultaneously to the pharmacological therapy. MAIN OUTCOMES MEASURES: Cognitive performances, mood, interpersonal interactions, and perceived abilities were assessed using standardized neuropsychological and psycho-behavioural measurements. RESULTS: At baseline, the patient reported a tendency to feel tense, nervous, and angry and difficulties in memory and visuospatial performances, frequently accompanied by attention drops. The social network was a habitual component of the patient's life, but not a source of sharing of personal experiences, safety or comfort. Neuropsychological tests showed deficits in object and figure naming, verbal fluency, short and long-term verbal memory, short-term spatial memory, selective attention, and visuomotor coordination. After AMT, the cognitive profile significantly improved in attention, visuomotor coordination, and verbal and spatial memory. Such positive changes were confirmed at the three-months follow-up. An increase of the interpersonal interactions and consistent reduction of anxiety were also observed. CONCLUSIONS: In selected patients with VCI-ND, a well-structured AMT intervention added to standard therapy may contribute in determining a stable improvement of cognitive and psycho-behavioural aspects. Controlled studies are needed to confirm these promising results

Immunity assessment in the early stages of amyotrophic lateral sclerosis: a study of virus antibodies and lymphocyte subsets.

Serum and CSF from 32 patients with idiopathic ALS, 30 agematched controls and 30 MS patients were investigated regarding immunoglobulin concentration and virus-specific antibodies, the lymphocytes in the peripheral blood and lymphocyte subsets were also investigated. ALS patients’ results were compared with findings in MS and controls. The ALS patients had significantly higher IgG concentration in serum than the controls, marked lymphopenia, reduction of CD2, CD8 and Leu 7 positive cells and increase of the CD4/CD8 ratio and of SIg-positive lymphocytes. Compared with the MS patients, the ALS patients showed similarity in T-subset distribution with a lower standard deviation. No HTLV-I and HIV antibodies were found in any group and no significant differences in antibody distribution to Toxoplasma G, herpes simples, cytomegalovirus, measles and mumps viruses were evident. All ALS patients were investigated at an early disease stage, therefore, our findings seem to support the conclusion that the immune alterations are related to the mechanisms of the disease and not to complications of its evolution