Safer Attitude to Risky Decision-Making in Premanifest Huntington’s Disease Subjects

Huntington’s disease (HD) is an inherited neurodegenerative disorder characterized by involuntary, jerky movements, incoordination, behavioral changes and subtle executive and cognitive impairment starting before motor symptoms. Our study aimed to assess the risky decision-making process in premanifest (pre) HD subjects, by means Game of Dice Task (GDT). As dependent variables, several GDT outcomes have been taken into consideration. We recruited 30 subjects (15 females) with preHD (i.e., Diagnosis Confidence Level < 4; Total Motor Score < 10), and 21 age, gender and education matched neurologically normal subjects (11 females). GDT is a computer-guided task where subjects are invited to watch the digits on which to bet and to evaluate the related potential risk to win or loss. Our results showed that decision and feedback times were longer in preHD than in neurologically normal group in both disadvantageous and advantageous choices. PreHD subjects provided a greater number of “safe” strategies, taken with longer decision-making time than neurologically normal subjects, showing a reduced propensity to risk. Such behavior, characterized by increased slowness in acting and providing answers, might contribute to delineate a behavioral and cognitive profile in preHD

Can Stimulus Valence Modulate Task-Switching Ability? A Pilot Study on Primary School Children

Executive functions and emotional processes follow a time-dependent development that reflects the brain’s anatomo-functional maturation. Though the assessment of these cognitive functions is largely examined, in children the role of emotions in the mental set-shifting is still rarely investigated. The aim of this study was to assess how attention shifting can be modulated by the valence of emotional stimuli. To this end, sixty-two primary school children were tested with a new emotional task-switching paradigm obtained by manipulating the emotional valence and physical features of the stimulus pool. Thus, two tasks were alternatively presented: the Valence task and the Color task. Based on executive performance results, we found a lengthening of response times and a lower accuracy in the emotionally connoted task (Valence task), compared to the neutral task (Color task). The data demonstrate that the processing of emotional stimuli modulates the task-switching performance during development. These findings could help in the implementation of teaching strategies that can promote the development of executive functions and, therefore, functionally improve the overall academic performance of children. Finally, a better understanding of the developmental trajectories of executive functions can help neuropsychologists both in the early diagnosis and treatment of potential executive alterations

In-silico prediction and deep-DNA sequencing validation indicate phase variation in 115 Neisseria meningitidis genes

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Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Moral Judgement along the Academic Training

Moral reasoning and consequent decision making are central in the everyday life of all people, independent of their profession. It is undoubtedly crucial in the so-called “helping professions”, when the professional through his/her decisions can support or not support others. Our study aimed to investigate whether academic training can play an essential role in influencing moral reasoning. We used three different conditions: 20 moral personal, 20 moral impersonal, and 20 nonmoral dilemmas to assessed differences in moral judgement between students of Economics, Medicine, and Psychology at their first year and at the end of university training. We observed a difference between school and year of course: psychology students showing more time when asked to read and answer the proposed questions. Moreover, medical students showed a significant increase in sensitiveness to moral issues as a function of academic ageing, whereas such a moral sense regressed from the first to the fifth year of academic training in other students. Gender was also relevant, with women showing an increased response and reading times compared to than men when asked to cope with moral decisions. This study shows that the main factor driving moral decision making is the faculty to which one is enrolled, significantly modulated by sex and academic seniority

Sleep Quality and Psychological Status in a Group of Italian Prisoners

Prison could be considered a prolonged stressful situation that can trigger not only a dysregulation of sleep patterns but can also bring out psychiatric illness, such as anxiety and depression symptoms. Our study is aimed at exploring sleep quality and sleep habits in an Italian prison ward with three different security levels, and to attempt to clarify how anxiety state and the total time spent in prison can moderate insomnia complaints. There were 129 participants divided into three groups who enrolled in this study: 50 were in the medium-security prison ward (Group 1), 58 were in the high-security prison ward (Group 2) and 21 were in the medium-security following a protocol of detention with reduced custodial measures (Group 3). All participants filled in a set of questionnaires that included the Beck Depression Inventory (BDI-2), the State-Trait Anxiety Inventory (STAI), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Based on their responses, we observed that all participants showed poor sleep quality and insomnia, mild to moderate depressive symptoms that tended to a higher severity in Groups 1 and 3, and the presence of clinically significant anxiety symptoms, mainly in Groups 1 and 3. Our study shows that increased anxiety state-level and the presence of mood alteration corresponds to an increase in both poor sleep quality and, more specifically, insomnia complaints. Finally, we propose that TiP (total time in prison) could have an interesting and stabilizing paradox-function on anxiety state and insomnia

Effects of Physical Activity on Cognitive Functioning: The Role of Cognitive Reserve and Active Aging

Background: The increase in average life expectancy necessitates the identification of possible mechanisms capable of promoting “active aging” to ensure adequate levels of global functioning. Numerous studies show that regular physical activity promotes, even in the elderly, a state of functional psychophysical well-being capable of slowing down age-related cognitive decline. This study aimed to clarify whether, and how, the intensity of physical activity can modulate cognitive and executive skills by influencing specific psychological variables. Methods: Our sample consisted of 151 senior subjects divided into hikers (HIK), gentle gymnastics (GYM), and sedentary (SED), who practice intense, moderate, and reduced physical activity, respectively. A battery of psychological questionnaires was administrated to evaluate attentional skills, decision-making, the ability to implement targeted behaviors, perceived self-efficacy, and psychophysical well-being. We included: the Mini-Mental State Examination, Cognitive Reserve Index Questionnaire, General Self-Efficacy Scale, Letter Cancellation Test, Everyday Competence Questionnaire, and Geriatric Depression Scale (GDS). Results: Comparisons between the scores reported by the three groups showed that the HIK group differs from the others with respect to most of the measurements, presenting better mood and cognitive performance, and a specific psychological profile. On the contrary, the GYM group appeared to have a greater affinity with the SED group than with the HIK group, both cognitively and psychologically. Conclusions: Types of physical activity, as well as the intensity and frequency with which they are practiced, are factors that promote an active aging process, protecting the psychophysical well-being and overall cognitive functioning of the elderly