The Role of Brief Global Cognitive Tests and Neuropsychological Expertise in the Detection and Differential Diagnosis of Dementia

Dementia is a global public health problem and its impact is bound to increase in the next decades, with a rapidly aging world population. Dementia is by no means an obligatory outcome of aging, although its incidence increases exponentially in old age, and its onset may be insidious. In the absence of unequivocal biomarkers, the accuracy of cognitive profiling plays a fundamental role in the diagnosis of this condition. In this Perspective article, we highlight the utility of brief global cognitive tests in the diagnostic process, from the initial detection stage for which they are designed, through the differential diagnosis of dementia. We also argue that neuropsychological training and expertise are critical in order for the information gathered from these omnibus cognitive tests to be used in an efficient and effective way, and thus, ultimately, for them to fulfill their potential

Prevalence of post-traumatic symptomatology and anxiety among residential nursing and care home workers following the first COVID-19 outbreak in Northern Italy

The current COVID-19 pandemic has been officially linked to the deaths of hundreds of thousands of people across the globe in just a few months. It is particularly lethal for the elderly in general, as well as for populations residing in long-term stay facilities. By this time, those working and caring for high-risk populations have been exposed to very intense and sudden levels of physical and psychological strain. The situation has taken a particularly tragic turn in residential nursing and care homes (NCH), which were hit hard by the pandemic. In residential NCH, neither residents nor workers tend to have immediate access to the same expertise, medication and equipment as in hospitals, which exacerbates an already tense situation. Among the mental health conditions related to exposure to potentially traumatic events, post-traumatic stress disorder and anxiety are the most prevalent and scientifically recognized. In this survey-based epidemiological study, we test the prevalence of anxiety and post-traumatic symptomatology in residential nursing and care home workers—a group of individuals that has been largely neglected but who nonetheless plays a very important and sensitive role in our society. We do this by focusing on the North of Italy, the most affected region during the first COVID-19 outbreak in Italy. Using a single-stage cluster design, our study returns an estimate for the prevalence of moderate-to-severe anxiety and/or post-traumatic symptomatology of 43% (s.e. = 3.09; 95% CI [37–49]), with an 18% (s.e. = 1.83; 95% CI [14–22]) prevalence of comorbidity among workers of Northern Italian NCH between 15 June and 25 July 2020 (i.e. 12–52 days after the end of national lockdown). Women and workers who had recently been in contact with COVID-19-positive patients/colleagues are more likely to report moderate-to-severe symptoms, with odds ratios of 2.2 and 1.7, respectively

Effectiveness of self-help plus (SH+) in reducing anxiety and post-traumatic symptomatology among care home workers during the COVID-19 pandemic: a randomized controlled trial

This article describes a randomized controlled trial to evaluate the effectiveness of a supervised online delivery of self-help plus (SH+), during the second wave of COVID-19 contagions in Northern Italy. The SH+ is a psychological intervention developed by the World Health Organization to increase a person's ability to deal with stress. In this trial, it was tested primarily as a tool to reduce anxiety and post-traumatic symptomatology in workers of residential nursing and care homes. In order to partial out non-specific effects of the intervention, the SH+ was compared to an equally supervised and structured alternative activity. Secondarily, in view of future emergencies, the potential of SH+ as a tool to reduce perceived stress, increase subjective well-being and foster individual resilience was explored. At post-intervention, the preregistered analysis revealed no difference in self-reported anxiety and/or post-traumatic symptomatology between the group receiving the SH+ and the group engaged in an alternative activity. Some specific and positive effects of the SH+ intervention were only found on self-reported intervention effectiveness and engagement in exploratory analyses. These findings raise the question whether the previously documented effectiveness of the SH+ on self-reported symptomatology and on the prevention of psychiatric conditions could be attributed mostly to non-specific rather than specific factors connected with participant enrolment in a psychological intervention. Indeed, the effects of the SH+ had been previously compared only to the effects of not being engaged in any alternative activity (often described in the literature as ‘treatment as usual’—or ‘enhanced treatment as usual’, when some relevant information is given to the control group as a one-off). Given the negative findings of this study, before the SH+ is implemented in clinical practice, further studies should be conducted to examine its short- and long-term beneficial effects, by means of randomized studies that employ alternative but similarly structured interventions as control conditions, aiming to minimize the confounding effect of non-specific factors

COMT Val158Met polymorphism and socioeconomic status interact to predict attention deficit/hyperactivity problems in children aged 10–14

The functional Val158Met COMT polymorphism appears to affect a host of behaviours mediated by the pre-frontal cortex, and has been found associated to the risk for disruptive behaviours including ADHD. Parental socioeconomic status (SES) has also been reported as a predictor for the same childhood disorders. In a general population sample of 575 Italian pre-adolescents aged 10–14, we examined the association of the functional Val158Met COMT polymorphism and SES—both as linear and interactive effects—with oppositional defiant problems, conduct problems, and attention deficit/hyperactivity problems, as defined by the newly established Child Behaviour Check-List/6-18 DSM oriented scales. Multivariate- and subsequent univariate-analysis of covariance showed a significant association of COMT × SES interaction with CBCL 6/18 DOS attention deficit/hyperactivity problems (p = 0.004), and revealed higher scores among those children with Val/Val COMT genotype who belonged to low-SES families. We also found a significant association of SES with attention deficit/hyperactivity problems and conduct problems DOS (p = 0.04 and 0.01, respectively). Our data are consistent with a bulk of recent literature suggesting a role of environmental factors in moderating the contribution of specific genetic polymorphisms to human variability in ADHD. While future investigations will refine and better clarify which specific environmental and genetic mechanisms are at work in influencing the individual risk to ADHD in pre-adolescence, these data may contribute to identify/prevent the risk for ADHD problems in childhood

Reduced probability of improving viro-immunological state in subjects with vertical transmission of HIV reaching adult age: A multicenter retrospective cohort study

Introduction: Young adults with vertical transmission (VT) of human immunodeficiency virus (HIV) represent a fragile population. This study evaluates factors associated with viro-immunological outcome of these patients. Methods: We performed a multicenter study including HIV-infected subjects with VT ≥ 18 years old from six Italian clinics. Subjects were observed from birth to death, lost to follow-up, or last visit until December 31, 2019. Condition of "optimal viro-immunological status" (OS) was defined as the simultaneous presence of HIV ribonucleic acid (RNA) < 50 copies/mL, CD4+ > 500 cells/mm3 , and CD4+/CD8+ ratio ≥ 1. Results: A total of 126 subjects were enrolled. At 18 years of age, 52/126 (44.4%) had HIV-RNA > 50 copies/mL, 47/126 (38.2%) had CD4+ < 500/mm3 , and 78/126 (67.2%) had CD4+/CD8+ < 1; 28 subjects (23.7%) presented in the condition of OS. Having a CD4+/CD8+ ratio ≥ 1 at 18 years of age was related with an increased probability of shift from suboptimal viro-immunological status (SOS) to OS (HR: 7.7, 95% confidence interval [CI]: 4.23-14.04), and a reduced risk of shift from the OS to the SOS (HR: 0.49, 95% CI: 0.26-0.92). Acquired immunodeficiency syndrome (AIDS) diagnosis significantly reduced the probability of shift from a viro-immunological SOS to OS (HR: 0.09, 95% CI: 0.03-0.30). Subjects who had not achieved an OS at 18 years of age had an increased risk of discontinuation of combination antiretroviral therapy (cART, p = .019). Conclusions: Only a small proportion of subjects with VT of HIV reached the adult age with "OS". Transition to the adult care with a compromised viro-immunological condition represents a negative driver for future optimal infection control, with a higher risk of discontinuation of cART and a reduced probability to improve the immunological status later in the years

Distribuzione e valutazione del rischio di composti perfluorati in bacini fluviali italiani.

Perfluoroalkyl substances (PFASs) are emerging pollutants with so peculiar physico-chemical characteristics that these compounds found wide applications in several industrial processes and daily products. Their characteristics and the wide use make them widespread in all environmental compartments, very persistent and partially bioaccumulable. A past survey at the basin closures of the main European rivers highlighted that river Po was the most contaminated (200 ng/L) by perfluorooctanoic acid (PFOA), the currently most diffused perfluoroalkyl acid (PFAA). This evidence led to a funded project which aimed to evaluate the PFAA distribution in main Italian river basins and to assess the correlated environmental and sanitary risks. An UHPLC-MS/MS multi-residue method based on an on-line SPE procedure was developed for the simultaneous determination of 12 PFAAs to support the sampling program in river basins that covered about 40% of the Italian surface area and about 45% of the Italian population. In Italy the most important sources of PFAA are fluorochemical plants, followed by discharges from tannery and textile industrial districts, while the contribution of urban areas is limited. Considering the most populated and industrialized Italian area, the river Lambro basin, Lombardy, detailed mass balance of the emission sources have been carried out. The environmental risks for the aquatic ecosystem were evaluated in river Bormida (Piedmont) downstream the discharge of a fluoropolymer plant which is the most significant source of PFOA in Italy. An effect-based approach was applied to the study of macrobenthic community, evaluating the ecological quality, the community structure and the genetic variance

Distribuzione e valutazione del rischio di composti perfluorati in bacini fluviali italiani.

Perfluoroalkyl substances (PFASs) are emerging pollutants with so peculiar physico-chemical characteristics that these compounds found wide applications in several industrial processes and daily products. Their characteristics and the wide use make them widespread in all environmental compartments, very persistent and partially bioaccumulable. A past survey at the basin closures of the main European rivers highlighted that river Po was the most contaminated (200 ng/L) by perfluorooctanoic acid (PFOA), the currently most diffused perfluoroalkyl acid (PFAA). This evidence led to a funded project which aimed to evaluate the PFAA distribution in main Italian river basins and to assess the correlated environmental and sanitary risks. An UHPLC-MS/MS multi-residue method based on an on-line SPE procedure was developed for the simultaneous determination of 12 PFAAs to support the sampling program in river basins that covered about 40% of the Italian surface area and about 45% of the Italian population. In Italy the most important sources of PFAA are fluorochemical plants, followed by discharges from tannery and textile industrial districts, while the contribution of urban areas is limited. Considering the most populated and industrialized Italian area, the river Lambro basin, Lombardy, detailed mass balance of the emission sources have been carried out. The environmental risks for the aquatic ecosystem were evaluated in river Bormida (Piedmont) downstream the discharge of a fluoropolymer plant which is the most significant source of PFOA in Italy. An effect-based approach was applied to the study of macrobenthic community, evaluating the ecological quality, the community structure and the genetic variance

Evolutionary Toxicology as a Tool to Assess the Ecotoxicological Risk in Freshwater Ecosystems

Borrowing the approaches of population genetics, evolutionary toxicology was particularly useful in assessing the transgenerational effects of a substance at sublethal concentrations, as well as evaluating genetic variation in populations exposed to pollutants. Starting from assays in controlled conditions, in recent years this approach has also found successful applications multi-stressed natural systems. It is also able to exploit the huge amount of data provided by Next Generation Sequencing (NGS) techniques. Similarly, the focus has shifted from effects on the overall genetic variability, the so-called “genetic erosion”, to selective effects induced by contaminants at more specific pathways. In the aquatic context, effects are usually assessed on non-model species, preferably native fish or macroinvertebrates. Here we provide a review of current trends in this specific discipline, with a focus on population genetics and genomics approaches. In addition, we demonstrate the potential usefulness of predictive simulation and Bayesian techniques. A focused collection of field and laboratory studies is discussed to demonstrate the effectiveness of this approach, covering a range of molecular markers, different endpoints of genetic variation, and different classes of chemical contaminants. Moreover, guidelines for a future implementation of evolutionary perspective into Ecological Risk Assessment are provided