Visuospatial planning and problem solving in Alzheimer's disease patients: a study with the Tower of London Test

Background: Executive dysfunction in Alzheimer's disease (AD) has been recently recognized as an early and prominent clinical sign. The Tower of London (ToL), a task specifically devised to test executive functions of visuospatial planning and problem solving, has frequently been used in neuropsychological experiments, but rarely in the clinical ground. Methods: One hundred and sixty-one AD patients and 212 nondemented healthy controls were administered a simplified ToL version. Results: AD patients were significantly impaired (p < 0.0001) in all ToL scores and in the total execution time. The 'accuracy' score of ToL at a cut off of <= 29/36 yielded a sensitivity of 71.2% and a specificity of 76.4% (AUC 0.79) for the diagnosis of AD versus controls. Conclusions: Visuospatial planning and problem solving are significantly impaired in early dementia of the Alzheimer's type. A successful sensitivity/specificity ratio, the independence of education and the simplicity of this version of ToL make it a useful executive functioning screening test for early AD. Copyright (c) 2007 S. Karger AG, Basel

When hospital patients fall: preliminary data from Ferrara, Italy.

Falls represent common and serious problems among older people. One-third of subjects aged 65 years and older fall at least one a year, and risk increases with age. Although anedoctal evidence and clinical experience suggest a nocturnal preference for falls events, chronobiological studies are not available. This study was aimed to verify whether hospital falls occur randomly throughout the day or exhibit a rhythmic pattern. We considered all falls occurred from January 1 to December 31, 2009. Based on time of event, total sample and subgroups: gender, age (75 years), modalities (witness, alone, upright, sitting, bed with or without banks, slipped dry or wet floor, stumbled, loss of strength, equilibrium or consciousness; bathroom, room), outcome (lesion, fracture), were categorized into twenty-four 1-hour increments, and analyzed for circadian rhythmicity with validated chronobiological software.8 During 2009, 371 consecutive falls were recorded (mean age 73.8±17.6 years, men 55.8%). A circadian variation was found for the entire population, with significant peaks in morning and late-evening hours (11 AM-24 PM). A significant morning main peak was found for men, subjects falling alone, loss of consciousness, falls in the bathroom, subjects with footwears, and falls with fracture. The evening-night main peak was found for patients with beds with banks, slipped on wet floor, subjects without footwears, falls without lesion. Falls events are among the most common and severe adverse events for hospitalized older patients. This preliminary study shows that falls occur either during nighttime (as expected), but late-morning hours are at high risk as well. Moreover, morning hours are characterized by higher frequency of fractures, maybe due to attempts to rise for lunch or personal hygiene. To the best of our knowledge, there are no studies performed with chronobiologic analysis. Identification of rhythmic patterns of certain events means predicibility of events itself, and when an event is predicible, adequate strategies of prevention may be attempted