936 research outputs found
Aging clinical problems: a difficult balance between age and frailty
Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults. Frailty is a condition associated with ageing with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss. As a population ages, a central focus of geriatricians and public health practitioners is to understand, and then beneficially intervene on, the factors and processes that put elders at such risk, especially the increased vulnerability to stressors (e.g. extremes of heat and cold, infection, injury, or even changes in medication) that characterizes many older adults. The syndrome of geriatric frailty is hypothesized to reflect impairments in the regulation of multiple physiologic systems, embodying a lack of resilience to physiologic challenges and thus elevated risk for a range of deleterious endpoints. The empirical assessment of geriatric frailty in individuals seeks to capture this or related features.
Riassunto
Fragilità è la predisposizione alla rottura, al danno. L’etimologia della parola fragilità da "frango", rompere, rimanda alla nozione di qualche cosa che se sottoposto a una pressione, a un impatto, rischia di danneggiarsi facilmente. E’ dunque una nozione ampia e intuitiva che può avere ambiti di precisazione più diversi a seconda che se ne parli in fisica (dove esistono dei coefficienti esatti) piuttosto che nei campi della morale o del sentimento, dove la valutazione sarà sempre più "poetica" e affidata alla sensibilità individuale
The geriatric canon
Over the years Geriatrics and gerontology have developed a language shared by most clinicians and researchers who unequivocally defines the health conditions of aging people: one could speak of "geriatric canon", i.e. the set of fundamentals (paradigms, principles, standard reference vocabulary) of geriatric knowledge, the heritage from which they draw inspiration and from which the actions for the care of the elderly can be driven, the scientific works for the study of their health. The aim of this paper is to describe and report the most important terms of the geriatric canon, in a simplified way, in order to establish a more precise use of geriatric terminology that can be easily utilized by the cardiologists, or other specialists who takes care of elderly patients, without depriving them of their clinical significance, and becoming heritage of ordinary medical language
Goals of surgery and assessment tools for elderly patients referred for cardiac and noncardiac surgery
Surgery in elderly patients is associated with the risk of death, complications, functional decline and disability. Prior to surgery, therefore, an assessment of the health-related priorities, a realistic evaluation of the surgical risks, and individualized optimization of the procedural pathway to follow are mandatory
Efficacy of SSRIs on cognition of Alzheimer's disease patients treated with cholinesterase inhibitors.
Background: This study examines the joint effect on cognition of selective serotonin re-uptake inhibitors
(SSRIs) and cholinesterase inhibitors (AChEIs) in depressed patients affected by Alzheimer’s disease (AD)
living at home.
Methods: The study was conducted in two different outpatient neurological clinics. 338 patients with probable
ADwere treated with ChEis (donepezil, rivastigmine and galantamine) as per the clinician’s judgment and were
observed for nine months. At study entry, participants underwent a multidimensional assessment evaluating
cognitive, functional and psychobehavioral domains. All patients were evaluated at baseline, after one (T1),
three (T2) and nine months (T3). Patients were grouped in three different categories (patients not depressed
and not treated with SSRIs, patients depressed and treated with SSRIs, and patients depressed but not treated
with SSRIs).
Results: At baseline 182 were diagnosed as not depressed and not treated with SSRIs, 66 as depressed and
treated with SSRIs, and 90 as depressed but not treated with SSRIs. The mean change in MMSE score
from baseline to nine months showed that depressed patients not treated worsened in comparison with those
not depressed and not treated with SSRIs (mean change −0.8±2.3 vs 0.04±2.9; p = 0.02) and patients
depressed and treated with SSRI (mean change −0.8±2.3 vs 0.1±2.5; p = 0.03).
Conclusions: In AD patients treated with AChEIs, SSRIs may exert some degree of protection against the
negative effects of depression on cognition
Free copper in serum: An analytical challenge and its possible applications
Copper (Cu), as an essential metal, plays a crucial role in biochemical reactions and in physiological regulations
Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease.
Objectives: Neuropsychiatric symptoms are common in patients with Alzheimer disease
(AD). Treatment for both AD and psychiatric disturbances may affect the clinical observed
pattern and comorbidity. The authors aimed to identify whether particular
neuropsychiatric syndromes occur in untreated patients with AD, establish the severity of
syndromes, and investigate the relationship between specific neuropsychiatric syndromes
and AD disease severity. Design: Cross-sectional, multicenter, clinical study.
Participants: A total of 1,015 newly diagnosed, untreated outpatients with AD from five
Italian memory clinics were consecutively enrolled in the study from January 2003 to
December 2005. Measurements: All patients underwent thorough examination by
clinical neurologists/geriatricians, including neuropsychiatric symptom evaluation with
the Neuropsychiatric Inventory. Results: Factor analysis revealed five distinct neuropsychiatric
syndromes: the apathetic syndrome (as unique syndrome) was the most frequent,
followed by affective syndrome (anxiety and depression), psychomotor (agitation,
irritability, and aberrant motor behavior), psychotic (delusions and hallucinations), and
manic (disinhibition and euphoria) syndromes. More than three quarters of patients
with AD presented with one or more of the syndromes (N 790, 77.8%), and more than
half exhibited clinically significant severity of symptoms (N 603, 59.4%). With the
exception of the affective one, all syndromes showed an increased occurrence with
increasing severity of dementia. Conclusions: The authors’ study supports the use of a
syndrome approach for neuropsychiatric evaluation in patients with AD. Individual
neuropsychiatric symptoms can be reclassified into five distinct psychiatric syndromes.
Clinicians should incorporate a thorough psychiatric and neurologic examination of
patients with AD and consider therapeutic strategies that focus on psychiatric syndromes,
rather than specific individual symptoms
Divergent thinking abilities in frontotemporal dementia: A mini-review
A large number of studies, including single case and case series studies, have shown that patients with different types of frontotemporal dementia (FTD) are characterized by the emergence of artistic abilities. This led to the hypothesis of enhanced creative thinking skills as a function of these pathological conditions. However, in the last years, it has been argued that these brain pathologies lead only to an augmented \u201cdrive to produce\u201d rather than to the emergence of creativity. Moreover, only a few studies analyzed specific creative skills, such as divergent thinking (DT), by standardized tests. This Mini-Review aimed to examine the extent to which DT abilities are preserved in patients affected by FTD. Results showed that DT abilities (both verbal and figural) are altered in different ways according to the specific anatomical and functional changes associated with the diverse forms of FTD. On the one hand, patients affected by the behavioral form of FTD can produce many ideas because of unimpaired access to memory stores (i.e., episodic and semantic), but are not able to recombine flexibly the information to produce original ideas because of damages in the pre-frontal cortex. On the other hand, patients affected by the semantic variant are impaired also in terms of fluency because of the degradation of their semantic memory store. Potential implications, limitations, and future research directions are discussed
- …