The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition

Background: Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression.Methods: Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling. Network analysis was performed to explore the unique adjusted associations between clinical dimensions.Results: Sadness was associated with worse turning and walking ability and movement transitions from walking to sitting, as well as with worse general cognitive abilities. Sadness was also connected with dyspnea, while neurovegetative depressive burden was connected with activity limitations.Discussion: Limitations of motor and cognitive function, dyspnea, and weakness may contribute to the persistence of residual symptoms of late-life depression

Impaired bone remodeling in children with osteogenesis imperfecta treated and untreated with bisphosphonates: the role of DKK1, RANKL, and TNF-α

In this study, we investigated the bone cell activity in patients with osteogenesis imperfecta (OI) treated and untreated with neridronate. We demonstrated the key role of Dickkopf-1 (DKK1), receptor activator of nuclear factor-κB ligand (RANKL), and tumor necrosis factor alpha (TNF-α) in regulating bone cell of untreated and treated OI subjects. These cytokines could represent new pharmacological targets for OI. Introduction: Bisphosphonates are widely used in the treatment of children with osteogenesis imperfecta (OI) with the objective of reducing the risk of fractures. Although bisphosphonates increase bone mineral density in OI subjects, the effects on fracture incidence are conflicting. The aim of this study was to investigate the mechanisms underlying bone cell activity in subjects with mild untreated forms of OI and in a group of subjects with severe OI treated with cycles of intravenous neridronate. Methods: Sclerostin, DKK1, TNF-α, RANKL, osteoprotegerin (OPG), and bone turnover markers were quantified in serum of 18 OI patients (12 females, mean age 8.86 ± 3.90), 8 of which were receiving cyclic intravenous neridronate, and 21 sex- and age-matched controls. The effects on osteoblastogenesis and OPG expression of media conditioned by the serum of OI patients and anti-DKK1 neutralizing antibody were evaluated. Osteoclastogenesis was assessed in cultures from patients and controls. Results: DKK1 and RANKL levels were significantly increased both in untreated and in treated OI subjects with respect to controls. The serum from patients with high DKK1 levels inhibited both osteoblast differentiation and OPG expression in vitro. High RANKL and low OPG messenger RNA (mRNA) levels were found in lymphomonocytes from patients. High amounts of TNF-α were expressed by monocytes, and an elevated percentage of circulating CD11b-CD51/CD61+ osteoclast precursors was observed in patients. Conclusions: Our study demonstrated the key role of DKK1, RANKL, and TNF-α in regulating bone cell activity of subjects with OI untreated and treated with bisphosphonates. These cytokines could represent new pharmacological targets for OI patients

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Cocaína y conductas violentas. Un estudio cualitativo desde una perspectiva de género.

RESUMEN A través de esta investigación, de enfoque cualitativo, se pretende obtener un mejor conocimiento sobre el tema del consumo de cocaína en general y, en particular, sobre la relación entre el abuso de esta sustancia y el desarrollo de comportamientos violentos, estudiando el tipo de conductas violentas derivadas directa o indirectamente del abuso de cocaína, evaluando el peso que la variable género tiene en el desarrollo de dichas conductas, como en aspectos más prácticos, como son el análisis de los programas asistenciales dirigidos a los dependientes de cocaína para conocer si contemplan los comportamientos violentos y si tienen en cuenta las diferencias de género. Los principales resultados obtenidos mostraron que en el ámbito concreto de la Comunidad Valenciana existe una falta de coordinación entre los recursos públicos de atención a la violencia de género y de atención a las drogodependencias. Los hombres cocainómanos suelen presentar más violencia de tipo físico contra sus parejas, mientras que las mujeres cocainómanas suelen presentar una violencia de tipo autodestructivo. Las mujeres dependientes de cocaína víctimas de maltrato, se encuentran en situación de desprotección por la falta de accesibilidad a centros de ayuda a la mujer maltratada, debido a su condición de drogodependiente. Los profesionales del área de las drogodependencias resultan claves en la prevención de la violencia de género entre cocainómanas, pues con frecuencia son los primeros que conocen la situación de violencia vivida por las usuarias a las que tratan. No es necesario diseñar tratamientos específicos de atención a las drogodependencias según género, pero sí que es importante adaptar el tratamiento a la persona teniendo en cuenta la variable género. __________________________________________________________________________________________________The purpose of this study is to evaluate violent behaviours among males and females with a diagnosis of cocaine addiction. Qualitative methodology was used. Results revealed a lack of coordination between public drug abuse treatment resources and public centres against violence, in the Autonomous Region of Valencia. The relation between cocaine abuse and violent behaviours differed between males and females. Men tended to be violent with their partners and women tended to be violent with themselves. Male cocaine addicts tended to have more support networks than women when they requested treatment. On the other hand, women cocaine addicts victims of violence were unprotected because they did not have access to shelters since they are drug abusers. Drug abuse professionals play a very important role in the prevention of gender violence among women cocaine addicts. Women frequently report their situation to them because of their relationship of trust. There is no need to develop specific treatment programs by gender, but it is very important to adapt each treatment to each person giving special consideration to gender variables

Abilitazione e riabilitazione cognitiva in una prospettiva \u201clife span\u201d.

Introduzione Santo Di Nuovo e Renzo Vianello 1 - Abilitazione e riabilitazione cognitiva in una pro-spettiva \u2018life span\u2019 Renzo Vianello, Silvia Lanfranchi e Francesca Pulina 2 - Il declino cognitivo: un destino inevitabile? Marcello Cesa-Bianchi e Carlo Cristini 3 - Modificazioni delle funzioni cognitive nell\u2019invecchiamento Erika Borella, Lucia Gava e Rossana De Beni 4 - Funzioni adattive ed emotive nell\u2019et\ue0 anziana Guido Amoretti 5 - Le demenze e i precursori: il \u201cMild Cognitive Im-pairment\u201d Santo Di Nuovo 6 - Basi neurobiologiche e trattamento farmacologico del deterioramento cognitivo nelle demenze Filippo Caraci e Filippo Drago 7 - Le persone con disabilit\ue0 intellettiva invecchiano Serafino Buono 8 - L\u2019assessment neuropsicologico del deterioramen-to Sabina Cilia 9 - Valutare il deterioramento involutivo: quali funzioni? quali strumenti? Santo Di Nuovo e Sabrina Castellano 10 - Esperienze di riabilitazione del deterioramento cognitivo Giorgio Pavan e Silvia Vettor 11 - Dall\u2019approccio riabilitativo a quello \u2018capacitan-te\u2019 Pietro Vigorelli e Angelida Ullo 12 - Il trattamento congiunto fisico, cognitivo e di socializzazione per pazienti con demenza e caregiver Tiziana Maci 13 - Percorso diagnostico e terapeutico-assistenziale per le demenze Gabriele Tripi, Mario Santagati, Giuseppe Proven-zano, Marcello Giordano, Viviana Surdo, Sabina Cilia e Giuseppe Fichera 14 - Tailorizzazione cognitiva per l\u2019apprendimento multimediale negli anziani Maria Sinatra e Lucia Monacis Per concludere: alcune risposte e ulteriori domande Santo Di Nuovo e Renzo Vianello Bibliografia Appendici: Clinical Dementia Rating Scale (CDRS) Caregiver Burden Inventory (CBI) Riquadri: I - La definizione di disabilit\ue0 dell\u2019OMS II - Disabilit\ue0 / disturbi acquisiti nel corso del ciclo di vita III - Il programma \u2018Day Habilitation\u2019 per persone adulte con Disabilit\ue0 Intellettiva IV - Mini-Mental State Examination e altri strumenti di valutazione generale del deterioramento V - Strumenti psicodiagnostici per l\u2019esame di funzioni specifiche VI - Programmi di intervento per anziani con deterioramento cognitivo VII - Attivit\ue0 previste nel protocollo del progetto \u2018Gruppo Alzheimer in Attivit\ue0\u2019 (GAIA) VIII - Gli attori del percorso diagnostico-terapeutico-assistenzial

Physical exercise for late life depression: effects on cognition and disability

Background:: Late-life depression is often associated with cognitive impairments and disability, which may persist even after adequate antidepressant drug treatment. Physical exercise is increasingly recognized as an effective antidepressant agent, and may exert positive effects on these features too. However, few studies examined this issue, especially by comparing different types of exercises. Methods:: We performed secondary analyses on data from the Safety and Efficacy of Exercise for Depression in Seniors study, a trial comparing the antidepressant effectiveness of sertraline (S), sertraline plus thrice-weekly non-progressive exercise (S+NPE), and sertraline plus thrice-weekly progressive aerobic exercise (S+PAE). Exercise was conducted in small groups and monitored by heart rate meters. Patients with late-life depression without severe cognitive impairment were recruited from primary care and assessed at baseline and 24 weeks, using the Montreal Cognitive Assessment (MOCA, total and subdomain scores) and Brief Disability Questionnaire. Analyses were based on Generalized Linear Models. Results:: In total, 121 patients (mean age 75, 71% females) were randomized to the study interventions. Compared with the S group, patients in the S+PAE group displayed greater improvements of MOCA total scores (p=0.006, effect size=0.37), visuospatial/executive functions (p=0.001, effect size=0.13), and disability (p=0.02, effect size= 120.31). Participants in the S+NPE group did not display significant differences with the control group. Conclusions:: Adding aerobic, progressive exercise to antidepressant drug treatment may offer significant advantages over standard treatment for cognitive abilities and disability. These findings suggest that even among older patients exercise may constitute a valid therapeutic measure to improve patients\u2019 outcomes

Mind, brain and altered states of consciousness

The consciousness is the expression of an enormous and complex variety of neurobiological events, phenomenological and psychological that, from the early stages of development, prepare the emergence soil of the Self. It is a complex of tangible and intangible characters distinct from one another - neural infrastructure, awareness, temporality, qualitative subjectivity, intentionality - to such an extent as to seem welded faces of the same prism. Consciousness is not a simple function of the mind, but its organization. In this paper we intend to show how its order is not strictly hierarchical, but sustained by multiple horizontal levels, each of which in a structural and functional continuum with several emerging phenomena. The same distinction between quantitative aspects (surveillance) and qualitative (content of consciousness) of consciousness is founded on the premise that the supervision is regulated by widespread in projection systems of the brain stem, hypothalamus and thalamus; while the content of consciousness depends on the cortical activity, and particularly from the associative areas of the cortex connected between them. The so-called disturbances of consciousness (vegetative state, the minimally conscious state, a coma, the Locked in syndrome) suggests the existence of an alteration of a common underlying system. Although the current heterogeneity of the data makes it impossible to attribute with certainty whether positive or negative about the alleged absence of consciousness in the individual patient, the search is deriving significant benefits from the accumulation of neuroimaging evidence in paintings like coma, general anesthesia , sleep, epilepsy and somnambulism. In this sense, it seems increasingly urgent a deeper understanding of the neural correlates during sleep or general anesthesia, as well as the relationships between neural processes and altered states of consciousness generated by pharmacological manipulations

Notulae to the Italian alien vascular flora: 15

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions for Italy or for Italian administrative regions. Nomenclatural and distribution updates, published elsewhere, and corrections are provided as Suppl. material 1

Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study

Objective To date motor subtypes of delirium have been evaluated in single-center studies with a limited examination of the relationship between predisposing factors and motor profile of delirium. We sought to report the prevalence and clinical profile of subtypes of delirium in a multicenter study. Methods This is a point prevalence study nested in the â\u80\u9cDelirium Day 2015â\u80\u9d, which included 108 acute and 12 rehabilitation wards in Italy. Delirium was detected using the 4-AT and motor subtypes were measured with the Delirium Motor Subtype Scale (DMSS). A multinomial logistic regression was used to determine the factors associated with delirium subtypes. Results Of 429 patients with delirium, the DMSS was completed in 275 (64%), classifying 21.5% of the patients with hyperactive delirium, 38.5% with hypoactive, 27.3% with mixed and 12.7% with the non-motor subtype. The 4-AT score was higher in the hyperactive subtype, similar in the hypoactive, mixed subtypes, while it was lowest in the non-motor subtype. Dementia was associated with all three delirium motor subtypes (hyperactive, OR 3.3, 95% CI: 1.2-8.7; hypoactive, OR 2.8, 95% CI: 1.2-6.5; mixed OR 2.6, 95% CI: 1.1-6.2). Atypical antipsychotics were associated with hypoactive delirium (OR 0.23, 95% CI: 0.1-0.7), while intravenous lines were associated with mixed delirium (OR 2.9, 95% CI: 1.2-6.9). Conclusions The study shows that hypoactive delirium is the most common subtype among hospitalized older patients. Specific clinical features were associated with different delirium subtypes. The use of standardized instruments can help to characterize the phenomenology of different motor subtypes of delirium