Live 3-D stress echo: is beauty also a sign of intelligence?

Background: Last generation 3-D live stress echo has potential for adding "beauty" (seductive display) and also "intelligence" (unique quantitative information) to the robust, albeit qualitative, classic 2-D stress echo based on wall motion analysis. Aim: to assess feasibility of 3-D stress echo. Materials and methods: From May 2005, we enrolled 214 consecutive patients (age=64?11 years; 88 females) routinely screened for suspect coronary artery disease with dipyridamole (0.84 mg/kg in 6\u27) stress echo. Transthoracic echocardiography (2D, 3D and coronary flow reserve, CFR, by pulsed Doppler) was performed with commercially available systems (iE33) using phase array probes (1-5 and 3-8 MHz, S5-S8) and a matrix 3D probe for 3D-Live application. Each data set was analyzed with a dedicated software (3DQ, QLab - Advanced Ultrasound Quantification Software - vs. 4.1 and 4.2, Philips Electronics), including 3D volumes and dissynchrony index (DI), considered as the mean value of standard deviation of maximum time to systolic volume variation. Results: Interpretable 2D data were obtained in all pts (100 % feasibility), CFR data on left anterior descending artery in 185 pts (88 %) and 3D data in 151 pts (70 %). In the 48 pts with negative stress echo (for wall motion criteria) by 2D and 3D, 3D-DI decreased (rest=1.3?.8 vs. stress=.99?.54, p<.001): see figure. In patients with normal resting echo and positive stress echo, 3D-DI increased (rest= 4.5?1.9 vs. stress= 8.3?3.2, p<0.01). Last generation live 3D dipyridamole stress echo still suffers a feasibility gap vs. 2D and Doppler-CFR stress echo, but shows potential for adding substantial "beauty" (convincing display) and perhaps some extra-"intelligence" (quantitative support) to classic stress echo

Clinical Perception and Treatment Options for Behavioral and Psychological Symptoms of Dementia (BPSD) in Italy

Background: Behavioral and psychological symptoms of dementia (BPSD) have a high prevalence, and their presence is associated with a severe impact in terms of social costs. However, dedicated clinical tools or biomarkers to detect these symptoms are lacking. Thus, BPSD management in clinical settings is challenging. The aim of this study was to investigate the perception and the treatment strategies for BPSD in Italian centers working in the dementia field. Methods: A multicenter, national survey was developed by BPSD Study Group of the Italian Neurological Society for Dementia (SINDEM). The survey consisted of a semi-structured questionnaire that was e-mailed to SINDEM members, dementia centers part of the national network of memory clinics (Centers for Cognitive Deterioration and Dementia [CDCD]), and clinicians working in dementia care settings. The questions were focused on (1) perceived global frequency and relevance of BPSD; (2) tools used to assess BPSD; (3) pharmacological treatment for psychosis, apathy, agitation, aggression, depression, anxiety, sleep, and nutrition disturbances; (4) non-pharmacological treatments; (5) drugs side effects. Results: One-hundred and thirty-six clinicians participated in this study. Seventy-nine participants worked in a CDCD and 57 in other settings. The perceived frequency of BPSD was 74%. BPSD are detected by means of a clinical assessment for 96.3% or a caregiver interview for 97%. For psychosis treatment the first choice was atypical antipsychotics (83.3%), followed by typical antipsychotic (8.9%) and antidepressants (4.8%). For agitation, atypical antipsychotics were the first-choice treatment in 64% of cases and antidepressants in 16.1%. For aggression, the most used drugs were atypical antipsychotics (82.9%). For anxiety, 55.2% use antidepressants, 17.9% use atypical antipsychotics, and 16.9% use benzodiazepines. Interestingly, most of the centers apply non-pharmacological treatments for BPSD. Some differences emerged comparing the responses from CDCD and other care settings. Conclusion: The survey results revealed many differences in BPSD perception, treatment options, and observed side effect according to the clinical setting. This variability can be explained by the absence of clear guidelines, by differences in patients' characteristics, and by clinical practice based on subjective experience. These results suggest that producing guidelines for the pharmacological treatment of BPSD is a major need