The Italian fund for Alzheimer's and other dementias: strategies and objectives to face the dementia challenge

The Italian Fund for Alzheimer's and other dementias was approved and signed in December 2021. The Fund is financed with 15 million euros in three years. The main goal is to provide new strategies in the field of dementia with a Public Health perspective. The Fund includes eight main activities that will be monitored and supervised by the Italian National Institute of Health: 1) development of a guideline for the assessment, management and support for people with dementia and their families/carers; 2) updating of the Dementia National Plan (DNP); 3) implementation of the documents of the DNP; 4) conducting surveys dedicated to the Italian Dementia Services; 5) promotion of dementia prevention strategies; 6) training strategies for healthcare professionals, families and caregivers; 7) creation of a National Electronic Record for Dementia; 8) evaluation and monitoring of activities promoted by Regions and Autonomous Provinces in the field of dementia, together with the dementia National Permanent Table. These activities are outlined in detail in the present paper

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Stimolazione cognitiva nei soggetti affetti da lieve deficit cognitivo amnesico mediante un intervent individualizzato ed ecologico

Con il crescere dell\u2019attenzione da parte della comunit\ue0 medico-scientifica nei confronti della malattia di Alzheimer, una grande parte degli studi si \ue8 rivolta alla fase prodromica, detta Mild Cognitive Impairment (MCI), con l\u2019obiettivo di identificare criteri validi per individuare soggetti a rischio di sviluppo di MA. Tra i sottotipi di MCI individuati, \ue8 di particolare interesse la forma amnestica che pu\uf2 essere a singolo dominio (sd) o a dominio multiplo (md) se, oltre alla memoria, colpisce almeno un\u2019altra funzione cognitiva (Petersen e Negash, 2008). Lo scopo dello studio \ue8 quello di costruire un intervento strategicamente orientato al miglioramento o mantenimento della funzionalit\ue0 cognitiva nei soggetti con a-MCI e al benessere complessivo della persona. 30 pazienti con diagnosi di a-MCI (secondo i criteri indicati da Petersen 2008) sono stati suddivisi in due gruppi, omogenei per et\ue0 e scolarit\ue0. Il confronto tra gruppi (Kruskal-Wallis - SPSS: Statistical Package Social Sciences) a T.0 non mostra alcuna differenza significativa nei test considerati. In T.1 si evidenzia un miglioramento significativo della funzionalit\ue0 attentiva e mnesica del gruppo A rispetto al B. Le funzioni esecutive e la velocit\ue0 di risposta non subiscono invece significative modificazioni (Tabella 1). Nell\u2019analisi interna al gruppo A (Friedman \u2013 15 sogg) tra T.0 e T.1 si registra un miglioramento significativo alle prove di attenzione selettiva, che viene parzialmente perso nella fase di assenza di trattamento (differenza tra T.0 e T.2 su 10 sogg non significativa). La memoria risente positivamente del trattamento (confronto tra T.0 e T.1 con un mantenimento) che mantiene l\u2019effetto in T.2 ( confronto tra T.2 e T.0 p= .083). I risultati ottenuti, preliminari, portano a ritenere che l\u2019intervento mirato sulle abilit\ue0 metacognitive e di acquisizione di strategie mnestiche possa portare ad un miglioramento specifico delle abilit\ue0 di memoria che sembra mantenersi nel tempo. Viceversa, i miglioramenti delle funzioni attentive, evidenti alla fine del training intensivo, tendono a ridursi con il tempo, probabilmente perch\ue9 pi\uf9 strettamente connessi ad un effetto di allenamento. Ulteriori analisi dovranno essere effettuate al completamento dello studio, soprattutto finalizzate a comprendere le possibili strade da intraprendere per aumentare l\u2019effetto temporale dei benefici connessi all\u2019intervento di stimolazione cognitiva

Cognitive Stimulation in a-MCI: an experimental study

Nowadays, preventing the effects of mental decline is an international priority, but there is little research into cognitive training inmild cognitive impairment (MCI). We present the results of a program aimed at teaching memory strategies and improvingmetacognitive abilities. This was associated with training to ameliorate caregivers\u2019 assistance. Two groups (A and B) werecompared in a crossover design. After the first evaluation, group A (but not B) participated in a 6-month cognitive stimulationprogram. After a second assessment, only B received treatment and then a final evaluation was carried out on both the groups.The results show that (1) both the groups improved their performance as an effect of training; (2) improvements are specific tothe functions trained; (3) in the interval without intervention, performance of group B worsened; and (4) group A has maintainedtheir results over time. In conclusion, our results show that specific training may reduce memory impairment in MCI

Symptoms of eating disorders and feeding practices in obese mothers

Background: The potential that obesity in pregnancy has to affect symptoms associated with eating disorders and breastfeeding is unclear. Aim: This study analyzed symptoms of eating disorders and breastfeeding practices in obese mothers. Study design: Prospective, case-control study. Subjects: Participants included 25 obese (BMI>30kg/m2) and 25 normal-weight puerperae, matched for parity and delivery route. Outcome measures: The participants completed the Eating Disorders Inventory (EDI-2), investigating cognitive, emotional, and behavioral symptoms of eating disorders before they were discharged from the maternity hospital and later participated in telephone interviews concerning breastfeeding practices which were classified according to WHO definitions. Results: Although none of the scores fell in the pathological range, the obese mothers had more and more pronounced symptoms of eating disorders in all EDI-2 subscales with respect to normal-weight mothers. They had, in particular, significantly higher scores in body dissatisfaction (p. <. .0001), ineffectiveness (p. = .004), interoceptive awareness (p. = .005), and maturity fear (p. = .007). Finally, while breastfeeding practices were similar in the two groups, the obese mothers were more likely to maintain full breastfeeding at 6 months (20 vs 8%) and their tendency to postpone weaning was found to be significant (p. <. .04). Conclusions: While the obese mothers studied have more pronounced symptoms of eating disorders with respect to their normal-weight counterparts, they tended to maintain breastfeeding longer, postponing weaning. \ua9 2013 Elsevier Ltd

Neurosyphilis manifesting with rapidly progressive dementia: report of three cases.

Neurosyphilis is rather an unusual cause of dementia characterized by a rapidly progressive course and psychiatric symptoms. Diagnosis of neurosyphilis should be suspected in the presence of a global cognitive impairment consisting in disorientation, amnesia and severe impairment of speech and judgement and psychiatric symptoms such as depression, mania and psychosis, with a subacute onset. More commonly, clinical manifestations of neurosyphilis include general PARESIS (involvement of Personality, Affect, Reflexes, Eye, Sensorium, Intellect and Speech). Upon clinical suspicion, diagnosis of neurosyphilis is confirmed by a reactive cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory. Here we report three Human Immunodeficiency Virus (HIV)-negative male patients presenting with psychiatric symptoms and a rapidly evolving dementia. Although magnetic resonance imaging did not address to diagnosis, CSF examination was mandatory in neurosyphilis diagnosis. Other diagnostic tools such as neuropsychology and single-photon emission computed tomography resulted supportive in the diagnosis. We showed that a prompt antibiotic treatment might stop disease progression. Therefore, neurosyphilis should be always considered even in HIV-negative patients in the presence of unexpected psychiatric symptoms accompanied by a rapidly evolving cognitive decline