Adriana Servello

Depressive symptoms in older people with metabolic syndrome: is there a relationship with inflammation?

To investigate if there is a higher prevalence of depressive symptoms in older people with metabolic syndrome (MetS) compared with those without and whether dedpressive symptoms are independently associated to MetS and its single components and to the inflammatory markers.

Role of cardiovascular risk factors (CRF) in the patients with mild cognitive impairment (MCI)

Few therapeutic options are available nowadays to improve the prognosis of patients with Alzheimers disease (AD). There are rather several evidences in literature that controlling vascular risk factors may be an effective intervention for modifying the course of this disease. The aim of our study was to investigate the role of CRF in 50 patients with MCI according to Petersenss criteria, and to evaluate their influence on cognitive and behavioral features of the disease and on the development of dementia. Statistical analysis of the data showed that the 60% of the patients with MCI and CRF developed dementia, while 40% maintained the same cognitive conditions at the end of the study. Only 32% of the subjects without cardiovascular comorbidities developed dementia. The results of the study suggest that CRF play a key role in cognitive decline of patients with MCI. Patients with MCI and CRF showed not only worse cognitive performances, but also behavioral disorders, depression and functional disability. Patients with CRF had higher conversion rate to AD than the other group, with a mean disease-free period 3 months shorter than the control group.

A POSSIBLE ROLE OF ATRIAL FIBRILLATION AS A RISK FACTOR FOR DEMENTIA

Atrial fibrillation (AF), which is a very common disease among the elderly, is already well known as a risk factor for arterial thromboembolism and stroke. The attention of medical research is now focused on establishing a possible role of AF in the development of cognitive impairment in order to include this arrhythmia among risk factors for dementia. The aim of this work was to investigate the relationship between AF and various types of dementia, such as vascular dementia (VaD), Alzheimers disease (AD) and mixed dementia (MD). The study consisted of 71 VaD, AD or MD patients, 31 males and 40 females. The sample has been divided in 2 groups according to the sex, and these two groups have been analyzed separately. In females, a statistically significant association was found between mini mental state examination (MMSE) and clinical dementia rating (CDR) scores and AF occurrence (r=-0.32; p<0.05; r=0.33; p<0.05). On the contrary, no significant linear correlation was found between AF and a lower activities if daily living (ADL) and instrumental activities if daily living (IADL) scores. In males, AF/MMSE, AF/CDR, AF/ADL and AF/IADL variables have not been found to be linearly related to each other. Unexpectedly, AF turned to be associated to AD more often than to VAD, becoming a possible risk factor for this neurodegenerative disease. Our results are supported by many studies in literature attributing a basic role of brain hypoperfusion in sporadic AD patho-genesis. More and more scientific data suggest that the already well known risk factors for AD could be considered just the top of an iceberg, providing powerful arguments for impaired cerebral perfusion as the primary trigger in the development of this disease. Moreover, the mildly favorable treatment response in patients with AD to therapy that improves cerebral blood flow is a consistent finding; the same cannot be said of antiamyloid treatments. This opens new possibilities to find an effective way to treat this dramatic pathology.

Olfactory Deficit and Hippocampal Volume Loss for Early Diagnosis of Alzheimer Disease A Pilot Study

Background:The aim of this pilot study was to verify the role of olfactory test and volumetric magnetic resonance imaging measure of hippocampus to predict conversion from mild cognitive impairment to Alzheimer disease (AD). Materials and Methods:Eighteen patients with amnesic mild cognitive impairment, broadly defined, were followed at 12 months. Hypothesized baseline predictors for follow-up conversion to AD were olfactory deficit and hippocampal volumes loss. Results:In the 1-year follow-up, 5 patients converted to AD. The 2 clinical predictors olfactory test and hippocampal volume loss showed the same sensitivity of 92.3% but the olfactory test showed a higher specificity than the hippocampal volume loss (75% vs. 60%). Conclusions:Our findings suggest the potential utility of olfactory test and hippocampal volume loss for early detection of AD.

[Predictors of liver fibrosis in patients with non-alcoholic fatty liver disease. The role of metabolic syndrome, insulin-resistance and inflammation].

INTRODUCTION NAFLD (non-alcoholic fatty liver disease) reaches an high prevalence in the general population, and it is closely related to metabolic syndrome (MetS). The entity of metabolic abnormalities and the chronic inflammation seem to play a main role in the development of liver fibrosis. The aim of our study is to determine whether subjects with NAFLD and MetS have higher liver fibrosis degree when compared with NAFLD subjects without MetS, and to investigate the relations between fibrosis, MetS and its single components and inflammation. MATERIALS AND METHODS We considered 24 patients with NAFLD. Those who had viral- and alcohol- related liver disease were excluded. MetS was diagnosed according to NCEP ATP III criteria; inflammatory status was determined through C-reactive protein (PCR) assay. The peripheral insulin-resistance was assessed by calculating HOMA ir. Liver fibrosis was measured by transient elastography (Fibroscan®). RESULTS Subjects with MetS had higher HOMA ir, PCR and Fibroscan® score (log value: 0.92±0.24 KPa vs 0.73±0.2 KPa; p=0.047). The linear correlation analysis showed that Fibroscan® score was related to MetS, number of MetS components, waist circumference, HOMA ir and PCR. However the multivariate regression analysis showed that only HOMA ir (B=0.077; 95%CI: -0.002- 0.157; p=0.05) and PCR (B=0.152; 95% CI: 0.006 - 0.299; p=0.006) were independent predictors of higher Fibroscan® score. CONCLUSION MetS is associated to higher liver fibrosis degree in subjects with NAFLD. The insulin-resistance and inflammation seem to be the main determinants.

Vascular depression in the elderly. Does inflammation play a role

Vascular depression in the elderly. Does inflammation play a role?Depression is the most common comorbidity in the elderly, and it is a major determinant of disability. The late-onset depression in highly associated to cardiovascular disease. Depressive symptoms may follow vascular brain damage, especially when mood regulating areas are affected. However depression is strongly associated to vascular disease even when there is no manifest brain damage. Recently great attention has been given to chronic inflammation, both related to depression and vascular disease. Both experimental and clinical evidence shows that a rise in the concentrations of proinflammatory cytokines and glucocorticoids in depressed patients is associated with defect in serotonergic function. Chronic inflammation may underlie many forms of depression associated with vascular disease and metabolic syndrome. The importance of the inflammation hypothesis of depression lies is that psychotropic drugs may have central anti-inflammatory action, and that new generation of central anti-inflammatory drugs may be useful in depression treatment.

Cerebral perfusional effects of 1-year rivastigmine treatment in Alzheimer disease: a case report.

It is described the case of a 74-years-old woman with probable Alzheimer Disease who showed good clinical response to rivastigmine associated with relevant improvement of cerebral perfusion after 1 year of treatment. The single-photon emission computed tomography (SPECT) scan showed a significant improvement in cortical uptake of the tracer in temporo-parietal and frontal regions in comparison to the examination performed before the treatment.

Olfactory Deficit and Hippocampal Volume Loss for Early Diagnosis of Alzheimer’s Disease

amygdala atrophy plays a role in smell identification failure in AD and its potential prodromal stage amnestic mild cognitive impairment (aMCI). Methods: 18 AD patients, 30 aMCI patients and 11 healthy controls were included in the study. All subjects underwent smell identification assessment using a smell identification test developed at our memory clinic the Motol Hospital Smell Test (MHST). As formerly approved, MHST results correlate with the UPSIT results (r 1⁄4 0,68, p < 0,0005). Volume of the left amygdala (LA) and right amygdala (RA) was measured using MRI manual tracing. Results: Smell identification was impaired in the AD group (p < 0,001) compared to the control group, the difference between the aMCI and the control group approached statistical significance (p 1⁄4 0,08). Volume of the LA was reduced in the AD group (p 1⁄4 0,026), whereas the aMCI group did not differ from the control group (p 1⁄4 0,102). Volume of the RAwas reduced in both AD (p < 0,001) and aMCI groups (p 1⁄4 0,013) when compared to the control group. There was a medium-strong correlation between smell identification and the LA volume (r 1⁄4 0,443, p < 0,001) and a weak correlation between smell identification and the RAvolume (r 1⁄4 0,348, p 1⁄4 0,007). Conclusions: The smell identification impairment and the reduction of the amygdala volumes in AD patients correspond with previous studies. The results obtained in the aMCI group probably reflect the heterogeneity of aMCI patients who are at higher risk for developing AD but not all of them represent a prodromal stage of AD. Our results suggest that amygdala plays a role in smell identification failure in AD patients.