Alberto Baroni

Foot pain and disability in older persons: an epidemiologic survey.

OBJECTIVE: To investigate the prevalence of foot pain in older people and its association with pathological conditions of the feet and with disability in basic and instrumental activities of daily living.

Does the Clock Drawing Test Predict Cognitive Decline in Older Persons Independent of the Mini-Mental State Examination?

OBJECTIVE: To evaluate the value of the Clock Drawing Test (CDT) in predicting cognitive deterioration over a 4‐year period, independent of baseline cognitive status evaluated by the Mini‐Mental State Examination (MMSE).

Human ballistic arm abduction movements Effects of L‐dopa treatment in Parkinson's disease

In patients with Parkinsons disease who had never previously been treated with any antiparkinsonism drug, we studied the effects of L-dopa on ballistic arm abduction movement in a step-tracking task. L-Dopatreatment increased the mean velocity of the initial movement towards the target without loss of accuracy and with improved motor performance under open-loop conditions. Performance also improved in motor tasks with expected perturbation. EMG patterns of arm abduction movements showed abnormal features in untreated patients and improved after L-dopa treatment.

Flunarizine-induced Parkinsonism in the elderly

Twenty‐seven patients (19 women and 8 men, ages 63 to 88 years; mean, 74 years) displayed mild to moderate parkinsonism and altered ballistic motor performances during long‐term flunarizine treatment. One month after, flunarizine withdrawal, 20 patients showed clear‐cut improvements in both clinical features and ballistic motor performances; a complete recovery within 6 months was observed in all these patients but one, who still showed very mild slowness of movement. On the other hand, seven patients showed little clinical improvement and still maintained markedly altered ballistic motor performances 1 month after drug withdrawal. At the 2‐month follow‐up assessments, either they did not improve further or they deteriorated; they were successfully treated with l‐dopa and, despite the ameliorations, after 12 to 24 months they still have definite parkinsonian syndrome. The authors conclude that (1) flunarizine, even at the recommended dose (10 mg daily), can induce reversible parkinsonism, at least in subjects older than 60; (2) the persistence of a marked symptomatology 2 months after flunarizine withdrawal should lead to starting treatment with antiparkinsoniam drugs; (3) the study of ballistic movements is proposed as a useful tool for objective quantisation and early detection of bradykinesia.

Relationship between health status, fluid intelligence and disability in a non demented elderly population

This study examines the impact of overall health status and common chronic medical conditions on cognitive performance in an older population and the effect of poor cognitive performance on functional disability. The study population consisted of 485 subjects who were 77 and 78 years old, and residing in district No. 6 of the city of Florence; all participants underwent a structured interview to collect information on demographics, education, physical health, disability, and cognitive status. Data from 94 subjects, who were previouslydiagnosed as affected by dementia or other conditions known to be direct causes of cognitive impairment, and from 6 subjects, who scored less than 20 in the Mini-Mental State Examination, were excluded from the analysis. The number of chronic conditions, drugs used, contacts with the physician, days in bed, and days of hospitalization in the last 6 months were considered as indicators of physical health. Functional disability was assessed evaluating both ADLs and IADLs. The Mini-Mental State and the “Blocks” test, a component of the Wechsler Adult Intelligence Scale Revised, were used for the assessment of cognitive status. After adjusting for the level of formal education, physical health status and several specific chronic conditions were predictors of cognitive performance. A significant association was found between a low “Blocks” test score and a decreased level of functional status. In a multivariate model, better performance on the “Blocks” test was associated with a higher score in the disability scale. This association was independent of the effect of education. The results suggest that in the elderly, poor health status is associated with a cognitive impairment that can be measured by the “Blocks” test. However, the role of this association in the pathway from disease to disability remains unclear. (Aging Clin. Exp. Res. 5: 435–443, 1993)

A neurotropic approach to the treatment of multi-infarct dementia using L-α-glycerylphosphorylcholine

Abstract A multicenter, unblinded, randomized, controlled clinical trial was conducted to evaluate the efficacy and tolerability of L-α-glycerylphosphorylcholine (L-α-GPC) 1 gm/day IM compared with that of cytidine diphosphocholine (CDP-choline) 1 gm/day IM in 112 patients with mild to moderate multi-infarct dementia (MID). A 90-day treatment period with the test drug was followed by a 90-day follow-up period without treatment to observe how long the results obtained with treatment could be maintained. A total of 97 patients completed the treatment period; of these, 73 completed the follow-up period. Eighteen patients did not complete the study because of poor compliance, and 21 patients at one center were not followed up. Treatments were started after a 2-week washout period during which other drugs that could affect cognitive function were withdrawn. Clinical efficacy was evaluated by comparing the results at baseline, after 30 days, at the end of treatment, and at the end of the follow-up period on the following psychometric tests: the Sandoz Clinical Assessment Geriatric (SCAG) Rating Scale, the Blessed Dementia Scale, the Blessed Information, Memory, Concentration test, the Wechsler Memory Scale (WMS), the Rapid Disability Rating Scale 2 (RDRS 2), the Word Fluency test, the Token test, and the Simple Drawing Copy (SDC). The patients receiving L-α-GPC showed a significant improvement of cognitive functions, behavior, and personality at the end of the treatment, compared with baseline values. This improvement was still apparent at the end of the follow-up period. Only aphasia, as measured by the Word Fluency test, was significantly improved by the CDP-choline treatment. A comparison of the results obtained with L-α-GPC and CDP-choline shows that the performance of the patients treated with L-α-GPC was significantly better than that of the CDP-choline group on the Blessed Dementia Scale, WMS, RDRS 2, and SDC at the end of treatment and on the Blessed Dementia Scale, WMS, SCAG, and Token test at the end of the follow-up period. Both treatments were well tolerated.

Disability and Quality of Life in Old Age

In the past century life expectancy in Europe has increased by more than 20 years. Mortality rates in the elderly have sharply decreased. The oldest-old segment of the population, those age 85 years and older, is currently growing faster than any other age group. Older persons are likely to suffer from one or more diseases or disabilities (Hermanova, 1989; Hermanova et al.,1992). In spite of this, little information is presently available on the dynamic development of chronic diseases, and on their effect on the quality of life in old age.

Improvement of Parkinsonism after Withdrawing Long-Term Flunarizine Treatment

Recently it has been reported that some patients presenting parkinsonism during flunarizine treatment showed partial or complete recovery after drug withdrawal.’ Parkinsonism in general can be assessed clinically and investigated further by studying kinematic and electromyographic (EMG) variables of ballistic movements. Patients with Parkinson’s disease have been proved to be unable to perform ballistic actions within a single cyle of alternating EMG agonist and antagonist activity as normal subjects do,2” thus providing a physiological explanation for bradykinesia? The aim of this study was to ascertain whether parkinsonism, and bardykinesia in particular, observed in patients during flunarizine treatment shared common features with Parkinson’s disease, by analyzing clinical features and kinematic and EMG variables of ballistic arm abduction movements performed in a step-tracking task.’ Twenty-two patients (15 women, 7 men; aged 66-88 years, mean 74) with parkinsonism noticed during long-term flunarizine therapy (10 mg daily; 2-48 months) were studied. Clinical assessment, scored with the Webster rating scale, and the analysis of ballistic movements were carried out before and one month after drug withdrawal. Ten healthy subjects of similar age were studied for comparison. Before withdrawing flunarizine treatment, all patients showed mild to moderate parkinsonism: mild to severe bradykinesia and rigidity were present in all the patients, whereas tremor, posture, and gait disturbances were not constantly observed. A11 the patients displayed abnormal ballistic movements characterized by a lower mean velocity and altered EMG patterns (see B, FIGURE 1). One month after flunarizine discontinuation, all patients clinically improved mainly in rigidity and bradykinesia (TABLE 1). In general, when present, tremor and gait disturbances were not affected by drug withdrawal. Ballistic movements were performed with higher mean velocity, and underlying EMG patterns became more similar to those recorded in normal subjects (see C, FIGURE 1 ) . After a 60-day washout, seven patients were diagnosed as affected by Parkinson’s disease and successfully treated with L-dopa whereas the others completely recovered.