Alessia Renzi

Exercise training and music therapy in elderly with depressive syndrome: A pilot study

OBJECTIVE Recent studies have thrown doubt on the true effectiveness of anti-depressants in light and moderate depression. The aim of this study is to evaluate the impact of physical training and music therapy on a sample group of subjects affected by light to moderate depression versus subjects treated with pharmacological therapy only. DESIGN AND SETTING Randomized controlled study. Patients were randomized into two groups. Subjects in the pharmacotherapy group received a therapy with antidepressant drugs; the exercise/music therapy group was assigned to receive physical exercise training combined with listening to music. The effects of interventions were assessed by differences in changes in mood state between the two groups. MAIN OUTCOME MEASURES Medically eligible patients were screened with the Hamilton Anxiety Scale and with the Geriatric Depression Scale. We used plasmatic cytokine dosage as a stress marker. RESULTS We recruited 24 subjects (mean age: 75.5 ± 7.4, 11 M/13 F). In the pharmacotherapy group there was a significant improvement in anxiety only (p<0.05) at 6-months. In the exercise/music therapy was a reduction in anxiety and in depression at 3-months and at 6-months (p<0.05). We noted an average reduction of the level of TNF-a from 57.67 (± 39.37) pg/ml to 35.80 (± 26.18) pg/ml. CONCLUSIONS Our training may potentially play a role in the treatment of subjects with mild to moderate depression. Further research should be carried out to obtain more evidence on effects of physical training and music therapy in depressed subjects.

The development of a new tool for the evaluation of handicap in elderly: the Geriatric Handicap Scale (GHS)

BackgroundTo date, the comprehensive geriatric assessment (CGA) does not include an evaluation tool for handicap.AimTo develop a new instrument for assessing handicap in the elderly: the Geriatric Handicap Scale (GHS).Methods656 community-dwelling elderly were enrolled in this study. We identified the thematic areas investigated by the CGA which showed a significant correlation with the handicap condition (handicap yes/not) to be included in our scale (Phase 1). Afterwards, we evaluated the possible correlations between: (1) the score obtained in each area of GHS and those obtained in CGA tests investigating similar dimensions, (2) GHS total score and the Multidimensional Prognostic Index (MPI) total score (Phase 2).ResultsIn Phase 1, data analysis showed several significant correlations between the handicap condition and the scores obtained to the CGA tests exploring cognition, mood, functional impairment, comorbidity, social and environmental variables. Thus, we developed a tool considering five variables: (1) cognition and mood; (2) functional impairment; (3) hearing/visual impairment; (4) any additional comorbidity factors; (5) environmental/social risk factors. In Phase 2, data analysis showed significant correlations between the score obtained in each area of GHS and those obtained in the CGA tests investigating similar dimensions. A positive correlation between GHS total score and MPI total score (r = 68; p = 0.001) was also reported. Cut-off score for the GHS was established. Psychometric properties of GHS were also investigated and adequate estimates of internal reliability were demonstrated.ConclusionsOur tool could prove useful to correctly categorize the disadvantageous condition related to patient’s disability.

Efficacy and safety of spinning exercise in middle-aged and older adults with metabolic syndrome: randomized control trial.

BACKGROUND Few studies have been conducted to investigate the effects of spinning exercise on cardio-vascular weal. AIM To assess whether a 6 months spinning training, combined with proper diet, is more effective than standard training programs and diet alone in improving metabolic abnormalities in middle-aged and older adults. DESIGN Randomized clinical trial. SETTING Rehabilitation Unit of our Department. POPULATION Patients with Metabolic Syndrome (MetS) according to the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria. METHODS Patients were randomly assigned to receive treatment with diet (group A, n = 10), with diet and general gymnastics program (group B, n = 10), with diet and spinning physical training program (group C, n = 10). RESULTS During the study period we observed a significant reduction in blood pressure (group C: systolic blood pressure p = 0.03; diastolic blood pressure p = 0.004 / group B: systolic blood pressure p = 0.001), in lipid profile (group B: plasma total cholesterol p = 0.001; triglycerides p = 0.001 / group C: plasma total cholesterol p = 0.04); in fasting blood glucose (group B: p = 0.01; group C: p = 0.008); in Homeostatic Model Assessment of Insulin Resistance (group B: p = 0.01; group C: p = 0.001); in waist circumference (group C: p = 0.005; group A: p = 0.02; group B: p = 0.04). No patients reported adverse events during follow-up. CONCLUSION Our results confirm the effectiveness of spinning training combined with diet in the management of MetS. CLINICAL REHABILITATION IMPACT The findings provide a preliminary evidence to support that spinning training may represent a useful and safe intervention also in middle-aged and older adults geriatric with multiple CV risk factors.

Alexithymia according to Bucci's multiple code theory: A preliminary investigation with healthy and hypertensive individuals

OBJECTIVE To evaluate the relation between alexithymia and Referential Activity (RA), a linguistic measure of the process by which non-verbal emotional experience is connected to language. METHODS The 20-Item Toronto Alexithymia Scale (TAS-20) and the Toronto Structured Interview for Alexithymia (TSIA) were administered to 20 postgraduate students and 15 outpatients with hypertension. The Weighted Referential Activity Dictionary (WRAD) and other linguistic measures (Reflection, Disfluency, and Somatic Sense) were applied to texts derived from the TSIA using the Discourse Attributes Analysis Program (DAAP). RESULTS Multiple linear regressions performed in the whole sample showed a relation between TSIA scores and Somatic Sense. Comparing the two groups, hypertensive subjects yielded higher scores on the TSIA than the young adult sample; no differences in DAAP measures emerged. A significant negative correlation was found between the TAS-20 Difficulty Describing Feelings score and the DAAP measure of references to body activations (Somatic Sense) both in the young adult sample and in hypertensives. In the young adult sample, negative relations emerged between different TSIA factors, WRAD score, and Somatic Sense; a positive relation with fragmented speech (Disfluency) and use of rationalization (Reflection) was also found. In hypertensive subjects, using the TSIA, a negative correlation between alexithymia and Somatic Sense and a positive correlation between alexithymia and the Mean High WRAD (a measure of intensity of engagement during the speech) were found. CONCLUSION The TSIA seems to be a more adequate instrument than the TAS-20 to explore relations between alexithymia and RA. Results appear to suggest a complex, nonlinear relation between alexithymia and RA, presumably influenced by subject-specific characteristics. PRACTITIONER POINTS A relation between alexithymia and RA has been proposed on theoretical grounds, but there has been minimal empirical investigation. This was the first study to employ both a self-report measure and a structured interview for measuring alexithymia in relation to RA. The results of this study suggest a complex, nonlinear relation between alexithymia and RA; this finding is essentially obtained with the structured interview measure of alexithymia. This relation is presumably influenced by subject-specific characteristics.

The Effect of a Physical Training with the Use of an Exoskeleton on Depression Levels in Institutionalized Elderly Patients: A Pilot Study

ContextThe Human Body Posturizer (HBP) is an exoskeleton used in the neurorehabilitation. The HBP may improve motor control by stimulating the pre-frontal cortex, a brain region involved also in the inhibitory modulation of the amygdala whose hyperactivity is involved in the mechanisms of depression.ObjectiveThe aim of the study was to investigate in institutionalized elderly patients the effects on depression of a physical training with the use of the HBP compared to a traditional training.DesignRandomized controlled trial.Participants20 institutionalized patients (mean age = 88, ds = ± 5, 3 males) with moderate depression levels.InterventionThe participants were randomly assigned to: a) HBP Group, which carried out physical training using the HBP; b) Excercise Group, which carried out a training without the use of the orthosis. The training was conducted for 6 months (3 sessions each week), with the same kind of exercises with or without the HBP according to the assignment group.MeasurementsParticipants were evaluated at baseline using the Tinetti balance and Gait scale, the Mini Mental State Examination and the Geriatric Handicap Scale. The Geriatric Depression Scale was administered to the participants before and after the period of training. RESULTS: The two groups were homogeneous for age, baseline motor ability (risk falls), handicap score, cognitive functioning and depression levels. After 6 months of exercise training a significant reduction in depression levels was reported only in the HBP Group (p <.01).ConclusionsA positive effect of the HBP in the modulation of mood in institutionalized elderly subjects was found. It is possible to hypothesis that a traditional training without the HBP may require more time to achieve significant results. Clinical implications will be discussed.

The Effects of the Perception of Being Recognized by Patients With Alzheimer Disease on a Caregiver’s Burden and Psychophysical Health

Caring for a patient with Alzheimer disease (AD) represents a real challenge that can have considerable long-term psychological and physical consequences. The aim of this study was to evaluate the impact of the perception of being recognized on both the psychophysical health and the level of burden reported in caregivers of patients with AD. The secondary aim was to evaluate the association between the use of a home care assistance service and the burden and psychophysical health in caregivers. The Caregiver Burden Inventory (CBI), the 36-item Short-Form Health Survey (SF-36), and a visual analog scale (VAS) to evaluate the level of perception of being recognized were administered to 31 caregivers of patients with AD. Data were also collected from patients with AD using the Mini-Mental State Examination (MMSE). The level of perception of being recognized was significantly and negatively correlated with total burden (r = −0.36; P = .045) and objective burden (r = −0.53; P = .002). It was also significantly and positively correlated with the MMSE score (r = 41; P = .02). Regression models showed that only the perception of being recognized, and not MMSE, significantly predicted lower caregiver objective burden scores. Furthermore, the use of a home care assistance service significantly predicted higher caregiver physical functioning. The perception of being recognized by an AD relative significantly predicted the caregiver’s objective burden associated with a shortage of time. The use of a home care assistance service also resulted in a promotion in the caregiver’s social functioning. Further studies are needed to confirm these results.

Music, Spatial Task Performance, and Brain Plasticity in Elderly Adults.

To the Editor: The effect of music by Mozart on cognitive performance and brain plasticity in elderly adults was explored. To the knowledge of the authors, this is the first study to provide documentary evidence of an increase in brain-derived neurotropic factor (BDNF) serum levels after exposure to Mozart’s music in human beings. The Mozart effect (ME), an enhancement of performance or change in neurophysiological activity associated with listening to Mozart’s music, was first described in 1993. Other studies did not succeed in repeating the ME, and some have suggested that it is an artifact of arousal or mood. Music can increase cerebral synaptic plasticity. BDNF is a growth factor that promotes neurogenesis and structural plasticity in the hippocampus. Knowing the effect of exposure to Mozart’s music on the concentration of BDNF in humans could help in better understanding the underlying mechanisms of ME. Twenty elderly adults were enrolled: 10 controls with no known cognitive deficit (average age 68 4.5) and 10 with a diagnosis of mild cognitive impairment (MCI) (average age 69 3.1). Duration of MCI was between 6 months and 10 years and was defined as a Mini-Mental State Examination score between 23 and 27 and a Clinical Dementia Rating Scale score of 0.5. Exclusion criteria were neurological diseases, use of cholinesterase inhibitors or N-methyl-D-aspartate-receptor antagonists, anxiety or depression, and experience as a musician. Informed consent was obtained from all participants. The study was conducted according to the guidelines on biomedical research involving human subjects (Declaration of Helsinki). Each individual underwent two sessions of musical exposure.

Mente e corpo nella teoria del codice multiplo. Riflessioni sul concetto di alessitimia

L’alessitimia e definita come una difficolta ad identificare e descrivere le proprie emozioni, caratteristiche accompagnate da un pensiero orientato ad aspetti pratici dell’esperienza e da scarse capacita immaginative. Attualmente si e proposto di utilizzare la Teoria del Codice Multiplo sviluppata da Wilma Bucci nella concettualizzazione dell’alessitimia. La situazione alessitimica corrisponderebbe ad una dissociazione tra il sistema subsimbolico e i due sistemi simbolici, che comporterebbe il non avere parole per le emozioni. Tale definizione implica, rispetto al concetto di alessitimia e del rapporto mente/corpo, un completo superamento del dualismo mente/corpo nelle dinamiche di costruzione della salute/malattia che coinvolgono la regolazione degli affetti, e una conferma teorica che l’alessitimia si pone nell’area del deficit piuttosto che delle difese, rappresentando un fattore di rischio per lo sviluppo di tutta la patologia, sia fisica che mentale.