Carlo Biagini

Effects of Low Blood Pressure in Cognitively Impaired Elderly Patients Treated With Antihypertensive Drugs

IMPORTANCE The prognostic role of high blood pressure and the aggressiveness of blood pressure lowering in dementia are not well characterized. OBJECTIVE To assess whether office blood pressure, ambulatory blood pressure monitoring, or the use of antihypertensive drugs (AHDs) predict the progression of cognitive decline in patients with overt dementia and mild cognitive impairment (MCI). DESIGN, SETTING, AND PARTICIPANTS Cohort study between June 1, 2009, and December 31, 2012, with a median 9-month follow-up of patients with dementia and MCI in 2 outpatient memory clinics. MAIN OUTCOMES AND MEASURES Cognitive decline, defined as a Mini-Mental State Examination (MMSE) score change between baseline and follow-up. RESULTS We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4). Among them, 68.0% had dementia, 32.0% had MCI, and 69.8% were being treated with AHDs. Patients in the lowest tertile of daytime systolic blood pressure (SBP) (≤ 128 mm Hg) showed a greater MMSE score change (mean [SD], -2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], -0.7 [2.5]; P = .002) and patients in the highest tertile (≥ 145 mm Hg) (mean [SD], -0.7 [3.7]; P = .003). The association was significant in the dementia and MCI subgroups only among patients treated with AHDs. In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups. The association between office SBP and MMSE score change was weaker. Other ambulatory blood pressure monitoring variables were not associated with MMSE score change. CONCLUSIONS AND RELEVANCE Low daytime SBP was independently associated with a greater progression of cognitive decline in older patients with dementia and MCI among those treated with AHDs. Excessive SBP lowering may be harmful for older patients with cognitive impairment. Ambulatory blood pressure monitoring can be useful to help avoid high blood pressure overtreatment in this population.

Day Care for older dementia patients: favorable effects on behavioral and psychological symptoms and caregiver stress

To assess the effects of Day Care (DC) on older subjects with dementia and their caregivers.

Is Antidepressant Treatment Associated with Reduced Cognitive Decline in Alzheimer's Disease?

Background: Although antidepressant drugs (ATD) are frequently prescribed to patients with Alzheimer’s disease (AD), their effect on cognitive status has been only rarely assessed. Methods: The impact of depressive symptoms and ATD on cognitive status was retrospectively assessed in 72 older AD outpatients with mild-to-moderate cognitive impairment, treated with cholinesterase inhibitors, over a 9-month follow-up. Results: Compared to subjects without baseline depressive symptoms, those with symptoms who were continuously treated with ATD had less cognitive decline; those never treated, or not continuously treated despite baseline symptoms, had an intermediate trend. Such a protective action of ATD was, at least in part, independent of their action on depressive symptoms. Conclusion: These observations suggest that ATD may reduce cognitive decline in depressed older AD patients.

Tolerability of ambulatory blood pressure monitoring (ABPM) in cognitively impaired elderly

Abstract Objective: Recent guidelines have widened clinical indications for out-of-office blood pressure measurement, including home blood pressure monitoring and ambulatory blood pressure monitoring (ABPM), suggesting the latter as recommended method in cognitively impaired patients. There is, however, a widespread belief that ABPM could be poorly tolerated in dementia, often leading to withdraw from its use in these patients. Aim: To assess the actual tolerability of ABPM in a group of cognitively impaired elderly, affected by dementia or mild cognitive impairment (MCI). Methods: We evaluated 176 patients aged 65 + years, recruited in two different memory clinics, with a Mini Mental State Examination (MMSE) between 10 and 27. Behavioral and psychological symptoms were assessed with Neuropsychiatric Inventory (NPI). A patient was considered tolerant if able to keep the device on continuously for 24 h. The minimum number of correct measurements required was 70% of the predicted total number. Results: 16% of patients wore the device for less than 24 h. Dividing the study population in tertiles of MMSE performance, 29% failed to tolerate the device in the lowest, 12% in the middle and 7% in the highest tertile (p < 0.01). Dividing the study population in tertiles of NPI performance, 30% of patients failed in the highest, 19% in the middle and 8% in the lowest tertile (p = 0.02); 31% of patients who tolerated the device did not achieve the minimum number of measurements required, with a mean number of 63% of predicted measurements. Conclusion: The ABPM proved a generally well-tolerated technique even in cognitively impaired elderly. Only a minority of subjects with poorer cognitive performances and greater behavioral symptoms did not tolerate the monitoring. Among most patients who failed to achieve the minimum number of measurements needed, the number of valid measurements was very close to the minimum required.

IT Procedures For Simulation Of Historical Building Restoration Site

Dealing with renovation and restoration of historical building heritage, often means facing several difficulties concerning the way of representing not only the ancient building and the design ideas, but also phases of interventions on site. The designers have always to take into account a range of possible compatible solutions that avoid endangering the cultural significance of the historical building. Traditional methods are often time consuming and barely efficient, because they are related to exchange two-dimensional and paper-based support information. The Building Information Modeling may represent an answer to these problems, allowing the users to model the three-dimensional compounds of the building and to link a variety of information to it. This work intends to propose an innovative approach to the construction management of historical building interventions, based on BIM technologies, facing different kinds of problems, such as: parametric modeling of historical buildings, starting with laser scanner survey: LoD (level of detail) definition and measurement accuracy related to modeling procedures; parametric modeling of the site and the several phases of the restoration works in a fixed schedule (4D dimension); 3D graphic representation of safety procedures and related tools. The case study was offered by the SS. Nome di Maria church (Italy), built in 1748, which was seriously damaged during the earthquake that occurred in Italy in 2012.

Federated Parametric Models for Seismic Risk Analysis in Existing Buildings

The paper deals with the results of a research activity related to the application of BIM technologies for the analysis of seismic risk in existing school buildings. Digital modelling was carried up in phases, organizing the various disciplinary models according to a federated model approach. The case study highlighted potential and criticality in the generation of integrated architectural, structural and analytical models, and in the development of the information data flow, on which the reliability of the simulations of structural behavior depends.

[OP.3C.02] LOOKING FOR THE OPTIMAL BLOOD PRESSURE VALUES IN OLD PEOPLE WITH COGNITIVE DECLINE: A LONGITUDINAL STUDY BASED ON 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING

Objective: Available data on the prognostic role of blood pressure in older subjects with cognitive impairment are still scarce. We recently showed that tight control of blood pressure may be associated with a greater progression of cognitive impairment in the short term. Aim of this study is to evaluate the long term association of clinical and ambulatory blood pressure (BP) and antihypertensive drugs (AHD) with survival and desease progression in older subjects with cognitive impairment. Design and method: We enrolled 198 subjects (average age 79, 72% with high BP) with Mild Cognitive Impairment (39%) or dementia (61%) referred to the memory clinic. Each patient underwent cognitive assessment with Mini Mental State Examination (MMSE) and 24-hour blood pressure monitoring (ABPM). Subjects were divided into tertiles according to the values of systolic (SBP) and diastolic (DBP) blood pressure, assessed both clinically and by ABPM (mean daytime and night-time). Results: After a mean 3-year follow-up, an independent association was observed between higher night-time SBP (> 135 mmHg) and mortality (p < 0,001), after adjustment for age, vascular comorbidity and functional status. A similar, although weaker association was observed for higher night-time DBP and daytime SBP. Conversely, MMSE decline was greater in patients with lower daytime SBP (< 128 mmHg) (p = 0.029), but limited to the subgroup of subjects receiving AHD (p = 0.002), independently of age, vascular comorbidity and baseline MMSE score. No significant association was observed for clinical SBP. Conclusions: In this study higher mean SBP, especially at night, was predictive of mortality at 3 years, while lower average daytime SBP in subjects receiving AHD was associated with progression of cognitive impairment. High-normal SBP values (130–145 mmHg) seem to be the optimal target to reduce the risk of mortality and the progression of cognitive decline among cognitively impaired older subjects. ABPM is needed for BP assessment in this vulnerable population.

OSPEDALI VECCHI E NUOVI: IL DIBATTITO TECNICO-CULTURALE SUL RINNOVAMENTO DELLE STRUTTURE OSPEDALIERE NELL'ITALIA POST-UNITARIA. IL CASO DEL SANTA MARIA NUOVA A FIRENZE

SUMMARY In the middle of the nineteenth century, the crisis of the traditional model of town planning also determined a strong change in supply and demand for public health. In Italy, a health reformation and reorganization of free hospital treatment and health service were considered essential for civil and social development by public opinion.Meanwhile hygiene was becoming an autonomous discipline incorporating medical, statistical and technical contributions. In particular new rules for hospital design were being formulated which did not only concern buildings, but also involved management and administration.Nevertheless, the presence of monumental hospitals in many Italian towns delays the spread of new typological models, especially because of the high costs in building new hospitals. «Old or new hospitals» was the theme of a very interesting debate, involving technical and scientific environments and public opinion. The Santa Maria Nuova Hospital in Florence is an outstanding example of the above.