David Simoni

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.

Different motor tasks impact differently on cognitive performance of older persons during dual task tests

BACKGROUND Dual task paradigm states that the introduction of a second task during a cognitive or motor performance results in a decreased performance in either task. Treadmill walk, often used in clinical applications of dual task testing, has never been compared to overground walk, to ascertain its susceptibility to interference from a second task. We compared the effects of overground and treadmill gait on dual task performance. METHODS Gait kinematic parameters and cognitive performance were obtained in 29 healthy older adults (mean age 75 years, 14 females) when they were walking freely on a sensorized carpet or during treadmill walking with an optoelectronic system, in single task or dual task conditions, using alternate repetition of letters as a cognitive verbal task. FINDINGS During overground walking, speed, cadence, step length stride length, and double support time (all with P value<0.001) and cognitive performance (number of correct words, P<0.001) decreased substantially from single to dual task testing. When subjects walked at a fixed speed on the treadmill, cadence decreased significantly (P=0.005), whereas cognitive performance remained unaffected. INTERPRETATION Both motor and cognitive performances decline during dual task testing with overground walking. Conversely, cognitive performance remains unaffected in dual task testing on the treadmill. In the light of current dual task paradigm, these findings may have relevant implication for our understanding of motor control, as they suggest that treadmill walk does not involve brain areas susceptible to interference from the introduction of a cognitive task.

Biomarkers of Alzheimer's Disease: From Central Nervous System to Periphery?

Alzheimers Disease (AD) is the most frequent form of dementia and represents one of the main causes of disability among older subjects. Up to now, the diagnosis of AD has been made according to clinical criteria. However, the use of such criteria does not allow an early diagnosis, as pathological alterations may be apparent many years before the clear-cut clinical picture. An early diagnosis is even more valuable to develop new treatments, potentially interfering with the pathogenetic process. During the last decade, several neuroimaging and cerebrospinal fluid (CSF) parameters have been introduced to allow an early and accurate detection of AD patients, and, recently, they have been included among research criteria for AD diagnosis. However, their use in clinical practice suffers from limitations both in accuracy and availability. The increasing amount of knowledge about peripheral biomarkers will possibly allow the future identification of reliable and easily available diagnostic tests.

Electrophysiological correlates of word recognition memory process in patients with ischemic left ventricular dysfunction

OBJECTIVE The relationship between left ventricular ejection fraction (LVEF) and cognitive performance in patients with coronary artery disease without overt heart failure is still under debate. In this study we combine behavioral measures and event-related potentials (ERPs) to verify whether electrophysiological correlates of recognition memory (old/new effect) are modulated differently as a function of LVEF. METHODS Twenty-three male patients (12 without [LVEF>55%] and 11 with [LVEF<40%] left ventricular dysfunction), and a Mini Mental State Examination score >25 were enrolled. ERPs were recorded while participants performed an old/new visual word recognition task. RESULTS A late positive ERP component between 350 and 550ms was differentially modulated in the two groups: a clear old/new effect (enhanced mean amplitude for old respect to new items) was observed in patients without LVEF dysfunction; whereas patients with overt LVEF dysfunction did not show such effect. In contrast, no significant differences emerged for behavioral performance and neuropsychological evaluations. CONCLUSIONS These data suggest that ERPs may reveal functional brain abnormalities that are not observed at behavioral level. SIGNIFICANCE Detecting sub-clinical measures of cognitive decline may contribute to set appropriate treatments and to monitor asymptomatic or mildly symptomatic patients with LVEF dysfunction.

High blood pressure in older subjects with cognitive impairment

High blood pressure and cognitive impairment often coexist in old age, but their pathophysiological association is complex. Several longitudinal studies have shown that high blood pressure at midlife is a risk factor for cognitive impairment and dementia, although this association is much less clear in old age. The effect of blood pressure lowering in reducing the risk of dementia is only borderline significant in clinical trials of older subjects, partly due to the insufficient follow-up time. Conversely, dementia onset is associated with a decrease of blood pressure values, probably secondary to neurodegeneration. Prognostic effect of blood pressure values in cognitively impaired older subjects is still unclear, with aggressive blood pressure lowering being potentially harmful in this patients category. Brief cognitive screening, coupled with simple motor assessment, are warranted to identify frail older subjects who need a more cautious approach to antihypertensive treatment. Values obtained with ambulatory blood pressure monitoring seem more useful than clinical ones to predict the outcome of cognitively impaired older subjects. Future studies should identify the most appropriate blood pressure targets in older subjects with cognitive impairment.

AB0797 Gait abnormalities in rheumatic patients with temporomandibular joint involvement.

Background The relationship between temporomandibular joint disorders (TMD) and alterations of posture and gait has been widely discussed in several investigations, reaching different and sometimes opposite conclusions Objectives To investigate whether TMD in early rheumatoid and psoriatic arthritis could influence gait pattern, assessed by computerized gait analysis with dual task (DT) paradigm. Methods Two groups of subjects were examined: a group of 30 patients with TMD in early rheumatoid or psoriatic arthritis without signs of involvement of other joints and a control group of 30 healthy subjects. Both temporomandibular joints were examined by ultrasound imaging in every subject. Gait analysis with a photogrammetric system during treadmill walking was performed. In DT procedure, treadmill walking was associated with a cognitive task. The coordination patterns thigh-leg, leg-foot and thigh-foot were analyzed. Results Sonographic findings showed joint effusion and alterations of condylar profile in all patients. Spatio-temporal parameters, during treadmill walking, did not show significant differences between controls and patients in single and dual task. Patients showed an asymmetric behavior of the coordination pattern leg-foot in DT procedure, during swing and stance phase of walking. In healthy subjects no significant difference of the coordination pattern leg-foot was observed. Conclusions DT procedure assessed the relationship between TMD and changes of the coordination pattern leg-foot during walking. DT shows that patients with TMD involvement develop an inadequate walking performance. These data focus the attention on the presence of postural abnormalities and gait alterations in patients with TMD, suggesting its evaluation in arthritides to obtain a timely correction of the gait modifications. Disclosure of Interest None Declared