E. Ferrario

Carotid plaque, aging, and risk factors. A study of 457 subjects.

Background and Purpose The aim of this study was to assess the prevalence of extracranial carotid artery atherosclerosis and its relation to principal cardiovascular risk factors at different ages in a sample of the general population. Methods B-mode ultrasonography was used to investigate the carotid district in 457 subjects (231 men and 226 women; mean age, 55.4±18.7 years; range, 18 to 97 years) in the metropolitan area. The ultrasonographic findings were then related to risk factors. Results Carotid plaques were found in 178 subjects (38.9%). The prevalence of atherosclerosis, number of plaques, and severity of stenosis were observed to increase with age. Age (P<.0001), cigarette smoking (P<.0001), male sex (P<.001), total cholesterol (P<.05), and, inversely, the ratio of high-density lipoprotein cholesterol to total cholesterol (P<.05) were found to be independently associated with carotid atherosclerosis. Stratified analysis by sex and age showed effect modifications by age on cigarette smoking, total cholesterol, and the ratio of high-density lipoprotein cholesterol to total cholesterol. After multivariate analysis including interaction terms, cigarette smoking and cholesterol levels were no longer found to be associated with carotid atherosclerosis in elderly subjects. Age (P<.01), total cholesterol (P<.05), and diabetes (P<.05) were positively related to the severity of vascular narrowing. Conclusions There is a high prevalence of asymptomatic carotid atherosclerosis in the general population, particularly among the very old. The association between risk factors and carotid atherosclerosis is less pronounced in the elderly than in younger subjects.

Low folate levels in the cognitive decline of elderly patients and the efficacy of folate as a treatment for improving memory deficits

The relevance of low folate levels as determinants of cognitive deficits and the usefulness of folate supplementation in the treatment of cognitive deficits was reviewed from the literature. Over 40 papers and book chapters published in English, French, German, Italian and Spanish were examined. This represents those papers published in the international literature in the last 10 years which were identified by various key words including folate, cognition and aging (or ageing). Among these papers, only 13 articles specifically addressed issues relevant to the criteria adopted for this review. The remaining papers were principally concerned with depression and or with other pathologies of the aged associated with folate deficiency. Although the specific role of low folate levels in the physiopathology of dementia is still under debate, a growing consensus is emerging in the literature where low folate as well as cobalamin levels in aged patients with cognitive deficits are being considered as a sign of functional problems in the absorption and utilization of vitamins, and not merely as a sign of bad eating habits. In studies where folate compounds were evaluated for treatment effects, the results of a majority of investigations indicated that folate treatment was effective in lessening cognitive deficits. Treatment efficacy, however, has not yet been sufficiently demonstrated by these results because there were no controlled studies and the methodology was heterogeneous for the evaluation of cognitive characteristics. An ad hoc double-blind, controlled versus placebo pilot study was undertaken to evaluate the efficacy of folic acid in 30 aged patients with abnormal cognitive decline and folate level below 3 ng/ml to better understand the value of this type of intervention. Our results from this preliminary study demonstrated that patients treated with folic acid for 60 days showed a significant improvement on both memory and attention efficiency when compared with a placebo group. The intensity of memory improvement was positively correlated with initial severity of folate deficiency. On the contrary, the severity of initial cognitive decline was unrelated to the degree of folate deficiency.

Determination of selected trace elements in patients affected by dementia

The relationship between dementia and trace elements is widely debated. Neurotoxicity of aluminium is well recognized. The purpose of the study was to evaluate serum levels of a few trace elements and a few serum proteins in demented subjects. The study was carried out on 452 women, age range 73-88 years. Thirty one of them were affected by dementia of Alzheimer type in early or middle stages. The diagnosis had been performed by history, physical and instrumental examinations, as well as by psychometric tests. The following parameters were determined: iron, zinc, copper, serum albumin, transferrin, ceruloplasmin. Iron, copper and zinc are somewhat lower in demented subjects than in controls, but the differences are statistically not significant. The slightly diminished levels of serum albumin and transferrin in the study group may be related to a mild malnutrition. The reduction of the proteins binding trace elements, particularly of transferrin, could cause a higher bioavailability of neurotoxic trace elements such as aluminium.

Health and functional status in elderly patients living in nursing homes

Socio-economic background, functional status, multiple pathology and medical conditions requiring care have been evaluated in 506 elderly subjects living in nursing homes in Turin (Italy). In the sample 78.8% are women, mean age 84.2 years, only 21.2% are men, mean age 76.3 years. Particularly in the oldest age classes women are more represented than men. Most subjects (94.3%) require help in at least one Activity of Daily Living (ADL). Part of the sample (21.2%) comes from home, 13.2% from acute wards, 9.1% from long term care wards, 6.3% from mental hospitals, 26.3% from residential homes. Education level is rather low. Before retirement, many men were workmen (38.3%), while many women were housewives (46.6%). Multiple pathology is very common: 23.7% of patients suffer from 4 pathologies, more than 5 diseases are present in 18.8%, while only 4.7% of subjects have less than two pathologies. Half of the sample (52.6%) is affected by dementia, 37.6% by cardiovascular diseases, 29.1% by chronic obstructive lung disease and 25.5% by stroke. Bone fractures are present in 22.1% of the subjects. Severe impairments in strength and/or motility in at least two limbs affect 43.7% of patients, double incontinence 49.2%, severe disturbances in speech and communication 35.4%. The prevalence of care needs is higher in women compared with men. More females than males need aid in walking, help in eating, diapers, pressure sores prevention and bedposts.

MINI-MENTAL STATE EXAMINATION AND WECHSLER MEMORY SCALE SUBTEST OF LOGICAL MEMORY: CORRELATION IN AN OVER 70-YEAR-OLD POPULATION

Summary The correlation between the mini-mental state examination (MMSE) and the logical memory (LM) subtest of the Wechsler memory scale (WMS) was evaluated in a group of healthy Italians, aged seventy and over, with no significant cognitive impairment. A horizontal study was carried out using 146 subjects (126 women and 20 men; mean age 72.7 ±3.7 years) who enrolled consecutively in the exercise courses for the elderly organized by the Municipality of Torino. A statistically significant correlation was found between the average total MMSE score and the LM score (r = 0.4315, p

Evaluation of cognitive and behavioral status of institutionalized elderly. Follow-up two and seven years

Summary The evolution of cognitive and behavioral disturbances over time in institutionalized elderly has not yet been widely studied. Our research was performed on a sample of 318 subjects admitted to a nursing home in Torino, Italy. Among them, anamnestic and clinical data identified 142 demented patients. In the baseline assessment Mini Mental State Examination (MMSE) and Crichton Geriatric Evaluation Rating Scale were included. After two years, 148 subjects including 50 patients who had been diagnosed as demented, could be retested with the same tools. Basal MMSE values were low for the demented subgroup (10.7 ± 5.6 points) but also for the subjects classified as non demented (21.8 ± 6.1 points). This finding can be explained by the advanced age of the sample (mean 80.2 ±9.2 years), the low education level (mean 5.97 ± 2.7 years) and socio-economic status and by the concomitance of multiple illnesses leading non-demented patients to seek institutional care. MMSE scores after two years showed a slight, significant improvement in the 98 non-demented patients, while a significant decline in cognitive performance was seen in the demented group. Behavioral problems at start were much more pronounced in the demented subgroup (Crichton mean score 28.4 ± 8.0 vs. 20.5 ± 5.7) but they remained relatively stable, while in the non-demented subgroup a mild impairment was seen over the two-year observation period. Seven years after admission, 39 surviving patients, including 13 elderly who had been diagnosed as demented, were re-evaluated with MMSE and Crichton. Both scores were found to worsen in the whole sample regardless of the diagnosis on admission. Functional and mental decline was slight in the first two years of observation and much more pronounced in the following five years.

Nutritional patterns in elderly patients with dementia of Alzheimer type

Body weight and some nutritional serum parameters (albumin, urea nitrogen, creatinine, glycemia, hemoglobin, total cholesterol, triglycerides, potassium) were analyzed in 44 subjects aged over 60 in order to evaluate weight loss and its possible link with the progression of dementia. Patients were consecutively admitted to our Day Hospital with the complaint of psychogeriatric symptoms. They all were living at home, no one presented risk factors for malnutrition and their cognitive impairment did not exceed the 4th degree of GDS (Global Deterioration Scale). Subjects were divided into two groups on the basis of diagnosis at discharge: (i) Possible or probable dementia of Alzheimer type (30 subjects, mean age 72.1 +/- 5.9 years), (ii) Age-associated memory impairment (14 subjects, mean age 73.6 +/- 6.2 years). One year later, a second control of body weight and nutritional parameters was performed. Differences between these latter measures versus the initial values were not significant when analyzed in the total group of demented patients or in the subgroups with different degree of cognitive impairment and physical activity. A possible hypothesis to explain the absence of differences among groups is that the caregivers were very carefully looking after all the patients examined.

AGE-ASSOCIATED MEMORY IMPAIRMENT AND DEMENTIA

Summary This study was performed on 54 women, 29 of them were affected by ageassociated memory impairment (AAMI) and 25 with normal mental function. All patients were examined by using the mini mental state examination (MMSE) and the logical memory (LM) subtest of the Wechsler memory scale in 1991, and the same testing was repeated on them after 5 years. The follow up total scores were compared to the original data by using the Students t test for paired samples. Two subjects, previously included in the AAMI group, showed an evolution towards dementia, according to the DSM-IV and the NINCDS-ADRDA criteria (probable dementia). This observation is in agreement with the results of others. The lack of specific markers for the preclinical stages of dementia suggests that patients meeting the criteria for AAMI should undergo a follow up to reveal the very early pathological signs and a possible progression of the symptoms.