Egle Perissinotto

Parkinson's disease and parkinsonism in a longitudinal study: Two-fold higher incidence in men

Objective: To determine the incidence of parkinsonism and PD in the Italian elderly, and to explore the relation with age and gender. Methods: In eight Italian municipalities, a population-based, parkinsonism-free cohort was followed for an average of 3 years. At the end of the follow-up, the cohort survivors were directly contacted (screening and clinical examination). Cohort members who had died were studied using death certificates, clinical records, and information gathered from relatives and general practitioners. Parkinsonism diagnosis and subtyping were made according to specified diagnostic criteria. Results: The cohort consisted of 4,341 individuals (65 to 84 years of age): 596 died before the examination, 2,863 (76.4% of the survivors) completed the screening procedure, and 882 refused to participate. The authors found 68 incident cases of parkinsonism: 42 PD (62%), 7 drug-induced parkinsonism (10%), 8 parkinsonism in dementia (12%), 8 vascular parkinsonism (12%), and 3 parkinsonism, unspecified (5.8%). Average annual incidence rate (per 100,000 person-years) in the population aged 65 to 84 years, adjusted to the 1992 Italian population, was 529.7 (95% CI, 400.5 to 658.9) for parkinsonism, and 326.3 (95% CI, 224.1 to 427.5) for PD. Incidence rates for both parkinsonism and PD increased with age in both men and women; men had higher rates in every age group. Age-adjusted relative risk in men compared with women was 1.66 (95% CI, 1.02 to 2.70) for parkinsonism and 2.13 (95% CI, 1.11 to 4.11) for PD. Conclusions: Incidence of parkinsonism and PD increased with age, PD was the most common type of parkinsonism, and men had a risk of developing PD twice that of women.

Anthropometric measurements in the elderly: age and gender differences.

In clinical practice and epidemiological surveys, anthropometric measurements represent an important component of nutritional assessment in the elderly. The anthropometric standards derived from adult populations may not be appropriate for the elderly because of body composition changes occurring during ageing. Specific anthropometric reference data for the elderly are necessary. In the present study we investigated anthropometric characteristics and their relationship to gender and age in a cross-sectional sample of 3,356 subjects, randomly selected from an elderly Italian population. In both sexes, weight and height significantly decreased with age while knee height did not. The BMI was significantly higher in women than in men (27.6 SD 5.7 v. 26.4 SD 3.7; P<0.001) and it was lower in the oldest than in the youngest subjects (P<0.05) of both genders. The 75th year of age was a turning point for BMI as for other anthropometric measurements. According to BMI values, the prevalence of malnutrition was lower than 5 % in both genders, whereas obesity was shown to have a higher prevalence in women than in men (28% v. 16%; P<0.001). Waist circumference and waist: hip ratio values were higher for the youngest men than for the oldest men (P<0.05), whereas in women the waist: hip ratio values were higher in the oldest women, suggesting that visceral redistribution in old age predominantly affects females. In conclusion, in the elderly the oldest subjects showed a thinner body frame than the youngest of both genders, and there was a more marked fat redistribution in women.

Incidence of Dementia, Alzheimer's Disease, and Vascular Dementia in Italy. The ILSA Study

OBJECTIVES: To estimate the incidence of dementia, Alzheimers disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship of age, gender, and education to developing dementia.

Tooth loss in the elderly and its association with nutritional status, socio-economic and lifestyle factors

Objective. Tooth loss impacts on general health and is a risk factor for malnutrition, disability, loss of self-sufficiency, and deterioration in quality of life. The present study was carried out to evaluate the prevalence of edentulism and its association with social and lifestyle factors in a population of elderly Italians. Material and Methods. Dental, social, and disease conditions were evaluated in a large community-based cohort (3054) of elderly subjects (≥65 years) of both sexes in northern Italy. Logistic regression analyses with stepwise forward selection were performed to estimate the independent contribution of nutritional, socio-economic, and lifestyle variables to dental status. Adjusted ORs and 95% CI were estimated for variables significantly associated with edentulism. Results. The prevalence of edentulism was about 44.0%. It was more pronounced in females and it was twice as prevalent in the 90+ years age group. Among edentulous subjects, 17.5% wore no prostheses. Difficulties in chewing and in swallowing were reported by 47.6% and 13.7% of the subjects, respectively. Multivariate analysis indicates that edentulism was associated with age in both sexes. For women, independently associated risk factors were: years since menopause >23 (OR = 1.81; 95% CI: 1.37–2.40), number of children >3 (OR = 1.95; 95% CI: 1.36–2.80), and living alone (OR = 1.47; 95% CI: 1.15–1.88). For men, these were serum albumin <40 g/l (OR = 1.79; 95% CI: 1.22–2.63), current smoking (OR = 4.01; 95% CI: 2.59–6.20), and former smoking (OR = 3.42; 95% CI: 2.42–4.82). Conclusions. The prevalence of edentulism among the elderly Italian population studied was at the high end among Western countries, and higher in women than in men. In women, tooth loss correlated with aging, female events (pregnancies, menopausal status), and living alone. In men, aging and smoking are important determinants of edentulism, which is associated with the risk condition of hypoalbuminemia. Difficulty in chewing was associated with dentition type. In our study, the high prevalence of edentulous subjects without prostheses suggests a need for educational and social measures to improve patients’ attitudes to dental care and to encourage the use of prostheses among the elderly.

Pre-frailty and risk of cardiovascular disease in elderly men and women: the Pro.V.A. study.

BACKGROUND Frailty is an important risk factor for cardiovascular disease (CVD), but the impact of early, potentially reversible stages of frailty on CVD risk is unknown. OBJECTIVES This study sought to ascertain whether pre-frailty can predict the onset of CVD in a cohort of community-dwelling, not disabled, elderly people. METHODS A sample of 1,567 participants age 65 to 96 years without frailty or disability at baseline was followed for 4.4 years. Pre-frailty was defined as the presence of 1 or 2 modified Fried criteria (unintentional weight loss, low physical activity level, weakness, exhaustion, and slow gait speed), and incident CVD as onset of coronary artery diseases, heart failure, stroke, peripheral artery disease, or CVD-related mortality. RESULTS During follow-up, 551 participants developed CVD. Compared with participants who did not become frail, those with 1 modified Fried criterion (p = 0.03) and those with 2 criteria (p = 0.001) had a significantly higher risk of CVD, even after adjusting for several potential confounders (traditional risk factors for CVD, inflammatory markers, and hemoglobin A1c levels). Low energy expenditure (p = 0.03), exhaustion (p = 0.01), and slow gait speed (p = 0.03) were significantly associated with the onset of CVD, whereas unintentional weight loss and weakness were not. CONCLUSIONS Our findings suggest that pre-frailty, which is potentially reversible, is independently associated with a higher risk of older adults developing CVD. Among the physical domains of pre-frailty, low gait speed seems to be the best predictor of future CVD.

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

Objectives:The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds.Subjects and methods:Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.5±5.3 years and 136 men aged 73.9±5.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry.Results:The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI <22 (OR=12) and a protein intake <65.7 g/day (OR=3.7). Women carried some risk already in the BMI 25–30 class (OR=5), and a much greater risk in the BMI <22 class (OR=26). Albumin <40 g/l also emerged as an independent risk factor (OR=2.6).Conclusions:BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values <22 are normal for younger adults but carry a higher risk of osteoporosis in the elderly, particularly in women. Age-related sarcopenia does not seem to be involved in bone mass loss.

Vitamin D and physical performance in elderly subjects: the Pro.V.A study.

Background The role of Vitamin D in musculoskeletal functionality among elderly people is still controversial. We investigated the association between serum 25-hydroxyvitamin D (25OHD) levels and physical performance in older adults. Methods 2694 community-dwelling elderly women and men from the Progetto Veneto Anziani (Pro.V.A.) were included. Physical performances were assessed by: tandem test, 5 timed chair stands (TCS), gait speed, 6-minute walking (6 mW) distance, handgrip strength, and quadriceps strength. For each test, separate general linear models and loess plots were obtained in both genders, in relation to serum 25OHD concentrations, controlling for several potential confounders. Results Linear associations with 25OHD levels were observed for TCS, gait speed, 6 mW test and handgrip strength, but not for tandem test and quadriceps strength. After adjusting for potential confounders, linear associations with 25OHD levels were still evident for the 6 mW distance in both genders (p = .0002 in women; <.0001 in men), for TCS in women (p = .004) and for gait speed (p = .0006) and handgrip strength (p = .03) in men. In loess analyses, performance in TCS in women, in gait speed and handgrip strength in men and in 6 mW in both genders, improved with increasing levels of 25OHD, with most of the improvements occurring for 25OHD levels from 20 to 100 nmol/L. Conclusion lower 25OHD levels are associated with a worse coordination and weaker strength (TCS) in women, a slower walking time and a lower upper limb strength in men, and a weaker aerobic capacity (6 mW) in both genders. For optimal physical performances, 25OHD concentrations of 100 nmol/L appear to be more advantageous in elderly men and women, and Vitamin D supplementation should be encouraged to maintain their 25OHD levels as high as this threshold.

Cancer incidence among male military and civil pilots and flight attendants: an analysis on published data.

Flight personnel are exposed to cosmic ionizing radiation, chemicals (fuel, jet engine exhausts, cabin air pollutants), electromagnetic fields from cockpit instruments, and disrupted sleep patterns. Only recently has cancer risk among these workers been investigated. With the aim of increasing the precision of risk estimates of cancer incidence, follow-up studies reporting a standardized incidence ratio for cancer among male flight attendants, civil and military pilots were obtained from online databases and analysed. A meta-analysis was performed by applying a random effect model, obtaining a meta-standardized incidence ratio (SIR), and 95% confidence interval (CI). In male cabin attendants, and civil and military pilots, meta-SIRs were 3.42 (CI=1.94-6.06), 2.18 (1.69-2.80), 1.43 (1.09-1.87) for melanoma; and 7.46 (3.52-15.89), 1.88 (1.23-2.88), 1.80 (1.25-2.58) for other skin cancer, respectively. These tumors share as risk factors, ionizing radiation, recreational sun exposure and socioeconomic status. The meta-SIRs are not adjusted for confounding; the magnitude of risk for melanoma decreased when we corrected for socioeconomic status. In civil pilots, meta-SIR was 1.47 (1.06-2.05) for prostate cancer. Age (civil pilots are older than military pilots and cabin attendants) and disrupted sleep pattern (entailing hyposecretion of melatonin, which has been reported to suppress proliferative effects of androgen on prostate cancer cells) might be involved. In male cabin attendants, meta-SIR was 21.5 (2.25-205.8) for Kaposi’s sarcoma and 2.49 (1.03-6.03) for non-Hodgkin’s lymphoma. AIDS, which was the most frequent single cause of death in this occupational category, likely explains the excess of the latter two tumors.

Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis.

OBJECTIVE Thymectomy is a well-defined therapeutic option for patients with myasthenia gravis; however, controversies still exist about the surgical approach, indication, and timing for surgery. We reviewed our experience reporting surgical and neurologic results after robotic thymectomy in patients with myasthenia gravis. METHODS Between 2002 and 2010, 100 patients (74 female and 26 male; median age, 37 years) underwent left-sided robotic thymectomy using the da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, Calif). The Myasthenia Gravis Foundation of America classification was adopted for pre- and postoperative evaluation. Preoperative Myasthenia Gravis Foundation of America class was I in 10% of patients, II in 35% of patients, III in 39% of patients, and IV in 16% of patients. RESULTS Median operative time was 120 (60-300) minutes. No death or intraoperative complications occurred. Postoperative complications were observed in 6 patients (6%) (bleeding requiring blood transfusions in 3, chylothorax in 1, fever in 1, and myasthenic crisis in 1). Median hospital stay was 3 days (range, 2-14 days). Histologic analysis revealed 76 patients (76%) with hyperplasia, 7 patients (7%) with atrophy, 8 patients (8%) with small thymomas, and 9 patients (9%) with normal thymus; ectopic thymic tissue was found in 26 patients (26%). Clinical follow-up showed a 5-year probability of complete stable remission and overall improvement of 28.5% and 87.5%. Remission was significantly associated with preoperative I to II Myasthenia Gravis Foundation of America class (P = .02). A significant improvement rate was found in Myasthenia Gravis Foundation of America class I to II (P = .03) and AbAchR+ (P = .04). A high percentage of patients interrupted or reduced their medications. CONCLUSIONS Robotic thymectomy is a safe and effective procedure. We observed a neurologic benefit in a great number of patients. A better clinical outcome was obtained in patients with early Myasthenia Gravis Foundation of America class.

Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program: a randomized controlled trial

BACKGROUND Magnesium deficiency is associated with poor physical performance, but no trials are available on how magnesium supplementation affects elderly peoples physical performance. OBJECTIVE The aim of our study was to investigate whether 12 wk of oral magnesium supplementation can improve physical performance in healthy elderly women. DESIGN In a parallel-group, randomized controlled trial, 139 healthy women (mean ± SD age: 71.5 ± 5.2 y) attending a mild fitness program were randomly allocated to a treatment group (300 mg Mg/d; n = 62) or a control group (no placebo or intervention; n = 77) by using a computer-generated randomization sequence, and researchers were blinded to their grouping. After assessment at baseline and again after 12 wk, the primary outcome was a change in the Short Physical Performance Battery (SPPB); secondary outcomes were changes in peak torque isometric and isokinetic strength of the lower limbs and handgrip strength. RESULTS A total of 124 participants allocated to the treatment (n = 53) or control (n = 71) group were considered in the final analysis. At baseline, the SPPB scores did not differ between the 2 groups. After 12 wk, the treated group had a significantly better total SPPB score (Δ = 0.41 ± 0.24 points; P = 0.03), chair stand times (Δ = -1.31 ± 0.33 s; P < 0.0001), and 4-m walking speeds (Δ = 0.14 ± 0.03 m/s; P = 0.006) than did the control group. These findings were more evident in participants with a magnesium dietary intake lower than the Recommended Dietary Allowance. No significant differences emerged for the secondary outcomes investigated, and no serious adverse effects were reported. CONCLUSIONS Daily magnesium oxide supplementation for 12 wk seems to improve physical performance in healthy elderly women. These findings suggest a role for magnesium supplementation in preventing or delaying the age-related decline in physical performance.