G Orru

Does the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), predict mortality in cancer patients? Results of a prospective observational trial

OBJECTIVE Despite the lack of definitive data on the impact of Comprehensive Geriatric Assessment (CGA) in the geriatric oncology setting, the broad use of any form of CGA is strongly recommended before any treatment decision in elderly cancer patients (ECP); currently there is no consensus about the best format for this geriatric assessment. The aim of this study was to firstly test the Multidimensional Prognostic Index (MPI) in ECP with locally advanced or metastatic disease. MATERIALS AND METHODS Patients aged ≥70years with inoperable or metastatic solid cancer consecutively admitted to our Program of Geriatric Oncology were assessed by a multidisciplinary team and received a basal CGA to calculate the MPI score. RESULTS A hundred and sixty patients entered the study. In the Coxs regression model, MPI, CIRS-SI, BSA, GDS, MMSE, chemotherapy and a diagnosis of primary lung cancer were associated with mortality at 6 and 12months. The ROC curves confirmed the prognostic value of MPI, with the best discriminatory power for mortality at both 6 and 12months. CONCLUSION The present study is the first to indicate that the MPI retains its prognostic value even in elderly cancer patients with advanced stage of disease. The CIRS-SI and the GDS may potentiate the prognostic value of MPI.

Serial position effect in a free recall task: differences between probable dementia of Alzheimer type (PDAT), vascular (VaD) and mixed etiology dementia (MED).

Here we report an investigation on the serial position effect (SPE) in elderly patients with early dementia due to different etiologies. The Reys 15 words test has been used to evaluate whether different types of dementia show different patterns of immediate and delayed recall and of learning process. Ninety-four patients were recruited from the Geriatric Clinic of Padua. We evaluated the primacy effect (PE), the recency effect (RE) and the learning process within the sample. Our results indicate that different etiologies have different patterns of anterograde memory impairment.

A retrospective pilot study on the development of cognitive, behavioral and functional disorders in a sample of patients with early dementia of Alzheimer type.

This pilot study retrospectively analyzes the evolution of cognitive-behavioral symptoms and functional autonomy in a sample of patients with early diagnosis of probable Alzheimers disease (AD). One hundred patients with early mild cognitive impairment (MCI) were considered and submitted to a multidimensional evaluation: the 53% presented probable AD. These 53 subjects were evaluated for cognitive performance by using the mini mental examination (MMSE), behavioral functions by the neuropsychiatric inventory (NPI) and functional dependence by the activities of daily living (ADL) and the instrumental ADL (IADL) scales at basal time and after 6-12 months. Results were analyzed according to the duration of therapy with acetyl-cholinesterase inhibitors (ACHEI) and to the timing of the beginning with respect to the diagnosis. AD patients treated with ACHEI at the moment of the diagnosis, showed a statistically significant improvement in MMSE (2.7+/-1.5) after 6 months (p=0.012) which was maintained even after 12 months. Subjects beginning ACHEI at the visit of 6 months showed a statistically worsened MMSE, even after 6 months of therapy (-2.8+/-1.7, p=0.026). We conclude that the timing of administration of ACHEI therapy in mild AD is essential to obtain beneficial effects on cognitive decline.

Detection of Malingering in Personal Injury and Damage Ascertainment

One of the most important challenges encountered by forensic and medicolegal professionals is the evaluation of simulating and dissimulating behaviors exhibited by litigants. The main feature of malingering is represented by the intentional production of false or exaggerated symptoms, motivated by external incentives. Assessment of malingering is often inadequate when exclusively based on the clinical interview, sometimes also grounded solely on the clinician’s negative opinion. For this reason, the misclassification rate in the detection of malingerers can be considered alarmingly high (over 80 %). Malingering is not an all-or-nothing phenomenon, but it can be realized on several levels. Moreover, an examinee may attempt to malinger in a number of different ways, including fabricating or exaggerating psychiatric symptoms or presenting various types of cognitive deficits. Thus, several strategies have been identified for malingering detection (e.g., discrepancy method, symptoms analysis, and symptom validity testing).

Detection of Malingering in Psychic Damage Ascertainment

Malingering is the intentional feigning or exaggeration of physical or psychological symptoms. Since the beginning of 1900 malingering detection has been one of the main challenges in medico-legal practice and in particular in psychiatric and cognitive assessment, as behavioral symptoms are very easy to produce, so that the need for specific tools and strategies for malingering detection is crucial. Although several tools and strategies are available, conclusions are often derived from mere subjective impressions and in many cases they lead to misclassifications. Here we present a non-exhaustive review of strategies for the detection of malingering, starting from the logic underlying a qualitative analysis of symptoms, to validated tools specifically designed to detect attempts at simulating or exaggerating psychopathological, psychiatric or cognitive diseases. Finally, we describe two recent approaches to the malingering detection problem. These approaches are grounded on the analysis of the reaction-times and on the dynamic analysis of kinematic features of mouse trajectories while an examinee is answering to double-choice questions.