G. Troisi

Is there a relationship between high C-reactive protein (CRP) levels and dementia?

Inflammation is believed to play a pivotal role in dementia, but its role is still unclear. The aim of our study was to analyze the interplay among markers of inflammation, such as fibrinogen and high CRP levels, and dementia. First, we performed a cross-sectional study comparing markers of inflammation between 99 patients affected by dementia (mean age: 83.0+/-0.6 years) and 99 controls (mean age: 83.9+/-0.7 years). Then, we analyzed the relationship between inflammation and dementia in the same population composed by 34 Alzheimers disease (AD) patients (mean age: 83.4+/-0.8 years), 64 vascular dementia (VaD) patients (mean age: 82.7+0.8 years) and 99 controls. Patients affected by dementia had higher CRP levels than controls (2.6+/-+/-0.2 vs. 0.7 + 0.1 p < 0.001, respectively). AD patients had higher CRP levels than VaD patients (4.2 + 0.6 vs. 1.7+/-0.2, p < 0.001, respectively). Stepwise multiple logistic regression analysis showed that dementia (odds ratio=OR=4.965, 95% confidence interval=Cl=1.402-13.23, p=0.004), fibrinogen (OR=1.011, Cl=1.007-1.015, p<0.001), and age (OR=1.158, Cl=1.063-1.261, p<0.001) are independently correlated with high levels of CRP. The study suggests that inflammation may have a pathogenetic role in AD.

IMPACT OF THERAPY WITH α-LIPOIC ACID (ALA) ON THE OXIDATIVE STRESS IN THE CONTROLLED NIDDM: A POSSIBLE PREVENTIVE WAY AGAINST THE ORGAN DYSFUNCTION?

There is a growing evidence that excess generation of highly reactive free radicals, largely due to hyperglycemia, causes oxidative stress, which further exacerbates the development and progression of diabetes and its complications. The purpose of this study was to evaluate the impact of ALA on lipid profile, oxidative pattern and inflammation in patients with controlled non-insulin dependent diabetes mellitus (NIDDM). ALA, 400mg/day was investigated in NIDDM patients over a period of 4 weeks using a randomized, placebo-(PLA)-controlled study with two parallel groups. The marker of oxidative stress was the concentration of reactive oxygen metabolites, evaluated using a commercially available test, called d-ROMs test, and the biological antioxidant potential (BAP); besides, the lipid profile (total cholesterol=TC, high-density lipoprotein-cholesterol = HDL-C; low-density lipoprotein-cholesterol=LDL-C, and triglycerides=TG) and the C-reactive protein (CRP), marker of inflammation were measured at the beginning and at the end of the treatment. A total of 14 patients were randomly assigned to the two groups. ALA was safe and well tolerated in the only oral daily administration. The d-ROMs test (p=0.03) and HDL-C (p=0.04) showed a significant difference between the two groups. BAP (p=0.06) tended to be higher in the treated patients, while LDL-C (p=0.07) presented a moderate decline. There were no significant differences in TC (p=0.65), TG (p=0.78) and CRP (p=0.96) between the ALA and PLA groups. ALA therapy appears to reduce significantly d-ROMs and to improve HDL-C value, especially in men with metabolic syndrome treated with oral hypoglycemic drugs. These findings will be useful in patient selection in future clinical trials with ALA in long term studies.

Role of 99mTc-Sestamibi scintimammography by SPEM camera in the management of breast cancer in the elderly

The incidence of breast cancer in the elderly is 10 fold higher than in the population younger than 65 years. Moreover, in this segment of the population there are not defined clear practice guidelines regarding patient management. X-ray mammography, the most widely used diagnostic technique, is often inadequate to differentiate benign from malignant lesions.99m Tc Sestamibi scintimammography plays an important role as complement to mammography; in fact it is a very sensitive and specific method for breast cancer detection, when cancers > 1 cm diameter are considered. However, sensitivity values fall to 50–60% in the case of small tumors (T1a and T1b). In this study we present the results of a new Small Field Of View (SFOV) Gamma Camera with very high spatial resolution that allows the first Single Photon Emission Mammography (SPEM). Eighteen patients aged 71 ± 6 years with mammographically detected breast lesions were submitted to a Prone Scinti Mammography (PSM) by conventional Gamma Camera and to a SPEM on craniocaudal view. A final diagnosis was reached by histopathology. SPEM correctly diagnosed 15 of 16 cancers, while PSM was not able to recognize 5 malignant lesions with subcentimeter size. Both the techniques provided normal findings in the case of benign lesions. The 99mTc Sestamibi scintimammography, particularly when performed by SPEM camera, is a sensitive, specific, and non invasive method to define the nature of radiologically described breast masses and would be very useful as a complement to X-ray mammography in screening programs for breast cancer.

Stress in centenarians

Everybody is subject to a physical clock, determining the calendar age, and also to a biological clock, the speed of which depends on the interaction between the genetic reserves and the environment. Stress is taken into account more and more as one of the main factors responsible for the acceleration of the biological clock and the dishomogeneity of the aging process. Despite the fact that centenarians are prone to chronic stress due to a progressive loss of self-sufficiency, more than a half of our centenarians were not depressed and had a low trait-anxiety: they showed an emotional tendency to react with a low anxiety-intensity to stressful conditions. Their good physical conditions may be explained by a positive character-disposition and by strong adaptability to the adversities of the life. Personality traits can be reduced to five basic phenomena, the so-called Big Five: extroversion, agreeableness, conscientiousness, openness to experience and emotional stability. In our sample 65.4% were classified as extroverted, 50% as open minded and 34.5% showed good emotional stability. In the centenarians aging of all apparatuses was slowed down by a healthy lifestyle and also by good adaptability that allowed for a positive and effective response to stress throughout their whole lives.

Atrial fibrillation (AF) and cognitive impairment in the elderly: A case–control study

AF is able not only to increase the risk of cognitive decline due to acute cerebrovascular events, but also to reduce cardiac output, with the consequence of impaired cerebral perfusion. The aim of this study was to evaluate the association between AF, dementia and depression in patients with negative anamnesis for past strokes. Our sample included 26 patients with a diagnosis of AF (paroxystic, persistent, permanent) and 31 patients with sinus rhythm, enrolled as controls. All selected patients underwent a Multidimensional Geriatric Assessment in order to investigate cognitive and behavioral functions. Statistical analysis of results showed a greater frequency of latent cognitive impairment in patients with AF, even in the absence of memory disorders. As a matter of facts, AF patients showed Mini Mental State Examination (MMSE) scores significantly lower than those with sinus rhythm (p<0.05) and Geriatric Depression Scale (GDS) scores higher than those without AF, evidencing a greater risk of depression too (p<0.02). Results showed a statistically significant association between AF, depression and cognitive impairment in early stage. In conclusion, AF is not only associated with the risk of developing cognitive impairment, but it can also be considered as a risk factor for dementia and depression, even in the absence of medical history of past stroke.

The treatment of hypertension with telmisartan in the sphere of circadian rhythm in metabolic syndrome in the elderly.

This study compares the efficacy of telmisartan with that of valsartan and ramipril in reducing blood pressure (BP) over 24 hrs in the elderly patients with metabolic syndrome (MS). This prospective and open label study analyzed a sample of 60 patients over 65 years of age with hypertension and with MS. At the beginning the BP was monitored by a 24-hr ambulatory blood pressure monitoring (AMBP). Following this, the 60 patients were divided into 3 groups of 20, to each of which was prescribed, respectively, telmisartan, valsartan and ramipril to take for 12 weeks. The drugs were to be taken at 9.00 a.m. Later on the doses were increased. After 12 weeks of therapy, BP was monitored by a 24-hr AMBP. The use of telmisartan caused a greater reduction of the BP in the final 4-6 hours of the period between the 1st administration of the drug and the next one, these last 4-6 hours being those when cardiovascular and cerebrovascular accidents are more frequent (between 6.00 and 10.00 a.m.). Comparing to valsartan and ramipril, telmisartan results in excellent pressure control during the last 4-6 hours between the 1st administration of the drug and the next one.

A rare familiar case of hereditary bisalbuminemia and diabetic predisposition: A possible predictive link?

We present a case report of hereditary bisalbuminemia in an Italian family with three affected members. Bisalbuminemia represents a genetic variant of the albumin, it will then be permanent, or acquired and then be transient. It is characterized by the presence of two albumin bands in electrophoresis: the first band with the same mobility of the normal albumin, the second band with a fast variable or a slow variable. The double band of albumin was detected fortuitously on a routine analytical study of an adult woman who was referred to our laboratory with an increase of fasting glucose value, this originated the study of the rest of the members of the family. Finally, it is like the genetic peculiarity of this family core show a possible predictive link between bisalbuminemia on one hand and the predisposition to type II diabetes mellitus on the other hand. As a result of such high probability we are eager to continue further search at our medicine predictive centre.

Aging and Adherence to the Mediterranean Diet: Relationship with Cardiometabolic Disorders and Polypharmacy

ObjectivesTo investigate the association between adherence to the Mediterranean Diet (Med-Diet), cardiometabolic disorders and polypharmacy.DesignCross-sectional study.SettingGeriatrics outpatient clinic, Policlinico Umberto I, Sapienza University of Rome.Participants508 patients (219 male, 289 female) aged 50 to 89 who were evaluated for cardiovascular and metabolic disorders.Methods and MeasurementsPatients underwent a comprehensive medical assessment including medical history and the use of medications. Adherence to Med-Diet was assessed using the validated Med-Diet 14-item questionnaire; for the analysis, patients were divided in high (≥8) and medium-low (<8) adherence. Polypharmacy was defined as taking ≥5 medications.Results476 patients completed the study. Mean age was 70.4 years; 58% female. Median Med-Diet score was 8 (6-9). Patients with medium-low adherence had higher body mass index (p=0.029) and higher prevalence of arterial hypertension (p<0.001), previous coronary (p=0.002) and cerebrovascular events (p=0.011), diabetes, (p<0.001) and dyslipidemia (p=0.001) compared to those at high adherence. Med-Diet score decreased with the number of cardiometabolic disorders (p<0.001). The prevalence of polypharmacy was 39%. Consumption of olive oil (p=0.005), vegetables, (p<0.001), wine (p=0.017), legumes (p=0.028), fish (p=0.046) and nuts (p=0.045) were all inversely associated with the overall number of medications. In a multivariable regression model, medium-low adherence to Med-Diet was independently associated to polypharmacy (O.R.:1.859; 95% CI 1.142 to 3.025; p=0.013), after adjusting for possible confounding factors.ConclusionMed-Diet was inversely associated with cardiometabolic disorders and with polypharmacy, suggesting that improved Med-Diet adherence might potentially delay the onset of age-related health deterioration and reduce the need of multiple medications.

Insufficienza respiratoria acuta trattata con ventilazione meccanica non invasiva

This is a case of 89 years old patient suffering by chronic obstructive pulmonary disease and affected by acute respiratory failure characterized by hypoxemia and hipercapnia. It is interesting because, comparing oxygen therapy and non invasive ventilation, the best results were reached with the last technique, in an elder patient.This is a case of 89 years old patient suffering by chronic obstructive pulmonary disease and affected by acute respiratory failure characterized by hypoxemia and hipercapnia. It is interesting because, comparing oxygen therapy and non invasive ventilation, the best results were reached with the last technique, in an elder patient.

Prevalence of depression in a geriatric population with metabolic syndrome

Metabolic Syndrome (Metabolic Syndrome, MS) is associated with many other diseases in the elderly. We have studied a possible correlation between this disorder and depression in a Geriatric Centre. The study was conducted on a random sample of 30 geriatric patients, then divided into 2 groups according to clinical and instrumental diagnostic investigations: 15 patients affected MS according to the criteria of NCEP ATP III, and 15 controls without MS. Then its administered the Geriatric Depression Scale (GDS). Elaboration of the results it appears statistically significant correlation (t=2.05, p=0.0495) between MS and depression in the elderly.Metabolic Syndrome (Metabolic Syndrome, MS) is associated with many other diseases in the elderly. We have studied a possible correlation between this disorder and depression in a Geriatric Centre. The study was conducted on a random sample of 30 geriatric patients, then divided into 2 groups according to clinical and instrumental diagnostic investigations: 15 patients affected MS according to the criteria of NCEP ATP III, and 15 controls without MS. Then its administered the Geriatric Depression Scale (GDS). Elaboration of the results it appears statistically significant correlation (t=2.05, p=0.0495) between MS and depression in the elderly.