Laura Corsinovi

Prevalence of silent cerebral ischemia in paroxysmal and persistent atrial fibrillation and correlation with cognitive function.

OBJECTIVES The aim of this study was to compare the prevalence of silent cerebral ischemia (SCI) and cognitive performance in patients with paroxysmal and persistent atrial fibrillation (AF) and controls in sinus rhythm. BACKGROUND Large registries have reported a similar risk for symptomatic stroke in both paroxysmal and persistent AF. The relationship among paroxysmal and persistent AF, SCI, and cognitive impairment has remained uncharted. METHODS Two hundred seventy subjects were enrolled: 180 patients with AF (50% paroxysmal and 50% persistent) and 90 controls. All subjects underwent clinical assessment, neurological examination, cerebral magnetic resonance, and the Repeatable Battery for the Assessment of Neuropsychological Status. RESULTS At least 1 area of SCI was present in 80 patients (89%) with paroxysmal AF, 83 (92%) with persistent AF (paroxysmal vs. persistent, p = 0.59), and 41 (46%) controls (paroxysmal vs. controls and persistent vs. controls, p < 0.01). The number of areas of SCI per subject was higher in patients with persistent AF than in those with paroxysmal AF (41.1 ± 28.0 vs. 33.2 ± 22.8, p = 0.04), with controls reporting lower figures (12.0 ± 26.7, p < 0.01 for both). Cognitive performance was significantly worse in patients with persistent and paroxysmal AF than in controls (Repeatable Battery for the Assessment of Neuropsychological Status scores 82.9 ± 11.5, 86.2 ± 13.8, and 92.4 ± 15.4 points, respectively, p < 0.01). CONCLUSIONS Patients with paroxysmal and persistent AF had a higher prevalence and number of areas of SCI per patient than controls and worse cognitive performance than subjects in sinus rhythm.

Left atrial appendage morphology and silent cerebral ischemia in patients with atrial fibrillation

BACKGROUND Left atrial appendage (LAA) is the major source of cardiac thrombi in atrial fibrillation (AF) and plays a major role in cardioembolic events. OBJECTIVE To investigate the correlation between LAA morphology and the burden of silent cerebral ischemia (SCI) as a new thromboembolic risk marker in patients with AF. METHODS A total of 348 patients with AF undergoing transcatheter ablation were enrolled. A cerebral magnetic resonance (MR) was performed to assess SCI burden, while LAA morphology was studied by MR or computed tomography and categorized as follows: cactus in 52 (14.9%) patients, chicken wing in 177 (50.9%), wind sock in 101 (29.0%), and cauliflower in 18 (5.2%). RESULTS SCIs were detected in 295 (84.8%) patients, with a median number of lesions of 23. SCI burden was related to LAA complexity: 30.8% and 17.3% patients with cactus, 30.5% and 22.0% with chicken wing, 13.9% and 27.7% with wind sock, and 16.7% and 38.9% with cauliflower LAA morphologies were in the first and fourth quartiles of number of SCI per patient, respectively (P = .035). After adjustment for potential confounders, only age (β 0.12; 95% CI 0.08-0.16; P < .001), chicken wing (β -0.28; 95% CI -0.51 to -0.04; P = .021), wind sock (β 0.38; 95% CI 0.12-0.65; P = .005), and cauliflower (β 0.61; 95% CI 0.07-1.14; P = .026) LAA morphologies were significantly related to SCI burden. CONCLUSION LAA morphology relates to the burden of SCI in AF patients. Future research should corroborate if accessible methods (eg, echocardiography) are able to describe LAA morphology, permitting its use within universal thromboembolic risk predictors in AF patients.

Dietary lipids and their oxidized products in Alzheimer's disease

Alzheimers disease (AD) is the commonest form of dementia in the elderly, characterized by memory dysfunction, loss of lexical access, spatial and temporal disorientation, and impaired judgment. A growing body of scientific literature addresses the implication of dietary habits in the pathogenesis of AD. This review reports recent findings concerning the modulation of AD development by dietary lipids, in animals and humans, focusing on the pathogenetic role of lipid oxidation products. Oxidative breakdown products of ω-6 polyunsaturated fatty acids (ω-6 PUFAs), and cholesterol oxidation products (oxysterols), might play a role in favoring β-amyloid deposition, a hallmark of ADs onset and progression. Conversely, ω-3 PUFAs appear to contribute to preventing and treating AD. However, high concentrations of ω-3 PUFAs can also produce oxidized derivatives reacting with important functions of nervous cells. Thus, altered balances between cholesterol and oxysterols, and between ω-3 and ω-6 PUFAs must be considered in ADs pathophysiology. The use of a diet with an appropriate ω-3/ω-6 PUFA ratio, rich in healthy oils, fish and antioxidants, such as flavonoids, but low in cholesterol-containing foods, can be a beneficial component in the clinical strategies of prevention of AD.

Early re-hospitalization of elderly people discharged from a geriatric ward.

Background and aims: Hospitalized elderly patients generally have a high level of disability and comorbidity. In many cases, at hospital discharge, the achieved health status balance is poor, and consequently the risk of further disability and hospital readmission is great. Identifying factors leading to hospital readmission could be helpful in reducing such events. The aim of the study was to evaluate the incidence and predictive factors of hospital readmission. Methods: We conducted an observational cohort study of a group of patients discharged from the Geriatric Ward of the San Giovanni Battista Hospital, Torino (Italy). The study sample contained 839 patients aged 80.6±6.3 years. The average hospital stay was 17.5±18.9 days (range 1–274 days). Results: Follow-up lasted three months, at the end of which 107 patients (12.8%) had been readmitted, 83 (9.9%) had only one readmission and 24 (2.9%) one or more readmissions. The first readmission took place within 15 days of discharge for 24 patients (2.9%) and within 30 days of discharge for 27 (3.2%). A new hospital admission within 15 days of discharge increased the risk of mortality (RR=3) and also the probability of a second re-hospitalization. 10.1% patients died; 88.2% of the patients who died had at least one readmission, whereas only 4.2% of live patients had a new hospital admission. Conclusions: Tumors, dementia, comorbidity, high education level, day hospital course and period of convalescence were all significantly and independently related to readmission.

Efficacy of oxycodone/acetaminophen and codeine/acetaminophen vs. conventional therapy in elderly women with persistent, moderate to severe osteoarthritis-related pain

We aimed to evaluate the efficacy and safety of oxycodone/acetaminophen (O/A) and codeine/acetaminophen (C/A) vs. conventional therapy (CT) without opioids in older women suffering from osteoarthritis (OA)-related pain, sub-optimally responsive to prior conventional treatments. We performed a 6 week, randomized, single blind, controlled study in three nursing homes. We enrolled 154 women with painful OA. They were assigned to treatment with O/A (n=52) and C/A (n=52) vs. CT (n=50). We evaluated at baseline and at week 6: average pain in the last week (mean pain, MeP), pain at rest (RP), pain in movement (MP) (numeric rating scale, NRS); depressive symptoms (Beck Depression Inventory-II, BDI-II); functional status (activities of daily living, ADL) and cognitive status (mini mental state evaluation, MMSE). We considered the adverse events (AEs) in the study period. At week 6, MeP, RP and MP were significantly reduced in all three groups (p<0.001); compared to CT, O/A and C/A were associated with greater reductions in MeP (p<0.001 and p=0.004, respectively), in RP (p=0.028 and p=0.032, respectively) in MP (p<0.001 and p=0.002, respectively) and with significant improvement in BDI-II score (p=0.05 and p=0.04, respectively) and ADL value (p=0.04 and p=0.05, respectively). AE rates did not differ between groups.

Risk factors of functional decline during hospitalization in the oldest old

Background and aims: The number of hospital admissions of the elderly is increasing and hospitalization often leads to functional decline. The aim of this study was to identify major risk factors for functional decline in the hospitalized oldest old. Methods: Prospective, observational, non-randomized study of patients aged ≥80 years, admitted for at least two days to the University Department of Geriatric Medicine of Torino, Italy, between November 2003 and November 2004. For detection of functional decline, the ADL scale was used, referring to the number of dependent ADL. Results: At discharge, ADL mean scores were significantly higher than on admission (2.5±2 vs 2.3±1.9, p<0.001). 23.9% of the sample lost at least one ADL function during hospitalization, and 19.2% were transferred to long-term care, compared with 5.4% of those with no functional decline. Length of hospitalization, neoplasm, low level of albumin and high number of drugs prescribed were associated with functional decline. At multivariate analysis, only in-hospital stay was an independent risk factor for functional decline (RR 1.1 per day of hospitalization, CI 1.03–1.14). Conclusions: Hospitalization of the oldest old increases the risk of functional decline, especially if prolonged. It is important to identify patients at high risk for functional decline after hospital admission.

High-Sensitivity C-Reactive Protein Is Not Independently Associated With Peripheral Subclinical Atherosclerosis

Objective. This study investigated whether high-sensitivity C-reactive protein (hs-CRP) levels are independently associated with subclinical peripheral atherosclerosis. Methods. Clinical variables, cardiovascular (CV) risk factors, 10-year CV risk, the ankle-brachial Index (ABI), and the carotid intima—media thickness (cIMT) were determined in a sample of consecutive subjects free from previous CV disease, admitted for a first visit at a lipid clinic. Results. In the overall sample (320 subjects, mean age 63 years, 35.8% men), hs-CRP levels were associated with major CV risk factors, 10-year CV risk, lower ABI, and higher cIMT values. In a logistic model, after adjustment for significant covariates, the associations of hs-CRP levels with ABI and cIMT were no longer statistically significant. Conclusions. Among asymptomatic, moderate- to-high CV risk subjects, hs-CRP levels were associated with severity of peripheral atherosclerosis, but these associations were not independent of traditional CV risk factors, suggesting a limited predictive role of hs-CRP for subclinical atherosclerosis.

Implications of routinely measuring Ankle-Brachial Index (ABI) among patients attending at a Lipid Clinic

BACKGROUND Low (< or = 90) Ankle Brachial Index (ABI) values identify patients at high risk for cardiovascular (CV) disease and mortality. Implications for CV risk classification from routinely measuring ABI in the context of a Lipid Clinic have not been fully investigated. We aimed to evaluate whether and to what extent routine ABI determination on top of conventional risk prediction models may modify CV risk classification. METHODS Consecutive asymptomatic non-diabetic individuals free from previous CV events attending for a first visit at a Lipid Clinic underwent routine ABI determination and conventional CV risk classification according either to national CUORE model (including age, gender, smoking, total and high density lipoprotein cholesterol, systolic blood pressure and current use of blood pressure lowering drugs) and SCORE model for low risk countries. RESULTS In the overall sample (320 subjects, mean age 64.8 years) 77 subjects (24.1%) were found to have low ABI value. Forty-two of 250 subjects (16.8%) and 47 of 215 individuals (21.3%) at low or moderate risk according to the CUORE and SCORE models, respectively, were found to have low ABI values, and should be reclassified at high risk. CONCLUSION In a series of consecutive asymptomatic individuals in a Lipid Clinic, we observed a high prevalence of low ABI values among subjects deemed at low or moderate risk on conventional prediction models, leading to CV high-risk reclassification of roughly one fifth of patients. These findings reinforce recommendations for routine determination of ABI at least within referral primary prevention settings.