Maddalena Riva

Odor Identification Deficit Predicts Clinical Conversion from Mild Cognitive Impairment to Dementia Due to Alzheimer's Disease

The aim of this study was to analyze the relationship between olfactory and cognitive functions in subjects affected by mild cognitive impairment (MCI) and to investigate whether olfactory deficits might reflect the likelihood of conversion from MCI to dementia. In this longitudinal study conducted on a sample of MCI outpatients, CA-SIT Smell Identification Test was administered to 88 MCI subjects and 46 healthy control subjects. MCI subjects have been divided into two groups, considering smell identification performances: 40% had normal performances (MCI olfactory-normal), whereas 60% had a moderate olfaction deficit (MCI olfactory-impaired). At 2-year follow-up, the 47% of MCI olfactory-impaired subjects and the 11% of MCI olfactory-normal subjects progressed to dementia. In a logistic regression model, a lower score in MMSE (95%, OR 1.9; IC 1.23-3.01; p = .004) and a pathological smell identification at baseline (95%, OR 5.1; IC 1.16-22.6; p = .03) were independently associated with the progression to dementia within 2 years. This study confirms that smell identification testing may be useful in high-risk settings to identify patients at risk for developing dementia.

Changes in characteristics of Alzheimer patients at first visit to centers for dementia: a 10-year follow-up study

Background and aims: The Cronos Project is an observational study on Alzheimer’s disease (AD), created by Italy’s Ministry of Public Health in 2000. The aim of our study was to evaluate whether the clinical characteristics of patients at their first visit to the Alzheimer Evaluation Unit (UVA) changed from September 2000 to December 2009, and to examine possible reasons for changes noted. Methods: 1532 consecutive patients were enrolled in two UVAs (September 2000 to December 2009) in a retrospective, descriptive study, with medical records as the primary source of data. Results: Patients’ age at the first visit was not different throughout the period of observation. No differences were observed with regard to education or functional characteristics. However, a reduction in the severity of cognitive impairment was found during the period of evaluation: patients consecutively recruited in the first years were more cognitively, functionally, and psycho-behaviorally compromised than patients recruited in the following years. Conclusions: Data show changes in characteristics at the first visit in patients affected by cognitive deterioration during the years of observation. This finding indicates new clinical needs of patients, requiring changes in pharmacological treatment and in general of the clinical approach.

Cognitive dysfunction and age-related macular degeneration.

Several previous studies showed that age-related macular degeneration (AMD) and Alzheimer’s disease (AD) share common risk factors and histopathology changes, and there is epidemiological evidence linking AMD to cognitive impairment. We tested this theory in 51 patients with late-stage AMD and 24 controls by analyzing their neuropsychological profiles. In this study, data showed that patients affected by late-stage AMD have a worse global cognitive function than those of the controls and, in particular, show worse performances in memory tasks. Moreover, patients affected by the dry form of AMD are significantly impaired in executive functions in addition to memory. Data support the hypothesis of a possible association between AMD and cognitive impairment. In particular, patients affected by the dry form of AMD may be at greater risk of developing subsequent dementia.

Knowledge and attitudes about Alzheimer’s disease in the lay public: influence of caregiving experience and other socio-demographic factors in an Italian sample

Background and aims: Despite increasing attention on the knowledge of dementia among patients and family members, little is known about the general public’s level of understanding about dementia. The aim of this study was to assess the influence of the caregiving experience, sex and age on the knowledge of AD. Methods: Eleven hundred and eleven individuals were enrolled. They fulfilled a questionnaire made of 25 questions. The questionnaires were submitted in the waiting rooms of several departments of the Hospital “Spedali Civili di Brescia”. The questionnaires assessed several issues, including the general knowledge about Alzheimer’s disease, the management and ethical problems. The present study is focused on the analysis of 9 of the 25 questions included in the questionnaire, highlighting aspects about knowledge of symptoms, risk factors, therapies and services. Results: The percentage of correct responses was significantly greater among the caregivers. The group of old respondents gave similar answers, independently of their caregiving status. Women, caregivers or not, are the more knowledgeable group. Conclusion: The entire population needs accurate information, but education programs should be specifically tailored for the different sections of the population because they may start with different levels of knowledge.

The impact of cognitive deficit on self-reported car crashes in ultra-octogenarian population: data of an Italian population-based study

To examine the usefulness of specific neurocognitive tests for predicting the crash involvement in ultra‐octogenarian population.

Dementia after Three Months and One Year from Stroke: New Onset or Previous Cognitive Impairment?

OBJECTIVE Stroke is an important risk factor for dementia, but the exact mechanism involved in cognitive decline remains unclear. METHODS Patients were divided into 2 groups: poststroke dementia group (PSD) and poststroke nondementia group (PSND). Variables and neuroradiological hallmarks were compared between 2 groups at 3 months (114 subjects) and 1 year (105 subjects) after stroke. RESULTS Older age (OR 1.11, 95% CI 1.0-1.2; P < .05), education (OR .6, 95% CI .4-.8; P < .05), prestroke IQCODE (Informant Questionnaire on Cognitive Decline in the Elderly; OR .78, 95% CI .1-5.9; P < .05), premorbid apathy (OR 2.03, 95% CI 1.1-3.7; P < .05), and medial temporal lobe atrophy (MTLA) (OR 6.14, 95% CI 1.4-26.2; P < .05) were independently associated with PSD at 3 months after a cerebrovascular event, whereas at 1-year follow-up older age (OR 1.1, 95% CI 1.0-1.2; P < .05), prestroke IQCODE (OR .05, 95% CI .0-.9; P < .05), MTLA (OR 1.3, 95% CI 1.0-1.6; P < .05), and APACHE II (Acute Physiology and Chronic Health Evaluation; OR .6, 95% CI .4-.9; P < .05) were independently associated with PSD. CONCLUSIONS Acute cerebrovascular disease could not be the only one mechanism explaining PSD. Neurodegenerative pathology must be taken into account.

Prestroke Dementia: Characteristics and Clinical Features in Consecutive Series of Patients

Background/Aim: The prestroke level of cognitive function should be taken into account in order to predict the impact of stroke on the subsequent risk of dementia. The aim of the present study was to investigate the presence and correlates of prestroke dementia (PSD) as well as to identify its clinical features. Methods: Premorbid clinical and cognitive features of 158 consecutively recruited patients with a diagnosis of acute cerebrovascular pathology were assessed by interviewing the caregivers using multidimensional assessment. Patients were divided into two groups (PSD group and prestroke nondemented group). Baseline cognitive, functional and behavioral variables and neuroradiological hallmarks (medial temporal lobe atrophy, MTLA) were compared between these two groups. Results: In a logistic regression model, older age (OR 1.05), female gender (OR 2.3), Neuropsychiatric Inventory total score (OR 1.1) and MTLA (OR 1.2) were the variables independently associated with PSD. Conclusions: These findings support the hypothesis that cognitive impairment in patients with stroke may not only be a direct consequence of the acute cerebrovascular event but also a consequence of underlying neurodegenerative pathology.

Does Age at Observation Time Affect the Clinical Presentation of Mild Cognitive Impairment

Background: To date, there are no published data investigating the role of age in the clinical and neuropsychological presentation of mild cognitive impairment (MCI). The aim of the study was to evaluate whether age at the time of evaluation modulates clinical, functional or cognitive profiles in MCI subjects. Methods: A total of 167 outpatients with a clinical diagnosis of MCI were consecutively enrolled and entered in the study. Clinical and demographic characteristics were carefully recorded. Each patient underwent a wide neuropsychological standardized assessment. Results: MCI subjects were divided into 3 groups according to their age at observation time: 58 MCI patients were classified as young (≤69 years), 89 as old (70–79 years) and 20 as very old (≧80 years). The 3 groups did not differ in demographic characteristics, general cognitive functions and memory impairment. Very old MCI subjects showed a significantly greater impairment than younger MCI patients in cognitive domains involving executive functions. In particular, very old MCI patients were more frequently classified as having multiple-domain amnestic MCI. Conclusion: Present data highlight that the clinical presentation of MCI is affected by age: at presentation, very old MCI subjects show a worse performance than younger MCI subjects on multiple abilities, particularly on executive functions.

Depressive disorders in dementia

Several observational studies reported evidence that depressive symptoms are commonly associated with late life dementia of Alzheimer Type (AD). The link between these two conditions is not completely clarified. Depression could serves as an independent risk factor for developing AD possibly by reducing the brains ‘reserve capacity’ and increasing neurofibrillary tangles and amyloid plaques in the hippocampus (Sierksma et al., 2010). Moreover high levels of depressive symptoms lead to a more rapid decline of global cognition (Raji et al., 2007) and a lifetime history of depressive episodes increases the chance of developing AD by at least twofold (Ownby et al., 2006). Other data show a reverse causality hypothesis, suggesting that depressive symptoms do not constitute a true risk factor, but a consequence of the disease (Chen et al., 1999). In this line the diagnosis of depressive disorders in elderly affected by dementia is crucial, although it is still a complex issue. In particular a progress in diagnosis could facilitate the approach to demented patients and predispose to a correct treatment. Are we sure that diagnostic tools currently used to detect depressive symptoms in elderly people (i.e. Geriatric Depression Scale, Beck Depression Inventory or the newly proposed single items instrument) (Ayalon et al., 2010) are valid to investigate the depression in older subjects with cognitive decline?Trying to answer this question, we have analysed preliminary data from an on-going longitudinal study on a group of 67 patients affected by mild to moderate cognitive deterioration (Mini Mental State Examination, MMSE from15 to 28) consecutively recruited in the last two months at the Alzheimer Evaluation Unit of the Neurological Clinic, University of Brescia, Italy. Participants underwent a wide clinical and neurological assessment, including the MMSE and the Basic and Instrumental Activities of Daily Living (BADL and IADL). Neuropsychiatric Inventory scale (NPI) has been used to evaluate the presence of behavioural disturbances whereas anxiety symptoms have been detected with the Geriatric Anxiety Inventory scale (GAI). Depressive symptoms were analysed using the Geriatric Depression scale (GDS 15 items, short version). The clinical, behavioural and neuropsychological characteristics of the sample are described in the Table 1. The purpose of this study is to evaluate if there are factors influencing answers to the GDS in patients with cognitive impairment. We administered the GDS scale twice to each patient: a first time at the beginning of the visit and a second time after the intercurrent administration of a test focusing on anxiety disturbances (GAI). Surprisingly it has been observed that the mean GDS score is lower of about 1 point at the second administration (GDS first 3.9 3.5 vs. GDS second 3.1 3.1; p1⁄4 .000). In particular 29 subjects improved their GDS score (improvers), with a difference of 1.7 points between the two administrations (GDS first 5.8 2.5 vs. GDS second 4.1 3.2; p1⁄4 .000). The keys to interpret these data could be several. First, we hypothesize that the memory impairment and the fluctuation of cognitive status in patients affected by dementia could be the reason for these divergent answers. However, it would be possible that taking care of patients with a long interview could be ‘therapeutic’ in subjects affected by cognitive deterioration, inducing an apparent improvement of symptoms. Clinicians screening depression in older subjects should take into account the variability and the influence exerted by external factors on patients with cognitive decline.

Pre-stroke and post-stroke dementia: Preliminary data from an Italian study

dian survival increased to 8 years from disease onset (95%CI: 7.3-8.6), and 4 years from initial evaluation (95%CI: 3.4-4.6). Extrapyramidal symptoms and disinhibition remained significant predictors of decreased survival, with reduced survival in males compared to females. However, motor speech deficits and tau pathology were no longer associated with survival when excluding cases with MND. Conclusions: BvFTD is associated with a poor prognosis. Our findings suggest that presence of MND, extrapyramidal symptoms and disinhibition negatively impact survival in bvFTD.