Marco Trabucchi

International Association of Gerontology and Geriatrics: A Global Agenda for Clinical Research and Quality of Care in Nursing Homes

A workshop charged with identifying the main clinical concerns and quality of care issues within nursing homes was convened by the International Association of Gerontology and Geriatrics, with input from the World Health Organization. The workshop met in Toulouse, France, during June 2010. Drawing on the latest evidence and mindful of the international development agenda and specific regional challenges, consensus was sought on priority actions and future research. The impetus for this work was the known variation in the quality of nursing home care experiences of older people around the world. The resulting Task Force recommendations include instigation of sustainable strategies designed to enhance confidence among older people and their relatives that the care provided within nursing homes is safe, mindful of their preferences, clinically appropriate, and delivered with respect and compassion by appropriately prepared expert doctors, registered nurses, administrators, and other staff. The proposals extend across 4 domains (Reputational Enhancement and Leadership, Clinical Essentials and Care Quality Indicators, Practitioner Education, and Research) that, in concert, will enhance the reputation and status of nursing home careers among practitioners, promote effective evidence-informed quality improvements, and develop practice leadership and research capabilities.

APOE-ε4 is associated with less frontal and more medial temporal lobe atrophy in AD

Objective: To test the hypothesis that the ε4 allele of APOE is associated with a region-specific pattern of brain atrophy in AD. Methods: Volumes of the hippocampi, entorhinal cortices, and anterior temporal and frontal lobes were measured in 28 mild to moderate AD patients and 30 controls using MRI. Within the AD group, 14 patients were noncarriers (−/−), 9 were heterozygous (ε4/−), and 5 were homozygous (ε4/4) for the ε4 allele. Dementia severity was similar across the three AD groups. Results: Smaller volumes were found with increasing dose of the ε4 allele in the hippocampus, entorhinal cortex, and anterior temporal lobes in AD patients. When compared with controls, the volume loss in the right and left temporal regions ranged from −15.3 to −22.7% in the −/− AD group, from −26.2 to −36.0% in the ε4/− group, and from −24.0 to −48.0% in the ε4/4 group (p < 0.0005). In contrast, larger volumes were found in the frontal lobes with increasing ε4 gene dose. When compared with controls, volume differences of the right frontal lobe were −11.8% in the −/− AD group, −8.5 in the ε4/− group, and −1.4% in the ε4/4 group (p = 0.03). Conclusions: We found smaller volumes in the temporal lobe regions but larger volumes in the frontal lobes with increasing APOE-ε4 gene dose in AD patients. These data suggest a region-specific biological effect of the ε4 allele in the brains of AD patients.

Nutritional Intake, Socioeconomic Conditions, and Health Status in a Large Elderly Population

The nutritional intake of a large population of noninstitutionalized older people living in an urban area was studied in relation to socioeconomic conditions (living environment, income, and education) and health status (affective, functional, and physical health) to identify the subgroups at risk for malnutrition. Twenty‐four‐hour dietary recall was used to determine the percentage of older subjects with dietary intake of specific nutrients below two thirds of the 1980 Recommended Dietary Allowances. Ninety percent of the older people examined showed inadequate intake of thiamine and vitamin B6, and 30% to 40% demonstrated deficiencies of vitamin A, vitamin C, niacin, vitamin B12, calcium, and iron; only 10% of subjects had inadequate intake of protein. Poor nutritional intake was correlated more strongly with socioeconomic conditions, functional level, and affective status than with physical health status.

Atrial fibrillation and cognitive disorders in older people

OBJECTIVES: To find a correlation between chronic non‐rheumatic atrial fibrillation (CNRAF) and cognitive impairment in a group of older, nondemented patients.

Decreased density of benzodiazepine receptors in lymphocytes of anxious patients: reversal after chronic diazepam treatment

Peripheral‐type benzodiazepine receptors were measured in human circulating lymphocytes using 3H‐PK 11195 as specific ligand. In a group of outpatients with anxiety disorders a significant decrease of receptor density (– 37%) was found compared with age‐matched controls. In these patients long‐term diazepam treatment restored binding density to normal levels: the effect persisted after drug withdrawal. Acute i.v. diazepam administration did not change receptor density. The observed receptor changes could reflect a down‐regulation phenomenon and indicate that lymphocyte function reflect central nervous events.

Regulation of phorbol ester binding and protein kinase C activity in aged rat brain

Protein kinase C (PKC) function was analyzed in aged male Sprague-Dawley rat brain using two different approaches: the binding of [3H]-phorbol-12,13-dibutyrate and the in vitro phosphorylation of histone H1. In cortex the binding was decreased while in cerebellum no age-related modifications were observed. In hippocampus the binding capacity was increased in old animals and the affinity decreased. The kinase activity in both soluble and particulate fractions was decreased in cortex, increased in hippocampus and unmodified in cerebellum. The area selective, age-dependent modifications in neuronal PKC may sustain short- and long-term regional changes of neuronal excitability.

Reality Orientation Therapy to delay outcomes of progression in patients with dementia. A retrospective study

Objective: To evaluate the impact of continued Reality Orientation Therapy (ROT) in delaying the outcomes of dementia progression. Design: Retrospective study. Data collection was based on review of clinical charts and on telephone interviews performed with patients or primary caregivers. Setting: Day hospital of the Alzheimers Disease Unit, Brescia (Italy). Subjects: Seventy-four patients enrolled in at least one cycle of ROT from 1994 to 1998 were studied. Interventions: Rehabilitative intervention based on formal ROT. Main outcome measures: This study analysed the time to the occurrence of any of the following: cognitive decline on Mini-Mental State Examination scores, urinary incontinence as an index of functional decline, institutionalization, and death. Results: Data on a 30-month period after the first ROT session were analysed. We compared 46 patients (treatment group) who completed from 2 to 10 ROT cycles (corresponding to 8–40 weeks of training; mean = 15.48) with 28 patients (control group) who completed only one ROT cycle (4 weeks). Treatment group showed higher estimated survival rates than control group on cognitive decline (p = 0.022) and institutionalization (p = 0.002). The relative risks for cognitive decline and institutionalization in the control group compared with treatment group were 0.60 (p = 0.014), and 0.42 (p = 0.021), respectively. Conclusions: Continued ROT classes during the early to middle stages of dementia may delay nursing home placement and slow down the progression of cognitive decline.

Ethanol administration in vivo alters calcium ions control in rat striatum

The present paper investigates the effect of chronic ethanol treatment administered through drinking water on [3H]nitrendipine binding and 45Ca uptake in rat striatum. The calcium-independent [3H]nitrendipine binding was slightly increased in treated rats, while the calcium stimulation of the binding was reduced to one fifth of the controls. In striatal slices prepared from a similar group of ethanol-treated rats the K+-stimulated 45Ca uptake was greatly reduced. These results are the first evidence of calcium-antagonist binding-site plasticity following an in vivo pharmacological manipulation correlated with a change in calcium ion transport. In addition, the effect of ethanol on calcium-entry regulation may be a mechanism important for the understanding of its neurotoxic action.

Characterization of peripheral benzodiazepine receptors in human blood mononuclear cells

In the present study, peripheral-type benzodiazepine receptors in human circulating mononuclear cells were characterized, using [3H]PK 11195 as specific ligand. The specific binding was saturable, with a Bmax of 14 pmol/mg protein and a Kd of 7 nM. The pharmacological characterization, using different displacing drugs, indicated a mitochondrial type of peripheral benzodiazepine receptor since it was not coupled to the GABA receptor and was displaced by protoporphyrin IX. These data indicate that human circulating mononuclear cells possess benzodiazepine recognition sites, similar to non-neuronal receptors. The role of these receptors and possible modifications in different diseases need to be investigated.

Age-dependent increase in [3H]verapamil binding to rat cortical membranes.

[3H]Nitrendipine bound to cerebral cortex membranes is displaced more efficiently by verapamil in old rats (24 months old) compared to young ones (3 months old). In addition, [3H]verapamil binding was studied in detail in 3-, 12- and 24-month-old rats. Aging increases the Bmax of [3H]verapamil, leaving the affinity unchanged. These observations further indicate that aging may affect calcium channels leading to a derangement of calcium movements which in turn alter neuronal activity.