Authors: D’Onofrio, Grazia | Sancarlo, Daniele | Ricciardi, Francesco | Panza, Francesco | Seripa, Davide | Cavallo, Filippo | Giuliani, Francesco | Greco, Antonio
Article Type: Research Article
Abstract: Background: Significant innovations have been introduced in recent years in the application of information and communication technologies (ICTs) to support healthcare for patients with dementia. Objective: In the present systematic review, our goal is to keep track of ICT concepts and approaches to support the range of activities of daily living for people with dementia and to provide a snapshot of the effect that technology is having on patients’ self-reliance. Methods: We reviewed the literature and identified systematic reviews of cohort studies and other authoritative reports. Our selection criteria included: (1) activities of daily living, (2) ICT, and (3) dementia. …Results: We identified 56 studies published between 2000 and 2015, of which 26 met inclusion criteria. The present systematic review revealed many ICT systems that could purportedly support the range of activities of daily living for patients with dementia. The results showed five research bodies: 1) technologies used by patients with dementia, 2) technologies used by caregivers, 3) monitoring systems, 4) ambient assistive living with ICTs, and 5) tracking and wayfinding. Conclusions: There is a potential for ICTs to support dementia care at home and to improve quality of life for caregivers, reducing healthcare costs and premature institutional care for these patients. Show more
Keywords: Keywords: Basic activities of daily living, dementia, information and communication technologies, instrumental activities of daily living
DOI: 10.3233/JAD-161145
Citation: Journal of Alzheimer's Disease, vol. 57, no. 3, pp. 927-935, 2017
Authors: Panza, Francesco | Seripa, Davide | Solfrizzi, Vincenzo | Tortelli, Rosanna | Greco, Antonio | Pilotto, Alberto | Logroscino, Giancarlo
Article Type: Review Article
Abstract: Late-life cognitive disorders may be prevented by influencing age-related conditions such as frailty, characterized by decreased resistance to stressors and increased risk for adverse health outcomes. In the present review article, we examined clinical and epidemiological studies investigating the possible role of different frailty models in modulating the risk of Alzheimer’s disease (AD), dementia, vascular dementia (VaD), mild cognitive impairment (MCI), and late-life cognitive impairment/decline that have been published over the past 3 years. Both deficit accumulation and physical frailty models were associated with late-life cognitive impairment/decline, incident dementia, AD, MCI, VaD, non-AD dementias, and AD pathology, proposing cognitive frailty …as a new clinical construct with coexisting physical frailty and cognitive impairment in nondemented older subjects. Two subtypes of this new clinical condition have been recently proposed: “potentially reversible” cognitive frailty and “reversible” cognitive frailty. The physical factors should be physical prefrailty and frailty, while the cognitive impairment of potentially reversible cognitive frailty should be MCI (Clinical Dementia rating Scale = 0.5), while the cognitive impairment of reversible cognitive frailty should be pre-MCI Subjective Cognitive Decline (SCD), as recently proposed by the SCD Initiative Working Group. The mechanisms underlying the cognitive-frailty link are multifactorial and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. Considering both physical frailty and cognition as a single complex phenotype may be crucial in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects. Show more
Keywords: Alzheimer’s disease, cognitive disorders, cognitive frailty, dementia, frailty index, mild cognitive impairment, physical frailty, subjective cognitive decline, vascular dementia
DOI: 10.3233/JAD-150358
Citation: Journal of Alzheimer's Disease, vol. 47, no. 4, pp. 793-813, 2015
Authors: Lauriola, Michele | D’Onofrio, Grazia | Ciccone, Filomena | Germano, Carmela | Cascavilla, Leandro | Paris, Francesco | Greco, Antonio
Article Type: Research Article
Abstract: Background: Alzheimer’s disease (AD) may be a vascular disorder with neurodegenerative consequences opening possibility of preventing AD by targeting vascular risk factors including homocysteine. Objective: The study aims were to assess homocysteine distribution in different forms and severity of cognitive impairment (CogI) [mild cognitive impairment (MCI), probable AD (Prob-AD), possible AD (Poss-AD), and vascular dementia (VaD)] and in NoCogI, and to estimate possible association between hyperhomocysteinemia levels with functional deficit severity and psychobehavioral complications. Methods: In total, 929 (M = 366, F = 563; mean age of 72.55±6.24 years) patients were evaluated with cognitive, neuropsychiatric, affective, and functional assessment scales. Homocysteine serum was set …on two levels: between 0 and 10μ mol/L and > 10μ mol/L. For each patient, blood concentration of folate, vitamin B12, hemoglobin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), cholesterol, triglycerides, and glycemia were measured. Results: CogI patients demonstrated significantly a higher frequency of homocysteine > 10 (p = 0.003), than NoCogI patients. Patients with moderate and severe dementia had a higher frequency of homocysteine > 10 (p < 0.0001), than MCI and mild dementia. Poss-AD and VaD had a higher frequency of homocysteine > 10 (p = 0.003), than Prob-AD patients. Homocysteine > 10 frequency is directly proportional to increased neuropsychiatric symptom severity (p < 0.0001), and functional impairment severity respectively for ADL (p < 0.0001) and IADL (p < 0.0001). Conclusion: Higher homocysteine level seems to be significantly related to cognitive impairment frequency and severity, possible AD and VaD, neuropsychiatric symptom severity, and functional impairment severity. Show more
Keywords: Activities of daily living, Alzheimer’s disease, homocysteine, mild cognitive impairment, neuropsychiatric symptoms, vascular dementia
DOI: 10.3233/JAD-210166
Citation: Journal of Alzheimer's Disease, vol. 82, no. 1, pp. 235-248, 2021
Authors: D’Onofrio, Grazia | Panza, Francesco | Sancarlo, Daniele | Addante, Filomena | Solfrizzi, Vincenzo | Cantarini, Chiara | Mangiacotti, Antonio | Lauriola, Michele | Cascavilla, Leandro | Paris, Francesco | Lozupone, Madia | Daniele, Antonio | Greco, Antonio | Seripa, Davide
Article Type: Research Article
Abstract: Alzheimer’s disease (AD) and vascular dementia (VaD) lead to progressive decline in executive function. We estimated the prevalence of executive dysfunction in AD and VaD patients, investigating cognitive, functional, and clinical correlates and also using a multidimensional approach based on a standardized comprehensive geriatric assessment (CGA). We included 215 patients (115 AD patients and 100 VaD patients) consecutively evaluated with a complete cognitive and affective assessment, a CGA, and the Frontal Assessment Battery (FAB) with six subtests investigating conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. The prevalence of dysexecutive syndrome screened with a FAB …score <12 points was high in both AD (97 patients) and VaD (77 patients) (84.3% versus 77.0%, p = 0.171). AD patients were significantly younger, with higher grade of cognitive impairment and less severe comorbidity and polypharmacy than VaD patients. AD patients showed a significantly higher impairment in FAB total score and five FAB subtests (conceptualization, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy) than VaD patients. These findings were largely confirmed in a sub-analysis conducted subdividing the sample in mild and moderate-to-severe demented patients and suggesting that in moderate-to-severe AD there was higher impairment in FAB total score and four FAB subtests (conceptualization, sensitivity to interference, inhibitory control, and environmental autonomy). Executive dysfunction could be greater in AD patients with moderate-to-severe dementia compared to VaD patients, although our groups were also not matched for age, comorbidity or polypharmacy, which could also exert an effect. Show more
Keywords: Alzheimer’s disease, comprehensive geriatric assessment, dementia, executive function, vascular dementia
DOI: 10.3233/JAD-170365
Citation: Journal of Alzheimer's Disease, vol. 62, no. 2, pp. 699-711, 2018
Authors: D’Onofrio, Grazia | Panza, Francesco | Sancarlo, Daniele | Paris, Francesco F. | Cascavilla, Leandro | Mangiacotti, Antonio | Lauriola, Michele | Paroni, Giulia H. | Seripa, Davide | Greco, Antonio
Article Type: Research Article
Abstract: In Alzheimer’s disease (AD) patients with delusions, clinical outcomes and mortality result from a combination of psychological, biological, functional, and environmental factors. We determined the effect of delusions on mortality risk, clinical outcomes linked to comprehensive geriatric assessment (CGA), cognitive, depressive, and neuropsychiatric symptoms (NPS) in 380 consecutive AD patients with Mini-Mental State Examination, Clinical Dementia Rating scale, 15-item Geriatric Depression Scale, and Neuropsychiatric Inventory (NPI), assessing one-year mortality risk using the Multidimensional Prognostic Index (MPI). We included 121 AD patients with delusions (AD-D) and 259 AD patients without delusions (AD-noD). AD-D patients were significantly older, with higher age at …onset and cognitive impairment, a more severe stage of dementia, and more depressive symptoms than AD-noD patients. Disease duration was slightly higher in AD-D patients than in those without delusions, although this difference was not statistically significant. At CGA, AD-D patients showed a higher grade of disability in basic and instrumental activities of daily living, and an increased risk of malnutrition and bedsores. The two groups of patients significantly differed in MPI score (AD-D: 0.65 versus AD-noD: 0.51, p < 0.0001) and MPI grade. AD-D patients showed also a significant higher score in NPI of the following NPS than AD-noD patients: hallucinations, agitation/aggression, depression mood, apathy, irritability/lability, aberrant motor activity, sleep disturbances, and eating disorders. Therefore, AD-D patients showed higher dementia severity, and higher impairment in cognitive and depressive symptoms, and several neuropsychiatric domains than AD-noD patients, and this appeared to be associated with higher multidimensional impairment and increased risk of mortality. Show more
Keywords: Alzheimer’s disease, comprehensive geriatric assessment, delusions, depressive symptoms, functional status, mortality, Multidimensional Prognostic Index, neuropsychiatric symptoms
DOI: 10.3233/JAD-150944
Citation: Journal of Alzheimer's Disease, vol. 51, no. 2, pp. 427-437, 2016
Authors: Panza, Francesco | Lozupone, Madia | Solfrizzi, Vincenzo | Sardone, Rodolfo | Dibello, Vittorio | Di Lena, Luca | D’Urso, Francesca | Stallone, Roberta | Petruzzi, Massimo | Giannelli, Gianluigi | Quaranta, Nicola | Bellomo, Antonello | Greco, Antonio | Daniele, Antonio | Seripa, Davide | Logroscino, Giancarlo
Article Type: Review Article
Abstract: Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial domains or phenotypes. Cognitive frailty is a condition recently defined by operationalized criteria describing coexisting physical frailty and mild cognitive impairment (MCI), with two proposed subtypes: potentially reversible cognitive frailty (physical frailty/MCI) and reversible cognitive frailty (physical frailty/pre-MCI subjective cognitive decline). In the present article, we reviewed the framework for the definition, different models, and the current epidemiology of cognitive frailty, also describing neurobiological mechanisms, and exploring the possible prevention of the cognitive frailty progression. Several studies …suggested a relevant heterogeneity with prevalence estimates ranging 1.0–22.0% (10.7–22.0% in clinical-based settings and 1.0–4.4% in population-based settings). Cross-sectional and longitudinal population-based studies showed that different cognitive frailty models may be associated with increased risk of functional disability, worsened quality of life, hospitalization, mortality, incidence of dementia, vascular dementia, and neurocognitive disorders. The operationalization of clinical constructs based on cognitive impairment related to physical causes (physical frailty, motor function decline, or other physical factors) appears to be interesting for dementia secondary prevention given the increased risk for progression to dementia of these clinical entities. Multidomain interventions have the potential to be effective in preventing cognitive frailty. In the near future, we need to establish more reliable clinical and research criteria, using different operational definitions for frailty and cognitive impairment, and useful clinical, biological, and imaging markers to implement intervention programs targeted to improve frailty, so preventing also late-life cognitive disorders. Show more
Keywords: Alzheimer’s disease, biomarkers, dementia, frailty, lifestyle, mild cognitive impairment, nutrition, prevention, subjective cognitive decline, vascular dementia
DOI: 10.3233/JAD-170963
Citation: Journal of Alzheimer's Disease, vol. 62, no. 3, pp. 993-1012, 2018
Authors: Solfrizzi, Vincenzo | Agosti, Pasquale | Lozupone, Madia | Custodero, Carlo | Schilardi, Andrea | Valiani, Vincenzo | Sardone, Rodolfo | Dibello, Vittorio | Di Lena, Luca | Lamanna, Angela | Stallone, Roberta | Bellomo, Antonello | Greco, Antonio | Daniele, Antonio | Seripa, Davide | Sabbà, Carlo | Logroscino, Giancarlo | Panza, Francesco
Article Type: Research Article
Abstract: The link diet-cognitive function/dementia has been largely investigated in observational studies; however, there was a lack of evidence from randomized clinical trials (RCTs) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults. In the present article, we systematically reviewed RCTs published in the last four years (2014–2017) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation (i.e., dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches) as well as possible underlying mechanisms …of nutritional prevention. From the 35 included RCTs, there was moderate evidence that intervention through dietary pattern changes, medical food/nutraceutical supplementation, and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers. There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect Show more
Keywords: Alzheimer’s disease, dementia, dietary pattern, healthy diet, macronutrients, medical food, Mediterranean diet, micronutrients, mild cognitive impairment, nutraceuticals, prevention
DOI: 10.3233/JAD-179940
Citation: Journal of Alzheimer's Disease, vol. 64, no. s1, pp. S229-S254, 2018
Authors: D’Onofrio, Grazia | Sancarlo, Daniele | Raciti, Massimiliano | Burke, Megan | Teare, Aimee | Kovacic, Tanja | Cortis, Keith | Murphy, Kathy | Barrett, Eva | Whelan, Sally | Dolan, Aisling | Russo, Alessandro | Ricciardi, Francesco | Pegman, Geoff | Presutti, Valentina | Messervey, Thomas | Cavallo, Filippo | Giuliani, Francesco | Bleaden, Andy | Casey, Dympna | Greco, Antonio
Article Type: Research Article
Abstract: Background: In the EU funded MARIO project, specific technological tools are adopted for the people living with dementia (PLWD). In the final stage of the project, a validation of the MARIO companion robot was performed from August to October 2017. Objective: The aims of the present study are: 1) to illustrate the key results and evidence obtained in the final evaluation phase of the project across the three different pilot sites; 2) to assess the engagement dimensions of the PLWD who interacted with the MARIO robot; and 3) to assess the acceptability and efficacy of the MARIO companion robot on …clinical, cognitive, neuropsychiatric, affective and social aspects, resilience, quality of life in PLWD, and burden level of the caregivers. Methods: 38 people (M = 14; F = 24) with Alzheimer’s disease were screened for eligibility and all were included. The following tests were administered Pre and Post interactions with MARIO: Observational Measurement of Engagement (OME), Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Frontal Assessment Battery (FAB), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Multidimensional Scale of Perceived Social Support (MSPSS), 14-item Resilience Scale (RS-14), Quality of Life in Alzheimer’s Disease (QOL-AD), Caregiver Burden Inventory (CBI), Tinetti Balance Assessment (TBA), and Comprehensive Geriatric Assessment (CGA) was carried out. Results: In Post-MARIO interactions, significant improvements were observed in RS-14 (p = 0.020).Considering the age of the people, PLWD with 68–76 years perceived that they had major social support (MSPSS Total: p = 0.016) and friends to support them (MSPSS Fri: p = 0.014). Indeed, the younger people (55–67 years) were less depressed (CSDD: p = 0.033), and more resilient (RS-14: p = 0.003). The people aged 77–85 years perceived they had major family support (MSPSS Fam: p = 0.018). The participants were gender and education matched without any statistically significant difference. Conclusion: MARIO may be a useful tool in mitigating depression and loneliness, while enhancing social connectedness, resilience, and overall quality of life for people with dementia. Show more
Keywords: Acceptability, comprehensive geriatric assessment, dementia, loneliness, resilience, robots, quality of care, quality of life, safety
DOI: 10.3233/JAD-181165
Citation: Journal of Alzheimer's Disease, vol. 68, no. 4, pp. 1587-1601, 2019
Authors: Solfrizzi, Vincenzo | Custodero, Carlo | Lozupone, Madia | Imbimbo, Bruno P. | Valiani, Vincenzo | Agosti, Pasquale | Schilardi, Andrea | D’Introno, Alessia | La Montagna, Maddalena | Calvani, Mariapaola | Guerra, Vito | Sardone, Rodolfo | Abbrescia, Daniela I. | Bellomo, Antonello | Greco, Antonio | Daniele, Antonio | Seripa, Davide | Logroscino, Giancarlo | Sabbá, Carlo | Panza, Francesco
Article Type: Research Article
Abstract: In the last decade, the association between diet and cognitive function or dementia has been largely investigated. In the present article, we systematically reviewed observational studies published in the last three years (2014–2016) on the relationship among dietary factors and late-life cognitive disorders at different levels of investigation (i.e., dietary patterns, foods and food-groups, and dietary micro- and macronutrients), and possible underlying mechanisms of the proposed associations. From the reviewed evidence, the National Institute on Aging–Alzheimer’s Association guidelines for Alzheimer’s disease (AD) and cognitive decline due to AD pathology introduced some evidence suggesting a direct relation between diet and changes …in the brain structure and activity. There was also accumulating evidence that combinations of foods and nutrients into certain patterns may act synergistically to provide stronger health effects than those conferred by their individual dietary components. In particular, higher adherence to a Mediterranean-type diet was associated with decreased cognitive decline. Moreover, also other emerging healthy dietary patterns such as the Dietary Approach to Stop Hypertension (DASH) and the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diets were associated with slower rates of cognitive decline and significant reduction of AD rate. Furthermore, some foods or food groups traditionally considered harmful such as eggs and red meat have been partially rehabilitated, while there is still a negative correlation of cognitive functions with saturated fatty acids and a protective effect against cognitive decline of elevated fish consumption, high intake of monounsaturated fatty acids and polyunsaturated fatty acids (PUFA), particularly n-3 PUFA. Show more
Keywords: Alzheimer’s disease, dementia, dietary pattern, food groups, foods, healthy diet, Mediterranean diet, macronutrients, micronutrients, mild cognitive impairment
DOI: 10.3233/JAD-170248
Citation: Journal of Alzheimer's Disease, vol. 59, no. 3, pp. 815-849, 2017
