Orazio Zanetti

Purpose Informal care constitutes an important part of the total care for people with dementia. Therefore, the impact of the syndrome on their caregivers as well as that of health and social care services for people with dementia should be considered. This study investigated the convergent and clinical validity of the CarerQol instrument, which measures and values the impact of providing informal care, in a multi-country sample of caregivers for people with dementia. Methods Cross-sectional data from a sample of 451 respondents in eight European countries, collected by the Actifcare project, were evaluated. Convergent validity was analysed with Spearman’s correlation coefficients and multivariate correlations between the CarerQol-7D utility score and dimension scores, and other similar quality of life measures such as CarerQol-VAS, ICECAP-O, and EQ-5D. Clinical validity was evaluated by bivariate and multivariate analyses of the degree to which the CarerQol instrument can differenti...

Background: The occurrence of Behavioral and Psychological Symptoms of Dementia (BPSD) in Alzheimer’s Disease (AD) patients hampers the clinical management and exacerbates the burden for caregivers. The definition of the clinical distribution of BPSD symptoms, and the extent to which symptoms are genetically determined, are still open to debate. Moreover, genetic factors that underline BPSD symptoms still need to be identified. Purpose. To characterize our Italian AD cohort according to specific BPSD symptoms as well as to endophenotypes. To evaluate the associations between the considered BPSD traits and COMT, MTHFR, and APOE genetic variants. Methods. AD patients (n = 362) underwent neuropsychological examination and genotyping. BPSD were assessed with the Neuropsychiatric Inventory scale. Results. APOE and MTHFR variants were significantly associated with specific single BPSD symptoms. Furthermore, “Psychosis” and “Hyperactivity” resulted in the most severe endophenotypes, with A...

and 47 Caucasians). Resting state scans were pre-processed using the DPARSF-A toolbox, followed by Independent Component Analysis using theGroup ICAof fMRIToolbox to derive connectivitymeasures. We then analyzed components containing posterior DMN nodes as they are most affected in AD and linked to cerebral tau PETabnormalities. We used as regions of interests the precuneus, posterior cingulate, bilateral hippocampus, and bilateral inferior parietal lobule, and calculated connectivity values between each node pair. Amultivariatemodel for FNCwas then performedwith race, age, gender, diagnosis, and race X diagnosis as independent variables. Results:Race significantly modified the relationship between functional connectivity and diagnosis (p 1⁄4 0.01) in one of the six analyzed node pairs. Compared to Caucasians, African Americans with normal cognition had lower connectivity between the posterior DMN nodes (precuneus and posterior cingulate). Furthermore, whereasMCI/ADwas associatedwith decreased connectivity compared to cognitively normal seniors in Caucasians, MCI/AD was associated with increased connectivity in African Americans. No such differences were observed for other node pairs. Conclusions: Race appears to modify the relationship between MCI/AD and posteriorDMNconnectivity to result in a race-associated double dissociation of DMN connectivity. Similar to CSFAD biomarkers, an fMRI-based AD-signature based on Caucasians may not translate to African Americans. Future investigation need to focus on mechanisms underlying race-associated connectivity differences in normal cognition as well as MCI/AD.

Purpose The pressure on healthcare budgets remains high, partially due to the ageing population. Economic evaluation can be a helpful tool to inform resource allocation in publicly financed systems. Such evaluations frequently use health-related outcome measures. However, in areas such as care of older people, improving health outcomes is not necessarily the main focus of care interventions and broader outcome measures, including outcomes for those providing informal care, may be preferred when evaluating such interventions. This paper validates a recently introduced well-being measure, the ICECAP-O, in a population of informal carers for people with dementia from eight European countries. Methods Convergent and discriminant validity tests were performed to validate the ICECAP-O using data obtained in a sample of 451 respondents from Germany, Ireland, Italy, the Netherlands, Norway, Portugal, Sweden and the UK. These respondents completed a number of standardized questionnaires with...

This study reports the findings of the first large-scale Phase III investigator-driven clinical trial to slow the rate of cognitive decline in Alzheimer disease with a dihydropyridine (DHP) calcium channel blocker, nilvadipine. Nilvadipine, licensed to treat hypertension, reduces amyloid production, increases regional cerebral blood flow, and has demonstrated anti-inflammatory and anti-tau activity in preclinical studies, properties that could have disease-modifying effects for Alzheimer disease. We aimed to determine if nilvadipine was effective in slowing cognitive decline in subjects with mild to moderate Alzheimer disease. NILVAD was an 18-month, randomised, placebo-controlled, double-blind trial that randomised participants between 15 May 2013 and 13 April 2015. The study was conducted at 23 academic centres in nine European countries. Of 577 participants screened, 511 were eligible and were randomised (258 to placebo, 253 to nilvadipine). Participants took a trial treatment ca...

On November 18th, 2014, a female 87 years old (I.E.) was once more admitted to our Geriatric Rehabilitation UnitNursing home accompanied by a social worker and the city police of Brescia. The social worker insisted on the need of her institutionalization (even if it was against the patient’s will) due to the fact that her living conditions for the second time in a few months had returned to being unhealthy and unhygienic: a new accumulation of useless objects, food, and trash that took this time only 4 months to make. The photographs taken (see below) show a tendency of excessive acquisition of and the inability to discard objects, also the incapacity of programming and planning the typical activities of house cleaning and tidying up. (Fig. 1) I.E. was single, who was in the past employed in a big national public company; she lived alone in an elegant building. In January 2014, she was hospitalized in an acute care hospital for cachexia and recurring falls. She was discharged with the following diagnosis: vascular ischaemic encephalopathy, moderate cognitive impairment, accidental fall with compound fracture of the eighth rib, malnutrition and dehydration, recurrent ulcer of the left leg with infection, abdominal aorta aneurysm (diameter 6 cm), sever reflux esophagitis, hiatal hernia Permagna with peptic ulcer, chronic gastritis, moderate anemia, igg lambda monoclonal component, and severe hearing impairment. In the patient’s clinical records emerged an important problem regarding her home and her unhealthy living conditions. The photographs obtained by the social service showed the complete disorder and the cluttering of various objects, wasted food, and trash inside the patient’s apartment, underlying the total lack of hygiene. The final impression that the viewer receives is that of a person who lacks in goodhouse keeping and an uncontrollable need to accumulate large quantities of useless objects. The female cousin of the patient during an interview, described her aunt’s life before the hospitalization: she lived in a well-defended state of voluntary isolation for quite a long time (at least 2 years); the cousin recalls the conversations she had on the phone with her and stated that her aunt’s intellect was intact and active (the patient conserved interests in music, botany, trekking stories, politics, current events); the cousin used a curious statement to describe the situation that had been created “my aunt, it seems, turned the pyramid of Maslow upside down”. The patient did not realize the dangerous situation she’s gotten herself in: she blames the disorder of her apartment due to her reduced mobility prior to a recent and painful ulcer of the leg. After discharge from the hospital she was transferred for the first time to our Geriatric Rehabilitation Unit-Nursing Home. At her arrival a MMSE screening valuation was given resulting in a score of 14/30, that was interpreted as the consequence of the recent hospitalization and to the transfer to an unknown environment. In fact, after a period of proper assistance, appropriate hydration, and regular meals, the patient flourished with good health and returned to cultivating her many interests (music, botany, etc.). Stunning how, from hereinafter, the patient regained a huge improvement in intellect. The psychologist, during the interviews with the patient would describe her to be clearminded, cooperative, and showing but a little confusion when it came to talking about her problems with the state of her home. In the meantime, the cousin informs us that a legal order was given to * Orazio Zanetti ozanetti@fatebenefratelli.eu

Insomnia is the most common and widespread sleep disorder. Managing insomnia in the elderly patient becomes a difficult challenge for the presence of a multi-disease and multi-drug condition. An organic and functional background that becomes even more fragile when the picture is complicated by psychomotor agitation and cognitive impairment. From the contribution of four experts of different fields and disciplines, stems the need to share an integrated vision that starts from the pharmacological basis of hypnotic drugs, delineates the features of depression in the elderly, addressed the delicate issue of chronic use/abuse of benzodiazepines and ultimately arrives to the management of behavioral disturbances. The pathway includes studies of clinical pharmacology and investigates the potential properties of trazodone, a multifunctional drug capable of acting on different biochemical and neurotransmitter pathways.

The Actifcare (Access to timely formal care) study investigated needs of people with dementia and their families during the phase in which formal care is being considered, and examined whether higher need levels are related to lower quality of life (QOL). From eight European countries 451 people with dementia and their carers participated. Needs were measured with the Camberwell Assessment of Need for the Elderly. QOL was measured with the QOL-AD, and carer quality of life was measured with the CarerQol. The relationship between needs and QOL was analysed with multiple regression analyses. Needs were expressed in the domains of psychological distress, daytime activities, company and information. People with dementia rated their unmet needs significantly lower than their carers: the mean number of self-rated unmet needs was 0.95, whereas the mean proxy ratings were 1.66. For met needs, the self-rated mean was 5.5 and was 8 when proxy-rated. The level of needs reported was negatively ...

Alcohol, coffee, and tobacco consumption was assessed on 151 FTD outpatients and 151 matched controls in a multicenter retrospective case-control design. No association was found for smoking and coffee intake. The risk of FTD was decreased by alcohol consumption (adj. OR 0.30, 95% CI 0.14-0.63); risk reduction was significant in current alcohol consumers (adj. OR 0.22, 95% CI 0.10-0.51). The risk of FTD inversely correlated with the duration of exposure (adj. OR 0.88, 95% CI 0.81-0.95, for every 5 years of exposure increase). Retrospective information and the unknown amount of consumed alcohol are limits of the present work.

As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the...

Previous findings indicate that people with dementia and their informal carers experience difficulties accessing and using formal care services due to a mismatch between needs and service use. This mismatch causes overall dissatisfaction and is a waste of the scarce financial care resources. This article presents the background and methods of the Actifcare (ACcess to Timely Formal Care) project. This is a European study aiming at best-practice development in finding timely access to formal care for community-dwelling people with dementia and their informal carers. There are five main objectives: 1) Explore predisposing and enabling factors associated with the use of formal care, 2) Explore the association between the use of formal care, needs and quality of life and 3) Compare these across European countries, 4) Understand the costs and consequences of formal care services utilization in people with unmet needs, 5) Determine the major costs and quality of life drivers and their rela...

Alzheimer’s disease is a progressive and fatal neurodegenerative disorder manifested by cognitive and memory deterioration, progressive impairment of activities of daily living, and a variety of neuropsychiatric symptoms and behavioural disturbances. A correct and early diagnosis not only allows prompt treatment but can also give the person with Alzheimer’s and his family more time to arm themselves with knowledge about this type of dementia and the best way to live with the disease. The role of Family Physician is very important in early diagnosis: dementia may be suspected if memory deficits are exhibited during the medical history and physical examination. Information from the patient’s family members, friends and caregivers may also point to signs of dementia. We report a case of a 75-years-old man who was suffering from cognitive deficits and behavioural problems: the first disease symptom was a strong feeling of jealousy towards his wife.

Agrammatic variant primary progressive aphasia is a neurodegenerative disorder specifically characterized by language deficits. A recent study has demonstrated a beneficial effect of transcranial direct current stimulation (tDCS) in combination with language training on naming accuracy in these patients. The aim of the study was to evaluate whether the improvement of naming accuracy after tDCS during language training was related to regional grey matter (GM) density. Eighteen avPPA patients underwent a brain magnetic resonance imaging before receiving a treatment that consisted of tDCS over the left dorsolateral prefrontal cortex during individualized language training (10 daily therapy sessions, 5 days per week from Monday to Friday). Performances on neuropsychological tests and naming of objects (treated and untreated) and actions were assessed at baseline, post-treatment  and 3 months after treatment. Correlations between individual changes after treatment on neuropsychological tests and on picture naming task and voxel-based GM volume at baseline were performed. We found that the improvement in the naming of treated objects was positively correlated with GM volume in the left fusiform, left middle temporal, and right inferior temporal gyri whereas action naming change was related to GM density in the left middle temporal gyrus. In conclusion baseline density of GM in these brain regions was associated with greater treatment response on naming performances, suggesting that intervention in early disease stages might be most successful. These findings have implication for designing future rehabilitation protocols in language variants of frontotemporal dementia.

Meta-analyses show that serum copper non-bound-to-ceruloplasmin (non-Cp-Cu) is higher in patients with Alzheimer's disease (AD). ATP7B gene variants associate with AD, modulating the size of non-Cp-Cu pool. However, a dedicated genetic study comparing AD patients after stratification for a copper biomarker to demonstrate the existence of a copper subtype of AD has not yet been carried out. An independent patient sample of 287 AD patients was assessed for non-Cp-Cu serum concentrations, rs1801243, rs1061472, and rs732774 ATP7B genetic variants and the APOE4 genotype. Patients were stratified into two groups based on a non-Cp-Cu cutoff (1.9 μM). Single-locus and haplotype-group analyses were performed to define their frequencies in dependence of the non-Cp-Cu group. The two AD subgroups did not differ regarding age, sex, MMSE score, or APOE4 frequency allele, while they did differ regarding non-Cp-Cu concentrations in serum, allele, genotype, and haplotype frequencies of rs1061472...

The effectiveness of oxiracetam (1600 mg/day) vs placebo was assessed in a group of 96 out-patients suffering from cognitive disorders secondary to primary degenerative dementia. The study, performed in double-blind, lasted 26 weeks and is expected to be continued in open conditions until a whole year of treatment is completed. The assessment of the results obtained at 6 months was carried out following both the methodology based on neuropsychological tests and scales, and the study of the simple reaction time by any of a computerised portable tachystoscope. The patients treated with oxiracetam showed a statistically significant improvement of cognitive function and simple reaction time. No significant variations in the scores of the tests used were observed in the placebo group. The patients themselves appeared in favour of oxiracetam. The drug tolerability proved to be very good for the whole duration of the treatment. The authors believe that oxiracetam favourably acts on the sym...

Previous studies have reported significant deficits in emotion recognition among individuals along the frontotemporal dementia (FTD) spectrum. The basis of emotional impairment is still poorly understood and explicit (emotion appraisal) and implicit (autonomic system activity) responses have not been carefully evaluated. We investigated explicit evaluation of emotions by testing valence and arousal using self-report measures and we also assessed automatic responses to emotional cues, using autonomic measures (skin conductance response and heart rate). 16 behavioral variant FTD and 12 agrammatic variants of primary progressive aphasia patients were included. The performance of these patients was compared to a group of 14 patients with Alzheimer's disease and 20 healthy controls. Each subject was required to observe and evaluate affective pictures while autonomic parameters were recorded. FTD patients preserved a functional general competency in terms of valence (correct positive ...

The association between caregiver's stress and depressive symptoms, and sociodemographic and clinical characteristics of Alzheimer's patients and caregivers was evaluated in 63 primary caregivers consecutively recruited at the Alzheimer's Dementia Research and Care Unit of Brescia, northern Italy. Family caregivers' informal support was also evaluated. Patients' behavioral disturbances, and the number of persons who lived in the household were the main correlates of caregivers' stress. The greater the number of persons, the lower the report of caregiver stress. Lower frequency of visits of friends or relatives, caregivers' poor health and higher age, and the presence of patients' behavioral disturbances were the main determinants of caregivers' depressive symptoms. Cognitive impairment of patients was not correlated to caregivers' distress. Our study underlines that the imperatives of dementia and caregiving appear to be so significant that th...

Health status, functional status, and social influences were analyzed as risk factors associated with mortality in 1201 elderly subjects (70-75 years old), living in the center of Brescia, Northern Italy, followed up for three years.Mortality was positively associated with degree of impairment in health status, functional status, and mental status as measured by cognitive function and mood depression. Among social conditions no relation was found between mortality and living alone, education, or income, while a significant inverse relationship has been found between mortality and activities. In defining risk factors of mortality in aged people not only health status and cognitive function have to be taken into account but also social activities; these latter may act as protective factors buffering the organism from the effects of noxious stimuli.

Frontotemporal Lobar Degeneration (FTLD) has always been considered a rare disorder, but only a few epidemiologic studies are available. The aim of the present work was to ascertain all FTLD patients in a Northern Italy area from January 2001 to December 2008, and to estimate the disease prevalence. On the census day, 213 FTD patients were still alive, resulting in an overall prevalence of 17.6 per 100,000 inhabitants. The prevalence of FTLD in patients aged 45-65 years was 22 per 100,000 inhabitants (95% CI=17-27). The prevalence of FTLD was the highest in patients aged 66-75 (78 per 100,000 inhabitants, 95% CI=56-100), and it was still high over 75 years (54 per 100,000 inhabitants, 95% CI=36-69). FTLD is a more common form of dementia than previously recognized. Our results claimed that FTLD is not only an early-onset disorder, but it is frequent in advanced age as well.

To determine the level of agreement between the primary caregiver's report on patient activities of daily living (ADLs) and ADLs assessed directly in a sample of patients affected by very mild and mild dementia and to assess whether this agreement is influenced by the caregiver's depressive symptoms and burden. Data were obtained from the baseline sample of the Mild Dementia Longitudinal Study, consisting of 111 consecutive patients affected by dementia with very mild to mild functional impairment (grades .5 and 1 on the Clinical Dementia Rating Scale). As is usual for patients referred to our Alzheimer's Unit, anamnestic, cognitive, functional and behavioral information are collected from the primary caregiver. Along with sociodemographic characteristics, caregivers' depressive symptoms (Beck Depression Inventory Scale) and burden (Nowak and Guest's Caregiver Burden Inventory Scale) were also evaluated. Patients underwent a performance-based assessment of the ac...

To the Editor: The new drugs proposed recently for Alzheimer’s disease (AD), as well as those currently in trial, constitute significant progress in the field. However, they are expected to be only partially effective. The drugs currently approved for the treatment of AD treat only the symptoms and do not affect the underlying neuropathological process. Thus, nonpharmacological approaches could be of paramount importance, and even if effective pharmacological treatment could be made available for the short term, a complementary role for drug treatment and nonpharmacological interventions could be hypothesized in order to face the various clinical aspects cognitive, functional, behavioral, and affective of AD and related disorders in the future. Recently, pessimistic attitudes toward rehabilitative approaches in AD have been partially done away with by demonstrating that AD patients in the milder stages of the disease can benefit from memory training and Reality Orientation Therapy.’-’ Our group demonstrated the efficacy of Reality Orientation Therapy (ROT), a technique for multimodal verbal, visual, written presentation and reinforcement of basic orientation information, by slowing down the progression of disease in 17 mild-to-moderate AD patients.’ Making a blind comparison of the ROT-treated subjects with a group of clinically homogeneous controls for an 8-month time period, we observed a significant effect on cognitive functions measured with the MiniMental State Examination. In this paper, we discuss the cost and the cost-effectiveness of ROT therapy. Each 1-hour ROT class

and 47 Caucasians). Resting state scans were pre-processed using the DPARSF-A toolbox, followed by Independent Component Analysis using theGroup ICAof fMRIToolbox to derive connectivitymeasures. We then analyzed components containing posterior DMN nodes as they are most affected in AD and linked to cerebral tau PETabnormalities. We used as regions of interests the precuneus, posterior cingulate, bilateral hippocampus, and bilateral inferior parietal lobule, and calculated connectivity values between each node pair. Amultivariatemodel for FNCwas then performedwith race, age, gender, diagnosis, and race X diagnosis as independent variables. Results:Race significantly modified the relationship between functional connectivity and diagnosis (p 1⁄4 0.01) in one of the six analyzed node pairs. Compared to Caucasians, African Americans with normal cognition had lower connectivity between the posterior DMN nodes (precuneus and posterior cingulate). Furthermore, whereasMCI/ADwas associatedwith decreased connectivity compared to cognitively normal seniors in Caucasians, MCI/AD was associated with increased connectivity in African Americans. No such differences were observed for other node pairs. Conclusions: Race appears to modify the relationship between MCI/AD and posteriorDMNconnectivity to result in a race-associated double dissociation of DMN connectivity. Similar to CSFAD biomarkers, an fMRI-based AD-signature based on Caucasians may not translate to African Americans. Future investigation need to focus on mechanisms underlying race-associated connectivity differences in normal cognition as well as MCI/AD.

The effectiveness of Oxiracetam (1600 mg/day) versus placebo was assessed in a group of 96 out-patients suffering from cognitive disorders secondary to primary degenerative dementia. The study lasted twelve months and was performed in two stage, a) double-blind (26 weeks) and b) open study (26 weeks). The assessment of the results obtained at two, six and twelve months was carried out following both the methodology based on neuropsychological tests and scales, and the study of the simple reaction time by any of a computerized portable tachystoscope. The patients treated with Oxiracetam showed a statistically significant improvement of simple reaction time and cognitive function detected by the Attention matrix. In the placebo group after twelve months a significant worsening of cognitive and global function was observed in comparison with baseline scores. The patients themselves appeared in favor of Oxiracetam. The drug tolerability proved to be very good for the whole duration of t...

To compare the ability of Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), and the Physical Performance Test (PPT) to detect health status impairments. Five hundred forty nine community-dwelling elders (89.8% of the eligible elderly population) aged 70 and over; mean age [was] 76.8 +/- 6.1; 179 were males and 370 females. City of Ospitaletto, Brescia, Northern Italy. A multidimensional questionnaire assessing demographic variables, indicators of social activities, psychological function, and somatic health and functional status (BADL and IADL). Also, the PPT was administered. Cognitive and effective status were independently associated with BADL, IADL function, and age; number of drugs were also associated with IADL function. Other health variables (number of diseases, number of symptoms, and global health score) did not independently contribute to explaining the BADL and IADL variance. Cognitive status, number of symptoms, number of diseases,...

developed together with Oliver Huber, PhD, for the treatment of essential hypertension.2 With aging, muscle cells become pale through loss of sarcoplasm and muscle hemoglobin. Brief, maximal, extensive isometrics may possibly delay this process of aging" while counteracting the effects of muscle disuse, improving muscle tone, increasing muscle strength, and maintaining muscle vascularity. Brief, maximal, extensive isometrics is performed in a relaxed standing position (it can be done recumbently) by tensing all voluntary muscles of the body, including face muscles, for six seconds, three times with several seconds relaxation between. Normal breathing (no Valsalva) must be maintained during the exercise. The above procedure is repeated three to five times a day starting in the morning. It is to be remembered that our isometrics are brief as opposed to sustained isometrics and can be started at any age. It would be a long time to wait for a pharmacological or other solution for regaining or maintaining muscle tone as suggested in Dr. Sullivan's editorial. The time of BMEI has come.

To the Editor:-I appreciate greatly your publication of Churchill’s paper, “Should We Ration Health Care by Age?”‘ If we geriatricians don’t rise to answer this question, who will? Who better can? I share emphatically Churchill’s, ”No” answer to the question, at least for the foreseeable future. I suggest that there is a rational, useful, and powerful alternative approach to age as the instrument for resource allocation, and that is function. In a paper published by Sage et a12 in JAGS last year, it was shown that old patients did very well in the Stanford University Hospital ICU, at the same functional level, judged by the APACHE (acute physiologic and chronic health estimate) ranking system. Furthermore, the older patients esteemed their post-ICU lives more highly than did the younger survivors. It follows naturally that a 40-year-old may be too old for admission into an ICU, if his function is poor. A centenarian may be appropriate for the ICU, if his function is good. It remains for the physician caring for older patients to define and refine functional criteria for successful outcomes. Fit older persons are assets to society. We need to cherish them, and not place them off limits.

family room. With this as a possible cause, he ventilated the house and shut off the stove. While the dog seemingly returned to normal over a period of 72 hours, the patient reported steady improvement over the next two weeks. In the winter there may be others who suffer from subclinical or manifest carbon monoxide intoxication caused by wood-burning stoves or other heating appliances that bum carbon incompletely. In the elderly this may increase vulnerability to falls, accidents, and acute dilusional states. This would be especially likely if a person's cerebral circulation were already compromised.

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.

Frontotemporal dementia (FTD) has a strong genetic basis, with familial forms occurring in 30-50% of cases. Causative genes have been identified, with an autosomal dominant pattern of inheritance. Notwithstanding, in a number of cases with positive family history no pathogenetic mutation has been reported, and the role of genetics in sporadic cases is still unclear. In the present study, we aim to estimate the genetic contribution to FTD using concordance among parent-offspring pairs. Heritability of early-onset (EO, <65 years) and late-onset (LO, ≥65 years) FTD was estimated by examining the concordance between parents and offspring. Probands with at least one parent whose dementia status was known were recruited from 15 Italian centers, and the presence or absence of dementia was considered in siblings. Different prevalence estimates, as available by literature data, were tested. A total of 260 probands and 1619 family members were considered in this study. We found that parent...

Atrophy in the medial temporal lobe (MTL) structures depicted with brain imaging is one of the most accurate markers of Alzheimer disease (AD), but practical considerations have thus far limited their routine clinical use. The aim of this study was to explore the validity of a CT- and MR-based measure of MTL atrophy that would be feasible for routine clinical use. We acquired brain CT scans in the temporal lobe plane with thin sections in 42 patients with AD and in 29 control patients without dementia. We also acquired MR images (according to a 3D magnetization-prepared rapid gradient-echo protocol) in 28 patients with AD and in 28 control subjects without dementia. The radial width of the temporal horn (rWTH) of the lateral ventricle was measured with a precision caliper at the tip of the horn on CT scans or high-quality MR images. The validity of the rWTH variable was assessed by test-retest and interrater reliability, convergent and discriminant validity compared with progressive...

... In general, the size of the gains has been quite impressive. It has been speculated that implicit memory processes (memory without awareness) may be involved in spaced-retrieval learning. ... Prior to that, reminiscing was believed to be pathological. ...