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2. The efficacy of cognitive stimulation, cognitive training, and cognitive rehabilitation for people living with dementia: a systematic review and meta-analysis

Author

Paggetti, A, Druda, Y, Sciancalepore, F, Della Gatta, F, Ancidoni, A, Locuratolo, N, Piscopo, P, Vignatelli, L, Sagliocca, L, Guaita, A, Secreto, P, Stracciari, A, Caffarra, P, Vanacore, N, Fabrizi, E, Lacorte, E, Null, N, Battista, P, Borgarelli, C, Cerami, C, Chiari, A, Corbo, M, Costa, A, Cotelli, M, Dodich, A, Faè, E, Favaretto, E, Frisardi, V, Fubini, L, Gandelli, M, Gollin, D, Imperiale, D, Ivaldi, C, Izzicupo, F, Lanzoni, A, Lavermicocca, V, Lazzarino, M, Liperoti, R, Massaia, M, Menabue, G, Molinari, M, Morelli, A, Peruzzi, A, Piazza, F, Possenti, M, Ricci, C, Russo, S, Spadin, P, Spalletta, G, Zenaro, D, Coclite, D, Fauci, A, Napoletano, A, Bacigalupo, I, Bellomo, G, Canevelli, M, Carbone, E, Crestini, A, Distaso, E, Esposito, S, Fumagalli, G, Morelli, S, Remoli, G, Rivabene, R, Salemme, S, Valletta, M, Veronese, N, Zaccaria, V, Bini, C, Mennini, F, Sciattella, P, Ceccarini, A, Mitrova, Z, Pizzarelli, S, Saulle, R, Gainotti, S, Riva, L, Petrini, C, De Masi, S, Nonino, F, Martelli, G, Porrello, M, Paggetti, Alice, Druda, Ylenia, Sciancalepore, Francesco, Della Gatta, Francesco, Ancidoni, Antonio, Locuratolo, Nicoletta, Piscopo, Paola, Vignatelli, Luca, Sagliocca, Luciano, Guaita, Antonio, Secreto, Piero, Stracciari, Andrea, Caffarra, Paola, Vanacore, Nicola, Fabrizi, Elisa, Lacorte, Eleonora, null, null, Caffarra, P., Guaita, A., Secreto, P., Stracciari, A., Vanacore, N., Sagliocca, L., Vignatelli, L., Battista, P., Borgarelli, C., Cerami, C., Chiari, A., Corbo, M., Costa, A., Cotelli, M., Dodich, A., Faè, E., Favaretto, E., Frisardi, V., Fubini, L., Gandelli, M., Gollin, D., Imperiale, D., Ivaldi, C., Izzicupo, F., Lanzoni, A., Lavermicocca, V., Lazzarino, M., Liperoti, R., Massaia, M., Menabue, G., Molinari, M. A., Morelli, A., Peruzzi, A., Piazza, F., Possenti, M., Ricci, C., Russo, S., Spadin, P., Spalletta, G., Zenaro, D., Piscopo, P., Coclite, D., Fauci, A., Napoletano, A., Bacigalupo, I., Bellomo, G., Canevelli, M., Carbone, E., Crestini, A., Distaso, E., Druda, Y., Esposito, S., Fumagalli, G., Morelli, S., Paggetti, A., Remoli, G., Rivabene, R., Salemme, S., Sciancalepore, F., Valletta, M., Veronese, N., Zaccaria, V., Bini, C., Mennini, F. V., Sciattella, P., Ceccarini, A., Mitrova, Z., Pizzarelli, S., Saulle, R., Gainotti, S., Riva, L., Petrini, C., De Masi, S., Nonino, F., Martelli, G., Porrello, M. C., Paggetti, A, Druda, Y, Sciancalepore, F, Della Gatta, F, Ancidoni, A, Locuratolo, N, Piscopo, P, Vignatelli, L, Sagliocca, L, Guaita, A, Secreto, P, Stracciari, A, Caffarra, P, Vanacore, N, Fabrizi, E, Lacorte, E, Null, N, Battista, P, Borgarelli, C, Cerami, C, Chiari, A, Corbo, M, Costa, A, Cotelli, M, Dodich, A, Faè, E, Favaretto, E, Frisardi, V, Fubini, L, Gandelli, M, Gollin, D, Imperiale, D, Ivaldi, C, Izzicupo, F, Lanzoni, A, Lavermicocca, V, Lazzarino, M, Liperoti, R, Massaia, M, Menabue, G, Molinari, M, Morelli, A, Peruzzi, A, Piazza, F, Possenti, M, Ricci, C, Russo, S, Spadin, P, Spalletta, G, Zenaro, D, Coclite, D, Fauci, A, Napoletano, A, Bacigalupo, I, Bellomo, G, Canevelli, M, Carbone, E, Crestini, A, Distaso, E, Esposito, S, Fumagalli, G, Morelli, S, Remoli, G, Rivabene, R, Salemme, S, Valletta, M, Veronese, N, Zaccaria, V, Bini, C, Mennini, F, Sciattella, P, Ceccarini, A, Mitrova, Z, Pizzarelli, S, Saulle, R, Gainotti, S, Riva, L, Petrini, C, De Masi, S, Nonino, F, Martelli, G, Porrello, M, Paggetti, Alice, Druda, Ylenia, Sciancalepore, Francesco, Della Gatta, Francesco, Ancidoni, Antonio, Locuratolo, Nicoletta, Piscopo, Paola, Vignatelli, Luca, Sagliocca, Luciano, Guaita, Antonio, Secreto, Piero, Stracciari, Andrea, Caffarra, Paola, Vanacore, Nicola, Fabrizi, Elisa, Lacorte, Eleonora, null, null, Caffarra, P., Guaita, A., Secreto, P., Stracciari, A., Vanacore, N., Sagliocca, L., Vignatelli, L., Battista, P., Borgarelli, C., Cerami, C., Chiari, A., Corbo, M., Costa, A., Cotelli, M., Dodich, A., Faè, E., Favaretto, E., Frisardi, V., Fubini, L., Gandelli, M., Gollin, D., Imperiale, D., Ivaldi, C., Izzicupo, F., Lanzoni, A., Lavermicocca, V., Lazzarino, M., Liperoti, R., Massaia, M., Menabue, G., Molinari, M. A., Morelli, A., Peruzzi, A., Piazza, F., Possenti, M., Ricci, C., Russo, S., Spadin, P., Spalletta, G., Zenaro, D., Piscopo, P., Coclite, D., Fauci, A., Napoletano, A., Bacigalupo, I., Bellomo, G., Canevelli, M., Carbone, E., Crestini, A., Distaso, E., Druda, Y., Esposito, S., Fumagalli, G., Morelli, S., Paggetti, A., Remoli, G., Rivabene, R., Salemme, S., Sciancalepore, F., Valletta, M., Veronese, N., Zaccaria, V., Bini, C., Mennini, F. V., Sciattella, P., Ceccarini, A., Mitrova, Z., Pizzarelli, S., Saulle, R., Gainotti, S., Riva, L., Petrini, C., De Masi, S., Nonino, F., Martelli, G., and Porrello, M. C.

Abstract

Cognition-oriented treatments (COTs) are a group of non-pharmacological treatments aimed at maintaining or improving cognitive functioning. Specific recommendations on the use of these interventions in people living with dementia (PLwD) are included in the Italian Guideline on the Diagnosis and Treatment of Dementia and Mild Cognitive Impairment, developed by the Italian National Institute of Health. This systematic review and meta-analysis, based on the GRADE methodology, is part of the guideline. Considered outcomes included the cognitive functions, quality of life, and functional abilities of PLwD, taking into account disease severity, modality and system of delivery, and form of the intervention. The effectiveness of these interventions on caregivers’ outcomes was also assessed. Both group and individual cognitive stimulation were reported as effective in supporting cognitive functions in PLwD at any degree of severity. Individual cognitive training and group cognitive training were reported as effective in improving global cognitive functions in people with mild dementia. Cognitive rehabilitation appeared to be effective only in improving the functional abilities of people with mild dementia. Cognitive rehabilitation appeared to be the most effective in improving caregivers’ outcomes, with results suggesting a reduction in care burden. The observed differences in the effectiveness of these interventions in people with different disease severity can be explained by the intrinsic characteristics of each intervention. Despite the large number of available studies, a high clinical, statistical, and methodological heterogeneity was observed. More methodologically rigorous studies are needed to clarify the effectiveness of each protocol and modality of intervention.

Published
2024

5. The Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment

Author

Elisa, F, Antonio, A, Nicoletta, L, Paola, P, Francesco, D, Simone, S, Sara Maria, P, Domitilla, M, Luca, V, Luciano, S, Paolo, C, Piero, S, Antonio, G, Andrea, S, Nicola, V, Eleonora, L, Caffarra, P, Guaita, A, Secreto, P, Stracciari, A, Vanacore, N, Sagliocca, L, Vignatelli, L, Battista, P, Borgarelli, C, Cerami, C, Chiari, A, Corbo, M, Costa, A, Cotelli, M, Dodich, A, Faè, E, Favaretto, E, Frisardi, V, Fubini, L, Gandelli, M, Gollin, D, Imperiale, D, Ivaldi, C, Izzicupo, F, Lanzoni, A, Lavermicocca, V, Lazzarino, M, Liperoti, R, Massaia, M, Menabue, G, Angela Molinari, M, Morelli, A, Peruzzi, A, Piazza, F, Possenti, M, Ricci, C, Russo, S, Spadin, P, Spalletta, G, Zenaro, D, Ancidoni, A, Della Gatta, F, Fabrizi, E, Lacorte, E, Locuratolo, N, Piscopo, P, Bacigalupo, I, Bellomo, G, Canevelli, M, Carbone, E, Crestini, A, Distaso, E, Druda, Y, Esposito, S, Fumagalli, G, Morelli, S, Paggetti, A, Remoli, G, Rivabene, R, Salemme, S, Sciancalepore, F, Valletta, M, Veronese, N, Zaccaria, V, Coclite, D, Fauci, A, Napoletano, A, Bini, C, Saverio Mennini, F, Sciattella, P, Ceccarini, A, Mitrova, Z, Pizzarelli, S, Saulle, R, Gainotti, S, Petrini, C, Riva, L, De Masi, S, Nonino, F, Cristina Porrello, M, Martelli, G, Fabrizi, Elisa, Ancidoni, Antonio, Locuratolo, Nicoletta, Piscopo, Paola, Della Gatta, Francesco, Salemme, Simone, Pani, Sara Maria, Marconi, Domitilla, Vignatelli, Luca, Sagliocca, Luciano, Caffarra, Paolo, Secreto, Piero, Guaita, Antonio, Stracciari, Andrea, Vanacore, Nicola, Lacorte Eleonora, Paolo Caffarra, Antonio Guaita, Piero Secreto, Andrea Stracciari, Nicola Vanacore, Luciano Sagliocca, Luca Vignatelli, Petronilla Battista, Consuelo Borgarelli, Chiara Cerami, Annalisa Chiari, Massimo Corbo, Alfredo Costa, Maria Cotelli, Alessandra Dodich, Elisa Faè, Elisa Favaretto, Vincenza Frisardi, Lidia Fubini, Monica Gandelli, Donata Gollin, Daniele Imperiale, Claudio Ivaldi, Fabio Izzicupo, Alessandro Lanzoni, Valentina Lavermicocca, Margherita Lazzarino, Rosa Liperoti, Massimiliano Massaia, Giacomo Menabue, Maria Angela Molinari, Alessia Morelli, Anna Peruzzi, Fabrizio Piazza, Mario Possenti, Clara Ricci, Stefano Russo, Patrizia Spadin, Gianfranco Spalletta, Davide Zenaro, Antonio Ancidoni, Francesco Della Gatta, Elisa Fabrizi, Eleonora Lacorte, Nicoletta Locuratolo, Paola Piscopo, Ilaria Bacigalupo, Guido Bellomo, Marco Canevelli, Elena Carbone, Alessio Crestini, Eugenio Distaso, Ylenia Druda, Sabrina Esposito, Giorgio Fumagalli, Sandra Morelli, Alice Paggetti, Giulia Remoli, Roberto Rivabene, Simone Salemme, Francesco Sciancalepore, Martina Valletta, Nicola Veronese, Valerio Zaccaria, Daniela Coclite, Alice Fauci, Antonello Napoletano, Chiara Bini, Francesco Saverio Mennini, Paolo Sciattella, Alessandra Ceccarini, Zuzana Mitrova, Scilla Pizzarelli, Rosella Saulle, Sabina Gainotti, Carlo Petrini, Luciana Riva, Salvatore De Masi, Francesco Nonino, Maria Cristina Porrello, Gabriella Martelli, Elisa, F, Antonio, A, Nicoletta, L, Paola, P, Francesco, D, Simone, S, Sara Maria, P, Domitilla, M, Luca, V, Luciano, S, Paolo, C, Piero, S, Antonio, G, Andrea, S, Nicola, V, Eleonora, L, Caffarra, P, Guaita, A, Secreto, P, Stracciari, A, Vanacore, N, Sagliocca, L, Vignatelli, L, Battista, P, Borgarelli, C, Cerami, C, Chiari, A, Corbo, M, Costa, A, Cotelli, M, Dodich, A, Faè, E, Favaretto, E, Frisardi, V, Fubini, L, Gandelli, M, Gollin, D, Imperiale, D, Ivaldi, C, Izzicupo, F, Lanzoni, A, Lavermicocca, V, Lazzarino, M, Liperoti, R, Massaia, M, Menabue, G, Angela Molinari, M, Morelli, A, Peruzzi, A, Piazza, F, Possenti, M, Ricci, C, Russo, S, Spadin, P, Spalletta, G, Zenaro, D, Ancidoni, A, Della Gatta, F, Fabrizi, E, Lacorte, E, Locuratolo, N, Piscopo, P, Bacigalupo, I, Bellomo, G, Canevelli, M, Carbone, E, Crestini, A, Distaso, E, Druda, Y, Esposito, S, Fumagalli, G, Morelli, S, Paggetti, A, Remoli, G, Rivabene, R, Salemme, S, Sciancalepore, F, Valletta, M, Veronese, N, Zaccaria, V, Coclite, D, Fauci, A, Napoletano, A, Bini, C, Saverio Mennini, F, Sciattella, P, Ceccarini, A, Mitrova, Z, Pizzarelli, S, Saulle, R, Gainotti, S, Petrini, C, Riva, L, De Masi, S, Nonino, F, Cristina Porrello, M, Martelli, G, Fabrizi, Elisa, Ancidoni, Antonio, Locuratolo, Nicoletta, Piscopo, Paola, Della Gatta, Francesco, Salemme, Simone, Pani, Sara Maria, Marconi, Domitilla, Vignatelli, Luca, Sagliocca, Luciano, Caffarra, Paolo, Secreto, Piero, Guaita, Antonio, Stracciari, Andrea, Vanacore, Nicola, Lacorte Eleonora, Paolo Caffarra, Antonio Guaita, Piero Secreto, Andrea Stracciari, Nicola Vanacore, Luciano Sagliocca, Luca Vignatelli, Petronilla Battista, Consuelo Borgarelli, Chiara Cerami, Annalisa Chiari, Massimo Corbo, Alfredo Costa, Maria Cotelli, Alessandra Dodich, Elisa Faè, Elisa Favaretto, Vincenza Frisardi, Lidia Fubini, Monica Gandelli, Donata Gollin, Daniele Imperiale, Claudio Ivaldi, Fabio Izzicupo, Alessandro Lanzoni, Valentina Lavermicocca, Margherita Lazzarino, Rosa Liperoti, Massimiliano Massaia, Giacomo Menabue, Maria Angela Molinari, Alessia Morelli, Anna Peruzzi, Fabrizio Piazza, Mario Possenti, Clara Ricci, Stefano Russo, Patrizia Spadin, Gianfranco Spalletta, Davide Zenaro, Antonio Ancidoni, Francesco Della Gatta, Elisa Fabrizi, Eleonora Lacorte, Nicoletta Locuratolo, Paola Piscopo, Ilaria Bacigalupo, Guido Bellomo, Marco Canevelli, Elena Carbone, Alessio Crestini, Eugenio Distaso, Ylenia Druda, Sabrina Esposito, Giorgio Fumagalli, Sandra Morelli, Alice Paggetti, Giulia Remoli, Roberto Rivabene, Simone Salemme, Francesco Sciancalepore, Martina Valletta, Nicola Veronese, Valerio Zaccaria, Daniela Coclite, Alice Fauci, Antonello Napoletano, Chiara Bini, Francesco Saverio Mennini, Paolo Sciattella, Alessandra Ceccarini, Zuzana Mitrova, Scilla Pizzarelli, Rosella Saulle, Sabina Gainotti, Carlo Petrini, Luciana Riva, Salvatore De Masi, Francesco Nonino, Maria Cristina Porrello, and Gabriella Martelli

Abstract

Introduction: Approximately 2 million people in Italy are currently living with dementia or mild cognitive impairment (MCI), and 4 million are involved as family members or caregivers. Considering the significant impact of dementia, the Italian Ministry of Health entrusted the Italian National Institute of Health (Istituto Superiore di Sanità) with the development of a guideline within the Italian National Guideline System (Sistema Nazionale Linee Guida, SNLG) on the diagnosis and treatment of dementia and MCI. The main objective was to provide evidence-based recommendations aimed at reducing the variability and ensuring the appropriateness of clinical practices throughout the whole care process from identification and diagnosis to the end of life for people with dementia (PwD) or MCI and their families/caregivers. Methods: The GRADE-ADOLOPMENT approach was used to adopt, adapt and update the guideline developed by the National Institute for Health and Care Excellence in 2018 (NG97). The methodology was based on the Methodological Handbook produced by the SNLG. A multidisciplinary panel of 29 experts and four representatives of family members/caregivers discussed and approved 47 review questions. Of these, 34 questions were adopted from the NG97, and 13 were new questions, including 10 questions referring to MCI. Systematic literature reviews were performed for each question, and a team of methodological and clinical experts qualitatively assessed and summarised results from included studies based on the GRADE approach. To facilitate the implementation and dissemination of the contents of this guideline, a care pathway and a leaflet dedicated to PwD or MCI and their families/caregivers were also developed. Results: The literature review for this guideline included studies published up to November 2023. More than 1000 peer-reviewed publications were included, covering the following areas: (i) identification, diagnosis and post-diagnostic support; (ii) care models an

Published
2024

6. Neuropathological hints from CSF and serum biomarkers in corticobasal syndrome (CBS): a systematic review

Author

Remoli, G, Schilke, E, Magi, A, Ancidoni, A, Negro, G, Da Re, F, Frigo, M, Giordano, M, Vanacore, N, Canevelli, M, Ferrarese, C, Tremolizzo, L, Appollonio, I, Remoli, Giulia, Schilke, Edoardo Dalmato, Magi, Andrea, Ancidoni, Antonio, Negro, Giulia, Da Re, Fulvio, Frigo, Maura, Giordano, Martina, Vanacore, Nicola, Canevelli, Marco, Ferrarese, Carlo, Tremolizzo, Lucio, Appollonio, Ildebrando, Remoli, G, Schilke, E, Magi, A, Ancidoni, A, Negro, G, Da Re, F, Frigo, M, Giordano, M, Vanacore, N, Canevelli, M, Ferrarese, C, Tremolizzo, L, Appollonio, I, Remoli, Giulia, Schilke, Edoardo Dalmato, Magi, Andrea, Ancidoni, Antonio, Negro, Giulia, Da Re, Fulvio, Frigo, Maura, Giordano, Martina, Vanacore, Nicola, Canevelli, Marco, Ferrarese, Carlo, Tremolizzo, Lucio, and Appollonio, Ildebrando

Abstract

Corticobasal syndrome (CBS) is a clinical syndrome determined by various underlying neurodegenerative disorders requiring a pathological assessment for a definitive diagnosis. A literature review was performed following the methodology described in the Cochrane Handbook for Systematic Reviews to investigate the additional value of traditional and cutting-edge cerebrospinal fluid (CSF) and serum/plasma biomarkers in profiling CBS. Four databases were screened applying predefined inclusion criteria: (1) recruiting patients with CBS; (2) analyzing CSF/plasma biomarkers in CBS. The review highlights the potential role of the association of fluid biomarkers in diagnostic workup of CBS, since they may contribute to a more accurate diagnosis and patient selection for future disease-modifying agent; for example, future trial designs should consider baseline CSF Neurofilament Light Chains (NfL) or progranulin dosage to stratify treatment arms according to neuropathological substrates, and serum NfL dosage might be used to monitor the evolution of CBS. In this scenario, prospective cohort studies, starting with neurological examination and neuropsychological tests, should be considered to assess the correlations of clinical profiles and various biomarkers.

Published
2024

9. An updated overview of recent and ongoing deep brain stimulation (DBS) trials in patients with dementia: a systematic review

Author

Remoli, G, Tariciotti, L, Remore, L, Palmisciano, P, Sciancalepore, F, Canevelli, M, Lacorte, E, Da Re, F, Bruno, G, Ferrarese, C, Appollonio, I, Locatelli, M, Vanacore, N, Remoli G., Tariciotti L., Remore L. G., Palmisciano P., Sciancalepore F., Canevelli M., Lacorte E., Da Re F., Bruno G., Ferrarese C., Appollonio I., Locatelli M., Vanacore N., Remoli, G, Tariciotti, L, Remore, L, Palmisciano, P, Sciancalepore, F, Canevelli, M, Lacorte, E, Da Re, F, Bruno, G, Ferrarese, C, Appollonio, I, Locatelli, M, Vanacore, N, Remoli G., Tariciotti L., Remore L. G., Palmisciano P., Sciancalepore F., Canevelli M., Lacorte E., Da Re F., Bruno G., Ferrarese C., Appollonio I., Locatelli M., and Vanacore N.

Abstract

Background: Dementia affects more than 55 million people worldwide. Several technologies have been developed to slow cognitive decline: deep brain stimulation (DBS) of network targets in Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) have been recently investigated. Objective: This study aimed to review the characteristics of the populations, protocols, and outcomes of patients with dementia enrolled in clinical trials investigating the feasibility and efficacy of DBS. Materials and methods: A systematic search of all registered RCTs was performed on Clinicaltrials.gov and EudraCT, while a systematic literature review was conducted on PubMed, Scopus, Cochrane, and APA PsycInfo to identify published trials. Results: The literature search yielded 2122 records, and the clinical trial search 15 records. Overall, 17 studies were included. Two of 17 studies were open-label studies reporting no NCT/EUCT code and were analysed separately. Of 12 studies investigating the role of DBS in AD, we included 5 published RCTs, 2 unregistered open-label (OL) studies, 3 recruiting studies, and 2 unpublished trials with no evidence of completion. The overall risk of bias was assessed as moderate-high. Our review showed significant heterogeneity in the recruited populations regarding age, disease severity, informed consent availability, inclusion, and exclusion criteria. Notably, the standard mean of overall severe adverse events was moderately high (SAEs: 9.10 ± 7.10%). Conclusion: The population investigated is small and heterogeneous, published results from clinical trials are under-represented, severe adverse events not negligible, and cognitive outcomes uncertain. Overall, the validity of these studies requires confirmation based on forthcoming higher-quality clinical trials.

Published
2023

11. Translation of Research on Sarcopenia Into Clinical Practice

Author

Cesari, M., Calvani, Riccardo, Canevelli, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Cesari, M., Calvani, Riccardo, Canevelli, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), and Marzetti E. (ORCID:0000-0001-9567-6983)

Abstract

N/A

Published
2022

12. The Management of Frailty: Barking Up the Wrong Tree

Author

Cesari, M., Canevelli, M., Calvani, Riccardo, Aprahamian, I., Inzitari, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Cesari, M., Canevelli, M., Calvani, Riccardo, Aprahamian, I., Inzitari, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), and Marzetti E. (ORCID:0000-0001-9567-6983)

Abstract

Frailty is today a hot topic in the scientific community and among clinicians. Geriatricians are no longer the only specialists discussing this age-related condition. Many medical disciplines (e.g., oncologists (1), cardiologists (2), neurologists (3), nephrologists (4), infectious disease specialists (5), pneumologists (6), anesthesiologists (7)) have finally started looking at this critical aspect in older persons, particularly impactful on prognosis and treatment modalities (e.g., (8, 9)). In the debate about this “novel” condition, it may sometimes happen that the word “frailty” is inappropriately used, suggesting a still incomplete understanding of the condition of interest. Some concepts seem difficult to get through, especially in those fields that are not used to the holistic approach and multidisciplinarity typical of geriatrics.

Published
2022

15. The Italian fund for Alzheimer's and other dementias: strategies and objectives to face the dementia challenge

Author

Ancidoni, A., Sciancalepore, F., Bacigalupo, I., Bellomo, G., Canevelli, M., Lacorte, E., Lombardo, F. L., Lorenzini, P., Palazzesi, I., Piscopo, P., Salvi, E., Bianchi, C. B. N. A., Landoni, F., La Sala, L., Di Fiandra, T., Vanacore, N., Basso, C., Bonino, P., Bruni, A. C., Caci, A., Fabbo, A., Giordano, M., Greco, A., Lidonnici, E., Lombardi, A., Lovaldi, F., March, A., Madrigali, S., Palummeri, E., Perratone, P., Scalmana, S., Caffarra, P., Mazzoleni, F., Pirani, A., Trabucchi, M., Belardinelli, M., Possenti, M., Spadin, P., Bargagli, A. M., Bartorelli, L., Biagini, C., Capasso, A., Cozzari, M. P., Gainotti, S., Di Palma, A., Gabelli, C., Gambina, G., Gasparini, M. M., Guaita, A., Izzicupo, F., Notarelli, A., Petrini, C., Riva, L., Secreto, P., Stracciari, A., Losito, G., Ciampa, A., Camilli, F. -M., Carnevale, G., Coclite, D., Crestini, A., Della Gatta, F., Distaso, E., Druda, Y., Esposito, S., Fabrizi, E., Fauci, A., Fumagalli, G., Gasparini, M., Giaquinto, F., Locuratolo, N., Lombardo, F., Martelli, G., Matascioli, F., Mennini, S., Milanese, A., Morelli, S., Napoletano, A., Porrello, M. C., Remoli, G., Rivabene, R., Sagliocca, L., Sciattella, P., Vaccaro, R., Valletta, M., Veronese, N., Vignatelli, L., and Zaccaria, V.

Subjects
Caregivers, Financial Management, Alzheimer Disease, public health, Humans, Dementia, dementia national plan, Public Health, dementia, caregivers, humans, alzheimer disease, financial management
Abstract

The Italian Fund for Alzheimer's and other dementias was approved and signed in December 2021. The Fund is financed with 15 million euros in three years. The main goal is to provide new strategies in the field of dementia with a Public Health perspective. The Fund includes eight main activities that will be monitored and supervised by the Italian National Institute of Health: 1) development of a guideline for the assessment, management and support for people with dementia and their families/carers; 2) updating of the Dementia National Plan (DNP); 3) implementation of the documents of the DNP; 4) conducting surveys dedicated to the Italian Dementia Services; 5) promotion of dementia prevention strategies; 6) training strategies for healthcare professionals, families and caregivers; 7) creation of a National Electronic Record for Dementia; 8) evaluation and monitoring of activities promoted by Regions and Autonomous Provinces in the field of dementia, together with the dementia National Permanent Table. These activities are outlined in detail in the present paper.

Published
2022

17. Comorbidity status of deceased COVID-19 in-patients in Italy

Author

Vetrano, D. L., Tazzeo, C., Palmieri, L., Marengoni, A., Zucchelli, A., Lo Noce, C., Onder, G., Andrianou, X., Barbariol, P., Bella, A., Bellino, S., Benelli, E., Bertinato, L., Boros, S., Brambilla, G., Calcagnini, G., Canevelli, M., Castrucci, M. R., Censi, F., Ciervo, A., Colaizzo, E., D'Ancona, F., Del Manso, M., Di Benedetto, C., Donfrancesco, C., Fabiani, M., Facchiano, F., Filia, A., Floridia, M., Galati, F., Giuliano, M., Grisetti, T., Kodra, Y., Langer, M., Lega, I., Maiozzi, P., Malchiodi Albedi, F., Manno, V., Martini, M., Urdiales, A. M., Mattei, E., Meduri, C., Meli, P., Minelli, G., Nebuloni, M., Nistico, L., Nonis, M., Palmisano, L., Petrosillo, N., Pezzotti, P., Pricci, F., Punzo, O., Puro, V., Raparelli, V., Rezza, G., Riccardo, F., Rota, M. C., Salerno, P., Serra, D., Siddu, A., Stefanelli, P., Tamburo de Bella, M., Tiple, D., Unim, B., Vaianella, L., Vanacore, N., Vichi, M., Villani, E. R., Zona, A., and Brusaferro, S.

Subjects
Aging, medicine.medical_specialty, Short Communication, Disease, Type 2 diabetes, Comorbidity, Chronic disease, NO, 03 medical and health sciences, 0302 clinical medicine, COVID-19, Mortality, Multimorbidity, Risk Factors, Internal medicine, medicine, 80 and over, Diabetes Mellitus, Dementia, Humans, 030212 general & internal medicine, Stroke, Aged, Aged, 80 and over, COPD, business.industry, SARS-CoV-2, Atrial fibrillation, Italy, Diabetes Mellitus, Type 2, medicine.disease, 030228 respiratory system, Heart failure, Geriatrics and Gerontology, business, Type 2
Abstract

Background Most COVID-19-related deaths have occurred in older persons with comorbidities. Specific patterns of comorbidities related to COVID-19 deaths have not been investigated. Methods A random sample of 6085 individuals in Italy who died in-hospital with confirmed COVID-19 between February and December 2020 were included. Observed to expected (O/E) ratios of disease pairs were computed and logistic regression models were used to determine the association between disease pairs with O/E values ≥ 1.5. Results Six pairs of diseases exhibited O/E values ≥ 1.5 and statistically significant higher odds of co-occurrence in the crude and adjusted analyses: (1) ischemic heart disease and atrial fibrillation, (2) atrial fibrillation and heart failure, (3) atrial fibrillation and stroke, (4) heart failure and COPD, (5) stroke and dementia, and (6) type 2 diabetes and obesity. Conclusion In those deceased in-hospital due to COVID-19 in Italy, disease combinations defined by multiple cardio-respiratory, metabolic, and neuropsychiatric diseases occur more frequently than expected. This finding indicates a need to investigate the possible role of these clinical profiles in the chain of events that lead to death in individuals who have contracted SARS-CoV-2.

Published
2021

18. On Schrödinger’s Cat and Evaluation of Trials Disrupted by the Covid19 Pandemic: A Critical Appraisal

Author

Cesari, M., Calvani, Riccardo, Canevelli, M., Aprahamian, I., de Souto Barreto, P., Azzolino, D., Fielding, R. A., Vanacore, N., Inzitari, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), Marzetti E. (ORCID:0000-0001-9567-6983), Cesari, M., Calvani, Riccardo, Canevelli, M., Aprahamian, I., de Souto Barreto, P., Azzolino, D., Fielding, R. A., Vanacore, N., Inzitari, M., Marzetti, Emanuele, Calvani R. (ORCID:0000-0001-5472-2365), and Marzetti E. (ORCID:0000-0001-9567-6983)

Abstract

From the beginning of 2020, the world has been fighting the SARS-Cov-2 outbreak. The life of each one of us has profoundly hanged. Unavoidably, our clinical routine has drastically modified in its priorities and methodologies (1). The COVID-19 pandemic has also raised significant issues in the field of research. The investigators’ responsibility has increased with the need to thoughtfully weigh the risk-benefit ratio for each protocol in an emergency and evolving scenario (2).

Published
2021

21. Prevalence and clinical correlates of dementia among COVID-19-related deaths in Italy

Author

Canevelli, M., Palmieri, L., Raparelli, V., Lo Noce, C., Colaizzo, E., Tiple, D., Vaianella, L., Vanacore, N., Brusaferro, S., Onder, G., Bertinato, L., Brambilla, G., Calcagnini, G., Censi, F., Donfrancesco, C., Facchiano, F., Floridia, M., Giuliano, M., Grisetti, T., Kodra, Y., Langer, M., Lega, I., Albedi, F. M., Manno, V., Mattei, E., Meli, P., Minelli, G., Nebuloni, M., Nistico, L., Nonis, M., Palmisano, L., Petrosillo, N., Pricci, F., Punzo, O., Salerno, P., Debella, M. T., Taruscio, D., Unim, B., Vichi, M., Villani, E. R., and Zona, A.

Subjects
medicine.medical_specialty, Pediatrics, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Clinical Neurology, Short Report, lcsh:Geriatrics, lcsh:RC346-429, SARS‐CoV‐2, NO, 03 medical and health sciences, 0302 clinical medicine, COVID‐19, Intensive care, Medicine, Dementia, lcsh:Neurology. Diseases of the nervous system, 030304 developmental biology, Diagnostic Assessment & Prognosis, 0303 health sciences, business.industry, SARS-CoV-2, Public health, COVID-19, dementia, public health, Cognition, medicine.disease, lcsh:RC952-954.6, Psychiatry and Mental health, Concomitant, Population study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Introduction We aimed at exploring the proportion of patients dying with COVID‐19 and concomitant dementia in Italy, as well as their clinical characteristics and trajectories of care. Methods The proportion of COVID‐19‐related deaths occurring in people with dementia and the clinical characteristics of deceased individuals according to their dementia status were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n = 2621). Results A total of 415 individuals with dementia were identified in the study population, accounting for 15.8% of overall COVID‐19‐related deaths. Patients with dementia less frequently presented with cough, had lower chance of receiving supportive therapies and intensive care approaches, and showed a faster clinical worsening as compared with individuals with intact cognition. Discussion Dementia confers a relevant risk of adverse outcomes in case of SARS‐CoV‐2 infection and influences the clinical presentation, course and management of affected individuals.

Published
2020

22. Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy

Author

Raparelli, V., Palmieri, L., Canevelli, M., Pricci, F., Unim, B., Lo Noce, C., Villani, E. R., Rochon, P. A., Pilote, L., Vanacore, N., Onder, G., Agazio, E., Andrianou, X., Barbariol, P., Bella, A., Bellino, S., Benelli, E., Bertinato, L., Boros, S., Brambilla, G., Calcagnini, G., Daqar, Q. Z., Castrucci, M. R., Censi, F., Ciervo, A., Colaizzo, E., D'Ancona, F., Delmanso, M., Donfrancesco, C., Fabiani, M., Facchiano, F., Filia, A., Floridia, M., Galati, F., Giuliano, M., Grisetti, T., Kodra, Y., Langer, M., Lega, I., Lonoce, C., Maiozzi, P., Malchiodialbedi, F., Manno, V., Martini, M., Urdiales, A. M., Mattei, E., Meduri, C., Meli, P., Minelli, G., Nebuloni, M., Nistico, L., Nonis, M., Palmisano, L., Petrosillo, N., Pezzotti, P., Punzo, O., Puro, V., Rezza, G., Riccardo, F., Rota, M. C., Salerno, P., Serra, D., Siddu, A., Stefanelli, P., Tamburo DeBella, M., Tiple, D., Vaianella, L., Vichi, M., Zona, A., and Brusaferro, S.

Subjects
Male, Multivariate analysis, covid-19, comorbidities, in-hospital complications, sex, transition of care, lcsh:Medicine, Disease, Comorbidity, 030204 cardiovascular system & hematology, Comorbidities, COVID-19, In-hospital complications, Sex, Transition of care, lcsh:Physiology, Aged, Aged, 80 and over, Betacoronavirus, Coronavirus Infections, Female, Hospitalization, Humans, Italy, Middle Aged, Multimorbidity, Multivariate Analysis, Pandemics, Patient Transfer, Pneumonia, Viral, Prevalence, Retrospective Studies, Risk Factors, SARS-CoV-2, Sex Factors, 0302 clinical medicine, Endocrinology, 80 and over, 030212 general & internal medicine, Viral, lcsh:QP1-981, Acute kidney injury, medicine.medical_specialty, NO, Gender Studies, 03 medical and health sciences, Internal medicine, medicine, Dementia, business.industry, Research, lcsh:R, Outbreak, Retrospective cohort study, Pneumonia, medicine.disease, business, Kidney disease
Abstract

Background Among the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited sex-disaggregated data available. Methods A retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27–June 11, 2020). Clinical characteristics and the times from symptoms’ onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex. Results Of the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39–2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29–2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13–1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55–0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25–0.63), yet both sexes had a high level of multimorbidity. The times from symptoms’ onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45–5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13–1.90). Conclusions Men and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.

Published
2020

25. The Italian dementia with Lewy bodies study group (DLB-SINdem): toward a standardization of clinical procedures and multicenter cohort studies design

Author

Bonanni, L, Cagnin, A., Agosta, F., Babiloni, C., Borroni, B., Bozzali, M., Bruni, A. C., Filippi, M., Galimberti, D., Monastero, R., Muscio, C., Parnetti, L., Perani, D., Serra, L., Silani, V., Tiraboschi, P., Padovani, A., On behalf of DLB SINdem study group, Null, Alberici, A., Alberoni, M., Amici, S., Appollonio, I., Arena, M. G., Arighi, A., Avanzi, S., Bagella, C. F., Baglio, F., Barocco, F., Belardinelli, N., Bonuccelli, U., Bottini, G., Bruno Bossio, R., Bruno, G., Buccomino, D., Cacchiò, G., Calabrese, E., Campanelli, A., Canevelli, M., Canu, E. D. G., Cappa, A., Capra, C., Carapelle, E., Caratozzolo, S., Carbone, G. F. S., Cattaruzza, T., Cerami, C., Cester, A., Cheldi, A., Cherchi, R., Chiari, A., Cirafisi, C., Colao, R., Confaloni, A., Conti, M. Z., Costa, A., Costa, B., Cotelli, M. S., Cova, I., Cravello, L., Cumbo, E., Cupidi, C., De Togni, L., Del Din, G., Del Re, M. L., Dentizzi, C., Di Lorenzo, F., Di Stefano, F., Dikova, N., Farina, E., Floris, G., Foti, A., Franceschi, M., Fumagalli, G. G., Gabelli, C., Ghidoni, E., Giannandrea, D., Giordana, M. T., Giorelli, M., Giubilei, F., Grimaldi, L., Grimaldi, R., Guglielmi, V., Lanari, A., Le Pira, F., Letteri, F., Levi Minzi, G. V., Lorusso, S., Ludovico, L., Luzzi, S., Maggiore, L., Magnani, G., Mancini, G., Manconi, F. M., Manfredi, L., Maniscalco, M., Marano, P., Marcon, M., Marcone, A., Marra, C., Martorana, A., Mascia, M. G., Mascia, V., Mauri, M., Mazzei, B., Meloni, M., Merlo, P., Messa, G., Milia, A., Monacelli, F., Montecalvo, G., Moschella, V., Mura, G., Nemni, R., Nobili, F., Notarelli, A., Di Giacomo, R., Onofrj, M., Paci, C., Padiglioni, C., Perini, M., Perotta, D., Perri, Formenti A., Perri, R., Piccininni, C., Piccoli, T., Pilia, G., Pilotto, A., Poli, S., Pomati, S., Pompanin, S., Pucci, E., Puccio, G., Quaranta, D., Rainero, I., Rea, G., Realmuto, S., Riva, M., Rizzetti, M. C., Rolma, G., Rozzini, L., Sacco, L., Saibene, F. L., Scarpini, E., Sensi, S., Seripa, D., Sinforiani, E., Sorbi, S., Sorrentino, Giuseppe, Spallazzi, M., Stracciari, A., Talarico, G., Tassinari, T., Thomas, A., Tiezzi, A., Tomassini, P. F., Trebbastoni, A., Tremolizzo, L., Tripi, G., Ursini, F., Vaianella, L., Valluzzi, F., Vezzadini, G., Vista, M., Volontè, M. A., Bonanni, L, Cagnin, A, Agosta, F, Babiloni, C, Borroni, B, Bozzali, M, Bruni, A, Filippi, M, Galimberti, D, Monastero, R, Muscio, C, Parnetti, L, Perani, D, Serra, L, Silani, V, Tiraboschi, P, Padovani, A, Alberici, A, Alberoni, M, Amici, S, Appollonio, I, Arena, M, Arighi, A, Avanzi, S, Bagella, C, Baglio, F, Barocco, F, Belardinelli, N, Bonuccelli, U, Bottini, G, Bruno Bossio, R, Bruno, G, Buccomino, D, Cacchiò, G, Calabrese, E, Campanelli, A, Canevelli, M, Canu, E, Cappa, A, Capra, C, Carapelle, E, Caratozzolo, S, Carbone, G, Cattaruzza, T, Cerami, C, Cester, A, Cheldi, A, Cherchi, R, Chiari, A, Cirafisi, C, Colao, R, Confaloni, A, Conti, M, Costa, A, Costa, B, Cotelli, M, Cova, I, Cravello, L, Cumbo, E, Cupidi, C, de Togni, L, Del Din, G, Del Re, M, Dentizzi, C, Di Lorenzo, F, Di Stefano, F, Dikova, N, Farina, E, Floris, G, Foti, A, Franceschi, M, Fumagalli, G, Gabelli, C, Ghidoni, E, Giannandrea, D, Giordana, M, Giorelli, M, Giubilei, F, Grimaldi, L, Grimaldi, R, Guglielmi, V, Lanari, A, Le Pira, F, Letteri, F, Levi Minzi, G, Lorusso, S, Ludovico, L, Luzzi, S, Maggiore, L, Magnani, G, Mancini, G, Manconi, F, Manfredi, L, Maniscalco, M, Marano, P, Marcon, M, Marcone, A, Marra, C, Martorana, A, Mascia, M, Mascia, V, Mauri, M, Mazzei, B, Meloni, M, Merlo, P, Messa, G, Milia, A, Monacelli, F, Montecalvo, G, Moschella, V, Mura, G, Nemni, R, Nobili, F, Notarelli, A, Di Giacomo, R, Onofrj, M, Paci, C, Padiglioni, C, Perini, M, Perotta, D, Perri, F, Perri, R, Piccininni, C, Piccoli, T, Pilia, G, Pilotto, A, Poli, S, Pomati, S, Pompanin, S, Pucci, E, Puccio, G, Quaranta, D, Rainero, I, Rea, G, Realmuto, S, Riva, M, Rizzetti, M, Rolma, G, Rozzini, L, Sacco, L, Saibene, F, Scarpini, E, Sensi, S, Seripa, D, Sinforiani, E, Sorbi, S, Sorrentino, G, Spallazzi, M, Stracciari, A, Talarico, G, Tassinari, T, Thomas, A, Tiezzi, A, Tomassini, P, Trebbastoni, A, Tremolizzo, L, Tripi, G, Ursini, F, Vaianella, L, Valluzzi, F, Vezzadini, G, Vista, M, Volontè, M, Bruni, Ac, DLB-SINdem study, Group, Bruni, AC, and Padovani, A - On behalf of DLB-SINdem study group

Subjects
Lewy Body Disease, medicine.medical_specialty, Pediatrics, Dementia with Lewy bodie, Dementia with Lewy bodies, Dermatology, Cohort Studies, Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Alzheimer Disease, Surveys and Questionnaires, mental disorders, Standardization of diagnostic procedures, Diagnosis, Survey, Disease Management, Humans, Italy, Research Design, 2708, Neurology (clinical), Psychiatry and Mental Health, medicine, Dementia, 030212 general & internal medicine, MED/01 - STATISTICA MEDICA, MED/26 - NEUROLOGIA, business.industry, Standardization of diagnostic procedure, General Medicine, medicine.disease, Settore MED/26 - NEUROLOGIA, Cohort, Differential, Physical therapy, Delirium, Alzheimer's disease, medicine.symptom, business, 030217 neurology & neurosurgery, Frontotemporal dementia, Cohort study
Abstract

Dementia with Lewy bodies (DLB) causes elevated outlays for the National Health Systems due to high institutionalization rate and patients' reduced quality of life and high mortality. Furthermore, DLB is often misdiagnosed as Alzheimer's disease. These data motivate harmonized multicenter longitudinal cohort studies to improve clinical management and therapy monitoring. The Italian DLB study group of the Italian Neurological Society for dementia (SINdem) developed and emailed a semi-structured questionnaire to 572 national dementia centers (from primary to tertiary) to prepare an Italian large longitudinal cohort. The questionnaire surveyed: (1) prevalence and incidence of DLB; (2) clinical assessment; (3) relevance and availability of diagnostic tools; (4) pharmacological management of cognitive, motor, and behavioural disturbances; (5) causes of hospitalization, with specific focus on delirium and its treatment. Overall, 135 centers (23.6 %) contributed to the survey. Overall, 5624 patients with DLB are currently followed by the 135 centers in a year (2042 of them are new patients). The percentage of DLB patients was lower (27 ± 8 %) than that of Alzheimer's disease and frontotemporal dementia (56 ± 27 %) patients. The majority of the centers (91 %) considered the clinical and neuropsychological assessments as the most relevant procedure for a DLB diagnosis. Nonetheless, most of the centers has availability of magnetic resonance imaging (MRI; 95 %), electroencephalography (EEG; 93 %), and FP-CIT single photon emission-computerized tomography (SPECT; 75 %) scan for clinical applications. It will be, therefore, possible to recruit a large harmonized Italian cohort of DLB patients for future cross-sectional and longitudinal multicenter studies.

Published
2017

26. Older HIV-infected adults: complex patients— geriatric syndromes (II)

Author

Bertagnoli, L., Iannuzzi, P., Ciccone, S., Canevelli, M., Marzetti, Emanuele, Guaraldi, G., Cesari, M., Marzetti E. (ORCID:0000-0001-9567-6983), Bertagnoli, L., Iannuzzi, P., Ciccone, S., Canevelli, M., Marzetti, Emanuele, Guaraldi, G., Cesari, M., and Marzetti E. (ORCID:0000-0001-9567-6983)

Abstract

With the widespread adoption of highly active antiretroviral therapy (HAART), HIV infection starts to be considered one of the many chronic illnesses of advanced age. A growing proportion of the affected patients is presently older than 50. It has been suggested that HIV infection may today represent a model of accelerated and accentuated ageing. The need for a closer collaboration between geriatricians and HIV physicians is being growingly recognised to better address the priorities and needs of HIV patients. The final aim behind the generation of such synergies resides in the design of personalised plans of interventions. These plans should stem from the results of a comprehensive assessment of the individual spanning clinical, environmental, and psychosocial domains. Through the early identification of stressors and risk factors potentially disrupting the homeostatic balance of frail patients (including those living with HIV), it might be possible to protect the “biologically old” (but not necessarily “chronologically old”) HIV-infected people from developing detrimental geriatric syndromes. In this article, specific features making the ageing HIV population of special interest for geriatric medicine, and the importance of a multidisciplinary model of care are described. The final objective is to stress how the only way for adequately tackling the multifaceted frailty condition of people with HIV is to implement novel models of care based on the comprehensive geriatric assessment.

Published
2019

27. Italian Frontotemporal Dementia Network (FTD Group-SINDEM): sharing clinical and diagnostic procedures in Frontotemporal Dementia in Italy

Author

Borroni, B, Turrone, R, Galimberti, D, Nacmias, B, Alberici, A, Benussi, A, Caffarra, P, Caltagirone, C, Cappa, S, Frisoni, G, Ghidoni, R, Marra, C, Padovani, A, Rainero, I, Scarpini, E, Silani, V, Sorbi, S, Tagliavini, F, Tremolizzo, L, Bruni, A, Agosta, F, Alberoni, M, Appollonio, I, Arighi, A, Avanzi, S, Baglio, F, Benussi, L, Bianchetti, A, Binetti, G, Bonanni, L, Bottacchi, E, Bruno, G, Canevelli, M, Canu, E, Cerami, C, Chiari, A, Conti, M, Costa, A, Costa, M, Cotelli, M, Cupidi, C, Daniele, A, D'Anna, S, de Caro, M, De Togni, L, Dell'Osa, M, Di Stefano, F, Ferrarese, C, Ferrari, C, Filastro, F, Floris, G, Franceschi, M, Gennuso, M, Ghidoni, E, Giordana, M, Gragnaniello, D, Grimaldi, L, Lanari, A, Le Pira, F, Lombardi, G, Lorusso, S, Ludovico, L, Luzzi, S, Magnani, G, Manfredi, L, Marano, P, Marcone, A, Marrosu, M, Martorana, A, Mascia, M, Masullo, C, Mauri, M, Mazzone, A, Mela, A, Merlo, P, Micheli, A, Milia, A, Mina, C, Montella, P, Mura, G, Murru, M, Nemni, R, Paci, C, Pantieri, R, Panza, F, Parnetti, L, Perini, M, Pettenati, C, Piccininni, M, Piccoli, T, Pilia, G, Pinessi, L, Piras, M, Realmuto, S, Ricca, I, Rizzetti, M, Rozzini, L, Rubino, E, Sambati, L, Seripa, D, Siano, P, Sinforiani, E, Sorrentino, G, Specchio, L, Stracciari, A, Susani, E, Talarico, G, Tartaglione, B, Tessitore, A, Thomas, A, Tiezzi, A, Tiraboschi, P, Tognoni, G, Tondelli, M, Trebbastoni, A, Turla, M, Ursini, F, Valluzzi, F, Vista, M, Zannino, G, Zanusso, G, Borroni B., Turrone R., Galimberti D., Nacmias B., Alberici A., Benussi A., Caffarra P., Caltagirone C., Cappa S. F., Frisoni G. B., Ghidoni R., Marra C., Padovani A., Rainero I., Scarpini E., Silani V., Sorbi S., Tagliavini F., Tremolizzo L., Bruni A. C., Agosta F., Alberoni M., Appollonio I., Arighi A., Avanzi S., Baglio F., Benussi L., Bianchetti A., Binetti G., Bonanni L., Bottacchi E., Bruno G., Canevelli M., Canu E., Cerami C., Chiari A., Conti M. Z., Costa A., Costa M., Cotelli M., Cotelli M. S., Cupidi C., Daniele A., D'Anna S., de Caro M. F., De Togni L., Dell'Osa M. T., Di Stefano F., Ferrarese C., Ferrari C., Filastro F., Floris G., Franceschi M., Gennuso M., Ghidoni E., Giordana M. T., Gragnaniello D., Grimaldi L., Lanari A., Le Pira F., Lombardi G., Lorusso S., Ludovico L., Luzzi S., Magnani G., Manfredi L. G., Marano P., Marcone A., Marrosu M. G., Martorana A., Mascia M. G., Masullo C., Mauri M., Mazzone A., Mela A., Merlo P., Micheli A., Milia A., Mina C., Montella P., Mura G., Murru M. R., Nemni R., Paci C., Pantieri R., Panza F., Parnetti L., Perini M., Pettenati C., Piccininni M., Piccoli T., Pilia G., Pinessi L., Piras M. R., Realmuto S., Ricca I., Rizzetti M. C., Rozzini L., Rubino E., Sambati L., Seripa D., Siano P., Sinforiani E., Sorrentino G., Specchio L. M., Stracciari A., Susani E., Talarico G., Tartaglione B., Tessitore A., Thomas A., Tiezzi A., Tiraboschi P., Tognoni G., Tondelli M., Trebbastoni A., Turla M., Ursini F., Valluzzi F., Vista M., Zannino G., Zanusso G., Borroni, B, Turrone, R, Galimberti, D, Nacmias, B, Alberici, A, Benussi, A, Caffarra, P, Caltagirone, C, Cappa, S, Frisoni, G, Ghidoni, R, Marra, C, Padovani, A, Rainero, I, Scarpini, E, Silani, V, Sorbi, S, Tagliavini, F, Tremolizzo, L, Bruni, A, Agosta, F, Alberoni, M, Appollonio, I, Arighi, A, Avanzi, S, Baglio, F, Benussi, L, Bianchetti, A, Binetti, G, Bonanni, L, Bottacchi, E, Bruno, G, Canevelli, M, Canu, E, Cerami, C, Chiari, A, Conti, M, Costa, A, Costa, M, Cotelli, M, Cupidi, C, Daniele, A, D'Anna, S, de Caro, M, De Togni, L, Dell'Osa, M, Di Stefano, F, Ferrarese, C, Ferrari, C, Filastro, F, Floris, G, Franceschi, M, Gennuso, M, Ghidoni, E, Giordana, M, Gragnaniello, D, Grimaldi, L, Lanari, A, Le Pira, F, Lombardi, G, Lorusso, S, Ludovico, L, Luzzi, S, Magnani, G, Manfredi, L, Marano, P, Marcone, A, Marrosu, M, Martorana, A, Mascia, M, Masullo, C, Mauri, M, Mazzone, A, Mela, A, Merlo, P, Micheli, A, Milia, A, Mina, C, Montella, P, Mura, G, Murru, M, Nemni, R, Paci, C, Pantieri, R, Panza, F, Parnetti, L, Perini, M, Pettenati, C, Piccininni, M, Piccoli, T, Pilia, G, Pinessi, L, Piras, M, Realmuto, S, Ricca, I, Rizzetti, M, Rozzini, L, Rubino, E, Sambati, L, Seripa, D, Siano, P, Sinforiani, E, Sorrentino, G, Specchio, L, Stracciari, A, Susani, E, Talarico, G, Tartaglione, B, Tessitore, A, Thomas, A, Tiezzi, A, Tiraboschi, P, Tognoni, G, Tondelli, M, Trebbastoni, A, Turla, M, Ursini, F, Valluzzi, F, Vista, M, Zannino, G, Zanusso, G, Borroni B., Turrone R., Galimberti D., Nacmias B., Alberici A., Benussi A., Caffarra P., Caltagirone C., Cappa S. F., Frisoni G. B., Ghidoni R., Marra C., Padovani A., Rainero I., Scarpini E., Silani V., Sorbi S., Tagliavini F., Tremolizzo L., Bruni A. C., Agosta F., Alberoni M., Appollonio I., Arighi A., Avanzi S., Baglio F., Benussi L., Bianchetti A., Binetti G., Bonanni L., Bottacchi E., Bruno G., Canevelli M., Canu E., Cerami C., Chiari A., Conti M. Z., Costa A., Costa M., Cotelli M., Cotelli M. S., Cupidi C., Daniele A., D'Anna S., de Caro M. F., De Togni L., Dell'Osa M. T., Di Stefano F., Ferrarese C., Ferrari C., Filastro F., Floris G., Franceschi M., Gennuso M., Ghidoni E., Giordana M. T., Gragnaniello D., Grimaldi L., Lanari A., Le Pira F., Lombardi G., Lorusso S., Ludovico L., Luzzi S., Magnani G., Manfredi L. G., Marano P., Marcone A., Marrosu M. G., Martorana A., Mascia M. G., Masullo C., Mauri M., Mazzone A., Mela A., Merlo P., Micheli A., Milia A., Mina C., Montella P., Mura G., Murru M. R., Nemni R., Paci C., Pantieri R., Panza F., Parnetti L., Perini M., Pettenati C., Piccininni M., Piccoli T., Pilia G., Pinessi L., Piras M. R., Realmuto S., Ricca I., Rizzetti M. C., Rozzini L., Rubino E., Sambati L., Seripa D., Siano P., Sinforiani E., Sorrentino G., Specchio L. M., Stracciari A., Susani E., Talarico G., Tartaglione B., Tessitore A., Thomas A., Tiezzi A., Tiraboschi P., Tognoni G., Tondelli M., Trebbastoni A., Turla M., Ursini F., Valluzzi F., Vista M., Zannino G., and Zanusso G.

Abstract

In the prospect of improved disease management and future clinical trials in Frontotemporal Dementia, it is desirable to share common diagnostic procedures. To this aim, the Italian FTD Network, under the aegis of the Italian Neurological Society for Dementia, has been established. Currently, 85 Italian Centers involved in dementia care are part of the network. Each Center completed a questionnaire on the local clinical procedures, focused on (1) clinical assessment, (2) use of neuroimaging and genetics; (3) support for patients and caregivers; (4) an opinion about the prevalence of FTD. The analyses of the results documented a comprehensive clinical and instrumental approach to FTD patients and their caregivers in Italy, with about 1,000 newly diagnosed cases per year and 2,500 patients currently followed by the participating Centers. In analogy to other European FTD consortia, future aims will be devoted to collect data on epidemiology of FTD and its subtypes and to provide harmonization of procedures among Centers.

Published
2015

28. Italian Frontotemporal Dementia Network (FTD Group-SINDEM): sharing clinical and diagnostic procedures in Frontotemporal Dementia in Italy

Author

Borroni B., Turrone R., Galimberti D., Nacmias B., Alberici A., Benussi A., Caffarra P., Caltagirone C., Cappa S. F., Frisoni G. B., Ghidoni R., Marra C., Padovani A., Rainero I., Scarpini E., Silani V., Sorbi S., Tagliavini F., Tremolizzo L., Bruni A. C., Agosta F., Alberoni M., Appollonio I., Arighi A., Avanzi S., Baglio F., Benussi L., Bianchetti A., Binetti G., Bonanni L., Bottacchi E., Bruno G., Canevelli M., Canu E., Cerami C., Chiari A., Conti M. Z., Costa A., Costa M., Cotelli M., Cotelli M. S., Cupidi C., Daniele A., D'Anna S., de Caro M. F., De Togni L., Dell'Osa M. T., Di Stefano F., Ferrarese C., Ferrari C., Filastro F., Floris G., Franceschi M., Gennuso M., Ghidoni E., Giordana M. T., Gragnaniello D., Grimaldi L., Lanari A., Le Pira F., Lombardi G., Lorusso S., Ludovico L., Luzzi S., Magnani G., Manfredi L. G., Marano P., Marcone A., Marrosu M. G., Martorana A., Mascia M. G., Masullo C., Mauri M., Mazzone A., Mela A., Merlo P., Micheli A., Milia A., Mina C., Montella P., Mura G., Murru M. R., Nemni R., Paci C., Pantieri R., Panza F., Parnetti L., Perini M., Pettenati C., Piccininni M., Piccoli T., Pilia G., Pinessi L., Piras M. R., Realmuto S., Ricca I., Rizzetti M. C., Rozzini L., Rubino E., Sambati L., Seripa D., Siano P., Sinforiani E., Sorrentino G., Specchio L. M., Stracciari A., Susani E., Talarico G., Tartaglione B., Tessitore A., Thomas A., Tiezzi A., Tiraboschi P., Tognoni G., Tondelli M., Trebbastoni A., Turla M., Ursini F., Valluzzi F., Vista M., Zannino G., Zanusso G., Piccoli, T, B. Borroni, R. Turrone, D. Galimberti, B. Nacmia, A. Alberici, A. Benussi, P. Caffarra, C. Caltagirone, S. F. Cappa, G. B. Frisoni, R. Ghidoni, C. Marra, A. Padovani, I. Rainero, E. Scarpini, V. Silani, S. Sorbi, F. Tagliavini, L. Tremolizzo, A. C. Bruni, The FTD Group-SINDEM, Borroni, B, Turrone, R, Galimberti, D, Nacmias, B, Alberici, A, Benussi, A, Caffarra, P, Caltagirone, C, Cappa, Sf, Frisoni, Gb, Ghidoni, R, Marra, C, Padovani, A, Rainero, I, Scarpini, E, Silani, V, Sorbi, S, Tagliavini, F, Tremolizzo, L, Bruni, Ac, The FTD, Group-SINDEM, Agosta, F, Cappa, S, Frisoni, G, Bruni, A, Alberoni, M, Appollonio, I, Arighi, A, Avanzi, S, Baglio, F, Benussi, L, Bianchetti, A, Binetti, G, Bonanni, L, Bottacchi, E, Bruno, G, Canevelli, M, Canu, E, Cerami, C, Chiari, A, Conti, M, Costa, A, Costa, M, Cotelli, M, Cupidi, C, Daniele, A, D'Anna, S, de Caro, M, De Togni, L, Dell'Osa, M, Di Stefano, F, Ferrarese, C, Ferrari, C, Filastro, F, Floris, G, Franceschi, M, Gennuso, M, Ghidoni, E, Giordana, M, Gragnaniello, D, Grimaldi, L, Lanari, A, Le Pira, F, Lombardi, G, Lorusso, S, Ludovico, L, Luzzi, S, Magnani, G, Manfredi, L, Marano, P, Marcone, A, Marrosu, M, Martorana, A, Mascia, M, Masullo, C, Mauri, M, Mazzone, A, Mela, A, Merlo, P, Micheli, A, Milia, A, Mina, C, Montella, P, Mura, G, Murru, M, Nemni, R, Paci, C, Pantieri, R, Panza, F, Parnetti, L, Perini, M, Pettenati, C, Piccininni, M, Pilia, G, Pinessi, L, Piras, M, Realmuto, S, Ricca, I, Rizzetti, M, Rozzini, L, Rubino, E, Sambati, L, Seripa, D, Siano, P, Sinforiani, E, Sorrentino, G, Specchio, L, Stracciari, A, Susani, E, Talarico, G, Tartaglione, B, Tessitore, A, Thomas, A, Tiezzi, A, Tiraboschi, P, Tognoni, G, Tondelli, M, Trebbastoni, A, Turla, M, Ursini, F, Valluzzi, F, Vista, M, Zannino, G, and Zanusso, G

Subjects
Counseling, Male, medicine.medical_specialty, Neurology, Network, Frontotemporal dementia, Frontotemporal lobar degeneration, Genetics, Survey, Aged, Aged, 80 and over, Caregivers, Female, Frontotemporal Dementia, Humans, Italy, Prevalence, Community Networks, Information Dissemination, Medicine (all), 2708, Neurology (clinical), Psychiatry and Mental Health, Dermatology, ddc:616.89, Caregivers/psychology, Epidemiology, mental disorders, medicine, 80 and over, Dementia, Disease management (health), Psychiatry, MED/26 - NEUROLOGIA, Italian network, FRONTO Temporal dementia, business.industry, Frontotemporal dementia, Frontotemporal lobar degeneration, Network, Survey, Genetics, Counseling, General Medicine, Frontotemporal Dementia/diagnosis/epidemiology, medicine.disease, Clinical trial, Settore MED/26 - Neurologia, Neurosurgery, business
Abstract

In the prospect of improved disease management and future clinical trials in Frontotemporal Dementia, it is desirable to share common diagnostic procedures. To this aim, the Italian FTD Network, under the aegis of the Italian Neurological Society for Dementia, has been established. Currently, 85 Italian Centers involved in dementia care are part of the network. Each Center completed a questionnaire on the local clinical procedures, focused on (1) clinical assessment, (2) use of neuroimaging and genetics; (3) support for patients and caregivers; (4) an opinion about the prevalence of FTD. The analyses of the results documented a comprehensive clinical and instrumental approach to FTD patients and their caregivers in Italy, with about 1,000 newly diagnosed cases per year and 2,500 patients currently followed by the participating Centers. In analogy to other European FTD consortia, future aims will be devoted to collect data on epidemiology of FTD and its subtypes and to provide harmonization of procedures among Centers.

Published
2014

29. The Italian Dementia National Plan. Commentary

Author

Di Fiandra, T, Canevelli, M, Di Pucchio, A, Vanacore, N, Italian Dementia National Plan, W. G, Corti, Mc, Chiodini, M, Trequattrini, A, Lombardi, A, Gilli, M, Trambusti, B, Vassalle, A, Giordano, M, Pomo, V, Scarcali, G, Vitale, R, Lagalla, G, Di Furia, L, Petrali, R, Bersani, M, Mancardi, GIOVANNI LUIGI, Zammitti, P, Scalmana, S, Agnoletto, A, Carafelli, A, Fabrizio, R, Fabbo, A, Greco, A, Bruni, A, Desideri, G, Angeli, G, Spadin, P, Salvini Porro, G, Possenti, M, Bartorelli, L, Ruocco, G, Guerra, R, Malara, P, and Pisanti, P.

Subjects
Aged, 80 and over, dementia, alzheimer’s disease, national plan, public health, national strategies, Health Policy, Social Support, Caregivers, Italy, Quality of Life, Humans, Dementia, Aged
Abstract

The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1) promote health- and social-care interventions and policies; 2) create/strengthen the integrated network of services for dementia based on an integrated approach; 3) implement strategies for promoting appropriateness and quality of care; and 4) improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

Published
2016

30. Predicting the Rate of Cognitive Decline in Alzheimer Disease: Data From the ICTUS Study

Author

Canevelli, M, Kelaiditi, E, del Campo, N, Bruno, G, Vellas, B, Cesari, M, Salvà A., and Coley, Nicola

Subjects
aging, prediction models, longitudinal studies, Alzheimer disease, cognitive decline
Abstract

Background:Different rates of cognitive progression have been observed among Alzheimer disease (AD) patients. The present study aimed at evaluating whether the rate of cognitive worsening in AD may be predicted by widely available and easy-to-assess factors.Methods:Mild to moderate AD patients were recruited in the ICTUS study. Multinomial logistic regression analysis was performed to measure the association between several sociodemographic and clinical variables and 3 different rates of cognitive decline defined by modifications (after 1 year of follow-up) of the Mini Mental State Examination (MMSE) score: (1) slow progression, as indicated by a decrease in the MMSE score 1 point; (2) intermediate progression, decrease in the MMSE score between 2 and 5 points; and (3) rapid progression, decrease in the MMSE score 6 points.Results:A total of 1005 patients were considered for the present analyses. Overall, most of the study participants (52%) exhibited a slow cognitive course. Higher ADAS-Cog scores at baseline were significantly associated with both intermediate and rapid decline. Conversely, increasing age was negatively associated with rapid cognitive worsening.Conclusions:A slow progression of cognitive decline is common among AD patients. The influence of age and baseline cognitive impairment should always be carefully considered when designing AD trials and defining study populations.

Published
2016

31. Geriatric syndromes: How to treat

Author

Cesari, M., Marzetti, Emanuele, Canevelli, M., Guaraldi, G., Marzetti E. (ORCID:0000-0001-9567-6983), Cesari, M., Marzetti, Emanuele, Canevelli, M., Guaraldi, G., and Marzetti E. (ORCID:0000-0001-9567-6983)

Abstract

The survival of HIV-infected persons has been increasing over the last years, thanks to the implementation of more effective pharmacological and non-pharmacological interventions. Nevertheless, HIV-infected persons are often “biologically” older than their “chronological” age due to multiple clinical, social, and behavioral conditions of risk. The detection in this population of specific biological features and syndromic conditions typical of advanced age has made the HIV infection an interesting research model of accelerated and accentuated aging. Given such commonalities, it is possible that “biologically aged” HIV-positive persons might benefit from models of adapted and integrated care developed over the years by geriatricians for the management of their frail and complex patients. In this article, possible strategies to face the increasingly prevalent geriatric syndromes in HIV-infected persons are discussed. In particular, it is explained the importance of shifting from the traditional disease-oriented approach into models of care facilitating a multidisciplinary management of frailty.

Published
2017

32. Effects of Gingko biloba supplementation in Alzheimer's disease patients receiving cholinesterase inhibitors: Data from the ICTUS study

Author

Canevelli, M, Adali, N, Kelaiditi, E, Cantet, C, Ousset, PJ, Cesari, M, Salvà A., and ICTUS DSA Grp

Subjects
Cognitive impairment, Ginkgo biloba, Cholinesterase inhibitors, Alzheimer's disease
Abstract

Ginkgo biloba (Gb) is currently the most investigated and adopted herbal remedy for cognitive disorders and Alzheimer's disease (AD). Nevertheless, its efficacy in the prevention and treatment of dementia still remains controversial. Specifically, the added effects of Gb in subjects already receiving "conventional" anti-dementia treatments have been to date very scarcely investigated. We evaluated whether the use of Gb is associated with additional cognitive and functional benefit in AD patients already in treatment with cholinesterase inhibitors (ChEIs). Data are from mild to moderate AD patients under ChEI treatment recruited in the Impact of Cholinergic Treatment USe (ICTUS) study. Mixed model analyses were performed to measure six-monthly modifications in the Mini Mental State Examination (MMSE), the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score, and the Activities of Daily Living (ADL) scale over a follow-up of 1 year according to the additional Gb supplementation. A total of 828 subjects were considered for the present analyses. Significantly different modifications at the MMSE score over the 12-month follow-up were reported between patients on combined therapy compared to those only taking ChEIs. On the contrary, the modification of the ADAS-Cog score between the two groups did not show statistically significant differences, although similar trends were noticed. No significant modifications of the two adopted outcome measures were observed at the mid-term 6-month evaluation. The modifications over time of the ADL score did not show statistically significant differences between the two groups of interest. Our findings suggest that Gb may provide some added cognitive benefits in AD patients already under ChEIs treatment. The clinical meaningfulness of such effects remains to be confirmed and clarified. (C) 2014 Elsevier GmbH. All rights reserved.

Published
2014

33. Impact of behavioral subsyndromes on cognitive decline in Alzheimer's disease: data from the ICTUS study

Author

Canevelli, M., Adali, N., Cantet, C., Andrieu, S., Bruno, G., Cesari, M., Vellas, B., Olde Rikkert, M., Rigaud, A.S., et al., Canevelli, M., Adali, N., Cantet, C., Andrieu, S., Bruno, G., Cesari, M., Vellas, B., Olde Rikkert, M., Rigaud, A.S., and et al.

Abstract

Item does not contain fulltext, Behavioral and psychological symptoms of dementia (BPSD) represent common manifestations among patients affected by Alzheimer's disease (AD). Some reports have recently classified BPSD into specific clusters/subsyndromes exploring the internal structure of the Neuropsychiatric Inventory (NPI). We evaluated whether specific behavioral subsyndromes are associated with worsening cognitive function. Mild to moderate AD patients were recruited from the cohort of the Impact of Cholinergic Treatment USe (ICTUS) study. Neuropsychiatric symptoms were classified in three subsyndromes, identified at baseline, grouping different combinations of NPI items: (1) "psychotic" ("delusions" and/or "hallucinations"); (2) "affective" ("agitation" and/or "depression" and/or "anxiety" and/or "irritability"); and (3) "behavioral" ("euphoria" and/or "apathy" and/or "disinhibition" and/or "aberrant motor behavior"). Mixed model analyses were performed to measure six-monthly changes in the ADAS-Cog score over a follow-up of 2 years, according to these subsyndromes. All analyses were stratified according to AD severity as defined by the Clinical Dementia Rating (CDR). A total of 1,375 AD subjects were recruited. No NPI cluster was found to significantly (p < 0.05) affect the rate of cognitive decline across the 3 CDR classes. Our results suggest that the cognitive course of AD is not substantially influenced by the presence of specific neuropsychiatric phenotypes. Further studies are needed to extend the present findings and identify possible biological and clinical bases for behavioral subsyndromes.

Published
2013

36. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group.

Author

Kelaiditi, Eirini, Cesari, M., Canevelli, M., van Kan, G.A., Ousset, P.J., Gillette-Guyonnet, S., Ritz, P., Duveau, F., Soto, M.E., Provencher, V., Nourhashemi, F., Salva, A., Robert, P., Andrieu, S., Rolland, Y., Touchon, J., Fitten, J.L., Vellas, B., IANA/IAGG, Kelaiditi, Eirini, Cesari, M., Canevelli, M., van Kan, G.A., Ousset, P.J., Gillette-Guyonnet, S., Ritz, P., Duveau, F., Soto, M.E., Provencher, V., Nourhashemi, F., Salva, A., Robert, P., Andrieu, S., Rolland, Y., Touchon, J., Fitten, J.L., Vellas, B., and IANA/IAGG

Abstract

The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. in parallel, dementia and cognitive disorders also represent major healthcare and social priorities. although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. an international Consensus Group on “Cognitive Frailty” was organized by the international academy on nutrition and aging (i.a.n.a) and the international association of Gerontology and Geriatrics (i.a.G.G) on april 16th, 2013 in toulouse (France). the present report describes the results of the Consensus Group and provides the first definition of a “Cognitive Frailty” condition in older adults. specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. the consensus panel proposed the identification of the so-called “cognitive frailty” as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. in particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (Cdr=0.5); and 2) exclusion of concurrent ad dementia or other dementias. under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. a potential for reversibility may also characterize this entity. a psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.

37. Patient-reported outcomes in sarcopenia: An ICFSR task force report.

Author

Beaudart C, Cella D, Fielding RA, Rolland Y, Vellas B, and Canevelli M

Subjects
Humans, Frailty diagnosis, Aged, Quality of Life, Sarcopenia diagnosis, Sarcopenia therapy, Patient Reported Outcome Measures, Advisory Committees
Abstract

The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force convened in March 2024 to address patient-reported outcomes measures (PROMs) in the field of sarcopenia. PROMs are crucial to enhance healthcare services at both individual and societal levels. PROMs complement objective outcome measures by capturing insights that patients are best suited to judge. In recent years, there has been an increase in the recognition of PROMs' importance within clinical trials by pharmaceutical industries and regulatory agencies. Consequently, it has become imperative to develop valid and reliable tools tailored to capture various aspects of patient's experience and health status. This report aims to present the state-of-the-art available and validated PROMs for sarcopenia that can be used within clinical settings by various stakeholders, and to highlight several research gaps and barriers that need to be addressed to expedite and improve the use of these outcome measures within the context of clinical trials., Competing Interests: Conflict of interest Charlotte Beaudart and Yves Rolland are stakeholders of SARQOL SRL, a spin-off of the University of Belgium, in charge of the interests of SarQoL, a specific health-related quality of life questionnaire for sarcopenia. However, they have never received any financial compensation for this role. Roger A. Fielding is partially supported by the US Department of Agriculture (USDA), under agreement No. 58–8050–9–004, by NIH Boston Claude D. Pepper Center (OAIC; 1P30AG031679). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the USDA. RAF reports grant support from Lonza, Biophytis, National Institutes of Health, and USDA, scientific advisory board membership for Biophytis, Amazentis, Inside Tracker, Rejuventate Biomed, Aging in Motion, consultancies for Embion, Biophytis, Amazentis, Pfizer, Nestle, Rejuvenate Biomed. David Cella is an uncompensated board member of the PROMIS Health Organization, a nonprofit organization dedicated to education about and advancement of PROMIS. Johannes Grillari is co-founder and scientific advisor of Rockfish Bio AG, Vienna, Austria. Other authors did not report any other conflicts of interest., (Copyright © 2024. Published by Elsevier Masson SAS.)

Published
2025
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38. Assessment and management of frailty in individuals living with dementia: expert recommendations for clinical practice.

Author

Borda MG, Landi F, Cederholm T, Venegas-Sanabria LC, Duque G, Wakabayashi H, Barreto GE, Rodriguez-Sanchez I, Canevelli M, Cano-Gutierrez C, Pérez-Zepeda MU, Wallace L, Rockwood K, Salas-Carrillo M, Gjestsen M, Testad I, Ballard C, and Aarsland D

Subjects
Humans, Geriatric Assessment methods, Aged, Frail Elderly psychology, Quality of Life, Nutritional Status, Practice Guidelines as Topic, Dementia therapy, Dementia psychology, Frailty diagnosis
Abstract

Frailty complicates the care of individuals with dementia, increasing their vulnerability to adverse outcomes. This Personal View presents expert recommendations for managing frailty in individuals with dementia, aimed at health-care providers, particularly those in primary care. We conducted a rapid literature review followed by a consensus process involving 18 international experts on dementia and frailty. The experts identified key areas, including diagnosis of frailty, assessment of nutritional status and nutritional management, physical activity, prevention of falls, and polypharmacy management. The recommendations emphasise early identification of frailty and a comprehensive, interdisciplinary approach to care that aims to maintain the individual's daily functioning, quality of life, and independence. The recommendations highlight the importance of tailored interventions, regular monitoring, and the integration of psychosocial support into the therapeutic approach. These recommendations address a crucial gap in existing clinical guidelines, offering practical guidance for clinicians managing frailty in individuals with dementia., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Published
2025
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39. Neuropsychological Effects of the Lockdown Due to the COVID-19 Pandemic on Patients with Alzheimer's Disease and Their Caregivers: The "ACQUA" (Alzheimer-COVID QUArantine Questionnaire) Study.

Author

Trebbastoni A, Margiotta R, D'Antonio F, Barbetti S, Canevelli M, Diana S, Di Vita A, Imbriano L, Sepe Monti M, Talarico G, Guariglia C, and Bruno G

Subjects
Humans, Male, Female, Aged, Surveys and Questionnaires, Aged, 80 and over, Middle Aged, SARS-CoV-2, Social Isolation psychology, Pandemics, Cognition, COVID-19 psychology, Alzheimer Disease psychology, Caregivers psychology, Quality of Life, Quarantine psychology
Abstract

Background: The lockdown due to the COVID-19 pandemic, imposed in many countries in 2021, led to social isolation and the interruption of many activities that were useful in stimulating cognition. The impact of these changes has been particularly severe in older subjects with cognitive impairment., Methods: The present study aimed to investigate the effects of lockdown on Alzheimer's disease patients (in cognition, behavior, and autonomy) and on their caregivers (in emotions, burden, and quality of life). We created a questionnaire and performed an extensive semi-structured telephone interview with each caregiver. The main outcomes were (1) changes in cognitive and behavioral symptoms and autonomy levels in the patients and (2) effects on caregivers' emotions, burden, and quality of life., Results: The lockdown severely impaired patients' cognition and independence and worsened behavioral and psychological symptoms of dementia. These effects contributed to increasing caregivers' burden and stress levels, with a significant perceived deterioration in quality of life among caregivers with higher education levels ( p = 0.047)., Conclusions: This study might contribute to our understanding of the impact of lockdown on Alzheimer's disease patients and their caregivers, to guide future public health interventions aimed at preventing and/or reducing the consequences of similar extraordinary events in frail subjects.

Published
2024
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40. Identification of research gaps to improve care for healthy ageing: a scoping review .

Author

Cesari M, Canevelli M, Amuthavalli Thiyagarajan J, Choi SE, Grushevska P, Kumar S, Chen M, Jang H, Sumi Y, and Banerjee A

Subjects
Humans, Quality Improvement, Evidence Gaps, Healthy Aging
Abstract

Objective: Several research gaps affect the improvement of care for healthy ageing. Their identification is crucial to developing a specific research prioritisation agenda supporting progress at the micro (clinical), meso (service delivery) and macro (system) levels. To achieve this, a scoping review was carried out to describe the most significant gaps impeding the improvement of care for healthy ageing., Design: A scoping review of the literature was conducted according to the Joanna Briggs Institute methodology. The selected articles were analysed to identify topics or areas essential for improving care for healthy ageing but requiring further support from research., Eligibility Criteria: Every type of scientific article, except for randomised controlled trials, was considered of potential interest without restrictions on publication date, type of publication and methodology., Information Sources: A systematic search (last search: 6 December 2023) was conducted using PubMed, MEDLINE and Scopus., Results: Overall, 1558 articles were retrieved from the literature. Of these, 310 were finally retained for this work. A total of 1195 research gaps were identified (average: 3.85 per article) and clustered into the 13 primary areas: ageing, care approach, caregivers, health economics, health, interventions, policies, research, settings, training, technology, specific populations and understanding the older person. In particular, research for improving the person-centred approach (n=38), better considering cultural diversities (n=27), implementing integrated care (n=25) and ensuring access to care (n=25) were the most prevalent priorities reported in the literature., Conclusions: A wide range of factors spanning multiple disciplines, from clinical to policy levels, require special consideration, exploration and resolution. The findings of this scoping review represent an essential step in identifying gaps for developing a research prioritisation agenda to improve care for healthy ageing., Competing Interests: Competing interests: None declared., (© World Health Organization 2024. Licensee BMJ.)

Published
2024
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41. Dementia among migrants in Italy: a qualitative study of the ImmiDem project.

Author

Di Nolfi A, Giusti A, Canevelli M, Vanacore N, Pomati S, Cova I, Ancidoni A, Marchetti F, and Zambri F

Subjects
Humans, Italy, Female, Male, Focus Groups, Middle Aged, Aged, Dementia psychology, Dementia therapy, Qualitative Research, Transients and Migrants psychology, Caregivers psychology
Abstract

Introduction: In recent years, the number of migrants referred to centres for cognitive disorders and dementias has increased. The aim of this study was to provide information on the provision of care for migrants with dementia through the perceptions and experiences of the professionals and caregivers involved., Methods: The study is an exploratory qualitative research. Between 2020 and 2021, three focus group, involving caregiver and professionals were organized., Results: The study explored several areas of care provision including needs, cultural representation of dementia, strengths and weaknesses and opportunities for improvement in care provision., Discussion and Conclusions: The perceptions of people directly involved in dementia care provide critical insights into the functioning of the care system, capturing nuances that standard care practices may overlook. Disorientation between services, language barriers and cultural representations of the disease are the main obstacles to continuity of care. A more holistic approach, which also addresses the emotional and social implications of dementia, is essential in ensuring equitable, timely and culturally sensitive care.

Published
2024
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42. Sex-specific clinical and neurobiological correlates of fatigue in older adults.

Author

Toccaceli Blasi M, Alfano AR, Salzillo M, Buscarnera S, Raparelli V, Cesari M, Bruno G, and Canevelli M

Abstract

Fatigue is a common and distressful symptom in older people and has been associated with adverse health outcomes. Nevertheless, its sex-specific pathophysiological underpinnings and clinical correlates have been scarcely investigated. We aimed to comprehensively explore the clinical and neurobiological determinants of fatigue in cognitively unimpaired older adults. A sex-stratified analysis was conducted to look for differences in the clinical expression of fatigue among women and men. Data on cognitively normal individuals were gathered from the Alzheimer's Disease Neuroimaging Initiative (ADNI) 2 study. Fatigue was defined based on self-report at baseline. For each participant, information on sociodemographics, comorbidities, mood, cognitive performance, frailty, and biomarkers of brain pathology was collected. Logistic regression models, stratified by sex, were conducted to explore the factors associated with fatigue. Among the 291 participants selected, 44 subjects (15.1% of the total sample) self-reported fatigue at baseline. Subjects reporting fatigue were more likely women, had higher frailty degrees, and more severe depressive symptoms than those without fatigue. Moreover, they tended to have lower MRI hippocampus volumes. Among women, those reporting fatigue exhibited higher frailty levels, worse depression, and lower MRI hippocampus volumes relative to those without fatigue. Higher frailty degrees were also observed in men reporting vs. non-reporting fatigue. In the adjusted logistic regression model, more severe depression (OR 1.64, 95% CI 1.18-2.28; p < 0.01) and lower MRI hippocampus volumes (OR 0.41, 95% CI 0.19-0.90; p = 0.03) resulted independently associated with fatigue in women, while higher frailty degrees (OR 3.10, 95% CI 1.27-7.54 per 0.1 increase in a 39-item Frailty index; p = 0.01) in men. Fatigue is a complex symptom with a sex-specific pattern of clinical and neurobiological correlates. A better understanding of the underlying mechanisms of these associations is warranted to develop sex-informed approaches for personalized treatments., (© 2024. World Health Organization.)

Published
2024
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44. Blood biomarkers of Alzheimer's disease in the community: Variation by chronic diseases and inflammatory status.

Author

Valletta M, Vetrano DL, Rizzuto D, Winblad B, Canevelli M, Andersson S, Dale M, Fredolini C, Fratiglioni L, and Grande G

Subjects
Humans, Female, Male, Aged, Chronic Disease, Sweden epidemiology, Aged, 80 and over, Glial Fibrillary Acidic Protein blood, Neurofilament Proteins blood, Alzheimer Disease blood, Biomarkers blood, Inflammation blood, Interleukin-6 blood, tau Proteins blood
Abstract

Introduction: We explored the variations of blood biomarkers of Alzheimer's disease (AD) by chronic diseases and systemic inflammation., Methods: We explored the association of AD blood biomarkers with chronic diseases and systemic inflammation (interleukin-6 [IL-6]), in 2366 dementia-free participants of the Swedish National Study on Aging and Care-in Kungsholmen, using quantile regression models., Results: A greater number of co-occurring chronic diseases was associated with higher concentrations of phosphorylated-tau 181 (p-tau181), total-tau (t-tau), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) (p < 0.01). Anemia, kidney, cerebrovascular, and heart diseases were associated with variations in the levels of AD blood biomarkers. Participants in the highest (vs. lowest) interleukin-6 (IL-6) tertile had higher NfL concentration. Systemic inflammation amplified the associations between several chronic diseases and p-tau181, t-tau, NfL, and GFAP., Discussion: In the community, the concentration of AD blood biomarkers varies in relation to medical conditions and systemic inflammation. Recognizing these influences is crucial for the accurate interpretation and clinical implementation of blood biomarkers., Highlights: Participants with a complex clinical profile (i.e., multiple co-occurring diseases or specific disease combinations) display elevated levels of AD blood-biomarkers. Anemia, heart, cerebrovascular, and kidney diseases are associated with variations is the levels of AD blood biomarkers in cognitively intact older adults. Systemic inflammation amplifies the association between several chronic diseases and AD blood biomarkers., (© 2024 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Published
2024
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45. Frailty as a comprehensive health measure beyond seizure control in patients with epilepsy: A cross-sectional study.

Author

Cerulli Irelli E, Borioni MS, Morano A, Mazzeo A, Moro P, Orlando B, Salamone EM, Giordano L, Petrungaro A, Toccaceli Blasi M, Giallonardo AT, Canevelli M, and Di Bonaventura C

Subjects
Humans, Male, Female, Cross-Sectional Studies, Middle Aged, Adult, Quality of Life, Seizures drug therapy, Aged, Frailty diagnosis, Epilepsy drug therapy, Epilepsy diagnosis, Anticonvulsants therapeutic use
Abstract

Objective: Due to the high clinical heterogeneity of epilepsy, there is a critical need for novel metrics aimed at capturing its biological and phenotypic complexity. Frailty is increasingly recognized in various medical disciplines as a useful construct to understand differences in susceptibility to adverse outcomes. Here, we develop a frailty index (FI) for patients with epilepsy (PwE) and explore its association with demographic and clinical features., Methods: In this cross-sectional study, we consecutively enrolled 153 PwE from an outpatient epilepsy clinic. Participants were assessed for various health deficits to calculate the FI. Associations between FI and demographic/clinical features, antiseizure medications (ASMs), and patient-reported outcomes were analyzed using general linear models and Spearman correlation., Results: The median age at the time of study visit was 47 years (interquartile range = 33-60), and 89 (58.2%) patients were females. Multiple linear regression revealed that the developed 33-item FI showed an independent association with age, female sex, higher body mass index, family history of epilepsy, intellectual disability, and the number of ASMs used. A robust analysis of covariance showed higher FI levels in patients using cytochrome P450 3A4-inducer ASMs. We found a moderate positive correlation between FI and psychological distress, lower quality of life, and physical frailty, measured by the Hospital Anxiety and Depression Scale, Quality of Life in Epilepsy Inventory-10, and handgrip strength, respectively. Finally, a weak association was observed between higher FI scores and an increased number of epileptic falls., Significance: This study highlights the significance of frailty as a comprehensive health measure in epilepsy. It suggests that frailty in this specific population is not only a manifestation of aging but is inherently linked to epilepsy and treatment-related factors. Future research is warranted to validate and refine the FI in diverse epilepsy populations and investigate its impact on specific adverse outcomes in longitudinal studies., (© 2024 International League Against Epilepsy.)

Published
2024
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46. Childhood Trauma, Mentalization and Obsessive Compulsive Symptoms in a Non-Clinical Sample: A Mediation Analysis Study.

Author

De Rossi E, Imperatori C, Sciancalepore F, Prevete E, Maraone A, Canevelli M, Tarsitani L, Pasquini M, Farina B, and Bersani FS

Abstract

Objective: Obsessive and compulsive symptoms (OCS) are cross-cutting psychopathological manifestations frequently detected in a variety of clinical and non-clinical samples. It has been suggested that impaired mentalization abilities and traumatic experiences during childhood may be relevant etiopathogenetic factors in the development of OCS. The purpose of the current study was to cross-sectionally assess these variables in a non-clinical sample, testing the mediational role of mentalization abilities in the association between childhood trauma (CT) and OCS., Method: 667 participants (488 females; mean age= 29.76 ± 11.87 years; age range: 18-80) answered a survey including the Childhood Trauma Questionnaire, the Mentalization Questionnaire and the Obsession-Compulsion subscale of the Brief Symptom Inventory., Results: The mediation model was significant for the total effect (p< .001), showing that CT was positively associated with OCS (95% CI: .006; .019) and that this association was mediated by reduced levels of mentalization capacity (95% CI: .003; .009). Such results were significant controlling for potential sociodemographic and clinical confounding variables., Conclusions: The findings contribute to elucidate the complex relationships between CT, mentalization capacity, and OCS, supporting the possibility that mentalization impairments, arising from CT, may affect top-down control mechanisms thus contributing to the development of OCS., Competing Interests: Competing interests: None., (© 2024 Giovanni Fioriti Editore s.r.l.)

Published
2024
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47. Association of mild and complex multimorbidity with structural brain changes in older adults: A population-based study.

Author

Valletta M, Vetrano DL, Calderón-Larrañaga A, Kalpouzos G, Canevelli M, Marengoni A, Laukka EJ, and Grande G

Subjects
Humans, Aged, Aging pathology, Magnetic Resonance Imaging, Sweden epidemiology, Multimorbidity, Brain diagnostic imaging, Brain pathology
Abstract

Introduction: We quantified the association of mild (ie, involving one or two body systems) and complex (ie, involving ≥3 systems) multimorbidity with structural brain changes in older adults., Methods: We included 390 dementia-free participants aged 60+ from the Swedish National Study on Aging and Care in Kungsholmen who underwent brain magnetic resonance imaging at baseline and after 3 and/or 6 years. Using linear mixed models, we estimated the association between multimorbidity and changes in total brain tissue, ventricular, hippocampal, and white matter hyperintensities volumes., Results: Compared to non-multimorbid participants, those with complex multimorbidity showed the steepest reduction in total brain (β*time -0.03, 95% CI -0.05, -0.01) and hippocampal (β*time -0.05, 95% CI -0.08, -0.03) volumes, the greatest ventricular enlargement (β*time 0.03, 95% CI 0.01, 0.05), and the fastest white matter hyperintensities accumulation (β*time 0.04, 95% CI 0.01, 0.07)., Discussion: Multimorbidity, particularly when involving multiple body systems, is associated with accelerated structural brain changes, involving both neurodegeneration and vascular pathology., Highlights: Multimorbidity accelerates structural brain changes in cognitively intact older adults These brain changes encompass both neurodegeneration and cerebrovascular pathology The complexity of multimorbidity is associated with the rate of brain changes' progression., (© 2024 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Published
2024
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48. Neuropathological hints from CSF and serum biomarkers in corticobasal syndrome (CBS): a systematic review.

Author

Remoli G, Schilke ED, Magi A, Ancidoni A, Negro G, Da Re F, Frigo M, Giordano M, Vanacore N, Canevelli M, Ferrarese C, Tremolizzo L, and Appollonio I

Abstract

Corticobasal syndrome (CBS) is a clinical syndrome determined by various underlying neurodegenerative disorders requiring a pathological assessment for a definitive diagnosis. A literature review was performed following the methodology described in the Cochrane Handbook for Systematic Reviews to investigate the additional value of traditional and cutting-edge cerebrospinal fluid (CSF) and serum/plasma biomarkers in profiling CBS. Four databases were screened applying predefined inclusion criteria: (1) recruiting patients with CBS; (2) analyzing CSF/plasma biomarkers in CBS. The review highlights the potential role of the association of fluid biomarkers in diagnostic workup of CBS, since they may contribute to a more accurate diagnosis and patient selection for future disease-modifying agent; for example, future trial designs should consider baseline CSF Neurofilament Light Chains (NfL) or progranulin dosage to stratify treatment arms according to neuropathological substrates, and serum NfL dosage might be used to monitor the evolution of CBS. In this scenario, prospective cohort studies, starting with neurological examination and neuropsychological tests, should be considered to assess the correlations of clinical profiles and various biomarkers., (© 2024. The Author(s).)

Published
2024
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49. Frailty is associated with the clinical expression of neuropsychological deficits in older adults.

Author

Canevelli M, Wallace LMK, Bruno G, Cesari M, Rockwood K, and Ward DD

Subjects
Humans, Female, Aged, Male, Cross-Sectional Studies, Cognition, Neuropsychological Tests, Alzheimer Disease complications, Frailty complications, Frailty psychology, Cognitive Dysfunction psychology
Abstract

Background and Purpose: The aim was to determine whether frailty is associated with the relationship between neuropsychological markers and global cognition in older adults., Methods: Cross-sectional analyzes were conducted of baseline data from three large cohort studies: National Alzheimer's Coordinating Center (NACC), Rush Memory and Aging Project (MAP) and Alzheimer's Disease Neuroimaging Initiative (ADNI). Studies recruited North American participants along the spectrum of cognitive functioning (44% no cognitive impairment at baseline). A frailty index was computed in each dataset. Frailty indices, neuropsychological tests (including measures of processing speed, episodic, semantic and working memory) and Mini-Mental State Examination (MMSE) scores were the variables of interest, with age, sex, education and apolipoprotein E ε4 evaluated as confounders., Results: Across all studies, 23,819 participants aged 55-104 (57% female) were included in analyzes. Frailty index scores were significantly and inversely associated with MMSE scores and significantly moderated relationships between neuropsychological test scores and MMSE scores. In participants with higher frailty index scores, lower neuropsychological test scores were more strongly associated with lower MMSE scores (standardized interaction coefficients ranged from -0.19 to -1.17 in NACC, -0.03 to -2.27 in MAP and -0.04 to -0.38 in ADNI, depending on the neuropsychological test). These associations were consistent across the different databases and were mostly independent of the composition of frailty indices (i.e., after excluding possible symptoms of dementia)., Conclusions: Amongst older Americans, frailty is associated with the cognitive expression of neuropsychological deficits. Implementation of frailty assessment in routine neurological and neuropsychological practice should be considered to optimize care outcomes for older adults., (© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Published
2024
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50. Multimorbidity patterns and 18-year transitions from normal cognition to dementia and death: A population-based study.

Author

Valletta M, Vetrano DL, Xia X, Rizzuto D, Roso-Llorach A, Calderón-Larrañaga A, Marengoni A, Laukka EJ, Canevelli M, Bruno G, Fratiglioni L, and Grande G

Subjects
Humans, Aged, Multimorbidity, Cognition, Chronic Disease, Dementia epidemiology, Dementia diagnosis, Cognitive Dysfunction, Neoplasms
Abstract

Background: Several chronic diseases accelerate cognitive decline; however, it is still unknown how different patterns of multimorbidity influence individuals' trajectories across the cognitive continuum., Objectives: We aimed to investigate the impact of multimorbidity and of specific multimorbidity patterns on the transitions across cognitive stages (normal cognition, cognitive impairment, no dementia [CIND], dementia) and death., Methods: We included 3122 dementia-free individuals from the Swedish National study on Aging and Care in Kungsholmen. Using fuzzy c-means cluster analysis, multimorbid participants were classified into mutually exclusive groups characterized by commonly coexisting chronic diseases. Participants were followed up to 18 years to detect incident CIND, dementia, or death. Transition hazard ratios (HRs), life expectancies, and time spent in different cognitive stages were estimated using multistate Markov models., Results: At baseline, five multimorbidity patterns were identified: neuropsychiatric, cardiovascular, sensory impairment/cancer, respiratory/metabolic/musculoskeletal, and unspecific. Compared to the unspecific pattern, the neuropsychiatric and sensory impairment/cancer ones showed reduced hazards of reverting from CIND to normal cognition (HR 0.53, 95% CI 0.33-0.85 and HR 0.60, 95% CI 0.39-0.91). Participants in the cardiovascular pattern exhibited an increased hazard of progression from CIND to dementia (HR 1.70, 95% CI 1.15-2.52) and for all transitions to death. Subjects with the neuropsychiatric and cardiovascular patterns showed reduced life expectancy at age 75, with an anticipation of CIND (up to 1.6 and 2.2 years, respectively) and dementia onset (up to 1.8 and 3.3 years, respectively)., Conclusions: Multimorbidity patterns differentially steer individual trajectories across the cognitive continuum of older adults and may be used as a risk stratification tool., (© 2023 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Published
2023
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