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Biomedical subjects

A Bianchetti

Publications and source records attributed to A Bianchetti.

160 records · Page 9Linked to original sources
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Pharmacological actions of levallorphan allyl bromide (CM 32191), a new peripheral narcotic antagonist.

A dissociation of the effects of the newly synthesized quaternary ammonium narcotic antagonist, levallorphan allyl bromide (CM 32191) on morphine-induced analgesia and constipation in the mouse is reported. CM 32191 behaved as a pure morphine antagonist on the "in vitro" preparation of longitudinal muscle of guinea-pig ileum and antagonized dose-dependently the peripherally mediated morphine constipation (ID50:15.6 mg/kg) without significantly affecting morphine analgesia (ID50: greater than 80 mg/kg). Its peripheral selectivity was greater than that of another quaternary ammonium compound, N-methyl naloxone. It is proposed as a useful pharmacological tool to differentiate the peripherally mediated from the centrally mediated effects of opioids.

Animals↗
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Risk factors for the development of pressure sores in hospitalized elderly patients: results of a prospective study.

Pressure sores are a serious and still common complication of immobility in the elderly. Despite the potential seriousness of the problem, factors that identify bedridden patients at the greatest risk for pressure sores have not been well characterized and the epidemiology is not yet well defined. The characteristics of 56 subjects with pressure sores and 92 at risk (confined to bed or chair for at least 1 week) were first compared in a cross-sectional analysis; subjects at risk were then followed up for 2 months to identify factors that may contribute to the appearance of pressure sores during hospitalization. In hospitalized patients at risk we found an incidence of 22.8% within 60 days. Our data suggest that age is not a risk factor for the development of pressure sores, while urinary incontinence, fecal incontinence, altered consciousness, impairment of cognitive function, poor functional status, time spent in bed, lack of caregivers and poor nutritional status are important factors associated with pressure sores in hospitalized elderly patients.

Journal Article↗
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Behavioral syndromes in Alzheimer's disease: description and correlates.

INTRODUCTION: Behavioral disturbances in patients with Alzheimer's disease (AD) are ill-defined conditions. We hypothesize that the many behavioral disturbances hitherto described and studied might be grouped into few syndromes with separate determinants and correlates. PATIENTS AND METHODS: 162 consecutive patients with probable AD admitted to a dementia unit were assessed by the UCLA Neuropsychiatric Inventory (NPI). RESULTS: Factor analysis was carried out on NPI subscales, leading to three syndromes: 'mood', 'psychotic' and 'frontal'. Patients with the 'psychotic' syndrome were older, had older age at dementia onset, had poorer cognition, were more often males, and had faster rate of dementia progression. Patients with the 'frontal' syndrome had higher education, longer disease duration, and slower rate of progression. DISCUSSION: Some combinations of behavioral disturbances occur more frequently together and might represent separate behavioral syndromes. Different clinical correlates of the syndromes suggest separate etiologies.

Aged↗
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Drug treatment in Lewy body dementia.

The treatment of Lewy body dementia (LBD) is particularly difficult for the co-occurrence of psychiatric and parkinsonian symptoms: antipsychotic drugs can worsen parkinsonism, and antiparkinsonian drugs can precipitate delusions and hallucinations. The aim of this study was to describe treatment strategies and outcomes of 10 clinically diagnosed LBD patients. Two patients had mainly motor symptoms, L-dopa therapy was moderately successful, and psychotic symptoms did not worsen. Eight had relevant psychiatric symptoms needing neuroleptic therapy. Six of these had sufficient response to low-dose neuroleptics and 2 did not respond; parkinsonism worsened in all 8 and L-dopa therapy or treatment with an antiparkinsonian drug was started in 6. L-Dopa or antiparkinsonian drugs were given also to those 2 patients who did not receive neuroleptics. Of the 8 patients taking L-dopa or antiparkinsonian drugs, 6 had a moderate or good response with no or only mild adverse effects. Psychiatric symptoms were sensitive to trazodone or clozapine in 2 patients, without side effects. A flow chart of drug therapy in LBD is proposed.

Aged↗
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Apolipoprotein E epsilon 4 allele in Alzheimer's disease and vascular dementia.

The frequency of the epsilon 4 allele of the apolipoprotein E (apoE) is increased in familial and sporadic late-onset Alzheimer's disease, but its prevalence in non-Alzheimer dementias in Caucasian populations is unknown. We found that the frequency of the apoE epsilon 4 allele was 0.45 in 93 Alzheimer's disease patients, 0.46 in 23 vascular dementia patients, 0.31 in 13 dementia of the frontal type patients, and 0.18 in 51 elderly controls. The association of apoE epsilon 4 allele is not unique to Alzheimer's disease, and its importance as a risk factor for the disease should be reconsidered.

Adult↗
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Usefulness of simple measures of temporal lobe atrophy in probable Alzheimer's disease.

Diagnosis of Alzheimer's disease is made on clinical grounds, and the availability of a simple and sensitive quantitative index of the disease might aid in the routine diagnosis. The aim of this study was to assess whether linear measures of brain atrophy as detected by magnetic resonance imaging can be helpful in the differentiation of mild to moderate Alzheimer's disease from nondemented elderly. Measures of global (bifrontal index and interuncal distance) and hippocampal (minimum thickness of the medial temporal lobe, hippocampal height, width of the choroid fissure, and width of the temporal horn) atrophy were taken from 26 cases and 21 controls. Measures of hippocampal atrophy were the most sensitive in the differentiation of cases from controls, and among them width of the temporal horn yielded the highest sensitivity, predicting the disease in 73% of cases with 95% specificity. A compound measure comprising width of the temporal horn, width of the choroid fissure, and hippocampal height increased sensitivity to 85%. These results suggest that selected simple indices of hippocampal atrophy might be useful in the diagnosis of Alzheimer's disease.

Aged↗
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The gain of apolipoprotein E genotyping to separate patients with Alzheimer's disease from normal individuals: relevance to community studies.

Neuropsychological screening tests such as the Mini Mental State Examination (MMSE) are commonly used for case finding in community studies on dementia or Alzheimer's disease (AD). However, the high proportion of false-positives is an important limitation to the feasibility of such studies. The aim of this study was to evaluate whether adding apoliporotein E (apoE) genotyping to the MMSE is followed by a significant reduction of the false-positive rate. Subjects were 70 AD patients (MMSE 13-28) and 70 normal controls (MMSE 25-30). Multivariable discriminant analysis was used to classify subjects on the basis of age, gender, MMSE score and the presence of the epsilon 4 allele of apoE. When sensitivity was set at 99%, the model including age, gender and MMSE had a false-positive rate of 13.5%, while adding epsilon 4 to the previous variables decreased this figure to 6.7%. In a hypothetical community study screening for AD in a population of 1,000,000, this would turn in a decrease of false-positives from about 19,000 to about 9,500. We conclude that the use of apoE genotyping in community case-finding studies is promising and should deserve further consideration.

Aged↗
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Predictors of mortality and institutionalization in Alzheimer disease patients 1 year after discharge from an Alzheimer dementia unit.

Several factors have been reported to predict death and institutionalization in demented patients, even if the results of the studies are often conflicting. We conducted a study on a group of 86 consecutive noninstitutionalized probable Alzheimer disease (AD) patients, to evaluate clinical and social factors predicting mortality and institutionalization 1 year after discharge from the Alzheimer Dementia Unit at 'Sacro Cuore Fatebenefratelli' Hospital, Brescia, Italy. The 1-year mortality rate was 13.9% and the 1-year rate of admission to a nursing home was 34%. Our data indicate that the number of lost functions on the Activity of Daily Living scale is the most important predictor of short-term mortality, independently of the degree of cognitive impairment, the duration of the dementia, the age of the patients and the number of chronic diseases. Our data also demonstrate that, in a short period of observation, behavioral disturbances (and in particular insomnia) and availability of social services play a major role in the decision to institutionalize AD patients.

Age Factors↗
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Neuropsychological heterogeneity in mild Alzheimer's disease.

In order to investigate neuropsychological differences in patients with mild AD, we carried out a pilot study on 28 patients with a clinical diagnosis of mild dementia (CDR: 0.5-1) using an extensive neuropsychological battery, in comparison with 28 normal controls. The results of a cluster analysis, applied on the neuropsychological variables, showed the existence of at least two main subgroups of patients. Cluster 1 patients had a mean age of 61.1 years and showed a greater impairment on measures of language, abstract reasoning and verbal fluency; cluster 2 patients, with a mean age of 72.0, had more severe impairment in memory function. These preliminary results may suggest the existence of different subtypes of AD characterized by selective neuropsychological deterioration in the early stages of the disease.

Aged↗
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Clinical characteristics and risk factors of delirium in demented and not demented elderly medical inpatients.

OBJECTIVES: to evaluate the differences in clinical characteristics and risk factors of delirium in elderly medical inpatients according to the presence or not of dementia. DESIGN: cross-sectional, observational study. SETTING: acute medical care unit (ACU) of a general hospital. PARTICIPANTS: 330 patients aged 65 and older consecutively admitted on a 24-week period. MEASUREMENTS: Functional status, cognitive abilities, severity of acute illness (Acute Physiology, Age and Chronic Health Evaluation (APACHE II) score), Confusion Assessment Method (CAM), Delirium Rating Scale (DRS) and One Day Fluctuation Scale (ODFS). RESULTS: patients with delirium represent 19.1% of the sample, 41.0% of which had also dementia. Hyperactive form of delirium was 41.0%; hypoactive 11.0% and mixed 48.0%. In non demented patients, the delirious patients showed higher APACHE II score, more severe functional decline, poorer cognitive status respect to not delirious. In demented patients no differences were found in APACHE II score and cognitive status among delirious and not delirious subjects. In this group, functional decline (p = .012), acute infection (p = .007), psychotropic drugs use (p = .028) and severe hypoalbuminemia (p = .036) represented risk factors for the onset of delirium. Demented patients had higher perceptual disturbances (p = .040) and less severe delusions (p = .001), while total DRS score do not differs in the two groups. According to ODFS, delirium episode was more fluctuating in patients with dementia. CONCLUSION: clinical characteristics and risk factors of delirium are different in demented and not demented elderly inpatients. Patients with dementia are vulnerable to delirium at lower levels of medical acuity than non-demented patients.

APACHE↗