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G B Frisoni

Publications and source records attributed to G B Frisoni.

At least 37 records · Page 2Linked to original sources
PubMed2002

Detection of grey matter loss in mild Alzheimer's disease with voxel based morphometry.

OBJECTIVES: To test the applicability of an automated method of magnetic resonance image analysis (voxel based morphometry) to detect presence and severity of regional grey matter density reduction-a proxy of atrophy-in Alzheimer's disease. METHODS: Twenty nine probable Alzheimer's patients and 26 non-demented controls (mini-mental state examinations mean (SD) 21 (4) and 29 (1)) underwent high resolution 3D brain magnetic resonance imaging. Spatial normalisation to a stereotactic template, segmentation into grey matter, white matter, and cerebrospinal fluid, and smoothing of the grey matter were carried out based on statistical parametric mapping (SPM99) algorithms. Analyses were carried out: (a) contrasting all Alzheimer's patients with all controls (p<0.05 corrected for multiple comparisons); (b) contrasting the three Alzheimer's patients with mini-mental state of 26 and higher with all controls (p<0.0001 uncorrected); and (c) correlating grey matter density with mini-mental state score within the Alzheimer's group (p<0.0001 uncorrected). RESULTS: When all Alzheimer's patients were compared with controls, the largest atrophic regions corresponded to the right and left hippocampal/amygdalar complex. All parts of the hippocampus (head, body, and tail) were affected. More localised atrophic regions were in the temporal and cingulate gyri, precuneus, insular cortex, caudate nucleus, and frontal cortex. When the mildest Alzheimer's patients were contrasted with controls, the hippocampal/amygdalar complex were again found significantly atrophic bilaterally. The mini-mental state score correlated with grey matter density reduction in the temporal and posterior cingulate gyri, and precuneus, mainly to the right. CONCLUSIONS: Voxel based morphometry with statistical parametric mapping is sensitive to regional grey matter density reduction in mild Alzheimer's disease.

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PubMed2001

The Itel-MMSE: an Italian telephone version of the Mini-Mental State Examination.

METHOD: We compared performance in an Italian telephone version of the Mini-Mental Status Examination (Itel-MMSE) with performance in the standard MMSE administered face to face to 104 inpatients affected by cognitive deficit. RESULTS: Their cognitive ability varied from mildly to severely impaired. Total scores of the two MMSE versions correlated strongly for all patients (r=0.85) and for very mildly (r=0.77), mildly (r=0.79), and moderately (r=0.72) demented. A weak but statistically significant correlation was observed for severely demented patients (r=0.46). The study establishes the validity and reliability of the Itel-MMSE as well as between rater and test-retest reliability. We calculated a regression equation for use in predicting MMSE scores from Itel-MMSE scores. Data fit a linear regression model.

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PubMed2001

Mild cognitive impairment: clinical features and review of screening instruments.

Clinical criteria to recognize subjects with cognitive impairment in the pre-dementia stage are becoming available. These are frail subjects, at risk of adverse outcomes, such as death, institutionalization, and functional and cognitive deterioration. Early identification of these subjects has a great importance in order to start rehabilitative or pharmacological interventions that could slow the progression of cognitive impairment, and the onset of disability. In this regard, cognitive screening tests might be helpful in different clinical settings (general practice, acute care, rehabilitation, and nursing home). We describe the most frequent clinical presentations of cognitive impairment in the pre-dementia stage, and review eleven screening tests to provide recommendations on which should be preferred in each setting.

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PubMed2001

Treatment of Alzheimer's disease with acetylcholinesterase inhibitors: bridging the gap between evidence and practice.

Views on drug therapy with acetylcholinesterase inhibitors of the cognitive symptoms of Alzheimer's disease are not uniform, varying from excitement at the possibility of significantly improving the personal and social burden of the disease to skeptical and nihilistic attitudes. Clinical practice from generous prescription to evidence-based guidelines and advising much stricter rules, mirror these attitudes. The epidemiological and clinical relevance of the issue requires understanding of the factors responsible for such discrepancies. Randomized clinical trials have only been able to address a few of the many variables that can affect the response to acetylcholinesterase inhibitors. The effect on behavioral symptoms, severe Alzheimer's dementia, and non-Alzheimer's forms of degenerative dementia need to be clarified as well as the modulating effect of frequently associated conditions such as cognitive changes due to physical diseases and cerebrovascular disease. The gap between evidence and clinical practice might be closed with appropriately designed observational studies rather than randomized clinical trials.

Alzheimer Disease↗
PubMed2001

The management of adverse clinical events in nursing homes: a 1-year survey study.

OBJECTIVE: In Italian nursing homes (NHs), care delivery at night and during holidays is not regulated by regional laws; some facilities employ staff physicians, others employ physicians engaged from year to year (temporary physicians), and others employ publicly funded National Health System (NHS) physicians. This study was designed to determine whether the use of different kinds of physicians leads to different outcomes with regard to the rate of hospitalization and appropriateness of the management of adverse clinical events. DESIGN: Prospective, nonrandomized-survey data collection. SETTING: Ten nonprofit nursing facilities in Italy. PARTICIPANTS: Three hundred and fifty-two NH residents, staff physicians, temporary physicians, and NHS physicians. MEASUREMENTS: Medical intervention during adverse clinical events occurring at night and during holidays. RESULTS: Three hundred and fifty-two residents experienced 551 adverse clinical events; 78 were hospitalized. The hospitalization rate of NHS physicians was about two times that of the temporary physicians and six times that of the staff physicians. Staff physicians' diagnoses and management were appropriate in the majority of cases; NHS diagnosis and management were doubtful or incorrect in about one-third of all cases. CONCLUSIONS: NH residents frequently experience adverse clinical events; physician characteristics influence the rate of hospitalization and the quality of medical interventions.

Activities of Daily Living↗
PubMed2001

Longevity and the epsilon2 allele of apolipoprotein E: the Finnish Centenarians Study.

BACKGROUND: Whether and which genetic factors affect human longevity is unclear. This study assesses the association between the epsilon2 allele of apolipoprotein E (APOE), a putative longevity gene, and extremely old age. METHODS: This study is based on all centenarians living in Finland in 1991. Subjects were 179 persons (28 men and 151 women) aged 100 years and older (response rate, 97%). RESULTS: The percentages of epsilon2-allele carriers in persons aged 100 to 101, 102 to 103, and 104 years and older were 9% (10/117), 21% (9/42), and 25% (5/20; gender-adjusted p for trend = .01), respectively. The effect was particularly strong in women: 8% (8/100), 18% (6/33), and 28% (5/18; p for trend = .01) by age group, respectively. Low cell numbers prevented clear conclusions being drawn for men. Seventeen percent (30/179) of the adult Finnish population were carriers of the epsilon4 allele, a figure lower than expected, and stable by age group. CONCLUSIONS: Carriers of the epsilon2 allele of APOE might be predisposed to reach extremely old age.

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PubMed2001

Reality orientation therapy to delay outcomes of progression in patients with dementia. A retrospective study.

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

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PubMed2001

[Music therapy in Alzheimer's disease: is an evidence-based approach possible?].

The application of music therapy to Alzheimer's patients is relatively recent. The studies available in literature show that music therapy has a positive effect either on mood or cognition. However, the generalization of data is difficult because these researches have lacked methodological design rigour. Based on the application of this rehabilitative technique in our Alzheimer Unit in Brescia and on the recent researches of music neuroanatomy, this work tries to identify which processes are involved in the therapeutic effect of music therapy. Despite the perceived effect on mood and socialisation abilities, cultural and methodological problems hinder to demonstrate the efficacy of music therapy. Information about neurophysiological and neurochemical correlates of music therapy are so poor that the use of this technique is often based on the assumption that the supposed positive effect of music is enough to justify its application. The methodological problem is related to the evaluation of outcomes. The fact that those studies which investigated the effects of music therapy were characterized by less specific indicators (cognition, behavior) and by less standardized instruments made difficult to generalize and quantify the results. The aim of the study is to organize the present knowledge with a systematic approach so that further researches lead to base the application of music therapy on evidence instead of on singular clinical finding.

Alzheimer Disease↗
PubMed2000

Hippocampus and entorhinal cortex in frontotemporal dementia and Alzheimer's disease: a morphometric MRI study.

BACKGROUND: Magnetic resonance imaging (MRI) of hippocampal atrophy is a sensitive but not specific method to support the clinical diagnosis of early Alzheimer's disease (AD). We recently described our findings that atrophy of the entorhinal cortex (ERC) in frontotemporal dementia (FTD) is equal to that found in AD but that hippocampal atrophy in FTD is less than that found in AD. The MRI volumes of these structures provide a topographic representation of the region of interest. We hypothesized that two different dementias with distinct histopathologic and clinical features might, in addition to quantitative patterns, display topographically different patterns of atrophy. METHODS: We adopted a morphometric approach to monitor the pattern of atrophy of the hippocampus and the ERC by computing two-dimensional profiles from MRI volumes of the structures in control subjects and patients with FTD and AD. RESULTS: Compared with control subjects, atrophy of the hippocampus in patients with AD was diffuse. In patients with FTD, atrophy of the hippocampus was localized predominantly in the anterior hippocampus, suggesting a different pattern of hippocampal atrophy in FTD compared with AD. The amount and pattern of atrophy of the entorhinal cortex was virtually equal in both demented groups. CONCLUSIONS: This study provides novel data on the nature of medial temporal lobe atrophy in FTD. Morphometric MRI may be a useful technique for characterizing different patterns of atrophy in primary degenerative dementias in vivo.

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PubMed2000

Mild cognitive impairment in the population and physical health: data on 1,435 individuals aged 75 to 95.

BACKGROUND: The physical health correlates of mild cognitive impairment (MCI) in the older individual are poorly known. The aim of this study was to investigate the relationship between physical health and MCI with population data. METHODS: Subjects were 1,435 nondemented 75- to 95-year-old subjects. MCI was defined as scoring one standard deviation below age- and education-specific means on the Mini-Mental State Examination. MCI was consistently associated with indicators of poorer health in logistic regression models with adjustment for potential confounders. RESULTS: The adjusted odds ratios for those with two, three, four, or more somatic symptoms compared with those with one or no symptoms were 1.3 (95% confidence intervals 1.0 to 1.9) and 2.1 (1.2 to 4.5; p for trend =.004); for those with poor self-rated health the odds ratio was 1.9 (1.4 to 2.6); for those with one, two, or more chronic diseases compared with those with no chronic diseases, the odds ratios were 1.3 (0.9 to 1.9) and 3.0 (1.2 to 7.6; p for trend =.02); and for those dying during the 3-year follow-up period the odds ratio was 1.5 (1.1 to 2.2). CONCLUSIONS: MCI is associated with poor physical health, leading to the hypothesis of a causal relationship between physical diseases and MCI in older populations.

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