Biomedical subjects
M Trabucchi
Publications and source records attributed to M Trabucchi.
Disability and principal lifetime occupation in the elderly.
This study addresses the relationship of disability with principal lifetime occupation in the elderly. Daily function, cognitive, and physical health variables were assessed in an Italian population of 524 community-dwelling elders aged seventy and over. Farmers had 1.4 (95% C.I.: 0.6 to 2.2) instrumental daily functions lost higher than white-collar workers. Adjustment for age, education, and financial dissatisfaction with multiple linear regression analysis decreased the difference to a still significant figure of 0.9 (95% C.I.: 0.1 to 1.7). On the contrary, adjustment only for cognitive status resulted in complete disappearance of the association [0.2 functions lost (95% C.I.: -0.5 to 0.9)]. The data indicate that greater disability in the most disadvantaged occupational groups may be due to poorer cognition.
Linear measures of atrophy in mild Alzheimer disease.
PURPOSE: To assess the sensitivity of linear measures of brain atrophy in the diagnosis of Alzheimer disease (AD) in the early stages. METHODS: Linear measures of regional frontal (Bifrontal index, interhemispheric fissure width), medial temporal lobe (interuncal distance, minimum thickness of the medial temporal lobe), and hippocampal (hippocampal height, width of the choroid fissure, width of the temporal horn) atrophy were made on magnified MR images obtained in 46 patients with AD (33 with mild severity and 13 with moderate severity) and in 31 control subjects. Gaussian modeling was used to compute sensitivity with specificity set at 95%. Discriminant analysis was used to identify measures independently contributing to the ability to discriminate AD patients from control subjects. RESULTS: The measure with the best sensitivity in discriminating AD patients from control subjects was the width of the temporal horn. A compound measure of width of the temporal horn, width of the choroid fissure, height of the hippocampus, and interuncal distance could discriminate patients with mild AD from control subjects with 86% sensitivity. Cross validation in patients with moderate AD confirmed the usefulness of the model (81% sensitivity). Measures of hippocampal atrophy alone could discriminate patients with mild AD from control subjects with 83% sensitivity; in patients with moderate AD, cross validation produced 87% sensitivity. CONCLUSIONS: Linear measures of hippocampal atrophy can be a useful adjunct in the routine diagnosis of AD, even in its early stages.
Defective phorbol ester-stimulated secretion of beta-amyloid precursor protein from Alzheimer's disease fibroblasts.
The present study shows that cultured fibroblasts from sporadic Alzheimer's disease patients are deficient in protein kinase C-regulated secretion of amyloid precursor protein. In particular, Alzheimer fibroblasts show a reduced basal secretion and a reduced response at low concentrations of phorbol-12,13-dibutyrate, with an EC50 twofold higher than control fibroblasts. Furthermore, we observed that such defective regulation of the amyloid precursor secretion can possibly be correlated to a specific defect in protein kinase C alpha in fibroblasts from Alzheimer patients.
Apolipoprotein e4 allele and cognitive decline. May be less relevant.
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Gene dose of the epsilon 4 allele of apolipoprotein E and disease progression in sporadic late-onset Alzheimer's disease.
A strong association has been described in cross-sectional studies between the epsilon 4 allele of the apolipoprotein E and late-onset Alzheimer's disease (LOAD). This study addresses the relationship between disease progression and the epsilon 4 allele in 62 sporadic LOAD (onset at age 70 and over) patients. Disease progression was estimated retrospectively with the Mini-Mental State Examination (MMSE) amounting to 4.7, 3.8, and 2.2 points per year (sex-adjusted test for trend: p = 0.01) and with the Clinical Dementia Rating (CDR) to 0.76, 0.67, and 0.42 units per year (p = 0.03) in -/-, epsilon 4/-, and epsilon 4/epsilon 4 patients. The proportion of patients with fast progression decreased (p < or = 0.005) and with slow progression increased (p = 0.002) with increasing epsilon 4 gene dose. These findings were confirmed in a smaller sample of 28 patients for whom longitudinal assessments of MMSE were available and when nonlinear progression of the disease was accounted for in a stratified analysis. These data suggest that disease duration might be longer in epsilon 4 carriers and that this might at least partly account for the cross-sectional association between the epsilon 4 allele and LOAD.
Release from proactive interference in early Alzheimer's disease.
The study analyses the performance of 22 mild Alzheimer's disease (AD) patients on the Release from Proactive Interference (RPI) paradigm with the aim to investigate the relationship of RPI with frontal function. Twenty-one normal elderly subjects, age and education matched, constituted the control group. Patients with AD were found to recall less words on each trial of the RPI than did the controls. The analysis of Proactive Interference (PI) and Release from PI, in AD patients, by using Anova (trial x group), showed a significant effect of trial and group but not a group by trial interaction. These results indicate a similarity between the performance of AD patients and normal controls on the Release from Proactive Interference paradigm. Despite the similar pattern of performance, AD patients were significantly inferior to normal controls with regard to global performance level. The AD patients' scores on "frontal lobe" tests were correlated with an index of RPI (shift condition index). The only significant result was with the number of categories on the Wisconsin Card Sorting Test, suggesting a weak correlation between RPI and "frontal lobe" function.
Semantic memory in Alzheimer's disease: an analysis of category fluency.
In order to study the strategies of access to semantic knowledge and the status of semantic representation, we analyzed the performance in a semantic fluency task (Animal naming) of 70 patients with probable Alzheimer's disease (AD), including 40 mild AD patients and 30 moderate-severe AD patients, and 35 matched elderly normal control subjects. The total amount of words produced, their lexical frequency, the number and type of errors, as well as the presence and the type of clusters of related animal names were recorded. AD patients produced less animal exemplars than controls. In addition to a lower total number of clusters, the AD patients showed a strong limitation in clusters' selection, producing a limited number of different clusters. While normal subjects produced several different clusters, only farm animals were clustered by AD patients. When the total amount of words was considered, the mean lexical frequency was higher in the AD group. On the other hand, the words produced within clusters were comparable to terms of lexical frequency and number. These data confirm the impairment of AD patients in category fluency tasks, and suggest a degradation of semantic knowledge as the most likely underlying mechanism.
Sensory impairments and mortality in an elderly community population: a six-year follow-up study.
Previous studies have shown that sensory impairments adversely affect the quality of life of elderly people, but have failed to demonstrate consistent results on mortality. We examined the predictive value of hearing and visual impairments on mortality in an urban population of 1140 non-institutionalized elderly subjects, aged 70-75 years. Baseline information was collected in 1986 through a door-to-door interview with a standardized questionnaire and the sensory assessment was performed using bedside tasks: the whispered voice test for hearing and the Snellen chart for vision. Overall mortality rate at 6 years was 25.5%, with a significant sex difference (males = 37.5%; females = 19.8%) and a significant interaction between sex and sensory impairment. Bivariate logistic regression showed that hearing deficit was associated with a significant increase in mortality risk only in the men. This increase remained significant even after control for the demographic variables and the global physical health status. Multivariate logistic regression showed that the effect of hearing deficit on mortality was mediated by psychosocial parameters (mood and social relationships level). Sensory assessment through simple bedside tests should become part of the routine clinical evaluation of elderly people.
Food intake and mortality in the frail elderly.
BACKGROUND: Adequate qualitative and quantitative food intake is a major determinant of health. However, nutritional requirements in the elderly are unknown, and even more so in the frail elderly. The aim of the study was to evaluate the influence of energy and macro-nutrients on health in the frail nursing home elderly. METHODS: Food intake of 72 not severely diseased elderly patients was assessed with direct weighing method. Outcome measure was survival over 28-month follow-up period. Confounders of the association of food intake with survival were: age, gender, body-mass index, daily function, somatic health, anergy, and nutritional status. Crude association of food intake with survival was assessed with Kaplan-Meyer method, and adjusted association with multiple Cox regression models. RESULTS: Patients of the study had good average food intake. Mortality rate was relatively low (.20 per year). Low levels of energy, protein, lipid, and carbohydrate intake were negatively associated with survival even after adjustment for confounders. When compared to high intake, adjusted relative risks for mortality of low intake were 4.74, 3.75, 4.71, and 2.04, respectively. Medium levels of energy, protein, and lipid, but not carbohydrate, intake yielded intermediate mortality risk. CONCLUSIONS: Food intake is a strong predictor of survival even in moderately diseased elderly patients, suggesting possible low-cost interventions.
The puzzle of functional status in mild and moderate Alzheimer's disease: self-report, family report, and performance-based assessment.
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Effect of age and education on performance on the Mini-Mental State Examination in a healthy older population and during the course of Alzheimer's disease.
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Is it heaven? Pleasant visual hallucinations in nonagenarians.
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Functional and biomedical components in the measures of disease severity in older people.
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Delusions and dementia: clinical and CT correlates.
INTRODUCTION: Delusions occur frequently during the course of Alzheimer's disease (AD) and multi-infarct dementia (MID). Their clinical significance and their relationship with progression of disease and involvement of selected cerebral areas are still unclear. The aim of the study was to determine the clinical and CT correlates of delusions in patients with dementia. MATERIAL AND METHODS: A series of 67 probable AD and 32 MID patients, underwent computed tomographic scans, psychometric tests, neurologic and psychiatric examination, and blood and serum tests. RESULTS: Twenty-four patients were found to have delusions during the clinical evaluation. Delusional patients showed a significantly higher age when compared with non-delusional patients. The results of a multiple logistic regression (with stepwise deletion of the redundant variables) of the CT lesions on the presence of delusions, showed that only the presence of isolated white matter lesions in the frontal lobes were significantly related to the occurrence of delusions (Exp B = 3.42; Beta = 1.2; S.E. = 0.6; Sig T = 0.04). Frontal white matter changes were significantly related to delusions when a multiple regression analysis, entering age and total number of lesions at CT scans, was carried out. CONCLUSIONS: We found that focal lesions in the frontal areas were the only variable that appeared to be significantly and independently associated with delusional disorders.
Corticobasal degeneration: neuropsychological assessment and dopamine D2 receptor SPECT analysis.
We report a case of clinically diagnosed corticobasal degeneration, in whom neuropsychological testing was performed along with functional imaging with IBZM SPECT. HM-PAO SPECT showed marked perfusion asymmetry in parietal cortical regions, lower to the right, contralateral to the most affected side. IBZM SPECT, which gives information about postsynaptic dopaminergic D2 receptors, showed severe reduction of tracer uptake in the right basal ganglia. Our findings suggest that a postsynaptic lesion in the basal ganglia might account for the lack of response of extrapyramidal motor symptoms to dopaminergic agonists in corticobasal degeneration.
Computed tomography in the detection of the vascular component in dementia.
We evaluated the presence and type of vascular lesions with computerized tomography (CT) in 94 cognitively impaired elderly patients who had been defined as degenerative (Alzheimer's disease, AD) or vascular (multi-infarct dementia, MID) dementia patients on the basis of clinical data. Twenty-six percent of the 77 AD, but only 59% of the 17 MID patients had vascular lesions. The most represented vascular lesions were leukoaraiosis in AD and hemispherical cortical lesions in MID patients. Age, signs indicative of, and risk factors for vascular disease were associated with vascular lesions on CT. We conclude that CT scan is a necessary complement to historical and clinical data in the detection of vascularity in demented patients.