ABSTRACT
BPSD are very frequent, so that 90% of demented patients have at least one. BPSD are troublesome both for elders with dementia and for caregivers, fostering the institutionalization. Yet, BPSD may vary as long as the disease progresses, and may fluctuate in the short run, either spontaneously or by pharmacological as well as non-pharmacological interventions. The aim of the study was to investigate by factor analysis possible groupings among the modifications occurring in BPSD, during the stay in a special care unit (SCU). BPSD were rated through the neuropsychiatric inventory (NPI); frequency x severity scores were calculated for any single BPSD at entry and at discharge: the differences were analyzed using factor analysis. The sample comprised 214 demented persons, 65.4% females; of mean age 79.6 years; Overall entry score of NPI was 46.1+/-20.7; NPI overall mean difference at discharge=-30.4+/-20.3. BPSD factor analysis on frequency x severity crude baseline scores resulted in 4 groups: 1 (agitation+irritability+aberrant motor activity+disinhibition); 2 (delusions+hallucinations); 3 (anxiety+dysphoria); 4 (apathy+euphoria). When differences (discharge frequency x severity-entry frequency x severity) for each BPSD scores were factor analyzed, grouping was rather similar: (i) agitation+irritability; (ii) delusions+hallucinations; (iii) anxiety+dysphoria+aberrant motor activity; (iv) euphoria+disinhibition; (v) apathy. In our sample, BPSD improved during the stay in the SCU. These improvements followed trajectories that looked plausible and were consistent with baseline groupings, by factor analysis.
Subject(s)
Anxiety/epidemiology , Anxiety/psychology , Dementia/epidemiology , Dementia/psychology , Psychomotor Agitation/epidemiology , Psychomotor Agitation/psychology , Psychotic Disorders/epidemiology , Psychotic Disorders/psychology , Aged , Anxiety/therapy , Cognition Disorders/diagnosis , Cognition Disorders/epidemiology , Drug Therapy/methods , Factor Analysis, Statistical , Female , Humans , Irritable Mood , Male , Neuropsychological Tests , Prevalence , Psychomotor Agitation/therapy , Psychotic Disorders/therapy , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
Alzheimer's disease (AD) is a progressive neurodegenerative disease that affects both sexes, with a higher prevalence in women. Declining estrogen levels after menopause may render estrogen target neurons in the brain more susceptible to age or disease-related processes such as AD. To investigate the role of two single nucleotide polymorphisms in the first intron of the ER-alpha gene, denominated PvuII and XbaI, and their interaction with the known AD susceptibility gene APOE, we examined 131 patients with sporadic AD and 109 healthy control subjects. In multinomial logistic regression analysis, a significantly increased risk of sporadic AD because of interaction between the ER-alpha p allele and APOE epsilon4 allele was observed in women, taking subjects who had neither the p allele nor epsilon4 as reference [odds ratio (OR) 7.24; 95% CI, 2.22-23.60]. For women carrying the ER-alpha x allele together with APOE epsilon4, the risk of sporadic AD was similarly elevated (OR 8.33; 95% CI, 1.73-40.06). The data suggest that the p and x alleles of polymorphic ER-alpha gene interact synergistically with the APOE epsilon4 allele to increase the risk of AD in women but not in men in this Italian cohort.
Subject(s)
Alzheimer Disease/genetics , Apolipoproteins E/genetics , Estrogen Receptor alpha/genetics , Genetic Predisposition to Disease , Polymorphism, Genetic , Risk , Aged , Aged, 80 and over , Alzheimer Disease/epidemiology , Apolipoprotein E4 , Confidence Intervals , DNA Mutational Analysis/methods , Female , Gene Frequency , Genotype , Humans , Italy/epidemiology , Logistic Models , Male , Middle Aged , Odds Ratio , Sex FactorsABSTRACT
OBJECTIVE: to evaluate whether oral supplementation with zinc or zinc/arginine increases the antibody response to influenza vaccine or modulates the lymphocyte phenotype in elderly subjects. DESIGN: a randomized controlled trial with two supplemented groups and one control group. SETTING: a community nursing home. PARTICIPANTS: 384 subjects aged 64-100 (mean age 82 years) examined in three separate studies. INTERVENTION: oral supplementation with zinc (400 mg/day) or zinc plus arginine (4 g/day) for 60 days starting 15 days before influenza vaccination. The control groups received vaccine only. MEASUREMENTS: haematological and nutritional indices, antibody titre against influenza viral antigens, lymphocyte phenotype. RESULTS: supplementation with zinc or zinc plus arginine increased zinc plasma concentrations restoring the age-related impairment in zinc concentrations to values found in younger people. The antibody titre against influenza viral antigens was not increased in zinc or zinc/arginine supplemented groups in comparison with subjects receiving vaccine alone. The number of CD3, CD4 or CD8 lymphocytes was not affected by zinc or zinc/arginine supplementation. CONCLUSION: prolonged supplementation with zinc or zinc/arginine restores zinc plasma concentrations but is ineffective in inducing or ameliorating the antibody response after influenza vaccination in elderly subjects.
