Cognitive and affective assessment and multiple pathologies in institutionalized elderly.

Studies were carried out using the mini mental state examination (MMSE) and the geriatric depression scale (GDS) in 71 elderly patients, in order to establish eventual correlations between cognitive deficit, depression and multiple pathologies. This examination was part of a multidimensional evaluation involving patients over 65 years of age hospitalized in the Department of Clinical Medicine. The patients were divided into 5 grades on the basis of the extent ot functional impairments (from Grade 0 to Grade IV) (British Columbia Classification). Mean MMSE and GDS scores, as well as the mean of the multiple pathologies were calculated in each group. As all the MMSE items could not always be applied, we used a score obtained by dividing the maximum score accomplished by the maximum score applicable. No MMSb impairment was present in 94.11% of the Grade 0 patients, in 57.14% of the Grade I, in 37.5% of the Grade II, and in 40% of the Grade III patients. However, impairment was present in all the Grade IV patients. GDS analysis revealed no depression in 82.35% of Grade 0 patients, in 21.43% Grade I, in 50% Grade II, in 16% Grade III patients. However, some degree of depression was present in all Grade IV patients. The occurrence of patients affected by multiple pathologies was as follows: 1-2 pathologies were recorded in 47.06% of Grade 0 patients, in 57.14% Grade I, in 37.5% Grade II, in 36% Grade III, and in 57.14% of Grade IV patients.

Multiple pathologies and drug consumption in a group of centenarians from Eastern Sicily.

Multiple pathologies are characteristic for the elderly. We evaluated the prevalence of multiple pathologies in 28 randomly selected centenarians living in Eastern Sicily and compared the data with those obtained in another random group of 28 control subjects over 80 years of age. It has been revealed that 25% of the centenarians suffered from 0-3 pathologies, while the remaining 75% displayed more than 3 pathologies. The control subjects had 0-3 pathologies in 50% of over 80 years, while 50% were affected by more than 3 pathologies. In centenarians the most prevalent pathologies involved the sensorial apparatus (sight and hearing), followed by the digestive, urogenital and cardiovascular systems. In the control group the rank of occurrence was as follows: cardiovascular system, osteoarticular and respiratory apparatuses, and sensorium. We compared drug consumption in the two age groups. In the centenarians, 71.43% took 0-3 drugs, while 28.57% took more than 3 drugs. In the control group, 53.57% took 0-3 drugs, whereas 46.43% took more than 3 drugs.

Functional evaluation of a group of centenarians in Eastern Sicily by means of the activity of daily living scale.

A random sample of 28 centenarians was studied (32.56% of all centenarians in Eastern Sicily) within the framework of the Italian Multicenter Study on Centenarians. The activity of daily living (ADL) scale was applied to evaluate their capacity to perform everyday tasks autonomously. The study sample consisted of 8 males (28.57%) and 20 females (71.43%), overall mean age was 102.57 +/- 2.1 years. The patients fell into 3 groups according to their ADL scores independent group (with score A) 5 persons, 17.86% (2 males and 3 females); partially independent group (with scores B and C) 5 persons, 17.86% (1 male and 4 females); dependent group (with scores D-E-F-G and other) 18 persons, 64.29% (5 males and 13 females). We compared the results with a control study sample of 28 elderly patients (8 males, 20 females) over 85 years of age resident in a small village in Eastern Sicily (Graniti) and observed that the centenarians presented greater independence, especially the women.

Sense of smell in centenarians from Eastern Sicily.

The sense of smell was studied in a group of centenarians from Eastern Sicily, displaying a mini mental state examination score larger than 19. Analysis of the data demonstrated that centenarians retain the capacity to perceive olfactory stimuli. However, as compared to the results obtained in groups of young and elderly subjects, a statistically significant quantitative reduction (p < 0.001) in the sense of smell was revealed in the centenarians.

Study on the sense of taste in a group of Sicilian centenarians.

The sense of taste was studied in a group of 20 centenarians from Eastern Sicily, displaying a mini mental state examination (MMSE) score higher than 19. Control subjects were 20 adult (mean age 27.7 +/- 3.2 years) and 20 elderly subjects (mean age 71.3 +/- 5.5 years). Although it has been revealed that centenarians retain considerably the capacity to perceive tastes, they displayed statistically significant reductions (p < 0.001) in taste functions for sweet, sour, salty and bitter, as compared to both the adult and elderly controls.

Life conditions of Sicilian centenarians.

Aim of the study was at furnishing a description of the socio-economic reality of Sicilian centenarians. Informations were taken from the records of Italian Multicentric Study on Centenarians. Randomly selected 28 centenarians (8 males, 20 females), in the age range 100-108 years from Eastern Sicily were examined. The following average socioeconomic profile of the centenarians was established: they are widows or widowers with 4 children; have primary education, mediocre socioeconomic conditions, have worked in the fields or had been housewives; their hobbies were before gardening or embroidering and sewing and now is watching TV; they live in their own salubrious 4 roomed house in small center in the hills. These observations reveal that the social and intellectual quality of life is better in cases of centenarian subjects living at home, in their family environment, surrounded by their children and grandchildren as they receive greater affection and physical care than those living in old peoples' homes.

Quality control for estrogen and progesterone receptor assay in human breast cancer: the influence of computation methods on intra and interlaboratory variability.

The importance of evaluating receptors for estrogen and progestin in human breast cancer has been pointed out by many authors. In the absence of a reference standard, receptor assays must be controlled by intra and interlaboratory quality control programs. Much interlaboratory variability exists due to non-uniform analytical protocols, non-uniform ligands, intrinsic errors and also errors in computation methods. The goals of our Italian Quality Control Program on Multicenter Trials are to standardize the analytical procedures and computation methods. Twenty Italian laboratories participated in the Quality Control Program. Each specimen was assayed for steroid receptor content according to the standardized dextran-coated-charcoal method. Data were subjected to computerized analyses by 5 different methods of calculation (Scatchard plot, direct plot, Lineweaver-Burk method, Brunauer-Emmet-Teller analysis, single-point approach). The results were than evaluated to identify intra- and inter-assay variation coefficients and to define other statistical parameters. The authors suggest different calculation methods depending on the specific experimental and/or physiopathological conditions.

Circadian and circaseptan rhythmicities in corticosteroid-binding globulin (CBG) binding activity of human milk.

It has been demonstrated that human milk contains a corticosteroid-binding globulin (CBG, transcortin) which is very similar to that isolated from plasma. It is agreed, moreover, that the cortisol environment of the breast is important for the synthesis of major milk proteins. It was of interest, therefore, to investigate whether milk transcortin exhibits circadian variations in the binding activity as does the plasma counterpart. Twelve lactating women, aged 23-35 years, collected specimens of milk just before feeding at different times of the 24-h cycle for 3 consecutive days in the first week of lactation. Six women extended milk collection for at least a 28-days span in the first 2 months of lactation. To obtain whey, milk was centrifuged in cellulose nitrate tubes at 105,000 g for 30 min at 4 degrees C. Specific cortisol binding activity of CBG was measured by an adsorption technique and data were expressed as a function of protein content. Cortisol levels in milk were measured by radioimmunoassay. Rhythmometric analyses (single- and mean-cosinor procedures) yielded detection of a significant circadian rhythm in 'apparent specific binding activity' for cortisol (ASBA-F) whereas no significant oscillation was found as far as milk cortisol concentrations were concerned. Mean acrophase of the CBG-binding activity in milk was located in the evening, lagging behind the corresponding activity in serum by approximately 8 h. A circaseptan rhythmicity in milk binding activity was also present in our longitudinal series at a high level of significance. These results provide evidence that CBG binding activity in human milk has a clear circadian rhythm in the face of ecchronic milk cortisol concentrations. Phase-shift with regard to the rhythm of the plasma counterpart may be accounted for by processes of milk accumulation before nursing The significance of circadian and circaseptan variations in specific cortisol (and other steroids) binding in milk awaits further investigation.

Circannual rhythmicities of cortisol levels in the peripheral plasma of healthy subjects.

Seasonal variations of endocrine function have been extensively studied both in rodents and in man. However, only few studies have attempted to concomitantly evaluate and compare circadian and circannual components by inferential rhythmometric procedures. We have examined [9] circadian profiles (single cosinor: P less than 0.01) of plasma cortisol obtained from samples drawn at 4-h intervals in healthy adult subjects of both sexes (71 males, 120 females, aged 20-54 years) along a 7-year span, from 1974 to 1980. All subjects were routine synchronized. Circulating cortisol was measured by a competitive protein-binding technique and expressed as microgram/dl; intra-assay coefficient of variation was always less than 5%. Both conventional and rhythmometric analysis were used to evaluate seasonal differences of mesor, amplitude and acrophase. The population-mean cosinor analyses revealed statistically significant differences as a function of the time of the year in both the circadian amplitude and acrophase. Examining data year by year revealed in 5 out of 7 annual cycles an apparent tendency to a delayed acrophase and to a reduced amplitude with advancing months towards winter. No significant changes in mesor values were found. Further fitting to a 365.25-day cosine curve of circadian parameters available for different months of an 'average' year yielded significant circannual rhythmicity for acrophase and amplitude; crest-value resulted in spring and autumn, respectively. Our data extend previous observations and are consistent with the existence of circannual variations in plasma cortisol levels in the human. In Italian people, cortisol secretion is conceivably higher in cold months; seasonal changes, on the other hand, appear to be of minor entity of at least as inferred by transverse sampling on a relatively large population. Effects of lighting regimen and of other climatological variables upon the adrenal cycle have to be considered.

Circadian patterns of plasma cortisol and testosterone in chronic male alcoholics.

Twelve alcoholic men (28-55 yr) presenting hypogonadal features but without overt liver failure were hospitalized and examined still consuming alcohol regularly. Sleep was approximately from 2200 to 0600; three equicaloric meals were served at 0700, 1200, and 1800. Blood samples were drawn at 4-hr intervals throughout a 24-hr span starting from 0800. Measured levels of cortisol and testosterone were then analyzed by rhythmometric procedures in order to estimate parameters of the circadian oscillation such as mesor, amplitude, and acrophase, and the relevant confidence limits. Data were compared to those obtained in a matched group of 20 healthy controls. With regard to cortisol, the rhythmometric analyses allowed the demonstration of a normally synchronized circadian rhythm substantially superimposable in alcoholics and controls. With regard to testosterone, the results were compatible with a significant circadian oscillation only in the control group. Alcoholics did show ample interindividual variability of plasma testosterone levels, but the apparent lack of the circadian rhythm was independent of the steroid concentration. These data extend previous observations and are consistent with the occurrence of important abnormalities in the circadian pattern of plasma testosterone in chronic male alcoholics prior to liver failure.