A pandemic of delirium: an updated systematic review and meta-analysis of occurrence of delirium in older adults with COVID-19.

PURPOSE: Delirium has been recognized as an atypical presenting feature of COVID-19 in older adults and is independently associated with mortality. We aimed to perform an updated systematic review of the literature and proportional meta-analysis to assess prevalence and incidence of delirium in older adults with COVID-19, addressing differences according to sex, frailty status, and settings. METHODS: We searched databases for English-language articles on prevalence and incidence of delirium in older adults with COVID-19, published between March 2020 and January 2023. RESULTS: Of the 1171 articles identified, 66 met selection criteria and were included in the meta-analysis (n = 35,035 participants, age-range 66-90 years old, 46.6% females). We observed similar pooled prevalence (20.6% [95% Confidence Interval (CI) 17.8-23.8%]) and incidence (21.3% [95% CI 14.7-30%]) of delirium. Pooled occurrence (both prevalence and incidence) of delirium was similar according to sex (females 21.3% [95% CI 16-27.5%] vs. males 23.8%% [95% CI 18.2-30.4%], p-value = 0.55) and study setting (nursing homes 22.5% [95% CI 14.2-33.6%] vs. hospital 20.3% [95% CI 17-24%], p = 0.68), but it was significantly higher in frail versus non-frail patients (37% [95% CI 26.6-48.8%] vs. 12.5% [95% CI 7.8-19.6%], p-value < 0.01). Delirium definitions and assessment tools largely varied across studies. CONCLUSION: This review delineates delirium as a common feature of COVID-19, particularly in frail older adults, and supports its formal inclusion among COVID-19 symptoms. The considerable heterogeneity in delirium assessment highlights the need for an operational strategy to standardize definitions and tools utilization in the management of frail older adults.

Developing Pulmonary Rehabilitation for COVID-19: Are We Linked with the Present Literature? A Lexical and Geographical Evaluation Study Based on the Graph Theory.

The Coronavirus Disease 2019 (COVID-19) pandemic is a severe ongoing global emergency. Despite high rates of asymptomatic patients, in many cases, the infection causes a rapid decline in pulmonary function due to an acute respiratory distress-like syndrome, leading to multi-organ failure and death. To date, recommendations about rehabilitation on COVID-19 are based on clinical data derived from other similar lung diseases. Rehabilitation literature lacks a standard taxonomy, limiting a proper evaluation of the most effective treatments for patients after COVID-19 infection. In this study, we assessed the clinical and rehabilitative associations and the geographical area involved in interstitial lung diseases (ILD) and in COVID-19, by a mathematical analysis based on graph theory. We performed a quantitative analysis of the literature in terms of lexical analysis and on how words are connected to each other. Despite a large difference in timeframe (throughout the last 23 years for ILD and in the last 1.5 years for COVID-19), the numbers of papers included in this study were similar. Our results show a clear discrepancy between rehabilitation proposed for COVID-19 and ILD. In ILD, the term "rehabilitation" and other related words such as "exercise" and "program" resulted in lower values of centrality and higher values of eccentricity, meaning relatively less importance of the training during the process of care in rehabilitation of patients with ILD. Conversely, "rehabilitation" was one of the most cited terms in COVID-19 literature, strongly associated with terms such as "exercise", "physical", and "program", entailing a multidimensional approach of the rehabilitation for these patients. This could also be due to the widespread studies conducted on rehabilitation on COVID-19, with Chinese and Italian researchers more involved. The assessment of the terms used for the description of the rehabilitation may help to program shared rehabilitation knowledge and avoid literature misunderstandings.

Emotional valence may influence memory performance for visual artworks in Parkinson's disease.

BACKGROUND: Non-motor symptoms in Parkinson's disease (PD) include reduced reactivity to emotional stimuli. Visual artworks can evoke emotional responses. Motor, sensorial and cognitive networks implicated in the aesthetic experience and in the emotional-reward domain show a significant overlap with the pathological nigrostriatal, mesocortical and mesolimbic circuitry that characterises PD. METHODS: Memory enhancement by emotional stimuli such as visual artwork-stimuli was explored in 12 right-sided and 12 left-sided non-demented-PD patients, 12 Alzheimer's disease patients (AD) and 13 healthy controls (HC). Ten emotional and 10 non-emotional stimuli were previously identified based on the ratings of the emotional impact provided by 45 non-PD subjects on 82 pictures of paintings. Only figurative artworks were included. Patients and HC were requested to rate on a 7-point scale the emotional impact of 20 pictures; they were then requested to recognise the 20 pictures amongst 20 distractors (incidental memory task). RESULTS AND CONCLUSION: Recognition of emotional stimuli was more accurate compared to non-emotional stimuli in AD, left-sided PD and HC; right-sided PD did not show sensitivity to the emotional valence of the stimuli suggesting the involvement of the nigrostriatal, mesocortical and mesolimbic circuitry of the left hemisphere in the emotional-reward system related to the aesthetic experience.

Body Mass Index is Strongly Associated with Hypertension: Results from the Longevity Check-up 7+ Study.

The present study was undertaken to provide a better insight into the relationship between different levels of body mass index (BMI) and changing risk for hypertension, using an unselected sample of participants assessed during the Longevity Check-up 7+ (Lookup7+) project. Lookup7+ is an ongoing cross-sectional survey started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns) across Italy. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Specific health metrics are assessed through a brief questionnaire and direct measurement of standing height, body weight, blood glucose, total blood cholesterol, and blood pressure. The present analyses were conducted in 7907 community-living adults. According to the BMI cutoffs recommended by the World Health Organization, overweight status was observed among 2896 (38%) participants; the obesity status was identified in 1135 participants (15%), with 893 (11.8%) participants in class I, 186 (2.5%) in class II, and 56 (0.7%) in class III. Among enrollees with a normal BMI, the prevalence of hypertension was 45% compared with 67% among overweight participants, 79% in obesity class I and II, and up to 87% among participants with obesity class III (p for trend < 0.001). After adjusting for age, significantly different distributions of systolic and diastolic blood pressure across BMI levels were consistent. Overall, the average systolic blood pressure and diastolic blood pressure increased significantly and linearly across BMI levels. In conclusion, we found a gradient of increasing blood pressure with higher levels of BMI. The fact that this gradient is present even in the fully adjusted analyses suggests that BMI may cause a direct effect on blood pressure, independent of other clinical risk factors.

Relationship between cardiovascular health metrics and physical performance in community-living people: Results from the Longevity check-up (Lookup) 7+ project.

Cardiovascular health metrics (CHMs) may predict disability independent of vascular events. Though, the link between CHMs and physical performance is unclear. This relationship was explored using data from the Longevity check-up (Lookup) 7+ project. Lookup 7+ is an ongoing cross-sectional survey conducted in unconventional settings across Italy. People who are at least 18-year-old and provide written informed consent are eligible. CHMs [i.e., smoking status, healthy diet, body mass index (BMI), blood pressure, blood cholesterol, and diabetes status] are assessed through closed questions and objective measurements. Physical performance is measured via the 5-repetition chair-stand test. Analyses included 7446 participants (55.5 ± 14.9 years; 56% women). Physical performance positively correlated with CHMs scores, such that participants who scored higher (6-7 points) completed the chair-stand test about 2 s faster than those scoring lower (1-2 points). In fully adjusted analysis, better physical performance was more frequently observed in younger, non-smoking, physically active men, with ideal BMI, and no diabetes. Our findings indicate a gradient of better physical function with increasing CHMs scores. Future investigations should establish the longitudinal effect of unhealthy behaviours and cardiovascular risk factors on physical performance and verify whether implementation of large-scale primordial cardiovascular prevention may positively impact physical fitness.

Impact of habitual physical activity and type of exercise on physical performance across ages in community-living people.

The maintenance of muscle function into late life protects against various negative health outcomes. The present study was undertaken to evaluate the impact of habitual physical activity and exercise types on physical performance across ages in community-living adults. The Longevity check-up 7+ (Lookup 7+) project is an ongoing cross-sectional survey conducted in unconventional settings (e.g., exhibitions, malls, and health promotion campaigns across Italy) that began on June 1st 2015. The project was designed to raise awareness in the general population on major lifestyle behaviors and risk factors for chronic diseases. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Physical performance is evaluated through the 5-repetition chair stand test. Analyses were conducted in 6,242 community-living adults enrolled between June 1st 2015 and June 30th 2017, after excluding 81 participants for missing values of the variables of interest. The mean age of the 6,242 participants was 54.4 years (standard deviation 15.2, range 18-98 years), and 3552 (57%) were women. The time to complete the chair stand test was similar from 18 to 40-44 years, and declined progressively across subsequent age groups. Overall, the performance on the chair stand test was better in physically active participants, who completed the test with a mean of 0.5 s less than sedentary enrollees (p < .001). After adjusting for potential confounders, a different distribution of physical performance across exercise intensities was observed, with better performance being recorded in participants engaged in more vigorous activities. Our findings suggest that regular physical activity modifies the age-related pattern of decline in physical performance, with greater benefits observed for more intensive activities. Efforts are needed from health authorities and healthcare providers to promote the large-scale adoption of an active lifestyle throughout the life course.

Pre-hospital dietary intake correlates with muscle mass at the time of fracture in older hip-fractured patients.

BACKGROUND: Failure to meet an adequate dietary intake is involved in the pathogenesis of sarcopenia and osteoporosis, which in turn increase the risk for falls and fractures, respectively. Older people with hip fracture are often protein-malnourished at hospitalization. Whether low protein-energy intake is associated with muscle atrophy in hip-fractured patients is presently unknown. This information is necessary for the development of novel strategies to manage this especially vulnerable patient population. The aim of this study was, therefore, to explore the relationship between dietary intake and muscle mass in older hip-fractured patients. METHODS: Analyses were conducted in hip-fractured elderly admitted to an orthopedic and trauma surgery ward (University Hospital). Muscle mass was estimated by bioelectrical impedance analysis within 24 h from admission. Dietary information was collected via 24-h dietary recall and nutrient intake calculated by a nutrition software. RESULTS: Among 62 hip-fractured patients (mean age 84.6 ± 7.6 years, 84% women), the average energy intake was 929.2 ± 170.3 Kcal day(-1), with higher values reported by men (1.046.8 ± 231.4 Kcal day(-1)) relative to women (906.5 ± 148.3 Kcal day(-1); p = 0.01). Absolute and normalized protein intake was 50.0 ± 13.5 g day(-1) and 0.88 ± 0.27 g kg (body weight)(-1) day(-1), respectively, with no gender differences. A positive correlation was determined between total energy intake and muscle mass (r = 0.384; p = 0.003). Similarly, protein and leucine consumption was positively correlated with muscle mass (r = 0.367 and 0.311, respectively; p = 0.005 for both). CONCLUSION: A low intake of calories, protein, and leucine is associated with reduced muscle mass in hip-fractured elderly. Given the relevance of sarcopenia as a risk factor for adverse outcomes in this patient population, our findings highlight the importance of a comprehensive dietary assessment for the detection of nutritional deficits predisposing to or aggravating muscle atrophy.