Ongoing Research Protocols for the Pharmacological Treatment of Neuropsychiatric Symptoms in Dementia.

The implementation of effective interventions for neuropsychiatric symptoms (NPS) is perceived as one of the most pressing research priorities in the field of dementia and one of the main unmet needs from the perspective of affected individuals and their caregivers and relatives. Nevertheless, to date, only a relatively marginal part of dementia research has focused on NPS. This study aimed to describe and discuss the state of the art concerning the identification and development of new pharmacological treatments for NPS in dementia. A review of 320 ongoing phase 1, 2, 3, and 4 protocols registered in the clinicaltrials.gov database was performed. All the trials enrolling patients with dementia were selected. Only studies adopting clinical measures of NPS frequency and/or severity as primary outcome were retained and analyzed. Overall, only a minority of ongoing phase 1, 2, 3 and 4 protocols on dementia (i.e., 9.0%) is primarily targeting NPS. Most of these studies are adopting a placebo-controlled parallel assignment design, testing oral compounds, and targeting specific NPS (mostly agitation and/or aggression). A total of 3,445 subjects with dementia will tentatively be recruited in these trials. The methodologies adopted in these studies, the characteristics of the tested interventions, the eligibility criteria, and the operational definitions of NPS are presented and discussed. The relevance of NPS is not yet matched by an adequate research effort. The current tendency at privileging disease-modifying approaches and other symptoms of dementia and the methodological complexity of studying NPS are still substantially contributing to the gap between research activities and clinical needs.

Estimating dementia cases amongst migrants living in Europe.

BACKGROUND AND PURPOSE: The phenomenon of dementia amongst migrants and ethnic minorities represents an emerging concern for European healthcare systems, posing additional challenges in terms of clinical approach, access to care and resource utilization. The aim of the present study was to estimate the cases of dementia amongst immigrant older subjects living in Europe and in each European country. METHODS: The estimated cases of dementia amongst older (i.e. 65+) migrants living in the European Union (EU-28) and European Free Trade Association member states were calculated by multiplying the number of migrants (obtained through the data provided by Eurostat) with the age- and sex-specific prevalence rates (derived by a recent meta-analysis). RESULTS: Overall, 6 507 360 older migrants lived in Europe in 2017. In addition, 1 204 671 migrants were registered in Germany in 2010. Nearly 475 000 dementia cases (329 028 women, 147 410 men) were estimated in this population by applying age- and sex-specific prevalence rates. When considering each European country, the number of estimated cases ranged from 108 (Iceland) to 119 161 (France). In parallel, the proportion of dementia cases occurring in migrants ranged from 0.9% (Czech Republic) to 51.2% (Liechtenstein). CONCLUSIONS: The issue of dementia in migrants and ethnic minorities is emerging but already relevant for European healthcare systems. The magnitude of this phenomenon and its complexities reinforce the need for coordinated initiatives both at a national and continental level. These epidemiological data should ideally be integrated with those coming from 'real world' services in order to better calibrate these actions.

[Mitochondrial disease and complete heart block. Kearns-Sayre syndrome. Description of a case]. / Malattie mitocondriali e blocco cardiaco completo. Sindrome di Kearns-Sayre. Descrizione di un caso.

Defects of the mitochondrial respiratory chain form a clinically and biochemically heterogeneous group of diseases. Mitochondrial diseases include myopathies and multisystem disorders that are defined either by biochemical abnormalities of the mitochondria or by the presence of "ragged red fibers" in muscle-biopsy specimens stained with modified Gomori's trichrome stain. Several syndromes have been identified. Typical Kearns-Sayre syndrome is a sporadic condition that is characterized by an onset before the age of 20, progressive external ophthalmoplegia, pigmentary retinopathy and cardiac disorders. Mitochondrial DNA deletions were found in patient with Kearns-Sayre syndrome. We report the case of a 33 year-old woman, with neuromuscular syndrome of the Kearns-Sayre type, insulin-sensitive diabetes and complete heart block, who was implanted a pacemaker.

[Primary malignant lymphoma of the heart. Description of a case and review of the literature]. / Linfoma maligno primitivo del cuore. Descrizione di un caso e revisione della letteratura.

Primary cardiac tumors are rare. Approximately 25% of primary cardiac tumors are malignant, with the majority of these being sarcomas. Primary lymphoma of the heart is a very rare malignancy, usually recognized at autopsy or fatal within a few weeks of diagnosis. we report the case of a patient with diffuse large uncleaved cell lymphoma of the heart who had dyspnea, distention of the neck veins, edema of the face and arms. The diagnosis in this patient was aided by 2D-echocardiography, CT scan of the chest and superior vena caval angiography. The diagnosis was confirmed at operation and by histological examination. Surgical procedures were only palliative and aimed at prolonging life. However, prognosis remained severe and unchanged.

Nail changes in glandular disease.

There are a number of glandular disorders that can affect the nails. A listing of the diseases and their corresponding nail changes is shown in Table 2. It is imperative to be able to discern this possible etiology from others, such as trauma and shoegear. A good clue to systemic abnormalities affecting the nails is multiple nail involvement. When a glandular disorder is the source of nail pathology, the signs are very often nonspecific. Many pathologies produce similar nail changes, and singular nail changes may be caused by different pathologies. One must use extreme caution in trying to diagnose systemic pathologies from changes observed in nails.

Lupus anticoagulant in myelofibrosis.

A patient with myelofibrosis who also demonstrates a lupus anticoagulant is reported. The presence of a circulating anticoagulant adds to the list of potential hemorrhagic diatheses in myelofibrosis and also demonstrates myelofibrosis to involve a system that may be separate from the myeloid elements of the bone marrow.