Insulin-like growth factor-1 (IGF-1): relation with cognitive functioning and neuroimaging marker of brain damage in a sample of hypertensive elderly subjects.

IGF-1 decline has been related to age-dependent cognitive impairment and dementia. No study examined IGF-1 levels in subjects with a risk factor for brain damage such as hypertension. We investigated the relationship between IGF-1, cognitive functioning and neuroimaging in a sample of 75 hypertensive elderly subjects aged > 65. Cognitive performance were tested by mini mental state examination (MMSE), Cambridge cognitive examination (CAMDEX-R), and the frontal assessment battery (FAB). Among other indices, free IGF-1 in serum was assayed. The radial width of the temporal horn (rWTH) evaluates medial cerebral temporal lobe atrophy. Significant correlations between IGF-1 levels and both total and sub-domain scores of cognition were found. IGF-1 level was significantly lower in cognitively declined group. The lowest IGF-1 -percentile subgroup was significantly cognitively impaired. A statistically non-significant, but lower IGF-1 level was found in the sub-sample with pathologically wider rWTH. Levels of IGF-1 below 79.4 microg/l are associated with cognitive decline, whereas a level above 118 microg/l seems to be a marker of normal cognitive performance. A decreasing of IGF-1 related to a widening of the rWTH suggests an involvement of this hormone in hippocampus atrophy.

Relations between a novel, reliable, and rapid index of arterial compliance (PP-HDI) and well-established inidices of arterial blood pressure (ABP) in a sample of hypertensive elderly subjects.

Hypertension is a risk factor for a long-lasting arterial wall-remodelling leading to stiffness. The rapid method measuring the pulse pressure (PP) by means of the tool of Hypertension Diagnostic Instruments (HDI) called PP-HDI, overcomes some of the problems arising with more-time consuming methods, like ambulatory blood pressure monitoring (ABPM), and give information about the elasticity of the arterial walls. We studied the relationship between the PP-HDI, the large artery compliance (LA-C) and small artery compliance (SA-C) and few well-established indices of arterial blood pressure (ABP) in a sample of 75 hypertensive subjects, aged 65 years and over. Significant correlations between LA-C and heart rate (HR), PP-ABPM and PP-HDI were found. SA-C relates with HR and systolic blood pressure (SBP) measured in lying and standing positions. Applying a stepwise regression analysis, we found that LA-C variance stems from PP-HDI and HR, while SA-C variance stems from SBP in lying position. Receiver operator characteristic (ROC) curves for thresholds of PP showed that PP-HDI reached levels of sensitivity/specificity similar to PP-ABPM. In conclusion, surveillance of ABP through hemo-dynamic indices, in particular of SBP, is essential, nevertheless the advantage of this control is not known in an elderly population where the organ damage is already evident. PP needs necessarily an instrumental measurement. The PP-HDI result is similar in reliability with respect to PPABPM, but is more rapid and well applicable in an elderly population.

A scale evaluating the emotivity and well-being of elderly (Italian acronym: SVEBA): analysis of psychometric characteristics.

The psychopathology in the aged is an increasing burden for the last decades of the life and a large source of expenditure. An early recognition and treatment could lead to reduce personal distress and improve prognosis. For the use in the general practitioner (GP) office and ward settings most of the short check-lists available are focused on depression symptoms. For this reason a 15 items check-list, oriented to cover a wider array of symptoms, has been designed for the Italian population in the '90 (called SVEBA abbreviated from its Italian name). This work intended to investigate the presence of symptomatological clusters in order to detect different profiles of symptoms in populations with different comorbidities, in 214 home-dwelling elderly, with a mean age 80.2 years, referred to the geriatric memory clinic. We used the Keiser-Meyer-Olkin and Bartlett tests to check for applicability of factorial analysis, then a principal axis factoring extraction method was applied. The analysis identified the following factors: the first, collected items related to lack of motivation and initiative The second is related to the perceived "locus of control". The third, collected items related to sleep disturbance. The fourth, included items related to somatic complaints and anxiety. In the structure of SVEBA index is possible to identify three main symptom profiles related to motivation, anxiety and somatic symptoms and sleep disturbances.

Postural sways related to stomatognatic proprioception in elderly.

Postural control requests an automatic process that involves central and pheripheral inputs such as visual, vestibular and proprioceptive ones. The level of automatic is modulated by complex cognitive activities. The efficiency in postural control is modified by a cognitive task in old people with/without cognitive impairment. Odontostomatognatic inputs have shown to influence postural control in children and adults. In elderly the presence/absence of denture can modify the odontostomatognatic functioning, but there is no safe knowledge about the relationship between postural control and odontostomatognatic modification. We investigated possible differences in postural sways at rest between elderly subjects, with/without denture, with normal cognitive functioning and mild-moderate cognitive impairment. Moreover, we analyzed possible differences in postural sways during an interpolated cognitive task. Finally we investigated which indices, in aged subjects, of health status influence postural indices.

[The noninvasive quantitative evaluation of the acute hemodynamic effects of sublingual and transdermal nitroglycerin in man]. / Valutazione quantitativa non invasiva degli effetti emodinamici acuti della nitroglicerina sublinguale e transdermica nell'uomo.

BACKGROUND: Organic nitrates are complex vasodilators: the hemodynamic action of these drugs is different in the venous and arterial resistance and capacitance beds. The aim of our study was to obtain a quantitative, noninvasive evaluation of the acute effects of sublingual and transdermal (td) nitroglycerin (NTG). METHODS: Twenty-one pts (mean age 49 years) underwent strain-gauge plethysmography and digital photoplethysmography under control conditions, 5 min after sublingual NTG (0.4 mg), 1 hour thereafter and 2 hours after NTG td (10 mg patch). Forearm venous capacitance (CV, ml.100 ml-1) and arteriolar resistance (RA, mmHg.ml-1.100 ml.min) and the b/a ratio of arterial pulse wave (%) were measured. RESULTS: After sublingual NTG, CV increased (+24%, p < 0.01) and b/a was reduced (-35%, p < 0.01), while heart rate and RA increased (+9% and +36% respectively, both p < 0.01). Two hours after NTG td, CV increase was not statistically significant (+11%, p = 0.056), b/a was reduced (-31%, p < 0.01), heart rate and RA did not change. CONCLUSIONS: The combined use of plethysmography and digital photoplethysmography is suitable for the evaluation of vasoactive drugs such as nitrates, which have a complex profile of action on arterial and venous beds. By this method we have shown that NTG td 10 mg dilates venous beds to a low extent; this approach will be utilized in future studies aimed at elucidating dose-response and regimen effect of these drugs.