Neuropsychological assessment of the severely impaired elderly patient: validation of the Italian short version of the Severe Impairment Battery (SIB). Gruppo di Studio sull'Invecchiamento Cerebrale della Società Italiana di Gerontologia e Geriatria.

One hundred and sixty-nine severely demented patients were tested in a multicenter study with the short version of the Severe Impairment Battery which was translated into Italian with the purpose of adapting and validating it for an Italian population. Patients were enrolled in Italian geriatric centers participating in the Study Group on Aging Brain of the Italian Society of Gerontology and Geriatrics. Following thorough clinical and instrumental examinations, they were evaluated with the Mini Mental State Examination, the Clinical Dementia Rating, the Severe Impairment Battery (SIB), the Gottfries-Bråne-Steen Rating Scale for Dementia, the Activity of Daily Living index, and the Bedford Alzheimer Nursing Severity scale (BANS.s). The inter-rater reliability of the SIB was highly significant for the total score and its subtests; test-retest reliability showed the same significance in all items. Also concurrent validity, performed comparing the total SIB score with the total BANS.s score, was significant. The short Italian version of the SIB proved to be a very reliable tool for the evaluation of severely demented patients; it has the advantage of being easy to administer, it evaluates more cognitive domains that, are typically assessed in dementia, and has a wide enough range of scores to detect even small differences in the examined abilities.

Idebenone in senile dementia of Alzheimer type: a multicentre study.

Idebenone is a new cerebro-active drug, effective in dementia disorders, particularly indicated in primary degenerative dementias, i.e. Alzheimer's disease. This new molecule acts as an electron trapper and a free radical scavenger protecting mitochondrial membranes from lipid peroxidation. A multicentric, double-blind trial of idebenone (45 mg twice daily orally) vs. placebo was carried out on 102 elderly patients affected by Alzheimer-type dementia of mild or moderate severity. Idebenone was administered for 4 consecutive months, 45 mg twice daily. Clinical evaluations were performed at the time of enrollment (t0) and monthly thereafter (t30, t60, t90 and t120) and at follow-up (t150 ). Tolerability to idebenone treatment was good and was associated with a statistically significant improvement of memory, attention and behaviour. It is worthwhile noting that these cognitive and behavioral findings were observed after the first month of treatment with enhancement evident in the following period.

Randomized, double-blind, placebo controlled, multicentre study of idebenone in patients suffering from multi-infarct dementia.

In this randomized double-blind, placebo controlled, multicentre study on 108 elderly patients with mild to moderate mental deterioration of vascular origin, idebenone - a benzoquinone derivative with a hydroxyalkyl side chain - proved to be therapeutically effective in the treatment of multi-infarct dementia. The oral administration of idebenone 45 mg/day b.i.d. for 120 days significantly improved the scores of the following test in comparison with placebo: Mini Mental State, Randt Memory Test, Gottfries Rating Scale, Token Test, Toulouse Piéron Test, indicating improvements in memory attention and cognitivity. The drug was well tolerated and effective in patients with multi-infarct dementia. No changes in laboratory parameters were observed either before or after treatment.

Ketanserin in the treatment of mild hypertension in elderly patients: preliminary results of a controlled double-blind trial.

Thirty elderly patients (mean age 77.5 years) with mild hypertension were considered for a double-blind trial comparing the effects of ketanserin and propranolol. After 28 days of placebo, a group of 15 patients was given ketanserin at the daily dose of 20 mg twice daily for 15 days and of 40 mg twice daily for the subsequent 75 days, while the other group of 15 patients was given propranolol for 90 days at the dose of 80 mg twice daily. Blood pressure and pulse rate in the supine and standing positions were evaluated every 15 days. After the beginning of treatment with ketanserin there was a gradual but highly significant decrease of the systolic and diastolic blood pressure values. No relevant side-effects or significant biochemical alterations were observed during treatment with ketanserin.

Circadian rhythms of heart rate and premature ventricular beats in the aged.

The chronobiological analysis by means of the cosinor method on the dynamic electrocardiographic tracings of 30 subjects aged over 65 years with no clinical or instrumental signs of heart disease revealed a significant circadian rhythm of heart rate with acrophase in the early afternoon. When compared with a group of 30 young adult subjects, the elderly exhibited only a non-significant reduction of the rhythm amplitude. Elderly patients with heart disease exhibited a similar chronobiological pattern of heart rate. Premature ventricular beats (PVBs) were present in all subjects and occurred mostly during the day. A significant circadian rhythm was present only in elderly heart patients with 30-150 PVBs/h. The circadian distribution of PVBs showed significant interindividual differences with nocturnal acrophase in about one third of the patients. The chronobiological analysis can represent the basis for a more appropriate therapeutic approach to the elderly with PVBs.

[Arrhythmias in the elderly]. / Le aritmie nell'anziano.

A survey was made on a population of 6059 subjects aged more than 60 years with the aim to assess 1. the prevalence of heart arrhythmias and 2. the relationships between arrhythmias and some other ecg alterations. Arrhythmias resulted present in 29.0% of the whole population with a significantly higher prevalence among males (30.7% vs 28.1%, P less than 0.05) and among subjects over 75 years of age (33.2% vs 23.9%, P less than 0.001). Supraventricular extrasystoles (SE, 11.55%), atrial fibrillation (AF, 10.44%) and ventricular extrasystoles (VE, 8.91%) were the most frequent arrhythmias, followed by sinus bradycardia (SB, 2.04%), sinus arrhythmia (SA, 1.35%), atrial flutter (AFL, 1.09%) and junctional rhythms (JR, 0.20%). AF and AFL resulted significantly more frequent among females, whilst SE, VE and SB were more frequent among males. All the above arrhythmias, with the exception of AFL and JR resulted significantly more frequent among subjects over 75. A significantly higher prevalence of ecg signs of left ventricular hypertrophy, ischemia, previous myocardial infarction (MI) and of the so-called "minor" T-wave changes (MTC) was found among the subjects with arrhythmia as compared with those free from rhythm disturbances. Ecg signs of MI and MTC were significantly more frequent among males and MTC were more frequent among females and among subjects over 75. It is concluded that in an old person the presence of an arrhythmia should lead to a careful evaluation of the general and cardiological clinical situation in order to avoid 1. to prescribe an unnecessary and potentially dangerous antiarrhythmic treatment, and 2. to misdiagnose an underlying clinical condition liable to a decisive improvement under adequate treatment.

[Hemochemical data in the function study of the senile kidney]. / Considerazione di alcuni dati ematochimici per l'inquadramento funzionale del rene senile.

A survey was made of 2426 serum creatinine (SC) values in subjects over 60 and free from kidney diseases or other conditions capable of influencing the renal function. SC values were higher in males than in females and showed a tendency to increase with advancing age. The study of the correlation between endogenous creatinine clearance and both urea and SC showed that the latter represents a more reliable index of glomerular filtration rate than the former.

[Polycardiographic researches on over 90 years old subjects (author's transl)]. / Rilievi policardiografici su soggetti ultranovantenni.

In the recent years an increasing attention has been focused on the systolic time intervals (STI) as reliable indicators of left ventircular contractile performance. As regards the diagnostic usefulness of STI in old persons only few papers can be found in the literature, all of them being concerned with subjects aged less than 90 years. With the aim to assess the usefulness and the reliability of the method and the caracteristics of left ventricular function in the tenth decade, STI as well as heart volume (HV) were determined on a group of 35 subjects aged 90 years and over (mean age 93.2 years) normotensive and free from clinical evidence of heart disease. STI (PEPI, LVETI, QS2I, PEP/LVET) values showed no differences with those considered as normal. A marked increase was recorded for the HV values. These results suggest that in the very advanced age a good level of left ventricular contractile performance can be mantained by the compensatory mechanism represented by heart dilation according to the Frank Starling principle.

Left fascicular hemiblocks in the elderly.

A three-year follow-up study was made of 45 elderly subjects with left anterior hemiblock, either alone or associated with right bundle-branch block. In the LAH + RBBB group, there was a higher mortality rate and frequent evolution toward complete A-V block. The prognostic significance of left fascicular hemiblocks is discussed.

[Incidence and outcome of fascicular blocks in the aged. Retrospective studies]. / Frequenza ed evoluzione dei blocchi fascicolari negli anziani. Indagine retrospettiva

The results of a three-year follow-up study of 45 elderly subjects (mean age 79,5 years, range 67-96 years) with left anterior hemiblock (LAH) alone or associated to right bundle branch block (RBBB) are reported. In the presence of isolated LAH no significant changes in the mortality rate were observed. The patients with LAH+RBBB showed an increase in mortality rate and not rarely (2 cases out of 13) an evolution toward a complete A-V block. The role of age as a factor influencing the natural history of these patients is discussed.