Home care for demented subjects: new models of care and home-care allowance.

This study on home care for demented patients is one of the finalized research projects sponsored by the Ministry of Health. The teams involved are: the Home Hospitalization Service (HHS) of S. Giovanni Battista Hospital of Torino, the "Azienda Sanitaria Locale n 20" (ASL 20) of Alessandria and Tortona and the "Presidio Ospedaliero Riabilitativo Fatebenefratelli" of San Maurizio Canavese (Torino). Aim of the study is to assess the feasibility and usefulness of taking care of elderly demented patients at home and to improve the quality of life of patients and their relatives, involving training experiences and economic help. The Geriatric Department of San Giovanni Battista Hospital started a randomized controlled study on 109 severely demented subjects admitted to the emergency room of the hospital. Fifty-three patients were transferred to the traditional geriatric ward and 56 to the HHS. The team of ASL 20 of Alessandria and Tortona selected and evaluated 45 elderly demented patients living at home. These subjects, stratified for their cognitive and functional impairment, were randomly allocated to two different groups: a group receiving an economic help for one year and a control group. In the first setting of research the degree of dementia was severe, mini mental state examination (MMSE) score was 10.0 +/- 5.2 for patients at home, and 10.5 +/- 6 for the second group. The majority of patients followed at home (78.6 %) were discharged, while only 47.2 % of the in-patients returned home (p < 0.001). Seventeen out of 53 patients (32.1 %) admitted to the traditional ward and only two of home-hospitalization patients had to be sent to nursing home (p <0.001). The 45 subjects evaluated by the team of ASL 20 were divided into two groups.Twenty-four subjects were allocated to receive a home care allowance. Their functional status was impaired. Their MMSE score was 12.6 +/- 5.4 and clinical dementia rating scale(CDR) score 2.7 +/- 0.9. A control group of 21 subjects (17 women and 4 men) showed similar characteristics as the previously described group.

Is videopupillography useful in the diagnosis of Alzheimer's disease?

Patients with Alzheimer's disease (AD) reportedly exhibit greater pupillary dilation than healthy subjects in response to tropicamide. By means of videopupillography, we have found that the average basal pupillary diameter was greater in AD patients than in normal controls and that there is an inverse relationship between the average pupillary diameter and the maximal dilation obtained following tropicamide application in both groups. Pupillary response to tropicamide and videopupillography do not distinguish between Alzheimer's patients and controls.

The Italian version of the Alzheimer's Disease Assessment Scale (ADAS): psychometric and normative characteristics from a normal aged population.

The Alzheimer's Disease Assesment Scale (ADAS) was specifically proposed for the clinical assessment of patients suffering from dementia and is used in different countries. The Italian version of ADAS is presented in this paper together with the description of criteria used in transforming the American edition in the Italian edition. Psychometric and normative data are illustrated and discussed. A sample of 95 healthy volunteers of both sexes ranging in age from 50 to 79 years were recruited from the general population in different parts of Italy and from different social and educational levels. Their performance on the ADAS was analysed by sex, age, and educational level. Results indicated a specific influence of subjects' educational level on the Cognitive Subscale Total Score of ADAS and the need for an adequate correction was evidenced. The two objective measures of memory which constitute, together with the Cognitive Subscale Total Score, the cognitive subscale of ADAS were sensitive to both age and educational level, requiring corrections. The factor structure of the cognitive subscale of ADAS confirms the validity of distinguishing between the clinical-functional scores, which are summarized by the Cognitive Subscale Total Score (CSTS), from those of the objective memory tasks, which are kept separate and used to quantify specific memory characteristics. The main components of the CSTS were 3 factors. The first factor was

delta F508 deletion in cystic fibrosis in Italian families.

In 20 Italian families with cystic fibrosis (CF), restriction fragment length polymorphisms were detected by five linked markers; a strong linkage disequilibrium is observed between the haplotype B (alleles 2/1 with respect to KM19/XV2c) and CF. The frequency of the delta F508 deletion in CF chromosomes of this sample is 50%. A significant correlation is found between the absence of the delta F508 mutation and pancreatic sufficiency.

Autosomal dominant polycystic kidney disease: a linkage evaluation of heterogeneity in Italy. Italian Collaborative Group on Polycystic Kidney Disease.

A survey of 29 families with Adult Polycystic Kidney Disease (ADPKD) was performed to evaluate the genetic heterogeneity of the disease in Italy. The approach was through the linkage between the disease and 2 polymorphic DNA fragments as detected by the probes 3'HVR and 24.1. Linkage between the polymorphic markers and the disease was confirmed, with the following lod scores: between 3'HVR and ADPKD1 = 12.974 at theta = 0.02; between 24.1 and ADPKD = 1.716 at theta = 0.07; between 3'HVR and 24.1 = 2.738 at theta = 0.09. No evidence of significant genetic heterogeneity in the examined Italian regions was detected.

Mitochondrial DNA polymorphism in four Sardinian villages.

Polymorphism of mitochondrial DNA has been studied in two highland (Desulo, Tonara) and in two lowland (Galtellì, Orosei) Sardinian isolates, formerly subjected to different selective pressure due to malaria, and in 103 individuals from Northern Italy (Bergamo area), where malaria never appeared to be endemic. Two mitochondrial restriction endonuclease patterns (morphs) never described before have been found, one in the Bergamo and Orosei samples, and the other one only in Orosei. Four new mitochondrial types (mitotypes) due to different combinations of morphs have been identified; two of them have been found only in Sardinia, but with such a low frequency that they cannot be defined as typical Sardinian mitotypes. One mitotype (BamHI-morph 3, MspI-morph 4, AvaII-morph 9 and HaeII-morph 1) showed a significantly higher frequency in the highland rather than in the lowland Sardinian villages or in the Bergamo area. Since this mitotype has been found at a relatively high frequency in Central and Southern Italy, while it has been reported to be rare in Caucasians of Central European origin and absent in other ethnic groups (Africans, Chinese, Japanese and Israeli Jews), we suggest it may represent an ancient Mediterranean type. The analysis of these data suggests that drift or other evolutive forces different from malaria might be the major cause of mitochondrial DNA variation in Sardinia.