1,721,426 research outputs found
Hypertension and cognitive impairment in the elderly [Ipertensione arteriosa e decadimento cognitivo]
No full textThe prevalence and incidence of dementia is expected to exponentially increase in the future 30 years. Accordingly, the identification of the causes of dementia and of the possible risk factors become very important for researchers and clinicians. A growing body of evidence suggests that hypertension may be a risk factor for vascular and neurodegenerative dementias. Recently, it has been shown that hypertension is associated not only with cerebrovascular disease, which is in turn associated with dementia, but it could also affect the course of Alzheimer disease. A strong relationship between long-standing hypertension and cognitive impairment or dementia has been demonstrated by several large observational studies, especially with untreated hypertension. The risk increases with increasing blood pressure. However, the relationship between blood pressure and dementia is not linear. Blood pressure may decrease to normal or low levels before dementia (and especially Alzheimer's disease) becomes clinically manifest. There may also be an association between blood pressure variability in hypertensive patients and impaired cognition. In an extension of the Systolic Hypertension in Europe (Syst-Eur) study in older people and in other studies using the 24-hour non-invasive monitoring of the blood pressure values, an increased blood pressure variability at baseline has been shown to positively correlate with worse cognitive performances. This variability may reflect central nervous system dysregulation or occult injury to the prefrontal autonomic centers, occurring just before the clinical manifestation of dementia. Randomized therapeutic hypertension trials focusing on cognitive function and the occurrence of dementia have shown that an active treatment may be beneficial, although the optimal levels of blood pressure have not yet defined. Future studies, comparing the effect of different classes of antihypertensive drugs on the absolute blood pressure levels and of the 24 hour blood pressure variability, are expected to further clarify this topic
Cognitive and Social Consequences of Exposure to Emotional Narratives: Two Studies on Secondary Social Sharing of Emotions
No full textOutcomes of older people admitted to postacute facilities with delirium [12]
No full text[No abstract available
Cognitive and Social Consequences of Exposure to Emotional Narratives: Three Studies on Secondary Social Sharing of Emotions
No full textDelirium superimposed on dementia
No full textPurpose: Delirium superimposed on dementia (DSD) is a frequent and growing emerging clinical challenge, given the increasing prevalence of dementia. Methods: This narrative review focuses on and discusses the current knowledge on epidemiology, pathogenesis, diagnosis and management of DSD. Results: There is a close interaction between delirium and dementia since dementia is a risk factor for delirium and delirium is a known risk factor for newly developed dementia or worsening of dementia. The occurrence of DSD causes adverse clinical outcomes. However, DSD is often under-recognized or is frequently considered as the regular course of dementia. Indeed, especially in the advance stages of dementia, DSD diagnosis is challenging since a clear distinction between symptoms attributable to delirium and to dementia is difficult. Given the importance of DSD, it is essential to educate health care providers on the best approach for delirium management and treatment. It is now well recognized that delirium can be prevented using multicomponent interventions carried out by a multidisciplinary team targeting predisposing and precipitating risk factors for delirium. On the contrary, antipsychotics should only be used in patients with severe distressing symptoms and whose behavior means their safety or the safety of those around them is compromised, given the harmful of these medications in patients with pre-existing dementia. Conclusions: It is essential to improve health care providers knowledge on DSD to improve the quality of care for an epidemiologically relevant though understudied population
Medications use in the elderly Problemi di farmacologia clinica in età geriatrica
No full textThe quality of medication prescribing and use in older persons has been a recurring issue of substantial concern for policy-makers, regulators, health care researchers, and the public. Although there have been numerous efforts to measure the extent of the problem and to identify areas in greatest need of change, constructing meaningful quality indicators relevant to drug therapy in elderly patients has continued to be a challenge. Prescribing medication in the elderly is a very complex task, either because they are more prone than adults to experience adverse drugs-related clinical events, either because their compliance to pharmachological prescription is often quite difficult. Furthermore, pharmacodinamic and pharmachokinetic changes occurring with age, need to be taken into the account In this article, the most relevant problems of pharmachological prescription in the elderly and the strategies to improve quality medication use are suggested
Music interventions against agitated behaviour in elderly persons with dementia: a cost-effective perspective
No full textWe discussed the possibility that ‘nursing facilities
for patients with dementia adopt group music intervention
as a routine institutional activity’. In fact,
while from the clinical point of view, the intervention
is certainly useful in reducing agitated behaviours, we
are concerned about economical sustainability of such
interventions. In our country, the daily cost for each resident
in nursing home ranges between 70 and 100 euro, so
we can estimate that the music intervention is equivalent
to 1/70th of the daily cost of care. On the basis of
these calculations, we may conclude that the intervention
deserves attention by directors of nursing facilities
in light of the large number of patient affected by
dementia and behavioural and psychological symptoms
of dementia (BPSD)
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