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Background: during the dementia time course Behavioral and Psychological Symptoms of Dementia (BPSD) may arise. Despite their use is still off‐label and they are associated with several side effects, antipsychotics represent the main pharmacological strategy to alleviate BPDS Method: aim of this retrospective study was to evaluate the correlation between antipsychotics use and all‐cause mortality. BPSD were classified in three clusters: "mood/apathy", "psychosis" and "hyperactivity". ANOVA for repeated measures was used to evaluate the functional/cognitive changes over three time points (baseline, 6 months and 12 months follow‐up). Chi‐Square test was carried out to verify the correlation between antipsychotic drug use and mortality. Logistic regression and stepwise regression method were used to analyze the relationship between mortality and other potential influencing factors, including ADL, IADL, CFS, in addiction of antipsychotics drugs use. Result: a total of 209 patients with a clinical diagnosis of dementia were enrolled (71.3% women; mean age = 83.24±4.98 years). The results of the ANOVA indicated a significant worsening of ADL and IADL over time [ADL Wilks' Lambda = 0.744, F(2,80) = 13.75, p<0.001, η2 = 0.256, IADL Wilks' Lambda = 0.71, F(2,80) = 16.3, p<0.001, η2 = 0.29, respectively], a significant progression of cognitive impairment as measured with MMSE and a significant worsening in frailty at CFS at 6 and 12 months follow up [MMSE Wilks' Lambda = 0.751, F(2,73) = 12.11, p<0.001, η2 = 0.249, CFS Wilks' Lambda = 0.749, F(2,79) = 13.224, p<0.001, η2 = 0.241]. Patients on antipsychotic therapy reported a higher mortality rate, although there is no statistically significant association between antipsychotic use and mortality. We found no significant correlation between mortality and antipsychotic drug use within the different BPSD cluster ("mood/apathy" p = 0.464, "psychosis" p = 0.569, "hyperactivity" 0.528), and no statistically significant association between mortality and other potential influencing factors. Using a stepwise regression, the loss of independence in IADL survived as factor associated to mortality (p = 0.002). Conclusion: patients on antipsychotic therapy reported a higher mortality rate, although there is no statistically significant association between antipsychotic use and mortality. Further work is needed to establish the relationship between antipsychotics and mortality in elderly patients with dementia. [ABSTRACT FROM AUTHOR]

Introduction: Rates of elderly patients with inflammatory bowel diseases (IBDs) are increasing, and biomarkers are needed to optimise their therapies. Serum triiodothyronine‐to‐thyroxine (T3/T4) ratio has been correlated with geriatric patient frailty. Aim: To assess the suitability of T3/T4 ratio as a response marker to biologics in elderly patients with IBD. Methods: Patients with IBD over 60 years old were enrolled, when starting biological therapy. Therapeutic outcome was assessed after 54 weeks of treatment as mucosal healing (Mayo endoscopic score < 2 for ulcerative colitis; ulcer disappearance for Crohn's disease) and clinical remission (Partial Mayo Score < 2 for ulcerative colitis; Harvey‐Bradshaw Index < 5 for Crohn's disease). T3/T4 ratio was evaluated at baseline, and its association with therapeutic outcomes was tested by multivariable logistic regression and receiver operating characteristic (ROC). Results: We enrolled 80 patients; 44 achieved clinical remission and 36 mucosal healing. Baseline T3/T4 ratio was higher in patients with mucosal healing, as compared with those without mucosal healing (P < 0.0001), regardless of the disease type or biological drug (OR 6.4 [2.9‐14.3] for each T3/T4 unit increase, P < 0.0001). A cut point of 3.3 was identified as the optimal threshold of baseline T3/T4 ratio for predicting mucosal healing, providing 78% sensitivity and 89% specificity (area under the ROC curve 0.88 [0.79‐0.94]; positive and negative likelihood ratios 6.8 [2.9‐15.9] and 0.3 [0.1‐0.5] respectively). Conclusions: T3/T4 ratio seems a reliable tool for predicting therapeutic outcome of biological therapy in elderly patients with IBD. If validated, the assessment of this parameter before starting biological treatment might be suggested. [ABSTRACT FROM AUTHOR]

Introduction: Optimizing the approach to older adults with cancer is now a priority given the increasing frequency of new cancer diagnoses that are made in the older population. The comprehensive geriatric assessment (CGA) represents the gold‐standard for (1) defining prognosis and ability to withstand cancer treatments, (2) exploring the multiple aspects that define the complexity of frail older persons, and (3) designing person‐tailored interventions. Materials and methods: In this document, based on a comprehensive revision of the literature, the Italian Society for Geriatrics and Gerontology proposes a CGA model (ONCOGER CGA) to be adopted by oncology centers for their routine approach to older patients with cancer. Results and discussion: A widespread use of this standardized CGA format will facilitate comparisons across institutions, promote studies based on a multidimensional patient assessment, and foster the inclusion of geriatric endpoints in oncological clinical trials. Furthermore, we predict that the use of a standardized CGA approach will increase the integration of geriatricians into oncology care teams with the final result of improving therapeutic choices and clinical outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare the diagnostic accuracy of lung ultrasound (LUS) and standard chest X‐ray (CXR) in older patients admitted to an acute‐care geriatric ward for suspected acute pneumonia, and to develop an easy‐to‐use diagnostic tool, now called Pneumonia Lung Ultrasound Score (PLUS), for early risk stratification. DESIGN: Prospective, single‐center, cohort study. SETTING: Acute‐care geriatric ward of tertiary care center. PARTICIPANTS: Individuals, aged 65 years and older, with suspected acute pneumonia. MEASUREMENTS: Participants were stratified according to the Multidimensional Prognostic Index. All the patients underwent CXR and LUS, whereas chest computed tomography was performed in case of mismatch between LUS and CXR. Using logistic multivariate regression, we assessed the influence of age, sex, multimorbidity, cognitive impairment, and clinical biomarkers in the misdiagnosis of acute pneumonia. Finally, an easy‐to‐perform diagnostic tool based on the combination of biomarkers (brain natriuretic peptide, high‐sensitivity C‐reactive protein, and partial pressure arterial oxygen/fraction of inspired oxygen ratio) and LUS was realized. A receiver operating characteristic curve was used to verify the predictive accuracy of PLUS, CXR, and LUS in pneumonia diagnosis. RESULTS: A total of 132 subjects (69% women; mean age = 85.3 ± 6.9 years) were enrolled in the study. Acute pneumonia was diagnosed in 94 of 132 cases. LUS showed higher diagnostic accuracy compared with CXR (0.91 (95% confidence interval (CI) = 0.85–0.93) vs 0.67 (95% CI = 0.58–0.75)) in detecting pneumonic consolidations. A higher degree of cognitive impairment was associated with both LUS and CXR pneumonia misdiagnosis (odds ratio = 1.30 (95% CI = 1.04–1.65)). PLUS showed higher predictive accuracy in the diagnosis of acute pneumonia compared with LUS (AUC = 0.92 (95% CI = 0.87–0.98) vs 0.86 (95% CI = 0.80–0.96); P =.029). CONCLUSIONS: This study confirms the higher diagnostic accuracy of LUS compared with CXR for acute pneumonia in older adults. Nonetheless, the accuracy of PLUS, an easy‐to‐use, biomarker‐derived diagnostic tool, was superior to LUS regardless of patientsʼ degree of frailty. [ABSTRACT FROM AUTHOR]

Background: dementia is a clinical syndrome characterized by progressive cognitive decline and loss of independence in activities of daily living. Alongside the cognitive symptoms, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, causing considerable distress to both patients and caregivers Method: aim of this retrospective study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified in three clusters: "mood/apathy", "psychosis" and "hyperactivity". Using the Clinical Frailty Scale (CFS), patients were categorized as "severely frail", "mild/moderately frail" and "robust" (CFS ≥ 7, 4‐6 and ≤ 3, respectively). In order to better understand the complex pattern of relationships between the different factors, we performed a network analysis. Result: 209 patients (71.3% women, mean age 83.24±4.98 years) with a clinical diagnosis of dementia were enrolled. The most represented group was the mild/moderately frail one (n = 155, 74%); lower numbers were seen in the robust (n = 18, 9%) and severely frail (n = 36, 17%) ones. Among the "severely frail" the percentage of BPSD was higher compared to the "mild/moderate" and "robust" groups. A significant correlation between frailty and "hyperactivity" cluster emerged, both at baseline and follow up visits (p<0.001, p = 0.022, p = 0.028 respectively). At the network analysis, the degree of frailty related to behavioral and psychological symptoms of the hyperactivity cluster, such as agitation and motor aberrant activity; the relationship was still positive although not so strong with other symptoms like apathy and hallucinations. Conclusion: in this study an association between frailty and the number of neuropsychiatric symptoms of the "hyperactivity" cluster was found; however, whether the loss of independence is a possible cause of frailty or viceversa is still to be determined. The assessment of frailty may help identifying patients at risk of developing behavioral and psychological symptoms of dementia, and could provide the clinicians with a time‐window to target intervention in the earliest phases of both frail condition and BPSD. [ABSTRACT FROM AUTHOR]

Introduction A relationship between vestibular disorders and thyroid autoimmunity independently from thyroid function has been postulated. Aim To shed more light on the actual relationship between vestibular lesions and Hashimoto's thyroiditis ( HT) regardless of thyroid function. Methods Forty-seven patients with HT (89·4% F; aged 48·3 ± 12·7 years), 21 with multinodular goitre ( MNG; 57·1% F; 54·1 ± 9·8 years) and 30 healthy volunteers (56·7% F; 50·7 ± 13·9 years) were enrolled. Inclusion criteria were the presence of normal thyroid function tests and no clinical history of vestibular dysfunction. Each subject was submitted to complete vestibular evaluation [Caloric Test, Vestibular evoked myogenic potentials ( VEMPs), Head Shaking Test ( HST)]. Results 52·2% of HT patients showed an alteration of VEMPs and 44·7% of caloric test ( P < 0·0001 for both). None of the MNG patients showed any vestibular alteration, while one healthy control showed an altered caloric test. A correlation was found between vestibular alterations of HT patients and the degree of serum TPOAb level, not affected by age and serum TSH value. By logistic regression analysis, the absence of thyroid autoimmunity significantly reduced the risk of vestibular alterations: HR 0.19 (95% CI: 0·003-0.25, P = 0·0004) for caloric test; HR 0·07 (95% CI: 0·02-0·425, P < 0·0001) for VEMPs; and HR 0·22 (95% CI: 0·06-0·7, P = 0·01) for HST. Conclusion In euthyroid HT patients, a significant relationship between subclinical vestibular damage and the degree of TPOAb titre was documented. This finding suggests that circulating antithyroid autoantibodies may represent a risk factor for developing vestibular dysfunction. An accurate vestibular evaluation of HT patients with or without symptoms is therefore warranted. [ABSTRACT FROM AUTHOR]

The new echocardiographic techniques for the study of physiopathological intramyocardial phenomena include video densitometry (VD), integrated backscatter (IBS), and color Doppler myocardial imaging (CDMI). Being more independent from cardiac load and from rotational and translational heart motion, these new sensible, noninvasive techniques such as CDMI and IBS show a real incremental value in comparison with conventional echocardiography and allow to detect subtle functional and textural abnormalities of intramural myocardium, partially undetectable by conventional two-dimensional Doppler echocardiography. Subclinical thyroid dysfunction (STD), both in its hypo- and hyperthyroidism form, has a relatively high prevalence in general population (9–15% with a lower percentage of adult males), hence it could be very useful to study more deeply heart involvement in these physiopathological conditions and understand the complex relationship between thyroid and heart. The use of these new ultrasonic techniques in subclinical hypothyroidism helps to detect the early simultaneous involvement of both cardiac cycle phases, which causes a decrease of intramyocardial contractility and an impairment of both active and passive phases of diastole. In subclinical hyperthyroidism, these new ultrasonic techniques permitted to discover more complex and different early cardiac abnormalities of both systolic and diastolic phases. [ABSTRACT FROM AUTHOR]

DESIGN, PATIENTS AND MEASUREMENTS The presence of neuromuscular symptoms was ascertained by questionnaire in 33 consecutive patients with subclinical hypothyroidism (sHT) as compared to 44 age- and sex-matched controls. Blood was sampled for PTH, magnesium, phosphate, and total and ionized calcium determination. Patients reporting three or more symptoms were also studied by surface electromyography (sEMG). The study was repeated following a six-month L-T4 course. RESULTS Neuromuscular symptoms were significantly more frequent in patients than in controls (P = 0.0001), and correlated with TSH values (r = 0.52; P = 0.0001). Among patients showing three or more symptoms (n = 11), sEMG documented the presence of repetitive discharges in 8 patients. L-T4 therapy led to a significant improvement of symptoms (P = 0.0001); persistent repetitive discharges were no longer observed. Total and ionized calcium values, always within the normal limits, were significantly lower in patients than controls (P < 0.0001). An inverse relationship was observed between ionized calcium and: TSH values (r = -0.69, P = 0.0001); the number of neuromuscular symptoms (r = -0.53, P = 0.0001). L-T4 replacement induced a significant increase in both total and ionized calcium levels (P < 0.01 and P < 0.0001, respectively). CONCLUSIONS Neuromuscular symptoms and dysfunction are rather common in subclinical hypothyroidism, and may be associated with abnormalities in serum calcium balance and surface electromyography. The ability of L-T4 treatment to reverse all these changes suggests that subclinical hypothyroidism patients may require early therapy not only to prevent progression to frank hypothyroidism, but also to improve their neuromuscular dysfunction. [ABSTRACT FROM AUTHOR]