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The presence of pain in elderly persons with cognitive decline is often neglected, under-reported, underestimated, misdiagnosed and not adequately treated, with consequences that have a strong impact on health, independence in activities of daily living and quality of life. There is no empirical evidence that people with dementia experience less pain; therefore, in patients with severe cognitive impairment the progression of cognitive decline dramatically affects the ability to verbalize the presence of pain. Self-assessment scales are considered the “gold standard” for pain assessment, but the presence of cognitive impairment is likely to reduce the reliability of these measures. Treatment of pain in elderly with cognitive decline or dementia is based on non-pharmacological and pharmacological strategies. Pharmacological treatment should consider physiological changes, high comorbidity and drug interactions that occur frequently in the elderly. This narrative review aims to describe current knowledge, methods of detection and treatment approaches for chronic pain in elderly persons with cognitive deficits.

The objective of the present review was to systematically characterize the types of cognitive impairment that are found in different non-brain types of cancer as measured by objective and validated tests, and also to further examine depression and cognitive function in cancer patients and explore their available rehabilitation treatments. A total of 29 articles were reviewed. Most of these studies suggest that chemotherapy as well as the combination of chemotherapy and hormonal therapy can influence cognition in different types of cancer patients. Breast cancer patients appear to be the most affected in neuropsychological function, specifically in terms of cognitive impairment and reduced quality of life, as compared to other non-brain solid tumours. Overall, the most impaired functions were verbal ability, memory, executive function, and motor speed. Chemotherapy-related cognitive dysfunction remains under-recognized and undertreated. The various studies reported differing and non-homogenous findings with mixed results, obtained by self-reporting and web-assisted assessment, with other confounding factors such as age and depression during both cancer diagnosis and treatment. An objective neuropsychological assessment is fundamental to avoid underestimation of the extent of chemobrain. Self-reported and web-assisted assessment may ultimately result in confusion between the neuropsychological signs of chemobrain versus those of depression.

Background: Cardiovascular autonomic failure is a frequent non-motor symptom of Parkinson’s disease (PD), its key feature being orthostatic hypotension (OH). Recent studies suggest that blood pressure deregulation in PD may be associated with increased cerebrovascular damage. Cerebral vasoreactivity (CVR) refers to the vasodilatory response of cerebral arterioles to elevation of pCO2. Reduced CVR is considered a risk factor for chronic cerebrovascular damage in the setting of hypertension or severe carotid artery stenosis. Here we evaluated CVR in PD patients with or without cardiovascular autonomic failure and age-matched healthy subjects. Methods: Transcranial doppler ultrasound was applied to measure blood flow velocity in the middle cerebral arteries of 12 PD patients and 11 healthy subjects. CVR was quantified by means of the breath holding index (BHI). OH was identified during a standing test, and in this setting blood flow velocities were likewise recorded. Results: PD patients displayed significantly lower BHI compared to controls, independently from the presence of OH. Patients with OH had lower mean arterial blood flow velocities compared to those without OH, both in supine and orthostatic position. Conclusions: These preliminary results show interactions between cerebral hemodynamics and blood pressure disturbances in PD, that may contribute to chronic cerebrovascular ischemic damage in PD.

The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results, whereas little information is available regarding the use of this therapy in subacute stroke patients. The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase. Fifty adult stroke patients participated to the study: 25 subjects were randomly assigned to balance training with Wii Fit, and the other 25 subjects were assigned to usual balance therapy. Both groups were also treated with conventional physical therapy (40 min 2 times/day). The main outcome was functional balance (Berg Balance Scale-BBS), and secondary outcomes were disability (Barthel Index-BI), walking ability (Functional Ambulation Category), and walking speed (10-meters walking test). Wii Fit training was more effective than usual balance therapy in improving balance (BBS: 53 versus 48,P=0.004) and independency in activity of daily living (BI: 98 versus 93,P=0.021). A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke.