Search

Introduction: Scientific evidence shows how ICG sensibility and specificity is comparable to 99Tc, and in many Breast Units ICG has become the gold standard for sentinel lymph node detection. Aim of this study is a cost-effectiveness analysis of the sentinel lymph node detection pathway using ICG, compared to the 99Tc one. Materials and methods: 291 patients received a 99Tc injection the day before surgery and an ICG one in the OP day. As in our hospital a Nuclear Medicine Department does not exist, patients had to undergo an adjunctive travel in order to receive Technetium. We calculated costs of the whole Technetium procedure as like as the costs of the ICG one. Results: The overall amount of costs of the Technetium injection has been equal to 450363,62€. The ICG pathway has had an overall cost of 98668,7€, equal to a 21.9% of the Technetium expenses. Discussion: According to the Law, Technetium may be managed only in a Nuclear medicine department. This is the reason why Patients undergo a sometimes long travel to reach one. This traffic represents a cost for Patients and a work overload for the hospital structures. Indocyanine green allows to avoid a travel to the Nuclear Medicine and to spare a big amount of costs.

OBJECTIVES: To investigate whether problems in instrumental activities of daily living (IADL) can add to conventionally used clinical measurements in helping to predict a diagnosis of dementia at 1- and 2-year follow-up. DESIGN: Multicenter prospective cohort study. SETTING: Memory clinics in Europe. PARTICIPANTS: Individuals aged 55 and older without dementia. MEASUREMENTS: IADLs were measured using pooled activities from five informant-based questionnaires. Structural equation modeling (SEM) was used to investigate the relation between IADLs and dementia. Age, sex, education, depression, and cognitive measures (Mini-Mental State Examination and verbal memory) were included in the model. RESULTS: Five hundred thirty-one participants had baseline and 1-year follow-up assessments; 69 (13.0%) of these had developed dementia at 1-year follow-up. At 2-year follow- up, 481 participants were seen, of whom 100 (20.8%) had developed dementia. Participants with IADL disabilities at baseline had a higher conversion rate (24.4%) than participants without IADL disabilities (16.7%) (chisquare = 4.28, degrees of freedom = 1, P =.04). SEM showed that IADL disability could help predict dementia in addition to the measured variables at 1-year follow-up (odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.51-3.13) and 2-year follow-up (OR = 2.11, 95% CI = 1.33-3.33). CONCLUSION: IADL disability is a useful addition to the diagnostic process in a memory clinic setting, indicating who is at higher risk of developing dementia at 1- and 2-year follow-up. J Am Geriatr Soc 59: 2273-2281, 2011.

Background: The APOE ε4 allele is a risk factor for Alzheimer’s disease (AD). APOE ε4 is common in non-demented subjects with cognitive impairment. In both healthy people and people with AD, its prevalence has a north-south gradient across Europe. In the present study, we investigated whether the relation between the APOE ε4 allele and cognitive impairment varied across Northern, Middle and Southern Europe. We also investigated whether a north-south gradient existed in subjects with subjective cognitive impairment (SCI), amnestic mild cognitive impairment (MCI) and non-amnestic MCI. Methods: Data from 16 centers across Europe were analyzed. Results: A north-south gradient in APOE ε4 prevalence existed in the total sample (62.7% for APOE ε4 carriers in the northern region, 42.1% in the middle region, and 31.5% in the southern region) and in subjects with SCI and amnestic MCI separately. Only in Middle Europe was the APOE ε4 allele significantly associated with poor performance on tests of delayed recall and learning, as well as with the amnestic subtype of MCI. Conclusion: The APOE ε4 allele frequencies in subjects with SCI and amnestic MCI have a north-south gradient. The relation between the APOE ε4 allele and cognition is region dependent.

Aim In the framework of IMI PharmaCog project (Grant Agreement no. 115009), this study evaluated whether abnormal cortical sources of resting state electroencephalographic (EEG) rhythms are correlated to cerebrospinal fluid (CSF) ® amyloid (A®) level in amnesic Mild Cognitive Impairment (MCI) subjects. Methods Artifact-free resting state eyes-closed EEG rhythms (19 electrodes) were recorded. Individual datasets were divided into those with high CSF A® level (81 A®-negative, CSF A ® > 550 pg / ml ) and those with low CSF A® level (46 A®-positive, CSF A ® 550 pg / ml ). Regional normalized cortical sources of EEG rhythms at frequency bands of interest were estimated by LORETA package. ANOVA compared these sources between the two MCI groups ( p Results Statistical results showed: (1) source pattern Nold p r =−0.26; p =0.003) across all MCI subjects. Conclusions These results suggest a relationship between the brain amyloid charge, as revealed by CSF A® level, and pathological delta cortical sources indicating cortical disconnection in amnesic MCI subjects. EEG delta sources could represent a promising early diagnostic marker of Alzheimer's disease (AD).

Background Although Indocyanine green (ICG) is used to find sentinel nodes (SN) in patients with breast cancer (BC), its role in clinical practice is still debated, and needs a definitive validation to be included in the standard approach to finding sentinel nodes in breast cancer. Materials and methods To validate the ICG methods of detecting the SN in BC we have recently concluded a prospective validation trial. Patients with clinically node-negative, invasive early BC scheduled for breast surgery and SN biopsy were included in the trial. All the patients underwent SN detection using both the standard-of-care procedure using radioisotope technetium (99mTc) and the ICG, using the Photodynamic Eye camera. A comparison of the detection rate and the diagnostic accuracy of the two methods was performed to detect the equivalency of the two approaches. Results At the end of the enrolment, 301 patients were considered eligible and included in the trial, and 589 nodes were removed. Five hundred and eighty-three nodes (99%) were identified with ICG (median 2 nodes per patient) and 452 (76.7%) were identified with 99mTc (median 2 nodes per patient). A concordance index of 98.75% (CI, 95% = 97.1%–99.5%) was detected. The dosage given ranged from 0.3 to 1.4 ml. ICG was used in all patients eligible for SN biopsy without any significant acute side effects. Conclusions The index of concordance between 99mTc and ICG seems to be extremely high, suggesting that ICG could be validated as an alternative method to 99mTc in the detection of SN in BC.

Aim In the framework of IMI PharmaCog project (Grant Agreement no. 115009), this study evaluated whether cortical sources of AO-ERPs are related to cerebrospinal fluid (CSF)® amyloid (A®) level in amnesic Mild Cognitive Impairment (MCI) subjects. Methods Artifact-free AO-ERPs (19 electrodes) were recorded in 115 MCI subjects. Individual datasets were divided into those with high CSF A® level (61 A®-negative, CSF A® > 550 pg/ml) and those with low CSF A® level (43 A®-positive, CSF A® Results The ANOVA for the P3a peak illustrate a statistically significant interaction effect (F = 2.87; p = 0.006) between the factors Group and Brodmann Area (BA 10 and 11). The ANOVA for the P3b peak illustrate a statistically significant interaction effect (F = 2.745; p = 0.008) between the factors Group and BA (BA 5,7,23,31). Conclusions The present study provides support to the hypothesis that specific neurophysiological markers may enrich the discrimination of aMCI subjects in an early stage of prodromal Alzheimer’s disease (AD) for early diagnosis and preventive treatments.

We investigated the effect of apolipoprotein E (ApoE) on the whole brain in 51 individuals with mild cognitive impairment using voxel-based morphometry. Between cases heterozygous for the ApoE Ε4 (n = 15) and those who were ApoE Ε4 noncarriers (n = 28), only the right parahippocampal gyrus, with the entorhinal cortex included, reached the level of statistical significance. In cases homozygous for the Ε4 allele (n = 8) versus noncarriers, the greatest atrophy was located in the right amygdala followed by the right parahippocampal gyrus, the left amygdala and the left medial dorsal thalamic nucleus.

Cortical sources of resting state electroencephalographic (EEG) rhythms are abnormal in subjects with mild cognitive impairment (MCI) and in patients with Alzheimer’s disease (AD). Here, we tested the hypothesis that they reflect disease progression for future clinical trials. Resting state eyes-closed EEG data were recorded in 54 amnesic MCI subjects and in 88 mild AD patients at baseline and at 1-year follow up. LORETA was used for data analysis. In the mild AD patients, the follow-up EEG recordings showed increased power of widespread delta sources as well as decreased power of widespread alpha and posterior beta 1 sources ( p p Cortical sources of resting state EEG rhythms may be used as secondary “surrogate” end points for drug discovery in prodromal and manifest AD patients.

Occipital sources of resting state alpha rhythms are abnormal in patients with amnesic mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Here we hypnotized whether the activity of these sources is related to neurodegeneration in occipital lobe as measured by magnetic resonance imaging (MRI). Resting-state eyes-closed EEG rhythms were recorded in 30 healthy elderly (Nold), 37 MCI, and 40 AD subjects. Neurodegeneration of the occipital lobe was indexed by weighted averages of gray matter density (GMD). EEG rhythms of interest were alpha 1 (8–10.5 Hz) and alpha 2 (10.5–13 Hz). EEG cortical sources were estimated by LORETA. Results showed a positive correlation between GMD in the occipital lobe and the magnitude of occipital alpha sources in the MCI and AD subjects. Furthermore, there was a positive correlation between the magnitude of alpha sources and the cognitive status as revealed by Mini Mental State Evaluation score all subjects. These results suggest that in amnesic MCI and AD subjects, occipital sources of resting state alpha rhythms reflect AD neurodegeneration in the occipital lobe. Cortical sources of resting state EEG rhythms in AD patients are promising for preliminary screening of elderly subjects at risk for AD.

Alzheimer’s disease (AD) patients show abnormal cortical sources of resting state EEG rhythms, especially at delta (1–4 Hz) and alpha (8–13 Hz) bands. Here we hypothesized that this abnormality is correlated to impaired structural brain connectivity. Eyes closed resting state EEG and structural MRI-DTI (diffusion tensor imaging) data were acquired in 21 AD and in 9 mild cognitive impairment (MCI) patients. LORETA and FSL were used for data analysis. Compared to MCI subjects, AD patients showed a reduction of DTI fractional anisotropy (FA) in several white matter brain bundles ( p p p