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2. Skeletal Muscle Fiber Size and Gene Expression in the Oldest-Old With Differing Degrees of Mobility

Author

Fabio Naro, Massimo Venturelli, Lucia Monaco, Luana Toniolo, Ettore Muti, Chiara Milanese, Jia Zhao, Russell S. Richardson, Federico Schena, and Carlo Reggiani

Subjects
aging, oldest-old, physical activity, muscle atrophy, single muscle fibers, myonuclei, Physiology, QP1-981
Abstract

The oldest-old, in the ninth and tenth decades of their life, represent a population characterized by neuromuscular impairment, which often implies a loss of mobility and independence. As recently documented by us and others, muscle atrophy and weakness are accompanied by an unexpected preservation of the size and contractile function of skeletal muscle fibers. This suggests that, while most fibers are likely lost with their respective motoneurons, the surviving fibers are well preserved. Here, we investigated the mechanisms behind this fiber preservation and the relevance of physical activity, by comparing a group of 6 young healthy controls (YG: 22–28 years) with two groups of oldest-old (81–96 years), one able to walk (OW: n = 6, average 86 years) and one confined to a wheelchair (ONW n = 9, average 88 years). We confirmed previous results of fiber preservation and, additionally, observed a shift in fiber type, toward slow predominance in OW and fast predominance in ONW. Myonuclear density was increased in muscles of ONW, compared to YG and OW, potentially indicative of an ongoing atrophy process. We analyzed, by RT-qPCR, the expression of genes relevant for fiber size and type regulation in a biopsy sample from the vastus lateralis. In all oldest-old both myostatin and IGF-1 expression were attenuated compared to YG, however, in ONW two specific IGF-1 isoforms, IGF-1EA and MGF, demonstrated a further significant decrease compared to OW. Surprisingly, atrogenes (MURF1 and atrogin) expression was also significantly reduced compared to YG and this was accompanied by a close to statistically significantly attenuated marker of autophagy, LC3. Among the determinants of the metabolic fiber type, PGC1α was significantly reduced in both OW and ONW compared to YG, while AMPK was down-regulated only in ONW. We conclude that, in contrast to the shift of the balance in favor of pro-atrophy factors found by other studies in older adults (decreased IGF-1, increase of myostatin, increase of atrogenes), in the oldest-old the pro-atrophy factors also appear to be down-regulated, allowing a partial recovery of the proteostasis balance. Furthermore, the impact of muscle activity, as a consequence of lost or preserved walking ability, is limited.

Published
2019
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3. The Vascular Side of Chronic Bed Rest: When a Therapeutic Approach Becomes Deleterious

Author

Anna Pedrinolla, Alessandro L. Colosio, Roberta Magliozzi, Elisa Danese, Emine Kirmizi, Stefania Rossi, Silvia Pogliaghi, Massimiliano Calabrese, Matteo Gelati, Ettore Muti, Emiliano Cè, Stefano Longo, Fabio Esposito, Giuseppe Lippi, Federico Schena, and Massimo Venturelli

Subjects
Vascular function, Inflammatory profile, physical constrain, bed-rest, Medicine
Abstract

The interplay between chronic constraint and advanced aging on blood flow, shear-rate, vascular function, nitric oxide (NO)-bioavailability, microcirculation, and vascular inflammation factors is still a matter of debate. Ninety-eight individuals (Young, n = 28, 23 ± 3 yrs; Old, n = 36, 85 ± 7 yrs; Bedridden, n = 34, 88 ± 6 yrs) were included in the study. The bedridden group included old individuals chronically confined to bed (3.8 ± 2.3 yrs). A blood sample was collected and analyzed for plasma nitrate, and vascular inflammatory markers. Hyperemic response (∆peak) during the single passive leg movement (sPLM) test was used to measure vascular function. Skeletal muscle total hemoglobin was measured at the vastus lateralis during the sPLM test, by means of near infrared spectroscopy (NIRS). Bedridden subjects revealed a depletion of plasma nitrates compared with Old (−23.8%) and Young (−31.1%). Blood flow was lower in the Bedridden in comparison to Old (−20.1%) and Young (−31.7%). Bedridden presented lower sPLM ∆peak compared Old (−72.5%) and the Young (−83.3%). ∆peak of NIRS total hemoglobin was lower in the Bedridden compared to that in the Young (−133%). All vascular inflammatory markers except IL-6 were significantly worse in the Bedridden compared to Old and Young. No differences were found between the Old and Young in inflammatory markers. Results of this study confirm that chronic physical constraint induces an exacerbation of vascular disfunction and differential regulation of vascular-related inflammatory markers. The mechanisms involved in these negative adaptations seems to be associated with endothelial dysfunction and consequent diminished NO-bioavailability likely caused by the reduced shear-rate consequential to long-term reduction of physical activity.

Published
2020
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4. Impact of Nitric Oxide Bioavailability on the Progressive Cerebral and Peripheral Circulatory Impairments During Aging and Alzheimer's Disease

Author

Massimo Venturelli, Anna Pedrinolla, Ilaria Boscolo Galazzo, Cristina Fonte, Nicola Smania, Stefano Tamburin, Ettore Muti, Lucia Crispoltoni, Annamaria Stabile, Alessandra Pistilli, Mario Rende, Francesca B. Pizzini, and Federico Schena

Subjects
circulation, aging, Alzheimer's disease, nitric oxide, vascular dysfunction, Physiology, QP1-981
Abstract

Advanced aging, vascular dysfunction, and nitric oxide (NO) bioavailability are recognized risk factors for Alzheimer's disease (AD). However, the contribution of AD, per se, to this putative pathophysiological mechanism is still unclear. To better answer this point, we quantified cortical perfusion with arterial spin labeling (PVC-CBF), measured ultrasound internal carotid (ICA), and femoral (FA) artery blood flow in a group of patients with similar age (~78 years) but different cognitive impairment (i.e., mild cognitive impairment MCI, mild AD-AD1, moderate AD-AD2, and severe AD-AD3) and compared them to young and healthy old (aged-matched) controls. NO-metabolites and passive leg-movement (PLM) induced hyperemia were used to assess systemic vascular function. Ninety-eight individuals were recruited for this study. PVC-CBF, ICA, and FA blood flow were markedly (range of 9–17%) and significantly (all p < 0.05) reduced across the spectrum from YG to OLD, MCI, AD1, AD2, AD3 subjects. Similarly, plasma level of nitrates and the values of PLM were significantly reduced (range of 8–26%; p < 0.05) among the six groups. Significant correlations were retrieved between plasma nitrates, PLM and PVC-CBF, CA, and FA blood flow. This integrative and comprehensive approach to vascular changes in aging and AD showed progressive changes in NO bioavailability and cortical, extracranial, and peripheral circulation in patients with AD and suggested that they are directly associated with AD and not to aging. Moreover, these results suggest that AD-related impairments of circulation are progressive and not confined to the brain. The link between cardiovascular and the central nervous systems degenerative processes in patients at different severity of AD is likely related to the depletion of NO.

Published
2018
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5. Non-Aβ-Dependent Factors Associated with Global Cognitive and Physical Function in Alzheimer’s Disease: A Pilot Multivariate Analysis

Author

Anna Pedrinolla, Massimo Venturelli, Stefano Tamburin, Cristina Fonte, Anna Maria Stabile, Ilaria Boscolo Galazzo, Barbara Ghinassi, Mary Anna Venneri, Francesca Benedetta Pizzini, Ettore Muti, Nicola Smania, Angela Di Baldassarre, Fabio Naro, Mario Rende, and Federico Schena

Subjects
Alzheimer’s disease, mild cognitive impairment, dementia, exercise, memory, physical activity, Medicine
Abstract

Recent literature highlights the importance of identifying factors associated with mild cognitive impairment (MCI) and Alzheimer’s Disease (AD). Actual validated biomarkers include neuroimaging and cerebrospinal fluid assessments; however, we investigated non-Aβ-dependent factors associated with dementia in 12 MCI and 30 AD patients. Patients were assessed for global cognitive function (Mini-Mental state examination—MMSE), physical function (Physical Performance Test—PPT), exercise capacity (6-min walking test—6MWT), maximal oxygen uptake (VO2max), brain volume, vascular function (flow-mediated dilation—FMD), inflammatory status (tumor necrosis factor—α ,TNF- α, interleukin-6, -10 and -15) and neurotrophin receptors (p75NTR and Tropomyosin receptor kinase A -TrkA). Baseline multifactorial information was submitted to two separate backward stepwise regression analyses to identify the variables associated with cognitive and physical decline in demented patients. A multivariate regression was then applied to verify the stepwise regression. The results indicated that the combination of 6MWT and VO2max was associated with both global cognitive and physical function (MMSE = 11.384 + (0.00599 × 6MWT) − (0.235 × VO2max)); (PPT = 1.848 + (0.0264 × 6MWT) + (19.693 × VO2max)). These results may offer important information that might help to identify specific targets for therapeutic strategies (NIH Clinical trial identification number NCT03034746).

Published
2019
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6. Possible Predictors of Involuntary Weight Loss in Patients with Alzheimer's Disease.

Author

Massimo Venturelli, Emiliano Cè, Eloisa Limonta, Ettore Muti, Renato Scarsini, Anna Brasioli, Federico Schena, and Fabio Esposito

Subjects
Medicine, Science
Abstract

Loss in body mass (∆BM) is a common feature in patients with Alzheimer's disease (AD). However, the etiology of this phenomenon is unclear. The aim of this cohort study was to observe possible ∆BM in AD patients following a standard institutionalized diet. Secondary objective was to identify possible predictors of ∆BM. To this end, 85 AD patients (age: 76±4 yrs; stature: 165±3 cm; BM: 61.6±7.4 kg; mean±standard deviation) and 86 controls (CTRL; age: 78±5 yrs; stature: 166±4 cm; BM: 61.7±6.4 kg) were followed during one year of standard institutionalized diet (~1800 kcal/24h). BM, daily energy expenditure, albuminemia, number of medications taken, and cortisolism, were recorded PRE and POST the observation period. Potential predictors of ∆BM in women (W) and men (M) with AD were calculated with a forward stepwise regression model. After one year of standard institutionalized diet, BM decreased significantly in AD (-2.5 kg; p < 0.01), while in CTRL remained unchanged (-0.4 kg; p = 0.8). AD patients and CTRL exhibited similar levels of daily energy expenditure (~1625 kcal/24h). The combination of three factors, number of medications taken, albuminemia, and cortisolism, predicted ∆BM in W with AD. At contrary, the best predictor of ∆BM in M with AD was the cortisolism. Despite a controlled energy intake and similar energy expenditure, both W and M with AD suffered of ∆BM. Therefore, controlled diet did not prevent this phenomenon. The assessments of these variables may predict W and M with AD at risk of weight loss.

Published
2016
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7. Repeated Passive Mobilization to Stimulate Vascular Function in Individuals of Advanced Age Who Are Chronically Bedridden: A Randomized Controlled Trial

Author

Massimo Venturelli, Massimiliano Calabrese, Giuseppe Lippi, Anna Pedrinolla, Alessandro L. Colosio, Federico Schena, Roberta Magliozzi, Stefania Rossi, Fabio Esposito, Silvia Pogliaghi, Elisa Danese, Stefano Longo, Ettore Muti, Matteo Gelati, and Emiliano Cè

Subjects
Male, Aging, medicine.medical_treatment, Movement, Femoral artery, bed rest, 030204 cardiovascular system & hematology, single passive leg movement, Bed rest, law.invention, vascular function, 03 medical and health sciences, 0302 clinical medicine, Primary outcome, Randomized controlled trial, law, medicine.artery, medicine, Humans, Range of Motion, Articular, Aged, Aged, 80 and over, Leg, Mobilization, business.industry, Hemodynamics, Blood flow, Femoral Artery, repeated passive mobilization, Anesthesia, Female, Geriatrics and Gerontology, Limited mobility, Vascular function, business, 030217 neurology & neurosurgery
Abstract

Background Vascular dysfunction and associated disorders are major side effects of chronic bed rest, yet passive mobilization as a potential treatment has only been theorized so far. This study investigated the effects of passive mobilization treatment on vascular function in older, chronically bedridden people. Method The study sample was 45 chronically bedridden people of advanced age (mean age: 87 years; 56% female; mean bed rest: 4 years) randomly assigned to a treatment (n = 23) or a control group (CTRL, n = 22). The treatment group received passive mobilization twice daily (30 minutes, 5 times/wk) for 4 weeks. A kinesiologist performed passive mobilization by passive knee flexion/extension at 1 Hz in one leg (treated leg [T-leg] vs control leg [Ctrl-leg]). The CTRL group received routine treatment. The primary outcome was changes in peak blood flow (∆peak) as measured with the single passive leg movement test at the common femoral artery. Results ∆Peak was increased in both legs in the Treatment group (+90.9 mL/min, p < .001, in T-leg and +25.7 mL/min, p = .039 in Ctrl-leg). No difference in peak blood flow after routine treatment was found in the CTRL group. Conclusion Improvement in vascular function after 4 weeks of passive mobilization was recorded in the treatment group. Passive mobilization may be advantageously included in standard clinical practice as an effective strategy to treat vascular dysfunction in persons with severely limited mobility.

Published
2021

8. Exercise training improves vascular function in patients with Alzheimer’s disease

Author

Barbara Ghinassi, Ettore Muti, Gaia Giuriato, Federico Schena, Massimo Venturelli, Stefano Tamburin, Cristina Fonte, Angela Di Baldassarre, Fabio Naro, Valentina Varalta, Anna Pedrinolla, and Nicola Smania

Subjects
0301 basic medicine, Male, Vascular Endothelial Growth Factor A, medicine.medical_specialty, Sports medicine, Physiology, Strength training, Movement, Population, physical activity, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Cognition, Alzheimer Disease, Physiology (medical), Internal medicine, medicine, Dementia, Humans, passive-leg movement, Orthopedics and Sports Medicine, flow-mediated dilation, education, Aged, Aged, 80 and over, education.field_of_study, vascular endothelial growth factor, business.industry, Public Health, Environmental and Occupational Health, Area under the curve, Hemodynamics, General Medicine, Blood flow, medicine.disease, Peripheral, Exercise Therapy, Vascular endothelial growth factor, 030104 developmental biology, chemistry, Acoustic Stimulation, Cardiology, dementia, Female, Original Article, business, 030217 neurology & neurosurgery, Photic Stimulation
Abstract

Purpose Vascular dysfunction has been demonstrated in patients with Alzheimer’s disease (AD). Exercise is known to positively affect vascular function. Thus, the aim of our study was to investigate exercise-induced effects on vascular function in AD. Methods Thirty-nine patients with AD (79 ± 8 years) were recruited and randomly assigned to exercise training (EX, n = 20) or control group (CTRL, n = 19). All subjects performed 72 treatment sessions (90 min, 3 t/w). EX included moderate–high-intensity aerobic and strength training. CTRL included cognitive stimuli (visual, verbal, auditive). Before and after the 6-month treatment, the vascular function was measured by passive-leg movement test (PLM, calculating the variation in blood flow: ∆peak; and area under the curve: AUC) tests, and flow-mediated dilation (FMD, %). A blood sample was analyzed for vascular endothelial growth factor (VEGF). Arterial blood flow (BF) and shear rate (SR) were measured during EX and CTRL during a typical treatment session. Results EX group has increased FMD% (+ 3.725%, p p = 0.004), AUC (+ 37.359AU, p = 0.037) and VEGF (+ 8.825 pg/ml, p = 0.004). In the CTRL group, no difference between pre- and post-treatment was found for any variable. Increase in BF and SR was demonstrated during EX (BF + 123%, p p Conclusion Exercise training improves peripheral vascular function in AD. These ameliorations may be due to the repetitive increase in SR during exercise which triggers NO and VEGF upregulation. This approach might be included in standard AD clinical practice as an effective strategy to treat vascular dysfunction in this population.

Published
2020

9. Non-Aβ-Dependent Factors Associated with Global Cognitive and Physical Function in Alzheimer’s Disease: A Pilot Multivariate Analysis

Author

Ettore Muti, Francesca B. Pizzini, Stefano Tamburin, Fabio Naro, Cristina Fonte, Ilaria Boscolo Galazzo, Massimo Venturelli, Nicola Smania, Anna Pedrinolla, Anna Maria Stabile, Barbara Ghinassi, Mario Rende, Angela Di Baldassarre, Mary Anna Venneri, and Federico Schena

Subjects
Oncology, Multivariate statistics, medicine.medical_specialty, Multivariate analysis, physical activity, lcsh:Medicine, Disease, Alzheimer’s disease, mild cognitive impairment, dementia, exercise, memory, behavioral disciplines and activities, Article, 03 medical and health sciences, 0302 clinical medicine, Neuroimaging, alzheimer's disease, global cognitive function, maximal oxygen uptake, physical function, exercise capacity, brain volume, vascular function, TNF- α, interleukin-6, interleukin-10, interleukin-15, neurotrophin receptors, Internal medicine, mental disorders, Medicine, Dementia, 030304 developmental biology, 0303 health sciences, business.industry, lcsh:R, VO2 max, Cognition, General Medicine, Stepwise regression, medicine.disease, n/a, business, human activities, 030217 neurology & neurosurgery
Abstract

Recent literature highlights the importance of identifying factors associated with mild cognitive impairment (MCI) and Alzheimer&rsquo, s Disease (AD). Actual validated biomarkers include neuroimaging and cerebrospinal fluid assessments, however, we investigated non-A&beta, dependent factors associated with dementia in 12 MCI and 30 AD patients. Patients were assessed for global cognitive function (Mini-Mental state examination&mdash, MMSE), physical function (Physical Performance Test&mdash, PPT), exercise capacity (6-min walking test&mdash, 6MWT), maximal oxygen uptake (VO2max), brain volume, vascular function (flow-mediated dilation&mdash, FMD), inflammatory status (tumor necrosis factor&mdash, &alpha, TNF- &alpha, interleukin-6, -10 and -15) and neurotrophin receptors (p75NTR and Tropomyosin receptor kinase A -TrkA). Baseline multifactorial information was submitted to two separate backward stepwise regression analyses to identify the variables associated with cognitive and physical decline in demented patients. A multivariate regression was then applied to verify the stepwise regression. The results indicated that the combination of 6MWT and VO2max was associated with both global cognitive and physical function (MMSE = 11.384 + (0.00599 &times, 6MWT) &minus, (0.235 &times, VO2max)), (PPT = 1.848 + (0.0264 &times, 6MWT) + (19.693 &times, VO2max)). These results may offer important information that might help to identify specific targets for therapeutic strategies (NIH Clinical trial identification number NCT03034746).

Published
2019
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10. An indoor therapeutic garden for behavioral symptoms in Alzheimer's Disease: a randomized controlled trial

Author

Massimo Venturelli, Federico Schena, Alessio Sollima, Anna Pedrinolla, Stefano Tamburin, Anna Brasioli, Cristina Fonte, Nicola Smania, and Ettore Muti

Subjects
0301 basic medicine, Male, Activities of daily living, Hydrocortisone, behavioral symptoms, Blood Pressure, Disease, Neuropsychological Tests, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Activities of Daily Living, Single-Blind Method, Aged, 80 and over, General Neuroscience, General Medicine, Gardening, Neuropsychiatric inventory, Mental Status and Dementia Tests, Psychiatry and Mental health, Clinical Psychology, Treatment Outcome, non-pharmacological treatment, Female, Alzheimer’s disease, medicine.drug, Antipsychotic Agents, medicine.medical_specialty, Environment, cortisol, 03 medical and health sciences, Quetiapine Fumarate, Alzheimer Disease, Internal medicine, medicine, Dementia, Humans, gardens, Adverse effect, Aged, business.industry, medicine.disease, 030104 developmental biology, Blood pressure, Quetiapine, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery
Abstract

BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) affect 60-90% of patients with Alzheimer's disease (AD). OBJECTIVE To determine if environmental therapy is an effective strategy to reduce BPSD, we tested 163 patients with AD with Neuropsychiatric Inventory (NPI) before and after 6 months of an indoor therapeutic garden (TG) or standard environment. METHODS A single-blind randomized controlled trial on AD patients with BPSD. Participants were randomized to an indoor TG (N = 82), or standard environment (control, N = 81) for 6 months. PRIMARY OUTCOME change in the NPI score from baseline (T0) to end of treatment (T1). SECONDARY OUTCOMES change in use of quetiapine, cognition, activities of daily living, salivary cortisol, blood pressure from T0 to T1. RESULTS NPI score significantly ameliorated (TG versus control: -31.8 points), quetiapine dosage (-150 mg), blood pressure (-2.6 mm Hg), and salivary cortisol (-6.4 to -2.1 Nmol/l) were significantly reduced, the Mini-Mental State Examination significantly improved (1.8 points) in the TG versus control arm at T1 (p

Published
2019

11. The Vascular Side of Chronic Bed Rest: When a Therapeutic Approach Becomes Deleterious

Author

Massimo Venturelli, Emine Kirmizi, Giuseppe Lippi, Anna Pedrinolla, Ettore Muti, Roberta Magliozzi, Matteo Gelati, Fabio Esposito, Stefania Rossi, Massimiliano Calabrese, Stefano Longo, Emiliano Cè, Elisa Danese, Alessandro L. Colosio, Silvia Pogliaghi, and Federico Schena

Subjects
medicine.medical_specialty, Exacerbation, medicine.medical_treatment, lcsh:Medicine, 030204 cardiovascular system & hematology, Bed rest, Article, Microcirculation, Nitric oxide, 03 medical and health sciences, chemistry.chemical_compound, Therapeutic approach, 0302 clinical medicine, Internal medicine, medicine, Endothelial dysfunction, Inflammatory profile, Vascular function, bed-rest, physical constrain, business.industry, lcsh:R, Skeletal muscle, General Medicine, Blood flow, medicine.disease, medicine.anatomical_structure, chemistry, Cardiology, business, 030217 neurology & neurosurgery
Abstract

The interplay between chronic constraint and advanced aging on blood flow, shear-rate, vascular function, nitric oxide (NO)-bioavailability, microcirculation, and vascular inflammation factors is still a matter of debate. Ninety-eight individuals (Young, n = 28, 23 ± 3 yrs; Old, n = 36, 85 ± 7 yrs; Bedridden, n = 34, 88 ± 6 yrs) were included in the study. The bedridden group included old individuals chronically confined to bed (3.8 ± 2.3 yrs). A blood sample was collected and analyzed for plasma nitrate, and vascular inflammatory markers. Hyperemic response (∆peak) during the single passive leg movement (sPLM) test was used to measure vascular function. Skeletal muscle total hemoglobin was measured at the vastus lateralis during the sPLM test, by means of near infrared spectroscopy (NIRS). Bedridden subjects revealed a depletion of plasma nitrates compared with Old (−23.8%) and Young (−31.1%). Blood flow was lower in the Bedridden in comparison to Old (−20.1%) and Young (−31.7%). Bedridden presented lower sPLM ∆peak compared Old (−72.5%) and the Young (−83.3%). ∆peak of NIRS total hemoglobin was lower in the Bedridden compared to that in the Young (−133%). All vascular inflammatory markers except IL-6 were significantly worse in the Bedridden compared to Old and Young. No differences were found between the Old and Young in inflammatory markers. Results of this study confirm that chronic physical constraint induces an exacerbation of vascular disfunction and differential regulation of vascular-related inflammatory markers. The mechanisms involved in these negative adaptations seems to be associated with endothelial dysfunction and consequent diminished NO-bioavailability likely caused by the reduced shear-rate consequential to long-term reduction of physical activity.

Published
2020

12. Passive mobilization‐induced vascular function adaptations in bedridden oldest‐old

Author

Federico Schena, Anna Pedrinolla, Ettore Muti, Emiliano Cè, Silvia Pogliaghi, Stefano Longo, Alessandro L. Colosio, Massimo Venturelli, and Fabio Espositio

Subjects
Mobilization, business.industry, Genetics, Medicine, Physiology, business, Vascular function, Oldest old, Molecular Biology, Biochemistry, Biotechnology
Published
2018

13. Exercise training on locomotion in patients with Alzheimer's disease. A feasibility Study

Author

Stefano Tamburin, Cristina Fonte, Anna Pedrinolla, Daniele Munari, Luisa Zanolla, Ettore Muti, Federico Schena, Doriana Rudi, Maria Vittoria Benetti, Nicola Smania, and Massimo Venturelli

Subjects
Male, medicine.medical_specialty, Strength training, Population, physical activity, Disease, 03 medical and health sciences, 0302 clinical medicine, Gait (human), Physical medicine and rehabilitation, Alzheimer Disease, medicine, Humans, Dementia, Single-Blind Method, In patient, education, Gait, Aged, Aged, 80 and over, education.field_of_study, business.industry, General Neuroscience, Biomechanics, Cognition, 030229 sport sciences, General Medicine, medicine.disease, spatio-temporal gait parameters, Biomechanical Phenomena, Exercise Therapy, Psychiatry and Mental health, Clinical Psychology, Italy, Exercise Test, Feasibility Studies, dementia, energy cost of walking, physical activity, spatio-temporal gait parameters, Female, Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, energy cost of walking, dementia
Abstract

Background Although current literature has shown that patients with Alzheimer's disease (AD) have worse locomotion compared with healthy counterparts, no studies have focused on the efficacy of exercise training in improving gait abnormalities including biomechanics and metabolic aspects, in this population. Objective To verify the effectiveness of exercise training (ET) on gait parameters (i.e., speed, step and stride length, single and double support, and energy cost of walking (Cw)) in patients with AD with respect to a standard cognitive treatment (CT). Methods In this study, we included a small portion of data belonging to a larger study (ClinicalTrials.gov number, NCT03034746). Patients with AD (Mini-Mental State Examination 22±5) were included in the study. Gait parameters and Cw were assessed at baseline and after 6 months (72 treatment sessions) of treatment. ET included 90 min of aerobic and strength training. CT included 90 min of cognitive stimuli. Results The 16 patients assigned to ET exhibited significant improvement of Cw (-0.9±0.1 J/kg·m-1), while differences in gait parameters were negligible. The effect on gait parameters were undetectable in the 18 patients assigned to CT (-0.2±0.5 J/kg·m-1). Conclusions Data from this study showed that ET program seems effective in improving Cw in patients with AD. Interestingly, the positive effect of ET on Cw was not coupled with ameliorations of patient's gait parameters, suggesting that the gain of metabolic aspects of locomotion were the main factors responsible for this positive result.

Published
2018

14. Effectiveness of Exercise- and Cognitive-Based Treatments on Salivary Cortisol Levels and Sundowning Syndrome Symptoms in Patients with Alzheimer's Disease

Author

Massimo Venturelli, Ettore Muti, Angela Valentina Bisconti, Alessio Sollima, Fabio Esposito, Emiliano Cè, Eloisa Limonta, and Anna Brasioli

Subjects
Male, medicine.medical_specialty, Hydrocortisone, Statistics as Topic, Disease, cortisol, Neuropsychological Tests, 03 medical and health sciences, 0302 clinical medicine, Alzheimer Disease, Internal medicine, medicine, Aerobic exercise, Humans, In patient, behavioral disorders, 030212 general & internal medicine, Saliva, Salivary cortisol, Aged, exercise, Cognitive Behavioral Therapy, business.industry, General Neuroscience, Sundowning, Mental Disorders, Cognition, General Medicine, Cognitive training, Circadian Rhythm, Exercise Therapy, Psychiatry and Mental health, Clinical Psychology, Endocrinology, Alzheimer’s disease, Etiology, Female, Geriatrics and Gerontology, medicine.symptom, business, Energy Metabolism, Mental Status Schedule, 030217 neurology & neurosurgery
Abstract

Sundowning syndrome (SDS) in patients with Alzheimer's disease (AD) is characterized by the intensification of behavioral disorders at sunset. Despite SDS etiology being unclear, a strong relationship between high cortisol levels and SDS has been reported. Aerobic exercise (AE) and cognitive training (CT) can reduce cortisol levels. However, whether SDS would benefit from AE and CT is still unknown. Therefore, the aim of this study was to investigate whether AE and CT treatments are effective in reducing SDS via downregulation of cortisol levels. The possible additive effects of combined AE+CT were also assessed. Eighty AD patients were randomly assigned to AE (n = 20), CT (n = 20), AE+CT (n = 20), and standard therapy (no treatment, NT; n = 20). Treatments were administered for 3 months, 5 days/week, 1 hour before sunset. Before and after treatments, salivary cortisol levels were sampled at 7, 11, 15, at sunset, and 20 (time of day). Blind assessment of behavioral disorders (neuropsychiatric inventory, NPI) and agitation (agitated behavior scale, ABS) were also performed. After interventions, cortisol levels were reduced in AE and AE+CT by ∼26%. In the same groups, NPI and ABS decreased by ∼50%. By contrast, cortisol and behavioral disorders were similar to baseline in CT and NT. Changes in NPI and ABS were significantly correlated with the reduction in cortisol levels. AE or AE+CT effects on SDS and cortisol levels and the lack of effect of CT alone indicate the effectiveness of an exercise-based treatment on SDS, suggesting a possible hypothalamic-pituitary-adrenal axis dysregulation underpinning SDS.

Published
2016

15. Possible Predictors of Involuntary Weight Loss in Patients with Alzheimer’s Disease

Author

Emiliano Cè, Federico Schena, Eloisa Limonta, Ettore Muti, Massimo Venturelli, Anna Brasioli, Renato Scarsini, and Fabio Esposito

Subjects
0301 basic medicine, Male, Hydrocortisone, Physiology, lcsh:Medicine, Organic chemistry, patients, Biochemistry, Cohort Studies, 0302 clinical medicine, body mass loss, Weight loss, Blood plasma, Medicine and Health Sciences, controls, Lipid Hormones, lcsh:Science, Vitamin A, Aged, 80 and over, Multidisciplinary, controlled diet, Neurodegenerative Diseases, Vitamins, Hematology, Alzheimer's disease, Body Fluids, Physical sciences, Chemistry, Blood, Neurology, Research Design, Female, medicine.symptom, Anatomy, medicine.drug, Cohort study, Research Article, medicine.medical_specialty, Bioenergetics, Research and Analysis Methods, Blood Plasma, 03 medical and health sciences, Chemical compounds, Alzheimer Disease, Internal medicine, Albumins, Mental Health and Psychiatry, Organic compounds, Weight Loss, medicine, Humans, Serum Albumin, Nutrition, Aged, Steroid Hormones, business.industry, lcsh:R, Case-control study, Biology and Life Sciences, Proteins, Stepwise regression, medicine.disease, Hormones, Diet, 030104 developmental biology, predictors, Case-Control Studies, Etiology, Physical therapy, lcsh:Q, Dementia, business, Energy Metabolism, 030217 neurology & neurosurgery, Biomarkers
Abstract

Loss in body mass (∆BM) is a common feature in patients with Alzheimer's disease (AD). However, the etiology of this phenomenon is unclear. The aim of this cohort study was to observe possible ∆BM in AD patients following a standard institutionalized diet. Secondary objective was to identify possible predictors of ∆BM. To this end, 85 AD patients (age: 76±4 yrs; stature: 165±3 cm; BM: 61.6±7.4 kg; mean±standard deviation) and 86 controls (CTRL; age: 78±5 yrs; stature: 166±4 cm; BM: 61.7±6.4 kg) were followed during one year of standard institutionalized diet (~1800 kcal/24h). BM, daily energy expenditure, albuminemia, number of medications taken, and cortisolism, were recorded PRE and POST the observation period. Potential predictors of ∆BM in women (W) and men (M) with AD were calculated with a forward stepwise regression model. After one year of standard institutionalized diet, BM decreased significantly in AD (-2.5 kg; p < 0.01), while in CTRL remained unchanged (-0.4 kg; p = 0.8). AD patients and CTRL exhibited similar levels of daily energy expenditure (~1625 kcal/24h). The combination of three factors, number of medications taken, albuminemia, and cortisolism, predicted ∆BM in W with AD. At contrary, the best predictor of ∆BM in M with AD was the cortisolism. Despite a controlled energy intake and similar energy expenditure, both W and M with AD suffered of ∆BM. Therefore, controlled diet did not prevent this phenomenon. The assessments of these variables may predict W and M with AD at risk of weight loss.

Published
2016

16. Fall-risk factors in hospitalized elderly: the role of adapted physical activity

Author

Massimo Venturelli, Emiliano Cè, Fabio Esposito, Valentina Tonni, Andrea Magri, Stefano Longo, Susanna Rampichini, Eloisa Limonta, Angela Valentina Bisconti, Ettore Muti, and Anna Brasioli

Subjects
Gerontology, medicine.medical_specialty, Activities of daily living, Sports medicine, Physical activity, Disease, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, falls, medicine, risk factors, Orthopedics and Sports Medicine, 030212 general & internal medicine, Recidivism, business.industry, Cognition, adapted physical activity, ageing, 030229 sport sciences, Gait, Falling (accident), medicine.symptom, business, human activities
Abstract

Falls are common events in institutionalized elderly. Recent evidence suggests that several risk factors (FRFs) may be related to these falls. The aim of this study was to elucidate if some demographic and clinical factors are associated with the risk of falls in institutionalized elderly. The role of adapted physical activity (APA) in the risk of falls was also assessed. With a Kaplan–Meier statistical model, the mean survivor time (MST) to a fall event was recorded for 6 months in 128 new-admitted patients to nursing home. Demographic factors such as sex, age, stature, body mass or other FRFs such as fall recidivism, gait and balance performance, cognitive impairment, activity of daily living (ADL) levels, Parkinson’s disease, utilization of gait assistant devices, and the employment of a program of APA were considered potential co-variants. Thirty patients experienced a fall during the observation period (6 months) with an overall MST of 154.8 ± 4.6 (range 2–167) days. Moreover, history of previous fallen, reduced gait capacity, poor cognitive function, limited performance in the ADL, and Parkinson’s disease were associated with a reduced MST to a fall event. While at contrary, the employment of the APA significantly reduced the fall-risk. Our results suggest the effectiveness of an APA program for the prevention of falling in institutionalized elderly. Moreover, new-admitted patients to nursing homes with a history of previous fallen, reduced gait capacity, poor cognitive function, limited performance in the ADL, and Parkinson’s disease are associated with an increased risk of fallen.

Published
2016

17. Passive Mobilization-induced Vascular Function

Author

Massimo Venturelli, Ettore Muti, Emiliano Cè, Fabio Esposito, Alessandro L. Colosio, Stefano Longo, Silvia Pogliaghi, Anna Pedrinolla, and Federico Schena

Subjects
medicine.medical_specialty, Mobilization, business.industry, Internal medicine, Cardiology, medicine, Physical Therapy, Sports Therapy and Rehabilitation, Orthopedics and Sports Medicine, Vascular function, business, Oldest old
Published
2018

18. In vivo and in vitro evidence that in oldest-old humans intrinsic upper- and lower-limb skeletal muscle function is unaffected by ageing and disuse

Author

P. Saggin, Luana Toniolo, Cantor Tarperi, Ettore Muti, Russell S. Richardson, Lina Cancellara, Elisa Calabria, Federico Schena, Carlo Reggiani, Fabio Naro, and Massimo Venturelli

Subjects
Adult, medicine.medical_specialty, Aging, Physiology, invitro, invivo, oldest-old, sarcopenia, Physiological, Elbow, In vitro, In vivo, Oldest-old, Sarcopenia, Adaptation, Physiological, Aged, 80 and over, Extremities, Humans, Muscle Contraction, Muscle Strength, Muscle, Skeletal, Quadriceps Muscle, Young Adult, in vivo, in vitro, Biceps, in vitro,in vivo,oldest-old,sarcopenia, Article, Internal medicine, 80 and over, medicine, Adaptation, Aged, Diminution, business.industry, Skeletal muscle, Skeletal, Anatomy, medicine.anatomical_structure, Endocrinology, Ageing, Muscle, Upper limb, business
Abstract

Aim To parse out the impact of advanced ageing and disuse on skeletal muscle function, we utilized both in vivo and in vitro techniques to comprehensively assess upper- and lower-limb muscle contractile properties in 8 young (YG; 25 ± 6 years) and 8 oldest-old mobile (OM; 87 ± 5 years) and 8 immobile (OI; 88 ± 4 years) women. Methods In vivo, maximal voluntary contraction (MVC), electrically evoked resting twitch force (RT), and physiological cross-sectional area (PCSA) of the quadriceps and elbow flexors were assessed. Muscle biopsies of the vastus lateralis and biceps brachii facilitated the in vitro assessment of single fibre-specific tension (Po). Results In vivo, compared to the young, both the OM and OI exhibited a more pronounced loss of MVC in the lower limb [OM (−60%) and OI (−75%)] than the upper limb (OM = −51%; OI = −47%). Taking into account the reduction in muscle PCSA (OM = −10%; OI = −18%), only evident in the lower limb, by calculating voluntary muscle-specific force, the lower limb of the OI (−40%) was more compromised than the OM (−13%). However, in vivo, RT in both upper and lower limbs (approx. 9.8 N m cm−2) and Po (approx. 123 mN mm−2), assessed in vitro, implies preserved intrinsic contractile function in all muscles of the oldest-old and were well correlated (r = 0.81). Conclusion These findings suggest that in the oldest-old, neither advanced ageing nor disuse, per se, impacts intrinsic skeletal muscle function, as assessed in vitro. However, in vivo, muscle function is attenuated by age and exacerbated by disuse, implicating factors other than skeletal muscle, such as neuromuscular control, in this diminution of function.

Published
2015

19. Sundowning syndrome and hypothalamic-pituitary-adrenal axis dysregulation in individuals with Alzheimer's disease: is there an association?

Author

Ettore Muti, Federico Schena, Renato Scarsini, Gian Luca Salvagno, and Massimo Venturelli

Subjects
Male, medicine.medical_specialty, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Disease, Sundowning syndrome (SDS), patients, Alzheimer Disease, Internal medicine, medicine, Humans, Alzheimer’s disease, hypothathalamic–pituitary-adrenal axis disregulation, clinical assessment, Circadian rhythm, Psychiatry, Confusion, Psychomotor Agitation, Aged, 80 and over, business.industry, Sundowning, Syndrome, Circadian Rhythm, medicine.anatomical_structure, Endocrinology, Sunlight, Female, Geriatrics and Gerontology, medicine.symptom, business, Hypothalamic–pituitary–adrenal axis
Published
2013

20. Limitations to exercise in female centenarians: evidence that muscular efficiency tempers the impact of failing lungs

Author

Massimo Venturelli, Renato Scarsini, Ettore Muti, Federico Schena, and Russell S. Richardson

Subjects
Spirometry, Aging, Vital capacity, medicine.medical_specialty, Adolescent, Vital Capacity, Population, centenarian, exercise capacity, lung function, Article, Young Adult, FEV1/FVC ratio, Forced Expiratory Volume, Internal medicine, medicine, Humans, Exercise physiology, education, Exercise, Life Style, Aged, 80 and over, education.field_of_study, Muscle Weakness, medicine.diagnostic_test, business.industry, Oxygen transport, General Medicine, Respiratory Muscles, Respiratory Function Tests, Disease Progression, Exercise Test, Physical therapy, Cardiology, Female, Geriatrics and Gerontology, Centenarian, Respiratory Insufficiency, business, Respiratory minute volume
Abstract

Centenarians are an outstanding model of successful aging, with genetics and healthy lifestyle certainly being key factors responsible for their longevity. Exercise capacity has been identified to play an important role in healthy aging, but a comprehensive assessment of the limitations to maximal exercise in this population is lacking. Following, health histories, lung function, and anthropometric measures, eight female centenarians (98-102 years old) and eight young females (18-22 years old) performed a series of graded maximal exercise tests on a cycle ergometer that facilitated absolute and relative work rate comparisons. Centenarians revealed a dramatically attenuated lung function, as measured by spirometry (forced expiratory volume in 1 s (FEV1/forced vital capacity (FVC), 55 ± 10%) compared to the young (FEV1/FVC, 77 ± 5%). During exercise, although the centenarians relied heavily on respiratory rate which yielded ~50% higher dead space/tidal volume, minute ventilation was similar to that of the young at all but maximal exercise, and alveolar PO2 was maintained in both groups. In contrast, peak WR and VO2 were significantly reduced in the centenarians (33 ± 4 vs 179 ± 24 W; 7.5 ± 1.2 vs 39.6 ± 3.5 ml min(-1) kg(-1)). Arterial PO2 of the centenarians fell steadily from the normal range of both groups to yield a large A-a gradient (57 ± 6 mmHg). Metabolic cost of a given absolute work rate was consistently lower, ~46% less than the young at maximal effort. Centenarians have significant limitations to gas exchange across the lungs during exercise, but this limited oxygen transport is tempered by improved skeletal muscle mechanical efficiency that may play a vital role in maintaining physical function and therefore longevity in this population.

Published
2013

21. Positive effects of physical training in activity of daily living-dependent older adults

Author

Massimo Venturelli, Ettore Muti, Federico Schena, and Massimo Lanza

Subjects
Aging, medicine.medical_specialty, Activities of daily living, ADL, Frail Elderly, Physical exercise, Motor Activity, Neuropsychological Tests, Sitting, law.invention, Cognition, Arts and Humanities (miscellaneous), Randomized controlled trial, law, Assisted Living Facilities, Fitness, Activities of Daily Living, medicine, Humans, Muscle Strength, Exercise physiology, Range of Motion, Articular, Exercise, Geriatric Assessment, General Psychology, Trained subjects, Aged, 80 and over, Analysis of Variance, Shoulder Joint, Gerontology, Ageing, Physical training, Older adults, Wheelchairs, Physical therapy, Arm, Feasibility Studies, Female, Analysis of variance, Geriatrics and Gerontology, Range of motion, Psychology, Cognition Disorders, human activities
Abstract

The goal of this study was to determinate the effects of physical training in older adults with mobility limitations. Thirty frail women (84 +/- 6 years) were randomly assigned to a training or control group for 12 weeks of upper body physical training (UBT) performed sitting on wheelchairs. Trained subjects showed a significant improvement in arms strength (+29%), and shoulder flexibility (+10 cm) but did not improve in arms circumference. The activities of daily living (ADLs) were improved (+77%), cognitive function as defined by the Mini-Mental State Examination (MMSE) was maintained in the trained group (+3%) and declined in the control group (-21%). These results demonstrate that UBT in dependent older women with mobility limitations can increase strength and improve ADLs.

Published
2010

22. 'Delirium Day': a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Author

Bellelli, Giuseppe, Morandi, Alessandro, Di Santo, Simona G., Mazzone, Andrea, Cherubini, Antonio, Mossello, Enrico, Mario, Bo, Bianchetti, Angelo, Rozzini, Renzo, Zanetti, Ermellina, Musicco, Massimo, Ferrari, Alberto, Ferrara, Nicola, Trabucchi, Marco, Boffelli, Stefano, Stefano, Fabio Di, Filippi, Francesco De, Guerini, Fabio, Bertoletti, Erik, March, Albert, Margiotta, Alessandro, Mecocci, Patrizia, Addesi, Desireè, Fantò, Fausto, Dijik, Babette, Porrino, Paola, Cotroneo, Antonino Maria, Galli, Giovanni, Bruni, Amalia Cecilia, Bernardini, Bruno, Corsini, Carla, Cagnin, Annachiara, Zurlo, Amedeo, Barbagallo, Giuseppe, Lunardelli, Maria Lia, Martini, Emilio, Battaglia, Giuseppe, Latella, Raffaele, Petritola, Donatella, Sinforiani, Elena, Cester, Alberto, Formilan, Marino, Carbone, Pasqualina, Appollonio, Ildebrando, Cereda, Diletta, Tremolizzo, Lucio, Bottacchi, Edo, Lucchetti, Lucio, Mariani, Claudio, Rapazzini, Piero, Romanelli, Giuseppe, Marengoni, Alessandra, Zuliani, Giovanni, Bianchi, Lara, Suardi, Teresa, Muti, Ettore, Bottura, Renato, Sgrò, Giovanni, Mandas, Antonella, Serchisu, Luca, Crippa, Patrizia, Ivaldi, Claudio, Ungar, Andrea, Villani, Daniele, Raimondi, Clara, Mussi, Chiara, Isaia, Giancarlo, Provenzano, Giuseppe, Mari, Daniela, Odetti, Patrizio, Monacelli, Fiammetta, Incalzi, Raffaele Antonelli, Pluderi, Alice, Bellamoli, Claudio, Terranova, Luciano, Scarpini, Elio, D'Amico, Ferdinando, Cavallini, Maria Chiara, Guerrini, Gianbattista, Scotuzzi, Anna Maria, Chiarello, Antonino, Pilotto, Alberto, Tognini, Sara, Dell'Aquila, Giuseppina, Toigo, Gabriele, Ceschia, Giuliano, Piccinini, Maristella, Fabbo, Andrea, Zoli, Marco, Forti, Paola, Wenter, Christian, Basile, Giorgio, Lasagni, Anna, Padovani, Alessandro, Rozzini, Luca, Cottino, Maria, Vitali, Silvia, Tripi, Gabriele, Avanzi, Stefano, Annoni, Giorgio, Ruotolo, Giovanni, Boschi, Federica, Bonino, Paolo, Marchionni, Niccolo, Fascendini, Sara, Noro, Gabriele, Turco, Renato, Ubezio, Maria C., Serrati, Carlo, Infante, Maria, Gentile, Simona, Pernigotti, Luigi M., Biagini, Carlo A., Canonico, Enzo, Bonati, Pietro, Gareri, Pietro, Caffarra, Paolo, Ceretti, Arcangelo, Castiglia, Rosanna, Gabelli, Carlo, Storto, Mario Lo, Putzu, Paolo, Santo, Simona Di, Malara, Alba, Spadea, Fausto, Di Cello, Serena, Ceravolo, Francesco, Fabiano, Francesco, Rispoli, Vincenzo, Chiaradia, Giuseppe, Gabriele, Amedeo, Settembrini, Vincenzo, Capomolla, Domenico, Citrino, Antonella, Scriva, Antonietta, Bruno, Irene, Secchi, Roberto, De Martino, Eugenio, Muccinelli, Roberto, Lupi, Gerardo, Paonessa, Patrizio, Fabbri, Andrea, Castellari, Sofia, Andrea, Po, Gaggioli, Guido, Varesi, Massimo, Moneti, Paolo, Capurso, Sebastiano, Latini, Vincenzo, Ghidotti, Stefano, Riccardelli, Francesco, Macchi, Maurizio, Cassinadri, Angela, Tonini, Gabriele, Andreani, Laura, Coralli, Mirco, Balotta, Antonio, Cancelliere, Roberto, Strazzacapa, Mara, Cavallino, Pierangela, Fabio, Stefano, De Filippi, Francesco, Giudice, Chiara, Floris, Patrizia, Dentizzi, Cosimo, D’Elia, Katia, Azzini, Margherita, Cazzadori, Marco, Benati, Claudia, Tobaldini, Chiara, Antonioli, Angela, Mombelloni, Paolo, Fontanini, Fulvio, Oliverio, Martina, Del Grosso, Luciano, Giavedoni, Cristina, Bidoli, Giuliano, Mazzei, Bruno, Corsonello, Andrea, Fusco, Sergio, Vena, Silvio, De Vuono, Tommaso, Maiuri, Giorgio, Castegnaro, Eugenio, De Rosa, Salvatore, Sechi, Rossella Bazzano, Benvenuti, Enrico, Del Lungo, Ilaria, Giardini, Sante, Giulietti, Chiara, D’Amico, Ferdinando, Caronzolo, Francesco, Grippa, Alessandro, Lombardo, Giuseppina, Pipicella, Tiziana, Nitti, Maria Teresa, Felici, Alessandro, Pavan, Silvia, Piazzani, Fabrizio, Lunelli, Alessandra, Dimori, Sergio, Magnani, Angelo, Soglia, Tiziano, Postacchini, Demetrio, Brunelli, Roberto, Santini, Silvia, Francavilla, Monia, Macchiati, Ilenia, Sorvillo, Francesca, Giuli, Cinzia, Perticone, Francesco, Rosa, Paola Cerra, Bencardino, Giuseppe, Falbo, Tania, Grillo, Nadia, Isaia, Gianluca, Pezzilli, Stella, Bergamo, Daniele, Furno, Elisabetta, Rrodhe, Sokol, Lucarini, Simonetta, Dall’Acqua, Francesca, Cappelletto, Francesco, Calvani, Donatella, Becheri, Dimitri, Gambardella, Lucia, Valente, Carlo, Ceci, Giacomo, Ettorre, Evaristo, Tironi, Sara, Grassi, Maria Grazia, Troisi, Elio, Gabutto, Anna, Baglietto, Nino, Quazzo, Loredana, Rosatello, Annalisa, Suraci, Domenico, Tagliabue, Benedetta, Perrone, Chiara, Ferrara, Lucia, Castagna, Alberto, Tremolada, Maria Luisa, Piano, Simonetta, Serviddio, Gaetano, Lo Buglio, Aurelio, Gurrera, Tiziana, Merlo, Valeria, Rovai, Carla, Carlucci, Rosaria, Abbaldo, Anna, Monzani, Fabio, Qasem, Ahmad Amedeo, Bini, Giacomo, Tafuto, Silvia, Mancuso, Giovanna, Fragiacomo, Federica, Pompanin, Sara, Guerra, Gianluca, Pala, Marco, Menozzi, Luca, Gatti, Chiara Delli, Magon, Stefania, Di Francesco, Vincenzo, Faccioli, Silvia, Pellizzari, Luca, Lia Lunardelli, Maria, Macchiarulo, Maria, Corneli, Maria, Bacci, Monica, Lo Storto, Mario, Seresin, Chiara, Simonato, Matteo, Loreggian, Michele, Cestonaro, Fausta, Durando, Mario, Mazzoleni, Marta, Russo, Giuseppe, Ponte, Martino, Valchera, Alessandro, Salustri, Giuseppe, Costa, Alfredo, Cotta, Matteo Ramusino, Pizio, Renato Nicola, Perego, Germana, Bucciantini, Elisabetta, Di Giovanni, Marco, Franchi, Fabrizio, Claudio Mariani, Sara Barbieri, Grande, Giulia, Fugazza, Luciano, Guerrini, Chiara, De Paduanis, Giovanna, Iallonardo, Lucia, Palumbo, Pasquale, Ortolani, Beatrice, Capatti, Eleonora, Soavi, Cecilia, Francesconi, Daniela, Miselli, Agata, Zaccarini, Cinzia, Mirra, Gianluca, Secreto, Piero, Bisio, Erika, Cecchettani, Marco, Naldi, Tamara, Pallavicino, Alessandra, Pugliese, Michela, Iozzo, Rosaria Cosima, Guido Grassi, Giovanni Sgrò, Dell’Oro, Raffaella, Mannironi, Antonio, Giorli, Elisa, Oberti, Sara, Fierro, Brigida, Piccoli, Tommaso, Giacalone, Fabio, Costaggiu, Diego, Pinna, Elisa, Orrù, Francesca, Mannai, Martina, Cordioli, Zeno, Pelizzari, Luca, Chiloiro, Roberta, Cimino, Rosella, Ruberto, Carmen, Dal Santo, Pierluigi, Andriolli, Antonino, Burattin, Giuseppe, Rossi, Laura, Tezza, Fabiana, Aloisio, Paola, Di Monda, Tiziana, Galbassini, Gloria, Russo, Anna Maria, Pesci, Alberto, Suigo, Giulia, Zanasi, Massimo, Moniello, Giovanni, Rostagno, Carlo, Cartei, Alessandro, Polidori, Gianluca, Melis, Maria Ramona, Martellini, Eleonora, Battiston, Bruno, Berardino, Maurizio, Cavallo, Simona, Lombardi, Bruna, D’Ippolito, Pierpaolo, Furini, Angela, Guarneri, Massimo, Paolucci, Stefano, Bassi, Andrea, Coiro, Paola, De Angelis, Domenico, Morone, Giovanni, Venturiero, Vincenzo, Palleschi, Lorenzo, Raganato, Paolo, Di Niro, Giuseppina, Imoscopi, Alessandra, Tibaldi, Vittoria, Bottignole, Giuliana, Calvi, Elisa, Clementi, Carlotta, Zanocchi, Mauro, Agosta, Luca, Criasia, Antonio, Spertino, Elena, Nortarelli, Antonella, Principato, Pietro, Rizzo, Anita, Cellura, Eleonora, Zanghierato, Angelo, Romano, Federica Y., Rosini, Francesca, Mansi, Marta, Rossi, Silvia, Riccardelli, Alex, Potena, Alfredo, Lichii, Mihaela, Candiani, Tiziana, Grimaldi, William, Bertani, Emiliano, Calogero, Pietro, Pinto, Daniela, Bernardi, Roberto, Nicolino, Francesco, Galetti, Caterina, Gianstefani, Alice, Prefumo, Matteo, Paolisso, Giuseppe, Rizzo, Maria Rosaria, Prestano, Raffaele, Dalise, Anna Maria, Barra, Davide, Dal Bosco, Livio, Asprinio, Vincenzo, Dallape, Luciana, Perina, Elisa, Bartoli, Isaura Rossi, Maina, Antonella, Pecoraro, Elisabetta, Sciarra, Michela, Prudente, Angela, Benini, Lucia, Levato, Francesco, Mhiuta, Victor, Alius, Florin, Davidoaia, Diana, Giardini, Vittorio, Garancini, Mattia, Bozzini, Claudia, Tosoni, Paolo, Provoli, Emma, Cascone, Luisa, Dioli, Andrea, Ferrarin, Gianfranco, Bucci, Adelmo, Bua, Guido, Fenu, Sara, Bianchi, Giovanna, Casella, Silvia, Romano, Valentina, Belotti, Gloria, Cavaliere, Sabina, Cuni, Estella, Merciuc, Nina, Oberti, Rosella, Colombo, Katia, D’Arcangelo, Paolo, Montenegro, Nicola, Montanari, Roberto, Lamanna, Pierpaolo, Gasperini, Beatrice, Arighi, Andrea, Granata, Antonino, Ranalli, Claudia, Cammilli, Alessandra, Tricca, Manola, Natella, Daniela, Sozzi, Ferdinando, Valenti, Luigi, Monia, Monella, Prete, Camilla, Senesi, Barbara, Meta, Anna Cristina, Pendenza, Enrico, Pasqualetti, Giuseppe, Polini, Antonio, Ballino, Elena, Dell’Aquila, Giuseppina, Gasparrini, Pina Maria, Marotti, Elisabetta, Migale, Monica, Scrimieri, Antonia, Rosso, Alessia, Tongiorgi, Chiara, Scarpa, Cristina, Pacchioni, Maurizio, De Dominicis, Luigino, Pucci, Eugenio, Renzi, Sara, Cartechini, Elisabetta, Barilaro, Giuseppe, Ugenti, Francesca, Romeo, Pasquale, Nardelli, Anna, Lauretani, Fulvio, Visioli, Sandra, Montanari, Ilaria, Ermini, Francesca, Giordano, Antonio, Pigato, Giorgio, Simeone, Emilio, Colameco, Franco, Cecamore, Antonella, Scurti, Rosa, Lupinetti, Maria Cristina, Barbujani, Mario, Perazzi, Beatrice, Giampieri, Marina, Amoruso, Raffaele, Ferrari, Camilla, Gambetti, Claudio, Sfrappini, Mario, Semeraro, Letizia, Striuli, Rinaldo, Mariani, Claudia, Pelliccioni, Giuseppe, Marinelli, Donatella, Rossi, Tommaso, Pesallaccia, Martina, Sabbatini, Debora, Gobbi, Beatrice, Cerqua, Raffaella, Tagliani, Giancarla, Schlauser, Elena, Caser, Luciano, Caramello, Elisa, Sandigliano, Franca, Rosso, Giorgio, Bendini, Chiara, Scevola, Moreno, Vitale, Enrico, Maugeri, Domenico, Sorace, Rosaria, Anzaldi, Massimiliano, De Gesu, Roberto, Morrone, Giuseppe, Davolio, Federica, Pirazzoli, Luca, Fabbri, Elisa, Ruffini, Ingrid, Insam, Miriam, Abraham, Elisabeth, Kirchlechner, Christine, Cucinotta, Domenico, Parise, Pasquale, Boccali, Andrea, Amici, Serena, Gambacorta, Maurizia, Lovati, Roberto, Giovinazzo, Francesca, Kimak, Elzbieta, Lo Castro, Marika, Mauro, Flavia, De Luca, Alessandro, Sancesario, Giuseppe, Martorana, Alessandro, Scaricamazza, Beatrice, Toniolo, Sofia, Di Lorenzo, Francesco, Liguori, Claudio, Lasco, Antonino, Vita, Natale, Giomi, Mirna, Forte, Floriana, Ceraso, Anna, Marelli, Eleonora, Miceli, Salvatore, Urso, Giovanni, Grioni, Giuseppe, Vezzadini, Giuliana, Misaggi, Giulia, Forlani, Chiara, Iemolo, Francesco, Giordano, Antonello, Sanzaro, Enzo, D’Asta, Gabriele, Proietto, Maria, Carnemolla, Anna, Razza, Grazia, Spadaro, Daniela, Bertolotti, Marco, Neviani, Francesca, Balestri, Francesca, Torrini, Monica, Mannarino, Giulio, Tesi, Francesca, Bigolari, Michela, Natale, Alessia, Grassi, Simona, Bottaro, Cinzia, Stefanelli, Sara, Bovone, Ugo, Tortorolo, Umberto, Quadri, Roberto, Leone, Giuseppe, Ponzetto, Maria, Frasson, Paola, Bruni, Adriana, Confalonieri, Roberto, Corsi, Maurizio, Moretti, Daniela, Teruzzi, Fabiola, Umidi, Simona, Barocco, Federica, Spallazzi, Marco, Chioatto, Paolo, Bortolamei, Sandra, Soattin, Lucia, Bertazzoli, Marco, Rota, Elisabetta, Adobati, Annamaria, Scarpa, Alberto, Granziera, Serena, Zuccher, Paola, Dal Fabbro, Angela, Zara, Daniela, Lo Nigro, Ambra, Franchetti, Lorena, Toniolo, Marika, Marcuzzo, Cinzia, Rollone, Marco, Guerriero, Fabio, Sgarlata, Carmelo, Massè, Alessandro, Zatti, Giovanni, Piatti, Massimiliano, Graci, Jole, Benati, Giuseppe, Biondi, Mario, Fiumi, Nicoletta, Locatelli, Sergio M., Mauri, Sabrina, Beretta, Mauro, Margheritis, Laura, Desideri, Giovanbattista, Liberatore, Ester, Carucci, Anna Cecilia, Caput, Margherita, Antonietti, Maria Paola, Polistena, Giuseppe, De la Pierre, Franz, Mari, Marcello, Massignani, Paola, Tombesi, Fabio, Selvaggio, Fabio, Verbo, Brunella, Bodoni, Paolo, Marchionni, Niccolò, Sabatini, Tony, Mussio, Eleonora, Titoldini, Giulia, Cossu, Beatrice, Licini, Cristina, Tomasoni, Angela, Calderazzo, Massimo, Prampolini, Raffaella, Melotti, Rita Maria, Lilli, Albina, Buda, Simona, Adversi, Marco, Mantovani, Anna Roberta, Viola, Maria C., D’Ambrosio, Viviana, Mazzanti, Paolo, Brambilla, Cristina, Sportelli, Silvia, Quattrocchi, Daniela, Pisu, Cristina, Sicuro, Francesca, Zagnoni, Piergiuseppe, Ghiglia, Stefania, Mosca, Massimiliano, Corazzin, Ileana, Deola, Mariangela, Biagini, Carlo Adriano, Bencini, Francesca, Cantini, Claudia, Tonon, Elisabetta, Pierinelli, Silvia, Onofrj, Marco, Thomas, Astrid, Bonanni, Laura, Cacchiò, Gabriella, Comi, Giancarlo, Magnani, Giuseppe, Santangelo, Roberto, Mazzeo, Salvatore, Barbieri, Cristina, Giroldi, Liviana, Bandini, Fabio, Masina, Marco, Malservisi, Simona, Cicognani, Annalena, Ricca, Laura, Tassinari, Tiziana, Brogi, Davide, Sugo, Annalisa, Bellelli G., Morandi A., Di Santo S.G., Mazzone A., Cherubini A., Mossello E., Bo M., Bianchetti A., Rozzini R., Zanetti E., Musicco M., Ferrari A., Ferrara N., Trabucchi M., Boffelli S., Stefano F.D., Filippi F.D., Guerini F., Bertoletti E., March A., Margiotta A., Mecocci P., Addesi D., Fanto F., Dijik B., Porrino P., Cotroneo A.M., Galli G., Bruni A.C., Bernardini B., Corsini C., Cagnin A., Zurlo A., Barbagallo G., Lunardelli M.L., Martini E., Battaglia G., Latella R., Petritola D., Sinforiani E., Cester A., Formilan M., Carbone P., Appollonio I., Cereda D., Tremolizzo L., Bottacchi E., Lucchetti L., Mariani C., Rapazzini P., Romanelli G., Marengoni A., Zuliani G., Bianchi L., Suardi T., Muti E., Bottura R., Sgro G., Mandas A., Serchisu L., Crippa P., Ivaldi C., Ungar A., Villani D., Raimondi C., Mussi C., Isaia G., Provenzano G., Mari D., Odetti P., Monacelli F., Incalzi R.A., Pluderi A., Bellamoli C., Terranova L., Scarpini E., D'Amico G., Cavallini M.C., Guerrini G., Scotuzzi A.M., Chiarello A., Pilotto A., Tognini S., Dell'Aquila G., Toigo G., Ceschia G., Piccinini M., Fabbo A., Zoli M., Forti P., Wenter C., Basile G., Lasagni A., Padovani A., Rozzini L., Cottino M., Vitali S., Tripi G., Avanzi S., Annoni G., Ruotolo G., Boschi F., Bonino P., Marchionni N., Fascendini S., Noro G., Turco R., Ubezio M.C., Serrati C., Infante M., Gentile S., Pernigotti L.M., Biagini C.A., Canonico E., Bonati P., Gareri P., Caffarra P., Ceretti A., Castiglia R., Gabelli C., Storto M.L., Putzu P., Santo S.D., Malara A., Spadea F., Di Cello S., Ceravolo F., Fabiano F., Rispoli V., Chiaradia G., Gabriele A., Settembrini V., Capomolla D., Citrino A., Scriva A., Bruno I., Secchi R., De Martino E., Muccinelli R., Lupi G., Paonessa P., Fabbri A., Castellari S., Po A., Gaggioli G., Varesi M., Moneti P., Capurso S., Latini V., Ghidotti S., Riccardelli F., Macchi M., Cassinadri A., Tonini G., Andreani L., Coralli M., Balotta A., Cancelliere R., Strazzacapa M., Cavallino P., Fabio S., De Filippi F., Giudice C., Floris P., Dentizzi C., D'Elia K., Azzini M., Cazzadori M., Benati C., Tobaldini C., Antonioli A., Mombelloni P., Fontanini F., Oliverio M., Del Grosso L., Giavedoni C., Bidoli G., Mazzei B., Corsonello A., Fusco S., Vena S., De Vuono T., Maiuri G., Castegnaro E., De Rosa S., Sechi R.B., Benvenuti E., Del Lungo I., Giardini S., Giulietti C., D'Amico F., Caronzolo F., Grippa A., Lombardo G., Pipicella T., Nitti M.T., Felici A., Pavan S., Lunelli A., Dimori S., Magnani A., Soglia T., Postacchini D., Brunelli R., Santini S., Francavilla M., Macchiati I., Sorvillo F., Giuli C., Perticone F., Rosa P.C., Bencardino G., Falbo T., Grillo N., Pezzilli S., Bergamo D., Furno E., Rrodhe S., Lucarini S., Dall'Acqua F., Cappelletto F., Calvani D., Becheri D., Gambardella L., Valente C., Ceci G., Ettorre E., Tironi S., Grassi M.G., Troisi E., Gabutto A., Baglietto N., Quazzo L., Rosatello A., Suraci D., Tagliabue B., Perrone C., Ferrara L., Castagna A., Tremolada M., Piano S., Serviddio G., Lo Buglio A., Gurrera T., Merlo V., Rovai C., Carlucci R., Abbaldo A., Monzani F., Qasem A., Bini G., Tafuto S., Mancuso G., Fragiacomo F., Pompanin S., Guerra G., Pala M., Menozzi L., Gatti C.D., Magon S., Di Francesco V., Faccioli S., Pellizzari L., Lia Lunardelli M., Macchiarulo M., Corneli M., Bacci M., Lo Storto M., Seresin C., Simonato M., Loreggian M., Cestonaro F., Durando M., Mazzoleni M., Russo G., Ponte M., Valchera A., Salustri G., Costa A., Cotta M.R., Pizio R.N., Perego G., Bucciantini E., Di Giovanni M., Franchi F., Claudio Mariani S.B., Grande G., Fugazza L., Guerrini C., De Paduanis G., Iallonardo L., Palumbo P., Ortolani B., Capatti E., Soavi C., Francesconi D., Miselli A., Zaccarini C., Mirra G., Secreto P., Bisio E., Cecchettani M., Naldi T., Pallavicino A., Pugliese M., Iozzo R., Guido Grassi G.S., Dell'Oro R., Mannironi A., Giorli E., Oberti S., Fierro B., Piccoli T., Giacalone F., Costaggiu D., Pinna E., Orru F., Mannai M., Cordioli Z., Pelizzari L., Chiloiro R., Cimino R., Ruberto C., Dal Santo P., Andriolli A., Burattin G., Rossi L., Tezza F., Aloisio P., Di Monda T., Galbassini G., Russo A., Pesci A., Suigo G., Zanasi M., Moniello G., Rostagno C., Cartei A., Polidori G., Melis M., Martellini E., Battiston B., Berardino M., Cavallo S., Lombardi B., D'Ippolito P., Furini A., Guarneri M., Paolucci S., Bassi A., Coiro P., De Angelis D., Morone G., Venturiero V., Palleschi L., Raganato P., Di Niro G., Imoscopi A., Tibaldi V., Bottignole G., Calvi E., Clementi C., Zanocchi M., Agosta L., Criasia A., Spertino E., Nortarelli A., Principato P., Rizzo A., Cellura E., Zanghierato A., Romano F.Y., Rosini F., Mansi M., Rossi S., Riccardelli A., Potena A., Lichii M., Candiani T., Grimaldi W., Bertani E., Calogero P., Pinto D., Bernardi R., Nicolino F., Galetti C., Gianstefani A., Prefumo M., Paolisso G., Rizzo M.R., Prestano R., Dalise A.M., Barra D., Dal Bosco L., Asprinio V., Dallape L., Perina E., Bartoli I.R., Maina A., Pecoraro E., Sciarra M., Prudente A., Benini L., Levato F., Mhiuta V., Alius F., Davidoaia D., Giardini V., Garancini M., Bozzini C., Tosoni P., Provoli E., Cascone L., Dioli A., Ferrarin G., Bucci A., Bua G., Fenu S., Bianchi G., Casella S., Romano V., Belotti G., Cavaliere S., Cuni E., Merciuc N., Oberti R., Colombo K., D'Arcangelo P., Montenegro N., Montanari R., Lamanna P., Gasperini B., Arighi A., Granata A., Ranalli C., Cammilli A., Tricca M., Natella D., Sozzi F., Valenti L., Monia M., Prete C., Senesi B., Meta A.C., Pendenza E., Pasqualetti G., Polini A., Ballino E., Gasparrini P., Marotti E., Migale M., Scrimieri A., Rosso A., Tongiorgi C., Scarpa C., Pacchioni M., De Dominicis L., Pucci E., Renzi S., Cartechini E., Barilaro G., Ugenti F., Romeo P., Nardelli A., Lauretani F., Visioli S., Montanari I., Ermini F., Giordano A., Pigato G., Simeone E., Colameco F., Cecamore A., Scurti R., Lupinetti M.C., Barbujani M., Perazzi B., Giampieri M., Amoruso R., Ferrari C., Gambetti C., Sfrappini M., Semeraro L., Striuli R., Pelliccioni G., Marinelli D., Rossi T., Pesallaccia M., Sabbatini D., Gobbi B., Cerqua R., Tagliani G., Schlauser E., Caser L., Caramello E., Sandigliano F., Rosso G., Bendini C., Scevola M., Vitale E., Maugeri D., Sorace R., Anzaldi M., De Gesu R., Morrone G., Davolio F., Pirazzoli L., Fabbri E., Ruffini I., Insam M., Abraham E., Kirchlechner C., Cucinotta D., Parise P., Boccali A., Amici S., Gambacorta M., Lovati R., Giovinazzo F., Kimak E., Lo Castro M., Mauro F., De Luca A., Sancesario G., Martorana A., Scaricamazza B., Toniolo S., Di Lorenzo F., Liguori C., Lasco A., Vita N., Giomi M., Forte F., Ceraso A., Marelli E., Miceli S., Urso G., Grioni G., Vezzadini G., Misaggi G., Forlani C., Iemolo F., Sanzaro E., D'Asta G., Proietto M., Carnemolla A., Razza G., Spadaro D., Bertolotti M., Neviani F., Balestri F., Torrini M., Mannarino G., Tesi F., Bigolari M., Natale A., Grassi S., Bottaro C., Stefanelli S., Bovone U., Tortorolo U., Quadri R., Leone G., Ponzetto M., Frasson P., Bruni A., Confalonieri R., Corsi M., Moretti D., Teruzzi F., Umidi S., Barocco F., Spallazzi M., Chioatto P., Bortolamei S., Soattin L., Bertazzoli M., Rota E., Adobati A., Scarpa A., Granziera S., Zuccher P., Dal Fabbro A., Zara D., Lo Nigro A., Franchetti L., Toniolo M., Marcuzzo C., Rollone M., Guerriero F., Sgarlata C., Masse A., Zatti G., Piatti M., Graci J., Benati G., Biondi M., Fiumi N., Locatelli S.M., Mauri S., Beretta M., Margheritis L., Desideri G., Liberatore E., Carucci A.C., Caput M., Antonietti M.P., Polistena G., De la Pierre F., Mari M., Massignani P., Tombesi F., Selvaggio F., Verbo B., Bodoni P., Sabatini T., Mussio E., Titoldini G., Cossu B., Licini C., Tomasoni A., Calderazzo M., Prampolini R., Melotti R.M., Lilli A., Buda S., Adversi M., Mantovani A.R., Viola M.C., D'Ambrosio V.V., Mazzanti P., Brambilla C., Sportelli S., Quattrocchi D., Pisu C., Sicuro F., Zagnoni P., Ghiglia S., Mosca M., Corazzin I., Deola M., Bencini F., Cantini C., Tonon E., Pierinelli S., Onofrj M., Thomas A., Bonanni L., Cacchio G., Comi G., Magnani G., Santangelo R., Mazzeo S., Barbieri C., Giroldi L., Bandini F., Masina M., Malservisi S., Cicognani A., Ricca L., Tassinari T., Brogi D., Sugo A., Bellelli, G, Morandi, A, Di Santo, S, Mazzone, A, Cherubini, A, Mossello, E, Bo, M, Bianchetti, A, Rozzini, R, Zanetti, E, Musicco, M, Ferrari, A, Ferrara, N, Trabucchi, M, Appollonio, I, Cereda, D, Tremolizzo, L, Annoni, G, Zatti, G, Bellelli, Giuseppe, Morandi, Alessandro, Di Santo, Simona G, Mazzone, Andrea, Cherubini, Antonio, Mossello, Enrico, Bo, Mario, Bianchetti, Angelo, Rozzini, Renzo, Zanetti, Ermellina, Musicco, Massimo, Ferrari, Alberto, Ferrara, Nicola, Trabucchi, Marco, Giuseppe Bellelli, Alessandro Morandi, Simona G. Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Mario Bo, Angelo Bianchetti, Renzo Rozzini, Ermellina Zanetti, Massimo Musicco, Alberto Ferrari, Nicola Ferrara, Marco Trabucchi, and on behalf of the Italian Study Group on Delirium (ISGoD), Stefano Boffelli, Fabio Di Stefano, Francesco De Filippi, Fabio Guerini, Erik Bertoletti, Albert March, Alessandro Margiotta, Patrizia Mecocci, Desireè Addesi, Fausto Fantò, Gianluca Isaia, Babette Dijik, Paola Porrino, Antonino Maria Cotroneo, Giovanni Galli, Amalia Cecilia Bruni, Bruno Bernardini, Carla Corsini, Annachiara Cagnin, Amedeo Zurlo, Giuseppe Barbagallo, Maria Lia Lunardelli, Emilio Martini, Giuseppe Battaglia, Raffaele Latella, Donatella Petritola, Elena Sinforiani, Alberto Cester, Marino Formilan, Pasqualina Carbone, Ildebrando Appollonio, Diletta Cereda, Lucio Tremolizzo, Edo Bottacchi, Lucio Lucchetti, Claudio Mariani, Piero Rapazzini, Giuseppe Romanelli, Alessandra Marengoni, Giovanni Zuliani, Lara Bianchi, Teresa Suardi, Ettore Muti, Renato Bottura, Giovanni Sgrò, Antonella Manda, Luca Serchisu, Patrizia Crippa, Claudio Ivaldi, Andrea Ungar, Daniele Villani, Clara Raimondi, Chiara Mussi, Giancarlo Isaia, Giuseppe Provenzano, Daniela Mari, Patrizio Odetti, Fiammetta Monacelli, Raffaele Antonelli Incalzi, Alice Pluderi, Claudio Bellamoli, Luciano Terranova, Elio Scarpini, Ferdinando D'Amico, Maria Chiara Cavallini, Gianbattista Guerrini, Anna Maria Scotuzzi, Antonino Chiarello, Alberto Pilotto, Sara Tognini, Giuseppina Dell’Aquila, Gabriele Toigo, Giuliano Ceschia, Maristella Piccinini, Andrea Fabbo, Marco Zoli, Paola Forti, Christian Wenter, Giorgio Basile, Anna Lasagni, Alessandro Padovani, Luca Rozzini, Maria Cottino, Silvia Vitali, Gabriele Tripi, Stefano Avanzi, Giorgio Annoni, Giovanni Ruotolo, Federica Boschi, Paolo Bonino, Niccolò Marchionni, Maria C. Cavallini, Sara Fascendini, Gabriele Noro, Renato Turco, Maria C. Ubezio, Carlo Serrati, Maria Infante, Simona Gentile, Luigi M. Pernigotti, Carlo A. Biagini, Enzo Canonico, Pietro Bonati, Pietro Gareri, Paolo Caffarra, Arcangelo Ceretti, Rosanna Castiglia, Carlo Gabelli, Mario Lo Storto, Paolo Putzu, Simona Di Santo, Andrea, Mazzone, and Rita Maria Melotti

Subjects
Male, Cross-sectional study, Hospitalized patients, Prevalence, 0302 clinical medicine, Surveys and Questionnaires, 80 and over, Odds Ratio, Medicine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Multicenter, Acute hospital, 2. Zero hunger, Aged, 80 and over, Medicine(all), Medicine (all), Settore BIO/14, General Medicine, 3. Good health, 4AT, Delirium, Hospital, Aged, Cross-Sectional Studies, Female, Humans, Inpatients, Italy, Logistic Models, medicine.symptom, Research Article, Rehabilitation hospital, medicine.medical_specialty, NO, 03 medical and health sciences, 4AT, Delirium, Hospital, Multicenter, Prevalence, Aged, Aged, 80 and over, Cross-Sectional Studies, Delirium, Female, Humans, Inpatients, Italy, Logistic Models, Male, Odds Ratio, Prevalence, Prospective Studies, Surveys and Questionnaires, mental disorders, Psychiatry, business.industry, Odds ratio, Emergency medicine, business, 030217 neurology & neurosurgery
Abstract

Background To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods This is a point prevalence study (called “Delirium Day”) including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01–1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12–1.27), dementia (OR 3.25, 95 % CI 2.41–4.38), malnutrition (OR 2.01, 95 % CI 1.29–3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45–2.82), feeding tubes (OR 2.51, 95 % CI 1.11–5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06–1.87), urinary catheters (OR 1.73, 95 % CI 1.30–2.29), and physical restraints (OR 1.84, 95 % CI 1.40–2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29–3.14), while admission to other settings was not. Conclusions Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The “Delirium Day” project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys. Electronic supplementary material The online version of this article (doi:10.1186/s12916-016-0649-8) contains supplementary material, which is available to authorized users.

Published
2016

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