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Background: Alzheimer’s disease (AD) is clinically heterogeneous, including the classical-amnesic (CA-) phenotype and some variants. Objective: We aim to describe a further presentation we (re)named confabulation-misidentification (CM-) phenotype. Methods: We performed a retrospective longitudinal case-series study of 17 AD outpatients with the possible CM-phenotype (CM-ADs). Then, in a cross-sectional study, we compared the CM-ADs to a sample of 30 AD patients with the CA-phenotype (CA-ADs). The primary outcome was the frequency of cognitive and behavioral features. Data were analyzed as differences in percentage by non-parametric Chi Square and mean differences by parametric T-test. Results: Anterograde amnesia (100%) with early confabulation (88.2%), disorientation (88.2%) and non-infrequently retrograde amnesia (64.7%) associated with reduced insight (88.2%), moderate prefrontal executive impairment (94.1%) and attention deficits (82.3%) dominated the CM-phenotype. Neuropsychiatric features with striking misidentification (52.9%), other less-structured delusions (70.6%), and brief hallucinations (64.7%) were present. Marked behavioral disturbances were present early in some patients and very common at later stages. At the baseline, the CM-ADs showed more confabulation (p

The pandemic has accelerated the processes of change taking place in the Italian school, bringing to the center of the debate the need to rethink teaching-learning models in a more dynamic and ecological way, inserting them in current events and putting them in continuous dialogue with contexts. The main theoretical references are indicated to found the perspective of change as a culture of education, according to the good practices and qualified experiences that are presented in subsequent interventions.

Background Socially desirable responding is a potentially relevant issue in older adults and can be evaluated with the Marlowe-Crowne Social Desirability Scale (MCSDS). However, the eight-item MCSDS has never been specifically administered to geriatric subjects, and there is a dearth of literature on the relationship between social desirability and cognitive impairment. Also, the connection between social desirability and subjective measures of psychological well-being is a matter of controversy. This study has three main aims. First, to determine the psychometric properties of the eight-item MCSDS in geriatric outpatients without dementia (i.e. with normal cognition (NC) or mild cognitive impairment (MCI)). Second, to investigate the link between social desirability and cognitive functioning. Third, to determine the association between social desirability and the assessment of self-reported mental health. Methods Community-dwelling outpatients (aged ≥ 65) were consecutively recruited and neuropsychologically tested to diagnose NC or MCI (n = 299). Social desirability was assessed with the eight-item MCSDS. Depressive and anxiety symptoms were measured with the short Geriatric Depression (GDS-s) and the State-Trait Personality Inventory Trait Anxiety (STPI-TA) scales. Results On principal components analysis, the eight-item MCSDS was found to have a multidimensional structure. Of the initial three-component solution, only two subscales had acceptable internal consistency (Cronbach’s alpha > 0.6): “Acceptance of responsibility” and “Integrity”. The third subscale (“Kindness towards others”) appeared to gauge two distinct constructs of formal (i.e. politeness) versus substantive (i.e. forgiveness) compassion. On binary logistic regression, only higher income was a significant predictor of formal compassion. Test-retest reliability was substantial to excellent (Gwet’s AC2 ≥ 0.8). There were no meaningful differences in social desirability between the NC and MCI groups. Likewise, negative Spearman’s correlations between social desirability and cognitive Z-scores across the whole sample were weak (rs Conclusions Our results suggest that social desirability need not be a major concern when using questionnaires to assess mental health in geriatric outpatients without dementia.

Mild cognitive impairment (MCI) is a heterogeneous syndrome with two main clinical subtypes, amnestic (aMCI) and non-amnestic (naMCI). The analysis of heart rate variability (HRV) is a tool to assess autonomic function. Cognitive and autonomic processes are linked via the central autonomic network. Autonomic dysfunction entails several adverse outcomes. However, very few studies have investigated autonomic function in MCI and none have considered MCI subtypes or the relationship of HRV indices with different cognitive domains and structural brain damage. We assessed autonomic function during an active orthostatic challenge in 253 oupatients aged ≥ 65, [n = 82 aMCI, n = 93 naMCI, n = 78 cognitively normal (CN), neuropsychologically tested] with power spectral analysis of HRV. We used visual rating scales to grade cerebrovascular burden and hippocampal/insular atrophy (HA/IA) on neuroimaging. Only aMCI showed a blunted response to orthostasis. Postural changes in normalised low frequency (LF) power and in the LF to high frequency ratio correlated with a memory test (positively) and HA/IA (negatively) in aMCI, and with attention/executive function tests (negatively) and cerebrovascular burden (positively) in naMCI. These results substantiate the view that the ANS is differentially impaired in aMCI and naMCI, consistently with the neuroanatomic substrate of Alzheimer's and small-vessel subcortical ischaemic disease.

The article titled “Peripheral Blood Mononuclear Cells as a Laboratory to Study Dementia in the Elderly” [1] was found to contain a substantial amount of material from previously published articles including the following sources: (i)Manraj S. Bhamra and Nicholas J. Ashton, “Finding a pathological diagnosis for Alzheimer’s disease: Are inflammatory molecules the answer?: Proteomics and 2DE”, Electrophoresis, 2012. 10.1002/elps.201200161. [2] (not cited)(ii)Kelly M. Bakulski, Laura S. Rozek, Dana C. Dolinoy, Henry L. Paulson and Howard Hu, “Alzheimer’s Disease and Environmental Exposure to Lead: The Epidemiologic Evidence and Potential Role of Epigenetics”, Current Alzheimer Research (2012) 9: 563. 10.2174/156720512800617991. [3] (cited as reference [75])(iii)Cristina Gussago, “Il Recettore Adenosinico A2a Come Possibile Biomarcatore Nella Diagnosi Differenziale Delle Demenze Nell’anziano”, Universita Degli Studi Di Milano. 10.13130%2Fgussago-cristina_phd2014-03-10. [4] (not cited)(iv)B. Arosio, A. Bulbarelli, S. Bastias Candia, E. Lonati, L. Mastronardi, P. Romualdi, S. Candeletti, C. Gussago, D. Galimberti, E. Scarpini, B. Dell Osso, C. Altamura, M. Maccarrone, L. Bergamaschini, C. D Addario, D. Mari. “Pin1 Contribution to Alzheimer s Disease: Transcriptional and Epigenetic Mechanisms in Patients with Late-Onset Alzheimer s Disease”, Neurodegenerative Diseases, 2012.10.1159/000333799. [5] (cited as reference [66])(v)K. Ando, P. Dourlen, A. V. Sambo et al., “Tau pathology modulates Pin1 post-translational modifications and may be relevant as biomarker,” Neurobiology of Aging, vol. 34, no. 3, pp. 757–769, 2013. 10.1016/j.neurobiolaging.2012.08.004. [6] (cited as reference [69]) The authors apologise in particular for not acknowledging the work of Bhamra and Ashton (2012). Copyright © 2020 Beatrice Arosio et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This paper focuses on the journalism workshops held in Ussita (Italy) during the 2019’s winter. The workshops were aimed at children and they involved local kids from 5 to 10 years old. This project was a part of the data collection for the doctoral research program “Growing up informed”. The method involved participants observation, field recording, written and drawn material. Ussita is one of the towns wrecked by the earthquakes of 2016. We chose this place because the research program focuses also on media education as a mean to develop territorial awareness. Territorial awareness may be crucial after an earthquake, for it is one of the features that create resilience. The main teaching activity was about explaining to children how to make interviews, matching a previous format we studied in 2018. They made interviews in different locations and situations. They were able to meet a photographer, a biologist (Ussita is part of a National Park), a member of a local association. The children also visited several old people in their emergency homes to interview them. We organized a follow up in April in which they had to interview some local adults about a traditional festival that was about to be held. The group managed to interview these people, even if the context was slightly different, showing they remembered what they have learned. The results show how children managed to tackle a variety of local topic (nature, history, problems, opportunity) by interviewing people and how the activity affected their local awareness in this sensitive moment.

The technological development is changing, involving and conditioning everyday life, making it faster, hyper-connected and immediate. New technologies can have a double outcome: positive, given that they take on the role of facilitator, or negative, when people tend to make excessive and unconscious use of it or technology repeatedly replaces human beings. Today, therefore, new skills are needed for the entire population, the digital skills, both in everyday life and in the labour market. These are transversal skills that allow human beings to choose the right technologies: to research, analyze data and choose reliable information from those that require further study, to check and verify the health of people, to interact with different and distant subjects in the world, to improve school learning, ... The plurality of people that this technological development is involving allows us to analyze the population in terms of generations, from Silent Generation to Alpha Generation. In this article we want to present a literature review within the Google Scholar database in the last 10 years using the terms digital skills and different generation. This preliminary research allows us to analyze the different theories that make for the Digital Skills a definition, dimensions and evaluation model, and the generational profiles in order to have a shared and common theory among the different professionals. Having an accurate background of digital skills and generational profiles favours the inclusion of all people, and the improvement of the quality of life in the creation of psycho-pedagogical projects and in the design of technological products.

The aims of this study are to analyse, in community-dwelling people aged 65+ living in Italy’s Lombardy Region, electrocardiographic (ECG) monitoring for new users of the atypical antipsychotic quetiapine co-prescribed with acetylcholinesterase inhibitors (AChEIs) or memantine and to find independent predictors of ECG monitoring before and after the starting of this prescription. The Lombardy Region’s administrative health database was used to retrieve prescriptions of ECG exams as well as prevalence rates of subjects aged 65+ who were prescribed such psychotropic drugs from 2005 to 2009. Multivariable analyses were adjusted for age, sex, number of drugs, treatment with beta-blockers, digoxin, verapamil or diltiazem, any antiarrhythmic drug and antidepressants. Overall 2,623 community-dwelling older people started therapy with quetiapine, co-prescribed with AChEIs or memantine, during these 5 years. At least one ECG was performed in 714 cases (27.2 %) in the 6 months before—and in 398 cases (15.2 %) within 3 months after—the starting of this prescription. ECG monitoring was performed both before and after starting quetiapine in only 160 cases (6.1 %). At multivariable analyses, number of drugs taken, beta-blocker and antiarrhythmic drug use were found to be independent correlates of ECG monitoring whereas female sex was associated with a lower probability of receiving an ECG within 3 months after the initiation of quetiapine (odds ratio 0.78, 95 % CI 0.62–0.98). ECG monitoring for new prescriptions of quetiapine in older people suffering from behavioural and psychological symptoms in dementia was actually performed infrequently, independently of the age of drug users, especially in women. Our results support the need for greater awareness within the medical community of the importance of such ECG monitoring.

We describe a sporadic case of frontotemporal lobar degeneration, associated with the C9ORF72 mutation, with prominent behavioral changes and semantic deficits. Predominant deficits in naming, vocabulary, word comprehension, and face and object recognition emerged on neuropsychological assessment. Amnesia, behavioral changes, and isolated psychotic symptoms were also present. Hyposmia was an unspecific prodromal sign. Brain imaging showed basofrontal and temporopolar hypometabolism bilaterally, and predominantly left-sided atrophy. Levels of cerebrospinal fluid biomarkers (amyloid-β, tau and p-tau) were normal. This description further confirms the heterogeneous presentation of the C9ORF72 mutation.

The steady and dramatic increase in the incidence of Alzheimer’s disease (AD) and the lack of effective treatments have stimulated the search for strategies to prevent or delay its onset and/or progression. Since the diagnosis of dementia requires a number of established features that are present when the disease is fully developed, but not always in the early stages, the need for a biological marker has proven to be urgent, in terms of both diagnosis and monitoring of AD. AD has been shown to affect peripheral blood mononuclear cells (PBMCs) that are a critical component of the immune system which provide defence against infection. Although studies are continuously supplying additional data that emphasize the central role of inflammation in AD, PBMCs have not been sufficiently investigated in this context. Delineating biochemical alterations in AD blood constituents may prove valuable in identifying accessible footprints that reflect degenerative processes within the Central Nervous System (CNS). In this review, we address the role of biomarkers in AD with a focus on the notion that PBMCs may serve as a peripheral laboratory to find molecular signatures that could aid in differential diagnosis with other forms of dementia and in monitoring of disease progression.

Studying the construction of identity in adolescence ( Erikson, 1968 ) we use some elements of Bruner's Cultural Psychology (1990). In particular we refer to the indicators of Self identified by Bruner (1998) in text-type self-reports analysis. Adopting Bruner's indicators allows to understand the most popular qualities that the current generation of adolescents uses as a point of reference in the identity construction process

Confabulation may be present in Alzheimer’s disease (AD), but usually it is not a primary feature of either its typical or atypical variants. In this report, we describe the case of an AD patient who showed an unusual and enduring neuropsychiatric phenotype characterized by early and prominent spontaneous confabulation. Surprisingly, such atypical AD presentation bears a striking resemblance to presbyophrenia, a subtype of dementia which was described at the beginning of the twentieth century and then sank into oblivion. In discussion, we speculate on the “return” of presbyophrenia as an unrecognized neuropsychiatric variant of AD and its possible neuroanatomical substrates.

To analyse, in older community-dwelling people living in Italy's Lombardy region, 8-year trends in new users of spironolactone co-prescribed with angiotensin-converting-enzyme inhibitors (ACE-Is) and/or angiotensin receptor blockers (ARBs); blood test monitoring; and independent predictors of appropriate blood test monitoring.The region's administrative health database from 2001 to 2008 was used to retrieve yearly frequencies of subjects aged 65+ who started this co-prescription. Multivariate analyses were adjusted for age, sex, local health unit, treatment with beta-blockers, drugs for diabetes, and polypharmacy (i.e., exposure to five or more different drugs).Only new users of spironolactone co-prescribed with ARBs increased from 2001 to 2008 (P 0.001). In the 6 months before starting the co-prescriptions 96 to 100% of patients measured serum creatinine (mean 99.3%), sodium (97.3%) and potassium (98.6%). Within 3 months of starting the co-prescriptions 96 to 99% of patients measured serum sodium (mean 97.3%) and potassium (98.6%), but on average only 48% of them (range 43 to 53%) measured serum creatinine, with an increase over time (odds ratio [change in regression per year] = 1.03, 95% CI 1.02-1.05, P 0.001). At multivariate analysis polypharmacy was found to be the only independent predictor of such creatinine monitoring (P 0.001).Our results support the need for greater awareness within the medical community of the potential renal toxicity of the association of spironolactone with ACE-Is and/or ARBs. Adequate short-term monitoring of serum creatinine in all older community-dwelling people who receive such co-prescription is necessary in order to ensure safe usage of these medications.

Heart rate variability (HRV) is the temporal beat-to-beat variation in successive RR intervals on an electrocardiographic (ECG) recording and it reflects the regulation of the heart rate (HR) by the autonomic nervous system (ANS). HRV analysis is a noninvasive tool for the assessment of autonomic function that gained momentum in the late 1980s when its clinical relevance as a predictor of mortality was established by a milestone study by Kleiger et al. in patients with postacute myocardial infarction. In the last few decades, the increasing availability of commercial ECG devices offering HRV analysis has made HRV a favorite marker for risk stratification in the setting of cardiovascular disease. The rapid aging of the world population and the growing popularity of HRV have also fueled interest for the prognostic value of HRV in the elderly, outside a specific cardiological context. However, the discussion of HRV measures in the elderly is still very much centered on the rather reductionistic model of sympathovagal balance, with the orthosympathetic and parasympathetic limbs of the ANS exercising opposing effects on the heart via autonomic tone. The expanding application of nonlinear dynamics to medicine has brought to the forefront the notion of system complexity, embedded in the mathematical concepts of chaos theory and fractals, and provides an opportunity to suggest a broader interpretation for the prognostic significance of HRV, especially in the elderly. Although the use of novel indices of HRV may be hampered by practical issues, a more holistic approach to HRV may still be safeguarded if traditional time- and frequency-domain measures are viewed in terms of autonomic modulation. This review focuses on HRV in geriatric populations. It considers studies on the prognostic value of HRV in elderly subjects, discussing the potential confounding effect of erratic rhythm, and concentrates on the conceptual distinction between autonomic tone and autonomic modulation. It also briefly addresses the question of the practicality of ECG recordings and identifies a promising area for future research in the effects of common noncardioactive drugs on HRV.

The aim of this retrospective study was to investigate the accuracy of informant reports on cognitive status in mild cognitive impairment (MCI) by comparing the subjective evaluation made by patients’ relatives with the objective results of neuropsychological assessment. We enrolled 119 MCI outpatients and their relatives. Cognitive impairment was assessed by a battery of standardized neuropsychological tests. Informant reports on cognitive functioning were obtained by means of a structured interview. Subjective and objective evaluations of cognitive status were rated according to the same scoring system in order to enable comparison. All but one relative reported cognitive dysfunctions at the interview, but the kind of cognitive profile emerging from their reports was quite different from the one highlighted by neuropsychological assessment. A subjective evaluation of cognitive status based on informant reports could therefore be useful to identify patients with MCI but is unable to define MCI subtypes.

Erectile dysfunction (ED) is often associated with cardiovascular disease (CVD) and the risk of sildenafil-induced orthostatic hypotension (OH) in subjects with CVD is a matter of concern. We describe our experience in using the tilt test (TT) with continuous plethysmography to evaluate the occurrence of OH in patients with CVD and ED after a test dose of sildenafil. When sildenafil was added on top of their usual pharmacological treatment two patients out of 32 (6.2%) developed asymptomatic OH, with a maximum blood pressure fall of 40/20 mm Hg. The low prevalence and modest clinical relevance of OH in our high-risk population coupled with the known high sensitivity and reproducibility of the TT seem to suggest that sildenafil is haemodynamically safer than is generally believed even when added on top of vasoactive treatment. These findings should be put into perspective against the growing wealth of evidence that PDE5 inhibitors may have therapeutic potential for a number of CV conditions.

This paper reports a study that aimed to identify the predictors of the turnover of privately-employed personal-care staff that provide community-dwelling older adults in Italy with assistance in the activities of daily living. The prospective cohort study enrolled 121 older adults (mean age 85.6 years) living at home, along with their personal-care workers and 107 informal carers. The older participants underwent a comprehensive geriatric assessment. At a one-year follow-up between May 2006 and June 2008, 12 of the older participants had been placed in a nursing home and 26 had died. Of the 83 still living at home, 22 had changed their personal-care staff (26.5% turnover). Multivariate logistic regression analysis identified one characteristic of the personal-care staff, living far away from their families (odds ratio (OR) 16.30, p=0.01), and two characteristics of the elders, namely being widowed (OR 0.09, p=0.01) and having cognitive impairment (OR 0.10, p=0.01), as one-year predictors of turnover and of the retention of personal-care workers, respectively. Further studies are needed both to evaluate whether immigration politics that enable family reconjunction would reduce the turnover of personal-care workers, and to investigate the lower turnover among personal-care staff caring for widowed elders and older adults with cognitive impairment.

To determine the main social, functional and clinical characteristics of community-dwelling older outpatients living alone and to find correlates of frailty in this population.Cross-sectional survey of 302 community-dwelling outpatients aged 65+ (median age 82 years) consecutively referred to a geriatric medicine clinic in Italy from June to November 2009. Participants underwent a comprehensive geriatric assessment including frailty status evaluated by means of the study of osteoporotic fractures (SOF) criteria. Student's t-test and the chi-squared test were used to compare subjects 'living alone' and 'not living alone' as well as 'frail' and 'not frail' subjects among the participants living alone. Multiple logistic regression analyses were performed to find independent correlates of frailty among participants living alone.Participants 'living alone' were 124 (41%). Compared to subjects 'not living alone' (n = 178), they were older, received less assistance from informal and formal caregivers, had poorer living and financial conditions, a better cognitive status and functional self-sufficiency but a worse emotional status. One-third of them (n = 41) were frail. Among frail elders (n = 116), subjects living alone also showed a higher prevalence of unexpected new diagnoses of dementia than those not living alone. Independent correlates of frailty among participants living alone were: having experienced a severe acute disease in the past year (odds ratio [OR] 303.9; 95% confidence interval [CI] 13-7091; p0.001), dependence in the bathing BADL ability (OR 62.74; 95% CI 12.17-323.32; p0.001), depression (OR 10.43; 95% CI 2.31-47.13; p = 0.002) and incontinence (OR 3.98; 95% CI 1.01-15.66; p = 0.048).In older outpatients living alone, including those who were frail, we found a lower availability of personal assistance, significantly more social and financial vulnerability and a higher risk of depression. In frail elders there was also a higher prevalence of underdiagnosed dementia. In order to better recognise frail subjects in this specific population, four independent correlates of frailty were identified.

Addressing the issue of prevention from alcohol abuse, the realized project was not built with reference to a typical medical or sanitary perspective on health, but mainly adopting the perspective of developmental and socio-cultural psychology. We were primarily interested in knowing the meanings adolescents attach to their prevailing experiences and their representations of drinking alcohol. We also assumed that adolescents use alcohol to test themselves and to challenge themselves into possible identities. So we designed the survey as an action research, collecting information from participants to the project and discussing the data with them, both on their alcohol representations and their identities conceptions. We will show the main results, in terms of the collected data.

The paper offers a discussion about the concept of training from a psychological point of view. In a life-long learning perspective adults’ training is developing relevant. Innovative technologies and methodologies demonstrate to be very needful to answer to new learning requests, and this is also because requests mainly come from workers. Even Universities are restyling their paths, organizing online courses in addition to traditional classes. But is it possible to do e-training? And, if possible, in which way the assessment has to be conducted? A study case is provided to deal with these questions.

Os antibióticos são comumente utilizados para melhorar uma infecção estabelecida e possuem a finalidade de eliminar ou impedir o crescimento bacteriano. Os riscos mais importantes relacionados ao seu uso são: reações adversas, resistência bacteriana e possíveis interações medicamentosas. Foram realizadas entrevistas com os pacientes para observar o entendimento dos mesmos sobre o uso do antibiótico e tratamento. 38,3% dos pacientes são menores de 18 anos e a maioria é do sexo feminino. Um terço não compreende diagnóstico ou posologia e a maioria consultou-se com um clínico geral. Ainda há resistência na prescrição do nome genérico. Cerca de 8% das receitas continham interação medicamentosa. Grande parte dos tratamentos pode estar comprometida pelo não entendimento do paciente ou presença de interação medicamentosa. A eficácia do tratamento depende de todos os profissionais de saúde, sendo necessário treinamento a esses profissionais tanto para conhecimento próprio quanto para atenção farmacêutica.The use of antibiotics in the treatment of established infections for inhibiting or abolishing the growth of microorganism is very common. The risks related to their use include side effects, drug resistance and potential drug-drug interactions. A structured questionnaire was applied to patients in order to collect information about their understanding of the treatment and of how to use the antibiotic. As to the profile of the patients, 38.3% are younger than 18 years and most are females. One third does not understand the diagnosis or prescribed dosage and most of the patients had consulted with the general practitioner. Prescriptions of generic drugs continue rare, probably due to the physicians' resistance to prescribe this kind of medication. About 8% of prescriptions involved drug-drug interactions. Many treatments are compromised due to the lack of information provided to the patient or to drug-drug interactions. The efficiency of a treatment depends on all health professionals involved, who need to be adequately trained for providing effective pharmacy care.

The issue of recognition, validation and certification of skills, especially those developed in non-formal and informal fields, is becoming a current topic for all educative institutions, including University. Soft skills is a psycho-sociological term relating to a cluster of personality traits, social abilities, communication, language, personal attitudes that characterize relationships with other people. Soft skills complement hard skills which are the occupational requirements of a job and many other activities. In Italy the legal framework on skills is leaded by the Legislative Decree n. 13/13. According to the Decree, University should assure the effective implementation of lifelong learning through guidance and counselling services. The University of Macerata (UNIMC) has been involved from a long time in the field of soft skills with many activities, formal as well as informal and non-formal. A system to recognize and validate them has been experienced in the last years. The objective of the paper is to describe the designed procedures aimed to the recognition and validation of soft skills such as observation, active listening, communication in small group and problem solving. Each skill was operationalized through the identification of specific indicators to recognize three level of expertise: basic, intermediate, advanced. Moreover several tasks were tested in order to identify a set of activities useful for the aim of a kind of formal recognition.