Ettore Muti - Academia.edu (original) (raw)

Papers by Ettore Muti

European Journal of Applied Physiology, 2020

Purpose Vascular dysfunction has been demonstrated in patients with Alzheimer’s disease (AD). Exe... more 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 typica...

Journal of the American Medical Directors Association, 2020

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, w... more Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the "Delirium Day" study, a nationwide Italian pointprevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors.

Medicine & Science in Sports & Exercise, 2018

RESULTS: Twenty-one older adults (11 men, 10 women; age 70 ± 6 yrs.) completed the study. There w... more RESULTS: Twenty-one older adults (11 men, 10 women; age 70 ± 6 yrs.) completed the study. There were no significant correlations for BF% (r = 0.19, p = 0.41), LBMS (r = -0.07, p = 0.78), and PF (r = 0.14, p = 0.55) on WE at the 0.45 m·sec speed. Correlations were also not significant on WE at the 0.89 m·sec -1 speed [BF% (r = -0.22, p = 0.34), LBMS (r = 0.01, p = 0.96), and PF (r = 0.18, p = 0.44)] and the 1.34 m·sec speed [BF% (r = 0.09, p = 0.71), LBMS (r = 0.14, p = 0.54), and PF (r = -0.26, p = 0.25)]. CONCLUSION: BF%, LBMS, and PF may not be associated with age-related decrements in WE with older adults during treadmill walking. Future research is needed to better determine the interactions of these variables on WE in older adults.

Frontiers in Physiology, 2020

Journal of Alzheimer's Disease, 2019

BACKGROUND Behavioral and psychological symptoms of dementia (BPSD) affect 60-90% of patients wit... more 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 < 0.001). No adverse events were reported. CONCLUSION The indoor TG seems safe and may reduce BPSD, medication intake, and cortisol levels in AD.

Frontiers in Physiology, 2019

Journal of Clinical Medicine, 2019

Recent literature highlights the importance of identifying factors associated with mild cognitive... more 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 regress...

Frontiers in physiology, 2018

Advanced aging, vascular dysfunction, and nitric oxide (NO) bioavailability are recognized risk f... more Advanced aging, vascular dysfunction, and nitric oxide (NO) bioavailability are recognized risk factors for Alzheimer's disease (AD). However, the contribution of AD, , 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 < 0.05) reduced across the spectrum from YG to OLD, MCI, AD1, AD2, AD3 subjects. ...

Journal of Alzheimer's disease : JAD, 2018

Although current literature has shown that patients with Alzheimer's disease (AD) have worse ... more 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. 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). 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. The 16 patients assigned to ET exhibited signif...

Journal of Alzheimer's disease : JAD, Jul 14, 2016

Sundowning syndrome (SDS) in patients with Alzheimer's disease (AD) is characterized by the i... more 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 (ne...

PLOS ONE, 2016

Loss in body mass (ΔBM) is a common feature in patients with Alzheimer's disease (AD). However, t... more Loss in body mass (ΔBM) 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 ΔBM in AD patients following a standard institutionalized diet. Secondary objective was to identify possible predictors of ΔBM. 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 ΔBM 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 ΔBM in W with AD. At contrary, the best predictor of ΔBM in M with AD was the cortisolism. Despite a controlled energy intake and similar energy expenditure, both W and M with AD suffered of ΔBM. 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.

Background: Aging is associated with reduction in activities of daily living (ADL) and this decli... more Background: Aging is associated with reduction in activities of daily living (ADL) and this decline can play major role in loss of independence in elderly people. ADL performance assessed in active older are directly related with medical conditions, social and economy level and also with leg muscle strength and power. For very old people, unable to walk alone, is not possible to estimate lower body capacity and it is not clear if residual ADL are influenced only by biomedical conditions or also from fitness level of upper part of body. The purpose of this study was to determine if there are any relationship between upper body muscle strength, shoulders flexibility, arms circumferences, number of drugs, number of pathologies, cognitive level with ADL in older adults with severe mobility limitation. Methods: Forty-four patients, (16 men and 28 women; mean age 83.7±5y), not able to walk and dependent on assistance in one or more personal ADL, were evaluated in the community living center Arrigo Mazzali in Mantova. Test retest measurements of arms strength were assessed with arm curl test (AC), upper body flexibility were evaluated with back-scratch test (BS), standing arms circumferences was evaluated with a flexible tape measure (ACI). Number of pathologies (NP) and drugs treatments (ND) were collected by specialist in geriatrics medicine, physiotherapist assessed the ability to perform ADL with the Barthel index examination and cognitive level with MMSE. Multiple linear regression was use for estimate relations between ADL and AC, BS, ACI, NP, ND, MMSE. Results: The general equation pf multiple regression was ADL=2.009+(1.229*AC)+(0.358*BS)+(0.628*MMSE)+(0.0682*ND)(0.726*NP)+(0.371*ACI); overall correlation coefficient R=0.818. Significant correlations were found with AC and ability to perform ADL p<0.001, and also between BS & ADL p=0.004, ACI seem to be not related with ADL p=0.416. NP probably never influences ADL p=0.471 and ND p=0.929, but significant correlations were found with MMSE p=0.013. Conclusion: Biomedical condition evaluated with NP & ND in this dependent elderly group are higher than active older adults, but are homogeneously distributed and not related to residual ADL. Cognitive level and arms strength appear correlated to residual ADL, for older adults with severe mobility limitation an adequate level of arms strength and flexibility probably allows to be much more active and powerful in ADL. These data suggests that a good upper body fitness can be very helpful in elderly with severe mobility limitation and a specific training on upper limbs could also preserve from a complete drop in ADL and cognitive functions. References: Posner, J.D., et al. 1995. Arc of Phys Med Rehab, 76, 373-0. Chodzko-Zajko, W.J., et al. 1994. Exer Sport Sci Rev, 22, 195-0. Rikli, R.E., et al. 1999. JAPA, 7, 129-161.

Journal of the American Geriatrics Society, 2013

To the Editor: Sundowning syndrome (SDS) in individuals with Alzheimer’s disease (AD) is a clinic... more To the Editor: Sundowning syndrome (SDS) in individuals with Alzheimer’s disease (AD) is a clinical phenomenon characterized by the intensification of neuropsychiatric symptoms in the late afternoon. This behavioral disorder is common in subjects with advanced dementia, with an incidence of 25%. Despite extensive clinical literature on the features of SDS, the etiology of this neuropsychiatric manifestation remains unknown. Limited exposure to sunlight, disordered circadian rhythm, low levels of melatonin, sleep disturbances, and the side effects of various medications have been proposed as potential triggers of SDS, although there is strong evidence that AD is associated with irregular glucocorticoid secretion, primarily caused by dysregulation of the hypothalamic–pituitary–adrenal axis (HPA axis) and consequently likely to contribute to the behavioral disorders that individuals with AD exhibit. It is not clear whether the high prevalence of HPA-axis dysfunction in individuals with AD is associated with SDS, so the aim of this study was to investigate the potential associations between HPA axis dysregulation and SDS in individuals with Alzheimer’s disease. Fifty-one individuals with a clinically confirmed diagnosis of severe AD were selected from among nursing home residents of the Mons Mazzali Geriatric Institute, Mantua, Italy. An additional 24 aged-matched individuals with no symptoms of dementia or depression were selected as controls. Individuals with AD and controls were assessed on separate days. On Day 1, the Mini-Mental State Examination (MMSE) was administered, a health history was taken, a physical examination was performed, blood pressure was measured, and a blood sample was taken. To evaluate changes in neuropsychiatric symptoms throughout the day, on Days 2 and 3, a battery of neuropsychological tests was performed in the morning at 7:00 a.m. and at sunset. An increase in neuropsychiatric symptoms of more than 15% between morning and sunset was regarded as an indicator of SDS. The neuropsychological evaluation battery consisted of the Neuropsychiatric Inventory (NPI), to measure the person’s behavior, and the Geriatric Depression Scale (GDS), to evaluate depression symptoms. Saliva samples were collected on Days 4 and 5 using collection devices (Sarstedt Salivette, N€ umbrecht, Germany). Samples were collected at 7:00 a.m., 11:00 a.m., 3:00 p.m., 8:00 p.m., midnight, and sunset. Samples were centrifuged for 2 minutes at 1,000 revolutions per minute, and purified saliva was stored at 20°C until it was analyzed in blind way using a cortisol assay on an immunoanalyzer system (ROCHE COBAS 6000; Roche Diagnostics, Mannheim, Germany). The relationship between cortisol levels and changes in neuropsychiatric

Experimental Aging Research, 2010