S. Vitali - Academia.edu (original) (raw)

Papers by S. Vitali

Studies in health technology and informatics, 1998

Neurology, 1991

In a double-blind, placebo-controlled, parallel-group, randomized clinical trial, we studied the ... more In a double-blind, placebo-controlled, parallel-group, randomized clinical trial, we studied the efficacy of long-term (1-year) oral treatment with acetyl-L-carnitine in 130 patients with a clinical diagnosis of Alzheimer's disease. We employed 14 outcome measures to assess functional and cognitive impairment. After 1 year, both the treated and placebo groups worsened, but the treated group showed a slower rate of deterioration in 13 of the 14 outcome measures, reaching statistical significance for the Blessed Dementia Scale, logical intelligence, ideomotor and buccofacial apraxia, and selective attention. Adjusting for initial scores with analysis of covariance, the treated group showed better scores on all outcome measures, reaching statistical significance for the Blessed Dementia Scale, logical intelligence, verbal critical abilities, long-term verbal memory, and selective attention. The analysis for patients with good treatment compliance showed a greater drug benefit than for the overall sample. Reported adverse events were relatively mild, and there was no significant difference between the treated and placebo groups either in incidence or severity.

Archives of Gerontology and Geriatrics, 1998

ABSTRACT ABSTRACT: The aim of the study was to assess and adapt home environment to the needs of ... more ABSTRACT ABSTRACT: The aim of the study was to assess and adapt home environment to the needs of demented patients, before their discharge from our special care unit (SCU) for Alzheimer disease and related disorders. The project is a part of a larger study named “Technology, Ethics and Dementia” (TED), supported by the European Community. The research will evaluate the ethical issues involved in adopting technological solutions in the care of demented elderly. The program of the home environment evaluation and modification is described. Results pertaining to 26 demented patients and to their households, concerning the more frequently occurring specific problems, are presented. The data highlight the association between executive skills and functioning in basic activities of daily living. Practical examples are illustrated as a demonstration of what was achieved within the home environment modification program. The work plan related to these examples is set in terms of intervention, aim and goal and generalized solution. The interventions are always the product of a negotiation between the different needs expressed by the actors involved in the so-called social triangle of care, namely the patient, the informal carer and the formal carer.

Archives of Gerontology and Geriatrics, 2004

A study has been carried out in our geriatric rehabilitation wards, to know better the role of co... more A study has been carried out in our geriatric rehabilitation wards, to know better the role of cognitive dysfunction in treatment outcome and processing, mainly functional recovery and comorbidity. We analyzed 478 frail inpatients, 2/3 of them were females, aged 78.7 + 9.2 years, consecutively admitted to the unit. Assessment of cognitive function was performed by the mini mental state examination (MMSE), of functional status by Barthel index (BI), of co-morbidity by cumulative illness rating scale (CIRS) both at the admission and discharge for each patient, together with the usual clinical parameters and social outcome. More than one people in three lived alone and showed some communication problems; one in seven needed modifications in food preparation or nutritional system; more than one in five had pressure sore ≥ 2 (EPUAP = European Pressure Ulcers Advisory Panel classification). The mean (± SD) levels of the admitted were: MMSE = 20 ± 7.2; BI total score = 45.5 ± 28.9; ClRS class = 4 ± 2, CIRS severity score = 1.9 ± 0.4. Of the patients, 74.5% were discharged to home. Mean functional gain was 20 points at BI: 65.6 ± 30.7; MMSE improved to 21.6 ± 7.1 (p = 0.00005 for both comparisons, by Wilcoxon test). MMSE was positively correlated to BI (r = 0.6, p = 0.0005) and negatively correlated (p = 0.0005) to ClRS comorbidity (r =-0.33) and severity (r =-0.26), and to age (r =-0.38, p = 0.0005) both at admission and at discharge. MMSE at admission was correlated neither to functional gain, nor to improvement of clinical indicators, nor to measures of functional and clinical efficiency. MMSE at discharge showed similar results. In a stepwise multiple correlation analysis, taking the gain in BI as the dependent variable, while BI, serum albumin level, MMSE, ClRS severity and comorbidity indexes at admission as independent variables, MMSE together with BI admission total score and ClRS severity index retained a strong association with functional gain, whilst admission serum albumin levels and ClRS index lost it. Consistently with some literary data, we showed the actual possibility of functional and clinical gains for people cared in a geriatric rehabilitation ward, all through a wide range of MMSE score, including subnormal scores. Poor cognitive status bears heavily on frailty, but does not hamper the outcomes of genuine rehabilitative efforts in geriatrics.

ABSTRACT RICONOSCIMENTO DELLE EMOZIONI NEI VOLTI IN PERSONE CON DEMENZA G. Gerontol. 2008; 56(5):... more ABSTRACT RICONOSCIMENTO DELLE EMOZIONI NEI VOLTI IN PERSONE CON DEMENZA G. Gerontol. 2008; 56(5): 496 M. Malnati 1, R. Vaccaro 1, R. Pezzati 2, J. Marcionetti 2, S. Vitali1, M. Colombo1, A.Guaita1 1 Fondazione “CenciGallingani” e Istituto “Golgi”,Abbiategrasso(MI) ; 2 Ospedale Beata Vergine di Mendrisio (CH) Scopo : L’obiettivo di questo studio è mettere in evidenza la comprensione delle emozioni nei malati di Alzheimer. L’abilità nell’interpretare le emozioni degli altri ha un ruolo importante nella qualità delle relazioni sociali, sia nei normali che nei dementi, e l’emozione espressa dal volto, nella specie umana, è un buon veicolo di informazioni sia attive che passive del proprio e altrui stato d’animo, predisponendo ad una azione conseguente al contesto sociale e situazionale (1). Nella demenza di Alzheimer la capacità comunicativa verbale viene prima o poi compromessa, e nella possibilità di comunicare acquistano sempre più importanza veicoli non verbali come le espressioni corporee e quelle del volto in particolare. Infatti i circuiti cerebrali che sottendono al riconoscimento di un volto sono diversi da quelli che consentono di comprenderne l’espressione emotiva, legati all’amigdala, alla zona prefrontale e al giro cingolato più compromessi nella demenza frontotemporale e in quella vascolare che nella demenza di Alzheimer. Le emozioni del volto potrebbero quindi essere un veicolo informativo anche in casi di fase moderato severa e grave della malattia, quando sia la comprensione verbale che il riconoscimento di identità risultano essere non più funzionanti. Materiali e metodi : Abbiamo valutato la capacità di comprendere le espressioni emotive dei volti in 79 persone con diagnosi di demenza di Alzheimer probabile e possibile, degenti presso i reparti dei nostri due servizi residenziali. Per questo abbiamo selezionato , dopo un pre test su 160 foto, 14 fotografie, esprimenti 7 emozioni con volto maschile e femminile, rappresentanti le emozioni di base: gioia ,tristezza, paura, disgusto, noia, rabbia, sorpresa. A ogni persona veniva chiesto di osservare il volto e la risposta classificata come : capacità di nominare e riconoscere, capacità di riconoscere pur senza denominare, riconoscimento con aiuto, riconoscimento della valenza positiva o negativa della emozione . Le valutazioni sono state sempre verificate previa visione del filmato. Il metodo ha mostrato una ottima inter rate reliability media (“K” : 0,736 ) . Oltre ai dati demografici sono stati considerati la comorbilità (Cumulative Illness Rating Scale “CIRS”), i disturbi psicocomportamentali (Neuro Psychiatric Inventory “NPI” ), l’autonomia ( Indice di Barthel “BI”) , la performance nel controllo dell’equilibrio e del cammino (scala di Tinetti “Gait e Balance” ), il livello di consapevolezza di malattia ( Clinical Insight Rating “CIR”)(2), la sfera cognitiva ( Mini Mental State Examination “MMSE” e Clinical Dementia Rating “CDR”). Risultati : i soggetti, 62 % donne, hanno una età media di 80,69 (ds  8,4); scolarità di 5,97 anni. Inoltre : MMSE medio:13.96 (ds + 5.33); CDR 2.14 (ds + 0.95); indice di Barthel 35,9 (ds+ 24,06); CIR ha un valore di 4,06 (8 = punteggio peggiore possibile). Il 53 % delle persone riconosce fino a 5 espressioni emozionali su 14 , con riconoscimento massimo pari a 11 raggiunto da 2 soli soggetti; l’emozione più riconosciuta è la gioia. Analizzando il rapporto di regressione del MMSE con la capacità di riconoscere le emozioni si definisce una “beta” di 0,75 a partire dal punteggio 9 di MMSE ( cioè ogni punto del MMSE produce 0,75 riconoscimenti in più; p<0.0001). Il numero di riconoscimenti medi di 8,4 ottenuto nei controlli “sani” individua il 25° percentile migliore dei soggetti con demenza, mentre a CDR 1 sono il 40 %, CDR 2 il 19%, CDR 3 17,9 %, CDR 4 lo 0 %. Correlati risultano lo NPI la “Tinetti Gait”, ma non la CIRS nè il BI, mentre CIR è ai limiti della significatività. Conclusione : i dati confermano come le emozioni espresse dal volto umano sono riconosciute anche in fasi moderate severe e gravi della demenza da una buona percentuale di soggetti. Le emozioni positive sono meglio riconosciute di quelle negative, confermando i dati della letteratura.(3). I parametri cognitivi e comportamentali influenzano la capacità di riconoscere le emozioni espresse dal volto, ma anche nelle fasi più gravi può persistere la capacità di riconoscere la valenza positiva o negativa della espressione del volto. Questo ha una grande importanza per i care giver e per lo staff di cura di questi malati. Bibliografia : 1) Aziz-Zadeh L, Koski L, Zaidel E, Mazziotta J, Iacoboni M. Lateralization of the human mirror neuron system. J. Neurosci. 2006 15;26:2964-70. 2 ) Malnati M, Guaita A, Rossi S, Vitali S La consapevolezza di malattia in persone con demenza in fase avanzata.G Gerontol 2003; 51: 210 3) MacPherson Se, Phillips LH, Della Sala S Age related differences in the ability to perceive sad facial expressions Aging Clin Exp…

Diabetes Care, 1984

This study has been designed to investigate, in five non-insulin-dependent diabetic patients, the... more This study has been designed to investigate, in five non-insulin-dependent diabetic patients, the influence of physical training (1 h a day, 7 days a wk for 6 wk, at 50-60% maximum oxygen uptake) on blood glucose control, glucose tolerance, insulin secretion, and insulin action. Physical training resulted in a significant improvement in blood glucose control, glucose tolerance, and insulin action. These results suggest that short-term intense physical training ameliorates the main metabolic derangements of non-insulin-dependent diabetes mellitus.

Diabetes Care, 2003

Compare the efficacy, safety, and patient satisfaction of continuous subcutaneous insulin infusio... more Compare the efficacy, safety, and patient satisfaction of continuous subcutaneous insulin infusion (CSII) therapy with multiple daily injection (MDI) therapy for patients with type 2 diabetes. A total of 132 CSII-naive type 2 diabetic patients were randomly assigned (1:1) to CSII (using insulin aspart) or MDI therapy (bolus insulin aspart and basal NPH insulin) in a multicenter, open-label, randomized, parallel-group, 24-week study. Efficacy was assessed with HbA(1c) and eight-point blood glucose (BG) profiles. Treatment satisfaction was determined with a self-administered questionnaire. Safety assessments included adverse events, hypoglycemic episodes, laboratory values, and physical examination findings. HbA(1c) values decreased similarly for both groups from baseline (8.2 +/- 1.37% for CSII, 8.0 +/- 1.08% for MDI) to end of study (7.6 +/- 1.22% for CSII, 7.5 +/- 1.22% for MDI). The CSII group showed a trend toward lower eight-point BG values at most time points (only significant 90 min after breakfast; 167 +/- 48 vs. 192 +/- 65 mg/dl for CSII and MDI, respectively; P = 0.019). A total of 93% of CSII-treated subjects preferred the pump to their previous injectable insulin regimen for reasons of convenience, flexibility, ease of use, and overall preference. Safety assessments were comparable for both treatment groups. Insulin aspart in CSII therapy provided efficacy and safety comparable to MDI therapy for type 2 diabetes. Patients with type 2 diabetes can be trained as outpatients to use CSII and prefer CSII to injections, indicating that pump therapy should be considered when initiating intensive insulin therapy for type 2 diabetes.

Archives of Gerontology and Geriatrics, 2001

Our target was to draw a profile of wandering demented female elderly persons. We analysed data 1... more Our target was to draw a profile of wandering demented female elderly persons. We analysed data 132 inpatients of our Special Care Unit. The sample had a mean age 78.6 + 9.4 (+S.D.) years, and school years of 4.5 + 1.5. Clinical dementia rating (CDR) 3 was in 56 %; Global deterioration scale (GDS) 5 was in 57 %; Mini Mental State Examination (MMSE) = 7.6 + 7.6; Barthel Index total score = 57.7 + 31.9; Hachinski ischemic score (HIS) = 4.9 + 2.8; Neuropsychiatric Inventory (NPI) total score = 32.0 + 19.1; aberrant motor behavior was 4.2 + 4.9. Wanderers represented about half of the sample (51 %), they were somewhat younger (76.4 + 10.9 vs. 80.5 + 7.2 years) and more agitated. NPI agitated behavior score was higher in wanderers (4.7 + 5.0) than in non-wanderers (3.0 + 4.4). NPI agitated behavior total score positively correlated with Bedford Alzheimer Nursing Severity Scale (BANSS), so that most functionally deteriorated persons showed more aberrant motor behavior. Wandering looks associated with anamnesis positive for dementia in patients' fathers. Cluster analysis showed a correlation of wandering with the agitated behavior. Yet, wandering is in a cluster by itself. Wanderers fall thrice as much over a 3 months observation: 1.6 and 0.6 falls respectively. Wandering severity was negatively correlated with either comorbidity or severity, as shown by the Cumulative Illness Rating Scale (CIRS). The use of neurotropic drugs strongly correlated with behavioral disturbances, but not with wandering. In conclusion, most links postulated by theoretical perspectives were confirmed.

Archives of Gerontology and Geriatrics, 2007

BPSD are very frequent, so that 90% of demented patients have at least one. BPSD are troublesome ... more BPSD are very frequent, so that 90% of demented patients have at least one. BPSD are troublesome both for elders with dementia and for caregivers, fostering the institutionalization. Yet, BPSD may vary as long as the disease progresses, and may fluctuate in the short run, either spontaneously or by pharmacological as well as nonpharmacological interventions. The aim of the study was to investigate by factor analysis possible groupings among the modifications occurring in BPSD, during the stay in a special care unit (SCU). BPSD were rated through the neuropsychiatric inventory (NPI); frequency x severity scores were calculated for any single BPSD at entry and at discharge: the differences were analyzed using factor analysis. The sample comprised 214 demented persons, 65.4% females; of mean age 79.6 years; Overall entry score of NPI was 46.1 ± 20.7; NPI overall mean difference at discharge = -30.4 ± 20.3. BPSD factor analysis on frequency x severity crude baseline scores resulted in 4 groups: 1 (agitation + irritability + aberrant motor activity + disinhibition); 2 (delusions + hallucinations); 3 (anxiety + dysphoria); 4 (apathy + euphoria). When differences (discharge frequency x severityentry frequency x severity) for each BPSD scores were factor analyzed, grouping was rather similar: (i) agitation + irritability; (ii) delusions + hallucinations; (iii) anxiety + dysphoria + aberrant motor activity; (iv) euphoria + disinhibition; (v) apathy. In our sample, BPSD improved during the stay in the SCU. These improvements followed trajectories that looked plausible and were consistent with baseline groupings, by factor analysis.

Archives of Gerontology and Geriatrics, 2009