Homocysteinemia and Depression in Community-Dwelling Older Adults: The Cohort Longitudinal Study “InveCeAb” (Brain Aging in Abbiategrasso)

Depression is a major health problem, especially for elderly people. According to the “homocysteine hypothesis of depression”, high homocysteine levels may cause depression of mood via cerebrovascular diseases. Whilst biologically plausible, such hypothesis needs yet confirmation. We aimed at: 1) studying the relationships between homocysteinemia (HCY) and depression in a community-dwelling cohort of people aged 70 to 75 years at baseline;2) investigating plasma levels of HCY and 3) comparing these levels between males and females, in the same population. We exploited the data from four waves (2010, 2012, 2014 and 2018) of the longitudinal study “InveCeAb”, with specific regard towards mood assessment, by Geriatric Depression Scale (GDS) scoring, and diagnosis of clinically relevant or subthreshold depression. HCY plasma levels were measured in the waves 2012, 2014 and 2018. Sample attrition was due mainly to death or overall worsening. No statistically significant differences were found in plasma homocysteine levels in each wave, according to depressive symptoms. No correlations were found between plasma HCY levels in each wave with their corresponding GDS scores, even after adjustment for folate and cobalamin blood concentrations. Dichotomized levels of HCY (≤15 vs >15 μM/l) were not associated with dichotomized GDS scores (≤4 vs higher), clinically relevant and subthreshold depression diagnosis and any antidepressive use, in any wave. First (2012) HCY levels increased with participants’ increasing age, cross-sectionally. Listwise HCY concentrations decreased along the 3 waves. HCY levels were always higher in males than in females. Our results may challenge the “homocysteine hypothesis” of depression, whilst supporting the role of high homocysteinemia as a marker of overall bad health.

The Remote Testing in Abbiategrasso (RTA) Study Protocol: A Counter-Balanced Crossover Trial to Assess the Feasibility of Direct-to-Home-Neuropsychology with Older People

Background: The Sars-Cov-2 pandemic has accelerated the spreading of telemedicine, including TeleNeuroPsychology (TNP). Also in a non-pandemic scenario, TNP gives the advantage of reaching older subjects, which often have mobility or transportation limitations. Previous studies on the feasibility, acceptability and reliability of TNP provide promising indications. However, it remains unclear how elderly populations in Italy welcome this practice, in particular when carried out “direct-to-home” (DTH neuropsychology—DTH-NP), hence without assistance in setting up, i.e., the videoconference, and which tests validated in Italian populations show good comparability between remote (either by voice phone call or videoconference) and face-to-face administration. Aims: Here we present a study protocol aimed at assessing: 1) the recruitment rate in a study on DTH neuropsychological assessment through voice calls or videoconference, 2) the feasibility and acceptability of a DTH neuropsychological assessment, 3) the comparability between DTH and face-to-face neuropsychological assessments. Methods: Fifty-eight older adults (65 - 85 years) were recruited among donors of the Abbiategrasso Brain Bank and will undergo both a face-to-face and a DTH neuropsychological assessment in a counterbalanced cross-over design (Group 1: remote session first;Group 2: face-to-face session first). Recruitment rate will be first evaluated. Then, the responses to an acceptability questionnaire will be compared between the two administration modalities. Finally, the DTH-face-to-face comparability will be evaluated as good reliability of a DTH neuropsychological assessment and agreement between scores obtained in the two modalities. Discussion and Conclusion: This study protocol aims at describing the procedures allowing a more reliable implementation of DTH-NP in the Italian clinical and research contexts. The inclusion of both phone-call and videoconference DTH neuropsychological assessment will give the opportunity to evaluate the feasibility of DTH-NP also in older adults with low digital skills. The results of the comparability analysis will offer the first evidence in the Italian context on which neuropsychological tests can be reliably delivered DTH, by phone call or videoconference.

Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms

Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.

Modification in self-rated health in patients discharged by a geriatric rehabilitation ward

Self-rated health is a valuable outcome in geriatric rehabilitation besides objective results. The present work aims at measuring and analyzing overall health as it is perceived at admission into and at discharge from a geriatric rehabilitation ward. Overall health was self-appraised through a visual-analogue scale (VAS), spanning from 0 (worst) to 10 (best). We studied 1997 patients (70% females), aged 79 (standard deviation, s.d. 8.7) years;most were frail, either functionally, clinically and cognitively. 80% of patients were discharged to home after a length of stay lasting 47.5 (s.d. 22.7) days. At admission, 3/5 patients appraised favorably their overall health (VAS ≥ 6/10): at discharge, the proportion rose to 3/4, with a mean (s.d.) gain = 2 (2) points. The improvement in self-perceived health score positively correlates with the grade expressing clients’ overall satisfaction for the stay (p 0.001), and with discharge versus admission differences in: Barthel Index (BI) total score (p < 0.001), Tinetti total score, Mini Mental State Examination (MMSE), Geriatric Depression Scale (5?items GDS), pain (VAS 0 to 10). A Linear regression model predicting the changes in self-perceived health included changes in BI, MMSE, GDS, pain, dropping Tinetti test. Changes in self-rated health were positively correlated to functional gain adjusted for pre-morbid level, and to relative functional gain. By analysis of variance, health self-appraisal changed more favorably in patients discharged to home than for other social outcomes (all p < 0.001). As expected, trends in self-perceived health parallel improvements in objective functional gauges and subjective indicators.

Technology Usage among Elderly with Self-Reported Hearing Disability: Results from InveCe.Ab

Background: Awareness of hearing disability in the elderly has adverse cognitive and functional consequences over time, in a longitudinal population-based study. Aim: To analyze the hypothesis that over time old people aware of hearing disability make less use of technology and lose more instrumental activities of daily living than peers with other self-reported hearing conditions. Methods: We analyzed 1171 healthy participants in the longitudinal population-based InveCe.Ab study. The consistency between self-reported hearing loss with clinician-evaluated hearing status (Whispered Voice Test;WVT), was categorized by consistency as: unaware of hearing loss (UHL), aware of hearing loss (AHL), only subjective hearing loss (OSHL), without hearing loss (noHL). Results: At baseline (2010), hearing loss was found in 159 [13.6% (95% CI: 11.7 - 15.7)] of the participants [28 = 17.6% (95% CI: 12.0 - 24.4) AHL;131 = 82.4% (95% CI: 75.6 - 88) UHL], while 23 [2.3% (95% CI: 1.4 - 3.4)] of the subjects with normal WVT had OSHL. Mobile phone usage was significantly associated with different consistency categories (p i.e. executive, memory and visuo-spatial) were independently associated with maintaining mobile phone usage and instrumental activities of daily living. Conclusion: Self-reported hearing disability is linked to subsequent loss of mobile phone usage and functional dependency. As cognitive performances independently influence technology usage and functional impairment, targeted preventive interventions should address functional impact of perceived hearing loss, but also encourage social participation and improve mobile phone usage. Trial registration: ClinicalTrials.gov, NCT01345110;registered on April 29, 2011.

Patients’ Expectations in a Geriatric Rehabilitation Ward: Matching with Actual Outcomes

Aim: Person-centered care is a core issue in rehabilitation;the study aims at: 1) enquiring the outcome expectations of patients in a geriatric rehabilitation ward;2) matching outcome expectations with actual outcomes. Methods: Expectations of 186 patients [79.4 (8.7) years, 70% females] analyzed through a questionnaire. 80.6% of patients were discharged home;functional recovery = 17.7 (22) points in Barthel Index total score, and 5 (4.2) points in Barthel Index walking subscore;also conditions with nursing needs improved significantly. Results: Patients’ expectations were coded as: functional (31.4%), overall (29.6%), and clinical improvement (21.5%), discharge home (7%);no answers or explicit lack of expectations (7.5%). Walking ability recovery differed according to outcome expectations. Highest improvements were achieved by patients wishing clinical improvement, followed by those expecting functional or overall improvement (5 points) [p = 0.009 (Welch)/p = 0.041 (Brown- Forsythe)];worst improvement in walking ability (2.8 points) were got by patients faulting or declaring explicit failure of expectations. Conditions with nursing needs improved most in those expecting clinical improvements [p = 0.029 (Brown-Forsythe)], and less in case of expectation default. No further matching was found. Conclusions: Improvement in actual outcomes matched expected improvements in two circumstances: recovery in walking ability and in conditions with nursing needs. The high yield of different favorable outcomes may have masked the statistical significance for correspondence between actual and expected results. Special attention is worthy towards patients short of expectations, as their actual outcomes result poorer.