The A.C.E.S.I.D.E. group aims to provide psychological support to caregivers of patients with dementia. The purposes of the A.C.E.S.I.D.E. group are many: give caregivers a space in which they can think to themselves and deal with issues related to anxiety and mood disorders that may be a consequence of their caring tasks, and to find coping strategies in comparison with professionals and with other people in the same situation. /INS;We also want to inform the participants of what it means to be suffering from dementia illustrating the main symptoms and also inform them on key local services that constitute a rich resource. /INS;Participants are caregivers of dementia patients. Participation is voluntary, although it still requires continuity. The group consists of a number of participants, from 8 to 12. The meetings are 6 and their frequency is fortnightly. After the first meeting devoted to the project description and presentation of conductors and participants, subsequent meetings are devoted to the illustration of the main concepts related to dementia and the management of anxiety and stress, as well as of mood problems, which may occur in everyday life of the caregiver. In the first part of each meeting, nurses inform participants about local services and how to get more aid and /INS;economic assistance. /INS;Participants say they are always very satisfied and feel "/INS;privileged"/INS; to have the opportunity to attend a support group. Generally there is a decrease in anxiety and activation of better strategies to combat stress.

PURPOSE:The aim of our work was to design, implement and evaluate an e-learning programme in favour of trainee radiologists enrolled at the many specialty schools located throughout Italy, in the spirit of "sharing culture".MATERIALS AND METHODS:Once a common educational programme and time slot had been identified and planned, the programme was delivered via Internet-based video conferencing once a week for 2-h lectures. Each lecture was followed by interaction between the teaching staff and trainees at the individual sites. The universities involved were Trieste, Udine, Verona, Milano Bicocca, Novara, Varese, Genova, Sassari, Rome "Campus", Rome "Cattolica", Chieti, Foggia, Catania, Modena and Firenze. The University of Rome "Cattolica" participated in the project with two locations: Rome "Policlinico Gemelli" and Rome "Cattolica Campus of Campobasso".RESULTS:Eighteen lectures were conducted, for a total of 36 h. "Transient" connection interruption occurred 13 times for a total of 33 min over 2,160 min of lessons. Video quality and, in particular, details of radiological images shown in slides or moving pictures, were rated as very good by 71% of trainees, good by 24% and satisfactory by 4.5%; no one gave a rating of unsatisfactory.CONCLUSIONS:Based on our experience, whereas e-learning in radiology has become established and compulsory, there is the need for legislation that on the one hand protects online teaching activity and on the other allows study and continuing medical education (CME) credits to be recognised.

Bursaphelenchus eremus Ruhm (Goodey) occurs in declining oak forests of some European countries, although data are lacking on the possibility of the nematode to colonize healthy trees. To evaluate the pathogenicity of the nematode, we carried out an inoculation test in Tuscany (central Italy) in 2007-2008: on May 2007, 32 Quercus robur L. plants (7 years old) were inoculated with an Italian isolate of B. eremus (IT37w) and 16 plants were maintained as controls. There were two inoculation sites on each plant: one immediately below the fresh top shoot and another 30 cm below the first site. All plants were kept outdoors under a zinc-coated cage covered with a cloth. After four months, 16 inoculated plants and eight controls were randomly selected and each stem was cut into three parts, weighed, crushed in a grinder and subjected to Baermann funnel extraction. After 16 months, the remaining 18 inoculated and 6 control plants were chosen and examined with the same procedure.Bursaphelenchus eremus was obtained from the stems of all infected oak trees. The difference was in the number of nematodes/g of fresh wood in the different plant portions both after four (F-2,F-16=86.94) and 16 months (F-2,F-18=400.71). The highest density was always recorded in the fresh top shoot tissue, while no nematode was obtained from the lower stem portion. The RHS (relative host suitability) index value increased from 0.6 (4 months) to 2.1 (16 months) but it was still too low to be accompanied by signs of wilting. Because of the resemblance between B. eremus and the Pine Wood Nematode, we suggest that further experimental studies are needed to evaluate the potential risk of this nematode for different species of oaks common to the Mediterranean area, where the maximum summer temperatures reach the optimal temperature range for B. eremus development.

Due to population aging, cardio-vascular diseases represent the main reason of death in our country. With advancing age, the vascular risk changes from mainly cardio-vascular into mainly cerebro-vascular. Dementia, a disease very common at an old age (6%), has a strong social and medical impact and its incidence increases with age (7% between 65 e 74 years; 28% more than 85 years). This study aims at verifying, in a sample of old people, the prevalence of each cardiocerebrovasculopathy risk factor, taking into account their mutual association and their relationship with dementia.

In this study we report a case of valproate-induced delirium in a patient affected with Alzheimer's disease (AD). A 75-year-old woman with AD presented moderate cognitive impairment associated to behavioral disorders, characterized by aggression, agitation, severe insomnia. She was treated with galantamine, promazine, acetylsalicylic acid and pantoprazole. Since behavioral disorders worsened more and more, home neurological consultation was asked. The neurologist prescribed a mood stabilizer, sodium valproate 500mg daily for the first week and then, twice a day and stopped promazine. After an apparent initial benefit, about 16 days later, patient suddenly developed hyperactive delirium. It was characterized by worsening of insomnia and agitation, severe confusion, delusions, visual hallucinations alternated to sedation. She became progressively unable to walk and completely dependent in daily living activities. An urgent geriatric consultation was performed at patient's home; physical examination showed mild dehydration, normal blood pressure. Oxygen saturation and electrocardiogram were normal. Sodium valproate was immediately stopped and rehydration was performed. The patient was admitted to a Geriatric Unit, where organic and metabolic damages were excluded. During the hospital stay the patient was agitated, aggressive, confused; intramuscular haloperidol 5mg and saline intravenous infusion 1500cc daily were performed, they were partly successful. Three days after she was discharged and continued treatment with oral haloperidol 5mg daily. One week later the patient recovered and she is at present healthy. This is a case report of valproate-induced delirium. The Naranjo scale scored 7, classifying this drug-related event as probable. The present case report suggests the need for minimizing the use of psychoactive drugs in elderly demented patients, whether possible; age-related changes in pharmacokinetics and pharmacodynamics suggest the opportunity of a careful evaluation and a slow titration of treatments in these patients.

Two vineyards planted in the Langhe (Piedmont, Italy) with clonal vines of Vitis vinifera cv. Nebbiolo originating from heat-treated mother plants, were monitored for the occurrence and spread of viral infections. More than tell years after the establishment of one of the vineyards, where rows of vines infected with Grapevine virus A (GVA) and Grapevine leafroll-associated virus 1 (GLRaV-1) or GVA and Grapevine leafroll-associated virus 3 (GLRaV-3) were interplanted with rows of healthy plants, viruses had spread to 18.5% of the healthy vines. Spreading was slow and limited to small groups of vines, the size of which increased slowly, thus providing Indirect evidence of transmission by vectors. Mealybugs collected in the vineyard were classified as Heliococcus bohemicus. RT-PCR analysis of mealybugs revealed the presence of at least one virus in more than 45% of the tested insect batches, indicating that H bohemicus can acquire Viruses during feeding on infected plants, thus acting as a potential vector. No natural spread of Grapevine fanleaf virus (GFLV) was detected in I second vineyard which had been fumigated before re-planting, because of the heavy incidence of fanleaf disease in the preceding uprooted vineyard, and where Xiphinema index, the GFLV vector, was found only occasionally.

Aims: To review currently available knowledge on presentation, clinical features and management of heart failure (HF) in elderly people. Methods: To review currently available evidence, we performed a thorough search of several evidence-based sources of information, including Cochrane Database of Systematic Reviews, Clinical Evidence, Evidence-based guidelines from National Guidelines Clearinghouse and a comprehensive MEDLINE search with the MeSH terms: 'heart failure', 'elderly' and 'management'. Results: A number of features of ageing may predispose elderly people to HF, and may impair the ability to respond to injuries. Another hallmark of elderly patients is the increasing prevalence of multiple coexisting chronic conditions and geriatric syndromes that may complicate the clinical presentation and evolution of HF. Although diagnosis may be challenging, because atypical symptoms and presentations are common, and comorbid conditions may mimic or complicate the clinical picture, diagnostic criteria do not change in elderly people. Drug treatment is not significantly different from that recommended in younger patients, and largely remains empiric, because clinical trials have generally excluded elderly people and patients with comorbid conditions. Disease management programmes may have the potential to reduce morbidity and mortality for patients with HF. Conclusions: Heart failure is the commonest reason for hospitalisation and readmission among older adults. HF shows peculiar features in elderly people, and is usually complicated by comorbidities, presenting a significant financial burden worldwide, nevertheless elderly people have been generally excluded from clinical trials, and thus management largely remains empiric and based on evidence from younger age groups.

Good sleep is an important index of the quality of life in people and above all in old subjects. Among all the symptoms reported to general practitioner, insomnia is at the 3(rd) place and this is present in particular in the elderly. In elderly people high comorbidity and polytreatment are often present. We have studied 60 elderly people with history of insomnia and concomitant diseases: depression, dementia and behavioral disturbances. All the patients of the present study were visited in our outpatients' department. Three hypnotic drugs were used for the treatment of insomnia: zolpidem, or triazolam, or oxazepam, respectively at doses of 10mg/day, 0.125-0.25mg/day and 15.0mg/day. All the three drugs showed to be effective and safe; no paradoxical effects were observed.

Drug-induced delirium is a common matter in the elderly and anticholinergics, together with a number of different drugs, may significantly contribute to the delirium onset, especially in demented people. We report a case of a probable anticholinergic drug-induced delirium in an elderly patient. An 80-year-old man with Alzheimer's dementia presented with wandering, depressed mood with crying, somatic worries, anedonism and suicide recurrent ideas. A first external psychiatric assessment led to the diagnosis of melancholic depression and therapy with haloperidol 2 mg/day, orphenadrine 100 mg daily, amitriptyline 40 mg/day, lorazepam 2 mg/day was started. Two weeks later patient suddenly developed delirium, characterized by nocturnal agitation, severe insomnia, daytime sedation, confusion, hallucinations and persecutory delusions. These symptoms progressively worsened, with the consequent caregiver's stress. A geriatric consultation excluded the main causes of delirium, therefore both Operative Units of Pharmacovigilance and Psychiatry were activated, for a clinical pharmacological and psychiatric assessment. Haloperidol, amitriptyline and orphenadrine were promptly dismissed. The patient began a treatment with quetiapine 25 mg/day for two days, then twice a day, and infusion of saline 1000 ml/day for two days; psychiatric symptoms gradually diminished and therapy with galantamine was begun. We postulate that this clinical report is suggestive for an anticholinergic drug-induced delirium since the Naranjo probability scale indicated a probable relationship between delirium and drug therapy. In conclusion, a complete geriatric, pharmacological, and psychiatric evaluation might be necessary in order to reduce the adverse drug reactions in older patients treated with many drugs.

This double-blind study evaluated the efficacy and safety of risperidone or olanzapine vs. promazine in the treatment of behavioral and psychological symptoms in dementia (BPSD). Patients were required to be 65 years or older, to have DSM-IV diagnoses of Alzheimer's disease (AD), vascular dementia (VD) or a combination of both. A brain computerized tomography (CT) was performed for all the patients; 60 demented patients, 27 men (45 %) and 33 women (55 %) were selected for this study. The University of California Los Angeles neuropsychiatric inventory (NPI) was administered at baseline, then after 4 and 8 weeks. Patients had at least a score of 24 or more. The Hoehn and Yahr scale was used for evaluating parkinsonism. The scales were administered by an examinator who was not aware of the kind of treatment of the patients. After a wash-out period of 10 days, 20 patients, 9 men and 11 women, mean age 76.6 +/- 6.0 years, were randomly assigned to risperidone 1 mg daily in divided doses (morning and bedtime) (Group A); 20 patients, 9 men and 11 women, mean age 82.5 +/- 9.3 years were randomly assigned to olanzapine 5 mg at bedtime (Group B), and 20 patients, 9 men and 11 women, mean age 77.6 +/- 4.6 years, were randomly assigned to promazine 50 mg daily (morning and bedtime) (Group C). In case of lack of clinical response, after 4 weeks, the dose could be increased to 2 mg/day of risperidone, 10 mg/day of olanzapine, and to 100 mg/day of promazine in the respective groups. Repeated measures ANOVA was used for the statistical analysis of rating scales over time (baseline, 4 and 8 weeks). At the end of the 8th week, a global improvement was obtained in 80 % of patients treated with risperidone and olanzapine, vs. 65 % of patients treated with promazine (p < 0.01). The results show that risperidone in doses of 1-2 mg/day and olanzapine in doses of 5-10 mg/day are effective and safe in the treatment of BPSD. Risperidone presents a major and dose-dependent antidopaminergic action and seems to be preferable when hallucinations and delusions are prevailing symptoms, even if it gives good results on aggression and wandering. Olanzapine seems to be faster in its sedative effect, probably for H-1 receptor blockade. Moreover, 5-HT6 antagonism may favor acethylcholine release and this explains why these patients have not presented a cognitive worsening. However, both drugs are comparable or even superior to promazine, with significantly fewer side effects of both anticholinergic and extrapyramidal character.

The aim of the present study was to evaluate the efficacy and safety of zolpidem in elderly subjects with disorders of sleep and comorbidibes. The patients of this study had to present the following requirements: age over 70 years, reported disorders of sleep such as insomnia, and they had to be affected with diabetes and arterial hypertension. Patients presenting diseases that could interfere with sleep, i.e., anxiety, depression, panic attacks, alcohol abuse, some drugs were excluded from the study. All the jobs potentially causing insomnia carried out in the past from the patients were considered, too. A questionnaire of sleep was administered to all the patients (World Psychiatric Association: WPA, 1971). Insomnia, whenever present, was classified according to the criteria of the American Sleep Disorders (ASD) Society and the American Professional Sleep Society (APSS). The following scales were also administered: instrumental activities of daily living scale (IADL), activities of daily living (ADL), geriatric depression scale (GDS), cumulative illness rating scale (CIRS), short portable mental status questionnaire (SPMSQ), mini nutritional assessment (MNA), disease medical index (DMI), sleep questionnaire, social and environmental status. Two groups of patients were evaluated. Group A: 50 patients, 35 women and 15 men, mean age 78.9 years, with a history of insomnia, and Group B 30 patients, 20 women and 10 men, mean age 78.4 years, with onset of insomnia in the last three weeks. The two groups were further divided into three subgroups, diabetic, hypertensive and healthy patients. Zolpidem showed to be effective and well tolerated in both groups of patients.

The aim of the present study was to evaluate the efficacy of risperidone in the treatment of behavioral disorders in elderly patients with dementia. Thirteen patients with diagnosis of dementia, 7 men (53.8 %) and 6 women (46.2 %), mean age 76.5 +/- 6.3 years, were selected from "Casa di Cura S. Vincenzo", Catanzaro, and from the Medicine Unit of "Ospedale Maria Vittoria", Torino. To evaluate behavioral disturbances, the UCLA Neuropsychiatric Inventory (NPI) was administered at start, and after 4 and 8 weeks. After a wash-out period of 10 days, risperidone was administered in doses of 1 mg/day in the morning; in case of lack of clinical response, dose could be increased to 2 mg/day in divided doses (morning and bedtime) after 4 weeks. Concomitant use of other antipsychotics, antidepressants, mood stabilizers was avoided. Lorazepam (1 to 3 mg/day) could be administered in case of need until the end of the first two weeks. Repeated measure analysis of variance (ANOVA) was used for the statistical evaluation of rating scale scores over time. A good response to risperidone was present in 9 of 13 patients (69.2 %), 5 men and 4 women, a partial response in 3 patients (23.1 %), 2 men and 1 woman and no response in 1 woman (7.7 %). The main results were obtained on agitation, anxiety, euphoria, disinhibition, irritability and wandering. Mean score of NPI was 46.7 +/- 6.9 at start, 14.7 +/- 5.2 after 4 weeks and 11.4 +/- 5.8 after 8 weeks. The decreases in mean score during treatment were significant (p < 0.0001). The plasma concentrations of risperidone plus 9-OH-risperidone ranged from 11.5 to 20 nmol/l. To be noticed, the Mini Mental State Examination (MMSE) score did not worsen after risperidone treatment. The results of the present study indicate that risperidone at doses of 1 or 2 mg/day seems to be effective in reducing behavioral symptoms in patients with dementia. It is particularly active on agitation, aggression and wandering. Risperidone also showed a good tolerability and had an efficacy either superior to the traditional neuroleptics or generally comparable, but with fewer side effects.