Limited data are available on the prevalence and correlates of statin use for secondary cardiovascular (CV) prevention in the older adult population. We used data of older adults (65-79 years) with established atherosclerotic CV disease from the cross-sectional Italian Health Examination Survey 2008-2012 to address this issue. Lifestyles, CV risk factors, chronic diseases, and therapies were assessed using standardized procedures. A comprehensive geriatric assessment was performed to evaluate cognitive function, disability in basic activities of daily living/instrumental activities of daily living, mobility, and polypharmacy. Multiple regression analyses were performed to identify independent correlates of statin use. A total of 392 participants (mean age 72.1 ± 4.4 years, 61.5% men) were considered for this analysis. Coronary heart disease was identified in 67.1% of participants, cerebrovascular disease in 23.5%, and peripheral artery disease (PAD) in 18.1%. One hundred ninety (48.5%) were statin users. By multiple regression analysis, functional disability (odds ratio [OR] = 0.81; 95% confidence interval [CI] = 0.71-0.92; p = 0.002), cognitive impairment (OR = 0.87; 95% CI = 0.78-0.98; p = 0.018), and polypharmacy (OR = 0.86; 95% CI = 0.75-0.98; p = 0.035) predicted statin nonuse, whereas having hypertension (OR = 1.19; 95% CI = 1.05-1.34; p = 0.005), diabetes mellitus (OR = 1.14; 95% CI = 1.03-1.27; p = 0.013), or a previous myocardial revascularization (OR = 1.31; 95% CI = 1.16-1.48; p < 0.001) predicted statin use. Significant interaction terms were observed between cerebrovascular disease, PAD, cognitive impairment, and disability in predicting statin nonuse. Statin underuse in older adults aged 65-79 years with CV disease, and thus suboptimal secondary CV prevention, is highly prevalent despite current guidelines and recommendations. Common geriatric conditions are associated with statin nonuse. Such results support the need for improving the awareness of statin treatment for secondary CV prevention.

Background: To assess the association of antidepressant (AD) medication use with prevalence and control of cardiovascular (CV) risk factors. Methods: Data of older adults from the population-based Italian Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey (OEC/HES) Study 2008-2012 were used. CV risk factors were measured using standardized procedures. Information on clinical features, lifestyles, and medications was collected using standardized questionnaires. Logistic regression models were elaborated to assess associations between AD use and prevalence and control of CV risk factors. Results: Around 2549 participants (age 71.4 ± 4.2 years, 51.3% men) were studied; 268 (10.5%) were AD users. Of these, 72.4% used selective serotonin reuptake inhibitors (SSRI). AD users had less favorable CV risk factor profile and were less likely to achieve control of blood pressure and total cholesterol. After multiple adjustment for potentially confounding variables, AD use was associated with greater likelihood of having diabetes (OR = 1.05, 95% CI = 1.02-1.10, P = 0.008), hypertension (OR = 1.10, 95% CI = 1.05-1.20, P = 0.003), and hypercholesterolemia (OR = 1.08, 95% CI = 1.04-1.14, P < 0.001). Among participants treated for hypertension and hypercholesterolemia, AD use was associated with poorer control of BP (OR = 1.07, 95% CI = 1.03-1.12, P = 0.001) and cholesterol (OR = 1.06, 95% CI = 1.01-1.12, P = 0.021). Results persisted virtually unchanged when analyses were restricted to participants on SSRI. Conclusions: AD use was associated with greater prevalence and poorer control of traditional risk factors for CV disease in a population-based sample of older adults. Such results highlight the need for surveillance of CV risk factors and promotion of healthy lifestyles in older adults with psychopathology and, in particular, in those under AD treatment.

In 2011, 35.6 million people worldwide were living with dementia. 1 World Alzheimer’s Report 2009. Alzheimer’s Disease International, London2009 Google Scholar This number will more than triple by 2050. 1 World Alzheimer’s Report 2009. Alzheimer’s Disease International, London2009 Google Scholar Among noncommunicable diseases, dementia accounts for 11.9% of years lived with disability, 2 The Global Burden of Disease: 2004 Update. World Health Organization, Geneva2008 Google Scholar and the annual global cost of either formal or informal care has been more than US$600 billion in 2010, with alarming, probably unsustainable, increases expected in the near future. 3 World Alzheimer’s Report 2010: the global economic impact of dementia. Alzheimer’s Disease International, London2010 Google Scholar Given this, the World Health Organization (WHO) has set dementia as a major public health priority. 4 World Health Organization and Alzheimer’s Disease International Dementia: a public health priority. World Health Organization, Geneva2012 Google Scholar On December 7, 2017, the WHO has launched the web-based platform Global Dementia Observatory, with the aim to monitor the presence of national policy and plans for surveillance and care of dementia either within countries or globally. 5 World Health Organization Mental health: Development of the Global Dementia Observatory. www.who.int/mental_health/neurology/dementia/GDO/en/Date accessed: December 11, 2017 Google Scholar The WHO emphasizes the importance of early diagnosis and surveillance of the condition at a population level, especially in relation to potentially modifiable risk factors. 4 World Health Organization and Alzheimer’s Disease International Dementia: a public health priority. World Health Organization, Geneva2012 Google Scholar

Objectives: Chronic kidney disease (CKD) negatively impacts aging success. This study evaluates the association between CKD and functional disability, defined as limitations in performing mobility tasks, basic (ADLs) and instrumental activities of daily living (IADLs), in a population-based sample of older adults. In particular, we examined whether such a relationship extended to mild-moderate CKD stages (G1-G3ab). Methods: Data from the Cardiovascular risk profile in Renal patients of the Italian Health Examination Survey (CARHES) study were used.Prevalence of CKD was estimated by means of urinary albumin to creatinine ratio (ACR) and eGFR (CKD-EPI equation-enzymatic assay of serum creatinine). A validated questionnaire was used to assess functional limitations. Potentially confounding variables, e.g. socio-demographic features, lifestyles, cardiovascular (CV) risk factors and prevalent CV diseases, were considered. Results: 1309 participants, age 71.4 +/- 4.3 years, 53.8% men, were studied. 15.2% of participants were identified as having CKD. Of these, 11.5% were aware of the condition. Prevalence of CKD increased with age, and was similar between men and women. Mild-moderate CKD was found to be significantly associated with disability in mobility (OR = 1.05, 95%CI =1.01-1.09, p = .014) and ADLs/IADLs (OR = 1.06, 95%CI = 1.02-1.12, p = .011) after multiple simultaneous adjustment including socio-demographic variables, CV risk profile, ACR, cognitive impairment and self-rated health. Conclusions: Mild-moderate CKD independently associated with functional disability in a population-based sample of older adults. Evidence-based recommendations for disability prevention in CKD are needed.

Population ageing represents a "triumph" and a "challenge" for society. The increase in life expectancy corresponds to an increase of risk factors and age-associated non communicable diseases, with consequent rise in health care costs and the burden of healthcare sustainability. Aim of this analysis is to describe the prevalence of non communicable diseases, comorbidity and disability in non-institutionalized elderly population, aged 75-79 years, examined within the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey. Cardiovascular disease is the most frequent occurring in 27% of the examined population, followed by diabetes (24%) and chronic kidney disease (21%); 60% of examined elderly population suffers of one or more chronic diseases, while 40% is in a good health. Ninety-three per cent of the examined population is free of disability; cognitive function disorders, assessed by the Folstein's Mini Mental State Examination, are recorded in 21% men and 29% women. In the context of prevention, there is still much that needs to be done. It is important to initiate or maintain preventive actions concerning also this age-group at both community and individual level, to promote the cultural notion that a good quality of life in advanced age is built day by day starting from one's youth through a healthy diet, regular physical activity and non-smoking habit.

Objective Impairment of physical performance might identify older people at higher risk of dementia over time. The present study evaluated handgrip strength as independent predictor of cognitive decline. Design Observational, prospective. Follow-up duration: 11.2 ± 0.8 months. Setting and participants Geriatric outpatients center. 104 consecutive stroke- and dementia-free older adults (44% men, ages 80.2±5.4 years). Methods The Clinical Dementia Rating scale and the Clock Drawing Test (CDT) were administered. Handgrip strength was assessed using a Jamar hand dynamometer. Brain magnetic resonance imaging studies at 1.5 T were performed. White matter damage was expressed as severity of white matter hyperintensities (WMHs). Longitudinal changes in cognitive function were expressed as 1-year decline in CDT performance. Results A robust association was observed between baseline handgrip strength and 1-year cognitive decline after multiple adjustment. Of note, the strength of such association was only minimally attenuated after adjusting for deep WMHs extent (β coefficient for handgrip strength = 0.183, SE= 0.038, p= 0.007, R2= 0.58). Conclusions Handgrip strength predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older adults. Future studies are needed to elucidate the causal mechanisms linking limitations in physical function with dementia risk.

Objectives: To describe longitudinal relationships of metabolic syndrome (MetS) to cognitive decline and functional disability in a sample of older non-institutionalized men.Methods: data from 1991 to 2000 of the Italian cohorts of the Finland, Italy, the Netherlands, Elderly (FINE) study, were used. Global cognitive function and functional disability, defined as limitations in mobility, basic (ADLs) and instrumental activities of daily living (IADLs) were screened in 1991 and 2000. MetS was defined according to the NCEP ATP-III criteria.Results: The study sample consisted of 195 men, baseline age 76.1 +/- 3.1 years. Baseline MetS was prospectively associated with greater 10-year cognitive and functional decline in ADLs and IADLs. After multiple adjustment including age, education, marital status, ApoE epsilon 4 allele, cerebrovascular disease and initial cognitive and depressive status, MetS predicted cognitive decline (B = - 1.684, 95% CI = - 2.202 to - 1.167, p < 0.001) and risk of IADLs (OR = 1.09, 95% CI = 1.01-1.20, p = 0.048) and ADLs disability (OR = 1.35, 95% CI = 1.12-1.62, p < 0.001). Interestingly, such associations were not attributable to individual altered components of MetS nor to their sum. Incident disability in ADLs and IADLs were not explained by parallel decline in cognitive function.Conclusions: MetS as an entity was associated with accelerated cognitive and functional decline in a population-based sample of very old men. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Objective: To assess efficacy and safety of citalopram compared to quetiapine and olanzapine for the treatment of agitation in patients with Alzheimer disease (AD).Design: Longitudinal, 6-month study.Setting: Nursing home (NH).Participants: 75 NH residents with AD and agitation, randomized to citalopram (n = 25), quetiapine (n = 25), or olanzapine (n = 25).Measurements: Changes in Neuropsychiatric Inventory (NPI) agitation subscale score and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC) were used to assess treatment efficacy. Participants were surveilled for adverse health outcomes.Results: Citalopram treatment (30 +/- 5.8 mg/d) resulted in similar 6-month efficacy compared to both quetiapine (94.0 +/- 40.4 mg/d) and olanzapine (5.2 +/- 1.6 mg/d), lower occurrence of falls than olanzapine [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.68-0.97, P =.012], lower incidence of orthostatic hypotension than both quetiapine (OR = 0.80, 95% CI = 0.66-0.95, P =.032) and olanzapine (OR = 0.75, 95% CI = 0.69-0.91, P = .02), and less all-cause hospitalizations than both quetiapine (OR = 0.92, 95% CI = 0.88-0.95, P = .016) and olanzapine (OR = 0.78, 95% CI = 0.64-0.92, P = .004), after multiple adjustment for potentially confounding variables. No differences were observed for cognitive and functional decline, QTc prolongation, and infections.Conclusions: Citalopram resulted in similar efficacy and less adverse outcomes when compared to 2 atypical antipsychotics for treatment of agitation in NH residents with AD. Replication of these findings and assessment of long-term efficacy and safety of citalopram for treatment of neuropsychiatric symptoms in dementia are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Objectives: Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral anticoagulant treatment (OAT) in a sample of older AF patients.Methods: Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed. Dementia cases were ascertained by consensus of 2 experienced geriatricians. Dementia severity was assessed using the Clinical Dementia Rating scale (CDR).Results: 316 AF patients (ages 74.7 +/- 7.0 years, 55.7% women) with high stroke risk (77.5% had a CHA(2)DS(2)VASC score >= 3), low bleeding and falling risk, and no neuropsychiatric/behavioral symptoms, were included. 60.1% were prescribed with OAT. Among patients with dementia (n = 86, 27.2%), 22.0% received inadequate antithrombotic prophylaxis (i.e. antiplatelet) and 38.5% no treatment. Proportion of those receiving inadequate or no prophylaxis increased at increasing CDR score. By multiple regression models, either dementia (yes vs no), OR = 1.33, 95% CI = 1.11-1.46, p < 0.001, and dementia severity (CDR > 1), OR = 2.38, 95% CI = 2.19-2.60, p < 0.001, were associated with lack of OAT prescription independently of age, paroxysmal AF, and comorbidity burden.Conclusions: Dementia might be associated with underuse of OAT in older AF patients even in the absence of established contraindications. Future studies are needed to assess the real dimension of the problem and clinician's barriers to prescribing OAT in demented patients.

Frailty is a common geriatric syndrome that confers increased risk of adverse health outcomes. 1 Fried L.P. Tangen C.M. Walston J. et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 106: 3-5 Google Scholar , 2 Viscogliosi G. The metabolic syndrome: A risk factor for the frailty syndrome?. J Am Med Dir Assoc. 2016; 17: 364-366 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Because of its close association with functional disability, frailty has a devastating impact on individuals, families, and society as a whole. Thus, searching for modifiable risk factors for such conditions is a major challenge.

Frailty is a condition resulting from age-related decline in multiple physiological domains, clinically typified by physical weakness, in which individuals have increased the risk of adverse health outcomes and mortality when exposed to a stressor. 1 Fried L.P. Tangen C.M. Walston J. et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156 Crossref PubMed Google Scholar Frailty affects 7% of individuals age 65 years and approximately 30% of those age 80. 1 Fried L.P. Tangen C.M. Walston J. et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156 Crossref PubMed Google Scholar Paralleling with the population aging, Westernized societies are also facing a pandemic of obesity- and sedentary-related disorders. The metabolic syndrome (MetS), with its nexus of metabolic and cardiovascular traits, might predict risk of age-associated conditions other than cardiovascular (CV) diseases, such as dementia, depression, and functional disability. 2 Carriere I. Pérès K. Ancelin M.L. et al. Metabolic syndrome and disability: Findings from the prospective three-city study. J Gerontol A Biol Sci Med Sci. 2014; 69: 79-86 Crossref PubMed Scopus (40) Google Scholar No study has specifically explored hypothetical associations between MetS and the frailty phenotype in older adults. There might be common etiological aspects. 3 Barzilay J.I. Blaum C. Moore T. et al. Insulin resistance and inflammation as precursors of frailty: The Cardiovascular Health Study. Arch Intern Med. 2007; 167: 635-641 Crossref PubMed Scopus (331) Google Scholar , 4 Abbatecola A.M. Paolisso G. Is there a relationship between insulin resistance and frailty syndrome?. Curr Pharm Des. 2008; 14: 405-410 Crossref PubMed Scopus (67) Google Scholar Our study preliminarily assessed associations between MetS and frailty in a sample of older noninstitutionalized individuals.

Community-acquired pneumonia (CAP), the leading infectious cause of hospitalization in older adults, often represents a life-changing event with long-term disabling sequelae. 1 Restrepo M.I. Faverio P. Anzueto A. Long-term prognosis in community-acquired pneumonia. Curr Opin Infect Dis. 2013; 26: 151-158 Crossref PubMed Scopus (94) Google Scholar Delirium is frequent among older inpatients with CAP. 2 Pieralli F. Vannucchi V. Mancini A. et al. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia. Intern Emerg Med. 2014; 9: 195-200 Crossref PubMed Scopus (33) Google Scholar Several mechanisms may explain this relationship (ie, respiratory failure, inflammation, and medications). No study has systematically assessed what the factors are for predicting in-hospital delirium in this frail population. Stratifying delirium risk is important to implement tailored interventions to reduce its burden of disability.

To the Editor: Dementia is among the most frequent causes of disability in older people. Although great efforts have been made in identifying clinical predictors of pathological cognitive decline over time, to date there is a lack of evidence-based preventive strategies and, even more, there is no evidence of treatments that effectively allow clinicians to modify dementia course.1, 2 Growing evidence indicates that traditional risk factors for cardiovascular (CV) diseases, and brain subcortical small vessels diseases, also represent potent additional risk factors for Alzheimer's dementia, the most frequent diagnosis worldwide, whose etiology has been traditionally attributed to a pure neurodegenerative process.2 Paralleling with the increase in life expectancy, Westernized societies are facing a pandemic of obesity- and sedentary-related diseases.3, 4 It has been estimated that around 40% of people ages 65 years and more carry the metabolic syndrome (MetS), a constellation of CV and metabolic risk factors including hypertension, altered glucose homeostasis, atherogenic dyslipidemia and abdominal obesity.3, 4 Peripheral insulin resistance and chronic micro-inflammation are thought to be the fundamental determinants of MetS, as both conditions importantly influence occurrence of the other diagnostic traits of MetS.4 Excessive abdominal visceral fat accumulation is typically associated with chronic elevation of pro-inflammatory cytokines and development of insulin resistance. Visceral adipose tissue colonization by activated macrophages is the key factor promoting chronic subclinical inflammation. Chronic secretion of pro-inflammatory cytokines, especially IL-1 and –6 and TNF-α, is closely associated with subsequent development of insulin resistance.4 MetS is risky for the aging brain, as it has been associated with greater occurrence and severity of cerebrovascular damage and accelerated cognitive decline.1, 2, 5 Growing evidence indicates that the risk of dementia associated with the MetS may be greater than that conferred by the sum of its altered components and cerebrovascular damage extent, and it may be largely mediated by chronic insulin resistance and inflammation.1, 5 It is well established that excessive abdominal fat accumulation, namely android obesity, is a robust predictor of CV events.4, 6 In clinical practice, systemic and central obesity are usually quantified using anthropometric measurements, e.g., body mass index, waist circumference, waist-to-hip ratio. However, clinical utility of such markers may be limited in older subjects, due to to aging-associated changes in body composition. Lean mass wasting, especially sarcopenia, may result in markedly reduced sensitivity of standard anthropometric measures in assessing adiposity in older adults. Studies investigating the relationships of MetS and obesity to cognitive function in late life have reported conflicting results, with authors suggesting that the relationship of MetS to dementia risk may be no more apparent in later life.7 We hypothesize that the aforementioned age-associated changes in body composition may partly explain such heterogeneity in results. Several studies have indicated that epicardial fat thickness may be a better predictor of incident CV events when compared to other proxies of visceral adiposity.8 Epicardial adipose tissue (EAT) is a part of visceral fat accumulated around the heart between visceral pericardium and myocardium, mostly lodged around coronary arteries.6, 9 Growing evidence indicates that EAT is closely associated with insulin resistance and chronic micro-inflammation.6, 9 Furthermore the greater the EAT thickness the greater the risk of coronary artery disease and stroke.8 To the best of our knowledge, there is only one published study reporting on the association between EAT extent and cognitive function.10 Authors have cross-sectionally found, in a sample of 71 older subjects, that EAT thickness, measured through trans-thoracic echocardiography, was significantly associated with poorer global cognitive performances, evaluated by MMSE. Furthermore the authors have shown that EAT mediated the relationships between MetS, insulin resistance and body mass index with MMSE performances. Building on the above-mentioned considerations, we believe that searching for accurate measures of visceral fat accumulation may add important information in assessing CV risk profile as well as in identifying older subjects with greater risk of accelerated cognitive decline over time. The echocardiographic assessment of EAT is an objective, noninvasive and inexpensive test that could be successfully implemented in clinical practice to reliably estimate visceral adiposity in older people.9 Given that the prevalence of dementia is expecting to double over the next decades, identification of potentially modifiable clinical markers predicting dementia over time may have great relevance for healthcare systems and societies as a whole. Future longitudinal studies are required to establish whether EAT thickness assessment may help in identifying individuals with greater risk of cognitive decline and dementia over time. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Giovanni Viscogliosi and Evaristo Ettorre: concept and preparation of manuscript; Iulia Maria Chiriac and Paola Andreozzi: literature review and data interpretation. Sponsor's Role: None.

1 Toba K, Nakai R, Akishita M et al. Vitality index as a useful tool to assess elderly with dementia. Geriatr Gerontol Int 2002; 2: 23–29. 2 Kobayashi K, Hashimoto K, Kato R et al. The aging males’ symptoms scale for Japanese men: reliability and applicability of the Japanese version. Int J Impot Res 2008; 20: 544–548. 3 Corona G, Rastrelli G, Vignozzi L, Mannucci E, Maggi M. How to recognize late-onset hypogonadism in men with sexual dysfunction. Asian J Androl 2012; 14: 251–259. 4 Wang C, Nieschlag E, Swerdloff R et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol 2008; 159: 507–514. 5 Buvat J, Maggi M, Guay A, Torres LO. Testosterone deficiency in men: systematic review and standard operating procedures for diagnosis and treatment. J Sex Med 2013; 10: 245–284. 6 Wu FC, Tajar A, Beynon JM et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010; 363: 123–135. 7 Matsumoto AM. Andropause. Clinical implications of the decline in serum testosterone level with aging in men. J Gerontol A Biol Sci Med Sci 2002; 57: M76–M99.

Objectives: The present study evaluated the metabolic syndrome (MetS) as independent predictor of 1-year longitudinal changes in cognitive function. Methods: 104 stroke-and dementia-free older hypertensive subjects were studied. MetS was defined by NCEP ATP-III criteria. Cognitive function was assessed by the Clock Drawing Test (CDT); 1-year changes in cognitive function were expressed as annual changes in CDT performance. Brain magnetic resonance imaging studies (1.5T) were performed. Results: Participants with MetS exhibited greater cognitive decline than those without (-1.78 +/- 1.47 versus -0.74 +/- 1.44 CDT points, t = 3.348, df = 102, p < 0.001). MetS predicted cognitive decline (beta = -0.327, t = -3.059, df = 96, p = 0.003) independently of its components, age, baseline cognition, neuroimaging findings, blood pressure levels, and duration of hypertension. With the exception of systolic blood pressure, none of the individual components of MetS explained 1-year changes in CDT performance. Conclusions: MetS as an entity predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older hypertensive subjects.

Objective: The aim of this study was to explore the relationship between 25-hydroxyvitamin D (25 [OH]D) serum concentrations and body fat distribution in a sample of postmenopausal women.Methods: We enrolled sixty-two postmenopausal women; 25(OH)D serum concentrations, serum intact parathyroid hormone, blood analyses, and anthropometric measurements were carried out. Body fat composition was evaluated by dual-energy X-ray absorptiometry. Insulin resistance was estimated by homeostatic model assessment of insulin resistance (HOMA-IR) calculation.Results: Low levels of vitamin D (<30 ng/mL) were found in 77.4% of the population studied. There was a correlation (P < 0.0001) between 25(OH)D and waist circumference (r = -0.543), android fat to gynoid fat (A/G) ratio (r = -0.554), high-density lipoprotein cholesterol (r = -0.498), and HOMAIR (r = -0.520). A/G fat ratio (B = -34.90; 95% confidence interval [-55.30, 14.1]; P = -0.019), HOMA-IR (B = -3.17; 95% confidence interval [-5.99, -0.351]; P = -0.028), and high-density lipoprotein cholesterol (B = 0.361; 95% confidence interval [-0.033, -0.698]; P = -0.032), were found to be independent predictors of lower 25(OH)D by multilogistic regression analysis. Except for waist circumference, both these results were maintained when correlations were adjusted for age, onset of menopause, serum intact parathyroid hormone, and medications, and when body mass index was added as covariate.Conclusions: Vitamin D deficiency and insufficiency are common conditions. A/G ratio appeared to be associated with 25(OH)D concentrations and it is well-known that the android disposition of body fat is more closely associated with the onset of metabolic syndrome. Longitudinal studies are needed to better characterize the direction and the causal links of this association. (C) 2016 Elsevier Inc. All rights reserved.

La demenza rappresenta una delle più frequenti cause di disabilità funzionale nell’anziano. A oggi non esistono terapie efficaci in grado di modificare il decorso della malattia. Grandi sforzi sono stati compiuti nello studio dei correlati biologici della demenza. Una crescente quantità di evidenze ha riportato che i classici fattori di rischio cardiovascolare sono potentemente associati a varie forme di demenza. Nonostante l’ipertensione arteriosa sia stato il fattore di rischio più studiato in relazione alla funzione cognitiva e rischio di demenza, è ancora difficile mettere insieme i risultati degli studi, a causa di differenze metodologiche tra i maggiori studi, e trarre conclusioni definitive. La relazione tra pressione arteriosa e demenza sembra essere molto complessa e non unidirezionale. Sia livelli pressori troppo elevati sia troppo bassi sono associati a deterioramento della funzione cognitiva nell’anziano. I cambiamenti età-correlati sia nella pressione arteriosa sia nella funzione cognitiva, così come il danno cerebrovascolare e l’invecchiamento arterioso sistemico, potrebbero esercitare effetti confondenti. Studi futuri di tipo longitudinale sono necessari per ottenere risultati coerenti. In generale, la possibilità di prevenire la demenza a livello di popolazione attraverso il controllo dei fattori di rischio cardiovascolare non è ancora stata dimostrata.

Dementia is among the most frequent causes of disability in the elderly. Up today, there are no effective therapies that allow to modify the disease course. Great efforts have been made in studying biological correlates of dementia. A growing body of evidence is reporting that classical cardiovascular risk factors are potent predictors of several forms of dementia. Although hypertension has been the most studied in relation to cognitive function, it is yet difficult to pool results and draw strong inferences, due to relevant methodological differences across studies. The association between blood pressure and dementia seems to be complex and far from being unidirectional. Both high and low blood pressure levels have been reported to be associated with impairment in cognitive function in older subjects. Age-related changes in both blood pressure levels and cognitive function, as well as vascular brain damage and systemic arterial aging, may exert a confounding role. Future longitudinal studies are deemed necessary in order to obtain consistent results. In general, the hypothesis of dementia prevention by risk factor control at a population level needs to be established.