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Biomedical subjects

P Cicconetti

Publications and source records attributed to P Cicconetti.

At least 19 recordsLinked to original sources
PubMed2004

Blood pressure variability and cognitive function in older hypertensives.

Several studies have shown that cerebrovascular organ damage can related not only to average blood pressure (BP) levels, but also to BP variability. The aim of this study was to investigate the relationship between 24 hr BP variability and cognitive function in older hypertensives. Forty older, never treated hypertensives were submitted to 24 hr ambulatory BP monitoring (ABPM) and subdivided, according to the variability of the systolic BP (SBP), in two groups: 23 with higher (> PV) and 17 with lower (< PV) SBP variability, defined as the standard deviation (SD) of the mean 24 hr SBP values and as coefficient of variation (CV). They underwent a cognitive assessment by mini mental state examination (MMSE) and a recording of the brain event-related potentials (ERPs). ERPs record neuronal electric activity when the patients are submitted to frequent and rare acoustic stimuli and must recognize and count rare (target) stimuli. The two groups with statistically different 24 hr SBP variability, did not show significant differences in MMSE scores or in N2 and P300 ERP latencies, thus indicating a lack of difference in the cognitive ability between the two groups. Our results show that cognitive function is not related to 24 hr SBP variability in older hypertensives.

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PubMed2004

Smoking and longevity: an incompatible binomial?

In Western countries data from clinical and epidemiological studies have induced the public health offices to promote a great deal of advertising and informative campaigning for smoking reduction. Cigarette smoking has been clearly linked to the most common causes of death in the elderly and contributes to the higher death rate and disability rate associated with many chronic illnesses that are common in this age group. The combination of smoking along with other risk factors like hypertension and diabetes increase high frequency diseases, disability as well as adding to an increase in mortality rate. In order to verify if a healthy lifestyle really favors longevity and how much smoking is incompatible with extreme longevity we investigated the prevalence of smokers and the total smoking exposure of a sample of centenarians in relation with residual survival and health conditions. Our sample consists of 157 centenarians living in Rome, 39 males and 118 females (ratio m/f =1:3),mean age being 101.59 +/- 1.8 years (+/-SD), 83.8% of the centenarians have never smoked,13.5 % are former smokers, and 2.7% are active smokers. The average starting age of smoking is 21.2 years, while the average age of quitting is 65.7 years with an average of 44.7 +/- 17.1 smoking years. The average number of smoked cigarettes per day is quite low,less than 10 cigarettes, so that the total average number of smoked cigarettes is 158,045,well under 280,000 which is considered the cut-off point in many studies of when tumors are noticed. There seemed to be a significant difference (p < 0.001) in gender results in smokers: among male centenarians smokers reached 46%, while female smoker centenarians reached only 8.1%. Statistically significant chronic illnesses were noted among centenarian smokers over the age of 65 (p < 0.02). Moreover, Cox's regression has shown in centenarians a lower survival rate (p < 0.05) in smokers (20.7 +/- 11.2 months) than in non-smokers (27.0 +/- 19.0 months). In conclusion, our study evidences that smoking is for all but some exceptional subjects, incompatible with successful aging and compromises life expectancy even in extreme longevity.

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PubMed2003

Circadian blood pressure pattern and cognitive function in newly diagnosed older hypertensives.

Hypertensive subjects can be subdivided in two groups, dippers and non-dippers, according to the presence or the lack of a nocturnal fall of blood pressure (BP) of over 10%. Several studies have investigated cardiovascular and cerebrovascular organ damage in the two groups with discordant results, but fewer of them analysed the relationship between circadian BP pattern and cognitive function, and none in the early phases of hypertension. To this purpose, we selected 40 older hypertensives, 23 dippers and 17 non-dippers, with newly diagnosed hypertension, never treated, who underwent to 24-h ambulatory BP monitoring (ABPM), Mini-Mental State Examination (MMSE) and recording of event-related potentials (ERPs). No significant differences between dippers and non-dippers were found in the MMSE scores and P300 latency values, as we expected, and not even in N2 wave latency values, showing that the non-dipping pattern is not associated with lower cognitive function in the early phases of hypertension.

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PubMed2001

Neural network analysis in predicting 2-year survival in elderly people: a new statistical-mathematical approach.

We designed this study to test the usefulness of artificial neural networks (ANN) in assessing 2-year survival in elderly persons, and to understand the net's logical functioning, thus determining the relative importance of the single biological and clinical variables which influence survival. ANN are statistical-mathematical tools able to determine the existence of a correlation between series of data and, once 'trained', to predict output data given input data. Although ANN have been applied in various areas of medical research, they have only very recently been applied in geriatrics (Cacciafesta et al., 2000. Arch. Gerontol. Geriatr. 31 (in press)). We built up an ANN to investigate how 17 clinical variables relating to a sample of 159 elderly people affect survival, and the possibility of predicting 2-year survival or non-survival for each single subject. When tested on a sample of 20 elderly people, the trained network gave the correct answer in 85% of the cases. We then extracted the mathematical function that the net used for calculating the output (survival) for each set of input data (clinical variables). Using this formula, we investigated how some clinical variables influence 2-year survival: we found that a low serum cholesterol level is an unfavourable characteristic in relation to survival. We conclude-despite the fact that the sample studied was relatively small-that ANN are useful in predicting 2-year survival in elderly people. The mathematical function we obtained from the net seems useful in determining the relative importance of single variables related to survival.

Journal Article↗
PubMed2001

[Arterial hypertension in very old people. Problems of treatment].

Several epidemiological tests showed that, in the very old, low blood pressure was associated with higher mortality and hypertension with a longer life. But more recent studies, some from our school, and the data from Framingham have clarified that the higher mortality in the very old with low blood pressure is to be attributed to pre-existing pathologies which caused the low blood pressure in the first place. Though specific intervention trials on the very old are not available, the analyses of the results of antihypertensive therapy in the sub-groups of the very old in some trials carried-out with elderly hypertensives suggest the use of pharmacological treatment also in the very old (> 80 yrs), at least for isolated systolic hypertension. The therapy must be based on a careful choice of drugs and carried-out with particular caution to avoid disability from hypertension as well as to avoid side effects which worsen the quality of life of your very old patients.

Age Factors↗
PubMed2001

[Cardiovascular risk factors and diseases in centenarians].

Aging is considered a product of an interaction between genetic, environmental and lifestyle factors. Are centenarians, who have almost arrived at the maximum life-span (120 yrs), free of cardiovascular disease or do they have an increased resistance? How many cardiovascular risk factors are present? We have studied a group of 148 centenarians selected from registered residents of Rome (average age 101.8 +/- 1.9; range 100-108). Their health was assessed through direct 1.5 hour interviews, conducted by physicians with geriatric training at the patient's residence, which includes geriatric assessment scales' submission. The prevalence of cardiovascular disease of our centenarians is 16.7%, represented by heart failure (8%), myocardial infarction (4.7%) and angina pectoris (4%). Among the cardiovascular risk factors, hypertension (31.1%) and hypercholesterolemia are the most frequent, while diabetes is not present. These data, compared with younger samples, point out a lower percentage of cardiovascular disease and risk factors. Moreover centenarians have always conducted a healthy lifestyle (Mediterranean diet, smoking abstention, physical activity, low levels of anxiety and depression). Finally, having identified the golden mean which allows us to carry out a programmed intervention for the prevention of cardiovascular risk factors and diseases, we will be able to increase longevity, allowing a larger number of subjects to reach the maximum human life-span.

Age Factors↗
PubMed2000

Influence of sex and age on blood pressure variability.

The aim of this study has been to identify changes of 24-h blood pressure variability, as related to age and sex in hypertensive subjects. As regards this point several international studies have shown the increase of morbidity and mortality caused by cardiovascular diseases in postmenopausal women produced by a lack of sex hormones, which had protected the women until this period. Each hypertensive subject was submitted to an ambulatory blood pressure monitoring (ABPM) and two variability indexes were obtained: S.D. and coefficient of variation (CV). The results have shown a strict correlation between blood pressure variability and age, without significant sex-related differences. A decrease of blood pressure variability and mean blood pressure (BP) values have also been found, in the night-time with respect to the day-time data; it was more pronounced in females than in males but this would not seem an age-related difference. Despite the fact that the correlation between blood pressure variability and age is very significant in every considered period in males, it has been found that women have statistical differences only in the day-time and in the nocturnal diastolic blood pressure (DBP) fluctuations. This might be caused by other independent factors, such as a postmenopausal lack of sex hormones.

Journal Article↗
PubMed2000

A neural network study of the correlation between metabolic-cardiovascular diseases and disability in elderly people.

Numerous studies have affirmed the existence of a correlation between various cardiovascular diseases and functional decline in elderly people. Not much information, however, is available concerning the overall effect of various, possibly coexisting, cardiovascular pathologies, or metabolic conditions notoriously related to them, on determining disability. We wanted to verify if it were possible to assess: (1) The overall importance of various metabolic and cardiovascular diseases which elderly people often suffer from contemporaneously in determining a condition of not self-sufficiency; (2) The possibility of predicting a condition of not self-sufficiency in relation to the above-mentioned pathologies. In order to achieve this aim, we used an artificial neural network: a statistical-mathematical tool able to determine the existence of a correlation between series of data and, once 'trained', to predict output data given the input data. Although artificial neural networks have been applied in various areas of medical research, they have not been previously applied in geriatrics. We have applied this method to a sample of 179 elderly people, demonstrating that seven clinical-biological variables concerning their metabolic and cardiovascular conditions are strictly related, all together, to the presence or otherwise of a functional impairment. When tested on a sample of 20 'unknown' elderly people, the trained network gave the correct answer-self-sufficiency or not self-sufficiency-in 95% of the cases. Despite the fact that the sample studied was relatively small, artificial neural networks are undoubtedly useful in predicting functional impairment in elderly people in relation to the presence of metabolic and cardiovascular diseases.

Journal Article↗
PubMed2000

Event-related potentials in the elderly with new mild hypertension.

Hypertension is a risk factor for cerebrovascular diseases (CVD) and cognitive impairment and the relative risk of CVD at every level of blood pressure (BP) is greater among the elderly. We submitted 20 elderly affected by new mild hypertension and 10 elderly normotensives to 24-hour ambulatory BP monitoring (ABPM), to evaluate their cognitive state using the Mini-Mental-State-Examination and to the recording of related acoustic evoked potentials (P300 and N2). We did not find significant differences for P300 latency between hypertensives and normotensives, while N2 latency recording showed a statistically significant protracted value in elderly hypertensives. In these patients we found a significant correlation between the N2 latency and systolic blood pressure values recorded by ABPM. These results demonstrated early functional alterations of cognitive state in elderly hypertensives, that are related to systolic blood pressure and future data might point to an earlier use of therapy.

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PubMed2000

[Nutritional deficiency and Alzheimer's disease: how to identify and prevent].

Weight loss is a very common problem for patients with Alzheimer's Disease (AD), whether they live at home or in long-term care facilities. At any rate it depends on an imbalance between energy expenditure and intake. Though in the initial phases of the illness, the weight loss might be caused by socio-environmental and psychological factors and reduced autonomy, in the following stages it depends on Adversive Feeding Behaviours (AFBs). The AFBs invariably lead to protein, fat and sugar deficits as well as a vitamin deficit which presents a positive correlation with the cognitive performance level and negatively affects the course of the disease. Thus it is important to identify AFBs (Blandford Scale) as soon as possible, especially when they can be treated. Furthermore it is very important to recognise weight loss immediately and identify a possible malnutrition state, using investigative methods which allow for follow-up monitoring (Mini Nutritional Assessment). Pharmacological therapy of cognitive deficit and AFBs together with possible contemporary conditions (depression) and intervention on the nutrition, will be useful to avoid a deficiency state and the consequent negative repercussion on the disease.

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