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Depression is one of the most common mood disorders in the late-life population and is associated with poor quality of life and increased morbidity, disability and mortality. Nevertheless, in older adults, it often remains undetected and untreated. This narrative review aims at giving an overview on the main definitions, clinical manifestations, risk and protective factors for depression in the elderly, and at discussing the main reasons for its under/misdiagnosis, such as cognitive decline and their overlapping symptomatology. A practical approach for the global and multidisciplinary care of the older adult with depression, derived from cross-checking evidence emerging from the literature with everyday clinical experience, is thus provided, as a short and flexible \"pocket\" guide to orient clinicians in recognizing, diagnosing and treating depression in the elderly.

The present study aims to investigate the role that cognitive cerebellar lobules, compared to the motor ones, could have on performance abilities control in older individuals with Mild Cognitive Impairment (MCI). Thirty-six participants with MCI were retrospectively recruited from the outpatient clinic for Cognitive Decline and Dementia at Geriatric Clinic and Regional Center for Brain Aging. Cognition was assessed through a reaction time (RT) task in which a mere cognitive (COG) component (RT/S1 COG, RT/S3 COG) has been isolated from a motor (MOT) component (RT/S1 MOT, RT/S3 MOT). Performance abilities were evaluated using Short Physical Performance Battery (SPPB), Tinetti Scale, and Activities of Daily Living (ADL). Finally, structural neuroimaging was conducted using magnetic resonance imaging at 3T. Left_Crus_I showed a correlation with SPPB, ADL%, and RT/S3 COG. Vermis_VI and Right_VI were correlated to ADL%, and RT/S3 COG with the entire lobule VI. ADL% showed negative correlations with RT/S1 COG, RT/S3 COG, and RT/S3 MOT. In the regression analysis, the strongest associations were found between RT/S3 COG and SPPB gait speed (R2 = 0.44, p = 0.03), Tinetti gait speed (R2 = 0.62, p < 0.001), and ADL% (R2 = 0.78, p < 0.001). Regarding cerebellar volumes, Right_Crus_I was associated with all SPPB tests, while Left_VI was associated with functional autonomy (ADL%: R2 = 0.78, p = 0.04). No associations were found between performance variables and total intracranial volume. This study highlights that the cognitive cerebellar component dominates over the motor one even in the control of physical and functional capabilities of older adults with MCI.

The intermediate and advanced stages of Alzheimer's disease (AD) are frequently associated with weight loss (WL), but WL may even precede the onset of cognitive symptoms. This review focuses on the possible aetiologic and temporal relationships between AD and WL. When WL occurs some years before any signs of cognitive impairment, it may be a risk factor for dementia due to deficiency of several micronutrients, such as vitamins and essential fatty acids, and consequent oxidative tissue damage. The leptin reduction associated with WL may also facilitate cognitive decline. The mechanisms potentially inducing WL in AD include lower energy intake, higher resting energy expenditure, exaggerated physical activity, or combinations of these factors. A hypermetabolic state has been observed in animals with AD, but has not been confirmed in human subjects. This latter mechanism could involve amyloid assemblies that apparently increase the circulating cytokine levels and proton leakage in mitochondria. WL may be caused by patients’ increased physical activity as they develop abnormal motor behaviour (restlessness and agitation) and waste energy while trying to perform daily activities. During the course of AD, patients usually find it increasingly difficult to eat, so they ingest less food. AD-related neurodegeneration also affects brain regions involved in regulating appetite. The caregiver has an important role in ensuring an adequate food intake and controlling behavioural disturbances. In conclusion, WL is closely linked to AD, making periodic nutritional assessments and appropriate dietary measures important aspects of an AD patient's treatment.

BackgroundsAcetylcholinesterase inhibitors (AChEI) and cognitive stimulation (CS) are the standard pharmacological and non-pharmacological treatments for Alzheimer’s disease (AD).AimsThe aim of this study was to investigate the effects of these treatments, alone or combined, on the neuropsychological profiles of patients with AD.MethodsForty participants were assigned to three groups receiving either only AChEI (n = 14), AChEI + CS (n = 15), or only CS (n = 11). Cognition was evaluated at baseline and after three months. Linear mixed-effects models were used to investigate differences among the treatments in terms of changes in the patients’ neuropsychological profiles.ResultsResults, although preliminary because of the small sample size, suggest that a general improvement was found in patients who received AChEI + CS and those who received only CS compared with those who received only AChEI. Interestingly, individuals who received only CS showed a significant improvement in immediate memory recall than those who received only AChEI. Furthermore, the group receiving AChEI + CS showed an improvement in delayed recall than the other two groups.DiscussionThe combination of AChEI and CS seems to have the greatest benefit for patients with mild AD. More interestingly, CS alone is more effective than AChEI alone, even in improving memory, considered to be the “lost” cognitive domain in AD.

Background Current guidelines for osteoporosis diagnosis do not recommend forearm dual-energy X-ray absorptiometry (DXA) as a standard tool, except in specific cases. This systematic review and meta-analysis investigates the potential correlation between forearm BMD and BMD at the lumbar and/or hip sites. Methods The protocol was registered in PROSPERO (CRD42024568756), and the study adhered to the PRISMA guidelines. Major databases were systematically searched from their inception until August 2024 to identify studies evaluating the ability of forearm DXA scans to detect osteoporosis, particularly in comparison to central sites like the femoral neck and lumbar spine. A meta-analysis was conducted on studies that reported correlation coefficients between these measurements. Quality assessment was conducted independently by 3 reviewers following Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Additionally, a narrative synthesis of the main findings across different patient groups was performed. Results Thirteen studies were included. Published between 1992 and 2023, these studies involved 5941 participants. Forearm scans exhibited strong correlations with lumbar and femoral sites (pooled effect size 0.603, 95%CI 0.579–0.627 and 0.641, 95%IC 0.600–0.680, respectively) demonstrating good predictive value for central osteoporosis. Despite some result variations, forearm DXA scanning emerged as a valid method, especially when lumbar and femoral measures are challenging. Conclusions A DXA scan of the distal forearm proves to be a valuable supplementary tool for identifying osteoporotic conditions. This could be particularly relevant in older patients, where conducting lumbar or hip scans is often challenging or not feasible.

Background In older and multimorbid patients, chronic conditions may affect the prognostic validity of computed tomography (CT) findings in COVID-19. This study aims at assessing to which extent CT findings have prognostic implications in COVID-19 older patients. Methods Hospitalized COVID-19 patients aged 60 years or more enrolled in the multicenter, observational and longitudinal GeroCovid study who underwent chest CT were included. Patients were stratified by tertiles of age and pneumonia severity to compare CT findings. Hierarchical clustering based on CT findings was performed to identify CT-related classificatory constructs, if any. The hazard ratio (HR) of mortality was calculated for individual CT findings and for clusters, after adjusting for potential confounders. Results 380 hospitalized COVID-19 patients, with a mean age of 78 (SD:9) years, underwent chest CT scan. Ground glass opacity (GGO), consolidation, and pleural effusion were the three most common CT findings, with GGO prevalence decreasing from younger to older patients and pleural effusion increasing. More severe the pneumonia more prevalent were GGO, consolidation and pleural effusion. HR of mortality was 1.94 (95%CI 1.24–3.06) for pleural effusion and 13 (95%CI 6.41–27) for cluster with a low prevalence of GGO and a high prevalence of pleural effusion (“LH”), respectively. Out of the three CT based clusters, “LH” was the only independent predictor in the multivariable model. Conclusions Pleural effusion qualifies as a distinctive prognostic marker in older COVID-19 patients. Research is needed to verify whether pleural effusion reflects COVID-19 severity or a coexisting chronic condition making the patient at special risk of death. Trial registration ClinicalTrials.gov: NCT04379440

Although older people are particularly liable to sarcopenia, limited research is available on beta-hydroxy-beta-methylbutyrate (HMB) supplementation in this population, particularly in healthy subjects. In this parallel-group, randomized, controlled, open-label trial, we aimed to evaluate whether an oral supplement containing 1.5 g of calcium HMB for 8 weeks could improve physical performance and muscle strength parameters in a group of community-dwelling healthy older women. Eighty healthy women attending a twice-weekly mild fitness program were divided into two equal groups of 40, and 32 of the treated women and 33 control completed the study. We considered a change in the Short Physical Performance Battery (SPPB) score as the primary outcome and changes in the peak torque (PT) isometric and isokinetic strength of the lower limbs, 6-minute walking test (6MWT), handgrip strength and endurance as secondary outcomes. Body composition was assessed with dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT). The mean difference between the two groups on pre-post change were finally calculated (delta) for each outcome. After 8 weeks, there were no significant differences between the groups’ SPPB, handgrip strength or DXA parameters. The group treated with HMB scored significantly better than the control group for PT isokinetic flexion (delta = 1.56±1.56 Nm; p = 0.03) and extension (delta = 3.32±2.61 Nm; p = 0.03), PT isometric strength (delta = 9.74±3.90 Nm; p = 0.02), 6MWT (delta = 7.67±8.29 m; p = 0.04), handgrip endurance (delta = 21.41±16.28 s; p = 0.02), and muscle density assessed with pQCT. No serious adverse effects were reported in either group. In conclusion, a nutritional supplement containing 1.5 g of calcium HMB for 8 weeks in healthy elderly women had no significant effects on SPPB, but did significantly improve several muscle strength and physical performance parameters. ClinicalTrials.gov NCT02118181.

The role of Vitamin D in musculoskeletal functionality among elderly people is still controversial. We investigated the association between serum 25-hydroxyvitamin D (25OHD) levels and physical performance in older adults. 2694 community-dwelling elderly women and men from the Progetto Veneto Anziani (Pro.V.A.) were included. Physical performances were assessed by: tandem test, 5 timed chair stands (TCS), gait speed, 6-minute walking (6 mW) distance, handgrip strength, and quadriceps strength. For each test, separate general linear models and loess plots were obtained in both genders, in relation to serum 25OHD concentrations, controlling for several potential confounders. Linear associations with 25OHD levels were observed for TCS, gait speed, 6 mW test and handgrip strength, but not for tandem test and quadriceps strength. After adjusting for potential confounders, linear associations with 25OHD levels were still evident for the 6 mW distance in both genders (p = .0002 in women; <.0001 in men), for TCS in women (p = .004) and for gait speed (p = .0006) and handgrip strength (p = .03) in men. In loess analyses, performance in TCS in women, in gait speed and handgrip strength in men and in 6 mW in both genders, improved with increasing levels of 25OHD, with most of the improvements occurring for 25OHD levels from 20 to 100 nmol/L. lower 25OHD levels are associated with a worse coordination and weaker strength (TCS) in women, a slower walking time and a lower upper limb strength in men, and a weaker aerobic capacity (6 mW) in both genders. For optimal physical performances, 25OHD concentrations of 100 nmol/L appear to be more advantageous in elderly men and women, and Vitamin D supplementation should be encouraged to maintain their 25OHD levels as high as this threshold.