Risultati per: Gestione delle complicanze psichiatriche e cognitive nel Parkinson

Circulation, Ahead of Print. BACKGROUND:Cognitive impairment is common in patients with heart failure and preserved ejection fraction but its clinical correlates and prognostic associations are poorly understood.METHODS:We analyzed cognitive function, using the Mini-Mental State Examination (MMSE), in patients with heart failure and preserved ejection fraction enrolled in a prespecified substudy of the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction). Logistic regression analyses were performed to determine the variables associated with lower MMSE scores at baseline and postbaseline decline in MMSE scores at 48 weeks. Cox proportional hazards regression and semiparametric proportional rates models were used to examine the risk of clinical outcomes related to baseline MMSE scores, and decline in MMSE scores during follow-up, adjusted for prognostic variables including NT-proBNP (N-terminal pro-B-type natriuretic peptide).RESULTS:At baseline, cognitive function was normal (MMSE score 28–30) in 1809 of 2895 patients (62.5%), borderline (score 24–27) in 794 (27.4%), and impaired (score

Treatment with CVN424 was safe and well-tolerated. Despite the short study duration and small sample size, the 150 mg CVN424 dose provided a clinically meaningful reduction in daily OFF-time. This study supports the development of CVN424 for the treatment of PD.

Introduction
Behaviour change interventions are advocated as a key approach to manage behavioural risk factors such as insufficient physical activity, poor diet and smoking. Integrated motivational interviewing and cognitive behavioural therapy (MI-CBT) interventions have become increasingly popular to promote behaviour change; however, there is a lack of agreement as to what constitutes necessary components of MI-CBT interventions for lifestyle behaviour change. The primary objective of this study is to use a consensus method to develop guidelines to design and deliver MI-CBT interventions for lifestyle behaviour change.

Methods
A three-round modified Delphi study will be conducted with an expert, international panel of clinicians and researchers. An online survey will be developed from assessments of key MI-CBT literature and practice guides to identify commonly used components of individually delivered MI and CBT interventions. In each round, participants will rate the extent to which they agree with each component using a Likert scale. Responses from Rounds 1 and 2 will be presented to participants in subsequent rounds. Responses will be represented using bar graphs and include the median and IQR of participants’ responses. To encourage consensus, participants will be asked to consider the group responses before finalising their opinion to the statements. If at least 80% of the experts agree to a statement in Rounds 2 or 3, it will be included in a final list of necessary statements.

Discussion
This modified Delphi process will help transparency in the design and implementation of MI-CBT interventions. The consensus statement will also help reporting and comparability among effectiveness studies for MI-CBT intervention studies, and help inform research, policy and practice.

Ethics and dissemination
Ethical approval has been granted by the La Trobe University Human Research Ethics Committee (approval number HEC24066). The results will be disseminated via peer-reviewed publications, conferences and international professional associations.

Musicista soffre di una distonia, evento di solidarietà a Prato

I risultati del progetto Iss “Veterani in Sella”

I risultati del progetto Iss “Veterani in Sella”

Tra gli effetti indesiderati le disfunzioni di tiroide e ipofisi

Objectives
To investigate the association between subelements of physical job demands and cognitive impairment risk in middle-aged and older workers in Korea.

Design
Longitudinal study using eight waves (2006–2020) of the Korean Longitudinal Study of Aging.

Setting
Nationally representative sample of the Korean population aged 45 years and older.

Participants
2170 workers aged 45 and older at baseline.

Primary outcome measures
Cognitive function was evaluated using the Korean version of the Mini-Mental State Examination and cognitive impairment was defined as a score below 24.

Results
High physical strength demands were inversely associated with cognitive impairment (OR 0.31, 95% CI 0.14 to 0.68 for ‘always’ vs ‘never’ category). Conversely, frequent heavy lifting (OR 2.67, 95% CI 1.36 to 5.26) and bending, kneeling or squatting (OR 1.69, 95% CI 0.82 to 3.47) tasks were associated with increased impairment risk. Dose–response relationships were observed between all physical job demands and cognitive impairment, persisting among those with lower education but not among those with higher education.

Conclusions
Different types of physical job demands have varying relationships with cognitive impairment in middle-aged and older workers. Tasks requiring high physical strength may protect against cognitive impairment while tasks involving heavy lifting and bending, kneeling or squatting may increase the risk. These findings highlight the need for tailored interventions that consider the type of physical job demands and workers’ educational levels to mitigate cognitive impairment risks. Further research is needed to explore the underlying mechanisms and validate these findings.

Sono circa 10 milioni i malati nel mondo, 250mila in Italia

Sono circa 10 milioni i malati nel mondo, 250mila in Italia

Introduction
Stroke and vascular cognitive impairment (VCI) are major global public health pandemics. The increased incidence of stroke and VCI is in part due to modifiable risk factors (MRFs), with hypertension (HTN) being the strongest single MRF. Even though the underlying causes of HTN are multifactorial, lifestyle choices (eg, poor diet, physical inactivity, alcohol consumption) are chief contributors. Lifestyle medicine (LSM) is a medical and evidence-based discipline that is a promising approach for preventing stroke and cognitive impairment, including VCI. The empirical evidence from systematic reviews, meta-analyses and large population-based studies has reported on the effectiveness of LSM interventions. However, the evaluation of such complex, social and behavioural interventions warrants more information to allow its successful implementation into innovative clinical care models. More importantly, we need to understand how such interventions work, who it works for and under what circumstances to successfully manage HTN and other MRFs (eg, hyperlipidaemia, smoking, alcohol use and diet).

Methods and analysis
This realist review will follow the Realist and Meta-narrative Evidence Synthesis: Evolving Standards. The review will comprise four stages: (1) clarify the scope, (2) search for the evidence, (3) critically appraise primary studies and extract data focusing on the context, mechanism and outcome configuration and (4) synthesise evidence and draw conclusions.

Ethics and dissemination
Research ethics board approval is not required for this review. The primary output of this review will be an evidence-based programme theory for LSM interventions for the management of HTN and other MRFs to reduce the risk of stroke and VCI. Findings from this review will be disseminated at three levels: micro (eg, patients, caregivers, clinicians, non-research partners), meso (eg, public, national not-for-profit organisations, professional associations and centres) and macro (eg, policymakers and government partners).

PROSPERO registration number
CRD42024511566.

Introduction
The impact of digital activity on adolescent mental health has been difficult to assess because of methodological limitations and a lack of strong theory. Dynamic Interplay of Online Risk and Resilience in Adolescence (DIORA) is a longitudinal study designed to address these core limitations and tease apart the reciprocal influences linking digital activity and depression symptoms (hereafter ‘depression’) over 12 months in middle adolescence. This study will examine whether negative affective and cognitive reactions evoked by risky digital activities increase depression. It will additionally examine whether protective characteristics (eg, self-efficacy) moderate the associations between digital activity and depression. DIORA will also explore the reverse pathways between digital activity and depression, namely whether depression exacerbates negative affective and cognitive reactions and, in turn, increase risky digital activities or, further, whether risks can be mitigated through active management of digital activity and/or reactions that it evokes. Finally, the study will examine whether the effects of digital activity observed for depression contrast with those observed for well-being.

Methods and analysis
This is a prospective observational study with three assessment points: baseline (T1), 6 months (T2) and 12 months (T3). We aim to recruit a minimum of 276 adolescents aged between 13 and 14 years from secondary schools in the UK and 1 parent/caregiver/guardian (hereafter, ‘parent’) for each adolescent. Study questionnaires will be completed online.
We will fit a range of models to examine the direct and indirect associations among digital activity, the reactions it evokes, depression and wellbeing, and individual and contextual mediators and moderators drawing on the structural equation modelling framework.

Ethics and dissemination
The study was approved by the London School of Economics and Political Science Research Ethics Committee, reference number 249287. The results will be published in peer-reviewed scientific journals and disseminated through presentations, posters and blogs.

This cohort study investigates the risk of mild cognitive impairment, Alzheimer disease, and all-cause dementia associated with subjective cognitive decline using the subjective cognitive decline–plus criteria among cognitively normal adults in the community.

A diminished sense of purpose and personal growth may precede mild cognitive impairment (MCI) in older adults, according to research recently published in the Journal of Neurology, Neurosurgery & Psychiatry.