Silvia Pancani
@dongnocchi.it
Scopus Publications
Scopus Publications
Alessandro SODERO, Silvia CAMPAGNINI, Anita PAPERINI, Chiara CASTAGNOLI, Ines HOCHLEITNER, Angela M. POLITI, Donata BARDI, Benedetta BASAGNI, Teresa BARRETTA, Erika GUOLO,et al.
Edizioni Minerva Medica
BACKGROUND The complexity of stroke sequelae, the heterogeneity of outcome measures and rehabilitation pathways, and the lack of extensively validated prediction models represent a challenge in predicting stroke rehabilitation outcomes AIM To prospectively investigate a multidimensional set of variables collected at admission to inpatient post-stroke rehabilitation as potential predictors of the functional level at discharge. DESIGN Multicentric prospective observational study. SETTING Patients were enrolled in four Intensive Rehabilitation Units (IRUs). POPULATION Patients were consecutively recruited in the period December 2019-December 2020 with the following inclusion criteria: aged 18+, with ischemic/haemorrhagic stroke, and undergoing inpatient rehabilitation within 30 days from stroke. METHODS This is a multicentric prospective observational study. The rehabilitation pathway was reproducible and evidence-based. The functional outcome was disability in activities of daily living, measured by the modified Barthel Index (mBI) at discharge. Potential multidimensional predictors, assessed at admission, included demographics, event description, clinical assessment, functional and cognitive profile, and psycho-social domains. The variables statistically associated with the outcome in the univariate analysis were fed into a multivariable model using multiple linear regression. RESULTS A total of 220 patients were included (median [IQR] age: 80 [15], 112 women, 175 ischemic). Median mBI was 26 (43) at admission and 62.5 (52) at discharge. In the multivariable analysis younger age, along with better functioning, fewer comorbidities, higher cognitive abilities, reduced stroke severity, and higher motor functions at admission, remained independently associated with higher discharge mBI. The final model allowed a reliable prediction of discharge functional outcome (adjusted R2=77.2%). CONCLUSIONS The model presented in this study, based on easily collectable, reliable admission variables, could help clinicians and researchers to predict the discharge scores of the global functional outcome for persons enrolled in an evidence-based inpatient stroke rehabilitation program. CLINICAL REHABILITATION IMPACT A reliable outcome prediction derived from standardized assessment measures and validated treatment protocols could guide clinicians in the management of patients in the subacute phase of stroke and help improve the planning of the rehabilitation individualized project.
Stefano Savonitto, Nuccia Morici, Silvia Pancani, Anna Nozza, Francesco Cosentino, Pasquale Perrone Filardi, Claudio Cavallini, Fabio Angeli, Barbara E. Stähli, Hiddo J.L. Heerspink,et al.
Elsevier BV
Leonardo Pellicciari, Benedetta Basagni, Anita Paperini, Silvia Campagnini, Alessandro Sodero, Bahia Hakiki, Chiara Castagnoli, Angela Maria Politi, Lucia Avila, Manuele Barilli,et al.
Elsevier BV
Gemma Lombardi, Silvia Pancani, Silvia Bagnoli, Federica Vannetti, Benedetta Nacmias, Sandro Sorbi, Francesca Cecchi, and Claudio Macchi
Springer Science and Business Media LLC
Gemma Lombardi, Marco Baccini, Alice Gualerzi, Silvia Pancani, Silvia Campagnini, Stefano Doronzio, Diego Longo, Alessandro Maselli, Giulio Cherubini, Michele Piazzini,et al.
Frontiers Media SA
BackgroundIntensive treadmill training (TT) has been documented to improve gait parameters and functional independence in Parkinson’s Disease (PD), but the optimal intervention protocol and the criteria for tailoring the intervention to patients’ performances are lacking. TT may be integrated with augmented virtual reality (AVR), however, evidence of the effectiveness of this combined treatment is still limited. Moreover, prognostic biomarkers of rehabilitation, potentially useful to customize the treatment, are currently missing. The primary aim of this study is to compare the effects on gait performances of TT + AVR versus TT alone in II-III stage PD patients with gait disturbance. Secondary aims are to assess the effects on balance, gait parameters and other motor and non-motor symptoms, and patient’s satisfaction and adherence to the treatment. As an exploratory aim, the study attempts to identify biomarkers of neuroplasticity detecting changes in Neurofilament Light Chain concentration T0-T1 and to identify prognostic biomarkers associated to blood-derived Extracellular Vesicles.MethodsSingle-center, randomized controlled single-blind trial comparing TT + AVR vs. TT in II-III stage PD patients with gait disturbances. Assessment will be performed at baseline (T0), end of training (T1), 3 (T2) and 6 months (T3, phone interview) from T1. The primary outcome is difference in gait performance assessed with the Tinetti Performance-Oriented Mobility Assessment gait scale at T1. Secondary outcomes are differences in gait performance at T2, in balance and spatial–temporal gait parameters at T1 and T2, patients’ satisfaction and adherence. Changes in falls, functional mobility, functional autonomy, cognition, mood, and quality of life will be also assessed at different timepoints. The G*Power software was used to estimate a sample size of 20 subjects per group (power 0.95, α < 0.05), raised to 24 per group to compensate for potential drop-outs. Both interventions will be customized and progressive, based on the participant’s performance, according to a predefined protocol.ConclusionThis study will provide data on the possible superiority of AVR-associated TT over conventional TT in improving gait and other motor and non-motor symptoms in persons with PD and gait disturbances. Results of the exploratory analysis could add information in the field of biomarker research in PD rehabilitation.
Benedetta Basagni, Serena Malloggi, Cristina Polito, Leonardo Pellicciari, Silvia Campagnini, Silvia Pancani, Andrea Mannini, Paola Gemignani, Emilia Salvadori, Sara Marignani,et al.
MDPI AG
A domain-specific perspective to cognitive functioning in stroke patients may predict their cognitive recovery over time and target stroke rehabilitation intervention. However, data about domain-specific cognitive impairment after stroke are still scarce. This study prospectively investigated the domain-specific pattern of cognitive impairments, using the classification proposed by the Montreal Cognitive Assessment (MoCA), in a cohort of 49 stroke patients at admission (T0), discharge (T1), and six-month follow-up (T2) from subacute intensive rehabilitation. The predictive value of T0 cognitive domains cognitive impairment at T1 and T2 was also investigated. Patients’ cognitive functioning at T0, T1, and T2 was assessed through the MoCA domains for executive functioning, attention, language, visuospatial, orientation, and memory. Different evolutionary trends of cognitive domain impairments emerged across time-points. Patients’ impairments in all domains decreased from T0 to T1. Attention and executive impairments decreased from T0 to T2 (42.9% and 26.5% to 10.2% and 18.4%, respectively). Conversely, altered visuospatial, language, and orientation increased between T1 and T2 (16.3%, 36.7%, and 40.8%, respectively). Additionally, patients’ global cognitive functioning at T1 was predicted by the language and executive domains in a subacute phase (p = 0.031 and p = 0.001, respectively), while in the long term, only attention (p = 0.043) and executive (p = 0.019) domains intervened. Overall, these results confirm the importance of a domain-specific approach to target cognitive recovery across time in stroke patients.
Maria Infantino, Boaz Palterer, Maurizio Benucci, Valentina Grossi, Silvia Pancani, Mariangela Manfredi, and Nicola Bizzaro
Springer Science and Business Media LLC
Chiara Francesca Gheri, Luca Scalfi, Barbara Biffi, Silvia Pancani, Sara Madiai, Olivia Di Vincenzo, Michele Ghaderi, Rebecca Celoni, Mara Dalladonna, Francesca Draghi,et al.
MDPI AG
Preliminary evidence in the literature suggests a high prevalence of malnutrition (undernutrition) in patients with severe acquired brain injuries (sABI), with an expected negative impact on clinical outcomes and pressure ulcers (PUs) in particular. In a retrospective cohort study on patients discharged from intensive care units (ICU) and admitted to an intensive rehabilitation unit (IRU), the risk of malnutrition was systematically assessed, in addition to standard clinical procedures (including PUs evaluation), using two different tools: the Malnutrition Universal Screening Tool (MUST) and the Controlling Nutritional Status (CONUT) tool. Eighty-eight patients were included in the analysis. A high proportion (79.5%) of patients with sABI suffered from PUs, being older and more frequently men, with a longer ICU stay between the event and admission to IRU, and a greater MUST score. At discharge, when compared to patients whose PUs had healed, those with persisting PUs were more often men and had the worst cognitive performance at admission. As for nutritional risk, the baseline CONUT score was identified as an independent negative predictor of PUs at discharge by the logistic regression model. In conclusion, the assessment of nutritional risk using simple standard tools may be useful in the clinical evaluation of sABI patients with PUs.
Maria Infantino, Boaz Palterer, Silvia Pancani, Maurizio Benucci, Valentina Grossi, Mariangela Manfredi, and Nicola Bizzaro
Walter de Gruyter GmbH
Abstract Objectives Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by the presence of autoantibodies that are used for classification of the disease. Though routine diagnostics is commonly restricted to measuring rheumatoid factor (RF) and anti-citrullinated protein antibodies, detection of RF IgM, IgG and IgA isotypes, may increase the power of RA serodiagnosis by reducing the number of seronegative patients as well as provide prognostic information. The agglutination-based RF assays, such as nephelometry or turbidimetry, are unable to differentiate isotypes. We compared three different immunoassays used in current laboratory practice to detect RF isotypes. Methods We tested 117 consecutive serum samples that were positive for total RF at nephelometry, from 55 RA and 62 non-RA subjects. IgA, IgG, and IgM isotypes of RF were tested by immunoenzymatic (ELISA, Technogenetics), fluoroenzymatic (FEIA, ThermoFisher) and chemiluminescence (CLIA, YHLO Biotech Co.) immunoassays. Results Diagnostic performance differed considerably between the assays, especially with regard to RF IgG isotype. Agreement among methods by Cohen’s kappa ranged from 0.05 (RF IgG CLIA vs. FEIA) to 0.846 (RF IgM CLIA vs. FEIA). Conclusions The poor agreement observed in this study indicates substantial lack of comparability among assays for RF isotypes. Harmonization of these tests requires further efforts before their measurement can be used in clinical practice.
Barbara Binazzi, Federica Provini, Silvia Pancani, Antonello Grippo, Federica Vannetti, Guido Pasquini, Roberta Frandi, Nona Turcan, Lorenzo Razzolini, Francesca Cecchi,et al.
Wiley
BACKGROUND
Very few studies have investigated sleep characteristics in the oldest-old individuals (aged ≥85 years) and data collected often rely on self-reported information. This study had three aims: (i) to objectively assess, using a wearable device, the sleep characteristics of a large community of oldest-old subjects; (ii) to assess differences in sleep parameters between self-reported 'good sleepers' and 'bad sleepers'; (iii) to assess whether there was a relationship between sleep parameters and cognitive status in this community-dwelling population.
METHODS
There were 178 subjects (74.2% women, median age 92 years) included in the 'Mugello study', who wore an armband 24 h/day for at least two consecutive nights to estimate sleep parameters. The perceived sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), the cognitive status through the Mini-Mental State Examination. Continuous variables were compared between men/women, and good/bad sleepers with the independent t-test or Mann-Whitney U-test, according to data distribution. Chi-square test was used for categorical/dichotomous variables. An ordinal logistic regression model was used to study the possible association between sleep parameters and cognitive function.
RESULTS
Participants spent in bed nearly 9 h, with a total sleep time of 7 h, a sleep onset latency of 17 min, and a sleep efficiency of 83%. Sleep onset latency was significantly associated with different cognitive levels when age and education level were considered. No significant difference in sleep parameters estimated using the SenseWear armband were found between poor (n = 136, 76.4%) and good sleepers (n = 42, 23.6%), identified according to the PSQI.
CONCLUSIONS
In this study, actigraphic measurements revealed that subjects with a cognitive decline were more prone to increased sleep onset latency. Sleep quality assessed using the PSQI was not coherent with actigraphic measurements in this sample, supporting the need for objective measures when investigating sleep quality in the oldest-old population.
Chiara CASTAGNOLI, Silvia PANCANI, Teresa BARRETTA, Leonardo PELLICCIARI, Silvia CAMPAGNINI, Benedetta BASAGNI, Camilla GUCCI, Alessandro SODERO, Erika GUOLO, Bahia HAKIKI,et al.
Edizioni Minerva Medica
BACKGROUND
Stroke survivors report physical, cognitive, and psychological impairments, with a consequent limitation of participation. Participation is the most context-related dimension of functioning, but the literature on participation in Italian stroke patients is scant.
AIM
This study aimed to describe the recovery of participation six months after stroke with a validated Italian version of the Frenchay Activity Index (FAI) and to investigate potential correlates with higher participation scores.
DESIGN
The study is a prospective observational study.
SETTING
The cohort of patients was enrolled in four intensive inpatient rehabilitation units of IRCCS Fondazione Don Carlo Gnocchi Onlus, Florence, Italy.
POPULATION
Adults addressing postacute intensive inpatient rehabilitation after an ischemic or hemorrhagic stroke occurred within 30 days from recruitment were prospectively enrolled.
METHODS
Data were collected at admission to intensive inpatient rehabilitation, and a six-month follow-up. The primary outcome was participation, measured by a validated Italian version of the FAI; only patients whose data included both anamnestic FAI and FAI at six months follow-up were included in this analysis. The data were analyzed by univariate and multivariate linear regressions.
RESULTS
A cohort of 105 patients (median age 78 years [interquartile range, IQR=21]; 46.7% males) with completed FAI at follow-up were included in this study. The sample reported a FAI median score of 28 (IQR=8) at admission (referred to the participation in the 3-6 months before the stroke) and 13 (IQR=20) at follow-up. All items were significantly affected, with the exception of reading and making trips. The multivariate regression for all patients with good participation before the stroke (N.=101), showed that 6 months after the stroke a higher FAI Score was independently associated with better functioning in activities of daily living (modified Barthel Index) (B=0.133; P=0.015), and absence of cognitive impairment (B=4.755; P=0.027); a lower stroke severity in the postacute phase (NIHSS B=-0.832; P=0.001) and a higher prestroke FAI Score (B=0.410; P=0.028) were also independently related to follow-up FAI Score.
CONCLUSIONS
In our cohort of patients addressing postacute stroke rehabilitation, prestroke participation levels were on average good, while they were severely reduced six months after stroke for all the considered items except reading and making trips. Higher FAI at follow-up was independently associated with a higher functional level and no cognitive impairment at follow-up, with lower stroke severity in the postacute phase, as well as a higher anamnestic participation score.
CLINICAL REHABILITATION IMPACT
Our results suggest that investigating prestroke participation may be highly relevant to predict, and possibly address, participation recovery after stroke.
Salvatore Mazzeo, Silvia Pancani, Alessandro Sodero, Chiara Castagnoli, Angela Maria Politi, Monica Barnabè, Francesca Ciullini, Marco Baccini, Antonello Grippo, Bahia Hakiki,et al.
SAGE Publications
Introduction Previous studies showed that depression acts as an independent factor in functional recovery after stroke. In a prospective cohort of patients admitted to intensive inpatient rehabilitation after a stroke, we aimed to test depression as a moderator of the relationship between the functional level at admission and the effectiveness of rehabilitation at discharge. Methods All patients admitted to within 30 days from an ischemic or hemorrhagic stroke to 4 intensive rehabilitation units were prospectively screened for eligibility to a multicenter prospective observational study. Enrolled patients underwent an evidence-based rehabilitation pathway. We used clinical data collected at admission (T0) and discharge (T1). The outcome was the effectiveness of recovery at T1 on the modified Barthel Index (proportion of achieved over potential functional improvement). Moderation analysis was performed by using the PROCESS macro for SPSS using the bootstrapping procedure. Results Of 278 evaluated patients, 234 were eligible and consented to enrolment; 81 patients were able to answer to the Hospital Anxiety and Depression Scale (HADS) and were included in this analysis. The relationship between the functional status at admission and rehabilitation effectiveness was significant only in persons with fewer depressive symptoms; depression (HADS cut-off score: 5.9) moderated this relationship ( P = .047), independent from age and neurological impairment. Conclusions Our results suggest that depression moderates between the functional status at admission and the functional recovery after post-stroke rehabilitation. This approach facilitates the identification of subgroups of individuals who may respond differently to stroke rehabilitation based on depression.
Bahia Hakiki, Silvia Pancani, Anna Maria Romoli, Francesca Draghi, Daniela Maccanti, Andrea Mannini, and Francesca Cecchi
Frontiers Media SA
ObjectivesThe “cognitive reserve” (CR) theory posits that higher premorbid cognitive activities can mitigate the effects of brain damage. This study aimed to investigate the association between CR and long-term functional autonomy in patients surviving a severe traumatic brain injury (sTBI).SettingData were collected from the database of inpatients with severe acquired brain injury in a rehabilitation unit admitted from August 2012 to May 2020.ParticipantsPatients that had incurred an sTBI, aged 18+ years, completing the phone Glasgow Outcome Scale-Expanded at follow-up (pGOS-E) in absence of previous brain trauma or neurological disease, or cognitive disorders were included. Patients with severe brain injury from non-traumatic etiologies were not included in the study.DesignIn this longitudinal study, all patients underwent a multidimensional assessment including the cognitive reserve index questionnaire (CRIq), the coma recovery scale-revised, the level of cognitive functioning, the Disability Rating Scale (DRS), and the Galveston Orientation and Amnesia Test at admission. At discharge, functional scales were administered again together with the Glasgow Outcome Scale. The pGOS-E was assessed at follow-up.Main measurespGOS-E.ResultsA total of 106 patients/caregivers underwent the pGOS-E after 5.8 [3.6] years from the event. Among them, 46 (43.4%) died after discharge, and 60 patients [men: 48 (80%); median age: 54 years; median time post-onset: 37 days; median education level: 10 years; median CRIq total score: 91] were included in the analysis exploring the association between pGOS-E and demographic data, cognitive reserve surrogates, and clinical variables at admission and discharge from the rehabilitation unit. A younger age (B = −0.035, p = 0.004) and a lower DRS category at discharge (B = −0.392, p = 0.029) were significantly related to a higher long-term functional autonomy in the multivariate analysis.ConclusionLong-term functional autonomy was not influenced by CR as assessed through the educational level and the CRIq.
Benedetta Basagni, Sara Marignani, Silvia Pancani, Andrea Mannini, Bahia Hakiki, Antonello Grippo, Claudio Macchi, and Francesca Cecchi
Georg Thieme Verlag KG
AbstractDysphagia represents one of the most frequent symptoms in the post–acute stroke population. Swallowing impairment and cognitive deficits can often co-occur. This study aims to investigate the relationship between cognitive impairment and the recovery of dysphagia in patients attending specific rehabilitation. Patients admitted to intensive rehabilitation units were administered the Functional Oral Intake Scale (FOIS) and Montreal Cognitive Screening Test (MoCA); when screening positive for dysphagia, they entered a rehabilitation program. Their FOIS score at discharge was the primary outcome measure. In the multivariate analysis, younger age (B = − 0.077, p = 0.017), higher MoCA (B = 0.191, p = 0.002), and higher FOIS (B = 1.251, p = 0.032) at admission were associated with higher FOIS at discharge. When executive function (EF) replaced the MoCA total score in the model, younger age (B = − 0.134, p = 0.001), higher admission EF (B = 1.451, p < 0.001), and FOIS (B = 1.348, p = 0.035) were associated with higher FOIS at discharge. Our results confirm the hypothesis that a better cognitive profile upon admission is associated with a higher probability of dysphagia recovery at discharge. EF seems to have a crucial role in dysphagia recovery. These results highlight the importance of considering the cognitive profile when assessing and treating dysphagia after stroke and of using screening tests that include executive functions.
Carmen Barbato, Laura Antonucci, Leonardo Pellicciari, Chiara Castagnoli, Ines Hochleitner, Anita Paperini, Silvia Pancani, Sonia Verdesca, Benedetta Basagni, Claudio Macchi,et al.
Informa UK Limited
BACKGROUND
Community ambulation ability is one of the most important functional loss after stroke. The assessment of the level of community walking plays an important role in the multidimensional bio-psycho-social approach, to improve quality of life and social participation of stroke survivors. The modified Functional Walking Categories (mFWC) is a worldwide widely used tool to assess community ambulation in stroke survivors, but no Italian version is yet available.
OBJECTIVE
To cross-culturally adapt the mFWC into Italian and to assess its validity and reliability.
METHODS
According to the international guidelines, a multistep translation and cultural adaptation were conducted and revised by a committee of experts. Patients admitted to intensive inpatient rehabilitation with a sub-acute stroke were recruited. Inter- and intra-rater reliability and construct validity were studied.
RESULTS
Sixty patients with sub-acute stroke were prospectively enrolled in this study. Findings showed almost perfect intra- and inter-rater reliability (k = 1.000 [95% CI 1.000-1.000] and k = 0.984 [95% CI 0.955-1.000], respectively). The construct validity of the scale was satisfactory, as 100.0% a-priori hypotheses were met.
CONCLUSIONS
The Italian mFWC offers a valid tool for measuring community ambulation in stroke patients. Our work provides a validated and a cross-cultural adapted Italian version of the mFWC to accurately measure community ambulation both in clinical and research settings in Italy.
Ines Hochleitner, Leonardo Pellicciari, Chiara Castagnoli, Anita Paperini, Angela Maria Politi, Silvia Campagnini, Silvia Pancani, Benedetta Basagni, Filippo Gerli, Maria Chiara Carrozza,et al.
Informa UK Limited
PURPOSE
To assess the intra- and inter-rater reliability motor and sensory functioning, balance, joint range of motion and joint pain subscales of the Italian Fugl-Meyer Assessment (FMA) Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE) at the item- subtotal- and total-level in patients with sub-acute stroke.
MATERIALS AND METHODS
The FMA was administered to 60 patients with sub-acute stroke (mean age ± SD = 75.4 ± 10.7 years; 58.3% men) and independently rated by two physiotherapists on two consecutive days. Intra- and inter-reliability was studied by a rank-based statistical method for paired ordinal data to detect any systematic or random disagreement.
RESULTS
The item-level intra- and inter-rater reliability was satisfactory (>70%). Reliability level >70% was achieved at subscale and total score level when one- or two-points difference was considered. Systematic disagreements were reported for five items of the FMA-UE, but not for FMA-LE.
CONCLUSIONS
The Italian version of the FMA showed to be a reliable instrument that can therefore be recommended for clinical and research purposes.Implications for rehabilitationThe FMA is the gold standard for assessing stroke patients' sensorimotor impairment worldwide.The Italian Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE) is substantially reliable within and between two raters at the item, subtotal, and total score level in patients with sub-acute stroke.The use of FMA in the Italian context will provide an opportunity for international comparisons and research collaborations.
Benedetta Basagni, Silvia Pancani, Leonardo Pellicciari, Paola Gemignani, Emilia Salvadori, Sara Marignani, Antonello Grippo, Bahia Hakiki, Andrea Mannini, Donata Bardi,et al.
MDPI AG
Background: The Token Test (TT) is widely used to examine comprehension disorders in aphasic patients, but abilities other than language may affect a patient’s performance. This study aims to explore the correlation between the TT subtest performances and the performances in extra-linguistic cognitive areas in a cohort of patients from the Intensive Rehabilitation Post-Stroke (RIPS) study with a first, right hemisphere stroke and without aphasia, prospectively enrolled at admission to intensive inpatient post-acute rehabilitation. Methods: The patients were administered the TT (50-item version), the forward and backward digit span (DST), and the Montreal Cognitive Assessment (MoCA). Spearman’s partial correlations adjusted by age were used to evaluate the association between the number of errors in the TT and the other tests’ corrected scores. Results: Of the 37 patients enrolled in this study, 29.7% made 3–11 errors on the TT, 27.0% more than 11 errors, mostly in parts IV and V. The forward and backward digit span scores showed correlations with errors in part V of the TT (r = −0.408, p = 0.013; r = −0.307, p = 0.027). The errors in part IV of the TT presented a correlation with a forward digit span too (r = −0.394, p = 0.017). With respect to MoCA domains, executive functioning, and orientation were related to the TT part V errors (r = −0.468, p = 0.007; r = −0.499, p = 0.003). The orientation also correlated with the TT part III (r = −0.504, p = 0.002). Conclusion: Our findings show that the TT performances in patients with right hemisphere stroke and without aphasia are related to impairments in auditory–verbal span/auditory working memory mostly for TT scores on subpart V as measured by the DST and to executive function and orientation, as measured by the MoCA subtests.
Silvia Pancani, Gemma Lombardi, Francesco Sofi, Anna Maria Gori, Roberta Boni, Chiara Castagnoli, Anita Paperini, Guido Pasquini, Federica Vannetti, Raffaello Molino Lova,et al.
Springer Science and Business Media LLC
Abstract Background Life expectancy has increased over the last century and a growing number of people is reaching age 90 years and over. However, data on nonagenarians’ health trends are scarce due to difficulties in investigating this specific population. This study aims to identify risk factors for one-year mortality in nonagenarians using data collected within the “Mugello Study”. Methods Complete information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 nonagenarians, as well as information about survival after 1 year from the interview. Results The sample included 314 women (72.5%) and 119 men (27.5%) with a median age of 92 years (range 90-99 years). The mortality rate was 20.3% (88 deaths). After adjustment for age and sex, a significantly higher risk of dying within 12 months was observed in individuals with more severe cognitive impairment (HR = 5.011, p < 0.001), more severe disability in basic activities of daily living (HR = 4.193, p < 0.001), sedentary lifestyle (HR = 3.367, p < 0.001), higher number of drugs assumed (HR = 1.118, p = 0.031), and kidney dysfunction (HR = 2.609, p = 0.004). When all the variables were included in the analysis, only older age (HR = 1.079, p = 0.048), lower cognitive function (HR = 2.859, p = 0.015), sedentary lifestyle (HR = 2.030, p = 0.026), and kidney dysfunction (HR = 2.322, p = 0.018) remained significantly associated with reduced survival. Conclusions Data from the Mugello study support the hypothesis that survival at 12 months in nonagenarians is not a stochastic process and that older age, reduced cognitive function, sedentary lifestyle, and the presence of kidney dysfunction are associated with mortality.
Maria Infantino, Teresa Carbone, Ignazio Brusca, Maria-Grazia Alessio, Giulia Previtali, Stefan Platzgummer, Giusi Paura, Caterina Castiglione, Martina Fabris, Giampaola Pesce,et al.
Elsevier BV
Gemma Lombardi, Silvia Pancani, Francesca Lorenzini, Federica Vannetti, Guido Pasquini, Roberta Frandi, Nona Turcan, Lorenzo Razzolini, Raffaello Molino Lova, Francesca Cecchi,et al.
MDPI AG
As more and more persons live into their 90s and beyond, investigating causes of disability in the oldest-old population is relevant for public health implications to plan preventive strategies and rehabilitation interventions. A negative association between physically demanding work and midlife physical function has been shown, but there is a paucity of longitudinal studies investigating possible work-related long-term effects in the oldest old. This study investigates the relationship between physically demanding work exposure and late-life physical performances, disability, general health status, and quality of life in a sample of women aged 90 years and over inside the Mugello Study. Sociodemographic data, cognitive and functional status, lifestyle, medical history, drug use, and work history were collected from 236 participants. Farmers had a lower percentage of individuals with preserved independence in basic activities of daily living compared to other occupations. However, in the multivariate analysis, only a higher cognitive function remained associated with functional independence. While confirming the well-known association between cognitive and functional decline in very old age, our results do not support the hypothesis that the negative effects of physical work exposure observed in midlife are relevant to predict disability in nonagenarian women.
Laura Antonucci, Carmen Barbato, Leonardo Pellicciari, Anita Paperini, Ines Hochleitner, Chiara Castagnoli, Sonia Verdesca, Giulia Lucidi, Sara Marignani, Silvia Pancani,et al.
Springer Science and Business Media LLC
Francesca Di Cesare, Leonardo Tenori, Gaia Meoni, Anna Maria Gori, Rossella Marcucci, Betti Giusti, Raffaele Molino-Lova, Claudio Macchi, Silvia Pancani, Claudio Luchinat,et al.
Springer Science and Business Media LLC
AbstractThis study defines and estimates the metabolite-lipidic component association networks constructed from an array of 20 metabolites and 114 lipids identified and quantified via NMR spectroscopy in the serum of a cohort of 355 Italian nonagenarians and ultra-nonagenarian. Metabolite-lipid association networks were built for men and women and related to an array of 101 clinical and biochemical parameters, including the presence of diseases, bio-humoral parameters, familiarity diseases, drugs treatments, and risk factors. Different connectivity patterns were observed in lipids, branched chains amino acids, alanine, and ketone bodies, suggesting their association with the sex-related and sex-clinical condition-related intrinsic metabolic changes. Furthermore, our results demonstrate, using a holistic system biology approach, that the characterization of metabolic structures and their dynamic inter-connections is a promising tool to shed light on the dimorphic pathophysiological mechanisms of aging at the molecular level.
Bahia Hakiki, Francesca Cecchi, Silvia Pancani, Anna Maria Romoli, Francesca Draghi, Maenia Scarpino, Raisa Sterpu, Andrea Mannini, Claudio Macchi, and Antonello Grippo
MDPI AG
Background: Disorders of consciousness (DoCs) include unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS). Critical illness polyneuropathy and myopathy (CIPNM) is frequent in severe acquired brain injuries and impacts functional outcomes at discharge from the intensive rehabilitation unit (IRU). We investigated the prevalence of CIPNM in DoCs and its relationship with the consciousness assessment. Methods: Patients with DoCs were retrospectively selected from the database including patients admitted to the IRU of the IRCCS Don Gnocchi Foundation, Florence, from August 2012 to May 2020. Electroneurography/electromyography was performed at admission. Consciousness was assessed using the Coma Recovery Scale-Revised (CRS-R) at admission and discharge. Patients transitioning from a lower consciousness state to a higher one were classified as improved responsiveness (IR). Results: A total of 177 patients were included (UWS: 81 (45.8%); MCS: 96 (54.2%); 78 (44.1%) women; 67 years (IQR: 20). At admission, 108 (61.0%) patients had CIPNM. At discharge, 117 (66.1%) patients presented an IR. In the multivariate analysis, CRS-R at admission (p = 0.006; OR: 1.462) and CIPNM (p = 0.039; OR: −1.252) remained significantly associated with IR only for the UWS patients. Conclusions: CIPNM is frequent in DoCs and needs to be considered during the clinical consciousness assessment, especially in patients with UWS.
Silvia Pancani, Gemma Lombardi, Francesco Sofi, Anna Maria Gori, Roberta Boni, Chiara Castagnoli, Anita Paperini, Guido Pasquini, Federica Vannetti, Raffaello Molino Lova,et al.
SAGE Publications
Objective to identify the predictors of mortality in a cohort of nonagenarians inside the “Mugello study” after 10 years follow-up. Methods Information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 non-selected participants aged 90-99 years, living in the Mugello area (Italy). Participants were followed over 10 years and their dates of death were retrieved from the municipal registers. Cox regression analysis was used to determine significant potential prognostic factors. Results The mortality rate was 96.5%. Cox proportional hazards analysis showed that a lower cognitive status was significantly associated with higher mortality as well as a poorer functional status, a higher comorbidity, and a higher number of drugs consumption. Discussion Impaired cognitive function, loss of functional independence, higher comorbidity, and higher drugs intake were the stronger predictors of mortality.
Bahia Hakiki, Piergiuseppe Liuzzi, Gastone Pansini, Silvia Pancani, Annamaria Romoli, Francesca Draghi, Simone Orlandini, Andrea Mannini, Alessandro Della Puppa, Claudio Macchi,et al.
Informa UK Limited
PURPOSE
Decompressive craniectomy (DC) is a life-saving procedure conducted to treat refractory intracranial hypertension. Although DC reduces mortality of severe Acquired Brain Injury (sABI) survivors, it has been associated with severe long-term disability. This observational study compares functional outcomes at discharge from an Intensive Rehabilitative Unit (IRU) between sABI patients with and without DC.
MATERIAL AND METHODS
sABI patients undergoing DC before entering the Don Gnocchi Foundation IRU were compared with a group of sABI patients who did not undergo DC (No-DC group), after matching it by age, sex, aetiology, time post-onset, and clinical status. Inclusion criteria were: diagnosis of sABI, age 18+, time from the event <90 days.
RESULTS
A total of 87 (DC: 47) patients were included (median age: 60.5 [IQR = 17.47]). The two groups did not differ for admission clinical features except for the tracheostomy presence (more frequent in DC, p < 0.001). No significant differences were also found at discharge. DC group presented a significantly longer length-of-stay than No-DC group (p < 0.001) and a longer time to tracheostomy removal (p = 0.036). DC was not found to influence outcomes as consciousness improvement, tracheostomy removal, oral intake and functional independence.
CONCLUSIONS
sABI patients with DC improved after rehabilitation as much as No-DC patients did but they required a longer stay.Implications for RehabilitationDecompressive craniectomy (DC) is practiced during the acute phase after hemorrhagic, ischemic, traumatic severe brain injury as a life-saving procedure to treat refractory intracranial hypertensionDC has been associated with follow-up severe long-term disability, but no study yet addressed whether DC may affect intensive rehabilitation outcomes.Undergoing a DC is not a negative prognostic factor for achieving rehabilitation goals after a severe acquired brain injuryDC must be taken into account when customizing rehabilitation pathway especially because these patients required a longer time to reach the outcomes.