Sapienza University of Rome Dep Medical Physiopathology Food Science and Nutrition Laboratory
lorenzomaria.donini@uniroma1.it
Lorenzo M. Donini was born in Rome on the 20th April, 1955.
Education
"Ancien élève" at the Lycée Chateaubriand of Rome and graduated in Medicine and Surgery at the Catholic University “Sacro Cuore” of Rome; in 1990-1 he qualified as a Specialist in Nutrition Sciences and in 1995-6 in Statistics at the University of Rome “La Sapienza”.
Professional experiences
From February 1987 to October 2000 he worked at the Geriatrics Institute “ Villa delle Querce”, Nemi – Rome, in the 3rd Unit of the Geriatric Rehabilitation as Assistant to Geriatrics and Rehabilitation Division and as Head of the Clinical Nutrition and Dietetics Department.
The 1st November 2000 he joined the Faculty of Medicine and Surgery of the University of Rome "La Sapienza" as Associate Professor. There he also was nominated Confirmed Associate Professor (Rectorial Decree 3562 of 23rd December 2004) since the 1st November 2003 . He carries out his teaching and scientific activity in the facilities of the Department of Medical Physiopathology - Food Science Section – “Sapienza” University of Rome (Italy) (tel.: +39.06.4991.0996; fax.: +39.06.4991.0699; e-mail: lorenzomaria.donini@uniroma1.it).
Teaching
At present he is entrusted to teach "Physiology of Nutrition" at the second year of the Degree of Dietist of the 1st Faculty of Medicine of the University of Rome "La Sapienza". Since the academic year 2001-2 he was entrusted to teach: - Human Physiology and Anatomy (BIO09) in the Degree Courses “C” and “E” in Medicine and Surgery (Presidents: Prof. Pietro Gallo and Prof. Marella Maroder) - Applied Dietetics (MED 49) at the Integrated Courses of Methodology VIII in the Degree Courses “A” and “E” in Medicine and Surgery (Presidents: Prof. Eugenio Gaudio and Prof. Marella Maroder) -at the Specialisation School in Nutrition Sciences (Director: Prof. C. Cannella) Course of “Feeding and Nutrition in Elderly” (academic year 2001-2) and Integrated Course of “Physiology of Nutrition” (since academic year 2002-3)
Since 2001 he is vice-president of the 1st Level Degree Course for Dieticians (President: Prof. C. Cannella). Since June 2004 he is vice-director of the Specialisation School in Nutrition Sciences (Director: Prof. C. Cannella).
Research
Since 1991 he carries out research in collaboration with the Institute of Nutrition Sciences of the University of Rome "La Sapienza" (Director: Prof. C. Cannella), dealing specifically with the study of nutritional problems in elderly. He published more than 50 works in extenso (most part on international journals) relevant to: -malnutrition (identification of prediction equations for weight and stature in the Italian population, validation of tools for the assessment of the nutritional status, ethics of the nutritional intervention, impact of the nutritional status on the outcome of the rehabilitation programmes) -catering services (impact of the quality of hospital catering services on nutritional status of institutionalised elderly population, survey on the hospital dietetics and on the role of nutritional treatment of the patients admitted in the hospital) -obesity and metabolism (multidimensional approach to the treatment of obesity, use of spelt in the diets of subjects affected by type 2 diabetes mellitus) -eating behaviour (orthorexia nervosa, senile anorexia and refusal to eat in the elderly)
He collaborated to inter- and intra-university research projects -1993: Ageing Finalised Project CNR, sub-project 2, Epidemiological Longitudinal Study (scientific responsible of the Research: Prof. V. Marigliano). -2001: project “Biology and Molecular Medicine (BEMM)” (scientific responsible of the Research: Prof. A. Santoni) financed by COFINLAB 2001 At the moment he coordinates the research project: “Anorexia of aging: causes and prevalence” (MIUR-COFIN 2005).
He is a member of the Revisor Board MIUR-COFIN since April 2003 for the Biological Sciences Area (05 - BIO/09: Physiology), and of the Board of Experts of the Committee for the Evaluation of the Research (CIVR) since November 2004. He worked as referee for many scientific journals and since 2004 he is in the Editorial Board of the “Journal of Nutrition Health & Aging” and “Eating & Weight Disorders”.
Abstract: BACKGROUND: Malnutrition due to undernutrition or overnutrition is highly prevalent in hospital in-patients and it decisively conditions patients clinical outcome. One of the most influencing factors of malnutrition in hospitalized patients is--at least in part--the Catering Service Quality. AIM: Is to verify, over a 5 year period, the course of the quality of the institutional Catering Service, verifying the effectiveness of the quality improvement process used. METHODS: Quality control was performed by objective (meal order accuracy, proper distribution of food in trolleys, route time from the kitchen to the ward and time of food distribution, food weight and temperature, waste assessment) and subjective assessment (quality was measured by giving the patients a questionnaire after meals). RESULTS: The survey included: 572 meals and 591 interviews. A significant amount of "qualitative" errors (lack of respect for patient preferences or at the moment of supplying the food trolley) have been found. Over the time and the amount of patients that wasted a considerable amount of the portion served was considerably reduced food temperature have been improved. Also patient satisfaction with menu variability, portion size, temperature and cooking quality improved over time. The overall ratings of meals under observation improved too in fact, positive opinions ranged from 18% in 2002 to 48.3% in 2006. CONCLUSION: Ongoing research and quality verification, which include all catering service workers, yields a constant improvement in quality. Patients in healthcare settings should receive a service they appreciates, but it should be--at the same time--correct from a nutritional point of view. For this reason, it is necessary a continuous mediation between customers satisfaction and nutritionists work, dieticians and nursing staff. From this point of view the educational approach becomes essential to feed patient compliance to dietetic treatment that will continue after discharge.
Abstract: It is possible to identify risks or protective factors against dementia. Increased levels of homocysteine (HCY) and vitamin B deficiency, obesity and central adiposity in midlife are independent risk factors for the development of dementia. High dietary intake of antioxidants and omega-3 fatty acids lower the risk of Alzheimer disease (AD). The supplementation with single nutrients, like vitamin B, omega-3-polyunsaturated fatty acids (PUFA) or antioxidants is generally not effective in lowering the risk of dementia or in slowing the progression of the disease. It is probably necessary that these nutrients are part of a healthy diet (with at least five portions of fruit and vegetables per day and one portion of fish per week) during the lite where other factors interact with them as it happens in the Mediterranean diet. Nutritional strategies for modifying the clinical course of cognitive failure should consider the use of nutritional screening tools in the multidimensional geriatric evaluation. Moreover, the diet, oral supplementation, caregiver education could be important factors to prevent or treat weight loss and its consequences in AD while the use of artificial nutrition in demented patients may have questionable benefits.
Abstract: One univocal definition for nutritional status (NS) does not exist. One set of generally accepted standards for assessing the nutritional status does not exist, either. The NS assessment is absolutely necessary because it drives to identify malnutrition which is a potential cause and or an aggravation of morbidity and mortality. Since malnutrition shows a high prevalence in the elderly, literature about the validation of tools exploring single or complex NS parameters in the elderly has been systematically review. 115 papers, published from January 1st 1990 to July 31st 2003, have been identified: among them, just 9 complied with the established quality criteria and were suitable to be systematically reviewed. Parameters and diagnosis protocols to assess NS used in the selected papers were not homogeneous. Two implications arise from this evidence: - as regards clinical practice: an assessment on NS in clinical practice is complex, but not impossible. Hopefully, despite the absence of a sure reference, nutritionists, during their own clinical practice, ought to choose a validated on their own population and complete tool (considering as NS indicators both dietetic, anthropometric and functional parameters) for NS assessment, among all the redundant set of tools proposed until now; - respecting a scientific point of view, there is the necessity for calling a consensus conference in order to establish an initial consensus to diagnose malnutrition in the elderly and to promote, therefore, a validation study.
Abstract: BACKGROUND: The prevalence of pressure ulcers (PUs) ranges from 1 to 18% of in-patients and from 3 to 28% in long-term settings. The aim of our study was to verify how comorbidity and frailty influenced the course of PUs in a population of elderly subjects hospitalized in a long-term care setting. MATERIAL/METHODS: The charts of 125 patients with pressure ulcers were evaluated retrospectively. For each subject we took note of PU characteristics (stage, ulcer surface, evolution), and clinical characteristics (comorbidity, adverse clinical events, and cognitive, functional, and nutritional status). Frailty was defined considering age, cognitive functions, and functional and nutritional status. RESULTS: In 58 patients (46.4%) there was overall resolution of the lesions, while in 39 patients (31.2%) we had "improvement" of PUs. The course of PU was not significantly influenced by the patient's physiological characteristics, cognitive status, or the initial characteristics of PU. We noticed a significant difference in the course of PUs as a function of autonomy level and clinical and nutritional status. During the observation period we found significant differences in the frailty scores: 87.2% of those who showed an improvement in the score had resolution or improvement in PUs, while this occurred in only 27.3% of those who had a worsening in the level of frailty. CONCLUSIONS: We maintain that integration of multidimensional assessment, with special attention to comorbidity status and to frailty (particularly autonomy level and nutritional status), and the different approaches may allow optimal healing of PUs.
Abstract: The prevalence of pressure sores (PS) ranges from 1 to 18% of in-patients and from 3 to 28% of those admitted to long-term settings. The aim of our study was to verify, a posteriori, how nutritional status influenced the evolution of PS in a population of elderly subjects hospitalised in a long-term care setting. MATERIALS AND METHODS: The charts of 125 patients with ulcerative or necrotic pressure ulcers were evaluated retrospectively. For each subject we took note of: PS characteristics (stage, ulcer surface, evolution), clinical characteristics (comorbidity, adverse clinical events, cognitive, functional and nutritional status). RESULTS: In 58 patients (46.4%) there was overall healing of the lesions while in 39 patients (31.2%) we had however an "improvement" of PS. The course of PS was not significantly influenced by the patient's physiological characteristics, by cognitive status or by initial characteristics of PS. Instead, we noticed a significant difference in the course of PS as a function of the level of autonomy and clinical status. The course of PS, and in particular the Healing Index, were influenced by the Nutritional Status and, above all, by its course during the treatment period. CONCLUSIONS: The development of PS is multifactorial. Whereas, it is clear that factors other than nutrition influence the risk of developing PS, an important role for nutrition in the development and resolution of PS is suggested. Our data certainly confirm the "Quality indicators for prevention and management of pressure ulcers in vulnerable elders", especially were they say "if a vulnerable elder is identified as at risk for pressure ulcer development and has malnutrition, then nutritional intervention or dietary consultation should be instituted because poor diet, particularly low dietary protein intake, is an independent predictor of pressure ulcer development".
Abstract: AIM: To validate a questionnaire for the diagnosis of orhorexia oervosa, an eating disorder defined as "maniacal obsession for healthy food". MATERIALS AND METHODS: 525 subjects were enrolled. Then they were randomized into two samples (sample of 404 subjects for the construction of the test for the diagnosis of orthorexia ORTO-15; sample of 121 subjects for the validation of the test). The ORTO-15 questionnaire, validated for the diagnosis of orthorexia, is made-up of 15 multiple-choice items. RESULTS AND CONCLUSION: The test we proposed for the diagnosis of orthorexia (ORTO 15) showed a good predictive capability at a threshold value of 40 (efficacy 73.8%, sensitivity 55.6% and specificity 75.8%) also on verification with a control sample. However, it has a limit in identifying the obsessive disorder. For this reason we maintain that further investigation is necessary and that new questions useful for the evaluation of the obsessive-compulsive behavior should be added to the ORTO-15 questionnaire.
Abstract: An increased protein intake is one of the most common approaches to the dietary management of obesity. The authors analyze the issues related to protein requirement in normal-weight and obese subjects, to the use and to the usefulness of high-protein diets in the treatment of obesity. Caution with these diets is recommended in view of their only slight effect on weight and fat loss and owing to the scarce evidence of significant effects on satiety and energy intake. Furthermore, the risks of harmful outcomes may be correlated to an excessive protein intake. Moreover, these diets do not allow patients to adopt those nutritional behavior rules which are essential to maintain the weight and fat loss and, consequently, significantly reduce the cardiovascular and metabolic risks related to obesity.
Abstract: BACKGROUND AND AIMS: In a geriatric patient, nutritional status (NS), particularly in the case of malnutrition (M), may influence not only clinical results but also achievement of targets expected by geriatric rehabilitation. The aim of this study was to evaluate the effect of nutritional status (NS) on the occurrence of Adverse Clinical Events (ACE) and on mortality in geriatric rehabilitation patients. METHODS: We retrospectively examined the clinical records of 278 elderly subjects (154 women, 124 men), admitted to a geriatric hospital between September 2000 and December 2001 and evaluated for clinical, functional, cognitive and NS within the first 48 hours of admission. Clinical outcomes (ACE, mortality) were recorded during follow-up. Logistic regression analysis estimated models having mortality or the occurrence of ACE as outcome variables. RESULTS: Malnutrition was detected upon admission in 56.1% of the sample population. Incidence of ACE in malnourished subjects was higher than that in well-nourished patients (28.2 vs 13.1%). Equally, mortality among malnourished subjects was higher than among those whose NS was normal (23.1 vs 9.8%). The logistic regression models were able to predict: 1) mortality from comorbidity (OR 1.43; 95% CI 1.16-1.78; p=0.001) and NS (OR 2.64; 95% CI 1.29-5.4; p=0.008), and 2) occurrence of ACE from comorbidity (OR 1.69; 95% CI 1.36-2.1; p=0.000), cognitive (OR 1.22; 95% CI 1.11-1.35; p=0.000) and nutritional status (OR 2.38; 95% CI 1.19-4.8; p=0.015). CONCLUSIONS: NS emerged as the main independent predictor of both mortality and occurrence of ACE. Although most patients fell into the category of mild/moderate (energy) malnutrition (148/156), a mild deterioration of NS, for instance, reduction in triceps skinfold thickness (TSF) seemed to be sufficient to cause an increase in the incidence of ACE and in mortality.
Abstract: AIM: To propose a diagnostic proceeding and to try to verify the prevalence of orthorexia nervosa (ON), an eating disorder defined as "a maniacal obsession for healthy foods". MATERIALS AND METHODS: 404 subjects were enrolled. Diagnosis of ON was based on both the presence of a disorder with obsessive-compulsive personality features and an exaggerated healthy eating behaviour pattern. RESULTS: Of the 404 subjects examined, 28 were found to suffer from ON (prevalence of 6.9%). The analysis of the physiological characteristics, the social-cultural and the psychological behaviour that characterises subjects suffering from ON shows a higher prevalence in men and in those with a lower level of education. The orthorexic subjects attribute characteristics that show their specific "feelings" towards food ("dangerous" to describe a conserved product, "artificial" for industrially produced products, "healthy" for biological produce) and demonstrate a strong or uncontrollable desire to eat when feeling nervous, excited, happy or guilty.
Abstract: Although a high prevalence of overweight is present in elderly people, the main concern in the elderly is the reported decline in food intake and the loss of the motivation to eat. This suggests the presence of problems associated with the regulation of energy balance and the control of food intake. A reduced energy intake causing body weight loss may be caused by social or physiological factors, or a combination of both. Poverty, loneliness, and social isolation are the predominant social factors that contribute to decreased food intake in the elderly. Depression, often associated with loss or deterioration of social networks, is a common psychological problem in the elderly and a significant cause of loss of appetite. The reduction in food intake may be due to the reduced drive to eat (hunger) resulting from a lower need state, or it arises because of more rapidly acting or more potent inhibitory (satiety) signals. The early satiation appears to be predominantly due to a decrease in adaptive relaxation of the stomach fundus resulting in early antral filling, while increased levels and effectiveness of cholecystokinin play a role in the anorexia of aging. The central feeding drive (both the opioid and the neuropeptide Y effects) appears to decline with age. Physical factors such as poor dentition and ill-fitting dentures or age-associated changes in taste and smell may influence food choice and limit the type and quantity of food eaten in older people. Common medical conditions in the elderly such as gastrointestinal disease, malabsorption syndromes, acute and chronic infections, and hypermetabolism often cause anorexia, micronutrient deficiencies, and increased energy and protein requirements. Furthermore, the elderly are major users of prescription medications, a number of which can cause malabsorption of nutrients, gastrointestinal symptoms, and loss of appetite. There is now good evidence that, although age-related reduction in energy intake is largely a physiologic effect of healthy aging, it may predispose to the harmful anorectic effects of psychological, social, and physical problems that become increasingly frequent with aging. Poor nutritional status has been implicated in the development and progression of chronic diseases commonly affecting the elderly. Protein-energy malnutrition is associated with impaired muscle function, decreased bone mass, immune dysfunction, anemia, reduced cognitive function, poor wound healing, delayed recovery from surgery, and ultimately increased morbidity and mortality. An increasing understanding of the factors that contribute to poor nutrition in the elderly should enable the development of appropriate preventive and treatment strategies and improve the health of older people.
Abstract: OBJECTIVE: The aim of this study is to verify, in a sample of elderly subjects admitted to long-term care, the impact of malnutrition, according to the Mini Nutritional Assessment (MNA), on mortality and on the occurrence of Adverse Clinical Events in a 3-12 months follow-up study. SUBJECTS: The survey included all patients admitted to a geriatric hospital--"Villa delle Querce", Nemi (Rome, Italy)--between January 1997 and April 2000, whose nutritional status we were able to monitor for over 3 months. The study comprised 167 elderly subjects, of which 125 women (74.9%) aged 83.3 8 years (60-95 years), and 42 men (25.1%) aged 79.6 9 years with an average follow-up period of 7.5 months. METHODS: Upon admission and at every check we evaluated each subject's cognitive functions, functional status, co-morbidity, frailty, nutritional status (anthropometric and biochemical indices; MNA). During the follow-up we recorded Adverse Clinical Events. We calculated the predictive value of MNA, we correlated variations in MNA scores with variations of nutritional parameters. RESULTS: MNA's predictive ability both upon admission and upon discharge was found to be excellent. The MNA score was found to be correlated-although not to a very high degree-with variations nutritional parameters. Even more than malnutrition, a low MNA score was found to be predictive of a greater incidence of Adverse Clinical Events during hospitalisation and of higher mortality.
Abstract: The aim of our study was to measure the quality of a restaurant service of a geriatric rehabilitation and long-term setting as it is perceived from patients compared with an objective measure of the quality. We have also verified the weight of the restaurant service on the whole quality of the hospital. Our data showed some problems in the organisation of the service, a substantially negative judgment from patients, the necessity to integrate subjective judgments with objective evaluations. The data confirmed also the importance that patients give to taste and variability of food and to the way in which it is presented. The results we obtained suggested an audit of the organisation of the restaurant service. The outcome of the proposed changes will be followed up and bring, eventually, to further arrangements.
Abstract: BACKGROUND: Frail elderly people, living in nursing homes, usually show a malnutrition state caused by an increased need of energy or an inadequate food intake. Among the causes leading to reduction of food intake in elderly people and consequently to malnutrition, is the loss of appetite, often marker of depression and alterations of taste and smell perception. OBJECTIVE: The aim of this research is to verify the application of the AHSP Questionnaire and relate its score to nutritional state of a frail elderly population hospitalized in a geriatric rehabilitation care. SETTING AND SUBJECTS: All patients of the "3rd Rehabilitation Department" of the Istituto Geriatrico "Villa delle Querce" Nemi (Rome-Italy). METHODS: Informations, number and type of medical conditions, prescribed drugs, other parameters that can affect taste, smell, hunger and nutritional status, mood, cognitive and nutritional status have been collected from the clinical folders. To assess appetite, hunger smell and taste perception had been submitted the AHSP Questionnaire. RESULTS: The AHSP Questionnaire had been administered only to 44 of the 103 patients present at the survey because of the high prevalence of cognitive impairment. AHSP score is lower in presence of malnutrition assessed with MNA (Mini Nutritional Assessment). MNA, expressed as proportional score, seems to present a clear correlation with AHSP's (r=0.59; p=0.000). CONCLUSION: The results achieved show the scarce adaptability of the AHSP Questionnaire to frail elderly people living in geriatric rehabilitation care. MNA is at the moment the most reliable tool to single out dietary deficiency on geriatrics population.
Abstract: BACKGROUND: In a previous study we tested the predictive value of the Mini Nutritional Assessment (MNA) in an Italian population of frail elderly in long-term hospital care. The results of our study confirmed the MNA's excellent overall predictive value and sensitivity. Unfortunately we had a large number of false positive judgments, hence our study's low specificity, which we think was caused by two factors: 1. in most cases it was impossible to conduct a reliable subjective assessment of the patients' nutritional and health status. 2. most patients failed to respond to some of the MNA questions, which as a consequence received a "0" score. The result was an artificially low global MNA score even in well-nourished patients. OBJECTIVE AND DESIGN: We tried to neutralize the effects of the defective answers by modifying the total score and the cut-off points of the test. Thus, we: 1. replaced the subjective assessment of health and nutritional status with an objective evaluation; 2. replaced the total score of MNA with the ratio of this value with the maximum of points that each subject can obtain without including the items for which we could not have a response. Similarly, the cut-off points (17 and 24) were replaced with the ratio of these values with the maximum of points obtainable by a complete MNA (30). Patients are classified as "malnourished" below 0.56, "at risk of malnutrition" between 0.56 and 0.79, and "well-nourished" from 0.8 up. RESULTS: This way, the overall predictive value of MNA is increased from 80.3 to 85.4% and the specificity from 12.8 to 25%, whereas the sensitivity increase is modest (from 98 to 98.1%).
Abstract: Adequate quantification of weight and stature is essential in order to determine levels of nutritional support and to monitor the effects of nutritional intervention. Traditional anthropometric techniques are difficult to apply in elderly or handicapped patients chair or bed-bound. The purpose of the present study is to elaborate regression equations for the estimation of stature in the italian elderly population from other anthropometric measures that can be more easily determined. We have found a single model valid for both sexes (in which the value of the variable "sex" equals 0 if woman and 1 if man) to predict stature in italian elderly: Stature = 94.87 + 1.58 knee-height - 0.23 age + 4.8 sex. Cross validation on a control sample of 30 males and 54 females yielded pure errors of 3.1 cm for men and 2.74 cm for women.
Abstract: We have developed two different equations, for each sex of the elderly italian population to predict weight from selected measures of recumbent anthropometry, using data of 172 females (72.8 +/- 8 years old) and 113 males (73.4 +/- 8 years old). The independent variables for both sexes were knee stature. subscapular skinfold, arm and calf circumferences. Cross validation was conducted on a free-living sample of 54 females and 30 males. The recommended equations have a 95% probability of predicting the weight of an elderly man or woman to be within plus or minus 4.9 or 6.1 Kg respectively.
Abstract: The distribution of three DNA polymorphisms (XbaI, EcoRI, and I/D) of the apolipoprotein B (APOB) gene, and of the I/D polymorphism of the angiotensin I-converting enzyme (ACE) gene was investigated in 53 patients with vascular dementia, in 80 patients with late-onset sporadic Alzheimer's disease, and in 153 age-matched control subjects. Furthermore, plasma total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were measured in the three groups and the involvement of the genetic variation at APOB locus on lipid levels was determined. Major findings of this work are (1) no genotype or allele of the polymorphisms examined here seemed to be associated with vascular dementia or with Alzheimer's disease, (2) total cholesterol and LDL cholesterol levels were lower in Alzheimer's disease patients than in vascular dementia patients and in elderly controls, and (3) the dementia patients with APOB EcoRI R+R- genotype had higher total cholesterol and LDL cholesterol levels than R+R+ homozygotes.
Abstract: Aging and malnutrition are connected by social and pathological factors; many studies show that 60-80 % of hospitalized elderly patients are malnourished. The aim of this study was to establish a correlation between age and nutritional parameters in malnourished, hospitalized, elderly patients before and after restitution by tube feeding (using Clintec chemicals) for 45 days, with a mean caloric contribution of 2670 +/- 235 Kcal/day. Twenty-three patients were examined, matched for age (80.59 + 8.35 years) and sex (11 females and 12 males). Patients affected by malignant, chronic or acute diseases that could directly increase cytokine production (TNF-a, IL-1, etc.) were excluded. Anthropometric measurements were carried out always by the same operator using a fiberglass tape measure and a Harpenden skinfold caliper. Statistical analysis was carried out by ANOVA test and linear regression analysis. The main observations before and after tube feeding were the following: (i) Significant increases were found in serum albumin, triglyceride and cholesterol levels, whereas slightly increasing tendencies occurred, without reaching statistical significance, in serum transferrin levels, in triceps skinfold (TSF) and mid arm muscle crcumference (MAMC) values. In malnourished patients close correlations were found between the age and serum albumin (r = 0.486; p = 0.022), as well as between age and MAMC (r = 0.576; p = 0.005), however, these correlations disappeared after tube feeding. These data show that age itself does not represent an important impediment for nutritional restitution; the possibilities of the latter appear to be dependent on the self-sufficiency and cognitive faculty of the patient, as measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and mini mental state evaluation (MMSE) scores (p < 0.005).
Abstract: The Apolipoprotein E (APOE) epsilon 4 allele has been found to be strongly associated with Alzheimer's disease (AD) in most studies conducted up to now, though not all investigators have established a similar association with other forms of dementia, like vascular dementia. Our study examined the APOE polymorphism in a sample of 149 dementia patients, of which there were 80 with probable sporadic late-onset AD, 16 with a mixed form of dementia (MD), and 53 with vascular dementia (VD). An elderly control sample was composed of 126 subjects. The data obtained on the whole AD sample did not confirm the association already reported with APOE epsilon 4. A difference did emerge when the subjects were subdivided on the basis of age at the examination. AD patients aged < or = 80 years significantly differed from the correspondent elderly controls, while no difference was observed between the patients aged 81 years or older and controls. This pattern could be due to a previous disadvantageous effect of the epsilon 4 allele on the subjects bearing it. A substantially similar pattern was observed in the few MD patients, while no differences were found in the two VD subgroups. The odds ratio (OR) for AD associated with at least one epsilon 4 allele was significant and equal to 3.3 (95% CI = 1.2-9.1) for the < or = 80 age class, while it was not significant and equal to 1.1 (95% CI = 0.4-2.8) for the > 80 age class. Our data indicate that in AD patients aged less than 81 years, epsilon 4 is clearly associated with AD and that it can be considered a risk factor for AD chiefly before this age.
