Publications by authors named "Andrea Scalvini"

7 Publications

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Association of Orthostatic Hypotension With Cerebral Atrophy in Patients With Lewy Body Disorders.

Neurology 2021 Jun 7. Epub 2021 Jun 7.

Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA.

Objective: To evaluate whether orthostatic hypotension (OH) or supine hypertension (SH) is associated with brain atrophy and white matter hyperintensities (WMH), we analyzed clinical and radiological data from a large multicenter consortium of patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB).

Methods: Supine and orthostatic blood pressure and structural magnetic resonance imaging data were extracted from PD and DLB patients evaluated at eight tertiary-referral centers in the USA, Canada, Italy, and Japan. OH was defined as a systolic/diastolic BP fall ≥20/10 mm/Hg within 3 minutes of standing from the supine position (severe, ≥30/15 mm/Hg) and SH as a BP ≥140/90 mmHg with normal sitting blood pressure. Diagnosis-, age-, sex-, and disease duration-adjusted differences in global and regional cerebral atrophy, as well as WMH were appraised using validated semi-quantitative rating scales.

Results: A total of 384 patients (310 with PD, 74 with DLB) met eligibility criteria, of whom 44.3% (n= 170) had OH, including 24.7% (n= 42) with severe OH, and 41.7% (n= 71) with SH. OH was associated with global brain atrophy (p=0.004) and regional atrophy involving the anterior-temporal (p= 0.001) and medio-temporal (p=0.001) regions, greater in severe vs. non-severe OH (p=0.001). The WMH burden was similar in those with and without OH (p=0.49). SH was not associated with brain atrophy (p=0.59) or WMH (p=0.72).

Conclusions: OH, but not SH, was associated with cerebral atrophy in Lewy body disorders, with prominent temporal region involvement. Neither OH nor SH were associated with WMH.
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June 2021

Plasma NfL, clinical subtypes and motor progression in Parkinson's disease.

Parkinsonism Relat Disord 2021 Apr 27;87:41-47. Epub 2021 Apr 27.

Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Introduction: neurofilament light chain (NfL) levels have been proposed as reliable biomarkers of neurodegeneration in Parkinson's disease (PD) but the relationship between plasma NfL, clinical subtypes of PD and motor progression is still debated.

Methods: plasma NfL concentration was measured in 45 healthy controls and consecutive 92 PD patients who underwent an extensive motor and non-motor assessment at baseline and after 2 years of follow-up. PD malignant phenotype was defined as the combination of at least two out of cognitive impairment, orthostatic hypotension and REM sleep behavior disorder. PD patients were divided according to the age-adjusted cut-offs of plasma NfL levels into high and normal NfL (H-NfL and N-NfL, respectively). A multivariable linear regression model was used to assess the value of plasma NfL as predictor of 2-years progression in PD.

Results: NfL was higher in PD patients than in controls (p = 0.037). H-NfL (n = 16) group exhibited more severe motor and non-motor symptoms, higher prevalence of malignant phenotype and worse motor progression (MDS-UPDRS-III 11.3 vs 0.7 points, p = 0.003) compared to N-NfL group (n = 76). In linear regression analyses plasma NfL emerged as the best predictor of 2-year motor progression compared to age, sex, disease duration, baseline motor/non-motor variables.

Conclusion: increased plasma NfL concentration is associated with malignant PD phenotype and faster motor progression. These findings support the role of NfL assessment as a useful measure for stratifying patients with different baseline slopes of decline in future clinical trials of putative disease-modifying treatments.
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April 2021

The impact of COVID-19 on health status of home-dwelling elderly patients with dementia in East Lombardy, Italy: results from COVIDEM network.

Aging Clin Exp Res 2020 Oct 12;32(10):2133-2140. Epub 2020 Sep 12.

IPS Cardinal Gusmini, Vertova (Bergamo), Italy.

Background: COVID-19 outbreak has led to severe health burden in the elderly. Age, morbidity and dementia have been associated with adverse outcome.

Aims: To evaluate the impact of COVID-19 on health status in home-dwelling patients.

Methods: 848 home-dwelling outpatients with dementia contacted from April 27 to 30 and evaluated by a semi-structured interview to evaluate possible health complication due to COVID-19 from February 21 to April 30. Age, sex, education, clinical characteristics (including diagnosis of dementia) and flu vaccination history were obtained from previous medical records. Items regarding change in health status and outcome since the onset of the outbreak were collected. COVID-19 was diagnosed in patients who developed symptoms according to WHO criteria or tested positive at nasal/throat swab if hospitalized. Unplanned hospitalization, institutionalization and mortality were recorded.

Results: Patients were 79.7 years old (SD 7.1) and 63.1% were females. Ninety-five (11.2%) patients developed COVID-19-like symptoms. Non COVID-19 and COVID-19 patients differed for frequency of diabetes (18.5% vs. 37.9%, p < 0.001), COPD (7.3% vs. 18.9%, p < 0.001), and previous flu vaccination (56.7% vs. 37.9%, p < 0.001). Diabetes and COPD were positively associated with COVID-19, whereas higher dementia severity and flu vaccination showed an inverse association. Among COVID-19 patients, 42 (44.2%) were hospitalized while 32 (33.7%) died. Non COVID-19 patients' hospitalization and mortality rate were 1.9% and 1.2%, respectively. COVID-19 and COPD were significantly associated with the rate of mortality.

Discussion/conclusions: A high proportion of adverse outcome related to COVID-19 was observed in home-dwelling elderly patients with dementia. Active monitoring though telehealth programs would be useful particularly for those at highest risk of developing COVID-19 and its adverse outcomes.
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October 2020

Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy.

Neurology 2020 08 22;95(7):e910-e920. Epub 2020 May 22.

From the Neurology Unit (A.B., A. Pilotto, I.L., M.G., E.B., S.B., M.C., S.C.P., V.C., A.I., M. Locatelli, S.M., B.R., L.R., A.S., F.S.d.C., N.Z., B.B., A. Pezzini, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit (A.B., A. Pilotto, C.A., A.A., S.C., E.C., M.F., S. Gipponi, P.L., L.P., R.R., L.R., I.V., B.B., A. Pezzini, A. Padovani), Vascular Neurology Unit (E.P., A.C., I.D., M.G., N.G., R.S., V.V., M.M.), and Neurophysiology Unit (S. Gazzina, U.L.), Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia; Neurology Unit (M.B.), University of Bologna; Department of Neuroimmunology and Neuromuscular Diseases (L.B.) and Neurology (M. Leonardi), Public Health and Disability Unit, Foundation IRCCS Neurological Institute Carlo Besta, Milan; and Neurology Unit (P.I.), Fondazione Poliambulanza Hospital, Brescia, Italy.

Objective: To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19).

Methods: In this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period.

Results: One hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, = 0.009) on admission.

Conclusions: Patients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.
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August 2020

Extrastriatal dopaminergic and serotonergic pathways in Parkinson's disease and in dementia with Lewy bodies: a I-FP-CIT SPECT study.

Eur J Nucl Med Mol Imaging 2019 Jul 16;46(8):1642-1651. Epub 2019 May 16.

Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, P.zzale Spedali Civili, 1, 25123, Brescia, Italy.

Purpose: The aim of the study was to evaluate extrastriatal dopaminergic and serotonergic pathways in patients with Parkinson's disease (PD) and dementia with Lewy bodies (DLB) using I-FP-CIT SPECT imaging.

Methods: The study groups comprised 56 PD patients without dementia, 41 DLB patients and 54 controls. Each patient underwent a standardized neurological examination and I-FP-CIT SPECT. Binding in nigrostriatal and extrastriatal regions of interest was calculated in each patient from spatially normalized images. The occipital-adjusted specific to nondisplaceable binding ratio (SBR) in the different regions was compared among the PD patients, DLB patients and controls adjusting for the effects of age, sex, disease duration and serotonergic/dopaminergic treatment. Covariance analysis was used to determine the correlates of local and long-distance regions with extrastriatal I-FP-CIT deficits.

Results: Both PD and DLB patients showed lower I-FP-CIT SPECT SBR in several regions beyond the nigrostriatal system, especially the insula, cingulate and thalamus. DLB patients showed significantly lower I-FP-CIT SBR in the thalamus than controls and PD patients. Thalamic and cingulate I-FP-CIT SBR deficits were correlated, respectively, with limbic serotonergic and widespread cortical monoaminergic projections only in DLB patients but exhibited only local correlations in PD patients and controls.

Conclusion: PD and DLB patients both showed insular dopamine deficits, whereas impairment of thalamic serotonergic pathways was specifically associated with DLB. Longitudinal studies are necessary to determine the clinical value of the assessment of extrastriatal I-FP-CIT SPECT.
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July 2019

Potentially Serious Drug-Drug Interactions in Older Patients Hospitalized for Acute Ischemic and Hemorrhagic Stroke.

Eur Neurol 2016 9;76(3-4):161-166. Epub 2016 Sep 9.

Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy.

Background: Polypharmacy is very common in older persons and it is associated with inappropriate prescribing and potential drug-drug interactions (DDIs). Aims of this study were to identify prevalence of DDIs in older persons with acute stroke and to evaluate the association between stroke and DDIs.

Methods: One hundred forty-six patients admitted with diagnosis of acute stroke were enrolled. The therapeutic regimen of patients was analyzed at admission to identify the number of DDIs, prevalence and sorts of serious DDIs according to subtype of acute stroke (ischemic or hemorrhagic) and to its recurrence.

Results: Five hundred eighty-two DDIs were identified: 18 mild, 415 moderate and 149 serious. Sixty-one percent of patients were exposed to at least one serious DDI. A higher percentage of patients were exposed to at least one serious DDI among those with a recurring ischemic event compared to those with a first event (74 vs. 50%; p < 0.01, respectively). Serious DDIs potentially associated with an increased risk of a cerebral event were identified in 19 (17%) patients with ischemic stroke, and in 7 (19%) patients with hemorrhagic stroke.

Conclusions: The prevalence of serious DDIs was high in aging patients with acute stroke but different according to subtype and recurrence of the cerebrovascular event.
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September 2017