Publications by authors named "Martina Valletta"

11 Publications

  • Page 1 of 1

Supporting and Protecting People with Dementia in the COVID-19 Pandemic.

J Alzheimers Dis 2021 Jun 30. Epub 2021 Jun 30.

Department of Human Neuroscience, Sapienza University, Rome, Italy.

We aimed to explore the awareness and preparedness of dementia caregivers and people with mild cognitive deficits on how to prevent COVID-19 infection and cope with the indirect consequences of the pandemic. A total of 139 patient-caregiver dyads received a telephone survey and 109 completed the survey. The majority of respondents reported having a moderate-to-good knowledge of the typical manifestations of COVID-19. Conversely, only few of them were informed of the atypical presentations and on how to recognize emergency warning signs. Filling the knowledge gaps on COVID-19 in the most vulnerable people may represent a significant resource to tackle the pandemic.
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http://dx.doi.org/10.3233/JAD-210264DOI Listing
June 2021

Use of Biomarkers in Ongoing Research Protocols on Alzheimer's Disease.

J Pers Med 2020 Jul 24;10(3). Epub 2020 Jul 24.

National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, 00161 Rome, Italy.

The present study aimed to describe and discuss the state of the art of biomarker use in ongoing Alzheimer's disease (AD) research. A review of 222 ongoing phase 1, 2, 3, and 4 protocols registered in the clinicaltrials.gov database was performed. All the trials (i) enrolling subjects with clinical disturbances and/or preclinical diagnoses falling within the AD continuum; and (ii) testing the efficacy and/or safety/tolerability of a therapeutic intervention, were analyzed. The use of biomarkers of amyloid deposition, tau pathology, and neurodegeneration among the eligibility criteria and/or study outcomes was assessed. Overall, 58.2% of ongoing interventional studies on AD adopt candidate biomarkers. They are mostly adopted by studies at the preliminary stages of the drug development process to explore the safety profile of novel therapies, and to provide evidence of target engagement and disease-modifying properties. The biologically supported selection of participants is mostly based on biomarkers of amyloid deposition, whereas the use of biomarkers as study outcomes mostly relies on markers of neurodegeneration. Biomarkers play an important role in the design and conduction of research protocols targeting AD. Nevertheless, their clinical validity, utility, and cost-effectiveness in the "real world" remain to be clarified.
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http://dx.doi.org/10.3390/jpm10030068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564515PMC
July 2020

Role of frailty in the assessment of cognitive functioning.

Mech Ageing Dev 2019 07 3;181:42-46. Epub 2019 Jun 3.

Department of Human Neuroscience, Sapienza University, Rome, Italy.

Neuropsychological tests, besides reflecting the cognitive reserves and deficits of the tested individual, might also be differently affected by his/her underlying biological asset. In this context, the construct of frailty may offer an opportunity for better weighting the results of traditional tests. We evaluated the relationships between a set neuropsychological measures and a 35-item Frailty Index (FI). The role played by the FI in the relationship between neuropsychological tests and global cognition was also explored. Data from the first neurological and neuropsychological assessments of 79 subjects attending our university memory clinic because complaining cognitive disturbances were considered for the present analysis. A statistically significant correlation between FI and Trail Making Test-B was observed (Spearman's rho 0.33; p = 0.02). The relationship between the performance at the Rey Complex Figure and global cognition (as measured by the Mini Mental State Examination) was influenced by the FI. In fact, participants with higher FI levels had a weakened association linking constructional/visual memory abilities and general cognitive functioning. The interpretation of the neuropsychological assessment can be biased by the frailty status of the tested individual. It can be hypothesized the need of developing new models of correction, that may better reflect the person's biology and complexity.
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http://dx.doi.org/10.1016/j.mad.2019.111122DOI Listing
July 2019

Race reporting and disparities in clinical trials on Alzheimer's disease: A systematic review.

Neurosci Biobehav Rev 2019 06 1;101:122-128. Epub 2019 Apr 1.

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Geriatric Unit, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy.

Introduction: Race is an important health determinant and should adequately be considered in research and drug development protocols targeting Alzheimer's disease (AD).

Methods: A systematic review of available randomized controlled trials (RCTs) on the currently marketed treatments for AD was conducted with the aim of 1) documenting the reporting of race, and 2) exploring the impact of race on the efficacy and safety/tolerability of the considered medications.

Results: Overall, 59.2% of the 49 retained RCTs reported information concerning the race of participants. Only a striking minority of enrolled patients was constituted of blacks and Hispanics. None on the retained studies reported results on the efficacy and safety/tolerability of the tested treatment separately for racial groups nor performed sensitivity analyses accounting for the race of participants.

Discussion: Race has insufficiently been reported in previous interventional studies on AD. Its potential association with the effectiveness and safety/tolerability of the tested medications has completely been neglected.
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http://dx.doi.org/10.1016/j.neubiorev.2019.03.020DOI Listing
June 2019

Counting deficits or diseases? The agreement between frailty and multimorbidity in subjects with cognitive disturbances.

Aging Clin Exp Res 2020 Jan 6;32(1):179-182. Epub 2019 Mar 6.

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

In the present study, we explored the relationship between multimorbidity and frailty in a population of older individuals with cognitive disturbances attending a memory clinic. All subjects consecutively attending the Memory Clinic of the Department of Human Neuroscience, "Sapienza" University of Rome, between January 2017 and April 2018 for a first neurological evaluation were considered for the present analysis. Multimorbidity was defined as the simultaneous presence of two or more diseases in the same individual. A Frailty Index was computed by considering 44 age-related, multidimensional health deficits. Overall, 185 subjects were recruited in the study. A condition of multimorbidity was detected in 87.6% of the sample, whereas only the 44.6% of the study population was considered as frail. A poor agreement was observed between multimorbidity and frailty. The present findings confirm that counting diseases or health deficits may provide discordant information concerning the risk profile of older subjects.
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http://dx.doi.org/10.1007/s40520-019-01161-2DOI Listing
January 2020

Parkinson's disease among migrants in Europe: estimating the magnitude of an emerging phenomenon.

J Neurol 2019 May 14;266(5):1120-1126. Epub 2019 Feb 14.

Department of Human Neuroscience, Sapienza University, Viale dell'Università 30, 00185, Rome, Italy.

Introduction: The occurrence of age-related pathological conditions among subjects with a migration background and composing ethnic minorities is an emerging challenge for Western countries. Specifically, the onset of neurodegenerative diseases in these populations of individuals might assume special relevance and generate additional complexities for our healthcare systems. The aim of the present study was to estimate the number of Parkinson's disease (PD) cases in migrant subjects living in Europe.

Methods: The estimated cases of PD among ≥ 50-year-old migrants living in Europe, and in each of the 32 considered countries, were calculated by multiplying the number of migrants (derived by the Eurostat data) with the age-specific prevalence rates of PD (obtained by a recent meta-analysis).

Results: Nearly 20 million migrants ≥ 50 years lived in Europe in 2017. The application of the age-specific prevalence rates led to the estimation of 129,645 overall PD cases in this population, accounting for the 8% of overall PD cases in Europe. National estimates widely ranged from 36 cases in Iceland to 29,390 cases in France.

Conclusion: The present findings suggest that the occurrence of PD in migrants and minority groups already constitutes an important issue for European healthcare systems and will assume further relevance given the rapidly evolving sociodemographic scenario. Characterizing the phenomenon at the "real world" level and implementing coordinated initiatives and strategies represent novel but pressing needs for our countries.
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http://dx.doi.org/10.1007/s00415-019-09241-zDOI Listing
May 2019

Migrants seeking help for cognitive disturbances: exploratory data from an Italian memory clinic.

Neurol Sci 2019 Apr 4;40(4):857-859. Epub 2018 Dec 4.

Department of Human Neuroscience, "Sapienza" University, Rome, Italy.

Introduction: The phenomenon of dementia occurring in migrants and minority groups constitutes an emerging issue for Western countries. Nevertheless, it has been poorly explored from the perspective of "real-world" clinical services. We aimed to quantify the number of migrants from LMIC attending an Italian university memory clinic and to document its modifications over time.

Methods: All the subjects undergoing a first neurological and cognitive assessment between 2001 and 2017 were considered for the present analyses.

Results: The proportion of subjects from LMIC performing a first cognitive evaluation was found to remain substantially stable between 2001 and 2017. No statistically significant difference was found between "HIC" and "LMIC" individuals with regard to sociodemographic and clinical characteristics.

Conclusion: These findings seem to indicate that cognitive disorders in LMIC migrants still constitute a marginal public health issues for Italian dementia services. Nevertheless, the identification of eventual sociocultural and healthcare barriers may help to understand the real magnitude and relevance of this phenomenon.
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http://dx.doi.org/10.1007/s10072-018-3663-0DOI Listing
April 2019

Estimating dementia cases in the immigrant population living in Italy.

Neurol Sci 2018 Oct 15;39(10):1775-1778. Epub 2018 Jun 15.

National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy.

Introduction: The phenomenon of dementia among immigrants and ethnic minorities represents an emerging challenge for Western countries. The aim of the present study was to estimate the number of dementia cases among immigrant subjects residing in Italy and in each Italian region to provide pivotal information on the magnitude of such public health issue.

Method: The number of immigrant individuals, aged 65 years or older, living in Italy and in the 20 Italian regions was derived by the 2017 data of the National Institute for Statistics. The dementia prevalence rates were taken from the European data provided by the Neurologic Diseases in the Elderly Research Group. The estimated dementia cases were calculated by multiplying the number of immigrants with the age- and sex-specific prevalence rates.

Results:  Overall, 186,373 older immigrant subjects lived in Italy in January 2017. Nearly 7700 dementia cases were estimated in this population (5022 among women, 2725 among men). When considering each specific Italian region, the number of estimated cases ranged from 19 (Basilicata) to 1500 (Lombardia) with a marked inter-regional variability.

Discussion: Our findings indicate that the occurrence of dementia among immigrants and ethnic minorities constitutes a novel but already relevant issue for our healthcare systems. A non-negligible number of immigrant individuals is probably already seeking or might seek help for cognitive disturbances, thus potentially referring to general practitioners and/or to the Italian dementia services. The forecasted increasing magnitude of this phenomenon reinforces the need for tailored and locally oriented initiatives and policies.
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http://dx.doi.org/10.1007/s10072-018-3475-2DOI Listing
October 2018

Need to Recalibrate Research Outcomes in Alzheimer's Disease: Focus on Neuropsychiatric Symptoms.

J Am Geriatr Soc 2017 Sep 6;65(9):2071-2073. Epub 2017 Jul 6.

Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy.

Objectives: To determine whether neuropsychiatric symptoms (NPSs) are adequately considered in clinical research on Alzheimer's disease (AD).

Design: Systematic review.

Setting: Randomized controlled trials (RCTs) recruiting individuals with AD and published during the last 10 years in 16 major general medicine, neurology, psychiatry, and geriatric psychiatry journals and RCTs registered on clinicaltrials.gov and currently enrolling individuals with AD.

Participants: Individuals with AD.

Measurements: Outcome measures adopted by the included studies.

Results: Only 21.4% of the included studies identified through the bibliographic searches had measures of NPSs as a primary outcome. Only 17.7% of the studies retrieved on clinicaltrials.gov made a specific effort to test the effect of pharmacological or nonpharmacological interventions on NPSs.

Conclusion: These findings show how rarely previous and current research on AD has considered NPSs as primary research targets. Although these symptoms are widely recognized as the most-stressful and -challenging manifestations of dementia, they are addressed much less often than other research targets.
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http://dx.doi.org/10.1111/jgs.14989DOI Listing
September 2017

Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, and Therapeutic Approaches.

Front Med (Lausanne) 2016 27;3:73. Epub 2016 Dec 27.

Department of Neurology and Psychiatry, "Sapienza" University of Rome , Rome , Italy.

Sundowning means the emergence or worsening of neuropsychiatric symptoms (NPS) in the late afternoon or early evening. This syndrome has been recognized since a long time in the field of dementing illnesses and is well known among most of health-care providers involved in the assistance of people with dementia. Indeed, it represents a common manifestation among persons with dementia and is associated with several adverse outcomes (such as institutionalization, faster cognitive worsening, and greater caregiver burden). Its occurrence and phenotypic characteristics may be influenced by diverse neurobiological, psychosocial, and environmental determinants. Moreover, it may pose diagnostic challenges in relation to other common causes of behavioral disruptions. Beside these considerations, this phenomenon has so far drawn limited clinical and scientific interest compared to other specific NPS occurring in dementias, as indicated by the lack of commonly agreed definitions, specific screening/assessment tools, and robust estimates on its prevalence. Accordingly, no randomized controlled trial specifically investigating the effectiveness of pharmacological and non-pharmacological strategies in managing this condition among demented patients has been yet conducted. In the present narrative review, we present and discuss available evidence concerning sundowning occurring in people with dementia. A special focus is given to its definitions, pathophysiological determinants, and clinical relevance, as well as to the clinical and therapeutic approaches required for its management in the daily practice.
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http://dx.doi.org/10.3389/fmed.2016.00073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187352PMC
December 2016
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