Societá

Attivitá SIGG

Giornale di Gerontologia

Numero 6, Dicembre 2004 - Volume LII

Copertina

Editoriale

L´ impact factor delle riviste di Geriatria e Gerontologia nel 2003

M. FORONI, C. MUSSI, G. SALVIOLI

Centro di Valutazione e Ricerca Gerontologica, Universitá di Modena e Reggio Emilia

G GERONTOL 2004;52:521-527

Articoli daggiornamento

Modificazioni neuroendocrine ed invecchiamento

E. FERRARI, L. CRAVELLO, S. CHYTIRIS, F. FALVO, S.B. SOLERTE, M. FIORAVANTI, F. MAGRI

Dipartimento di Medicina Interna e Terapia Medica, Cattedra di Geriatria, Universitá di Pavia

G GERONTOL 2004;52:528-538

The neuroendocrine changes occurring with aging, although rarely clinically evident, may, however, play a role in the occurrence and/or in the progression ofmetabolic, functional and cognitive alterations. The main neuroendocrinechanges with a potential pathogenetic role are: 1) melatonin secretion, the principalhormone secreted by the pineal gland, with some possible anti-aging properties,whom secretion shows an evident age-related decline, particularly duringnight-time; 2) the hypothalamic-pituitary-adrenal axis activity, which undergoesto changes exposing the central nervous system to a neurotoxic steroidal milieu; and 3) the thyroid function, which, due to its importance in homeostasis, hasbeen deeply studied obtaining conflicting results.In this review it will be discussed the role played by these neuroendocrinechanges on physiological and pathological aging, on the basis of the literaturedata and of our personal findings.

Key words: Aging - Senile dementia - Centenarians - Melatonin - Hypothalamic-pituitary-adrenal axis - Thyroid hormones

L´artrite reumatoide nell´anziano

R. BORTOLOTTI, G. NORO

U.O. Geriatria Ospedale ″S. Chiara″, Azienda Provinciale Servizi Sanitari, Trento

G GERONTOL 2004;52:539-546

Rheumatoid arthritis is the most prevalent inflammatory arthritis and its prevalenceincreases with age in both sexes to a peak at age 70 years. Women are affectedapproximately three times more than men but sex differences diminishin the older age. Elderly onset rheumatoid arthritis is defined as a disease withan onset at age 60 years or over. A distinctive characteristic at presentation is thehigh frequency of acute onset and systemic symptoms (such fever and weightloss). Frequently large joints are involved. Some reports have indicated a reduceprevalence of rheumatoid factor positivity. The seronegative form constitute anheterogeneous group with a clinical picture overlapping with other syndromessuch as polymyalgia rheumatica and remitting seronegative symmetrical synovitiswith pitting edema (RS3PE). The majority of longitudinal studies shows aworse outcome in comparison with younger onset, because the disease is associatedwith more pronounced radiographic damage and poorer functional outcomebut most of these data relate to a positivity of rheumatoid factor. High diseaseactivity at baseline, bone erosions and comorbility are also important prognosticfactor. Given that structural damage occurs in a few time, early diagnosisand treatment is of great importance. Treatment is similar to that of youngeradultrheumatoid arthritis and must be chosen on the basis of its clinical presentationand prognostic factors. The treatment of these patients may give risesome particular problems because elderly are more.

Key words: Rheumatoid arthritis - Elderly

Articoli originali

Uso ″inappropriato″ del Comet assay per lo studio del processo di senescenza cellulare

A. MOCALI, L. GIOVANNELLI*, P. DOLARA*, V.A. MITIDIERI COSTANZA**, A. BAVAZZANO**, F. PAOLETTI

Dipartimento di Patologia e Oncologia Sperimentali, Universitá di Firenze;
* Dipartimento di Farmacologia, Universitá di Firenze; **Azienda Ospedaliera di Prato, Asl 4, Prato

G GERONTOL 2004;52:547-552

Objective: This work is aimed at disclosing some of the mechanisms involved during cellular senescence in vitro by using the Comet assay as the "conventional and unconventional" procedure.

Methods: Fetal lung fibroblasts from human MRC5 (NIA Aging Cell Repository) were propagated in DMEM plus 10% FCS and analyzed at low (PDL < 30) and high (PDL > 60) population doubling levels. Double/single DNA breaks were measured by the "alkaline Comet assay" employed also following lysis with ENDO-III, and expressed as % DNA in the Comet.

Results: The use of unconventional Comet assay has allowed to evaluate DNA damages (basal, total and oxidative) but also nuclear morphology and dimensions.Young and senescent MRC5 cultures exhibited similar levels of basal damage while the DNA oxidation level was clearly increased during senescence. This difference was not due to an increase of DNA damage in all the population; rather, there was an increased percentage of severely damaged nuclei. Senescent nuclei appeared more heterogeneous than young cells ought to the presence of large nuclei having less intense and more diffuse fluorescence. The separate analysis of either large or small nuclei showed a net correlation between DNA damage, essentially of oxidative type, and nuclear shape.

Conclusions: The contemporary analysis by Comet assay of different parameters can "fix" biologically heterogenous cultures and could provide information also on their evolution toward senescence irrespectively of their PDL.

Key words: Cellular senescence - Comet assay - DNA damage

Casi clinici

Sclerosi laterale amiotrofica (SLA): un caso clinico in etá geriatrica

F. BARONI* ***, M.K. GHISLA*, R. LEONARDI* **, V. GRASSI***

* Fondazione ″Ospedale e Casa di Riposo - Nobile Paolo Richiedei″ Gussago, Brescia; ** 1a Divisione
di Medicina Generale Azienda Ospedaliera Spedali Civili di Brescia; *** Universitá di Brescia, Cattedra
di Medicina Interna II, Scuola di Specializzazione in Geriatria

G GERONTOL 2004;52:553-558

Amyotrophic lateral sclerosis (ALS) - previously known as progressive muscular atrophy or progressive bulbar palsy - is a motor neurone disease characterized by degenerative changes most marked in the anterior horn cells of the spinal cord, the motor nuclei of the medulla and the corticospinal tracts. When associated with dementia, SLA usually presents with fronto-temporal degeneration together with motor neurone involvement.
A case of a 74 y.o. woman is presented with a suspected decline in cognitive performances: she had lost her ability to cope in basic and instrumental activities of daily living and complained of dysphagia for liquids, dysphonia, speech disturbances and nocturnal dyspnea. Thorough physical examination including neurological assessment together with radiological and neuropsychological tests allowed a primary suspicion ultimately confirmed by further specialist evaluation.
ALS affects more frequently male subjects between 45 and 75 years of age and leads to death in 2 to 3 years; its aetiology remains obscure. Clinically, progressive wasting of the muscles, especially those of upper limbs and those innervated by medulla, combines with symptoms of spinal tract degeneration. No cognitive or sensory symptoms can be attributed to ALS; patients are conscious and aware during the course of their disease. This paper describes a patient suspected to have cognitive impairment and then recognised to be affected by ALS.
Treatment of ALS remains unsatisfactory. During last years, the attitude towards this disease has changed: a pragmatic approach slowly emerged from the previous nihilism so that a better quality of life can be expected in the next years.
Neurologists usually pose the definitive diagnosis: General Practitioners as well as Geriatrics should be instructed to recognize initial neuro-muscular symptoms compatible with ALS in order to obtain early specialist consultation.

Key words: Amyotrophic lateral sclerosis (ALS) - Cognitive impairment - Quality of life

Articoli speciali

Morfologia della placca ed eventi ischemici

R. FELLIN, G.B. VIGNA

Dipartimento di Medicina Clinica e Sperimentale, Sezione di Medicina Interna, Gerontologia e Geriatria, Universitá di Ferrara

G GERONTOL 2004;52:559-562

RELAZIONE PRESENTATA IN OCCASIONE DEL 49° CONGRESSO NAZIONALE DELLA SOCIETÁ ITALIANA DI GERONTOLOGIA E GERIATRIA
FIRENZE, 3-7 NOVEMBRE 2004

Clinical and experimental evidence indicate that coronary occlusion and myocardial infarction develop more frequently from vascular stenoses of moderate-intermediate degree. In this context plaque instability, and not its dimension, may favorite thrombosis. The vulnerable plaque consists of a lipid core covered by a thin fibrous cap and inflammatory cells (macrophages, lymphocytes, mast-cells, neutrophils) capable of secreting cytokines, idrolases, pro-oxidative and pro-thrombotic substances which may cause plaque disruption. Several diagnostic imaging techniques are clinically available, or under investigation, for the detection of vulnerable plaque and will be briefly discussed.

Key words: Atherosclerosis - Vulnerable plaque - Diagnostic techniques

Nuove strategie terapeutiche per rallentare la progressione del danno artrosico

A. FIORAVANTI, G. LEO, M. FABBRONI, M. GALGANI

Dipartimento di Medicina Clinica e Scienze Immunologiche, Sezione di Reumatologia, Universitá di Siena

G GERONTOL 2004;52:563-572

RELAZIONE PRESENTATA IN OCCASIONE DEL 49° CONGRESSO NAZIONALE DELLA SOCIETÁ ITALIANA DI GERONTOLOGIA E GERIATRIA
FIRENZE, 3-7 NOVEMBRE 2004


The treatment of Osteoartritis (OA) is today aimed at controlling symptoms as well as at preventing or retarding progression of structural modifications involving joint tissues (cartilage, bone, synovium, ligaments and muscles). To this purpose the academia and pharmaceutical industry have developed a novel category of drugs defined in the past as chondroproptective agents which are now called Structure Modifying Drugs in OA.
Several pharmacological agents are currently being studied as structure modifying drugs. These drugs range from empirical compounds to specific inhibitors of metalloproteinases or cytokines.
Several compounds have shown symptomatic and structural activity in OA. So far the most compelling evidence of a potential for inhibiting the progression of OA is obtained with glucosamine sulphate, while some hints also suggest that chondroitin sulphate, diacerein, avocado/soybean unsaponificables and intraarticular hyaluronic acid could be in the same indications.
As regards the molecules currently in use, it is necessary to clarify which clinical and radiological stages should be selected for administration of a disease modifying therapy, which are its most appropriate administration modalities and schedules, which are the most effective and best tolerated drugs, and the time required for a good clinical response to be obtained.

Key words: Osteoarthritis - Chondroprotective agents - Structure modifying drugs

Atti Congresso

COMUNICAZIONI E POSTER PRESENTATI IN OCCASIONE DEL 49° CONGRESSO NAZIONALE DELLA SOCIETÁ ITALIANA DI GERONTOLOGIA E GERIATRIA

FIRENZE, 3-7 NOVEMBRE 2004


G GERONTOL 2004;52:573-578