Patrizia Lorenzini

Introduction: Older people and individuals with chronic illnesses living in long-term care facilities are at increased risk of infections due to the care setting, resulting in an increased probability of contracting SARS-CoV-2 and experiencing severe sequelae during the COVID-19 pandemic. To limit viral transmission, facilities adopted different policies according to national and regional prevention strategies, often reducing social contacts and promoting public health measures. We therefore conducted a national survey to investigate the impact of COVID-19 infection in Italian retirement homes for older adults and persons with disabilities (RHOAD). Methods: An online questionnaire investigating facility characteristics and COVID-19 impact between March 2023 and January 2024 was sent via email to Italian RHOAD. Results: Response from 510 RHOAD showed a trend in the percentage of COVID-19-positive individuals similar to that observed in Italy. An increase in cases was recorded in 2020, followed by a gradual decrease in 2021. Specific facility characteristics, such as a larger number of beds (80 or more vs. 0–20, OR 2.97, 95%CI 1.10–8.03), or challenges in transferring (OR 11.79, 95%CI 3.32–41.91) or isolating residents with COVID-19 (OR 4.43, 95%CI 2.13–9.22) or geographical location in the South (OR 0.17 95%CI 0.07–0.39) or Center (OR 0.39 95%CI 0.16–0.93) vs. North, were associated with an increased risk of having at least one COVID-19 case among residents in the multivariable logistic regression analysis. Similarly, facilities reporting at least one COVID-19 case applied national prevention measures related to visitor access less strictly (OR 2.16 95%CI 1.06–4.38) and registered an increase of adverse events (OR 2.49 95%CI 1.17–5.27). Discussion: Our findings highlighted the challenges faced by Italian RHOAD during the pandemic and support the optimization of the RHOAD organization to prevent disease transmission.

Background: Nursing homes (NHs) that provide for people with dementia (PWD) are responsible for meeting the needs of patients and their families through medical, personal, and rehabilitative care. However, little is known regarding the Italian facilities. Objective: To describe the characteristics of NHs and to detail the care services and treatments provided. Methods: In 2023, the Italian National Institute of Health conducted a national survey to assess dementia care services and update the Dementia Observatory's online Map of Services through a detailed facility questionnaire. Results: Overall, 1671 NHs accommodating PWD participated, representing 46.3% of facilities and 53.1% of beds. Significant disparities emerged when estimating the number of PWD per available NH across macro-area (North 214; Centre 332; South/Islands 850). R2D classification was more frequent in southern than central and northern facilities (28%, 10.9%, and 13.1%, respectively; p<0.001). Northern facilities had more rooms (North: 46, Centre: 28, South and Islands: 29; p<0.001) and beds (North: 87, Centre: 55, South and Islands: 58; p<0.001). Southern NHs had shorter admission wait times and longer stays. Conversely, Northern facilities had more staff, better training, and more digital systems and were more often integrated with day care centers and palliative care services. Conclusions: This is the first national study assessing the accessibility and affordability of Italian NHs housing PWD. The lack of special units, tailored environments and uneven services distribution and staff highlight the fragmentation of Italy's long-term care system. NH geographical distribution is inconsistent with epidemiological estimates of PWD.

Objectives: A national survey was conducted in the Italian Day Care Centers hosting people with dementia (DCCs). This national survey aimed to describe the characteristics, the organizational structure and the opening period during the COVID‐19 pandemic of the DCCs. Methods: A list of all national DCCs was provided by representatives from each Italian region. The online questionnaire consisted of two main parts: a profile section (location, access) and a data collection form (organization, services, treatments, activities, and any discontinuation of the services due to the COVID‐19 outbreak). Results: A total of 1084 DCCs were included in the study after verifying their actual capacity to accommodate persons with dementia. Overall, 443 facilities (41%) completed the profile section and 300 (27,7%) also completed the data collection form. Most of the DCCs participating in the survey were privately owned facilities affiliated with the Regional Health Service (88.5% vs. 11.5% of public facilities). The imbalance in favor of private facilities was present in all three Italian macro‐areas, particularly in the North, where almost all facilities were private (private vs. public, North 97.1% vs. 2.9%, Center 65.5% vs. 34.5%; Southern and Islands 75.5% vs. 24.5%). Only one‐fifth of the facilities exclusively admitted people with dementia. As regards the pandemic period, only 6% of facilities remained always open in 2020, in 2021 the percentage increased, with 48% of the facilities reported as open. Conclusions: This paper presents an overview of the current situation of DCCs in Italy, showing still considerable heterogeneity based on geographic location. The survey finally highlights how the COVID‐19 pandemic emergency has impacted the activities of these types of facilities.

Background: Increasing life expectancy will lead to more people living with dementia (PLwD) and, consequently, more caregivers experiencing burden. Caregivers burden is influenced by characteristics of both PLwD and caregivers themselves, as well as healthcare services organisation. The COVID‐19 pandemic and lockdown measures implemented in Italy worsened PLwD and their caregivers' well‐being. Recognising the importance of understanding the profiles and care needs of PLwD and their caregivers, a national survey was conducted within the Italian Fund for Alzheimer's and Dementias to investigate the sociodemographic characteristics of PLwD caregivers and their care recipients in Italy. This study aimed to describe the characteristics of Italian caregivers of PLwD, their use of services, and satisfaction with the latter. Methods: A cross‐sectional national survey was conducted. A self‐administered questionnaire was developed consisting mainly of multiple‐choice questions. Results: A total of 2369 caregivers participated in the survey. Most of them resided in Northern Italy (60.1%), were females (73.4%) and care recipients' children (74.1%). Median diagnostic delay ranged from 7 to 36 months. Diagnosis was formulated mainly by a physician from a Centre for Cognitive Disorders and Dementia. Caregiver training was poorly reported (34.1%). PLwD clinical condition worsened during the pandemic. The mean degree of satisfaction with services dedicated to dementia was “acceptable”. Negative/very negative degree of satisfaction was associated with not living in the North, increased caregiver's age, not having received training, severe degree of disease, having received the diagnosis suspicion from a private doctor, and not having used day care centres or Centres for Cognitive Disorders and Dementia. Conclusions: Differences in the sociodemographic profile of caregivers and disparity in services across Italy emerged. The establishment of a comprehensive, accessible, and well‐integrated network of services across all stages of the disease progression is needed.

Background: The Italian Fund for Alzheimer’s and other dementias approved in 2020 enabled the conducting of a survey in the Italian Centers for Cognitive Disorders and Dementias (CCDDs) to analyse the organization, the administrative features and the professionals’ characteristics. Aims: To investigate the current use of neuropsychological (NP) tests in Italian CCDDs and the association between the use of a basic set of tests for neuropsychological assessment (NPA) and organizational/structural characteristics of CCDDs. Methods: A survey was conducted with an online questionnaire in all CCDDs between July 2022 and February 2023. To verify the use of a comprehensive NPA in the diagnosis of cognitive disorders and dementia, we identified a minimum core test (MCT). Results: The CCDDs using a Minimum Core Test (MCT) significantly increased from 45.7% in 2015 to the current 57.1%. Territorial CCDDs using MCT significantly increased from 24.9% in 2015 to 37% in 2022 (p = 0.004). As multivariable results, the presence of psychologist/neuropsychologist in the staff and the University-based/IRCCS CCDDs increased the probability of using MCT (OR = 9.2; 95% CI 5.6–15.0; p < 0.001 and OR = 5.4; 95% CI 1.9–15.9; p = 0.002, respectively), while CCDDs in Southern Italy-Islands showed a lower probability than those in the North (OR = 0.4; 95% CI 0.2–0.7; p = 0.001). Discussion: Almost half of CCDDs (43%) do not use MCT in their clinical practice. The presence of the psychologist/neuropsychologist on the staff has a key role in the adoption of MCT and regional differences have increased over the past years. NPA is crucial in the diagnostic process and in characterizing risk profiles in order to implement targeted interventions for risk reduction. Conclusions: Our results could help to identify good practices aimed at improving dementia diagnosis. An intervention by health policymakers is urgently needed with the aim of improving diagnostic appropriateness and overcoming regional differences.

Background: The wait for the upcoming disease-modifying therapies (DMT) for Alzheimer’s disease in Europe is raising questions about the preparedness of national healthcare systems to conduct accurate diagnoses and effective prescriptions. In this article, we focus on the current situation in Italy. Objective: The primary goal is to propose a profile of the Italian Centers for Cognitive Disorders and Dementias (CCDDs) that could be taken into consideration by regional and autonomous provincial authorities when deciding on the prescribing centers for DMT. Methods: Based on responses to a national survey on CCDDs in Italy, we identified the CCDDs that meet the requirements for effective prescription: 1) Multidisciplinary team; 2) Minimum Core Test for the neuropsychological assessment; 3) PET, CSF, and Brain MRI assessments. Univariate and multivariate comparisons were conducted between CCDDs that met the criteria and the others. Results: Only 10.4% of CCDDs met the requirements for effective DMT prescription, mainly located in Northern Italy. They are also characterized by longer opening hours, a higher number of professionals, a university location, and a higher frequency of conducting genetic tests, and could potentially result in prescribing centers. Conclusions: The findings suggest that the Italian national healthcare system may benefit from further enhancements to facilitate the effective prescription of DMTs. This could involve initiatives to reduce fragmentation, ensure adequate resources and equipment, and secure sufficient funding to support this aspect of healthcare delivery.

Introduction: A new national survey has been carried out by the Italian Centers for Cognitive Disorders and Dementias (CCDDs). The aim of this new national survey is to provide a comprehensive description of the characteristics, organizational aspects of the CCDDs, and experiences during the COVID-19 pandemic. Methods: A list of all national CCDDs was requested from the delegates of each Italian region. The online questionnaire is divided in two main sections: a profile section, containing information on location and accessibility, and a data collection form covering organization, services, treatments, activities, and any service interruptions caused by the COVID-19 outbreak. Results: In total, 511 out of 534 (96%) facilities completed the profile section, while 450 out of 534 (84%) CCDDs also completed the data collection form. Almost half of the CCDDs (55.1%) operated for 3 or fewer days a week. About one-third of the facilities had at least two professional figures among neurologists, geriatricians and psychiatrists. In 2020, only a third of facilities were open all the time, but in 2021, two-thirds of the facilities were open. Conclusion: This paper provides an update on the current status of CCDDs in Italy, which still shows considerable heterogeneity. The survey revealed a modest improvement in the functioning of CCDDs, although substantial efforts are still required to ensure the diagnosis and care of patients with dementia.

The main aim of this study was to describe the clinical and immunological outcomes, as well as the inflammatory profile, of patients with advanced HIV in an assisted-living facility in which an outbreak of SARS-CoV-2 occurred. SARS-CoV-2 humoral and specific T-cell response were analyzed in patients with HIV infection and COVID-19; as a secondary objective of the analysis, levels of the inflammatory markers (IL-1β, IL-6, IL-8, and TNFα) were tested in the HIV/COVID-19 group, in HIV-positive patients without COVID-19, and in HIV-negative patients with mild/moderate COVID-19. Antibody kinetics and ability to neutralize SARS-CoV-2 were evaluated by ELISA assay, as well as the inflammatory cytokines; SARS-CoV-2 specific T-cell response was quantified by ELISpot assay. Mann–Whitney or Kruskal–Wallis tests were used for comparisons. Thirty patients were included with the following demographics: age, 57 years old (IQR, 53–62); 76% male; median HIV duration of infection, 18 years (15–29); nadir of CD4, 57/mmc (23–100) current CD4 count, 348/mmc (186–565). Furthermore, 83% had at least one comorbidity. The severity of COVID-19 was mild/moderate, and the overall mortality rate was 10% (3/30). Additionally, 90% of patients showed positive antibody titers and neutralizing activity, with a 100% positive SARS-CoV-2 specific T-cell response over time, suggesting the ability to induce an effective specific immunity. Significantly higher levels of IL-6, IL-8, and TNF-α in COVID-19 without HIV vs. HIV/COVID-19 patients (p < 0.05) were observed. HIV infection did not seem to negatively impact COVID-19-related inflammatory state and immunity. Further data are mandatory to evaluate the persistence of these immunity and its ability to expand after exposure and/or vaccination.

The optimal therapeutic approach for primary HIV infection (PHI) is still debated. We aimed to compare the viroimmunological response to a four- versus a three-drug regimen, both INSTI-based, in patients with PHI. This was a monocentric, prospective, observational study including all patients diagnosed with PHI from December 2014 to April 2018. Antiretroviral therapy (ART) was started, before genotype resistance test results, with tenofovir/emtricitabine and either raltegravir plus boosted darunavir or dolutegravir. Cumulative probability of virological suppression [VS] (HIV-1 RNA< 40 cp/mL), low-level HIV-1 DNA [LL-HIVDNA] (HIV-1 DNA < 200 copies/10⁶PBMC), and CD4/CD8 ratio ≥1 were estimated using Kaplan–Meier curves. Factors associated with the achievement of VS, LL-HIVDNA, and CD4/CD8 ≥ 1 were assessed by a Cox regression model. We enrolled 144 patients (95.8% male, median age 34 years): 110 (76%) started a four-drug-based therapy, and 34 (24%) a three-drug regimen. Both treatment groups showed a comparable high probability of achieving VS and a similar probability of reaching LL-HIVDNA and a CD4/CD8 ratio ≥1 after 48 weeks from ART initiation. Higher baseline HIV-1 RNA and HIV-1 DNA levels lowered the chance of VS, whereas a better preserved immunocompetence increased that chance. Not statistically significant factors associated with LL-HIVDNA achievement were found, whereas a higher baseline CD4/CD8 ratio predicted the achievement of immune recovery. In PHI patients, the rapid initiation of either an intensified four-drug or a standard three-drug INSTI-based regimen showed comparable responses in terms of VS, viral reservoir size, and immunological recovery.

Background: There is conflicting evidence for how HIV influences COVID-19 infection. The aim of this study was to compare characteristics at presentation and the clinical outcomes of people living with HIV (PLWH) versus HIV-negative patients (non-PLWH) hospitalized with COVID-19. Methods: Primary endpoint: time until invasive ventilation/death. Secondary endpoints: time until ventilation/death, time until symptoms resolution. Results: A total of 1647 hospitalized patients were included (43 (2.6%) PLWH, 1604 non-PLWH). PLWH were younger (55 vs. 61 years) and less likely to be with PaO₂/FiO₂ < 300 mmHg compared with non-PLWH. Among PLWH, nadir of CD4 was 185 (75–322) cells/μL; CD4 at COVID-19 diagnosis was 272 cells/μL (127–468) and 77% of these were virologically suppressed. The cumulative probability of invasive mechanical ventilation/death at day 15 was 4.7% (95%CI 1.2–17.3) in PLWH versus 18.9% (16.9–21.1) in non-PLWH (p = 0.023). The cumulative probability of non-invasive/invasive ventilation/death at day 15 was 20.9% (11.5–36.4) in PLWH versus 37.6% (35.1–40.2) in non-PLWH (p = 0.044). The adjusted hazard ratio (aHR) of invasive mechanical ventilation/death of PLWH was 0.49 (95% CI 0.12–1.96, p = 0.310) versus non-PLWH; similarly, aHR of non-invasive/invasive ventilation/death of PLWH was 1.03 (95% CI 0.53–2.00, p = 0.926). Conclusion: A less-severe presentation of COVID-19 at hospitalization was observed in PLWH compared to non-PLWH; no difference in clinical outcomes could be detected.