Corticosteroids have been widely used for acute respiratory distress syndrome (ARDS), but their role in the early phase of SARS-CoV-2 infection is controversial. Our study aimed to determine the effectiveness of early corticosteroid therapy (ECT) in preventing the progression of disease, reducing the escalation of care and improving clinical outcome in older patients hospitalized for COVID-19 pneumonia. A total of 90 subjects (47.7% women; mean age = 82.3 ± 6.7 years) were enrolled. ECT was administered to 33 out of 90 patients before the hospitalization. At admission, no difference was detected in median SOFA score (2, IQR:2 vs. 2, IQR: 2). We found a significant difference in mean PaO₂/FiO₂ ratio during the first week of hospitalization between ECT patients and controls (F = 5.49, p = 0.002) and in mean PaO₂/FiO₂ ratio over time (F = 6.94, p < 0.0001). We detected no-significant differences in terms of in-hospital mortality and transfer to ICU between ECT patients and controls (27.1% vs. 22.8%, respectively, p = 0.63). ECT was associated with worse clinical outcomes, showing no benefit in attenuating the progression of the disease or reducing the escalation of care. These findings are crucial given the current pandemic, and further studies are needed to provide additional data on the optimal timing of initiating corticosteroid treatment.

Background: During the time-course of cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, negatively impacting the outcomes. Methods: The aim of this single center, longitudinal study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified into three clusters: “mood/apathy” (depression, apathy, sleep disturbances, appetite disturbances), “psychosis” (delusions, hallucinations, and anxiety), and “hyperactivity” (agitation, elation, motor aberrant behavior, irritability, disinhibition). Using the Clinical Frailty Scale (CFS), patients were categorized as “severely frail”, “mild/moderately frail” and “robust” (CFS ≥ 7, 4–6, and ≤ 3, respectively). Results: In total, 209 patients (mean age 83.24 ± 4.98 years) with a clinical diagnosis of dementia were enrolled. BPSD were prevalent among the severely frail patients. A positive correlation at regression analysis was found between frailty and “hyperactivity” cluster at baseline and follow-up visits (p < 0.001, p = 0.022, p = 0.028, respectively), and was confirmed at the network analysis. Loss of independence in IADL was correlated to hyperactivity and psychosis symptoms (p < 0.001 and p = 0.013, respectively). Conclusions: Scarce literature is available regarding the correlation between frailty and BPSD, which in our study is significant, especially for symptoms in the hyperactivity cluster. Frailty assessment may help identify patients at the highest risk for developing BPDS who might benefit from targeted intervention in the earliest phases of the disease.

Background: dementia is a clinical syndrome characterized by progressive cognitive decline and loss of independence in activities of daily living. Alongside the cognitive symptoms, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, causing considerable distress to both patients and caregiversMethod: aim of this retrospective study was to evaluate the correlation between frailty and BPSD in a population of older patients with dementia. BPSD were classified in three clusters: “mood/apathy”, “psychosis” and “hyperactivity”. Using the Clinical Frailty Scale (CFS), patients were categorized as “severely frail”, “mild/moderately frail” and “robust” (CFS ≥ 7, 4‐6 and ≤ 3, respectively). In order to better understand the complex pattern of relationships between the different factors, we performed a network analysis.Result: 209 patients (71.3% women, mean age 83.24±4.98 years) with a clinical diagnosis of dementia were enrolled. The most represented group was the mild/moderately frail one (n = 155, 74%); lower numbers were seen in the robust (n = 18, 9%) and severely frail (n = 36, 17%) ones. Among the “severely frail” the percentage of BPSD was higher compared to the “mild/moderate” and “robust” groups. A significant correlation between frailty and “hyperactivity” cluster emerged, both at baseline and follow up visits (p<0.001, p = 0.022, p = 0.028 respectively). At the network analysis, the degree of frailty related to behavioral and psychological symptoms of the hyperactivity cluster, such as agitation and motor aberrant activity; the relationship was still positive although not so strong with other symptoms like apathy and hallucinations.Conclusion: in this study an association between frailty and the number of neuropsychiatric symptoms of the “hyperactivity” cluster was found; however, whether the loss of independence is a possible cause of frailty or viceversa is still to be determined. The assessment of frailty may help identifying patients at risk of developing behavioral and psychological symptoms of dementia, and could provide the clinicians with a time‐window to target intervention in the earliest phases of both frail condition and BPSD.

Background: during the dementia time course Behavioral and Psychological Symptoms of Dementia (BPSD) may arise. Despite their use is still off‐label and they are associated with several side effects, antipsychotics represent the main pharmacological strategy to alleviate BPDSMethod: aim of this retrospective study was to evaluate the correlation between antipsychotics use and all‐cause mortality. BPSD were classified in three clusters: “mood/apathy”, “psychosis” and “hyperactivity”. ANOVA for repeated measures was used to evaluate the functional/cognitive changes over three time points (baseline, 6 months and 12 months follow‐up). Chi‐Square test was carried out to verify the correlation between antipsychotic drug use and mortality. Logistic regression and stepwise regression method were used to analyze the relationship between mortality and other potential influencing factors, including ADL, IADL, CFS, in addiction of antipsychotics drugs use.Result: a total of 209 patients with a clinical diagnosis of dementia were enrolled (71.3% women; mean age = 83.24±4.98 years). The results of the ANOVA indicated a significant worsening of ADL and IADL over time [ADL Wilks’ Lambda = 0.744, F(2,80) = 13.75, p<0.001, η² = 0.256, IADL Wilks’ Lambda = 0.71, F(2,80) = 16.3, p<0.001, η² = 0.29, respectively], a significant progression of cognitive impairment as measured with MMSE and a significant worsening in frailty at CFS at 6 and 12 months follow up [MMSE Wilks’ Lambda = 0.751, F(2,73) = 12.11, p<0.001, η² = 0.249, CFS Wilks’ Lambda = 0.749, F(2,79) = 13.224, p<0.001, η² = 0.241]. Patients on antipsychotic therapy reported a higher mortality rate, although there is no statistically significant association between antipsychotic use and mortality. We found no significant correlation between mortality and antipsychotic drug use within the different BPSD cluster (“mood/apathy” p = 0.464, “psychosis” p = 0.569, “hyperactivity” 0.528), and no statistically significant association between mortality and other potential influencing factors. Using a stepwise regression, the loss of independence in IADL survived as factor associated to mortality (p = 0.002).Conclusion: patients on antipsychotic therapy reported a higher mortality rate, although there is no statistically significant association between antipsychotic use and mortality. Further work is needed to establish the relationship between antipsychotics and mortality in elderly patients with dementia.