The treatment of Alzheimer's disease (AD) in the field of non-pharmacological interventions is a challenging issue, given the limited benefits of the available drugs. Cognitive training (CT) represents a commonly recommended strategy in AD. Recently, repetitive transcranial magnetic stimulation (rTMS) has gained increasing attention as a promising therapeutic tool for the treatment of AD, given its ability of enhancing neuroplasticity. In the present randomized, double-blind, sham-controlled study, we aimed at investigating the add-on effect of a high frequency rTMS protocol applied over the left dorsolateral prefrontal cortex (DLPFC) combined with a face-name associative memory CT in the continuum of AD pathology. Fifty patients from a very early to a moderate phase of dementia were randomly assigned to one of two groups: CT plus real rTMS or CT plus placebo rTMS. The results showed that the improvement in the trained associative memory induced with rTMS was superior to that obtained with CT alone. Interestingly, the extent of the additional improvement was affected by disease severity and levels of education, with less impaired and more educated patients showing a greater benefit. When testing for generalization to non-trained cognitive functions, results indicated that patients in CT-real group showed also a greater improvement in visuospatial reasoning than those in the CT-sham group. Interestingly, this improvement persisted over 12 weeks after treatment beginning.The present study provides important hints on the promising therapeutic use of rTMS in AD.

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.

Background The RECage Project, funded by the European Commission, in the framework of the H2020 RIA projects, has a threefold objective: a) to validate a clinical intervention (the Special Care Unit for Behavioural and Psychological Symptoms of Dementia: acronym SCU‐B); b) to adapt it and produce a consensus document on a model SCU‐B c) to promote the implementation and scaling up of the intervention. The first objective is pursued through a clinical trial comparing two cohorts of persons with dementia of any etiology and important BPSD, the first one followed by clinical centres endowed with a SCU‐B and the second by centres lacking this facility. The study involves 520 patients and the follow‐up will last three years. Presently the recruitment phase has just ended and the results are foreseen in 2023. The clinical centres are located in six countries: Italy, France, Germany, Greece, Switzerland and Norway. Method In order to provide useful data for the second and third phase of the Recage project the Consortium decided to conduct a qualitative analysis in two Italian centres, the one with SCU‐B (Gazzaniga) and the other without SCU‐B (Mantova). The aims of this qualitative study were: to provide context and needs analysis for each case, underlying strengths, weaknesses, opportunities and threats (SWOT analysis); to identify the (social) innovations promoted by SCU‐B experiences; to identify the replicability characteristics of the SCU‐Bs, to support its implementation in different context. Seven expert interviews and four focus groups have been conducted, with 40 experts and stakeholders involved by specific invitation. The focus groups have been carried out both with the professionals (physicians, physiotherapists, psychologists, occupational therapists, nursing assistants, nurses, educational workers) and with the local stakeholders (local institutions, social services, volunteers, GPs, informal caregivers). Result The qualitative analysis shows that: the SCU‐B promotes social innovation; there are opportunities to promote SI and to build a SCU‐B in context in which it is lacking; currently, the complete system seems less replicable than some specific part of it. Conclusion We hope that these preliminary results can be confirmed by future analysis and help the development of new SCU‐B.