Yesterday afternoon, in the heart of the Rome of the Popes, at the Locanda di Pietro, home of Cucina Evolution, the volume entitled Silver Universe, Views on Active Living was presented to approximately sixty persons. In spite of the difficulty of the issue, many participants decided to face the challenge to think about aging, exploring the importance of nutrition and other relevant aspects, such as prevention. I spoke about primary and secondary prevention in the pre-onset of Alzheimer's disease. Roberto Giua shared about the genesis of the edited volume with a history of the difficulties faced while encouraging prevention in Italy, compared with the predisposition in the US (thanks to AIM, Alzheimer Impact Movement), with an important emphasis on following protocols indicated by Prof. Maffei in the "Train The Brain" project. Chiara Manzi has presented her balanced and extraordinary recipes, taking into account anti-aging properties as well as the pleasure of eating relevant for well-being. Finally, Roberto Cipolla, the Chef, has elaborated on how he was able to incorporate scientific findings into his profession. Some background discussion centered on the themes of Trauma, Stigma and Caregivers treated in the book by Laura Dryjanska and Marzia Giua.

1. SILVER
UNIVERSE
V I E W S O N
A C T I V E
L I V I N G
R O M E , 1 0 - 1 4 - 2 0 1 8

2. Introduction By Laura Dryjanska And Roberto Giua
Lack of Prevention
a Slap in the Face of Intergenerational Solidarity
• Silver Universe; what is this definition?We have coined the term to avoid
speaking simply about aging, which to many seems somewhat negative.
• Are you already dead when you lose your identity due to a
neurodegenerative disease?
• This is the first question that must be asked in the cases of person affected
by neurodegenerative diseases.

3. CONT.
• We recognize that active lives should also be meaningful.
• As already mentioned, our inspiration comes from Italy, a country famous for its beauty,
healthy diet, and the ability to enjoy and valorize the pleasures of life.
• The lack of prevention is like a slap in the face of intergenerational solidarity
• A neurodegenerative disease carries a very high emotional cost for the family members,
while impacting their finances and life choices. [caregivers]

4. CONT.
• “Train the Brain” non-pharmacological program was studied and successfully implemented by
neurophysiologist Prof. Lamberto Maffei, for the prevention and treatment of
neurodegenerative forms in patients at risk, with mild cognitive impairment.The
experimentation lasted four years and cost four million euros.The project must be refinanced
and the IGEA Foundation is raising funds.
• "Train the Brain" Protocol is managed by the President of the Igea Foundation Dr. Giovanni
Anzidei
• The “Train the Brain” non-pharmacological study has demonstrated that individuals at risk,
with mild cognitive and behavioral deficits, can be identified through neurological tests. If
needed, after proper clinical investigation, brain training can also be envisaged to keep the mind
active, slow down cognitive loss, and ease recovery.The protocol is also beneficial to healthy
people in order to keep their mind awake and delay aging.

5. CONT.
• The project called “Train the Brain” (TtB) was launched in 2012 and has been successfully
applied to patients suffering from the early stages of the disease.
• Through the reports drafted by general practitioners, about 1,000 subjects have been
identified. Only 400 of these turned out to be potentially at risk and underwent further check-
ups and clinical investigation through which they were reduced to 160 subjects in all. Eighty of
them were given treatment and eighty formed the control group. Subjects who received
treatment had to attend the center every other day three times a week, subdivided into
groups of ten at a time, and performed activities for three hours a day: two hours of cognitive
stimulation and one hour of physical exercise.
• 80% of the patients who participated in the programme show a significant cognitive
improvement; of the remaining 20%, the vast majority remained stable and only two patients
have worsened. Non-treated subjects in the control group, on the other hand, show a
significant deterioration over the same span of time.

6. CONT.
• In a spirit of emphasis on relationships, especially in the context of
community, Bruni, Laganà,Addesi, Notaro, and Frangipane embark on
the difficult topic of living with the Alzheimer’s disease.
• They coin the term “identity thief” when referring to dementia.

7. CONT.
• Gabriele Carbone, in his papers, Mono-strategic and Multi-strategic Rehabilitative
Interventions for Alzheimer’s Disease, explore effectiveness of rehabilitation.
Given the current lack of therapies that can change the presumed pathogenesis of Alzheimer’s
disease (AD), the scientific community has been stimulated to explore the effectiveness of
rehabilitation interventions to manage the manifestations of the dementia syndromes in order
to delay cognitive and functional decline.
• Rehabilitation interventions used for Alzheimer’s patients can be divided into direct, when they
are performed on the patient, and indirect, when one acts on the family and the environment
in which the patient lives. Direct rehabilitation interventions can then be divided into mono-
strategic and multi-strategic interventions; indirect rehabilitative actions include
psychoeducational and environmental interventions.

8. CONT.
• In clinical terms,AD is characterized by a progressive cognitive and functional deterioration
and by forms of mental and behavioral disturbance. From the appearance of symptoms until
death, five to fifteen years can pass.
• People afflicted by this pathology develop increasing cognitive and functional, mental and
behavioral, disturbances, and during the final stages of the disease they become completely
dependent on other people for their survival.
• The conceptual base to support this rehabilitation treatment is supported but two peculiarities
of the nervous tissue: neuroplasticity and cellular redundancy (functional reserve).
• Both in animals and in man it is thus possible to obtain the reorganization and adaptation of
cerebral representations both spontaneously and following important cerebral lesions through
adequate stimulations.
• People with AD are thus able to learn or relearn.

9. CONT.
• Fabio Cembrani proposes a reflection on the moral agency of an older
person who suffers from a disease. He considers legal implications of various
international, European, and Italian documents for decision-making of the
patients themselves, doctors, and family members.
• The essence of this contribution is the reflection on human dignity in the
face of death, taking into account the tradition of European thought,
including secular and Christian influences on the current legislative situation.

10. CONT.
• Civerchia, Castellani, and Lamura emphasize psychosocial
interventions, in particular in the area of stimulation of cognition and
emotions.
• Corrigan speaks about the importance of intergenerational learning,
discussing the ethos and mission of higher education institutions.
• Dryjanska summarizes different typologies of aging, defining primary,
secondary, tertiary, and optimal aging. She also looks at aging from a
chronological and functional perspective.
• The answer to combat that stigma is intergenerational solidarity.

11. CONT.
• Marzia Giua introduces the notion of national dementia plans in Europe.
She emphasizes the importance of feeling well from the point of view of the
patterns of public health care spending.
• She advances the perspective of shifting the paradigm from ensuring the cure
available for a lower number of patients with acute diseases to emphasizing
the cures available for a higher number of patients with chronic diseases.
• She concludes that these plans are a way to guarantee basic human rights to
the citizens, taking into account their self-determination.

12. CONT.
• In the spirit of promoting active living, the nutritionist Chiara Manzi
introduces the distinction between a killer food and a long-life food.
• Antiaging nutrition, also called nutrigenomics is the study of how what we
eat can modify our DNA.
• Manzi proposes the framework of the seven pillars for the implementation
of antiaging nutrition.

13. CONT.
• The best approaches have to be communicated in an effective way to the
general public.This is the focus of the chapter by Esther Martinez Pastor
on the public service advertising that concerns aging and dementia problems
• She concludes that a common denominator of such communication consists
of the promotion of the correct use of medicine, balanced diet, vaccination
campaigns, prevention of alcohol abuse, and information about chronic
patients and mental illness.

14. CONT.
• Specific national case study of best practices is the chapter by Gino Pavia
who discusses active aging and community care in Malta.
• Based on the principles of participation and social inclusion he introduces
the pillars of a balanced care strategy promoted by the country.

15. CONT.
• From a theological and bioethical perspective, Scott Rae provides an
extensive reflection upon death and dying. He discusses the notion of death
with dignity, what should be the overarching goal of medical efforts aimed at
improving the quality of life, and not solely combating isolated diseases.
• Based on the Scriptural view of human life as the sacred gift from God and the
notion of Imago Dei, he argues that death does not have to be seen as an
enemy.
• The author concludes with an important reflection on physician-assisted
suicide and end-of-life care, expanding on the notion of a “good death.”

16. CONT.
• Marco Ricceri provides a timely reflection upon the European Pillar of Social
Rights, concentrating on its intergenerational implications.
• In the international scenario, the goal is to make human capital prosperous by
positioning intergenerational solidarity as the factor of economic development
and not a social cost.

17. CONT.
• Richard Shope provides a perfect closure to the volume by describing his
personal experience with the art of a mine. He considers theoretical
underpinnings of the nature of this art, in the face of meaning-making and
communication.
• Especially when cognitive and physiological resources diminish, a person can
revert to the power of imagination expressed in movement.
• He provides practical guidelines on how a psychotherapist or physical
therapist can include my miming techniques in order to make their practice
more efficient.

18. ROBERTO GIUA & LAURA DRYJANSKA
RINGRAZIANO
• Per maggiori informazioni
• commissione.rotary@gmail.com
• laura.dryjanska@biola.edu