These results show a reduced ability to excrete a sodium load and early abnormalities of cardiac and hemodynamic adaptations to salt excess in patients with mild heart failure and no signs or symptoms of congestion.

The FBI is a neurobehavioral tool suitable to distinguish fv-FTD from other forms of dementia also when data from cognitive testing or other behavioral scales fail to support the differential diagnosis.

Previous in vitro studies indicate that insulin modifies vascular reactivity to different agents. We have previously demonstrated that in normotensive humans physiological hyperinsulinemia is associated with an increase of forearm norepinephrine release but does not modify vascular resistance. To explore whether insulin modulates peripheral vasoconstriction induced by reflex sympathetic activation, we studied its effects on forearm hemodynamics (strain-gauge plethysmography) during graded levels of lower body negative pressure (-5, -10, -15, and -20 mmHg, each for 5 minutes) in normotensive subjects. For this purpose, eight subjects received an intrabrachiai artery infusion of regular insulin at a systemically ineffective rate (0.05 milliunits/kg per minute) so that deep-venous insulin levels increased in the experimental forearm from 16.5±2.9 to 379.6±30 pmol/L (p<0.01), whereas arterial insulin levels remained unchanged (from 40.9±8.6 to 43.1 ±7.9 pmol/L, NS). In the control arm, forearm vascular resistance (units) increased from 52.3±3 to a peak of 78.4±5 (p<0.001) during lower body negative pressure. In the insulin-exposed forearm, vascular resistance ( recording muscle sympathetic nerve activity, forearm blood flow, and blood pressure in normotensive subjects during euglycemic hyperinsulinemia, found an increase in sympathetic discharge accompanied by an increase in forearm blood flow and a decrease in forearm vascular resistance. Thus, these authors concluded that with acute increases in plasma insulin within the physiological postprandial range, the pressor actions mediated by the sympathoexcitatory effects of insulin are offset by the vasodilator actions. More recently, we reported 4 that in both normotensive subjects and hypertensive patients during euglycemic clamp a physiological increase in plasma insulin levels is associated with a marked increase in forearm norepinephrine release with no increase in blood pressure and forearm vascular resistance. This observation further supports the hypothesis that insulin blunts vascular reactivity.However, in both those studies, insulin itself represents the stimulus for sympathetic overactivity, and therefore the direct effect of insulin on vascular reac-

in a rural community with a high prevalence of non-educated subjects, cognitive impairment is related to education, whereas independent functioning is limited mainly to age and not to cognition, if the latter remains (relatively) unimpaired. These results point to the importance of an "ecological" approach to the evaluation of elderly people, particularly those living in small rural communities, where education and the social environment may give rise to difficulties in diagnosis of dementia. The assessment of functional autonomy by ADL and IADL scales may be a better screening tool in diagnosing dementia than the MMSE scores.

Geschwind described a syndrome (Geschwind syndrome, GS) in patients with temporal lobe epilepsy, characterized by sexual behavioural disorders, hyper-religiosity, hypergraphia and viscosity. In this report we describe a patient affected by fronto-temporal dementia (FTD), who showed all the personality changes of GS without having epilepsy, and suggest that clinicians should be aware of several other features in FTD, such as hyposexuality and hypergraphia, which are usually not noted during the diagnostic evaluation.