2023, Articolo in rivista, ENG
Veronese, Nicola; Soysal, Pinar; Demurtas, Jacopo; Solmi, Marco; Bruyère, Olivier; Christodoulou, Nikos; Ramalho, Rodrigo; Fusar-Poli, Paolo; Lappas, Andreas; Pinto, Daniel; Frederiksen, Kristian Steen; Corbi, Grazia Maria; Karpenko, Olga; Georges, Jean; Duraes, Joao; Schlögl, Mathias; Yilmaz, Ozlem; Sieber, Cornel; Shenkin, Susan; Smith, Lee; Reginster, Jean-Yves; Maggi, Stefania; Limongi, Federica; Ars, Joan; Barbagallo,Mario ; Cherubini, Antonio; Quinn, Terry on behalf of Alzheimer Europe, European College of Neuropsychopharmacology, European Geriatric Medicine Society (Lead Society), European Interdisciplinary Council on Ageing, European Society of Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, International Association of Gerontology and Geriatrics-European Region, Scottish Brain Health ARC, World Psychiatry Association-Preventive Psychiatry Section, and endorsed by the European Academy of Neurology
Background: Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines. Objectives: To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia. Methods: Guideline content was developed with input from several scientific and lay representatives' societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels. Recommendations: Physical activity may be considered for the primary prevention of dementia. In people with MCI there is continued uncertainty about the role of physical activity in slowing the conversion to dementia. Mind-body interventions have the greatest supporting evidence. In people with moderate dementia, exercise may be used for maintaining disability and cognition. All these recommendations were based on a very low/low certainty of evidence. Conclusions: Although the scientific evidence on the beneficial role of physical activity and exercise in preserving cognitive functions in subjects with normal cognition, MCI or dementia is inconclusive, this panel, composed of scientific societies and other stakeholders, recommends their implementation based on their beneficial effects on almost all facets of health.
2022, Contributo in volume, ENG
Tonacci, Alessandro; Biba, Jorilda; Sansone, Francesco; Billeci, Lucia; D'Angelo, Gennaro; Minichiello, Immacolata; Conte, Raffaele; Pratali, Lorenza
Nowadays, wearable biomedical sensors provide a challenging opportunity to measure physiological parameters in an unobtrusive manner; therefore, they can be applied in nearly any scenarios with protocols adapted to the end-user evaluated. Furthermore, the opportunities offered by the new development in the field of Information and Communication Technology (ICT) allow such devices to be checked in real-time by means of a smartphone or tablet, further enhancing their usefulness. Recently, a growing interest in wearables was seen for their application in monitoring the health status of elderly people, which might benefit from a continuous control of their parameters without continuously getting to the General Practitioner (GP). As such, wearables are also used within scientific research for studying the physiological reactions to particular stimuli. Here, we evaluated the variation in electrocardiogram (ECG) parameters in a cohort of 44 subjects with Mild Cognitive Impairment (MCI), a pre-clinical condition often leading to dementia in a relatively short amount of time. Such parameters, often referred to the activation of the Autonomic Nervous System (ANS), were checked before, during and after a session of light physical activity in two different phases: i) at T0, and ii) after a 7-month treatment consisting of regular sessions of cognitive and physical training and advices about correct lifestyle (T1). Satisfaction questionnaires, as well as data from wearables were acquired and discussed, reporting an optimal usability for the devices by theMCI population and an effect, both at T0 and T1, for the physical activity on the autonomic parameters.
2022, Abstract in atti di convegno, ENG
Catricalà B.; Manca M.; Paternò F.; Santoro C.
Currently, cognitive stimulation exercises conducted with Mild Cognitive Impairment (MCI)-affected older adults are typically administered by care professionals through exercises, which require a high degree of involvement by professional therapists, and are often perceived as tedious by the older adults. We aim to offer novel digital training through serious games designed using personally relevant material from the older adults' life. They will be based on memories associated with their biography, thus making interactions personalised, relevant, and more engaging. The serious games can be accessed through humanoid robots, which can make the training exercise more engaging because of their human-like behaviour. In this paper we discuss our approach to biography-based games for older adults
2021, Articolo in rivista, ENG
Manca M.; Paterno F.; Santoro C.; Zedda E.; Braschi C.; Franco R.; Sale A.
The number of Mild Cognitive Impairment (MCI) older adults is increasing; thus, it becomes more and more important to provide them with support to avoid, or at least slow down, their cognitive decline. To this end, interactive serious games can play an important role. So far, most of them have been deployed through tablets, which represent a cost-effective solution, yet offering only limited possibilities for truly engaging such users in a multimodal manner. However, emerging humanoid robots, through their physical embodiment and human-like attributes, including facial expressions and body language, may open up new possibilities in more effectively engaging MCI older adults during repetitive cognitive training. We present a study aiming to better understand the impact of humanoid robots in supporting serious games for such users. In particular, we investigate how seniors with Mild Cognitive Impairments relate to and perceive serious games accessed through humanoid robots, as part of a training programme aimed to improve their cognitive status. For this purpose, two versions of a music-based memory game have been designed by a multi-disciplinary team, one for humanoid robots and one for tablets. We report on its use during a between-subject study that involved MCI seniors, and discuss their experience. The results show that the robot was received with more enthusiasm by the older adults, thus improving their level of engagement.
2020, Articolo in rivista, ENG
Di Costanzo A.; Paris D.; Melck D.; Angiolillo A.; Corso G.; Maniscalco M.; Motta A.
It is still debated whether non-specific preclinical symptoms of Alzheimer's disease (AD) can have diagnostic relevance. We followed the evolution from cognitively normal to AD by NMR-based metabolomics of blood sera. Multivariate statistical analysis of the NMR profiles yielded models that discriminated subjective memory decline (SMD), mild cognitive impairment (MCI) and AD. We validated a panel of six statistically significant metabolites that predicted SMD, MCI and AD in a blind cohort with sensitivity values ranging from 88 to 95% and receiver operating characteristic values from 0.88 to 0.99. However, lower values of specificity, accuracy and precision were observed for the models involving SMD and MCI, which is in line with the pathological heterogeneity indicated by clinical data. This excludes a "linear" molecular evolution of the pathology, pointing to the presence of overlapping "gray-zones" due to the reciprocal interference of the intermediate stages. Yet, the clear difference observed in the metabolic pathways of each model suggests that pathway dysregulations could be investigated for diagnostic purposes.
2019, Articolo in rivista, ENG
Cintoli S.; Radicchi C.; Noale M.; Maggi S.; Meucci G.; Tognoni G.; Bonuccelli U.; Sale A.; Berardi N.; Maffei L.; Maffei L.; Picano E.; Andreassi M.G.; Angelucci A.; Baldacci F.; Baroncelli L.; Begenisic T.; Bellinvia P.F.; Berardi N.; Biagi L.; Bonaccorsi J.; Bonanni E.; Bonuccelli U.; Borghini A.; Braschi C.; Broccardi M.; Bruno R.M.; Caleo M.; Carlesi C.; Carnicelli L.; Cartoni G.; Cecchetti L.; Cenni M.C.; Ceravolo R.; Chico L.; Cintoli S.; Cioni G.; Coscia M.; Costa M.; D'Angelo G.; D'Ascanio P.; DeNes M.; DelTurco S.; DiCoscio E.; DiGalante M.; diLascio N.; Faita F.; Falorni I.; Faraguna U.; Fenu A.; Fortunato L.; Franco R.; Gargani L.; Gargiulo R.; Ghiadoni L.; Giorgi F.S.; Iannarella R.; Iofrida C.; Kusmic C.; Limongi F.; Maestri M.; Maffei M.; Maggi S.; Mainardi M.; Mammana L.; Marabotti A.; Mariotti V.; Melissari E.; Mercuri A.; Micera S.; Molinaro S.; Narducci R.; Navarra T.; Noale M.; Pagni C.; Palumbo S.; Pasquariello R.; Pellegrini S.; Pietrini P.; Pizzorusso T.; Poli A.; Pratali L.; Retico A.; Ricciardi E.; Rota G.; Sale A.; Sbrana S.; Scabia G.; Scali M.; Scelfo D.; Sicari R.; Siciliano G.; Stea F.; Taddei S.; Tognoni G.; Tonacci A.; Tosetti M.; Turchi S.; Volpi L.
Background and aims: Cognitive impairments associated with aging and dementia are major sources of neuropsychiatric symptoms (NPs) and deterioration in quality of life (QoL). Preventive measures to both reduce disease and improve QoL in those affected are increasingly targeting individuals with mild cognitive impairment (MCI) at early disease stage. However, NPs and QoL outcomes are too commonly overlooked in intervention trials. The purpose of this study was to test the effects of physical and cognitive training on NPs and QoL in MCI. Methods: Baseline data from an MCI court (N = 93, mean age 74.9 ± 4.7) enrolled in the Train the Brain (TtB) study were collected. Subjects were randomized in two groups: a group participated to a cognitive and physical training program, while the other sticked to usual standard care. Both groups underwent a follow-up re-evaluation after 7 months from baseline. NPs were assessed using the Neuropsychiatric Inventory (NPI) and QoL was assessed using Quality of Life-Alzheimer's Disease (QOL-AD) scale. Results: After 7 months of training, training group exhibited a significant reduction of NPs and a significant increase in QOL-AD with respect to no-training group (p = 0.0155, p = 0.0013, respectively). Our preliminary results suggest that a combined training can reduce NPs and improve QoL. Conclusions: Measuring QoL outcomes is a potentially important factor in ensuring that a person with cognitive deficits can 'live well' with pathology. Future data from non-pharmacological interventions, with a larger sample and a longer follow-up period, could confirm the results and the possible implications for such prevention strategies for early cognitive decline.
2019, Articolo in rivista, ENG
Squitti, Rosanna; Malosio, Maria Luisa; Rongioletti, Mauro Ciro Antonio; Tecchio, Franca
Point of View with no abstract
2019, Articolo in rivista, ENG
Limongi, F.; Noale, M.; Bianchetti, A.; Ferrara, N.; Padovani, A.; Scarpini, E.; Trabucchi, M.; Maggi, S. for the MCI Working Group
AimsThe purpose of this study was to examine the tools used in Italy to diagnose mild cognitive impairment (MCI).MethodsIn collaboration with the Luigi Amaducci Research Consortium, the Italian Network of Alzheimer Evaluation Units prepared a questionnaire to describe how MCI is diagnosed in the Italian Centres for cognitive disorders and dementia (CCDD).ResultsMost of the ninety-two CCDDs participating in the survey were located in hospitals (54.7%); large percentages were coordinated by neurologists (50.8%) and geriatricians (44.6%). Almost all (98.5%) used the Mini Mental State Examination to diagnose MCI; the Clock Drawing Test was also frequently used (83.9%). Other neuropsychological, imaging and biomarker tests were utilized less frequently and a wide diversity in the instruments used was noted.ConclusionsAccording to the results, diagnoses of MCI are based on a multitude of instruments, with major differences in the clinical assessment of geriatricians and neurologists. Standardized testing protocols, validated instruments and cut-off points need to be identified and adopted by the CCDDs for assessing MCI.
2018, Articolo in rivista, ENG
Arlati, Sara; Greci, Luca; Mondellini, Marta; Zangiacomi, Andrea; Di Santo, Simona G.; Franchini, Flaminia; Marzorati, Mauro; Mrakic-Sposta, Simona; Vezzoli, Alessandra
This work presents a physical and cognitive training program, based on virtual reality technologies, designed with the aim of preventing the occurrence of symptoms of dementia in elderly with Mild Cognitive Impairment (MCI). The system foresees a physical task to be performed on a cycle-ergometer and two virtual environments for cognitive stimulation. In this paper, results of different validation phases conducted on both healthy and MCI subjects are described. The presented validation path allowed to implement, in parallel, the two current versions of the setup: the former, optimized to assess the efficacy of the intervention in a randomized clinical trial, which will take place in the next future, and the latter, more experimental, which foresees the employment of immersive environments to increase subjects' engagement and motivation.
2018, Abstract in atti di convegno, ENG
Magrini M.; Coscetti S.; Barcaro U.; Dolciotti C.
A hardware-software system is described for the administration of motor and cognitive exercises to people affected by mild or moderate cognitive impairment. This system was built in the framework of the "Intesa" project, funded by the region of Tuscany. The objective of this project has been the implementation of services based on non-invasive ICT technologies aimed at the improvement of the life quality of elderly non-disabled people in a condition of "fragility".
2018, Articolo in rivista, ENG
Italiani, Paola; Puxeddu, Ilaria; Napoletano, Sabrina; Scala, Emanuele; Melillo, Daniela; Manocchio, Simone; Angiolillo, Antonella, Migliorini, Paola; Boraschi, Diana; Vitale, Emilia, and Di Costanzo, Alfonso
Background. Although the mechanisms underlying AD neurodegeneration are not fully understood, it is now recognised that inflammation could play a crucial role in the initiation and progression of AD neurodegeneration. A neuro-inflammatory network, based on the anomalous activation of microglial cells, includes the production of a number of inflammatory cytokines both locally and systemically. These may serve as diagnostic markers or therapeutic targets for AD neurodegeneration. Methods. We have measured the levels of the inflammation-related cytokines and receptors of the IL-1 family in serum of subjects with AD, compared to mild cognitive impairment (MCI), subjective memory complaints (SMC), and normal healthy subjects (NHS). Using a custom-made multiplex ELISA array, we examined ten factors of the IL-1 family, the inflammation-related cytokines IL-1, IL-1, IL-18, and IL-33, the natural inhibitors IL-1Ra and IL-18BP, and the soluble receptors sIL-1R1, sIL-1R2, sIL-1R3, and sIL-1R4. Results. The inflammatory cytokines IL-1 and IL-1, their antagonist IL-1Ra, and their soluble receptor sIL-1R1 were increased in AD. The decoy IL-1 receptor sIL-1R2 was only increased in MCI. IL-33 and its soluble receptor sIL-1R4 were also significantly higher in AD. The soluble form of the accessory receptor for both IL-1 and IL-33 receptor complexes, sIL-1R3, was increased in SMC and even more in AD. Total IL-18 levels were unchanged, whereas the inhibitor IL-18BP was significantly reduced in MCI and SMC, and highly increased in AD. The levels of free IL-18 were significantly higher in MCI. Conclusions. AD is characterised by a significant alteration in the circulating levels of the cytokines and receptors of the IL-1 family. The elevation of sIL-1R4 in AD is in agreement with findings in other diseases and can be considered a marker of ongoing inflammation. Increased levels of IL-1Ra, sIL-1R1, sIL-1R4, and IL-18BP distinguished AD from MCI and SMC, and from other inflammatory diseases. Importantly, sIL-1R1, sIL-1R3, sIL-1R4, and IL-18BP negatively correlated with cognitive impairment. A significant elevation of circulating sIL-1R2 and free IL-18, not present in SMC, is characteristic of MCI and disappears in AD, making them additional interesting markers for evaluating progression from MCI to AD.
2017, Contributo in atti di convegno, ENG
Arlati, Sara; Arlati, Sara; Zangiacomi, Andrea; Greci, Luca; Di Santo, Simona Gabriella; Franchini, Flaminia; Sacco, Marco
This work aims at providing an evaluation of the acceptability and the usability of a virtual reality-based intervention developed for the physical and cognitive training of mild cognitive impaired elderlies. To perform this evaluation, participants enrolled in the intervention group (n = 4) of a randomized controlled trial to test the system were interviewed, and their adherence and their performances in the virtual environments for cognitive training were evaluated. In spite of the small sample, the active participation and the unanimous positive judgement of all the participants led to the conclusion that the training program was well accepted and enjoyable. Participants also claimed reduced level of anxiety in their ADL. On the basis of these encouraging results, a second trial, with enlarged sample and with a system implementing the improvements required to overcome the limitations and the problems highlighted with this pilot study, will be performed in the next future.
2017, Articolo in rivista, ENG
Coelho, Sara; Guerreiro, Manuela; Chester, Catarina; Silva, Dina; Silva, Dina; Maroco, João; Paglieri, Fabio; de Mendonça, Alexandre
Introduction: Patients with mild cognitive impairment (MCI) may make suboptimal decisions particularly in complex situations, and this could be due to temporal discounting, the tendency to prefer immediate rewards over delayed but larger rewards. The present study proposes to evaluate intertemporal preferences in MCI patients as compared to healthy controls. Method: Fifty-five patients with MCI and 57 healthy controls underwent neuropsychological evaluation and a delay discounting questionnaire, which evaluates three parameters: hyperbolic discounting (k), the percentage of choices for delayed and later rewards (%LL), and response consistency (Acc). Results: No significant differences were found in the delay discounting questionnaire between MCI patients and controls for the three reward sizes considered, small, medium, and large, using both k and %LL parameters. There were also no differences in the response consistency, Acc, between the two groups. Conclusions: Patients with MCI perform similarly to healthy controls in a delay discounting task. Memory deficits do not notably affect intertemporal preferences.
2016, Articolo in rivista, ENG
Di Carlo, A.; Baldereschi, M.; Lamassa, M.; Bovis, F.; Inzitari, M.; Solfrizzi, V.; Panza, F.; Galluzzo, L.; Scafato, E.; Inzitari, D.
Background: Preclinical cognitive changes may predict an increased risk of dementia, allowing selection of subgroups as possible targets for preventive or therapeutic interventions. Objective: To evaluate the predictive effect of daily functioning and motor performance (MP) on the progression to dementia in normal cognition, cognitive impairment, no dementia (CIND), and mild cognitive impairment (MCI). Methods: The Italian Longitudinal Study on Aging is a large population-based survey on age-related diseases of the cardiovascular and nervous systems. After the baseline assessment, to detect prevalent cases of cognitive impairment and dementia, participants were re-examined at 4-year and 8-year follow-ups. Functional independence was evaluated using the Index of Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL) Scale. A six-test battery was used to assess MP. Results: Overall, 2,386 individuals were included, for a total of 16,545 person-years. Eight-year incidence of dementia (per 1,000 person-years) was 12.69 in total sample, 9.86 in subjects with normal cognition at baseline, 22.99 in CIND, and 21.43 in MCI. Progression to dementia was significantly higher with increasing baseline ADL and IADL impairment, and with a worse MP. In Cox regression analyses controlled for demographics and major age-related conditions, increased IADL impairment was the stronger predictor of progression to dementia (p<0.001), with HR ranging from 2.16 (95 CI, 0.82-5.70) to 9.57 (95 CI, 3.40-26.91) in subjects with MCI at baseline. Conclusions: Inclusion of IADL in the MCI construct significantly improves the prediction of dementia. Individuation of different transition rates is required to plan cost-effective interventions.
2016, Articolo in rivista, ENG
Pagani M, Giuliani A, ?berg J, Chincarini A, Morbelli S, Brugnolo A, Arnaldi D, Picco A, Baucknhet A, Buschiazzo A, Sambuceti G, Nobili F
The assessment of the degree of order of brainmetabolism bymeans of a statisticalmechanistic approach applied to FDG-PET, allowed us to characterize healthy subjects as well as patients with mild cognitive impairment and Alzheimer's Disease (AD). The intensity signals from 24 volumes of interest were submitted to principal component analysis (PCA) giving rise to a major first principal component whose eigenvalue was a reliable cumulative index of order. This index linearly decreased from 77 to 44% going from normal aging to AD patients with intermediate conditions between these values (r =0.96, p b 0.001). Bootstrap analysis confirmed the statistical significance of the results. The progressive detachment of different brain regions from the first component was assessed, allowing for a purely data driven reconstruction of already known maximally affected areas. Wedemonstrated for the first time the reliability of a single global index of order in discriminating groups of cognitively impaired patients with different clinical outcome. The second relevant finding was the identification of clusters of regions relevant to AD pathology progressively separating fromthe first principal component through different stages of cognitive impairment, including patients cognitively impaired but not converted to AD. This paved the way to the quantitative assessment of the functional networking status in individual patients.
2016, Articolo in rivista, ENG
Vasta R.; Augimeri A.; Cerasa A.; Nigro S.; Gramigna V.; Nonnis M.; Rocca F.; Zito G.; Quattrone A.
Although measurement of total hippocampal volume is considered as an important hallmark of Alzheimer's disease (AD), recent evidence demonstrated that atrophies of hippocampal subregions might be more sensitive in predicting this neurodegenerative disease. The vast majority of neuroimaging papers investigating this topic are focused on the difference between AD and patients with mild cognitive impairment (MCI), not considering the impact of MCI patients who will or not convert in AD. For this reason, the aim of this study was to determine if measurements of hippocampal subfields provide advantages over total hippocampal volume for discriminating these groups. Hippocampal subfields volumetry was extracted in 55 AD, 32 converted and 89 not-converted MCI (c/nc-MCI) and 47 healthy controls, using an atlas-based automatic algorithm based on Markov random fields embedded in the Freesurfer framework. To evaluate the impact of hippocampal atrophy in discriminating the insurgence of AD-like phenotypes we used three classification methods: Support Vector Machine, Naïve Bayesian Classifier and Neural Networks Classifier. Taking into account only the total hippocampal volume, all classification models, reached a sensitivity of about 66% in discriminating between c-MCI and nc-MCI. Otherwise, classification analysis considering all segmenting subfields increased accuracy to diagnose c-MCI from 68% to 72%. This effect resulted to be strongly dependent upon atrophies of the subiculum and presubiculum. Our multivariate analysis revealed that the magnitude of the difference considering hippocampal subfield volumetry, as segmented by the considered atlas-based automatic algorithm, offers an advantage over hippocampal volume in distinguishing early AD from nc-MCI.
2016, Articolo in rivista, ENG
Salvatore C.; Battista P.; Castiglioni I.
The emergence of Alzheimer's Disease (AD) as a consequence of increasing aging population makes urgent the availability of methods for the early and accurate diagnosis. Magnetic Resonance Imaging (MRI) could be used as in vivo, non invasive tool to identify sensitive and specific markers of very early AD progression. In recent years, multivariate pattern analysis (MVPA) and machine- learning algorithms have attracted strong interest within the neuroimaging community, as they allow automatic classification of imaging data with higher performance than univariate statistical analysis. An exhaustive search of PubMed, Web of Science and Medline records was performed in this work, in order to retrieve studies focused on the potential role of MRI in aiding the clinician in early diagnosis of AD by using Support Vector Machines (SVMs) as MVPA automated classification method. A total of 30 studies emerged, published from 2008 to date. This review aims to give a state-of-the-art overview about SVM for the early and differential diagnosis of AD-related pathologies by means of MRI data, starting from preliminary steps such as image pre-processing, feature extraction and feature selection, and ending with classification, validation strategies and extraction of MRI-related biomarkers. The main advantages and drawbacks of the different techniques were explored. Results obtained by the reviewed studies were reported in terms of classification performance and biomarker outcomes, in order to shed light on the parameters that accompany normal and pathological aging. Unresolved issues and possible future directions were finally pointed out.
2013, Articolo in rivista, ENG
Morbelli, Silvia D.; Perneczky, Robert; Drzezga, Alexander E.; Frisoni, Giovanni Battista; Caroli, Anna; Van Berckel, Bart NM M; Ossenkoppele, Rik; Guedj, Éric; Didic, Mira; Brugnolo, Andrea; Naseri, Mehrdad; Sambuceti, Gianmario; Pagani, Marco; Nobili, Flavio Mariano
This project aimed to investigate the metabolic basis for resilience to neurodegeneration (cognitive reserve) in highly educated patients with prodromal Alzheimer disease (AD). Methods: Sixty-four patients with amnestic mild cognitive impairment who later converted to AD dementia during follow-up, and 90 controls, underwent brain 18F-FDG PET. Both groups were divided into a poorly educated subgroup (42 controls and 36 prodromal AD patients) and a highly educated subgroup (48 controls and 28 prodromal AD patients). Brain metabolism was first compared between education-matched groups of patients and controls. Then, metabolism was compared between highly and poorly educated prodromal AD patients in both directions to identify regions of high education-related metabolic depression and compensation. The clusters of significant depression and compensation were further used as volumetric regions of interest (ROIs) in a brain interregional correlation analysis in each prodromal AD subgroup to explore metabolic connectivity. All analyses were performed by means of SPM8 (P , 0.001 uncorrected at peak level, P , 0.05 false discovery rate-corrected at cluster level; age, sex, Mini-Mental State Examination score, and center as nuisance). Results: Highly educated prodromal AD patients showed more severe hypometabolism than poorly educated prodromal AD patients in the left inferior and middle temporal gyri and the left middle occipital gyrus (ROI depression). Conversely, they showed relative hypermetabolism in the right inferior, middle, and superior frontal gyri (ROI compensation). The sites of compensation, mainly corresponding to the right dorsolateral prefrontal cortex (DLFC), showed wide metabolic correlations with several cortical areas in both hemispheres (frontotemporal cortex, parahippocampal gyrus, and precuneus) in highly educated prodromal AD patients but not in poorly educated prodromal AD patients. To provide evidence on whether these metabolic correlations represent preservation of the physiologic networks of highly educated control subjects (neural reserve) or rather the recruitment of alternative networks (neural compensation), or a combination of the two, we performed metabolic connectivity analysis of the DLFC in highly educated controls as well. The correlation sites of right DLFC partly overlapped those of highly educated prodromal AD patients but were less extended. Conclusion: The present findings suggest that highly educated prodromal AD patients can cope better with the disease thanks to neural reserve but also to the recruitment of compensatory neural networks in which the right DLFC plays a key role.
2012, Articolo in rivista
Guarnieri, B.; Adorni, F.; Musicco, M.; Appollonio, I.; Bonanni, E.; Caffarra, P.; Caltagirone, C.; Cerroni, G.; Concari, L.; Cosentino, F. I. I.; Ferrara, S.; Fermi, S.; Ferri, R.; Gelosa, G.; Lombardi, G.; Mazzei, D.; Mearelli, S.; Morrone, E.; Murri, L.; Nobili, F. M.; Passero, S.; Perri, R.; Rocchi, R.; Sucapane, P.; Tognoni, G.; Zabberoni, S.; Sorbi, S.
Background/Aims: Sleep disturbances are common in the elderly and in persons with cognitive decline. The aim of this study was to describe frequency and characteristics of insomnia, excessive daytime sleepiness, sleep-disordered breathing, REM behavior disorder and restless legs syndrome in a large cohort of persons with mild cognitive impairment or dementia. Methods: 431 consecutive patients were enrolled in 10 Italian neurological centers: 204 had Alzheimer's disease, 138 mild cognitive impairment, 43 vascular dementia, 25 frontotemporal dementia and 21 Lewy body dementia or Parkinson's disease dementia. Sleep disorders were investigated with a battery of standardized questions and questionnaires. Results: Over 60% of persons had one or more sleep disturbances almost invariably associated one to another without any evident and specific pattern of co-occurrence. Persons with Alzheimer's disease and those with mild cognitive impairment had the same frequency of any sleep disorder. Sleep-disordered breathing was more frequent in vascular dementia. REM behavior disorder was more represented in Lewy body or Parkinson's disease dementia. Conclusion: A careful clinical evaluation of sleep disorders should be performed routinely in the clinical setting of persons with cognitive decline. Instrumental supports should be used only in selected patients. Copyright (C) 2012 S. Karger AG, Basel
2012, Articolo in rivista, ENG
Nicola Girtlera; Andrea Brugnolo; Claudio Campus; Fabrizio De Carli; Francesco Famà; Lucio Ghio; Philippe Robert; Maria Paola Barbieri; Marta Delmonte; Stefano Venuti; Filippo Gabrielli; Guido Rodriguez; Flavio Nobili.
AIMS: To validate the Italian version of the Short Cognitive Evaluation Battery (SCEB), consisting of 4 tests (temporal orientation, five words, clock drawing and verbal fluency) in healthy controls (CONT), patients with mild Alzheimer's disease (AD), mild cognitive impairment (MCI), and major depressive disorder (DEP). METHODS: Twenty-nine AD patients (mean Mini-Mental State Examination, MMSE, score: 22.1 ± 3.1), 27 MCI patients (mean MMSE score: 26.5 ± 2.0), 27 depressed patients (mean MMSE score: 26.9 ± 2.8), and 48 controls (mean MMSE score: 29.7 ± 0.5) were enrolled. RESULTS: MANCOVA showed highly significant (p < 0.0001) difference among groups. As for total SCEB score, AD were separated from CONT with high accuracy (93%; with sensitivity 93%, specificity 92%, area under ROC curve, AUC, 0.96) and from DEP with satisfying accuracy (84%; with sensitivity 76%, specificity 93%, AUC 0.84). Results in MCI versus CONT comparison yielded more moderate accuracy (80%; with sensitivity 70%, specificity 87%, AUC 0.80), which increased in the subgroup of MCI patients who later converted to AD (85%; with sensitivity 75%, specificity 83%, AUC 0.86). The direct comparison between MCI converters and nonconverters did not yield accurate results. CONCLUSION: The Italian version of the SCEB is a short (between 6 min in CONT and 12 min in DEP) screening tool in cognitive disorders of the elderly, and is potentially useful in clinical practice.