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Amanzio M, Cipriani GE, Canessa N, Borghesi F, Chirico A, Cipresso P. A unique neuropsychophysiological approach to objectify emotion (dys)regulation in healthy older adults during the COVID-19 pandemic. Sci Rep 2023; 13:23093. [PMID: 38155179 PMCID: PMC10754879 DOI: 10.1038/s41598-023-50310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023] Open
Abstract
The response of older people to the COVID-19 pandemic has attracted much attention as they are at increased risk of adverse outcomes. A longitudinal study has shown that improvement in global cognitive, executive and language functioning in healthy older adults enrolled at the University of the Third Age appears to play a protective role against emotional dysregulation and mood changes during the pandemic. To date, no study has examined emotional dysregulation through COVID-19-related images using facial electromyographic recordings in healthy older adults. Therefore, we aimed to analyze the relationships between zygomaticus and corrugator reactivity, neuropsychological measures, and the affective dimensions of arousal, dominance, and valence. The results showed an unexpected association between higher zygomaticus activity and higher levels of apathy, depression, and anxiety. In contrast, increased contracture of the corrugator was associated with poorer performance on cognitive tests (global cognition, memory, executive functions) and physical status, i.e., walking speed. These results are consistent with the reappraisal of emotional stimuli in response to the challenges of the pandemic. Interestingly, COVID-19-related stimuli triggered the activation of bottom-up affectivity strategies associated with higher mood levels and interacted with top-down factors that play an important role in the dysregulation of cognitive control.
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, 10024, Turin, Italy.
| | | | - Nicola Canessa
- ICoN Center, Scuola Universitaria Superiore IUSS, 27100, Pavia, Italy
- Cognitive Neuroscience Laboratory of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
| | | | - Alice Chirico
- Department of Psychology, Research Center in Communication Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Pietro Cipresso
- Department of Psychology, University of Turin, 10024, Turin, Italy
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, 20145, Milan, Italy
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2
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Werrmann M, Schegolevska A, Eid M, Niedeggen M. Uncovering mnestic problems in help-seeking individuals reporting subjective cognitive complaints. Sci Rep 2023; 13:15266. [PMID: 37709826 PMCID: PMC10502030 DOI: 10.1038/s41598-023-42527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023] Open
Abstract
In individuals with subjective cognitive impairments (SCI) the risk for the development of a neurodegenerative disease is assumed to be increased. However, it is not clear which factors contribute to the expression of SCI: Is it related to the cognitive resources already challenged, or is the psycho-affective state of more relevance? Using a novel online assessment combining self-report questionnaires and neuropsychological psychometric tests, significant predictors for the level of complaints were identified in two samples of elderly individuals: Help-seekers (HS, n = 48) consulting a memory clinic and a matched sample of non-help-seekers (nHS, n = 48). Based on the results of the online assessment, the SCI level was found to be significantly determined by the psycho-affective state (depressive mood) in the nHS group, whereas cognitive performance (cued recall) was the main predictor in the HS group. The predictive value of recall performance, however, is more-strongly expressed in memory tests which reduce the impact of compensatory strategies (face-name-association vs. word lists). Our results indicate that the problem-focused behavior of help-seeking individuals is also associated with a higher sensitivity for cognitive deficits-which can be uncovered with an appropriate psychometric test. Considering these factors, the conversion risk in individuals with SCI can probably be determined more reliably.
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Affiliation(s)
- M Werrmann
- Division of Experimental Psychology and Neuropsychology, Department of Educational Science and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany.
| | - A Schegolevska
- Division of Experimental Psychology and Neuropsychology, Department of Educational Science and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - M Eid
- Division of Methods and Evaluation, Department of Educational Science and Psychology, Freie Universität Berlin, Berlin, Germany
| | - M Niedeggen
- Division of Experimental Psychology and Neuropsychology, Department of Educational Science and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
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3
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Borghesi F, Chirico A, Pedroli E, Cipriani GE, Canessa N, Amanzio M, Cipresso P. Exploring Biomarkers of Mental Flexibility in Healthy Aging: A Computational Psychometric Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6983. [PMID: 37571766 PMCID: PMC10422551 DOI: 10.3390/s23156983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
Mental flexibility (MF) has long been defined as cognitive flexibility. Specifically, it has been mainly studied within the executive functions domain. However, there has recently been increased attention towards its affective and physiological aspects. As a result, MF has been described as an ecological and cross-subject skill consisting of responding variably and flexibly to environmental cognitive-affective demands. Cross-sectional studies have mainly focused on samples composed of healthy individual and of patients with chronic conditions such as Mild Cognitive Impairment and Parkinson's, emphasizing their behavioral rigidity. Our study is the first to consider a sample of healthy older subjects and to outline physiological and psychological markers typical of mental flexibility, to identify functional biomarkers associated with successful aging. Our results reveal that biomarkers (respiratory and heart rate variability assessments) distinguished between individuals high vs. low in mental flexibility more reliably than traditional neuropsychological tests. This unveiled the multifaceted nature of mental flexibility composed of both cognitive and affective aspects, which emerged only if non-linear multi-variate analytic approaches, such as Supervised Machine Learning, were used.
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Affiliation(s)
- Francesca Borghesi
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; (G.E.C.); (M.A.); (P.C.)
| | - Alice Chirico
- Department of Psychology, Research Center in Communication Psychology, Universitá Cattolica del Sacro Cuore, 20123 Milan, Italy;
| | - Elisa Pedroli
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy;
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Giuseppina Elena Cipriani
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; (G.E.C.); (M.A.); (P.C.)
| | - Nicola Canessa
- ICoN Center, Scuola Universitaria Superiore IUSS, 27100 Pavia, Italy;
- Istituti Clinici Scientifici Maugeri IRCCS, Cognitive Neuroscience Laboratory of Pavia Institute, 27100 Pavia, Italy
| | - Martina Amanzio
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; (G.E.C.); (M.A.); (P.C.)
| | - Pietro Cipresso
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; (G.E.C.); (M.A.); (P.C.)
- Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy
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4
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Amanzio M, Cipriani GE, Bartoli M, Canessa N, Borghesi F, Chirico A, Cipresso P. The neuropsychology of healthy aging: the positive context of the University of the Third Age during the COVID-19 pandemic. Sci Rep 2023; 13:6355. [PMID: 37076567 PMCID: PMC10115807 DOI: 10.1038/s41598-023-33513-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023] Open
Abstract
Older adults have been reported to have increased susceptibility to the adverse effects of SARS-CoV-2 infection, such as fatal outcomes, cognitive decline, and changes in physical and/or mental health. However, few studies have examined neuropsychological changes by comparing measurements before and during the pandemic in healthy older people. In addition, no longitudinal studies have examined whether older adults may have responded positively to the pandemic. We examined these issues through a 2-year neuropsychological study before and during the pandemic period. Results showed that scores before and during the pandemic were the same in memory and attention, whereas global cognitive, executive, and language functions improved. Participants also showed no longitudinal changes in depression, hypomania, and disinhibition, while apathy and, to a lesser extent, anxiety increased significantly. To examine possible signs of pandemic-related emotional (dys)regulation, subjects were shown images at follow-up that recalled the most dramatic lockdown phase while heart rate variability was recorded. Higher apathy was predicted by poorer global cognitive performance, increased anxiety, and emotional dysregulation as measured by a higher ratio of low-to-high frequency heart rate variability. Thus, preserved global cognition appears to play a protective role against the effects of pandemic-related anxiety and emotional dysregulation on apathy.
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, 10024, Turin, Italy.
| | | | - Massimo Bartoli
- Department of Psychology, University of Turin, 10024, Turin, Italy
| | - Nicola Canessa
- ICoN Center, Scuola Universitaria Superiore IUSS, 27100, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Cognitive Neuroscience Laboratory of Pavia Institute, 27100, Pavia, Italy
| | | | - Alice Chirico
- Department of Psychology, Research Center in Communication Psychology, Università Cattolica del Sacro Cuore, 20123, Milan, Italy
| | - Pietro Cipresso
- Department of Psychology, University of Turin, 10024, Turin, Italy
- Istituto Auxologico Italiano, IRCCS, 20145, Milan, Italy
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Chipi E, Fruttini D, Salvadori N, Montanucci C, Siena E, Menculini G, Mazzeschi C, Parnetti L. Repeatable Battery for the Assessment of Neuropsychological Status: Italian Normative Data for Older Adults. ARCHIVES OF CLINICAL NEUROPSYCHOLOGY : THE OFFICIAL JOURNAL OF THE NATIONAL ACADEMY OF NEUROPSYCHOLOGISTS 2023; 38:72-79. [PMID: 35909085 DOI: 10.1093/arclin/acac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), widely used for detecting cognitive impairment in different neuropsychiatric conditions, is increasingly applied for measuring cognitive functioning in older individuals. Available normative data for RBANS Italian version suffer from under-representation of the older ages (>60 years) and are not corrected for education. Moreover, normative data are provided only for Indexes and Total scores. We thus administered RBANS Italian version in a larger sample of older adults, taking into account the effect of age, education and gender on all scores. METHOD We used a regression-based model to assess the effect of age, education, and gender on RBANS Subtests, Indexes and Total scores in a consecutive series of healthy cognitively normal volunteers aged 60-79 years (N = 158). The obtained norms were compared with the Italian original normative data by means of Wilcoxon rank-sum test. RESULTS Multiple linear regression analyses showed that age and educational level significantly influence performances on most RBANS scores. A free-to-use Excel to calculate subject's percentiles for any single score was developed. When compared with original normative values, our percentiles distribution of Indexes and Total scores did not reveal significant differences (p > .05). CONCLUSION The obtained normative data show good concordance with previous norms. The instrument seems not significantly affected by educational level. The possibility to correct for any single score could make RBANS a more precise measure for capturing subtle cognitive deficits in prevention studies.
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Affiliation(s)
- Elena Chipi
- Center for Memory Disturbances, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniela Fruttini
- Section of Endocrinology and Metabolism, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicola Salvadori
- Center for Memory Disturbances, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Montanucci
- Center for Memory Disturbances, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisa Siena
- Center for Memory Disturbances, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Center for Memory Disturbances, Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Ibnidris A, Robinson JN, Stubbs M, Piumatti G, Govia I, Albanese E. Evaluating measurement properties of subjective cognitive decline self-reported outcome measures: a systematic review. Syst Rev 2022; 11:144. [PMID: 35850915 PMCID: PMC9290248 DOI: 10.1186/s13643-022-02018-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Subjective cognitive decline (SCD) is present in the early stage of preclinical Alzheimer's disease (AD) and is associated with an increased risk of further cognitive decline and AD dementia later in life. Early detection of at-risk groups with subjective complaints is critical for targeted dementia prevention at the earliest. Accurate assessment of SCD is crucial. However, current measures lack important psychometric evaluations and or reporting. OBJECTIVES To systematically evaluate measurement properties of self-reported outcome measures (PROMs) used to assess SCD in the older adult population with or at risk of AD. METHODS AND ANALYSIS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols 2015 Checklist for reporting. We conducted a literature search, screened, and included validation studies of SCD based on self-reported questionnaires from both population-based and clinical studies, conducted in older adults (≥ 55). We critically appraised the included primary studies using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. RESULTS Sixteen studies met the inclusion criteria. The included studies reported psychometric properties of 17 SCD self-reported questionnaires. We extracted data on the structural validity, internal consistency, test-retest reliability, and cross-cultural validity and found a widespread proneness to bias across studies, and a marked heterogeneity is assessed and reported measurement properties that prevented the consolidation of results. CONCLUSION Our findings suggest that available SCD questionnaires lack content validity evaluation. Currently available measurements of SCD lack development and validation standards. Further work is needed to develop and validate SCD self-reported measurement with good quality measurement properties.
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Affiliation(s)
- Aliaa Ibnidris
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland. .,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Janelle N Robinson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Marissa Stubbs
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | | | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Emiliano Albanese
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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Studart-Neto A, Moraes NC, Spera RR, Merlin SS, Parmera JB, Jaluul O, SanchesYassuda M, Brucki SMD, Nitrini R. Translation, cross-cultural adaptation, and validity of the Brazilian version of the Cognitive Function Instrument. Dement Neuropsychol 2022; 16:79-88. [PMID: 35719263 PMCID: PMC9170254 DOI: 10.1590/1980-5764-dn-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/20/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
Subjective cognitive decline (SCD) is defined as a self-perception of a progressive cognitive impairment, which is not detected objectively through neuropsychological tests. The Alzheimer's Disease Cooperative Study developed the Cognitive Function Instrument (CFI) to evaluate individuals with SCD. The CFI consists of two versions, namely, a self-report and a partner report.
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Affiliation(s)
- Adalberto Studart-Neto
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Natália Cristina Moraes
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Raphael Ribeiro Spera
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Silvia Stahl Merlin
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Jacy Bezerra Parmera
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Omar Jaluul
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Geriatria, São Paulo SP, Brazil
| | - Mônica SanchesYassuda
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Programa de Pós-Graduação em Gerontologia, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
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Evaluation of Available Cognitive Tools Used to Measure Mild Cognitive Decline: A Scoping Review. Nutrients 2021; 13:nu13113974. [PMID: 34836228 PMCID: PMC8623828 DOI: 10.3390/nu13113974] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Cognitive decline is a broad syndrome ranging from non-pathological/age-associated cognitive decline to pathological dementia. Mild cognitive impairment MCI) is defined as the stage of cognition that falls between normal ageing and dementia. Studies have found that early lifestyle interventions for MCI may delay its pathological progression. Hence, this review aims to determine the most efficient cognitive tools to discriminate mild cognitive decline in its early stages. After a systematic search of five online databases, a total of 52 different cognitive tools were identified. The performance of each tool was assessed by its psychometric properties, administration time and delivery method. The Montreal Cognitive Assessment (MoCA, n = 15), the Mini-Mental State Examination (MMSE, n = 14) and the Clock Drawing Test (CDT, n = 4) were most frequently cited in the literature. The preferable tools with all-round performance are the Six-item Cognitive Impairment Test (6CIT), MoCA (with the cut-offs of ≤24/22/19/15.5), MMSE (with the cut-off of ≤26) and the Hong Kong Brief Cognitive Test (HKBC). In addition, SAGE is recommended for a self-completed survey setting whilst a 4-point CDT is quick and easy to be added into other cognitive assessments. However, most tools were affected by age and education levels. Furthermore, optimal cut-off points need to be cautiously chosen while screening for MCI among different populations.
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Rossini PM, Cappa SF, Lattanzio F, Perani D, Spadin P, Tagliavini F, Vanacore N. The Italian INTERCEPTOR Project: From the Early Identification of Patients Eligible for Prescription of Antidementia Drugs to a Nationwide Organizational Model for Early Alzheimer's Disease Diagnosis. J Alzheimers Dis 2020; 72:373-388. [PMID: 31594234 DOI: 10.3233/jad-190670] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease is the most common age-related neurodegenerative disorder and its burden on patients, families, and society grows significantly with lifespan. Early modifications of risk-enhancing lifestyles and treatment initiation expand personal autonomy and reduce management costs. Many clinical trials with potentially disease-modifying drugs are devoted to mild cognitive impairment (MCI) prodromal-to-Alzheimer's disease. The identification of biomarkers for early diagnosis may thus be crucial for early intervention and identification of high-risk subjects, the most appropriate target of new drugs as soon as they will be discovered. INTERCEPTOR is a strategic project by the Italian Ministry of Health and the Italian Medicines Agency (AIFA), aiming to validate the best combination (highly accurate, non-invasive, available on the whole national territory and financially sustainable) of biomarkers and organizational model for early diagnosis. 500 MCI subjects will be enrolled at baseline and followed-up for 3 years for at least 400 of them in order to define a "hub & spoke" nationwide model with recruiting (spokes) centers for MCI identification and expert (hubs) centers for risk diagnosis.
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Affiliation(s)
- Paolo Maria Rossini
- Area of Neuroscience, University Policlinic A. Gemelli Foundation-IRCCS, Rome, Italy.,Institute of Neurology, Catholic University, Rome, Italy
| | - Stefano F Cappa
- University School for Advanced Studies IUSS Pavia, Pavia, Italy.,IRCCS St. John of God, Brescia, Italy
| | | | - Daniela Perani
- Nuclear Medicine Unit and Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Spadin
- President "Associazione Italiana Malattia di Alzheimer" - AIMA, Italy
| | | | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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PTSD and Depressive Symptoms as Potential Mediators of the Association between World Trade Center Exposure and Subjective Cognitive Concerns in Rescue/Recovery Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165683. [PMID: 32781591 PMCID: PMC7460046 DOI: 10.3390/ijerph17165683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/25/2020] [Accepted: 08/04/2020] [Indexed: 01/11/2023]
Abstract
We observed that World Trade Center (WTC) exposure, post-traumatic stress disorder (PTSD) symptoms and depressive symptoms were associated with subjective cognitive concerns in Fire Department of the City of New York (FDNY) rescue/recovery workers. This follow-up study examined whether PTSD symptoms and/or depressive symptoms mediate the observed association between WTC exposure and subjective cognitive concerns. We included WTC-exposed FDNY workers who completed the Cognitive Function Instrument (CFI), measuring self-perceived cognitive decline (N = 9516). PTSD symptoms and depressive symptoms were assessed using the PCL-S and CES-D, respectively. Multivariable linear regression estimated the association between WTC exposure and CFI score, adjusting for confounders. Mediation analyses followed the methods of Vanderweele (2014). Participants’ average age at CFI assessment was 56.6 ± 7.6 years. Higher-intensity WTC exposure was associated with worse CFI score, an effect that was entirely mediated by PTSD symptoms (%mediated: 110.9%; 95%CI: 83.1–138.9). When substituting depressive symptoms for PTSD symptoms, the WTC exposure–CFI association was largely mediated (%mediated: 82.1%; 95%CI: 60.6–103.7). Our findings that PTSD symptoms and depressive symptoms mediate the association between WTC exposure and subjective cognitive concerns indicate that in the absence of these symptoms, WTC exposure in rescue/recovery workers would not be associated with subjective cognition. Interventions targeting PTSD and depression may have additional value in mitigating cognitive decline in WTC-exposed populations.
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11
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Ingravallo F, Cerquetti I, Vignatelli L, Albertini S, Bolcato M, Camerlingo M, Corbi G, De Leo D, De Nicolò A, De Stefano F, Dell'Erba A, Di Giulio P, Domenici R, Fedeli P, Feola A, Ferrara N, Forti P, Frigiolini F, Gianniti P, Gili E, Iannone P, Lovato A, Lunardelli ML, Marengoni A, Marozzi F, Martelloni M, Mecocci P, Molinelli A, Polo L, Portas M, Rossi P, Scorretti C, Trabucchi M, Volpato S, Zoja R, Castellani GL. Medico-legal assessment of personal damage in older people: report from a multidisciplinary consensus conference. Int J Legal Med 2020; 134:2319-2334. [PMID: 32681208 PMCID: PMC7578136 DOI: 10.1007/s00414-020-02368-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/22/2020] [Indexed: 12/19/2022]
Abstract
Ageing of the global population represents a challenge for national healthcare systems and healthcare professionals, including medico-legal experts, who assess personal damage in an increasing number of older people. Personal damage evaluation in older people is complex, and the scarcity of evidence is hindering the development of formal guidelines on the subject. The main objectives of the first multidisciplinary Consensus Conference on Medico-Legal Assessment of Personal Damage in Older People were to increase knowledge on the subject and establish standard procedures in this field. The conference, organized according to the guidelines issued by the Italian National Institute of Health (ISS), was held in Bologna (Italy) on June 8, 2019 with the support of national scientific societies, professional organizations, and stakeholders. The Scientific Technical Committee prepared 16 questions on 4 thematic areas: (1) differences in injury outcomes in older people compared to younger people and their relevance in personal damage assessment; (2) pre-existing status reconstruction and evaluation; (3) medico-legal examination procedures; (4) multidimensional assessment and scales. The Scientific Secretariat reviewed relevant literature and documents, rated their quality, and summarized evidence. During conference plenary public sessions, 4 pairs of experts reported on each thematic area. After the last session, a multidisciplinary Jury Panel (15 members) drafted the consensus statements. The present report describes Conference methods and results, including a summary of evidence supporting each statement, and areas requiring further investigation. The methodological recommendations issued during the Conference may be useful in several contexts of damage assessment, or to other medico-legal evaluation fields.
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Affiliation(s)
- Francesca Ingravallo
- Ageing Research Centre, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, 40126, Bologna, Italy.
| | | | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Matteo Bolcato
- National Board of Young Medico-legal Experts, Legal Medicine, University of Padua, Padua, Italy
| | | | - Graziamaria Corbi
- Department of Medicine and Health Sciences "V. Tiberio" and Italian Society of Gerontology and Geriatrics, University of Molise, Campobasso, Italy
| | - Domenico De Leo
- College of Italian Professors of Legal Medicine, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | | | - Francesco De Stefano
- Italian Society of Legal and Insurance Medicine (SIMLA), Department of Science of Health (DISSAL), University of Genoa, Genoa, Italy
| | - Alessandro Dell'Erba
- Federation of the Italian Associations of Medico-Legal Experts (FAMLI), Department of Interdisciplinary Medicine (DIM), Section of Legal and Forensic Medicine, University of Bari, Bari, Italy
| | - Paola Di Giulio
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | | | - Piergiorgio Fedeli
- Italian Research Group on Personal Injury (GISDAP), University of Camerino, Camerino, Italy
| | - Alessandro Feola
- National Board of Young Medico-legal Experts, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences and Italian Society of Gerontology and Geriatrics, Federico II University of Naples, Naples, Italy
| | - Paola Forti
- Ageing Research Centre, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, 40126, Bologna, Italy
| | | | | | - Enrico Gili
- National Association of Insurance Companies (ANIA), Rome, Italy
| | - Primiano Iannone
- National Center for Clinical Excellence, Quality and Safety of Care (CNEC), Rome, Italy
| | - Alessandro Lovato
- The Surveillance and Cooperation Body on Civil Justice, Bologna, Italy
| | - Maria Lia Lunardelli
- Geriatric Unit, Orthogeriatric Ward, University Hospital Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Marozzi
- Federation of the Italian Associations of Medico-Legal Experts (FAMLI), Milan, Italy
| | - Massimo Martelloni
- Department of Legal Medicine, Local Health Trust Toscana Nordovest, Scientific Society of Forensic Medicine of Italian National Health Service Hospitals (COMLAS), Lucca, Italy
| | - Patrizia Mecocci
- Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Andrea Molinelli
- Italian Society of Legal and Insurance Medicine (SIMLA), Department of Science of Health (DISSAL), University of Genoa, Genoa, Italy
| | | | | | - Patrizio Rossi
- National Institute for Insurance against Accidents at Work (INAIL), Rome, Italy
| | | | - Marco Trabucchi
- Italian Association of Psychogeriatrics (AIP), University of Tor Vergata, Rome, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Riccardo Zoja
- Department of Health and Biomedical Sciences, Section of Legal Medicine, University of Milan, Milan, Italy
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12
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Singh A, Zeig-Owens R, Hall CB, Liu Y, Rabin L, Schwartz T, Webber MP, Appel D, Prezant DJ. World Trade Center exposure, post-traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers. Acta Psychiatr Scand 2020; 141:275-284. [PMID: 31721141 DOI: 10.1111/acps.13127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine whether World Trade Center (WTC)-exposure intensity and post-traumatic stress disorder (PTSD) are associated with subjective cognitive change in rescue/recovery workers. METHOD The population included 7875 rescue/recovery workers who completed a subjective cognition measure, the Cognitive Function Instrument (CFI), between 3/1/2018 and 2/28/2019 during routine monitoring, indicating whether they had experienced cognitive and functional difficulties in the past year. Higher scores indicated greater self-perceived cognitive change. Probable PTSD, depression, and alcohol abuse were evaluated by validated mental health screeners. Logistic regression assessed the associations of WTC exposure and current PTSD with top-quartile (≥2) CFI score, and of early post-9/11 PTSD with top-quartile CFI in a subpopulation (N = 6440). Models included demographics, smoking, depression, and alcohol abuse as covariates. RESULTS Mean age at CFI completion was 56.7 ± 7.7 (range: 36-81). Participants with high-intensity WTC exposure had an increased likelihood of top-quartile CFI score (odds ratio[OR] vs. low exposure: 1.32, 95%CI: 1.07-1.64), controlling for covariates. Current and early PTSD were both associated with top-quartile CFI (OR: 3.25, 95%CI: 2.53-4.19 and OR: 1.56, 95%CI: 1.26-1.93) respectively. CONCLUSIONS High-intensity WTC exposure was associated with self-reported cognitive change 17 years later in rescue/recovery workers, as was PTSD. Highly WTC-exposed subgroups may benefit from additional cognitive evaluation and monitoring of cognition over time.
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Affiliation(s)
- A Singh
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - R Zeig-Owens
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - C B Hall
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.,Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Y Liu
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - L Rabin
- Department of Psychology, Brooklyn College and The Graduate Center of CUNY, Brooklyn, NY, USA
| | - T Schwartz
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M P Webber
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - D Appel
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - D J Prezant
- The Bureau of Health Services and the FDNY World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, NY, USA.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Chipi E, Montanucci C, Eusebi P, D'Andrea K, Biscetti L, Calabresi P, Parnetti L. The Italian version of Cognitive Function Instrument (CFI) for tracking changes in healthy elderly: results at 1-year follow-up. Neurol Sci 2019; 40:2147-2153. [PMID: 31190254 DOI: 10.1007/s10072-019-03960-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Abstract
Cognitive Function Instrument (CFI) is a questionnaire aimed at detecting very early changes in cognitive and functional abilities and useful for monitoring cognitive decline in individuals without clinical impairment. The Italian version has been recently validated. The aim of the present study was to investigate the utility of the Italian version of CFI in tracking early cognitive changes in a cohort of healthy elderly subjects. A consecutive series of 257 cognitively healthy and functionally independent subjects, recruited either among relatives of patients attending our Memory Clinic or as volunteers after advertisement, underwent a baseline neuropsychological assessment. Of them, 157 subjects performed a 1-year follow-up assessment. All subjects completed the CFI, a short questionnaire composed of 14 items administered to both the subject and the referent (study-partner). Cognitive performance was assessed by Mini-Mental State Examination (MMSE) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). At 1-year follow-up, Cronbach's α was 0.79 (95% CI, 0.74-0.84) in self-report and 0.83 (95% CI, 0.79-0.87) for partner-report. CFI self-report correlated with MMSE (rS = - 0.22, p = 0.006) and RBANS (rS = - 0.23, p = 0.004). CFI partner-report showed negative correlation with MMSE (rS = - 0.17, p = 0.037) and RBANS (rS = - 0.20, p = 0.014). CFI 1-year follow-up score correlated with baseline both in self-report (rS = 0.56, p < 0.001) and partner-report (rS = 0.66, p < 0.001). Baseline CFI partner-report (p = 0.014) and CFI self+partner report (p = 0.023) were associated with RBANS total score less than 85 at 1-year follow-up, while only a trend was found considering baseline CFI self-report. Our results support the suitability of the Italian version of CFI for tracking cognitive changes along aging.
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Affiliation(s)
- Elena Chipi
- Center for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Chiara Montanucci
- Center for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Paolo Eusebi
- Center for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Katia D'Andrea
- Center for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Leonardo Biscetti
- Center for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Paolo Calabresi
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Lucilla Parnetti
- Center for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy.
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14
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Topographical disorientation in aging. Familiarity with the environment does matter. Neurol Sci 2018; 39:1519-1528. [DOI: 10.1007/s10072-018-3464-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/24/2018] [Indexed: 02/06/2023]
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15
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News on the journal Neurological Sciences in 2017. Neurol Sci 2018; 39:15-21. [PMID: 29327225 DOI: 10.1007/s10072-017-3241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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