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Ciolli L, Pescini F, Salvadori E, Del Bene A, Pracucci G, Poggesi A, Nannucci S, Valenti R, Basile AM, Squarzanti F, Bianchi S, Dotti MT, Adriano E, Balestrino M, Federico A, Gandolfo C, Inzitari D, Pantoni L. Influence of vascular risk factors and neuropsychological profile on functional performances in CADASIL: results from the MIcrovascular LEukoencephalopathy Study (MILES). Eur J Neurol 2013; 21:65-71. [PMID: 23869710 DOI: 10.1111/ene.12241] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 06/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral small vessel disease that may lead to disability and whose phenotype modulators are still unknown. METHODS In the MIcrovascular LEukoencephalopathy Study (MILES), we assessed the influence of vascular risk factors and the effect of different cognitive domains (memory, psychomotor speed and executive functions) performances on functional abilities in CADASIL in comparison with age-related leukoencephalopathy (ARL). RESULTS We evaluated 51 CADASIL patients (mean age 50.3 ± 13.8 years, 47.1% males) and 68 ARL patients (70.6 ± 7.4 years, 58.8% males). Considering vascular risk factors, after adjustment for age, CADASIL patients had higher mean BMI values than ARL patients. Stroke history frequency was similar in the two groups. After adjustment for age, more CADASIL patients were disabled (impaired on ≥ 2 items of the Instrumental Activities of Daily Living scale) in comparison with ARL patients, and CADASIL patients had worse functional performances evaluated with the Disability Assessment for Dementia (DAD) scale. In CADASIL patients, hypertension was related to both DAD score and disability. The cognitive profile of CADASIL and ARL patients was similar, but on a stepwise linear regression analysis functional performances were mainly associated with the memory index (β = -0.418, P < 0.003) in CADASIL patients and the executive function index (β = -0.321, P = 0.028) in ARL. CONCLUSIONS This study suggests that hypertension may contribute to functional impairment in CADASIL and that memory impairment has a large influence on functional decline in contrast with that observed in a sample of subjects with ARL.
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Affiliation(s)
- L Ciolli
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
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Ryberg C, Rostrup E, Sjöstrand K, Paulson OB, Barkhof F, Scheltens P, van Straaten ECW, Fazekas F, Schmidt R, Erkinjuntti T, Wahlund LO, Basile AM, Pantoni L, Inzitari D, Waldemar G. White matter changes contribute to corpus callosum atrophy in the elderly: the LADIS study. AJNR Am J Neuroradiol 2008; 29:1498-504. [PMID: 18556357 DOI: 10.3174/ajnr.a1169] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The corpus callosum (CC) is the most important structure involved in the transmission of interhemispheric information. The aim of this study was to investigate the potential correlation between regional age-related white matter changes (ARWMC) and atrophy of CC in elderly subjects. MATERIALS AND METHODS In 578 subjects with ARWMC from the Leukoaraiosis And DISability (LADIS) study, the cross-sectional area of the CC was automatically segmented on the normalized midsagittal MR imaging section and subdivided into 5 regions. The ARWMC volumes were measured quantitatively by using a semiautomated technique and segmented into 6 brain regions. RESULTS Significant correlation between the area of the rostrum and splenium regions of the CC and the ARWMC load in most brain regions was identified. This correlation persisted after correction for global atrophy. CONCLUSION Increasing loads of ARWMC volume were significantly correlated with atrophy of the CC and its subregions in nondisabled elderly subjects with leukoaraiosis. However, the pattern of correlation between CC subregions and ARWMC was not specifically related to the topographic location of ARWMC. The results suggest that ARWMC may lead to a gradual loss of CC tissue.
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Affiliation(s)
- C Ryberg
- Memory Disorders Research Group, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
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Korf ESC, van Straaten ECW, de Leeuw FE, van der Flier WM, Barkhof F, Pantoni L, Basile AM, Inzitari D, Erkinjuntti T, Wahlund LO, Rostrup E, Schmidt R, Fazekas F, Scheltens P. Diabetes mellitus, hypertension and medial temporal lobe atrophy: the LADIS study. Diabet Med 2007; 24:166-71. [PMID: 17257279 DOI: 10.1111/j.1464-5491.2007.02049.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HYPOTHESIS Based on recent findings on the association between vascular risk factors and hippocampal atrophy, we hypothesized that hypertension and diabetes mellitus (DM) are associated with medial temporal lobe atrophy (MTA) in subjects without disability, independent of the severity of white matter hyperintensities. METHODS In the Leukoaraiosis And DISability in the elderly (LADIS) study, we investigated the relationships between DM, hypertension, blood pressure and MTA in 582 subjects, stratified by white matter hyperintensity severity, using multinomial logistic regression. MTA was visually scored for the left and right medial temporal lobe (score 0-4), and meaned. RESULTS Mean age was 73.5 years (sd 5.1), 54% was female. Of the subjects, 15% had DM, and 70% had a history of hypertension. The likelihood of having MTA score 3 was significantly higher in subjects with DM (OR 2.9; 95% CI: 1.1-7.8) compared with an MTA score of 0 (no atrophy). The odds ratio for MTA score 2 was not significantly increased (OR 1.8; CI: 0.9-4). Systolic and diastolic blood pressure and a history of hypertension were not associated with MTA. There was no interaction between DM and hypertension. Stratification on white matter hyperintensities (WMH) did not alter the associations. CONCLUSION Our study strengthens the observation that MTA is associated with DM, independently of the amount of small vessel disease as reflected by WMH.
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Affiliation(s)
- E S C Korf
- Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
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Ryberg C, Rostrup E, Stegmann MB, Barkhof F, Scheltens P, van Straaten ECW, Fazekas F, Schmidt R, Ferro JM, Baezner H, Erkinjuntti T, Jokinen H, Wahlund LO, O'brien J, Basile AM, Pantoni L, Inzitari D, Waldemar G. Clinical significance of corpus callosum atrophy in a mixed elderly population. Neurobiol Aging 2006; 28:955-63. [PMID: 16797787 DOI: 10.1016/j.neurobiolaging.2006.04.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 03/14/2006] [Accepted: 04/09/2006] [Indexed: 11/29/2022]
Abstract
Corpus callosum (CC) is the main tract connecting the hemispheres, but the clinical significance of CC atrophy is poorly understood. The aim of this work was to investigate clinical and functional correlates of CC atrophy in subjects with age-related white matter changes (ARWMC). In 569 elderly subjects with ARWMC from the Leukoaraiosis And DISability (LADIS) study, the CC was segmented on the normalised mid-sagittal magnetic resonance imaging (MRI) slice and subdivided into five regions. Correlations between the CC areas and subjective memory complaints, mini mental state examination (MMSE) score, history of depression, geriatric depression scale (GDS) score, subjective gait difficulty, history of falls, walking speed, and total score on the short physical performance battery (SPPB) were analyzed. Significant correlations between CC atrophy and MMSE, SPPB, and walking speed were identified, and the CC areas were smaller in subjects with subjective gait difficulty. The correlations remained significant after correction for ARWMC grade. In conclusion, CC atrophy was independently associated with impaired global cognitive and motor function in subjects with ARWMC.
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Affiliation(s)
- C Ryberg
- Danish Research Center for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark
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5
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van der Flier WM, van Straaten ECW, Barkhof F, Ferro JM, Pantoni L, Basile AM, Inzitari D, Erkinjuntti T, Wahlund LO, Rostrup E, Schmidt R, Fazekas F, Scheltens P. Medial temporal lobe atrophy and white matter hyperintensities are associated with mild cognitive deficits in non-disabled elderly people: the LADIS study. J Neurol Neurosurg Psychiatry 2005; 76:1497-500. [PMID: 16227537 PMCID: PMC1739423 DOI: 10.1136/jnnp.2005.064998] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the associations of medial temporal lobe atrophy (MTA) and white matter hyperintensities (WMH) with cognitive function in a large group of independently functioning elderly people. METHODS Data were drawn from the multicentre, multinational leukoaraiosis and disability (LADIS) project which is studying prospectively the role of WMH as an independent predictor of the transition to disability in non-disabled elderly people. In all, 639 participants were enrolled in the LADIS study. For the present analysis, data on 581 subjects were available. Cognitive function was assessed by the mini-mental state examination (MMSE). Visual ratings of WMH and MTA were undertaken on magnetic resonance images (MRI). RESULTS The presence of either severe WMH or MTA was associated with a modest but non-significant increase in frequency of mild cognitive deficits (severe WMH: odds ratio (OR) = 1.9 (95% confidence interval (CI), 1.0 to 3.7); MTA present: OR = 1.5 (95% CI, 0.8 to 2.8)). However, subjects with the combination of MTA and severe WMH had a more than fourfold increase in frequency of mild cognitive deficits (OR = 4.1 (95% CI, 2.3 to 7.4)). Analysis of variance with post hoc Bonferroni t tests showed that subjects with both MTA and severe WMH performed worse on MMSE than those with either no MRI abnormality or a single MRI abnormality (p<0.05). CONCLUSIONS These results provide further evidence for the combined involvement of both Alzheimer type pathology and vascular pathology in the earliest stages of cognitive decline and suggest an additive effect of WMH and MTA.
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Affiliation(s)
- W M van der Flier
- Department of Neurology and Alzheimer Centre, Vrije Universiteit Medical Centre, 1007 MB Amsterdam, The Netherlands.
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Pantoni L, Sarti C, Pescini F, Bianchi S, Bartolini L, Nencini P, Basile AM, Lamassa M, Kalaria RN, Dotti MT, Federico A, Inzitari D. Thrombophilic risk factors and unusual clinical features in three Italian CADASIL patients. Eur J Neurol 2004; 11:782-7. [PMID: 15525301 DOI: 10.1111/j.1468-1331.2004.00915.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetically transmitted cerebrovascular disease. Typically, the first clinical manifestation is migraine and the full clinical spectrum of the disease with recurrent strokes of the subcortical type, cognitive, and mood disorders is seen during the fourth and fifth decades of life. Vascular risk factors are usually absent in CADASIL patients and the diagnosis of the disease is particularly suspected in young adults with cerebrovascular events of unknown cause, diffuse leukoencephalopathy on computed tomography or magnetic resonance imaging, and a history of cerebrovascular diseases or dementia in many family members. We describe three Italian CADASIL patients who presented to medical attention for cerebrovascular events occurred after the age of 55 and had, in addition to hypertension and hyperlipidemia, thrombophilic risk factors such as hyperhomocysteinemia, elevated levels of lipoprotein(a), and antiphospholipid antibodies. Symptoms possibly related to cortical involvement, such as dysphasia and visual field deficits, were reported by two of these patients. We conclude that a diagnosis of CADASIL should not be disregarded in patients with vascular risk factors and presenting with symptoms not immediately referable to subcortical damage at ages more advanced than commonly reported.
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Affiliation(s)
- L Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
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Abstract
Vascular dementia (VD) has not to be considered anymore as a univocal nosologic entity. Based on different types of lesions, distinct subtypes of vascular dementia may be identified, each caused by diverse pathophysiological mechanisms. Among these subtypes subcortical vascular dementia (SVD) may represent a well-defined entity in terms of pathophysiology, clinical features and neuroradiological aspects. The picture is characterized by history of arterial hypertension and other vascular risk factors, clinical symptoms and signs including, besides dementia, dysfunctions related to subcortical-frontal circuit damages, and extensive confluent or diffuse abnormalities in the subcortical brain white matter, small deep infarcts as revealed by computed tomographic (CT) or magnetic resonance imaging (MRI) scans. The homogeneity of this clinical-pathological picture is essential for the success of controlled clinical trials in the field of vascular dementia.
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Affiliation(s)
- D Inzitari
- Dipartimento di Scienze Neurologiche e Psichiatriche, Università degli Studi di Firenze, I-50134 Firenze, Italy.
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Panza F, D'Introno A, Colacicco AM, Capurso C, Basile AM, Torres F, Capurso A, Solfrizzi V. LBP-1c/CP2/LSF gene polymorphism and risk of sporadic Alzheimer's disease. J Neurol Neurosurg Psychiatry 2004; 75:166-8. [PMID: 14707336 PMCID: PMC1757468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Panza F, D'Introno A, Colacicco AM, Basile AM, Capurso C, Kehoe PG, Capurso A, Solfrizzi V. Vascular risk and genetics of sporadic late-onset Alzheimer’s disease. J Neural Transm (Vienna) 2003; 111:69-89. [PMID: 14714217 DOI: 10.1007/s00702-003-0071-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2003] [Accepted: 08/26/2003] [Indexed: 10/26/2022]
Abstract
In recent years, it is becoming apparent that genes may play an important role in the development of late-onset Alzheimer's disease (LOAD), and genetic studies could unravel new clues. Based on a growing vascular hypothesis for the pathogenesis of LOAD and other dementias, there is increasing interest for environmental and genetic vascular factors. Polymorphisms in different susceptibility genes already implicated in vascular disease risk are now also being suggested as possible genetic markers for increased risk of developing LOAD; however, many of these studies have shown conflicting results. Thus far, the apolipoprotein E (APOE) gene seems to be the only vascular susceptibility factor that is agreed to play a role in the multifactorial pathogenesis of AD although emerging genetic and biological evidence is now strengthening the case for additional inclusion of angiotensin I-converting enzyme 1 (ACE1) into this category. This review will focus on the current knowledge on genetic and nongenetic vascular factors likely to be involved in LOAD, with special emphasis placed on the APOE and ACE1 genes.
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Affiliation(s)
- F Panza
- Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy.
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Colacicco AM, Panza F, Basile AM, Solfrizzi V, Capurso C, D'Introno A, Torres F, Capurso S, Cozza S, Flora R, Capurso A. F175S change and a novel polymorphism in presenilin-1 gene in late-onset familial Alzheimer's disease. Eur Neurol 2002; 47:209-13. [PMID: 12037434 DOI: 10.1159/000057901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We analyzed at the molecular level with presenilin-1 (PS-1) and apolipoprotein E (apoE) genotyping the affected subjects and asymptomatic relatives of an Italian family with several members affected by late-onset familial Alzheimer's disease (AD). The screen for PS-1 gene mutations revealed a novel missense substitution phenylalanine 175 to serine in 1 of the affected individuals and 2 asymptomatic sons of the patient. This change was not found in other relatives of this family, as well as in 60 individuals with sporadic late-onset AD and 40 normal controls. Furthermore, a GG/TT substitution in the 3' end of intron 6 at the boundary with exon 7 was found in all relatives of the second and third generations of this family. All the affected relatives were female homo- or heterozygotes for apoE epsilon4 allele. This study provides evidence that a PS-1 gene missense change does not necessarily associate with early-onset disease, and can occur in single cases affected by late-onset disease.
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Affiliation(s)
- A M Colacicco
- Department of Geriatrics, Center for Aging Brain - Memory Unit, University of Bari, Italy
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Solfrizzi V, Panza F, D'Introno A, Colacicco AM, Capurso C, Basile AM, Capurso A. Lipoprotein(a), apolipoprotein E genotype, and risk of Alzheimer's disease. J Neurol Neurosurg Psychiatry 2002; 72:732-6. [PMID: 12023414 PMCID: PMC1737901 DOI: 10.1136/jnnp.72.6.732] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the possible role of serum lipoprotein(a) (Lp(a)), apolipoprotein E polymorphism, and total cholesterol (TC) serum concentrations in Alzheimer's disease (AD). METHODS Lp(a) serum concentrations, apolipoprotein E genotypes, and TC serum concentrations were determined in 61 patients with a diagnosis of probable AD and in 63 healthy unrelated age matched controls. Genomic DNA was obtained and amplified by polymerase chain reaction and apolipoprotein E genotypes were defined following a previously described procedure. RESULTS Lp(a) serum concentrations were significantly associated in a non-linear relation with an increased risk for AD, independently of apolipoprotein E genotypes and sex and dependent on age (truth association) and TC serum concentrations (spurious association). The effect of age adjusted for TC on the odds of having AD increased non-linearly with increasing Lp(a) serum concentrations, with a plateau between 70 and 355 mg/l (odds ratio 11.33). For Lp(a) serum concentrations > or = 360 mg/l, the effect of age (> or = 72 years) was associated with a reduction in odds of having AD (odds ratio 0.15). CONCLUSION It is suggested that increased Lp(a) serum concentrations, by increasing the risk for cerebrovascular disease, may have a role in determining clinical AD.
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Affiliation(s)
- V Solfrizzi
- Department of Geriatrics, Centre for Aging Brain, Memory Unit, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Solfrizzi V, Panza F, D'Introno A, Colacicco AM, Basile AM, Capurso C, Torres F, Mestro M, Valero R, Capurso A. Lipoprotein(a) in the elderly: beyond atherosclerosis. Arch Gerontol Geriatr 2002; 8:337-43. [PMID: 14764413 DOI: 10.1016/s0167-4943(02)00125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V Solfrizzi
- Department of Geriatrics, Center for Aging Brain, University of Bari, Italy. geriat.dot.@geriatria.uniba.it
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Panza F, Solfrizzi V, D'Introno A, Capurso C, Basile AM, Colaiccco AM, Sabba M, Noya R, Capurso A. Apolipoprotein and antiotensin converting enzyme genes: regional differences and extreme longevity in Europe. Arch Gerontol Geriatr 2002; 8:247-51. [PMID: 14764397 DOI: 10.1016/s0167-4943(02)00141-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F Panza
- Department of Geriatrics, Center for Aging Brain, University of Bari, Italy.
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Brun S, Bouchara JP, Bocquel A, Basile AM, Contet-Audonneau N, Chabasse D. Evaluation of five commercial Sabouraud gentamicin-chloramphenicol agar media. Eur J Clin Microbiol Infect Dis 2001; 20:718-23. [PMID: 11757973 DOI: 10.1007/s100960100577] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The diagnosis of fungal infections relies on the isolation of the causative agent by culture of clinical specimens. Among the different culture media, Sabouraud glucose agar remains the most widely used. The use of commercial culture media is highly recommended as good laboratory practice in clinical microbiology. Therefore, the comparative performance of five different Sabouraud gentamicin-chloramphenicol agar media, available commercially as plates, was investigated. A total of 124 strains encompassing 45 yeasts and 79 filamentous fungi were cultured. Colonies of the dermatophytes (28 strains) and some related keratinophilic fungi (6 strains) were of overall similar appearance or size on all five media. Conversely, all the Aspergillus strains tested (n=17) as well as a few other strains of Hyphomycetes (n=5/18) exhibited important differences in the colour of the colonies. Furthermore, growth of the members of Mucorace ae was also affected, with great differences in the diameter of the colonies observed. In addition, quantitative cultures of the yeasts revealed marked variations in the number of the colonies, or even no growth, for two Candida species, Cryptococcus species, and Trichosporon cutaneum. In conclusion, the only formulation that gave good results with all fungal types tested was the one from Becton Dickinson (France).
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Affiliation(s)
- S Brun
- UPRES-EA 3142, Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire, Angers, France.
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Pantoni L, Basile AM, Romanelli M, Piccini C, Sarti C, Nencini P, Inzitari D. Abulia and cognitive impairment in two patients with capsular genu infarct. Acta Neurol Scand 2001; 104:185-90. [PMID: 11551242 DOI: 10.1034/j.1600-0404.2001.00370.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND An internal capsule genu infarct has been rarely reported to cause cognitive impairment and behavioral changes. This clinical picture can be explained on anatomical and functional basis because important subcortical-cortical pathways traverse the internal capsule genu. We report 2 previously non-demented patients who developed acute confusional state, abulia, and moderate cognitive decline after the occurrence of an infarct in the capsular genu. METHODS Clinical, neuropsychological, and MRI evaluation at baseline and 12-month follow-up. RESULTS Abulia and cognitive impairment were still present 1 year after stroke. In 1 patient there were associated multiple lacunar infarcts and leukoaraiosis. In the other an old small left frontal infarct was also present. In both moderate cortical atrophy co-existed. CONCLUSIONS We hypothesize that co-existing lesions, possibly associated with a sub-clinical reduction of cognitive functions, facilitate the development of a persistent clinically evident mental deficit after the occurrence of an infarct in the capsular genu.
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Affiliation(s)
- L Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni 85, 50134 Florence, Italy.
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Di Carlo A, Perna AM, Pantoni L, Basile AM, Bonacchi M, Pracucci G, Trefoloni G, Bracco L, Sangiovanni V, Piccini C, Palmarini MF, Carbonetto F, Biondi E, Sani G, Inzitari D. Clinically relevant cognitive impairment after cardiac surgery: a 6-month follow-up study. J Neurol Sci 2001; 188:85-93. [PMID: 11489290 DOI: 10.1016/s0022-510x(01)00554-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE The majority of studies on neuropsychological complications after cardiac surgery used the raw variation of selective tests scores to define the occurrence of cognitive decline. We prospectively estimated the frequency of cognitive impairment after cardiac surgery, with a particular emphasis on persistent and clinically relevant cognitive decline. Possible baseline and operative predictors were also evaluated. METHODS An extensive neuropsychological battery was administered to 110 patients (mean age 64.1+/-9.4 years; 70.9% males) undergoing cardiac surgery before and 6 months after the operation. After evaluating the variations in the cognitive performances, two independent neuropsychologists ranked the patients as unchanged-improved, mildly-moderately deteriorated, or severely deteriorated, using a global and functionally oriented judgement. The degree of the impairment was determined in relation to its impact on everyday life activities. RESULTS Ten patients (9.1%) were ranked as severely deteriorated, 22 (20%) as mildly-moderately deteriorated, and 78 (70.9%) as unchanged-improved. Cognitively impaired patients were older (p=0.031), more often females (p=0.005), with a low education level (p=0.013). At multivariate analysis, female gender (odds ratio (OR) 6.14, 95% confidence interval (95% CI) 2.16-17.50), baseline use of beta-blockers (OR 4.55, 95% CI 1.30-15.92), and PaO2 at arrival in intensive care unit (OR for 1 mm Hg increment 1.012, 95% CI 1.004-1.020) were significant predictors of cognitive impairment of any degree. Positive predictors of severe cognitive impairment were history of hypertension (OR 5.33, 95% CI 1.03-27.64) and PaO2 at arrival intensive care unit (OR for 1 mm Hg increment 1.020, 95% CI 1.006-1.035), while education was protective (OR per year of increment 0.53, 95% CI 0.31-0.90). CONCLUSIONS A considerable proportion of cardiac surgery patients may undergo clinically relevant cognitive impairment. The knowledge of variables influencing cognitive outcome is essential for the adoption of preventive measures.
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Affiliation(s)
- A Di Carlo
- National Research Council of Italy (CNR-CSFET), Italian Longitudinal Study on Aging, Via L. Pancaldo, 21, 50127, Florence, Italy.
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Panza F, Colacicco AM, Basile AM, Capurso C, D'Introno A, Mastroianni F, Scicutella G, Capurso A, Solfruzzi V. Impact of decreased frequency of apolipoprotein Eepsilon4 allele on Alzheimer's disease in Southern Italy. Arch Gerontol Geriatr Suppl 2001; 7:299-306. [PMID: 11431078 DOI: 10.1016/s0167-4943(01)00153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- F Panza
- Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Policlinico, Italy
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Basile AM, Fusi C, Conti AA, Paniccia R, Trefoloni G, Pracucci G, Di Carlo A, Noferi D, Carbonetto F, Pretelli P, Calamai G, Vaccari M, Abbate R, Inzitari D. S-100 protein and neuron-specific enolase as markers of subclinical cerebral damage after cardiac surgery: preliminary observation of a 6-month follow-up study. Eur Neurol 2001; 45:151-9. [PMID: 11306858 DOI: 10.1159/000052114] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cerebral damage remains one of the hazards related to cardiac surgery with cardiopulmonary bypass. The use of biochemical markers of cerebral injury may be of practical value. We investigated the plasma release patterns of S-100 protein and neuron-specific enolase (NSE) during the intervention and their relationship with the development of neuropsychological deficits assessed 6 months after the intervention in 16 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Both S-100 and NSE significantly increased peri- and postoperatively. Significant correlations were found between values measured at several time points and impaired performance in a few tests at the 6-month follow-up. A stratification into two age subgroups led to the hypothesis that age might have a confounding or a modifying effect on the association between S-100 and NSE levels, and cognitive impairment.
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Affiliation(s)
- A M Basile
- Department of Neurological and Psychiatric Sciences, Section of Internal Medicine and Cardiology, University of Florence, Florence, Italy
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Abstract
Several fractions of a methanol extract from the leaves of Aristolochia paucinervis Pomel (Aristolochiaceae) were screened for their antidermatophytic efficiency against different human pathogenic fungi responsible for tinea and other skin infections. The antifungal study was carried out by the macrodilution agar method and the results showed that, with the exception of the aqueous fraction, all the fractions exhibited antifungal activities against the dermatophytic fungi tested. The hexane fraction was found to be the most effective (MIC range: 64-2048 microg/mL), whereas the butanol fraction was the least active (MIC range: 1024 microg/mL to more than 2048 microg/mL). The most susceptible fungi were Epidermophyton floccosum and Trichophyton violaceum in contrast to Trichophyton mentagrophytes and Trychophyton rubrum which were less sensitive to the fractions tested. The effects were compared with those of ketoconazole, amphotericin B and griseofulvin, for which MIC ranges were, respectively, 0.12-4 microg/mL, 0.5-4 microg/mL and 0.5-2 microg/mL.
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Affiliation(s)
- C A Gadhi
- Laboratoire de Phytochimie des Plantes Médicinales, Faculté des Sciences-Semlalia, Université Cadi Ayyad, B.P. S/15, Marrakech 40000, Morocco.
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Lamassa M, Di Carlo A, Pracucci G, Basile AM, Trefoloni G, Vanni P, Spolveri S, Baruffi MC, Landini G, Ghetti A, Wolfe CD, Inzitari D. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project). Stroke 2001; 32:392-8. [PMID: 11157172 DOI: 10.1161/01.str.32.2.392] [Citation(s) in RCA: 259] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The role of atrial fibrillation (AF) as a determinant of stroke outcome is not well established. Studies focusing on this topic relied on relatively small samples of patients, scarcely representative of the older age groups. We aimed at evaluating clinical characteristics, care, and outcome of stroke associated with AF in a large European sample. METHODS In a European Concerted Action involving 7 countries, 4462 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin scale). RESULTS AF was present in 803 patients (18.0%). AF patients, compared with those without AF, were older, were more frequently female, and more often had experienced a previous myocardial infarction; they were less often diabetics, alcohol consumers, and smokers (all P:<0.001). At 3 months, 32.8% of the AF patients were dead compared with 19.9% of the non-AF patients (P:<0.001). With control for baseline variables, AF increased by almost 50% the probability of remaining disabled (multivariate odds ratio 1.43, 95% CI 1.13 to 1.80) or handicapped (multivariate odds ratio 1.51, 95% CI 1.13 to 2.02). Before stroke, only 8.4% of AF patients were on anticoagulants. The chance of being anticoagulated was reduced by 4% per year of increasing age. AF patients underwent CT scan and other diagnostic procedures less frequently and received less physiotherapy or occupational therapy. CONCLUSIONS Stroke associated with AF has a poor prognosis in terms of death and function. Prevention and care of stroke with AF is a major challenge for European health systems.
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Affiliation(s)
- M Lamassa
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
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Panza F, Solfrizzi V, Torres F, Mastroianni F, Colacicco AM, Basile AM, Capurso C, D'Introno A, Del Parigi A, Capurso A. Apolipoprotein E in Southern Italy: protective effect of epsilon 2 allele in early- and late-onset sporadic Alzheimer's disease. Neurosci Lett 2000; 292:79-82. [PMID: 10998553 DOI: 10.1016/s0304-3940(00)01447-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Apolipoprotein E (apoE) polymorphism was evaluated in 81 sporadic late onset Alzheimer's disease (LOAD) patients, 28 sporadic early-onset Alzheimer's disease (EOAD) and 92 sex- and age-matched healthy controls from Apulia, Southern Italy. ApoE genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism method. The frequency of apoE epsilon 4 allele was significantly higher in EOAD patients than in the control group, but not in LOAD patients. Furthermore, EOAD patients carrying epsilon 4 allele had lower age at onset of AD symptoms (about 4. 5 years). In the whole sample, epsilon 4 was associated to AD by an odds ratio of 2.14, while it increased up to 6.55 in < 65 years old subjects. Finally, in both < 65 and > or = 65 subgroups of subjects, epsilon 2 played a protective role against the development of AD. It is concluded that the geographic decreasing trend of epsilon 4 allele and the age at onset may influence the association of apoE polymorphism with sporadic AD in a Southern Italian sample.
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Affiliation(s)
- F Panza
- Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Policlinico, 70124 Bari, Italy
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Panza F, Solfrizzi V, Torres F, Mastroianni F, Del Parigi A, Colacicco AM, Basile AM, Capurso C, Noya R, Capurso A. Decreased frequency of apolipoprotein E epsilon4 allele from Northern to Southern Europe in Alzheimer's disease patients and centenarians. Neurosci Lett 1999; 277:53-6. [PMID: 10643896 DOI: 10.1016/s0304-3940(99)00860-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Apolipoprotein E (apoE) polymorphism was studied in 79 sporadic late onset Alzheimer's disease (LOAD) patients, 125 unrelated caregivers or volunteers (19-80 years), and 67 centenarians from Apulia, Southern Italy. The frequency of apoE epsilon2 allele was higher in centenarians than in LOAD patients, while epsilon4 was lower. In middle-aged adults, the epsilon4 allele frequency was higher than in centenarians. The epsilon4 allele frequency was lower in healthy adults than in LOAD patients, while epsilon2 was higher. Compared with the allele frequencies of Northern and Central European countries, a geographic trend for epsilon3 and epsilon4 alleles in LOAD and middle-aged adults was observed. The frequency of epsilon3 increased from Northern to Southern Europe, while epsilon4 decreased significantly. In centenarians, epsilon2 showed a North-South increasing pattern, while epsilon4 was in opposite trend.
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Affiliation(s)
- F Panza
- Department of Geriatrics, Center for Aging Brain, Memory Unit University of Bari Policlinico, Italy
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Di Carlo A, Lamassa M, Pracucci G, Basile AM, Trefoloni G, Vanni P, Wolfe CD, Tilling K, Ebrahim S, Inzitari D. Stroke in the very old : clinical presentation and determinants of 3-month functional outcome: A European perspective. European BIOMED Study of Stroke Care Group. Stroke 1999; 30:2313-9. [PMID: 10548664 DOI: 10.1161/01.str.30.11.2313] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The oldest old represent the fastest-growing segment of the elderly population in developed countries. Knowledge of age-specific aspects of stroke is essential to establish diagnostic and therapeutic pathways and to set up prevention and rehabilitation programs. We sought to evaluate stroke features and functional outcome in patients aged >/=80 years compared with the younger age groups. METHODS In a European Union Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month disability (Barthel Index) and handicap (Rankin Scale). RESULTS Overall, 3141 patients (69.8%) were aged <80 years, and 1358 (30.2%) were aged >/=80 years. At baseline, female sex, prestroke institutionalization, and a worse prestroke Rankin score were significantly more frequent in the older patients, as were coma, paralysis, swallowing problems, and urinary incontinence in the acute phase (all P values <0.001). Brain imaging and other diagnostic tools were significantly less used in the older patients. Paralysis, swallowing problems, and incontinence during hospitalization independently predicted 3-month disability or handicap in both groups. For the older patients, prestroke institutionalization proved a further strong and independent determinant of 3-month disability (odds ratio, 2.33; 95% CI, 1.22 to 4.45) and handicap (odds ratio, 7.04; 95% CI, 1.62 to 30. 69). CONCLUSIONS In the very old, both medical and sociodemographic factors may significantly influence stroke outcome, showing peculiar characteristics. Knowledge of these determinants may reduce the burden on health systems, improving quality of care.
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Affiliation(s)
- A Di Carlo
- National Research Council of Italy (CNR-CSFET), Italian Longitudinal Study on Aging, Florence, Italy
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Basile AM, Nencini P, Inzitari D. [The molecular mechanisms of cerebral ischemia: the possible therapeutic interventions]. Ann Ital Med Int 1999; 14:94-105. [PMID: 10399371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Therapeutic interventions for acute ischemic stroke have not yet been established in clinical practice. The recognition of an area of reduced blood flow in which neuronal death may be prevented has focused attention on treatments aiming at minimizing ischemic brain damage, if they are initiated within short time after occlusion. The combination of restoring blood flow and providing neuroprotection may be the most productive approach in human acute ischemic stroke, but this combined therapy requires testing through clinical trials. To gain insight into the molecular mechanisms of cerebral ischemia, this review examines the excito-toxic cascade, synthesis and role of nitric oxide and oxidants, gene regulation and possible neuroprotective therapeutic targets. As neuroprotectants, glutamate-antagonists, calcium-antagonists and free radical scavengers have been investigated. The role of nitric oxide is very complex, as it can be cytotoxic or cytoprotective in relation to sources, time of synthesis, and medium redox state. Animal gene studies suggest that nitric oxide produced by endothelial nitric oxide synthase may be advantageous, while nitric oxide produced by neuronal and inducible nitric oxide synthase disadvantageous. A treatment strategy could involve the use of selective inhibitors of different types of nitric oxide synthase. Cell death after cerebral ischemia occurs through the dual pathway of ischemic necrosis and apoptosis. Novel therapies may be directed at genes mediating either recovery or apoptosis. There are, as yet, no conclusive data concerning the safety and efficacy of neuroprotectants in humans. Differences between animal models and clinical conditions may justify the discrepancy between experimental data and clinical practice.
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Affiliation(s)
- A M Basile
- Clinica Neurologica III, Università degli Studi di Firenze
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Percebois G, Basile AM, Schwertz A. [Common presence on strawberries of ascospores of Byssochlamys nivea capable of producing patulin]. Mycopathologia 1975; 57:109-11. [PMID: 1207720 DOI: 10.1007/bf01365712] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tha auteurs have obtained a strain of Byssochlamys nivea from heat processed strawberries. The mold grown on synthetic media shows antibiotic properties. The metabolite responsible is patulin which has been purified and characterized. Several strains of B. nivea produced this mycotoxin. Patulin seems to be stable in strawberries juice.
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