Visuospatial impairment in Parkinson's disease. Role of perceptual and motor factors

We investigated the role of perceptual and motor factors in visuospatial impairment in 30 patients with Parkinson's disease (PD) and 30 matched controls. All subjects were administered visuospatial tests, which included "visuoperceptual" tasks, requiring minimal motor responses, and "visuomotor" tasks. The performance of patients with PD was considerably impaired on several tasks from both groups, and this impairment was not related to depression or intellectual impairment. Patients in stage 3 of the disease tended to show the greatest impairment. Those in stage 1 (unilateral symptoms), however, tended to show more impairment than those in stage 2.

When, where, and how the corpus callosum changes in MCI and AD: a multimodal MRI study

BACKGROUND

The corpus callosum (CC) has been shown to be susceptible to atrophy in Alzheimer disease (AD) as a correlate of wallerian degeneration or retrogenesis. However, when and where these 2 mechanisms intervene is still unclear.

METHODS

In 3 memory clinics, we recruited 38 patients with amnestic mild cognitive impairment (MCI), 38 patients with mild AD, and 40 healthy controls (HC). Combining voxel-based morphometry and diffusion tensor imaging, we investigated CC white matter (WM) density and fractional anisotropy (FA), radial diffusivity (DR), and axial diffusivity (DA).

RESULTS

Compared with HC, patients with amnestic MCI showed reduced WM density in the anterior CC subregion; however, FA, DR, and DA did not differ between the 2 groups. Significant changes were found in patients with mild AD compared with HC in the anterior and posterior CC regions. These differences were evident in both voxel-based morphometry and diffusion tensor imaging analyses. Specifically, we found reduced callosal WM density in the genu, posterior body, and splenium; decreased FA and increased DR in the anterior CC subregion; and increased DA, with no difference in the FA, in the posterior CC subregion.

CONCLUSIONS

Callosal changes are already present in patients with amnestic mild cognitive impairment (MCI) and mild Alzheimer disease (AD). The precocious involvement of the anterior callosal subregion in amnestic MCI extends to posterior regions in mild AD. Two different mechanisms might contribute to the white matter changes in mild AD: wallerian degeneration in posterior subregions of the corpus callosum (suggested by increased axial diffusivity without fractional anisotropy modifications) and a retrogenesis process in the anterior callosal subregions (suggested by increased radial diffusivity without axial diffusivity modifications).

Functional basis of memory impairment in multiple sclerosis: a[18F]FDG PET study

Structural neuroimaging has been used to correlate lesional patterns with the cognitive profile of patients with multiple sclerosis (MS), especially for "frontal" dysfunction. However, a clear-cut anatomical explanation has yet to be found for the long-term memory deficit which is a hallmark of MS cognitive impairment. We have used PET to measure regional cerebral glucose metabolism (rCMRglc) in a group of 15 MS patients with involvement of verbal and/or spatial long-term memory. These patients were compared with 10 normal controls and 13 MS patients unimpaired on all neuropsychological tests. Relative to the controls, MS patients with memory deficits showed a significant bilateral reduction of rCMRglc in the hippocampus, cingulate gyrus, thalamus, associative occipital cortex, and cerebellum. Direct comparisons between patients with memory deficits and the group of unimpaired MS patients showed a metabolic reduction in the left thalamus and in both hippocampi. Seven of the memory-impaired patients also had neuropsychological signs of frontal dysfunction. These patients were compared with patients who had isolated memory deficit. Here we observed a further metabolic reduction in a number of brain regions including bilateral prefrontal cortex, inferior parietal cortex, and basal ganglia. Our findings indicate that hypometabolism of thalamic and deep cortical gray structures of the temporal lobe is associated with episodic memory dysfunction in MS. On the other hand, pathological performance on tests designed to assess frontal functions was associated with widespread reduction of glucose metabolism.

Calculation disturbances in adults with focal hemispheric damage

It has been suggested that hemisphere-damaged patients with calculation disorders can be subdivided into 3 groups: agraphia or alexia for numbers, spatial dyscalculia and anarithmetia. The purpose of the present study was to evaluate the role played by visuospatial disorders and by anarithmetia in subjects with impaired calculation abilities. Seventy-six patients with focal hemispheric lesions and 26 normal controls with demonstrated ability to read and write numbers were given a written calculation task, the Token Test, the Crosses Test, a test of Constructional Apraxia and Raven's Progressive Matrices. In the calculation task, a quantitative score represented the number of digits that were correct numerically and put in correct position. A qualitative score with emphasis on visuospatial factors was obtained by scoring each problem with the criteria used in Benton's Visual Retention Test. Analysis of the results showed that both left and right hemisphere-damaged patients performed significantly worse than controls and that patients with left posterior lesions were particularly impaired even after correction of the acalculia scores by the results of the other neuropsychological tests. These results suggest that even though different factors may contribute to calculation disorders (impairment of intelligence, visuoconstructive difficulties and above all aphasia), left posterior lesions are particularly prone to produce an impairment in calculating abilities which is partially independent from the above disorders.

SPECT, MRI and cognitive functions in multiple sclerosis

Seventeen patients with relapsing remitting multiple sclerosis (MS) and mild physical disability had neuropsychological testing, magnetic resonance imaging (MRI) and single photon emission computerised tomography (SPECT) using technetium 99m (99mTc) hexamethyl-propyleneamine oxime (HMPAO). Performance in verbal fluency, naming and memory testing appeared to be impaired in MS patients compared with 17 age-sex and education matched normal controls. Weighted periventricular and confluent lesion scores and the width of the third ventricle, proved to be the most sensitive MRI measures in differentiating more cognitively impaired patients from those who were relatively unimpaired. Ratios of regional to whole brain activity, measured by SPECT, showed significant reduction in the frontal lobes and in the left temporal lobe of MS patients. A relationship was found between left temporal abnormality in 99mTc-HMPAO uptake and deficit in verbal fluency and verbal memory. Finally, asymmetrical lobar activity indicated a predominant left rather than right temporo-parietal involvement.

Anterior corpus callosum atrophy and verbal fluency in multiple sclerosis

To determine whether different portions of the corpus callosum (CC) are responsible for transferring the information of specific cognitive modalities, eighteen females with relapsing-remitting Multiple Sclerosis (MS) were studied using neuropsychological procedures and Magnetic Resonance Imaging (MRI). Measures of both anterior and posterior CC areas were obtained in patients with MS as well as in eighteen age and sex matched healthy controls. MRI scans were additionally analyzed for each patient in order to evaluate the extent of demyelinating lesions in both periventricular and subcortical areas. Patients with MS exhibited a significant decrease in both the anterior and posterior CC areas compared with normal subjects. The results of statistical analysis showed that, even when the effect of demyelinating lesions was taken into account within a regression equation, the atrophy of anterior CC area strongly affected the performance on verbal fluency task. These data emphasize the importance of the anterior CC area for the interhemispheric transfer of cognitive information associated with verbal fluency.

Visuoperceptual and visuomotor abilities and locus of lesion

Possible differential effects of laterality and caudality of cerebral lesions on simple visuoperceptual and visuomotor skills were examined. As expected, the right hemisphere lesion group was significantly more impaired than the left hemisphere lesion group. The effects of the caudality of lesion, however, yielded interesting results. While the right posterior group was worse than the right anterior lesion group, as expected, the left posterior lesion group was better than the left anterior lesion group. Our findings points to a possibility that the left hemisphere, especially the anterior region, might not be as silent in processing simple visual stimuli as has been accepted.

Creativity and dementia: a review

In these last years, creativity was found to play an important role for dementia patients in terms of diagnosis and rehabilitation strategies. This led us to explore the relationships between dementia and creativity. At the aim, artistic creativity and divergent thinking are considered both in non-artists and artists affected by different types of dementia. In general, artistic creativity can be expressed in exceptional cases both in Alzheimer's disease and Frontotemporal dementia, whereas divergent thinking decreases in dementia. The creation of paintings or music is anyway important for expressing emotions and well-being. Yet, creativity seems to emerge when the right prefrontal cortex, posterior temporal, and parietal areas are relatively intact, whereas it declines when these areas are damaged. However, enhanced creativity in dementia is not confirmed by controlled studies conducted in non-artists, and whether artists with dementia can show creativity has to be fully addressed. Future research directions are suggested.

Remote effects of caudate hemorrhage: a clinical and functional study

Clinical, anatomical and functional findings in two cases of previous caudate nucleus hemorrhage, with good recovery, are presented. CBF data obtained with SPECT and 123 I-HIPDM well correlate with functional residual deficit, despite normal TCT examinations. These observations are suggestive of a partial "wallerian" diaschisis.

Hemispheric superiorities on a unilateral tactile test: relationship to cognitive dimensions

Subjects, 30 male and 30 female, were administered a unilateral tactile test, which requires the subject to judge line orientations. More field-independent individuals in the sample perceived line orientation significantly more accurately with their left hand than with their right hand, while more field-dependent individuals showed no significant lateral difference. However, a similar pattern was observed when a verbal comprehension measure was used as a criterion. The results are discussed as they relate to the hypothesis of a link between psychological differentiation and cerebral specialization.

Prolonged COVID 19 Outbreak and Psychological Response of Nurses in Italian Healthcare System: Cross-Sectional Study

Aim of the study was to analyze the posttraumatic stress disorder risk nurses, detecting the relationship between distress experience and personality dimensions in Italian COVID-19 outbreak. A cross-sectional study was conducted based on 2 data detection (March 2020 and September 2020). Mental evaluation was carried out in Laboratory of Clinical Psychology on n.69 nurses in range age 22-64 years old (mean age 37.3; sd ± 10.3; 55% working in nursing care with confirmed COVID-19 patients (named frontline; secondline nurses have been identified by nursing care working with infectious patients but no confirmed COVID-19). Measurement was focused on symptoms anxiety, personality traits, peritraumatic dissociation and post-traumatic stress for all participants. No online screening was applied. Comparisons (ANOVA test) within the various demographic characteristics demonstrated few significant differences between groups on DASS-21, PDEQ, and ISE-R scores. Correlation analysis (Spearman test) was performed among PDEQ, DASS-21, BFI-10 and IES-R and confirmed between anxiety (DASS-21) and peritraumatic dissociation and post-traumatic stress; then anxiety is positively correlated to agreeableness variable of BFI-10 test. The emotional distress was protracted overtime (after 6 months) but in long-term personality traits resulted mediator facing subjective stress. Our finding drew details for protective and predictive risk factors as well as mental health issues of nurses dealing with pandemic: healthcare workers faced the protracted challenge caring COVID-19 patients over and over again: in short time the impact was relevant, and the prolonged exposition to the stressor was tackled by personal resources such as personality traits.

Reading latency of words and nonwords in Alzheimer's patients

Contrasting data on reading ability in Alzheimer's disease patients have been reported in the literature. Recently Patterson, Graham and Hodges (1994) found that irregular words were misread by demented subjects, while regular words were read correctly. The present study hypothesizes that reading latency may be a sensitive measure of Alzheimer's patients reading impairment. Fifteen Alzheimer's patients were compared with 17 elderly normal subjects on three tasks that used the same set of concrete, regular words: a picture naming task, a word-picture matching task and a word-nonword reading task. The results of the study indicate that reading latency is longer in Alzheimer's patients than in normal subjects, and that misnamed and mismatched words are read with the same mechanism as nonwords.

Psychosomatic interactions in kidney transplantation: role of personality dimensions in mental health-related quality of life

Background and aims:

The increase in innovative and personalized medicine solutions in kidney surgery can improve patients’ chances of survival; however, during the transplantation process, patients are exposed to many psychological challenges. This study aimed to evaluate the role and impact of personality dimensions on the behaviour of waiting-list patients towards the post-surgery adaptation process.

Method:

The participants were 113 out-patients aged 18–70 years (mean age 54.7 years, SD ± 9.9) who had received a kidney transplant at least 3 years prior to the study.

Results:

The results of the study revealed that personality dimensions can predict mental health-related quality of life after kidney transplantation; in particular, the dimensions play an important role in patients’ behavioural ability to manage their quality of life both during end-stage renal disease and after kidney transplantation. Psychological distress and anxiety were associated with a low level of the conscientiousness dimension, while a high level of the openness dimension was associated with a high level of psychological distress and stress. In addition, body self-perception was associated with personality dimensions.

Conclusion:

Personality dimensions were found to predict behavioural reactions when emotional traits and body self-perception for each patient were combined; clinical psychologists could apply personalized intervention by modeling the treatments step by step and mitigating the negative effects of the whole kidney transplantation disease, thus helping the individual to adapt to a new life.

Word-stem completion task to investigate semantic network in patients with Alzheimer's disease

Semantic impairment in patients with Alzheimer's disease (AD) is revealed by tasks of verbal naming, verbal fluency, and semantic knowledge. Causes of the deficit remain unclear in spite of many studies to investigate whether AD patients suffer from the inability to have voluntary access to an almost intact semantic store or from its break down. Word-stem completion (WSC) tasks have been utilized in healthy subjects in order to study semantic memory and network by exploiting the possibility of the involuntary access to them. Available conflicting data refer to the presence of semantic prime in AD patients. To explore the semantic network in AD, patients were requested to complete with the first word that sprang to their mind a stem submitted immediately after presentation of the word prime, as a WSC task. Stems consisted of the three beginning letters of words that were semantically related to primes. We compared data obtained with this task from patients with mild to moderate AD with those from normal controls (NC). AD patients completed less stems (P<0.001) with the expected words than NC, suggesting a break down of the semantic network rather than a deficit in the access to the semantic store.

Cognitive Reserve and Digital Confidence among Older Adults as New Paradigm for Resilient Aging

OBJECTIVE

The purpose of this study was to examine the digital confidence of elder adults and identify behavioral patterns for technology that are related to cognitive abilities among elders.

METHOD

An observational study was conducted using a sample of 94 elders, aged 53 to 86 years. Neuropsychological and emotional measures were used, and technology use was assessed.

RESULTS

Finding showed elders by resilient neuropsychological aspects can have a good affinity for technology. We examined the role of not only cognitive reserve levels but also demographic characteristics (i.e., age, educational level) and found that elderly were more adherent to digital resources. Technology can be a beneficial resource to those with medium levels of cognitive reserve and make them feel "like they are leading an active lifestyle."

CONCLUSIONS

The focal point of our findings is the relevance of cognitive reserve during older adulthood as a key factor that should be examined in investigations on successful aging; it would be more interesting to examine these factors within the context of analyses on the impact of technology on aging and digital living.

Survivorship in young women after early breast cancer: a cross-sectional study of emotional traits along 3-years perspective

BACKGROUND

Breast cancer diagnosis and treatments have a strong impact on women's lives. This study aimed to evaluate the changes in emotional traits in women aged 38-50 years over a three-year period.

METHOD

By cross-sectional study design, a sample of n. 126 patients in range age 38-50 has been recruited in different timing of cancer disease, in order to evaluate the patients' emotional traits (variables: anxiety, anger, psychological distress, and depression) at the time of diagnosis, and 6, 12, 18, 24, and 36 months after diagnosis. Anger, anxiety, psychological distress, and depression were evaluated.

RESULTS

Results showed significant differences in each emotional variable during treatment. Anxiety showed a decreasing trend, whereas anger tended to improve significantly. At 12 and 24 months from the diagnosis, patients seemed more aware about their own psychological needs compared with the period immediately after the diagnosis (T0) and during the treatments. Women who had recently received a diagnosis (T0) seemed more resilient in their responses in facing an emergency.

CONCLUSIONS

Increased survival rate after breast cancer diagnosis is strongly linked to the management of emotional weakness of BC women because of modified living. Patients need to be supported to regain their life after clinical treatments though tailored psychological treatment along survivorship, not only in primary treatment.

The loss of conceptual associations in mild Alzheimer's dementia

Changes in semantic memory are a controversial topic in research on cognitive decline in aging. In this study, we analyzed whether the semantic deficits in mild Alzheimer's disease (AD) reflect the information acquisition process, and whether the deficits are related to when the information was initially stored. We hypothesized that in the earlier stages of dementia, the ability to access semantic associative relations reflects the use of these associations during different developmental stages. Specifically, we asserted that Alzheimer's patients might be able to access the relations that are learned earlier in life for the longest amount of time compared to those that are learned later. In this study, 254 subjects were divided into four groups (child, adult, senior, and Alzheimer's patients groups) and were evaluated with an experimental semantic association task that incorporated five semantic associative relations that were used to compare performance by age group. An analysis of variance (ANOVA) 4 × 5 test showed a significant main group effect, F(3, 250) = 97.1, p < .001, and an associative relations effect, F(4, 1000) = 23.1, p < .001, as well as an interaction of Group × Associative Relations, F(12, 1000) = 8.5, p < .001. The results demonstrated that the semantic associative relations that were acquired in later developmental stages were less preserved in persons with mild AD (i.e., superordinate relation, p < .0001). On the contrary, the semantic relations acquired earlier in childhood were better preserved in persons with mild AD. Our results suggest that semantic impairment begins with difficulties in using the associative relations that link concepts together in the semantic memory of patients with mild AD dementia (and possibly in individuals with mild cognitive impairment).

Emotional "Patient-Oriented" Support in Young Patients With I-II Stage Breast Cancer: Pilot Study

Objective: The recent increased survival rate after breast cancer (BC) diagnosis and treatment is mostly related to early screening in younger age. Evidence gained from newly detected assessed psychological needs as well as certain emotional regulatory patterns in younger survivors has been related in the literature to an extremely low rate of adherence to the psychological therapies offered. Tailored psychological support is necessary. The aim of the present study was to verify the preliminary efficacy of supportive psychological intervention with an innovative orientation: the Early BC Psychological Intervention (EBC-Psy).

Methods: A controlled study design was used to investigate the efficacy of EBC-Psy intervention. Preliminary data involved twenty-four patients in the age range of 35–50 years, diagnosed with cancer at the early stage (I–II), who were exposed to the EBC-Psy intervention. To address the effect of intervention, emotional variables were tested before the treatment (Time 1) and then again after 6 months of the treatment (Time 2); evaluated emotional dimensions were anxiety, anger, depression, and psychological distress.

Results: EBC-Psy intervention appears to be effective on both depression (p = 0.02) and psychological distress (p = 0.01), even in a short time, highlighting the strength of a reinforced positive psychological conceptual approach to deal with the “disease condition” in younger patients; on the contrary, the control group evidenced an increase in the same emotional variables in timing.

Conclusion: Our findings, even if limited by this small-scale protocol, seemed to confirm the role of positive psychotherapy after BC diagnosis and treatment through the impact of cognitive processes, coping strategies, and psychological resilience. Future theoretical framework could boost the intervention to design an innovative survivorship model.

Deterioration of semantic associative relationships in mild cognitive impairment and Alzheimer Disease

The aim of this research was to study semantic abilities and their loss in mild cognitive impairment (MCI) and in dementia, while analyzing efficiency in the use of associative relations, within verbal and visuoperceptual modalities. Participants were split into 4 groups: 19 participants with amnestic MCI, 16 patients with mild Alzheimer disease (AD), 20 patients with moderate AD, and 20 healthy controls (HCs). All participants performed standardized neuropsychological tests and experimental (naming and semantic associations) tasks to evaluate verbal and visuoperceptual semantic abilities. We analyzed 4 associative relations (part/whole, function, superordinate, and contiguity) in both verbal and visuoperceptual code. Our results suggest a progressive impairment in semantic categorization knowledge, with worse performance in the AD groups relative to the MCI and HC groups. Our data show a different pattern in the 4 associative relations and the involvement of associative semantic relations already in the early stage of disease, as well as a different pattern of deterioration between verbal and visuoperceptual modalities. Our data indicate that the visuoperceptual semantic network appears to be less deteriorated than the verbal network in AD. The verbal semantic network may be more sensitive in detecting patients at an early stage of the disease.

Object decision and multiple sclerosis: a preliminary study

The aim of this research was to study cognitive dysfunctions in multiple sclerosis (MS) by exploring subtle cognitive tasks, usually not included in the standard neuropsychological assessment. We wished to investigate whether it is possible to identify object decision deficits in MS patients without evident cognitive impairment; secondary objectives were to understand whether these deficits can be detected in the early stages of the disease and whether there are differences related to different phenotypes. Participants were divided into four groups: (a) 12 patients with early relapsing-remitting MS [ERR]; (b) 14 with late relapsing-remitting MS [LRR]; (c) 10 with secondary progressive MS [SP]; (d) 36 healthy controls [HCs]. All participants performed a series of experimental tasks: an object decision task (recognition of chimeric and real figures) and naming and visual discrimination tasks. Our results suggest that object decision disorders are detectable in patients without overt cognitive impairments and that performances on these tasks are related to phenotypes. On the other hand, the Chimeric Figures task is not appropriate for identifying cognitive dysfunctions in early MS.