Emergency medical care for multiple sclerosis: A five-year population study in the Campania Region (South Italy).

BACKGROUND: Emergency hospital admissions are common in multiple sclerosis (MS), and can highlight unmet medical needs. OBJECTIVES: To evaluate burden, predictors and outcomes of MS emergency admissions. METHODS: This is a population-based study, conducted in the Campania Region (South Italy) from 2015 to 2019, using hospital discharge records, drug prescriptions and outpatients. The risk of emergency hospital admissions and the likelihood of worse outcomes were evaluated using the Cox regression and multinomial logistic regression models, respectively, in relation to age, sex, disease-modifying treatments (DMTs), comorbidities and adherence. RESULTS: We recorded 1225 emergency admissions for 1001 patients (out of 5765 prevalent MS patients), overall costing 4,143,764.67 EUR. The risk of emergency admissions increased with age (hazard ratio (HR) = 1.02; 95% confidence interval (CI) = 1.01, 1.03; p < 0.01) and comorbidities (HR = 1.62; p < 0.01), and decreased in patients using DMTs (interferon beta/peg-interferon beta/glatiramer acetate HR = 0.19; p < 0.01; teriflunomide/dimethyl-fumarate/fingolimod HR = 0.18; p < 0.01, and alemtuzumab/cladribine/natalizumab/ocrelizumab HR = 0.21; p < 0.01), and with higher adherence (HR = 0.18; 95% CI = 0.13, 0.26; p < 0.01). Following emergency admission, older age was associated with probability of death (n = 63) (odds ratio (OR) = 1.06; p < 0.01) and discharge to long-term facility (n = 65) (OR = 1.03; p = 0.01). CONCLUSION: With 17% people with MS requiring emergency medical care over 5 years, improved management of DMTs and comorbidities could potentially reduce their medical, social and financial burden.

The Frontal Assessment Battery 20 years later: normative data for a shortened version (FAB15).

OBJECTIVE: The Frontal Assessment Battery (FAB) is a neuropsychological tool largely used to assess executive functions. Prior studies found a marked ceiling effect for the prehension behavior subtest (PBT) in healthy and clinical populations. Aims of the present study were (i) to examine the psychometric properties of the FAB without the contribution of PBT and (ii) to provide normative data for a revised version of the FAB after exclusion of PBT (FAB15). METHODS: The normative sample included 1,187 healthy participants. PBT had near-zero variance, poor content validity, and no discrimination power. Internal consistency increased when PBT was excluded. We assessed the FAB15 factorial structure, interrater, and test-retest reliabilities. Normative data  for the FAB15 were extracted through a regression-based procedure according to sex, age, and education. RESULTS: The principal component analysis revealed a single "executive factor" or alternatively a bifactorial solution reflecting the different degree of discriminative capability vs. difficulty of the subtests. The FAB15 demonstrated excellent interrater and test-retest reliabilities. Regression analysis showed that sex (lowly educated women < lowly educated men), higher age, and lower education affected FAB15 score. Accordingly, three grids for adjustment of raw scores (men, women, and both) were constructed. The cut-off was fixed at the non-parametric outer tolerance limit on the fifth centile (9.36, 95% CI). CONCLUSION: The observation of a ceiling effect in healthy subjects makes PBT not suitable for inclusion in a neuropsychological battery. The FAB15 may successfully replace the conventional FAB as a more severe and valid short screening tool to assess executive functioning.

Italian version of the Starkstein Apathy Scale (SAS-I) and a shortened version (SAS-6) to assess "pure apathy" symptoms: normative study on 392 individuals.

OBJECTIVES: The present normative study aimed to (1) develop the Italian version of the Starkstein Apathy Scale (SAS-I) and (2) construct a shortened version including only the most sensitive items to "pure apathy" experiences. METHODS: The normative sample included 392 healthy subjects. A regression-based procedure was used to explore the effects of sex, age, and education on the raw SAS-I score. A correction grid was designed for adjusting raw scores by adding or subtracting the contribution of any significant variable and net of sociodemographic interindividual differences. Cutoff scores were also calculated and fixed at the external tolerance limit on the ninety-fifth centile. To obtain the shortened version, each SAS-I item was correlated with the Beck's Depression Inventory (BDI) score. The only items showing no correlation with BDI were implemented to bypass the well-known overlap between apathetic and depressive symptoms. RESULTS: The mean raw SAS-I score was 11.27 (SD = 4.42). A significant education effect was observed, with highly educated subjects obtaining lower scores than lowly educated ones. The proposed general cutoff score was 20.68. The SAS-I had fair internal consistency and discriminant validity. Internal consistency increased by removing item 3. The new SAS-6 included items 1, 2, 4, 10, 11, and 13 of the original scale. CONCLUSION: The SAS-I is a reliable assessment tool to support the diagnosis of apathy. The SAS-6, instead, is a brief questionnaire useful for quickly screening apathetic symptoms in outpatient practice, addressing or not the clinician to further investigations.

Qualitative patterns at Raven's colored progressive matrices in mild cognitive impairment and Alzheimer's disease.

BACKGROUND: Visuo-spatial and problem-solving abilities are commonly impaired in patients with Alzheimer's disease (AD). Conversely, subjects with amnestic mild cognitive impairment (aMCI) do not exhibit overt involvement of cognitive domains other than memory. Consequently, a detection of an impairment at the Raven's colored progressive matrices (RCPM) could be useful to discriminate aMCI from AD and to mark the progression from one condition to another. AIM OF THE STUDY: To describe the pattern of errors at RCPM in subjects suffering from AD as compared with that of aMCI. METHODS: Fifteen patients with AD, 15 subjects with aMCI and 31 Healthy Controls (HC) received the RCPM. The errors were classified as: (1) difference (D); (2) inadequate individuation (II); (3) repetition of the pattern (RP); (4) incomplete correlation (IC). RESULTS: No difference approached significance between aMCI subjects and HC. AD patients always exhibited a higher number of errors as compared with HC. AD patients showed higher number of errors as compared with aMCI only on RP and IC errors. CONCLUSIONS: The results suggest that the visuo-spatial and problem-solving impairment that characterize AD, and probably subtend the progression from aMCI to dementia, do not affect to the same extent all cognitive dimensions explored by RCPM.

Depressive symptoms in patients admitted to a semi-intensive stroke unit.

Aim of this study was to evaluate depressive symptoms in a semi-intensive Stroke Unit (SI-SU) by a scale specifically devised to assess depression in patients with stroke and to identify the symptoms better contributing to the early detection of post stroke depression (PSD). Fifty-four patients admitted to a SI-SU because of suffering from single, first-ever hemispheric stroke were enrolled. Depressive symptoms were assessed by the Post Stroke Depression Rating Scale (PSDRS). All patients were also evaluated by the National Institute of Health Stroke Scale (NIHSS), the modified Rankin scale, the Mini-Mental State Examination (MMSE) and the Frontal Assessment Battery (FAB). The PSDRS detected depressive symptoms in twenty-two patients (40%). The PSDRS scores were not influenced by severity of stroke, functional outcome, site of lesion and type of stroke. Three psychopathological factors were identified inside the PSDRS: "reactivity", "melancholic" and "apathetic", with significant inverse correlations with cognitive measures found only with the "apathetic" factor Less than one-half items of the PSDRS were able to identify overt depressive symptoms. Depressive symptoms are a frequent and early complication in patients referred to a SI-SU with the PSDRS being a suitable tool to detect depressive symptoms in acute phases of stroke.

Similar TIAs and corresponding alterations in regional cerebral perfusion in Caucasian monozygotic twins with moyamoya disease.

We previously reported the first Caucasian monozygotic twins with moyamoya disease (MMD). In both patients, hyperventilation induced similar transient onset of left arm and hand paresthesias. Cerebral single photon emission computerized tomography (SPECT) showed overlapping perfusion abnormalities in the left parietal areas. Similarly, EEG showed high amplitude, bilateral, anterior, slow wave activity in the delta range during hyperventilation and rebuild-up phenomenon in both twins. Similar clinical symptoms mirrored alterations in regional cerebral perfusion by SPECT and EEG in our Caucasian monozygotic twins with MMD.

The Frontal Assessment Battery (FAB): normative data from an Italian sample and performances of patients with Alzheimer's disease and frontotemporal dementia.

The Frontal Assessment Battery (FAB) is a short neuropsychological tool aiming to assess executive functions at the bedside. Two-hundred and thirty-six normal controls were administered the FAB and three other tasks assessing attentional and executive functions. The FAB was also administered to 28 patients suffering from mild Alzheimer's disease (AD, n. 15 subjects) or frontotemporal dementia (FTD, n. 13 subjects). The FAB showed good concurrent and discriminant validity and high internal consistency. Test-retest and inter-rater reliability were fairly good. A multiple regression analysis showed a significant positive effect of education and a negative effect of age. Cut-off values of non-parametric distribution were computed. A difference on FAB scores within dementia patients was observed, with subjects with FTD performing worse than patients suffering from AD.