Assessments scales for the evaluation of health-related quality of life in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy: a systematic review.

Background: The concept of wellbeing is expansive and intricate, making it challenging to define precisely. Similarly, the instruments employed to assess wellbeing are complex and multifaceted. Therefore, it is more appropriate to refer to the notion of wellbeing as Health-Related Quality of Life (HRQoL), which is the central focus of many measures used to assess the feeling of wellbeing. This review aimed to identify the tools most commonly used to evaluate HRQoL in individuals with Parkinsonism-a group of movement disorders that negatively impact the quality of life due to the intricate interplay of symptoms, socio-demographic characteristics, and psychological factors. The main aim was to assess the psychometric properties of these measures in terms of validity and reliability. Methods: A literature review was conducted, focusing on research related to the assessment of HRQoL in connection to symptoms of Parkinsonism. This review included all studies that examined HRQoL using evaluation scales, exams, or self-reported questionnaires. The literature review was conducted using the databases Scopus and Web of Science and the search engine PubMed to identify studies published between 1996 and 2023. Only records that assessed HRQoL in individuals with Parkinson's disease and Parkinsonism were selected for evaluation. Results: A total of 393 records were examined, and eight tools were identified as the most frequently used in the evaluation of HRQoL. Discussion: The results show a significant gap in knowledge regarding the latent structure and measurement invariance of HRQoL measurements, which may have a significant influence on the interpretation of test outcomes. Moreover, there is a lack of clear divergent validity between HRQoL assessments and other tests used as predictors of HRQoL. This could represent a significant limitation, affecting the construct and criterion validity of HRQoL measures.

Regression-based normative data for Corsi Span and Supraspan learning and recall among Italian adults.

INTRODUCTION: The Corsi Block Tapping Test, or Corsi Span (CS), is a widely used task to measure visuospatial short-term and working memory. The same setup can be used to administer the Corsi SupraSpan Learning (CSSL) and Recall (CSSR), tests assessing visuospatial long-term memory. While the CS has relatively recent normative data, those of the CSSL are outdated For CSSR, no normative data are available. Given this critical lack, our study aimed to provide updated norms for CS, CSSL, and specifically for the recall delayed phase (CSSR). MATERIALS AND METHODS: A sample of 340 healthy participants, aged between 20 and 89, took part in the study. Norms were developed using a regression approach and defined using rank equivalent scores and percentiles. RESULTS: Age and education influenced Corsi's Span, while SupraSpan Learning and Recall were influenced by age, education, and span. The comparison with previous norms for Span and SupraSpan Learning shows a high level of agreement. CONCLUSIONS: This study provides integrated norms to evaluate visuospatial memory in all aspects of immediate recall, long-term learning and delayed recall. Its use is needed to assess specific neuropsychological deficits, dissociate visuospatial versus verbal memory deficits and allow the evaluation of memory in patients with limited verbal abilities.

Comparison of Eye Axial Length Measurements Taken Using Partial Coherence Interferometry and OCT Biometry.

This study evaluates the inter-device measurement properties of partial coherence interferometry (PCI) and spectral domain optical coherence tomography (SD-OCT) in measuring axial length, particularly for myopia management. We recruited 82 eyes from 41 adult participants with a mean age of 31.0 ± 17.6 years and a mean spherical equivalent of -2.20 ± 2.28 D. Axial length was measured using SD-OCT and PCI for both the right and left eyes. Agreement between the two measurements was assessed using Bland-Altman analysis, and graphs and values were compared with linear mixed models. The results show a near-to-zero and non-significant bias between measurements. The 95% limits of agreement showed a value of 0.06 mm. Both devices can accurately measure the axial length. OCT biometry performed with SD-OCT can be successfully interchanged with partial coherence interferometry, but they should be cautiously interchanged when performing longitudinal comparisons.

Systematic assessment of square-wave jerks in progressive supranuclear palsy: a video-oculographic study.

BACKGROUND: The presence of frequent macro-square-wave jerks (SWJs) has been recently included in the diagnostic criteria for progressive supranuclear palsy (PSP). The aim of the current video-oculographic study was to systematically assess the presence and features of SWJs during a brief fixation task in PSP, in comparison with Parkinson's disease (PD) patients and healthy controls (HC). METHODS: Thirty-eight PSP patients, 55 PD patients and 40 HC were enrolled in the study. All patients underwent a video-oculographic (VOG) examination including a 5-s fixation task, and the number, duration and amplitude of SWJs were recorded. The diagnostic performance of several SWJs parameters were then compared in distinguishing PSP from PD patients and controls. RESULTS: PSP patients showed a higher number and amplitude of SWJs compared to PD patients and controls. At least two SWJs within the 5-s fixation task were observed in 81.6% of PSP patients, 52.7% of PD patients and 25% of HC. The SWJs amplitude was the parameter showing the highest performances in distinguishing PSP from PD (AUC: 0.78) and HC (AUC: 0.88), outperforming the SWJ number and duration. The SWJ amplitude was larger in PSP-Richardson's syndrome than in PSP-Parkinsonism patients, while no difference was found between PSP patients with different degrees of vertical ocular motor dysfunction. CONCLUSIONS: This video-oculographic study provides robust evidence of larger SWJs number and amplitude in PSP than in PD patients, with some potential for differential diagnosis, supporting the inclusion of this ocular sign in PSP criteria.

Influence of living settings on physical activity levels and volition in exercise in male and female university students.

This study explored the influence of living settings on physical activity (PA) levels and volition in exercise and their correlation, considering sex differences. Five hundred and sixty-six university students (261 rural and 305 urban) from Calabria region (Italy) attending universities courses filled an online survey where Global Physical Activity Questionnaire and Volition in Exercise Questionnaire were administered. Rural females (RF) showed lower PA levels and self-confidence than rural males (RM) (p<0.01). Postponing training and unrelated thoughts were higher in RF than RM (p<0.01 and p<0.05 respectively). PA levels, self-confidence and coping with failure were lower in urban females (UF) than urban males (UM) (p<0.01), Postponing training and unrelated thoughts were higher in UF than UM (p<0.01 and p<0.05). In RF and UF, PA levels positively correlated with self-confidence (Rho = 0.397) and coping with failure (Rho = 0.330), whereas negatively correlated with postponing training (Rho = -0.487) and unrelated thoughts (Rho = -0.283). In RM and UM, PA levels positively correlated with self-confidence (Rho = 0.270) and coping with failure (Rho = 0.258), whereas it negatively correlated with postponing training (Rho = -0.285). PA levels positively correlated with reasons (Rho = 0.260) only in UM. We showed for the first time the relationship between PA and volition factors considering the living setting in university students. Sex differences were observed in some volition facilitators and PA levels independently by the living context.

The Complexity of Reading Revealed by a Study with Healthy Older Adults.

Aging, even when healthy, involves changes in cognitive functioning that can gradually affect the everyday activities and well-being of older people. Reading, which requires the integrity of several functions and their integration, is important to maintaining high cognitive and emotional stimulation over time. Our study aimed to investigate whether reading ability declines with aging. To explore also why reading would decline, we explored the changes in the performance of visual and attention tasks. A group of 58 neurologically healthy older people aged from 65 to 75 underwent neuropsychological assessment to investigate their global cognitive functioning, reading skills, crowding, and attention components. We found a decline in reading abilities as a function of aging (ß = 0.34, p < 0.05). We did not find an increase in crowding or difficulties in visual acuity. Furthermore, we found no decline with age in tasks of simple reaction times, visuospatial attention, and other single components of attention. Interestingly, we instead found a worsening with age in the Symbol Digit Modalities Test (ß = -0.26, p < 0.05), involving attention, working memory, and processing speed, which explains part of the reading decline. Our results suggest that task complexity is a fundamental aspect to account for aging changes.

Broken Ring enVision Search (BReViS): A New Clinical Test of Attention to Assess the Effect of Layout and Crowding on Visual Search.

The assessment of attention in neuropsychological patients could be performed with visual search tests. The Broken Rings enVision Search test (BReViS) here proposed represents a novel open access paper-and-pencil tool in which layout and crowding are varied among four cards. These manipulations allow the assessment of different components of attention: a selective component, the visuo-spatial orientation of attention, and the focal attention, involved in a crowding phenomenon. Our purpose was to determine the characteristics of the BReViS test, provide specific normative data, and assess these components across the lifespan. The test was administered to a sample of 550 participants aged between 20 and 79 years old and to a series of patients. Three indexes targeting different components of visuo-spatial attention (selective attention, strategic orientation of visual attention, focal attention) were obtained by combining execution times and accuracy together with the total errors. The results showed that age, education and gender influenced, in different combinations, the four indexes, for which specific norms were developed. Regression-based norms were provided in percentiles and equivalent scores. All patients showed pathological scores and specific patterns of attentional deficits. The BreViS test proved to be a free and easy valuable tool which can be used in the clinical environment to assess attentional deficits in neuropsychological patients.

Teleneuropsychology: normative data for the assessment of memory in online settings.

INTRODUCTION: The COVID-19 pandemic has forced significant changes in clinical practice. Psychologists and neuropsychologists had to modify their settings to assess patients' abilities, switching from an in-person modality to a remote setting by using video calling platforms. Consequently, this change brought about the need for new normative data tailored to remote settings. AIM AND METHODS: The study aimed to develop normative data for the online assessment of neuropsychological memory tests and to compare it with the published norms obtained in standard settings. Two hundred and four healthy Italian volunteers performed three verbal memory tests through the Google Meet platform: the Digit Span (Backward and Forward), the Rey Auditory Verbal Learning, and the Verbal Paired Associated Learning Test. RESULTS: This research provides specific norms that consider the influence of demographic characteristics. Their comparison with published norms shows a medium to high agreement between systems. The present study provides a reference for the clinical use of neuropsychological instruments to assess verbal memory in a remote setting and offers specific recommendations.

Normative Values of the Groffman Visual Tracing Test for the Assessment of Oculomotor Performance in the Adult Population.

The Groffman visual tracing (GVT) test is an indirect psychometric measure of oculomotor performance, used for the clinical assessment of eye movements. The test consists of two cards with five contorted lines of increasing overlap, crowding, and difficulty. The task starts from each of the letters at the top of the page, follows the line from the letter to the corresponding number at the bottom of the page, and the number is named. Although the GVT test was developed for the evaluation of children, it has also been applied to adults with visual and cognitive deficits. However, it lacks reference values. Therefore, the aim of the study was to assess oculomotor behavior across the typical human lifespan and to define normative data in an adult population. A total of 526 adults aged between 20 and 79 years, all without neurological or psychiatric deficits, were enrolled in the study. The results were analyzed by considering the accuracy and execution times separately. An influence of age, education and sex for accuracy was found, and age for the execution times was found. Norms for adults were developed considering the specific structure of the test and the accuracy and the execution time separately. The GVT test can now be applied in healthy and neurological adult populations for the evaluation of oculomotor performance.

A rank subdivision of equivalent score for enhancing neuropsychological test norms.

INTRODUCTION: Neuropsychological assessment of cognitive functioning is a crucial part of clinical care: diagnosis, treatment planning, treatment evaluation, research, and prediction of long-term outcomes. The Equivalent Score (ES) method is used to score numerous neuropsychological tests. The ES0 and the ES4 are defined respectively by the outer tolerance limit and the median. The intermediate ESs are commonly calculated using a z-score approach even when the distribution of neuropsychological data is typically non-parametric. To calculate more accurate ESs, we propose that the intermediate ESs need to be calculated based on a non-parametric rank subdivision of the distribution of the adjusted scores. MATERIAL AND METHODS: We make three simulations to explain the differences between the classical z-score approach, the rank-based approach, and the direct subdivision of the dependent variable. RESULTS: The results show that the rank procedure permits dividing the region between ES0 and ES4 into three areas with the same density. The z-score procedure is quite similar to the direct subdivision of the dependent variable and different from the rank subdivision. CONCLUSIONS: By subdividing intermediate ESs using the rank-subdivision, neuropsychological tests can be scored more accurately, also considering that the two essential points for diagnosis (ES = 0 and ES = 4) remain the same. Future normative data definition should consider the best procedure for scoring with ES.

Italian translation, validation, and repeatability of Standard Patient Evaluation of Eye Dryness (SPEED) Questionnaire.

PURPOSE: The assessment of symptoms of dry eye disease using a questionnaire is an effective and simple method of quantifying symptoms. The aim of this study was to translate the SPEED questionnaire and adapt it for the Italian language and verify the main psychometric performance of the translated version, including repeatability and agreement. METHODS: The SPEED questionnaire was translated into Italian following a standard methodology. The resulting questionnaire was administered to 206 adult participants in order to perform a validation analysis. A subgroup of 82 participants was retested after one week to give a repeatability and agreement assessment. RESULTS: Internal consistency showed an alpha of 0.852 (95% CI 0.818-0.881) and no unnecessary items. The factor analysis showed a saturation for three main factors related to (i) Dryness and Soreness, (ii) Fatigue, and (iii) Burning. Repeatability was high, with a CCC of 0.896 (95% CI 0.844-0.931). Agreement analysis showed no significant bias between sessions and an interval of agreement of 5 points for SPEED score. CONCLUSION: The translation and adaptation of the SPEED questionnaire for the Italian language have demonstrated good psychometric properties for the translated questionnaire, confirming and expanding the original psychometric characteristics. Consequently, the SPEED questionnaire could be used to measure the presence of symptoms of dry eye quantitatively.

Prism Adaptation and Optokinetic Stimulation Comparison in the Rehabilitation of Unilateral Spatial Neglect.

Prism adaptation (PA) is one of the most effective treatments for the rehabilitation of unilateral spatial neglect. Optokinetic stimulation (OKS) has also been demonstrated to be effective in ameliorating symptoms of neglect. The aim of this study is to compare the effectiveness of these two methods in a group of neglect patients using a crossover design. A group of 13 post-acute brain-damaged patients with unilateral spatial neglect, who had never been rehabilitated, were treated using PA and OKS. Each treatment was applied for 10 sessions, twice a day, to all patients with both treatments in crossed order (i.e., PA followed by OKS or vice versa). Neuropsychological assessments were performed: before the first (T1), at the end of the first/beginning of the second (T2) and at the end of the second training sessions (T3), and two weeks after the end of treatment (T4). Both procedures produced a significant improvement in clinical tests at T2, independent of the type of training. The results suggest that either PA or OKS induces a significant amelioration of neglect in right brain-damaged patients, mainly in the first block of treatment. Since no differences between treatments were found, they could be applied in clinical practice, according to the requirements of the individual patient.

Evaluation of stereoacuity with a digital mobile application.

PURPOSE: Stereopsis is a fundamental skill in human vision and visual actions. There are many ways to test and quantify stereoacuity: traditional paper and new digital applications are both valid ways to test the stereoacuity. The aim of this study is to compare the results obtained using standard tests and the new Stereoacuity Test App developed by the University of Bergamo. METHODS: A group of 497 children (272 males), aged between 6 and 11 years old, were tested using different tests for the quantification of stereopsis at near. These tests were TNO, Weiss EKW, and the new developed Stereoacuity Test App. RESULTS: A one-way repeated measure ANOVA showed that the three tests give different thresholds of stereoacuity (p < 0.0001). Post hoc analyses with Bonferroni correction showed that all tests showed different thresholds (p < 0.0001). The lower threshold was obtained by Titmus Stereo Test followed by Stereoacuity App, Weiss MKW, and TNO. CONCLUSION: The stereoacuity based on global stereopsis showed that the better values were obtained in order by Stereoacuity Test App, TNO, and Weiss EKW. However, the clinical significance of their values is similar. The new digital test showed a greater compliance by the child, showing itself in tune with the digital characteristics of today's children.

Spotlight on the Developmental Eye Movement (DEM) Test.

The developmental eye movement (DEM) test is a practical and simple method for assessing and quantifying ocular motor skills in children. In this review, a summary of the literature relevant to the DEM test has been made, its psychometric properties and its pros and cons have also been considered. The DEM test provides clinicians with a simple method of measuring eye movement using a psychometric test. Over the years, many studies have enabled the identification of the strengthens and weaknesses of this test apart from outlining the psychometric properties. The validity of the test has been checked and expanded over time and studies have shown that the DEM test measures an aspect of eye movement related to reading, rather than purely parameters associated with eye-movement. Some reservations have emerged regarding the repeatability of the test because a degree of learning effect emerges over multiple sessions. Being aware of this point allows correct clinical application and interpretation of the test. Normative data in children were available for nine languages and countries. So far, DEM test could be applied clinically in each case when a rapid test of eye movement was required, such as in testing for vision-related visual problems.

Measurement of visual acuity with a digital eye chart: optotypes, presentation modalities and repeatability.

PURPOSE: Digital or computerised eye charts are becoming standard in the examination of visual acuity. Each instrument allows the selection of different optotypes, presentation modalities, and crowding. The aim of this study was to examine the differences in visual acuity (VA) measurement using a digital eye chart, comparing different optotypes and procedures, together with an evaluation of the repeatability of the measurement. METHODS: Two groups of 52 participants aged between 18 and 31 years participated in the study. In the first experiment, VA thresholds were measured using LEA Symbols, Tumbling E, and Landolt Rings in monocular and binocular conditions using single line presentation and QUEST presentation. In the second experiment, we have compared all modalities of presentation together with a paper eye-chart and test the repeatability. RESULTS: The results showed that thresholds for LEA Symbols are low. The modality of presentation affects these thresholds. For Landolt Rings and Tumbling E, the QUEST procedure gave significantly better thresholds than line presentation, while this difference was absent for LEA Symbols. In comparing all modalities of presentation, single letter and line presentation showed similar values, slightly better than block presentation. Paper eye-charts showed better values of VA. Repeatability and agreement were good for all presentations, but best for QUEST. CONCLUSIONS: The QUEST modality of presentation provides a better threshold than line presentation except for LEA Symbols. Examiners using digital eye charts must take into account that not all modalities of presentation and optotypes are equivalent and give different VA thresholds. Specific thresholds need to be used for each optotype and presentation modality.

Comparison, within-session repeatability and normative data of three phoria tests.

PURPOSE: Phoria measurements form a routine part of the examination of binocular vision. Various studies have compared different methods of phoria measurement and their repeatability between sessions. However, no studies have accounted for within-session repeatability, and few norms have been available to date. Our aims were to assess the short-term within-session repeatability, the agreement and the comparisons between three phoria tests and the delineation of normative data. METHOD: The participants comprised 315 refractive corrected participants with a normal binocular vision, with ages between 20 and 80 years. Phoria was measured using three methods: von Graefe (VG), modified Thorington (MT) and Thorighton (TH) procedures. Each measurement was taken 3 consecutive times at far and near. RESULTS: The repeatability between measurements was high (0.87 to 0.96), but the relationship between tests was medium (0.407 to 0.682). About the mean bias, VG show more exo values (0.02 to 0.14 at far and 0.07 to 0.14 at near) and MT and TH similar values (-0.04 to 0.08 at far and -0.1 to 0.03 at near). The best agreement between tests was for TH and MT (LoA = 2.33 at far and LoA = 4.44 at near). Normative data for non-presbyopic were provided. CONCLUSION: Overall, there is a high agreement between MT and TH. Conversely, VG shows more exo values at near and shows large limits of agreement. We recommend that subjective measurements of phoria can best be quantified once using the MT or TH techniques in free space and the values compared with updated norms.

Open-source open-access reaction time test (OORTT): an easy tool to assess reaction times.

The speed of information processing is one of the most reliable indices of cognitive efficiency. The most common way to evaluate this ability is to assess reaction times (RTs). The technical limitations of previous tasks, aimed at measuring RT, have motivated us to develop a new battery for their evaluation. The aim of this study is to build an open-source, open-access reaction time test (OORTT), which has the following characteristics: rapid and easy administration, robust Italian normative data based on a wide age range, a simple scoring system, compatibility with all operating systems, no license or activation costs, and based on an open-source software platform. The battery is composed of three tasks: simple reaction times (SRT), Go/No-Go (GNG) condition, and four-position reaction times (4PRT). The battery was administered to 300 healthy participants aged between 14 and 89, and 3 groups of patients: 24 right brain-damaged; 21 left brain-damaged, and 19 degenerative cognitively impaired. We have developed specific norms for each task of the test battery: SRT, GNG, and 4PRT. Compared with healthy individuals, all groups obtained lower scores. More specifically, cognitively impaired patients obtained significantly longer RTs than healthy participants as well as unilateral brain-damaged patients. In the 4PRT task, right brain-damaged patients obtained a significantly left > right difference in RTs. In conclusion, the OORTT test battery proved to be a valuable tool which can be used in the clinical environment for cases of different attentional deficits after focal or degenerative brain damage.

The Brentano Illusion Test (BRIT): An implicit task of perceptual processing for the assessment of visual field defects in neglect patients.

In brain damaged patients with unilateral spatial neglect (USN), the differential diagnosis between the presence and absence of a unilateral visual half-field deficit (VHFD) is hampered by the similarity of their phenomenology. The absence of stimuli detection in the contralateral visual field, indeed, can be due to the co-occurrence of USN and VHFD or the sole presence of the USN. The disentangling of the two conditions is required to devise more specific rehabilitation programmes. Daini et al. [2002. Exploring the syndrome of spatial unilateral neglect through an illusion of length. Experimental Brain Research, 144(2), 224-237.] reported a difference in performance for the two conditions when the tasks required the bisection of Brentano illusory stimuli. Only when USN and VHFD co-occurred, the leftward illusory effect was disrupted. Based on previous findings, in this cross-sectional study, we developed the Brentano Illusion Test (BRIT), a clinical tool that helps the identification of VHFD in USN patients. The BRIT is a simple behavioural test of line bisection aimed at verifying the presence or absence of implicit processing in USN and thus helping the diagnosis of VHFD in USN patients; it also provides normative data for the line bisection task and the length effect.

Decline of cognitive and behavioral functions in amyotrophic lateral sclerosis: a longitudinal study.

Background: A cognitive impairment, ranging from frontotemporal dementia (FTD) to milder forms of dysexecutive or behavioral dysfunction, is detected in 30-50% of patients affected by amyotrophic lateral sclerosis (ALS) at diagnosis. Such condition considerably influences the prognosis, and possibly impacts on the decision-making process with regards to end-of-life choices. The aim of our study is to examine the changes of cognitive and behavioral impairment in a large population of ALS from the time of diagnosis to a 6-month follow-up (IQR 5.5-9.0 months), and to examine to what extent the progression of cognitive impairment affects survival time and rate of disease progression.Methods: We recruited 146 ALS patients classified according to revised criteria of ALS and FTD spectrum disorder. In a multidisciplinary setting, during two subsequent visits we examined clinical features with ALSFRS-r score, FVC% and BMI, and cognitive status with an extensive neuropsychological evaluation.Results: At second examination, one-third of patients showed a worsening of cognitive impairment, namely 88% of ALSbi, 27% of ALSci, 40% of ALScbi, and, interestingly, also 24% of cognitive normal ALS developed a significant cognitive dysfunction. We find that those who changed their cognitive status presented a lower ALSFRS-r score at t1 and a shorter survival time compared to those who did not change, regardless of the type of cognitive impairment.Conclusion: We show how cognitive disorders in ALS patients can not only be present at diagnosis, but also manifest during disease and influence the progression of motor deficit and the prognosis.

A new clinical evaluation of asomatognosia in right brain damaged patients using visual and reaching tasks.

INTRODUCTION: The term asomatognosia refers to a unilateral disturbance of body ownership following a cerebrovascular incident. Patients with asomatognosia consider the contralesional limbs as missing or having disappeared from awareness. This neuropsychological disorder modifies body ownership in terms of perceptual experience, visual identification and sense of belonging of contralesional body parts. In the literature, asomatognosia is usually tested by using verbal scales. METHOD: In this study, we first developed a new test to assess asomatognosia that includes a visual identification task and a reaching task. We examined 16 healthy participants and 20 right brain damaged patients. The participants were asked to identify, reach and touch their left hand when positioned in peripersonal space, in presence of an extraneous hand (belonging to the examiner). We analyzed how the deficit is modulated by the reciprocal positions in space of the two limbs, the relationship with personal neglect and the anatomical correlate using a Voxel-based Lesion Symptom Mapping (VLSM) analysis with CT data. RESULTS: The results show that the asomatognosia cannot be simply considered as one of the many manifestations of personal neglect but should be taken into account as a "productive" disorder characterized by the misidentification of the own hand with an extraneous hand. The VLSM analysis of patients with asomatognosia revealed the involvement of the inferior and middle frontal lobe. CONCLUSIONS: The novel task that has been developed in the present study could be used as an objective tool to measure this specific disorder of body ownership or to uncover subclinical conditions of asomatognosia.