Contributi scientifici in memoria di Antonio Fusco.

Come si leggerà nell'Introduzione della sezione propriamente scientifica del Volume, il presente testo nasce dalla volontà e, soprattutto, dall'esigenza culturale di omaggiare il fu Prof. Antonio Fusco. Un debito scientifico ed umano che trova il suo locus naturale in questa prima parte del testo stesso, cui farà poi seguito la parte propriamente scientifica. In siffatta parentesi dovuta per le ragioni appena menzionate, il lettore, l'amico o l'allievo dell'opera del Prof. Fusco potranno trovare un suo sintetico Curriculum Vitae, correlato da una specifica ed accurata prosa, svolta dal già Magnifico Rettore Carlo Cipolli; il quale, oltre che evidenziare, ricordando, i meriti del collega oramai scomparso, aggiunge alsuo scritto un elemento che sarebbe imprescindibile a non trasformare lo stesso in una mera sequenza di parole: l'amicizia e l'affetto per un amico che, oramai, non c'è più. A fine lettura, evidente risuonerà il fatto che la vita di ognuno, se mossa dalla passione per ciò per cui si è predisposti cognitivamente e psicologicamente, può essere ricca di riconoscimenti, riconoscenze e soddisfazioni che, lungi dal divenire un cuscino di allori su cui adagiarsi, per una mente creativa come quella del Prof. Fusco hanno funto solo da motivazioni ad agire instancabilmente guardando sempre al futuro. Il lavoro di una vita che, materialmente, è sancito da un supporto poco più di cm 25x15: una targa. Una materialità evidente che, con grande commozione e riconoscenza, è stata affissa il 25 ottobre 2019 sull'aula fronte l'Aula Magna del Campus "La Folcara", a testimonianza che quello spirito creativo in continua evoluzione non si ferma; non si arresta neppure con la fine biologica di chi lo ha "posseduto". Rimangono le opere ed il pensiero del Prof. Fusco e restano gli affetti. A tal proposito, il lettore troverà una breve e sentita sezione su Testimonianze; coloro i quali hanno avuto modo, nell'arco della vita accademica ed umana, personale, di Fusco di conoscerlo. Ecco, allora, che i ricordi saranno i veri protagonisti di questa parentesi. Dopo di ciò, prima dei contributi prettamente scientifici dei lavori, tenutisi in occasione del Convegno Internazionale Psicologia, Arte, Letteratura. Antiche e Nuove Tendenze, seguiranno i saluti delle autorità che in quei due giorni si sono succedute a rappresentare non solo l'istituzione affiliata, ma anche la relazione di stima e di affetto che le legava al compianto Professore. Si passerà, infine, al volume tradizionalmente inteso.

Plastic reorganization of neural systems for perception of others in the congenitally blind.

Recent evidence suggests that the function of the core system for face perception might extend beyond visual face-perception to a broader role in person perception. To critically test the broader role of core face-system in person perception, we examined the role of the core system during the perception of others in 7 congenitally blind individuals and 15 sighted subjects by measuring their neural responses using fMRI while they listened to voices and performed identity and emotion recognition tasks. We hypothesised that in people who have had no visual experience of faces, core face-system areas may assume a role in the perception of others via voices. Results showed that emotions conveyed by voices can be decoded in homologues of the core face system only in the blind. Moreover, there was a specific enhancement of response to verbal as compared to non-verbal stimuli in bilateral fusiform face areas and the right posterior superior temporal sulcus showing that the core system also assumes some language-related functions in the blind. These results indicate that, in individuals with no history of visual experience, areas of the core system for face perception may assume a role in aspects of voice perception that are relevant to social cognition and perception of others' emotions.

Age-related differences in sleep-dependent consolidation of motor skills in patients with narcolepsy type 1.

OBJECTIVE: The influence of post-training sleep on the consolidation process of procedural (ie, visual and motor) knowledge has shown to be less effective in patients with chronic sleep disorders compared with healthy subjects. To ascertain whether the influence of the altered architecture of sleep in patients with narcolepsy type 1 (ie, with cataplexy: NT1) also varies with age, we compared the performance values of 16 children (aged from nine to 14 years) and 16 adults (aged from 24 to 51 years) on finger tapping task (FTT) after daytime and nighttime periods of sleep in the 24 hours following training. METHODS: All patients, who were drug-free and underwent continuous polysomnographic recordings, could take one or more naps after the training session (at 10 a.m.) until one hour before the first retrieval session (at 6 p.m.) and had an undisturbed period of nighttime sleep from about 10 p.m. to two hours before the second retrieval session (again at 10 a.m.). RESULTS: The pattern of sleep-dependent consolidation was significantly different in the two groups of patients: while performance accuracy was higher in adults compared with children at each session, performance speed improved after daytime sleep in children and after nighttime sleep in adults. The improvement in performance speed, although not related with any sleep parameters in both groups, was positively correlated with the daytime and nighttime total sleep time (TST) in children with greater consolidation gain. CONCLUSION: The interaction between time of day and age in the time course of consolidation of new motor skills discloses a different role of daytime sleep (active in children, simply protective from interferences in adults) in NT1 patients and suggests a flexible use of napping in the educational context.

Sleep-dependent consolidation of motor skills in patients with narcolepsy-cataplexy.

BACKGROUND AND OBJECTIVES: This study investigated whether the altered organization of post-training sleep in patients with narcolepsy-cataplexy (NC) is associated with a lower off-line improvement in the consolidation of motor skills compared with normal subjects. STUDY DESIGN: Fourteen drug-naive NC patients, fulfilling the international clinical and polysomnographic diagnostic criteria, and 14 individually-matched controls underwent training at a sequential finger tapping task (FTT) and were re-tested on the next morning (after a night with polysomnographic recording) and after another six nights (spent at home). SETTING: Training and retrieval sessions were performed in a controlled laboratory setting. RESULTS: FTT performance was worse in NC patients than controls at training and at both retrieval sessions and showed a fairly different time course (slower than in controls) of consolidation. Several sleep indices (lower values of stage-2 NREM sleep and SWS) were compatible with a lower effectiveness of sleep for consolidation of motor skills in NC patients, although no statistically significant relationship was found between such indices and improvement rate. CONCLUSION: The consolidation process of motor skills results less effective in NC patients since training and slower than in normal subjects over the week following training. The wider variations in performance scores and sleep parameters of post.-training night in NC patients relative to controls suggest that a) the lower initial consolidation may be due to a less effective encoding consequent to altered prior sleep, and b) the consolidation process over the 24 h following training is negatively influenced not only by the altered characteristics of post-training sleep, but also by the daytime sleepiness following training.

The validity of informant report for grading the severity of Alzheimer's dementia.

The validity of informant-based techniques has been established for the detection of dementia cases by non-pathological individuals, but is still controversial for the assessment of the severity of dementia. This study aimed at ascertaining whether informant-based evaluation (the so-called informant report) of the cognitive and behavioral impairment of a patient is valid for grading the severity of dementia, and consistent with objective assessment of the patient's cognitive and behavioral functioning. We enrolled 96 community-dwelling outpatients and 56 controls assessed at the Geriatric Evaluation Unit of the University of Modena, Italy. All patients scored lower than 27 on the MMSE, and met DSM-IV inclusion criteria for Alzheimer's dementia. Patients and controls were administered the CAMDEX interview, containing a section which collects participant (patient or control) and informant evaluations on dementia-related cognitive and behavioral deficits. The informant report resulted effective at MANOVA for grading the severity of dementia in 4 of its 5 measures (namely, memory, everyday activities, general mental functioning and depressed mood), and was correlated with the scores of several scales of the CAMDEX cognitive section (i.e., CAMCOG). Instead, the participant's (patient or control) report showed a lower capacity for grading dementia, and was poorly correlated with the psychometric outcomes of cognitive functioning. On the whole, the results corroborated the validity of the informant report in the diagnostic work-up for grading dementia, given its sensitivity to the severity of dementia, and its consistency with cognitive psychometric outcomes.

Active processing of declarative knowledge during REM-sleep dreaming.

The ability to process recently acquired knowledge is clearly maintained during sleep. Here we assess whether and how far the sleeper controls this processing (in a non-volitional and non-conscious manner). We posit that during sleep, the cognitive concerns of previous waking may guide access to, and processing of, items of declarative knowledge with which those concerns are associated. In a delayed recall task, before each of three sleep onsets in the same night, 12 subjects heard a different nonsense sentence. When awakened in rapid eye movement (REM) sleep, they were asked to report their dream experience and to recall the last sentence heard. Occurrences of incorporation into dream content were more frequent for this sentence than for the sentences heard before previous sleep onsets, and also more frequent than occurrences of similar contents in reports from a control night. However, the modalities of elaboration of dream contents did not vary. These findings indicate that cognitive concern can affect the accessing of recently acquired declarative knowledge during sleep, but not the modalities by which this is inserted into dream content. They also suggest that cognitive concern may help consolidate knowledge by increasing the likelihood of it being processed during sleep.

Assessing behavioural and cognitive impairment in dementia using an informant's report: evidence from the CAMDEX interview.

The consistency of measures from informants' report and from objective testing, both incorporated into the CAMDEX interview, was tested for elderly persons with mild dementia (n = 46), with moderate dementia (n = 41), and without cognitive impairment (controls, n = 56). Informants' reports permitted grading severity of dementia and provided measures of memory and mental functioning in everyday activities highly related to indices derived from objective testing.

Validation of the full and short forms of the CAMDEX interview for diagnosing dementia: evidence from a one-year follow-up study.

The sensitivity and specificity of the two forms of the CAMDEX interview for dementia diagnosis were assessed in a 1-year follow-up study. At the beginning of the study, 60 patients (22 males and 38 females) who met DSM-IV criteria for dementia and 60 matched controls (15 males and 45 females), were administered the short form of the CAMDEX (short CAMDEX) 3 months after the full one (full CAMDEX). At the follow-up, all patients were administered both the full and short CAMDEX (again with a 3-month interval), whereas controls were administered either CAMDEX form (in any case, at a 12-month interval from initial testing). Upon initial testing, the sensitivity of the full CAMCOG proved to be significantly higher than that of the short CAMCOG, while the opposite trend was observed for specificity, that is the sensitivity of the full Organicity was lower than that of the short Organicity, with specificity remaining equal in the two forms. Upon follow-up, the specificity and sensitivity levels of the two forms did not significantly differ for the CAMCOG and Organicity indices. Moreover, in detecting mildly demented patients, the full CAMCOG proved to be more accurate than the short one, while the opposite trend was observed for Organicity. Among the dementia subjects, significant correlations were found between the homologous indices of the two forms for both test sessions. On the whole, the short CAMDEX appears to maintain most of the psychometric properties of the full version and therefore the two CAMDEX forms can be considered to be interchangeable.

Story-like organization of dream experience in different periods of REM sleep.

Four dream reports, collected from each of 16 subjects in an experimental night, were analysed using the criteria of Mandler and Johnson's story grammar. The experimental night was the first of the four nights where subjects had spontaneously given a dream report after each of the four awakenings planned in REM sleep. A multivariate analysis of covariance, taking the order of the nights where the experimental night occurred and the order of reports as factors, the number of stories per report as covariate and the number of statements in the setting, the number of statements in the event structure and number of episodes per story as dependent variables, showed that the greater length and complexity of reports collected in the second half of the night depends on a greater effectiveness of the dream production system rather than on a greater accuracy of recall. This increase concerns the organization of individual stories rather than the number of stories developed in a given time. These findings raise the issue of how dream production is re-triggered during REM sleep. To cast light on this issue, it seems important to establish whether and how the themes of the various stories developed in a given dream experience are interrelated.

The validity of informant reports in assessing the severity of dementia: evidence from the CAMDEX interview.

The evaluation of a patient's mental state, overall clinical profile and behavioural disturbance in the process of diagnosing dementia requires at least two sources of information: the patient and the informant. Since the severity of the dementia may interfere with the subjective perception of these disorders, it is important to evaluate the consistency between these two sources of information and the clinical and psychometric evaluation made by the physician. Accordingly, in this study five behavioural areas, derived from the semi-structured interview schedule provided by the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX, i.e., Sleep, Depressed Mood, Everyday Activity, Memory and Global Mental Functioning) have been tested on the patient and his/her informant. Eighty dementia patients (mean age = 74 years) and their informants participated in the study. The dementia group was subdivided into two levels of severity according to DSM-IIIR criteria: 41 with mild dementia and 39 with moderate dementia, respectively, matched for age and schooling. The rating of impairment was found to increase along with the severity of dementia in all the above-mentioned areas, except for sleep. However, the source of information per se significantly influenced the evaluation of memory functioning. Moreover, the significant interaction between the two factors considered indicates that memory functioning is evaluated quite differently by the patients and the informants, as only in the assessment made by the latter group did the impairment increase in parallel with severity of dementia. Finally, whereas none of the subjective measures recorded in the patients were significantly correlated with their test scores, the correlations between the informant memory appraisals and patient test results proved to be significant. The present findings confirm the validity of informant reports in assessing cognitive and memory disorders in early-stage dementia, as well as in distinguishing patients with mild from those with moderate dementia.

Binocular vertical perceptual adaptation in essential infantile esotropia.

This study assessed whether dissociated vertical deviation, corresponding to an occasional elevation of the deviated eye, is accompanied by a binocular vertical perceptual adaptation. Dissociated vertical deviation was elicited by means of neutral filters in 16 patients, 8 who had undergone operations for the disorder of essential infantile esotropia and 8 who had not. Neutral filters elicited dissociation vertical deviation, which was accompanied by binocular vertical perceptual adaptation. This effect was significantly greater for patients who had operations and was enhanced by the filter density. Surgical elimination of inhibitory mechanisms for dissociated vertical deviation in patients with essential infantile esotropia appears to facilitate a loose sensory adaptation, which permits a binocular vertical perceptual adaptation.

Functional uncertainty, aging and memory processes during sleep.

Disorganized sleep patterns, can be found both during normal development and in pathological conditions. Aging could also be accompanied by a disorganization of the night sleep episode; sleep could be interrupted by spontaneous awakening, sleep cycle could be shortened or incomplete, sleep states modified. These patterns suggest an inability to sustain a stable condition, i.e. a condition of functional uncertainty. Biological and cognitive implications of functional uncertainty conditions are discussed. In particular, the hypothesis has been put forward that disturbances of sleep could have a detrimental role on memory. Recent results obtained in our lab support this hypothesis: recall is correlated with NREM-REM cycles proportion. Future research should ascertain the role of the functional uncertainty with respect to the kind of memory being involved during sleep, and establish how much and for which cognitive processes (including those involved in dream production) the inability to sustain a steady condition impairs the functioning during sleep. The duration of the functional uncertainty condition is also important. The long-term study of the link between functional uncertainty and cognitive resources, could be important for the understanding of the night life and for an adequate treatment of patients.

The influence of depression on memory and metamemory in the elderly.

This study aimed to assess the relationships among depression level, memory and metamemory scores on a large sample of elderly subjects (139 men and 147 women). Preliminary examination showed that none of the sampled subjects had intellectual impairment (as assessed by means of the Mini-Mental State Examination) or neuropsychiatric symptoms. Each subject was administered the Randt Memory Test (RMT), the Sehulster Memory Scale (SMS) and the Geriatric Depression Scale (GDS). A Multivariate Analysis of Covariance revealed a negative influence of depression on the two RMT measures (Acquisition-Recall: AR; Delayed Memory: DM) and on the three SMS measures (Set1: self-comparison; Set2: memory complaints; Set3: peer comparison), and of age on AR and DM, and Set1 and Set2. A Multivariate Regression Analysis showed that DM scores were positively correlated with Set2 in men and women, and with Set1 in women and Set3 in men, whereas AR scores related to Set2 and Set3 in men and Set1 in women. In addition, depression influenced negatively Set1, Set2 and AR scores in both men and women and DM scores only in men. On the whole, the results suggest that depression, memory and metamemory are rather closely related in non-severely depressed older individuals, albeit with slightly different patterns in men and women, and that some areas of metamemory are congruent with objective functioning regardless of the level of depressive symptoms.

1995 IPA/Bayer Research Awards in Psychogeriatrics. Bihemispheric language disorders in early-stage dementia of the Alzheimer type: evidence from a novel metalinguistic task.

Because dementia of the Alzheimer type (DAT) is commonly characterized by bilateral cerebral atrophy, we examined the issue of higher linguistic abilities lateralized to the right cerebral hemisphere (RH) in earlystage DAT. A modified version of an insertion task was administered to 14 patients with probable DAT, 8 right-hemisphere brain-damaged (RHD) patients, 8 left-hemisphere brain-damaged (LHD) patients, and 28 normal elderly (control, CTR) right-handed subjects. The task consisted of presenting the subjects with 53 well-formed sentences; in each a word or syntagm had to be inserted grammatically. Twenty-eight word/syntagm insertions required grammatical role reassignment of a lexical item in the stimulus sentence (shift, sensitive to RHD); 25 insertions implied only semantic reinterpretation of the target sentence (nonshift, sensitive to LHD). The three pathological groups were relatively and similarly impaired on standard aphasia assessment. The performances of the DAT patients, controlled for global cognitive verbal proficiency, verbal cognitive skills, and mood, were found to be significantly worse than the performances of the CTR group on both insertion subtests, whereas there were no significant differences between the DAT and RHD subjects on the shift items or between the DAT and LHD subjects on the nonshift items. Similarly, no differences were noted between the RHD and CTR nonshift scores, or between the LHD and CTR shift scores. On the other hand, the LHD group outscored the RHD group on the shift insertions. A comparison between the two insertion subtests revealed that only the RHD and DAT groups performed significantly worse on the shift than on the nonshift items. Results are consistent with other anecdotally reported RH-specific language-related disorders in early DAT and replicate previous findings of bihemispheric extralinguistic disturbances in these patients.

Transient global amnesia: memory and metamemory.

Twenty patients (mean age 64 years) with a previous episode of transient global amnesia (TGA) were examined to assess the functioning of objective memory (by using the Randt Memory Test), the metamemory capacities (Sehulster Memory Scale), the residual level of retrograde amnesia (Questionnaire of Remote Events), and the level of depression (Geriatric Depression Scale). Patients with residual retrograde amnesia scored significantly lower than non-amnesic ones on indices of both short-term and long-term memory, and for one of three main metamemory components, namely self-rating of memory functioning through comparison with memory functioning of peers (Set3). Age, time interval from TGA attack and TGA duration did not prove to influence memory and metamemory scores. Retrograde amnesia and depression were rather substantially associated (1/5), and this association was found to negatively influence nearly all memory and metamemory scores. Depression level showed a positive correlation with short-term memory functioning in non-amnesics. The different pattern and strength of the relationships between metamemory components and objective memory dimensions observed in amnesics and non-amnesics indicate that metamemory evaluations are more closely related to memory functioning in amnesics than in non-amnesics.

Symposium: Cognitive processes and sleep disturbances: Sleep, dreams and memory: an overview.

Investigations into the role played by sleep in information processing have consistently shown that the retention of information is better when the memory storage is followed by a period of sleep than of waking. Less definitive evidence, however, is available as to whether the better performance is mainly due to (a) reduction of interference during sleep, (b) slowing down of decay, or (c) consolidation processes at work during sleep. Important insights as to whether consolidation takes place during sleep have recently been provided by the thematic continuity of dreams elaborated in the same night and by the repeated incorporation of pre-sleep stimuli into dream contents. The analysis of such aspects of dreaming indicates that the items of information which are repeatedly accessed during sleep and elaborated for insertion into the ongoing dream experience are better retained at delayed recall. Finally, it is suggested that the use of the strategies applied in studying the information processing in normals may also be extended to sleep-disturbed individuals, in order to establish how memory functioning during sleep is influenced by sleep disturbances.

Effect of estradiol on the sympathoadrenal response to mental stress in normal men.

It has been shown that steroid hormones are able to influence the sympathoadrenal system activity. Therefore, we have investigated in a double blind cross-over study the effect of percutaneous estradiol administration (100 micrograms) on the sympathoadrenal and cardiovascular responses to mental arithmetic stress in 20 normal young males. The plasma estradiol level was 154 +/- 14 pmol/L during the estrogen session (ES) and 44 +/- 7 pmol/L during the placebo session (PL; P < 0.001). The mental stress induced a significant increase in systolic blood pressure during both the PL (F = 7.2; P < 0.001) and the ES (F = 4.8; P < 0.01); the peak obtained during PL was, however, higher than that during ES (128 +/- 2 vs. 122 +/- 3 mm Hg; P < 0.02). A significant increase in pulse rate was observed during PL (F = 4.2; P < 0.002), but not during ES (F = 2.6; P = 0.47), with the peak pulse rate being higher during mental stress in the PL than the ES (78 +/- 2 vs. 74 +/- 2 beats/min; P < 0.03). In response to the mental stress, plasma epinephrine increased significantly during PL (F = 3.2; P < 0.03), but not during ES (F = 1.1; P = 0.3). The stress-induced peak in plasma epinephrine during PL was higher than that during ES when expressed as the absolute value or the incremental peak (513 +/- 103 vs. 125 +/- 32 pmol/L; P < 0.005). The incremental peak in plasma norepinephrine obtained during PL was higher than that during ES (0.78 +/- 0.1 vs. 0.27 +/- 0.07 nmol/L; P < 0.02). Plasma free fatty acid, acetoacetate, and 3-hydroxybutyrate increased significantly from basal values during PL, but not during ES. These data show that mildly elevated levels of estradiol are able to influence the response of the adrenal medulla to mental stress in men.

Validation of the full and short forms of the CAMDEX interview for diagnosing dementia. Cambridge Examination for Mental Disorders of the Elderly.

The present study compares the sensitivity and specificity of the short and full forms of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) interview in diagnosing dementia. We tested 73 subjects meeting DSM-IIIR criteria for dementia and 61 matched controls. The short version was applied 3 months after the full one to guarantee a relative stability of the tested functions. Referred to an independent clinical rating made at the beginning of the study, the levels of sensitivity and specificity were not significantly different in the two forms and fully comparable with those of the original full English version. Moreover, the scores on analogous sections of the two versions were highly correlated in the demented and control groups. These findings support the hypothesis that the short form of the CAMDEX maintains the psychometric properties of the full one, and consequently can be used in diagnostic routines for a variety of clinical and research purposes.