Sleep continuity scale in Alzheimer's disease (SCADS): application in daily clinical practice in an Italian center for dementia.

Sleep disorders can occur in many neurodegenerative disorders; in a previous paper we constructed a scale investigating sleep discontinuity/fragmentation with the aim to obtain a rapidly and easily administered tool suitable for early identification and longitudinal monitoring of sleep disturbances in Alzheimer's disease (AD). We introduced this instrument in the daily clinical practice in a center for dementia; here we present the results of our experience. Two hundred and sixteen AD outpatients referred to the Alzheimer's Disease Assessment Unit at the IRCCS C. Mondino National Neurological Institute, Pavia, Italy, in the period October 2012 to March 2014 were administered the scale. The questionnaire global score was correlated with measures of cognitive, functional and behavioral impairment; a significant association was found with Mini-Mental State (p = 0.005), Activities of Daily Living (p = 0.01), Neuropsychiatric Inventory (p = 0.01) and Clinical Dementia Rating (p = 0.0005). The present data indicate that the previously validated questionnaire proves to be a suitable, rapid and easy to use tool in investigating sleep quality in AD in daily clinical practice. An early identification and longitudinal monitoring of sleep disturbances in AD may improve pharmacological and non-pharmacological interventions.

A sleep continuity scale in Alzheimer's disease: validation and relationship with cognitive and functional deterioration.

Considering that disrupted sleep may be detrimental to daytime performance in people with dementia, we set out to construct a questionnaire able to identify sleep patterns potentially associated with clinical and functional disease variables in this population. Two subsets of items indicative of patterns of unstable sleep and of disordered rapid eye movement sleep (REM) were selected. The first included items investigating sleep continuity, with low sleep continuity markers considered indicative of high arousability; the second included items investigating the frequency and quality of dreams and the frequency of clinically identifiable REM sleep behaviour disorder episodes. The questionnaire was administered to 140 outpatients with a diagnosis of mild-to-moderate Alzheimer's disease. The Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Instrumental Activities of Daily Living, Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) were administered to quantify cognitive, functional and behavioural impairment. A subscale comprising items investigating sleep discontinuity/fragmentation and showing high internal consistency was constructed and found to correlate significantly with variables considered indexes of cognitive and functional deterioration in AD (MMSE, ADL and CDR). Conversely, it did not prove possible to obtain a subscale of dysfunctional REM phenomena. The use of a rapidly and easily administered sleep scale, like the one we constructed, appears to be suitable for early identification and longitudinal monitoring of sleep disturbances in AD.

Alien hand syndrome in left posterior stroke.

Alien hand syndrome is a rare neurological disorder characterized by involuntary and uncontrollable motor behaviour, usually of an arm or hand. The patient perceives the affected limb as alien, and may personify it. The case of a 61-year-old right-handed woman who developed right posterior AHS after ischaemic stroke in the left posterior cerebral artery territory is reported. Neuroimaging studies disclosed no frontal or parietal involvement, while a posterior thalamic lesion was detected. A possible role of the thalamus in the genesis of AHS is discussed.

Neuropsychological evaluation and follow up in jcv- and non-jcv-related leukoencephalopathies in HIV infection.

The introduction of highly active antiretroviral therapy does not seem to have altered the incidence of progressive multifocal leukoencephalopathy (PML) in HIV infection. Moreover, the occurrence of a HIV-related leukoencephalopathy, called not determined leukoencephalopaties (NDLE), has been reported. As neuropsychological impairment remains highly prevalent in HIV infection, the aim of this study is to describe the neuropsychological profile of PML and NDLE patients, analyzing the time-related changes. Clinical and neuropsychological data from 32 patients (17 PML, 15 NDLE) were compared with two control groups: (1) asymptomatic HIV+ patients without magnetic resonance imaging evidence of leukoencephalopathy; (2) age-/gender-/education-matched healthy subjects. Patients with rapidly worsening PML were significantly impaired on all neuropsychological tests, while PML with more benign course and NDLE groups showed a dysexecutive pattern of impairment. Asymptomatic HIV+ subjects showed mild and isolated cognitive deficits, without functional impact. Cognitive impairment should therefore be considered a key feature from HIV infection diagnosis.

Impact of gender differences on the outcome of Alzheimer's disease.

BACKGROUND AND AIMS: Since little is known about the role of gender in the course of Alzheimer's disease (AD), a prospective epidemiological study was conducted to detect gender differences in relation to AD evolution and outcome. METHODS: Six hundred AD patients, 214 men and 386 women, first seen between September 2000 and December 2003, were enrolled; the follow-up period lasted until December 2008. RESULTS: The men had greater comorbidity and higher mortality than the women, who instead recorded more disability and longer survival. Survival curves showed that women reach partial loss of autonomy faster than men. Higher Neuropsychiatric Inventory scores at baseline showed a predictive value for loss of autonomy regardless of gender. Pharmacological treatment seems to have a protective role on disability and mortality. CONCLUSIONS: Gender influences disease evolution not only directly but also through other factors such as comorbidity.

Cognitive disturbances in non-demented subjects: heterogeneity of neuropsychological pictures.

The aim of this study was to individuate different clinical and cognitive pictures among non-demented subjects reporting cognitive disturbances. We evaluated 75 subjects referring to Alzheimer's Disease Assessment Unit of IRCCS C. Mondino, Pavia, who complained memory disturbances in absence of impairment in every day activities, not fitting DSM-IV criteria for dementia (MMSE>24). The subjects underwent neurological examination, blood chemistry and neuroimaging. The neuropsychological evaluation included tests exploring language, short- and long-term memories, logical abilities, attentive and visuo-constructional functions. Fifty-two patients fitted the criteria for mild cognitive impairment (MCI); twenty-three subjects had a neuropsychological evaluation within normal range for age and schooling; they were significantly younger and better educated and presented higher scores at scale for depression and anxiety than the MCI patients. In the MCI group, on the basis of cognitive profile and neuroimaging, different subtypes could be distinguished. Subjective cognitive complaints represent a heterogeneous condition, which can develop into different clinical pictures. It is, therefore, important to individuate specific clinic and neuropsychological profiles, possible predictive of different evolution.

Hallucinations and sleep-wake cycle in Alzheimer's disease: a questionnaire-based study in 218 patients.

The aim was to evaluate the relationship between hallucinations and the sleep-wake cycle in a sample of Alzheimer's disease (AD) patients in the early-moderate stage. Two hundred and eighteen AD patients (66 males, 152 females, mean age 74.3+/-6.85) were administered a sleep questionnaire in the presence of a care-giver. Twenty-six out of 218 (12%) reported the occurrence of hallucinations, mainly visual. In 18/28 (69%) hallucinations occurred when the patient was awake and in 8 (31%) hallucinations were reported to occur close to a specific phase of the sleep-wake cycle. Vivid dreams were reported in 25/218 (11%) and violent sleep-related and dream-related behaviours (probable REM behaviour episodes) in 22/218 (10%). Both REM phenomena were more frequent in AD hallucinators than in AD non-hallucinators (26.9% vs. 9.3%, and 26.9% vs. 7.8%, p<0.007). Our data indicate a lower incidence of hallucinations and presumable REM behaviour disorder (RBD) in AD, at least in the early-moderate phase, than that observed in synucleinopathies. However, the higher occurrence of vivid dreams and RBD in AD patients with hallucinations compared to those without hallucinations indicates a potential role of disordered REM sleep in influencing the occurrence of hallucinations in AD, similar to what has been observed in synucleinopathies.

Cognitive rehabilitation in Parkinson's disease.

A rehabilitation program of 6 weeks, including both motor and cognitive training, was applied to 20 patients affected by Parkinson's disease (PD) in the early stages, presenting with mild cognitive deficits, but no dementia. Cognitive rehabilitation has been performed by utilizing a software elaborated for neuropsychological training (TNP). At the end of the scheduled sessions, the patients showed a significant improvement at verbal fluency, logic memory and Raven's matrices tests, as compared to baseline. These results remained stable over the time. We hypothesize that rehabilitative training exerts its positive effects by reinforcing cognitive strategies, in particular, by enhancing frontal function, which are typically impaired in PD, and suggests that this instrument could be implemented in nonpharmacological treatment of this pathology.