A longitudinal study on the effects of COVID-19 pandemic on non-motor symptoms in Parkinson's disease.

INTRODUCTION: The COVID-19 pandemic led to psychological consequences on people's mental health, representing a condition of increased vulnerability for the weakest sections of population, including elderly patients with Parkinson's disease (PD). This longitudinal study aimed at exploring the impact of the most frequent non-motor symptoms and their contribute on health-related quality of life of PD patients after the COVID-19 outbreak, in comparison with the pre-pandemic status. METHODS: Forty-two non-demented PD patients underwent a first assessment between December 2018 and January 2020 (T0). Then, between March and May 2021 (T1), they were contacted again and asked to complete the second assessment. Levels of global functioning, several non-motor symptoms (i.e. depression, apathy, anxiety, anhedonia) and health-related quality of life were investigated. RESULTS: Results of the the paired Wilcoxon signed-rank test showed that at T1, PD patients scored lower on the emotional subscale of the DAS, Z = - 2.49; p = 0.013; Cohen dz = 0.691. Higher scores of the TEPS total score, Z = - 2.38; p = 0.025; Cohen dz = 0.621, and LEDD, Z = - 2.63; p = 0.008; Cohen dz = 0.731, were also reported at T1. CONCLUSION: The present study suggested that self-isolation at home might lead to a reduction of apathy and anhedonia in PD patients due to the increase in social support provided by families during COVID-19 restrictions. This evidence brings out the need of a consistent and persistent social support which might be represented by caregivers or/and social assistive robotics.

The Italian version of the alternative form of Parkinson's Disease-Cognitive Rating Scale (PD-CRS/AF): normative values from 260 Italian healthy subjects.

INTRODUCTION: The Parkinson's Disease-Cognitive Rating Scale (PD-CRS) is a comprehensive PD-specific cognitive scale which assesses both fronto-subcortical and cortical functions. The original version of the PD-CRS is a valid and reliable instrument to screen for and diagnose PD-MCI. Although this battery was translated and validated into Italian language, an alternative form (AF) should be useful to minimize practice effect in test-retest conditions. The main aim of the present study was to validate the Italian version of the AF of the PD-CRS (PD-CRS/AF) and to collect normative values in a sample of Italian healthy adult and older population. MATERIALS AND METHODS: We adapted the PD-CRS/AF to Italian language, then 260 participants of different ages (age range 40-89 years) and educational levels (from primary school to university) underwent the PD-CRS/AF. Regression-based norming was used to explore the influence of demographic variables (age, education level, sex) on total score, cortical and subcortical scores, and for the score on each single subtest of the PD-CRS/AF. RESULTS: Multiple linear regression analysis revealed that age and education are significantly associated with the total score and the two sub-scores, whereas no significant effect of sex was revealed. A correction grid for raw scores was developed and inferential cut-off and equivalent scores for each sub-test were provided. CONCLUSIONS: The present study provides the first Italian translation of PD-CRS/AF and normative data to correct the scores according to relevant demographic variables, allowing clinicians to detect cognitive changes over time by means of a valid and reliable cognitive screening instrument.

Linking perception of bodily states and cognitive control: the role of interoception in impulsive behaviour.

Interoception and impulsivity are two multi-dimensional constructs and although the role of interoception in impulsiveness has been previously reported, it is not clear whether their different facets are related to each other. In the present study, we aimed at bridging this gap by investigating the relationships between interoception and impulsivity in the light of their multi-dimensional nature. To this aim, we conducted a cross-task comparison and assessed in the same sample of healthy participants, interoceptive accuracy, by the heartbeat perception task, interoceptive sensibility, by a self-reported measure, "hot" impulsivity, by a behavioural task of risk taking, and "cool" impulsivity, by a go/no-go task. Also, we assessed trait impulsivity by a self-report measure. We found that interoceptive sensibility contributed to "hot" impulsivity, while interoceptive accuracy was related to non-planning trait impulsivity. These findings underscore the need to investigate at a finer grain the relationships between these two complex, multi-dimensional constructs.

Prevalence and clinical aspects of mild cognitive impairment in Parkinson's disease: A meta-analysis.

Mild cognitive impairment associated with Parkinson's disease (PD) is a risk factor for the development of dementia. Despite the importance of early identification of mild cognitive impairment in PD, its prevalence and clinical correlates are still debated. The present meta-analysis provides a robust estimate of prevalence rate of mild cognitive impairment in PD according to the Movement Disorder Society clinical criteria and to explore the differences between PD patients with and without mild cognitive impairment in demographic, clinical, and neuropsychiatric features. A systematic literature search was performed up to April 2019 using PsycInfo (PROQUEST), PubMed, and Scopus. From 4706 titles and abstracts, 41 studies were selected (n = 7053 patients). Pooled mild cognitive impairment prevalence was 40% on a total sample of 7053 PD patients (95% confidence interval = 36-44; Q = 490.14, P < 0.0001; I2 = 91.84%) with a higher frequency for the multiple domain subtype (31%; 95% confidence interval = 23-41, Q = 93.24; P < 0.0001; I2 = 92.49%). Meta-regression analysis revealed that stage of PD moderate prevalence estimates of mild cognitive impairment (ß = 2.80; P = 0.008). Mild cognitive impairment in PD was associated with older age, lower education, longer disease duration, higher levodopa equivalent daily dose, more severe motor symptoms, and postural instability/gait difficulty motor subtype, poorer quality of life, higher levels of apathy, and depression. The present meta-analysis indicated that mild cognitive impairment in PD is a frequent cognitive status deserving to be early detected by means of standardized cognitive assessments in clinical practice. © 2019 International Parkinson and Movement Disorder Society.

Personality profile and depression in migraine: a meta-analysis.

BACKGROUND: Despite the clinical importance of psychological factors in migraine, the relationship between personality traits, depression, and migraine has been poorly investigated. OBJECTIVE: To delineate the personality profile distinctive for migraineurs and to explore the relationship between personality traits and depression in migraineurs compared to non-migraineurs. METHODS: A systematic literature search was performed up to March 2019 using PsycInfo (PROQUEST), PubMed and Scopus. Sixteen primary studies met inclusion and exclusion criteria and were included in the meta-analysis. RESULTS: The meta-analysis on the personality defined according to Psychobiological model revealed high Harm Avoidance (Hedges'g = 0.31; 95% confidence interval [CI] = 0.01-0.60), Persistence (Hedges'g = 0.37; 95% CI = 0.01to - 0.72) and low self-directedness (Hedges'g = - 0.33; 95% CI = -0.57 to - 0.09) in migraineurs. The meta-analysis on the personality defined according to Three Factor Model revealed high neuroticism (Hedges'g = 0.47; 95% CI = 0.32-0.63) and low extraversion (Hedges'g = - 0.08; 95% CI = - 0.14 to - 0.03) in migraineurs. Meta-regression analysis revealed that neuroticism moderated the relationship between depression and migraine. CONCLUSION: The findings evidenced that migraine is characterized by specific personality traits. Among them, neuroticism influenced the severity of depression in migraineurs, and, therefore, an early evaluation of the personality traits could allow identifying patients susceptible to develop migraine-associated psychopathological symptoms.

The effects of autistic traits and academic degree on visuospatial abilities.

In the present study, we were interested to investigate how autistic traits (including systemizing and empathy) and academic degree influence individuals' visuospatial abilities. To this end, 352 university students completed the Autism Spectrum Quotient (AQ), the Empathy Quotient, the Systemizing Quotient (SQ) and visuospatial tests measuring figure disembedding and mental rotation of two-dimensional figures. Engineering-design students (architecture and engineering) were the most accurate in disembedding and mentally rotating figures, followed by students of physical sciences (computer science, chemistry, physics, etc.) and fact-based humanities (languages, classics, law); biological (psychology and neuroscience, etc.) and systems-based social scientists (economics and commerce) were the least accurate. Engineering-design students also showed higher SQ scores with respect to the other four academic degree subjects, with students of biological sciences showing lower SQ scores. Importantly, results from a path analysis revealed that SQ (but not AQ) exerted an indirect effect on figure disembedding and mental rotations through the influence of the academic degree. Thus, the present findings reveal shady differences in systemizing degree and visuospatial performance within systemizing-based degree subjects. Implications for education are discussed.

Normative data of the Rey-Osterrieth Complex Figure for Italian-speaking elementary school children.

The Rey-Osterrieth Complex Figure Test (ROCF) is a widely used neuropsychological test for the evaluation of drawing disorders in different clinical populations, and, in particular, in persons with neurodevelopmental disorders. The aim of the present study is to provide normative data for ROCF copying (ROCF-Direct copy) and drawing from memory (ROCF-Immediate recall) in Italian-speaking children. The sample consisted of 348 children (147 males and 199 females), aged 7-11 years, recruited from elementary schools in Southern Italy. Normative data were gathered from 312 participants fulfilling the inclusion criteria, and estimated centiles were obtained according to the LMS method providing normalized growth centile standards. Results showed a significant effect of age on performance in both tasks, with a steady increase of drawing accuracy, whereas participants' gender and mean level of parental education did not exert any significant effect. Thus, normative data were stratified by age, and percentile scores were provided allowing a practical use of the ROCF for the clinical evaluation of drawing abilities in both typical and atypical children.

Assessment of apathy minimising the effect of motor dysfunctions in Parkinson's disease: a validation study of the dimensional apathy scale.

PURPOSE: Apathy is associated with motor symptoms in Parkinson's disease (PD); therefore, its evaluation could be influenced by motor disability. The Dimensional Apathy Scale (DAS) evaluates apathy excluding confounding effects of motor symptoms. The present study had three major aims: (a) to explore the psychometric properties of the DAS in non-demented PD patients; (b) to determine an optimal cut-off score of the DAS to identify apathetic PD patients; and (c) to determine a specific apathy profile in PD patients as compared to healthy controls (HC). METHODS: One hundred and seven PD patients and 100 HC completed the DAS. To explore convergent and divergent validity of the DAS in PD, patients underwent the Apathy Evaluation Scale and tools for assessing depressive symptoms, anxiety and cognition. Clinical aspects were recorded. Receiver operating characteristic curve analyses were carried out to estimate the optimal cut-off score to identify clinically significant apathy. RESULTS: The DAS scores showed high internal consistency and good evidence for convergent and discriminant validity. Maximum discrimination between apathetic and non-apathetic patients was obtained with a cut-off score of 28.5 (total score range: 0-72 with higher score indicating more severe apathy). Comparison between PD and HC groups revealed significant differences on total DAS, behavioural/cognitive initiation and emotional subscales. CONCLUSIONS: The DAS is a valid and reliable tool to assess multidimensional apathy in PD, independently of severity of motor symptoms. Reduced initiation of thought and behaviour and emotional blunting characterised PD patients, without confounding effects of motor disability.

Measuring mindreading in preschoolers: The perspective battery (PERBAT).

OBJECTIVE: The capacity to take another person's visual perspective is pivotal for solving mindreading tests, such as Theory of Mind (ToM) tasks, but most of them heavily rely on domain-general abilities (e.g., language, executive functions). Here we present a novel battery of visual perspective-taking tests for child neuropsychological assessment, the Perspective Battery (PERBAT), which poses a limited load on domain-general abilities. METHODS: The battery includes four tests: i) Block Building; ii) Hide and Seek; iii) Deceptive Figures; iv) Double-Sided Shelf. We administered the PERBAT to 126 typically developing preschoolers (65 males; 3-6-year-old); the participants also performed classical tests of social cognition, language, and nonverbal abstract reasoning. RESULTS: The scores of all the PERBAT tests were significantly and positively related with age and scores of the classical social cognition tests, but not with scores of the language and nonverbal abstract reasoning tests. CONCLUSIONS: The PERBAT could represent a useful neuropsychological tool providing a comprehensive assessment of visual perspective-taking skills in preschool children. Future investigation is needed to examine the validity of the PERBAT with neurotypical samples across countries, race, ethnicity, and language as well as with clinical populations. Longitudinal studies are also encouraged to examine whether early visual perspective-taking weaknesses are associated with later development of mindreading skills.

The Integrated Neuropsychological Therapy: A Psychotherapy Model Tying Neuropsychology and Cognitive Behavioral Therapy.

Transdiagnostic cognitive behavioral therapy (CBT) is based on the identification of dysfunctional processes and intervention principles shared across psychopathology. From a neuropsychological perspective, deficits of executive functions and social cognition have been identified as common mechanisms involved in the genesis and maintenance of different psychopathological disorders. The present article describes a new psychotherapy model, the integrated neuropsychological therapy (INPT), built on the principles of transdiagnostic CBT and neuropsychology. Case formulation is operationalized into three levels of functioning, that is, automatic, reflective, and strategic, considering both neuropsychological processes and clinical contents. Treatment planning involves three phases, that is, preparation, enhancement, and change, each consisting of different treatment modules defined according to the above levels of functioning. These modules are selected based on the patient's profile defined during case formulation. The theoretical foundations of INPT are provided, and a case description is presented, which illustrates the implementation of the treatment model.

Interoceptive abilities facilitate taking another's spatial perspective.

Information can be perceived from a multiplicity of spatial perspectives, which is central to effectively understanding and interacting with our environment and other people. Interoception, the sense of the physiological state of our body, is also a fundamental component contributing to our perception. However, whether the perception of our inner body signals influences our ability to adopt and flexibly change between different spatial perspectives remains poorly understood. To investigate this, 90 participants completed tasks assessing multiple dimensions of interoception (interoceptive sensibility, cardiac interoceptive accuracy and awareness) and the Graphesthesia task to assess tactile spatial perspective-taking and its flexibility. The results revealed that higher cardiac interoceptive awareness is associated with greater consistency in adopting a perspective decentred from the self. Second, higher cardiac interoceptive accuracy was associated with slower and less accurate performance in switching from a decentred to an egocentred perspective. These results show that interoceptive abilities facilitate decentred spatial perspective-taking, likely reflecting stronger perceived boundaries between internal states and the external world.

Visual and kinesthetic motor imagery in adults with different degrees of self-reported motor coordination difficulties.

Developmental Coordination Disorder (DCD) involves difficulties in performing coordinated movements with fine and/or gross motor skills deficits. Several studies showed that DCD is characterized by motor imagery deficits as well. Here we investigated in neurotypical adults (N = 334) the relationships between the ease of imaging two main motor imagery components, that is the visual and the kinesthetic one, self-reported motor coordination difficulties and handwriting speed. Self-reported motor difficulties were measured by the Adult Developmental Co-ordination Disorders/Dyspraxia Checklist (ADC) and scores were used to distinguish three groups: participants at risk of DCD (with both relevant childhood and current motor coordination difficulties); with motor coordination difficulties (relevant current but not childhood difficulties); without motor coordination difficulties (neither current nor childhood difficulties). The main results showed more kinesthetic and visual imagery difficulties in participants at risk of DCD than in those both with and without motor coordination difficulties. Interestingly, the relationships between the two imagery components and motor difficulties were different in the three groups, depending on: 1) the developmental phase (childhood or adulthood) to which motor coordination difficulties referred, and 2) the point of view (self or other), from which images were judged. Instead, no relationship was found between imagery abilities and handwriting speed. Thus, a nuanced pattern of the ease of imaging motor imagery emerged in adults with different degrees of self-reported motor coordination difficulties. These findings could be relevant for the assessment of people candidate to undergo a motor imagery training.

The Relationships between Self-Reported Motor Functioning and Autistic Traits: The Italian Version of the Adult Developmental Coordination Disorders/Dyspraxia Checklist (ADC).

BACKGROUND: We developed the Italian version of the adult developmental co-ordination disorders/dyspraxia checklist (ADC), providing reliability and concurrent validity data for the scale (Aim 1). In addition, we investigated the relationships between motor coordination difficulties and different autistic traits (Aim 2). METHODS: 498 participants (341 females; age range = 18-34) underwent the Italian version of the ADC, as well as a handwriting speed test, the autism spectrum quotient, the empathy quotient, and the systemizing quotient. RESULTS: The distinction between three main factors (A, B, and C) identified in the original version of the ADC was confirmed here. Internal consistency of the ADC subscales was adequate, as well as the correlation with the handwriting speed test used to assess concurrent validity. No substantial sex differences on the ADC scores were found. Furthermore, data revealed that poor autistic-related communication skills and lower levels of systemizing tendencies were, among all the investigated autistic traits, those more strongly associated with higher motor coordination difficulties. CONCLUSIONS: The Italian ADC seems a valuable tool for assessing motor coordination difficulties in adults and can reveal the nuanced impact exerted by different autistic traits on self-reported motor functioning.

Empathy through the Pandemic: Changes of Different Emphatic Dimensions during the COVID-19 Outbreak.

Growing evidence suggests that empathy is a relevant psychological trait to face the challenges imposed by the COVID-19 pandemic, but at the present very little is known on whether this multi-dimensional construct has been affected by the pandemic outbreak differently in its separate components. Here, we aimed at filling this gap by capitalizing on the opportunity of having collected data from different self-report measures and cognitive tasks assessing the main dimensions of empathy immediately before the beginning of the global pandemic and about one year later. The results showed a detrimental impact of the pandemic outbreak on empathic social skills but not on both cognitive (perspective-taking) and emotional empathy that instead significantly improved. Thus, reduced empathic social skills could be a weakness to be targeted in psychological interventions to help people cope with the mental health challenges related to COVID-19 pandemic, whereas the ability of understanding another's mental states and emotions could represent a strength in dealing with the current long-lasting crisis.

Anxiety Sensitivity Domains are Differently Affected by Social and Non-social Autistic Traits.

Anxiety sensitivity (AS) is implicated in the development and maintenance of several psychopathological conditions. Non-clinical individuals with high autistic traits may develop anxiety disorders and depressive symptoms. Here, we investigated the relationships of autistic traits with AS dimensions and depression, considering sex. We referred to the two-factor model of the autism spectrum quotient to distinguish social and non-social autistic traits and assessed 345 university students on AS and depression scales. Results showed that only social autistic traits predicted general AS and anxiety-related concerns regarding social and cognitive domains. The present results emphasize the need of assessing multiple domains of anxiety in individuals on the autistic spectrum, differentiating social and non-social traits.

Figure Disembedding: The Gottschaldt's Hidden Figure Test in Children with Typical Development and Autism.

In two studies, we used the Gottschaldt's Hidden Figure Test (GHFT) for assessing figure disembedding ability in children aged 7-11. Study 1 demonstrated in a large sample of typically developing children that GHFT accuracy and time scores differed across age groups, without sex and socioeconomic differences. Thus, we provided normative data only taking into account children's age. In Study 2, GHFT normative values were used to assess children with autism, who were also compared with a closely age-matched group of typical controls. Children with autism achieved time scores at or above the 50th centile and significantly differed from the controls for time score. The GHFT seems a valuable tool for defining the cognitive profile of children with autism.

The effect of autistic traits on disembedding and mental rotation in neurotypical women and men.

Recent data has revealed dissociations between social and non-social skills in both autistic and neurotypical populations. In the present study, we investigated whether specific visuospatial abilities, such as figure disembedding and mental rotation, are differently related to social and non-social autistic traits, in neurotypical women and men. University students (N = 426) completed the Autism Spectrum Quotient (AQ), figure disembedding and mental rotation of two-dimensional figures tasks. AQ social skills (AQ-social) and attention-to-details (AQ-attention) subscales were used as measures of social and non-social autistic traits, respectively. Mental rotation was affected by a significant interaction between sex, social and non-social traits. When non-social traits were above the mean (+ 1 SD), no sex differences in mental rotation were found. Instead, below this value, sex differences depended on the social traits, with men on average outperforming women at middle-to-high social traits, and with a comparable performance, and with women on average outperforming men, at lower social traits. A small positive correlation between figure disembedding and social traits was observed in the overall sample. These results are interpreted in terms of the hyper-systemizing theory of autism and contribute to the evidence of individual differences in the cognitive style of autistic people and neurotypical people with autistic traits.

Interactions between interoception and perspective-taking: Current state of research and future directions.

Interoception, the sense of the physiological state of the body, and perspective-taking, the ability to take another's point of view, are two fundamental components contributing to our perception and interaction with the external world. However, whether the perception of our inner body influences how we perceive the external world and other people remains poorly understood. Here, we review recent behavioural and neuroimaging evidence investigating the links between dimensions of interoception (i.e., accuracy, sensibility and awareness) and perspective-taking (i.e., affective, cognitive and visual). So far, only a limited subset of these dimensions has been investigated together and the results suggest that interoceptive abilities may only interact with perspective-taking when embodied mental transformations are required. Furthermore, mainly the emotional aspects of perspective-taking are related to interoception, influencing the ability to empathise with others. Future research should systematically investigate the links between all dimensions of interoception and perspective-taking to provide full understanding of the specific role interoception has on how we perceive the world and take another's point of view.

"Mind the thumb": Judging hand laterality is anchored on the thumb position.

People can decide whether the image of a hand represents a left or a right one. The laterality judgment mainly implies mentally imaging own hand movement (motor simulation) if the stimulus represents a palm, or analysing visual cues, as hand asymmetry, if the stimulus reproduces a dorsum. Here, by capitalizing on evidence underscoring the key role of thumb-palm complex in motor dexterity of human hand, we hypothesise that activation of motor or visual processes when judging hand laterality is due to the different relevance of palm-thumb and dorsum-thumb combinations to hand action. To test this thumb-anchored strategy, in a laterality judgment experiment, we concurrently manipulated the thumb position (flexed or extended) with respect to palm and dorsum, and the human likeness of the hand shape (influencing the salience of the thumb with respect to the hand shape). The main results demonstrated that viewing the flexed thumb from palm or dorsum elicited motor simulation, while viewing the extended thumb activated motor simulation when combined with palm but not dorsum. The present data highlight the pivotal role of the thumb in hand laterality judgments, consistent with its key role in human in-hand manipulation.

Tendency to Worry and Fear of Mental Health during Italy's COVID-19 Lockdown.

BACKGROUND: We tested whether the tendency to worry could affect psychological responses to quarantine by capitalizing on the opportunity of having collected data before the COVID-19 outbreak on measures of worry, anxiety, and trait mindfulness in a group of university students. METHODS: Twenty-five participants completed self-report measures assessing worry (Penn State Worry Questionnaire, PSWQ), anxiety (Anxiety Sensitivity Index, ASI-3), and trait mindfulness (Mindful Attention Awareness Scale, MAAS) at T0 (pre-lockdown, 4 November 2019-17 February 2020) and T1 (at the end of lockdown, 26 April-30 April 2020). We compared assessments at the two time points in the whole sample and in high and low worriers (defined at T0 by scores on PSWQ respectively above and below 1.5 SD from mean of the Italian normative sample). OUTCOMES: High worriers showed at T1 a significant increase of anxiety sensitivity and fear of mental health in comparison to low worriers. Moreover, in the whole sample, at T1 trait mindfulness was inversely related to worry and fear of mental health. INTERPRETATION: A valuable approach to support individuals experiencing anxiety related to the COVID-19 outbreak could be represented by mindfulness-based interventions improving the ability to focus attention and awareness on the present moment.