The effects of caregiver's burden on dynamic structure in disorder of consciousness families: An observational study.

INTRODUCTION: Disorder of consciousness is a clinical condition due to severe brain damage. The impact of consciousness disorder on the family is characterized by a combination of biopsychosocial factors. The burden and suffering perceived by caregivers can cause psychological distress characterized by anxiety, depression, and physical illness. The aim of the study was to investigate the interaction between family dynamics and caregiver burden. METHODS: We enlisted 35 caregivers of subjects in a minimally conscious state. Two skilled psychologists administered the Olson's Adaptability and Family Cohesion Assessment Scale and the Novak's Burden Inventory Caregiver Scale to assess family function and family burden, respectively. RESULTS: We found that the caregiver burden correlates with the family adaptability and cohesion, as well as with enmeshment, rigidity, and disengagement. CONCLUSION: Findings suggest that the traumatic event does not affect the family structure. Families are able to maintain a balanced functioning and control distress.

Assessment of insight in hospitalized neurological patient: Cognitive profile and mood disorder.

PURPOSE: Many studies have evaluated the characteristics of insight, especially in psychiatric patient populations. However, this construct has been poorly examined within neurological disorders. We explored the relationship between altered insight, mood disorders and neurocognitive functioning in a sample of patients admitted to a neurological rehabilitation unit. METHOD: Each patient, at the time of hospitalization (T0), underwent an evaluation of the overall cognitive profile, of the frontal functions, and the compilation of scales aimed at investigating the 4 domains under examination of insight and anxiety-depressive symptomatology. After 3 months (T1), at the end of the rehabilitative and supportive treatment, the patients underwent the same evaluation performed at T0. RESULTS: Our results showed significant differences between T0 and T1 in the variables examined related to insight. In particular, there was a correlation between the global cognitive profile, including executive functions, and all insight domains. This confirms how the degree of cognitive deficit, especially of executive type, affects all levels of awareness of the individual. We have also found correlations between mood disorders and insight. In particular, our results show that depression versus anxiety plays a fundamental role in a person's awareness. CONCLUSIONS: The study of insight is fundamental not only for the relapses it could have on the patient, but also on those to health care professionals. In fact, having an adequate insight could lead to a greater motivation of the patient to be more complimentary to pharmacological and rehabilitative therapies, also favoring social reintegration.

Assessment of spinal cord stimulation and radiofrequency: Chronic pain and psychological impact.

Pain has a major impact on anxiety and depression levels. The aim of this study is to demonstrate how these symptoms (depression and anxiety) could positively influence the perception of pain after neurostimulation system implantation.We enrolled 100 patients and divided in 2 different groups, by using tests screening such as Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Nursing Rating Scale (NRS): the group with spinal cord stimulation (SCS) and the group with pulsed spinal cord radiofrequency (RFP).We highlighted a significant decrease of scores (BDI, HAM-A, NRS) in each group between T0 (baseline) and T1. Moreover, the intra-group analysis showed a positive significant correlation between NRS and depressive and anxiety symptoms.We assert that the use of alternative methods (SCS and RFP) to the traditional pharmaceutical-surgical treatments, provide the reduction of the algic and anxiety-depressant symptoms, restoring also the perception of psychological well-being.

Neuropsychological assessment and clinical evaluation in temporal lobe epilepsy with associated cortical dysplasia.

Temporal Lobe Epilepsy (TLE) is a chronic neurological disorder, often associated to cognitive deficits. Focal cortical dysplasia (FCD), frequently associated to high risk of epilepsy, can lead to abnormalities in cognition. The aim of this study was to explore neuropsychological performance and to identify potential risk factors for cognitive impairment in TLE subjects with associated FCD. Our sample was composed by 46 TLE patients with FCD (37.76 ± 12.60 years; 29 females and 16 males) and 44 healthy controls (41.05 ± 9.74 years; 25 females and 19 males). All subjects performed a neuropsychological battery associated to a measurement of depression and anxiety. Results showed a poor performance of all domains of cognitive functioning and identified age of epilepsy onset as potential risk factor of cognitive impairment. These findings support the importance to focus on cognitive impairment in TLE patients with FCD to better clarify the impact of epilepsy features and FCD in therapeutic and everyday management.

Role of visual P300 in cognitive assessment of subacute stroke patients: a longitudinal study.

Aim: The aim of this study was to assess if pre- and post- event related potentials (ERPs) components after visual stimulation training admitted differences exist in subacute stroke patients and to observe the outcome markers of cognitive functions recovery by using Neurowave system.Materials and Methods: Eighteen ischemic subacute stroke patients were enrolled and underwent to neuropsychological evaluation and ERPs recording at two time points, at baseline (T0) and after 3 months from (T1). All patients were stimulated with customized images for three days a week.Findings: Intra group analysis showed a significance difference in ERPs parameters and neuropsychological tests. Correlation analysis showed a significant relation between neuropsychological and ERP values.Conclusion: Our findings confirm that P300 ERPs' component could be a predictive marker for cognitive recovery of ischemic subacute stroke patients. Intensive programs of neurosensory stimulation could facilitate recovery of cognitive and attentive functions in subacute cerebrovascular disease.

Assessment of sleep and obesity in adults and children: Observational study.

The sleep allows many psychological processes, such as immune system activity, body metabolism and hormonal balance, emotional and mental health, learning, mnemonic processes. The lack of sleep could undermine mental and physical purposes, causing an alteration in cognitive functions or metabolic disorders. In our study, we have examined the irregular sleep effects with the overweight and obesity risk in children and adults.The sample was composed of 199 subjects, of which 71 adults, (29 males and 42 females), and 128 children (73 males and 55 females). We have measured the weight and height with standard techniques; we also have measured the body mass index dividing the weight in kg with the height square expressed in meters (kg/m). Subjects were divided into underweight, normal weight, overweight, and obese. Were administered some questionnaires to measure the quantity and quality of sleep, and eating habits and individual consumption of food.Analysis of demographic variables not showed significant differences between male and female groups but highlighted a significant trend differences in normal-weight score. The clinical condition has a substantial impact on body mass index score and sleep hours were significant predictor on this.Quantity and quality sleep can also represent a risk factor of overweight and obesity, so sufficient sleep is a factor that influence a normal weight. Adults and children that sleep less, have an increase in obesity and overweight risk with dysfunctional eating behaviors, decreased physical activity, and metabolic changes.

Assessment of Duodopa® effects on quality of life of patients with advanced Parkinson's disease and their caregivers.

The gold standard of treatment in Parkinson's disease (PD) is levodopa/carbidopa whose long-term use induces motor and non-motor fluctuations and dyskinesias. Continuous infusion of intrajejunal levodopa/carbidopa intestinal gel (Duodopa®) reduces motor and non-motor symptoms and dyskinesias, and improves the quality of life of patients. The aim of this open observational prospective study was to evaluate the impact of Duodopa® on conditions of PD patients and caregivers, and their quality of life. We enrolled 12 patients with advanced PD and their caregivers. The PD patients were assessed at baseline, 3 and 6 months after Duodopa® treatment initiation using Unified Parkinson's Disease Rating Scale-Part III and IV (UPDRS-III and IV), Unified Dyskinesia Rating Scale (UdysRS), Beck Depression Inventory (BDI-II), Hamilton Anxiety Rating Scale (HAM-A) and Parkinson's Disease Quality of Life Questionnaire (PDQ-39). The caregivers were assessed, at the same time as the patients, using BDI-II, HAM-A, Caregiver Burden Inventory (CBI) and SF-36 Health Status Questionnaire. Six months after Duodopa® therapy, the scores of UPDRS-III and IV, UdysRS, BDI-II, HAM-A and PDQ-39 were significantly decreased (p < 0.01). After Duodopa® therapy, in caregiver group the scores of BDI-II, HAM-A and CBI were significantly decreased and the scores of SF-36 Health Status Questionnaire were significantly increased (p < 0.01). A reduction of anxiety after therapy correlated with mental status domains of SF-36 Health Status Questionnaire (r = 0.56). Overall, Duodopa® is effective even in the short time to improve the clinical conditions of PD patients and caregivers and their quality of life.

Does the radiologically isolated syndrome exist? A dual-task cost pilot study.

Simultaneous performance of motor and cognitive tasks may compete for common brain network resources in aging or patients with some neurological diseases, suggesting the occurrence of a cognitive-motor interference. While this phenomenon has been well described for multiple sclerosis (MS) patients, it never has been tested on asymptomatic subject with magnetic resonance imaging (MRI) findings suggestive of demyelinating disease (i.e., radiologically isolated syndrome: RIS). In this pilot study, 10 RIS subjects and 10 sex/age-matched healthy controls were tested by means of static posturography under eyes opened (single-task trial) and while performing two different cognitive tasks (semantic modified word list generation for first dual-task trial and phonemic semantic modified word list generation for second dual-task trial), to estimate the dual-task cost (DTC) of standing balance. In our sample, under cognitive interference (without any substantial differences between semantic and phonemic modified word list generation), the RIS group showed significance differences in CoP (center of pressure) total sway area, ellipse eccentricity, CoP sway path length, CoP median sway velocity along the AP (anteroposterior) axis and along the ML (mediolateral) axis, reflecting a higher negative DTC respect to healthy subjects (which have simply shown a statistical trend, failing to reach a significance, in some trials). The phenomenon of cognitive-motor interference might be unmasked by a dual-task posturography in RIS subjects, too. We hypothesize that this approach could be useful to early reveal the presence of a demyelinating disease and to reach a MS diagnosis in subjects otherwise classified as RIS.

Evaluation of Qualitative Outcomes after Surgical Intervention on Patients Affected by Arteriovenous Malformations.

BACKGROUND: Arteriovenous malformations are abnormal tangles of blood vessels that cause irregular connections between arteries and veins. Rupture of arteriovenous malformations represents a frequent complication associated with a neurological impairment and physical disability. METHODS: We investigated the relationship among coping dimensions and overall quality of life (QoL), and health status after surgical intervention in 20 patients affected by arteriovenous malformations. Each patient was administered a battery of self-report questionnaires (Short Form 12 Health Survey Questionnaire, Brief COPE Inventory, Beck Depression Inventory, and Hamilton Rating Scale for Anxiety). RESULTS: We found that surgical treatment of arteriovenous malformations affected subjective well-being and emotional aspects. Coping ability influenced the QoL and the presence of anxiety and depressive symptoms. We found a significant correlation between depression and humor (r = -.47, P = .03) and between QoL and self-distraction (r = -.48, P = .03) and humor (r = .44, P = .05). In particular, humor was a significant predictor of mental health and physical health. CONCLUSIONS: The presence of anxiety and depression was the cause of deterioration of QoL, even if psychological resources used to deal with the disease significantly modified the subjective perception of well-being. The evaluation of the impact of cerebrovascular disease on QoL should be a basis for planning and evaluating therapeutic and psychological rehabilitative interventions.

Neurophysiological assessment for evaluating residual cognition in vegetative and minimally conscious state patients: a pilot study.

The aim of this study was to assess residual cognitive function and perform outcome evaluation in vegetative state (VS) and minimally conscious state (MCS) patients, using Neurowave, a system able to monitor event-related potentials (ERPs) induced by neurosensory stimulation. Eleven VS and five MCS patients underwent neurological examination and clinical evaluation performed using validated clinical and behavioral scales; they also underwent neurosensory stimulation, which consisted of administration of target images (rare stimuli), relevant to the patient's personal history and having emotional significance, alternated with nontarget images ("standard" stimuli), which had no emotional significance. All simultaneous ERP responses at baseline (T0) and at three months from T0 (T1) were recorded. At T0 we found significant differences between the VS and MCS patients for the N200 (p=0.02) and P300 (p=0.04) waves. The neurophysiological analysis at T1 showed a significant difference only for P300 (p=0.02), probably due to the improvements observed in the VS subjects for the N100 (p=0.009) and N200 (p=0.02) sensory components. Neurophysiological assessment for evaluating residual cognition in vegetative and minimally conscious state patients: a pilot study Our findings seem to show the value of ERP monitoring in VS and MCS patients as a means of investigating residual cognitive function. This approach could guide early therapeutic and rehabilitation interventions, and contribute to identifying better diagnostic and prognostic markers for use in unresponsive or low-responsive patients.

Diffusion tensor imaging and neuropsychologic assessment in aphasic stroke.

With the recent advances in neuroimaging it has become possible to characterize the cerebral reorganization that occurs in response to therapy and the conditions under which this reorganization occurs. Diffusion tensor imaging (DTI) is a neuroimaging technique that allows us to visualize white matter tracts and potential changes associated with different treatments. To date, only few data on structural neuroplasticity related to the recovery of poststroke aphasia were reported. We describe a case of aphasic stroke patient, who was studied before and after the intense rehabilitative treatment by using neuropsychologic evaluation and DTI examination, to assess the integrity of the arcuate fasciculus related to motor, language, and cognitive recovery.