Conversion of mild cognitive impairment to dementia in elderly subjects: a preliminary study in a memory and cognitive disorder unit.

Prevalence and incidence of predementia syndromes vary as a result of different diagnostic criteria, as well as different sampling and assessment procedures. Mild cognitive impairment (MCI) is thought to be a prodromal phase of dementia and therefore highly predictive of subsequent conversion. The aim of our study was to investigate the risk of conversion to dementia for different MCI subtypes diagnosed according to standardized and recently revised criteria (amnestic; impairment of memory plus other cognitive domains; nonamnestic). Participants were recruited among the 2,866 patients referring to the Memory and Cognitive Disorders Unit of the Local Health Unit of Bologna, Maggiore Hospital, between October 2000 and February 2006. In this preliminary study we analyzed data from 52 elderly outpatients with a diagnosis of MCI and a mean follow-up of 1.21+/-0.61 years (range 0.23-3.10 years). Mean age was 72.8+/-6.6 years, males were 61.5%. Mean baseline mini mental state examination (MMSE) score was 27.1+/-1.5. There were 15 incident cases of dementia (28.8%), with Alzheimer's disease (AD) accounting for 53.3% of all cases, AD with cerebrovascular disease for 33.4% and fronto-temporal dementia for 13.3%. Overall rate of conversion was 23.8 per 100 person-years. During the same follow-up period, 53.8% of participants remained stable and 17.3% reverted to normal. Rates of conversion for the specific MCI subtypes were 38 per 100 person-years for amnestic MCI, 20 per 100 person- years for non-amnestic MCI, and 16 per 100 person-years for memory plus other cognitive domains MCI. With respect to non-converters, converters were generally older (76.1+/-4.2 vs. 71.5+/-7.0 years, p=0.021), had a lower MMSE score (26.4+/-1.66 vs. 27.4+/-1.4, p=0.035) and a higher prevalence of atrophy at neuroimaging (73.7% vs. 42.4%, p=0.047). Moreover, with respect to non-converters, converters tended to have higher serum high density lipoprotein (HDL) levels, and lower serum folate levels. No difference was observed for the other study variables, included MCI subtype. Our findings suggest that the current definitions for MCI subtypes, particularly those referring to individuals with multiple or non-amnestic cognitive impairment, include a substantial number of individuals who may not progress to dementia. The possible role of cortical atrophy and low folate in the conversion from MCI to dementia could have important implications, because both conditions are easily identifiable. Moreover, low folate status is potentially amenable to therapeutic options. Although discouraging with respect to the clinical usefulness of currently available MCI criteria, our results raise the possibility that defining a protocol of multiple clinical risk factors may be useful in identifying MCI individuals at increased risk of conversion.

Detour behaviour, imprinting and visual lateralization in the domestic chick.

Detour behaviour was studied in chicks faced with a vertical-bar barrier behind where an imprinting object (a red ball) was located. Right-eyed chicks took less time to detour the barrier than left-eyed chicks, and binocular chicks showed a bias to detour the barrier on the left side, thus maintaining visual contact with the imprinting object using the lateral field of the right eye, while circling around the barrier. In males, the asymmetries were consistent all along the first two weeks of life, whereas in females they disappeared on days 8 and 11. When tested with a slightly novel version of the original imprinting object (i.e., a ball of a different color), binocular chicks showed a bias to detour the barrier on the right side, thus showing preferential use of the left eye. The same bias occurred when unfamiliar conspecifics were used as goal-objects. Results suggest that cerebral lateralization in birds can directly affect visually-guided motor responses through selective use of the lateral field of vision of the eye contralateral to the hemisphere which has to be put in charge of control of overt behaviour.

Depression secondary to tumors in patients who underwent surgery for mammary carcinoma: psycho-pharmaceutical and psychotherapeutic care.

The Authors repeated a pilot psycho-social research they had already undertaken in this University in 1986-1987, with an increased number of patients, administering a psycho-therapeutic treatment to patients who had undergone surgery for mammary carcinoma and correlating the evolution of the tumoral disease with the role of depression and the immune system. These 50 patients were compared to another randomly chosen control-group of 50 patients. Both groups were homogeneous as regards medical-surgical and psycho-social parameters and had routine oncological care. Only the patients of the study-group were submitted to individual psychotherapy and treated psychopharmacologically. At the end of the study, the two groups showed a statistically significant difference as regards the evolution of the tumoral disease in favour of the study-group. In addition, a relevant improvement from depression was recorded in the study-group along with a normalization and a boost of the immunological measurements.