Cardiovascular risk factors and carotid intima-media thickness are associated with lower cognitive performance in HIV-infected patients.

OBJECTIVES: The aim of the study was to investigate the relationship between metabolic comorbidities, cardiovascular risk factors or common carotid intima-media thickness (cIMT) and cognitive performance in HIV-infected patients. METHODS: Asymptomatic HIV-infected subjects were consecutively enrolled during routine out-patient visits at two clinical centres. All patients underwent an extensive neuropsychological battery and assessment of metabolic comorbidities and cardiovascular risk factors. Moreover, cIMT was assessed by ultrasonography. Cognitive performance was evaluated by calculating a global cognitive impairment (GCI) score obtained by summing scores assigned to each test (0 if normal and 1 if pathological). RESULTS: A total of 245 patients (median age 46 years; 84.1% with HIV RNA < 50 copies/mL; median CD4 count 527 cells/µL) were enrolled in the study. Cardiovascular risk factors were highly prevalent in our population: the most frequent were dyslipidaemia (61.2%), cigarette smoking (54.3%) and hypertension (15.1%). cIMT was abnormal (≥ 0.9mm) in 31.8% of patients. Overall, the median GCI score was 2 [interquartile range (IQR) 1-4]; it was higher in patients with diabetes (P = 0.004), hypertension (P = 0.030) or cIMT ≥ 0.9 mm (P < 0.001). In multivariate analysis, it was confirmed that diabetes (P = 0.007) and cIMT ≥ 0.9 mm (P = 0.044) had an independent association with lower cognitive performance. In an analysis of patients on combination antiretroviral therapy (cART), abacavir use was independently associated with a better cognitive performance (P = 0.011), while no association was observed for other drugs or neuroeffectiveness score. CONCLUSIONS: Diabetes, cardiovascular risk factors and cIMT showed a strong association with lower cognitive performance, suggesting that metabolic comorbidities could play a relevant role in the pathogenesis of HIV-associated neurocognitive disorders in the recent cART era.

Comparison of cognitive performance in HIV or HCV mono-infected and HIV-HCV co-infected patients.

PURPOSE: Our aim was to explore the interplay between human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections in the expression of cognitive disorders. METHODS: We performed a multi-centre cross-sectional study, enrolling three groups of asymptomatic outpatients matched for age and education: (1) HIV mono-infected; (2) HCV mono-infected; (3) HIV-HCV co-infected. All subjects were subjected to the Zung depression scale and a comprehensive neuropsychological battery. RESULTS: A total of 50 patients for each group were enrolled. Patients in the three groups did not significantly differ in the main common demographic and clinical characteristics, except for a lower proportion of past injecting drug use (IDU) in group 1 (4 %) in comparison to groups 2 (38 %, p < 0.001) and 3 (78 %, p < 0.001), a longer duration of HIV infection in group 3 in comparison to group 1 (p < 0.001) and a longer duration of HCV infection in group 3 in comparison to group 2 (p = 0.028). Overall, 39.3 % of patients showed minor cognitive impairment, with a higher proportion in group 3 (54 %) when compared to groups 1 (28 %, p = 0.015) or 2 (36 %, p = 0.108). Patients in group 3 [odds ratio (OR) 3.35, p = 0.038 when compared to group 1] and those with higher depression scores (OR 1.05, p = 0.017) showed an increased risk of cognitive impairment after adjusting for education and past injection drug use. In particular, group 3 showed worse performance in psychomotor speed tasks when compared to group 1 (p = 0.033). CONCLUSIONS: A worse cognitive performance in HIV-HCV co-infected patients was observed, suggesting an additive role of the two viruses in the pathogenesis of cognitive disorders.

Gender may be related to the side of the motor syndrome and cognition in idiopathic Parkinson's disease.

BACKGROUND: and Sex and cognitive profile may be related to the laterality of motor symptoms in idiopathic Parkinson's disease. INTRODUCTION: Parkinson's disease (PD) is well recognised as an inherently asymmetric disease with unilateral onset of motor symptoms. The laterality of motor symptoms may be linked to sex, clinical and demographic variables, and neuropsychological disorders. However, the available data are inconsistent. This study aimed to explore the potential association between the laterality of motor symptoms and clinical and demographic variables and deficits in specific cognitive domains. MATERIAL AND METHODS: We retrospectively recruited 97 participants with idiopathic PD without dementia; 60 presented motor symptoms on the left side and 37 on the right side. Both groups were comparable in terms of age, age at disease onset, disease duration, and severity of the neurological deficits according to the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. RESULTS: Participants with left-side motor symptoms scored lower on the Schwab and England Activities of Daily Living scale. Our sample included more men than women (67% vs. 33%). Both sexes were not equally represented in the 2 groups: there were significantly more men than women in the group of patients with left-side motor symptoms (77% vs. 23%), whereas the percentages of men and women in the group of patients with right-side motor symptoms were similar (51% vs. 49%). Both groups performed similarly in all neuropsychological tasks, but women, independently of laterality, performed better than men in the naming task. CONCLUSION: We found a clear prevalence of men in the group of patients with left-side motor symptoms; this group also scored lower on the Schwab and England Scale. Female sex was predictive of better performance in the naming task. Sex should always be considered in disorders that cause asymmetric involvement of the brain, such as PD.

Gender may be related to the side of the motor syndrome and cognition in idiopathic Parkinson's disease.

BACKGROUND: and Sex and cognitive profile may be related to the laterality of motor symptoms in idiopathic Parkinson's disease. INTRODUCTION: Parkinson's disease (PD) is well recognised as an inherently asymmetric disease with unilateral onset of motor symptoms. The laterality of motor symptoms may be linked to sex, clinical and demographic variables, and neuropsychological disorders. However, the available data are inconsistent. This study aimed to explore the potential association between the laterality of motor symptoms and clinical and demographic variables and deficits in specific cognitive domains. MATERIAL AND METHODS: We retrospectively recruited 97 participants with idiopathic PD without dementia; 60 presented motor symptoms on the left side and 37 on the right side. Both groups were comparable in terms of age, age at disease onset, disease duration, and severity of the neurological deficits according to the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. RESULTS: Participants with left-side motor symptoms scored lower on the Schwab and England Activities of Daily Living scale. Our sample included more men than women (67% vs. 33%). Both sexes were not equally represented in the 2 groups: there were significantly more men than women in the group of patients with left-side motor symptoms (77% vs. 23%), whereas the percentages of men and women in the group of patients with right-side motor symptoms were similar (51% vs. 49%). Both groups performed similarly in all neuropsychological tasks, but women, independently of laterality, performed better than men in the naming task. CONCLUSION: We found a clear prevalence of men in the group of patients with left-side motor symptoms; this group also scored lower on the Schwab and England Scale. Female sex was predictive of better performance in the naming task. Sex should always be considered in disorders that cause asymmetric involvement of the brain, such as PD.

BuChE K variant is decreased in Alzheimer's disease not in fronto-temporal dementia.

Alzheimer's disease (AD) is characterized by a significant reduction in AcetylCholinesterase and an increase in ButyrylCholinesterase (BuChE) activity. The existence of polymorphic regions on the BuChE gene has been previously described; the most frequently found polymorphism is the so-called K variant, which leads to a 30% decreased enzymatic activity. Different studies reported a positive association between K variant and AD, strongest among late-onset AD and Apolipoprotein E (APOE) e4 carriers. We analyzed APOE and BuChE polymorphisms in 167 AD and 59 fronto-temporal dementia (FTD) patients compared with 129 healthy controls (HC). We reported a significantly lower frequency of the BuChE K variant in AD compared with HC and FTD and a significant increased frequency of the K variant in FTD. These results are in agreement with the known increase of the BuChE activity in AD and support the evidence of different molecular pathways involved in the pathogenesis of AD and FTD.

Psychopathological profile in COVID-19 patients including healthcare workers: the implications.

OBJECTIVE: The effects of COVID-19 seem to extend beyond the physical pain and is showing psychiatric implications as well. Moreover, psychopathological implications seem to last also after patients' discharge. Our goal is to investigate the psychological impact and psychopathological outcome of patients affected by COVID-19. PATIENTS AND METHODS: We have engaged 34 patients with COVID-19 conditions [eight of them were healthcare workers patients (HCW)] hospitalized at "Policlinico Gemelli Foundation" of Rome, Italy. All patients were evaluated through the Impact of Event Scale-Revised (IES-R) and the Symptom Checklist 90-R (SCL-90-R) first, during their hospitalization (baseline), and then, after 4 months from hospital discharge (follow-up), through phone interviews. RESULTS: At baseline, 82% of patients revealed from mild to severe psychological impact of COVID-19, according to the IES-R. At follow-up, the mean IES-R total score was significantly decreased (p<0.001) even if almost half (46.6%) of our cohort still showed it. HCW patients showed a significantly higher score than other patients at IES-R scale, both at baseline (p=0.005) and at follow-up (p<0.001). Moreover, at 4 months from discharge, they showed a significantly higher percentage of moderate and severe distress (p=0.015). In addition to this, at follow-up, our cohort of patients showed an increase of anxiety symptoms, even if not significant compared to baseline (46.7% vs. 35.3% respectively; p=1.000), and HCW patients suffered more sleep disorders (p=0.019) and anxiety symptoms (p=0.019) compared to other patients. CONCLUSIONS: We indicate the importance of assessing psychopathology of COVID-19 survivors, monitoring their changes over time, and providing psychological support to improve their psychological well-being.

Gender may be related to the side of the motor syndrome and cognition in idiopathic Parkinson's disease / Posible relación entre sexo y perfil cognitivo y la lateralidad de los síntomas motores en la enfermedad de Parkinson idiopática

Background: and Sex and cognitive profile may be related to the laterality of motor symptoms in idiopathic Parkinson's disease. Introduction: Parkinson's disease (PD) is well recognised as an inherently asymmetric disease with unilateral onset of motor symptoms. The laterality of motor symptoms may be linked to sex, clinical and demographic variables, and neuropsychological disorders. However, the available data are inconsistent. This study aimed to explore the potential association between the laterality of motor symptoms and clinical and demographic variables and deficits in specific cognitive domains. Material and methods: We retrospectively recruited 97 participants with idiopathic PD without dementia; 60 presented motor symptoms on the left side and 37 on the right side. Both groups were comparable in terms of age, age at disease onset, disease duration, and severity of the neurological deficits according to the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale. Results: Participants with left-side motor symptoms scored lower on the Schwab and England Activities of Daily Living scale. Our sample included more men than women (67% vs. 33%). Both sexes were not equally represented in the 2 groups: there were significantly more men than women in the group of patients with left-side motor symptoms (77% vs. 23%), whereas the percentages of men and women in the group of patients with right-side motor symptoms were similar (51% vs. 49%). Both groups performed similarly in all neuropsychological tasks, but women, independently of laterality, performed better than men in the naming task. Conclusion: We found a clear prevalence of men in the group of patients with left-side motor symptoms; this group also scored lower on the Schwab and England Scale. Female sex was predictive of better performance in the naming task. Sex should always be considered in disorders that cause asymmetric involvement of the brain, such as PD.(AU)

Introducción: La enfermedad de Parkinson (EP) es una enfermedad asimétrica en la que los primeros síntomas se presentan solo en un lado del cuerpo. El lado de inicio de la sintomatología puede depender del sexo, de variables clínicas y demográficas y de la presencia de trastornos neuropsicológicos. Sin embargo, la evidencia disponible no es consistente. Nuestro estudio pretende determinar si el lado que presenta síntomas motores tiene alguna relación con variables clínicas y demográficas y con déficits en determinados dominios cognitivos. Materiales y métodos: Incluimos 97 individuos con EP y sin demencia; 60 de ellos tenían síntomas motores en el lado izquierdo y 37 en el lado derecho. Ambos grupos presentaban similitudes en cuanto a edad, edad de inicio de la enfermedad, duración de la enfermedad, y gravedad de los síntomas neurológicos, según la Unified Parkinson's Disease Rating Scale y la Hoehn and Yahr Scale. Resultados: Los participantes con síntomas en el lado izquierdo obtuvieron puntuaciones más bajas en la Escala de Actividades de la Vida Diaria de Schwab y England. Nuestra muestra incluía más hombres que mujeres (67 vs. 33%). Además, la distribución de hombres y mujeres no era equitativa entre los dos grupos; había un número significativamente mayor de hombres en el grupo de pacientes con síntomas en el lado izquierdo (77 vs. 23%), mientras que la distribución por sexo era similar en el grupo de pacientes con síntomas en el lado derecho (51 vs. 49%). No encontramos diferencias en las puntuaciones de ninguna de las pruebas neuropsicológicas entre los grupos. Sin embargo, las mujeres, independientemente del lado afecto, obtuvieron mejores resultados que los hombres en la prueba de denominación. Conclusiones: Los hombres eran mucho más numerosos en el grupo de pacientes con afectación del lado izquierdo; este grupo mostró peores puntuaciones en la escala de Schwab y England...(AU)

Can cognitive and behavioural disorders differentiate frontal variant-frontotemporal dementia from Alzheimer's disease at early stages?

Frontal variant-Frontotemporal dementia (fvFTD) and Alzheimer's disease (AD) patients matched for severity of dementia at the Clinical Dementia Rating (CDR) received neuropsychological testing in order to explore if the dysexecutive disorder might characterise fvFTD at early stage, when AD is dominated by the episodic memory defect. We also determined if the behavioural syndrome was more severe in fvFTD than AD, and if specific patterns of behavioural symptoms could differentiate the two types of dementia, using the Neuropsychiatry Inventory (NPI). AD patients performed worse than fvFTD not only in memory but also in executive tasks. Apathy and eating disorders proved to be more severe or frequent in fvFTD even if the two groups did not differ in the total NPI score. CDR score significantly correlated with the NPI score in fvFTD and with the MMSE in AD. Our data confirm that the memory disorders may differentiate the two types of dementia; however, the dysexecutive syndrome is as severe, and even more severe in AD. The severity of the behavioural syndrome is comparable in the two groups but the nature of the behavioural disorders may vary to some extent. We conclude that AD dementia at early stage is a behavioural-cognitive syndrome, while in fvFTD the behavioural disorders appear when the cognitive deficit is still relatively mild.

The cerebellum contributes to linguistic production: a case of agrammatic speech following a right cerebellar lesion.

We describe a patient who, after a right cerebellar infarction, developed a right hemicerebellar syndrome and agrammatic speech without other cognitive impairments. We hypothesize that the cerebellum provides the temporal interplay among the neural structures underlying the processes responsible for production of sentences.

Dissociation between knowledge of living and nonliving things in dementia of the Alzheimer type.

Patients who survive herpes simplex encephalitis (HSE) sometimes present a category-specific disorder for living things. Since HSE specifically involves the temporolimbic structures of both hemispheres, these structures could play a critical role in processing and storing information about living things. If this were the case, a category-specific disorder for the same items should also be observed in the early stages of dementia of the Alzheimer type (DAT) as the temporolimbic structures are often severely affected in this condition. To test this hypothesis, we administered to 15 DAT patients and to 10 normal controls a confrontation-naming task and a verbal associates recognition task, with both living and nonliving items as stimuli. The hypothesis was confirmed, since DAT patients performed worse with living than with nonliving items, and scored worse than normal controls on the living but not the nonliving items.

Spatial dysgraphia and cerebellar lesion: a case report.

Spatial dysgraphia is a writing disorder that occurs in patients with right hemisphere lesion. We report a patient with cerebellar atrophy and spatial dysgraphia. To explain this finding, we hypothesize a discoordination between planning of the movement and performance due to a lack of the cerebellar modulation between supratentorial (premotor cortex) and peripheral (proprioceptive) afference during the ongoing handwriting movement.

The phonological short-term store-rehearsal system: patterns of impairment and neural correlates.

Two left brain-damaged patients (L.A. and T.O.) with a selective impairment of auditory-verbal span are reported. Patient L.A. was unable to hold auditory-verbal material in the phonological store component of short-term memory. His performance was however normal on tasks requiring phonological judgements, which specifically involve the phonological output buffer component of the rehearsal process. He also showed some evidence that rehearsal contributed to the immediate retention of auditory-verbal material. Patient T.O. never made use of the rehearsal process in tasks assessing both immediate retention and the ability to make phonological judgements, but the memory capacity of the phonological short-term store was comparatively preserved. These contrasting patterns of impairment suggest that the phonological store component of verbal short-term memory was severely impaired in patient L.A., and spared, at least in part, in patient T.O. The rehearsal process was preserved in L.A., and primarily defective in T.O. The localisation of the lesions in the left hemisphere (L.A.: inferior parietal lobule, superior and middle temporal gyri; T.O.: sub-cortical premotor and rolandic regions, anterior insula) suggests that these two sub-components of phonological short-term memory have discrete anatomical correlates.

Linguistic and non-linguistic abilities in a patient with early left hemispherectomy.

A patient who underwent early removal of the left hemisphere because of Sturge-Weber syndrome was submitted to detailed linguistic and visuospatial batteries. The performances were compared to performances of subjects matched for age, education and IQ, but without focal cerebral lesions. Language was mildly impaired but to the same extent as in IQ controls. On the contrary, visuospatial abilities were clearly worse than in IQ controls, and the most preserved visuospatial abilities seemed to be the less sophisticated ones. Non literal comprehension of language, a function generally attributed to the right hemisphere, was intact. This same pattern, that is, preservation of language and impairment of visuospatial abilities, also seems to occur in subjects who have undergone surgical removal of the right hemisphere; in other words, the cognitive pattern seems the same regardless of which hemisphere is removed. These observations suggest that no matter which hemisphere is removed, functional reorganisation follows a hierarchical criterion which privileges the linguistic function, and the visuospatial functions most essential for independent survival.

Evidence for a possible neuroanatomical basis for lexical processing of nouns and verbs.

Neuropsychological studies have revealed that brain-damaged patients may show impairments of specific word categories. This study reports the performance of three patients with impairments of the categories noun and verb. The first and second patients, with left frontal lobe atrophy, were impaired in naming and comprehension of verbs. The third patient, with striking atrophy of the left temporal lobe, was disproportionately impaired in naming and comprehension of nouns. These findings suggest that anatomically distinct neural systems in the temporal and frontal lobes of the dominant hemisphere might play a critical role in lexical processing of nouns and verbs, respectively.

The production of morphological and lexical opposites in aphasia.

Four unselected groups of Broca's, Wernicke's, conduction, amnesic aphasic patients and a group of normal controls were asked to produce the best opposite of 60 adjectives. For half of the stimuli the expected opposite was morphologically related to the stimulus word (e.g. "formal"/"informal"), for the other half it could be obtained only by selecting a new base-form within the lexicon (e.g. "good"/"bad"). Following some neurolinguistic observations by Hécaen et al., it was predicted that amnesic patients should produce mainly morphological opposites, whereas conduction aphasics should produce mainly lexical antonyms. Results confirmed the predictions, since amnesic aphasics showed a prevalent impairment in the selection lexical opposites, whereas conduction aphasics showed a selective impairment in the production of morphological antonyms.

Prosopagnosia can be associated with damage confined to the right hemisphere--an MRI and PET study and a review of the literature.

The early position that prosopagnosia is predominantly associated with right hemisphere (RH) injury was challenged by the finding that in practically all cases that come to autopsy pathological data point to bilateral damage. Yet the rejection of the RH hypothesis may have been too hasty. We report three prosopagnosic patients in whom MRI and CT documented a lesion confined to the right occipito-temporal areas and PET confirmed that hypometabolism involved the RH only. A review of the literature brought out 27 cases with neuroimaging evidence that prosopagnosia was associated with RH damage plus four cases with surgical evidence. It remains, however, that the inability to recognize familiar faces is a rare disorder, not manifested by the majority of patients with right temporo-occipital injury. We submit that right-handers differ in the degree of their RH specialization in processing faces and that in only a minority of them is it so marked that it cannot be compensated for by the healthy left hemisphere.

Naming deficit for non-living items: neuropsychological and PET study.

We report a patient with progressive left hemisphere atrophy who presented a lexical retrieval deficit more pronounced in naming non-living items than in naming living items. Word frequency and familiarity strongly influenced the performance, but the dissociation persisted when the items were controlled for these factors. In addition, the prevalent deficit for non-living items in respect to living items could be confirmed in tasks where other patients presented the opposite pattern. A PET study showed a significant hypometabolism in the left hemisphere regions suggesting that, at variance with living deficit which is observed in patients with bilateral lesions, non-living deficit is produced by unilateral left hemispheric lesions. This patient confirms that living and non-living categories may dissociate and that distinct neural systems subsume their knowledge.

Peripheral aspects of writing can be differentially affected by sensorial and attentional defect: evidence from a patient with afferent dysgraphia and case dissociation.

This study reports a patient with right posterior cerebral atrophy who was affected by afferent dysgraphia, characterised by case dissociation: cursive better than upper-case print. The patient also had severe visuocostructional deficit and simultanagnosia. The hypothesis advanced to explain this dissociation is that cases are not equally dependent on visual and kinaesthetic control. Thus, if visual and kinaesthetic feedback (or the attention to them) are impaired by cerebral lesions, upper case can be expected to be more impaired than cursive.

The relationship between type of naming error and semantic-lexical discrimination in aphasic patients.

When submitted to confrontation naming tasks, aphasic patients show different types of naming errors: phonetic, phonemic and verbal-semantic paraphasias, neologisms and anomia, but it is generally difficult to decide whether these errors are mainly due to a breakdown of the semantic systems or to post-lexical phonological disorders. In order to clarify this issue, 118 aphasic patients were given 3 tests of confrontation naming and 3 tests of semantic-lexical discrimination. Naming errors on confrontation were used to classify aphasic patients in various subgroups (according to the prevalence of a given type of naming error), whereas performances obtained on tests of semantic-lexical discrimination were taken as an index of disorganization of the semantic systems. The performances on semantic discrimination tests of patients showing a prevalence of phonetic, phonemic and verbal-semantic paraphasias, neologisms and anomia on confrontation naming tasks were compared. A very small number of semantic discrimination errors was obtained by patients showing a prevalence of phonetic and phonemic transformations on confrontation, whereas a much larger number of semantic discrimination errors was obtained by patients showing a prevalence of verbal-semantic paraphasias, neologisms and anomia.

The influence of semantic and perceptual factors on lexical comprehension in aphasic and right brain-damaged patients.

We investigated whether the errors made by aphasic patients and right brain-damaged (RBD) patients on a word-picture matching test were differently related to the semantic and perceptual difficulties of the task. To this effect, the target picture was presented in one condition along with two semantically similar distractors, in another condition with two perceptually similar distractors, and in a third condition with two distractors that were both semantically and perceptually similar. There were also two control conditions in which part of targets that had been originally shown with semantic distractors were now presented with perceptual distractors and vice versa. The findings were consistent with the hypothesis that aphasics mainly fail when the task involves semantic discrimination and RBD patients when it involves perceptual discrimination. In aphasics the semantic perceptual condition produced the highest number of errors, but this was due, it was argued, to an increase of the semantic demands of the task.