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.

Diffusion tensor imaging of white matter degeneration in early stage of Alzheimer's disease: a review.

Object: Alzheimer's disease is a progressive, irreversible neurodegenerative disorder associated with brain alterations. Diffusion tensor imaging (DTI) has contributed to identify degeneration in white matter cortical microstructural that can be considered an early and specific biomarker for Alzheimer's disease. This review aimed to provide a summary of DTI studies on white matter damage in Alzheimer's disease.Methods: On PubMed, Web of Science and Scopus databases, we reviewed the studies that used DTI for assessing fractional anisotropy in neurofiber tracts involved in Alzheimer's Disease progression: fornix, the cingulum, uncinate fasciculus, superior and inferior longitudinal fasciculus and corpus callosum. We included nine studies that met search criteria.Results: The results showed decreased fractional anisotropy value in mild cognitive impairment (MCI) patients. White matter diffusivity changes were associated with the progression of Alzheimer's disease.Conclusion: Microstructural alterations of the limbic and cortico-cortical tracts could be potential biomarkers for early diagnosis in preclinical disease phase.

Impaired Recognition of Facial Emotion in Patients With Parkinson Disease Under Dopamine Therapy.

INTRODUCTION: Parkinson disease (PD) is a neurodegenerative disorder characterized by motor and nonmotor symptoms. The impaired ability to recognize facial emotion expressions represents an important nonmotor symptom. The aim of this study is to investigate the ability in recognizing facial emotion expressions in patients with PD under dopamine replacement therapy. METHODS: Thirty medicated patients with PD and 15 healthy controls (HC) were enrolled. All participants performed the Ekman 60-Faces test for emotional recognition. All patients underwent a neuropsychological evaluation for global cognitive functioning, depression, and anxiety. RESULTS: Patients with PD were impaired in recognizing emotions. Significant differences between PD and HC were found in Ekman 60-Faces test scores (P < .001), and in Ekman 60-Faces test subscales, in particular, sadness, fear, disgust, anger, and surprise (P < .001). CONCLUSIONS: The nigrostriatal dopaminergic depletion seems to determine emotional information processing dysfunction. This relevant nonmotor symptom could have consequences in daily living reducing interactions and social behavioral competence.

Mindfulness interventions and pain management in a patient with encephalomyelitis.

Chronic pain is considered a common disabling disease, frequently related to a high comorbidity with anxiety and depression. Several psychological techniques have demonstrated to be effective in the treatment of chronic pain, in particular, mindfulness-based interventions (MBIs) seem to reduce pain acting on self-regulatory individual's ability. In addition, this approach could develop cognitive strategies to decrease impulsivity. We selected a case of a patient with encephalomyelitis and spastic tetraparesis to assess the application and effectiveness of MBIs to reduce pain perception, improve anxiety and depressive symptoms. Our treatment showed a reduction in pain perception, and an improvement in anxious and depressive symptoms. In conclusion, MBIs could be useful to relieve disorders related to pain in neurological patients.

Thought disorder in atypical schizophrenia-like psychosis after stroke: analysis of clinical cases.

Formal thought disorder refers to disorganized thinking and it represents a hallmark of schizophrenia and psychosis. Psychosis is a rare complication after stroke. We described two cases of female patients, who developed an atypical schizophrenia-like psychosis post-stroke, characterized by formal thought disorder, hallucinations, and delusion. Cerebrovascular disease affected the right temporal lobe, areas devoted to modulation of higher order cognitive processes. To date, the relation between stroke and psychosis remain unclear, maybe due to the involvement of a complex brain networks. However, the high impact of this disorder on physical, psychological and social wellbeing suggests the importance of improving specific treatments.

A multidisciplinary approach to assess recovery of consciousness in a patient with moyamoya disease.

INTRODUCTION: Moyamoya disease (MMD) meaning "hazy puff of smoke" in Japanese is a rare chronic cerebrovascular syndrome characterized by progressive stenosis and occlusion of the internal carotid arteries (ICAs) anterior cerebral arteries (ACAs), and middle cerebral arteries (MCAs). METHODS: Our moyamoya patient with severely impaired cognitive and motor functions underwent a specific motor and neuropsychological rehabilitative treatments to assess the recovery of consciousness. RESULTS: Results obtained showed an improvement of clinical and neuropsychological examination. These findings highlighted the importance of an intensive rehabilitation techniques used in the care of disorders of consciousness patients. CONCLUSIONS: The use of sensory methods provides advantages for the rehabilitation. In fact, in this study, we showed a correlation between sensory stimulation and changes in patient's clinical status.

Cognitive functions and psychological symptoms in migraine: a study on patients with and without aura.

AIM: Migraine is neurological disorder with a complex pathophysiology. We described the neuropsychological profile of 100 migraineurs (50 with visual aura and 50 without aura), in interictal phase, compared to 50 matched healthy controls. MATERIALS AND METHODS: A battery of standardized neuropsychological tests was used to assess attention, memory and executive functions. Beck Depression Inventory and Hamilton Rating Scale for Anxiety were used to evaluate anxiety and depressive symptoms. Severity of disability during daily activities was assessed by Migraine Disability Assessment. RESULTS: Migraine without aura showed a significant difference in comparison to healthy controls in semantic verbal fluency (p = 0.02), delayed memory (p < 0.001) and set-shifting (p < 0.001). Migraine with aura showed a significant difference in delayed memory (p = 0.001) and set-shifting (p = 0.005) if compared to healthy controls. No significant correlation between cognitive functions and mood was found (HAM-A p = 0.67) (BDI-II p = 0.42). CONCLUSIONS: Our data showed isolate and specific cognitive deficit during interictal phase in migraine patients. Future studies are need to identify if specific migraine characteristics may affect cognitive functions.

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.

Cognitive impairment in Parkinson's disease, Alzheimer's dementia, and vascular dementia: the role of the clock-drawing test.

AIM: Cognitive impairment is present in several neurodegenerative disorders. The clock-drawing test (CDT) represents a useful screening instrument for assessing the evolution of cognitive decline. The aim of this study was to investigate the sensitivity of the CDT in monitoring and differentiating the evolution of cognitive decline in Alzheimer's dementia (AD), vascular dementia (VaD), and Parkinson's disease (PD). METHODS: This study involved 139 patients, including 39 patients with PD and mild cognitive impairment, 16 demented PD patients, 21 VaD patients with mild cognitive impairment, 17 patients with VaD, 33 patients with mild cognitive impairment due to AD, and 13 patients with probable AD. All participants completed the CDT. The Mini-Mental State Examination was administered to establish patients' cognitive functioning. RESULTS: Comparisons of quantitative and qualitative CDT scores showed significant differences between the various diseases. Impairment of executive functioning seems to be more pronounced in PD and VaD than in AD. Patients with AD committed more errors related to a loss of semantic knowledge, indicating a severely reduced capacity in abstract and conceptual thinking. CONCLUSION: Results support the usefulness and sensitivity of the CDT in the detection of different dementia subtypes. Qualitative error analysis of the CDT may be helpful in differentiating PD, VaD, and AD, even in the early stages of each disease.

Neuroimaging and cognitive functions in temporal lobe epilepsy: A review of the literature.

Temporal lobe epilepsy (TLE) is the most common form of refractory focal epilepsy. Neuroimaging researches have demonstrated structural abnormalities in several cerebral regions. Cognitive impairment has been frequently described as a potential comorbidity of long-term TLE. This review investigated the state of research regarding neuropsychological impairment and neuroimaging studies in TLE patients. Studies were found on PubMed and Web of Sciences databases, 412 publications were selected: only 20 articles met search criteria. Results showed significant alterations in multiple cognitive domains, particularly memory, executive functions and language. The reported findings showed that the involvement of various factors, including neurobiological abnormalities and clinical features, is responsible for the onset of cognitive impairment in epileptic patients.

Augmentative and Alternative Communication Effects on Quality of Life in Patients with Locked-in Syndrome and Their Caregivers.

BACKGROUND: The aim of this study was to evaluate the impact of the augmentative and alternative communication system on anxiety and depression performances and the quality of life (QoL) of patients who have the locked-in syndrome (LIS) and that of their caregivers. METHOD: We enrolled 15 patients and their principal caregivers. The assessment consisted of the administration of the employed Short Form-36 Questionnaire for the assessment of QoL, the Hamilton Anxiety Rating Scale (HAM-A) for anxiety, and the Beck Depression Inventory for depression. RESULTS: We compared the clinical test at baseline (T0) and after 3 months (T1) for each group (patients and caregivers). In the patients group, we observed a significant difference in all clinical test scores. In the caregivers group, we observed a significant difference for HAM-A (P = .003), vitality (P < .001), social activity (P < .001), social role functioning (P < .001), and emotional role functioning (P < .001) and no significant differences for other clinical scores. CONCLUSION: The possibility of being able to communicate allows patients with the LIS to recuperate a affective contact with their caregivers, improving global family atmosphere.

Evolution of psychological condition in caregivers of patients with disorders of consciousness: a longitudinal study.

The aim of this study is to evaluate mood disorders and needs in caregivers of disorders of consciousness (DOC) patients during the admission to Neurorehabilitation Unit. A total of 80 caregivers was enrolled and divided in two groups (caregivers of vegetative state-VS patients and caregivers of minimally conscious state-MCS patients). Paired sample t tests were carried out to test differences between baseline observation (T0) and after 6 months (T1). Caregivers of VS patients showed an improvement between T0 and T1 especially, in vitality, mean health, Beck Depression Inventory (BDI-II), Spielberger State-Trait Anxiety Inventory-Y (STAI-Y), Prolonged Grief Disorder (PG 12) and Caregiver Needs Assessment (CNA). On the other hand, caregivers of MCS patients showed a significant improvement in: BDI II, STAI Y and CNA. These data confirmed that the presence of psychological problems, the quality of life and the psychological wellbeing of caregivers of DOC patients improved over the time.