Useful outcome measures in INPH patients evaluation.

Introduction: Idiopathic normal pressure hydrocephalus (INPH) is a neurological disorder that is potentially reversible and clinically characterized by a specific triad of symptoms, including gait disturbance, cognitive disorders, and urinary incontinence. In INPH assessment, the most commonly used test is the Timed Up and Go test (TUG), but a more comprehensive assessment would be necessary. The first aim of the present study is to verify the sensitivity of a protocol with both clinical and instrumental outcome measures for gait and balance in recognizing INPH patients. The second aim is to verify the most important spatio-temporal parameters in INPH assessment and their possible correlations with clinical outcome measures. Methods: Between January 2019 and June 2022, we evaluated 70 INPH subjects. We assessed balance performances with the Berg Balance Scale (BBS), Short Physical Performance Battery (SPPB), and TUG, both single (ST) and dual task (DT). We also performed an instrumental gait assessment with the GAITRite electronic walkway system, asking the patients to walk on the carpet for one minute at normal speed, fast speed, and while performing a dual task. We compared the results with those of 20 age-matched healthy subjects (HS). Results: INPH patients obtained statistically significant lower scores at the BBS, SPPB, and TUG DT but not at the TUG ST, likely because the DT involves cognitive factors altered in these subjects. Concerning instrumental gait evaluation, we found significant differences between HS and INPH patients in almost all spatio-temporal parameters except cadence, which is considered a relevant factor in INPH guidelines. We also found significant correlations between balance outcome measures and gait parameters. Discussion: Our results confirm the usefulness of BBS and suggest improving the assessment with SPPB. Although the TUG ST is the most commonly used test in the literature to evaluate INPH performances, it does not identify INPH; the TUG DT, instead, might be more useful. The GAITRite system is recognized as a quick and reliable tool to assess walking abilities and spatio-temporal parameters in INPH patients, and the most useful parameters are stride length, stride width, speed, and the percentage of double support. Both clinical and instrumental evaluation may be useful in recognizing subjects at risk for falls.

Is There a Role of Vitamin D in Alzheimer's disease?

Alzheimer's disease (AD) represents the most prevalent type of neurodegenerative dementia and the sixth leading cause of death worldwide. The so-called "non-calcemic actions" of vitamin D have been increasingly described, and its insufficiency has already been linked to the onset and progression of the main neurological diseases, including AD. Immune-mediated Aß plaque's phagocytosis and clearance, immune response, oxidative stress, and mitochondrial function are all influenced by vitamin D, and these functions are considered relevant in AD pathogenesis. However, it has been shown that the genomic vitamin D signaling pathway is already impaired in the AD brain, making things more complicated. In this paper, we aim to summarise the role of vitamin D in AD and review the results of the supplementation trials in AD patients.

Mental Imagery Skills in Alcohol-Dependent Subjects and Their Associations With Cognitive Performance: An Exploratory Study During Residential Rehabilitation.

People in alcohol-detoxification experience deficits in motor and non-motor functions including cognitive performance. Imagery, the cognitive process of generating visual, auditory or kinesthetic experiences in the mind without the presence of external stimuli, has been little studied in Alcohol Use Disorders (AUD). This pilot study aims to observe the cognitive abilities useful for the inspection, maintenance, generation and manipulation of images in these patients during residential rehabilitation and investigate the relationships with their cognitive performance. Thirty-six subjects who completed the 28-day rehabilitation program for alcohol addiction, completed the Mental Imagery Test (MIT) and Neuropsychological Battery (ENB-2). The global score at MIT did not show pathological scores. The 11.1% of AUD patients showed an impaired global score in the cognitive performance and the 5.7% with scoring at limits of norm. Significant correlations were found between Mental Imagery abilities and ENB-2 subscale and stepwise regression analysis showed the close association between the ability of imagery (Mental Imagery Test) and the overall cognitive performance (ENB-2) in alcohol dependent patients and this relationship is stronger than other cognitive tasks.

Cognitive Impairments in Early-Detoxified Alcohol-Dependent Inpatients and Their Associations with Socio-Demographic, Clinical and Psychological Factors: An Exploratory Study.

PURPOSE: Cognitive impairment is common among patients with alcohol use disorder (AUD). However, neuropsychological assessment is not usually included as routine practice in alcohol rehabilitation programs. The aim of this study was to describe qualitatively the cognitive deficits in early-detoxified AUD patients undergoing rehabilitation and to explore relevant associations with socio-demographic, clinical and psychological factors. PATIENTS AND METHODS: Forty-one patients with a diagnosis of AUD were consecutively recruited from a residential rehabilitation hospital in Northern Italy. Cognitive impairment was assessed using the Brief Neuropsychological Examination 2 (ENB-2). Anxiety, depression and severity of alcohol dependence were also evaluated using validated self-report questionnaires. Alcohol relapse was investigated 1 month after discharge. RESULTS: Overall, 31.7% of AUD patients showed cognitive impairments according to the global score scale. However, 70.7% had an impaired performance on at least one test of the ENB-2, with particular regard to executive function, visuospatial and memory domains. Age, education and abstinence at admission were the most relevant factors associated with cognitive deficits in this clinical population. CONCLUSION: The detection of cognitive impairments is essential in order to adapt alcohol rehabilitation treatment to patients with cognitive deficits and enhance clinical outcomes.