Adopting a Diary to Support an Ecological Assessment of Neuropsychiatric Symptoms of Dementia.

Neuropsychiatric symptoms (NPS) are one of the most challenging issues in the management and care of people with dementia. Their accurate assessment is thus crucial for properly approaching subjects with cognitive disorders in the clinical setting. In parallel, the correct evaluation of NPS is also particularly relevant in the research field where they serve as critical indicators for measuring the efficacy of interventions against cognitive disorders. However, the study of NPS is extremely challenging given their extreme inter- and intra-individual variability. Moreover, the available assessment tools are often inadequate to fully capture their complexity and phenotypic expression. Based on these considerations, novel modalities for the assessment and measurement of NPS may be important to identify and develop. In this regard, a promising alternative (or, at least, a complementary aid) to traditional scales and questionnaires might be constituted by diaries. In the present article, we discuss the potential advantages and implications that may result from the adoption of this kind of instruments for the ecological assessment of NPS in subjects with dementia.

Intestinal Permeability in Relapsing-Remitting Multiple Sclerosis.

Changes of intestinal permeability (IP) have been extensively investigated in inflammatory bowel diseases (IBD) and celiac disease (CD), underpinned by a known unbalance between microbiota, IP and immune responses in the gut. Recently the influence of IP on brain function has greatly been appreciated. Previous works showed an increased IP that preceded experimental autoimmune encephalomyelitis development and worsened during disease with disruption of TJ. Moreover, studying co-morbidity between Crohn's disease and MS, a report described increased IP in a minority of cases with MS. In a recent work we found that an alteration of IP is a relatively frequent event in relapsing-remitting MS, with a possible genetic influence on the determinants of IP changes (as inferable from data on twins); IP changes included a deficit of the active mechanism of absorption from intestinal lumen. The results led us to hypothesize that gut may contribute to the development of MS, as suggested by another previous work of our group: a population of CD8+CD161high T cells, belonging to the mucosal-associated invariant T (MAIT) cells, a gut- and liver-homing subset, proved to be of relevance for MS pathogenesis. We eventually suggest future lines of research on IP in MS: studies on IP changes in patients under first-line oral drugs may result useful to improve their therapeutic index; correlating IP and microbiota changes, or IP and blood-brain barrier changes may help clarify disease pathogenesis; exploiting the IP data to disclose co-morbidities in MS, especially with CD and IBD, may be important for patient care.