"Communicative competence assessment of the person with aphasia caregiver: Standardization of the ACCA-CHECKLIST".

Aphasia constitutes a very complex clinical entity that requires a "competent" caregiver to interact with the person with aphasia (PWA). The literature lacks a valid and reliable set of standardized tools which can offer objective and quantifiable data of a caregiver's communicative competence. The aim of the study was to develop, standardize and validate an evaluation tool suited to measur the caregivers' competence in communicating with family members affected by aphasic disorders. Forty-two patients with aphasia and their respective caregivers were enrolled in the study. Caregivers' communicative competence was assessed through a new evaluation tool called ACCA-cl. Aphasia severity and functional communication abilities of the PWA were also investigated. Our data showed encouraging results regarding the reliability and the validity of the ACCA-cl scale in detecting the caregiver's communicative competence, especially as far as verbal content was considered. This scale can also be used to assess the improvement achieved by the caregiver after a communication training. The analysis provides encouraging findings for verbal content scales of the ACCA-cl and its possible use in clinical settings as a quantitative tool for detecting changes induced by the educational method of the caregiver. The tool is currently available in Italian.

Can the right hemisphere read? A behavioral and disconnectome study on implicit reading in a patient with pure alexia.

Patients with pure alexia have major difficulties in reading aloud. However, they often perform above chance level in reading tasks that do not require overt articulation of the target word - like lexical decision or semantic judgment - a phenomenon usually known as "implicit reading." There is no agreement in the literature on whether implicit reading should be attributed to relative sparing of some left hemisphere (LH) reading centers or rather to signs of compensatory endeavors by the right hemisphere (RH). We report the case of an 81-year-old patient (AA) with pure alexia due to a lesion involving the left occipital lobe and the temporal infero-mesial areas, as well as the posterior callosal pathways. Although AA's reading was severely impaired and proceeded letter by letter, she showed an above-chance-level performance for frequent concrete words in a tachistoscopic lexical decision task. A structural disconnectome analysis revealed that AA's lesion not only affected the left occipital cortex and the splenium: it also disconnected white-matter tracts meant to connect the visual word-form system to decision-related frontal areas within the LH. We suggest that the RH, rather than the LH, may be responsible for patient AA's implicit reading.

Clinical and structural disconnectome evaluation in a case of optic aphasia.

Optic Aphasia (OA) and Associative Visual Agnosia (AVA) are neuropsychological disorders characterized by impaired naming on visual presentation. From a cognitive point of view, while stimulus identification is largely unimpaired in OA (where access to semantic knowledge is still possible), in AVA it is not. OA has been linked with right hemianopia and disconnection of the occipital right-hemisphere (RH) visual processing from the left hemisphere (LH) language areas.In this paper, we describe the case of AA, an 81-year-old housewife suffering from a deficit in naming visually presented stimuli after left occipital lesion and damage to the interhemispheric splenial pathway. AA has been tested through a set of tasks assessing different levels of visual object processing. We discuss behavioral performance as well as the pattern of lesion and disconnection in relation to a neurocognitive model adapted from Luzzatti and colleagues (1998). Despite the complexity of the neuropsychological picture, behavioral data suggest that semantic access from visual input is possible, while a lesion-based structural disconnectome investigation demonstrated the splenial involvement.Altogether, neuropsychological and neuroanatomical findings support the assumption of visuo-verbal callosal disconnection compatible with a diagnosis of OA.

Impulsivity and compulsivity in drug-naïve patients with Parkinson's disease.

BACKGROUND: Abnormal repetitive behaviors have been reported in Parkinson's disease (PD) during dopamine replacement therapy (DRT) and associated with individual predisposing features, including impulsivity. However, impulsivity and compulsive symptoms have never been explored in PD patients before initiation of DRT. We previously reported a 20% of impulse control disorders (ICD) in an Italian cohort. METHODS: 103 consecutive newly diagnosed drug-naïve PD patients (means: age = 60.5 ± 9.2 years; duration = 15.4 ± 15.3 months) were screened for compulsive sexual behavior, compulsive buying, intermittent explosive disorder (Minnesota Impulsive Disorders Interview, MIDI), and pathological gambling (South Oaks Gambling Screen, SOGS). Barratt Impulsiveness Scale (BIS-11) and Maudsley Obsessional-Compulsive Questionnaire (MOCQ/R) assessed impulsivity, obsessive-compulsive symptoms, respectively. Depression (GDS-15) and general cognitive status were additionally assessed. We also compared ICDs frequency with our healthy controls. RESULTS: 17.5% of PD patients screened positive for at least one ICD at MIDI (17/103) and SOGS (1/103), though none had a disorder based on DSM-IV criteria. These frequencies were similar to healthy controls. There was a trend toward higher scores in BIS-11 attentive-impulsivity subscale (15.2 ± 4.8 vs. 18.7 ± 4.9; P = 0.007) and in MOCQ/R-Doubting subscale (0.67 ± 1.1 vs. 1.5 ± 1.2; P = 0.007) in PD with ICD. We also observed a positive correlation between GDS-15 and BIS-11. CONCLUSIONS: Similar to our healthy control population, we found a significant proportion of early PD patients positive for ICDs before starting treatment. We also found a relationship between impulsivity and depression. A detailed behavioral assessment before starting dopaminergic therapy is recommended.

Speaking of events: the case of C.M.

C.M. is an agrammatic patient who on assessment tests shows a disproportionate difficulty when producing verbs compared with nouns. In three experiments, we investigated whether C.M. also has difficulties with nouns referring to events and whether event nouns and verbs show similar patterns of disruption. Experiment 1 suggested that she is sensitive to argument structure complexity and has a greater impairment in the production of event nouns and verbs than object nouns. Experiment 2 revealed that C.M. finds derivationally complex words, such as event nouns, difficult to produce. However, morphological complexity does not completely explain C.M.'s problems with event nouns. In Experiment 3, an assessment of C.M.'s ability to use different aspects of semantic and syntactic knowledge relative to event nouns and verbs showed an almost identical performance with the two types of words. The relevance of the findings with respect to models of word production is considered.

The association of cognitive reserve with motor and cognitive functions for different stages of Parkinson's disease.

INTRODUCTION: The cognitive reserve (CR) theory has been proposed to account for the mismatch between the degree of neuropathological changes and clinical outcome in dementias. Recently, it has also been applied to Parkinson's disease (PD) with promising results, but mostly just focusing on separate proxy measures of CR, such as education, working and leisure time activities, instead of adopting a more comprehensive approach. Using the Cognitive Reserve Index questionnaire (CRIq), this study examined the association of CR with motor functions and cognition in patients with medium-low (1-9 years) and medium-high (>9 years) PD duration. METHODS: Fifty patients with PD underwent a neurological and a neuropsychological assessment, comprised of: Unified Parkinson's Disease Rating Scale- section III, Mini-Mental State Examination, Clock-Drawing Test, Rey auditory verbal learning test (immediate and delayed recall trials), Digit Span Forward, Corsi Span Forward, Frontal Assessment Battery, Raven's Colored Progressive Matrices, WAIS similarities subtest, Phonemic Fluency, Semantic Fluency and CRIq. RESULTS: PD patients with a higher CRIq score showed a reduced motor impairment and a better global cognitive performance when compared to PD patients with a lower CRIq score, with an advantage especially observed on executive functions and short-term memory. The CR effect was even enhanced in the case of longer disease duration, as observed when considering the overall neuropsychological tests performance and non-verbal abstract reasoning in particular. The results obtained when considering education, as a single proxy measure of CR, provided no additional findings, nor did they reveal all the effects yielded by the adoption of the CRI score. CONCLUSION: Our results support the beneficial role of CR against motor and cognitive dysfunctions in PD and suggest that its protective role may be mostly manifested at the later stages of the disease. A theoretical framework able to explain the different impact of CR on Alzheimer Disease and PD is discussed. Finally, our results stressed the importance of using a comprehensive measure of CR instead of focusing on just one of its proxies.

Spontaneous recovery from acalculia.

A topic much considered in research on acalculia was its relationship with aphasia. Far less attention has been given to the natural course of acalculia. In this retrospective study, we examined the relationship between aphasia and acalculia in an unselected series of 98 left-brain-damaged patients and the spontaneous recovery from acalculia in 92 acalculic patients with follow-up. There was a significant association between aphasia and acalculia although 19 participants exhibited aphasia with no acalculia and six acalculia with no aphasia. We observed significant improvement between a first examination carried out between 1 and 5 months post-onset and a second examination carried out between 3 and 11 months later (mean: 5 months). The mechanisms of spontaneous recovery are discussed.