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Nigro S, Filardi M, Tafuri B, Nicolardi M, De Blasi R, Giugno A, Gnoni V, Milella G, Urso D, Zoccolella S, Logroscino G. Deep Learning-based Approach for Brainstem and Ventricular MR Planimetry: Application in Patients with Progressive Supranuclear Palsy. Radiol Artif Intell 2024; 6:e230151. [PMID: 38506619 DOI: 10.1148/ryai.230151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Purpose To develop a fast and fully automated deep learning (DL)-based method for the MRI planimetric segmentation and measurement of the brainstem and ventricular structures most affected in patients with progressive supranuclear palsy (PSP). Materials and Methods In this retrospective study, T1-weighted MR images in healthy controls (n = 84) were used to train DL models for segmenting the midbrain, pons, middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), third ventricle, and frontal horns (FHs). Internal, external, and clinical test datasets (n = 305) were used to assess segmentation model reliability. DL masks from test datasets were used to automatically extract midbrain and pons areas and the width of MCP, SCP, third ventricle, and FHs. Automated measurements were compared with those manually performed by an expert radiologist. Finally, these measures were combined to calculate the midbrain to pons area ratio, MR parkinsonism index (MRPI), and MRPI 2.0, which were used to differentiate patients with PSP (n = 71) from those with Parkinson disease (PD) (n = 129). Results Dice coefficients above 0.85 were found for all brain regions when comparing manual and DL-based segmentations. A strong correlation was observed between automated and manual measurements (Spearman ρ > 0.80, P < .001). DL-based measurements showed excellent performance in differentiating patients with PSP from those with PD, with an area under the receiver operating characteristic curve above 0.92. Conclusion The automated approach successfully segmented and measured the brainstem and ventricular structures. DL-based models may represent a useful approach to support the diagnosis of PSP and potentially other conditions associated with brainstem and ventricular alterations. Keywords: MR Imaging, Brain/Brain Stem, Segmentation, Quantification, Diagnosis, Convolutional Neural Network Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Mohajer in this issue.
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Affiliation(s)
- Salvatore Nigro
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Marco Filardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Benedetta Tafuri
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Martina Nicolardi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Roberto De Blasi
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Alessia Giugno
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Valentina Gnoni
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giammarco Milella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Daniele Urso
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Stefano Zoccolella
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
| | - Giancarlo Logroscino
- From the Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, 73039 Tricase, Italy (S.N., M.F., B.T., A.G., V.G., D.U., G.L.); Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy (M.F., B.T., G.M., G.L.); Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Italy (M.N., R.D.B.); Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England (D.U.); and Operative Unit of Neurology, San Paolo Hospital, ASL Bari, Bari, Italy (S.Z.)
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Barone R, Bramato G, Gnoni V, Giugno A, Urso D, Zecca C, Nigro S, Filardi M, Logroscino G. Sarcopenia in subjects with Alzheimer's disease: prevalence and comparison of agreement between EGWSOP1, EGWSOP2, and FNIH criteria. BMC Geriatr 2024; 24:278. [PMID: 38515016 PMCID: PMC10958903 DOI: 10.1186/s12877-024-04890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Sarcopenia is an age-related clinical syndrome characterized by the progressive loss of muscle mass and muscle strength. It appears to be closely linked to dementia, particularly Alzheimer's disease (AD); however, its prevalence among AD patients remains unclear. In this study, we assessed differences in sarcopenia prevalence between non-demented individuals and AD patients. Moreover, we assessed sex-specific differences in sarcopenia prevalence and explored the diagnostic value of the Muscle Quality Index (MQI) for diagnosing sarcopenia among AD patients. METHOD Cross-sectional study including 145 patients with probable AD and 51 older adults with normal cognition. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP1 and EWGSOP2) and of the Foundation for the National Institutes of Health (FNIH). The MQI was computed as the ratio of handgrip strength to skeletal muscle mass. RESULTS No significant difference in sarcopenia prevalence was observed between AD patients and controls. Prevalence ranged from 3.4 to 23.4% in AD patients and from 2 to 11.8% in controls, depending on diagnostic criteria. Prevalence was higher using EWGSOP1 and decreased using EWGSOP2 and FNIH. Prevalence was higher in males than in females with AD. The MQI was lower in AD patients than in controls (95%CI: - 0.23, - 0.05, p < 0.001), but displayed poor diagnostic accuracy in identifying sarcopenia cases. CONCLUSIONS AD patients and controls show comparable sarcopenia prevalence. Sarcopenia prevalence is higher in males than females among AD patients and higher when using EWGSOP1 compared to FNIH and EWGSOP2 criteria.
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Affiliation(s)
- Roberta Barone
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Giulia Bramato
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Chiara Zecca
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy.
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy.
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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Zoccolella S, Milella G, Giugno A, Devitofrancesco V, Damato R, Tamburrino L, Misceo S, Filardi M, Logroscino G. Neurophysiological indices for split phenomena: correlation with age and sex and potential implications in amyotrophic lateral sclerosis. Front Neurol 2024; 15:1371953. [PMID: 38515451 PMCID: PMC10956616 DOI: 10.3389/fneur.2024.1371953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Background Split phenomena (SP) are characterized by patterns of differential muscle wasting and atrophy, which are highly prevalent in amyotrophic lateral sclerosis (ALS) patients. Several neurophysiological indicators, including the split-hand index (SHI), split-leg index (SLI), and split-elbow index (SEI), have been proposed to assess SP. Nevertheless, their cutoff values and the impact of age and sex on these measures remain unclear. Methods We prospectively collected neurophysiological data from 300 healthy adult subjects. The following indices were measured from compound muscle action potentials (CMAPs): SHI [abductor pollicis brevis (APBcmap) x first dorsal interosseous (FDI)cmap/adductor digiti minimi (ADMcmap)], SEI (BICEPScmap/TRICEPScmap), SLI (extensor digit brevis (EDB)cmap/abductor Hallucis (AH)cmap), and the neurophysiological ratios APBcmap /ADMcmap and FDIcmap/ADMcmap. Multiple linear regression analysis was used to investigate the association between age, sex, CMAPs, and neurophysiological indicators. Results The median SHI was 10.4, with a median APBcmap/ADMcmap ratio of 0.9 and a median FDIcmap/ADMcmap ratio of 1.2. The median SEI was 1.6 (IQR:1.1-2.4) and the median SLI was 0.7 (IQR:0.5-1.0). Negative associations were observed between age, most of the CMAPs, and all the neurophysiological indices, except for SLI. The male subjects exhibited significantly higher CMAP values for the first dorsal interosseous (FDI), biceps, and SHI compared to the female participants. Conclusion Our findings highlight the importance of age- and sex-adjusted normative data for SP indices, which could enhance their diagnostic accuracy and clinical utility in patients with ALS. The SL index appears to be the most reliable indicator, as it showed no significant association with age or sex.
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Affiliation(s)
- Stefano Zoccolella
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Giammarco Milella
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Vito Devitofrancesco
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Rosaria Damato
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Salvatore Misceo
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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Manippa V, Palmisano A, Nitsche MA, Filardi M, Vilella D, Logroscino G, Rivolta D. Cognitive and Neuropathophysiological Outcomes of Gamma-tACS in Dementia: A Systematic Review. Neuropsychol Rev 2024; 34:338-361. [PMID: 36877327 PMCID: PMC10920470 DOI: 10.1007/s11065-023-09589-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/23/2023] [Indexed: 03/07/2023]
Abstract
Despite the numerous pharmacological interventions targeting dementia, no disease-modifying therapy is available, and the prognosis remains unfavorable. A promising perspective involves tackling high-frequency gamma-band (> 30 Hz) oscillations involved in hippocampal-mediated memory processes, which are impaired from the early stages of typical Alzheimer's Disease (AD). Particularly, the positive effects of gamma-band entrainment on mouse models of AD have prompted researchers to translate such findings into humans using transcranial alternating current stimulation (tACS), a methodology that allows the entrainment of endogenous cortical oscillations in a frequency-specific manner. This systematic review examines the state-of-the-art on the use of gamma-tACS in Mild Cognitive Impairment (MCI) and dementia patients to shed light on its feasibility, therapeutic impact, and clinical effectiveness. A systematic search from two databases yielded 499 records resulting in 10 included studies and a total of 273 patients. The results were arranged in single-session and multi-session protocols. Most of the studies demonstrated cognitive improvement following gamma-tACS, and some studies showed promising effects of gamma-tACS on neuropathological markers, suggesting the feasibility of gamma-tACS in these patients anyhow far from the strong evidence available for mouse models. Nonetheless, the small number of studies and their wide variability in terms of aims, parameters, and measures, make it difficult to draw firm conclusions. We discuss results and methodological limitations of the studies, proposing possible solutions and future avenues to improve research on the effects of gamma-tACS on dementia.
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Affiliation(s)
- Valerio Manippa
- Department of Education, Psychology and Communication, University of Bari "Aldo Moro", Bari, Italy.
| | - Annalisa Palmisano
- Department of Education, Psychology and Communication, University of Bari "Aldo Moro", Bari, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro" at Pia Fondazione "Cardinale G. Panico", Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Vilella
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro" at Pia Fondazione "Cardinale G. Panico", Tricase, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro" at Pia Fondazione "Cardinale G. Panico", Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Rivolta
- Department of Education, Psychology and Communication, University of Bari "Aldo Moro", Bari, Italy
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Filardi M, Gnoni V, Tamburrino L, Nigro S, Urso D, Vilella D, Tafuri B, Giugno A, De Blasi R, Zoccolella S, Logroscino G. Sleep and circadian rhythm disruptions in behavioral variant frontotemporal dementia. Alzheimers Dement 2024; 20:1966-1977. [PMID: 38183333 PMCID: PMC10984421 DOI: 10.1002/alz.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Sleep and rest-activity rhythm alterations are common in neurodegenerative diseases. However, their characterization in patients with behavioral variant frontotemporal dementia (bvFTD) has proven elusive. We investigated rest-activity rhythm alterations, sleep disturbances, and their neural correlates in bvFTD. METHODS Twenty-seven bvFTD patients and 25 healthy controls completed sleep questionnaires and underwent 7 days of actigraphy while concurrently maintaining a sleep diary. Cortical complexity and thickness were calculated from T1-weighted magnetic resonance (MR) images. RESULTS Compared to controls, bvFTD patients showed longer time in bed (95% confidence interval [CI]: 79.31, 321.83) and total sleep time (95% CI: 24.38, 321.88), lower sleep efficiency (95% CI: -12.58, -95.54), and rest-activity rhythm alterations in the morning and early afternoon. Increased sleep duration was associated with reduced cortical thickness in frontal regions. DISCUSSION Patients with bvFTD showed longer sleep duration, lower sleep quality, and rest-activity rhythm alterations. Actigraphy could serve as a cost-effective and accessible tool for ecologically monitoring changes in sleep duration in bvFTD patients. HIGHLIGHTS We assessed sleep and circadian rhythms in behavioral variant frontotemporal dementia (bvFTD) using actigraphy. Patients with bvFTD show increased sleep duration and reduced sleep quality. Patients with bvFTD show rest-activity alterations in the morning and early afternoon. Sleep duration is associated with reduced cortical thickness in frontal regions. These alterations may represent an early sign of neurodegeneration.
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Affiliation(s)
- Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Ludovica Tamburrino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Davide Vilella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Benedetta Tafuri
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Department of Diagnostic ImagingPia Fondazione “Card. G. Panico”TricaseItaly
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Neurology Unit, San Paolo HospitalAzienda Sanitaria Locale (ASL) BariBariItaly
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
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Manippa V, Filardi M, Vilella D, Logroscino G, Rivolta D. Gamma (60 Hz) auditory stimulation improves intrusions but not recall and working memory in healthy adults. Behav Brain Res 2024; 456:114703. [PMID: 37806563 DOI: 10.1016/j.bbr.2023.114703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
Gamma-band (> 30 Hz) brain oscillations (γ) play a crucial role in memory and long-term potentiation, and their disruptions have been consistently documented in patients with Alzheimer's Disease (AD). Gamma-band oscillation entrainment through 60 Hz transcranial alternating stimulation (tACS) and 40 Hz tACS/sensory stimulation has been shown to enhance memory performance in healthy adults and patients with AD, respectively. However, the impact of gamma auditory stimulation on healthy adults' memory remains uncertain. In this balanced crossover study, 36 healthy subjects (27 Females) underwent three auditory stimulation conditions: no auditory stimulation (NO_AS), 40 Hz, and 60 Hz. Long-term verbal memory (LTM) and verbal working memory (WM) were assessed using, respectively, the Ray Auditory Verbal Test (RAVLT) and Digit Span Backward test (DS-B). We hypothesized that 60 Hz would improve LTM (as compared to NO_AS), but not WM; no specific effects were hypothesized for 40 Hz. We found that gamma-band auditory stimulation (40 Hz and 60 Hz) did not significantly affect RAVLT recall or WM. However, 60 Hz stimulation reduced RAVLT immediate recall intrusion; this outcome negatively correlated with DS-B performance, suggesting a positive impact of 60 Hz on executive functions. In summary, gamma-band auditory stimulation did not enhance memory in healthy adults, but 60 Hz stimulation potentially benefits executive functions. Further investigation is needed to understand gamma oscillation's role in cognitive processes for both healthy and clinical populations.
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Affiliation(s)
- Valerio Manippa
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy.
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico", Tricase, Lecce, Italy; Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Davide Vilella
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico", Tricase, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Cardinale G. Panico", Tricase, Lecce, Italy; Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Davide Rivolta
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
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Manippa V, Filardi M, D'Anselmo A. Editorial: The promising role of non-invasive brain stimulation in neurocognitive disorders treatment. Front Hum Neurosci 2023; 17:1340023. [PMID: 38098760 PMCID: PMC10720745 DOI: 10.3389/fnhum.2023.1340023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- Valerio Manippa
- Department of Education, Psychology, and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Anita D'Anselmo
- Department of Psychological, Health, and Territorial Sciences, University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
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Milella G, Zoccolella S, Giugno A, Filardi M, Urso D, Nigro S, Tafuri B, Tamburrino L, Gnoni V, Logroscino G. The impact of upper and lower motor neuron burden on diagnostic certainty, and clinical course of spinal-onset amyotrophic lateral sclerosis: a cluster-based approach. J Neurol 2023; 270:4868-4875. [PMID: 37338613 DOI: 10.1007/s00415-023-11827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Upper motor neuron (UMN) and lower motor neuron (LMN) involvement represent the core clinical features of amyotrophic lateral sclerosis (ALS). Several studies divided patients into prevalent UMN and LMN impairment phenotypes to investigate the association between motor systems impairments and ALS clinical course. However, this distinction was somehow heterogeneous and significantly affected the comparability across studies. AIMS This study aimed to investigate whether patients spontaneously segregate based on the extent of UMN and LMN involvement without a-priori categorization and to identify potential clinical and prognostic features of different clusters. METHODS Eighty-eight consecutive spinal-onset ALS patients were referred to an ALS tertiary center between 2015 and 2022. UMN and LMN burden was assessed with the Penn Upper Motor Neuron scale (PUMNS) and the Devine score, respectively. PUMNS and LMN scores were normalized into 0-1 and analyzed using a two-step cluster analysis and the Euclidean distance measure. The Bayesian Information Criterion was used to determine the cluster number. Demographic and clinical variables were tested for differences among the clusters. RESULTS Three distinct clusters emerged at cluster analysis. Patients in "cluster-1" showed moderate UMN and severe LMN involvement, corresponding to the typical ALS phenotype. Patients in "cluster-2" showed mild LMN and severe UMN damage, corresponding to a predominant UMN phenotype, while "cluster-3" patients showed mild UMN and moderate LMN damage, corresponding to a predominant LMN phenotype. Patients in "cluster-1" and "cluster-2" showed a higher prevalence of definite ALS than those in "cluster-3" (61% and 46 vs 9%, p < 0.001). "Cluster-1" patients had a lower median ALSFRS-r score compared to both "cluster-2" and 3 patients (27 vs 40 and 35, < 0.001). "Cluster-1" (HR: 8.5; 95% CI 2.1-35.1 and p = 0.003) and 3 (HR: 3.2; 95% CI 1.1-9.1; p = 0.03) were associated with shorter survival than those in "cluster-2". CONCLUSIONS Spinal-onset ALS can be categorized into three groups according to LMN and UMN burden. The UMN burden is related to higher diagnostic certainty and broader disease spread, while LMN involvement is associated with higher disease severity and shorter survival.
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Affiliation(s)
- Giammarco Milella
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Stefano Zoccolella
- Neurology Unit, ASL Bari, San Paolo Hospital, Bari, Italy.
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy.
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Benedetta Tafuri
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Ludovica Tamburrino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain at Pia Fondazione "Card. G. Panico", University of Bari, Tricase (Lecce), Italy
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Zoccolella S, Giugno A, Milella G, Filardi M, Introna A, Fraddosio A, D'Errico E, Gnoni V, Tamburrino L, Urso D, Caputo F, Misceo S, Logroscino G. A Clinical Scale for Rating the Severity of Bulbar Lower Motor Neuron Dysfunction in Amyotrophic Lateral Sclerosis. Biomedicines 2023; 11:2039. [PMID: 37509677 PMCID: PMC10376980 DOI: 10.3390/biomedicines11072039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is characterized by the progressive loss of upper (UMN) and lower motor neurons (LMN) in four different body regions (bulbar, cervical, thoracic, and lumbosacral). Over the past decades, several clinical scoring systems have been developed to assess the UMN and LMN burden in ALS. However, concerning the bulbar LMN burden, the available scoring systems solely assess the presence/absence of bulbar LMN signs without providing a degree of impairment. Therefore, in this study, we proposed a novel scale to stratify subjects with ALS according to the bulbar LMN involvement and assessed its prognostic value. METHODS We developed a four-item scale based on the LMN signs according to the El Escorial criteria. Ten raters, specializing in ALS or neurocognitive disorders, retrospectively applied the scale to the first evaluation of 195 patients with ALS. Cohen's kappa (Cohen's k) and an intra-class correlation coefficient (ICC) were used to assess the inter-rater reliability. The Kaplan-Mayer estimator was used to estimate survival distribution according to the bulbar scale scores. RESULTS The raters showed a substantial to excellent agreement with Cohen's k, ranging from 0.834 to 0.975, with an overall ICC of 0.922 (95% CI = 0.906-0.936). The survival distribution was statistically different across the three bulbar scale scores (χ2(2) = 9.50, p < 0.01). CONCLUSIONS Our bulbar LMN scale represents a reliable measure of the bulbar LMN signs in ALS. This easy-to-administer clinical scale could provide unique information in phenotyping and predicting survival in ALS.
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Affiliation(s)
- Stefano Zoccolella
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, 70132 Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Giammarco Milella
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Alessandro Introna
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Angela Fraddosio
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Eustachio D'Errico
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
| | - Francesca Caputo
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
| | - Salvatore Misceo
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, 70132 Bari, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", 73039 Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy
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Gnoni V, Zoccolella S, Giugno A, Urso D, Tamburrino L, Filardi M, Logroscino G. Hypothalamus and amyotrophic lateral sclerosis: potential implications in sleep disorders. Front Aging Neurosci 2023; 15:1193483. [PMID: 37465321 PMCID: PMC10350538 DOI: 10.3389/fnagi.2023.1193483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that affects both motor and non-motor functions, including sleep regulation. Emerging evidence suggests that the hypothalamus, a brain region that plays a critical role in sleep-wake regulation, may be involved in the pathogenesis of ALS-related sleep disturbances. In this review, we have summarized results of studies on sleep disorders in ALS published between 2000 and 2023. Thereafter, we examined possible mechanisms by which hypothalamic dysfunctions may contribute to ALS-related sleep disturbances. Achieving a deeper understanding of the relationship between hypothalamic dysfunction and sleep disturbances in ALS can help improve the overall management of ALS and reduce the burden on patients and their families.
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Affiliation(s)
- Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Neurology Unit, San Paolo Hospital, Azienda Sanitaria Locale (ASL) Bari, Bari, Italy
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, United Kingdom
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”Tricase, Italy
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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Milella G, Zoccolella S, Urso D, Nigro S, Tamburrino L, Gnoni V, Filardi M, Logroscino G. Different patterns of spreading direction and motor neurons involvement in a cohort of limb-onset amyotrophic lateral sclerosis patients from Southern Italy: Potential implication on disease course or progression? Brain Behav 2023; 13:e2899. [PMID: 37208847 PMCID: PMC10275554 DOI: 10.1002/brb3.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Currently, there is a lack of knowledge concerning where the pathological process starts and how the neurodegeneration spreads during the course of amyotrophic lateral sclerosis (ALS). AIMS This study aims to evaluate the spreading direction of the disease and the corresponding clinical characteristics in a cohort of patients with limb-onset ALS. PATIENTS AND METHODS Consecutive incident ALS patients referring to an ALS tertiary center from Southern Italy, between 2015 and 2021, were recruited in the study. According to the initial directions of spread, patients were dichotomized into horizontal spreading pattern (HSP) or vertical spreading pattern (VSP) groups. RESULTS Among 137 newly diagnosed ALS, 87 presented a spinal onset. Ten patients with pure LMN were not included in the study. All cases reported a clear spread direction. The frequency of HSP and VSP spreading was similar overall (47 vs. 30). The prevalence of HSP was higher (74% vs. 50%) in patients with upper limb-onset (UL-ALS), compared to patients with lower limb-onset (LL-ALS; p < .05). Conversely, the occurrence of VSP spread was threefold higher in patients with LL-ALS, compared to UL-ALS (p < .05). Patients with VSP showed a wider upper motor neuron impairment, whereas the involvement of LMN resulted greater in patients with HSP. Patients with HSP exhibited a greater drop of ALSFRS-r sub-score in the region of onset, while VSP showed a slighter but more diffuse reduction of ASLFRS-r subscore in more body districts beyond the site of onset. Patients with VSP were also characterized by a higher median progression rate and an earlier median bulbar involvement, compared to HSP. CONCLUSIONS Our findings suggested investigating the spreading direction of ALS among patients with spinal onset, to better delineate the clinical profiles of patients with ALS, and predict an earlier impairment of bulbar muscle and a more rapid progression of the disease.
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Affiliation(s)
- Giammarco Milella
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Stefano Zoccolella
- ASL BariSan Paolo Hospital, Neurology UnitMilanItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Ludovica Tamburrino
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging Brain University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico,”TricaseItaly
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La Morgia C, Mitolo M, Romagnoli M, Stanzani Maserati M, Evangelisti S, De Matteis M, Capellari S, Bianchini C, Testa C, Vandewalle G, Santoro A, Carbonelli M, D'Agati P, Filardi M, Avanzini P, Barboni P, Zenesini C, Baccari F, Liguori R, Tonon C, Lodi R, Carelli V. Multimodal investigation of melanopsin retinal ganglion cells in Alzheimer's disease. Ann Clin Transl Neurol 2023; 10:918-932. [PMID: 37088544 PMCID: PMC10270274 DOI: 10.1002/acn3.51773] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE In Alzheimer's disease (AD), the presence of circadian dysfunction is well-known and may occur early in the disease course. The melanopsin retinal ganglion cell (mRGC) system may play a relevant role in contributing to circadian dysfunction. In this study, we aimed at evaluating, through a multimodal approach, the mRGC system in AD at an early stage of disease. METHODS We included 29 mild-moderate AD (70.9 ± 11 years) and 26 (70.5 ± 8 years) control subjects. We performed an extensive neurophtalmological evaluation including optical coherence tomography with ganglion cell layer segmentation, actigraphic evaluation of the rest-activity rhythm, chromatic pupillometry analyzed with a new data-fitting approach, and brain functional MRI combined with light stimuli assessing the mRGC system. RESULTS We demonstrated a significant thinning of the infero-temporal sector of the ganglion cell layer in AD compared to controls. Moreover, we documented by actigraphy the presence of a circadian-impaired AD subgroup. Overall, circadian measurements worsened by age. Chromatic pupillometry evaluation highlighted the presence of a pupil-light response reduction in the rod condition pointing to mRGC dendropathy. Finally, brain fMRI showed a reduced occipital cortex activation with blue light particularly for the sustained responses. INTERPRETATION Overall, the results of this multimodal innovative approach clearly document a dysfunctional mRGC system at early stages of disease as a relevant contributing factor for circadian impairment in AD providing also support to the use of light therapy in AD.
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Affiliation(s)
- Chiara La Morgia
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaProgramma di NeurogeneticaBolognaItaly
| | - Micaela Mitolo
- IRCCS Istituto delle Scienze Neurologiche di BolognaProgramma Neuroimmagini Funzionali e MolecolariBolognaItaly
- Dipartimento di Medicina e ChirurgiaUniversità di ParmaParmaItaly
| | - Martina Romagnoli
- IRCCS Istituto delle Scienze Neurologiche di BolognaProgramma di NeurogeneticaBolognaItaly
| | | | - Stefania Evangelisti
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
| | - Maddalena De Matteis
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Sabina Capellari
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
| | - Claudio Bianchini
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
| | - Claudia Testa
- IRCCS Istituto delle Scienze Neurologiche di BolognaProgramma Neuroimmagini Funzionali e MolecolariBolognaItaly
- Dipartimento di Fisica ed AstronomiaUniversità di BolognaBolognaItaly
| | - Gilles Vandewalle
- Sleep and Chronobiology Lab, GIGA‐Cyclotron Research Centre‐In Vivo ImagingUniversity of LiègeLiègeBelgium
| | - Aurelia Santoro
- Dipartimento di Medicina Specialistica Diagnostica e SperimentaleUniversità di BolognaBolognaItaly
- Alma Mater Research Institute on Global Challenges and Climate Change (Alma Climate)Università di BolognaBolognaItaly
| | - Michele Carbonelli
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
| | - Pietro D'Agati
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
| | - Marco Filardi
- Dipartimento di Medicina di Base, Neuroscienze e degli Organi di SensoUniversità di Bari Aldo MoroBariItaly
- Centro per le Malattie Neurodegenerative e l'Invecchiamento CerebraleUniversità di Bari Aldo Moro‐ A.O. Pia Fondazione Cardinale G. PanicoTricaseItaly
| | | | | | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di BolognaUnità di Epidemiologia e StatisticaBolognaItaly
| | - Flavia Baccari
- IRCCS Istituto delle Scienze Neurologiche di BolognaUnità di Epidemiologia e StatisticaBolognaItaly
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di BolognaUOC Clinica NeurologicaBolognaItaly
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
| | - Caterina Tonon
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaProgramma Neuroimmagini Funzionali e MolecolariBolognaItaly
| | - Raffaele Lodi
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaProgramma Neuroimmagini Funzionali e MolecolariBolognaItaly
| | - Valerio Carelli
- Dipartimento di Scienze Biomediche e NeuromotorieUniversità di BolognaBolognaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaProgramma di NeurogeneticaBolognaItaly
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Tafuri B, Filardi M, Frisullo ME, De Blasi R, Rizzo G, Nigro S, Logroscino G. Behavioral variant frontotemporal dementia in patients with primary psychiatric disorder: A magnetic resonance imaging study. Brain Behav 2023; 13:e2896. [PMID: 36864745 PMCID: PMC10097141 DOI: 10.1002/brb3.2896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD) in patients with a history of primary psychiatric disorder (PPD) is challenging. PPD shows the typical cognitive impairments observed in patients with bvFTD. Therefore, the correct identification of bvFTD onset in patients with a lifetime history of PPD is pivotal for an optimal management. METHODS Twenty-nine patients with PPD were included in this study. After clinical and neuropsychological evaluations, 16 patients with PPD were clinically classified as bvFTD (PPD-bvFTD+), while in 13 cases clinical symptoms were associated with the typical course of the psychiatric disorder itself (PPD-bvFTD-). Voxel- and surface-based investigations were used to characterize gray matter changes. Volumetric and cortical thickness measures were used to predict the clinical diagnosis at a single-subject level using a support vector machine (SVM) classification framework. Finally, we compared classification performances of magnetic resonance imaging (MRI) data with automatic visual rating scale of frontal and temporal atrophy. RESULTS PPD-bvFTD+ showed a gray matter decrease in thalamus, hippocampus, temporal pole, lingual, occipital, and superior frontal gyri compared to PPD-bvFTD- (p < .05, family-wise error-corrected). SVM classifier showed a discrimination accuracy of 86.2% in differentiating PPD patients with bvFTD from those without bvFTD. CONCLUSIONS Our study highlights the utility of machine learning applied to structural MRI data to support the clinician in the diagnosis of bvFTD in patients with a history of PPD. Gray matter atrophy in temporal, frontal, and occipital brain regions may represent a useful hallmark for a correct identification of dementia in PPD at a single-subject level.
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Affiliation(s)
- Benedetta Tafuri
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Maria Elisa Frisullo
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy.,Department of Radiology, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy.,Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Tricase, Italy
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14
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Liguori C, Mombelli S, Fernandes M, Zucconi M, Plazzi G, Ferini-Strambi L, Logroscino G, Mercuri NB, Filardi M. The evolving role of quantitative actigraphy in clinical sleep medicine. Sleep Med Rev 2023; 68:101762. [PMID: 36773596 DOI: 10.1016/j.smrv.2023.101762] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
Actigraphy has a consolidated role in Insomnia and Circadian Rhythm Sleep-Wake Disorders (CRSWD) and recent studies have highlighted the use of actigraphy for narcolepsy and REM sleep behaviour disorder (RBD). This review aims at summarising the results of studies published over the last decade regarding the use of actigraphy. Thirty-five studies proved eligible, and results were analysed separately for insomnia, narcolepsy and RBD. Actigraphy showed to consistently differentiate insomnia patients from healthy controls. Furthermore, the application of advanced analytical techniques has been shown to provide both unique insights into the physiology of insomnia and sleep misperception and to improve the specificity of actigraphy in detecting wakefulness within sleep periods. Regarding narcolepsy, several studies showed that actigraphy can detect peculiar sleep/wake disruption and the effects of pharmacological treatments. Finally, although the number of studies in RBD patients is still limited, the available evidence indicates a reduced amplitude of the activity pattern, sleep-wake rhythm dysregulation and daytime sleepiness. Therefore, the potential use of these markers as predictors of phenoconversion should be further explored. In conclusion, quantitative actigraphy presents a renewed interest when considering the possibility of using actigraphy in clinical sleep medicine to diagnose, monitor, and follow sleep disorders other than CRSWD.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
| | - Samantha Mombelli
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Milan, Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
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15
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Tafuri B, Filardi M, Urso D, Gnoni V, De Blasi R, Nigro S, Logroscino G. Asymmetry of radiomics features in the white matter of patients with primary progressive aphasia. Front Aging Neurosci 2023; 15:1120935. [PMID: 37213534 PMCID: PMC10196268 DOI: 10.3389/fnagi.2023.1120935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Primary Progressive Aphasia (PPA) is a neurological disease characterized by linguistic deficits. Semantic (svPPA) and non-fluent/agrammatic (nfvPPA) variants are the two main clinical subtypes. We applied a novel analytical framework, based on radiomic analysis, to investigate White Matter (WM) asymmetry and to examine whether asymmetry is associated with verbal fluency performance. Methods Analyses were performed on T1-weighted images including 56 patients with PPA (31 svPPA and 25 nfvPPA) and 53 age- and sex-matched controls. Asymmetry Index (AI) was computed for 86 radiomics features in 34 white matter regions. The relationships between AI, verbal fluency performance (semantic and phonemic) and Boston Naming Test score (BNT) were explored through Spearman correlation analysis. Results Relative to controls, WM asymmetry in svPPA patients involved regions adjacent to middle temporal cortex as part of the inferior longitudinal (ILF), fronto-occipital (IFOF) and superior longitudinal fasciculi. Conversely, nfvPPA patients showed an asymmetry of WM in lateral occipital regions (ILF/IFOF). A higher lateralization involving IFOF, cingulum and forceps minor was found in nfvPPA compared to svPPA patients. In nfvPPA patients, semantic fluency was positively correlated to asymmetry in ILF/IFOF tracts. Performances at BNT were associated with AI values of the middle temporal (ILF/SLF) and parahippocampal (ILF/IFOF) gyri in svPPA patients. Discussion Radiomics features depicted distinct pathways of asymmetry in svPPA and nfvPPA involving damage of principal fiber tracts associated with speech and language. Assessing asymmetry of radiomics in PPA allows achieving a deeper insight into the neuroanatomical damage and may represent a candidate severity marker for language impairments in PPA patients.
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Affiliation(s)
- Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
- *Correspondence: Benedetta Tafuri,
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King’s College London, London, United Kingdom
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Diagnostic Imaging, Pia Fondazione di Culto e Religione “Card. G. Panico”, Tricase, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Lecce, Italy
- Department of Translational Biomedicine and Neuroscience (DiBraiN), University of Bari Aldo Moro, Bari, Italy
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16
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Manippa V, Palmisano A, Filardi M, Vilella D, Nitsche MA, Rivolta D, Logroscino G. An update on the use of gamma (multi)sensory stimulation for Alzheimer's disease treatment. Front Aging Neurosci 2022; 14:1095081. [PMID: 36589536 PMCID: PMC9797689 DOI: 10.3389/fnagi.2022.1095081] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Alzheimer's disease (AD) is characterized by reduced fast brain oscillations in the gamma band (γ, > 30 Hz). Several animal studies show that inducing gamma oscillations through (multi)sensory stimulation at 40 Hz has the potential to impact AD-related cognitive decline and neuropathological processes, including amyloid plaques deposition, neurofibrillary tangles formation, and neuronal and synaptic loss. Therefore Gamma Entrainment Using Sensory stimulation (GENUS) is among the most promising approaches for AD patients' treatment. This review summarizes the evidence on GENUS effectiveness, from animal models to AD patients. Despite the application on human is in its infancy, the available findings suggest its feasibility for the treatment of AD. We discuss such results in light of parameter improvement and possible underlying mechanisms. We finally emphasize the need for further research for its development as a disease-modifying non-pharmacological intervention.
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Affiliation(s)
- Valerio Manippa
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy,Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany,*Correspondence: Valerio Manippa,
| | - Annalisa Palmisano
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Davide Vilella
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Michael A. Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany,Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy and University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Bielefeld, Germany
| | - Davide Rivolta
- Department of Education, Psychology and Communication, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”, Tricase, Italy
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17
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Veneruso M, Pizza F, Filardi M, Antelmi E, Nobili L, Plazzi G. Heterogeneous Neuropsychiatric Symptoms and Outcome in Very Early-Onset Narcolepsy Type 1: a Case Series. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Nigro S, Filardi M, Tafuri B, De Blasi R, Cedola A, Gigli G, Logroscino G. The Role of Graph Theory in Evaluating Brain Network Alterations in Frontotemporal Dementia. Front Neurol 2022; 13:910054. [PMID: 35837233 PMCID: PMC9275562 DOI: 10.3389/fneur.2022.910054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/02/2022] [Indexed: 11/21/2022] Open
Abstract
Frontotemporal dementia (FTD) is a spectrum of clinical syndromes that affects personality, behavior, language, and cognition. The current diagnostic criteria recognize three main clinical subtypes: the behavioral variant of FTD (bvFTD), the semantic variant of primary progressive aphasia (svPPA), and the non-fluent/agrammatic variant of PPA (nfvPPA). Patients with FTD display heterogeneous clinical and neuropsychological features that highly overlap with those presented by psychiatric syndromes and other types of dementia. Moreover, up to now there are no reliable disease biomarkers, which makes the diagnosis of FTD particularly challenging. To overcome this issue, different studies have adopted metrics derived from magnetic resonance imaging (MRI) to characterize structural and functional brain abnormalities. Within this field, a growing body of scientific literature has shown that graph theory analysis applied to MRI data displays unique potentialities in unveiling brain network abnormalities of FTD subtypes. Here, we provide a critical overview of studies that adopted graph theory to examine the topological changes of large-scale brain networks in FTD. Moreover, we also discuss the possible role of information arising from brain network organization in the diagnostic algorithm of FTD-spectrum disorders and in investigating the neural correlates of clinical symptoms and cognitive deficits experienced by patients.
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Affiliation(s)
- Salvatore Nigro
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Italy
- Salvatore Nigro
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Roberto De Blasi
- Department of Radiology, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Alessia Cedola
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Giuseppe Gigli
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
- Department of Mathematics and Physics “Ennio De Giorgi”, University of Salento, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- *Correspondence: Giancarlo Logroscino
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19
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Tafuri B, Filardi M, Urso D, De Blasi R, Rizzo G, Nigro S, Logroscino G. Radiomics Model for Frontotemporal Dementia Diagnosis Using T1-Weighted MRI. Front Neurosci 2022; 16:828029. [PMID: 35794955 PMCID: PMC9251132 DOI: 10.3389/fnins.2022.828029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
Abstract
Radiomics has been proposed as a useful approach to extrapolate novel morphological and textural information from brain Magnetic resonance images (MRI). Radiomics analysis has shown unique potential in the diagnostic work-up and in the follow-up of patients suffering from neurodegenerative diseases. However, the potentiality of this technique in distinguishing frontotemporal dementia (FTD) subtypes has so far not been investigated. In this study, we explored the usefulness of radiomic features in differentiating FTD subtypes, namely, the behavioral variant of FTD (bvFTD), the non-fluent and/or agrammatic (PNFA) and semantic (svPPA) variants of a primary progressive aphasia (PPA). Classification analyses were performed on 3 Tesla T1-weighted images obtained from the Frontotemporal Lobar Degeneration Neuroimaging Initiative. We included 49 patients with bvFTD, 25 patients with PNFA, 34 patients with svPPA, and 60 healthy controls. Texture analyses were conducted to define the first-order statistic and textural features in cortical and subcortical brain regions. Recursive feature elimination was used to select the radiomics signature for each pairwise comparison followed by a classification framework based on a support vector machine. Finally, 10-fold cross-validation was used to assess classification performances. The radiomics-based approach successfully identified the brain regions typically involved in each FTD subtype, achieving a mean accuracy of more than 80% in distinguishing between patient groups. Note mentioning is that radiomics features extracted in the left temporal regions allowed achieving an accuracy of 91 and 94% in distinguishing patients with svPPA from those with PNFA and bvFTD, respectively. Radiomics features show excellent classification performances in distinguishing FTD subtypes, supporting the clinical usefulness of this approach in the diagnostic work-up of FTD.
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Affiliation(s)
- Benedetta Tafuri
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Marco Filardi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Neurosciences, King’s College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Radiology, “Pia Fondazione Cardinale G. Panico”, Tricase, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Institute of Nanotechnology (NANOTEC), Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari “Aldo Moro”, Bari, Italy
- *Correspondence: Giancarlo Logroscino,
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20
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Filardi M, Barone R, Bramato G, Nigro S, Tafuri B, Frisullo ME, Zecca C, Tortelli R, Logroscino G. The Relationship Between Muscle Strength and Cognitive Performance Across Alzheimer's Disease Clinical Continuum. Front Neurol 2022; 13:833087. [PMID: 35645971 PMCID: PMC9133788 DOI: 10.3389/fneur.2022.833087] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/15/2022] [Indexed: 01/04/2023] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder characterized by a progressive cognitive decline, mostly prominent in the domain of memory, but also associated with other cognitive deficits and non-cognitive symptoms. Reduced muscle strength is common in AD. However, the current understanding of its relationship with cognitive decline is limited. This study investigates the relationship between muscle strength and cognition in patients with AD and mild cognitive impairment (MCI). We enrolled 148 consecutive subjects, including 74 patients with probable AD dementia, 37 MCI, and 37 controls. Participants underwent neuropsychological evaluation focused on attention, working memory, declarative memory and learning. Muscle strength and muscle mass were measured through hand dynamometer and bio-electrical impedance analysis, respectively. Patients with AD dementia were divided with respect to the severity of cognitive impairment into mild and moderate-to-severe patients. Moderate-to-severe patients with AD presented lower handgrip strength than MCI and controls. No differences were observed in muscle mass. In MCI and AD dementia, handgrip strength was associated with overall cognitive functioning, attentional and memory performance. The routine implementation of handgrip strength assessment in the clinical work-up of patients with MCI and AD could potentially represent a simple method to monitor functional and cognitive decline along the disease course.
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Affiliation(s)
- Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari “Aldo Moro,”Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- *Correspondence: Marco Filardi
| | - Roberta Barone
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Giulia Bramato
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Rome, Italy
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
- Institute of Nanotechnology (NANOTEC), National Research Council, Lecce, Italy
| | - Benedetta Tafuri
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari “Aldo Moro,”Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Maria Elisa Frisullo
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Chiara Zecca
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Rosanna Tortelli
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari “Aldo Moro,”Bari, Italy
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari “Aldo Moro” at Pia Fondazione “Card. G. Panico”, Tricase, Italy
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21
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Dodich A, Boccardi M, Sacco L, Monsch AU, Démonet JF, Filardi M, Logroscino G, Salmon DP, Weinbtraub S, Dubois B, Cappa SF, Cerami C. Answer to "Social cognition assessment for mild neurocognitive disorders". Alzheimers Dement 2022; 18:1441-1442. [PMID: 35394112 DOI: 10.1002/alz.12664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/12/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Alessandra Dodich
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Marina Boccardi
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock-Greifswald Standort, Rostock, Germany
| | - Leonardo Sacco
- Clinic of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Andreas U Monsch
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jean-François Démonet
- Leenaards Memory Centre-CHUV, Clinical Neuroscience Department, Cité Hospitalière CHUV, Lausanne, Switzerland
| | - Marco Filardi
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro," "Pia Fondazione Cardinale G. Panico" Tricase, Lecce, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro," "Pia Fondazione Cardinale G. Panico" Tricase, Lecce, Italy
| | - David P Salmon
- Department of Neurosciences, University of California San Diego School of Medicine, San Diego, California, USA
| | - Sandra Weinbtraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bruno Dubois
- Hôpital Pitié-Salpêtrière, AP-HP, Alzheimer Research Institute (IM2A) and Institut du cerveau et lamoelle (ICM) Sorbonne Université, Paris, France
| | - Stefano F Cappa
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy.,Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Cerami
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy.,Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy
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22
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Veneruso M, Pizza F, Finotti E, Amore G, Vandi S, Filardi M, Antelmi E, Nobili L, Cassio A, Pession A, Plazzi G. Child Neurology: A Case Series of Heterogeneous Neuropsychiatric Symptoms and Outcome in Very Early-Onset Narcolepsy Type 1. Neurology 2022; 98:984-989. [PMID: 35387850 DOI: 10.1212/wnl.0000000000200666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/16/2022] [Indexed: 11/15/2022] Open
Abstract
Narcolepsy type 1 is a central disorder of hypersomnolence characterized by excessive daytime sleepiness, cataplexy (i.e., sudden loss of muscle tone during wakefulness triggered by emotions), and rapid eye movement sleep-related manifestations that can present with a peculiar phenotype when arising at a pediatric age. Several features of childhood-onset narcolepsy type 1 are also common in neuropsychiatric conditions; discrete neuropsychiatric comorbidity has also been demonstrated.Here we report on three children with very early narcolepsy type 1. All three patients had psychiatric features at time of symptom onset coupled with peculiar motor disturbances. The course of narcolepsy symptoms also paralleled neuropsychiatric symptoms, suggesting a possible intrinsic link between sleep and psychological features.Multidisciplinary management is mandatory for pediatric narcolepsy type 1 since prompt disease management addressing neuropsychiatric symptoms could lead to better clinical outcomes and quality of life.
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Affiliation(s)
- Marco Veneruso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Finotti
- Department of Rehabilitation, Child and Adolescent Neuropsychiatry Unit, ULSS 6, Vicenza, Italy
| | - Giulia Amore
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense Organs, University Aldo Moro Bari, Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro -A.O. Pia Fondazione Cardinale G. Panico, Tricase, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lino Nobili
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Alessandra Cassio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,IRCCS S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Andrea Pession
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,IRCCS S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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23
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La Morgia C, Romagnoli M, Pizza F, Biscarini F, Filardi M, Donadio V, Carbonelli M, Amore G, Park JC, Tinazzi M, Carelli V, Liguori R, Plazzi G, Antelmi E. Chromatic Pupillometry in Isolated Rapid Eye Movement Sleep Behavior Disorder. Mov Disord 2021; 37:205-210. [PMID: 34617633 PMCID: PMC9293298 DOI: 10.1002/mds.28809] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/01/2021] [Accepted: 09/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Melanopsin retinal ganglion cell (mRGC)‐mediated pupillary light reflex (PLR) abnormalities have been documented in several neurodegenerative disorders including Parkinson's disease. Overall, isolated rapid eye movement (REM) sleep behavior disorder (iRBD) represents the strongest prodromal risk factor for impending α‐synucleinopathies. Objectives To quantitatively compare PLR and mRGC‐mediated contribution to PLR in 16 iRBD patients and 16 healthy controls. Methods iRBD and controls underwent extensive neuro‐ophthalmological evaluation and chromatic pupillometry. In iRBD, PLR metrics were correlated with clinical variables and with additional biomarkers including REM atonia index (RAI), DaTscan, and presence of phosphorylated‐α‐synuclein (p‐α‐syn) deposition in skin biopsy. Results We documented higher baseline pupil diameter and decreased rod‐transient PLR amplitude in iRBD patients compared to controls. PLR rod‐contribution correlated with RAI. Moreover, only iRBD patients with evidence of p‐α‐syn deposition at skin biopsy showed reduced PLR amplitude compared to controls. Conclusion The observed PLR abnormalities in iRBD might be considered as potential biomarkers for the risk stratification of phenoconversion of the disease. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Chiara La Morgia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Martina Romagnoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Francesco Biscarini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Marco Filardi
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.,Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro"- A.O. Pia Fondazione Cardinale G. Panico, Tricase, Italy
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Michele Carbonelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Giulia Amore
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michele Tinazzi
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Antelmi
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
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24
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D'Anselmo A, Agnoli S, Filardi M, Pizza F, Mastria S, Corazza GE, Plazzi G. Being creative during lockdown: The relationship between creative potential and COVID-19-related psychological distress in narcolepsy type 1. J Sleep Res 2021; 31:e13461. [PMID: 34409666 PMCID: PMC8420284 DOI: 10.1111/jsr.13461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/25/2022]
Abstract
The national lockdown imposed in several countries to counteract the coronavirus disease 2019 (COVID-19) pandemic led to an unprecedented situation with serious effects on mental health of the general population and of subjects affected by heterogeneous diseases. Considering the positive association between narcoleptic symptoms and creativity, we aimed at exploring the psychological distress associated with COVID-19 restrictions and its relationship with depressive symptoms and creativity in patients with narcolepsy type 1 (NT1). A total of 52 patients with NT1 and 50 healthy controls, who completed a previous study on creativity, were contacted during the first lockdown period to complete an online survey evaluating psychological distress related to the COVID-19 outbreak, sleep quality, narcolepsy and depressive symptoms, and creative abilities. The patients with NT1 showed an improvement in subjective sleepiness while controls reported worsening of sleep quality during the lockdown. Depression and NT1 symptom severity proved significant predictors of COVID-19-related distress. Creative performance, namely generative fluency, turned out to be a favourable moderator in the relationship between depression and patients' distress, reducing the detrimental effect of depression on the patients' wellbeing. On the contrary, creative originality proved to be a disadvantageous moderator in the relationship between NT1 symptom severity and the distress associated with this traumatic event indicating a higher vulnerability to developing COVID-19-related distress, particularly evident in patients displaying higher originality. Overall, these results highlight a crucial role of creativity in patients with NT1, suggesting that creative potential could be used as a protective factor against the development of distress associated with the lockdown.
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Affiliation(s)
- Anita D'Anselmo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,Marconi Institute for Creativity (MIC), Bologna, Italy
| | - Sergio Agnoli
- Marconi Institute for Creativity (MIC), Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Basic Medicine, Neuroscience and Sense Organs, University Aldo Moro Bari, Bari, Italy.,Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card G. Panico" Hospital, Lecce, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Mastria
- Marconi Institute for Creativity (MIC), Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Giovanni Emanuele Corazza
- Marconi Institute for Creativity (MIC), Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy.,Université de Paris and Univ Gustave Eiffel, LaPEA, Boulogne-Billancourt, France
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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25
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Lividini A, Pizza F, Filardi M, Vandi S, Ingravallo F, Antelmi E, Bruni O, Cosentino FII, Ferri R, Guarnieri B, Marelli S, Ferini-Strambi L, Romigi A, Bonanni E, Maestri M, Terzaghi M, Manni R, Plazzi G. Narcolepsy type 1 features across the life span: age impact on clinical and polysomnographic phenotype. J Clin Sleep Med 2021; 17:1363-1370. [PMID: 33666167 DOI: 10.5664/jcsm.9198] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES Narcolepsy type 1 (NT1) is a chronic neurological disorder typically arising during adolescence and young adulthood. Recent studies demonstrated that NT1 presents with age-specific features, especially in children. With this study we aimed to describe and to compare the clinical pictures of NT1 in different age groups. METHODS In this cross-sectional, multicenter study, 106 untreated patients with NT1 enrolled at the time of diagnosis underwent clinical evaluation, a semistructured interview (including the Epworth Sleepiness Scale), nocturnal video-polysomnography, and the Multiple Sleep Latency Test. Patients were enrolled in order to establish 5 age-balanced groups (childhood, adolescence, adulthood, middle age, and senior). RESULTS The Epworth Sleepiness Scale score showed a significant increase with age, while self-reported diurnal total sleep time was lower in older and young adults, with the latter also complaining of automatic behaviors in more than 90% of patients. Children reported the cataplexy attacks to be more frequent (> 1/d in 95% of patients). "Recalling an emotional event," "meeting someone unexpectedly," "stress," and "anger" were more frequently reported in adult and older adult patients as possible triggers of cataplexy. Neurophysiological data showed a higher number of sleep-onset rapid eye movement periods on the Multiple Sleep Latency Test in adolescent compared to senior patients and an age-progressive decline in sleep efficiency. CONCLUSIONS Daytime sleepiness, cataplexy features and triggers, and nocturnal sleep structure showed age-related difference in patients with NT1; this variability may contribute to diagnostic delay and misdiagnosis.
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Affiliation(s)
- Althea Lividini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | | | - Raffaele Ferri
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Biancamaria Guarnieri
- Center of Sleep Medicine, Department of Neurology, Villa Serena Hospital and Villa Serena Foundation for Research, Città S. Angelo, Pescara, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
| | - Andrea Romigi
- IRCCS Neuromed Istituto Neurologico Mediterraneo Sleep Medicine Centre, Pozzilli, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Michelangelo Maestri
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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26
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Filardi M, D'Anselmo A, Mazzoni A, Moresco M, Pizza F, Plazzi G. The importance of social zeitgeber in paediatric type 1 narcolepsy: What we can learn from the COVID-19 restrictions adopted in Italy? J Sleep Res 2021; 31:e13423. [PMID: 34157781 PMCID: PMC8420515 DOI: 10.1111/jsr.13423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 12/28/2022]
Abstract
The lockdown due to the new coronavirus pandemic (COVID‐19) has led to unparalleled changes in several aspects of human behaviour. During the lockdown, the general population delayed sleep timing and spent more time in bed; however, little is known on the effects of COVID‐19 restriction on children and adolescents suffering type 1 narcolepsy. In the last months of 2019, we performed follow‐up actigraphy in 18 type 1 narcolepsy children and adolescents under stable pharmacological treatment with sodium oxybate. We contacted these patients for a follow‐up actigraphy during the first Italian lockdown. Actigraphs and the Epworth Sleepiness Scale for children and adolescents (ESS‐CHAD) have been sent to participants’ homes. Differences in motor activity were analysed through functional linear modelling. During lockdown, type 1 narcolepsy children and adolescents went to bed and woke up later, slept more during the daytime and napped more frequently. No difference emerged in time in bed, estimated total sleep time and nocturnal sleep quality. Similarly, no difference emerged in ESS‐CHAD and body mass index. The time‐series analysis of motor activity documented reduced activity during the early morning and in the evening during the lockdown period compared with pre‐lockdown. Our study objectively showed that type 1 narcolepsy children and adolescents delayed the sleep phase and slept more during the daytime during the lockdown. The analysis of type 1 narcolepsy children and adolescents’ behaviour during the lockdown has provided new information that could pave the way to a personalized school programme.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Anita D'Anselmo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Alice Mazzoni
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Monica Moresco
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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27
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Filardi M, Blunda V, Vandi S, Musetti A, Posar A, Visconti P, Pizza F, Plazzi G, Franceschini C. Case Report: Burden of Illness in Narcolepsy Type 1: Hikikomori in a Teenage Girl. Front Psychol 2021; 12:634941. [PMID: 33776861 PMCID: PMC7995606 DOI: 10.3389/fpsyg.2021.634941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/12/2021] [Indexed: 12/01/2022] Open
Abstract
Narcolepsy type 1 (NT1) deeply impacts on quality of life, especially during adolescence, with NT1 children and adolescents that frequently report difficulties in integration with peers and decreased participation in after-school activities. Here we describe the case of NT1 teenager girl presenting with severe physical and social withdrawal, fulfilling the proposed diagnostic criteria for hikikomori, together with the classic NT1 symptoms. Social withdrawal is an overlooked phenomenon among NT1 children and adolescents that, if present, require a multidisciplinary approach and personalized interventions, but patients can benefit from NT1 pharmacological treatment.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Vincenza Blunda
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Semplice d'Istituto Disturbi dello Spettro Autistico, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unita Operativa Complessa Clinica Neurologica, Bologna, Italy
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Annio Posar
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Semplice d'Istituto Disturbi dello Spettro Autistico, Bologna, Italy
| | - Paola Visconti
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Semplice d'Istituto Disturbi dello Spettro Autistico, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unita Operativa Complessa Clinica Neurologica, Bologna, Italy
| | - Giuseppe Plazzi
- Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto delle Scienze Neurologiche di Bologna, Unita Operativa Complessa Clinica Neurologica, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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28
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Postiglione E, Pizza F, Ingravallo F, Vignatelli L, Filardi M, Mangiaruga A, Antelmi E, Moresco M, Oriolo C, Pagotto U, Plazzi G. Impact of COVID-19 pandemic lockdown on narcolepsy type 1 management. Brain Behav 2021; 11:e01955. [PMID: 33247632 PMCID: PMC7744913 DOI: 10.1002/brb3.1955] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/02/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022] Open
Abstract
STUDY OBJECTIVES Narcolepsy type 1 (NT1) is a chronic rare hypersomnia of central origin requiring a combination of behavioral and pharmacological treatments. During the coronavirus disease 2019 (COVID-19) pandemic, in Italy the population was forced into a lockdown. With this study, we aimed to describe the lockdown impact on NT1 symptom management, according to different patients' working schedule. METHODS In the period between 10 April and 15 May 2020, we performed routine follow-up visits by telephone (as recommended during the COVID-19 emergency) to 50 patients >18 years old (40% males) under stable long-term treatment. We divided patients into three groups: unchanged working schedule, forced working/studying at home, and those who lost their job ("lost occupation"). Current sleep-wake habit and symptom severity were compared with prelockdown assessment (six months before) in the three patient groups. RESULTS At assessment, 20, 22, and eight patients belonged to the unchanged, working/studying at home, and lost occupation groups, respectively. While in the lost occupation group, there were no significant differences compared with prepandemic assessment, the patients with unchanged schedules reported more nocturnal awakenings, and NT1 patients working/studying at home showed an extension of nocturnal sleep time, more frequent daytime napping, improvement of daytime sleepiness, and a significant increase in their body mass index. Sleep-related paralysis/hallucinations, automatic behaviors, cataplexy, and disturbed nocturnal sleep did not differ. CONCLUSIONS Narcolepsy type 1 patients working/studying at home intensified behavioral interventions (increased nocturnal sleep time and daytime napping) and ameliorated daytime sleepiness despite presenting with a slight, but significant, increase of weight.
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Affiliation(s)
- Emanuela Postiglione
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Anastasia Mangiaruga
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Monica Moresco
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Claudia Oriolo
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Policlinic, University of Bologna, Bologna, Italy
| | - Uberto Pagotto
- Endocrinology and Diabetes Prevention and Care Unit, Department of Medical and Surgical Sciences (DIMEC), S. Orsola Policlinic, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
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29
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Urso D, Gnoni V, Filardi M, Logroscino G. Delusion and Delirium in Neurodegenerative Disorders: An Overlooked Relationship? Front Psychiatry 2021; 12:808724. [PMID: 35115974 PMCID: PMC8804700 DOI: 10.3389/fpsyt.2021.808724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/24/2021] [Indexed: 12/04/2022] Open
Abstract
Delusions are part of the neuropsychiatric symptoms that patients suffering from neurodegenerative conditions frequently develop at some point of the disease course and are associated with an increased risk of cognitive and functional decline. Delirium is a syndrome characterized by acute onset of deficits in attention, awareness, and cognition that fluctuate in severity over a short time period. Delusions and delirium are frequently observed in the context of neurodegeneration, and their presence can easily mislead clinicians toward a misdiagnosis of psychiatric disorder further delaying the proper treatment. Risk factors for developing delusion and delirium in neurodegenerative conditions have been investigated separately while the possible interplay between these two conditions has not been explored so far. With this study, we aim to achieve a more comprehensive picture of the relationship between delusions and delirium in neurodegeneration by analyzing prevalence and subtypes of delusions in different neurodegenerative disorders; providing an overview of clinical tools to assess delusions in neurodegenerative patients and how delusions are covered by delirium assessment tools and discussing the possible common pathophysiology mechanisms between delusion and delirium in neurodegenerative patients. A more extensive characterization of the relationship between delusions and delirium may help to understand whether delusions may constitute a risk factor for delirium and may ameliorate the management of both conditions in patients with neurodegenerative disorders.
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Affiliation(s)
- Daniele Urso
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Valentina Gnoni
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marco Filardi
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, Pia Fondazione Cardinale G. Panico, University of Bari Aldo Moro, Bari, Italy.,Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Antelmi E, Filardi M, Pizza F, Vandi S, Moresco M, Franceschini C, Tinazzi M, Ferri R, Plazzi G. REM Sleep Behavior Disorder in Children With Type 1 Narcolepsy Treated With Sodium Oxybate. Neurology 2020; 96:e250-e254. [PMID: 33177222 PMCID: PMC7905776 DOI: 10.1212/wnl.0000000000011157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/25/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To study the effect of stable treatment with sodium oxybate (SO) on nocturnal REM sleep behavior disorder (RBD) and REM sleep without atonia (RSWA) that severely affected children with type 1 narcolepsy (NT1). Methods Nineteen children and adolescents with NT1 (9 female, mean age 12.5 ± 2.7 years, mean disease duration 3.4 ± 1.6 years) underwent neurologic investigations and video-polysomnography (v-PSG) at baseline and after 3 months of stable treatment with SO. v-PSG was independently analyzed by 2 sleep experts to rate RBD episodes. RSWA was automatically computed by means of the validated REM sleep atonia index (RAI). Results Compared to baseline, RAI significantly improved (p < 0.05) and complex movements during REM sleep were remarkably reduced after stable treatment with SO. Compared to baseline, children also reported improvement in clinical complaints and showed a different nighttime sleep-stage architecture. Conclusions RBD and RSWA improved after treatment with SO, pointing to a direct role of the drug in modulating motor control during REM sleep. Classification of Evidence This study offers Class IV evidence of the positive effect of SO on modulation of muscle atonia during REM sleep in children with NT1 because of the absence of a control group.
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Affiliation(s)
- Elena Antelmi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Marco Filardi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Fabio Pizza
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Stefano Vandi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Monica Moresco
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Christian Franceschini
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Michele Tinazzi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Raffaele Ferri
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Giuseppe Plazzi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy.
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Jalal B, Moruzzi L, Zangrandi A, Filardi M, Franceschini C, Pizza F, Plazzi G. Meditation-Relaxation (MR Therapy) for Sleep Paralysis: A Pilot Study in Patients With Narcolepsy. Front Neurol 2020; 11:922. [PMID: 32903364 PMCID: PMC7434831 DOI: 10.3389/fneur.2020.00922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 01/04/2023] Open
Abstract
Sleep paralysis (SP) is a condition where a person is paralyzed upon waking or falling asleep. SP afflicts ~20% of people, and is also one of the typical symptoms in narcolepsy. During SP the sleeper may experience hallucinations. Unsurprisingly, SP is associated with great fear globally. To date, there are no published clinical trials or outcome data for treating this condition. However, few non-pharmacological interventions have been proposed, including cognitive behavioral approaches, and case studies showing clinical amelioration with auto-hypnosis and Meditation-Relaxation (MR) therapy. The latter for instance showed positive preliminary results; when applied for 8 weeks it reduced SP frequency and anxiety/worry symptoms. With this paper we aimed to evaluate, with a small-scale pilot study, the efficacy of MR therapy for SP in patients with narcolepsy. Ten patients with narcolepsy and SP were enrolled in the study. Notably, MR therapy (n = 6), applied for 8 weeks, resulted in a dramatic decrease in the number of days SP occurred (50% reduction); and the total number of SP episodes (54% reduction) in the last month of the study (demonstrated by large within-group effect sizes); unlike the control intervention (deep breathing) (n = 4). These findings are preliminary and exploratory given the small sample. Nonetheless, they represent the first proof of concept at providing empirically-guided insights into the possible efficacy of a novel treatment for frequently occurring SP. Although the study was conducted in patients with narcolepsy we cautiously suggest that the findings may generalize to individuals with isolated SP.
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Affiliation(s)
- Baland Jalal
- Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Ludovico Moruzzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Andrea Zangrandi
- Clinical Neuropsychology, Cognitive Disorders and Dyslexia Unit, Department of Neuro-Motor Diseases, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | | | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Tonetti L, Martoni M, Filardi M, Fabbri M, Carissimi A, Giovagnoli S, Natale V. Variation of circadian activity rhythm according to body mass index in children. Sleep Med 2020; 74:33-38. [PMID: 32836184 DOI: 10.1016/j.sleep.2020.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND/OBJECTIVES This study aimed to examine the variations of circadian activity rhythm of children according to objective body mass index (BMI) values, using a novel statistical framework (ie, Functional Linear Modeling, FLM), separately for school- and weekend days. METHODS A total of 107 participants (60 females; mean age: 10.25 ± 0.48 years) wore an actigraph for seven days during a regular school-week. While valid actigraphic data during school days were available for each of these children, this number decreased to 53 (31 females; mean age: 10.28 ± 0.51 years) during weekend days. RESULTS Examining the school days, significantly higher motor activity in participants with higher BMI was observed from around 4:00 a.m. to 6:00 a.m., with a peak about 5:00 a.m. On the contrary, applying the FLM to the weekend days actigraphic data, no significantly different variation of circadian activity rhythm was observed, according to BMI. CONCLUSIONS In this specific sample of children, during school days, higher BMI is associated with higher activity level in a specific time window in the second half of nocturnal sleep. The lack of significant findings during weekend days could be explained because of higher variability of get-up time and/or the reduced sample size. Future longitudinal studies could explore if the higher motor activity in that specific time window qualifies as a predictive marker of the development of overweight and obesity. If so, early preventive strategies directed towards those at higher risk could be effectively implemented.
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Affiliation(s)
- Lorenzo Tonetti
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Monica Martoni
- Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Via Altura 3, 40139, Bologna, Italy.
| | - Marco Fabbri
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy.
| | - Alicia Carissimi
- Laboratório de Cronobiologia e Sono Do Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal Do Rio Grande Do Sul (UFRGS), Ramiro Barcelos 2350, CEP 90035-003, Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação Em Psiquiatria e Ciências Do Comportamento, Faculdade de Medicina, UFRGS, Ramiro Barcelos 2350, CEP 90035-003, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Sara Giovagnoli
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Vincenzo Natale
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
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Franceschini C, Fante C, Filardi M, Folli MC, Brazzi F, Pizza F, D’Anselmo A, Ingravallo F, Antelmi E, Plazzi G. Can a Peer Support the Process of Self-Management in Narcolepsy? A Qualitative Narrative Analysis of a Narcoleptic Patient. Front Psychol 2020; 11:1353. [PMID: 32733314 PMCID: PMC7358570 DOI: 10.3389/fpsyg.2020.01353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Narcolepsy type 1 (NT1) is a chronic and rare sleep disorder typically arising during adolescence and young adulthood. The main symptoms are excessive daytime sleepiness and cataplexy, a prototypical fall down elicited by huge emotions. Social relationships, school, work, and general health perception are frequently impaired in patients, who often show lower quality-of-life scores. We report which management strategies a young patient (DMG) adopted to cope with NT1 during his growth, avoiding exhibiting serious impairments to his global functioning. METHODS A clinical psychologist explores the history of the patient's disease and the self-acquired strategies used to cope with the symptoms. The patient's global adaptation to the disease, stress-related managing skills, and overall well-being are assessed by standardized scales [Illness Behavior Questionnaire (IBQ); Coping Orientations to Problems Experienced (COPE); and Psychological General Well-Being Index (PGWBI)]. We conducted a qualitative analysis of the patient's narration of his illness according to the procedure of the Grounded Theory. The MAXQDA software program was used to code the verbatim transcript. RESULTS From the qualitative analysis of the interview, three thematic cores emerged: 1) the disease history; 2) the patient's friendship with AD, a friend of his age diagnosed with NT1 since childhood; 3) the strategies used to deal with his symptoms before the diagnosis of NT1 and the related treatment. From the psychometric tests, the patient presents good coping strategies in dealing with stressful problems and events based mainly on acceptance and positive reinterpretation of the stressful situation. CONCLUSION This case shows that comparing peers of the same age and suffering from the same illness improve the patient's self-management ability to cope and live well with NT1.
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Affiliation(s)
| | - Chiara Fante
- Istituto per le Tecnologie Didattiche (ITD), National Research Council (CNR), Genova, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Francesca Brazzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Anita D’Anselmo
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
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Filardi M, Stefani A, Holzknecht E, Pizza F, Plazzi G, Högl B. Objective rest–activity cycle analysis by actigraphy identifies isolated rapid eye movement sleep behavior disorder. Eur J Neurol 2020; 27:1848-1855. [DOI: 10.1111/ene.14386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Affiliation(s)
- M. Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - A. Stefani
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - E. Holzknecht
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - F. Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - G. Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - B. Högl
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
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Dekker K, Benjamins JS, Maksimovic T, Filardi M, Hofman WF, van Straten A, Van Someren EJ. Combined Internet-Based Cognitive-Behavioral and Chronobiological Intervention for Insomnia: A Randomized Controlled Trial. Psychother Psychosom 2020; 89:117-118. [PMID: 31639813 PMCID: PMC7158227 DOI: 10.1159/000503570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/17/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Kim Dekker
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Jeroen S. Benjamins
- Department of Social, Health and Organisational Psychology, Utrecht University, Utrecht, The Netherlands,Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences − DIBINEM, University of Bologna, Bologna, Italy
| | - Winni F. Hofman
- Brain and Cognition Group, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands,Personal Health Institute International, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, VU University Amsterdam and EMGO Institute for Health Care and Research, Amsterdam, The Netherlands
| | - Eus J.W. Van Someren
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands,Department of Psychiatry, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands,Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands,*Eus J.W. Van Someren, Department of Sleep and CognitionNetherlands Institute for Neuroscience, Meibergdreef 47, NL–1105 BA Amsterdam (The Netherlands), E-Mail
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Filardi M, Demir N, Pizza F, Vandi S, Antelmi E, Noce S, Bruni O, Plazzi G. Prevalence and neurophysiological correlates of sleep disordered breathing in pediatric type 1 narcolepsy. Sleep Med 2020; 65:8-12. [DOI: 10.1016/j.sleep.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022]
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Abstract
PURPOSE To evaluate chronotype and the sleep management strategy adopted by sailors before the offshore solo sailing race "Mini Transat La Boulangère". As secondary aim, we assessed whether adopting pre-race sleep management strategy influences performance at race. MATERIALS AND METHODS Forty-two solo sailors completed questionnaires on sleep quality, sleepiness, chronotype and an ad hoc questionnaire on the pre-race sleep management strategy adopted. Arrival times, separately for each race's leg, were provided by the race organization team. RESULTS Solo sailors present mainly with a morning-type (40%) and intermediate-type (60%) chronotype, while none have an evening-type chronotype. Fifty-five percent of sailors adopted pre-race sleep management strategy. Sailors that adopted strategy have travelled more miles in offshore compared to sailors that did not adopt strategy (p<0.05). Significant differences emerged in rMEQ scores, with sailors that adopted strategy presenting lower score compared to sailors that did not adopt sleep strategy (p<0.05), as well as in chronotype distribution with morning-type sailors that are less likely to adopt pre-race sleep management strategy compared to intermediate type sailors (p<0.05). No differences emerged in final arrival times and in arrival time at leg1 and leg2. The most commonly adopted strategy (52% of sailors) consists of sleep extension, followed by the polyphasic sleep (26%), and sleep deprivation (22%) strategy. Sailors trained in polyphasic sleep have higher ESS than sailors trained in sleep deprivation (p<0.05). CONCLUSION Morning-type chronotype is overrepresented in this large cohort of solo sailors compared to the general population; moreover, chronotype seems to influence the adoption of sleep management strategy. A little over half of solo sailors participating in the Mini Transat trained in sleep management strategy before the race; however, neither the general adoption of pre-race sleep management strategy nor the adoption of a specific sleep strategy seems to significantly influence final arrival times.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Silvia Morini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, AUSL di Bologna, Bologna, Italy
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D'Anselmo A, Agnoli S, Filardi M, Pizza F, Mastria S, Corazza GE, Plazzi G. Creativity in Narcolepsy Type 1: The Role of Dissociated REM Sleep Manifestations. Nat Sci Sleep 2020; 12:1191-1200. [PMID: 33364866 PMCID: PMC7751730 DOI: 10.2147/nss.s277647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/22/2020] [Indexed: 12/04/2022] Open
Abstract
PURPOSE A higher creative potential has been reported in narcoleptic patients and linked to lucid dreaming. The aim of the present study was to explore the role of narcolepsy symptoms (presence and severity) in predicting creativity. PATIENTS AND METHODS Sixty-six consecutive type 1 narcolepsy patients (mean age 38.62 ± 17.05, 31 females) took part in this study. Creative achievement in different life domains and creative beliefs were assessed by a self-reported questionnaire and a scale measuring the creative self, respectively; creative performance was measured through a divergent thinking test (generation of alternative original solutions to an open problem). RESULTS We found a key effect of hypnagogic hallucinations in modulating creative behaviour. We therefore tested at first whether hypnagogic hallucinations could interact with specific mental states associated with creativity and in particular mind wandering, a factor associated with both creative performance and achievement. Secondly, we verified if hypnagogic hallucinations could influence the definition of creative identity in type 1 narcolepsy patients, which in turn could predict their creative achievement and creative performance. Results showed that spontaneous mind wandering influenced creative achievement through a moderation effect of sleep paralysis and hypnagogic hallucinations. Moreover, sleep paralysis and hypnagogic hallucinations indirectly influenced, through creative identity, both creative achievement and performance (fluency score). CONCLUSION Our results highlight the role of hypnagogic hallucinations in triggering the process of mind wandering which leads to greater creative success. In addition, this symptom affects creative identity in narcolepsy, leading in turn to higher creative success and creative potential of narcoleptic patients.
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Affiliation(s)
- Anita D'Anselmo
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,Marconi Institute for Creativity (MIC), Bologna, Italy
| | - Sergio Agnoli
- Marconi Institute for Creativity (MIC), Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Mastria
- Marconi Institute for Creativity (MIC), Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Giovanni Emanuele Corazza
- Marconi Institute for Creativity (MIC), Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy.,Université de Paris and Univ Gustave Eiffel, LaPEA, Paris, France
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Fino E, Plazzi G, Filardi M, Marzocchi M, Pizza F, Vandi S, Mazzetti M. (Not so) Smart sleep tracking through the phone: Findings from a polysomnography study testing the reliability of four sleep applications. J Sleep Res 2019; 29:e12935. [DOI: 10.1111/jsr.12935] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/18/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Edita Fino
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - Michele Marzocchi
- Department of Psychology Alma Mater Studiorum—University of Bologna Bologna Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - Michela Mazzetti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES) University of Bologna Bologna Italy
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40
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Antelmi E, Pizza F, Donadio V, Filardi M, Sosero YL, Incensi A, Vandi S, Moresco M, Ferri R, Marelli S, Ferini-Strambi L, Liguori R, Plazzi G. Biomarkers for REM sleep behavior disorder in idiopathic and narcoleptic patients. Ann Clin Transl Neurol 2019; 6:1872-1876. [PMID: 31386270 PMCID: PMC6764627 DOI: 10.1002/acn3.50833] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
To search for discriminating biomarkers, 30 patients with idiopathic rapid‐eye‐movements sleep behavior disorder (iRBD) were compared with 17 patients with RBD within narcolepsy type 1. Both groups underwent extensive examinations, including skin biopsy searching for phosphorylated α‐synuclein deposits and whole‐night video‐polysomnography. Skin biopsy was positive for phosphorylated α‐synuclein deposits in 86.7% of iRBD patients and in none of narcoleptic patients. The analysis of video‐polysomnographic motor events showed differences in their occurrence throughout the night in the two groups. iRBD and RBD due to narcolepsy do have different clinical and pathological findings, confirming a different pathophysiology.
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Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Vincenzo Donadio
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Yuri L Sosero
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alex Incensi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Monica Moresco
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Sara Marelli
- "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Centre, Milan, Italy
| | - Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Centre, Milan, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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41
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Pizza F, Filardi M, Moresco M, Antelmi E, Vandi S, Neccia G, Mazzoni A, Plazzi G. Excessive daytime sleepiness in narcolepsy and central nervous system hypersomnias. Sleep Breath 2019; 24:605-614. [DOI: 10.1007/s11325-019-01867-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 01/20/2023]
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42
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Filardi M, Pizza F, Antelmi E, Ferri R, Natale V, Plazzi G. In-field assessment of sodium oxybate effect in pediatric type 1 narcolepsy: an actigraphic study. Sleep 2019. [PMID: 29522206 DOI: 10.1093/sleep/zsy050] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Study Objectives Sodium oxybate (SXB) is a GABAergic agent widely used as off-label treatment in pediatric type 1 narcolepsy (NT1). Here, we aimed at analyzing by wrist actigraphy the sleep/wake profile of NT1 children and adolescents in drug-naïve condition and after 1 year of SXB treatment. As secondary aim, we investigated changes on sleepiness, cataplexy, and children's anthropometric profile after 1 year of SXB treatment. Methods Twenty-four drug-naïve NT1 children underwent 7 days of actigraphy during the school week. Information on sleepiness, narcolepsy symptoms, and anthropometric features were collected during the same week with questionnaires and semistructured clinical interview. Children started SXB treatment and underwent a second evaluation encompassing actigraphy, clinical interview, questionnaires, and anthropometric assessment after 1 year of stable treatment. Results Actigraphy effectively documented an improvement of nocturnal sleep quality and duration coupled with a reduction of diurnal total sleep time, nap frequency, and duration at 1 year follow-up. Reduction of sleepiness, cataplexy frequency and severity, and weight loss, mainly in obese and overweight NT1 children, were also observed at the 1 year follow-up. Conclusions Actigraphy objectively documented changes in nocturnal sleep quality and diurnal napping behavior after 1 year of SXB treatment, thus representing a valid approach to ecologically assess SXB treatment effect on NT1 children's sleep/wake profile. NT1 symptoms severity and children's anthropometric features also changed as expected. Actigraphy offers the possibility to longitudinally follow up children and has potential to become a key tool to tailor treatment in pediatric patients.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Vincenzo Natale
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
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43
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Leger D, Gauriau C, Tonetti L, Lantin M, Filardi M, Philip P, Faraut B, Natale V. Using actigraphy to assess sleep and wake rhythms of narcolepsy type 1 patients: a comparison with primary insomniacs and healthy controls. Sleep Med 2018; 52:88-91. [DOI: 10.1016/j.sleep.2018.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
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Filardi M, Pizza F, Antelmi E, Pillastrini P, Natale V, Plazzi G. Physical Activity and Sleep/Wake Behavior, Anthropometric, and Metabolic Profile in Pediatric Narcolepsy Type 1. Front Neurol 2018; 9:707. [PMID: 30197622 PMCID: PMC6117389 DOI: 10.3389/fneur.2018.00707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/03/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives: Regular physical activity is routinely recommended in children and adolescents suffering from narcolepsy type 1 (NT1), but controlled studies analyzing its influence on sleep/wake behavior, metabolic, and anthropometric profile in pediatric NT1 are lacking. Methods: Fifty consecutive drug-naïve NT1 children and adolescents were assessed through actigraphic, clinical, and metabolic evaluations. Patients were compared with respect to their engagement in leisure-time physical activities (LTPA): patients engaged in LTPA (n = 30) and patients not engaged (No-LTPA, n = 20), respectively. Results: LTPA patients presented lower BMI, with different BMI categories distribution and higher HDL cholesterol, when compared with No-LTPA subjects. Increased night-sleep duration, higher sleep quality, and reduction of nap frequency were documented through actigraphy in LTPA subjects. Subjective sleepiness, as measured by ESS-CHAD, was also lower in LTPA subjects while cataplexy frequency proved similar between the two groups. Discussion: In pediatric NT1 patients, regular engagement in LTPA is associated with significant differences on sleepiness, anthropometric and metabolic profile and objectively assessed sleep/wake behavior. Engagement in LTPA is beneficial and should be strongly encouraged in pediatric NT1 patients.
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Affiliation(s)
- Marco Filardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Azienda Unità Sanitaria Locale (AUSL) di Bologna, Bologna, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Azienda Unità Sanitaria Locale (AUSL) di Bologna, Bologna, Italy
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vincenzo Natale
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Azienda Unità Sanitaria Locale (AUSL) di Bologna, Bologna, Italy
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45
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Tonetti L, Conca A, Giupponi G, Filardi M, Natale V. Circadian activity rhythm in adult attention-deficit hyperactivity disorder. J Psychiatr Res 2018; 103:1-4. [PMID: 29753192 DOI: 10.1016/j.jpsychires.2018.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
The aim of the present study was to analyze the features of circadian motor activity rhythm of adult attention-deficit hyperactivity disorder (ADHD) patients, by means of functional linear modeling, within the theoretical framework of the two-process model of sleep regulation. Thirty-two ADHD patients and 32 healthy controls (HCs) participated the study. Actiwatch AW64 actigraph was used to quantify motor activity data in 1-min epochs. Participants wore the actigraph on the non-dominant wrist for seven consecutive days. Results show that ADHD patients had significantly higher motor activity than HCs from 4:00 to 7:00, with a peak around 5:00, and from 12:00 to 18:00, with another peak around 14:00. According to the two-process model of sleep regulation, the circadian activity rhythm of ADHD patients may indicate a lower homeostatic sleep pressure, as reflected by the absence of post-lunch dip, which could be considered a potential trait marker of adult ADHD.
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Affiliation(s)
- Lorenzo Tonetti
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
| | - Andreas Conca
- Division of Psychiatry, San Maurizio Hospital, Via Böhler 5, 39100, Bolzano, Italy.
| | - Giancarlo Giupponi
- Division of Psychiatry, San Maurizio Hospital, Via Böhler 5, 39100, Bolzano, Italy.
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139, Bologna, Italy.
| | - Vincenzo Natale
- Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127, Bologna, Italy.
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Moresco M, Lecciso M, Ocadlikova D, Filardi M, Melzi S, Kornum BR, Antelmi E, Pizza F, Mignot E, Curti A, Plazzi G. Flow cytometry analysis of T-cell subsets in cerebrospinal fluid of narcolepsy type 1 patients with long-lasting disease. Sleep Med 2018. [DOI: 10.1016/j.sleep.2017.11.1150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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47
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Antelmi E, Benedetti F, Pizza F, Filardi M, Vandi S, Liguori R, Ferri R, Plazzi G. REM sleep-related episodes in children with narcolepsy type 1 after treatment with sodium oxybate. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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48
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Mioč M, Antelmi E, Filardi M, Pizza F, Ingravallo F, Nobili L, Tassinari CA, Schenck CH, Plazzi G. Sexsomnia: a diagnostic challenge, a case report. Sleep Med 2017; 43:1-3. [PMID: 29482803 DOI: 10.1016/j.sleep.2017.11.1120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/31/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Marina Mioč
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Elena Antelmi
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS - Istituto delle Scienze Neurologiche, AUSL di Bologna, Italy
| | - Marco Filardi
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS - Istituto delle Scienze Neurologiche, AUSL di Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Lino Nobili
- "C. Munari" Center for Epilepsy Surgery, Department of Neuroscience, Niguarda Hospital, Milan, Italy
| | | | - Carlos H Schenck
- Department of Psychiatry, University of Minnesota School of Medicine, Minnesota Regional Sleep Disorders Center, Minneapolis, MN, USA
| | - Giuseppe Plazzi
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS - Istituto delle Scienze Neurologiche, AUSL di Bologna, Italy.
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49
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Ferri L, Filardi M, Moresco M, Pizza F, Vandi S, Antelmi E, Toni F, Zucchelli M, Pierangeli G, Plazzi G. Non-24-Hour Sleep-Wake Rhythm Disorder and Melatonin Secretion Impairment in a Patient With Pineal Cyst. J Clin Sleep Med 2017; 13:1355-1357. [PMID: 28992833 DOI: 10.5664/jcsm.6816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/16/2017] [Indexed: 11/13/2022]
Abstract
ABSTRACT We report the case of a 14-year-old girl with a wide non-compressive pineal cyst, associated with the inability to control her sleep-wake schedule. Actigraphic monitoring showed a 24-hour free-running disorder (tau 26.96 hours). A 24-hour serum melatonin curve assay, with concomitant video-polysomnographic and body-core temperature monitoring, was performed. Melatonin curve showed a blunted nocturnal peak, lower total quantity of melatonin, and prolonged melatonin secretion in the morning, with normal temperature profile and sleep parameters. Treatment with melatonin up to 14 mg at bedtime was initiated with complete realignment of the sleep-wake rhythm (tau 23.93 hours). The role of the pineal cyst in the aforementioned alteration of melatonin secretion and free-running disorder remains controversial, but our case supports the utility of monitoring sleep/wake, temperature, and melatonin rhythms in the diagnostic work-up of pineal cysts associated with free-running disorder.
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Affiliation(s)
- Lorenzo Ferri
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Filardi
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Monica Moresco
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Stefano Vandi
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Francesco Toni
- IRCCS Institute of Neurological Science of Bologna, Division of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Mino Zucchelli
- IRCCS Institute of Neurological Science Bologna, Pediatric Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Giulia Pierangeli
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- DIBINEM - Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
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50
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Tonetti L, Filardi M, Plazzi G, Natale V. Advantages of single step over step-by-step screening for sleep disorders. BIOL RHYTHM RES 2017. [DOI: 10.1080/09291016.2017.1390822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lorenzo Tonetti
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Psychology, University of Bologna, Bologna, Italy
- DIBINEM – Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- DIBINEM – Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCCS – Istituto delle Scienze Neurologiche, AUSL di Bologna, Bologna, Italy
| | - Vincenzo Natale
- Department of Psychology, University of Bologna, Bologna, Italy
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