Exploring cognitive reserve's influence: unveiling the dynamics of digital telerehabilitation in Parkinson's Disease Resilience

Telerehabilitation is emerging as a promising digital method for delivering rehabilitation to Parkinson's Disease (PD) patients, especially in the early stages to promote brain resilience. This study explores how cognitive reserve (CR), the brain's ability to withstand aging and disease, impacts the effectiveness of telerehabilitation. It specifically examines the influence of lifelong cognitive activities on the relationship between neural reserve and improved functional abilities following rehabilitation. In the study, 42 PD patients underwent a 4-month neuromotor telerehabilitation program. CR proxies were assessed using the Cognitive Reserve Index questionnaire (CRIq), brain changes via 3T-MRI, and functional response through changes in the 6-Minute Walk Distance (6MWD). Participants were divided into responders (n = 23) and non-responders (n = 19) based on their 6MWD improvement. A multiple regression model was run to test significant predictors of 6MWD after treatment in each group. The results revealed a significant correlation between 6MWD and CRIq scores, but only among responders. Notably, the CRIq Leisure-Time sub-index, along with baseline 6MWD, were predictors of post-treatment 6MWD. These findings highlight CR's role in enhancing the benefits of telerehabilitation on PD patients' neuromotor functions. Clinically, these results suggest that neurologists and clinicians should consider patients' lifestyles and cognitive engagement as important factors in predicting and enhancing the outcomes of telerehabilitation. The study underscores the potential of CR as both a predictor and booster of telerehabilitation's effects, advocating for a personalized approach to PD treatment that takes into account individual CR levels.

Social cognition in Parkinson's disease and functional movement disorders

INTRODUCTION

Functional movement disorders (FMD) can overlap with Parkinson's disease (PD), and distinguishing between the two clinical conditions can be complex. Framing social cognition (theory of mind) (TOM) disorder, attention deficit, and psychodynamic features of FMD and PD may improve diagnosis.

METHODS

Subjects with FMD and PD and healthy controls (HC) were administered tasks assessing TOM abilities and attention. The psychodynamic hypothesis of conversion disorder was explored by a questionnaire assessing dissociative symptoms. A comprehensive battery of neuropsychological tasks was also administered to FMD and PD.

RESULTS

Although both FMD and PD scored lower than HC on all TOM tests, significant correlations between TOM and neuropsychological tasks were found only in PD but not in FMD. Only PD showed a reduction in attentional control. Dissociative symptoms occurred only in FMD.

DISCUSSION

Cognitive-affective disturbances are real in FMD, whereas they are largely dependent on cognitive impairment in PD. Attentional control is preserved in FMD compared to PD, consistent with the hypothesis that overload of voluntary attentional orientation may be at the basis of the onset of functional motor symptoms. On a psychodynamic level, the confirmation of dissociative symptoms in FMD supports the conversion disorder hypothesis.

CONCLUSION

FMD and PD can be distinguished on an affective and cognitive level. At the same time, however, the objective difficulty often encountered in distinguishing between the two pathologies draws attention to how blurred the boundary between 'organic' and 'functional' can be.

Neural correlates of empathy in mild cognitive impairment

The occurrence of clinically significant changes in empathy is a matter of debate in Alzheimer's disease (AD). Altered empathic mechanisms observed in AD may be a consequence of cognitive impairment, more specifically of reduced mental flexibility and self-regulation. The present study explored possible changes in empathy for subjects in the prodromal phase of AD, namely mild cognitive impairment (MCI) due to AD, and of their neural substrates. Eighteen MCI patients and 20 healthy controls (HC) were included in the study. The Interpersonal Reactivity Index (IRI) questionnaire was administered to each participant. The IRI encompasses four factors: Perspective Taking; Fantasy; Empathic Concern; Personal Distress. MCI patients underwent a magnetic resonance imaging structural examination and were compared to 30 healthy controls (HC-MRI). A limited number of cortical and subcortical regions involved in social cognition was selected as regions of interest (ROIs). MCI individuals obtained lower scores than HC in the Perspective Taking and Fantasy subscales of the IRI, whereas they obtained higher scores on Empathic Concern. Regarding neuroimaging data, a significant correlation emerged between IRI scores and the neural measurements of different regions involved in empathy, especially covering the temporoparietal junction, which is a critical region engaged in both affective and cognitive dimensions of empathy. The results of the present study suggest that a subtle impairment in regulatory mechanisms of empathy may occur very early during the course of AD, possibly as a consequence of neuropathological changes occurring in brain regions involved in social cognition.

Clinical and MRI characterization of apraxic syndrome in corticobasal degeneration: A single-case study

Objective: To identify the cortical and subcortical distribution of atrophy and the disorganization of white matter bundles underlying the apraxic disorders in a patient with corticobasal degeneration (CBD). Method: Patient underwent appropriate neuropsychological tasks aimed at identifying the nature of the apraxic disorder and morphometric structural MRI with whole-brain voxel-wise analysis. Results: Progressive limbkinetic apraxia (LKA) with onset in the right upper limb with subsequent extension to the limbs, trunk, orofacial district, and eye movements was documented, associated with element of ideomotor apraxia (IMA). The MRI study showed grey matter atrophy extending to much of the frontal cortex bilaterally, including the precentral cortex, and into the inferior parietal regions. Caudate and putamen were involved on the left. Significant clusters of white matter atrophy were found in the bilateral superior longitudinal fasciculus (SLF), inferior longitudinal fasciculus (ILF) and corpus callosum (CC). Sensory evoked potentials (SEPs) and motor evoked potentials (MEPs) were normal. Conclusion: Previous observations in CBD indicate lack of inhibitory control from the sensory to the primary motor cortex with dysfunctional frontoparietal and cortico-motoneuron projections. Our neuroimaging data are partially consistent with these observations suggesting that the apraxic disorder in our patient might be produced by the disconnection of the primary motor cortex from the parietal areas that prevents selection and control of muscle movements, in the presence of preserved cortico-motoneuron as demonstrated by normal PEM. Apraxic disorders in CBD are high-level deficits of movement control that spare the motoneuron.

Cognitive Reserve proxies can modulate motor and non-motor basal ganglia circuits in early Parkinson's Disease

Parkinson's Disease (PD) is hallmarked by dysfunctional circuitry between the basal ganglia and dorsolateral-prefrontal cortex. Recently progress has been made in understanding factors contributing to differential susceptibility to pathology mitigating disease-related cognitive decline. Cognitive reserve, the brain processing resources accumulated throughout life while engaged in mentally stimulating activities, can play an important protective role in cognitive performance. We tested the hypothesis that Cognitive Reserve proxies may exert an impact on the basal ganglia and dorsolateral-prefrontal atrophy in early PD. Forty-five early patients with PD and 20 age-gender-matched healthy controls (HC) completed the Cognitive Reserve Index questionnaire to quantify Cognitive Reserve proxies by three indexes (CRI-Education, CRI-Working Activity, CRI-Leisure Time) and a structural MRI examination (3T). Morphometrical indexes for basal ganglia (bilateral putamen, caudate, pallidum volume) and dorsolateral-prefrontal cortex (cortical thickness) were computed. Significant differences between HC and PD were tested by direct comparisons in demographics, cognitive level, and cognitive reserve proxies indexes. Then two multiple regression analyses were performed to identify predictors of the basal ganglia and dorsolateral-prefrontal cortex structural integrity. Regression analysis revealed that basal ganglia volume was significantly predicted by CRI-Education (pFDR = 0.029), sex (pFDR = 0.029), and Total Intracranial Volume (pFDR < 0.001). Instead, the dorsolateral-prefrontal thickness was predicted by CRI-Leisure Time (pFDR = 0.030) and age (pFDR = 0.010). Cognitive Reserve proxies, especially education and leisure-time activities, can play a protective role on the structural integrity of the basal ganglia and dorsolateral-prefrontal cortex, respectively, critical regions hallmarking brain status of early phases of PD.

Production of emotions conveyed by voice in Parkinson's disease: Association between variability of fundamental frequency and gray matter volumes of regions involved in emotional prosody

OBJECTIVE

Parkinson's disease (PD) is associated with impairment in producing emotions conveyed by voice which could depend on motor limitations of the vocal apparatus and/or alterations in emotional processing. This study explores the relationship between the standard deviation of fundamental frequency (F0SD) of emotional speech and the volume of specific gray matter regions.

METHOD

Fifteen PD patients and 15 healthy controls (HC) were asked to produce different emotions vocally elicited by reading short stories. For each vocal track, the F0SD was calculated as index of variability. All subjects underwent a structural magnetic resonance imaging and a voxel-based morphometry analysis. An ad hoc mask of brain regions implicated in emotional prosody was constructed to test the relationship between F0SD and the level of brain atrophy.

RESULTS

PD patients showed lower F0SD values than HC in the expression of anger. Neuroimaging results showed brain atrophy in PD patients in a widespread bilateral network, including frontal areas, left cingulate cortex, parietal areas as well as occipital cortices. In the PD group, a positive correlation was observed between F0SD values of anger and volumes of the bilateral supramarginal gyrus, left thalamus, right inferior frontal gyrus, and amygdala.

CONCLUSIONS

The lower F0SD values observed in PD patients in anger production are consistent with their lower ability to express anger effectively through voice compared to HC. Our data demonstrated the involvement of right-lateralized areas, such as the inferior frontal gyrus and amygdala, which are typically involved in emotional prosody. Disturbances in emotion processing might contribute to speech production deficits in PD, probably in addition to the motor impairment of the articulatory system. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The rising role of cognitive reserve and associated compensatory brain networks in spinocerebellar ataxia type 2

Pre-existing or enhanced cognitive abilities influence symptom onset and severity in neurodegenerative diseases, which improve an individual's ability to deal with neurodegeneration. This process is named cognitive reserve (CR), and it has acquired high visibility in the field of neurodegeneration. However, the investigation of CR has been neglected in the context of cerebellar neurodegenerative disorders. The present study assessed CR and its impact on cognitive abilities in spinocerebellar ataxia type 2 (SCA2), which is a rare cerebellar neurodegenerative disease. We investigated the existence of CR networks in terms of compensatory mechanisms and neural reserve driven by increased cerebello-cerebral functional connectivity. The CR of 12 SCA2 patients was assessed using the Cognitive Reserve Index Questionnaire (CRIq), which was developed for appraising life-span CR. Patients underwent several neuropsychological tests to evaluate cognitive functioning and a functional MRI examination. Network based statistics analysis was used to assess functional brain networks. The results revealed significant correlations of CRIq measures with cognitive domains and patterns of increased connectivity in specific cerebellar and cerebral regions, which likely indicated CR networks. This study showed that CR may influence disease-related cognitive deficits, and it was related to the effective use of specific cerebello-cerebral networks that reflect a CR biomarker.

Decision-making under ambiguity and risk and executive functions in Parkinson's disease patients: A scoping review of the studies investigating the Iowa Gambling Task and the Game of Dice

Evidence shows that patients affected by Parkinson's disease (PD) display the tendency toward making risky choices. This is due, at least in part, to the pathophysiological characteristics of the disease that affects neural areas underlying decision making (DM), in which a pivotal role is played by nonmotor corticostriatal circuits and dopamine. Executive functions (EFs), which can be impaired by PD as well, may sustain optimal choices in DM processes. However, few studies have investigated whether EFs can support PD patients to make good decisions. Adopting the scoping review approach, the present article is designed to deepen the cognitive mechanisms of DM under conditions of ambiguity and risk (that are conditions common to everyday life decisions) in PD patients without impulse control disorders. We focused our attention on the Iowa Gambling Task and the Game of Dice Task, because they are the most commonly used and reliable tasks to assess DM under ambiguity and under risk, respectively, and analyzed the performances in such tasks and their relationships with EFs tests in PD patients. The analysis supported the relationships between EFs and DM performance, especially when a higher cognitive load is required to make optimal decisions, as it happens under conditions of risk. Possible knowledge gaps and further research directions are suggested to better understand DM mechanisms in PD sustaining patients' cognitive functioning and preventing negative consequences in everyday life derived from suboptimal decisions.

Self-assessment of empathy uncovers defective self-awareness in mild cognitive impairment

OBJECTIVE

Self-assessment scales are broadly used to evaluate empathy in neurological patients, but it is conceivable that some discrepancy with caregiver evaluation may emerge as consequence of reduced self-awareness. The aim of the present study was to verify the presence of discrepancies in the self-assessment of empathy in subjects with mild cognitive impairment (MCI) and to explore their neural correlates.

METHOD

Twenty MCI patients and 38 healthy controls (HCs) underwent the Interpersonal Reactivity Index (IRI), exploring the following four aspects of empathy: perspective taking (PT), fantasy, empathic concern, and personal distress. The questionnaire was administered in two modalities: self-administered, and administered to an informant, and the scores were compared. The correlation between discrepancies and regional cortical thickness was assessed.

RESULTS

The self-administered version of IRI showed higher PT scores in MCI as compared to HC (p = .017), with no differences detected in the other subscales. The difference between the scores obtained in the self-administered and in the informant-administered IRI-PT was significantly higher in MCI than in HCs (p = .006).

CONCLUSION

The self-assessment of empathy in subjects with MCI may be misleading because of a tendency toward an overestimation of the PT ability, typically considered as a cognitive component of empathy. Our results may reflect a particular aspect of reduced self-awareness in MCI subjects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gender may be related to the side of the motor syndrome and cognition in idiopathic Parkinson's disease

BACKGROUND

and Sex and cognitive profile may be related to the laterality of motor symptoms in idiopathic Parkinson's disease.

INTRODUCTION

Parkinson's disease (PD) is well recognised as an inherently asymmetric disease with unilateral onset of motor symptoms. The laterality of motor symptoms may be linked to sex, clinical and demographic variables, and neuropsychological disorders. However, the available data are inconsistent. This study aimed to explore the potential association between the laterality of motor symptoms and clinical and demographic variables and deficits in specific cognitive domains.

MATERIAL AND METHODS

We retrospectively recruited 97 participants with idiopathic PD without dementia; 60 presented motor symptoms on the left side and 37 on the right side. Both groups were comparable in terms of age, age at disease onset, disease duration, and severity of the neurological deficits according to the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale.

RESULTS

Participants with left-side motor symptoms scored lower on the Schwab and England Activities of Daily Living scale. Our sample included more men than women (67% vs. 33%). Both sexes were not equally represented in the 2 groups: there were significantly more men than women in the group of patients with left-side motor symptoms (77% vs. 23%), whereas the percentages of men and women in the group of patients with right-side motor symptoms were similar (51% vs. 49%). Both groups performed similarly in all neuropsychological tasks, but women, independently of laterality, performed better than men in the naming task.

CONCLUSION

We found a clear prevalence of men in the group of patients with left-side motor symptoms; this group also scored lower on the Schwab and England Scale. Female sex was predictive of better performance in the naming task. Sex should always be considered in disorders that cause asymmetric involvement of the brain, such as PD.

Placebo and Nocebo Effects as Bayesian-Brain Phenomena: The Overlooked Role of Likelihood and Attention

The Bayesian-brain framework applied to placebo responses and other mind-body interactions suggests that the effects on the body result from the interaction between priors, such as expectations and learning, and likelihood, such as somatosensorial information. Significant research in this area focuses on the role of the priors, but the relevance of the likelihood has been surprisingly overlooked. One way of manipulating the relevance of the likelihood is by paying attention to sensorial information. We suggest that attention can influence both precision and position (i.e., the relative distance from the priors) of the likelihood by focusing on specific components of the somatosensorial information. Two forms of attention seem particularly relevant in this framework: mindful attention and selective attention. Attention has the potential to be considered a "major player" in placebo/nocebo research, together with expectations and learning. In terms of application, relying on attentional strategies as "amplifiers" or "silencers" of sensorial information could lead to an active involvement of individuals in shaping their care process and health. In this contribution, we discuss the theoretical implications of these intuitions with the aim to provide a comprehensive framework that includes Bayesian brain, placebo/nocebo effects, and the role of attention in mind-body interactions.

Resting-state functional connectivity is modulated by cognitive reserve in early Parkinson's disease

Background

Fronto-striatal disconnection is thought to be at the basis of dysexecutive symptoms in patients with Parkinson's disease (PD). Multiple reserve-related processes may offer resilience against functional decline. Among these, cognitive reserve (CR) refers to the adaptability of cognitive processes.

Objective

To test the hypothesis that functional connectivity of pathways associated with executive dysfunction in PD is modulated by CR.

Methods

Twenty-six PD patients and 24 controls underwent resting-state functional magnetic resonance imaging. Functional connectivity was explored with independent component analysis and seed-based approaches. The following networks were selected from the outcome of the independent component analysis: default-mode (DMN), left and right fronto-parietal (l/rFPN), salience (SalN), sensorimotor (SMN), and occipital visual (OVN). Seed regions were selected in the substantia nigra and in the dorsolateral and ventromedial prefrontal cortex for the assessment of seed-based functional connectivity maps. Educational and occupational attainments were used as CR proxies.

Results

Compared with their counterparts with high CR, PD individuals with low CR had reduced posterior DMN functional connectivity in the anterior cingulate and basal ganglia, and bilaterally reduced connectivity in fronto-parietal regions within the networks defined by the dorsolateral and ventrolateral prefrontal seeds. Hyper-connectivity was detected within medial prefrontal regions when comparing low-CR PD with low-CR controls.

Conclusion

CR may exert a modulatory effect on functional connectivity in basal ganglia and executive-attentional fronto-parietal networks. In PD patients with low CR, attentional control networks seem to be downregulated, whereas higher recruitment of medial frontal regions suggests compensation via an upregulation mechanism. This upregulation might contribute to maintaining efficient cognitive functioning when posterior cortical function is progressively reduced.

The Cerebellum Is a Key Structure in the Neural Network for Mentalizing: An MRI Study in the Behavioral Variant of Frontotemporal Dementia

The behavioural variant of frontotemporal dementia (bvFTD) is primarily characterized by deficits in social behaviour and theory of mind (ToM). Although a consensus has been reached on the roles of the cerebellum in social cognition and ToM, its specific contribution to social impairments of bvFTD has never been specifically investigated. The aim of this study was to assess cerebellar structural and functional changes in patients with bvFTD and their potential association with ToM deficits of patients. Therefore, 15 patients with bvFTD and 34 healthy subjects underwent an MRI examination. Voxel-based morphometry was used to assess cerebellar (GM) changes, and a seed-based analysis was performed to test cerebello-cerebral functional connectivity (FC). The performance of bvFTD patients in a ToM task was then correlated with FC patterns. Compared to healthy subjects, patients with bvFTD showed significant cerebellar GM loss specifically involving cerebellar Crus I-II. Additionally, FC changes FC were observed between the cerebellum and cerebral regions related to ToM. Interestingly, patterns of changes in cerebello-cerebral FC correlated with altered ToM performances explored using the "Reading the Mind with the Eyes" test (RMET) of patients. The present findings suggest that specific changes in cerebello-cerebral FC may underlie ToM alterations in patients with bvFTD.

“Mens Sana in Corpore Sano”: The Emerging Link of Motor Reserve with Motor and Cognitive Abilities and Compensatory Brain Networks in SCA2 Patients

The ability to resiliently cope with neuropathological lesions is a key scientific concern. Accordingly, this study aims to investigate whether motor reserve (MR), likely to be boosted by exercise engagement in a lifetime, affects motor symptom severity, cognitive functioning, and functional brain networks in spinocerebellar ataxia type 2 (SCA2)—a cerebellar neurodegenerative disease. The MR of 12 SCA2 patients was assessed using the Motor Reserve Index Questionnaire (MRIq), developed ad hoc for estimating lifespan MR. The International Cooperative Ataxia Rating Scale was used to assess clinical motor features, and neuropsychological tests were used to evaluate cognitive functioning. Patients underwent an MRI examination, and network-based statistics (NBS) analysis was carried out to detect patterns of functional connectivity (FC). Significant correlations were found between MRIq measures and the severity of motor symptoms, educational and intellectual levels, executive function, and processing speed. NBS analysis revealed a higher FC within subnetworks consisting of specific cerebellar and cerebral areas. FC patterns were positively correlated with MRIq measures, likely indicating the identification of an MR network. The identified network might reflect a biomarker likely to underlie MR, influenced by education and cognitive functioning, and impacting the severity of motor symptoms.

Theory of Mind in migraine and medication-overuse headache: A cross-sectional study

Background

Theory of Mind (ToM) is the ability to predict and anticipate others' behaviors through the mental state attribution process. This study aims to investigate the ToM in patients with medication-overuse headache (MOH) and episodic migraine (EM) and to compare it with healthy controls (HC).

Methods

This study enrolled patients with MOH, patients with EM, and HC. ToM was assessed through the Theory of Mind Assessment Scale (ThOMAS), which includes four subscales: Scale A, I-Me, Scale B, Other-Self, Scale C, I-Other, and Scale D, Other-Me, through the Reading the Mind in the Eyes test (RMET), which measures complex emotion recognition, and through the Toronto Alexithymia Scale (TAS-20), which measures alexithymia. Concomitant psychiatric disturbances were evaluated through the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Dissociative Experiences Scale-II.

Results

The study involved 21 patients with EM, 22 patients with MOH, and 18 HC. In all the four subscales of the ThOMAS, there was a significant difference between HC, EM, and MOH patients: Scale A (p = 0.009), Scale B (p = 0.004), Scale C (p = 0.039), and Scale D (p = 0.008). In the RMET, MOH patients had worse performances than EM patients and HC (p = 0.039). MOH group exhibited higher levels of alexithymia when compared to the HC (p = 0.033) and higher levels of anxiety than HC (p = 0.001).

Conclusion

MOH patients showed a subtle psychopathological pattern characterized by impaired social adaptation.

Beyond the CAG triplet number: exploring potential predictors of delayed age of onset in Huntington's disease

OBJECTIVE

Huntington's disease (HD) is a genetic neurodegenerative disease characterized by cognitive, motor, and psychiatric dysfunction. It is caused by an expansion of the trinucleotide repeat sequence cytosine-adenine-guanine (CAG) in the Huntingtin gene on chromosome 4. Onset typically occurs in the fourth or fifth decade, ranging from childhood to late adulthood. The CAG triplet number is generally inversely proportional to the age of onset (AOO), but the repeat number only accounts for ∼70% of the variability in AOO. Several studies demonstrated the impact of genetic modifiers on age of disease onset. In addition to genetics, we also explored the demographic, anamnestic, and socio-environmental factors that can affect AOO, to help us understand the non-genetic variability of age of onset in HD.

METHODS

We analyzed the retrospective data of the ENROLL-HD global registry study, particularly focusing on the continuum of ages, to include sociodemographic, genetic, and anamnestic psychobehavioral variables in a multivariate regression model aimed at identifying the potential predictors of age of motor onset (n = 5053). We ran the same regression model in the sample of subjects who had the same number of triplets (41 CAG, n = 593) and in the sample whose family history was absent/unknown (n = 630).

RESULTS

Patients with delayed onset more frequently have unknown/missing family history, are married or widowed, live in larger urbanized contexts and have a lower educational level. Individuals with earlier onset more frequently develop psychobehavioral symptoms.

CONCLUSIONS

In the past, the HD gene was considered the epitome of genetic determinism. Our results are consistent with recent evidence that other factors might modulate its impact. These findings allow characterizing the determinants of AOO beyond the CAG expansions and provide valuable information for stratifying patients for future clinical trial designs.

Neuroanatomical Correlates of Semantic Features of Narrative Speech in Semantic and Logopenic Variants of Primary Progressive Aphasia

The semantic variant of a primary progressive aphasia (svPPA) is characterized by progressive disruption of semantic knowledge. This study aimed to compare the semantic features of words produced during a narrative speech in svPPA and the logopenic variant of PPA (lvPPA) and to explore their neuroanatomical correlates. Six patients with svPPA and sixteen with lvPPA underwent narrative speech tasks. For all the content words, a semantic depth index (SDI) was determined based on the taxonomic structure of a large lexical database. Study participants underwent an MRI examination. Cortical thickness measures were extracted according to the Desikan atlas. Correlations were computed between SDI and the thickness of cortical regions. Mean SDI was lower for svPPA than for lvPPA. Correlation analyses showed a positive association between the SDI and the cortical thickness of the bilateral temporal pole, parahippocampal and entorhinal cortices, and left middle and superior temporal cortices. Disruption of semantic knowledge observed in svPPA leads to the production of generic terms in narrative speech, and the SDI may be useful for quantifying the level of semantic impairment. The measure was associated with the cortical thickness of brain regions associated with semantic memory.

Cognitive reserve: a multidimensional protective factor in Parkinson's disease related cognitive impairment

We explored the association between cognitive reserve (CR) and Parkinson' s disease (PD) related cognitive deterioration.Forty PD patients and 12 matched healthy controls (HC) were enrolled. The PD group was balanced for the presence/absence of cognitive impairment. All participants underwent MOCA. CR was measured by the Brief Intelligence Test, and a new comprehensive tool, named Cognitive Reserve Test (CoRe-T), including sections on leisure activities and creativity.Participants with higher CR obtained a better MOCA score irrespective of the group they belonged to. At the same time, irrespective of the CR level, the performance of the HC group was always better in comparison to the PD group. Within the PD group, a higher frequency of leisure activities was associated to be cognitively unimpaired, independently by the severity of motor symptoms and age.CR could help to cope with PD-related cognitive decline. Its multidimensional nature could have important applications in prevention and rehabilitation interventions.

Writing errors in primary progressive aphasia

Peripheral errors in writing, that is errors produced download the spelling, have been occasionally described in primary progressive aphasia (PPA), but the possibility that these errors might be a marker of parkinsonism associated to some subtypes of PPA has not been explored. We investigated whether errors of peripheral nature characterize the writing disorder in PPA when associated with parkinsonian signs (PSs). Subgroups of PPA without PSs and with PSs were studied. The proportion of the central and peripheral errors in writing words and pseudowords was calculated in each group. In writing words, central errors significantly exceeded peripheral errors in subgroups without PSs. The higher the number of peripheral errors, the higher the probability of presenting PSs. No relation emerged between any error and the Unified Parkinson's Disease Rating Scale, but both types of errors correlated with measures of cognitive ability. Peripheral errors emerge when PSs are associated with PPA and may be linked to a decay of the cognitive control on movement, possibly involving the right hemisphere. Peripheral errors have clinical relevance in PPA, to the extent that they may assume the significance of a marker of specific subtypes and can help to outline the specific clinical picture of individual patients.

Impaired processing of conspecifics in Parkinson's disease

Experimental evidence indicates that the inferior frontal gyrus (IFG) processes emotional/affective features crucial to elaborate knowledge about social groups and that knowledge of social concepts is stored in the anterior temporal lobe (ATL).We investigated whether knowledge about social groups is impaired in Parkinson's disease (PD), in which dysfunctional connectivity between IFG and ATL has been demonstrated.PD patients (N = 20) and healthy controls (HC, N = 16) were given a lexical decision task in a semantic priming paradigm: the prime-targets included 144 words and 144 pseudowords, each preceded by three types of prime ("animals," "things," "persons"). Out of these 288 prime-targets, forty-eight were congruent (same category) and 96 incongruent (different category). Out of 48 congruent prime-targets, 24 denoted social items and 24 nonsocial items. Thus, four types of trials were obtained: congruent social; congruent nonsocial; incongruent social; incongruent nonsocial.Congruent target-words were recognized better than incongruent target-words by all groups. The semantic priming effect was preserved in PD; however, accuracy was significantly lower in PD than in HC in social items. No difference emerged between the two groups in nonsocial items.Impaired processing of words denoting social groups in PD may be due to impairment in accessing the affective/emotional features that characterize conceptual knowledge of social groups, for the functional disconnection between the IFG and the ATL.

Theory of mind: A clue for the interpretation of functional movement disorders

Objectives

Functional movement disorders (FMD) refer to a heterogeneous group of manifestations incongruent with known neurological diseases. Functional neuroimaging studies in FMD indicate the overlap between cerebral regions in which abnormal activation occurs and those considered crucial for theory of mind (ToM), the ability to attribute mental states. The aim of this study was to explore whether FMD might be related to ToM disorders to the extent that they reduce the ability to make inferences about the mental states underlying motor behaviour during social interaction.

Materials & Methods

Eighteen subjects with FMD and 28 matched healthy controls (HC) were given a ToM battery. The severity of FMD was rated by the Simplified‐FMD Rating Scale (S‐FMDRS). Dissociative symptoms were evaluated by the Dissociative Experiences Scale (DES‐II).

Results

FMD scored worse than the HC in most ToM tasks: second‐order False Beliefs (p = .005), Faux‐Pas Recognition Test (p < .001) and Reading the Mind in the Eyes Test (p = .020); control questions elicited normal scores. The DES‐II indicated dissociative‐borderline psychopathology and negatively correlated with accuracy on the second‐order False Belief (Spearman's rho = −.444; p = .032); the positive correlation between DES‐II and severity of motor symptoms (S‐FMDRS) approached significance (Spearman's rho test = .392; p = .054). ToM disorders were not correlated with S‐FMDRS, due to the typical variability in FMD over time with regard to the severity of symptoms and the district of body involved.

Conclusions

Our results are consistent with the hypothesis that FMD are related to ToM deficits, and future studies are needed to define the specific nature of this relationship.

Clinical and genetic characteristics of late-onset Huntington's disease in a large European cohort

Background and purpose

Huntington's disease (HD) is an autosomal dominant condition caused by CAG‐triplet repeat expansions. CAG‐triplet repeat expansion is inversely correlated with age of onset in HD and largely determines the clinical features. The aim of this study was to examine the phenotypic and genotypic correlates of late‐onset HD (LoHD) and to determine whether LoHD is a more benign expression of HD.

Methods

This was a retrospective observational study of 5053 White European HD patients from the ENROLL‐HD database. Sociodemographic, genetic and phenotypic variables at baseline evaluation of subjects with LoHD, common‐onset HD (CoHD) and young‐onset HD (YoHD) were compared. LoHD subjects were compared with healthy subjects (HS) aged ≥60 years. Differences between the CoHD and LoHD groups were also explored in subjects with 41 CAG triplets, a repeat number in the lower pathological expansion range associated with wide variability in age at onset.

Results

Late‐onset HD presented predominantly as motor‐onset disease, with a lower prevalence of both psychiatric history and current symptomatology. Absent/unknown HD family history was significantly more common in the LoHD group (31.2%) than in the other groups. The LoHD group had more severe motor and cognitive deficits than the HS group. Subjects with LoHD and CoHD with 41 triplets in the larger allele were comparable with regard to cognitive impairment, but those with LoHD had more severe motor disorders, less problematic behaviors and more often an unknown HD family history.

Conclusions

It is likely that cognitive disorders and motor symptoms of LoHD are at least partly age‐related and not a direct expression of the disease. In addition to CAG‐triplet repeat expansion, future studies should investigate the role of other genetic and environmental factors in determining age of onset.

The rehabilitation of object agnosia and prosopagnosia: A systematic review

BACKGROUND

Agnosia for objects is often overlooked in neuropsychology, especially with respect to rehabilitation. Prosopagnosia has been studied more extensively, yet there have been few attempts at training it. The lack of training protocols may partially be accounted for by their relatively low incidence and specificity to sensory modality. However, finding effective rehabilitations for such deficits may help to reduce their impact on the social and psychological functioning of individuals.

OBJECTIVE

Our aim in this study was to provide clinicians and researchers with useful information with which to conduct new studies on the rehabilitation of object agnosia and prosopagnosia. To accomplish this, we performed a systematic and comprehensive review of the effect of neuropsychological rehabilitation on visual object and prosopagnosia.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. In addition, the Single-Case Experimental Design (SCED) and the Critical Appraisal Skills Programme (CASP) scales were used to assess the quality of reporting.

RESULTS

Seven articles regarding object agnosia, eight articles describing treatments for prosopagnosia, and two articles describing treatments for both deficits were included.

CONCLUSIONS

In the light of the studies reviewed, treatments based on analysis of parts seem effective for object agnosia, while prosopagnosia appears to benefit most from treatments relying on holistic/configural processing. However, more attempts at rehabilitation of face and object agnosia are needed to clarify the mechanisms of these processes and possible rehabilitations. Moreover, a publication bias could mask a broader attempt to find effective treatments for visual agnosia and leaving out studies that are potentially more informative.

Neuroimaging Biomarkers Predicting the Efficacy of Multimodal Rehabilitative Intervention in the Alzheimer's Dementia Continuum Pathology

In this work we aimed to identify neural predictors of the efficacy of multimodal rehabilitative interventions in AD-continuum patients in the attempt to identify ideal candidates to improve the treatment outcome. Subjects in the AD continuum who participated in a multimodal rehabilitative treatment were included in the analysis [n = 82, 38 Males, mean age = 76 ± 5.30, mean education years = 9.09 ± 3.81, Mini Mental State Examination (MMSE) mean score = 23.31 ± 3.81]. All subjects underwent an MRI acquisition (1.5T) at baseline (T0) and a neuropsychological evaluation before (T0) and after intervention (T1). All subjects underwent an intensive multimodal cognitive rehabilitation (8–10 weeks). The MMSE and Neuropsychiatric Inventory (NPI) scores were considered as the main cognitive and behavioral outcome measures, and Delta change scores (T1–T0) were categorized in Improved (ΔMMSE > 0; ΔNPI < 0) and Not Improved (ΔMMSE ≤ 0; ΔNPI ≥ 0). Logistic Regression (LR) and Random Forest classification models were performed including neural markers (Medial Temporal Brain; Posterior Brain (PB); Frontal Brain (FB), Subcortical Brain indexes), neuropsychological (MMSE, NPI, verbal fluencies), and demographical variables (sex, age, education) at baseline. More than 50% of patients showed a positive effect of the treatment (ΔMMSE > 0: 51%, ΔNPI < 0: 52%). LR model on ΔMMSE (Improved vs. Not Improved) indicate a predictive role for MMSE score (p = 0.003) and PB index (p = 0.005), especially the right PB (p = 0.002) at baseline. The Random Forest analysis correctly classified 77% of cognitively improved and not improved AD patients. Concerning the NPI, LR model on ΔNPI (Improved vs. Not Improved) showed a predictive role of sex (p = 0.002), NPI (p = 0.005), PB index (p = 0.006), and FB index (p = 0.039) at baseline. The Random Forest reported a classification accuracy of 86%. Our data indicate that cognitive and behavioral status alone are not sufficient to identify best responders to a multidomain rehabilitation treatment. Increased neural reserve, especially in the parietal areas, is also relevant for the compensatory mechanisms activated by rehabilitative treatment. These data are relevant to support clinical decision by identifying target patients with high probability of success after rehabilitative programs on cognitive and behavioral functioning.

Decision making in Parkinson's disease: An analysis of the studies using the Iowa Gambling Task

In Parkinson's disease (PD) impairments in decision making can occur, in particular because of the tendency toward risky and rewarding options. The Iowa Gambling Task has been widely used to investigate decision processes involving these options. The task assesses the ability to manage risk and to learn from feedback. The present paper aims at critically examining those studies in which this task has been administered to PD patients, in order to understand possible anomalies in patients' decision processes and which variables are responsible for that. A meta‐analysis has been conducted as well. Features of the task, sociodemographic and clinical aspects (including daily drugs intake), cognitive conditions and emotional disorders of the patients have been taken into account. Neural correlates of decision‐making competences were considered. It emerged that PD patients show a trend of preference toward risky choices, probably due to an impairment in anticipating the unrewarding consequences or to an insensitiveness to punishment. The possible role played by dopamine medications in decision making under uncertain conditions, affecting basal ganglia and structures involved in the limbic loop, was discussed. Attention has been focused on some aspects that need to be investigated in further research, in order to delve into this issue and promote patients' quality of life.

What about the caregiver? A journey into Parkinson's disease following the burden tracks

OBJECTIVES

To investigate caregivers and patients characteristics related to different dimensions of burden in Parkinson's disease (PD).

METHODS

55 pairs of PD patients and caregivers were recruited. The burden was evaluated with the Caregiver Burden Inventory (CBI). Multivariate analysis was applied to evaluate the impact of caregivers' and patients' characteristics on the varying aspects of burden.

RESULTS

ADL score was the dominant predictor for the total score and all dimensions of CBI, except for the social burden, which is strongly predicted by the motor severity of PD. As one can easily imagine, the Total CBI decreases as the ADL score increases.

DISCUSSION

An increased appreciation for characteristics of caregiver burden is a fundamental aspect of the patient's global evaluation. Clinicians may need to directly probe for these factors in the caregiver as they may not be elicited routinely.

Gender may be related to the side of the motor syndrome and cognition in idiopathic Parkinson's disease

BACKGROUND

and Sex and cognitive profile may be related to the laterality of motor symptoms in idiopathic Parkinson's disease.

INTRODUCTION

Parkinson's disease (PD) is well recognised as an inherently asymmetric disease with unilateral onset of motor symptoms. The laterality of motor symptoms may be linked to sex, clinical and demographic variables, and neuropsychological disorders. However, the available data are inconsistent. This study aimed to explore the potential association between the laterality of motor symptoms and clinical and demographic variables and deficits in specific cognitive domains.

MATERIAL AND METHODS

We retrospectively recruited 97 participants with idiopathic PD without dementia; 60 presented motor symptoms on the left side and 37 on the right side. Both groups were comparable in terms of age, age at disease onset, disease duration, and severity of the neurological deficits according to the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr scale.

RESULTS

Participants with left-side motor symptoms scored lower on the Schwab and England Activities of Daily Living scale. Our sample included more men than women (67% vs. 33%). Both sexes were not equally represented in the 2 groups: there were significantly more men than women in the group of patients with left-side motor symptoms (77% vs. 23%), whereas the percentages of men and women in the group of patients with right-side motor symptoms were similar (51% vs. 49%). Both groups performed similarly in all neuropsychological tasks, but women, independently of laterality, performed better than men in the naming task.

CONCLUSION

We found a clear prevalence of men in the group of patients with left-side motor symptoms; this group also scored lower on the Schwab and England Scale. Female sex was predictive of better performance in the naming task. Sex should always be considered in disorders that cause asymmetric involvement of the brain, such as PD.

Psychopathological profile in COVID-19 patients including healthcare workers: the implications

OBJECTIVE

The effects of COVID-19 seem to extend beyond the physical pain and is showing psychiatric implications as well. Moreover, psychopathological implications seem to last also after patients' discharge. Our goal is to investigate the psychological impact and psychopathological outcome of patients affected by COVID-19.

PATIENTS AND METHODS

We have engaged 34 patients with COVID-19 conditions [eight of them were healthcare workers patients (HCW)] hospitalized at "Policlinico Gemelli Foundation" of Rome, Italy. All patients were evaluated through the Impact of Event Scale-Revised (IES-R) and the Symptom Checklist 90-R (SCL-90-R) first, during their hospitalization (baseline), and then, after 4 months from hospital discharge (follow-up), through phone interviews.

RESULTS

At baseline, 82% of patients revealed from mild to severe psychological impact of COVID-19, according to the IES-R. At follow-up, the mean IES-R total score was significantly decreased (p<0.001) even if almost half (46.6%) of our cohort still showed it. HCW patients showed a significantly higher score than other patients at IES-R scale, both at baseline (p=0.005) and at follow-up (p<0.001). Moreover, at 4 months from discharge, they showed a significantly higher percentage of moderate and severe distress (p=0.015). In addition to this, at follow-up, our cohort of patients showed an increase of anxiety symptoms, even if not significant compared to baseline (46.7% vs. 35.3% respectively; p=1.000), and HCW patients suffered more sleep disorders (p=0.019) and anxiety symptoms (p=0.019) compared to other patients.

CONCLUSIONS

We indicate the importance of assessing psychopathology of COVID-19 survivors, monitoring their changes over time, and providing psychological support to improve their psychological well-being.

Uncinate fasciculus and word selection processing in Parkinson's disease

We explored with Diffusion Tensor Imaging (DTI) technique whether the ability to select words among competitive alternatives during word production is related to the integrity of the left uncinate fasciculus (UF) in Parkinson's disease (PD). Nineteen PD patients (10 right-sided and 9 left-sided) and 17 matched healthy controls (HC) took part in the study. Participants were asked to derive nouns from verbs (reading from to read) or to generate verbs from nouns (to build from building). Noun and verb production, in this task, differ in the number of lexical entries among which the response is selected, as the noun must be selected from a larger number of alternatives compared to the verb, and thus is more demanding of processing resources. DTI evaluation was obtained for each subject. Fractional anisotropy (FA) and mean diffusivity (MD) maps were derived from DTI and median FA and MD values were computed within the left and right UF. Then, FA and MD of the left and right UF were correlated with noun and verb production. Both the left and right UF-FA correlated with the global (noun + verb) production and noun production in the whole PD group. In right-sided PD, correlations were found with the contralateral UF-FA; in left-sided PD the correlations emerged with both the left and right UF-FA. The most difficult task, noun production, significantly correlated with the right UF-FA in left-sided PD. The left UF is involved in word selection processes, and the right UF intervenes when the selection is particularly demanding of attentional resources.

Prevalence of Obsessive-Compulsive Symptoms in Elderly Parkinson Disease Patients: A Case-Control Study

BACKGROUND

The clinical picture of obsessive-compulsive disorder encompasses a broad range of symptoms that are related to multiple psychological domains, including perception, cognition, emotion, and social relatedness. As obsessive-compulsive symptoms (OCS) frequently have an early onset, there are limited data about OCS in older populations (≥65 years) and, in particular, in elderly subjects with Parkinson disease (PD).

OBJECTIVE

This study aimed to estimate the prevalence of OCS using a self-report measure (Obsessive-Compulsive Inventory-Revised) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients compared to a comparison group of similarly aged healthy volunteers.

RESULTS

The mean age was 74 ± 6 years in the PD patients and 73 ± 7 years in the comparison group. The mean disease duration was 9.6 ± 5.8 years. Among the PD patients, 30.7% reported at least one OCS or a related disorder compared to 21.1% in the comparison group. Hoarding was significantly more common in PD patients than in the comparison group.

CONCLUSIONS

Subclinical OCS were present at a high percentage in both PD patients and comparison group. The OCS phenotype in PD may present differently, as hoarding was more common in PD patients.

Cognitive impairment and cardiovascular disease related to alexithymia in a well-controlled HIV-infected population

Both cognitive diseases and alexithymia may be associated with HIV. Moreover, alexithymia has been linked to cardiovascular (CV) diseases. Our aim was to explore the prevalence of alexithymia and its associations with neurocognitive disorders (HAND) and CV risk factors in a well-controlled HIV-positive population. We consecutively enrolled 140 HIV-positive individuals on antiretroviral therapy and 35 healthy subjects matched for age, education and gender. In all participants alexithymia was explored by the 20-item Toronto Alexithymia Scale. For HIV-positive subjects also data about CV risk factors were collected, and a comprehensive neuropsychological examination was administered; HAND was defined according to Frascati criteria. Patients and controls did not differ in the proportion of alexithymic status (10% vs. 11%; p=0.761). Among HIV-positive patients, alexithymic participants presented a higher prevalence of diabetes (21% vs. 3%, p=0.035) and hypertension (36% vs. 13%, p= 0.037) compared to non-alexithymic. About 30% (n=41) of HIV-positive patients met criteria for asymptomatic HAND. Alexithymia was not independently associated with a higher risk of HAND (p=0.189). Analyzing each cognitive domain, alexithymia showed an independent association with an abnormal performance (OR 1.08; p=0.037) only in psychomotor speed. In conclusion, in the context of a well-controlled HIV infection, we found a low prevalence of alexithymia comparable to healthy controls. Alexithymia was linked to higher risk of CV disease in the HIV-positive population, but with a rate similar to that previously estimated in the HIV-negative alexithymic. Finally, alexithymia was clearly associated to cognitive impairment only in the psychomotor speed domain, suggesting a common fronto-striatal system dysregulation.

Prevalence of Impulsive-Compulsive Symptoms in Elderly Parkinson's Disease Patients: A Case-Control Study

BACKGROUND

Impulse-control disorders (ICDs) are frequently described in patients with Parkinson's disease (PD), particularly among those treated with dopaminergic medications, but data on the prevalence of ICDs in elderly populations are lacking.

OBJECTIVE

The aim of this study was to estimate the prevalence of ICDs by using an Italian validation of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients and in a control group of similarly aged healthy volunteers.

METHODS

Using the United Kingdom Parkinson's Disease Society Brain Bank diagnostic criteria, we included 115 consecutive PD and 105 healthy controls. They were recruited from June 2014 to December 2015. All participants completed the self-administered QUIP-Anytime for assessment of ICDs occurring any time during the course of PD.

RESULTS

Mean ± SD age was 75.7 ± 7.0 years in the PD patients and 76.1 ± 7.0 years in the control group. The mean disease duration was 6.8 years (range, 1-26 years). Among the PD patients, 44.7% (n = 51) had at least 1 ICD or related disorder compared to 25.2% (n = 26) in the control group (between-group difference: P = .003). Hypersexuality and compulsive shopping were significantly more common in the PD group than in the control group (P < .05). The prevalence of other compulsive behaviors was 42.5% in the PD group and 38.9% in the control group (P = NS). The Italian version of the QUIP-Anytime showed high test-retest reliability (κ > 0.70 for all items).

CONCLUSIONS

Our data confirm a high prevalence of ICD symptoms in elderly PD patients, approximately twice that seen in the general population.

Non-linear spelling in writing after a pure cerebellar lesion

The most common deficits in processing written language result from damage to the graphemic buffer system and refer to semantic and lexical problems or difficulties in phoneme-graphene conversion. However, a writing disorder that has not yet been studied in depth is the non-linear spelling phenomenon. Indeed, although some cases have been described, no report has exhaustively explained the cognitive mechanism and the anatomical substrates underlying this process. In the present study, we analyzed the modality of non-linear writing in a patient affected by a focal cerebellar lesion, who presented with an alteration of the normal trend to write the order of the letters. Based on this evidence, we analyzed the functional connectivity between the cerebellum and the brain network that subtends handwriting and demonstrated how the cerebellar lesion of the patient affected the connections between the cerebellum and cortical areas that support the anatomical system of writing. This is the first report of non-linear spelling in a patient with a lesion outside the fronto-parietal network, specifically with a focal cerebellar lesion. We propose that non-linear writing can be interpreted in view of the role of the cerebellum in timing and sequential processing. Thus, considering the current functional connectivity data, we hypothesize that the cerebellum might be relevant in the mechanism that allows the correct activation timing of letters within a string and placement of the letters in a specific sequential writing order.

Emotional valence may influence memory performance for visual artworks in Parkinson's disease

BACKGROUND

Non-motor symptoms in Parkinson's disease (PD) include reduced reactivity to emotional stimuli. Visual artworks can evoke emotional responses. Motor, sensorial and cognitive networks implicated in the aesthetic experience and in the emotional-reward domain show a significant overlap with the pathological nigrostriatal, mesocortical and mesolimbic circuitry that characterises PD.

METHODS

Memory enhancement by emotional stimuli such as visual artwork-stimuli was explored in 12 right-sided and 12 left-sided non-demented-PD patients, 12 Alzheimer's disease patients (AD) and 13 healthy controls (HC). Ten emotional and 10 non-emotional stimuli were previously identified based on the ratings of the emotional impact provided by 45 non-PD subjects on 82 pictures of paintings. Only figurative artworks were included. Patients and HC were requested to rate on a 7-point scale the emotional impact of 20 pictures; they were then requested to recognise the 20 pictures amongst 20 distractors (incidental memory task).

RESULTS AND CONCLUSION

Recognition of emotional stimuli was more accurate compared to non-emotional stimuli in AD, left-sided PD and HC; right-sided PD did not show sensitivity to the emotional valence of the stimuli suggesting the involvement of the nigrostriatal, mesocortical and mesolimbic circuitry of the left hemisphere in the emotional-reward system related to the aesthetic experience.

The role of cognitive reserve in cognitive aging: what we can learn from Parkinson's disease

Parkinson's disease (PD) typically occurs in elderly people and some degree of cognitive impairment is usually present. Cognitive reserve (CR) theory was proposed to explain the discrepancy between the degree of brain pathologies and clinical manifestations. We administered a comprehensive neuropsychological battery to 35 non-demented participants affected by PD. All participants underwent also the Cognitive Reserve Index questionnaire and the Brief Intelligence Test as proxies for CR. Relationships between CR and cognitive performance were investigated by linear regression analyses, adjusting for significant confounding factors. At linear regression analyses, higher CR scores were independently associated with a better performance on Word Fluency (p ≤ 0.04) and Digit Span (backward) (p ≤ 0.02); no associations were observed between CR and other cognitive tests. Our data provide empirical support to the relation between CR and cognitive impairment in PD. In particular, this study suggests that CR may have greater effects on the cognitive areas mostly affected in PD as executive functions.

Episodic memory for natural and transformed food

It has been proposed that the conceptual knowledge of food and its putative subdivision into natural (i.e., fruit/vegetables) and transformed (i.e., food that underwent thermic or non-thermic processing) may follow the living/non-living distinction. In the present study, we investigated whether the advantage for living things compared to non-living things observed in episodic memory (the so-called animacy effect) extends to natural foods and transformed foods respectively. We pursued this issue in two experiments. In Experiment 1, we measured episodic memory for natural and transformed foods in young participants. In Experiment 2, we enrolled dementia-free centenarians, patients with Alzheimer's disease (DAT), Progressive primary aphasia (PPA), and healthy controls whose episodic memory was also tested for living/non-living things. Results showed that young participants had better recognition memory for transformed foods compared to natural foods. This difference disappeared in centenarians and patients. However, centenarians and PPA exhibited enhanced levels of false alarms (FA) with natural food, and DAT patients with both natural and transformed food. As far as the living/non-living distinction is concerned, the episodic memory for the living category appears more resilient to the decline compared to the non-living category in patients, particularly those with PPA. In conclusion, our study shows that transformed food is better remembered than natural food, suggesting that it is more salient and possibly relevant from an evolutionary perspective. The natural/transformed distinction appears susceptible to erosion only in the presence of a high degree of episodic memory impairment. These results offer novel insight on episodic memory of food, and also extend the current knowledge on the animacy effect in episodic memory.

Laterality in Parkinson's disease may predict motor and visual imagery abilities

Experimental evidence suggests that motor imagery (MI) engages the same neural substrates supporting actual motor activities and is likely impaired when such substrates are damaged, as in Parkinson's disease (PD). MI intuitively relies on visual imagery (VI), because mental simulations of physical movements depend on the visual retrieval of these movements. Although VI is generally considered a right hemispheric function, the hemispheric dominance of MI is still in dispute. Disparities in sidedness of motor disturbances are a distinctive feature of PD, and recent findings indicate that such disparities may similarly characterize cognition. Specifically, the deficits observed may depend upon which hemisphere is principally involved. Essentially, MI and VI are cognitive tasks subject to differential impairment and reflecting the prevalence of hemispheric impairment in PD. Motor imagery (assessed by the Vividness of Motor Imagery Questionnaire [VMIQ]) and VI (assessed by the Vividness of Visual Imagery Questionnaire [VVIQ] and Test of Visual Imagery Control [TVIC]) were examined in patients with asymmetric PD and in healthy elderly control subjects (HC group). VMIQ scores were similar in PD laterality subsets and the HC group, but VVIQ scores were significantly lower in both PD groups compared with the HC group. TVIC scores were significantly lower in the presence of left motor (right hemispheric) impairment and were predictive of left motor (right hemispheric) impairment. We suspect that MI is strongly reliant on VI and that language may mediate these two functions, to the extent that both are evoked through verbal stimuli. Working memory, both visual and verbal, is also involved in MI and VI tasks. Without due attention to laterality of symptoms, any training incorporating MI and VI may not deliver expected outcomes in the setting of asymmetric PD symptomatology.

Use of ACE-inhibitors and falls in patients with Parkinson's disease

Falls represent a major concern in patients with Parkinson's disease (PD); however, currently acknowledged treatments for PD are not effective in reducing the risk of falling. The aim was to assess the association of use of ACE-inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) with falls among patients with PD. We analysed data of 194 elderly with PD attending a geriatric Day Hospital. Self-reported history of falls that occurred over the last year, as well as use of drugs, including ACEIs and angiotensin II receptor blockers (ARBs) were recorded. The association of the occurrence of any falls with use of ACEIs, and ARBs was assessed by logistic regression analysis. The association between the number of falls and use of ACEIs, and ARBs was assessed according to Poisson regression. In logistic regression, after adjusting for potential confounders, use of ACEIs was associated with a reduced probability of falling over the last year (OR=0.15, 95% CI=0.03-0.81; P=0.028). This association did not vary with blood pressure levels (P for the interaction term=0.528). Also, using Poisson regression, use of ACEIs predicted a reduced number of falls among participants who fell (PR=0.31; 95% CI=0.10-0.94; P=0.039). No association was found between use of ARBs and falls. Our results indicate that use of ACEIs might be independently associated with reduced probability, and a reduced number of falls among patients with PD. Dedicated studies are needed to define the single agents and dosages that might most effectively reduce the risk of falling in clinical practice.

Neural Underpinnings of the Decline of Topographical Memory in Mild Cognitive Impairment

Spatial navigation is one of the cognitive functions known to decline in both normal and pathological aging. In the present study, we aimed to assess the neural correlates of the decline of topographical memory in patients with amnestic mild cognitive impairment (aMCI). Patients with aMCI and age-matched controls were engaged in an intensive learning paradigm, lasting for 5 days, during which they had to encode 1 path from an egocentric perspective and 1 path from an allocentric perspective. After the learning period, they were asked to retrieve each of these paths using an allocentric or egocentric frame of reference while undergoing a functional magnetic resonance imaging scan. We found that patients with aMCI showed a specific deficit in storing new topographical memories from an allocentric perspective and retrieving stored information to perform the egocentric task. Imaging data suggest that this general decline is correlated with hypoactivation of the brain areas generally involved in spatial navigation.

Verbal list learning and memory profiles in HIV-infected adults, Alzheimer's disease, and Parkinson's disease: An evaluation of the "cortical hypothesis" of NeuroAIDS

HIV+ population is getting older because of progress in treatments. Yet, there are concerns that Older HIV+ individuals (OHIV+) may be more vulnerable for developing a "cortical" dementia such as Alzheimer Disease (AD). Our aim was to explore the hypothesis that the cognitive deficit extends to ''cortical'' functions in OHIV+ by comparing serial position effects (SPE) in different groups of participants affected by "cortical" or "subcortical" damage. We enrolled a total of 122 subjects: 22 OHIV+ (≥60 years of age), 31 Younger HIV+ (YHIV+) (<60 years of age), 18 participants with AD, 23 subjects with Parkinson Disease (PD), and 28 healthy subjects. All subjects performed verbal learning tasks (VLT) to explore SPE. Factorial analysis of covariance showed a significant effect of "group" (p < 0.001) and "task" (Primacy vs Recency) (p < 0.001), but no significant group*task (p = 0.257) interaction. Compared with healthy subjects (p = 0.003), AD had the most severe reduction of Primacy, confirming a primary "encoding deficit," while PD confirmed a "frontal pattern." OHIV+ showed a memory profile similar to that of PD with a worsening of the cognitive performance in comparison with YHIV+. In conclusion, we did not confirm the "cortical" hypothesis in OHIV+, at least in terms of learning and memory functions.

Neural substrates of the 'low-level' system for speech articulation: Evidence from primary opercular syndrome

We describe a patient with progressive disorder of speech, without language impairment (opercular syndrome). Morphometric analysis confirmed asymmetric volume reduction of the precentral areas (>left). Diffusion imaging showed significant white matter changes in the left frontal lobe, with specific involvement of the left corticobulbar tract and connections between supplementary/pre-supplementary motor areas and the frontal operculum (frontal aslant tract). We suggest that the organization of expressive language includes a 'low level' motor system principally distributed in the left hemisphere that shows specific susceptibility to neurodegeneration, distinct from neural systems subtending praxic, and cognitive aspects of language.

"The Memory of Beauty" Survives Alzheimer's Disease (but Cannot Help Memory)

The aesthetic experience, in particular the experience of beauty in the visual arts, should have neural correlates in the human brain. Neuroesthetics is principally implemented by functional studies in normal subjects, but the neuropsychology of the aesthetic experience, that is, the impact of brain damage on the appreciation of works of art, is a neglected field. Here, 16 mild to moderate Alzheimer's disease patients and 15 caregivers expressed their preference on 16 works of art (eight representational and eight abstract) during programmed visits to an art gallery. A week later, all subjects expressed a preference rate on reproductions of the same works presented in the gallery. Both patients and caregivers were consistent in assigning preference ratings, and in patients consistency was independent of the ability to recognize the works on which the preference rate had been given in an explicit memory task. Caregivers performed at ceiling in the memory task. Both patients and caregivers assigned higher preference ratings for representational than for abstract works and preference consistency was comparable in representational and abstract works. Furthermore, in the memory task, patients did not recognize better artworks they had assigned higher preference ratings to, suggesting that emotional stimuli (as presumably visual works of art are) cannot enhance declarative memory in this pathology. Our data, which were gathered in an ecological context and with real-world stimuli, confirm previous findings on the stability of aesthetic preference in patients with Alzheimer's disease and on the independence of aesthetic preference from cognitive abilities such as memory.

Primary progressive aphasia: linguistic patterns and clinical variants

We investigated whether primary progressive aphasias (PPA) reflect non-random degradation of linguistic dimensions that might be supported by different neural subsystems and to what extent this degradation contributes to the emergence of clinical entities: semantic (S), logopenic (L) and nonfluent (NF) aphasia; apraxia of speech was also considered if associated with language disorders (AOS/aph). Forty-two aphasic patients are reported. Two main definable patterns of linguistic deficits tended to emerge that corresponded with identifiable patterns of brain atrophy, and probably diseases: the S variant, which principally expresses the impact of a "deep" cognitive (semantic) disorder on language, and AOS/aph in which "peripheral" executive components play a significant role. By contrast, NF aphasia emerged as a heterogeneous variant due to disorganization of various dimensions within the linguistic domain, that assumes different patterns depending on the differential distribution of atrophy in the perisylvian regions.

Visuo-perceptive priming in Alzheimer's disease: evidence for a multi-componential implicit memory system

In the past two decades research has highlighted how implicit memory processes are spared in degenerative disorders, such as Alzheimer's disease (AD), which are characterized by the early onset of explicit memory deficits. However, according to recent studies, there may be dissociations among different types of implicit memory. Although several studies have shown selective sparing of lexical priming in AD, it is not completely clear what happens to other types of implicit memory processes, such as visuo-perceptual priming. The present study examines the possibility that the visuo-perceptual priming effect is spared in AD. We tested two groups of participants, i.e., a group of AD patients and a group of healthy age-matched controls, using a visuo-perceptual priming task. The task required the identification of fragmented pictures. Results showed a deficient priming effect in AD patients when it was measured by an Identification of Fragmented Pictures task. We discuss our results in light of the current hypothesis of a functional segregation in priming processes.