BACKGROUND AND PURPOSE: Action tremor may occur in patients with Parkinson's disease and cause misdiagnosis with other movement disorders such as essential tremor and dystonia. Data on the frequency of action tremor in Parkinson's disease and on the relationships with other motor and non-motor signs are limited. METHODS: A cross-sectional study of 237 patients with Parkinson's disease staging 1-2 on the Hoehn-Yahr scale was conducted. Data on action tremor and other motor and non-motor signs were collected using the Unified Parkinson's Disease Rating Scale part III and the Non-Motor Symptoms Scale. RESULTS: Action tremor was found in 46% of patients and was associated with both severity of rest tremor (adjusted odds ratio 3.0, P < 0.001) and severity of rigidity (adjusted odds ratio 1.5, P = 0.004). No association was found between action tremor and severity of bradykinesia (adjusted odds ratio 0.97, P = 0.4) or axial symptoms (adjusted odds ratio 0.9, P = 0.3). Moreover, patients who had action tremor reported a significant lower mean number of non-motor symptoms than those who had not (2.1 ± 1.3 vs. 2.4 ± 1.3; P = 0.04). CONCLUSIONS: Action tremor is a relatively frequent motor sign in patients with Parkinson's disease staging 1-2 on the Hoehn-Yahr scale. Action tremor correlates with rest tremor and rigidity and may be associated with a lower burden of non-motor symptoms. These findings suggest a contribution of non-dopaminergic mechanisms to action tremor pathophysiology.

BACKGROUND: Conventional magnetic resonance imaging (MRI) has improved the diagnosis and monitoring of multiple sclerosis (MS). In clinical trials, MRI has been found to detect treatment effects with greater sensitivity than clinical measures; however, clinical and MRI outcomes tend to correlate poorly. METHODS: In this observational study, patients (n = 550; 18-50 years; relapsing-remitting MS [Expanded Disability Status Scale score ≤4.0]) receiving interferon (IFN) β-1a therapy (44 or 22 µg subcutaneously [sc] three times weekly [tiw]) underwent standardized MRI, neuropsychological and quality-of-life (QoL) assessments over 3 years. In this post hoc analysis, MRI outcomes and correlations between MRI parameters and clinical and functional outcomes were analysed. RESULTS: MRI data over 3 years were available for 164 patients. T2 lesion and T1 gadolinium-enhancing (Gd+) lesion volumes, but not black hole (BH) volumes, decreased significantly from baseline to Year 3 (P < 0.0001). Percentage decreases (baseline to Year 3) were greater with the 44 μg dose than with the 22 μg dose for T2 lesion volume (-10.2% vs -4.5%, P = 0.025) and T1 BH volumes (-7.8% vs +10.3%, P = 0.002). A decrease in T2 lesion volume over 3 years predicted stable QoL over the same time period. Treatment with IFN β-1a, 44 μg sc tiw, predicted an absence of cognitive impairment at Year 3. CONCLUSION: Subcutaneous IFN β-1a significantly decreased MRI measures of disease, with a significant benefit shown for the 44 µg over the 22 µg dose; higher-dose treatment also predicted better cognitive outcomes over 3 years.

OBJECTIVE: To assess the evolution of cognitive and psychosocial functioning in a cohort of childhood and juvenile multiple sclerosis (MS) cases after a mean period of 2 years had elapsed since baseline evaluation. METHODS: In this cohort study, we used the same extensive neuropsychological battery with alternative versions of the tests assessing memory, attention/concentration, executive functions, and language. Fatigue and depression were also measured. An interview on school and daily living activities was obtained from the parents. The cognitive performance of the patients was compared with that of demographically matched healthy controls (HC). RESULTS: Fifty-six patients and 50 HC were assessed. At follow-up, criteria for cognitive impairment (failure on at least 3 tests) were fulfilled in 39 patients (70%) and 75% of the cases were classified as having a deteriorating cognitive performance. Changes were prominent in tests of verbal memory, complex attention, verbal fluency, and receptive language. In the regression analysis, the only significant predictor of cognitive deterioration was older age of the subject (odds ratio 1.9, 95% confidence interval 1.2-2.9, p = 0.003). Psychiatric disorders, most frequently depression, were diagnosed in 12 patients (30.5%). Fatigue was reported by 21% of the patients. MS negatively affected school and everyday activities in 30% to 40% of the subjects. CONCLUSIONS: Our findings confirm the importance of systematic assessment of cognitive and psychosocial issues in children and teens with MS. The progressive nature of the cognitive difficulties emphasizes the need for developing effective treatment strategies.

il contributo intende presentare i risultati di una ricerca-intervento condotta all'interno di Istituti di Istruzione Superiore del territorio barese, con l'obiettivo di verificare l'efficacia di un intervento psicoeducativo basato su attività didattico-formatico, role-playing e di educazione emotiva, finalizzate all'analisi e alla riduzione die comportamenti bullistici. I risultati evidenziano che l'intervento psico-educativo condotto ha prodotto una riduzione generale degli atti di bullismo ed un miglioramento del clima di classe. Tali risultati suggeriscono che la comprensione del fenomeno del bullismo al fine di insegnare agli studenti e alle studentesse le diverse forme della violenza e la capacità di riconoscere i segni e le conseguenze per le vittime, rappresenta una potenziale strategia per contrastare i comportamenti aggressivi e bullistici a scuola.

Cognitive impairment is frequent in patient with Parkinson's disease (PD), and can range from mild deterioration to dementia. Recently a contribution of Alzheimer's disease for the cognitive dysfunction in PD has been proposed, whereas the presence of tau protein and amyloid was recognized. Clusterin/ApoJ is a protein involved in the deposition of beta- amyloid and in its neurotoxicity. In this study we aimed to investigate the clusterin/Apoj's plasma levels in patients with PD to assess its potential role in fisiopathogenetic cognitive impairment.

These two studies extended the assessment of programs recently developed for promoting activity and orientation in persons with moderate Alzheimer’s disease. Specifically, Study I pursued a new evaluation of a program, in which pictorial instructions of activity steps are presented on a computer screen at preset intervals. Study II pursued a new evaluation of a program using music and strobe lights (emitted at the destinations) as spatial cues to support indoor orientation and travel. Six participants were included, three per study. The results of Study I showed that the participants reached high percentages of correct steps in each of the two activities targeted. The results of Study II showed that the participants had high percentages of correct orientation and travel within their day care context. The results of both studies were in line withthe data of previous studies in these areas. The practical implications of these results for helping participants with moderate Alzheimer’s disease manage activity engagement and orientation/travel are discussed.

Abstract SPECT imaging is widely used for the differential diagnosis of degenerative parkinsonisms by exploiting the high affinitiy of the radiotracer (123)I-FP-CIT for the dopamine transporter. Reduced levels of DAT are found in Parkinson Disease (PD), Dementia with Lewy Bodies (DLB), and Progressive Supranuclear Palsy (PSP) compared to in Essential Tremor (ET) and Healthy Controls (HC). However, the extent of the neurodegenerative process may extend beyond nigrostriatal system. We have exploited the affinity of the same radiotracer (123)I-FP-CIT for the serotonin transporter to investigate SERT levels in the midbrain of patients with PD, DLB, PSP, and ET compared to HC. Using MRI images as anatomical templates for midbrain uptake quantification, we found a mild decrease in SERT levels in PD compared to ET and HC, with marked inter-individual variability; on the other side, PSP and DLB patients displayed markedly reduced to undetectable levels of SERT, respectively. These findings show that the neurodegenerative process affects serotoninergic neurons in parkinsonisms, with much more severe involvement in DLB than in PD patients, despite the comparable loss of striatal DAT. SERT-dependent (123)I-FP-CIT uptake may allow a more comprehensive assessment of neurochemical disturbances in degenerative parkinsonisms and may have a value for differential diagnosis.

Background: Mirror writing (MW) refers to the production of individual letters, words or word strings in reversed direction [1]. When held to a mirror, these letters or words can be read normally. MW has mainly been observed in left hemisphere damaged patients writing with their left hand [2]. Two theories have been put forward to account for this phenomenon: a perceptual and a motor one. Objective: The aim of this study was to evaluate the presence of MW in patients with Mild Cognitive Impairment (MCI) compared to elderly volunteers Materials and Methods: 24 MCI and 21 healthy controls underwent a screening for MW. Results: No group difference emerged. MW of individual letters was observed in 3 MCI patients, but also in 6 controls. However, one individual (F.C.) with MCI showed overt and severe MW when writing with her left hand. She (50 y. old, 7 y. of education) was not an outlier in terms of severity of cognitive impairment or any other clinical or demographic variable. She and a matched control group of 6 women were further assessed with a comprehensive battery of tests aimed at investigating her MW. She was much slower than the controls but as accurate in all tests. In particular, she did not commit more errors in mirror reading and reading backwards text on paper, in executing directional actions (like screwing a lid), and in left-right discrimination, nor did she perform differently when asked to write under the surface of a table or in writing with transparent titles. However, under dictation (8 words) she reversed two individual letters and one whole word, whereas the performance of the controls was flawless. Conclusions: MW is a rare occurrence in MCI. The case of F.C. cannot be interpreted as resulting from a perceptual impairment, her performance is more easily accounted for by a deficit in the motor transformation of the engrams to be written with the non dominant hand or an impairment of the monitoring of directional errors. References [1] McIntosh R.D., Della Sala S. (2012). Mirror-writing. The Psychologist, 25: 742-6 [2] Balfour S, Borthwick S, Cubelli R, and Della Sala S. (2007). Mirror writing and reversing single letters in stroke patients and normal elderly. Journal of Neurology, 254: 436–441

According to the American Heart Association (AHA) , primitive dilated cardiomyopathy (PDCM) is a "progressive dilation of the left or both ventricles and a depressed contractility in absence of abnormal load conditions ". It evolves in progressive heart-failure. The term &quot;cardiogenic dementia&quot; expresses the intimate connection between heart diseases and cognitive functions. The association between PDCM and the neuropsychological functions is unclear: the main pathophysiological hypotheses are cerebral hypoperfusion and cardiogenic emboli. The aim of this study is to evaluate the impact that the PDCM has on neuropsychological decline and to detect early echocardiographic markers of cognitive impairment. We enrolled 235 patients: 168 suffering from PDCM as sample group and 67 suffering from hypertensive dilated cardiomyopathy (HTCM) as control group. They underwent a cardiology examination and a neuropsychological assessment . A p &lt;0.05 was considered significant. The two groups showed no differences in risk factors, demographic and cardiovascular parameters (except for dimensions of aortic root, left atrium and ventricle which appeared greater in PDCM and left ventricle ejection fraction that appeared lower in PDCM). Among administered neuropsychological tests, only the Stroop Test (which explores executive and attentive functions) appeared significantly lower in PDCM (p = 0.029). Moreover left ventricle end-diastolic diameter was inversely related to the Stroop Test Score (r= -0.32). PDCM doesn't appear to be at the basis of a generalized cognitive and neuropsychological decline. Only the executive functions seem impaired in PDCM. Left ventricle dilation seems to be associated to attentive and executive functions decline.

Osteoarthritis (OA) of the hip and knee causes pain and loss of joint mobility, leading to limitations in physical function. When conservative treatment fails total hip and knee replacement is a cost-effective surgical option. Patients have high expectations regarding functional outcome after these procedures. If such expectations are not met, they may still be dissatisfied with the outcome of a technically successful procedure. Recently, numerous studies reported that psychological factors can influence the outcome of total knee replacement (tkr) and total hip artrhoplasty with total hip replacement (thr). We conducted a prospective study on a consecutive sample of 280 patients affected by hip or knee OA who underwent total joint replacement. At patients’ admission, Harris Hip Score (HHS) and Knee Society Score (KSS) were used to assess pain and function. Furthermore, SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), Coping Orientation to Problems Experienced (BRIEF-COPE) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were administered. Patients had clinical and radio graphical follow up at 1, 3 and 6 months post-operatively. The HHS and KSS values before surgery showed a linear correlation with both SCL-90-R and MMSE. None of the investigated variables influenced post-operative HHS and KSS scores; however, the improvement of functional scores resulted conditioned by SCL-90-R values, VAS score, schooling and MMSE. Psychological factors and mental status in primary total hip and knee replacement can affect outcome and patient satisfaction. Strategies focused on identification and facing of these conditions must be considered to improve outcome of total replacement.

This study assessed whether three patients with Alzheimer’s disease could learn to use a basic orientation technology to reach different rooms within a day center. At each travel instance, the technology provided verbal messages (cues) from the room to reach. For the first two patients, the messages were presented at intervals of about 15 s. For the third patient (who had more extensive orientation problems), shorter intervals combined with the voice of the research assistant were initially used. Results showed that all three patients were successful in using the technology to orient their travel and find the rooms correctly. A social validation assessment, in which university psychology students were asked to rate the patients’ travel performance with the technology and with the help of a caregiver, provided generally higher (more positive) scores for the technology-assisted performance. The implications of the findings for daily programs of patients with Alzheimer’s disease are discussed.

People affected by mild cognitive impairment (MCI), a precursor of Alzheimer's Disease, present with impairments in picture naming, a lexical/semantic task which rests on the activation of perceptual, semantic, and phonological representations. The poor performance of MCI individuals in picture naming has been accounted for in terms of deficits of either the perceptual, semantic, or phonological stages. To disentangle the source of this deficit we compared the cumulative semantic interference effect (Howard et al., 2006. Cognition. 100, 464-482.) and the repetition priming effect of a group of people with MCI to that of a group of healthy elderly participants and with a group of healthy young participants. The cumulative semantic interference effect defines a linear increase in the picture naming reaction times which is function of the already named pictures belonging to the same semantic category to which the named picture belongs. The repetition priming effect refers to an increase in performance for repeated items compared to unrepeated items. Results showed that whereas the cumulative semantic interference effect was present in the healthy elderly and young samples, it was absent in the MCI sample; instead, all groups showed comparable repetition priming effects. This pattern of results suggests that the impairment in picture naming exhibited by MCI individuals is due to an inefficient semantic access.

Background. People affected by Alzheimer Dementia (AD) or Mild Cognitive Impairment (MCI) present with impairments in lexical/semantic processing. Picture naming could be seen as a lexical/semantic task which rests on the activation of perceptual, semantic, and phonological representations. The poor performance of MCI/AD individuals in picture naming has been accounted for in terms of deficits of either the perceptual, semantic, or phonological stages (e.g., Faust, Balota, & Multhaup, 2004) Aim. To disentangle the source of this deficit we compared the cumulative semantic interference effect (CSIE; Howard, Nickels, Coltheart, & Cole-Virtue, 2006) and the repetition priming effect (RPE) obtained with a sample of 20 healthy elderly to that obtained with a sample of 20 MCI/AD elderly. Method. The RPE refers to an increase in performance for repeated items compared to unrepeated items. The CSIE defines a linear increase in the naming RTs which is function of the already named pictures belonging to the same semantic category to which the named picture belongs. Results. CSIE was present in the healthy sample and absent in the MCI/AD sample. Instead, both groups showed comparable repetition priming effects. Conclusion. The impairment in picture naming exhibited by MCI/AD individuals is due to an inefficient semantic access. Ref. Faust, M. E., Balota, D. A., & Multhaup, K. S. (2004). Neuropsychology, 18, 526-536. Howard, D., Nickels, L., Coltheart, M., & Cole-Virtue, J. (2006). Cognition, 100, 464–482.

Pathological gambling involves multitudinous costs related to financial, legal, and public health care aspects, as well as to specific psychological disorders. Despite the overall evidence suggesting that comorbid disorders represent a risk factor for pathological gambling, there is scant evidence on the appropriate treatments for gamblers with such disorders. In this context, metacognitive therapy is an interesting approach because it considers psychological disorders as a result of the activation of perseverative cognitive processes and attentional strategies in response to inner events. Several studies report that metacognition is associated with different psychological problems. This study investigated the relationship among comorbid disorders, metacognition, and pathological gambling. 69 pathological gamblers at the first hospital admission and 58 controls drawn from general population (matched for age, gender, education) completed a battery of self report instruments: Symptom Checklist-90-R, Metacognition Questionnaire 30, South Oaks Gambling Scale. Compared to controls, pathological gamblers showed higher level of comorbid symptomatology and metacognition. Correlation analyses showed that: comorbid symptomatology and metacognition were positively and significantly correlated with pathological gambling; metacognition was positively and significantly associated with comorbid symptomatology. Mediation analysis indicated that dysfunctional metacognitive strategies could have an indirect effect on pathological gambling mediated by concurrent psychological disorders. These findings provide some implications for gambling treatment programs: pathological gamblers should be screened for psychiatric disorders, and metacognitive therapy could be considered a correct treatment of pathological gamblers. Metacognitive therapy might lead to the reduction of the pathological gambling by the diminishing of the concurrent psychological disorders.

Mirror writing (MW) has mainly been observed in left-hemisphere-damaged patients writing with the left hand. This study evaluated the presence of MW in 24 patients with mild cognitive impairment (MCI). We found that MW is not a typical feature of MCI. However, one woman (FC), mislabeled initially with MCI but in fact affected by anxiety, showed florid MW when writing with her left hand, which resolved as her anxiety receded. This case study supports anecdotal reports of MW triggered by anxiety, and the features of FC's performance indicate a motor rather than a perceptual basis for the phenomenon.