Cristina Geroldi - Academia.edu (original) (raw)
Papers by Cristina Geroldi
European Archives of Psychiatry and Clinical Neuroscience, Oct 1, 2002
s Abstract In this paper we explored patterns of frontal and temporal asymmetry in frontotemporal... more s Abstract In this paper we explored patterns of frontal and temporal asymmetry in frontotemporal dementia (FTD) and tried to isolate clinical correlates associated with asymmetry or lack thereof. Volumes of frontal and temporal lobes, hippocampus and entorhinal cortex were measured using magnetic resonance imaging (MRI) in 10 patients with FTD. Age-and cranial size-specific values were computed through linear regression analysis (W-scores). A subgroup of 3 patients with symmetric frontal and temporal atrophy was identified. When compared to patients with asymmetric atrophy, the former had younger age at onset of the disease (p = 0.02), greater overall frontotemporal (p = 0.02) and greater entorhinal atrophy (p < 0.04). Two of the three patients were apolipoprotein E ε4 carriers versus none of the asymmetric patients (p = 0.02). The lack of asymmetry in this small sample of FTD patients was associated with greater brain atrophy, younger age at onset, and presence of the ε4 allele of apolipoprotein E. The presence of the ε4 allele is consistent with the hypothesis of greater vulnerability of the brain in ε4 carriers.
Neurobiol Aging, 2004
MCI subjects. Methods: Eighteen subjects (9 males, 9 female, mean age 74,5 4-5,6 years) with amne... more MCI subjects. Methods: Eighteen subjects (9 males, 9 female, mean age 74,5 4-5,6 years) with amnestic MCI, according to Petersen's criteria were enrolled; they underwent a comprehensive clinical assessment, as well as a ill-MRS scan to measure N-acetyl aspartate (NAA), Choline (Cho), myo-inositol (mI) mad Creatine (Cr), in the paratrigonal white matter bilaterally. After a one year follow-up 5 subjects became demented (pMCI) and 13 remained stable (sMCI). The baseline levels of all metabolites were compared between sMCI and pMCI by mean of Kruskal-Wallis test. The significance level was set at p < 0,05. Results: 1. H-MRS examination show significantly higher levels of NAA/Cr (p = 0,012) and Cho/Cr (p = 0,034) in the left hemisphere in sMCI compared to pMCI. No statistically significant differences were found in the right hemisphere. Conclusions: In this preliminary study pMCI could be differentiate from sMCI because of a different cerebral metabolic pattern being pMCI more similar, already at baseline, to AD subjects. Particularly it is noteworthy that NAA/Cr level, have been shown to be lowered in AD white matter and correlates with the disease severity, is also lowered in pMCI. This might indicate that in the heterogeneous family of MCI, subjects in the pre-clinical phase of AD can be detected by means of 1 H-MRS. We can conclude that in the future might be useful to combine a cognitive assessment to a 1H-MRS exam to predict more accurately the progression of this cognitive disturbance.
Alzheimer Disease and Associated Disorders, 2010
Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture pa... more Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture patients presenting with mild and not yet disabling symptoms, and currently classified as mild cognitive impairment (MCI). We describe 2 very mild cases of MCI and their clinical outcome. The 2 cases were selected as they had unequivocal preservation of daily activities and normal global cognitive performance (Mini-Mental State Examination 29/30) and were positive to all 3 markers. Cognitive profile was assessed with an extensive neuropsychologic battery, medial temporal atrophy with hippocampal volumetry, hypometabolism on F-deoxyglucose positron emission tomography and voxel-based statistical parametric mapping analysis, and tau and amyloid beta-42 in the cerebrospinal fluid with enzyme-linked immunosorbent assay. Both patients had a poor performance in 2 out of 11 neuropsychologic tests. Both had hippocampal volumes at or below the first percentile of the age-specific distribution, retrosplenial glucose hypometabolism, and inversion of tau/amyloid beta-42 cerebrospinal fluid ratio. Both showed progression of the cognitive deficit over the following 12 months. These 2 patients with progressive MCI and positivity to all Alzheimer markers predicated by the new research criteria provide preliminary support to their validity. Future work will characterize the marker profile of the vast majority of patients with incomplete marker positivity.
Alzheimer Disease and Associated Disorders, 2010
Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture pa... more Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture patients presenting with mild and not yet disabling symptoms, and currently classified as mild cognitive impairment (MCI). We describe 2 very mild cases of MCI and their clinical outcome. The 2 cases were selected as they had unequivocal preservation of daily activities and normal global cognitive performance (Mini-Mental State Examination 29/30) and were positive to all 3 markers. Cognitive profile was assessed with an extensive neuropsychologic battery, medial temporal atrophy with hippocampal volumetry, hypometabolism on F-deoxyglucose positron emission tomography and voxel-based statistical parametric mapping analysis, and tau and amyloid beta-42 in the cerebrospinal fluid with enzyme-linked immunosorbent assay. Both patients had a poor performance in 2 out of 11 neuropsychologic tests. Both had hippocampal volumes at or below the first percentile of the age-specific distribution, retrosplenial glucose hypometabolism, and inversion of tau/amyloid beta-42 cerebrospinal fluid ratio. Both showed progression of the cognitive deficit over the following 12 months. These 2 patients with progressive MCI and positivity to all Alzheimer markers predicated by the new research criteria provide preliminary support to their validity. Future work will characterize the marker profile of the vast majority of patients with incomplete marker positivity.
Clinical Neurophysiology Official Journal of the International Federation of Clinical Neurophysiology, Jan 2, 2009
In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-... more In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-nine subjects with mild cognitive impairment (MCI) underwent EEG recording and MRI scan. The theta/gamma ratio of the relative power at the peak frequency was computed. Based on the tertiles values of the ratio, three groups with increasing values of theta/gamma ratio were obtained. The groups were characterized by the performance on cognitive tests. Changes in functional brain connectivity, as expressed by interhemisperic and intrahemispheric EEG linear coherence in the groups were also evaluated. Increase in theta/gamma ratio was associated with impairment in memory tests. This relationship was confirmed by correlation and multiple regression analysis. An independent association was found between theta/gamma ratio and alpha3/alpha2 power ratio. Coherence analysis showed modifications of interhemispheric functional coupling on temporal regions on slow frequencies. Theta/gamma ratio of relative power at peak frequency is significantly associated to memory decline. It could be a useful tool in detecting MCI subjects which are at major risk to develop Alzheimer&amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) or other dementias. A global modulation of brain rhythms could be driven by the pathological alterations of theta/gamma ratio.
Clinical Neurophysiology Official Journal of the International Federation of Clinical Neurophysiology, Jan 2, 2009
In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-... more In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-nine subjects with mild cognitive impairment (MCI) underwent EEG recording and MRI scan. The theta/gamma ratio of the relative power at the peak frequency was computed. Based on the tertiles values of the ratio, three groups with increasing values of theta/gamma ratio were obtained. The groups were characterized by the performance on cognitive tests. Changes in functional brain connectivity, as expressed by interhemisperic and intrahemispheric EEG linear coherence in the groups were also evaluated. Increase in theta/gamma ratio was associated with impairment in memory tests. This relationship was confirmed by correlation and multiple regression analysis. An independent association was found between theta/gamma ratio and alpha3/alpha2 power ratio. Coherence analysis showed modifications of interhemispheric functional coupling on temporal regions on slow frequencies. Theta/gamma ratio of relative power at peak frequency is significantly associated to memory decline. It could be a useful tool in detecting MCI subjects which are at major risk to develop Alzheimer&amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) or other dementias. A global modulation of brain rhythms could be driven by the pathological alterations of theta/gamma ratio.
J Psychophysiol, 2009
Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global ... more Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global cognitive function in aging. In this vein, the present study tested the hypothesis that the functional coupling of resting cortical electroencephalographic (EEG) rhythms is progressively abnormal in amnesic mild cognitive impairment (MCI) and AD subjects. Eyes-closed resting EEG data were recorded (10–20 system) in 33 mild
J Psychophysiol, 2009
Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global ... more Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global cognitive function in aging. In this vein, the present study tested the hypothesis that the functional coupling of resting cortical electroencephalographic (EEG) rhythms is progressively abnormal in amnesic mild cognitive impairment (MCI) and AD subjects. Eyes-closed resting EEG data were recorded (10–20 system) in 33 mild
Journal of the American Geriatrics Society, Feb 1, 1999
OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient ... more OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient activities of daily living (ADLs) and ADLs assessed directly in a sample of patients affected by very mild and mild dementia and to assess whether this agreement is influenced by the caregiver's depressive symptoms and burden.PATIENTS AND METHODS: Data were obtained from the baseline sample of the Mild Dementia Longitudinal Study, consisting of 111 consecutive patients affected by dementia with very mild to mild functional impairment (grades .5 and 1 on the Clinical Dementia Rating Scale). As is usual for patients referred to our Alzheimer's Unit, anamnestic, cognitive, functional and behavioral information are collected from the primary caregiver. Along with sociodemographic characteristics, caregivers' depressive symptoms (Beck Depression Inventory Scale) and burden (Nowak and Guest's Caregiver Burden Inventory Scale) were also evaluated. Patients underwent a performance-based assessment of the activities of daily living (DAFS) and direct assessment of physical function with the Physical Performance Test (PPT). Caregiver's report and direct observation have been compared for the following ADLs: dressing, toileting, walking, telephone use, shopping, and money use. Discriminant analyses were conducted to examine the degree of agreement between caregiver-report functional status and performance-based measures and whether additional agreement is attributable to caregiver's burden and depressive symptoms.RESULTS: The strength of the association between the caregiver's report and performance-based measures of ADLs is high for motor performance (walking), moderate to good for dressing, but only moderate for telephone, money use, and shopping. No association was found for toileting. The discrepancies between caregiver report and performance-based assessment were influenced substantially by the burden caused by demands and restrictions on a caregiver's time.CONCLUSIONS: With the exception of motor performance (walking), the caregiver's report and the performance-based assessment of functional status measure different aspects of a patient's functional status. Contrasts between the caregiver's report and observed ADL performance in mildly and very mildly demented patients are influenced by the caregiver's burden. J Am Geriatr Soc 47:196–202, 1999.
Journal of the American Geriatrics Society, Feb 1, 1999
OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient ... more OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient activities of daily living (ADLs) and ADLs assessed directly in a sample of patients affected by very mild and mild dementia and to assess whether this agreement is influenced by the caregiver's depressive symptoms and burden.PATIENTS AND METHODS: Data were obtained from the baseline sample of the Mild Dementia Longitudinal Study, consisting of 111 consecutive patients affected by dementia with very mild to mild functional impairment (grades .5 and 1 on the Clinical Dementia Rating Scale). As is usual for patients referred to our Alzheimer's Unit, anamnestic, cognitive, functional and behavioral information are collected from the primary caregiver. Along with sociodemographic characteristics, caregivers' depressive symptoms (Beck Depression Inventory Scale) and burden (Nowak and Guest's Caregiver Burden Inventory Scale) were also evaluated. Patients underwent a performance-based assessment of the activities of daily living (DAFS) and direct assessment of physical function with the Physical Performance Test (PPT). Caregiver's report and direct observation have been compared for the following ADLs: dressing, toileting, walking, telephone use, shopping, and money use. Discriminant analyses were conducted to examine the degree of agreement between caregiver-report functional status and performance-based measures and whether additional agreement is attributable to caregiver's burden and depressive symptoms.RESULTS: The strength of the association between the caregiver's report and performance-based measures of ADLs is high for motor performance (walking), moderate to good for dressing, but only moderate for telephone, money use, and shopping. No association was found for toileting. The discrepancies between caregiver report and performance-based assessment were influenced substantially by the burden caused by demands and restrictions on a caregiver's time.CONCLUSIONS: With the exception of motor performance (walking), the caregiver's report and the performance-based assessment of functional status measure different aspects of a patient's functional status. Contrasts between the caregiver's report and observed ADL performance in mildly and very mildly demented patients are influenced by the caregiver's burden. J Am Geriatr Soc 47:196–202, 1999.
Neurological Sciences, May 1, 2007
The objective was to evaluate the construct validity of the Italian version of the Frontal Behavi... more The objective was to evaluate the construct validity of the Italian version of the Frontal Behavioural Inventory (FBI) and its usefulness in the differential diagnosis of dementias. Standard criteria were used in the clinical diagnosis of dementias in 83 patients and 33 agematched healthy volunteers. The FBI scale was translated from English into Italian language and back-translated. Cronbach's alpha, inter-rater and test-retest reliability, FBI convergent validity and discriminant analysis were calculated. FBI profile was compared between patients affected by frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). The FBI showed a high internal consistency and inter-rater reliability and it distinguished normal behavioural conditions from those presented in FTLD or AD. An 86.8% diagnostic accuracy was calculated by the discriminant analysis, selecting only age at disease onset and FBI, and particularly distinguishing behavioural variants within the FTLD spectrum. FTLD patients showed a characteristic behavioural profile. The FBI might be a reliable and useful diagnostic tool for dementias in clinical practice.
Neurological Sciences, May 1, 2007
The objective was to evaluate the construct validity of the Italian version of the Frontal Behavi... more The objective was to evaluate the construct validity of the Italian version of the Frontal Behavioural Inventory (FBI) and its usefulness in the differential diagnosis of dementias. Standard criteria were used in the clinical diagnosis of dementias in 83 patients and 33 agematched healthy volunteers. The FBI scale was translated from English into Italian language and back-translated. Cronbach's alpha, inter-rater and test-retest reliability, FBI convergent validity and discriminant analysis were calculated. FBI profile was compared between patients affected by frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). The FBI showed a high internal consistency and inter-rater reliability and it distinguished normal behavioural conditions from those presented in FTLD or AD. An 86.8% diagnostic accuracy was calculated by the discriminant analysis, selecting only age at disease onset and FBI, and particularly distinguishing behavioural variants within the FTLD spectrum. FTLD patients showed a characteristic behavioural profile. The FBI might be a reliable and useful diagnostic tool for dementias in clinical practice.
International Psychogeriatrics Ipa, Dec 1, 2002
The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer&amp;... more The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) are far from understood. The aim of the study was to assess whether delusional AD patients have a specific pattern of regional brain atrophy. The setting of the study was the outpatient facility of a memory clinic. Subjects were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 +/- 3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale = 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or persecution). None of the patients had misidentifications or other delusions of nonparanoid content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and FI. AD patients without delusions had symmetrical enlargement of both temporal (8.1 +/- 3.9 vs. 8.5 +/- 4.5) and frontal horns (35.8 +/- 4.8 vs. 35.9 +/- 4.6). On the contrary, AD with delusions showed temporal horns larger to the right (9.1 +/- 3.3 vs. 7.7 +/- 3.1, p = .06) and the frontal horn to the left (35.7 +/- 4.3 vs. 37.5 +/- 4.2, p = .02). This different pattern was confirmed with a gender-adjusted repeated measures analysis of variance model interaction term between asymmetry and group: F1,38 = 5.5, p = .03). AD patients with delusions are characterized by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas nondelusional patients are symmetric. Because the asymmetry pattern of the delusional patients is similar to the physiological pattern of asymmetry of individuals without dementia, the data indicate that the absence of theft delusions in the mild stage of AD rather than their presence is associated with an abnormal asymmetry pattern.
Radiology, Mar 1, 2011
To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable ... more To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable Alzheimer disease (AD) and (b) patients with amnestic mild cognitive impairment (aMCI) and at least one abnormal biomarker and to investigate whether WM damage is related to gray matter (GM) atrophy. This study was approved by the institutional review board, and written informed consent was obtained from each participant. Twenty-three patients with AD, 15 patients with aMCI, and 15 healthy control subjects underwent diffusion tensor magnetic resonance imaging. WM tract damage was investigated by using tract-based spatial statistics, and GM atrophy was measured by using voxel-based morphometry. Compared with control subjects, patients with AD had an increase in mean diffusivity in all major WM tracts studied, including the limbic, cortico-cortical, interhemispheric, and corticospinal tracts. Conversely, fractional anisotropy decreased only in the parahippocampal tract, fornix, and small, inferior parietal regions. In addition, patients with AD showed a widespread increase in axial and radial diffusivity compared with control subjects. Patients with aMCI showed an increase in axial diffusivity only in tracts projecting to the frontal cortex and splenium of the corpus callosum. Significant and anatomically congruent correlations between WM changes and regional GM atrophy were found in patients with AD. Conversely, damage to most WM tracts in patients with aMCI did not correlate with GM atrophy. In AD, the observed patterns of WM abnormalities may reflect the advanced phase of a secondary degenerative process and an association, especially in the early phases of the disease, with primary WM tract damage over and above GM abnormalities.
Radiology, Mar 1, 2011
To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable ... more To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable Alzheimer disease (AD) and (b) patients with amnestic mild cognitive impairment (aMCI) and at least one abnormal biomarker and to investigate whether WM damage is related to gray matter (GM) atrophy. This study was approved by the institutional review board, and written informed consent was obtained from each participant. Twenty-three patients with AD, 15 patients with aMCI, and 15 healthy control subjects underwent diffusion tensor magnetic resonance imaging. WM tract damage was investigated by using tract-based spatial statistics, and GM atrophy was measured by using voxel-based morphometry. Compared with control subjects, patients with AD had an increase in mean diffusivity in all major WM tracts studied, including the limbic, cortico-cortical, interhemispheric, and corticospinal tracts. Conversely, fractional anisotropy decreased only in the parahippocampal tract, fornix, and small, inferior parietal regions. In addition, patients with AD showed a widespread increase in axial and radial diffusivity compared with control subjects. Patients with aMCI showed an increase in axial diffusivity only in tracts projecting to the frontal cortex and splenium of the corpus callosum. Significant and anatomically congruent correlations between WM changes and regional GM atrophy were found in patients with AD. Conversely, damage to most WM tracts in patients with aMCI did not correlate with GM atrophy. In AD, the observed patterns of WM abnormalities may reflect the advanced phase of a secondary degenerative process and an association, especially in the early phases of the disease, with primary WM tract damage over and above GM abnormalities.
AJNR. American journal of neuroradiology, 1996
To assess the sensitivity of linear measures of brain atrophy in the diagnosis of Alzheimer disea... more To assess the sensitivity of linear measures of brain atrophy in the diagnosis of Alzheimer disease (AD) in the early stages. Linear measures of regional frontal (Bifrontal index, interhemispheric fissure width), medial temporal lobe (interuncal distance, minimum thickness of the medial temporal lobe), and hippocampal (hippocampal height, width of the choroid fissure, width of the temporal horn) atrophy were made on magnified MR images obtained in 46 patients with AD (33 with mild severity and 13 with moderate severity) and in 31 control subjects. Gaussian modeling was used to compute sensitivity with specificity set at 95%. Discriminant analysis was used to identify measures independently contributing to the ability to discriminate AD patients from control subjects. The measure with the best sensitivity in discriminating AD patients from control subjects was the width of the temporal horn. A compound measure of width of the temporal horn, width of the choroid fissure, height of the...
Ajnr American Journal of Neuroradiology, 2002
BACKGROUND AND PURPOSE: Atrophy in the medial temporal lobe (MTL) structures depicted with brain ... more BACKGROUND AND PURPOSE: Atrophy in the medial temporal lobe (MTL) structures depicted with brain imaging is one of the most accurate markers of Alzheimer disease (AD), but practical considerations have thus far limited their routine clinical use. The aim of this study was to explore the validity of a CT-and MR-based measure of MTL atrophy that would be feasible for routine clinical use.
Journal of geriatric psychiatry and neurology, 1995
Dementia of the frontal type (DFT) is a degenerative disorder with early behavioral and language ... more Dementia of the frontal type (DFT) is a degenerative disorder with early behavioral and language disturbances and with relative preservation of memory and visuospatial abilities. On neuropathology, DFT lacks the pathologic hallmarks of Alzheimer's disease (AD). We assessed the neuropsychological and SPET imaging features of 11 DFT and 16 AD patients. The two groups had similar performances on verbal learning, while the former had significantly higher nonverbal learning scores. Testing of verbal and nonverbal instrumental abilities showed that this different behavior could be due to poorer verbal fluency of DFT patients, and not necessarily to poorer learning. Neuropsychological data indicated that the often reported sparing of memory in daily functions of DFT patients can also be shown with formal neuropsychological testing of nonverbal learning. SPET showed a comparatively higher perfusion deficit of frontal regions in the left hemisphere of DFT patients, suggesting that this r...
European Neurology, 2003
Subcortical ischemic vascular disease (SIVD) is frequently associated with cognitive impairment. ... more Subcortical ischemic vascular disease (SIVD) is frequently associated with cognitive impairment. Rating scales to grade cerebrovascular disease are available, but their sensitivity to the clinical features of mild SIVD is unclear. The aim of the study is to devise and validate a computed tomography (CT)-based visual rating scale sensitive to SIVD in patients with mild cognitive deterioration. Subjects were 122 consecutive outpatients of a memory clinic (mean age +/- SD 77 +/- 8 years, 71% females, mean +/- SD score of mental state exam 22 +/- 3, 61% with clinical dementia rating of 0.5 and 39% of 1). Diffuse leukoaraiosis, fuzzy and patchy lesions, and lacunes were assessed on ordinary CT films and weights were computed based on clinical indicators of SIVD. A continuous score and an ordinal class (0-3) with higher values indicating higher vascular damage were derived. Intraclass correlation coefficients for intra- and interrater reliability of the subcortical vascular score and class ranged from 0.84 to 0.88. Convergent validity versus the scale of Wahlund et al. was good (Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficient between 0.53 and 0.73, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0005). Known-group validity was assessed versus clinical diagnoses of degenerative (mild cognitive impairment determined by Petersen et al. and NINCDS-ADRDA probable Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease; n = 58), mixed (possible Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease with cerebrovascular disease; n = 21), and vascular cognitive impairment (criteria of Erkinjuntti et al. for subcortical vascular dementia and cognitive impairment; n = 43). Patients with degenerative cognitive impairment were more often in the lower subcortical vascular classes (43% in class 0, 43% in class 1, 14% in class 2, and 0% in class 3), while patients with mixed (0, 24, 24, and 52%) and vascular cognitive impairment were in increasingly higher subcortical vascular classes (0, 12, 35, 53%; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00005). Criterion-related validity was assessed versus clinical indicators of cerebrovascular disease. Hypertension, platelet aggregation inhibitor use, balance, gait, and bradykinesia increased linearly with increasing subcortical vascular class (p for trend &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.02). This rating scale is valid and sensitive to capture different degrees of SIVD associated with mild cognitive deterioration.
Journal of Alzheimer's disease : JAD, 2008
The working hypothesis of paper is that the functional coupling of brain areas is combined with d... more The working hypothesis of paper is that the functional coupling of brain areas is combined with different neuroradiological substrates and has different clinical manifestations. 31 normal old subjects and 85 subjects with mild cognitive impairment (MCI) underwent EEG recordings and magnetic resonance imaging (MRI). Intrahemispheric and interhemispheric linear EEG coherences were computed. At first, all normal old and MCI subjects were compared. Subsequently, three subgroups of MCI were obtained based on neuroradiological substrate (subcortical cerebrovascular damage, MCI-CVD; cholinergic pathways vascular damage MCI-CHOL; and hippocampal atrophy, MCI-HIPP) and compared with a normal old sample matched for age, education and Mini-Mental State Examination score. The group of MCI subjects compared to normal old subjects shows: 1) decrease of intrahemispheric coherence in fronto-parietal regions (both right and left hemisphere); 2) increase of interhemispheric coherence on frontal regio...
European Archives of Psychiatry and Clinical Neuroscience, Oct 1, 2002
s Abstract In this paper we explored patterns of frontal and temporal asymmetry in frontotemporal... more s Abstract In this paper we explored patterns of frontal and temporal asymmetry in frontotemporal dementia (FTD) and tried to isolate clinical correlates associated with asymmetry or lack thereof. Volumes of frontal and temporal lobes, hippocampus and entorhinal cortex were measured using magnetic resonance imaging (MRI) in 10 patients with FTD. Age-and cranial size-specific values were computed through linear regression analysis (W-scores). A subgroup of 3 patients with symmetric frontal and temporal atrophy was identified. When compared to patients with asymmetric atrophy, the former had younger age at onset of the disease (p = 0.02), greater overall frontotemporal (p = 0.02) and greater entorhinal atrophy (p < 0.04). Two of the three patients were apolipoprotein E ε4 carriers versus none of the asymmetric patients (p = 0.02). The lack of asymmetry in this small sample of FTD patients was associated with greater brain atrophy, younger age at onset, and presence of the ε4 allele of apolipoprotein E. The presence of the ε4 allele is consistent with the hypothesis of greater vulnerability of the brain in ε4 carriers.
Neurobiol Aging, 2004
MCI subjects. Methods: Eighteen subjects (9 males, 9 female, mean age 74,5 4-5,6 years) with amne... more MCI subjects. Methods: Eighteen subjects (9 males, 9 female, mean age 74,5 4-5,6 years) with amnestic MCI, according to Petersen's criteria were enrolled; they underwent a comprehensive clinical assessment, as well as a ill-MRS scan to measure N-acetyl aspartate (NAA), Choline (Cho), myo-inositol (mI) mad Creatine (Cr), in the paratrigonal white matter bilaterally. After a one year follow-up 5 subjects became demented (pMCI) and 13 remained stable (sMCI). The baseline levels of all metabolites were compared between sMCI and pMCI by mean of Kruskal-Wallis test. The significance level was set at p < 0,05. Results: 1. H-MRS examination show significantly higher levels of NAA/Cr (p = 0,012) and Cho/Cr (p = 0,034) in the left hemisphere in sMCI compared to pMCI. No statistically significant differences were found in the right hemisphere. Conclusions: In this preliminary study pMCI could be differentiate from sMCI because of a different cerebral metabolic pattern being pMCI more similar, already at baseline, to AD subjects. Particularly it is noteworthy that NAA/Cr level, have been shown to be lowered in AD white matter and correlates with the disease severity, is also lowered in pMCI. This might indicate that in the heterogeneous family of MCI, subjects in the pre-clinical phase of AD can be detected by means of 1 H-MRS. We can conclude that in the future might be useful to combine a cognitive assessment to a 1H-MRS exam to predict more accurately the progression of this cognitive disturbance.
Alzheimer Disease and Associated Disorders, 2010
Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture pa... more Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture patients presenting with mild and not yet disabling symptoms, and currently classified as mild cognitive impairment (MCI). We describe 2 very mild cases of MCI and their clinical outcome. The 2 cases were selected as they had unequivocal preservation of daily activities and normal global cognitive performance (Mini-Mental State Examination 29/30) and were positive to all 3 markers. Cognitive profile was assessed with an extensive neuropsychologic battery, medial temporal atrophy with hippocampal volumetry, hypometabolism on F-deoxyglucose positron emission tomography and voxel-based statistical parametric mapping analysis, and tau and amyloid beta-42 in the cerebrospinal fluid with enzyme-linked immunosorbent assay. Both patients had a poor performance in 2 out of 11 neuropsychologic tests. Both had hippocampal volumes at or below the first percentile of the age-specific distribution, retrosplenial glucose hypometabolism, and inversion of tau/amyloid beta-42 cerebrospinal fluid ratio. Both showed progression of the cognitive deficit over the following 12 months. These 2 patients with progressive MCI and positivity to all Alzheimer markers predicated by the new research criteria provide preliminary support to their validity. Future work will characterize the marker profile of the vast majority of patients with incomplete marker positivity.
Alzheimer Disease and Associated Disorders, 2010
Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture pa... more Revised research criteria for the diagnosis of Alzheimer disease have been proposed to capture patients presenting with mild and not yet disabling symptoms, and currently classified as mild cognitive impairment (MCI). We describe 2 very mild cases of MCI and their clinical outcome. The 2 cases were selected as they had unequivocal preservation of daily activities and normal global cognitive performance (Mini-Mental State Examination 29/30) and were positive to all 3 markers. Cognitive profile was assessed with an extensive neuropsychologic battery, medial temporal atrophy with hippocampal volumetry, hypometabolism on F-deoxyglucose positron emission tomography and voxel-based statistical parametric mapping analysis, and tau and amyloid beta-42 in the cerebrospinal fluid with enzyme-linked immunosorbent assay. Both patients had a poor performance in 2 out of 11 neuropsychologic tests. Both had hippocampal volumes at or below the first percentile of the age-specific distribution, retrosplenial glucose hypometabolism, and inversion of tau/amyloid beta-42 cerebrospinal fluid ratio. Both showed progression of the cognitive deficit over the following 12 months. These 2 patients with progressive MCI and positivity to all Alzheimer markers predicated by the new research criteria provide preliminary support to their validity. Future work will characterize the marker profile of the vast majority of patients with incomplete marker positivity.
Clinical Neurophysiology Official Journal of the International Federation of Clinical Neurophysiology, Jan 2, 2009
In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-... more In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-nine subjects with mild cognitive impairment (MCI) underwent EEG recording and MRI scan. The theta/gamma ratio of the relative power at the peak frequency was computed. Based on the tertiles values of the ratio, three groups with increasing values of theta/gamma ratio were obtained. The groups were characterized by the performance on cognitive tests. Changes in functional brain connectivity, as expressed by interhemisperic and intrahemispheric EEG linear coherence in the groups were also evaluated. Increase in theta/gamma ratio was associated with impairment in memory tests. This relationship was confirmed by correlation and multiple regression analysis. An independent association was found between theta/gamma ratio and alpha3/alpha2 power ratio. Coherence analysis showed modifications of interhemispheric functional coupling on temporal regions on slow frequencies. Theta/gamma ratio of relative power at peak frequency is significantly associated to memory decline. It could be a useful tool in detecting MCI subjects which are at major risk to develop Alzheimer&amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) or other dementias. A global modulation of brain rhythms could be driven by the pathological alterations of theta/gamma ratio.
Clinical Neurophysiology Official Journal of the International Federation of Clinical Neurophysiology, Jan 2, 2009
In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-... more In this study the theta/gamma ratio was investigated as early marker of cognitive decline. Forty-nine subjects with mild cognitive impairment (MCI) underwent EEG recording and MRI scan. The theta/gamma ratio of the relative power at the peak frequency was computed. Based on the tertiles values of the ratio, three groups with increasing values of theta/gamma ratio were obtained. The groups were characterized by the performance on cognitive tests. Changes in functional brain connectivity, as expressed by interhemisperic and intrahemispheric EEG linear coherence in the groups were also evaluated. Increase in theta/gamma ratio was associated with impairment in memory tests. This relationship was confirmed by correlation and multiple regression analysis. An independent association was found between theta/gamma ratio and alpha3/alpha2 power ratio. Coherence analysis showed modifications of interhemispheric functional coupling on temporal regions on slow frequencies. Theta/gamma ratio of relative power at peak frequency is significantly associated to memory decline. It could be a useful tool in detecting MCI subjects which are at major risk to develop Alzheimer&amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) or other dementias. A global modulation of brain rhythms could be driven by the pathological alterations of theta/gamma ratio.
J Psychophysiol, 2009
Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global ... more Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global cognitive function in aging. In this vein, the present study tested the hypothesis that the functional coupling of resting cortical electroencephalographic (EEG) rhythms is progressively abnormal in amnesic mild cognitive impairment (MCI) and AD subjects. Eyes-closed resting EEG data were recorded (10–20 system) in 33 mild
J Psychophysiol, 2009
Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global ... more Alzheimer’s disease (AD) is typically associated with an impairment of brain networks and global cognitive function in aging. In this vein, the present study tested the hypothesis that the functional coupling of resting cortical electroencephalographic (EEG) rhythms is progressively abnormal in amnesic mild cognitive impairment (MCI) and AD subjects. Eyes-closed resting EEG data were recorded (10–20 system) in 33 mild
Journal of the American Geriatrics Society, Feb 1, 1999
OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient ... more OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient activities of daily living (ADLs) and ADLs assessed directly in a sample of patients affected by very mild and mild dementia and to assess whether this agreement is influenced by the caregiver's depressive symptoms and burden.PATIENTS AND METHODS: Data were obtained from the baseline sample of the Mild Dementia Longitudinal Study, consisting of 111 consecutive patients affected by dementia with very mild to mild functional impairment (grades .5 and 1 on the Clinical Dementia Rating Scale). As is usual for patients referred to our Alzheimer's Unit, anamnestic, cognitive, functional and behavioral information are collected from the primary caregiver. Along with sociodemographic characteristics, caregivers' depressive symptoms (Beck Depression Inventory Scale) and burden (Nowak and Guest's Caregiver Burden Inventory Scale) were also evaluated. Patients underwent a performance-based assessment of the activities of daily living (DAFS) and direct assessment of physical function with the Physical Performance Test (PPT). Caregiver's report and direct observation have been compared for the following ADLs: dressing, toileting, walking, telephone use, shopping, and money use. Discriminant analyses were conducted to examine the degree of agreement between caregiver-report functional status and performance-based measures and whether additional agreement is attributable to caregiver's burden and depressive symptoms.RESULTS: The strength of the association between the caregiver's report and performance-based measures of ADLs is high for motor performance (walking), moderate to good for dressing, but only moderate for telephone, money use, and shopping. No association was found for toileting. The discrepancies between caregiver report and performance-based assessment were influenced substantially by the burden caused by demands and restrictions on a caregiver's time.CONCLUSIONS: With the exception of motor performance (walking), the caregiver's report and the performance-based assessment of functional status measure different aspects of a patient's functional status. Contrasts between the caregiver's report and observed ADL performance in mildly and very mildly demented patients are influenced by the caregiver's burden. J Am Geriatr Soc 47:196–202, 1999.
Journal of the American Geriatrics Society, Feb 1, 1999
OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient ... more OBJECTIVE: To determine the level of agreement between the primary caregiver's report on patient activities of daily living (ADLs) and ADLs assessed directly in a sample of patients affected by very mild and mild dementia and to assess whether this agreement is influenced by the caregiver's depressive symptoms and burden.PATIENTS AND METHODS: Data were obtained from the baseline sample of the Mild Dementia Longitudinal Study, consisting of 111 consecutive patients affected by dementia with very mild to mild functional impairment (grades .5 and 1 on the Clinical Dementia Rating Scale). As is usual for patients referred to our Alzheimer's Unit, anamnestic, cognitive, functional and behavioral information are collected from the primary caregiver. Along with sociodemographic characteristics, caregivers' depressive symptoms (Beck Depression Inventory Scale) and burden (Nowak and Guest's Caregiver Burden Inventory Scale) were also evaluated. Patients underwent a performance-based assessment of the activities of daily living (DAFS) and direct assessment of physical function with the Physical Performance Test (PPT). Caregiver's report and direct observation have been compared for the following ADLs: dressing, toileting, walking, telephone use, shopping, and money use. Discriminant analyses were conducted to examine the degree of agreement between caregiver-report functional status and performance-based measures and whether additional agreement is attributable to caregiver's burden and depressive symptoms.RESULTS: The strength of the association between the caregiver's report and performance-based measures of ADLs is high for motor performance (walking), moderate to good for dressing, but only moderate for telephone, money use, and shopping. No association was found for toileting. The discrepancies between caregiver report and performance-based assessment were influenced substantially by the burden caused by demands and restrictions on a caregiver's time.CONCLUSIONS: With the exception of motor performance (walking), the caregiver's report and the performance-based assessment of functional status measure different aspects of a patient's functional status. Contrasts between the caregiver's report and observed ADL performance in mildly and very mildly demented patients are influenced by the caregiver's burden. J Am Geriatr Soc 47:196–202, 1999.
Neurological Sciences, May 1, 2007
The objective was to evaluate the construct validity of the Italian version of the Frontal Behavi... more The objective was to evaluate the construct validity of the Italian version of the Frontal Behavioural Inventory (FBI) and its usefulness in the differential diagnosis of dementias. Standard criteria were used in the clinical diagnosis of dementias in 83 patients and 33 agematched healthy volunteers. The FBI scale was translated from English into Italian language and back-translated. Cronbach's alpha, inter-rater and test-retest reliability, FBI convergent validity and discriminant analysis were calculated. FBI profile was compared between patients affected by frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). The FBI showed a high internal consistency and inter-rater reliability and it distinguished normal behavioural conditions from those presented in FTLD or AD. An 86.8% diagnostic accuracy was calculated by the discriminant analysis, selecting only age at disease onset and FBI, and particularly distinguishing behavioural variants within the FTLD spectrum. FTLD patients showed a characteristic behavioural profile. The FBI might be a reliable and useful diagnostic tool for dementias in clinical practice.
Neurological Sciences, May 1, 2007
The objective was to evaluate the construct validity of the Italian version of the Frontal Behavi... more The objective was to evaluate the construct validity of the Italian version of the Frontal Behavioural Inventory (FBI) and its usefulness in the differential diagnosis of dementias. Standard criteria were used in the clinical diagnosis of dementias in 83 patients and 33 agematched healthy volunteers. The FBI scale was translated from English into Italian language and back-translated. Cronbach's alpha, inter-rater and test-retest reliability, FBI convergent validity and discriminant analysis were calculated. FBI profile was compared between patients affected by frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). The FBI showed a high internal consistency and inter-rater reliability and it distinguished normal behavioural conditions from those presented in FTLD or AD. An 86.8% diagnostic accuracy was calculated by the discriminant analysis, selecting only age at disease onset and FBI, and particularly distinguishing behavioural variants within the FTLD spectrum. FTLD patients showed a characteristic behavioural profile. The FBI might be a reliable and useful diagnostic tool for dementias in clinical practice.
International Psychogeriatrics Ipa, Dec 1, 2002
The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer&amp;... more The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD) are far from understood. The aim of the study was to assess whether delusional AD patients have a specific pattern of regional brain atrophy. The setting of the study was the outpatient facility of a memory clinic. Subjects were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 +/- 3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale = 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or persecution). None of the patients had misidentifications or other delusions of nonparanoid content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and FI. AD patients without delusions had symmetrical enlargement of both temporal (8.1 +/- 3.9 vs. 8.5 +/- 4.5) and frontal horns (35.8 +/- 4.8 vs. 35.9 +/- 4.6). On the contrary, AD with delusions showed temporal horns larger to the right (9.1 +/- 3.3 vs. 7.7 +/- 3.1, p = .06) and the frontal horn to the left (35.7 +/- 4.3 vs. 37.5 +/- 4.2, p = .02). This different pattern was confirmed with a gender-adjusted repeated measures analysis of variance model interaction term between asymmetry and group: F1,38 = 5.5, p = .03). AD patients with delusions are characterized by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas nondelusional patients are symmetric. Because the asymmetry pattern of the delusional patients is similar to the physiological pattern of asymmetry of individuals without dementia, the data indicate that the absence of theft delusions in the mild stage of AD rather than their presence is associated with an abnormal asymmetry pattern.
Radiology, Mar 1, 2011
To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable ... more To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable Alzheimer disease (AD) and (b) patients with amnestic mild cognitive impairment (aMCI) and at least one abnormal biomarker and to investigate whether WM damage is related to gray matter (GM) atrophy. This study was approved by the institutional review board, and written informed consent was obtained from each participant. Twenty-three patients with AD, 15 patients with aMCI, and 15 healthy control subjects underwent diffusion tensor magnetic resonance imaging. WM tract damage was investigated by using tract-based spatial statistics, and GM atrophy was measured by using voxel-based morphometry. Compared with control subjects, patients with AD had an increase in mean diffusivity in all major WM tracts studied, including the limbic, cortico-cortical, interhemispheric, and corticospinal tracts. Conversely, fractional anisotropy decreased only in the parahippocampal tract, fornix, and small, inferior parietal regions. In addition, patients with AD showed a widespread increase in axial and radial diffusivity compared with control subjects. Patients with aMCI showed an increase in axial diffusivity only in tracts projecting to the frontal cortex and splenium of the corpus callosum. Significant and anatomically congruent correlations between WM changes and regional GM atrophy were found in patients with AD. Conversely, damage to most WM tracts in patients with aMCI did not correlate with GM atrophy. In AD, the observed patterns of WM abnormalities may reflect the advanced phase of a secondary degenerative process and an association, especially in the early phases of the disease, with primary WM tract damage over and above GM abnormalities.
Radiology, Mar 1, 2011
To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable ... more To explore the regional patterns of white matter (WM) tract damage in (a) patients with probable Alzheimer disease (AD) and (b) patients with amnestic mild cognitive impairment (aMCI) and at least one abnormal biomarker and to investigate whether WM damage is related to gray matter (GM) atrophy. This study was approved by the institutional review board, and written informed consent was obtained from each participant. Twenty-three patients with AD, 15 patients with aMCI, and 15 healthy control subjects underwent diffusion tensor magnetic resonance imaging. WM tract damage was investigated by using tract-based spatial statistics, and GM atrophy was measured by using voxel-based morphometry. Compared with control subjects, patients with AD had an increase in mean diffusivity in all major WM tracts studied, including the limbic, cortico-cortical, interhemispheric, and corticospinal tracts. Conversely, fractional anisotropy decreased only in the parahippocampal tract, fornix, and small, inferior parietal regions. In addition, patients with AD showed a widespread increase in axial and radial diffusivity compared with control subjects. Patients with aMCI showed an increase in axial diffusivity only in tracts projecting to the frontal cortex and splenium of the corpus callosum. Significant and anatomically congruent correlations between WM changes and regional GM atrophy were found in patients with AD. Conversely, damage to most WM tracts in patients with aMCI did not correlate with GM atrophy. In AD, the observed patterns of WM abnormalities may reflect the advanced phase of a secondary degenerative process and an association, especially in the early phases of the disease, with primary WM tract damage over and above GM abnormalities.
AJNR. American journal of neuroradiology, 1996
To assess the sensitivity of linear measures of brain atrophy in the diagnosis of Alzheimer disea... more To assess the sensitivity of linear measures of brain atrophy in the diagnosis of Alzheimer disease (AD) in the early stages. Linear measures of regional frontal (Bifrontal index, interhemispheric fissure width), medial temporal lobe (interuncal distance, minimum thickness of the medial temporal lobe), and hippocampal (hippocampal height, width of the choroid fissure, width of the temporal horn) atrophy were made on magnified MR images obtained in 46 patients with AD (33 with mild severity and 13 with moderate severity) and in 31 control subjects. Gaussian modeling was used to compute sensitivity with specificity set at 95%. Discriminant analysis was used to identify measures independently contributing to the ability to discriminate AD patients from control subjects. The measure with the best sensitivity in discriminating AD patients from control subjects was the width of the temporal horn. A compound measure of width of the temporal horn, width of the choroid fissure, height of the...
Ajnr American Journal of Neuroradiology, 2002
BACKGROUND AND PURPOSE: Atrophy in the medial temporal lobe (MTL) structures depicted with brain ... more BACKGROUND AND PURPOSE: Atrophy in the medial temporal lobe (MTL) structures depicted with brain imaging is one of the most accurate markers of Alzheimer disease (AD), but practical considerations have thus far limited their routine clinical use. The aim of this study was to explore the validity of a CT-and MR-based measure of MTL atrophy that would be feasible for routine clinical use.
Journal of geriatric psychiatry and neurology, 1995
Dementia of the frontal type (DFT) is a degenerative disorder with early behavioral and language ... more Dementia of the frontal type (DFT) is a degenerative disorder with early behavioral and language disturbances and with relative preservation of memory and visuospatial abilities. On neuropathology, DFT lacks the pathologic hallmarks of Alzheimer's disease (AD). We assessed the neuropsychological and SPET imaging features of 11 DFT and 16 AD patients. The two groups had similar performances on verbal learning, while the former had significantly higher nonverbal learning scores. Testing of verbal and nonverbal instrumental abilities showed that this different behavior could be due to poorer verbal fluency of DFT patients, and not necessarily to poorer learning. Neuropsychological data indicated that the often reported sparing of memory in daily functions of DFT patients can also be shown with formal neuropsychological testing of nonverbal learning. SPET showed a comparatively higher perfusion deficit of frontal regions in the left hemisphere of DFT patients, suggesting that this r...
European Neurology, 2003
Subcortical ischemic vascular disease (SIVD) is frequently associated with cognitive impairment. ... more Subcortical ischemic vascular disease (SIVD) is frequently associated with cognitive impairment. Rating scales to grade cerebrovascular disease are available, but their sensitivity to the clinical features of mild SIVD is unclear. The aim of the study is to devise and validate a computed tomography (CT)-based visual rating scale sensitive to SIVD in patients with mild cognitive deterioration. Subjects were 122 consecutive outpatients of a memory clinic (mean age +/- SD 77 +/- 8 years, 71% females, mean +/- SD score of mental state exam 22 +/- 3, 61% with clinical dementia rating of 0.5 and 39% of 1). Diffuse leukoaraiosis, fuzzy and patchy lesions, and lacunes were assessed on ordinary CT films and weights were computed based on clinical indicators of SIVD. A continuous score and an ordinal class (0-3) with higher values indicating higher vascular damage were derived. Intraclass correlation coefficients for intra- and interrater reliability of the subcortical vascular score and class ranged from 0.84 to 0.88. Convergent validity versus the scale of Wahlund et al. was good (Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficient between 0.53 and 0.73, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0005). Known-group validity was assessed versus clinical diagnoses of degenerative (mild cognitive impairment determined by Petersen et al. and NINCDS-ADRDA probable Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease; n = 58), mixed (possible Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease with cerebrovascular disease; n = 21), and vascular cognitive impairment (criteria of Erkinjuntti et al. for subcortical vascular dementia and cognitive impairment; n = 43). Patients with degenerative cognitive impairment were more often in the lower subcortical vascular classes (43% in class 0, 43% in class 1, 14% in class 2, and 0% in class 3), while patients with mixed (0, 24, 24, and 52%) and vascular cognitive impairment were in increasingly higher subcortical vascular classes (0, 12, 35, 53%; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.00005). Criterion-related validity was assessed versus clinical indicators of cerebrovascular disease. Hypertension, platelet aggregation inhibitor use, balance, gait, and bradykinesia increased linearly with increasing subcortical vascular class (p for trend &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.02). This rating scale is valid and sensitive to capture different degrees of SIVD associated with mild cognitive deterioration.
Journal of Alzheimer's disease : JAD, 2008
The working hypothesis of paper is that the functional coupling of brain areas is combined with d... more The working hypothesis of paper is that the functional coupling of brain areas is combined with different neuroradiological substrates and has different clinical manifestations. 31 normal old subjects and 85 subjects with mild cognitive impairment (MCI) underwent EEG recordings and magnetic resonance imaging (MRI). Intrahemispheric and interhemispheric linear EEG coherences were computed. At first, all normal old and MCI subjects were compared. Subsequently, three subgroups of MCI were obtained based on neuroradiological substrate (subcortical cerebrovascular damage, MCI-CVD; cholinergic pathways vascular damage MCI-CHOL; and hippocampal atrophy, MCI-HIPP) and compared with a normal old sample matched for age, education and Mini-Mental State Examination score. The group of MCI subjects compared to normal old subjects shows: 1) decrease of intrahemispheric coherence in fronto-parietal regions (both right and left hemisphere); 2) increase of interhemispheric coherence on frontal regio...