Publications by authors named "Marta Picascia"

19 Publications

  • Page 1 of 1

Neurophysiological evaluation of visual function in iRBD: potential role in stratifying RBD conversion risk.

Sleep Med 2021 May 15;84:26-31. Epub 2021 May 15.

Neurology and Stroke Unit, ASST Sette Laghi Ospedale di Circolo, Varese; DMC University of Insubria, Varese, Italy.

Study Objectives: To evaluate neurophysiological alterations of visual function in idiopathic REM sleep Behavior Disorder (iRBD) both as markers and predictors of neurodegenerative disorders.

Methods: In a longitudinal follow-up study of 46 consecutive iRBD patients (follow-up duration 8.4 ± 3.4 years), the baseline parameters in luminance-contrast pattern (VEPp), red-green color (VEPc) and motion-onset (VEPm) Visual Evoked Potentials in iRBD were compared to early (ePD) and advanced (aPD) Parkinson's Disease subjects. Parameters of latency and amplitude of iRBD converters to neurodegenerative disease were compared with those of the non-converters.

Results: The VEP P100 mean latency values for both eyes and for both stimulation checks (30' and 15') were significantly longer in all the three groups of patients as compared to controls; moreover latencies were longer in aPD than in the iRBD group who did not differ from the ePD group. The same held true when we analyzed the number of abnormal subjects belonging to each diagnostic group with a higher number of abnormal subjects in the aPD group compared to both the ePD and in iRBD groups. Chromatic and motion potentials were not different from controls and did not differ in the 3 diagnostic groups. The iRBD subjects who converted to a neurodegenerative disorder showed longer P100 latencies and a higher occurrence of VEPp abnormalities than those who did not convert. Again chromatic and motion VEPs were not different depending on conversion.

Conclusions: In iRBD patients the detection of an abnormal VEPp should be considered as a red flag for possible synnucleinopathy, eventually contributing in stratifying the risk of phenoconversion.
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http://dx.doi.org/10.1016/j.sleep.2021.05.006DOI Listing
May 2021

Evaluation of the efficacy of physical therapy on cognitive decline at 6-month follow-up in Parkinson disease patients with mild cognitive impairment: a randomized controlled trial.

Aging Clin Exp Res 2021 May 12. Epub 2021 May 12.

IRCCS Mondino Foundation, Via Mondino 2, 20100, Pavia, Italy.

Background: In Parkinson's disease (PD), physical activity may represent a possible non-pharmacological intervention not only for improving motor symptoms but also for modulating cognitive impairment.

Aims: To evaluate the efficacy of an intensive physical program on cognitive functions in mid-stage PD patients with mild cognitive impairment (PD-MCI) over a 6-month follow-up.

Methods: This is a 6-month randomized controlled follow-up study. 40 PD-MCI patients were randomized to receive physical therapy (PT) or no specific intervention beside drug treatment (CT). Cognitive and motor assessments were performed at baseline (T0), 4 weeks after baseline (T1) and 6 months after T0. In a previous study, we reported a significant improvement in global cognitive functioning and attention/working-memory at T1. Here, we evaluated the residual effect of the training intervention at 6 months on both cognitive and motor performances.

Results: Intra-group analysis showed that at T2 most of cognitive and motor performances remained stable in the PT when compared to T0, while a significant worsening was observed in the CT. Between-group comparison at T2 showed significantly better results in PT than CT as regards MoCA and motor scales. The percentage change of cognitive and motor performances between T1 and T2 confirmed the benefit of physical therapy on global cognitive functioning scores (MMSE and MoCA).

Conclusions: In this follow-up extension of a longitudinal randomized controlled study, we demonstrated that physical therapy has a positive effect on cognitive functions, which extends beyond the duration of the treatment itself to, at least temporarily, reducing cognitive decline.

Trial Registration: Trial registration number (ClinicalTrials.gov): NCT04012086 (9th July 2019).
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http://dx.doi.org/10.1007/s40520-021-01865-4DOI Listing
May 2021

Correlation of Frontal Atrophy and CSF Tau Levels With Neuropsychiatric Symptoms in Patients With Cognitive Impairment: A Memory Clinic Experience.

Front Aging Neurosci 2021 5;13:595758. Epub 2021 Mar 5.

Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy.

: Behavioral and psychological symptoms of dementia (BPSD) are a distressful condition. We aimed to investigate the BPSD distribution in subjects with cognitive impairment, and the potential correlations between BPSD and neurodegeneration in terms of cerebrospinal fluid (CSF) tau and brain atrophy. : One-hundred patients with mild cognitive impairment (MCI) or dementia (Alzheimer's disease, AD; Lewy-body disease, LBD; frontotemporal dementia, FTD; vascular dementia, VD) underwent a complete diagnostic workup, including 3T-MRI and/or CT and CSF. Cortical atrophy was assessed with medial temporal atrophy (MTA), posterior atrophy (PA), and global cortical atrophy-frontal lobe (GCA-F) scales. BPSD were rated using the Neuropsychiatric Inventory (NPI), and BPSD clusters were defined according to the European Alzheimer Disease Consortium. : Delusions, hallucinations, and psychosis cluster were differently distributed among the diagnostic groups ( < 0.05, < 0.001, and < 0.05), with LBD patients showing higher scores for hallucinations (vs. MCI, < 0.001, and AD, < 0.05) and psychosis cluster (vs. MCI, < 0.05). In primary dementias, we found a negative correlation between NPI total score and tau levels ( = 0.08), confirmed by beta regression ( < 0.01), while a positive non-significant relationship was observed in MCI. Higher GCA-F scores were associated with delusions and apathy ( < 0.05, on both hemispheres) and hallucinations (left: < 0.01, right: < 0.05). GCA-F scores were positively correlated with psychosis cluster (right: < 0.05), and agitation/aggression (left: < 0.05). Conversely, nighttime disturbances were positively correlated with both GCA-F and MTA scores (left: < 0.01; right: < 0.05). : Our results suggest that psychotic symptoms are significantly more represented in LBD patients and that CSF tau and frontal atrophy are associated with the occurrence and severity of BPSD in clinical practice. Longitudinal studies are however required to ascertain their actual predictive value.
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http://dx.doi.org/10.3389/fnagi.2021.595758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973017PMC
March 2021

NREM sleep arousal-related disorders reflect cognitive impairment in Parkinson's disease.

Sleep Med 2020 11 5;75:491-496. Epub 2020 Sep 5.

Sleep and Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy.

Background: Sleep disorders and cognitive impairment are frequently reported in Parkinson's disease (PD) as non-motor disabling symptoms. While it is known that REM sleep Behaviour Disorder (RBD) in PD is associated with motor and cognitive decline, little is known about the neurobiological significance of NREM sleep arousal-related disorders.

Objectives: to evaluate the cognitive and clinical correlates of arousal-related disorders in PD.

Methods: Clinical data and video-polysomnography were analysed from one hundred-seventy consecutive subjects with PD. Based on the neuropsychological assessment, the subjects were divided into three groups: no cognitive impairment (PD; n = 58), mild cognitive impairment (PD-MCI; n = 58) and overt dementia (PDD; n = 54).

Results: Arousal-related disorders by history were reported in 32.9% of the subjects: 10.3% PD, 31.6% PD-MCI and 59.3% PDD (p = 0.001). Video-PSG captured arousal-related disorders in 1.7% PD, 21.2% MCI-PD and 35.6% PDD (p = 0.001). Arousal-related disorders and RBD were recorded in the same night in 7.7% PD, 9.8% MCI-PD and 15.6% PDD (p = 0.04). Patients with arousal-related disorders captured at V-PSG have a longer disease duration (p = 0.003), higher UPDRS score (p = 0.039), longer duration of treatment with levodopa (p = 0.017) and dopamine agonists (p = 0.018), worse H&Y staging (p = 0.001), lower MMSE score (p = 0.019) and more frequently hallucinations (p = 0.004). In multivariate analysis, cognitive impairment significantly increases the risk of arousal-related disorders (OR 3.387-95% CI 1.395-8.220, p = 0.007).

Conclusion: Arousal-related disorders appear to be a marker of cognitive decline in PD. Recognizing arousal-related disorders should make clinicians aware of a possible cognitive decline in PD and eventually modify the therapeutic approach.
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http://dx.doi.org/10.1016/j.sleep.2020.08.029DOI Listing
November 2020

Lumboperitoneal shunt in idiopathic normal pressure hydrocephalus: a prospective controlled study.

J Neurol 2020 Sep 5;267(9):2556-2566. Epub 2020 May 5.

Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.

Objective: In this prospective, controlled, monocentric study, we described the clinical and neuroimaging 12-month follow-up of two parallel cohorts of subjects with idiopathic normal pressure hydrocephalus (iNPH), who did or did not undergo lumboperitoneal shunt (LPS).

Methods: We recruited 78 iNPH patients. At baseline, subjects underwent clinical and neuropsychological assessments, 3 T magnetic resonance imaging (MRI), and tap test. After baseline, 44 patients (LPS group) opted for LPS implantation, whereas 34 subjects (control group) declined surgery. Both cohorts were then followed up for 12 months through scheduled clinical and neuropsychological evaluations every 6 months. 3 T MRI was repeated at 12-month follow-up.

Results: Gait, balance, and urinary continence improved in the LPS group, without significant influence on cognitive functions. Conversely, gait and urinary continence worsened in the control group. No preoperative MRI parameter was significant outcome predictor after LPS. Of relevance, in responders to LPS, we found postoperative reduction of periventricular white matter (PWM) hyperintensities, which were instead increased in the control group.

Conclusions: LPS is safe and effective in iNPH. An early surgical treatment is desirable to prevent clinical worsening. Post-surgery decrease of PWM hyperintensities may be a useful MRI marker surrogate for clinical effectiveness of LPS.
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http://dx.doi.org/10.1007/s00415-020-09844-xDOI Listing
September 2020

Early phases of cognitive disorders in the elderly patients: report of an Italian center for dementia.

Aging Clin Exp Res 2020 05 13;32(5):967-968. Epub 2019 Nov 13.

Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS C. Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.

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http://dx.doi.org/10.1007/s40520-019-01408-yDOI Listing
May 2020

Evening melatonin timing secretion in real life conditions in patients with Alzheimer disease of mild to moderate severity.

Sleep Med 2019 11 31;63:122-126. Epub 2019 May 31.

Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.

Background: Circadian dysfunction is thought to take part in the pathogenesis of sleep disorders in Alzheimer's disease (AD) and in AD pathophysiology itself.

Objective: Our study aims to calculate dim light melatonin onset (DLMO) secretion in order to define the circadian phase in patients with AD at an early stage of the disease.

Methods: Twenty-one patients (M/F: 11/10; mean age 74.1 ± 5.4 years; mean disease duration 3.4 ± 1.6 years) with a diagnosis of AD and 17 healthy controls (HC; M/F: 10/7; mean age 67.47 ± 3.8 years) were investigated for subjective nocturnal sleep quality and chronotype, for DLMO and quantitative aspects of the evening melatonin secretion by means of a 5-point in-home evening melatonin saliva test.

Results: Subjective sleep quality score on the Pittsburgh Sleep Quality Index questionnaire (PSQI) above 5 (p = 0.24), insomnia frequency as measured by Sleep Condition Indicator Questionnaire (p = 0.823) and the subjective chronotype according to Morning Evening Questionnaire (MEQ) scores distribution (p = 0.464) did not differ between AD and HC. However, DLMO occurred significantly later (55 min; p = 0.028), and melatonin secretion following DLMO was significantly decreased in AD patients compared to HC.

Conclusion: Initial evening secretion of melatonin proves to be delayed and mildly impaired in patients with a mild/moderate form of Alzheimer disease while patients' subjective sleep parameters and chronotype are reported to be similar to those of HC. These results indicate that subclinical altered patterns of melatonin secretion occur in subjects with AD at an early stage of the disease.
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http://dx.doi.org/10.1016/j.sleep.2019.04.018DOI Listing
November 2019

A computer-based cognitive training in Mild Cognitive Impairment in Parkinson's Disease.

NeuroRehabilitation 2019 ;44(4):555-567

Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS Mondino Foundation, Pavia, Italy.

Background: There is no successful pharmacological treatment for cognitive impairment in Parkinson's Disease, therefore treatments capable of slowing down the progression of cognitive dysfunction are needed.

Objective: To evaluate the effectiveness of a cognitive training, supported by the CoRe computerized tool, in patients with Parkinson's Disease Mild Cognitive Impairment.

Methods: This is a prospective, open-unblinded, randomized, controlled study. After baseline cognitive assessment (T0), enrolled patients were randomized to receive motor rehabilitation plus cognitive intervention (G1) or motor rehabilitation only (G2). Follow-up assessments were scheduled 4 weeks (T1) and 6 months after (T2). Global cognitive functioning scores (MOCA and MMSE) were considered as primary outcome. Outcome measures at T0, T1 and T2 were compared within- and between-groups. A percentage change score between T0 and next assessments was calculated to identify patients who improved, remain stable or worsened.

Results: Differently from G2, G1 showed a medium/large effect size improvement in primary (MoCA) and secondary outcome, both between T0 and T1 and T0 and T2. Moreover, within G1, most patients improved their cognitive state compared to the baseline.

Conclusions: Patients trained with CoRe showed a better evolution of cognitive decline, while untreated patients tended to get worse over time.
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http://dx.doi.org/10.3233/NRE-192714DOI Listing
October 2019

Assessment of cognitive profile as a prodromal marker of the evolution of rapid eye movement sleep behavior disorder.

Sleep 2019 08;42(8)

Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.

Study Objectives: To search for a specific neuropsychological profile in idiopathic REM sleep behavior disorder (iRBD), able to predict the onset of neurodegenerative disorders.

Methods: In a longitudinal follow-up study of 63 consecutive iRBD patients (follow-up duration 6.7 ± 3.8 years), the baseline cognitive profile of converters to neurodegenerative disease was compared with that of the nonconverters. Five cognitive domains were assessed: memory, attention-working memory, executive functions, visuospatial abilities, language. Mild cognitive impairment (MCI) was diagnosed according to the Movement Disorder Society's diagnostic criteria for Parkinson's disease.

Results: 30 subjects (47.6%) developed a neurodegenerative disease (latency to conversion 60.33 ± 44.81 months). MCI was found in 50% of the converters and 12% of the nonconverters (p = .001), and its presence conferred a neurodegenerative disease risk of 10% at 3 years, 36% at 5 years, and 73% at 10 years (p = .002). Pathological equivalent scores on at least one neuropsychological test were detected in 46.7% of the converters versus 21.2% of the nonconverters in the memory domain (p = .032), in 40.0% versus 6.1% in that of executive functions (p = .002), and in 20.0% versus 3% in the visuospatial abilities domain (p = .047). On multivariate analysis, impaired executive functions significantly correlated with phenoconversion (p = .018). Lower Mini Mental State Examination (MMSE) scores (p = .004) and memory deficits (p = .031) were found in patients who developed dementia first.

Conclusions: Cognitive profile is useful for stratifying risk of phenoconversion in patients with iRBD. The presence of MCI and impaired executive functions, memory, and visuospatial abilities discriminated the converters. Lower MMSE scores and memory deficits may characterize those subjects who first develop dementia.
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http://dx.doi.org/10.1093/sleep/zsz103DOI Listing
August 2019

Disease progression in relation to age at onset in a population with Alzheimer's Dementia.

Aging Clin Exp Res 2019 May 28;31(5):723-725. Epub 2018 Aug 28.

Neuropsychology/Alzheimer's Disease Assessment Unit, IRCCS C. Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.

One thousand and 679 Alzheimer's Disease patients (early onset EO: 152 and late onset LO: 1527) were evaluated after 12, 36 and 60 months. At baseline EO patients have higher Mini Mental State examination (MMSE) and fewer comorbidities in respect to LO group. The MMSE score did not significantly differ after 12, 36 and 60 months; a more marked worsening in instrumental daily activities was observed after 36 months in the EO compared with the LO group. These data allow to conclude that EO patients may have a slight faster progression in the disease within the first 3 years after the diagnosis, but in a longer follow-up no differences exist in respect to LO group. The literature failed to identify specific factors capable to influence the disease progression in AD. Our data are in substantial agreement with the literature and seem to confirm the great heterogeneity of AD patients.
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http://dx.doi.org/10.1007/s40520-018-1027-5DOI Listing
May 2019

Correlations among age, cognitive impairment, and comorbidities in Alzheimer's disease: report from a center for cognitive disorders.

Aging Clin Exp Res 2017 Dec 21;29(6):1299-1300. Epub 2017 Aug 21.

Neuropsychology/Alzheimer's Disease Assessment Unit, C. Mondino National Neurological Institute, IRCCS C. Mondino, Via Mondino 2, 27100, Pavia, Italy.

We report an update of our previous observations in Alzheimer's disease (AD) patients in the routine clinical practice considering in particular the interactions between age, concomitant pathologies, and treatment adherence. 2379 AD patients (M/F: 1058/1321, mean age: 74.1 ± 8.8) referred for a first visit to our center from September 2000 to April 2017. An increase of percentage of patients aged over 80 years along the years was confirmed (27% between September 2000 and December 2010, and 39% between January 2011 to April 2017). The patients over 80 years presented a Cumulative Illness Rating Scale (CIRS) significantly higher than patients under 80 years (p < 0.00001). Higher CIRS scores were associated with a lower treatment adherence (p < 0.0002) and greater cognitive impairment (p < 0.01). As people in advanced age with cognitive disorders will increase, our approach to dementing conditions has to change and fit to social and epidemiological modifications.
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http://dx.doi.org/10.1007/s40520-017-0807-7DOI Listing
December 2017

Modeling Alzheimer Disease Through Functional Independence and Participation.

Alzheimer Dis Assoc Disord 2017 Jul-Sep;31(3):218-224

*Neuro-Oncology Unit, IRCCS Regina Elena Cancer Institute, Rome †Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Care & Research Rehabilitation Hospitals, Zingonia di Ciserano, Bergamo ‡Alzheimer Assessment Unit/Laboratory of Neuropsychology, IRCCS Neurological National Institute C. Mondino Foundation, Pavia, Italy.

Introduction: The relationship between cognitive and functional impairment in Alzheimer Disease (AD) at the earliest stages of the disease is not well characterized. This study aimed at investigating such relationships along AD evolution by means of the Disability Assessment for Dementia (DAD).

Methods: Consecutive pairs of AD outpatients and their primary informal caregivers were enrolled. Patients were evaluated by means of the Mini Mental State Examination and neuropsychological tests. A clinician completed the Clinical Dementia Rating Scale to stage dementia severity and interviewed the caregivers to complete the Neuropsychiatric Inventory to assess behavioral disturbances and the DAD to evaluate patients' functional competence.

Results: A total of 158 dyads were enrolled; the Mini Mental State Examination score was used to stratify patients into 4 groups (>24; 20 to 23.9; 10 to 19.9; <10) that were compared. The statistical analysis revealed that all the cognitive domains were positively related to functional independence, but only logical and executive functions seemed to predict autonomy. An intergroup comparison did not show significant differences in the DAD subscales measuring initiation, planning and organization, and performance. The role of education emerged, confirming the relevance of cognitive reserve.

Discussion: As the field moves toward earlier intervention in preclinical AD, the detection of early functional changes may drive the definition of trials on prevention or intervention for dementia.
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http://dx.doi.org/10.1097/WAD.0000000000000167DOI Listing
May 2018

Spectrum of cognitive disorders in idiopathic normal pressure hydrocephalus.

Funct Neurol 2016 Jul-Sep;31(3):143-7

Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by ventricular dilation accompanied by a progressive triad of a gait disturbance, "dementia" and incontinence. We retrospectively evaluated cognitive profile, and its relationship with disease variables, in 64 iNPH patients. The iNPH group performed significantly worse than the control group on all neuropsychological tests, except for verbal memory (within the normal range). The patients were subdivided into four groups: group 1 (42%: global cognitive impairment); group 2 (24%: frontosubcortical dysfunction); group 3 (17%: isolated deficit of a single cognitive domain); group 4 (17%: no cognitive impairment). Group 1 was older, with a significantly longer disease duration and more severe motor disease, while groups 3 and 4 were younger and presented milder motor impairment and a shorter disease duration. These data suggest parallel progression of cognitive and motor impairment in iNPH; early shunt surgery might prevent the development, in older age, of dementia in these patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115228PMC
http://dx.doi.org/10.11138/fneur/2016.31.3.143DOI Listing
February 2017

A review of cognitive impairment and differential diagnosis in idiopathic normal pressure hydrocephalus.

Funct Neurol 2015 Oct-Dec;30(4):217-28

Idiopathic normal pressure hydrocephalus (iNPH) is a complex and still underestimated pathology. In the early stages, the cognitive profile is characterized mainly by impairments of attention, psychomotor speed and memory, suggesting frontal involvement; patients with more advanced iNPH show overall cognitive deterioration. The memory impairment, however, seems to be milder than that seen in Alzheimer's disease (AD). Clinical and neuroimaging data are crucial for the diagnosis of iNPH, but the presence of different variables, such as comorbidities, and the possible overlapping with other neurodegenerative diseases, AD in particular, make the differential diagnosis difficult. To date studies seeking to identify possible biological markers have provided inconclusive results; moreover reliable indices predictive of a good response to surgery are still lacking. There is a need for further studies with longer follow-ups and for closer interaction among the different professionals involved.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758774PMC
http://dx.doi.org/10.11138/fneur/2015.30.4.217DOI Listing
September 2016

Clinical characteristics of population referred to an Italian center for dementia: an update.

Aging Clin Exp Res 2015 Oct 28;27(5):755-6. Epub 2015 Jul 28.

Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy.

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http://dx.doi.org/10.1007/s40520-015-0429-xDOI Listing
October 2015

Ethical safety of deep brain stimulation: A study on moral decision-making in Parkinson's disease.

Parkinsonism Relat Disord 2015 Jul 23;21(7):709-16. Epub 2015 Apr 23.

Centro Clinico per la Neurostimolazione, le Neurotecnologie ed i Disordini del Movimento, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan, Italy. Electronic address:

Introduction: The possibility that deep brain stimulation (DBS) in Parkinson's disease (PD) alters patients' decisions and actions, even temporarily, raises important clinical, ethical and legal questions. Abnormal moral decision-making can lead to ethical rules violations. Previous experiments demonstrated the subthalamic (STN) activation during moral decision-making. Here we aim to study whether STN DBS can affect moral decision-making in PD patients.

Methods: Eleven patients with PD and bilateral STN DBS implant performed a computerized moral task in ON and OFF stimulation conditions. A control group of PD patients without DBS implant performed the same experimental protocol. All patients underwent motor, cognitive and psychological assessments.

Results: STN stimulation was not able to modify neither reaction times nor responses to moral task both when we compared the ON and the OFF state in the same patient (reaction times, p = .416) and when we compared DBS patients with those treated only with the best medical treatment (reaction times: p = .408, responses: p = .776).

Conclusions: Moral judgment is the result of a complex process, requiring cognitive executive functions, problem-solving, anticipations of consequences of an action, conflict processing, emotional evaluation of context and of possible outcomes, and involving different brain areas and neural circuits. Our data show that STN DBS leaves unaffected moral decisions thus implying relevant clinical and ethical implications for DBS consequences on patients' behavior, on decision-making and on judgment ability. In conclusion, the technique can be considered safe on moral behavior.
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http://dx.doi.org/10.1016/j.parkreldis.2015.04.011DOI Listing
July 2015

Treatment adherence in patients with Alzheimer's disease referred to an Italian center for dementia.

Aging Clin Exp Res 2015 Jun 5;27(3):395-6. Epub 2014 Nov 5.

Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, C. Mondino National Neurological Institute, Via Mondino 2, 27100, Pavia, Italy,

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http://dx.doi.org/10.1007/s40520-014-0279-yDOI Listing
June 2015

Quality of life in Alzheimer disease: a comparison of patients' and caregivers' points of view.

Alzheimer Dis Assoc Disord 2015 Jan-Mar;29(1):50-4

*Laboratory of Neuropsychology/Alzheimer Assessment Unit, IRCCS Neurological National Institute C. Mondino Foundation †Department of Public Health, Neuroscience, Experimental and Forensic Medicine, University of Pavia, Pavia ‡Neurorehabilitation Unit, IRCCS NEUROMED, Pozzilli (Isernia), Italy.

Unlike in other chronic diseases, the Quality of Life (QoL) of patients affected by Alzheimer Disease (AD) has not been well established, primarily because of the difficulties stemming from the study of patients with cognitive disorders. Because no cure is currently available for AD, the optimization of QoL represents the best possible outcome attainable in all stages of disease, making QoL assessment mandatory. This study identified variables related to patients' QoL and examined the agreement between patients' and caregivers' QoL ratings. A total of 135 dyads (patient and principal caregiver) were enrolled in the study. Patients' QoL evaluations showed a negative relationship with depressive mood and a positive relationship with Activities of Daily Living (ADL), whereas caregivers' QoL ratings showed a negative relationship with patients' depressive mood and behavioral disturbances. Caregivers tended to underestimate patients' QoL compared with the patients' own self-evaluations, with patients' dependency in performing ADL and behavioral disorders as well as caregivers' burdens and depression being the main factors associated with the discrepancy in these evaluations. These findings suggest that the use of proxies as a substitute for the self-report of QoL data should be treated with caution, always accounting for the presence of potential bias.
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http://dx.doi.org/10.1097/WAD.0000000000000050DOI Listing
November 2015