Publications by authors named "Sara Bottiroli"

41 Publications

High perceived isolation and reduced social support affect headache impact levels in migraine after the Covid-19 outbreak: A cross sectional survey on chronic and episodic patients.

Cephalalgia 2021 Jul 13:3331024211027568. Epub 2021 Jul 13.

Department of Brain and Behavioral Sciences, 19001University of Pavia, University of Pavia, Pavia, Italy.

Background: Psychosocial variables are key factors influencing psycho-physical equilibrium in migraine patients. Social isolation and vulnerability to stressors may prevent efficient psychological adjustment negatively affecting adaptation to life changes, as that imposed during Covid-19 lockdown. Here, we explored psychosocial dimensions and changes in clinical condition during Covid-19 lockdown in migraine patients, with regard to migraine type and headache impact.

Methods: Sixty-four migraine patients (32 episodic and 32 chronic) and 64 healthy control subjects were included in a case-control cross-sectional study. A two-step clustering procedure split patients into two clusters, based on the Headache Impact Test. Perceived global distress, loneliness, empathy, and coping levels were compared in groups, as well as changes in clinical condition.

Results: Migraine patients reported higher general loneliness and lower social support compared to healthy control subjects. Emotional loneliness was more marked in patients with higher headache impact. This subgroup of patients more frequently reported changes in the therapeutic and care paths as the perceived cause of the occurrence of motor or extra-motor symptomatology.

Conclusions: Migraine patients, especially those more severely affected, proved more vulnerable than healthy control subjects to Covid-19 lockdown. Long-lasting interruption of social interactions may be detrimental in fragile patients that are in need of structured support interventions to maintain psycho-physical wellbeing.
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http://dx.doi.org/10.1177/03331024211027568DOI Listing
July 2021

A double-blind randomized controlled trial combining cognitive training (CoRe) and neurostimulation (tDCS) in the early stages of cognitive impairment.

Aging Clin Exp Res 2021 Jun 22. Epub 2021 Jun 22.

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

Background: The prevalence of neurodegenerative diseases is expected to increase over the next years, therefore, new methods able to prevent and delay cognitive decline are needed.

Aims: To evaluate the effectiveness of a combined treatment protocol associating a computerized cognitive training (CoRe) with anodal transcranial direct current stimulation (tDCS).

Methods: In this randomized controlled trial, 33 patients in the early stage of cognitive impairment were assigned to the experimental group (CoRE + real tDCS) or control group (CoRE + sham tDCS). In each group, the intervention lasted 3 consecutive weeks (4 sessions/week). A neuropsychological assessment was administered at baseline (T0), post-intervention (T1) and 6-months later (T2).

Results: The CoRE + real tDCS group only improved in working memory and attention/processing speed at both T1 and T2. It reported a stable MMSE score at T2, while the CoRE + sham tDCS group worsened. Age, mood, and T0 MMSE score resulted to play a role in predicting treatment effects.

Conclusion: Combined multi-domain interventions may contribute to preventing or delaying disease progression.

Trial Registration: Trial registration number (ClinicalTrials.gov): NCT04118686.
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http://dx.doi.org/10.1007/s40520-021-01912-0DOI Listing
June 2021

Telemedicine and Virtual Reality at Time of COVID-19 Pandemic: An Overview for Future Perspectives in Neurorehabilitation.

Front Neurol 2021 25;12:646902. Epub 2021 Mar 25.

Headache Science and Neurorehabilitation Center, Istituto di Ricovero e Cura a Carattere Scientifico Mondino Foundation, Pavia, Italy.

In catastrophic situations such as pandemics, patients' healthcare including admissions to hospitals and emergency services are challenged by the risk of infection and by limitations of healthcare resources. In such a setting, the use of telemedicine interventions has become extremely important. New technologies have proved helpful in pandemics as a solution to improve the quality of life in vulnerable patients such as persons with neurological diseases. Moreover, telemedicine interventions provide at-home solutions allowing clinicians to telemonitor and assess patients remotely, thus minimizing risk of infection. After a review of different studies using telemedicine in neurological patients, we propose a telemedicine process flow for healthcare of subjects with chronic neurological disease to respond to the new challenges for delivering quality healthcare during the transformation of public and private healthcare organizations around the world forced by COVID-19 pandemic contingency. This telemedicine process flow represents a replacement for in-person treatment and thereby the provision equitable access to the care of vulnerable people. It is conceptualized as comprehensive service including (1) teleassistance with patient counseling and medical treatment, (2) telemonitoring of patients' health conditions and any changes over time, as well as (3) telerehabilitation, i.e., interventions to assess and promote body functions, activities, and consecutively participation. The hereby proposed telemedicine process flow could be adopted on a large scale to improve the public health response during healthcare crises like the COVID-19 pandemic but could equally promote equitable health care independent of people's mobility or location with respect to the specialized health care center.
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http://dx.doi.org/10.3389/fneur.2021.646902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027250PMC
March 2021

The Smart Aging Platform for Assessing Early Phases of Cognitive Impairment in Patients With Neurodegenerative Diseases.

Front Psychol 2021 15;12:635410. Epub 2021 Mar 15.

National Neurological Institute C. Mondino Foundation, Pavia, Italy.

Smart Aging is a serious game (SG) platform that generates a 3D virtual reality environment in which users perform a set of screening tasks designed to allow evaluation of global cognition. Each task replicates activities of daily living performed in a familiar environment. The main goal of the present study was to ascertain whether Smart Aging could differentiate between different types and levels of cognitive impairment in patients with neurodegenerative disease. Ninety-one subjects (mean age = 70.29 ± 7.70 years)-healthy older adults (HCs, = 23), patients with single-domain amnesic mild cognitive impairment (aMCI, = 23), patients with single-domain executive Parkinson's disease MCI (PD-MCI, = 20), and patients with mild Alzheimer's disease (mild AD, = 25)-were enrolled in the study. All participants underwent cognitive evaluations performed using both traditional neuropsychological assessment tools, including the Mini-Mental State Examination (MMSE), Montreal Overall Cognitive Assessment (MoCA), and the Smart Aging platform. We analyzed global scores on Smart Aging indices (i.e., accuracy, time, distance) as well as the Smart Aging total score, looking for differences between the four groups. The findings revealed significant between-group differences in all the Smart Aging indices: accuracy ( < 0.001), time ( < 0.001), distance ( < 0.001), and total Smart Aging score ( < 0.001). The HCs outperformed the mild AD, aMCI, and PD-MCI patients in terms of accuracy, time, distance, and Smart Aging total score. In addition, the mild AD group was outperformed both by the HCs and by the aMCI and PD-MCI patients on accuracy and distance. No significant differences were found between aMCI and PD-MCI patients. Finally, the Smart Aging scores significantly correlated with the results of the neuropsychological assessments used. These findings, although preliminary due to the small sample size, suggest the validity of Smart Aging as a screening tool for the detection of cognitive impairment in patients with neurodegenerative diseases.
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http://dx.doi.org/10.3389/fpsyg.2021.635410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005545PMC
March 2021

Virtual Reality as a Technological-Aided Solution to Support Communication in Persons With Neurodegenerative Diseases and Acquired Brain Injury During COVID-19 Pandemic.

Front Public Health 2020 16;8:635426. Epub 2021 Feb 16.

"Giustino Fortunato" University of Benevento, Benevento, Italy.

The COVID-19 poses an ongoing threat to lives around the world and challenges the existing public health and medical service delivery. The lockdown or quarantine measures adopted to prevent the spread of COVID-19 has caused the interruption in ongoing care and access to medical care including to patients with existing neurological conditions. Besides the passivity, isolation, and withdrawal, patients with neurodegenerative diseases experience difficulties in communication due to a limited access to leisure opportunities and interaction with friends and relatives. The communication difficulties may exacerbate the burden on the caregivers. Therefore, assistive-technologies may be a useful strategy in mitigating challenges associated with remote communication. The current paper presents an overview of the use of assistive technologies using virtual reality and virtual body ownership in providing communication opportunities to isolated patients, during COVID-19, with neurological diseases and moderate-to-severe communication difficulties. We postulate that the assistive technologies-based intervention may improve social interactions in patients with neurodegenerative diseases and acquired brain injury-thereby reducing isolation and improving their quality of life and mental well-being.
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http://dx.doi.org/10.3389/fpubh.2020.635426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921156PMC
March 2021

Cognitive Telerehabilitation for Older Adults With Neurodegenerative Diseases in the COVID-19 Era: A Perspective Study.

Front Neurol 2020 14;11:623933. Epub 2021 Jan 14.

Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Mondino Foundation, Pavia, Italy.

The COVID-19 pandemic is a global health problem that is radically transforming public and private healthcare organizations around the world, negatively affecting the rehabilitative treatments of non-COVID pathologies as well. In this situation, it becomes crucial to be able to guarantee the continuity of care also to all those patients with neurodegenerative diseases unable to reach healthcare services. Remote communication technologies are gaining momentum as potentially effective options to support health care interventions-including cognitive rehabilitation-while patients can stay safely at home. In this context, we are implementing HomeCoRe (i.e., Home Cognitive Rehabilitation software) in order to offer an innovative approach and a valid support for home-based cognitive rehabilitation in neurodegenerative diseases, such as mild cognitive impairment and early dementia. HomeCoRe has been developed within a research project between engineers and clinicians in order to obtain a usable and safe cognitive rehabilitation tool. This software has multiple advantages for patients and therapists over traditional approaches, as shown in its use in hospital settings. HomeCoRe could then represent an opportunity for accessing cognitive rehabilitation in all those situations where patients and therapists are not in the same location due to particular restrictions, such as COVID-19 pandemic.
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http://dx.doi.org/10.3389/fneur.2020.623933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840692PMC
January 2021

Telemedicine and Virtual Reality for Cognitive Rehabilitation: A Roadmap for the COVID-19 Pandemic.

Front Neurol 2020 15;11:926. Epub 2020 Sep 15.

Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.

The current COVID-19 pandemic presents unprecedented new challenges to public health and medical care delivery. To control viral transmission, social distancing measures have been implemented all over the world, interrupting the access to routine medical care for many individuals with neurological diseases. Cognitive disorders are common in many neurological conditions, e.g., stroke, traumatic brain injury, Alzheimer's disease, and other types of dementia, Parkinson's disease and parkinsonian syndromes, and multiple sclerosis, and should be addressed by cognitive rehabilitation interventions. To be effective, cognitive rehabilitation programs must be intensive and prolonged over time; however, the current virus containment measures are hampering their implementation. Moreover, the reduced access to cognitive rehabilitation might worsen the relationship between the patient and the healthcare professional. Urgent measures to address issues connected to COVID-19 pandemic are, therefore, needed. Remote communication technologies are increasingly regarded as potential effective options to support health care interventions, including neurorehabilitation and cognitive rehabilitation. Among them, telemedicine, virtual reality, augmented reality, and serious games could be in the forefront of these efforts. We will briefly review current evidence-based recommendations on the efficacy of cognitive rehabilitation and offer a perspective on the role of tele- and virtual rehabilitation to achieve adequate cognitive stimulation in the era of social distancing related to COVID-19 pandemic. In particular, we will discuss issues related to their diffusion and propose a roadmap to address them. Methodological and technological improvements might lead to a paradigm shift to promote the delivery of cognitive rehabilitation to people with reduced mobility and in remote regions.
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http://dx.doi.org/10.3389/fneur.2020.00926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522345PMC
September 2020

A double-blind randomized controlled trial of the efficacy of cognitive training delivered using two different methods in mild cognitive impairment in Parkinson's disease: preliminary report of benefits associated with the use of a computerized tool.

Aging Clin Exp Res 2021 Jun 8;33(6):1567-1575. Epub 2020 Sep 8.

IRCCS Mondino Foundation, Pavia, Italy.

Background: The effectiveness of computer-based cognitive training (CCT) remains controversial, especially in older adults with neurodegenerative diseases.

Aims: To evaluate the efficacy of CCT in patients with Parkinson's disease and mild cognitive impairment (PD-MCI).

Methods: In this randomized controlled trial, 53 patients were randomized to receive CCT delivered by means of CoRe software, traditional paper-and-pencil cognitive training (PCT), or an unstructured activity intervention (CG). In each group, the intervention lasted 3 consecutive weeks (4 individual face-to-face sessions/week). Neuropsychological assessment was administered at baseline (T0) and post-intervention (T1). Outcome measures at T0 and T1 were compared within and between groups. The Montreal Overall Cognitive Assessment (MoCA) was taken as the primary outcome measure.

Results: Unlike the PCT group and the CG, the patients receiving CCT showed significant medium/large effect size improvements in MoCA performance, global cognition, executive functions, and attention/processing speed. No baseline individual/demographic variables were associated with greater gains from the intervention, although a negative correlation with baseline MoCA performance was found.

Conclusion: CCT proved effective in PD-MCI patients when compared with traditional PCT. Further follow-up assessments are being conducted to verify the retention of the gains and the potential ability of the tool to delay conversion to PD-dementia. Trial registration number (ClinicalTrials.gov): NCT04111640 (30th September 2019).
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http://dx.doi.org/10.1007/s40520-020-01665-2DOI Listing
June 2021

Neurophysiological and biomolecular effects of erenumab in chronic migraine: An open label study.

Cephalalgia 2020 10 26;40(12):1336-1345. Epub 2020 Jul 26.

Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.

Introduction: Anti-calcitonin gene-related peptide antibodies proved effective in the preventive treatment of chronic migraine. In this open label study, we aim to assess the effects of erenumab administration on neurophysiological and biomolecular profiles in a representative cohort of chronic migraine patients.

Methods: Forty patients with a history of chronic migraine for at least 12 months prior to enrollment, and previous failure of at least two different preventive therapies, were enrolled. After a 1-month observation period (T0), patients were treated with erenumab 70 mg s.c. (every 28 days) for a total of three administrations. At week 12, they returned for the end-of-protocol visit (T3). At T0 and T3, patients underwent recording of clinical features, recording of single stimulus (RTh), temporal summation (TST) thresholds of the nociceptive withdrawal reflex, venous blood sampling for miR-382-5p, and miR-34a-5p quantification.

Results: At T3, 31 patients (77.5%) qualified as 30% Responders (reduction in monthly migraine days by at least 30% in the last 4-week observation period). RTh (T0: 15.4 ± 8.1 mA, T3: 19.7 ± 8.2 mA) as well as TST (T0: 11.2 ± 5.8 mA, T3: 13.4 ± 5.0 mA) significantly increased at T3 in 30% Responders ( = 0.001 for both), while we did not observe significant changes in NON-responder patients. MiR-382-5p and miR-34a-5p levels were significantly lower after erenumab administration in the overall study population ( = 0.015, and  = 0.001, respectively), without significant differences between 30% Responder and NON-responder groups.

Conclusions: Different migraine phenotypes, characterized by different treatment susceptibility, may exist as suggested by the divergent behavior between neurophysiological and biomolecular findings in 30% Responder vs. NON-responder patients.The study protocol was registered at clinicaltrials.gov (NCT04361721).
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http://dx.doi.org/10.1177/0333102420942230DOI Listing
October 2020

Immersive Virtual Reality and Virtual Embodiment for Pain Relief.

Front Hum Neurosci 2019 21;13:279. Epub 2019 Aug 21.

Neurorehabilitation Unit, IRCCS C. Mondino Foundation, Pavia, Italy.

A significant body of experimental evidence has demonstrated that it is possible to induce the illusion of ownership of a fake limb or even an entire fake body using multisensory correlations. Recently, immersive virtual reality has allowed users to experience the same sensations of ownership over a virtual body inside an immersive virtual environment, which in turn allows virtual reality users to have the feeling of being "embodied" in a virtual body. Using such virtual embodiment to manipulate body perception is starting to be extensively investigated and may have clinical implications for conditions that involve altered body image such as chronic pain. Here, we review experimental and clinical studies that have explored the manipulation of an embodied virtual body in immersive virtual reality for both experimental and clinical pain relief. We discuss the current state of the art, as well as the challenges faced by, and ideas for, future research. Finally, we explore the potentialities of using an embodied virtual body in immersive virtual reality in the field of neurorehabilitation, specifically in the field of pain.
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http://dx.doi.org/10.3389/fnhum.2019.00279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736618PMC
August 2019

HomeCoRe: Bringing Cognitive Rehabilitation at Home.

Stud Health Technol Inform 2019 Aug;264:1755-1756

IRCCS C. Mondino, Pavia, Italy.

CoRe is a system for cognitive rehabilitation that has been successfully used for several years in hospital settings. Leveraging on the positive survey results from the potential final users (patients and their home caregivers), we developed HomeCoRe. This new version of the system will allow discharged patients to continue the rehabilitation treatment at home.
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http://dx.doi.org/10.3233/SHTI190632DOI Listing
August 2019

Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events.

Front Neurol 2019 7;10:173. Epub 2019 Mar 7.

Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.

Early traumatic experiences and Stressful episodes appear to be associated to the development and perpetuation of chronic pain disorders and to dependence-related behaviors. The present study evaluated whether these factors can be predictors, together with psychiatric conditions, of the outcome of a detoxification treatment in patients suffering from chronic migraine and medication-overuse headache in a 2-month follow-up. Consecutive patients undergoing a detoxification program as therapy for treating chronic migraine and medication overuse headache at the Pavia Headache Center were analyzed. During this program, lasting about 1 week, all patients received the standard CARE in-patient withdrawal protocol, which consisted in discontinuing abruptly the overused drug(s) and receiving daily detoxification therapy. Data on childhood traumatic events and recent stressful ones were analyzed by means of the Childhood Trauma Questionnaire and Stressful life-events Questionnaire. Psychiatric conditions were evaluated using the Structured Clinical Interview for Diagnostic and Statistical Manual of mental disorders. A total of 166 (80% females; mean age 44.7) patients completed the follow-up at 2 months after the detoxification program: of these 118 (71%) (78% females; mean age 44.7) stopped overuse and reverted to an episodic pattern of headache (Group A); 19 (11%) (89% females; mean age 41.3) kept overusing and maintained a chronic pattern of headache (Group B); and 29 (18%) (79% females; mean age 46.9) stopped overuse without any benefit on headache frequency (Group C). At the multivariate analyses, a higher number of early life emotional distress (Odds Ratio 11.096; = 0.037) arose as a prognostic factor for the outcome in Group B, while major depression during life-time (Odds Ratio 3.703; = 0.006) and higher number of severe stressful episodes in the past 10 years (Odds Ratio 1.679; = 0.045) were prognostic factors for the outcome of Group C. Data suggest that early life traumas and stressful events have a negative impact on the outcome of the detoxification program in subjects overusing acute medication for headache. The history of emotional childhood traumas is associated to the failure to cease overuse, whereas recent very serious life events are associated to the persistence of headache chronicity.
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http://dx.doi.org/10.3389/fneur.2019.00173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416203PMC
March 2019

Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache: A six-month follow-up of the COMOESTAS Project.

Cephalalgia 2019 01 27;39(1):135-147. Epub 2018 Jun 27.

1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.

Aim: To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache.

Methods: Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge.

Results: Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis - migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) - and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes.

Conclusions: Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.
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http://dx.doi.org/10.1177/0333102418783317DOI Listing
January 2019

Traumatic Experiences, Stressful Events, and Alexithymia in Chronic Migraine With Medication Overuse.

Front Psychol 2018 14;9:704. Epub 2018 May 14.

Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.

Many factors are involved in the prognosis and outcome of Chronic Migraine and Medication Overuse Headache (CM+MOH), and their understanding is a topic of interest. It is well known that CM+MOH patients experience increased psychiatric comorbidity, such as anxiety, depression, or personality disorders. Other psychological factors still need to be explored. The present study is aimed to evaluate whether early life traumatic experiences, stressful life events, and alexithymia can be associated with CM+MOH. Three hundred and thirty-one individuals were recruited for this study. They belonged to one of the two following groups: CM+MOH ( = 179; 79% females, Age: 45.2 ± 9.8) and episodic migraine (EM) ( = 152; 81% females; Age: 40.7 ± 11.0). Diagnosis was operationally defined according to the International Classification of Headache Disorders 3rd edition (ICHD-IIIβ). Data on early life (physical and emotional) traumatic experiences, recent stressful events and alexithymia were collected by means of the Childhood Trauma Questionnaire, the Stressful life-events Questionnaire, and the Toronto Alexithymia Scale (TAS-20), respectively. Data showed a higher prevalence of emotional (χ = 6.99; . = 1; = 0.006) and physical (χ = 6.18; . = 1; = 0.009) childhood trauma and of current stressful events of important impact (χ = 4.42; . = 1; = 0.025) in CM+MOH patients than in EM ones. CM+MOH patients were characterized by higher difficulties in a specific alexithymic trait (Factor 1 subscale of TAS-20) [ = 6.76, = 0.01, η = 0.02] when compared to the EM group. The role of these factors was confirmed in a multivariate analysis, which showed an association of CM+MOH with emotional (OR 2.655; 95% CI 1.153-6.115, = 0.022) or physical trauma (OR 2.763; 95% CI 1.322-5.771, = 0.007), and a high score at the Factor 1 (OR 1.039; 95% CI 1.002-1.078, = 0.040). Our findings demonstrated a clear relationship between CM+MOH and life traumas, stressful events, and alexithymia. These observations have a relevant role in multiple fields of related to chronic headache: from the management to the nosographic framing.
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http://dx.doi.org/10.3389/fpsyg.2018.00704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960722PMC
May 2018

Factors associated to chronic migraine with medication overuse: A cross-sectional study.

Cephalalgia 2018 12 10;38(14):2045-2057. Epub 2018 Apr 10.

1 Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.

Background And Aim: Factors implicated in the evolution of episodic migraine into chronic migraine are largely elusive. Medication overuse is considered to be one of the main determinants, but other possible clinical and psychological factors can play a role. The aim of this study is to identify factors that are associated with chronic migraine with medication overuse.

Method: We enrolled consecutive migraine patients, subdividing them in two groups: Subjects with a long history of episodic migraine and subjects with chronic migraine and medication overuse. We then compared their clinical and psychological variables in a cross-sectional study.

Results: Three hundred and eighteen patients were enrolled, of which 156 were episodic migraine and 162 were chronic migraine and medication overuse patients. The mean age was 42.1 ± 10.3, 80.8% were female. The duration of migraine was 24.6 years in episodic migraine and 24.0 years in chronic migraine and medication overuse ( p = 0.57). After the multivariate analysis, the factors associated to chronic migraine and medication overuse were: Marital status (married vs. unmarried, OR 3.65, 95% CI 1.63-8.19, p = 0.002; separated/divorced/widowed vs. unmarried, OR 4.19, 95% CI 1.13-15.47, p = 0.031), physical activity (OR 0.42, 95% CI 0.19-0.91, p = 0.029), age at onset of migraine (OR 0.94, 95% CI 0.89-0.98, p = 0.016), use of at least one migraine preventive medication (OR 2.36, 95% CI 1.18-4.71, p = 0.014), history of depression (OR 2.91, 95% CI 1.25-6.73, p = 0.012), insomnia associated with the use of hypnotics (OR 5.59, 95% CI 1.65-18.93, p = 0.006), traumatic head injuries (OR 3.54, 95% CI 1.57-7.99, p = 0.002), snoring (OR 2.24, 95% CI 1.05-4.79, p = 0.036), previous and/or actual use of combined oral contraceptives (OR 3.38, 95% CI 1.10-10.3, p = 0.031) and higher scores in the Childhood Trauma questionnaire (OR 1.48, 95% CI 1.09-2.02, p = 0.012).

Conclusion: We considered several aspects that may be involved in the development of chronic migraine and medication overuse. A multivariate analysis identified 10 factors belonging to five different areas, to suggest that chronic migraine and medication overuse onset is likely influenced by a complex mixture of factors. This information is useful when planning strategies to prevent and manage chronic migraine and medication overuse.
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http://dx.doi.org/10.1177/0333102418761047DOI Listing
December 2018

The effect of strategic memory training in older adults: who benefits most?

Int Psychogeriatr 2018 08 7;30(8):1235-1242. Epub 2017 Dec 7.

Department of Brain and Behavioral Sciences,University of Pavia,Pavia,Italy.

ABSTRACTBackground:Previous research has suggested that there is a degree of variability among older adults' response to memory training, such that some individuals benefit more than others. The aim of the present study was to identify the profile of older adults who were likely to benefit most from a strategic memory training program that has previously proved to be effective in improving memory in healthy older adults.

Method: In total, 44 older adults (60-83 years) participated in a strategic memory training. We examined memory training benefits by measuring changes in memory practiced (word list learning) and non-practiced tasks (grocery list and associative learning). In addition, a battery of cognitive measures was administered in order to assess crystallized and fluid abilities, short-term memory, working memory, and processing speed.

Results: Results confirmed the efficacy of the training in improving performance in both practiced and non-practiced memory tasks. For the practiced memory tasks, results showed that memory baseline performance and crystallized ability predicted training gains. For the non-practiced memory tasks, analyses showed that memory baseline performance was a significant predictor of gain in the grocery list learning task. For the associative learning task, the significant predictors were memory baseline performance, processing speed, and marginally the age.

Conclusions: Our results indicate that older adults with a higher baseline memory capacity and with more efficient cognitive resources were those who tended to benefit most from the training. The present study provides new avenues in designing personalized intervention according to the older adults' cognitive profile.
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http://dx.doi.org/10.1017/S1041610217002691DOI Listing
August 2018

Smart Aging Platform for Evaluating Cognitive Functions in Aging: A Comparison with the MoCA in a Normal Population.

Front Aging Neurosci 2017 21;9:379. Epub 2017 Nov 21.

Headache Science Centre, C. Mondino National Neurological Institute, Pavia, Italy.

Smart Aging is a Serious games (SGs) platform in a 3D virtual environment in which users perform a set of screening tests that address various cognitive skills. The tests are structured as 5 tasks of activities of daily life in a familiar environment. The main goal of the present study is to compare a cognitive evaluation made with Smart Aging with those of a classic standardized screening test, the Montreal Cognitive Assessment (MoCA). One thousand one-hundred thirty-one healthy adults aged between 50 and 80 ( = 64.3 ± 8.3) were enrolled in the study. They received a cognitive evaluation with the MoCA and the Smart Aging platform. Participants were grouped according to their MoCA global and specific cognitive domain (i.e., memory, executive functions, working memory, visual spatial elaboration, language, and orientation) scores and we explored differences among these groups in the Smart Aging indices. One thousand eighty-six older adults ( = 64.0 ± 8.0) successfully completed the study and were stratified according to their MoCA score: Group 1 with MoCA < 27 ( = 360); Group 2 with 27 ≥ MoCA < 29 ( = 453); and Group 3 with MoCA ≥ 29 ( = 273). MoCA groups significantly differed in most of the Smart Aging indices considered, in particular as concerns accuracy (s < 0.001) and time (s < 0.001) for completing most of the platform tasks. Group 1 was outperformed by the other two Groups and was slower than them in these tasks, which were those supposed to assess memory and executive functions. In addition, significant differences across groups also emerged when considering the single cognitive domains of the MoCA and the corresponding performances in each Smart Aging task. In particular, this platform seems to be a good proxy for assessing memory, executive functions, working memory, and visual spatial processes. These findings demonstrate the validity of Smart Aging for assessing cognitive functions in normal aging. Future studies will validate this platform also in the clinical aging populations.
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http://dx.doi.org/10.3389/fnagi.2017.00379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702318PMC
November 2017

Self-guided strategy-adaption training for older adults: Transfer effects to everyday tasks.

Arch Gerontol Geriatr 2017 Sep 7;72:91-98. Epub 2017 Jun 7.

Georgia Institute of Technology, Atlanta, USA.

Objectives: The goal of the present research was to examine the potential of a learner-oriented approach to improving older adults' performance in tasks that are similar to real-life situations that require strategic deployment of cognitive resources. A crucial element of this approach involves encouraging older adults to explicitly analyze tasks to consider how to adapt trained skills to a new task context. In an earlier study, a specialist-directed intervention produced training gains and transfer to some untrained memory tasks.

Method: In the present study, older adults received a manual instructing them about principles of task analysis, two memory strategies, and strategy adaptation. Self-guided strategy-adaption training involved practicing some memory tasks as well as instructions on how the trained skills could be applied to new tasks that were not practiced. The criterion tasks involved practice tasks, non-practiced tasks that were discussed in the manual, and transfer tasks that were never mentioned in the manual. Two of the tests were from the Everyday Cognition Battery (inductive reasoning and working memory).

Results: As compared to a waiting-list control group, older adults assigned to self-guided strategy-adaption training showed memory improvements on tasks that were practiced or discussed during training. Most important, the learner-oriented approach produced transfer to the everyday tasks.

Conclusion: Our findings show the potential of instructing task appraisal processes as a basis for fostering transfer, including improving older adults' performance in simulated everyday tasks.
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http://dx.doi.org/10.1016/j.archger.2017.05.015DOI Listing
September 2017

Changes in anxiety and depression symptoms associated to the outcome of MOH: A post-hoc analysis of the Comoestas Project.

Cephalalgia 2018 04 11;38(4):646-654. Epub 2017 Apr 11.

1 Headache Science Centre, C. Mondino National Neurological Institute, Pavia, Italy.

Aims To evaluate the impact of treatment success on depression and anxiety symptoms in medication-overuse headache (MOH) and whether depression and anxiety can be predictors of treatment outcome. Methods All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion over a six-month period. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. Results A total of 663 MOH patients were evaluated, and 492 completed the entire protocol. Of these, 287 ceased overuse and reverted to an episodic pattern (responders) and 23 relapsed into overuse. At the final evaluation, the number of patients with depressive symptoms was reduced by 63.2% among responders ( p < 0.001) and did not change in relapsers ( p = 0.13). Anxious symptomatology was reduced by 43.1% in responders ( ps < 0.001) and did not change in relapsers ( p = 0.69). At the multivariate analysis, intake of a prophylactic drug and absence of symptoms of depression at six months emerged as prognostic factors for being a responder (OR 2.406; p = 0.002 and OR 1.989; p = 0.019 respectively), while lack of antidepressant drugs and presence of symptoms of depression at six months were prognostic factors for relapse into overuse (OR 3.745; p = 0.004 and OR 3.439; p = 0.031 respectively). Conclusions Symptomatology referred to affective state and anxiety can be significantly reduced by the treatment of MOH. Baseline levels of depression and anxiety do not generally predict the outcome at six months. Their persistence may represent a trait of patients with a negative outcome, rather than the consequence of a treatment failure.
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http://dx.doi.org/10.1177/0333102417704415DOI Listing
April 2018

Theory of mind plasticity in aging: The role of baseline, verbal knowledge, and executive functions.

Neuropsychol Rehabil 2019 Apr 7;29(3):440-455. Epub 2017 Apr 7.

a Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy.

Theory of Mind (ToM) refers to the ability to attribute mental states to the self and others in order to explain and predict social behaviour. Meta-analytic results have shown a decline in ToM abilities in healthy older adults. Recent research has also highlighted the possibility of enhancing older adults' ToM performance through group conversations focused on mental states. Our aim was to determine whether the extent to which older people benefited from a ToM training was predicted by performance on a battery of executive functioning tasks, on baselines in ToM tasks, on verbal knowledge. Forty-three older adults (60-84 years) participated in a three-session ToM training programme that has previously shown to be effective in improving ToM ability. Results showed that verbal knowledge predicted training gains in practiced ToM tasks. In addition, age, executive functions and baseline performance predicted training gains in non-practiced ToM tasks. Results are discussed in light of the amplification model.
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http://dx.doi.org/10.1080/09602011.2017.1308871DOI Listing
April 2019

Updating working memory: memory load matters with aging.

Aging Clin Exp Res 2017 Jun 6;29(3):371-377. Epub 2016 May 6.

Brain and Behavioral Science Department, University of Pavia, Piazza Botta 11, 27100, Pavia, Italy.

Age-related effects in working memory updating were investigated by administering a response time-based task to three adult age groups (young, young-old, and old-old). The task differentiated objects to update; participants were asked to update single memory contents or content-context bindings. The data showed an overall delay of response latencies in the elderly groups (both young-old and old-old), relative to the younger. Specifically, each age group showed longer latencies for content-context binding updating, than single memory content updating. However, an interaction with age was obtained when memory load was manipulated across content-context binding updating conditions. These results were taken as evidence of differences between specific objects of updating and age-related changes in cognition and were discussed with reference to the relevant aging literature.
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http://dx.doi.org/10.1007/s40520-016-0581-yDOI Listing
June 2017

Alexithymia in chronic and episodic migraine: a comparative study.

J Ment Health 2017 Jun 6;26(3):192-196. Epub 2016 Jan 6.

b Headache Science Center, National Neurological Institute C. Mondino , Pavia , Italy.

Background: Alexithymia is a term used to describe a disorder where patients have difficulty in expressing their own feelings in words.

Aims: The analysis of alexithymia in patients suffering from chronic migraine (CM) or episodic migraine (EM) compared to healthy controls.

Methods: Two clinical samples formed by 80 CM patients (21 males and 59 females, mean age: 44.65) and 44 EM patients (8 males and 36 females, mean age: 42.18) were enrolled. A group of 67 healthy subjects served as controls (26 males and 41 females, mean age: 41.21). All subjects were requested to fill in the 20-item version of the Toronto Alexithymia Scale (TAS-20).

Results: We found a statistically significant difference between groups in Factor 1 (difficulty in describing feelings), F(2, 191) = 7.96, p < 0.001, and in TAS total, F(2, 191) = 5.37, p = 0.005. Post-hoc analyses revealed that CM patients had higher scores in TAS factor 1 and in TAS total than healthy controls. There were no significant differences between CM and EM patients, even if CM sufferers reported a trend towards higher scores in each TAS factor as well as in TAS total.

Conclusions: Alexithymia emerges as a potential characteristic trait of migraine, regardless of disease severity.
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http://dx.doi.org/10.3109/09638237.2015.1124404DOI Listing
June 2017

Theory of Mind and social relationships in older adults: the role of social motivation.

Aging Ment Health 2017 03 19;21(3):253-258. Epub 2015 Nov 19.

a Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy.

Objectives: Previous research has shown that individual differences in Theory of Mind (ToM) are crucial for people's social relationships. However, very few studies have investigated this issue in ageing. The present study was designed to fill this gap and examine the associations between ToM and social relationships in elderly adults. In doing so, this study considered people's relationships with their relatives and friends, and examined the possible moderating role of social motivation.

Method: The study involved 53 healthy older adults (age: M = 67.91; SD = 6.93; range: 60--85 years). All participants were tested collectively during a 2-hr session and completed a demographic questionnaire as well as a battery of tests assessing verbal ability (vocabulary and word fluency), ToM and social relationships. They also answered a social motivation question.

Results: Results showed that individual differences in older people's ToM were overall significantly associated with those in relationships with friends, but not relatives. In addition, the Hayes moderating procedure showed that individual differences in ToM were related to those in friendships only for those people who had a high or medium level of social motivation.

Conclusion: These findings underline the importance of motivation in guiding the use of ToM in everyday social interactions.
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http://dx.doi.org/10.1080/13607863.2015.1114586DOI Listing
March 2017

Theory of Mind in aging: Comparing cognitive and affective components in the faux pas test.

Arch Gerontol Geriatr 2016 Jan-Feb;62:152-62. Epub 2015 Sep 26.

Department of Brain and Behavioral Sciences, University of Pavia, Italy.

Objectives: Theory of Mind (ToM) is a complex human ability that allows people to make inferences on others' mental states such as beliefs, emotions and desires. Previous studies on ToM in normal aging have provided heterogeneous findings. In the present study we examined whether a mixed calculation of different aspects of ToM may have contributed to these conflicting results. We had two aims. First, we explored the age-related changes in the performance of cognitive vs. affective ToM. Second, we investigated the extent to which the effect of aging on cognitive vs. affective ToM is mediated by age-related differences in executive functions.

Method: To address these issues three age groups (young, young-old, and old-old adults) were compared on cognitive and affective ToM using the faux pas test. In addition, participants were tested using a battery of executive function tasks tapping on inhibition, working memory updating, and word fluency.

Results: The analyses indicated that young adults outperform both young-old and old-old adults on cognitive ToM but not on affective ToM. Correlations showed that, whereas cognitive ToM was significantly associated with age, working memory updating, and inhibition, affective ToM was not. Finally, analyses revealed that individual differences in working memory updating (but not inhibition) mediated the effect of age on cognitive ToM.

Conclusion: Our findings support the view of selective age-related differences on cognitive, but not affective, ToM in normal aging. The distinction between the two ToM components is further supported by a dissociable pattern of correlations with executive functions.
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http://dx.doi.org/10.1016/j.archger.2015.09.009DOI Listing
April 2016

Training for generalization in Theory of Mind: a study with older adults.

Front Psychol 2015 4;6:1123. Epub 2015 Aug 4.

Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy.

Theory of Mind (ToM) refers to the ability to attribute independent mental states to self and others in order to explain and predict social behavior. Recent research in this area has shown a decline in ToM abilities associated with normal aging that is of a moderate magnitude or greater. Very few studies have investigated whether it is possible to improve older adults' ToM abilities. The present study was designed to address this gap in the literature by evaluating the impact of a ToM training on practiced and transfer tasks. We provided older adults with a variety of activities designed to facilitate the generalization of benefits to other ToM-demanding tasks. Participants were 63 healthy older adults, native Italian speakers (M age = 71.44, SD = 5.24, age range: 63-81 years). Participants were randomly assigned to one of two groups: the ToM training (age range: 63-81 years) and the physical-conversation training (age range: 64-81 years). Training effects were measured using the strange stories (practiced task) and the animation task (transfer task). Results revealed the efficacy of the training in producing improvements on practiced but also on transfer tasks.
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http://dx.doi.org/10.3389/fpsyg.2015.01123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523701PMC
August 2015

Promoting theory of mind in older adults: does age play a role?

Aging Ment Health 2016 1;20(1):22-8. Epub 2015 Jun 1.

a Department of Brain and Behavioral Sciences , University of Pavia , Pavia , Italy.

Objectives: Previous research on age-related changes in Theory of Mind (ToM) showed a decline in older adults, particularly pronounced over 75 years of age. Evidence that ToM may be enhanced in healthy aging people has been demonstrated, but no study has focused on the role of age on the effects of ToM training for elderly people. The present study was designed to examine the efficacy of a ToM training on practiced (ToM Strange Stories) and transfer tasks (ToM Animations) in both young and older adults.

Method: The study involved 127 older adults belonging to two age groups: young-old (Mage = 64.41; SD = 2.49; range: 60-69 years) and old-old (Mage = 75.66; SD = 4.38; range: 70-85 years), randomly assigned to either a ToM group or a control group condition. All participants took part in two 2-hour testing sessions and four 2-hour training sessions.

Results: Results showed that both young-old and old-old adults in the ToM group condition improved their ability to reason on complex-mental states significantly more than participants in the control group condition. This positive effect of the training was evident on practiced and transfer ToM tasks. Crucially, age did not moderate the effect of the ToM training.

Conclusion: These findings demonstrate that young-old and old-old adults equally benefit from the ToM training. Implications for the positive effect of the ToM training in old-old adults are discussed.
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http://dx.doi.org/10.1080/13607863.2015.1049118DOI Listing
May 2016

Serious games for screening pre-dementia conditions: from virtuality to reality? A pilot project.

Funct Neurol 2014 Jul-Sep;29(3):153-8

Conventional cognitive assessment is based on a pencil-and-paper neuropsychological evaluation, which is time consuming, expensive and requires the involvement of several professionals. Information and communication technology could be exploited to allow the development of tools that are easy to use, reduce the amount of data processing, and provide controllable test conditions. Serious games (SGs) have the potential to be new and effective tools in the management and treatment of cognitive impairments Serious games for screening pre-dementia conditions: from virtuality to reality? A pilot project in the elderly. Moreover, by adopting SGs in 3D virtual reality settings, cognitive functions might be evaluated using tasks that simulate daily activities, increasing the "ecological validity" of the assessment. In this commentary we report our experience in the creation of the Smart Aging platform, a 3D SGand virtual environment-based platform for the early identification and characterization of mild cognitive impairment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264781PMC
July 2015